WorldWideScience

Sample records for incident management

  1. Incident Information Management Tool

    CERN Document Server

    Pejovic, Vladimir

    2015-01-01

    Flaws of\tcurrent incident information management at CMS and CERN\tare discussed. A new data\tmodel for future incident database is\tproposed and briefly described. Recently developed draft version of GIS-­‐based tool for incident tracking is presented.

  2. Incident Management: Process into Practice

    Science.gov (United States)

    Isaac, Gayle; Moore, Brian

    2011-01-01

    Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…

  3. Information sharing for traffic incident management.

    Science.gov (United States)

    2009-01-01

    Traffic incident management focuses on developing procedures, implementing policies, and deploying technologies to more quickly identify incidents, improve response times, and more effectively and efficiently manage the incident scene. Because so man...

  4. Computer incident response and forensics team management conducting a successful incident response

    CERN Document Server

    Johnson, Leighton

    2013-01-01

    Computer Incident Response and Forensics Team Management provides security professionals with a complete handbook of computer incident response from the perspective of forensics team management. This unique approach teaches readers the concepts and principles they need to conduct a successful incident response investigation, ensuring that proven policies and procedures are established and followed by all team members. Leighton R. Johnson III describes the processes within an incident response event and shows the crucial importance of skillful forensics team management, including when and where the transition to forensics investigation should occur during an incident response event. The book also provides discussions of key incident response components. Provides readers with a complete handbook on computer incident response from the perspective of forensics team management Identify the key steps to completing a successful computer incident response investigation Defines the qualities necessary to become a succ...

  5. Traffic incident management resource management.

    Science.gov (United States)

    2009-01-01

    The necessity of a multi-disciplinary approach involving law enforcement, fire and rescue, transportation, towing and recovery, and others has been well-recognized and integrated into incident management operations. This same multidisciplinar...

  6. 49 CFR 1542.307 - Incident management.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Incident management. 1542.307 Section 1542.307 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats...

  7. Incident Management in Academic Information System using ITIL Framework

    Science.gov (United States)

    Palilingan, V. R.; Batmetan, J. R.

    2018-02-01

    Incident management is very important in order to ensure the continuity of a system. Information systems require incident management to ensure information systems can provide maximum service according to the service provided. Many of the problems that arise in academic information systems come from incidents that are not properly handled. The objective of this study aims to find the appropriate way of incident management. The incident can be managed so it will not be a big problem. This research uses the ITIL framework to solve incident problems. The technique used in this study is a technique adopted and developed from the service operations section of the ITIL framework. The results of this research found that 84.5% of incidents appearing in academic information systems can be handled quickly and appropriately. 15.5% incidents can be escalated so as to not cause any new problems. The model of incident management applied to make academic information system can run quickly in providing academic service in a good and efficient. The incident management model implemented in this research is able to manage resources appropriately so as to quickly and easily manage incidents.

  8. Improving freight crash incident management.

    Science.gov (United States)

    2015-06-01

    The objective of this study was to determine the most effective way to mitigate the effect of freight : crash incidents on Louisiana freeways. Candidate incident management strategies were reviewed from : practice in other states and from those publi...

  9. Integrating incident investigation into the management system

    International Nuclear Information System (INIS)

    Peterson, E.E.

    1992-01-01

    In the last 10 yr, the size and frequency of incidents affecting the communities and environment surrounding chemical processing facilities has increased. The chemical process industry, which has always concerned itself with the safety of its facilities, has responded by committing to stricter standards of operation and management. A critical element of these management practices is the use of a structured incident investigation program. Many facilities have implemented and disciplined themselves to perform good investigation of incidents. However, most of these facilities maintain incident investigation as part of their safety management programs. This allows the process to be disconnected from the management system that deals with the day-to-day business of the facility. The first step of integration is understanding the objectives and functions of the management system into which the integration is to occur. To begin, a common definition of management is needed. Management, for the purposes of this discussion, is defined as the system of activities used to control, coordinate, and improve the flow of work within a facility or organization. This definition refers to several concepts that need further development in order to understand how incident investigation can be integrated into a management system, including (a) flow of work, (b) control, and (c) improvement. Application can be made to the nuclear industry

  10. Managing Materials and Wastes for Homeland Security Incidents

    Science.gov (United States)

    To provide information on waste management planning and preparedness before a homeland security incident, including preparing for the large amounts of waste that would need to be managed when an incident occurs, such as a large-scale natural disaster.

  11. PREDICTIVE MODELS FOR SUPPORT OF INCIDENT MANAGEMENT PROCESS IN IT SERVICE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Martin SARNOVSKY

    2018-03-01

    Full Text Available ABSTRACT The work presented in this paper is focused on creating of predictive models that help in the process of incident resolution and implementation of IT infrastructure changes to increase the overall support of IT management. Our main objective was to build the predictive models using machine learning algorithms and CRISP-DM methodology. We used the incident and related changes database obtained from the IT environment of the Rabobank Group company, which contained information about the processing of the incidents during the incident management process. We decided to investigate the dependencies between the incident observation on particular infrastructure component and the actual source of the incident as well as the dependency between the incidents and related changes in the infrastructure. We used Random Forests and Gradient Boosting Machine classifiers in the process of identification of incident source as well as in the prediction of possible impact of the observed incident. Both types of models were tested on testing set and evaluated using defined metrics.

  12. Emergency and crisis management: critical incident stress management for first responders and business organisations.

    Science.gov (United States)

    Guenthner, Daniel H

    2012-01-01

    A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holistic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to community resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and programme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally-diverse community and organisation. Implementing a critical incident stress management programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be implemented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required.

  13. Evaluating and improving incident management using historical incident data : case studies at Texas transportation management centers.

    Science.gov (United States)

    2009-08-01

    The companion guidebook (0-5485-P2) developed as part of this study provides the procedures and : methodologies for effective use of historical incident data at Texas Transportation Management Centers : (TMCs). This research report documents the resu...

  14. Safer travel, improved economic productivity : incident management systems

    Science.gov (United States)

    1999-01-01

    This brochure gives an overview of how incident management technologies can be used to reduce incident-related congestion and increase road safety. It focuses on the need for interagency cooperation and the benefits that can be derived from the coope...

  15. Kentucky's highway incident management strategic plan.

    Science.gov (United States)

    2005-06-01

    Kentucky s Highway Incident Management Strategic Plan consists of a mission statement, 4 goals, 16 objectives, and 49 action strategies. The action strategies are arranged by priority and recommended time frame for implementation. When implemented...

  16. Resources planning for radiological incidents management

    Science.gov (United States)

    Hamid, Amy Hamijah binti Ab.; Rozan, Mohd Zaidi Abd; Ibrahim, Roliana; Deris, Safaai; Yunus, Muhd. Noor Muhd.

    2017-01-01

    Disastrous radiation and nuclear meltdown require an intricate scale of emergency health and social care capacity planning framework. In Malaysia, multiple agencies are responsible for implementing radiological and nuclear safety and security. This research project focused on the Radiological Trauma Triage (RTT) System. This system applies patient's classification based on their injury and level of radiation sickness. This classification prioritizes on the diagnostic and treatment of the casualties which include resources estimation of the medical delivery system supply and demand. Also, this system consists of the leading rescue agency organization and disaster coordinator, as well as the technical support and radiological medical response teams. This research implemented and developed the resources planning simulator for radiological incidents management. The objective of the simulator is to assist the authorities in planning their resources while managing the radiological incidents within the Internal Treatment Area (ITA), Reception Area Treatment (RAT) and Hospital Care Treatment (HCT) phases. The majority (75%) of the stakeholders and experts, who had been interviewed, witnessed and accepted that the simulator would be effective to resolve various types of disaster and resources management issues.

  17. Development of Kentucky's highway incident management strategic plan.

    Science.gov (United States)

    2005-05-01

    ven though Kentucky has undertaken many initiatives to improve specific aspects of incident management, there has never been a plan that establishes an overall framework for a systematic, statewide, multi-agency effort to improve the management of hi...

  18. Incident Management Organization succession planning stakeholder feedback

    Science.gov (United States)

    Anne E. Black

    2013-01-01

    This report presents complete results of a 2011 stakeholder feedback effort conducted for the National Wildfire Coordination Group (NWCG) Executive Board concerning how best to organize and manage national wildland fire Incident Management Teams in the future to meet the needs of the public, agencies, fire service and Team members. Feedback was collected from 858...

  19. CRITICAL INCIDENTS AND CRITICAL INCIDENT STRESS MANAGEMENT (CISM – AN EMPLOYEE ASSISTANCE PROGRAMME (EAP PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Terblanche, Lourie

    2014-04-01

    Full Text Available Employees are increasingly becoming victims of critical incidents. From a systems theory point of view, it is necessary to acknowledge the impact of critical incidents not only on the personal life of the employee, but on the workplace itself. Employees respond differently to critical incidents, which makes it even more complicated when this reaches the point of requiring therapeutic intervention. The most common response to critical incidents may be the risk of developing post-traumatic stress disorder (PTSD and/or depression. This reality requires management – through the Employee Assistance Programme (EAP – to be able to effectively deal with such critical incidents.

  20. Melanoma in Organ Transplant Recipients: Incidence, Outcomes and Management Considerations

    Directory of Open Access Journals (Sweden)

    Faisal R. Ali

    2012-01-01

    Full Text Available The incidence of melanoma continues to increase year on year. With better surgical techniques and medical management, greater numbers of organ transplants are being performed annually with much longer graft survival. The authors review our current understanding of the incidence of melanoma amongst organ transplant recipients, outcomes compared to the immunocompetent population, and management strategies in this burgeoning group.

  1. Factors affecting fire suppression costs as identified by incident management teams

    Science.gov (United States)

    Janie Canton-Thompson; Brooke Thompson; Krista Gebert; David Calkin; Geoff Donovan; Greg Jones

    2006-01-01

    This study uses qualitative sociological methodology to discover information and insights about the role of Incident Management Teams in wildland fire suppression costs. We interviewed 48 command and general staff members of Incident Management Teams throughout the United States. Interviewees were asked about team structure, functioning, and decision making as a...

  2. Control systems, personnel policies and management initiatives to limit pollution incidents

    International Nuclear Information System (INIS)

    Martin, B.F.

    1991-01-01

    After the regulatory requirements are met, an important collateral step in the continuing Hazardous Waste/Environmental Management cycle of activities is to minimize the possibility of a pollution incident, spill, contamination, mislabeling, mishandling or exposure, since this minimizes a major contingent liability of the company. Human failure accounts for 88% of accidents, 10% occur from mechanical failure and only 2% are unpreventable force majeure. This implies that fully 98% of all accidents can be prevented or minimized. Good engineering, production, management and educational practices can be formulated to minimize the occurrence and effects of accidental pollution incidents. Hazardous Material/Environmental Management tends to focus on technical and regulatory objectives, a reactionary mode caused in part by the rapidly changing regulatory environment and the need to continually adapt to these changes. Management functions such as personnel management and situational management get shortchanged in research and in practice. What is needed is a system that incorporates change readily, adapts personnel to change easily and mobilizes all the human resources of a company in meeting environmental and regulatory goals in the same way other goals of the company are met. Feedback Loop/Control System concepts have been applied to management practice in the popular Management By Objectives School as well as other schools of management practice. An Environmental Management program is proposed which incorporates feedback loop/ control systems to facilitate operations and training objectives and requirements. By incorporating Environmental and Hazardous Waste goals with other management goals in a system involving all levels of management and workers on the same team, the proposed system will reduce the probability of accidental pollution incidents and thus the contingent liability of a spill or other incident

  3. 76 FR 61371 - All-Hazard Position Task Books for Type 3 Incident Management Teams

    Science.gov (United States)

    2011-10-04

    ...-Hazard Position Task Books for Type 3 Incident Management Teams AGENCY: Federal Emergency Management... Books for Type 3 Incident Management Teams were developed to assist personnel achieve qualifications in... Management Teams were developed to assist personnel achieve qualifications in the All-Hazard ICS positions...

  4. IT Security Vulnerability and Incident Response Management

    NARCIS (Netherlands)

    Hafkamp, W.H.M.; Paulus, S.; Pohlman, N.; Reimer, H.

    2006-01-01

    This paper summarises the results of a Dutch PhD research project on IT security vulnerability and incident response management, which is supervised by the University of Twente in the Netherlands and which is currently in its final stage. Vulnerabilities are ‘failures or weaknesses in computer

  5. Military Personnel: DOD Has Processes for Operating and Managing Its Sexual Assault Incident Database

    Science.gov (United States)

    2017-01-01

    MILITARY PERSONNEL DOD Has Processes for Operating and Managing Its Sexual Assault Incident Database Report to...to DSAID’s system speed and ease of use; interfaces with MCIO databases ; utility as a case management tool; and users’ ability to query data and... Managing Its Sexual Assault Incident Database What GAO Found As of October 2013, the Department of Defense’s (DOD) Defense Sexual Assault Incident

  6. A management plan for hospitals and medical centers facing radiation incidents.

    Science.gov (United States)

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

    Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  7. Two incidents that changed quality management in the Australian livestock export industry

    Directory of Open Access Journals (Sweden)

    Peter R. Stinson

    2008-03-01

    Full Text Available Quality assurance in Australia's livestock export industry arose from a need to address animal welfare concerns. It was initially instigated by industry in the form of an accreditation scheme which contained standards, auditing requirements and training requirements. Two major incidents in long haul shipping of livestock demonstrated that risk management in the industry cannot be achieved through compliance with standards alone. A thorough investigation of the first incident recommended the introduction of formal risk management to complement a standards regime. This approach is applicable to the management of major risks, such as heat stress and disease. It is also especially suited to commercial risks, such as the rejection of cargo and where voyage or market specific treatments are needed and depend upon the expertise of the exporter. However, before these recommendations on risk management could be fully implemented, a significant public incident occurred which altered the direction of quality assurance in industry. The Australian response was to transfer authority to government regulators with a tightening of standards. This focuses on the need to ensure ownership of quality assurance programmes by the exporter. Formal risk management has been a casualty of the second incident and, unfortunately, has not been introduced.

  8. Incidence and management of chyle leakage after esophagectomy

    NARCIS (Netherlands)

    Lagarde, Sjoerd M.; Omloo, Jikke M. T.; de Jong, Koen; Busch, Olivier R. C.; Obertop, Hugo; van Lanschot, J. Jan B.

    2005-01-01

    BACKGROUND: Postoperative chyle leakage is a rare but well-recognized complication after esophageal surgery. The aim of this study was to identify its incidence and potentially predisposing factors and to assess the consequences and management. METHODS: A consecutive series of 536 patients who

  9. Responses to professional identity threat: Identity management strategies in incident narratives of health care professionals.

    Science.gov (United States)

    van Os, Annemiek; de Gilder, Dick; van Dyck, Cathy; Groenewegen, Peter

    2015-01-01

    The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat. The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives. The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison. The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care. The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents. This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care.

  10. The management of radiation treatment error through incident learning

    International Nuclear Information System (INIS)

    Clark, Brenda G.; Brown, Robert J.; Ploquin, Jodi L.; Kind, Anneke L.; Grimard, Laval

    2010-01-01

    Purpose: To assess efficacy of an incident learning system in the management of error in radiation treatment. Materials and methods: We report an incident learning system implementation customized for radiation therapy where any 'unwanted or unexpected change from normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment' is reported, investigated and learned from. This system thus captures near-miss (potential) and actual events. Incidents are categorized according to severity, type and origin. Results: Our analysis spans a period of 3 years with an average accrual of 11.6 incidents per week. We found a significant reduction in actual incidents of 28% and 47% in the second and third year when compared to the first year (p < 0.001), which we attribute to the many interventions prompted by the analysis of incidents reported. We also saw a similar significant reduction in incidents generated at the treatment unit correlating with the introduction of direct treatment parameter transfer and electronic imaging (p < 0.001). Conclusions: Implementation of an incident learning system has helped us to establish a just environment where all staff members report deviations from normal system behaviour and thus generate evidence to initiate safety improvements.

  11. A management plan for hospitals and medical centers facing radiation incidents

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari

    2015-01-01

    Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  12. The influence of incident management teams on the deployment of wildfire suppression resources

    Science.gov (United States)

    Michael Hand; Hari Katuwal; David E. Calkin; Matthew P. Thompson

    2017-01-01

    Despite large commitments of personnel and equipment to wildfire suppression, relatively little is known about the factors that affect how many resources are ordered and assigned to wildfire incidents and the variation in resources across incident management teams (IMTs). Using detailed data on suppression resource assignments for IMTs managing the highest complexity...

  13. Medical management of three workers following a radiation exposure incident

    International Nuclear Information System (INIS)

    House, R.A.; Sax, S.E.; Rumack, E.R.; Holness, D.L.

    1992-01-01

    The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experienced somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms

  14. Medical management of three workers following a radiation exposure incident

    Energy Technology Data Exchange (ETDEWEB)

    House, R.A.; Sax, S.E.; Rumack, E.R.; Holness, D.L. (Department of Occupational and Environmental Health, St. Michael' s Hospital, Toronto, Ontario (Canada))

    1992-01-01

    The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experienced somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms.

  15. Coordinated Traffic Incident and Congestion Management (TIM-CM) : Mitigating Regional Impacts of Major Traffic Incidents in the Seattle I-5 Corridor

    Science.gov (United States)

    2018-02-02

    Within the Seattle metropolitan area, traffic incident management (TIM) operations provide a multi-jurisdictional and coordinated strategy to detect, respond to, and clear traffic incidents so that traffic flow can be restored quickly and safely. The...

  16. Principal Experiences with Crisis Management Professional Development, Collaboration, and Implementation of the National Incident Management System Phases of Emergency Management

    Science.gov (United States)

    Naradko, Anthony M.

    2017-01-01

    The purpose of this qualitative single-subject case study was to identify the elements critical to crisis management professional development for school principals; the factors influencing the implementation of the National Incident Management System Phases of Emergency Management (2010) for principals; and the necessary elements for fostering…

  17. Simulating traffic for incident management and ITS investment decisions

    Science.gov (United States)

    1998-08-01

    UTPS-type models were designed to adequately support planning activities typical of the 1960s and 1970s. However, these packages were not designed to model intelligent transportation systems (ITS) and support incident management planning. To ov...

  18. Safety Incident Management Team Report for NIMLT Case 50796

    LENUS (Irish Health Repository)

    2017-01-17

    This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH.\\r\

  19. Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey

    Directory of Open Access Journals (Sweden)

    Walter Darren

    2007-12-01

    Full Text Available Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.

  20. Traffic incident and crisis management : challenges and obstacles in information sharing

    NARCIS (Netherlands)

    Steenbruggen, J.G.M.; Nijkamp, P.; Smits, J.M.; Mohabir, G.

    2012-01-01

    Disaster Management and Traffic Incident Management involves the coordinated interactions of many public and private actors. On many levels, there is clearly a strong relation be-tween the road infrastructure and the effective handling of large scale disasters. To support these tasks in an effective

  1. Defining Incident Management Processes for CSIRTs: A Work in Progress

    National Research Council Canada - National Science Library

    Alberts, Chris; Dorofee, Audrey; Killcrece, Georgia; Ruefle, Robin; Zajicek, Mark

    2004-01-01

    .... Workflow diagrams and descriptions are provided for each of these processes. One advantage of the model is that it enables examination of incident management processes that cross organizational boundaries, both internally and externally...

  2. The key incident monitoring and management system - history and role in quality improvement.

    Science.gov (United States)

    Badrick, Tony; Gay, Stephanie; Mackay, Mark; Sikaris, Ken

    2018-01-26

    The determination of reliable, practical Quality Indicators (QIs) from presentation of the patient with a pathology request form through to the clinician receiving the report (the Total Testing Process or TTP) is a key step in identifying areas where improvement is necessary in laboratories. The Australasian QIs programme Key Incident Monitoring and Management System (KIMMS) began in 2008. It records incidents (process defects) and episodes (occasions at which incidents may occur) to calculate incident rates. KIMMS also uses the Failure Mode Effects Analysis (FMEA) to assign quantified risk to each incident type. The system defines risk as incident frequency multiplied by both a harm rating (on a 1-10 scale) and detection difficulty score (also a 1-10 scale). Between 2008 and 2016, laboratories participating rose from 22 to 69. Episodes rose from 13.2 to 43.4 million; incidents rose from 114,082 to 756,432. We attribute the rise in incident rate from 0.86% to 1.75% to increased monitoring. Haemolysis shows the highest incidence (22.6% of total incidents) and the highest risk (26.68% of total risk). "Sample is suspected to be from the wrong patient" has the second lowest frequency, but receives the highest harm rating (10/10) and detection difficulty score (10/10), so it is calculated to be the 8th highest risk (2.92%). Similarly, retracted (incorrect) reports QI has the 10th highest frequency (3.9%) but the harm/difficulty calculation confers the second highest risk (11.17%). TTP incident rates are generally low (less than 2% of observed episodes), however, incident risks, their frequencies multiplied by both ratings of harm and discovery difficulty scores, concentrate improvement attention and resources on the monitored incident types most important to manage.

  3. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

    Science.gov (United States)

    Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

    2017-01-01

    This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

  4. Implementation of the National Incident Management System (NIMS)/Incident Command System (ICS) in the Federal Radiological Monitoring and Assessment Center(FRMAC) - Emergency Phase

    International Nuclear Information System (INIS)

    NSTec Environmental Restoration

    2007-01-01

    Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the NIMS

  5. [Second victim : Critical incident stress management in clinical medicine].

    Science.gov (United States)

    Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

    2013-09-01

    Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

  6. Using the Critical Incident Technique for Triangulation and Elaboration of Communication Management Competencies

    Science.gov (United States)

    Brunton, Margaret Ann; Jeffrey, Lynn Maud

    2010-01-01

    This paper presents the findings from research using the critical incident technique to identify the use of key competencies for communication management practitioners. Qualitative data was generated from 202 critical incidents reported by 710 respondents. We also present a brief summary of the quantitative data, which identified two superordinate…

  7. EP&R Standards Project Report: Technical Review of National Incident Management Standards

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.

    2007-04-24

    The importance and necessity for a fully developed and implemented National Incident Management System (NIMS) has been demonstrated in recent years by the impact of national events such as Hurricane Katrina in 2005. Throughout the history of emergency response to major disasters, especially when multiple response organizations are involved, there have been systemic problems in the consistency and uniformity of response operations. Identifying national standards that support the development and implementation of NIMS is key to helping solve these systemic problems. The NIMS seeks to provide uniformity and consistency for incident management by using common terminology and protocols that will enable responders to coordinate their efforts to ensure an efficient response.

  8. Program for accident and incident management support, AIMS

    International Nuclear Information System (INIS)

    Putra, M.A.

    1993-12-01

    A prototype of an advisory computer program is presented which could be used in monitoring and analyzing an ongoing incident in a nuclear power plant. The advisory computer program, called the Accident and Incident Management Support (AIMS), focuses on processing a set of data that is to be transmitted from a nuclear power plant to a national or regional emergency center during an incident. The AIMS program will assess the reactor conditions by processing the measured plant parameters. The applied model of the power plant contains a level of complexity that is comparable with the simplified plant model that the power plant operator uses. A standardized decay heat function and a steam water property library is used in the integral balance equations for mass and energy. A simulation of the station blackout accident of the Borssele plant is used to test the program. The program predicts successively: (1) the time of dryout of the steam generators, (2) the time of saturation of the primary system, and (3) the onset of core uncovery. The coolant system with the actual water levels will be displayed on the screen. (orig./HP)

  9. Smothering in UK free-range flocks. Part 1: incidence, location, timing and management.

    Science.gov (United States)

    Barrett, J; Rayner, A C; Gill, R; Willings, T H; Bright, A

    2014-07-05

    Smothering in poultry is an economic and welfare-related concern. This study presents the first results from a questionnaire addressing the incidence, location, timing and management of smothering of free-range farm managers from two commercial egg companies (representing 35 per cent of the UK free-range egg supply). Overall, nearly 60 per cent of farm mangers experienced smothering in their last flock, with an average of 25.5 birds lost per incidence, although per cent mortality due to smothering was low (x̄=1.6 per cent). The majority of farm managers also reported that over 50 per cent of all their flocks placed had been affected by smothering. The location and timing of smothering (excluding smothering in nest boxes) tended to be unpredictable and varied between farms. Blocking off corners/nest boxes and walking birds more frequently were identified as popular smothering reduction measures, although there was a wide variety of reduction measures reported overall. The motivation to implement reduction measures was related to a farm manager's previous experience of smothering. To our knowledge, this is the first study to provide a representative industry estimate on the incidence, location, timing and management of smothering. The results suggest that smothering is a common problem, unpredictable between flocks with no clear, effective reduction strategies. A follow-up study will investigate the correlations among smothering, disease and other welfare problems and may shed further light on management solutions. British Veterinary Association.

  10. [Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol].

    Science.gov (United States)

    Ferrete-Morales, C; Vázquez-Pérez, M A; Sánchez-Berna, M; Gilabert-Cerro, I; Corzo-Delgado, J E; Pineda-Vergara, J A; Vergara-López, S; Gómez-Mateos, J

    2010-01-01

    To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (phistory of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.

  11. EAP-based critical incident stress management: utilization of a practice-based assessment of incident severity level in responding to workplace trauma.

    Science.gov (United States)

    DeFraia, Gary S

    2013-01-01

    Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.

  12. Mathematical model as means of optimization of the automation system of the process of incidents of information security management

    Directory of Open Access Journals (Sweden)

    Yulia G. Krasnozhon

    2018-03-01

    Full Text Available Modern information technologies have an increasing importance for development dynamics and management structure of an enterprise. The management efficiency of implementation of modern information technologies directly related to the quality of information security incident management. However, issues of assessment of the impact of information security incidents management on quality and efficiency of the enterprise management system are not sufficiently highlighted neither in Russian nor in foreign literature. The main direction to approach these problems is the optimization of the process automation system of the information security incident management. Today a special attention is paid to IT-technologies while dealing with information security incidents at mission-critical facilities in Russian Federation such as the Federal Tax Service of Russia (FTS. It is proposed to use the mathematical apparatus of queueing theory in order to build a mathematical model of the system optimization. The developed model allows to estimate quality of the management taking into account the rules and restrictions imposed on the system by the effects of information security incidents. Here an example is given in order to demonstrate the system in work. The obtained statistical data are shown. An implementation of the system discussed here will improve the quality of the Russian FTS services and make responses to information security incidents faster.

  13. Integrating an incident management system within a continuity of operations programme: case study of the Bank of Canada.

    Science.gov (United States)

    Loop, Carole

    2013-01-01

    Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.

  14. Persistent perineal sinus. Incidence, pathogenesis, risk factors, and management

    International Nuclear Information System (INIS)

    Lohsiriwat, V.

    2009-01-01

    This review discusses the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS), defined as a perineal wound that remains unhealed more than 6 months after surgery. The incidence of PPS after surgery for inflammatory bowel disease (IBD) ranges from 3% to 70% and after abdominoperineal resection (APR) for Low rectal cancer, it can be up to 30%. These unhealed wounds are frequently related to perioperative pelvic or perineal sepsis. Crohn's disease (CD) and neoadjuvant radiation therapy are also important risk factors. The management of PPS is based on an understanding of pathogenesis and clinical grounds. The advantages and disadvantages of the current therapeutic approaches, including the topical administration of various drugs, vacuum-assisted closure, and perineal reconstruction with a muscle flap or a myocutaneous flap are also discussed. (author)

  15. Management of response to the polonium-210 incident in London

    International Nuclear Information System (INIS)

    Croft, John; Bailey, Michael; Tattersall, Phil; Morrey, Mary; McColl, Neil; Prosser, Lesley; Maguire, Helen; Fraser, Graham; Gross, Roger

    2008-01-01

    On the 23 November 2006, Alexander Litvinenko died in London allegedly from poisoning by 210 Po, an alpha particle emitter. The spread of radioactive contamination, arising from the poisoning and the events leading up to it, involved many locations in London. The potential for intakes of 210 Po arising from the contamination posed a public health risk and generated significant public concern. The scale of the event required a multi-agency response, including top level UK Government emergency response management arrangements. The Health Protection Agency (HPA) had a leading role in co-ordinating and managing the public health response. This paper reviews the management of the incident response and the issues involved. The fatal poisoning of Mr Litvinenko with 210 Po, and the associated public health hazard from the spread of contamination to many locations across London, was an unprecedented event. Fortunately, no one else is known to have suffered any acute effects. Results from the programme of individual monitoring showed that whilst more than 100 people had measurable intakes of 210 Po, only 17 had assessed doses in excess of 6 mSv. The highest dose of about 100 mSv gives rise to an increased risk of fatal cancer of about 0.5%, compared with the natural incidence of about 25%. The incident required a co-ordinated and sustained multi-agency emergency response. The Health Protection Agency, as the lead on public health matters played a significant role in this. Whilst inevitably some lessons have been identified, the response is considered to have been very effective and to have benefited from the wide spectrum of experience and expertise developed through normal work, together with the effort put into emergency preparedness and the various emergency response. (author)

  16. Early Detection and Localization of Downhole Incidents in Managed Pressure Drilling

    DEFF Research Database (Denmark)

    Willersrud, Anders; Imsland, Lars; Blanke, Mogens

    2015-01-01

    Downhole incidents such as kick, lost circulation, pack-off, and hole cleaning issues are important contributors to downtime in drilling. In managed pressure drilling (MPD), operations margins are typically narrower, implying more frequent incidents and more severe consequences. Detection...... and handling of symptoms of downhole drilling contingencies at an early stage are therefore crucial for the reliability and safety of MPD operations. In this paper we describe a method for early detection and localization of such incidents, based on a fit for purpose model of the downhole pressure hydraulics...... successfully been tested on experimental data from a medium-scale horizontal flow loop in Sta- vanger, Norway. The flow loop represents a 700 m borehole with emulation of the following downhole contingencies: drillstring washout, drill bit nozzle plugging, gas influx and fluid loss. In the tests...

  17. Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer.

    Science.gov (United States)

    Tan, Hung-Jui; Filson, Christopher P; Litwin, Mark S

    2015-01-01

    Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, Pmanagement and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors. Published by Elsevier Inc.

  18. Making the connection: advancing traffic incident management in transportation planning : a primer.

    Science.gov (United States)

    2013-07-01

    "The intent of this primer is to inform and guide traffic incident management (TIM) professionals and transportation planners to initiate and develop collaborative relationships and advance TIM programs through the metropolitan planning process. The ...

  19. The comparative incidence of reported concussions presenting for follow-up management in South African Rugby Union.

    Science.gov (United States)

    Shuttleworth-Edwards, Ann B; Noakes, Timothy D; Radloff, Sarah E; Whitefield, Victoria J; Clark, Susan B; Roberts, Craig O; Essack, Fathima B; Zoccola, Diana; Boulind, Melissa J; Case, Stephanie E; Smith, Ian P; Mitchell, Julia L G

    2008-09-01

    The objective of this study was to compare the seasonal concussion incidence for school, university, club and provincial level Rugby Union players in South Africa. The study presents a retrospective statistical analysis of the number of reported concussions documented annually for groups of Rugby Union players as a proportion of those who received preseason neurocognitive assessment. Between 2002 and 2006, concussion management programs using computerized neuropsychological assessment were implemented for clinical and research purposes by psychologists in selected South African institutions involved in Rugby Union from school through to the professional level. The incidence figures were based on 175 concussive episodes reported for 165 athletes who were referred for neurocognitive assessment from a population of 1366 athletes who received preseason baseline testing. Concussion management routines varied according to the protocols adopted by the different psychologists and rugby organizations. It was expected that the incidence of concussion would vary significantly due to level of play and different management protocols. There was wide disparity in the manner in which concussion follow-up was managed by the various organizations. Within broadly comparable cohorts, tighter control was associated with a relatively higher concussion incidence for athletes per rugby playing season, with average institutional figures ranging from 4% to 14% at school level and 3% to 23% at adult level. This analysis suggests that concussion goes unrecognized and therefore incorrectly managed in a number of instances. Recommendations for optimal identification of concussed athletes for follow-up management are presented.

