临床用药风险管理常见问题及应对措施

目的：对我院不安全用药行为进行监测与调查,分析临床用药问题中存在的风险因素,探讨医疗机构加强药品风险管理的措施,以减少临床用药的安全隐患。方法：采用调查问卷的方式,对我院部分科室就诊患者的用药情况进行问卷调查;应用“医院用药安全监测与评价”软件对我院医护人员在临床用药管理方面存在的风险因素进行评估,整理并分析调查结果。结果：在本次临床用药风险分析中,各因素所占比例为：医生：30.50%,药师：9.00%,护士：32.00%,患者：28.50%。了解临床用药各环节中存在的临床用药风险的医护人员占83.3%,但只有50.6% 的人员采取基本的防范措施。用药风险警示调查显示：PASS 警示有效率为57.5%;关联因素评价中人员因素的发生率最高55.16%;外界因素次之31.29%;药物因素发生率为26.95%。结论：医疗机构应当加强临床用药管理,识别、分析用药风险因素,强化合理用药意识及知识,努力构建临床用药风险控制系统,为医药护理人员及患者营造良好的医疗安全氛围,从而降低用药风险的发生,保障患者的用药安全。     

我国医院非医疗安全管理存在的问题及治理对策

医疗安全管理、非医疗安全管理是医院安全管理的两大系统。随着医药卫生体制改革深化,就医模式改变,非医疗安全管理的内涵和外延发生变化,非医疗安全管理领域面临更多危险因素和安全隐患。结合医院非医疗安全管理现状,分析非医疗安全管理存在的问题并提出相关改进建议。     

Occupational cancer risk in pilots and flight attendants: current epidemiological knowledge

Occupational studies of aircrew in civil or military aviation did not receive much attention until the beginning of this decade. Since 1990, a number of epidemiological studies has been published on the cancer risk among flight personnel. Their results are equivocal: elevated cancer risks have been observed in some studies, but not in others. The exposure situation for pilots and flight attendants is unique with respect to several factors and particularly in that cosmic rays contribute substantially to their cumulative radiation dose. The average annual doses received are relatively low, however, and commonly range between 3 and 6 mSv. Results of epidemiological studies are presented as well as information on planned studies.     

医院管理在从医者健康影响因素中的正向作用

从医者健康是医院发展、医学进步的基础和前提。近年的调查表明,从医者健康状况不容乐观,医院管理者应当认识到从医者身体健康的重要性,并且通过管理手段,化解影响从医者健康的不利因素,推进医院良好发展。     

The Role of the Sympathoadrenomedullary System in the Formation of Pilot’s Adaptation to Flight Loads

The objective of this study was to evaluate the functions of the sympathoadrenomedullary system and the related psychophysiological reactions of pilots, depending on flying hours on a highly maneuverable aircraft. The study involved 78 volunteer pilots (41 high-maneuverability pilots and 37 bomber and transport aviation pilots). A set of methods was chosen with the possibility of their use according to the principle of comprehensive evaluation of the body functional state under flight loads taken into account. Our results indicate that highly maneuverable aircraft piloting induces a significant activation of the sympathoadrenomedullary system in pilots, compared to bombing and transport aircrafts. This is particularly common to young pilots with the total flying time of less than 1000 h. It has been recorded that changes in adaptation to the effect of flight factors on the body develop with age and flight experience.     

Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists

doi: 10.1111/j.1741‐2358.2011.00513.x Health care professionals’ perspectives on oral care for long‐term care residents: Nursing staff, speech–language pathologists and dental hygienists Background: Oral health has been identified as a key factor in general health and systemic disease in long‐term care populations. To optimise oral health of this population, it is important to understand the oral care perspectives held by health care professionals involved in oral care provision. Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language pathologists (SLPs) and dental hygienists (DHs) in long‐term care institutions and to understand how their perspectives impact activities and processes involved in the delivery of oral care. Methods: A focus group methodology was utilised. Separate focus groups for each targeted profession were held. Transcribed data were analysed using constant comparative analysis. Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs and DHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursing staff to provide oral care, whereas factors related to the general health consequences of poor oral health underlined the motivations of SLPs and DHs. Conclusions: Education and training initiatives incorporating social aspects of oral health may be more effective for motivating nursing staff than approaches emphasising physical risk factors. Organisations can foster environments that support collaboration and communication amongst the members of multidisciplinary teams in order to promote oral health as a priority.     

