Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

"Bibliographical notes": pages [243]-244.

Principled discussions of civil rights became inherently less likely as a direct result of the observation by Earl Warren, in Brown v. Board of Education, that, respecting freedmen, “Education of Negroes was almost non-existent, and practically all of the race were illiterate,” and in proportion as that observation increasingly became the foundation of common opinion on the subject. Warren's observation was not true in any meaningful or non-trivial sense. Nevertheless, it served to perpetuate the myth of a backward people needing (...) help to catch up instead of the truth of a people being held back. That is the perspective – the disadvantaged group perspective – that ultimately infected all discussion of civil rights, even after the designation of so-called “disadvantaged groups” had been extended beyond American blacks. To define civil rights, we may well begin with what all mankind would likely recognize. Thus the dictionary definition of “civil rights” stands: “the rights that belong to all individuals in a nation or community touching property, marriage, and the like.” In that definition the term “rights” may be further expanded to mean “legitimate claims,” following the definition of right as law – as “a claim or title or interest in anything whatever that is enforceable by law.” This definition applies with minimal distinction of regimes intruding and, therefore, without the host of recent complications in the United States that create the impression that civil rights have something to do with pluralism. Previously, the generic definition was thought to exhaust the meaning of the term in the United States. (shrink)

Intellectual eminence apart, what did Kant, Clausewitz, Marx and Engels, and Tolstoy have in common? Professor Gallic argues that they made contributions to 'international theory' - to the understanding of the character and causes of war and of the possibility of peace between nations - which were of unrivalled originality in their own times and remain of undiminished importance in ours. But these contributions have been either ignored or much misunderstood ; chiefly because, as with all intellectual efforts in unexplored (...) fields, they were often imperfectly expressed, and were also overshadowed by their author's more striking achievements. Professor Gallic has sorted out, compared and contrasted, criticised and re-phrased the teachings of his chosen authors on peace and war. (shrink)

W. B. Gallie; IV—The Idea of Practice, Proceedings of the Aristotelian Society, Volume 68, Issue 1, 1 June 1968, Pages 63–86, https://doi.org/10.1093/aristoteli.

W. B. Gallie; I *—The Presidential Address: Rationality and the Use of Force, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 1–.

W. B. Gallie; IV—The Idea of Practice, Proceedings of the Aristotelian Society, Volume 68, Issue 1, 1 June 1968, Pages 63–86, https://doi.org/10.1093/aristoteli.

W. B. Gallie; I *—The Presidential Address: Rationality and the Use of Force, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 1–.

Everyone knows the statement of Servius that Virgil was compelled by Augustus to alter the second half of the Fourth Georgic after the fall of Gallus, and that he substituted the story of Aristaeus for the laudes Galli. This statement, often doubted by older generations, has had such a remarkable success in recent years that anyone who ventures to impugn it must feel that he is pleading with a halter round his neck before a one-sided jury. It is notable, however, (...) that these jurors, though one-sided, are by no means united, save in their determination to uphold the credit of Servius. One group will assure us that the episode of Aristaeus shows obvious signs not only of haste but of immaturity, and they draw a pathetic picture of the grief-stricken Virgil, ordered to bring out a second edition minus the praises of his friend Gallus, and half-heartedly throwing together some bits of juvenile stuff which he happened to have handy. Others assure us that the tale of Aristaeus shows us a more mature Virgil, nearer to the Virgil of the Aeneid. But the Servians really cannot have it both ways. They must make up their minds in the one direction or in the other if they are to be taken seriously. They make it doubly difficult for us to take them seriously when they try to tell us what Servius meant—but of that more anon. The present paper is an attempt by a converted Servian to examine frankly the arguments which have been advanced in support of Servius. Most of these may be found in Skutsch, Aus Vergils Frühzeit, pp. 140–147. One is very reluctant to use disparaging words about an eminent scholar who has served the cause of learning in so many ways; but it can scarcely be denied that the work just mentioned, in spite of its ingenuity and enthusiasm, shows a lamentable lack of three great essentials—a judicial temper, accurate statement of facts, and cogent reasoning. There is also at times a regrettable vagueness of expression, suggesting that the author is concealing inward doubts or shrinking from thought. All these deficiencies are to some extent present in the section with which this paper is concerned. (shrink)