  20. PROACTIVE APPROACH TO THE INCIDENT AND PROBLEM MANAGEMENT IN COMMUNICATION NETWORKS

    Directory of Open Access Journals (Sweden)

    Vjeran Strahonja

    2007-06-01

    Full Text Available Proactive approach to communication network maintenance has the capability of enhancing the integrity and reliability of communication networks, as well as of reducing maintenance costs and overall number of incidents. This paper presents approaches to problem and incident prevention with the help of root-cause analysis, aligning that with the goal to foresee software performance. Implementation of proactive approach requires recognition of enterprise's current level of maintenance better insights into available approaches and tools, as well as their comparison, interoperability, integration and further development. The approach we are proposing and elaborating in this paper lies on the construction of a metamodel of the problem management of information technology, particularly the proactive problem management. The metamodel is derived from the original ITIL specification and presented in an object-oriented fashion by using structure (class diagrams conform to UML notation. Based on current research, appropriate metrics based on the concept of Key Performance Indicators is suggested.

  1. Simulation analysis of route diversion strategies for freeway incident management : final report.

    Science.gov (United States)

    1995-02-01

    The purpose of this project was to investigate whether simulation models could : be used as decision aids for defining traffic diversion strategies for effective : incident management. A methodology was developed for using such a model to : determine...

  2. Application of Real-Time Automated Traffic Incident Response Plan Management System: A Web Structure for the Regional Highway Network in China

    Directory of Open Access Journals (Sweden)

    Yongfeng Ma

    2014-01-01

    Full Text Available Traffic incidents, caused by various factors, may lead to heavy traffic delay and be harmful to traffic capacity of downstream sections. Traffic incident management (TIM systems have been developed widely to respond to traffic incidents intelligently and reduce the losses. Traffic incident response plans, as an important component of TIM, can effectively guide responders as to what and how to do in traffic incidents. In the paper, a real-time automated traffic incident response plan management system was developed, which could generate and manage traffic incident response plans timely and automatically. A web application structure and a physical structure were designed to implement and show these functions. A standard framework of data storage was also developed to save information about traffic incidents and generated response plans. Furthermore, a conformation survey and case-based reasoning (CBR were introduced to identify traffic incident and generate traffic incident response plans automatically, respectively. Twenty-three traffic crash-related incidents were selected and three indicators were used to measure the system performance. Results showed that 20 of 23 cases could be retrieved effectively and accurately. The system is practicable to generate traffic incident response plans and has been implemented in China.

  3. Formal analysis of empirical traces in incident management

    International Nuclear Information System (INIS)

    Hoogendoorn, Mark; Jonker, Catholijn M.; Maanen, Peter-Paul van; Sharpanskykh, Alexei

    2008-01-01

    Within the field of incident management split second decisions have to be made, usually on the basis of incomplete and partially incorrect information. As a result of these conditions, errors occur in such decision processes. In order to avoid repetition of such errors, historic cases, disaster plans, and training logs need to be thoroughly analysed. This paper presents a formal approach for such an analysis that pays special attention to spatial and temporal aspects, to information exchange, and to organisational structure. The formal nature of the approach enables automation of analysis, which is illustrated by case studies of two disasters

  4. Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment : Research Summary

    Science.gov (United States)

    2017-12-01

    In designing an effective traffic management plan for non-recurrent congestion, it is critical for responsible highway agencies to have some vital information, such as estimated incident duration, resulting traffic queues, and the expected delays. Ov...

  5. Comparing badger (Meles meles) management strategies for reducing tuberculosis incidence in cattle.

    Science.gov (United States)

    Smith, Graham C; McDonald, Robbie A; Wilkinson, David

    2012-01-01

    Bovine tuberculosis (bTB), caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles) is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km(2) and were evaluated over the whole of a 300 km(2) area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km(2) plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease.

  6. Comparing badger (Meles meles management strategies for reducing tuberculosis incidence in cattle.

    Directory of Open Access Journals (Sweden)

    Graham C Smith

    Full Text Available Bovine tuberculosis (bTB, caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km(2 and were evaluated over the whole of a 300 km(2 area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km(2 plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease.

  7. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management.

    Science.gov (United States)

    Lee, Ka L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

    2010-05-01

    Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. Analysis of prospectively collected trauma registry data. Consecutive significantly injured trauma patients admitted through the emergency department (ED) suffering from blunt chest trauma who underwent thoracic computed tomography (TCT) between in calendar years 2007 and 2008 were included. An OP was defined as the identification (by a specialist radiologist) of a pneumothorax on TCT that had not been previously detected on supine CXR. 119 significantly injured patients were included. 56 patients had a pneumothorax on CXR and a further 36 patients had at least one OP [OP incidence 30% (36/119)]. Bilateral OP was present in 8/36 patients, so total OP numbers were 44. Tube thoracostomy was performed for 8/44 OP, all were mechanically ventilated in the ED. The remaining 36 OP were managed expectantly. No patients in the expectant group had pneumothorax progression, even though 8 patients required subsequent ventilation in the operating room for extrathoracic surgery. The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated. (c) 2010 Elsevier Ltd. All rights reserved.

  8. Causal Factors and Adverse Events of Aviation Accidents and Incidents Related to Integrated Vehicle Health Management

    Science.gov (United States)

    Reveley, Mary S.; Briggs, Jeffrey L.; Evans, Joni K.; Jones, Sharon M.; Kurtoglu, Tolga; Leone, Karen M.; Sandifer, Carl E.

    2011-01-01

    Causal factors in aviation accidents and incidents related to system/component failure/malfunction (SCFM) were examined for Federal Aviation Regulation Parts 121 and 135 operations to establish future requirements for the NASA Aviation Safety Program s Integrated Vehicle Health Management (IVHM) Project. Data analyzed includes National Transportation Safety Board (NSTB) accident data (1988 to 2003), Federal Aviation Administration (FAA) incident data (1988 to 2003), and Aviation Safety Reporting System (ASRS) incident data (1993 to 2008). Failure modes and effects analyses were examined to identify possible modes of SCFM. A table of potential adverse conditions was developed to help evaluate IVHM research technologies. Tables present details of specific SCFM for the incidents and accidents. Of the 370 NTSB accidents affected by SCFM, 48 percent involved the engine or fuel system, and 31 percent involved landing gear or hydraulic failure and malfunctions. A total of 35 percent of all SCFM accidents were caused by improper maintenance. Of the 7732 FAA database incidents affected by SCFM, 33 percent involved landing gear or hydraulics, and 33 percent involved the engine and fuel system. The most frequent SCFM found in ASRS were turbine engine, pressurization system, hydraulic main system, flight management system/flight management computer, and engine. Because the IVHM Project does not address maintenance issues, and landing gear and hydraulic systems accidents are usually not fatal, the focus of research should be those SCFMs that occur in the engine/fuel and flight control/structures systems as well as power systems.

  9. Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

    Science.gov (United States)

    Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim

    2014-07-01

    In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Technical Review of Law Enforcement Standards and Guides Relative to Incident Management

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.; Salter, R.; Stanton, J. R.; Fisher, D.

    2009-03-24

    In an effort to locate potential law enforcement-related standards that support incident management, a team from the Pacific Northwest National Laboratory (PNNL) contacted representatives from the National Institute of Standards-Office of Law Enforcement Standards (NIST-OLES), National Institute of Justice (NIJ), Federal Bureau of Investigation (FBI), Secret Service, ASTM International committees that have a law enforcement focus, and a variety of individuals from local and regional law enforcement organizations. Discussions were held with various state and local law enforcement organizations. The NIJ has published several specific equipment-related law enforcement standards that were included in the review, but it appears that law enforcement program and process-type standards are developed principally by organizations that operate at the state and local level. Input is provided from state regulations and codes and from external non-government organizations (NGOs) that provide national standards. The standards that are adopted from external organizations or developed independently by state authorities are available for use by local law enforcement agencies on a voluntary basis. The extent to which they are used depends on the respective jurisdictions involved. In some instances, use of state and local disseminated standards is mandatory, but in most cases, use is voluntary. Usually, the extent to which these standards are used appears to depend on whether or not jurisdictions receive certification from a “governing” entity due to their use and compliance with the standards. In some cases, these certification-based standards are used in principal but without certification or other compliance monitoring. In general, these standards appear to be routinely used for qualification, selection for employment, and training. In these standards, the term “Peace Officer” is frequently used to refer to law enforcement personnel. This technical review of national law

  11. Major Incident Hospital: Development of a Permanent Facility for Management of Incident Casualties.

    Science.gov (United States)

    Marres, Geertruid; Bemelman, Michael; van der Eijk, John; Leenen, Luke

    2009-06-01

    . Collaboration with the NVIC and infrastructural adjustments enable us to not only care for patients with physical trauma, but also to provide centralized care of patients under quarantine conditions for, say, MRSA, SARS, smallpox, chemical or biological hazards. Triage plays an important role in medical disaster management and is therefore key to organization and infrastructure. Caps facilitate role distribution and recognizibility. The PBR resulted in more accurate registration and real-time availability of patient and group information. Infrastructure and a plan is not enough; training, research and evaluation are necessary to continuously work on disaster preparedness. The MIH in Utrecht (Netherlands) is a globally unique facility that can provide immediate emergency care for multiple casualties under exceptional circumstances. Resulting from the cooperation between a large academic medical institution, a trauma center, a military hospital and the NVIC, the MIH offers not only a good and complete infrastructure but also the expertise required to provide large-scale emergency care during disasters and major incidents.

  12. Mantram repetition for stress management in veterans and employees: a critical incident study.

    Science.gov (United States)

    Bormann, Jill E; Oman, Doug; Kemppainen, Jeanne K; Becker, Sheryl; Gershwin, Madeline; Kelly, Ann

    2006-03-01

    This paper reports a study assessing the usefulness of a mantram repetition programme. Complementary/alternative therapies are becoming commonplace, but more research is needed to assess their benefits. A 5-week programme teaching a 'mind-body-spiritual' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed. A mantram was chosen by individuals, who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response. Participants who attended a 5-week course were invited to participate in the study. Of those who consented, a randomly selected subset (n = 66) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique. Participants were asked whether the intervention was helpful or not, and if helpful, to identify situations where it was applied. Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses. The data were collected in 2001-2002. Participants included 30 veterans, mostly males (97%), and 36 hospital employees, mostly females (86%). Mean age was 56 years (sd = 12.94). Fifty-five participants (83.3%) practiced the technique and reported 147 incidents where the programme was helpful. Outcomes were organized into a taxonomy of incidents using four major categories that included managing: (a) emotions other than stress (51%); (b) stress (23.8%); (c) insomnia (12.9%); and (d) unwanted thoughts (12.3%). A group of raters reviewed the categories for inter-rater reliability. The majority of participants from two distinct samples reported that the mantram programme was helpful in a variety of situations. The critical incident interviewing method was found to be practical, efficient, and thorough in collecting and analyzing data. Such qualitative methods contribute to understanding the benefits of mind-body complementary therapies.

  13. Explaining implementation behaviour of the National Incident Management System (NIMS).

    Science.gov (United States)

    Jensen, Jessica; Youngs, George

    2015-04-01

    This paper explains the perceived implementation behaviour of counties in the United States with respect to the National Incident Management System (NIMS). The system represents a massive and historic policy mandate designed to restructure, standardise and thereby unify the efforts of a wide variety of emergency management entities. Specifically, this study examined variables identified in the NIMS and policy literature that might influence the behavioural intentions and actual behaviour of counties. It found that three key factors limit or promote how counties intend to implement NIMS and how they actually implement the system: policy characteristics related to NIMS, implementer views and a measure of local capacity. One additional variable-inter-organisational characteristics-was found to influence only actual behaviour. This study's findings suggest that the purpose underlying NIMS may not be fulfilled and confirm what disaster research has long suggested: the potential for standardisation in emergency management is limited. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

  14. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Reports of change in control of bank management... change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in situations...

  15. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    International Nuclear Information System (INIS)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

    2012-01-01

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  16. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  17. Critical incidents and critical incident stress management (CISM) - an employee assistance programme (EAP) perspective

    OpenAIRE

    Terblanche, Lourie; van Wyk, André

    2014-01-01

    Employees are increasingly becoming victims of critical incidents. From a systems theory point of view, it is necessary to acknowledge the impact of critical incidents not only on the personal life of the employee, but on the workplace itself. Employees respond differently to critical incidents, which makes it even more complicated when this reaches the point of requiring therapeutic intervention. The most common response to critical incidents may be the risk of developing post-traumatic s...

  18. Report: Improvements Needed in CSB’s Identity and Access Management and Incident Response Security Functions

    Science.gov (United States)

    Report #18-P-0030, October 30, 2017. Weaknesses in the Identity and Access Management and Incident Response metric domains leave the CSB vulnerable to attacks occurring and not being detected in a timely manner.

  19. Incidence of laminitis and survey of dietary and management practices in pleasure horses and ponies in south-eastern Australia.

    Science.gov (United States)

    Potter, S J; Bamford, N J; Harris, P A; Bailey, S R

    2017-10-01

    The aims of this study were to (1) report the incidence of laminitis among a population of horses and ponies attending Pony Clubs in Victoria, Australia, and (2) describe the dietary and management practices of the sample population. Researchers visited 10 Pony Clubs over a 10-month period. Horse and pony owners completed a questionnaire to provide information on management relating to diet and exercise. Owners were also asked to report their animal's history of laminitis, if any. From a survey population of 233 horses and ponies, 15.0% of animals (35 individuals) were reported to have suffered from at least one episode of laminitis. Of the animals that had suffered from laminitis, more than half had experienced multiple episodes. The majority of previously laminitic horses and ponies (71.4%) had not experienced an episode of laminitis within the past 12 months; however, 14.2% had experienced an incident within the past month. The proportion of ponies affected by laminitis (31/142; 21.8%) was significantly higher (P horses affected by laminitis (4/91; 4.4%). The incidence of laminitis within the pony group sampled was 6.5 cases per 100 pony years, while the incidence in horses was 0.55 cases per 100 horse years. This study provided information on the incidence of laminitis in the general population of pleasure horses and ponies in south-eastern Australia. It also provided an overview of dietary and management practices. Given the high incidence of animals that had been affected by laminitis (and the associated welfare implications), this study highlights the importance of owner education regarding appropriate feeding and management strategies to reduce the risk of laminitis. © 2017 Australian Veterinary Association.

  20. Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    Science.gov (United States)

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

  1. Towards Incidence Management in 5G Based on Situational Awareness

    Directory of Open Access Journals (Sweden)

    Lorena Isabel Barona López

    2017-01-01

    Full Text Available The fifth generation mobile network, or 5G, moves towards bringing solutions to deploying faster networks, with hundreds of thousands of simultaneous connections and massive data transfer. For this purpose, several emerging technologies are implemented, resulting in virtualization and self-organization of most of their components, which raises important challenges related to safety. In order to contribute to their resolution, this paper proposes a novel architecture for incident management on 5G. The approach combines the conventional risk management schemes with the Endsley Situational Awareness model, thus improving effectiveness in different aspects, among them the ability to adapt to complex and dynamical monitoring environments, and countermeasure tracking or the role of context when decision-making. The proposal takes into account all layers for information processing in 5G mobile networks, ranging from infrastructure to the actuators responsible for deploying corrective measures.

  2. STUDY OF INCIDENCE & MANAGEMENT OF PARA PHARYNGEAL TUMORS

    Directory of Open Access Journals (Sweden)

    Aruna Kumari

    2015-11-01

    Full Text Available INTRODUCTION: Parapharyngeal tumors are rare, comprising approximately 0.5% of all head and neck tumours. Most of them are benign. These tumors present with difficulties in diagnosis - complementary MRI and CT scanning are necessary for diagnosis, and Fine Needle Aspiration Cytology (FNAC is very specific in the histological diagnosis of these tumours. Open biopsy is not advisable due to bleeding, breaching of the capsule and seeding of the tumor. These tumors presents a challenge to the surgeon due to its anatomical complexities. This study deals with the incidence and management of various parapharyngeal tumors. OBJECTIVE OF THE STUDY: This study deals with the incidence of various tumors in the parapharyngeal space in different age and sex groups, role of sophisticated diagnostic modalities like CT, MRI, MR Angio. Colour Doppler along with FNAC and various surgical approaches to this space. This study also deals with intra-operative and post operative complications. In this series, a total of 25 cases has been studied retrospectively in a time period of 2 years from 2012 to 2014, presenting in our ENT and Head and Neck Dept., Gandhi hospital. RESULTS: According to this study, there is male preponderance (52% and highest incidence is seen in 3rd and 5th decade (24% each. Most common presenting symptoms are difficulty in swallowing (36% and swelling either intraoral or in the neck (28%. Least common symptoms being cranial nerve palsy (4%, difficulty in breathing/noisy breathing (4%, nasal regurgitation (4% and hard of hearing (8%. FNAC was done in 21 cases, in which 13 were correlating with the biopsy report. CT scan was required in all cases. MR Angiography was done in 4 cases and colour Doppler in 2 cases. Surgery is the mainstay of the treatment. Most common tumor in PPS is neurogenic (schwannoma/neurofibroma.i.e 44%. Next commonly occurring tumor in our study is of salivary origin-pleomorphic adenoma (24%, paragangliomas (12%. Other less

  3. The unified approach of management and critical incident stress management: helping flight attendants and pilots in the aftermath of September 11.

    Science.gov (United States)

    McIntosh, Tania

    2006-01-01

    Experience suggests that effective and appropriate responses of an organization's management after a traumatic incident can help mitigate the reactions of primary, secondary, and tertiary victims. This commentary addresses the managerial response of Southwest Airlines to the trauma induced by September 11. It highlights the effectiveness of the unity between the company, the unions, and the Critical Incident Response Team, as well as the types of interventions that were highly regarded by flight attendants and pilots who received such services. This commentary also defines the phenomenon known as fear of flight.

  4. Incidence of Artifacts and Deviating Values in Research Data Obtained from an Anesthesia Information Management System in Children.

    Science.gov (United States)

    Hoorweg, Anne-Lee J; Pasma, Wietze; van Wolfswinkel, Leo; de Graaff, Jurgen C

    2018-02-01

    Vital parameter data collected in anesthesia information management systems are often used for clinical research. The validity of this type of research is dependent on the number of artifacts. In this prospective observational cohort study, the incidence of artifacts in anesthesia information management system data was investigated in children undergoing anesthesia for noncardiac procedures. Secondary outcomes included the incidence of artifacts among deviating and nondeviating values, among the anesthesia phases, and among different anesthetic techniques. We included 136 anesthetics representing 10,236 min of anesthesia time. The incidence of artifacts was 0.5% for heart rate (95% CI: 0.4 to 0.7%), 1.3% for oxygen saturation (1.1 to 1.5%), 7.5% for end-tidal carbon dioxide (6.9 to 8.0%), 5.0% for noninvasive blood pressure (4.0 to 6.0%), and 7.3% for invasive blood pressure (5.9 to 8.8%). The incidence of artifacts among deviating values was 3.1% for heart rate (2.1 to 4.4%), 10.8% for oxygen saturation (7.6 to 14.8%), 14.1% for end-tidal carbon dioxide (13.0 to 15.2%), 14.4% for noninvasive blood pressure (10.3 to 19.4%), and 38.4% for invasive blood pressure (30.3 to 47.1%). Not all values in anesthesia information management systems are valid. The incidence of artifacts stored in the present pediatric anesthesia practice was low for heart rate and oxygen saturation, whereas noninvasive and invasive blood pressure and end-tidal carbon dioxide had higher artifact incidences. Deviating values are more often artifacts than values in a normal range, and artifacts are associated with the phase of anesthesia and anesthetic technique. Development of (automatic) data validation systems or solutions to deal with artifacts in data is warranted.

  5. European Clearinghouse. Incidents related to reactivity management. Contributing factors, failure modes and corrective actions

    International Nuclear Information System (INIS)

    Bruynooghe, Christiane; Noel, Marc

    2009-01-01

    This work is part of the European Clearinghouse on Nuclear Power Plant Operational Experience Feedback (NPP-OEF) activity carried out at the Joint Research Centre/Institute for Energy (JRC/IE) with the participation of nine EU Regulatory Authorities. It investigates the 1999 Shika-1 criticality event together with other shortcomings in reactivity management reported to the IAE4 Incident Reporting System in the period 1981-2008. The aim of the work was to identify reactivity control failure modes, reactor status and corrective actions. Initiating factors and associated root causes were also analysed. Five of the 7 factors identified for all events were present in the 1999 Shika-1 event where criticality has been unexpectedly reached and maintained during 15 minutes. Most of the events resulted in changes in procedures, material or staff and management training. The analysis carried out put in evidence that in several instances appropriate communication based on operational experience feedback would have prevented incident to occur. This paper also summarises the action taken at power plants and by the regulatory bodies in different countries to avoid repetition of similar events. It identifies insights that might be useful to reduce the likelihood of operational events caused by shortcomings in reactivity management. (orig.)

  6. Development of the decision make supporting system on incident management

    International Nuclear Information System (INIS)

    Kasamatsu, Mizuki; Hanada, Satoshi; Noda, Eisuke

    2017-01-01

    Decision Make Supporting System is designed to support appropriate decision made by top management in the nuclear severe conditions. With crisis response in nuclear power plant (NPP), information entanglement between sites and control centers during intense situations interfere with prompt and accurate decision making. This research started with that kind of background. In order to solve the issue of the information entanglement, Mitsubishi Heavy Industries, Inc. (MHI) carried out the development of the Decision Make Supporting System and the system applies the technology combining the human factors engineering (HFE) and information and communication technology (ICT). During the crisis response, various commands, reactions and communications in a human system need to be managed. Therefore, the combined HFE method including detailed task analysis, user experience (UX), graphic user interface (GUI) and related human-system interface (HSI) design method is applied to the design of the system. These design results systematize the functions that prevent interference with decision-making in the headquarters for incident management. This new solution as a system enhances the safety improvement of the NPP and contributes to develop the skills and abilities of the resources in the NPP. The system has three key features for supporting emergency situations: 'understanding the situation', 'planning the next action', and 'managing resources'. The system helps commanders and responders to grasp the whole situation and allows them to share information in real time to get a whole picture, and the system accumulates the data of the past events in the chronological order to understand correctly how they happened and plan the next action by using a knowledge database that MHI has been developed. If the unexpected event happens which are not in the incident scenario, the system provides support to formulate alternative strategies and measures. With this

  7. Analysis of eighty-four commercial aviation incidents - Implications for a resource management approach to crew training

    Science.gov (United States)

    Murphy, M. R.

    1980-01-01

    A resource management approach to aircrew performance is defined and utilized in structuring an analysis of 84 exemplary incidents from the NASA Aviation Safety Reporting System. The distribution of enabling and associated (evolutionary) and recovery factors between and within five analytic categories suggests that resource management training be concentrated on: (1) interpersonal communications, with air traffic control information of major concern; (2) task management, mainly setting priorities and appropriately allocating tasks under varying workload levels; and (3) planning, coordination, and decisionmaking concerned with preventing and recovering from potentially unsafe situations in certain aircraft maneuvers.

  8. [Teaching non-technical skills for critical incidents: Crisis resource management training for medical students].

    Science.gov (United States)

    Krüger, A; Gillmann, B; Hardt, C; Döring, R; Beckers, S K; Rossaint, R

    2009-06-01

    Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.

  9. Contents of management plans for incidents and accidents involving the transport of radioactive substances. Guide no. 17, Version of 22/12/2014

    International Nuclear Information System (INIS)

    2014-01-01

    This guide presents the essential topics to be developed in a management plan for incidents and accidents involving the transport of radioactive substances for civil use. It does not aim to be exhaustive and could be added to by each party involved in the transport, who can make the necessary adaptations and additions, taking account of the particularities of its shipments and its organisation, as well as those of the company or group to which it belongs. The radioactive substances transport incident and accident management plan is a document comprising a descriptive part and an operational part. It presents the overall response of the party involved in the transport operation to an incident or accident situation concerning one of its shipments and the steps it intends to make in order to support the authorities in charge of this situation, in the best possible conditions. This response is designed to cover the cases of incidents or accidents whether or not they lead to a radiological emergency situation. The guide exclusively concerns: - road transport; - rail transport; - the 'road' and 'rail' parts of multimodal transport operations. The case of an incident or an accident occurring during a particular stop such as a transit site, in a transhipment area (port, airport, railway station, etc.), or in a transport infrastructure, is also covered by the radioactive substances transport incident and accident management plan, which then supports the entities in charge of managing this situation (operator of the transhipment area or the transport infrastructure and - as applicable - their supervisory authorities). The level of risk associated with transport incidents and accidents varies widely, according to the nature and quantities of the materials being carried, the number of shipments made and the package model used. The incident and accident management plan must therefore be tailored to the specific nature of the shipments by the party concerned. The radioactive

  10. Development of a highway incident management operational and training guide for incident responders in Illinois.

    Science.gov (United States)

    2011-08-01

    Each year highway traffic incidents, such as crashes, place responders on and beside roadways with : dangerous high-speed traffic. The unexpected conditions of an incident scene have the potential to surprise : unsuspecting or inattentive drivers, po...

  11. [The effect of colored syringes and a colored sheet on the incidence of syringe swaps during anesthetic management].

    Science.gov (United States)

    Hirabayashi, Yoshihiro; Kawakami, Takayuki; Suzuki, Hideo; Igarashi, Takashi; Saitoh, Kazuhiko; Seo, Norimasa

    2005-09-01

    Syringe swap is an important problem in anesthetic care, causing harm to patients. We examined the effect of colored syringe and a colored sheet on the incidence of syringe swaps during anesthetic management. We determined the color code. The blue-syringe contains local anesthetics; yellow-syringe, sympathomimetic drugs; and white-syringe with a red label fixed opposite the scale, muscle relaxants. The colored sheet displays the photographs of the syringe with drug name, dose and volume. The colored syringe and colored sheet were supplied for use from February 2004. We compared the incidence of syringe swaps during the period from February 2004 to January 2005 with that from February 2003 to January 2004. Although five syringe swaps were recorded from February 2003 to January 2004, in 5901 procedures, we encountered no syringe swaps from February 2004 to January 2005, in 6078 procedures. The colored syringe and colored sheet significantly decreased the incidence of syringe swaps during anesthetic management (P sheet together with colored syringes can prevent syringe swaps during anesthesia.

  12. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    Science.gov (United States)

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  13. On the Appropriateness of Incident Management Systems in Developing Countries: A Case from the UAE

    Directory of Open Access Journals (Sweden)

    Faouzi Kamoun

    2010-12-01

    Full Text Available Road traffic incidents are eliciting growing public concerns due to their devastating social, economical, and environmental impacts. The severity of these random events is particularly alarming in developing countries, where the situation is just worsening. Recently, Incident Management Systems (IMSs have been proposed as powerful tools to enhance the coordination and management of rescue operations during traffic accidents. However, most of the available commercial IMS solutions are designed for large metropolitan cities and within the contexts of developed nations. This paper explores the issues of appropriateness and customization of IMS solutions in developing countries through an exploratory inquiry consisting of a case study from the United Arab Emirates (UAE. The paper also explores the important issues related to managing the organizational changes that an IMS introduces to the operations of the command and control room. This contribution calls for the development of more comprehensive theoretical frameworks that can guide towards the implementation of appropriate IMS solutions in developing countries. Our research highlights the need for developing countries to acquire appropriate IMS solutions that are tailored to the local organizational work context in which these systems will be used. The experience reported herein can also inspire other public safety agencies in developing countries to consider the option of developing customized IMS solutions that best suit their needs.

  14. The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008.

    Science.gov (United States)

    Rutherford, J S; Flin, R; Irwin, A

    2015-07-01

    The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance". A total of 90 critical incidents involving ATs were retrieved, 69 of which described their use of non-technical skills. In 20 reports, the ATs ameliorated the critical incident, whilst in 46 they exacerbated the critical incident, and three cases had both positive and negative non-technical skills described. Situation awareness was identified in 39 reports, task management in 23, teamwork in 21 and decision-making in two, but there were no descriptions of issues related to leadership, stress or fatigue management. Situation awareness, task management and teamwork appear to be important non-technical skills for ATs in the development or management of critical incidents in the operating theatre. This analysis has been used to support the development of a non-technical skills taxonomy for anaesthetic assistants.

  15. Management of In-Field Patient Tracking and Triage by Using Near-Field Communication in Mass Casualty Incidents.

    Science.gov (United States)

    Cheng, Po-Liang; Su, Yung-Cheng; Hou, Chung-Hung; Chang, Po-Lun

    2017-01-01

    Near field communications (NFC) is an emerging technology that may potentialy assist with disaster management. A smartphone-based app was designed to help track patient flow in real time. A table-drill was held as a brief evaluation and it showed significant imporvement in both efficacy and accuracy of patient management. It is feasible to use NFC-embedded smartphones to clarify the ambiguous and chaotic patient flow in a mass casualty incident.

  16. Characterization of post-disaster environmental management for Hazardous Materials Incidents: Lessons learnt from the Tianjin warehouse explosion, China.

    Science.gov (United States)

    Zhang, Hui; Duan, Huabo; Zuo, Jian; Song, MingWei; Zhang, Yukui; Yang, Bo; Niu, Yongning

    2017-09-01

    Hazardous Materials Incidents (HMIs) have attracted a growing public concern worldwide. The health risks and environmental implications associated with HMIs are almost invariably severe, and underscore the urgency for sound management. Hazardous Materials Explosion incidents (HMEIs) belong to a category of extremely serious HMIs. Existing studies placed focuses predominately on the promptness and efficiency of emergency responses to HMIs and HMEIs. By contrast, post-disaster environmental management has been largely overlooked. Very few studies attempted to examine the post-disaster environmental management plan particularly its effectiveness and sufficiency. In the event of the Tianjin warehouse explosion (TWE), apart from the immediate emergency response, the post-disaster environmental management systems (P-EMSs) have been reported to be effective and sufficient in dealing with the environmental concerns. Therefore, this study aims to critically investigate the P-EMSs for the TWE, and consequently to propose a framework and procedures for P-EMSs in general for HMIs, particularly for HMEIs. These findings provide a useful reference to develop P-EMSs for HMIs in the future, not only in China but also other countries. Copyright © 2017. Published by Elsevier Ltd.

  17. Workload management and geographic disorientation in aviation incidents: A review of the ASRS data base

    Science.gov (United States)

    Williams, Henry P.; Tham, Mingpo; Wickens, Christopher D.

    1993-01-01

    NASA's Aviation Safety Reporting System (ASRS) incident reports are reviewed in two related areas: pilots' failures to appropriately manage tasks, and breakdowns in geographic orientation. Examination of 51 relevant reports on task management breakdowns revealed that altitude busts and inappropriate runway usee were the most frequently reported consequences. Task management breakdowns appeared to occur at all levels of expertise, and prominent causal factors were related to breakdowns in crew communications, over-involvement with the flight management system and, for small (general aviation) aircraft, preoccupation with weather. Analysis of the 83 cases of geographic disorientation suggested that these too occurred at all levels of pilot experience. With regard to causal factors, a majority was related to poor cockpit resource management, in which inattention led to a loss of geographic awareness. Other leading causes were related to poor weather and poor decision making. The potential of the ASRS database for contributing to research and design issues is addressed.

  18. Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

    Science.gov (United States)

    Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

    2014-10-01

    On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

  19. Application of Incident Command Structure to clinical trial management in the academic setting: principles and lessons learned.