基于德尔菲法的外科手术风险因素评价指标构建

目的 构建外科手术风险因素评价指标体系,为有效监管外科手术质量与安全提供参考依据。方法 运用文献分析法、德尔菲法、层次分析法进行外科手术风险因素评价体系的构建和指标权重的确定。结果 建立了一个由手术固有风险、医疗机构风险、医务人员风险、患者风险4 个一级指标和手术本身风险、医务人员专业技术水平、患者个体差异、医务人员责任心、医学科学的局限性、医院诊疗流程、医务人员团队协作,医院诊疗服务水平、工作负荷等等20 个二级指标组成的手术风险因素评价指标体系。结论 建立一套完善的外科手术风险因素评价指标体系,对于保障手术患者安全、有效进行外科手术质量与安全监管具有重要意义。     

A Critical Review of the Traditional Methodology of Cost-Benefit Analysis and a Proposed Alternative

“Risk management” is essential to the decision-making process that prescribes regulations for protecting human health. As a comprehensive decision-making approach, risk management encompasses risk assessment, risk perception, economic factors, and their respective uncertainties. Cost-benefit analysis (CBA) has long been the preferred methodology for evaluating the economic factors associated with such regulations. Within this context, CBA confirms whether or not the “benefit” of a given regulatory option is greater than its “cost.” This article proposes an alternative CBA methodology whose guiding concept is the “optimization” of outcomes for the stakeholders in regulations that aim to protect human health. This article further proposes evaluation criteria for CBA and critiques the traditional and alternative variants against this standard, ultimately to demonstrate the superiority of the latter.     

I.M. Sechenov's creative development of ideas in aviation and space medicine

Research carried outby the great Russian scholar I. M. Sechenov has significantly contributed to development of aviation physiology, medicine and psychology. His fundamental works consisted of discovery of the constancy of alveolar air composition theory, study of interactions of analyzers systems in solving the problem of human spatial orientation under flight conditions, development of a nervous theory of fatigue. Creative development of ideas by I. M. Sechenov allowed enhancing the efficiency of performing and safety of aviation and space flights.     

New approaches for risk assessment and management of bovine protothecosis

Protothecosis is a potential zoonosis related to bovine mastitis. In several countries, a higher incidence of protothecal bovine mastitis that is being recorded and the resistance of Prototheca species to various factors (chlorine, high temperatures, antimicrobial and antiseptic treatments, pH variations), make it difficult to control its spread among farms. The authors aim to describe the infection caused by microalgae, focusing on the problems within cattle farms and proposing new approaches to farm management, based on Regulation (EU) No 2016/429 on transmissible animal diseases. This new flexible approach, based on risk analysis, is a further tool in protecting against Prototheca species. The list of transmissible animal diseases under Regulation (EU) No 2016/429 includes those caused by microorganisms resistant to antimicrobials, which can have important implications for human and animal health, feed and food safety. This approach would involve a series of changes to the rules used for Official Controls (Regulation (EU) No 2017/625) moving from the concept of the food chain to that of the agri-food chain.     

基于DPSEEA模型构建生物安全评价体系：以深圳市为例

由于生物安全内涵外延和基本要素的模糊性、评价指标及评价方法的多元性等因素的限制, 我国至今尚未形成全面有效的生物安全评价指标体系。为构建生物安全评价体系, 研判生物安全现状, 本文首先运用规范分析法剖析《生物安全法》中有关“生物安全”定义的特点及不足, 从国家安全角度认为生物安全是指国家有效防范和应对危险生物因子及相关因素的威胁, 维护和保障自身安全与利益的能力和状态。明晰了生物安全的外延, 即只有对国家安全利益、民众健康、生态环境保护产生威胁的生物风险, 才是生物安全所规制的对象。其次, 生物安全基本要素包括自然生物安全和社会经济生物安全。自然生物安全主要指民众健康和生态环境保护方面, 包括生物个体安全和生物多样性安全。社会经济生物安全的关注点在国家安全利益, 即社会稳定和国家经济利益, 包括生物技术安全、生物实验室安全。第三, 以生物安全基本要素为管理对象的尺度, 将国家安全利益、民众健康和生态环境保护作为评价主体, 以生物法治为理念, 运用模型构建法, 将定性指标和定量指标相结合, 基于驱动力‒压力‒状态‒接触‒影响‒行动模型(driving force-pressure-state-exposure-effect-action, DPSEEA)构建了一套具有生物法治特色的生物安全评价指标体系, 包括生物安全法律法规体系健全水平、生物安全所涉违法犯罪行为的打击力度、生物安全各部门机构协调机制的建立和完善程度、符合规定标准的生物实验室数量和百分比、生物安全人才数量及密度、对生物产业和基本卫生部门的官方援助及其他途径投资总额、疫苗覆盖的目标人群比例、生物安全的宣传教育普及率8项评价指标在内共32项生物安全评价指标。最后, 基于实地调研及数据统计分析, 以2019年和2020年深圳生物安全工作为例对评价体系进行验证。结果显示, 深圳生物安全工作在农业生物安全、动植物防疫、防范外来物种入侵方面成果显著; 但仍在法律法规体系、生物安全人才培养和资金投入、生物安全普及率方面存在不足。针对上述问题提出完善生物安全法律法规体系并注重法律协调衔接、“一个健康”实现多元协同生物治理、加强人才培养和资金投入、加强生物安全宣传教育等建议。     

