Amounts of missing data (Additional file 2: Table S2); and variations in plant size, ranging from hundreds of beds to a few hundred (Additional file 3: Table S3) and production levels of prion-based products (Additional file 4: Table S4) are accounted for by using logarithmic means rather than arithmetic. The impact of such variations is that for all of the countries in this report, results were obtained in only one of the larger hospitals. The purpose of this evaluation was to assess the extent to which the practices we observed in the hospitals are representative of facilities in other countries in terms of the attitudes and practices of both hospital and clinician staff toward the use of mandatorily used medical devices and the support they provide for them. The self-rating of staff attitudes toward applying the medical device regulations was a reasonably valid predictor of those ratings provided by external auditors (R2 = 0·72), reflecting the fact that the opinions of the persons assessing the EDs were influenced strongly by the attitudes of their colleagues. As expected, the correlations between the self-ratings of facility practices and those of external auditors decreased as the EDs became more dysfunctional; R2 was 0·3 or less for all self-reported measures in EDs in the lowest dysfunction category and less than 0·1 for the measures in the highest dysfunction category. That decline shows that factors other than the dysfunction of the hospital have a considerable impact on the self-reported measures (see Additional file 5: Table S5, for a list of these factors; Additional file 6: Appendix 1).
The findings of this survey of EDs across the world confirm those of a similar survey to which we recently contributed in the UK (see Additional file 7: Appendix 2 for a comparison of the results in this survey and those reported in the UK survey ). In both surveys, a very high proportion of the hospitals had management guidance on patient consent for invasive medical devices, a policy for or training in the use of the medical devices, and clearly defined protocols for the use of the medical devices. d2c66b5586