What are the most common domains of the core competencies of disaster nursing? A scoping review.

AIM: Scoping review was conducted to identify the most common domains of the core competencies of disaster nursing. BACKGROUND: Nurses play an essential role in all phases of disaster management. For nurses to respond competently, they must be equipped with the skills to provide comprehensive and holistic care to the populations affected by or at risk of disasters. METHODS: A scoping review was conducted using the Joanna Briggs Institute methodology. The review used information from six databases: the Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE, ScienceDirect, ProQuest, Scopus and the Education Resources Information Center. Keywords and inclusion and exclusion criteria were identified as strategies to use in this review. RESULTS: Twelve studies were eligible for result extraction, as they listed domains of the core competencies. These domains varied among studies. However, the most common domains were related to communication, planning, decontamination and safety, the Incident Command System and ethics. CONCLUSION: Knowledge of the domains of the core competencies, such as understanding the content and location of the disaster plan, communication during disaster and ethical issues is fundamental for nurses. Including these domains in the planning and provision of training for nurses, such as disaster drills, will strengthen their preparedness to respond competently to disaster cases. Nurses must be involved in future research in this area to explore and describe their fundamental competencies in each domain.

Analysis of railroad tank car releases using a generalized binomial model.

The United States is experiencing an unprecedented boom in shale oil production, leading to a dramatic growth in petroleum crude oil traffic by rail. In 2014, U.S. railroads carried over 500,000 tank carloads of petroleum crude oil, up from 9500 in 2008 (a 5300% increase). In light of continual growth in crude oil by rail, there is an urgent national need to manage this emerging risk. This need has been underscored in the wake of several recent crude oil release incidents. In contrast to highway transport, which usually involves a tank trailer, a crude oil train can carry a large number of tank cars, having the potential for a large, multiple-tank-car release incident. Previous studies exclusively assumed that railroad tank car releases in the same train accident are mutually independent, thereby estimating the number of tank cars releasing given the total number of tank cars derailed based on a binomial model. This paper specifically accounts for dependent tank car releases within a train accident. We estimate the number of tank cars releasing given the number of tank cars derailed based on a generalized binomial model. The generalized binomial model provides a significantly better description for the empirical tank car accident data through our numerical case study. This research aims to provide a new methodology and new insights regarding the further development of risk management strategies for improving railroad crude oil transportation safety.

The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

As yoga has gained popularity as a therapeutic intervention, its safety has been questioned in the lay press. Thus, this review aimed to systematically assess and meta-analyze the frequency of adverse events in randomized controlled trials of yoga. MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through February 2014. Of 301 identified randomized controlled trials of yoga, 94 (1975-2014; total of 8,430 participants) reported on adverse events. Life-threatening, disabling adverse events or those requiring intensive treatment were defined as serious and all other events as nonserious. No differences in the frequency of intervention-related, nonserious, or serious adverse events and of dropouts due to adverse events were found when comparing yoga with usual care or exercise. Compared with psychological or educational interventions (e.g., health education), more intervention-related adverse events (odds ratio = 4.21, 95% confidence interval: 1.01, 17.67; P = 0.05) and more nonserious adverse events (odds ratio = 7.30, 95% confidence interval: 1.91, 27.92; P < 0.01) occurred in the yoga group; serious adverse events and dropouts due to adverse events were comparable between groups. Findings from this review indicate that yoga appears as safe as usual care and exercise. The adequate reporting of safety data in future randomized trials of yoga is crucial to conclusively judge its safety.

Lifestyle and safety practices of firefighters and their relation to cardiovascular risk factors.

BACKGROUND: In the United States, over 50% of the deaths of on-duty firefighters are classified as sudden cardiac deaths. A holistic view of the multiple risk factors and their relation to the prevalence of cardiovascular disease (CVD) is necessary to determine a baseline for prevention. METHODS: This study surveyed 154 firefighters in a large Midwestern county about their individual exposure to particulates, noise, heat stress, skin contamination, and physical stress; lifestyle factors such as exercise, diet, smoking, and alcohol consumption; health status; and demographic factors. RESULTS: Consumption of whole grains and alcohol were associated with a reduction of the risk of heart disease, while higher Body Mass Index (BMI) scores and increasing age were associated with increased risk of heart disease. CONCLUSIONS: Although firefighters are exposed to substantial occupational risks, only lifestyle factors were found to significantly predict CVD and related health issues. BMI is a modifiable risk factor, which, if controlled, could appreciably improve health outcomes.