    Science.gov (United States)

    Reynolds, Penny S; Michael, Mary J; Spiess, Bruce D

    2017-02-09

    Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the 'gold standard' management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied ICS principles to organisation and management of the Prehospital Use of Plasma in Traumatic Haemorrhage (PUPTH) trial. This trial was a multidepartmental, multiagency, randomised clinical trial investigating prehospital administration of thawed plasma on mortality and coagulation response in severely injured trauma patients. We describe the ICS system as it would apply to large clinical trials in general, and the benefits, barriers, and lessons learned in utilising ICS principles to reorganise and coordinate the PUPTH trial. Without a formal trial management structure, early stages of the trial were characterised by inertia and organisational confusion. Implementing ICS improved organisation, coordination, and communication between multiple agencies and service groups, and greatly streamlined regulatory compliance administration. However, unfamiliarity of clinicians with ICS culture, conflicting resource allocation priorities, and communication bottlenecks were significant barriers. ICS is a flexible and powerful organisational tool for managing large complex clinical trials. However, for successful implementation the cultural, psychological, and social environment of trial participants must be

  20. Emergency response to mass casualty incidents in Lebanon.

    Science.gov (United States)

    El Sayed, Mazen J

    2013-08-01

    The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure.

  1. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

  2. Development of Incident Report Database for Organizational Learning

    Science.gov (United States)

    Otsuka, Yuichi; Abe, Tomotaka; Noguchi, Hiroshi; Makinouchi, Akifumi

    The necessity of an incident reporting system has recently been increasing for hospitals. Japan Council for Quality Health Care (JCQHC) started operating a national incident reporting system to which domestic hospitals would report their incidents. However, the reporting system obtained an additional problem for the hospitals. They managed their own systems which collected reports by papers. The purposes of the reporting systems was to analyze considerable causes involved in incidents to improve the quality of patient safety management. On the contrary, the national reporting system aimed at collecting a statistical tendency of normal incidents. Simultaneously operating the two systems would be too much workload for safety managers. The load may have the managers rest only a short time for summarizing occurrences, not enough for analyzing their causes. However, to the authors' knowledge, there has not been an integrating policy of the two forms to adapt them to practical situations in patient safety management. The scope of this paper is to establish the integrated form in order to use in analyzing the causes of incidents as well as reporting for the national system. We have developed new data base system using XML + XSLT and Java Servlet. The developed system is composed of three computers; DB server , DB client and Data sending server. To investigate usability of the developed system, we conducted a monitoring test by real workers in reporting workplaces. The result of subjective evaluations by examinees was so preferable for the developed system. The results of usability test and the achievement of increasing the number of reports after the introduction can demonstrate the enough effectiveness of the developed system for supporting the activity of patient safety management.

  3. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    Science.gov (United States)

    Blancher, Marc; Albasini, François; Elsensohn, Fidel; Zafren, Ken; Hölzl, Natalie; McLaughlin, Kyle; Wheeler, Albert R; Roy, Steven; Brugger, Hermann; Greene, Mike; Paal, Peter

    2018-02-15

    Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue. High Alt Med Biol. 00:000-000, 2018. Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

  4. Taxonometric Applications in Radiotherapy Incident Analysis

    International Nuclear Information System (INIS)

    Dunscombe, Peter B.; Ekaette, Edidiong U.; Lee, Robert C.; Cooke, David L.

    2008-01-01

    Recent publications in both the scientific and the popular press have highlighted the risks to which patients expose themselves when entering a healthcare system. Patient safety issues are forcing us to, not only acknowledge that incidents do occur, but also actively develop the means for assessing and managing the risks of such incidents. To do this, we ideally need to know the probability of an incident's occurrence, the consequences or severity for the patient should it occur, and the basic causes of the incident. A structured approach to the description of failure modes is helpful in terms of communication, avoidance of ambiguity, and, ultimately, decision making for resource allocation. In this report, several classification schemes or taxonomies for use in risk assessment and management are discussed. In particular, a recently developed approach that reflects the activity domains through which the patient passes and that can be used as a basis for quantifying incident severity is described. The estimation of incident severity, which is based on the concept of the equivalent uniform dose, is presented in some detail. We conclude with a brief discussion on the use of a defined basic-causes table and how adding such a table to the reports of incidents can facilitate the allocation of resources

  5. National Incident Management System (NIMS) Standards Review Panel Workshop Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.; Kirk, Jennifer L.; Stanton, James R.; Shebell, Peter; Schwartz, Deborah S.; Judd, Kathleen S.; Gelston, Gariann M.

    2006-02-07

    The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, because the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon

  6. Incidence of Artifacts and Deviating Values in Research Data Obtained from an Anesthesia Information Management System in Children

    NARCIS (Netherlands)

    Hoorweg, Anne-Lee J; Pasma, Wietze; van Wolfswinkel, Leo; de Graaff, Jurgen C

    BACKGROUND: Vital parameter data collected in anesthesia information management systems are often used for clinical research. The validity of this type of research is dependent on the number of artifacts. METHODS: In this prospective observational cohort study, the incidence of artifacts in

  7. Information System of Resolution of Procedural Incidents and Management of the Modifications Made to the Electronic Court Registration

    Directory of Open Access Journals (Sweden)

    Ştefan Gheorghe PENTIUC

    2011-01-01

    Full Text Available This information system was made for its use by the staff responsible for random distribution of cases to the courts. The Information System of Resolution of Procedural Incidents and Management of the Modifications Made to the Electronic Court Registration consists of three new developed modules: the management module is a Web application which chronicles the modifications made in the electronic court registration, regarding the random assignment of cases,the resolution of procedural incidents, which is a Web service whose logic implements a logic Semantic Web application and the module of confirming judges which is a windows service running on the judges’ workstations. The Web service implements a Semantic Web application which processes the knowledgebase achieved through OWL ontology (Ontology Web Language by applying inferences leading to the correct solution. If this does not solve the problem, a set of associated Jena rules are used to infer and generate new knowledge. It also uses the SPARQL(SPARQL Protocol and RDF Query Language language that allows queries on the knowledge,similar to the classic query languages of databases. The novelty of the new conceived, designed and implemented system consists in accessing the domain knowledge as a web service to solve the procedural incidents occurred in electronic court registration.

  8. Incident Duration Modeling Using Flexible Parametric Hazard-Based Models

    Directory of Open Access Journals (Sweden)

    Ruimin Li

    2014-01-01

    Full Text Available Assessing and prioritizing the duration time and effects of traffic incidents on major roads present significant challenges for road network managers. This study examines the effect of numerous factors associated with various types of incidents on their duration and proposes an incident duration prediction model. Several parametric accelerated failure time hazard-based models were examined, including Weibull, log-logistic, log-normal, and generalized gamma, as well as all models with gamma heterogeneity and flexible parametric hazard-based models with freedom ranging from one to ten, by analyzing a traffic incident dataset obtained from the Incident Reporting and Dispatching System in Beijing in 2008. Results show that different factors significantly affect different incident time phases, whose best distributions were diverse. Given the best hazard-based models of each incident time phase, the prediction result can be reasonable for most incidents. The results of this study can aid traffic incident management agencies not only in implementing strategies that would reduce incident duration, and thus reduce congestion, secondary incidents, and the associated human and economic losses, but also in effectively predicting incident duration time.

  9. Incidence, diagnosis and management of eye affections in dogs ...

    African Journals Online (AJOL)

    A retrospective study of ocular affections in dogs was conducted at some selected clinics and hospitals in Southwest Nigeria between 2003 and, 2013 to determine the incidence, pattern of distribution, methods of diagnosis and treatment modalities using descriptive statistical tool. Overall incidence of eye affection in dogs ...

  10. Developing an incident management system to support Ebola response -- Liberia, July-August 2014.

    Science.gov (United States)

    Pillai, Satish K; Nyenswah, Tolbert; Rouse, Edward; Arwady, M Allison; Forrester, Joseph D; Hunter, Jennifer C; Matanock, Almea; Ayscue, Patrick; Monroe, Benjamin; Schafer, Ilana J; Poblano, Luis; Neatherlin, John; Montgomery, Joel M; De Cock, Kevin M

    2014-10-17

    The ongoing Ebola virus disease (Ebola) outbreak in West Africa is the largest and most sustained Ebola epidemic recorded, with 6,574 cases. Among the five affected countries of West Africa (Liberia, Sierra Leone, Guinea, Nigeria, and Senegal), Liberia has had the highest number cases (3,458). This epidemic has severely strained the public health and health care infrastructure of Liberia, has resulted in restrictions in civil liberties, and has disrupted international travel. As part of the initial response, the Liberian Ministry of Health and Social Welfare (MOHSW) developed a national task force and technical expert committee to oversee the management of the Ebola-related activities. During the third week of July 2014, CDC deployed a team of epidemiologists, data management specialists, emergency management specialists, and health communicators to assist MOHSW in its response to the growing Ebola epidemic. One aspect of CDC's response was to work with MOHSW in instituting incident management system (IMS) principles to enhance the organization of the response. This report describes MOHSW's Ebola response structure as of mid-July, the plans made during the initial assessment of the response structure, the implementation of interventions aimed at improving the system, and plans for further development of the response structure for the Ebola epidemic in Liberia.

  11. An Examination of Commercial Aviation Accidents and Incidents Related to Integrated Vehicle Health Management

    Science.gov (United States)

    Reveley, Mary S.; Briggs, Jeffrey L.; Thomas, Megan A.; Evans, Joni K.; Jones, Sharon M.

    2011-01-01

    The Integrated Vehicle Health Management (IVHM) Project is one of the four projects within the National Aeronautics and Space Administration's (NASA) Aviation Safety Program (AvSafe). The IVHM Project conducts research to develop validated tools and technologies for automated detection, diagnosis, and prognosis that enable mitigation of adverse events during flight. Adverse events include those that arise from system, subsystem, or component failure, faults, and malfunctions due to damage, degradation, or environmental hazards that occur during flight. Determining the causal factors and adverse events related to IVHM technologies will help in the formulation of research requirements and establish a list of example adverse conditions against which IVHM technologies can be evaluated. This paper documents the results of an examination of the most recent statistical/prognostic accident and incident data that is available from the Aviation Safety Information Analysis and Sharing (ASIAS) System to determine the causal factors of system/component failures and/or malfunctions in U.S. commercial aviation accidents and incidents.

  12. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  13. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    International Nuclear Information System (INIS)

    Shah, Chirag; Vicini, Frank A.

    2011-01-01

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer–related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2–65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  14. The Incidence and Management of Conflicts in Secular and Non-Secular Tertiary Institutions in South West Nigeria

    Science.gov (United States)

    Ayodele, Joseph Babatola; Adewumi, Joseph Olukayode

    2007-01-01

    This paper compared the incidence and management of conflicts in secular and non-secular tertiary institutions in Nigeria. The sample of this study was made of sixty staff, and two hundred and forty students randomly selected each from two secular and two non-secular tertiary institutions in south western Nigeria. A validated questionnaire was…

  15. Acute incidents during anaesthesia

    African Journals Online (AJOL)

    management of acute incidents and the prevention of ... High or total (complete) spinal blocks in obstetric .... Pain and opioid analgesics lead to delayed ... Step up postoperative care and use ... recognise suprasternal and supraclavicular.

  16. Working relationships between obstetric care staff and their managers: a critical incident analysis.

    Science.gov (United States)

    Chipeta, Effie; Bradley, Susan; Chimwaza-Manda, Wanangwa; McAuliffe, Eilish

    2016-08-26

    Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi's disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres' providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers' lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers' job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.

  17. Exploring the perception of aid organizations' staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study.

    Science.gov (United States)

    Bazeli, Javad; Aryankhesal, Aidin; Khorasani-Zavareh, Davoud

    2017-07-01

    Traffic incidents are of main health issues all around the world and cause countless deaths, heavy casualties, and considerable tangible and intangible damage. In this regard, mass casualty traffic incidents are worthy of special attention as, in addition to all losses and damage, they create challenges in the way of providing health services to the victims. The present study is an attempt to explore the challenges and facilitators in management of mass casualty traffic incidents in Iran. This qualitative grounded theory study was carried out with participation of 14 purposively selected experienced managers, paramedics and staff of aid organizations in different provinces of Iran in 2016. Semi-structured interviews were conducted in order to develop the theory. The transcribed interviews were analyzed through open, axial and selective coding. Despite the recent and relatively good improvements in facilities and management procedure of mass casualty traffic incidents in Iran, several problems such as lack of coordination, lack of centralized and integrated command system, large number of organizations participating in operations, duplicate attempts and parallel operations carried out by different organizations, intervention of lay people, and cultural factors halt provision of effective health services to the victims. It is necessary to improve the theoretical and practical knowledge of the relief personnel and paramedics, provide public with education about first aid and improve driving culture, prohibit laypeople from intervening in aid operations, and increase quality and quantity of aid facilities.

  18. Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system

    International Nuclear Information System (INIS)

    Novak, Avrey; Nyflot, Matthew J.; Ermoian, Ralph P.; Jordan, Loucille E.; Sponseller, Patricia A.; Kane, Gabrielle M.; Ford, Eric C.; Zeng, Jing

    2016-01-01

    Purpose: Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. Methods: From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Results: Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically

  19. Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system

    Energy Technology Data Exchange (ETDEWEB)

    Novak, Avrey; Nyflot, Matthew J.; Ermoian, Ralph P.; Jordan, Loucille E.; Sponseller, Patricia A.; Kane, Gabrielle M.; Ford, Eric C.; Zeng, Jing, E-mail: jzeng13@uw.edu [Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific Street, Campus Box 356043, Seattle, Washington 98195 (United States)

    2016-05-15

    Purpose: Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. Methods: From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Results: Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically

  20. Incidence and Management Costs of Freshwater Aquatic Nuisance Species at Projects Operated by the U.S. Army Corps of Engineers

    Science.gov (United States)

    2010-07-01

    the occurrence of ANS impacts (Yes or No) from freshwater algae, large aquatic plants, fish, zebra mussels, Asiatic clams, water fleas, crayfish...2005. Freshwater aquatic nuisance species impacts and management costs and benefits at federal water resources projects. ERDC/TN ANSRP-06-3...ER D C/ EL T R- 10 -1 3 Aquatic Nuisance Species Research Program Incidence and Management Costs of Freshwater Aquatic Nuisance Species

  1. A remotely piloted aircraft system in major incident management: concept and pilot, feasibility study.

    Science.gov (United States)

    Abrahamsen, Håkon B

    2015-06-10

    Major incidents are complex, dynamic and bewildering task environments characterised by simultaneous, rapidly changing events, uncertainty and ill-structured problems. Efficient management, communication, decision-making and allocation of scarce medical resources at the chaotic scene of a major incident is challenging and often relies on sparse information and data. Communication and information sharing is primarily voice-to-voice through phone or radio on specified radio frequencies. Visual cues are abundant and difficult to communicate between teams and team members that are not co-located. The aim was to assess the concept and feasibility of using a remotely piloted aircraft (RPA) system to support remote sensing in simulated major incident exercises. We carried out an experimental, pilot feasibility study. A custom-made, remotely controlled, multirotor unmanned aerial vehicle with vertical take-off and landing was equipped with digital colour- and thermal imaging cameras, a laser beam, a mechanical gripper arm and an avalanche transceiver. We collected data in five simulated exercises: 1) mass casualty traffic accident, 2) mountain rescue, 3) avalanche with buried victims, 4) fisherman through thin ice and 5) search for casualties in the dark. The unmanned aerial vehicle was remotely controlled, with high precision, in close proximity to air space obstacles at very low levels without compromising work on the ground. Payload capacity and tolerance to wind and turbulence were limited. Aerial video, shot from different altitudes, and remote aerial avalanche beacon search were streamed wirelessly in real time to a monitor at a ground base. Electromagnetic interference disturbed signal reception in the ground monitor. A small remotely piloted aircraft can be used as an effective tool carrier, although limited by its payload capacity, wind speed and flight endurance. Remote sensing using already existing remotely piloted aircraft technology in pre

  2. Incidence of root rot diseases of soybean in Multan Pakistan and its management by the use of plant growth promoting rhizobacteria

    International Nuclear Information System (INIS)

    Haq, M.I.; Tahir, M.I.; Mahmood, S.

    2012-01-01

    Eight villages in Multan district were surveyed to record incidence of disease and losses of soybean (Glycine max L.) caused by root rot fungi. The root incidence ranged 10-17% and losses ranged 6.75-15.5%. The evaluation of four PGPR isolates was used in combination with organic amendment for the management of root-rot disease incidence and to reduce the population of root pathogenic fungi and to increase the yield in field. This study demonstrated effective biological control by the PGPR isolates tested, thereby indicating the possibility of application of rhizobacteria for control of soil bor ne diseases of soybean in Pakistan and other countries. (author)

  3. Safety culture and learning from incidents: the role of incident reporting and causal analyses

    International Nuclear Information System (INIS)

    Wilpert, B.

    1994-01-01

    Nuclear industry more than any other industrial branch has developed and used predictive risk analysis as a method of feedforward control of safety and reliability. Systematic evaluation of operating experience, statistical documentation of component failures, systematic documentation and analysis of incidents are important complementary elements of feedback control: we are dealing here with adjustment and learning from experience, in particular from past incidents. Using preliminary findings from ongoing research at the Research Center Systems Safety at the Berlin University of Technology the contribution discusses preconditions for an effective use of lessons to be learnt from closely matched incident reporting and in depth analyses of causal chains leading to incidents. Such conditions are especially standardized documentation, reporting and analyzing methods of incidents; structured information flows and feedback loops; abstaining from culpability search; mutual trust of employees and management; willingness of all concerned to continually evaluate and optimize the established learning system. Thus, incident related reporting and causal analyses contribute to safety culture, which is seen to emerge from tightly coupled organizational measures and respective change in attitudes and behaviour. (author) 2 figs., 7 refs

  4. Results of an online questionnaire to survey calf management practices on dairy cattle breeding farms in Austria and to estimate differences in disease incidences depending on farm structure and management practices.

    Science.gov (United States)

    Klein-Jöbstl, Daniela; Arnholdt, Tim; Sturmlechner, Franz; Iwersen, Michael; Drillich, Marc

    2015-08-19

    Calf disease may result in great economic losses. To implement prevention strategies it is important to gain information on management and to point out risk factors. The objective of this internet based survey was to describe calf management practices on registered dairy breeding farms in Austria and to estimate differences in calf disease incidences depending on farm structure and management practices. A total of 1287 questionnaires were finally analysed (response rate 12.2 %). Herd characteristics and regional distribution of farms indicated that this survey gives a good overview on calf management practices on registered dairy farms in Austria. The median number of cows per farm was 20 (interquartile range 13-30). Significant differences regarding farm characteristics and calf management between small and large farms (≤20 vs >20 cows) were present. Only 2.8 % of farmers tested first colostrum quality by use of a hydrometer. Storing frozen colostrum was more prevalent on large farms (80.8 vs 64.2 %). On 85.1 % of the farms, whole milk, including waste milk, was fed to the calves. Milk replacer and waste milk were more often used on large farms. In accordance with similar studies from other countries, calf diarrhoea was indicated as the most prevalent disease. Multivariable logistic regression analysis revealed that herd size was associated with calf diarrhoea and calf respiratory tract disease, with higher risk of disease on large farms. Furthermore, feeding waste milk to the calves was associated with increasing calf diarrhoea incidence on farm. In the final model with calf respiratory tract disease as outcome, respondents from organic farms reported less often a respiratory tract disease incidence of over 10 % compared with conventional farms [odds ratio (OR) 0.40, 95 % confidence interval (CI) 0.21-0.75] and farmers that housed calves individually or in groups after birth significantly reported more often to have an incidence of respiratory tract

  5. Social, institutional, and psychological factors affecting wildfire incident decision making

    Science.gov (United States)

    Matthew P. Thompson

    2014-01-01

    Managing wildland fire incidents can be fraught with complexity and uncertainty. Myriad human factors can exert significant influence on incident decision making, and can contribute additional uncertainty regarding programmatic evaluations of wildfire management and attainment of policy goals. This article develops a framework within which human sources of uncertainty...

  6. Integrated Incident Management System (IIMS) web client application development, deployment and evaluation: an evaluation of a potential IIMS deployment in Western New York : final report.

    Science.gov (United States)

    2015-09-30

    Incident Management (IM) is an area of transportation management that can significantly decrease the congestion and increase the : efficiency of transportation networks in non-ideal conditions. In this study, the existing state of the Integrated Inci...

  7. The critical incident technique reappraised: using critical incidents to illuminate organizational practices and build theory

    OpenAIRE

    Bott, Gregory; Tourish, Dennis

    2016-01-01

    Purpose: The purpose of this paper is to offer a reconceptualization of the critical incident technique (CIT) and affirm its utility in management and organization studies.\\ud \\ud Design/methodology/approach: Utilizing a case study from a leadership context, the paper applies the CIT to explore various leadership behaviours in the context of nonprofit boards in Canada. Semi-structured critical incident interviews were used to collect behavioural data from 53 participants – board chairs, board...

  8. Error-Based Accidents and Security Incidents in Nuclear Materials Management

    International Nuclear Information System (INIS)

    Pond, Daniel J.; Greitzer, Frank L.

    2005-01-01

    Hazard and risk assessments, along with human error analysis and mitigation techniques, have long been mainstays of effective safety programs. These tools have revealed that worker errors contributing to or resulting in accidents are often the consequence of ineffective system conditions, process features, or individual employee characteristics. At Los Alamos National Laboratory (LANL), security, safety, human error, and organizational analysts determined that the system-induced human errors that make accidents more likely also are contributing to security incidents. A similar set of system conditions has been found to underlie deliberate, non-malevolent deviations from proper security practices - termed breaches - that also can result in a security incident. In fiscal-year (FY) 2002, LANL's Security Division therefore established the ESTHER (Enhanced Security Through Human Error Reduction) program to identify and reduce the influence of the factors that underlie employee errors and breaches and, in turn, security incidents. Recognizing the potential benefits of this program and approach, in FY2004 the Department of Energy (DOE) Office of Security Policy (DOE-SO) funded an expansion of ESTHER implementation to the causal assessment and reporting of security incidents at other DOE sites. This presentation will focus on three applications of error/breach assessment and mitigation techniques. One use is proactive, accomplished through the elimination of contributors to error, whereas two are reactive, implemented in response to accidents or security incidents as well as to near misses, to prevent recurrence. The human performance and safety bases of these techniques will be detailed. Associated tools - including computer-based assessment training and web-based incident reporting modules developed by Pacific Northwest National Laboratory - will be discussed

  9. Incidence, risk factors and management of severe post-transsphenoidal epistaxis.

    Science.gov (United States)

    De Los Reyes, Kenneth M; Gross, Bradley A; Frerichs, Kai U; Dunn, Ian F; Lin, Ning; Rincon-Torroella, Jordina; Annino, Donald J; Laws, Edward R

    2015-01-01

    Among the major complications of transsphenoidal surgery, less attention has been given to severe postoperative epistaxis, which can lead to devastating consequences. In this study, we reviewed 551 consecutive patients treated over a 4 year period by the senior author to evaluate the incidence, risk factors, etiology and management of immediate and delayed post-transsphenoidal epistaxis. Eighteen patients (3.3%) developed significant postoperative epistaxis - six immediately and 12 delayed (mean postoperative day 10.8). Fourteen patients harbored macroadenomas (78%) and 11 of 18 (61.1%) had complex nasal/sphenoid anatomy. In the immediate epistaxis group, 33% had acute postoperative hypertension. In the delayed group, one had an anterior ethmoidal pseudoaneurysm, and one had restarted anticoagulation on postoperative day 3. We treated the immediate epistaxis group with bedside nasal packing followed by operative re-exploration if conservative measures were unsuccessful. The delayed group underwent bedside nasal hemostasis; if unsuccessful, angiographic embolization was performed. After definitive treatment, no patients had recurrent epistaxis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Cyber crisis management: a decision-support framework for disclosing security incident information

    OpenAIRE

    Kulikova, Olga; Heil, Ronald; van den Berg, Jan; Pieters, Wolter

    2012-01-01

    The growing sophistication and frequency of cyber attacks force modern companies to be prepared beforehand for potential cyber security incidents and data leaks. A proper incident disclosure strategy can significantly improve timeliness and effectiveness of incident response activities, reduce legal fines, and restore confidence and trust of a company's key stakeholders. In this paper, four factors that shape organizational preferences regarding incident information disclosure are introduced....

  11. Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges.

    Science.gov (United States)

    Deebel, Nicholas A; Morin, Jacqueline P; Autorino, Riccardo; Vince, Randy; Grob, Baruch; Hampton, Lance J

    2017-12-01

    To critically analyze the available evidence regarding the incidence, etiopathogenesis, and management of prostate cancer (CaP) in transgender women. In addition, this article aims to present a recent case report of a transgender woman with a unique presentation at the author's institution. An electronic nonsystematic literature search was performed to identify pertinent studies. PubMed search engine was queried by using the following search terms: "prostate cancer," "male to female transsexual," "transgender patient," "androgen + prostate cancer," "estrogen therapy + prostate cancer," and "health care barrier." In addition, a clinical case managed at our institution was reviewed and critically discussed. Including our case, there have been only 10 documented cases of CaP in transgender women. Additionally, an emerging body of literature has questioned the role of androgens in the development of CaP and suggested that estrogen therapy may not be as protective as initially thought. Therefore, the current evidence suggests that the transgender woman should be screened for CaP the same as a nontransgender men. Barriers to care in the transgender female population include accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs pathologizing transgender patients, financial restrictions of the patient, and health system determinants. Although rare, CaP in transgender women has been documented. Both the mechanism and the impact of receiving a bilateral orchiectomy on disease development are unclear. Future study is needed to examine these factors, and to further shape the treatment and screening regimen for these patients. Published by Elsevier Inc.

  12. Cyber crisis management: a decision-support framework for disclosing security incident information

    NARCIS (Netherlands)

    Kulikova, Olga; Heil, Ronald; van den Berg, Jan; Pieters, Wolter

    2012-01-01

    The growing sophistication and frequency of cyber attacks force modern companies to be prepared beforehand for potential cyber security incidents and data leaks. A proper incident disclosure strategy can significantly improve timeliness and effectiveness of incident response activities, reduce legal

  13. Current approaches to managing aggressive incidents among in ...

    African Journals Online (AJOL)

    Background: Aggressive behavior and incidents in psychiatric wards are ... Results: Seventy five people were admitted in the acute psychiatric wards during this ... Although the study sample is small and convenience-based, the dearth of ...

  14. Dealing Collectively with Critical Incident Stress Reactions in High Risk Work Environments

    DEFF Research Database (Denmark)

    Müller-Leonhardt, Alice; Strøbæk, Pernille Solveig; Vogt, joachim

    2015-01-01

    organisations. Indeed, we found that the CISM programme once integrated within the socio-cultural patterns of this specific working environment enhanced not only individual feelings of being supported but also organisational safety culture. Keywords: coping; safety culture; critical incident stress management......aim of this paper is to shift the representation of coping patterns within high risk occupations to an existential part of cultural pattern and social structure, which characterises high reliability organisations. Drawing upon the specific peer model of critical incident stress management (CISM......), in which qualified operational peers support colleagues who experienced critical incident stress, the paper discusses critical incident stress management in air traffic control. Our study revealed coping patterns that co-vary with the culture that the CISM programme fostered within this specific high...

  15. Hepatic adenoma: incidence and management between the year 2002-2006 Hospital R. Calderon Guardia

    International Nuclear Information System (INIS)

    Pages Zamora, Alberto

    2008-01-01

    The incidence and management of hepatic adenoma at the Hospital Calderon Guardia are analyzed between the years 2002-2006. The main hepatic pathologies diagnosed by biopsy are shown. The relationship of hepatic adenoma with the above risk factors and presentation of each case of hepatic adenoma found are analyzed. The media diagnosed in this type of pathology were investigated. The evolution and control of each case of hepatic adenoma have been studied. The results of the management of each case are compared with the recommended in literature. The ideal management of this type of pathology is analyzed. Among the conclusions is given benign liver pathology as the most frequent cause of liver biopsy in the Hospital Calderon Guardia. Metastatic disease of the digestive tract has been the primary neoplastic disease at the hepatic level. Focal nodular hyperplasia has been the biopsy of benign tumor that is performed more frequently. Hepatic adenoma has been a rare entity, but with significant mortality rates. All cases were presented as solitary lesions. It is more common in women of childbearing age but can occur also in older people and in men. A close relationship has existed between the use of oral gestagens and the incidence of hepatic adenoma. Hepatic adenomas and its complications have been related to its size. Most cases of hepatic adenoma were presented with symptoms. The preoperative studies have shown high sensitivity in the detection of lesions, but little specificity. A protocol for the study of hepatic masses is required. A relationship between the size of the adenoma and possible complications was demonstrated. The reason for surgery in most cases has been the possibility of malignancy in the liver injury. The correlation between preoperative diagnosis and the end was unsuccessful in 75 percent of cases. The mortality related to the procedures did not exist, but if a case of morbidity. The study of liver masses should be more exhaustive to improve

  16. Final Documentation: Incident Management And Probabilities Courses of action Tool (IMPACT).

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, Donna M.; Ray, Jaideep; Tucker, Mark D.; Whetzel, Jonathan; Cauthen, Katherine Regina

    2018-03-01

    This report pulls together the documentation produced for the IMPACT tool, a software-based decision support tool that provides situational awareness, incident characterization, and guidance on public health and environmental response strategies for an unfolding bio-terrorism incident.

  17. Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment

    Science.gov (United States)

    2017-12-01

    Traffic incidents have long been recognized as the main contributor to congestion in highway networks. Thus, contending with non-recurrent congestion has been a priority task for most highway agencies over the past decades. Under most incident scenar...

  18. Reflections on Leadership and Governance from the Incident Manager of Liberia's Ebola Response.

    Science.gov (United States)

    Nyenswah, Tolbert

    The 2014-2016 epidemic of Ebola virus disease occurred in a region with a recent history of civil war, unstable health systems, and widespread poverty. Despite these contextual challenges, the national Ebola response in Liberia controlled transmission under strong leadership that was able to rapidly coordinate activities, to manage local and international players, and to adapt upon recognizing missteps. Such leadership has persisted to improve public health capacity in post-Ebola Liberia. This article highlights the progress made toward developing a resilient health security system with capacity to prevent, detect, and respond to disease threats before they reach epidemic level. In particular, Liberia's development of a Global Health Security Agenda roadmap, a Joint External Evaluation (JEE) report for International Health Regulation (2005) core capacities, and recent establishment of a National Public Health Institute are described. To better protect the country's population and the greater global community from health threats, emerging institutions and policies in Liberia will depend on leadership and governance that draws from the successes and lessons learned during the Ebola outbreak. The author provides insight based on his role as incident manager of Liberia's Ebola response.

  19. Customer focused incident monitoring in anaesthesia.

    Science.gov (United States)

    Khan, F A; Khimani, S

    2007-06-01

    The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external customers. Only 30% of the complaints came from the operating room. Thirty-four per cent of all incidents related to communication, behaviour and delay in service. A requirement to teach communication skills and stress handling formally in anaesthesia training programmes, and at the time of induction of staff into the department, has been identified.

  20. Traffic Incident Clearance Time and Arrival Time Prediction Based on Hazard Models

    Directory of Open Access Journals (Sweden)

    Yang beibei Ji

    2014-01-01

    Full Text Available Accurate prediction of incident duration is not only important information of Traffic Incident Management System, but also an effective input for travel time prediction. In this paper, the hazard based prediction models are developed for both incident clearance time and arrival time. The data are obtained from the Queensland Department of Transport and Main Roads’ STREAMS Incident Management System (SIMS for one year ending in November 2010. The best fitting distributions are drawn for both clearance and arrival time for 3 types of incident: crash, stationary vehicle, and hazard. The results show that Gamma, Log-logistic, and Weibull are the best fit for crash, stationary vehicle, and hazard incident, respectively. The obvious impact factors are given for crash clearance time and arrival time. The quantitative influences for crash and hazard incident are presented for both clearance and arrival. The model accuracy is analyzed at the end.

  1. Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management

    DEFF Research Database (Denmark)

    Gagnon, David J; Nielsen, Niklas; Fraser, Gilles L

    2015-01-01

    INTRODUCTION: Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development...... of pneumonia in that population. METHODS: We conducted a retrospective cohort study comparing patients treated with PRO to those not receiving PRO (no-PRO) using Northern Hypothermia Network registry data. Cardiac arrest survivors ≥ 18 years of age with a GCS...-34 °C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome. RESULTS: 416 of 1240 patients (33.5%) received PRO. Groups were...

