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1.
S Afr Med J ; 0(0): 13162, 2020 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-33334390

RESUMO

BACKGROUND: Given the global shortage of N95 filtering facepiece respirators (FFP2 in Europe) during the COVID-19 pandemic, KN95 masks (Chinese equivalent of the N95 and FFP2) were imported and distributed in South Africa (SA). However, there are hardly any published independent safety data on KN95 masks. OBJECTIVES: To evaluate the seal, fit and filtration efficiency of several brands of KN95 masks marketed for widespread use in SA healthcare facilities, using standardised testing protocols. METHODS: The verifiability of manufacturer and technical details was first ascertained, followed by evaluation of the number of layers comprising the mask material. The testing protocol involved a directly observed positive and negative pressure user seal check, which if passed was followed by qualitative fit testing (sodium saccharin) in healthy laboratory or healthcare workers. Quantitative fit testing (3M) was used to validate the qualitative fit testing method. The filtration efficacy and integrity of the mask filter material were evaluated using a particle counter-based testing rig utilising aerosolised saline (expressed as filtration efficacy of 0.3 µm particles). Halyard FLUIDSHIELD 3 N95 and 3M 1860 N95 masks were used as controls. RESULTS: Twelve KN95 mask brands (total of 36 masks) were evaluated in 7 participants. The mask type and manufacturing details were printed on only 2/12 brands (17%) as per National Institute of Occupational Safety and Health and European Union regulatory requirements. There was considerable variability in the number of KN95 mask layers (between 3 and 6 layers in the 12 brands evaluated). The seal check pass rate was significantly lower in KN95 compared with N95 masks (1/36 (3%) v. 12/12 (100%); p<0.0001). Modification of the KN95 ear-loop tension using head straps or staples, or improving the facial seal using Micropore 3M tape, enhanced seal test performance in 15/36 KN95 masks evaluated (42%). However, none of these 15 passed downstream qualitative fit testing compared with the control N95 masks (0/15 v. 12/12; p<0.0001). Only 4/8 (50%) of the KN95 brands tested passed the minimum filtration requirements for an N95 mask (suboptimal KN95 filtration efficacy varied from 12% to 78%, compared with 56% for a surgical mask and >99% for the N95 masks at the 0.3 µm particle size). CONCLUSIONS: The KN95 masks tested failed the stipulated safety thresholds associated with protection of healthcare workers against airborne pathogens such as SARS-CoV-2. These preliminary data have implications for the regulation of masks and their distribution to healthcare workers and facilities in SA.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Teste de Materiais/métodos , Exposição Ocupacional/prevenção & controle , /epidemiologia , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Análise de Falha de Equipamento , Humanos , Gestão da Segurança/organização & administração , África do Sul/epidemiologia
2.
Health Aff (Millwood) ; 39(10): 1792-1798, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33017232

RESUMO

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership's work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.


Assuntos
Condução de Veículo/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Licenciamento/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gestão da Segurança/organização & administração , Interface Usuário-Computador , Adolescente , Infecções por Coronavirus/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Veículos Automotores/estatística & dados numéricos , Ohio , Pandemias/estatística & dados numéricos , Philadelphia , Projetos Piloto , Pneumonia Viral/epidemiologia , Transportes/métodos , Adulto Jovem
4.
Recurso na Internet em Espanhol | LIS - Localizador de Informação em Saúde | ID: lis-47877

RESUMO

Boletín sobre el reporte de casos positivos para Covid-19, Casos recuperados, fallecidos y casos importados, además de anuncios de medidas preventivas.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Gestão da Segurança/organização & administração , Isolamento Social
5.
Artigo em Inglês | MEDLINE | ID: mdl-32872189

RESUMO

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.