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems.

OBJECTIVE: To evaluate the impact of changing energy prices on Australian ambulance systems. METHODS: Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. RESULTS: Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. CONCLUSION: Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.

Benchmarking road safety of U.S. states: a DEA-based Malmquist productivity index approach.

In this study, a DEA based Malmquist index model was developed to assess the relative efficiency and productivity of U.S. states in decreasing the number of road fatalities. Even though the national trend in fatal crashes has reached to the lowest level since 1949 (Traffic Safety Annual Assessment Highlights, 2010), a state-by-state analysis and comparison has not been studied considering other characteristics of the holistic national road safety assessment problem in any work in the literature or organizational reports. In this study, a DEA based Malmquist index model was developed to assess the relative efficiency and productivity of 50 U.S. states in reducing the number of fatal crashes. The single output, fatal crashes, and five inputs were aggregated into single road safety score and utilized in the DEA-based Malmquist index mathematical model. The period of 2002-2008 was considered due to data availability for the inputs and the output considered. According to the results, there is a slight negative productivity (an average of -0.2 percent productivity) observed in the U.S. on minimizing the number of fatal crashes along with an average of 2.1 percent efficiency decline and 1.8 percent technological improvement. The productivity in reducing the fatal crashes can only be attributed to the technological growth since there is a negative efficiency growth is occurred. It can be concluded that even though there is a declining trend observed in the fatality rates, the efficiency of states in utilizing societal and economical resources towards the goal of zero fatality is not still efficient. More effective policy making towards increasing safety belt usage and better utilization of safety expenditures to improve road condition are derived as the key areas to focus on for state highway safety agencies from the scope of current research.

The Ciclovia and Cicloruta programs: promising interventions to promote physical activity and social capital in Bogotá, Colombia.

OBJECTIVES: We compared participants from the Ciclovia (streets temporarily closed to motorized vehicles and open for pedestrians) and Cicloruta (bicycle paths) programs in Bogotá, Colombia, to assess associations of program participation with physical activity, safety, social capital, and equity. METHODS: We conducted 2 cross-sectional studies in October 2009 with intercept surveys: one among 1000 Ciclovia participants and the other among 1000 Cicloruta participants. RESULTS: Most Ciclovia participants met the physical activity recommendation in leisure time (59.5%), and most Cicloruta participants met it by cycling for transportation (70.5%). Ciclovia participants reported a higher perception of safety (51.2% regarding traffic and 42.4% about crime) and social capital (odds ratio = 2.0; 95% confidence interval = 1.4, 2.8) than did Cicloruta users. Most Cicloruta users reported living in low socioeconomic status categories (53.1%), had lower educational attainment (27%), and did not own cars (82.9%). Most Ciclovia participants reported living in middle socioeconomic status categories (64%), had low-to-middle educational attainment (51.1%), and did not own cars (66.1%). CONCLUSIONS: The Ciclovia and Cicloruta programs have the potential to equitably promote physical activity and provide a mobility alternative in complex urban settings such as Bogotá.

Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses.

CONTEXT: The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether these clinicians can provide these services safely and effectively. METHODS: Allopathic physicians, ayurvedic physicians and nurses (10 of each), none of whom had experience in abortion provision, were trained to perform medication abortions. In 2008-2010, these providers performed medication abortions in five clinics in Bihar and Jharkhand for 1,225 women with a pregnancy of up to eight weeks' gestation. A two-sided equivalence design was used to test whether providers' assessments of client eligibility and completeness of abortion matched those of an experienced physician "verifier," and whether medication abortions performed by nurses and ayurvedic physicians were as safe and effective as those done by allopathic physicians. RESULTS: Failure rates were low (5-6%), and those for nurses and ayurvedic physicians were statistically equivalent to those for allopathic physicians. Provider assessments of client eligibility and completeness of abortion differed from those of the verifier in only a small proportion of cases (3-4% for eligibility and 4-5% for completeness); these proportions, and rates of loss to follow-up, were statistically equivalent among provider types. No serious complications were observed, and services by all three groups of providers were acceptable to women. CONCLUSION: Findings support amending existing laws to improve women's access to medication abortion by expanding the provider base to include ayurvedic physicians and nurses.