  2. Sports Related Injuries: Incidence, Management and Prevention

    OpenAIRE

    Stanger, Michael A.

    1982-01-01

    The incidence of injury related to various sports is reviewed according to sport, area of injury, number of participants and hours per week spent at the sport. Organized sports accounted for fewer injuries than unsupervised recreational activities like tree climbing, skateboarding and running. The knee is the most commonly injured site. Sensitivity to patients' commitment to their sport is necessary: sometimes instead of rest, they can substitute a less hazardous form of exercise. Principles ...

  3. An incident command system in practice and reality

    International Nuclear Information System (INIS)

    Spitzer, J.D.

    1992-01-01

    The basic organizational problems and options for forming a pollution response organization are described. Problems with multi-agency response organizations include poor coordination and lack of accountability. Alternatives to autonomous organizations operating with minimal coordination are the multi-agency/organization teams working under a controlling organization, and organizations formed into a single response organization (the incident command system or ICS). Design criteria for an ICS include flexibility as to the jurisdiction and agency, adaptable organizational structure, capability to expand in a logical manner, and uniform elements in terminology, organization, and procedures. ICS in practice is illustrated both by the CANUSLAK exercise undertaken in August 1990 and a real incident that occurred several days after the exercise was finished. CANUSLAK involved the US Coast Guard and its Canadian and Michigan counterparts in a simulated incident in the St. Clair river. The real incident was the explosion of the gasoline-carrying tank vessel Jupiter in the Saginaw River. In both instances, ICS combined many organizations into one team with a single incident commander. The eight basic components of ICS are common terminology, modular organization, integrated communications, unified command structure, consolidated action plan, manageable span of control, designated incident facilities, and comprehensive resource management. ICS has been tailored to a wide range of applications and is not only used in major disasters but as a part of routine operations. 18 refs., 5 figs

  4. State Methods for a Cyber Incident

    Science.gov (United States)

    2012-03-01

    Glossary S905 - Incident Submission and Response Standard S910 - Data Breach Notification Standard E-5 Our state characterizes information system...Office of Management and Budget. (2011a). Legislative Language Data Breach Notification. Retrieved September 20, 2010, from http://www.whitehouse.gov...sites/default/files/omb/legislative/letters/ data - breach -notification.pdf Executive Office of the President. Office of Management and Budget

  5. Decision-support information system to manage mass casualty incidents at a level 1 trauma center.

    Science.gov (United States)

    Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

    2013-12-01

    Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events.

  6. Critical incidents in headteachers’ professional paths

    Directory of Open Access Journals (Sweden)

    Jurema Silvia de Souza Alves

    2015-11-01

    Full Text Available School management is considered one of the greatest challenges in achieving quality standards in contemporary education. Understanding the path of its main protagonist, the manager, living in a time and context that is different from those in which he/she acts, is essential to guide continued career management as well as to re-advise the initial career of teachersand future managers. In order to contribute to this knowledge, we present the result of a biographical-narrative research project that seeks to identify the critical incidents present in the professional lives of school managers from a medium-sized municipality in São Paulo state, Brazil. The answers to a questionnaire made it possible to characterize 25 managers, 32 of which being from school units in the city, and to select nine for interview. The interviews, which were transcribed and organized into biograms, showed that these professionals, mostly women, unlike the men surveyed, did not direct their careers to a role in management. Most of the regular critical incidents on their professional paths refer to the influence of supervisors who recommended them or encouraged them to study for admission tests related to management; the birth of their children, which motivated them to progress in their careers and/or promoting a break for future investment; their initial training, for many the Faculty of Education, was considered by participants as being insufficient for a role in management. It is considered that the career in management must be intensified as a continued career and be revised/altered from its initial background, so that managing activities correspond to the objectives of a high quality education.

  7. Analysis of a radiological incident and lessons to be learned: a case of industrial radiographic incident in great Britain

    International Nuclear Information System (INIS)

    Croft, J.; Lefaure, Ch.

    2000-01-01

    This note describes a case study to provide feedback analysis and lessons to be learned from a radiological incident. This one occurred in the UK. It has been published in the European ALARA Newsletter no. 2 (January 1997) and has been selected from the IRID database (Ionising Radiation Incident Database) managed by the Health and Safety Executive, National Radiological Protection Board and Environmental Agency. (authors)

  8. Risk assessment of several incidents in nuclear waste management facilities

    International Nuclear Information System (INIS)

    Buetow, E.; Memmert, G.; Storck, R.; Weymann, J.; Matthies, M.; Vogt, K.J.

    1981-01-01

    Regarding surface facilities two incidents of MAVA (failure of the filter in the exhaust gas system, fire in the bituminization system) and one incident in the Krypton storage and regarding underground systems the water inlet in the pit building have been evaluated. According to the calculations only the two nuclides Tc-99 and J-129 can involve a considerable exposure. The barrier system of overlying rocks and the pit system as a whole is largely redundant and diverse. (DG) [de

  9. Design and Testing of BACRA, a Web-Based Tool for Middle Managers at Health Care Facilities to Lead the Search for Solutions to Patient Safety Incidents

    Science.gov (United States)

    Mira, José Joaquín; Vicente, Maria Asuncion; Fernandez, Cesar; Guilabert, Mercedes; Ferrús, Lena; Zavala, Elena; Silvestre, Carmen; Pérez-Pérez, Pastora

    2016-01-01

    Background Lack of time, lack of familiarity with root cause analysis, or suspicion that the reporting may result in negative consequences hinder involvement in the analysis of safety incidents and the search for preventive actions that can improve patient safety. Objective The aim was develop a tool that enables hospitals and primary care professionals to immediately analyze the causes of incidents and to propose and implement measures intended to prevent their recurrence. Methods The design of the Web-based tool (BACRA) considered research on the barriers for reporting, review of incident analysis tools, and the experience of eight managers from the field of patient safety. BACRA’s design was improved in successive versions (BACRA v1.1 and BACRA v1.2) based on feedback from 86 middle managers. BACRA v1.1 was used by 13 frontline professionals to analyze incidents of safety; 59 professionals used BACRA v1.2 and assessed the respective usefulness and ease of use of both versions. Results BACRA contains seven tabs that guide the user through the process of analyzing a safety incident and proposing preventive actions for similar future incidents. BACRA does not identify the person completing each analysis since the password introduced to hide said analysis only is linked to the information concerning the incident and not to any personal data. The tool was used by 72 professionals from hospitals and primary care centers. BACRA v1.2 was assessed more favorably than BACRA v1.1, both in terms of its usefulness (z=2.2, P=.03) and its ease of use (z=3.0, P=.003). Conclusions BACRA helps to analyze incidents of safety and to propose preventive actions. BACRA guarantees anonymity of the analysis and reduces the reluctance of professionals to carry out this task. BACRA is useful and easy to use. PMID:27678308

  10. Design and Testing of BACRA, a Web-Based Tool for Middle Managers at Health Care Facilities to Lead the Search for Solutions to Patient Safety Incidents.

    Science.gov (United States)

    Carrillo, Irene; Mira, José Joaquín; Vicente, Maria Asuncion; Fernandez, Cesar; Guilabert, Mercedes; Ferrús, Lena; Zavala, Elena; Silvestre, Carmen; Pérez-Pérez, Pastora

    2016-09-27

    Lack of time, lack of familiarity with root cause analysis, or suspicion that the reporting may result in negative consequences hinder involvement in the analysis of safety incidents and the search for preventive actions that can improve patient safety. The aim was develop a tool that enables hospitals and primary care professionals to immediately analyze the causes of incidents and to propose and implement measures intended to prevent their recurrence. The design of the Web-based tool (BACRA) considered research on the barriers for reporting, review of incident analysis tools, and the experience of eight managers from the field of patient safety. BACRA's design was improved in successive versions (BACRA v1.1 and BACRA v1.2) based on feedback from 86 middle managers. BACRA v1.1 was used by 13 frontline professionals to analyze incidents of safety; 59 professionals used BACRA v1.2 and assessed the respective usefulness and ease of use of both versions. BACRA contains seven tabs that guide the user through the process of analyzing a safety incident and proposing preventive actions for similar future incidents. BACRA does not identify the person completing each analysis since the password introduced to hide said analysis only is linked to the information concerning the incident and not to any personal data. The tool was used by 72 professionals from hospitals and primary care centers. BACRA v1.2 was assessed more favorably than BACRA v1.1, both in terms of its usefulness (z=2.2, P=.03) and its ease of use (z=3.0, P=.003). BACRA helps to analyze incidents of safety and to propose preventive actions. BACRA guarantees anonymity of the analysis and reduces the reluctance of professionals to carry out this task. BACRA is useful and easy to use.

  11. Review article: A systematic review of emergency department incident classification frameworks.

    Science.gov (United States)

    Murray, Matthew; McCarthy, Sally

    2017-10-11

    As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. What have we learned about intelligent transportation systems? Chapter 2, What have we learned about freeway incident and emergency management and electronic toll collection?

    Science.gov (United States)

    2000-12-01

    The intelligent infrastructure is often the most visible manifestation of intelligent transportation systems (ITS) along with roads, freeways, and incident management is often among the first ITS elements implemented. They can significantly contribut...

  13. Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

    Science.gov (United States)

    2012-01-01

    Background Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. Methods The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. Results During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as ‘high risk’ work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury – there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. Conclusions Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical

  14. Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

    Directory of Open Access Journals (Sweden)

    Cashmore Aaron W

    2012-08-01

    Full Text Available Abstract Background Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. Methods The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. Results During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71% was more common than physical abuse (29%. The most (44% incidents of workplace violence (including both verbal and physical abuse occurred in adult male prisons, although the most (50% incidents of physical abuse occurred in a forensic hospital. Most (90% of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as ‘high risk’ work duties for verbal abuse and physical abuse, respectively. Most (93% of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46% or low (52% Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury – there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%. Few (6% victims of verbal abuse sought help from a health professional. Conclusions Among employees of a large correctional health service, verbal abuse in the workplace was substantially more

  15. Dyslexic entrepreneurs: the incidence; their coping strategies and their business skills.

    Science.gov (United States)

    Logan, Julie

    2009-11-01

    This comparative study explores the incidence of dyslexia in entrepreneurs, corporate managers and the general population. It examines the suggestion that dyslexic entrepreneurs develop coping strategies to manage their weaknesses, which are subsequently of benefit in the new venture creation process. Results of this study suggest that there is a significantly higher incidence of dyslexia in entrepreneurs than in the corporate management and general US and UK populations and some of the strategies they adopt to overcome dyslexia (such as delegation of tasks) may be useful in business. The study was undertaken in two parts. First, entrepreneurs and corporate managers completed an online questionnaire, which combined questions about their company, their management or leadership role and their business skills together with questions that were designed to explore the likely incidence of dyslexia. A follow-up study that made use of a semi-structured questionnaire explored business issues and educational experience in more depth with those who had been diagnosed as dyslexic and those who did not have any history of dyslexia or any other learning difficulty.

  16. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

    NARCIS (Netherlands)

    Berger, Ferco H.; Körner, Markus; Bernstein, Mark P.; Sodickson, Aaron D.; Beenen, Ludo F.; McLaughlin, Patrick D.; Kool, Digna R.; Bilow, Ronald M.

    2016-01-01

    In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior

  17. Acute Appendicitis: Incidence and Management in Nigeria | Alatise ...

    African Journals Online (AJOL)

    Appendicitis is the leading cause of surgical emergency admission in most hospital in Nigeria. It accounts for about 15-40% of all emergency surgery done in most centers in the country. All age groups can develop the disease including the fetus in utero, but the incidence is higher in the second and third decade of life.

  18. Clinical review: Bleeding - a notable complication of treatment in patients with acute coronary syndromes: incidence, predictors, classification, impact on prognosis, and management

    Science.gov (United States)

    2013-01-01

    This article focuses on the incidence, predictors, classification, impact on prognosis, and management of bleeding associated with the treatment of acute coronary syndrome. The issue of bleeding complications is related to the continual improvement of ischemic heart disease treatment, which involves mainly (a) the widespread use of coronary angiography, (b) developments in percutaneous coronary interventions, and (c) the introduction of new antithrombotics. Bleeding has become an important health and economic problem and has an incidence of 2.0% to 17%. Bleeding significantly influences both the short- and long-term prognoses. If a group of patients at higher risk of bleeding complications can be identified according to known risk factors and a risk scoring system can be developed, we may focus more on preventive measures that should help us to reduce the incidence of bleeding. PMID:24093465

  19. Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management.

    Science.gov (United States)

    Zantomio, D; Grigg, A P; MacGregor, L; Panek-Hudson, Y; Szer, J; Ayton, R

    2006-10-01

    Female genital tract graft-versus-host disease (GVHD) is an under-recognized complication of allogeneic stem cell transplantation impacting on quality of life. We describe a prospective surveillance programme for female genital GVHD to better characterize incidence, risk factors and clinical features and the impact of a structured intervention policy. A retrospective audit was conducted on the medical records of all female transplant recipients surviving at least 6 months at a single centre over a 5-year period. Patients commenced topical vaginal oestrogen early post transplant with hormone replacement as appropriate for age, prior menopausal status and co-morbidities. A genital tract management programme included regular gynaecological review and self-maintenance of vaginal capacity by dilator or intercourse. The incidence of genital GVHD was 35% (95% confidence interval (CI) (25, 50%)) at 1 year and 49% (95% CI (36, 63%)) at 2 years. Topical therapy was effective in most cases; no patient required surgical intervention to divide vaginal adhesions. The main risk factor was stem cell source with peripheral blood progenitor cells posing a higher risk than marrow (hazard ratio=3.07 (1.22, 7.73), P=0.017). Extensive GVHD in other organs was a common association. We conclude that female genital GVHD is common, and early detection and commencement of topical immunosuppression with dilator use appears to be highly effective at preventing progression.

  20. Appraisal of snakebite incidence and mortality in Bolivia.

    Science.gov (United States)

    Chippaux, Jean-Philippe; Postigo, Jorge R

    2014-06-01

    No information has been yet published on snakebite in Bolivia. The country includes very different ecological situations leading to various epidemiological risks. A study has been carried out to evaluate the incidence and location of snakebite, particularly in relation with altitude, in order to improve management. Investigations on snakebite epidemiology were based on a) cases treated in health facilities as reported by health authorities and b) household surveys carried out in areas with high variations of altitude, in various regions of Bolivia. An average of 700 bites was treated each year in Bolivia (national annual incidence = 8 bites per 100,000 people) with a great disparity between districts. Household surveys showed annual incidences ranged from 30 to 110 bites per 100,000 inhabitants depending on location. Annual mortality ranged 0.1-3.9 per 100,000 people. A significant and constant inverse correlation was shown between snakebite incidence and altitude, which may be explained by both snake and human distributions and activities. Notification of snakebite is useful for improving patient management and informing antivenom distribution. It should also involve the report of deaths and clinical details of envenomation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Effects of plant conduction systems and organic fertilizer management on disease incidence and severity in ‘Osiana’ and ‘Carola’ roses

    Directory of Open Access Journals (Sweden)

    Márcia de Nazaré Oliveira Ribeiro

    2015-04-01

    Full Text Available Conventional pruning is a very common practice for pruning rose cultivars in Brazil. However, few Brazilian producers known any other efficient plant training method for roses, namely “lateral stem bending” or “arching technique”, which involves bending the branches of the rosebush in order to increase the photosynthetic rate of the plant. As well as plant training, the use of fertilizers must also be done carefully in order to obtain high quality roses. Biofertilizers are recommended because of their multiple effects: fertilizer, protein synthesis stimulant, insect repellent, and disease controller. The aim of this study was to assess the plant training system and management of organic fertilizer on the incidence and severity of disease in the ‘Osiana’ and ‘Carola’ roses. The ‘Osiana’ rosebushes received three concentrations (0%, 5%, and 15% of foliar biofertilizer applied monthly to the leaves together with two plant conduction methods (conventional pruning and lateral stem bending. ‘Carola’ roses were treated with three types of fertilizer (chemical fertilizer on the soil + bokashi on the soil, chemical fertilizer on the soil + foliar FishfertilÒand chemical fertilization on the soil without applying organic fertilizers every two weeks, together with 2 plant conduction systems (conventional pruning and lateral stem bending. The additional treatments in ‘Carola’ roses were composed of two organic fertilizers (Bokashi and foliar Fishfertil® and chemical fertilization with lateral pruning. The incidence and severity of disease in these plants during the experiment were assessed over 5 months. For the ‘Osiana’ rose, the incidence and severity of disease were not influenced by fertilizer management or plant training methods. For the ‘Carola’ roses, the different types of fertilizer caused different responses according to the plant training system used, with the biofertilizer Fishfertil® reducing the incidence

  2. Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation.

    Science.gov (United States)

    Piacentino, Massimo; Pilleri, Manuela; Bartolomei, Luigi

    2011-12-01

    Device-related infection is a common occurrence after deep brain stimulation (DBS) surgery, and may result in additional interventions and a loss of efficacy of therapy. This retrospective review aimed to evaluate the incidence, severity and management of device-related infections in 212 DBS procedures performed in our institute. Data on 106 patients, in whom 212 DBS procedures were performed between 2001 and 2011 at our institute by a single neurosurgeon (M.P.), were reviewed to assess the incidence, severity, management and clinical characteristics of infections in the first year after the implantation of a DBS system. Infections occurred in 8.5% of patients and 4.2% of procedures. Of the nine infections, eight involved the neurostimulator and extensions, and one the whole system. The infections occurred 30.7 days after implantation: 7 within 30 days and 2 within 6 months. Infected and uninfected patients were comparable in terms of age, sex, indication for DBS implantation and neurostimulator location. In eight cases, the system components involved were removed and re-implanted after 3 months, while in one case the complete hardware was removed and not re-implanted. The overall incidence of postoperative infections after DBS system implantation was 4.2%; this rate decreased over time. All infections required further surgery. Correct and timely management of partial infections may result in successful salvage of part of the system.

  3. Trends in the incidence, clinical presentation, and management of traumatic rupture of the corpus cavernosum.

    Science.gov (United States)

    Ekwere, Paul D; Al Rashid, Mohammed

    2004-02-01

    Recent observations in our hospital of apparent increase in frequency prompted a revisit to the subject of fracture of penis. In a retrospective review, patients' age, marital status, and causal activities; clinical presentations; methods of management; operative findings; and postoperative complications were analyzed for changing trends. Literature was also reviewed briefly. Nineteen episodes of penile fracture in 18 patients exceed the previous incidence by more than 58%. Most were due to noncoital causes (73.7%); more unmarried people (31.6%) were affected. Most presented with the classic symptoms/signs, and tears were repaired by degloving through subcoronal incisions; one was treated conservatively. The higher morbidity observed was attributed to higher rates of hematoma and wound infections, probably enhanced by poor hemostasis and early persistent, postoperative erections. Painful erections, painful coitus, and deformities, however subsided within weeks, with no long-term ill effects. The incidence of penile fracture, postoperative hematoma, and infections has increased; about 32% of the patients were unmarried. The prominence of masturbation as a cause of penile fracture and increased ratio of noncoital to coital causes are highlighted. Degloving through subcoronal incisions remains an acceptable method of approach for repair in line with cultural practices in Saudi Arabia.

  4. Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States.

    Science.gov (United States)

    Suskind, Anne M; Saigal, Christopher S; Hanley, Janet M; Lai, Julie; Setodji, Claude M; Clemens, J Quentin

    2016-04-01

    To determine the incidence and characteristics of women with uncomplicated recurrent urinary tract infections (UTIs) and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Using MarketScan claims from 2003 to 2011, we identified UTI-naive women ages 18-64 with incident-uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (eg, abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy, and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. We identified 48,283 women with incident-uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18-34 and 55-64. Sixty-one percent of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of intravenous antibiotic use, whereas demonstrating higher rates of UTI-related office visits and pyelonephritis. The incidence of uncomplicated recurrent UTIs increases with age. Urine culture-directed care is beneficial in reducing high-cost services including UTI-related hospitalizations and intravenous antibiotic use, making urine cultures a valuable component to management of these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Manual handling incident claims in the healthcare sector: Factors and outcomes.

    Science.gov (United States)

    Dockrell, Sara; Johnson, Muriel; Ganly, Joe; Bennett, Kathleen

    2011-01-01

    Manual handling (MH) incidents may result in injury, absenteeism and/or compensation claim. This study investigated the factors associated with MH incidents among healthcare workers who had made a claim, and the management and outcome of those workers. A national sample of healthcare sector MH incident claim files (n=247) were accessed and 35~files met the inclusion criteria. Data were collected and presented graphically or descriptively using percentages (and 95% Confidence intervals, CI). Chi-square (χ2) tests were used for comparing proportions between groups. SPSS (v14.0) was used for analysis. Significance at p 52 weeks. Only 58% (49%, 65%) returned to work. Claimants who had been in communication with employers were significantly more likely to return to work than those who did not (χ2 test, p=0.017). Improved management of MH incidents and injured workers are recommended.

  6. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Directory of Open Access Journals (Sweden)

    Jamie E McFadden-Hiller

    Full Text Available Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents. We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula, primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99, with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping

  7. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Science.gov (United States)

    McFadden-Hiller, Jamie E; Beyer, Dean E; Belant, Jerrold L

    2016-01-01

    Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents). We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula), primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC) to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99), with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping techniques to

  8. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  9. Lessons learned from process incident databases and the process safety incident database (PSID) approach sponsored by the Center for Chemical Process Safety

    International Nuclear Information System (INIS)

    Sepeda, Adrian L.

    2006-01-01

    Learning from the experiences of others has long been recognized as a valued and relatively painless process. In the world of process safety, this learning method is an essential tool since industry has neither the time and resources nor the willingness to experience an incident before taking corrective or preventative steps. This paper examines the need for and value of process safety incident databases that collect incidents of high learning value and structure them so that needed information can be easily and quickly extracted. It also explores how they might be used to prevent incidents by increasing awareness and by being a tool for conducting PHAs and incident investigations. The paper then discusses how the CCPS PSID meets those requirements, how PSID is structured and managed, and its attributes and features

  10. IMPLEMENTATION OF INCIDENT DETECTION ALGORITHM BASED ON FUZZY LOGIC IN PTV VISSIM

    Directory of Open Access Journals (Sweden)

    Andrey Borisovich Nikolaev

    2017-05-01

    Full Text Available Traffic incident management is a major challenge in the management of movement, requiring constant attention and significant investment, as well as fast and accurate solutions in order to re-establish normal traffic conditions. Automatic control methods are becoming an important factor for the reduction of traffic congestion caused by an arising incident. In this paper, the algorithm of automatic detection incident based on fuzzy logic is implemented in the software PTV VISSIM. 9 different types of tests were conducted on the two lane road section segment with changing traffic conditions: the location of the road accident, loading of traffic. The main conclusion of the research is that the proposed algorithm for the incidents detection demonstrates good performance in the time of detection and false alarms

  11. The relationship between the implementation of voluntary Five-Star occupational health and safety management system and the incidence of fatal and permanently disabling injury

    DEFF Research Database (Denmark)

    Hedlund, Frank Huess

    2014-01-01

    This paper examines two properties of the South African NOSA 5-Star System, a voluntary occupational health and safety (OHS) management system. The first property is the association between system implementation and final OHS outcomes measured as incidence rates of fatal and permanently disabling...... of their positive impact on OHS. It is clear though, that such systems cannot substitute authority enforcement activities.......This paper examines two properties of the South African NOSA 5-Star System, a voluntary occupational health and safety (OHS) management system. The first property is the association between system implementation and final OHS outcomes measured as incidence rates of fatal and permanently disabling...... injury. The second is the association between the Star audit rating and rates of serious occupational injury. Although there are many uncertainties involved the paper argues that companies committed to the NOSA system experienced fewer fatal and permanently disabling injuries than the general...

  12. Incident Command System - Environmental Unit responsibilities

    International Nuclear Information System (INIS)

    Hillman, S. O.

    1997-01-01

    The Incident Command System (ICS) for crisis management, used for response to oil spills by the Alyeska Pipeline Service Company throughout its facilities, including the Trans Alaska Pipeline and the Valdez Marine Terminal, was described. Special attention was given to the Environmental Unit within the ICS which functions as a primary support unit for the Incident Operations Section. Details of the Unit's function were provided. These include the collection, evaluation and dissemination of information on all environmental issues concerning the crisis, provision of advice and direction on environmental aspects, and up-front agency interaction. A checklist of tasks is included. 7 refs

  13. Qualitative analysis of factors leading to clinical incidents.

    Science.gov (United States)

    Smith, Matthew D; Birch, Julian D; Renshaw, Mark; Ottewill, Melanie

    2013-01-01

    The purpose of this paper is to evaluate the common themes leading or contributing to clinical incidents in a UK teaching hospital. A root-cause analysis was conducted on patient safety incidents. Commonly occurring root causes and contributing factors were collected and correlated with incident timing and severity. In total, 65 root-cause analyses were reviewed, highlighting 202 factors implicated in the clinical incidents and 69 categories were identified. The 14 most commonly occurring causes (encountered in four incidents or more) were examined as a key-root or contributory cause. Incident timing was also analysed; common factors were encountered more frequently during out-hours--occurring as contributory rather than a key-root cause. In total, 14 commonly occurring factors were identified to direct interventions that could prevent many clinical incidents. From these, an "Organisational Safety Checklist" was developed to involve departmental level clinicians to monitor practice. This study demonstrates that comprehensively investigating incidents highlights common factors that can be addressed at a local level. Resilience against clinical incidents is low during out-of-hours periods, where factors such as lower staffing levels and poor service provision allows problems to escalate and become clinical incidents, which adds to the literature regarding out-of-hours care provision and should prove useful to those organising hospital services at departmental and management levels.

  14. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael B.; Dappa, Evelyn; Jungmann, Florian; Kloeckner, Roman; Schotten, Sebastian; Wirth, Gesine M.; Mildenberger, Peter; Kreitner, Karl-Friedrich; Oberholzer, Katja; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Mittler, Jens; Lang, Hauke [University Hospital of Mainz, Department of Abdominal, Visceral and Transplantation Surgery, Mainz (Germany)

    2015-07-15

    To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. (orig.)

  15. Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.

    Science.gov (United States)

    Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa

    2014-01-01

    Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

  16. FEMA's Earthquake Incident Journal: A Web-Based Data Integration and Decision Support Tool for Emergency Management

    Science.gov (United States)

    Jones, M.; Pitts, R.

    2017-12-01

    For emergency managers, government officials, and others who must respond to rapidly changing natural disasters, timely access to detailed information related to affected terrain, population and infrastructure is critical for planning, response and recovery operations. Accessing, analyzing and disseminating such disparate information in near real-time are critical decision support components. However, finding a way to handle a variety of informative yet complex datasets poses a challenge when preparing for and responding to disasters. Here, we discuss the implementation of a web-based data integration and decision support tool for earthquakes developed by the Federal Emergency Management Agency (FEMA) as a solution to some of these challenges. While earthquakes are among the most well- monitored and measured of natural hazards, the spatially broad impacts of shaking, ground deformation, landslides, liquefaction, and even tsunamis, are extremely difficult to quantify without accelerated access to data, modeling, and analytics. This web-based application, deemed the "Earthquake Incident Journal", provides real-time access to authoritative and event-specific data from external (e.g. US Geological Survey, NASA, state and local governments, etc.) and internal (FEMA) data sources. The journal includes a GIS-based model for exposure analytics, allowing FEMA to assess the severity of an event, estimate impacts to structures and population in near real-time, and then apply planning factors to exposure estimates to answer questions such as: What geographic areas are impacted? Will federal support be needed? What resources are needed to support survivors? And which infrastructure elements or essential facilities are threatened? This presentation reviews the development of the Earthquake Incident Journal, detailing the data integration solutions, the methodology behind the GIS-based automated exposure model, and the planning factors as well as other analytical advances that

  17. Managing the risks of risk management on large fires

    Science.gov (United States)

    Donald G. MacGregor; Armando González-Cabán

    2013-01-01

    Large fires pose risks to a number of important values, including the ecology, property and the lives of incident responders. A relatively unstudied aspect of fire management is the risks to which incident managers are exposed due to organizational and sociopolitical factors that put them in a position of, for example, potential liability or degradation of their image...

  18. The Incidence, Classification, and Management of Acute Adverse Reactions to the Low-Osmolar Iodinated Contrast Media Isovue and Ultravist in Contrast-Enhanced Computed Tomography Scanning.

    Science.gov (United States)

    Zhang, Bin; Dong, Yuhao; Liang, Long; Lian, Zhouyang; Liu, Jing; Luo, Xiaoning; Chen, Wenbo; Li, Xinyu; Liang, Changhong; Zhang, Shuixing

    2016-03-01

    Some epidemiologic surveillance studies have recorded adverse drug reactions to radiocontrast agents. We aimed to investigate the incidence and management of acute adverse reactions (AARs) to Ultravist-370 and Isovue-370 in patients who underwent contrast-enhanced computed tomography (CT) scanning.Data from 137,473 patients were analyzed. They had undergone enhanced CT scanning with intravenous injection of Ultravist-370 or Isovue-370 during the period of January 1, 2006 to December 31, 2012 in our hospital. We investigated and classified AARs according to the American College of Radiology and the Chinese Society of Radiology (CSR) guidelines for iodinated contrast media. We analyzed risk factors for AARs and compared the AARs induced by Ultravist-370 and Isovue-370.Four hundred and twenty-eight (0.31%) patients experienced AARs, which included 330 (0.24%) patients with mild AARs, 82 (0.06%) patients with moderate AARs, and 16 (0.01%) patients with severe AARs (including 3 cases of cardiac arrest and one case of death). The incidence of AARs was higher with Ultravist-370 than with Isovue-370 (0.38% vs 0.24%, P management, the symptoms and signs of 96.5% of the AARs resolved within 24 hours without sequelae.Ultravist-370 and Isovue-370 are safe for patients undergoing enhanced CT scanning. The incidence of AARs is higher with Ultravist-370 than with Isovue-370, but this difference is limited only to the mild AARs. The incidence of AARs could be affected by multiple factors.

  19. Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions

    Directory of Open Access Journals (Sweden)

    Maria Isabel do Nascimento

    2014-03-01

    Full Text Available OBJECTIVE: To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death (IUFD, and clinical management to anticipate the childbirth. METHODS: It was a retrospective cohort study with 163 mothers with IUFD, at the second half of pregnancy, who were managed to anticipate childbirth using pharmacological preparations and/or a mechanical method (Foley catheter in a teaching hospital in Rio de Janeiro State, Brazil. Cox regression was used to evaluate the effect of the clinical methods on the kind of delivery. RESULTS: The Subgroups A (misoprostol or Oxytocin, B (misoprostol and Oxytocin, and C (Foley catheter alone or combined with misoprostol and/or Oxytocin were formed according to the applied methods. Nine out of 163 cases ended with cesarean section. The incidence of cesarean section was 3.5 per 1,000 people-hours, meaning that a pregnant woman with IUFD had a 15.6% risk of cesarean section during the first 48 hours of clinical management to anticipate childbirth. The conditions significantly associated with the mode of delivery were placental abruption (HR: 44.97, having two or more previous cesarean deliveries (HR: 10.03, and mechanical method with Foley catheter (HR: 5.01. CONCLUSION: Cesarean section was an essential conduct in this cohort and followed previous cesarean delivery and placental abruption. The effect of the mechanical method on the abdominal route suggests that the Foley catheter method was used in the most difficult cases and that the surgery was performed to ensure maternal health.

  20. Surveillance of Otitis Media With Effusion in Thai Children With Cleft Palate: Cumulative Incidence and Outcome of the Management.

