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1.
Cancer Radiother ; 19(2): 89-97, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25600666

RESUMEN

PURPOSE: To report the application of the global risk analysis (GRA) in the pulsed-dose rate (PDR) brachytherapy workflow. MATERIAL AND METHODS: Analyses were led by a multidisciplinary working group established within the unit with the guidance of a quality engineer. First, a mapping of hazardous situations was developed as a result of interactions between the patient workflow for a treatment using PDR brachytherapy split into 51 sub-phases with a comprehensive list of the hazards that he/she faces (44). Interactions, when relevant, were sorted by level of priority: to be treated immediately, secondarily (the group is not entitled to treat the situation), or later (safe situation). Secondly, for each high priority dangerous situation, scenarios were developed to anticipate their potential consequences. Criticality was assessed, using likelihood and severity scales and a matrix, which allocated risks into categories: acceptable (C1), tolerable under control (C2) and unacceptable (C3). Then, corrective actions were proposed and planned when relevant, after assessment of their feasibility with a scale of effort. Finally, the criticality of the scenarios was reevaluated, taking into account the implementation of these actions, leading to a residual risk mapping, which could trigger additional proposals of actions. RESULTS: Two thousand one hundred and eighty-four potential interactions between the list of hazards and the workflow were analyzed. Mapping of dangerous situations identified 213 relevant interactions, from which 61 were considered with high priority. One hundred and twenty-six scenarios were generated: 68 with a low criticality (74.3%), 58 with an intermediate score (25.7%). No scenario with the highest criticality was individualized. Twenty-one corrective actions were planned. Mapping of residual risk resulted in the disappearance of most C2 risks, leaving 5 C2 scenarios (4%), for which four monitoring indicators were implemented in addition to the corrected actions decided on. CONCLUSION: The implementation of the GRA appeared feasible, and led to implement 21 corrective actions, based on scenarios and not on incidents.


Asunto(s)
Braquiterapia/métodos , Braquiterapia/instrumentación , Humanos , Grupo de Atención al Paciente , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Traumatismos por Radiación/prevención & control , Radioterapia Guiada por Imagen , Medición de Riesgo , Administración de la Seguridad , Flujo de Trabajo
2.
Cancer Radiother ; 17(4): 308-16, quiz 332, 2013.
Artículo en Francés | MEDLINE | ID: mdl-23787020

RESUMEN

Five radiotherapy accidents, from which two serial, occurred in France from 2003 to 2007, led the authorities to establish a roadmap for securing radiotherapy. By analogy with industrial processes, a technical decision form the French Nuclear Safety Authority in 2008 requires radiotherapy professionals to conduct analyzes of risks to patients. The process of risk analysis had been tested in three pilot centers, before the occurrence of accidents, with the creation of cells feedback. The regulation now requires all radiotherapy services to have similar structures to collect precursor events, incidents and accidents, to perform analyzes following rigorous methods and to initiate corrective actions. At the same time, it is also required to conduct analyzes a priori, less intuitive, and usually require the help of a quality engineer, with the aim of reducing risk. The progressive implementation of these devices is part of an overall policy to improve the quality of radiotherapy. Since 2007, no radiotherapy accident was reported.


Asunto(s)
Traumatismos por Radiación/prevención & control , Errores de Configuración en Radioterapia/prevención & control , Radioterapia/efectos adversos , Medición de Riesgo/métodos , Gestión de Riesgos/métodos , Francia , Agencias Gubernamentales , Humanos , Consentimiento Informado , Cooperación Internacional , Errores Médicos/prevención & control , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/etiología , Oncología por Radiación/legislación & jurisprudencia , Oncología por Radiación/normas , Errores de Configuración en Radioterapia/legislación & jurisprudencia , Errores de Configuración en Radioterapia/estadística & datos numéricos , Medición de Riesgo/legislación & jurisprudencia , Gestión de Riesgos/legislación & jurisprudencia , Gestión de Riesgos/normas , Conducta de Reducción del Riesgo
4.
Am J Respir Crit Care Med ; 157(3 Pt 1): 776-84, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9517590

RESUMEN

To investigate interactions between the endothelium and leukocytes in patients with sepsis, we measured soluble adhesion molecules (sE-selectin and sICAM-1), von Willebrand factor antigen (vWf:Ag), myeloperoxidase (MPO), and lactoferrin (Lacto-f) as plasma markers of endothelial and neutrophil activation. We tested whether the five proteins were predictors of clinical severity, which was evaluated by simplified acute physiological score (SAPS), number of organ failures (MOF), acute lung injury (ALI), and subsequent final outcome. Levels of the five plasma markers were higher in patients with severe infection (n = 25) than in patients without sepsis (n = 7) and healthy volunteers (n = 9). In the study population, levels of sE-selectin, sICAM-1, and vWf:Ag were higher for nonsurvivors as well as for patients with septic shock or with bacteremia, and they were correlated with SAPS and MOF. Survival outcome was predicted with high sensitivity and specificity by initial plasma levels of sICAM-1 and vWf:Ag. The initial sICAM-1 level appeared to be an independent prognostic variable, based on a logistic regression analysis. Unlike sE-selectin, sICAM-1 remained at high levels indefinitely in nonsurvivors. We conclude that, unlike neutrophil activation markers, levels of endothelium-derived soluble adhesion molecules and vWf:Ag in severe sepsis syndrome are correlated with the severity of illness and may be considered as predictors of survival outcome.


Asunto(s)
Selectina E/sangre , Molécula 1 de Adhesión Intercelular/sangre , Sepsis/sangre , Choque Séptico/sangre , Factor de von Willebrand/análisis , APACHE , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/sangre , Bacteriemia/fisiopatología , Biomarcadores/sangre , Endotelio Vascular/fisiología , Femenino , Estudios de Seguimiento , Predicción , Humanos , Lactoferrina/sangre , Leucocitos/fisiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/fisiopatología , Activación Neutrófila/fisiología , Peroxidasa/sangre , Pronóstico , Sensibilidad y Especificidad , Sepsis/fisiopatología , Choque Séptico/fisiopatología , Tasa de Supervivencia , Resultado del Tratamiento
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