Translating road safety into health outcomes using a quantitative impact assessment model.

INTRODUCTION: The majority of traffic safety policies are limited to preventing mortality. However, non-fatal injuries also impose a significant risk of adverse health. Therefore, both mortality and morbidity outcomes should be included in the evaluation of traffic safety policies. The authors propose a method to evaluate different policy options taking into account both fatalities and serious injuries. METHODS: A health impact model was developed and aligned with a transport and road safety model, calculating the health impact of fatalities and seriously injured traffic victims for two transport scenarios in Flanders and Brussels (Belgium): a base scenario and a fuel price increase of 20% as an alternative. Victim counts were expressed as disability adjusted life years, using a combination of police and medical data. Seriously injured victims were assigned an injury, using injury distributions derived from hospital data, to estimate the resulting health impact from each crash. Health impact of fatalities was taken as the remaining life expectancy at the moment of the fatal crash. RESULTS: The fuel price scenario resulted in a decrease of health impact due to fatalities of 5.53%--5.85% and 3.37%--3.88% for severe injuries. This decrease was however not equal among all road users. CONCLUSIONS: With this method, the impact of traffic polices can be evaluated on both mortality and morbidity, while taking into account the variability of different injuries following a road crash. This model however still underestimates the impact due to non-fatal injuries.

Professional conceptualisation and accomplishment of patient safety in mental healthcare: an ethnographic approach.

BACKGROUND: This study seeks to broaden current understandings of what patient safety means in mental healthcare and how it is accomplished. We propose a qualitative observational study of how safety is produced or not produced in the complex context of everyday professional mental health practice. Such an approach intentionally contrasts with much patient safety research which assumes that safety is achieved and improved through top-down policy directives. We seek instead to understand and articulate the connections and dynamic interactions between people, materials, and organisational, legal, moral, professional and historical safety imperatives as they come together at particular times and places to perform safe or unsafe practice. As such we advocate an understanding of patient safety 'from the ground up'. METHODS/DESIGN: The proposed project employs a six-phase data collection framework in two mental health settings: an inpatient unit and a community team. The first four phases comprise multiple modes of focussed, unobtrusive observation of professionals at work, to enable us to trace the conceptualisation and enactment of safety as revealed in dialogue and narrative, use of artefacts and space, bodily activity and patterns of movement, and in the accomplishment of specific work tasks. An interview phase and a social network analysis phase will subsequently be conducted to offer comparative perspectives on the observational data. This multi-modal and holistic approach to studying patient safety will complement existing research, which is dominated by instrumentalist approaches to discovering factors contributing to error, or developing interventions to prevent or manage adverse events. DISCUSSION: This ethnographic research framework, informed by the principles of practice theories and in particular actor-network ideas, provides a tool to aid the understanding of patient safety in mental healthcare. The approach is novel in that it seeks to articulate an 'anatomy of patient safety' as it actually occurs, in terms of the networks of elements coalescing to enable the conceptual and material performance of safety in mental health settings. By looking at how patient safety happens or does not happen, this study will enable us to better understand how we might in future productively tackle its improvement.

WNA's worldwide overview on front-end nuclear fuel cycle growth and health, safety and environmental issues.

This paper presents the WNA's worldwide nuclear industry overview on the anticipated growth of the front-end nuclear fuel cycle from uranium mining to conversion and enrichment, and on the related key health, safety, and environmental (HSE) issues and challenges. It also puts an emphasis on uranium mining in new producing countries with insufficiently developed regulatory regimes that pose greater HSE concerns. It introduces the new WNA policy on uranium mining: Sustaining Global Best Practices in Uranium Mining and Processing-Principles for Managing Radiation, Health and Safety and the Environment, which is an outgrowth of an International Atomic Energy Agency (IAEA) cooperation project that closely involved industry and governmental experts in uranium mining from around the world.

[Post-marketing safety profile of avocado-soybean unsaponifiables]. / Profil d'effets indésirables des insaponifiables d'avocat et de soja.