    Science.gov (United States)

    Ungkanont, Kitirat; Boonyabut, Panrasee; Komoltri, Chulaluk; Tanphaichitr, Archwin; Vathanophas, Vannipa

    2018-04-01

    To study the incidence and outcome of management of otitis media with effusion in Thai children with cleft palate. Retrospective cohort study in the tertiary care center. Ninety-five children with cleft palate were referred for ear evaluation, from June 1997 to January 2015. Fifteen children (15.8%) had associated craniofacial syndromic anomalies. Cumulative incidence of otitis media with effusion, rate of ventilation tube insertion, duration of indwelling tubes, hearing outcome, and complications of ventilation tubes. Ear examinations were done every 8 to 12 weeks throughout the study. Cumulative incidence of otitis media with effusion was 53.7% in children within 12 months of age and 81.1% within 24 months of age. At the end of the study, all of the patients had at least 1 episode of otitis media with effusion. Eighty-eight children (92.6%) had palatoplasty, and there was no significant difference in the incidence of otitis media before and after palatoplasty. The mean hearing level at recruitment was 40.8 ±18.4 dB. Ventilation tube insertion was done in 76 patients (80%). The median time for indwelling tubes was 11.7 months. Rate of ventilation tube insertion was 0.5/year. The mean hearing level at last follow-up was 23.5 ± 14 dB. Otorrhea through tube was found in 24 cases (31.6%). Otitis media with effusion was common in Thai children with cleft palate. Surveillance of middle ear effusion and ventilation tube insertion contributed to a favorable hearing outcome.

  1. reputation Risks through Information Security Incidents

    Directory of Open Access Journals (Sweden)

    Vitaly Eduardovich Dorokhov

    2014-05-01

    Full Text Available The article deals with accounting reputational risks arising through information security breaches in the management of a business entity. Security breach incidents which results to the loss of reputation are identified. Based on this analysis the definition of reputational risk in information security is given.

  2. Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack.

    Science.gov (United States)

    Bloch, Yuval H; Leiba, Adi; Veaacnin, Nurit; Paizer, Yohanan; Schwartz, Dagan; Kraskas, Ahuva; Weiss, Gali; Goldberg, Avishay; Bar-Dayan, Yaron

    2007-01-01

    Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to

  3. Constitution of an incident database suited to statistical analysis and examples

    International Nuclear Information System (INIS)

    Verpeaux, J.L.

    1990-01-01

    The Nuclear Protection and Safety Institute (IPSN) has set up and is developing an incidents database, which is used for the management and analysis of incidents encountered in French PWR plants. IPSN has already carried out several incidents or safety important events statistical analysis, and is improving its database on the basis of the experience it gained from this various studies. A description of the analysis method and of the developed database is presented

  4. Spatial-Temporal Hotspot Pattern Analysis of Provincial Environmental Pollution Incidents and Related Regional Sustainable Management in China in the Period 1995–2012

    Directory of Open Access Journals (Sweden)

    Lei Ding

    2015-10-01

    Full Text Available Spatial-temporal hotspot pattern analysis of environmental pollution incidents provides an indispensable source of information for the further development of incident prevention measures. In this study, the spatial-temporal patterns of environmental pollution incidents in China in the period of 1995–2012 were analyzed, using the Spatial Getis-Ord statistic and an Improved Prediction Accuracy Index (IAPI. The results show that, in this period, the occurrence of environmental incidents exhibited a dynamic growth pattern but then dropped and continued to drop after the year 2006, which was considered a crucial turning point. Not coincidentally, this corresponds to the year when the State Council issued its National Environmental Emergency Plan, and following the examination of major incidents, special actions were taken to strengthen the control of incidents and emergency responses. The results from Getis-Ord General G statistical analysis show that the spatial agglomeration phenomenon was statistically significant after 1999 and that the level of spatial agglomeration was rising, while the Getis-Ord Gi* statistical analysis reveals that environmental pollution incidents were mainly agglomerated in the Pan Yangtze River Delta and Pan Pearl River Delta regions. Accordingly, the spatial-temporal hotspot pattern based on the IAPI values at the provincial scale could be categorized into: stable hotspots, unstable hotspots, and cold-spot areas. The stable hotspots category was further divided into three subtypes: industrial distribution type, industrial transfer type, and extensive economic growth type. Finally, the corresponding measures for sustainable management were proposed: stable hotspots were classified as essential regions requiring the immediate prevention and control of environmental pollution incidents; unstable hotspots were characterized by their need for ongoing and continual prevention measures, and cold-spots were those areas that

  5. Sequelae of Endoscopic Inguinal Hernia Repair : Incidence, evaluation and management

    NARCIS (Netherlands)

    Burgmans, J.P.J.

    2015-01-01

    The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair

  6. Critical incident monitoring in anaesthesia.

    Science.gov (United States)

    Choy, Y C

    2006-12-01

    Critical incident monitoring in anaesthesia is an important tool for quality improvement and maintenance of high safety standards in anaesthetic services. It is now widely accepted as a useful quality improvement technique for reducing morbidity and mortality in anaesthesia and has become part of the many quality assurance programmes of many general hospitals under the Ministry of Health. Despite wide-spread reservations about its value, critical incident monitoring is a classical qualitative research technique which is particularly useful where problems are complex, contextual and influenced by the interaction of physical, psychological and social factors. Thus, it is well suited to be used in probing the complex factors behind human error and system failure. Human error has significant contributions to morbidities and mortalities in anaesthesia. Understanding the relationships between, errors, incidents and accidents is important for prevention and risk management to reduce harm to patients. Cardiac arrests in the operating theatre (OT) and prolonged stay in recovery, constituted the bulk of reported incidents. Cardiac arrests in OT resulted in significant mortality and involved mostly de-compensated patients and those with unstable cardiovascular functions, presenting for emergency operations. Prolonged-stay in the recovery extended period of observation for ill patients. Prolonged stay in recovery was justifiable in some cases, as these patients needed a longer period of post-operative observation until they were stable enough to return to the ward. The advantages of the relatively low cost, and the ability to provide a comprehensive body of detailed qualitative information, which can be used to develop strategies to prevent and manage existing problems and to plan further initiatives for patient safety makes critical incident monitoring a valuable tool in ensuring patient safety. The contribution of critical incident reporting to the issue of patient safety is

  7. A Retrospective Study of the Incidence of Missed Opportunities in Identifying, Managing and Referring At-Risk of Overweight and Overweight Children and Adolescents in an Outpatient Primary Care Setting

    National Research Council Canada - National Science Library

    Quirke, Amy

    2004-01-01

    A descriptive study of the incidence of missed opportunities in identifying, managing and referring children and adolescents at-risk of overweight and overweight were conducted using a retrospective...

  8. Preparedness for and response to a radiological or nuclear incident

    International Nuclear Information System (INIS)

    Norman Coleman, C.

    2014-01-01

    Public health and medical planning for a nuclear or radiological incident requires a complex, multi-faceted systematic approach involving federal, state and local governments, private sector organizations, academia, industry, international partners and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services in collaboration with other U.S. Departments is the result of efforts from government and non-government experts that connect the available capabilities, resources, guidance tools, underlying concepts and science into the Nuclear Incident Medical Enterprise (NlME). It is a systems approach that can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Experience is gained in exercises specific to radiation but also from other mass casualty incidents as there are many principles and components in common. Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by effective planning, preparation and training, timely response, clear communication, and continuous improvements based on new science, technology, experience and ideas. Recognizing that preparation for a radiological or nuclear incident will be a lower priority for healthcare workers and responders due to other demands, the Radiation Emergency Medical Management website has been developed with the National Library of Medicine. This includes tools for education and training, just-in-time medical management and triage among others. Most of the components of NIME are published in the peer review medical and disaster medicine literature to help ensure high quality and accessibility. While NIME is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is presented. (author)

  9. The discourses of incidents: Cougars on Mt. Elden and in Sabino Canyon, Arizona

    Science.gov (United States)

    Mattson, David J.; Clark, Susan G.

    2012-01-01

    Incidents are relatively short periods of intensified discourse that arise from public responses to symbolically important actions by public officials, and an important part of the conflict that increasingly surrounds state wildlife management in the West. In an effort to better understand incidents as a facet of this conflict, we analyzed the discourses of two incidents in Arizona that were precipitated by the intended removal of cougars by managers in response to public safety concerns. We used newspaper content, 1999–2007, to elucidate seminal patterns of public discourses and discourse coalitions as well as differences in discursive focus between incident periods and background periods. Cougars were mentioned in newspaper articles 13–33 times more often during incidents compared with background periods. State wildlife agency commissioners and hunters were part of a discourse coalition that advocated killing cougars to solve problems, blamed cougars and those who promoted the animals’ intrinsic value and sought to retain power to define and solve cougar-related problems. Personnel from affected state and federal agencies expressed a similar discourse. Environmentalists, animal protection activists, and some elected officials were of a coalition that defined “the problem” primarily in terms of people’s behaviors, including behaviors associated with current institutional arrangements. This discourse advocated decentralizing power over cougar management. The discourses reflected different preferences for the allocations of power and use of lethal versus non-lethal methods, which aligned with apparent core beliefs and participants’ enfranchisement or disenfranchisement by current state-level management power arrangements.

  10. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

  11. Fuzzy Algorithm for the Detection of Incidents in the Transport System

    Science.gov (United States)

    Nikolaev, Andrey B.; Sapego, Yuliya S.; Jakubovich, Anatolij N.; Berner, Leonid I.; Stroganov, Victor Yu.

    2016-01-01

    In the paper it's proposed an algorithm for the management of traffic incidents, aimed at minimizing the impact of incidents on the road traffic in general. The proposed algorithm is based on the theory of fuzzy sets and provides identification of accidents, as well as the adoption of appropriate measures to address them as soon as possible. A…

  12. The Equivalent Uniform Dose as a severity metric for radiation treatment incidents

    International Nuclear Information System (INIS)

    Dunscombe, Peter B.; Iftody, Sandra; Ploquin, Nicolas; Ekaette, Edidiong U.; Lee, Robert C.

    2007-01-01

    In allocating resources within a risk management program, ideally we would like to know both the probabilities and consequences of potential incidents. We simulate, on a treatment planning computer, several commonly reported incidents in radiation treatment and explore their consequences for the EUDs of targets and organs at risk

  13. Impact of Incidents on Traffic Congestion in Dar es Salaam City

    Directory of Open Access Journals (Sweden)

    David Mfinanga

    2013-06-01

    Full Text Available Poorly managed traffic incidents have largely contributed to congestion and delay in the city of Dar es Salaam. A thorough understanding of travel delays caused by incidents is therefore essential for effective countermeasures against the increasing congestion. The method used to determine delays in this research is based on the deterministic queuing theory. Information on incidents was obtained from traffic surveys, traffic police and road users. Counting of the number of vehicles passing the incident location was done on incident and incident-free days. The cumulative traffic counts on incident and incident-free days were then calculated and used to plot the queuing diagram used to determine incident induced delay. This method turned out to be a useful tool for estimating incident induced delay in areas with less sophisticated equipment i.e. where there are no sensors, CCTV cameras, etc. The method provided good estimates of incident induced delay which may help planners and transportation officials in better understanding incident related congestion and in selecting more effective countermeasures against incident related traffic congestion in the city. It was found out that the effects of incidents were different for the different zones, types of incidents and the periods the incident occurred. In addition to the incident duration and the number of vehicles affected, the impact of incidents also depended on availability of alternative routes, number of lanes on the road, discipline of the driver in manoeuvring at incident location and traffic control at the scene.

  14. From novice to proficient general practitioner: a critical incident study.

    Science.gov (United States)

    Sim, M G; Kamien, M; Diamond, M R

    1996-09-01

    To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident

  15. Safe management of spent radiation source

    International Nuclear Information System (INIS)

    Kosako, Toshiso; Sugiura, Nobuyuki; Valdezco, E.M.; Choi, Kwang-Sub

    2003-01-01

    Presented are 8 investigation reports concerning the safe management of spent radiation source (SRS) during the current 2 years. Four reports from Japan are: Scheme for SRS management (approach and present status of the SRS management and consideration toward solving problems); Current International Atomic Energy Agency (IAEA) activities related to safety of radiation sources (Chronology of action plan development, Outline of revised action plan, and Asian regional activities); Current status of SRS management in Japan (Regulation system, Obligations of licensed users, Regulatory system on sealed sources, Status in the incidents on sources occurred, Incident of source loss, and Incidents of orphan sources); and SRS management system in Japan (Current status of using of sealed sources, collection system of SRS-Japan Radioisotope Association (JRIA) services, and Disposal of SRS). Four reports from the Asian countries also concern the current statuses of SRS management in the Philippine (Radioactive waste sources, Waste management strategies, Conditioning of Ra sources, Ra project action plan, as low as reasonably achievable (ALARA) program, Dose assessment, Regulations on radioactive waste, Action plan on the safety and security of sources, IAEA Regional Demonstration Centers, and sitting studies for a near surface disposal facility); Thailand (Current status of using sealed sources, Inventory of SRS, and Current topics of SRS management); Indonesia (Principles of management of radiation sources, Legislative framework of SRS management practices, Regulatory on SRS, management of sealed SRS, management hurdles, and reported incidents); and Korea (Regulatory frame work, Collection systems of SRS, Radioisotope waste generation, Radiation exposure incident, and Scrap monitoring system). (N.I.)

  16. Successful emergency operations and the Incident Command System

    International Nuclear Information System (INIS)

    Montgomery, M.

    1994-01-01

    The Incident Command System (ICS) was developed to provide an ''all-risk'' system of effective emergency scene management. The Cy-Fair Volunteer Fire Department (CFVFD) has made ICS an integral part of their operations since 1987. On January 26, 1993, CFVFD was called to investigate a petroleum odor and possible spill near State Highway 6 and Jackrabbit Road in northwest Harris County. Over the next six-hour period, the dispatch center received over 100 calls an hour regarding this incident. Personnel from CFVFD, the oil company, mutual aid fire departments, and private contractors worked around the dock to successfully contain, clean and reduce the effects of a 25,000 gallon crude oil spill next to a 141-foot diameter oil storage tank at the Satsuma Station. Among the keys to success was proper use of the Incident Command System (ICS). Problems overcome included the lack of a readily available water source, limited foam supplies, time of day, and incident duration

  17. The Critical Incident Technique in Library and Information Management Research.

    Science.gov (United States)

    Fisher, Shelagh; Oulton, Tony

    1999-01-01

    Focuses on the application of the Critical Incident Technique (CIT) in three studies at the Department of Information and Communications, Manchester Metropolitan University, United Kingdom. Examines staff-development needs as a key element in change in higher education; decision-making practices in small- to medium-size libraries; and development…

  18. Defining Incident Management Processes for CSIRTs: A Work in Progress

    Science.gov (United States)

    2004-10-01

    royalty -free government-purpose license to use, duplicate, or disclose the work, in whole or in part and in any manner, and to have or permit others to...Methodology of Incident Handling.” InfoSecurity 2001 Conference Program. Malaysian National Computer Confederation, 2001. 22 CMU/SEI-2004-TR-015

  19. Incidence and management of pancreatic leakage after pancreatoduodenectomy

    NARCIS (Netherlands)

    de Castro, S. M. M.; Busch, O. R. C.; van Gulik, T. M.; Obertop, H.; Gouma, D. J.

    2005-01-01

    Background: Optimal management of severe pancreatic leakage after pancreatoduodenectomy can reduce morbidity and mortality. Completion pancreatectomy may be adequate but leads to endocrine insufficiency. This study evaluated an alternative management strategy for pancreatic leakage. Methods: Outcome

  20. Emergency surgical airway management in Denmark

    DEFF Research Database (Denmark)

    Rosenstock, C V; Nørskov, A K; Wetterslev, J

    2016-01-01

    for difficult airway management. RESULTS: In the DAD cohort 27 out of 452 461 patients had an ESA representing an incidence of 0.06 events per thousand (95% CI; 0.04 to 0.08). A total of 12 149/452 461 patients underwent Ear-Nose and Throat (ENT) surgery, giving an ESA incidence among ENT patients of 1.6 events...... of which three failed. Reviewers evaluated airway management as satisfactory in 10/27 patients. CONCLUSIONS: The incidence of ESA in the DAD cohort was 0.06 events per thousand. Among ENT patients, the ESA Incidence was 1.6 events per thousand. Airway management was evaluated as satisfactory for 10......BACKGROUND: The emergency surgical airway (ESA) is the final option in difficult airway management. We identified ESA procedures registered in the Danish Anaesthesia Database (DAD) and described the performed airway management. METHODS: We extracted a cohort of 452 461 adult patients undergoing...

  1. Using incident response trees as a tool for risk management of online financial services.

    Science.gov (United States)

    Gorton, Dan

    2014-09-01

    The article introduces the use of probabilistic risk assessment for modeling the incident response process of online financial services. The main contribution is the creation of incident response trees, using event tree analysis, which provides us with a visual tool and a systematic way to estimate the probability of a successful incident response process against the currently known risk landscape, making it possible to measure the balance between front-end and back-end security measures. The model is presented using an illustrative example, and is then applied to the incident response process of a Swedish bank. Access to relevant data is verified and the applicability and usability of the proposed model is verified using one year of historical data. Potential advantages and possible shortcomings are discussed, referring to both the design phase and the operational phase, and future work is presented. © 2014 Society for Risk Analysis.

  2. Evaluation of the effectiveness of ATM messages used during incidents : final report.

    Science.gov (United States)

    2016-01-01

    This project investigated the use of Intelligent Lane Control Signs based Active Traffic Management for : Incident Management on a heavily traveled urban freeway. The subject of the research was the ILCS : system on I-94 westbound in downtown Minneap...

  3. Incidence of fistula after management of perianal abscess

    Directory of Open Access Journals (Sweden)

    Riyadh Mohamad Hasan

    2016-10-01

    Full Text Available Background: Perianal fistula is among the most common anorectal diseases encountered in adults, men are more prone to be affected than women. There is a close relationship of abscess and fistula in etiology, anatomy, pathophysiology, therapy, complications and morbidity, it is appropriate to consider them as one entity. Aim of study: To determine the incidence of fistula formation and recurrent abscess in a sample of Iraqi patients in Baghdad and decide whether primary fistulotomy should be performed at the time of incision and drainage of perianal abscesses. Patients and methods: A retrospective study of 68 patients with perianal abscess operations conducted in Baghdad. They underwent incision and drainage under either local or general anesthesia at Al-Kindy Teaching Hospitals and private hospitals over a 15-year period from January 2000 to December 2015. Their ages ranged from 20 to 68 years (40.21 ± 1.34 males (63/68 (92.64% were more than females (5/68 (7.35%. Patients were treated with incision over the abscess under anesthesia and drainage of the abscess was done. The patients were followed up for an average 18 months (range 12–24 months after abscess drainage or until a fistula appeared and abscess recurrence. Results: The study group comprised of 68 (92.64% patients with perianal abscess with a median age 39 years (range 20–68 years. The mean follow-up period was identified to be 18 months (range 12–24 months. Males (63/68 (92.64% were more than females (5/68 (7.35%. The incidence of fistula formation after follow up, the patients with perianal abscess after incision and drainage was 31/68 (45.58% and males (30/31 (44.11% were more than females (1/31 (1.47%. The most common site was posterior then left lateral position. The percentage of patients with recurrent abscess n = 6 (8.82%were lower than fistula formation n = 31 (45.58%. The percentage of males n = 4/6 (5.88% were more than females 2/6 (2.94%. Conclusions: The

  4. Major incidents in Kenya: the case for emergency services development and training.

    Science.gov (United States)

    Wachira, Benjamin W; Smith, Wayne

    2013-04-01

    Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in Kenya for the period 2000-2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

  5. [Dental caries incidence in adolescents in a city Northeast Brazil, 2006].

    Science.gov (United States)

    Noro, Luiz Roberto Augusto; Roncalli, Angelo Giuseppe; Mendes Júnior, Francisco Ivan Rodrigues; Lima, Kenio Costa

    2009-04-01

    The main objective of this study was to evaluate the incidence of tooth decay in adolescents, associated with socioeconomic status, access to services, and self-perceived oral health. This was a longitudinal study using an epidemiological survey of dental caries and a structured questionnaire with a sample of 688 adolescents residing in Sobral, Ceará State, Brazil. Incidence increased progressively with age, from 1.60 at 12 years of age to 2.28 at 15, with a mean incidence of 1.86 decayed teeth per adolescent. Among the study variables, tooth pain in the previous six months [RR = 1.46 (1.22-1.76)], school lunch [RR = 1.45 (1.21-1.74)], frequency of dental appointments [RR = 1.48 (1.33-1.79)], and access to the Health Service [RR = 1.21 (1.01-1.45)], adjusted by perceived need for treatment, were associated with high caries incidence. It is essential for health professionals and health system managers to formulate public policies that are not limited merely to clinical and preventive aspects, encouraging the population to struggle for better living conditions and allowing equitable access to services and developing collective management of health actions.

  6. Literature review on medical incident command.

    Science.gov (United States)

    Rimstad, Rune; Braut, Geir Sverre

    2015-04-01

    It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published. This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders' performances be measured and assessed? A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis. The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders' tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted

  7. Cyber Incidents Involving Control Systems

    Energy Technology Data Exchange (ETDEWEB)

    Robert J. Turk

    2005-10-01

    The Analysis Function of the US-CERT Control Systems Security Center (CSSC) at the Idaho National Laboratory (INL) has prepared this report to document cyber security incidents for use by the CSSC. The description and analysis of incidents reported herein support three CSSC tasks: establishing a business case; increasing security awareness and private and corporate participation related to enhanced cyber security of control systems; and providing informational material to support model development and prioritize activities for CSSC. The stated mission of CSSC is to reduce vulnerability of critical infrastructure to cyber attack on control systems. As stated in the Incident Management Tool Requirements (August 2005) ''Vulnerability reduction is promoted by risk analysis that tracks actual risk, emphasizes high risk, determines risk reduction as a function of countermeasures, tracks increase of risk due to external influence, and measures success of the vulnerability reduction program''. Process control and Supervisory Control and Data Acquisition (SCADA) systems, with their reliance on proprietary networks and hardware, have long been considered immune to the network attacks that have wreaked so much havoc on corporate information systems. New research indicates this confidence is misplaced--the move to open standards such as Ethernet, Transmission Control Protocol/Internet Protocol, and Web technologies is allowing hackers to take advantage of the control industry's unawareness. Much of the available information about cyber incidents represents a characterization as opposed to an analysis of events. The lack of good analyses reflects an overall weakness in reporting requirements as well as the fact that to date there have been very few serious cyber attacks on control systems. Most companies prefer not to share cyber attack incident data because of potential financial repercussions. Uniform reporting requirements will do much to make this

  8. A critical incident study of general practice trainees in their basic general practice term.

    Science.gov (United States)

    Diamond, M R; Kamien, M; Sim, M G; Davis, J

    1995-03-20

    To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

  9. Nonlinearity management and diffraction management for the ...

    Indian Academy of Sciences (India)

    Variational equations and partial differential equation have been simulated numerically. Analytical and numerical studies have shown that nonlinearity management and diffraction management stabilize the pulse against decay or collapse providing undisturbed propagation even for larger energies of the incident beam.

  10. Dyslexic Entrepreneurs: The Incidence; Their Coping Strategies and Their Business Skills

    Science.gov (United States)

    Logan, Julie

    2009-01-01

    This comparative study explores the incidence of dyslexia in entrepreneurs, corporate managers and the general population. It examines the suggestion that dyslexic entrepreneurs develop coping strategies to manage their weaknesses, which are subsequently of benefit in the new venture creation process. Results of this study suggest that there is a…

  11. Longitudinal variation in pressure injury incidence among long-term aged care facilities.

    Science.gov (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Westbrook, Johanna I

    2018-05-04

    To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation. Longitudinal incidence study using routinely-collected electronic care management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016. Risk-adjusted PI incidence rates over eight study quarters. Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038). There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

  12. Radiological incident preparedness for community hospitals: a demonstration project.

    Science.gov (United States)

    Jafari, Mary Ellen

    2010-08-01

    In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

  13. Risks management in the hospital environment: incidence and risk factors associated with falls and pressure injuries in a clinical unit

    Directory of Open Access Journals (Sweden)

    Rayane Oliveira Cedraz

    2018-03-01

    Full Text Available Abstract Objective: To evaluate the incidence and risk factors associated with falls and pressure injuries in a clinical unit. Methods: A quantitative, cross-sectional, descriptive-exploratory study was conducted at a university hospital in Rio de Janeiro using secondary data from patient records and information of registers of patients treated in 2015/2016. Data were analyzed using descriptive and inferential statistics. Results: Of the 157 treated patients, women, cardiovascular (43.9% and oncological diseases (35.0% predominated. The risk and incidences of falls and pressure injuries were higher in men. There were significant associations of gender with the risk of falling, the occurrence of falls and pressure injuries, and between the length of hospital stay and risk of falling. Conclusion: Risk management is essential to promote patient safety and improve quality of health care. Nurse staff plays a fundamental role in the process of guiding activities, updating the nursing team and evaluating interventions. The use of tools, such as protocols and indicators, allows the optimization of the work process and the achievement of these goals.

  14. A Computer-Based Glucose Management System Reduces the Incidence of Forgotten Glucose Measurements: A Retrospective Observational Study.

    Science.gov (United States)

    Okura, Tsuyoshi; Teramoto, Kei; Koshitani, Rie; Fujioka, Yohei; Endo, Yusuke; Ueki, Masaru; Kato, Masahiko; Taniguchi, Shin-Ichi; Kondo, Hiroshi; Yamamoto, Kazuhiro

    2018-04-17

    Frequent glucose measurements are needed for good blood glucose control in hospitals; however, this requirement means that measurements can be forgotten. We developed a novel glucose management system using an iPod ® and electronic health records. A time schedule system for glucose measurement was developed using point-of-care testing, an iPod ® , and electronic health records. The system contains the glucose measurement schedule and an alarm sounds if a measurement is forgotten. The number of times measurements were forgotten was analyzed. Approximately 7000 glucose measurements were recorded per month. Before implementation of the system, the average number of times measurements were forgotten was 4.8 times per month. This significantly decreased to 2.6 times per month after the system started. We also analyzed the incidence of forgotten glucose measurements as a proportion of the total number of measurements for each period and found a significant difference between the two 9-month periods (43/64,049-24/65,870, P = 0.014, chi-squared test). This computer-based blood glucose monitoring system is useful for the management of glucose monitoring in hospitals. Johnson & Johnson Japan.

  15. Current Trends in the Oncologic and Surgical Managements of Breast Cancer in Women with Implants: Incidence, Diagnosis, and Treatment.

    Science.gov (United States)

    Veronesi, Paolo; De Lorenzi, Francesca; Loschi, Pietro; Rietjens, Mario; Veronesi, Umberto

    2016-04-01

    Breast augmentation is the most common cosmetic surgery in the United States, and thousands of augmented patients develop breast cancer each year. The possible effects of implants on cancer incidence, diagnosis, and treatment usually generate a disarming confusion. The present paper represents an update of the more recent oncologic and surgical strategies, aiming to support plastic and general surgeons in such challenging aspects. Several aspects of breast cancer management in augmented women are investigated, including (1) risk estimation and cancer characteristics, stage at diagnosis, and prognosis; (2) cancer diagnosis with clinical examination, mammography, ultrasound, and magnetic resonance imaging; (3) cancer treatment including breast conservation, intraoperative radiotherapy, sentinel node biopsy and mastectomy, and reconstruction. A brief resume of recommendations and conclusions is suggested, elucidating correct trends in the oncologic management of augmented patients and refusing well-established misconceptions: (1) breast augmentation does not increase the risk of breast cancer incidence, and it does not influence the prognosis; (2) possible risks exist in cancer detection due to technical difficulties; (3) sentinel lymph node detection is feasible; (4) intraoperative radiotherapy represents a good chance for conserving treatment; (5) immediate reconstruction with submuscular-subfascial implants is the most common procedure after mastectomy, and biological substitutes could support this procedure. Breast clinicians should be alerted because of high expectations of this subgroup of patients, accustomed to emphasize the aesthetic result. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  16. High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device.

    Science.gov (United States)

    Wilke, Iris; Witzel, Katrin; Münch, Julia; Pecha, Simon; Blankenberg, Stephan; Reichenspurner, Hermann; Willems, Stephan; Patten, Monica; Aydin, Ali

    2016-07-01

    Atrial fibrillation (AF) is an important prognostic parameter in patients with hypertrophic cardiomyopathy (HCM). Though cardiac rhythm management (CRM) devices (e.g., ICD, pacemaker or implantable loop recorder) can detect subclinical AF, data describing the incidence of AF are rare. We therefore investigated the incidence and clinical impact of de novo and subclinical AF detected by CRM devices in patients with HCM. In our retrospective single-center study, we included patients with HCM and need for CRM devices. The primary endpoint of the study was the incidence of clinical and subclinical de novo AF. During follow-up, patients were screened for adverse events like stroke, ventricular arrhythmia, heart failure, or death. From 192 HCM patients, 44 patients received a CRM device (38 ICDs, 5 pacemakers, 1 implantable loop recorder). In 14 of these patients (32%), AF had been documented before device implantation. Thirty (68%) patients were free from AF at the time of implantation. During a median follow-up of 595 days (interquartile range, 367-890 days), de novo AF was recorded in 16 of these 30 patients (53%). Fourteen (88%) of the 16 patients with de novo AF were free from any clinical symptoms, so these patients were classified to have subclinical AF. In logistic regression analysis, age was the only significant predictor for an increased risk of AF. AF is common in patients with HCM who need a CRM device. More than 50% of these patients develop de novo AF that was predominantly subclinical in our cohort. © 2016 Wiley Periodicals, Inc.

  17. IDAS-RR: an incident data base system for research reactors

    International Nuclear Information System (INIS)

    Matsumoto, Kiyoshi; Kohsaka, Atsuo; Kaminaga, Masanori; Murayama, Youji; Ohnishi, Nobuaki; Maniwa, Masaki.

    1990-03-01

    An Incident Data Base System for Research Reactors, IDAS-RR, has been developed. IDAS-RR has information about abnormal incidents (failures, transients, accidents, etc.) of research reactors in the world. Data reference, input, editing and other functions of IDAS-RR are menu driven. The routine processing and data base management functions are performed by the system software and hardware. PC-9801 equipment was selected as the hardware because of its portability and popularity. IDAS-RR provides effective reference information for the following activities. 1) Analysis of abnormal incident of research reactors, 2) Detail analysis of research reactor behavior in the abnormal incident for building the knowledge base of the reactor emergency diagnostic system for research reactor, 3) Planning counter-measure for emergency situation in the research reactor. This report is a user's manual of IDAS-RR. (author)

  18. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    Science.gov (United States)

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and

  19. Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

    Energy Technology Data Exchange (ETDEWEB)

    Greenwalt, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hibbard, W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-08-09

    Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans. These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.

  20. Contaminated Mexican steel incident

    International Nuclear Information System (INIS)

    1985-01-01

    This report documents the circumstances contributing to the inadvertent melting of cobalt 60 (Co-60) contaminated scrap metal in two Mexican steel foundries and the subsequent distribution of contaminated steel products into the United States. The report addresses mainly those actions taken by US Federal and state agencies to protect the US population from radiation risks associated with the incident. Mexico had much more serious radiation exposure and contamination problems to manage. The United States Government maintained a standing offer to provide technical and medical assistance to the Mexican Government. The report covers the tracing of the source to its origin, response actions to recover radioactive steel in the United States, and return of the contaminated materials to Mexico. The incident resulted in significant radiation exposures within Mexico, but no known significant exposure within the United States. Response to the incident required the combined efforts of the Nuclear Regulatory Commission (NRC), Department of Energy, Department of Transportation, Department of State, and US Customs Service (Department of Treasury) personnel at the Federal level and representatives of all 50 State Radiation Control Programs and, in some instances, local and county government personnel. The response also required a diplomatic interface with the Mexican Government and cooperation of numerous commercial establishments and members of the general public. The report describes the factual information associated with the event and may serve as information for subsequent recommendations and actions by the NRC. 8 figures

  1. Attitudes and perceived barriers influencing incident reporting by nurses and their correlation with reported incidents: A systematic review.