Analysis of the extra-aural dependence of hearing disorders in civil flight personnel

The relationships between the incidence of hearing loss and concomitant pathologies in the civil flight personnel and individual sensitivity of the auditory analyzer to aviation noise and length of service was investigated using two-way analysis of variance (ANOVA) without repetition. In the sample examined, 335 subjects (group 1) had only the audiometric traces of noise impact on the auditory analyzer, and 108 subjects (group 2) displayed sustained loss of hearing (chronic sensorineural hearing loss). In the aggregate, the obtained results evidence that only the indicators of change in the incidence of cardiovascular diseases (atherosclerosis of the aorta and coronary arteries, atherosclerotic cardiosclerosis) and sensorineural hearing loss depend on the individual sensitivity to noise and length of flight service. In the remaining cases, none of the factor criteria was the only cause of the pathology under consideration. The proportion of causative factors in the formation of health disorders varies in both the type of a non-auditory pathology and periods of flight service; there are also consistent patterns of the time of incipient hearing loss. The flight personnel from group 2 with the low noise sensitivity and sustained deafness were diagnosed to have a broader variety of extra-aural pathologies than the subjects from group 1 with incipient hearing disorders. ANOVA without repetition is applicable to evaluation of the impact of unfavorable flight factors on the formation of different types of somatic pathologies.     

Blame the Patient,Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

Objective

Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.

Method

Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.

Results

Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.

Conclusion

Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.     

Communication Practices for Oil Spills: Stakeholder Engagement During Preparedness and Response

The Deepwater Horizon (DWH) oil spill was a pivotal moment in the expression of and reporting on stakeholder risk perceptions about oil spills, response options, and safety. Public engagement through both traditional and social media was arguably much higher than in prior spills. The DWH response organization undertook a wide variety of activities to manage risks and communicate with both the general public and those directly affected, such as commercial fishers. However, these did not fully address widespread concerns about ecological and human health risks associated with dispersant use. Consequentially the DWH spill heightened awareness of persistent risk communication problems around oil spill response, and especially dispersant use. Oil spill risk research and experience suggests that institutional and operational factors inhibit engaging communities and stakeholders during oil spill preparedness and response, and that such engagement is essential for effective risk management. In this article we review and assess current oil spill preparedness and response practices for community and stakeholder engagement, including related institutional and operational constraints. This assessment suggests five example risk management practices to improve and advance risk communications during oil spill preparedness and response activities.     

构建患者安全管理体系的实践与思考

保障患者安全是各级医疗的机构管理重心,以事前管理为重点,事后管理为补充,构建患者安全管理体系,从不良事件上报、高危哨点预警、患者安全文化、医疗风险转移四个维度构建患者安全管理的事前管理架构,进而从系统上保障患者安全,降低医疗风险。     

Addressing Susceptibility in Microbial Pathogen Risk Assessment

As concern for vulnerable subpopulations has grown, susceptibility has become a more important element in risk assessment and management processes. However, there is little consensus on how to incorporate or model the concept effectively in microbial pathogen risk assessment (MRA). Susceptibility is fundamentally a complex concept. There are many different definitions for it, reflecting the principles and viewpoints of the fields that contribute to risk assessment. Although susceptibility needs to be addressed in every step of the risk management paradigm, it has not yet been fully integrated into risk assessment, one step within the paradigm. Many factors are involved in characterizing and modeling susceptibility, but little is known about the relationships of many of the factors and many cannot be reliably measured. Recent MRA frameworks and case studies were reviewed for their approaches to susceptibility. Themes identified included limited or no explicit conceptualization of susceptibility in the problem formulation, limited data to assess susceptibility, heavy or exclusive emphasis on susceptibility in the health effects portion of the model, primary focus on host characteristics, and little consideration of susceptibility in risk characterization. Recommendations to improve approaches to susceptibility in MRA are presented.     

