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)

In his paper “Has Austin Refuted the Sense-Datum Theory?” A. J. Ayer contends that the argument from illusion calls attention to perspectival distortion, perceptual misidentification and elusive perceptual belief only in order to establish the possibility of perceptual error. Pointing to our occasional perceptual failures reminds us that perceptual error is always logically possible—that any particular perceptual belief to the effect that one is perceiving a physical surface could be mistaken. This in turn is thought by Ayer to show that (...) the ordinary belief that we perceive physical surfaces requires qualification—along lines urged by sense-datum philosophers—to the effect that even in those situations properly described for non-philosophical purposes as perceptions of physical surfaces it cannot be physical surfaces that are literally present to one's senses. Ayer believes that this can be established, for any given case, by the possibility of perceptual error alone. (shrink)

The article is a critique of malcolm and the wittgensteinians and their criticisms of russell which the author finds to be "prosecuting russell on false charges." (staff).

In this paper I argue that warrant for Lewis’ principle of recombination presupposes warrant for a combinatorial analysis of intrinsicality, which in turn presupposes warrant for the principle of recombination. This, I claim, leads to a vicious circularity: warrant for neither doctrine can get off the ground.

JOHN STUART MILL by R. J. Halliday. (Political Thinkers, 4.) Allen & Unwin, 1976. 151 pp. £5.95 cloth, £2.95 paper.

Originally published in 1949. Understanding the questions is the major problem when beginning philosophy. This book does not attempt to provide the answers, but defines the questions and shows by example how they should be tackled. Subjects treated include the nature of the objects of thought and judgment; truth and error in belief; perception and knowledge of the material world; the status and function of memory.

We recall some of the early occurrences of the notions of interactivity and symmetry in the operational and denotational semantics of programming languages. We suggest some connections with ludics.

The article by Academician P. L. Kapitsa published below is devoted to problems of the utmost importance, which have come to be termed "global." The Twenty - fifth Congress of the CPSU pointed to the need to study them scientifically and solve them practically, emphasizing that they touch on the interests of humanity as a whole and will exercise an increasingly marked influence on the lives of every people and on the entire system of international relations. In their social philosophical (...) aspects they have been discussed more than once in the pages of Voprosy filosofii. Discussions of these problems took place at the round tables entitled "Man and His Environment" [See translation in our Fall-Winter 1974 number. — Ed., Soviet Studies in Philosophy], "Social Philosophy Problems of Demography," and "Science and Global Problems of Our Time," and numerous articles have been published in such series as "Science and Social Progress," "The Peace Program and the Dialectics of International Relations" [See translation in our Fall 1975 issue. — Ed., Soviet Studies in Philosophy], and "Man — Society — Nature." The editors of the journal, guided by the directives of the Twenty-fifth Party Congress on the need for further investigation of such global problems of our time, are inclined to continue the discussion of them in the future; another round table devoted to these problems is being planned now. The article by Academician P. L. Kapitsa, it seems to us, will provide fruitful stimuli for discussion at this round table, which will probably be published in several installments. As the author himself emphasizes, certain positions in his article are debatable and require discussion. The journal invites philosophers, demographers, economists, and representatives of the natural sciences to take part in discussions of the problems posed. Certain questions examined in Kapitsa's article are also treated in articles by Howard L. Parsons, A. D. Ado, and Iu. A. Kirshin published in this issue of the journal. (shrink)

Note by the Editor of Voprosy filosofii: The presidium of the USSR Academy of Sciences has decided to hold, in Moscow in December 1980, the Third USSR Conference on Philosophical Problems of Contemporary Natural Science, dedicated to the one hundred and tenth anniversary of the birth of V. I. Lenin, and has established an organizing committee headed by P. N. Fedoseev, vice-president of the Academy, to prepare and conduct the conference.