    Science.gov (United States)

    Fung, Wing Mei; Koh, Serena Siew Lin; Chow, Yeow Leng

    Clinical incident reporting is an integral feature of risk management system in the healthcare sector. By reporting clinical incidents, nurses allow for learning from errors, identification of error patterns and development of error preventive strategies. The need to understand attitudes to reporting, perceived barriers and incident reporting patterns by nurses are the core highlights of this review. INCLUSION CRITERIA: This review considered descriptive quantitative studies that examined nurses' attitudes or perceived barriers towards incident reporting.The participants in this review were nurses working in acute care settings or step-down care settings. Studies that included non-nursing healthcare personnel were excluded.This review considered studies which examined nurses' attitudes towards incident reporting, perceived barriers and incident reporting practices.The outcomes of interest were the attitudes that nurses have towards incident reporting, perceived barriers and the types of reported incidents in correlation with nurses' attitudes and barriers. A three-step search strategy was utilised in this review. An initial limited search of CINAHL and MEDLINE was undertaken. Search strategies were then developed using identified keywords and index terms. Lastly, the reference lists of all identified articles were examined. All searches were limited to studies published in English, between 1991 and 2010. The studies were independently assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Descriptive/ Case Series studies. The reviewers extracted data independently from included studies using the Joanna Briggs Institute Data Extraction Form for Descriptive/ Case Series studies. Due to the descriptive nature of the study designs, statistical pooling was not possible. Therefore, the findings of this systematic review are presented in a narrative summary. Fifty-five papers were identified from the searches based on their titles and

  2. [Rules and regulations applying to incidents in radiotherapy].

    Science.gov (United States)

    Lohr, F; Baus, W; Vorwerk, H; Schlömp, B; André, L; Georg, D; Hodapp, N

    2012-07-01

    Radiotherapy is an essential and reliable element of the treatment armamentarium in oncology. Numerous rules, regulations, and protocols minimize the associated risks. It can, however, never be excluded that errors in the treatment delivery chain result in inadequate tumor doses or unnecessary damage to organs at risk. A legal framework governs the management of such incidents. The most important European and North American regulations are reported. Various directives issued by the European Union are differently implemented nationally. This applies particularly to the characterization of incidents that must be reported to authorities. Reporting thresholds, audit systems, and the extent of the integration of voluntary reporting systems vary. Radiotherapy incidents are dealt with differently on an international level. Changes are to be expected based on the European Basic Safety Standards Directive that is currently being prepared and will have to be implemented nationally in due course.

  3. Rules and regulations applying to incidents in radiotheraphy

    International Nuclear Information System (INIS)

    Lohr, F.; Andre, L.; Georg, D.; Hodapp, N.

    2012-01-01

    Aims and purpose: Radiotherapy is an essential and reliable element of the treatment armamentarium in oncology. Numerous rules, regulations, and protocols minimize the associated risks. It can, however, never be excluded that errors in the treatment delivery chain result in inadequate tumor doses or unnecessary damage to organs at risk. A legal framework governs the management of such incidents. The most important European and North American regulations are reported. Results: Various directives issued by the European Union are differently implemented nationally. This applies particularly to the characterization of incidents that must be reported to authorities. Reporting thresholds, audit systems, and the extent of the integration of voluntary reporting systems vary. Conclusion: Radiotherapy incidents are dealt with differently on an international level. Changes are to be expected based on the European Basic Safety Standards Directive that is currently being prepared and will have to be implemented nationally in due course. (orig.)

  4. INCIDENCE OF MAXILLOFACIAL TRAUMA IN SONEPAT (HARYANA, INDIA

    Directory of Open Access Journals (Sweden)

    Malik SUNITA

    2013-03-01

    Full Text Available Background: Maxillofacial injuries represent a therapeutic challenge to oral and maxillofacial surgeons working in emerging countries. This study was carried out to determine the incidence of maxillofacial trauma, clinical management and associated complications. This study highlights the need of oral and maxillofacial surgery along with other disciplines to deliver the emergency services and management to the maxillofacial trauma patients. Patients and Methods: A prospective Medical institute study of maxillofacial injured patients was carried out between September 20122 and December 2012, at the recently founded B.P.S Government Medical College for women, Khanpur kalan, Sonepat, Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed. Results: A total of 462 patients were studied. Males outnumbered females by a ratio of 2.9:1. age range was 9 months to 75 years with the peak incidence occurring in the age group 17-34 years .Most injuries were caused by road traffic accidents (75.8%, followed by assault and falls in 10.6% and 8% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (53.1% and limb injuries (28.1% were the most prevalent associated injuries. Surgical debridement and soft tissue suturing (95.1% were the most common surgical procedures. Closed reduction of maxillofacial fractures was employed in 56% of patients, Open reduction and internal fixation was performed in 35% of cases and 9% were managed conservatively. Complications occurred in 3.4% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was 10.12 ± 6.24 days. Conclusion: This study highlights the importance of Dental surgery department alongwith other disciplinaes in the management of maxillofacial injuries. Moreover there is a need to reinforce legislation aimed to

  5. The role of poison control centers in CBRN incidents

    International Nuclear Information System (INIS)

    Borron, S. W.; Haynes, J.; Young, P.

    2009-01-01

    Poison Control Centers (PCCs) have historically played a limited, parallel role in management of CBRN incidents; they are frequently called for advice by the public or health care providers when such incidents occur, but in many cases are not considered an integral part of the CBRN disaster emergency response team, lacking a 'place' in the Incident Command Structure (ICS). This is unfortunate, as PCCs represent an important public health resource. The roughly 60 centers in the U.S. are available 24/7, 365 days/year. Telephones are manned by professionals, including pharmacists and nurses with additional specialized training in poisoning response. PCC medical directors are generally trained in Emergency Medicine, Pediatrics or Preventive Medicine, with subspecialty training in Medical Toxicology. Many toxicologists attend specialized training in the radiation emergency management at REAC/TS. PCCs have extensive databases for poisoning management coupled with GIS surveillance. This combination of expertise and information renders PCCs well prepared to advice on decontamination and treatment of CBRN-contaminated victims. Their toxicology expertise allows their participation in risk assessment. PCCs are highly trusted by the community, enhancing their role in risk communication. We recently initiated a program that provides guidance on activation of PCCs by the Region 6 Regional Response Team (RRT6), Co-Chaired by the US Environmental Protection Agency (EPA) and the US Coast Guard, serving as the federal component of the National Response System for the states of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. The program will be described, with emphasis on how PCCs may work within ICS.(author)

  6. Incidence of falls and preventive actions in a University Hospital.

    Science.gov (United States)

    Luzia, Melissa de Freitas; Cassola, Talita Portela; Suzuki, Lyliam Midori; Dias, Vera Lucia Mendes; Pinho, Leandro Barbosa de; Lucena, Amália de Fátima

    2018-01-01

    Objective Describing the incidence of falls and its relation with preventive actions developed in a Brazilian university hospital. Method A retrospective longitudinal study. Hospitalized adult patients in the clinical, surgical, psychiatric and emergency units who suffered a fall in the institution, and who had the event notified in the period from January 2011 to December 2015 were included in the study. The data were collected from the institution's management information system and analyzed in the SPSS statistical program. Results There were 2,296 falls, with a mean incidence of 1.70 falls/1,000 patients per day. An increase in the incidence of falls was observed in the period from 2011 (1.61) to 2012 (2.03). In the following years, the incidence of falls decreased from 1.83 falls/1,000 patients per day in 2013 to 1.42 falls/1,000 patients per day in 2015. The incidence of falls accompanied an implementation of preventive actions, suggesting the impact of such interventions in reducing the event occurrence. Conclusion The findings demonstrate the importance of implementing preventive interventions in reducing the incidence of falls in hospitalized patients.

  7. Global incidence and outcome of testicular cancer

    Science.gov (United States)

    Shanmugalingam, Thurkaa; Soultati, Aspasia; Chowdhury, Simon; Rudman, Sarah; Van Hemelrijck, Mieke

    2013-01-01

    Background Testicular cancer is a rare tumor type accounting for 1% of malignancies in men. It is, however, the most common cancer in young men in Western populations. The incidence of testicular cancer is increasing globally, although a decline in mortality rates has been reported in Western countries. It is important to identify whether the variations in trends observed between populations are linked to genetic or environmental factors. Methods Age-standardized incidence rates and age-standardized mortality rates for testicular cancer were obtained for men of all ages in ten countries from the Americas, Asia, Europe, and Oceania using the Cancer Incidence in Five Continents (CI5plus) and World Health Organization (WHO) mortality databases. The annual percent change was calculated using Joinpoint regression to assess temporal changes between geographical regions. Results Testicular cancer age-standardized incidence rates are highest in New Zealand (7.8), UK (6.3), Australia (6.1), Sweden (5.6), USA (5.2), Poland (4.9), and Spain (3.8) per 100,000 men. India, China, and Colombia had the lowest incidence (0.5, 1.3, and 2.2, respectively) per 100,000 men. The annual percent changes for overall testicular cancer incidence significantly increased in the European countries Sweden 2.4%, (2.2; 2.6); UK 2.9%, (2.2; 3.6); and Spain 5.0%, (1.7; 8.4), Australia 3.0%, (2.2; 3.7), and China 3.5%, (1.9; 5.1). India had the lowest overall testicular cancer incidence −1.7%, (−2.5; −0.8). Annual percent changes for overall testicular cancer mortality rates were decreasing in all study populations, with the greatest decline observed in Sweden −4.2%, (−4.8; −3.6) and China −4.9%, (−6.5; −3.3). Conclusion Testicular cancer is increasing in incidence in many countries; however, mortality rates remain low and most men are cured. An understanding of the risks and long-term side effects of treatment are important in managing men with this disease. PMID:24204171

  8. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

    Directory of Open Access Journals (Sweden)

    Huber-Wagner S

    2009-12-01

    Full Text Available Abstract Background Hospitals have a critically important role in the management of mass causality incidents (MCI, yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%, pelvic injuries (11.5%, thoracic injuries (5.0% and major amputations (3.1%. The mean cut to suture time was 130 min (IQR 65-165 min. Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00, ISS ≥ 35 (OR 2,94, hemoglobin level ≤ 8 mg/dL (OR 1,40, pulse rate on hospital admission 120/min (OR 1,39, blood pressure on hospital admission Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

  9. Explaining mastitis incidence in Dutch dairy farming: the influence of farmers' attitudes and behaviour.

    Science.gov (United States)

    Jansen, J; van den Borne, B H P; Renes, R J; van Schaik, G; Lam, T J G M; Leeuwis, C

    2009-11-15

    When mastitis incidence increases, either infection pressure has increased or cows' resistance has decreased. This usually indicates that farm management is not optimal. Numerous quantitative studies have demonstrated the effect of management practices on mastitis. In most of these studies, the identified risk factors could explain only part of the variance in mastitis incidence on farms. Several studies suggest that the unexplained variance is caused by farmers' attitudes towards different aspects of mastitis treatment and preventive behaviour. This study aims to determine, to quantify and to specify the extent to which farmers' attitudes, over and above farmers' behaviour, are factors that explain the variation in mastitis incidence, measured in terms of the quantifiable effect of management factors. An extensive survey on self-reported attitudes, behaviour and mastitis incidence was conducted on 336 Dutch dairy farms. Results of multiple linear regression analyses show that farmers' self-reported behaviour and attitudes together explain 48%, 31% and 23% of the variation within, respectively, the average farm bulk milk somatic cell count (BMSCC), the clinical mastitis incidence and the combined clinical and subclinical mastitis incidence. Both behaviour and attitudes explain part of the variance. However, most of the variance in all three dependant measures is explained solely by the attitude variables. The variation in BMSCC value is best explained by (1) farmers' normative frame of reference about mastitis, (2) farmers' perceptions about the control of mastitis and (3) the perceived effect of a BMSCC penalty level. The variation in clinical mastitis is best explained by farmers' perceptions about mastitis control. The variation in the combined clinical and subclinical mastitis incidence rate is best explained by the perceived effect of a BMSCC penalty level and the frequency of contact with others. The results of this study show that farmers' attitudes are a

  10. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome.

    Science.gov (United States)

    Vlug, Roos D; Lopriore, Enrico; Janssen, Marleen; Middeldorp, Johanna M; Rath, Mirjam E A; Smits-Wintjens, Vivianne E H J

    2015-02-01

    Polycythemia occurs in 1 to 5% of neonates and is associated with complications, including an increased risk of thrombocytopenia. To evaluate incidence, risk factors, management and outcome of thrombocytopenia in neonates with polycythemia. All neonates with polycythemia admitted to our neonatal intensive care unit between 2006 and 2013 were included in this retrospective study. We evaluated the incidence of thrombocytopenia (platelet count polycythemia and is independently associated with growth restriction. Increased hematocrit is associated with decreased platelet count.

  11. Preventing construction worker injury incidents through the management of personal stress and organizational stressors.

    Science.gov (United States)

    Leung, Mei-yung; Chan, Isabelle Yee Shan; Yu, Jingyu

    2012-09-01

    Construction workers (CWs) are positioned at the lowest level of an organization and thus have limited control over their work. For this reason, they are often deprived of their due rewards and training or sometimes are even compelled to focus on production at the expense of their own safety. These organizational stressors not only cause the CWs stress but also impair their safety behaviors. The impairment of safety behaviors is the major cause of CW injury incidents. Hence, to prevent injury incidents and enhance safety behaviors of CWs, the current study aimed to identify the impact of various organizational stressors and stress on CW safety behaviors and injury incidents. To achieve this aim, we surveyed 395 CWs. Using factor analysis, we identified five organizational stressors (unfair reward and treatment, inappropriate safety equipment, provision of training, lack of goal setting, and poor physical environment), two types of stress (emotional and physical), and safety behaviors. The results of correlation and regression analyses revealed the following: (1) injury incidents were minimized by safety behaviors but escalated by a lack of goal setting, (2) safety behaviors were maximized by moderate levels of emotional stress (i.e., an inverted U-shape relationship between these two variables) and increased in line with physical stress and inappropriate safety equipment, (3) emotional stress was positively predicted by the provision of training and inappropriate safety equipment, and (4) physical stress was predicted only by inappropriate safety equipment. Based on these results, we suggest various recommendations to construction stakeholders on how to prevent CW injury incidents. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Hospital planning for weapons of mass destruction incidents

    Directory of Open Access Journals (Sweden)

    Perry Ronald

    2006-01-01

    Full Text Available As terrorists attacks increase in frequency, hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction. This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations. This includes the public health authorities, political authorities, prehospital care agencies, and emergency management agencies. A review is completed of six special elements of weapons of mass destruction incidents that should be addressed in hospital disaster plans: incident command, hospital security, patient surge, decontamination, mental health consequences, and communications. The paper closes with a discussion of the importance of training and exercises in maintaining and improving the disaster plan.

  13. Analysis on incidence and management of complications after femtosecond laser-assisted small incision lenticule extraction

    Directory of Open Access Journals (Sweden)

    Cai-Hong Li

    2018-04-01

    Full Text Available AIM: To evaluate the safety and postoperative complications of femtosecond laser-assisted small incision lenticule extraction(SMILE. METHODS: Retrospective case series. A total of 1127 patients(2 236 eyeswho were treated with SMILE for myopia or myopia astigmatism between June 2016 and May 2017 were enrolled in this study. Eyes that developed postoperative complications were noted and identified. The incidence, risk factors, management and prognosis were analyzed. The follow-up was 6mo.RESULTS: The rate of postoperative complications was 8.05%, included diffuse lamellar keratitis(3.31%, delayed visual acuity(2.59%, minor interface residue(0.63%, and ghost images(1.52%. These complications had an impact on best corrected visual acuity(BCVAat 3mo in only 1 eye with decentered ablation and was re-treated with topography-guided laser-assisted subepithelial keratomileusis(LASEK. Good visual outcomes were achieved in all eyes finally. CONCLUSION: Although few eyes suffered postoperative complications, SMILE is an acceptable safe surgery. Careful surgical skill, appropriate surgical parameter, and rational postoperative medication can decrease the risk of complication.

  14. A day in the life of a volunteer incident commander: errors, pressures and mitigating strategies.

    Science.gov (United States)

    Bearman, Christopher; Bremner, Peter A

    2013-05-01

    To meet an identified gap in the literature this paper investigates the tasks that a volunteer incident commander needs to carry out during an incident, the errors that can be made and the way that errors are managed. In addition, pressure from goal seduction and situation aversion were also examined. Volunteer incident commanders participated in a two-part interview consisting of a critical decision method interview and discussions about a hierarchical task analysis constructed by the authors. A SHERPA analysis was conducted to further identify potential errors. The results identified the key tasks, errors with extreme risk, pressures from strong situations and mitigating strategies for errors and pressures. The errors and pressures provide a basic set of issues that need to be managed by both volunteer incident commanders and fire agencies. The mitigating strategies identified here suggest some ways that this can be done. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  15. Neuropathic pain other than CRPS in children and adolescents: incidence, referral, clinical characteristics, management, and clinical outcomes.

    Science.gov (United States)

    Kachko, Ludmyla; Ben Ami, Shiri; Lieberman, Alon; Shor, Rita; Tzeitlin, Elena; Efrat, Rachel

    2014-06-01

    Chronic pain in children and adolescents is common, but proportion of neuropathic pain (NP), a heterogeneous group of diseases with major impact on health-related quality of life, significant economic burden, and limited treatment options, is unclear. Many studies have focused only on complex regional pain syndrome (CRPS). Our aim was to examine the incidence, clinical features, management, and outcome of non-CRPS NP in patients referred to a chronic pediatric pain clinic (CPPC) at a tertiary-care hospital. Retrospective analyses of the patient's files with non-CRPS NP from 2008 until 2012. Twenty patients (9.9-22.0 years; 10.7% of new referrals) were treated with non-CRPS NP (postoperative 8/20, trauma-related 5/20, disease-related 7/20). The number of consultations performed and the number of medications used before CPPC were significantly higher than in CPPC (Z = 0.75, P = 0.005; Z = 1.68, P = 0.003; respectively, Wilcoxon test). The number of diagnostic procedures was not statistically significant. Invasive treatments were used in 50% of patients. Full/partial recovery was accomplished in 95%. anova with repeated measures yielded a highly significant difference between the initial and final visual analog scale (VAS) scores (8.2 ± 1.3; 1.19 ± 2.01, respectively; P CRPS NP is crucial to timely and correct diagnosis and effective management, but even children with delayed diagnosis still have a good outcome. The management of this condition by an experienced team is recommended. © 2014 John Wiley & Sons Ltd.

  16. Challenges of information security incident learning: An industrial case study in a Chinese healthcare organization.

    Science.gov (United States)

    He, Ying; Johnson, Chris

    2017-12-01

    Security incidents can have negative impacts on healthcare organizations, and the security of medical records has become a primary concern of the public. However, previous studies showed that organizations had not effectively learned lessons from security incidents. Incident learning as an essential activity in the "follow-up" phase of security incident response lifecycle has long been addressed but not given enough attention. This paper conducted a case study in a healthcare organization in China to explore their current obstacles in the practice of incident learning. We interviewed both IT professionals and healthcare professionals. The results showed that the organization did not have a structured way to gather and redistribute incident knowledge. Incident response was ineffective in cycling incident knowledge back to inform security management. Incident reporting to multiple stakeholders faced a great challenge. In response to this case study, we suggest the security assurance modeling framework to address those obstacles.

  17. Explaining mastitis incidence in Dutch dairy farming: The influence of farmers’ attitudes and behaviour

    NARCIS (Netherlands)

    Jansen, J.; Borne, van den B.H.P.; Renes, R.J.; Schaik, van G.; Lam, T.J.G.M.; Leeuwis, C.

    2009-01-01

    When mastitis incidence increases, either infection pressure has increased or cows’ resistance has decreased. This usually indicates that farm management is not optimal. Numerous quantitative studies have demonstrated the effect of management practices on mastitis. In most of these studies, the

  18. Congenital clinical malaria: Incidence, management and outcome ...

    African Journals Online (AJOL)

    Objective: With paucity of documentation of congenital clinical malaria in the world literature, we therefore aimed to review its rates, presentation, management and out come of this problem in neonates at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methodology: This prospective study was carried out in ...

  19. Response to a Chemical Incident or Accident -- Who Is In Charge?

    National Research Council Canada - National Science Library

    Briggs, Darryl J

    2007-01-01

    .... The thesis of the paper is as follows: Combatant Commanders and the Services must have specific guidance and appropriate authorities to be able to effectively manage a Chemical Accident and Incident Response and Assistance (CAIRA...

  20. Spatial Interaction Modeling to Identify Potentially Exposed Populations during RDD or IND Terrorism Incidents

    International Nuclear Information System (INIS)

    Regens, J.L.; Gunter, J.T.; Gupta, S.

    2009-01-01

    Homeland Security Presidential Directive no.5 (HSPD-5) Management of Domestic Incidents and Department of Homeland Security (DHS) Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents underscore the need to delineate radiological emergency guidance applicable to remedial action and recovery following an RDD or IND incident. Rapid delineation of the population potentially exposed to ionizing radiation from fallout during terrorist incidents involving RDDs or low-yield nuclear devices (≤ 20 KT) is necessary for effective medical response and incident management as part of the recovery process. This paper illustrates the application of spatial interaction models to allocate population data for a representative U.S. urban area (≅1.3M people; 1,612.27 km 2 area) at a geographical scale relevant for accurately estimating risk given dose concentrations. Estimated total dose equivalents (TEDE) are calculated for isopleths moving away from the detonation point for typical release scenarios. Population is estimated within the TEDE zones using Euclidean distances between zip code polygon centroids generated in ArcGIS version 9.1 with distance decay determined by regression analysis to apportion origin-destination pairs to a population count and density matrix on a spatial basis for daytime and night-time release scenarios. (authors)

  1. Development of a highway incident management operational and training guide : phase II.

    Science.gov (United States)

    2014-08-01

    The overall goal of both phases of this project was to reduce responder fatalities and injuries, as well as to prevent : secondary crashes, especially those involving incident responders. The phases of this project worked toward this goal : by creati...

  2. Incidence, causes and pattern of cancellation of Elective surgical ...

    African Journals Online (AJOL)

    This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management. Methods: This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical ...

  3. Critical incidents among women entrepreneurs: Personal and professional issues

    Directory of Open Access Journals (Sweden)

    Vânia Maria Jorge Nassif

    2016-06-01

    Full Text Available ABSTRACT The objective of this paper is to analyze critical situations experienced by women entrepreneurs and understand how they have overcome such situations. The study contributes to the understanding of the issues related to the activities of women entrepreneurs and shows that the use of the critical incident technique is relevant to the development of research in the field of entrepreneurship. The data were collected using a specific form with 115 women participating in the study. The analysis of critical incidents showed that in addition to the practical issues regarding the management of their business, emotions are interconnected with their business development. Unlike international studies in the field, the critical incidents experienced by Brazilian women entrepreneurs overlap with personal aspects. The women involved in this study face emotional difficulties, but are also motivated by strong feelings of determination to overcome their problems.

  4. Acanthamoeba keratitis: study of the 5-year incidence in Israel.

    Science.gov (United States)

    Graffi, Shmuel; Peretz, Avi; Jabaly, Haneen; Koiefman, Anna; Naftali, Modi

    2013-11-01

    Acanthamoeba keratitis (AK) is not a notifiable disease in Israel, so there are no accurate incidence rates for this condition in Israel. The aim of this study was to estimate the incidence of AK in Israel for the years 2008-2012. We distributed a survey questionnaire to laboratory managers in Israel. The laboratories were affiliated to medical institutes that either provided ophthalmology services or served community ophthalmology clinics. Our questionnaire requested survey respondents to provide information regarding the methods used to diagnose AK, and the number of positive and negative cultures for Acanthamoebae species performed for each of the years from 2008 to 2012. Six laboratories used non-nutrient agar with Escherichia coli as the culture medium, one used calcofluor-white staining with fluorescent microscopy, and two used PCR for diagnosing AK. Twenty-three AK cases were identified, to give an estimated incidence of 1/1 668 552. AK is mostly attributable to the use of contact lenses. As contact lenses are popular in Israel, we expected a higher incidence rate. A lower than expected incidence rate may indicate insufficient awareness of AK in Israel.

  5. Automatic road traffic safety management system in urban areas

    Directory of Open Access Journals (Sweden)

    Oskarbski Jacek

    2017-01-01

    Full Text Available Traffic incidents and accidents contribute to decreasing levels of transport system reliability and safety. Traffic management and emergency systems on the road, using, among others, automatic detection, video surveillance, communication technologies and institutional solutions improve the organization of the work of various departments involved in traffic and safety management. Automation of incident management helps to reduce the time of a rescue operation as well as of the normalization of the flow of traffic after completion of a rescue operation, which also affects the reduction of the risk of secondary accidents and contributes to reducing their severity. The paper presents the possibility of including city traffic departments in the process of incident management. The results of research on the automatic incident detection in cities are also presented.

  6. Analysis of mass incident diffusion in Weibo based on self-organization theory

    Science.gov (United States)

    Pan, Jun; Shen, Huizhang

    2018-02-01

    This study introduces some theories and methods of self-organization system to the research of the diffusion mechanism of mass incidents in Weibo (Chinese Twitter). Based on the analysis on massive Weibo data from Songjiang battery factory incident happened in 2013 and Jiiangsu Qidong OJI PAPER incident happened in 2012, we find out that diffusion system of mass incident in Weibo satisfies Power Law, Zipf's Law, 1/f noise and Self-similarity. It means this system is the self-organization criticality system and dissemination bursts can be understood as one kind of Self-organization behavior. As the consequence, self-organized criticality (SOC) theory can be used to explain the evolution of mass incident diffusion and people may come up with the right strategy to control such kind of diffusion if they can handle the key ingredients of Self-organization well. Such a study is of practical importance which can offer opportunities for policy makers to have good management on these events.

  7. Incidental durotomy in lumbar spine surgery - incidence, risk factors and management

    Directory of Open Access Journals (Sweden)

    Adam D.

    2015-03-01

    Full Text Available Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence varies depending on several risk factors and regarding the intra and postoperative management, there is no consensus. Our objective was to report our experience with incidental durotomy in patients who were operated on for lumbar disc herniation, lumbar spinal stenosis and revision surgeries. Between 2009 and 2012, 1259 patients were operated on for degenerative lumbar disorders. For primary operations, the surgical approach was mino-open, interlamar, uni- or bilateral, as for recurrences, the removal of the compressive element was intended: the epidural scar and the disc fragment. 863 patients (67,7% were operated on for lumbar disc herniation, 344 patients (27,3% were operated on for lumbar spinal stenosis and 52 patients (5% were operated for recurrences. The operations were performed by neurosurgeons with the same professional degree but with different operative volume. Unintentional durotomy occurred in 20 (2,3% of the patients with herniated disc, in 14 (4,07% of the patients with lumbar spinal stenosis and in 12 (23% of the patients who were operated on for recurrences. The most frequent risk factors were: obesity, revised surgery and the physician’s low operative volume. Intraoperative dural fissures were repaired through suture (8 cases, by applying muscle, fat graft or by applying curaspon, tachosil. There existed 4 CSF fistulas which were repaired at reoperation. Incidental dural fissures during operations for degenerative lumbar disorders must be recognized and immediately repaired to prevent complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and treating unintentional durotomies can be best achieved by respecting a neat surgical technique and a standardized treatment protocol.

  8. A preliminary analysis of incident investigation reports of an integrated steel plant: some reflection.

    Science.gov (United States)

    Verma, A; Maiti, J; Gaikwad, V N

    2018-06-01

    Large integrated steel plants employ an effective safety management system and gather a significant amount of safety-related data. This research intends to explore and visualize the rich database to find out the key factors responsible for the occurrences of incidents. The study was carried out on the data in the form of investigation reports collected from a steel plant in India. The data were processed and analysed using some of the quality management tools like Pareto chart, control chart, Ishikawa diagram, etc. Analyses showed that causes of incidents differ depending on the activities performed in a department. For example, fire/explosion and process-related incidents are more common in the departments associated with coke-making and blast furnace. Similar kind of factors were obtained, and recommendations were provided for their mitigation. Finally, the limitations of the study were discussed, and the scope of the research works was identified.

  9. Neuropathic pain: A personal case reflection on a critical incident

    Directory of Open Access Journals (Sweden)

    Balaji P Duraisamy

    2011-01-01

    Full Text Available Neuropathic pain is a distressing symptom for the patient and a difficult symptom for the physician to treat. There is lack of evidence-based clinical guidelines for the management of malignant neuropathic pain. The case reflection is a personal account of what has been learnt from a critical incident in a particular patient in the management of neuropathic pain. Psychological issues are known to increase pain percetion and affect the quality of life. The case reflection explores problem areas, defines lacunae in knowledge, and demonstrates active learning of the management of neuropathic pain through reflective practice.

  10. Laboratory biorisk management biosafety and biosecurity

    CERN Document Server

    Salerno, Reynolds M

    2015-01-01

    Over the past two decades bioscience facilities worldwide have experienced multiple safety and security incidents, including many notable incidents at so-called ""sophisticated facilities"" in North America and Western Europe. This demonstrates that a system based solely on biosafety levels and security regulations may not be sufficient.Setting the stage for a substantively different approach for managing the risks of working with biological agents in laboratories, Laboratory Biorisk Management: Biosafety and Biosecurity introduces the concept of biorisk management-a new paradigm that encompas

  11. Effectiveness of a stress management pilot program aimed at reducing the incidence of sports injuries in young football (soccer) players.

    Science.gov (United States)

    Olmedilla-Zafra, Aurelio; Rubio, Victor J; Ortega, Enrique; García-Mas, Alexandre

    2017-03-01

    Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence. Pre-post treatment-non treatment group comparison. The program was administered by a trained psychologist on a once-a-week, 1-h session basis. Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group. Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview. Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η 2 p  = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η 2 p  = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Strategies for Improved Hospital Response to Mass Casualty Incidents.

    Science.gov (United States)

    TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas

    2018-03-19

    Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

  13. Decreased incidence of gout in diabetic patients using pioglitazone.

    Science.gov (United States)

    Niu, Sheng-Wen; Chang, Kai-Ting; Lin, Hugo You-Hsien; Kuo, I-Ching; Chang, Yu-Han; Chen, Yu-Han; Hung, Chi-Chih; Chiu, Yi-Wen; Hwang, Shang-Jyh

    2018-01-01

    The incidence and prevalence of gout are increasing, but the management is poor. Considering the increased prevalence of gout in the diabetic population, this study evaluated the effects of pioglitazone, an insulin resistance inhibitor, on the incidence of gout in the diabetic population. We used data from the National Health Insurance program in Taiwan. The pioglitazone cohort contained 30 100 patients and each patient was age and sex matched with three non-pioglitazone users who were randomly selected from the diabetic population. Cox proportional hazards regression analysis was conducted to estimate the effects of pioglitazone on the incidence of gout in the diabetic population. The incidence of gout was significantly lower in pioglitazone users than in non-pioglitazone users [adjusted hazard ratio (aHR) 0.81 (95% CI 0.78, 0.85)]. The HR for the incidence of gout was lower in both male [aHR 0.80 (95% CI 0.75, 0.85)] and female [aHR 0.83 (95% CI 0.78, 0.88)] pioglitazone users than in non-pioglitazone users. An analysis of three age groups (gout in the diabetic population using pioglitazone was less. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  14. Incidence, epidemiology and clinical features of Kawasaki disease in Catalonia, Spain.

    Science.gov (United States)

    Sánchez-Manubens, Judith; Antón, Jordi; Bou, Rosa; Iglesias, Estíbaliz; Calzada-Hernandez, Joan

    2016-01-01

    To assess the incidence, epidemiology and clinical features of Kawasaki disease (KD) in Catalonia (northeast region of Spain). This was an observational population-based study including all Paediatric Units in Catalonia, under both public and private management. Retrospective data retrieval was performed for 10 years (2004-2013). A 12-month (March 2013 to March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. Data from 399 patients over the 10-year study period was analysed, revealing that 233 (58.4%) had complete KD, 159 (39.8) incomplete KD and 7 (1.7%) were considered atypical KD. Mean annual incidence was 3.5/105 children 10(th) day of illness, ages 8 yo and the presence of sterile piuria, aseptic meningitis, abdominal pain and uveitis at diagnosis were found to have higher risk of coronary aneurisms (CAA) (pIncidence, clinical features and treatment plans in our cohort are similar to those described in other European studies.

