Missed, delayed, or incorrect diagnosis can lead to inappropriate patient care, poor patient outcomes, and increased cost. This systematic review analyzed evaluations of interventions to prevent diagnostic errors. Searches used MEDLINE (1966 to October 2012), the Agency for Healthcare Research and Quality's Patient Safety Network, bibliographies, and prior systematic reviews. Studies that evaluated any intervention to decrease diagnostic errors in any clinical setting and with any study design were eligible, provided that they addressed a patient-related outcome. Two independent reviewers extracted study data and rated study quality. There were 109 studies that addressed 1 or more intervention categories: personnel changes (n = 6), educational interventions (n = 11), technique (n = 23), structured process changes (n = 27), technology-based systems interventions (n = 32), and review methods (n = 38). Of 14 randomized trials, which were rated as having mostly low to moderate risk of bias, 11 reported interventions that reduced diagnostic errors. Evidence seemed strongest for technology-based systems (for example, text message alerting) and specific techniques (for example, testing equipment adaptations). Studies provided no information on harms, cost, or contextual application of interventions. Overall, the review showed a growing field of diagnostic error research and categorized and identified promising interventions that warrant evaluation in large studies across diverse settings.

Simulation is a versatile technique used in a variety of health care settings for a variety of purposes, but the extent to which simulation may improve patient safety remains unknown. This systematic review examined evidence on the effects of simulation techniques on patient safety outcomes. PubMed and the Cochrane Library were searched from their beginning to 31 October 2012 to identify relevant studies. A single reviewer screened 913 abstracts and selected and abstracted data from 38 studies that reported outcomes during care of real patients after patient-, team-, or system-level simulation interventions. Studies varied widely in the quality of methodological design and description of simulation activities, but in general, simulation interventions improved the technical performance of individual clinicians and teams during critical events and complex procedures. Limited evidence suggested improvements in patient outcomes attributable to simulation exercises at the health system level. Future studies would benefit from standardized reporting of simulation components and identification of robust patient safety targets.

Unbounded, unordered, global-scale datasets are increasingly common in day-to-day business (e.g. Web logs, mobile usage statistics, and sensor networks). At the same time, consumers of these datasets have evolved sophisticated requirements, such as event-time ordering and windowing by features of the data themselves, in addition to an insatiable hunger for faster answers. Meanwhile, practicality dictates that one can never fully optimize along all dimensions of correctness, latency, and cost for these types of input. As a result, data processing practitioners are left with the quandary of how to reconcile the tensions between these seemingly competing propositions, often resulting in disparate implementations and systems. We propose that a fundamental shift of approach is necessary to deal with these evolved requirements in modern data processing. We as a field must stop trying to groom unbounded datasets into finite pools of information that eventually become complete, and instead live and breathe under the assumption that we will never know if or when we have seen all of our data, only that new data will arrive, old data may be retracted, and the only way to make this problem tractable is via principled abstractions that allow the practitioner the choice of appropriate tradeoffs along the axes of interest: correctness, latency, and cost. In this paper, we present one such approach, the Dataflow Model, along with a detailed examination of the semantics it enables, an overview of the core principles that guided its design, and a validation of the model itself via the real-world experiences that led to its development.