Assuntos
Coleta de Dados/métodos , Erros Médicos/prevenção & controle , Segurança do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão de Riscos/organização & administração , Gestão da Segurança/estatística & dados numéricos , Hospitais Universitários , Humanos , Itália , Auditoria Administrativa , Erros Médicos/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração
6.
PLoS One ; 15(9): e0239472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956391

RESUMO

BACKGROUND: Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel's resilience assessment grid (RAG) into a custom-made RAG (ED-RAG) to support resilience management in EDs. METHODS: The study approach had three parts: 1) translation of Hollnagel's RAG into Chinese version, followed by generation of a tailored set of ED-RAG questions adapted to EDs; 2) testing and revising the tailored sets until to achieve satisfactory validity for application; 3) design of a new rating scale and scoring method. The test criteria of the ED-RAG questionnaire adopted the modified three-level scoring criteria proposed by Bloom and Fischer. The study setting of the field test is a private regional hospital. RESULTS: The fifth version of ED-RAG was acceptable after a field test. It has three sets of open structured questions for the potentials to respond, monitor, and anticipate, and a set of structured questions for the potential to learn. It contained 38 questions corresponding to 32 foci. A new 4-level rating scale along with a novel scaling method can improve the scores conversion validity and communication between team members and across investigations. This final version is set to complete an interview for around 2 hours. CONCLUSIONS: The ED-RAG represents a snapshot of EDs'resilience under specific conditions. It might be performed multiple times by a single hospital to monitor the directions and contents of improvement that can supplement conventional safety management toward resilience. Some considerations are required to be successful when hospitals use it. Future studies to overcome the potential methodological weaknesses of the ED-RAG are needed.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Gestão da Segurança/organização & administração , Inquéritos e Questionários , China , Gestão de Recursos da Equipe de Assistência à Saúde , Humanos , Entrevistas como Assunto , Tradução , Carga de Trabalho
9.
Front Health Serv Manage ; 37(1): 33-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842087

RESUMO

The COVID-19 pandemic has created global health and economic disruption. Hospitals and other healthcare providers have been hit particularly hard. While efforts to effectively treat and eradicate the coronavirus continue, so do the efforts of supply chains to support the provision of patient care in the event of a resurgence or future pandemic. Supply chain leaders must continuously evaluate their strategic and tactical positions to address critical supply needs. Whether the supply chain can meet expectations remains uncertain, given rolling supply shortages of personal protective equipment (PPE) and other medical-surgical supplies as healthcare providers resume prepandemic levels of operations. The ability to ensure a reliable, sustainable supply of critical PPE in the near term will remain a challenge. Longer-term substantive changes to the function and performance of healthcare supply chains will be necessary across multiple areas to meet demand more effectively during a crisis.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Equipamentos e Provisões Hospitalares/economia , Equipamentos e Provisões Hospitalares/provisão & distribução , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Gestão da Segurança/organização & administração , Humanos , Estados Unidos
10.
Crit Care Nurs Q ; 43(4): 413-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833778

RESUMO

As the confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to grow with over 1 million documented infections in the United States alone, researchers and health care workers race to find effective treatment options for this potentially fatal disease. Mortality remains high in patients whose disease course requires mechanical ventilation and admission to intensive care units. While focusing on therapies to decrease mortality is essential, we must also consider the logistical hurdles faced with regard to safely and effectively delivering treatment while limiting the risk of harm to hospital staff and other noninfected patients. In this article, we discuss aspects of surge planning, considerations in limiting health care worker exposure, the logistics of medication delivery in a uniform and consolidated manner, protocols for delivering emergent care in a rapidly deteriorating coronavirus disease-2019 (COVID-19) patient, and safe practices for transporting infected patients.


Assuntos
Protocolos Clínicos , Infecções por Coronavirus/terapia , Hospitais Gerais/organização & administração , Exposição Ocupacional/prevenção & controle , Pneumonia Viral/terapia , Gestão da Segurança/organização & administração , Capacidade de Resposta ante Emergências/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pennsylvania/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
11.
Chin J Traumatol ; 23(5): 265-270, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32680704

RESUMO

PURPOSE: Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source. METHODS: This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system. RESULTS: Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance. CONCLUSION: All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.