  15. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Montgomery, Logan; Kildea, John [McGill University Health Centre (Canada)

    2016-08-15

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  16. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    International Nuclear Information System (INIS)

    Montgomery, Logan; Kildea, John

    2016-01-01

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  17. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

    Science.gov (United States)

    Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

    2018-01-01

    The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

  18. Application of grey incidence analysis to connection between human errors and root cause

    International Nuclear Information System (INIS)

    Ren Yinxiang; Yu Ren; Zhou Gang; Chen Dengke

    2008-01-01

    By introducing grey incidence analysis, the relatively important impact of root cause upon human errors was researched in the paper. On the basis of WANO statistic data and grey incidence analysis, lack of alternate examine, bad basic operation, short of theoretical knowledge, relaxation of organization and management and deficiency of regulations are the important influence of root cause on human err ors. Finally, the question to reduce human errors was discussed. (authors)

  19. Difficult incidents and tutor interventions in problem-based learning tutorials.

    Science.gov (United States)

    Kindler, Pawel; Grant, Christopher; Kulla, Steven; Poole, Gary; Godolphin, William

    2009-09-01

    Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

  20. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical?

    DEFF Research Database (Denmark)

    Maaløe, R; la Cour, M; Hansen, A

    2006-01-01

    The purpose of the present study was to measure the incidence and type of incidents that occurred in relation to anaesthesia and surgery during a 1-year period in six Danish hospitals. Furthermore, we wanted to identify risk factors for incidents, as well as risk factors for incidents being deeme...... critical....

  1. Trends in Diabetes Incidence Among 7 Million Insured Adults, 2006–2011

    Science.gov (United States)

    Nichols, Gregory A.; Schroeder, Emily B.; Karter, Andrew J.; Gregg, Edward W.; Desai, Jay; Lawrence, Jean M.; O'Connor, Patrick J.; Xu, Stanley; Newton, Katherine M.; Raebel, Marsha A.; Pathak, Ram D.; Waitzfelder, Beth; Segal, Jodi; Lafata, Jennifer Elston; Butler, Melissa G.; Kirchner, H. Lester; Thomas, Abraham; Steiner, John F.

    2015-01-01

    An observational cohort analysis was conducted within the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) DataLink, a consortium of 11 integrated health-care delivery systems with electronic health records in 10 US states. Among nearly 7 million adults aged 20 years or older, we estimated annual diabetes incidence per 1,000 persons overall and by age, sex, race/ethnicity, and body mass index. We identified 289,050 incident cases of diabetes. Age- and sex-adjusted population incidence was stable between 2006 and 2010, ranging from 10.3 per 1,000 adults (95% confidence interval (CI): 9.8, 10.7) to 11.3 per 1,000 adults (95% CI: 11.0, 11.7). Adjusted incidence was significantly higher in 2011 (11.5, 95% CI: 10.9, 12.0) than in the 2 years with the lowest incidence. A similar pattern was observed in most prespecified subgroups, but only the differences for persons who were not white were significant. In 2006, 56% of incident cases had a glycated hemoglobin (hemoglobin A1c) test as one of the pair of events identifying diabetes. By 2011, that number was 74%. In conclusion, overall diabetes incidence in this population did not significantly increase between 2006 and 2010, but increases in hemoglobin A1c testing may have contributed to rising diabetes incidence among nonwhites in 2011. PMID:25515167

  2. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades.

    LENUS (Irish Health Repository)

    Walsh, Jennifer M

    2011-04-01

    We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia.

  3. Incidence and Outcome of CPAP Failure in Preterm Infants.

    Science.gov (United States)

    Dargaville, Peter A; Gerber, Angela; Johansson, Stefan; De Paoli, Antonio G; Kamlin, C Omar F; Orsini, Francesca; Davis, Peter G

    2016-07-01

    Data from clinical trials support the use of continuous positive airway pressure (CPAP) for initial respiratory management in preterm infants, but there is concern regarding the potential failure of CPAP support. We aimed to examine the incidence and explore the outcomes of CPAP failure in Australian and New Zealand Neonatal Network data from 2007 to 2013. Data from inborn preterm infants managed on CPAP from the outset were analyzed in 2 gestational age ranges (25-28 and 29-32 completed weeks). Outcomes after CPAP failure (need for intubation CPAP using adjusted odds ratios (AORs). Within the cohort of 19 103 infants, 11 684 were initially managed on CPAP. Failure of CPAP occurred in 863 (43%) of 1989 infants commencing on CPAP at 25-28 weeks' gestation and 2061 (21%) of 9695 at 29-32 weeks. CPAP failure was associated with a substantially higher rate of pneumothorax, and a heightened risk of death, bronchopulmonary dysplasia (BPD) and other morbidities compared with those managed successfully on CPAP. The incidence of death or BPD was also increased: (25-28 weeks: 39% vs 20%, AOR 2.30, 99% confidence interval 1.71-3.10; 29-32 weeks: 12% vs 3.1%, AOR 3.62 [2.76-4.74]). The CPAP failure group had longer durations of respiratory support and hospitalization. CPAP failure in preterm infants is associated with increased risk of mortality and major morbidities, including BPD. Strategies to promote successful CPAP application should be pursued vigorously. Copyright © 2016 by the American Academy of Pediatrics.

  4. Incident command linkup: the vital key for CBRN response

    International Nuclear Information System (INIS)

    Smith, D.

    2009-01-01

    The most vital element for responding emergency personnel to a CBRN attack is the incident command linkup and dissemination of information. Incident Command, the basic foundation of the National Incident Management System (NIMS), is the first thing that must be effectively established when a response is required in any emergency. When initial evaluation of the scene determines that the incident involves CBRN, specialized resources from a wide array of assets must be activated quickly to mitigate the hazards. In this paper, we examine the information that the Incident Commander must be prepared to convey to those specialized assets responding. We will also look at what questions those specialized resources may ask while en route and upon arrival. Another key element that will be discussed is the placement of those resources in the hierarchy of the National Incident Management System. The information that the Incident Commander (IC) must be prepared to convey to those specialized assets responding is crucial for an efficient response and effective deployment. What questions might those specialized CBRN resources ask while en route and upon arrival? At a bare minimum, the four basic questions of who is in charge of the incident, where is the incident located, what transpired to trigger a response, and when did the incident occur must be answered. These questions should be answered while en route to the scene so that the Commander of the responding CBRN unit can formulate a plan on the move and prepare his response accordingly. While in transit, the CBRN responders should maintain contact with a representative of the Incident Command at the scene so that the latest information is available. Discussions should include anticipated logistical requirements such as personal protective equipment (PPE), decon requirements, communications protocols, and medical care issues. The CBRN Commander will need to know if the site is secure, has it been cleared of explosive hazards

  5. Management of an incident of failed sterilization of surgical instruments in a dental clinic in Hong Kong

    Directory of Open Access Journals (Sweden)

    Vincent Chi-Chung Cheng

    2013-11-01

    Conclusion: Rapid response is extremely crucial in minimizing the impact of this incident and relieving the anxiety of the affected patients. Proper recording and documentation of autoclave cycles and regular auditing should be enforced to prevent similar incidents.

  6. Introduction of a prehospital critical incident monitoring system--pilot project results.

    Science.gov (United States)

    Stella, Julian; Davis, Anna; Jennings, Paul; Bartley, Bruce

    2008-01-01

    Hospital medical incident monitoring improves preventable morbidity and mortality rates. Error management systems have been adopted widely in this setting. Data relating to incident monitoring in the prehospital setting is limited. Implementation of an incident monitoring process in a prehospital setting. This is a prospective, descriptive study of the pilot phase of the implementation of an incident monitoring process in a regional prehospital setting, with a focus on trauma care. Paramedics and emergency department staff submitted anonymous incident reports, and a chart review was performed on patients who met major trauma criteria. Selected trauma cases were analyzed by a structured interview/debriefing process to elucidate undocumented incidents. A project committee coded and logged all incidents and developed recommendations. Of 4,429 ambulance responses, 41 cases were analyzed. Twenty-four (58.5%; 95% CI = 49.7-67.4%) were reported anonymously, and the rest were major trauma patients. A total of 77 incidents were identified (mean per case = 1.8; CI = 1.03-2.57). Anonymous cases revealed 26 incidents (mean = 1.1; CI = 0.98-1.22); eight trauma debriefings revealed 38 incidents (mean = 4.8; CI = 0.91-8.69) and nine trauma chart reviews revealed 13 incidents (mean = 1.6; CI = 1.04-2.16). A total of 56 of 77 (72.7%; CI = 65.5-80.0%) incidents related to system inadequacies, and 15 (57.7%; CI = 46.7-68.6%) anonymously reported incidents related to resource problems. A total of 35 of 77 (45.5%; CI = 40.4-50.5%) incidents had minimal or no impact on the patients' outcomes. Thirty-four of 77 (44.2%; CI = 39.3-49.1%) incidents were considered mitigated by circumstance. Incident monitoring led to generalized feedback in most cases (65 of 77; 84.4%; CI = 77.6-91.3%); in three cases (3.9%; CI = 3.7-4.1%), specific education occurred; two cases were reported to an external body (2.6%; CI = 2.5-2.7%); three cases resulted in remedial action (3.9%; CI = 3.7-4.1%); four for

  7. Analysis of human factors in incidents reported by Swiss nuclear power plants to the inspectorate

    International Nuclear Information System (INIS)

    Alder, H.P.; Hausmann, W.

    1997-01-01

    197 reported incidents in Swiss Nuclear Power Plants were analyzed by a team of the Swiss Federal Nuclear Safety Inspectorate (HSK) using the OECD/NEA Incident Reporting System. The following conclusions could be drawn from this exercise. While the observed cause reported by the plant was ''technical failure'' in about 90% of the incidents, the HSK-Team identified for more than 60% of the incidents ''human factors'' as the root cause. When analyzing this root cause further it was shown that only a smaller contribution came from the side of the operators and the more important shares were caused by plant maintenance, vendors/constructors and plant management with procedural and organizational deficiencies. These findings demonstrate that root cause analysis of incidents by the IRS-Code is a most useful tool to analyze incidents and to find weak points in plant performance. (author). 5 tabs

  8. Incidents with hazardous radiation sources

    International Nuclear Information System (INIS)

    Schoenhacker, Stefan

    2016-01-01

    Incidents with hazardous radiation sources can occur in any country, even those without nuclear facilities. Preparedness for such incidents is supposed to fulfill globally agreed minimum standards. Incidents are categorized in incidents with licensed handling of radiation sources as for material testing, transport accidents of hazardous radiation sources, incidents with radionuclide batteries, incidents with satellites containing radioactive inventory, incidents wit not licensed handling of illegally acquired hazardous radiation sources. The emergency planning in Austria includes a differentiation according to the consequences: incidents with release of radioactive materials resulting in restricted contamination, incidents with release of radioactive materials resulting in local contamination, and incidents with the hazard of e@nhanced exposure due to the radiation source.

  9. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

  10. Incidents analysis

    Energy Technology Data Exchange (ETDEWEB)

    Francois, P

    1997-12-31

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs.

  11. Effect of farming practices and farm history on incidence of coconut ...

    African Journals Online (AJOL)

    Management of coconut (Cocos nucifera) lethal yellowing disease (CLYD), which has killed about eight million coconut trees in Mozambique, has proved challenging. The objective of this study was to investigate the impact of farming practices and related history, on the CLYD incidence in Mozambique. The methodology ...

  12. Incidence of severe critical events in paediatric anaesthesia (APRICOT)

    DEFF Research Database (Denmark)

    Habre, Walid; Disma, Nicola; Virag, Katalin

    2017-01-01

    a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist......BACKGROUND: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. METHODS...... 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring...

  13. Improving patient safety: how and why incidences occur in nursing care

    Directory of Open Access Journals (Sweden)

    Maria Cecilia Toffoletto

    2013-10-01

    Full Text Available The present investigation was a cross-sectional, quantitative research study analyzing incidents associated with nursing care using a root-cause methodological analysis. The study was conducted in a public hospital intensive care unit (ICU in Santiago de Chile and investigated 18 incidents related to nursing care that occurred from January to March of 2012. The sample was composed of six cases involving medications and the self-removal of therapeutic devices. The contributing factors were related to the tasks and technology, the professional work team, the patients, and the environment. The analysis confirmed that the cases presented with similar contributing factors, thereby indicating that the vulnerable aspects of the system are primarily responsible for the incidence occurrence. We conclude that root-cause analysis facilitates the identification of these vulnerable points. Proactive management in system-error prevention is made possible by recommendations.

  14. Epidemiology Characteristics and Trends of Lung Cancer Incidence in Iran.

    Science.gov (United States)

    Almasi, Zeinab; Salehiniya, Hamid; Amoori, Neda; Enayatrad, Mostafa

    2016-01-01

    Lung cancer is one of the most common cancers in the world and a major cause of death from cancer. One of the important indicators to compare the prevalence and incidence of the disease is a change in the trend. The aim of this study was to investigate the changes in the incidence of lung cancer in Iran. This study was conducted based on existing data obtained from a national registry of cancer cases and the Disease Management Center of Ministry of Health in Iran. All cases registered in the country were included during 2003-2008. Incidence rates were reported based on the direct method and standard population of World Health Organization. The study also examined the morphology of common lung cancers. Trends in incidence underwent joinpoint regression analysis. Based on the results of this study, 14,403 cases of lung cancer have been recorded of which 10,582 cases were in men and 3,821 in women. Highest incidence rates were observed in the 80-84 age group. Considerable variation across provinces was evident. In females squamous cell carcinoma (SCC) demonstrated a reduction from 24% to 16% of lesions over the period of study, while adenocarcinoma rose from 21% to 29%. In males a similar reduction in SCC was apparent (42% to 29%, again with increase in AC (13 % to 18%). The results show that the increase in the incidence of lung cancer the trend is that more men than women and in men and may be caused by changes in smoking pattern. The incidence of lung cancer in the North West and West provinces was higher than in other regions.

  15. Economic impact profiling of CBRN events: focusing on biological incidents.

    Science.gov (United States)

    Cavallini, Simona; Bisogni, Fabio; Mastroianni, Marco

    2014-12-01

    Chemical, biological, radiological and nuclear (CBRN) incidents, both caused accidentally by human error or natural/technological events and determined intentionally as criminal/malicious/terroristic acts, have consequences that could be differently characterized. In the last years many efforts to analyze the economic impact of terrorist threat have been carried out, while researches specifically concerning CBRN events have not been extensively undertaken. This paper in particular aims at proposing a methodological approach for studying macro-level economic impact profiles of biological incidents caused by weaponized and non-weaponized materials. The suggested approach investigates the economic consequences of biological incidents according to two main dimensions: type of large-scale effect and persistence of effect. Biological incident economic impacts are analyzed taking into account the persistence of effect during time as short-term impact (i.e. immediately after the incident), medium-term impact (i.e. by a month) and long-term impact (i.e. by years). The costs due to preventive countermeasure against biological threats (e.g. prevention, protection and preparedness expenses) are not taken into account. To this purpose, information on the key features of past biological incidents can be used as case studies to try to build impact profiles taking into account the proposed two main dimensions. Consequence management and effect mitigation of CBRN emergencies and disasters may benefit from an ex ante definition of the impact profiling related to this kind of incidents. The final goal of this paper is to define an approach to organize information on possible biological events according to their impact profile for supporting more effective and efficient first responders' prompt actions and policy makers' strategic decisions after the event occurrence.

  16. Wheelchair incidents

    NARCIS (Netherlands)

    Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM

    2002-01-01

    This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with

  17. Acute ureterolithiasis: Incidence of secondary signs on unenhanced helical CT and influence on patient management

    Energy Technology Data Exchange (ETDEWEB)

    Ege, G. E-mail: gurkanege@yahoo.com; Akman, H.; Kuzucu, K.; Yildiz, S

    2003-12-01

    AIM: The purpose of this study was to determine the incidence of secondary signs associated with ureteral stones on unenhanced helical computed tomography (CT) of patients with acute renal colic, and to correlate these with patient management and outcome. MATERIALS AND METHODS: One hundred and ten patients with ureterolithiasis were evaluated prospectively for the secondary signs of obstruction on unenhanced helical CT. Our attention was focused primarily on the presence or absence of seven secondary signs on unenhanced helical CT, including hydronephrosis, unilateral renal enlargement, perinephric oedema, unilateral absence of the white pyramid, hydroureter, periureteral oedema and lateroconal fascial thickening. RESULTS: Of the 110 patients, 91 (82.7%) had hydroureter, 88 (80%) had hydronephrosis, 65 (59%) had periureteric oedema and 63 (57.2%) had unilateral renal enlargement. Ninety stones passed spontaneously and 21 required intervention. CONCLUSION: Secondary signs of urinary tract obstruction are useful and supportive findings in interpretation of the CT examination. In our experience, the most reliable signs indicating ureteral obstruction are hydroureter, hydronephrosis, periureteral oedema and unilateral renal enlargement, respectively. In addition, stones larger than 6 mm, located within the proximal two thirds of the ureter, and seen associated with five or more the secondary signs of obstruction, are more likely to require endoscopic removal and/or lithotripsy.

  18. Critical incidents connected to nurses’ leadership in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Elaine Cantarella Lima

    Full Text Available ABSTRACT Objective: The goal of this study is to analyze nurses’ leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses’ behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses’ activities; people management; and the setting of high quality care targets. Final considerations: Researchers identified a mixed leadership model, leading them to the conclusion that nurses’ knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization’s results.

  19. Savannah River experience using a Cause Coding Tree to identify the root cause of an incident

    International Nuclear Information System (INIS)

    Paradies, M.W.; Busch, D.A.

    1986-01-01

    Incidents (or near misses) provide important information about plant performance and ways to improve that performance. Any particular incident may have several ''root causes'' that need to be addressed to prevent recurrence of the incident and thereby improve the safety of the plant. Also, by reviewing a large number of these incidents, one can identify trends in the root causes and generic concerns. A method has been developed at Savannah River Plant to systematically evaluate incidents, identify their root causes, record these root causes, and analyze the trends of these causes. By providing a systematic method to identify correctable root causes, the system helps the incident investigator to ask the right questions during the investigation. It also provides the independent safety analysis group and management with statistics that indicate existing and developing trouble sports. This paper describes the Savannah River Plant (SRP) Cause Coding Tree, and the differences between the SRP Tree and other systems used to analyze incidents. 2 refs., 14 figs

  20. Incidence, management, and course of cancer in patients with inflammatory bowel disease.

    Science.gov (United States)

    Algaba, Alicia; Guerra, Iván; Marín-Jiménez, Ignacio; Quintanilla, Elvira; López-Serrano, Pilar; García-Sánchez, María Concepción; Casis, Begoña; Taxonera, Carlos; Moral, Ignacio; Chaparro, María; Martín-Rodríguez, Daniel; Martín-Arranz, María Dolores; Manceñido, Noemí; Menchén, Luis; López-Sanromán, Antonio; Castaño, Ángel; Bermejo, Fernando

    2015-04-01

    Patients with inflammatory bowel disease [IBD] are at increased risk for developing some types of neoplasia. Our aims were to determin the risk for cancer in patients with IBD and to describe the relationship with immunosuppressive therapies and clinical management after tumor diagnosis. Retrospective, multicenter, observational, 5-year follow-up, cohort study. Relative risk [RR] of cancer in the IBD cohort and the background population, therapeutic strategies, and cancer evolution were analyzed. A total of 145 cancers were diagnosed in 133 of 9100 patients with IBD (global cumulative incidence 1.6% vs 2.4% in local population; RR = 0.67; 95% confidence interval [CI]: 0.57-0.78). Patients with IBD had a significantly increased RR of non-melanoma skin cancer [RR = 3.85; 2.53-5.80] and small bowel cancer [RR = 3.70; 1.23-11.13]. After cancer diagnosis, IBD treatment was maintained in 13 of 27 [48.1%] patients on thiopurines, in 2 of 3 on methotrexate [66.6%], none on anti-TNF-α monotherapy [n = 6] and 4 of 12 [33.3%] patients on combined therapy. Rate of death and cancer remission during follow-up did not differ [p > 0.05] between patients who maintained the treatment compared with patients who withdrew [5% vs 8% and 95% vs 74%, respectively]. An association between thiopurines [p = 0.20] or anti-TNF-α drugs [p = 0.77] and cancer was not found. Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  1. Surgical site infections following transcatheter apical aortic valve implantation: incidence and management.

    Science.gov (United States)

    Baillot, Richard; Fréchette, Éric; Cloutier, Daniel; Rodès-Cabau, Josep; Doyle, Daniel; Charbonneau, Éric; Mohammadi, Siamak; Dumont, Éric

    2012-11-13

    The present study was undertaken to examine the incidence and management of surgical site infection (SSI) in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI). From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES) at the Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ) as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry. Five (3.2%) patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI) and were considered as organ/space SSI's based on Center for Disease Control criteria (CDC). Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4±3.1 vs 26.2±4.4 p=0.0099) than the other patients in the cohort. While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major muscle were used successfully in these patients.

  2. Traffic management simulation development : summary.

    Science.gov (United States)

    2011-01-01

    Increasingly, Florida traffic is monitored electronically by components of the Intelligent Traffic System (ITS), which send data to regional traffic management centers and assist management of traffic flows and incident response using software called...

  3. Food risk management quality: Consumer evaluations of past and emerging food safety incidents

    NARCIS (Netherlands)

    Kleef, van E.; Ueland, O.; Theodoridis, G.; Rowe, G.; Pfenning, U.; Houghton, J.R.; Dijk, van H.; Chryssochoidis, G.; Frewer, L.J.

    2009-01-01

    In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what

  4. Post-event reviews: Using a quantitative approach for analysing incident response to demonstrate the value of business continuity programmes and increase planning efficiency.

    Science.gov (United States)

    Vaidyanathan, Karthik

    2017-01-01

    Business continuity management is often thought of as a proactive planning process for minimising impact from large-scale incidents and disasters. While this is true, and it is critical to plan for the worst, consistently validating plan effectiveness against smaller disruptions can enable an organisation to gain key insights about its business continuity readiness, drive programme improvements, reduce costs and provide an opportunity to quantitatively demonstrate the value of the programme to management. This paper describes a post mortem framework which is used as a continuous improvement mechanism for tracking, reviewing and learning from real-world events at Microsoft Customer Service & Support. This approach was developed and adopted because conducting regular business continuity exercises proved difficult and expensive in a complex and distributed operations environment with high availability requirements. Using a quantitative approach to measure response to incidents, and categorising outcomes based on such responses, enables business continuity teams to provide data-driven insights to leadership, change perceptions of incident root cause, and instil a higher level of confidence towards disaster response readiness and incident management. The scope of the framework discussed here is specific to reviewing and driving improvements from operational incidents. However, the concept can be extended to learning and evolving readiness plans for other types of incidents.

  5. Diagnosed hypertension in Canada: incidence, prevalence and associated mortality

    Science.gov (United States)

    Robitaille, Cynthia; Dai, Sulan; Waters, Chris; Loukine, Lidia; Bancej, Christina; Quach, Susan; Ellison, Joellyn; Campbell, Norman; Tu, Karen; Reimer, Kim; Walker, Robin; Smith, Mark; Blais, Claudia; Quan, Hude

    2012-01-01

    Background: Hypertension is a leading risk factor for cardiovascular diseases. Our objectives were to examine the prevalence and incidence of diagnosed hypertension in Canada and compare mortality among people with and without diagnosed hypertension. Methods: We obtained data from linked health administrative databases from each province and territory for adults aged 20 years and older. We used a validated case definition to identify people with hypertension diagnosed between 1998/99 and 2007/08. We excluded pregnant women from the analysis. Results: This retrospective population-based study included more than 26 million people. In 2007/08, about 6 million adults (23.0%) were living with diagnosed hypertension and about 418 000 had a new diagnosis. The age-standardized prevalence increased significantly from 12.5% in 1998/99 to 19.6% in 2007/08, and the incidence decreased from 2.7 to 2.4 per 100. Among people aged 60 years and older, the prevalence was higher among women than among men, as was the incidence among people aged 75 years and older. The prevalence and incidence were highest in the Atlantic region. For all age groups, all-cause mortality was higher among adults with diagnosed hypertension than among those without diagnosed hypertension. Interpretation: The overall prevalence of diagnosed hypertension in Canada from 1998 to 2008 was high and increasing, whereas the incidence declined during the same period. These findings highlight the need to continue monitoring the effectiveness of efforts for managing hypertension and to enhance public health programs aimed at preventing hypertension. PMID:22105752

  6. Development of a model for recording and evaluating incidents in radiotherapy

    International Nuclear Information System (INIS)

    Ribeiro, A.L.C.; Paiva, E. de; Teixeira, F.C.S.

    2017-01-01

    Radiotherapy has been constantly improving to become increasingly effective, thus contributing to increase the chances of healing patients. In this sense, incident learning gained prominence during successive approaches to patient safety. The objective is to develop a tool for recording and analyzing incidents in radiotherapy and applying it to clinics in Rio de Janeiro in order to implement the policy of quality management and safety culture. Steps were taken that involved the analysis of the process maps for the enrichment of the system (called the Standardized System of Incidents in Radiotherapy - SPIRad) that already has a version in physical form. The proposal is the conversion of this form to a digital tool to be used through the intranet. The next step is to apply it to radiotherapy clinics in Rio de Janeiro and evaluate the results obtained with the objective of possible improvements through feedback from users

  7. Adverse incidents resulting in exposure to body fluids at a UK dental teaching hospital over a 6-year period

    Directory of Open Access Journals (Sweden)

    Hughes A

    2012-10-01

    Full Text Available A Hughes,1 L Davies,1 R Hale,1 JE Gallagher21Kings College Hospital NHS Foundation Trust, 2King's College London Dental Institute, London, United KingdomBackground: The safety and protection of patients and health care workers is of paramount importance in dentistry, and this includes students in training who provide clinical care. Given the nature of dental care, adverse incidents can and do occur, exposing health care workers to body fluids and putting them at risk of infection, including contracting a blood-borne virus. The aim of this research was to analyze trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital from 2005 to 2010.Methods: Descriptive analysis of trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital over a six-year period was undertaken in relation to the level of outpatient and day surgery activity.Results: In total, 287 incidents were reported over a six-year period, which amounted to 0.039% of outpatient or day surgery appointments. Nearly three quarters of all the incidents (n = 208, 72% took place during treatment or whilst clearing away after the appointment. The most frequent incidents were associated with administration of local anesthetic (n = 63, 22%, followed by burs used in dental hand pieces (n = 51, 18%.Conclusion: This research confirms that adverse incidents are a feature of dental hospitals and reports the common sources. The importance of accurate and consistent reporting of data to ensure that these issues are monitored to inform action and reduce risks to staff, students, and patients are highlighted.Keywords: risk management, blood-borne virus, dental hospital, body fluids exposure, adverse event reporting

  8. Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

    DEFF Research Database (Denmark)

    Aasvang, E K; Laursen, M B; Madsen, J

    2018-01-01

    include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA....../TKA, hindering evidence-based information and potential anaesthesia stratification. METHODS: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American...... Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. RESULTS: In all, 1451 patients were included for analysis...

  9. Annual incidence of snake bite in rural bangladesh.

    Directory of Open Access Journals (Sweden)

    Ridwanur Rahman

    Full Text Available BACKGROUND: Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4/100,000 person years (95% C I 513.4-789.2/100,000 person years. Biting occurs mostly when individuals are at work. The majority of the victims (71% receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. CONCLUSIONS/SIGNIFICANCE: Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.

  10. Tracking Traffickers. The IAEA Incident and Trafficking Database

    International Nuclear Information System (INIS)

    Webb, Greg

    2013-01-01

    Radioactive material is missing from a hospital. Contaminated metal is found in a scrap yard. Smugglers try to peddle nuclear- weapon-usable material. These different scenarios illustrate the risks that these materials can pose to human safety and security. To assess those risks and to develop strategies to reduce them, States must understand the implications and the scope of such incidents that are occurring around the world. To better understand and respond to these events, the IAEA maintains an Incident and Trafficking Database (ITDB) which collects information from 122 participating States and some select international organizations. They are asked to share data on a voluntary basis about incidents in which nuclear and other radioactive material has fallen ''out of regulatory control.'' This could mean reporting cases of material that has gone missing, or discoveries of material where none was expected. The cases range from the innocent misplacement of industrial radioactive sources to criminal smuggling efforts which could aid terrorist acts. This information is shared among ITDB participants, and IAEA analysts try to identify trends and characteristics that could help prevent the misuse of these potentially dangerous materials. ''The ITDB has become an internationally recognized tool for States to study the extent and nature of these incidents,'' said John Hilliard, head of the Information Management and Coordination Section that administers the database. ''We've learned a lot by studying them, and we hope the information helps us prevent accidents or crimes in the future.'' The IAEA established the database in 1995 after States became alarmed by a growing number of trafficking incidents in the early 1990s. The service was originally operated by the Department of Safeguards, but later moved to the Department of Nuclear Safety and Security, where the Office of Nuclear Security now administers all the data collection and analysis

  11. Stroke Incidence in Victoria, Australia—Emerging Improvements

    Directory of Open Access Journals (Sweden)

    Benjamin B. Clissold

    2017-05-01

    Full Text Available BackgroundEvidence of a decline in the incidence of stroke has emerged from population-based studies. These have included retrospective and prospective cohorts. However, in Australia and other countries, government bodies and stroke foundations predict a rise in the prevalence of stroke that is anticipated to increase the burden of stroke across the entire domain of care. This increase in prevalence must be viewed as different from the decline in incidence being observed, a measure of new stroke cases. In Victoria, all public emergency department visits and public and private hospital admissions are reported to the Department of Health and Human Services and include demographic, diagnostic, and procedural/treatment information.MethodsWe obtained data from financial years 1997/1998 to 2007/2008 inclusive, for all cases with a primary stroke diagnosis (ICD-10-AM categories with associated data fields. Incident cases were established by using a 5-year clearance period.ResultsFrom 2003/2004 to 2007/2008 inclusive, there were 53,425 patients with a primary stroke or TIA diagnosis. The crude incident stroke rate for first ever stroke was 211 per 100,000 per year (95% CI 205–217 [females—205 per 100,000 per year (95% CI 196–214 and males—217 per 100,000 per year (95% CI 210–224]. The overall stroke rates were seen to significantly decline over the period [males (per 100,000 per year 227 in 2003/2004 to 202 in 2007/2008 (p = 0.0157 and females (per 100,000 per year 214 in 2003/2004 to 188 in 2007/2008 (p = 0.0482]. Ischemic stroke rates also appeared to decline; however, this change was not significant.ConclusionThese results demonstrate a significant decline in stroke incidence during the study period and may suggest evidence for effectiveness of primary and secondary prevention strategies in cerebrovascular risk factor management.

  12. Finding the Sweet Spot for Catastrophic Incident Search and Rescue

    Science.gov (United States)

    2009-09-01

    with SAR assets. Another high-tech SAR structure is found in the Cosmicheskaya Sistema Poiska Avariynyh Sudov56 (COSPAS-SARSAT) system. This model...shows clear 56 COSPAS is an acronym for the Russian, “Cosmicheskaya Sistema Poiska Avariynyh...under each of the preparedness categories. HSPD 5 is the companion document to HSPD 8, which discusses management of domestic incidents (Bush, 2003

  13. Measuring the association between artemisinin-based case management and malaria incidence in southern Vietnam, 1991-2010.