AIM: To determine the post-marketing safety profile of avocado-soybean unsaponifiables since their commercialization in France until 2008. METHODS: We used data provided by French spontaneous reporting system via the network of National Pharmacovigilance centres. We analysed all suspected adverse drug reactions (ADRs) concerning avocado-soybean unsaponifiables (ASU) reported between 1978 and 2008 and notified in the French Pharmacovigilance Database. RESULTS: We kept 117 ADRs concerning 117 patients (mean age 65.5 years, 72% female). ADRs (35.9%) were "serious" (resulted in hospitalisation or prolonged it). No death was reported. In most of cases, causality of ASU was "possible" and others drugs were also suspected. The most frequently reported ADRs were cutaneous (32.5% of all ADRs, with eczemas or urticaria), hepatic (16.2%, mostly hepatocellular injuries) and gastrointestinal (12%, with 9 cases of colitis and/or diarrhea) ADRs. In these cases, dechallenge of ASU allowed rapid regression of symptoms. Others significant ADRs were coagulation and platelet (6.8%), neurological (6%) and metabolic or nutritional (4.3%) disorders. DISCUSSION-CONCLUSION: This Pharmacovigilance analysis of ASU notified since their commercialisation in France highlights the diversity of ADRs with several class-organ involved. Cutaneous, hepatic and gastro-intestinal disorders were the most frequently reported ADRs. Since ASU is largely prescribed in France, incidence of their ADRs seems to be "very rare" (although we did not take into account the part of under-notification). These safety data should be discussed in the light of the poor expected clinical benefit of ASU in rheumatology (low "Service Medical Rendu") or in stomatology (insufficient "Service Medical Rendu").

Eficacia y seguridad a corto plazo de etanercept en la psoriasis / Short term efficacy and safety of etanercept in psoriasis

La psoriasis es una enfermedad crónica, que cursa por brotes, y que en un momento determinado de su evolución, o en ciertos pacientes, puede afectar una gran parte de la superficie corporal con graves repercusiones físicas y psíquicas. Los tratamientos utilizados en este tipo de pacientes se asocian a múltiples efectos secundarios y requieren numerosos controles clínicos y analíticos. La aparición de las nuevas terapias biológicas en el arsenal terapéutico del dermatólogo ha aportado numerosas ventajas para el control y mantenimiento del paciente psoriásico. La facilidad de uso, limpieza, comodidad posológica y sencillez de su manejo han cambiado la perspectiva de la enfermedad. Su eficacia parece comparable o superior a la conseguida por terapias sistémicas clásicas como la fototerapia, los retinoides, metotrexato o ciclosporina. Presentamos un caso clínico de psoriasis grave, que presentó una rápida y completa respuesta a etanercept. A propósito del mismo realizamos un revisión bibliográfica dirigida a los aspectos de seguridad y eficacia a corto plazo –menos de 12 semanas de tratamiento– en pacientes psoriásicos tratados con esta molécula (AU)

Psoriasis is a chronic disease that occurs in episodes and which, in a certain moment of its evolution or in some patients, may affect a large portion of the body surface with serious physical and psychological repercussions. The treatment used in this type of patient is associated to many side effects and requires numerous clinical and laboratory controls. We present a clinical case of severe psoriasis that presented a rapid and complete response to etanercept. Based on this case, we performed a bibliographic review aimed at the short-term safety and efficacy aspects, less than 12 weeks of treatment, in psoriatic patients treated with this molecule (AU)

Eficacia y seguridad a largo plazo de etanercept en la psoriasis / Long term efficacy and safety of etanercept in psoriasis

Existen numerosos estudios que demuestran que etanercept es un medicamento eficaz y seguro para el tratamiento de la psoriasis moderada a grave a corto plazo. Sin embargo, la psoriasis es una enfermedad con curso crónico o recurrente, asociada a artritis y comorbilidades que merman la salud y la calidad de vida de los pacientes, requiriendo a menudo tratamiento a largo plazo, ya sea de forma continua o intermitente. Los datos disponibles sobre el empleo de etanercept como tratamiento de la psoriasis a largo plazo, incluso en dosis altas, demuestran un buen perfil de eficacia y seguridad. La mitad de los pacientes obtienen una mejoría PASI (Psoriasis Area and Severity Index) 75 durante tratamientos prolongados hasta 96 meses. La respuesta PASI 75 es superior en pautas continuas que en pautas intermitentes (con pausas). La mayoría de los pacientes mantienen la respuesta a largo plazo, aunque en algunos se observa una disminución de la eficacia, como ocurre con otros inhibidores del factor de necrosis tumoral. La experiencia acumulada con etanercept en otras enfermedades inflamatorias crónicas también respalda este buen perfil de seguridad (AU)