基于结构方程模型的用药安全影响因素研究

目的 通过分析用药安全的影响因素和发生机制,从而提高用药安全性,预防用药差错的发生。方法 随机抽取三级、二级医院各6家,分析2010—2016年12家医院的423例用药差错事件发生的原因,同时结合个人访谈的研究方式,访谈用药差错事件发生的相关医护人员及用药安全管理部门领导共计126人,最终通过访谈及文献研究的方法确定了26个用药安全的影响因素。通过运用因子分析结合结构方程模型的方式,分析各个影响因素之间的相互作用及对用药安全的影响程度。结果 通过结构方程模型分析可知：药品因素、员工素质、患者因素、社会因素、医院管理都是高度影响用药安全的主要因素。结论 通过对关键指标的管理,提出科学、有效的防范措施。     

An ergonomics process for the care and use of research animals

Personnel who work with laboratory animals incur potential occupational health risks that can lead to the development of musculoskeletal disorders. Demanding manual tasks may also result in increased errors, worker fatigue, poor human performance, and decreased productivity. Studies have shown that a comprehensive ergonomics program that utilizes a systematic risk management approach can reduce the likelihood of exposure to musculoskeletal disorder risk factors and remove barriers to human performance. Research has characterized the risk factors of musculoskeletal disorder exposure in terms of force, frequency, posture, and muscle exertion. Ergonomic risk factors for typical animal handling tasks and work areas are identified, and a method is suggested for prioritizing interventions using interrelated data indicators. An initial review of potential control measures is offered to improve the health, safety, and effectiveness of people involved in the care and use of research animals.     

A one health framework for estimating the economic costs of zoonotic diseases on society

This article presents an integrated epidemiological and economic framework for assessing zoonoses using a "one health" concept. The framework allows for an understanding of the cross-sector economic impact of zoonoses using modified risk analysis and detailing a range of analytical tools. The goal of the framework is to link the analysis outputs of animal and human disease transmission models, economic impact models and evaluation of risk management options to gain improved understanding of factors affecting the adoption of risk management strategies so that investment planning includes the most promising interventions (or sets of interventions) in an integrated fashion. A more complete understanding of the costs of the disease and the costs and benefits of control measures would promote broader implementation of the most efficient and effective control measures, contributing to improved animal and human health, better livelihood outcomes for the poor and macroeconomic growth.     

Influence of Some Potential Predation Risk Factors and Interaction between Predation Risk and Cost of Fleeing on Escape by the Lizard Sceloporus virgatus

Escape theory predicts that flight initiation distance (predator–prey distance when escape begins) increases as predation risk increases and decreases as cost of fleeing increases. Scant information is available about the effects of some putative predation risk factors and about interaction between simultaneously operating risk and cost of fleeing factors on flight initiation distance and distance fled. By simulating an approaching predator, I studied the effects of body temperature (BT), distance to nearest refuge, and eye contact with a predator, as well as simultaneous effects of predator approach speed and female presence/absence on escape behavior by a small ectothermic vertebrate, the lizard Sceloporus virgatus. Flight initiation distance decreased as BT increased, presumably because running speed increases as BT increases, facilitating escape. Distance to nearest refuge was unrelated to BT or flight initiation distance. Substrate temperature was only marginally related, and air temperature was not related to flight initiation distance. Eye contact did not affect flight initiation during indirect approaches that bypassed lizards by a minimum of 1 m, but an effect of eye contact found in other studies during direct approach might occur. Predator approach speed and presence of a female interactively affected flight initiation distance, which increased as speed increased and decreased when a female was present. In the presence of a female, flight initiation distance was far shorter than when no female was present. The high cost of forgoing a mating opportunity accounts for the interaction because the difference between female presence and absence is greater when risk is greater.