Assuntos
Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Coleta de Dados/métodos , Gestão da Segurança/organização & administração , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle , Humanos , Irã (Geográfico)/epidemiologia , Sistema de Registros , Segurança
12.
Ren Fail ; 42(1): 710-725, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32713282

RESUMO

Coronavirus disease 19 (COVID-19) became a nightmare for the world since December 2019. Although the disease affects people at any age; elderly patients and those with comorbidities were more affected. Everyday nephrologists see patients with hypertension, chronic kidney disease, maintenance dialysis treatment or kidney transplant who are also high-risk groups for the COVID-19. Beyond that, COVID-19 or severe acute respiratory syndrome (SARS) due to infection may directly affect kidney functions. This broad spectrum of COVID-19 influence on kidney patients and kidney functions obviously necessitate an up to date management policy for nephrological care. This review overviews and purifies recently published literature in a question to answer format for the practicing nephrologists that will often encounter COVID-19 and kidney related cases during the pandemic times.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Nefrologistas/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal/métodos , Gestão da Segurança/organização & administração , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrologia/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Diálise Renal/estatística & dados numéricos
13.
Rev. esp. med. legal ; 46(2): 56-65, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193991

RESUMO

En los últimos años ha habido un incremento de reclamaciones contra médicos por presunta mala praxis. Nuestro objetivo ha sido analizar retrospectivamente las denuncias por responsabilidad médica en los juzgados de Barcelona durante los años 2004-2009, evaluadas en el Instituto de Medicina Legal y Ciencias Forenses de Cataluña. MATERIAL Y MÉTODO: Se realizó a partir de 3 bases de datos: la primera, las 283 periciales elaboradas por los médicos forenses durante estos años; la segunda, el programa informático judicial TEMIS-2; y la tercera, revisión de sentencias judiciales. RESULTADOS: En 257 casos (90,81%) la reclamación fue penal, 18 (6,36%) procedimientos contencioso-administrativos, 5 civiles (1,77%) y 3 de Fiscalía (1,06%). La edad media fue de 48,38 años (DE±19,39), en el 62,77% la perjudicada fue una mujer, siendo estas las que sufrieron más secuelas. En el 88,34% la reclamación era contra un médico, siendo la más habitual el mal resultado terapéutico (32,86%). Las especialidades más denunciadas fueron la traumatología, obstetricia y ginecología y cirugía general. Hubo más reclamaciones en la sanidad privada. En el 72,41% de los casos que llegaron a juicio la sentencia fue absolutoria y de los 8 que fueron condenados, solo en uno hubo prisión. La mediana del tiempo hasta la sentencia fue de 1.602 días. CONCLUSIONES: La vía penal es la más frecuente. Las mujeres reclaman más y sufren más secuelas. Las especialidades quirúrgicas son las más denunciadas. En el 27,59% de los casos que llegaron a juicio hubo sentencias condenatorias y solo en uno privación de libertad


In recent years there has been an increase in claims against doctors for alleged malpractice. Our objective was to retrospectively analyze complaints of medical liability in the courts of Barcelona between 2004-2009, evaluated at the Institute of Legal Medicine and Forensic Sciences of Catalonia. MATERIAL AND METHOD: We used 3 databases: the first, the 283 forensic reports prepared by forensic doctors during those years; the second, the judicial computer programme TEMIS-2; and the third, a review of judicial sentences. RESULTS: In 257 cases (90.81%) the claim was criminal, 18 (6.36%) contentious-administrative proceedings, 5 civil (1.77%) and 3 Prosecutor's Office claims (1.06%). The average age was 48.38 years (SD±19.39), in 62.77% the injured party was a woman, and they suffered more sequelae. In 88.34% the claim was against a doctor, a poor therapeutic outcome being the most common (32.86%). The most reported specialties were traumatology, obstetrics and gynaecology, and general surgery. There were more complaints in private healthcare. In 72.41% of the cases that came to trial the sentence was acquittal, and of the 8 convictions, only one was imprisoned. The median time to sentencing was 1,602 days. CONCLUSIONS: The criminal route is the most frequent. Women claim more and suffer more consequences. Surgical specialties are the most reported. In 27.59% of the cases that came to trial there were convictions, and only one resulted in deprivation of liberty


