Managing risk associated with cryopreservation.
(33/166)
Patients who consent to the frozen storage of sperm or embryos quite rightly expect the storing centre to do everything reasonably possible to keep them in optimum conditions. Both the process of cryopreservation and the cryofacility are loaded with risk, from patient/sample processing, through to the eventual utilization or disposal of specimens. The risk management process should focus on minimizing losses, including staff injury, premature warming of cells and tissues, mistaken identity, and transmission of infection. Early warning and monitoring systems should be in place for quality assurance and to prevent incidents involving cryovessels turning critical. Centres must ensure that every reasonable practical measure that can be put in place is done so, and that resourcing of the service adequately reflects the liability it represents. (+info)
Fewer but better auditory alarms will improve patient safety.
(34/166)
Auditory warnings and alarms are used throughout the medical environment but often fall short of ideal. In some instances they can be a hindrance rather than a help to medical practice. The main reasons why alarms are less than ideal are: (1) they are used too often and people's hearing as the primary warning sense is over-used; (2) false alarm rates are often exceedingly high because trigger points are inappropriately set; and (3) their design is often poor. However, enough is now known about auditory warning design and implementation to overcome many of the traditional problems associated with them. A new draft international standard incorporates many of these measures, and increasing pressure from safety organisations such as the Joint Commission on the Accreditation of Healthcare Organisations in the USA and the National Patient Safety in the UK can help to improve the way that auditory warnings are used in medical care by implementing what is known from research into practice. (+info)
Analyzing a bioterror attack on the food supply: the case of botulinum toxin in milk.
(35/166)
We developed a mathematical model of a cows-to-consumers supply chain associated with a single milk-processing facility that is the victim of a deliberate release of botulinum toxin. Because centralized storage and processing lead to substantial dilution of the toxin, a minimum amount of toxin is required for the release to do damage. Irreducible uncertainties regarding the dose-response curve prevent us from quantifying the minimum effective release. However, if terrorists can obtain enough toxin, and this may well be possible, then rapid distribution and consumption result in several hundred thousand poisoned individuals if detection from early symptomatics is not timely. Timely and specific in-process testing has the potential to eliminate the threat of this scenario at a cost of <1 cent per gallon and should be pursued aggressively. Investigation of improving the toxin inactivation rate of heat pasteurization without sacrificing taste or nutrition is warranted. (+info)
Operational effectiveness of suicide-bomber-detector schemes: a best-case analysis.
(36/166)
Standoff explosives-detection technologies allow, in principle, for the detection of pedestrian suicide bombers, although such sensors are not yet sufficiently affordable and reliable to justify widespread deployment. What if they were? Assuming the availability of cheap, perfectly sensitive and specific suicide-bomber-sensing devices, we analyze the operational effectiveness of sensor-based detector schemes in reducing casualties from random suicide-bombing attacks. We model the number of casualties resulting from pedestrian suicide bombings absent intervention, the reduction in casualties from alternative interventions, given timely detection of a suicide-bombing attack, and the probability of timely detection under best-case assumptions governing the performance of suicide-bomber-detector schemes in two different urban settings. Even under such optimistic assumptions, we find that the widespread deployment of suicide-bomber detectors will not reliably result in meaningful casualty reductions. Relaxing the best-case assumptions only makes matters worse. Investment in intelligence-gathering to prevent suicide bombers before they attack seems a wiser strategy than relying on sensor-based suicide-bomber-detector schemes. (+info)
Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study.
(37/166)
BACKGROUND: Over recent years there has been an increasing prevalence of verbal and physical violence in Israel, including in the work place. Physicians are exposed to violence in hospitals and in the community. The objective was to characterize acts of verbal and physical violence towards hospital- and community-based physicians. METHODS: A convenience sample of physicians working in the hospital and community completed an anonymous questionnaire about their experience with violence. Data collection took place between November 2001 and July 2002. One hundred seventy seven physicians participated in the study, 95 from the hospital and 82 from community clinics. The community sample included general physicians, pediatricians, specialists and residents. RESULTS: Ninety-nine physicians (56%) reported at least one act of verbal violence and 16 physicians (9%) reported exposure to at least one act of physical violence during the previous year. Fifty-one hospital physicians (53.7%) were exposed to verbal violence and 9 (9.5%) to physical violence. Forty-eight community physicians (58.5%) were exposed to verbal violence and 7 (8.5%) to physical violence. Seventeen community physicians (36.2%) compared to eleven hospital physicians (17.2%) said that the violence had a negative impact on their family and on their quality of life (p < 0.05). The most common causes of violence were long waiting time (46.2%), dissatisfaction with treatment (15.4%), and disagreement with the physician (10.3%). CONCLUSION: Verbal and/or physical violence against physicians is common in both the hospital and in community clinics. The impatience that accompanies waiting times may have a cultural element. Shortening waiting times and providing more information to patients and families could reduce the rate of violence, but a cultural change may also be required. (+info)
Coverage of the Test of Memory Malingering, Victoria Symptom Validity Test, and Word Memory Test on the Internet: is test security threatened?
(38/166)
In forensic neuropsychological settings, maintaining test security has become critically important, especially in regard to symptom validity tests (SVTs). Coaching, which can entail providing patients or litigants with information about the cognitive sequelae of head injury, or teaching them test-taking strategies to avoid detection of symptom dissimulation has been examined experimentally in many research studies. Emerging evidence supports that coaching strategies affect psychological and neuropsychological test performance to differing degrees depending on the coaching paradigm and the tests administered. The present study sought to examine Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it. Steps that could be taken to improve this situation and limitations to this exploration are discussed. (+info)
Pathological effects of the supermaximum prison.
(39/166)
The drawings of Todd (Hyung-Rae) Tarselli, a prisoner confined in a Pennsylvania "close-security" or "supermaximum" prison, tell a story--one that graphically portrays the devastating effects of a prison on the mental health of its inmates. (+info)
Relation between policies and work related assault: Minnesota Nurses' Study.
(40/166)
AIMS: To assess the relation between violence prevention policies and work related assault. METHODS: From Phase 1 of the Minnesota Nurses' Study, a population based survey of 6300 Minnesota nurses (response 79%), 13.2% reported experiencing work related physical assault in the past year. In Phase 2, a case-control study, 1900 nurses (response 75%) were questioned about exposures relevant to violence, including eight work related violence prevention policy items. A comprehensive causal model served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were conducted for potential exposure misclassification and the presence of an unmeasured confounder. RESULTS: Results of multiple regression analyses, controlling for appropriate factors, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR = 0.5, 95% CI 0.4 to 0.8) and having policies regarding types of prohibited violent behaviours (OR = 0.5, 95% CI 0.3 to 0.9). Analyses adjusted for non-response and non-selection resulted in wider confidence intervals, but no substantial change in effect estimates. CONCLUSIONS: It appears that some work related violence policies may be protective for the population of Minnesota nurses. (+info)