There are many studies that have shown that etanercept is an effective and safe drug for the short-term treatment of moderate to severe psoriasis. However, psoriasis is a disease with a chronic or recurrent course associated to arthritis and comorbidities that diminish the patient's health and quality of life and that often requires either continuous or intermittent long-term treatment. The data available on the use of etanercept in the long-term treatment of psoriasis, even at high doses, have shown that it has a good efficacy and safety profile. Half of the patients obtained a 75% improvement on the Psoriasis Area and Severity Index (PASI-75 during prolonged treatments of up to 96 months. The PASI 75 response is higher in continuous regimes than in intermittent ones (with pauses). Most of the patients maintain the response at long-term, although a decrease in efficacy is observed in some of them, as occurs with other tumor necrosis factor inhibitors. Accumulated experience with etanercept in other chronic inflammatory diseases also supports this good safety profile (AU)

Uso intermitente de etanercept en psoriasis / Intermittent use of etanercept in psoriasis

Para el tratamiento de la psoriasis en placas moderada-grave en España, hasta hace muy poco, únicamente estaba aprobado el uso de etanercept de forma intermitente o en ciclos de tratamiento no superiores a 24 semanas. A partir de septiembre de 2009 se aprobó su administración ininterrumpida para aquellos pacientes con psoriasis moderada-grave que, a criterio médico, así lo requieran. Esta decisión está avalada por los resultados de varios estudios que evaluaban la eficacia y seguridad de etanercept a corto y largo plazo, en terapia continua o intermitente. El estudio CRYSTEL evalúa la eficacia y seguridad de etanercept en tratamiento continuo o intermitente durante 54 semanas. Los resultados demostraron que tanto los pacientes que recibieron tratamiento continuo como los que recibieron tratamiento intermitente experimentaron mejorías significativas en su enfermedad y se mostraron muy satisfechos con el resultado, sin observarse hallazgos inesperados de seguridad en ambos grupos (AU)

Systemic treatment for psoriasis has radically changed since the emergence of new biological therapies. One of these biological agents is etanercept. Until recently, the use of etanercept for treatment of moderate-to-severe psoriasis in Spain was only approved in an intermittent way or in cycles of treatment (not exceeding 24 weeks). However, from September 2009, its administration has been also approved in a continuous way for patients who require it. This decision is based on the results of several studies that evaluate the efficacy and safety of etanercept administrated in short and long term and in a continuous or intermittent therapy. One of these studies is Crystel study, what evaluates the efficacy and safety of continuous and paused etanercept regimens in psoriasis patients for 54-week-period. Crystel study results showed that both continuous and paused etanercept therapies improved PGA and PASI scores and patient satisfaction rates, no unexpected adverse effects were observed. Therefore, doctors may use one treatment or another according to patients needs (AU)

Parent/Caregiver supervision and child injury: a systematic review of critical dimensions for understanding this relationship.

This study reviewed the relationship between recognized dimensions of supervision and children's injuries based on Saluja et al's (Injury Control and Safety Promotion. 2004;11:17-22) hierarchal model of supervision strategies. A systematic review of peer-review studies was done with the earliest records available to 2007. There were 112 potentially relevant articles identified; 31 studies met all inclusion criteria. Reported studies were categorized according to the dimensions of supervision they addressed. Studies were not evenly distributed across the dimensions. There was evidence from the study that directly linking dimensions of supervision to child injury risk and outcomes is scarce. Future studies should consider attention, proximity, and continuity of supervision to provide a holistic understanding of the relationship between supervision and injury.

Associations between self-reported working conditions and registered health and safety results.

OBJECTIVE: To investigate the association between self-reported working conditions and registered health and safety results in a petroleum company in Norway. METHODS: We analyzed data from company surveys of working and organizational conditions in 2003 and 2004 and data from the company's files of sickness absence, personal injuries, serious incidents, and undesirable incidents in 2003 and 2004 as well as personal injuries from 2000 to 2004 using Pearson's correlation analysis and multiple linear regression analyses. RESULTS: Good perception of confidence in management in 2003 and 2004 was significantly negatively correlated with the number of personal injuries from 2000 to 2004. CONCLUSIONS: Management style and trust in the manager are important factors for predicting personal injuries. The company's working and organizational survey might be used as an indicator for injury risk.