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Imperícia/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Responsabilidade Legal , Gestão da Segurança/organização & administração
14.
J Evid Based Soc Work (2019) ; 17(5): 514-526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573377

RESUMO

This study aims to conceptualize the key stakeholders in emergency management of childcare facilities for applicable nations by referring to the Korean case. Qualitative content analysis is the main methodology used. Unique features are gathered from the Korean literature on childcare facilities and then summarized; however, universal principles from the English language literature on international childcare facilities are emphasized. The analysis of five major stakeholders in Korean childcare facilities, namely, governments, community personnel, parents, childcare providers, and children, shows that their current efforts are directed only at general safety management. Multi-hazard management or an integrated approach in terms of social work is thus provided as an alternative for not only Korea but also other nations.


Assuntos
Prevenção de Acidentes/normas , Creches/organização & administração , Creches/estatística & dados numéricos , Guias como Assunto , Gestão da Segurança/organização & administração , Gestão da Segurança/estatística & dados numéricos , Prevenção de Acidentes/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , República da Coreia
19.
Hu Li Za Zhi ; 67(3): 38-47, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32495328

RESUMO

BACKGROUND: Establishing a positive reporting culture, which helps medical and healthcare workers learn from errors and reduce the risks of future adverse events, is essential to fostering a culture of patient safety. PURPOSE: The objectives of this study were to investigate the differences among the three levels of hospitals in terms of the knowledge and attitudes of hospital staff regarding the patient safety reporting system and to identify the potential factors affecting these differences. METHODS: This cross-sectional study was carried out in six hospitals, including two academic medical centers, two regional hospitals, and two district hospitals. The subjects were physicians, nurses, medical technicians, and administrative staffs. Data were collected using a patient safety reporting questionnaire. RESULTS: Three hundred and forty-eight participants were recruited, with 348 valid questionnaires returned (response rate: 100%). The average score for knowledge of patient safety reporting was 12.76 (total possible score: 14). Age, work position, and work experience were significantly associated with knowledge of patient safety reporting (p < .01). The patient safety reporting attitudes questionnaire comprised 21 items, each of which was scored using a five-point Likert scale. The mean score for each item was 3.92 ± 0.50. Gender, age, work position, work experience, and job discipline were significantly associated with attitude toward reporting (p < .01). The level of hospital was found to significantly impact attitudes toward patient safety reporting (p = .01), with participants working at medical centers scoring the highest. In addition, participants who were older and in more-senior positions scored higher and more positively for both knowledge and attitudes. CONCLUSIONS: The key factors to successfully fostering a strong patient safety reporting culture are staff security, a reliable reporting system, and a user-friendly interface. Improving attitudes toward reporting requires more resources and time than improving knowledge of reporting, which may be improved using education and promotion. Regional hospitals may invest more resources to enhance positive attitudes toward reporting and increase the willingness of staff to report.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico Hospitalar/psicologia , Segurança do Paciente , Gestão da Segurança/organização & administração , Estudos Transversais , Hospitais , Humanos , Corpo Clínico Hospitalar/estatística & dados numéricos , Cultura Organizacional , Inquéritos e Questionários
20.
BMC Health Serv Res ; 20(1): 426, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410618

RESUMO

BACKGROUND: Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals' needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. METHODS: Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital's OT. RESULTS: 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. CONCLUSIONS: Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.


Assuntos
Hospitais , Segurança do Paciente , Gestão da Segurança/organização & administração , Humanos , Aprendizagem , Países Baixos , Recursos Humanos em Hospital/psicologia , Projetos Piloto , Pesquisa Qualitativa
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