    Science.gov (United States)

    Peak, Corey M; Thuan, Phung Duc; Britton, Amadea; Nguyen, Tran Dang; Wolbers, Marcel; Thanh, Ngo Viet; Buckee, Caroline O; Boni, Maciej F

    2015-04-01

    In addition to being effective, fast-acting, and well tolerated, artemisinin-based combination therapies (ACTs) are able to kill certain transmission stages of the malaria parasite. However, the population-level impacts of ACTs on reducing malaria transmission have been difficult to assess. In this study on the history of malaria control in Vietnam, we assemble annual reporting on malaria case counts, coverage with insecticide-treated nets (ITN) and indoor residual spraying (IRS), and drug purchases by provincial malaria control programs from 1991 to 2010 in Vietnam's 20 southern provinces. We observe a significant negative association between artemisinin use and malaria incidence, with a 10% absolute increase in the purchase proportion of artemisinin-containing regimens being associated with a 29.1% (95% confidence interval: 14.8-41.0%) reduction in slide-confirmed malaria incidence, after accounting for changes in urbanization, ITN/IRS coverage, and two indicators of health system capacity. One budget-related indicator of health system capacity was found to have a smaller association with malaria incidence, and no other significant factors were found. Our findings suggest that including an artemisinin component in malaria drug regimens was strongly associated with reduced malaria incidence in southern Vietnam, whereas changes in urbanization and coverage with ITN or IRS were not. © The American Society of Tropical Medicine and Hygiene.

  14. Study on actions for social acceptance of a nuclear power plant incident/accident

    International Nuclear Information System (INIS)

    Kotani, Fumio; Tsukada, Tetsuya; Hiramoto, Mitsuru; Nishimura, Naoyuki

    1998-01-01

    When an incident/accident has occurred, dealing technically with it in an appropriate way is essential for social acceptance. One of the most important actions that are expected from the plant representative is to provide, without delay, each of the concerned authorities and organizations with full information concerning the incident/accident, while necessary technical measures are being implemented. While the importance of socially dealing with the incident/accident is widely recognized, up to now there have been no attempts to study previous incidents/accidents cases from the social sciences viewpoint. Therefore, in the present study is a case study of the incident/accident that occurred in 1991 at the No.2 Unit of the Mihama Nuclear Plant of Kansai Power Co., Ltd.. The data used in the present study is based on intensive interview of the staff involved in this incident/accident. The purpose of the study was to shed light on the conditions necessary for maintaining and improving the skill of the plant representative when dealing with social response in case of an incident/accident. The results of the present study has led to a fuller recognition of the importance of the following factors: On the personal level: 1) recognition of personal accountability, 2) complete disclosure of information concerning the incident/accident. On the organizational level: 1) acceptance of different approaches and viewpoints, 2) promoting risk-taking behavior, 3) top management's vision and commitment to providing a social response. (author)

  15. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics.

    Science.gov (United States)

    Paulson, Kelly G; Park, Song Youn; Vandeven, Natalie A; Lachance, Kristina; Thomas, Hannah; Chapuis, Aude G; Harms, Kelly L; Thompson, John A; Bhatia, Shailender; Stang, Andreas; Nghiem, Paul

    2018-03-01

    Merkel cell carcinoma (MCC) incidence rates are rising and strongly age-associated, relevant for an aging population. Determine MCC incidence in the United States and project incident cases through the year 2025. Registry data were obtained from the SEER-18 Database, containing 6600 MCC cases. Age- and sex-adjusted projections were generated using US census data. During 2000-2013, the number of reported solid cancer cases increased 15%, melanoma cases increased 57%, and MCC cases increased 95%. In 2013, the MCC incidence rate was 0.7 cases/100,000 person-years in the United States, corresponding to 2488 cases/year. MCC incidence increased exponentially with age, from 0.1 to 1.0 to 9.8 (per 100,000 person-years) among age groups 40-44 years, 60-64 years, and ≥85 years, respectively. Due to aging of the Baby Boomer generation, US MCC incident cases are predicted to climb to 2835 cases/year in 2020 and 3284 cases/year in 2025. We assumed that the age-adjusted incidence rate would stabilize, and thus, the number of incident cases we projected might be an underestimate. An aging population is driving brisk increases in the number of new MCC cases in the United States. This growing impact combined with the rapidly evolving therapeutic landscape warrants expanded awareness of MCC diagnosis and management. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Radiological incidents in radiotherapy

    International Nuclear Information System (INIS)

    Hobzova, L.; Novotny, J.

    2008-01-01

    In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)

  17. [Telematics equipment for poison control surveillance. Its applications in the health management of relevant chemical incidents].

    Science.gov (United States)

    Butera, R; Locatelli, C; Gandini, C; Minuco, G; Mazzoleni, M C; Giordano, A; Zanuti, M; Varango, C; Petrolini, V; Candura, S M; Manzo, L

    1997-01-01

    Health management of major chemical incidents requires a close collaboration between rescuers (on the disaster site and in the emergency department) and the poison center. The study tested telematic technologies allowing telepresence and teleconsulting, a real time and continuous connection among health care personnel and toxicologists involved in the management of the emergency. The link between the poison center (PC) and the emergency department in the local hospital is provided by a ISDN operating video conferencing system, while the data transmission from the site of the accident to the PC is achieved with a personal computer and GSM cellular data transmission. Toxicological databases and risk assessment software are integrated in the system, to support information sharing. To test such instruments in operative nearly realistic conditions, the main phase of the study has implemented simulated chemical disasters in different locations in Italy. Instruments for telepresence and teleconsulting have been effectively utilized to evaluate from a remote location the scenario and the severity of the accident, by inspecting either specific details or the whole scene, to enable PC guiding the triage of the victims before and after hospitalization, to utilize and share data, such as intervention protocols or patient records, and to document all the activities. In summary, this experience shows that the telematic link allows the toxicologists of the poison center to rapidly understand the situation, and to correctly learn about the conditions of patients with the help of images. The results of this study indicate the valuable benefits of telematic instruments for the health care in case of major chemical disasters occurring in a remote geographical location or in an area which lacks local toxicological experts, where specialized expertise can be achieved by the use of telematic technologies.

  18. Investigation of drum pressurization incident in the 331 Building, Room 175 on January 10, 1995

    International Nuclear Information System (INIS)

    Pollari, R.A.

    1995-02-01

    On January 10, 1995, a pressurized drum incident occurred at the 331 Building, Room 175. On January 12, 1995, the Manager of the Life Sciences Center appointed members to an Investigation Board to investigate the incident (see Exhibit A). This incident was initially categorized as an Off-Normal Occurrence, but was later elevated to an Unusual Occurrence by the Occurrence Classifier. The scope of this investigation was to employ a formal method of root cause analysis, identify the methodology, and report the results of the analysis, fully explaining the technical elements of the causal sequence along with a description of the barriers that should have or could have prevented the occurrence. During the course of the investigation, the scene of the event was not accessible. Therefore, the investigation relied primarily on testimony from staff members directly involved and their management. In addition, other outside professionals were also consulted. The Investigation Board visited the previous location of the drum, 331A Building, Room 9; Room 173, which fronts room 175, was also visited. The Investigation Board reviewed selected documents, which are also listed

  19. Hospital-related incidents; causes and its impact on disaster preparedness and prehospital organisations

    Directory of Open Access Journals (Sweden)

    Khorram-Manesh Amir

    2009-06-01

    Full Text Available Abstract Background A hospital's capacity and preparedness is one of the important parts of disaster planning. Hospital-related incidents, a new phenomenon in Swedish healthcare, may lead to ambulance diversions, increased waiting time at emergency departments and treatment delay along with deterioration of disaster management and surge capacity. We aimed to identify the causes and impacts of hospital-related incidents in Region Västra Götaland (western region of Sweden. Methods The regional registry at the Prehospital and Disaster Medicine Center was reviewed (2006–2008. The number of hospital-related incidents and its causes were analyzed. Results There were an increasing number of hospital-related incidents mainly caused by emergency department's overcrowdings, the lack of beds at ordinary wards and/or intensive care units and technical problems at the radiology departments. These incidents resulted in ambulance diversions and reduced the prehospital capacity as well as endangering the patient safety. Conclusion Besides emergency department overcrowdings, ambulance diversions, endangering patient s safety and increasing risk for in-hospital mortality, hospital-related incidents reduces and limits the regional preparedness by minimizing the surge capacity. In order to prevent a future irreversible disaster, this problem should be avoided and addressed properly by further regional studies.

  20. Development of operation management database for research reactors

    International Nuclear Information System (INIS)

    Zhang Xinjun; Chen Wei; Yang Jun

    2005-01-01

    An Operation Database for Pulsed Reactor has been developed on the platform for Microsoft visual C++ 6.0. This database includes four function modules, fuel elements management, incident management, experiment management and file management. It is essential for reactor security and information management. (authors)

  1. Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

    Science.gov (United States)

    Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

    2014-10-01

    At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.

  2. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012.

    Science.gov (United States)

    Zhang, Xingyu; Zhang, Tao; Pei, Jiao; Liu, Yuanyuan; Li, Xiaosong; Medrano-Gracia, Pau

    2016-01-01

    The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis.

  3. Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures.

    Science.gov (United States)

    Meling, Terje; Harboe, Knut; Søreide, Kjetil

    2009-11-01

    Musculoskeletal trauma represents a considerable global health burden; however, reliable population-based incidence data are lacking. Thus, we prospectively investigated the age- and sex-specific incidence patterns of long-bone fractures in a defined population. A 4-year prospective study of all long-bone fractures in a defined Norwegian population was carried out. The demographic data, as well as data on fracture type and location and mode of treatment were collected using recognised classification (e.g., AO/OTA - Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; Gustilo-Anderson (GA) for open fractures). Age- and sex-adjusted incidences were calculated using population statistics. During the study period, 4890 long-bone fractures were recorded. The overall incidence per 100,000 per year was 406 with a 95% confidence interval (95%CI) of 395-417. The age-adjusted incidence for those lower than that for those >or=16 years (427; 95%CI: 414-440). The overall male incidence (337; 95%CI: 322-355) was lower than the female (476; 95%CI: 459-493), but the male:female ratio was 2:1 among those or=50 years. The upper limb fractures had an overall incidence of 159 (95%CI: 152-166), whereas the lower limb fracture incidence was 247 (95%CI: 238-256). Open fractures occurred in 3%, with an incidence of 13 (95%CI: 11-15). Paediatric fractures were more likely to be treated conservatively with only 8% requiring internal fixation, compared to 56% internal fixation in those >or=16 years of age. An increase in the use of angular stable plates occurred during the study period. This prospectively collected study of long-bone fractures in a defined population recognises age- and gender-specific fracture patterns. Boys predominate in the younger age group for which treatment is basically conservative. In the senior population, women and operative treatment predominate.

  4. Traffic incident management in construction and maintenance work zones.

    Science.gov (United States)

    2009-01-01

    In 2004, the Federal Highway Administration published updated rules governing work zone safety and mobility; all highway construction and maintenance projects using federal-aid highway funds are required to develop transportation management plans (TM...

  5. GIS-based tools to identify tradeoffs between waste management and remediation strategies from radiological dispersal device incidents

    Energy Technology Data Exchange (ETDEWEB)

    Lemieux, P.; Wood, J.; Snyder, E. [U.S. Environmental Protection Agency, Research Triangle Park, NC (United States); Boe, T. [Oak Ridge Inst. for Science and Education, Research Triangle Park, NC (United States); Schulthiesz, D.; Peake, T.; Ierardi, M. [U.S. Environmental Protection Agency, Washington, DC (United States); Hayes, C.; Rodgers, M. [Eastern Research Group, Inc., Morrisville, NC (United States)

    2011-07-01

    Management of waste and debris from the detonation of a Radiological Dispersal Device (RDD) will likely comprise a significant portion of the overall remediation effort and possibly contribute to a significant portion of the overall remediation costs. As part of the recent National Level Exercise, Liberty RadEx, that occurred in Philadelphia in April 2010, a methodology was developed by EPA to generate a first-order estimate of a waste inventory for the hypothetical RDD from the exercise scenario. Determination of waste characteristics and whether the generated waste is construction and demolition (C&D) debris, municipal solid waste (MSW), hazardous waste, mixed waste, or low level radioactive waste (LLRW), and characterization of the wastewater that is generated from the incident or subsequent cleanup activities will all influence the cleanup costs and timelines. Decontamination techniques, whether they involve chemical treatment, abrasive removal, or aqueous washing, will also influence the waste generated and associated cleanup costs and timelines. This paper describes the ongoing effort to develop a tool to support RDD planning and response activities by assessing waste quantities and characteristics as a function of potential mitigation strategies and targeted cleanup levels. (author)

  6. GIS-based tools to identify tradeoffs between waste management and remediation strategies from radiological dispersal device incidents

    International Nuclear Information System (INIS)

    Lemieux, P.; Wood, J.; Snyder, E.; Boe, T.; Schulthiesz, D.; Peake, T.; Ierardi, M.; Hayes, C.; Rodgers, M.

    2011-01-01

    Management of waste and debris from the detonation of a Radiological Dispersal Device (RDD) will likely comprise a significant portion of the overall remediation effort and possibly contribute to a significant portion of the overall remediation costs. As part of the recent National Level Exercise, Liberty RadEx, that occurred in Philadelphia in April 2010, a methodology was developed by EPA to generate a first-order estimate of a waste inventory for the hypothetical RDD from the exercise scenario. Determination of waste characteristics and whether the generated waste is construction and demolition (C&D) debris, municipal solid waste (MSW), hazardous waste, mixed waste, or low level radioactive waste (LLRW), and characterization of the wastewater that is generated from the incident or subsequent cleanup activities will all influence the cleanup costs and timelines. Decontamination techniques, whether they involve chemical treatment, abrasive removal, or aqueous washing, will also influence the waste generated and associated cleanup costs and timelines. This paper describes the ongoing effort to develop a tool to support RDD planning and response activities by assessing waste quantities and characteristics as a function of potential mitigation strategies and targeted cleanup levels. (author)

  7. Vuosaari Harbour Road Tunnel Traffic Management and Incident Detection System Design Issues

    Directory of Open Access Journals (Sweden)

    Caj Holm

    2006-11-01

    Full Text Available Helsinki is constructing in Vuosaari a new modem and effectivecargo harbour. All cargo harbour activities will be concentratedthere. The total project includes the harbour, a logisticsarea, traffic connections (road, railway and fairway and aBusiness Park. The road connection goes through the Porvarinlahtiroad tunnel. The harbour will commence operatingin 2008. This paper gives an oveTView of the tunnel design phasefunctional studies and risk analysis tunnel incident detectionsystem design issues and some specific environmental featuresof the tunnel.

  8. Best practices in incident investigation in the chemical process industries with examples from the industry sector and specifically from Nova Chemicals

    International Nuclear Information System (INIS)

    Morrison, Lisa M.

    2004-01-01

    This paper will summarize best practices in incident investigation in the chemical process industries and will provide examples from both the industry sector and specifically from NOVA Chemicals. As a sponsor of the Center for Chemical Process Safety (CCPS), an industry technology alliance of the American Institute of Chemical Engineers, NOVA Chemicals participates in a number of working groups to help develop best practices and tools for the chemical process and associated industries in order to advance chemical process safety. A recent project was to develop an update on guidelines for investigating chemical process incidents. A successful incident investigation management system must ensure that all incidents and near misses are reported, that root causes are identified, that recommendations from incident investigations identify appropriate preventive measures, and that these recommendations are resolved in a timely manner. The key elements of an effective management system for incident investigation will be described. Accepted definitions of such terms as near miss, incident, and root cause will be reviewed. An explanation of the types of incident classification systems in use, along with expected levels of follow-up, will be provided. There are several incident investigation methodologies in use today by members of the CCPS; most of these methodologies incorporate the use of several tools. These tools include: timelines, sequence diagrams, causal factor identification, brainstorming, checklists, pre-defined trees, and team-defined logic trees. Developing appropriate recommendations and then ensuring their resolution is the key to prevention of similar events from recurring, along with the sharing of lessons learned from incidents. There are several sources of information on previous incidents and lessons learned available to companies. In addition, many companies in the chemical process industries use their own internal databases to track recommendations from

  9. Surgical site infections following transcatheter apical aortic valve implantation: incidence and management

    Directory of Open Access Journals (Sweden)

    Baillot Richard

    2012-11-01

    Full Text Available Abstract Objective The present study was undertaken to examine the incidence and management of surgical site infection (SSI in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI. Methods From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES at the Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry. Results Five (3.2% patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI and were considered as organ/space SSI’s based on Center for Disease Control criteria (CDC. Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4±3.1 vs 26.2±4.4 p=0.0099 than the other patients in the cohort. Conclusions While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major

  10. Increased incidence of bowel cancer after non-surgical treatment of appendicitis.

    Science.gov (United States)

    Enblad, Malin; Birgisson, Helgi; Ekbom, Anders; Sandin, Fredrik; Graf, Wilhelm

    2017-11-01

    There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis. Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated. Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1). Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  11. Epidemiology and incidence of acute and chronic Post-Surgical pain.

    Science.gov (United States)

    Sansone, Pasquale; Pace, Maria Caterina; Passavanti, Maria Beatrice; Pota, Vincenzo; Colella, Umberto; Aurilio, Caterina

    2015-01-01

    Post Surgical Pain (PSP) treatment represents a significant aspect of management of surgical patients. Incidence of severe PSP, with significant functional deficit is estimated at 5-10%. Most studies include a limited number of patients and this is a factor which affects power of results. Aims of our prospective observational study was to evaluate the incidence and characteristics of acute and chronic PSP in patients undergoing surgery at the university hospital of second university of naples. After Ethics Committee approval and written informed consent, the PSP acute on first day (at least 6 hours after surgery) through the International Pain Outcomes questionnaire was rated. Subsequently, patients were followed-up at 6 and 12 months; data collection took place by e-mail or phone and the Brief Pain Inventory and the DN4 were administered. We enrolled 235 patients, 219 performed the follow-up to 6months, 195 even that to 12 The incidence of CPSP at 6 months was of 45.2% for mild pain, 15.9% for moderate pain and of 2.7% for severe pain while the incidence of CPSP at 12 months was 35.9%, 11.8% and 2.5% respectively for the pain mild, moderate and severe. Neuropathic pain occurred in 40.3% of patients who CPSP moderate at 12 months compared with 31.9% of the patients interviewed at 6 months. Incidence and characteristics of PSP varied, often considerably, depending on the type of surgery, gender, age of the patient and the presence of PSP severe in the 24 hours following surgery. The incidence of CPSP 12 months after surgery must be improved in the next future. Preoperative pain and the percentage of time with severe pain during the first 24 hours after surgery seem to be CPSP predictors.

  12. Thyroid cancer incidence in the Ukraine after the Chernobyl accident: comparison with spontaneous incidences

    International Nuclear Information System (INIS)

    Sobolev, B.; Kairo, I.; Likhtarev, I.; Heidenreich, W.F.; Jacob, P.; Goulko, G.

    1997-01-01

    The thyroid cancer incidence in the Ukraine among those born in the period 1968-1986 was analyzed with the aim to identify the enhancement due to the Chernobyl accident. Since any Ukrainian data referring to the time period before the accident are scarce and the variation of spontaneous incidences in other countries is immense, the Ukrainian incidences in the period 1986-1989 were used to estimate the baseline risk. Following 1990, the incidence in the southern part of the Ukraine increased by about 30%, independent of age. In the other parts the increase of the incidence depended on age at exposure. In the age group of 9-year-old children, the incidences in three regions defined as the 'high-dose area', the northern, and the middle oblasts, increased by factors of 50, 20, and 6, respectively. These rates (1991-1995) are well above spontaneous rates in other countries. In the age group of 17-year-old juveniles, the incidence increased by a factor of 6 for the 'high dose area' and in the three northern oblasts, whereas in the nine 'middle' oblasts it was similar to the incidence of the 'southern' Ukraine. These rates are within the range found in other countries. (orig.)

  13. Pregnancy incidence and outcomes in women with perinatal HIV infection.

    Science.gov (United States)

    Byrne, Laura; Sconza, Rebecca; Foster, Caroline; Tookey, Pat A; Cortina-Borja, Mario; Thorne, Claire

    2017-07-31

    To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV). The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland. The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV. Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4 cell count (P pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

  14. IMI - An information system for effective Multidisciplinary Incident Management

    NARCIS (Netherlands)

    Lee, M.D.E. van der; Vugt, M. van der

    2004-01-01

    The field of crisis response and disaster management can be characterized, upon many other factors, by distributed operations, not daily routine work and multidisciplinary aspects. In designing and developing information systems for crisis response these factors need special attention. On behalf of

  15. Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event Symposium

    Energy Technology Data Exchange (ETDEWEB)

    Lesperance, Ann M.

    2008-06-30

    On March 19, 2008, policy makers, emergency managers, and medical and Public Health officials convened in Seattle, Washington, for a workshop on Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event. The day-long symposium was aimed at generating a dialogue about restoration and recovery through a discussion of the associated challenges that impact entire communities, including people, infrastructure, and critical systems.

  16. Cancer incidence among waiters

    DEFF Research Database (Denmark)

    Reijula, Jere; Kjaerheim, Kristina; Lynge, Elsebeth

    2015-01-01

    AIMS: To study cancer risk patterns among waiters in the Nordic countries. METHODS: We identified a cohort of 16,134 male and 81,838 female waiters from Denmark, Finland, Iceland, Norway and Sweden. During the follow-up period from 1961 to 2005, we found that 19,388 incident cancer cases were...... diagnosed. Standardised incidence ratio (SIR) was defined as the observed number of cancer cases divided by the expected number, based on national age, time period and gender-specific cancer incidence rates in the general population. RESULTS: The SIR of all cancers in waiters, in the five countries combined...... INCIDENCE IN SOME CANCER SITES CAN LIKELY BE EXPLAINED BY HIGHER ALCOHOL CONSUMPTION, THE PREVALENCE OF SMOKING AND OCCUPATIONAL EXPOSURE TO TOBACCO SMOKE HOPEFULLY, THE INCIDENCE OF CANCER AMONG WAITERS WILL DECREASE IN THE FUTURE, DUE TO THE BANNING OF TOBACCO SMOKING IN RESTAURANTS AND BARS IN THE NORDIC...

  17. Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS).

    Science.gov (United States)

    Yarmohammadian, Mohammad Hossein; Atighechian, Golrokh; Shams, Lida; Haghshenas, Abbas

    2011-08-01

    Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS) is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS). This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research instrument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Findings of study were categorized into three general categories including requirements (organizational and sub-organizational), barriers (internal and external) of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authorities in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable framework and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

  18. TU-CD-BRD-00: Incident Learning / RO-ILS

    International Nuclear Information System (INIS)

    2015-01-01

    It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: How to create a system that is easy for front line staff to access How to motivate staff to report How to promote the system as positive and educational and not punitive or demeaning How to organize the team for reviewing and responding to reports How to prioritize which reports to discuss in depth How not to dismiss the rest How to identify underlying causes How to design corrective actions and implement change How to develop useful statistics and analysis tools How to coordinate a departmental system with a larger risk management system How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample time set

  19. TU-CD-BRD-00: Incident Learning / RO-ILS

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: How to create a system that is easy for front line staff to access How to motivate staff to report How to promote the system as positive and educational and not punitive or demeaning How to organize the team for reviewing and responding to reports How to prioritize which reports to discuss in depth How not to dismiss the rest How to identify underlying causes How to design corrective actions and implement change How to develop useful statistics and analysis tools How to coordinate a departmental system with a larger risk management system How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample time set

  20. Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents.

    Science.gov (United States)

    DeFraia, G S

    2015-07-01

    Psychologically traumatic workplace events (known as critical incidents) occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.

  1. Reducing risky driver behaviour through the implementation of a driver risk management system

    Directory of Open Access Journals (Sweden)

    Rose Luke

    2014-11-01

    Full Text Available South Africa has one of the highest incidences of road accidents in the world. Most accidents are avoidable and are caused by driver behaviour and errors. The purpose of this article was to identify the riskiest driver behaviours in commercial fleets in South Africa, to determine the business impact of such behaviour, to establish a framework for the management of risky driver behaviour and to test the framework by applying a leading commercial driver behaviour management system as a case study. The case study comprised three South African commercial fleets. Using data from these fleets, critical incident triangles were used to determine the ratio data of risky driver behaviour to near-collisions and collisions. Based on managing the riskiest driver behaviours as causes of more serious incidents and accidents, the results indicated that through the implementation of an effective driver risk management system, risky incidents were significantly reduced.

  2. Adaptive management: good business or good buzzwords?

    Science.gov (United States)

    Sally. Duncan

    1998-01-01

    Adaptive management is a fusion of science and managment used to improve and care for natural resources. This issue of "Science Findings" centers on how this type of management is used to tame wildfire incidents in northeastern Oregon's Blue Mountain range.The following article considers how adaptive management is being used by the La Grande,...

  3. Incidence of work injuries amongst Danish adolescents and their association with work environment factors

    DEFF Research Database (Denmark)

    Rasmussen, Kurt; Hansen, Claus D; Nielsen, Kent Jacob

    2011-01-01

    psychological demands and low social support increased the risk of experiencing work injuries after adjustment for a number of factors. CONCLUSIONS: The incidence of work injuries among adolescents appears to be higher than the incidence among their older colleagues. Lack of social support from management......BACKGROUND: The objective was to examine the incidence of work accidents that required medical attention among Danish adolescents and to identify possible work environment factors associated with such accidents. METHODS: We collected information in two questionnaire rounds (2004 and 2007) from...... a birth cohort comprising all adolescents born in 1989 (n = 3,687) living in Ringkjobing County, Denmark. The questionnaire contained items on self-reported number of accidents and number of working hours in both rounds and on work environment factors in the second round. RESULTS: Approximately 5...

  4. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012

    Science.gov (United States)

    Zhang, Xingyu; Zhang, Tao; Pei, Jiao; Liu, Yuanyuan; Li, Xiaosong; Medrano-Gracia, Pau

    2016-01-01

    Background The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. Methods In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). Results The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. Conclusion Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis. PMID:26901682

  5. Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2015-07-01

    Full Text Available Background: Psychologically traumatic workplace events (known as critical incidents occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. Objective: To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. Methods: Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. Results: Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. Conclusion: Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.

  6. Crisis management during anaesthesia: obstruction of the natural airway.

    Science.gov (United States)

    Visvanathan, T; Kluger, M T; Webb, R K; Westhorpe, R N

    2005-06-01

    Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient. To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia. The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases. Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist's clinical practice requirements.

  7. 'We have to put up with it--don't we?' The experience of being the registered nurse on duty, managing a violent incident involving an elderly patient: a phenomenological study.

    Science.gov (United States)

    Chambers, N

    1998-02-01

    The incidence of violence directed towards nurses is well known. However, despite guidelines and training aimed at preventing or minimizing these incidents, recent reports indicate an increase in their occurrence. This phenomenological study investigated the experiences of five registered nurses who had to manage a violent incident involving an elderly patient. The purpose of this was to discover what these nurses 'know' about the structure of such an experience and, through the use of Colaizzi's method of data analysis, present this knowledge in the form of an exhaustive description of the experience. Taped interviews were used to collect the data. The analytical process revealed that the experience is structured around five themes: professional competence, nursing identity, powerlessness and oppression, loss (neglected and deserted) and strategies for survival. The discussion analyses these themes and the relationships between them, highlighting the issues of nurse autonomy and exercising accountability. The implications for nursing practice, education and research include recognition of nurses as a professional group to enable autonomous practice, the ways in which nurses' perceptions of nursing knowledge may affect their educative role and the need to extend this study further to provide answers to the questions raised therein.

  8. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique.

    Science.gov (United States)

    Kueper, Janina; Fantini, Gary A; Walker, Brendon R; Aichmair, Alexander; Hughes, Alexander P

    2015-04-01

    This article examines the incidence and management of vascular injury during Lateral Lumbar Interbody Fusion (LLIF). The details of the mini-open access technique are presented. A total of 900 patients who underwent a LLIF at an average 1.94 levels (range: 1-5 levels) by one of six fellowship trained surgeons on 1,754 levels from 2006 to 2013 were identified. The incidence of intraoperative vascular injury was retrospectively determined from the Operative Records. The management of vascular injury was evaluated. The mini-open access adapted by our institution for LLIF is described. The incidence of major vascular complication in our series was 1/900. The incidence of minor vascular injury was 4/900. The overall incidence of vascular injury was calculated to be 0.056 % per case and 0.029 % per level. All minor vascular injuries were identified to be segmental vessel lacerations, which were readily ligated under direct visualization without further extension of the incision with no clinical sequelae. The laceration of the abdominal aorta, the major vascular complication of this series, was emergently repaired through an exploratory laparotomy. None of the patients suffered long-term sequelae from their intraoperative vascular injuries. The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.

  9. Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

    2014-01-01

    Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

  10. Incidence of malignancy in females presenting with breast lumps in OPD: a study of 277 cases

    International Nuclear Information System (INIS)

    Chaudhary, I.A.; Qureshi, S.K.; Rasul, S.

    2003-01-01

    Objective: To find the incidence of malignancy in females presenting with breast lumps in surgical out patient and to find out the age related incidence of benign and malignant diseases in these patients. Patients and Methods: All cases reporting to surgical outdoor with breast lumps were included and underwent investigation for the breast lumps to determine the histopathological diagnosis. Results: A total of 277 cases were studied. 24.2% breast lumps were malignant and 75.8% were benign. The incidence of malignancy increases from 0% in 2nd decade to 38.9% in 5th and 100% in 9th decade of life. The probability of diagnosing a breast lump as a malignant is one in three in 4th decade, two in five in 5th decade and more than one in two there after. Fibrocystic disease (33.8%) and Fibro adenoma (27.1%) was the commonest finding among the benign lumps. Among malignant lumps infiltrating duct carcinoma (68.7%) is the commonest finding. Conclusion: There is a significantly high incidence of malignant breast lumps after the 3rd decade of life and it increases subsequently. It is recommended that the surgeon managing a case of breast lump in a patient above 30 years should be highly suspicious and cautious so that early detection and management of malignant lumps be carried out. (author)

  11. Increasing incidence of pyogenic spondylodiscitis

    DEFF Research Database (Denmark)

    Kehrer, Michala; Pedersen, Court; Jensen, Thøger G

    2014-01-01

    Smaller studies indicate that the incidence of pyogenic spondylodiscitis is increasing, possible related to a growing elderly population. Data supporting this is sparse, and we therefore studied patient characteristics and changes in spondylodiscitis incidence 1995-2008.......Smaller studies indicate that the incidence of pyogenic spondylodiscitis is increasing, possible related to a growing elderly population. Data supporting this is sparse, and we therefore studied patient characteristics and changes in spondylodiscitis incidence 1995-2008....

  12. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway.

    Science.gov (United States)

    Støen, R O; Nordsletten, L; Meyer, H E; Frihagen, J F; Falch, J A; Lofthus, C M

    2012-10-01

    This study reports a significant decrease in age-adjusted incidence rates of hip fracture for women in Oslo, Norway, even compared with data from 1978/1979. Use of bisphosphonate may explain up to one third of the decline in the incidence. The aims of the present study were to report the current incidence of hip fractures in Oslo and to estimate the influence of bisphosphonates on the current incidence. Using the electronic diagnosis registers and lists from the operating theaters of the hospitals of Oslo, all patients with ICD-10 codes S72.0 and S72.1 (hip fracture) in 2007 were identified. Medical records of all identified patients were reviewed to verify the diagnosis. Age- and gender-specific annual incidence rates were calculated using the population of Oslo on January 1, 2007 as the population at risk. Data on the use of bisphosphonates were obtained from official registers. A total number of 1,005 hip fractures, 712 (71%) in women, were included. The age-adjusted fracture rates per 10,000 for the age group >50 years were 82.0 for women and 39.1 for men in 2007, compared with 110.8 and 41.4 in 1996/1997, 116.5 and 42.9 in 1988/1989, and 97.5 and 34.5 in 1978/1979, respectively. It was estimated that the use of bisphosphonates may explain up to 13% of the decline in incidence in women aged 60-69 years and up to 34% in women aged 70-79 years. The incidence of hip fractures in women in Oslo has decreased significantly during the last decade and is now at a lower level than in 1978/1979. This reduction was not evident in men. The incidence of hip fractures in Oslo is, however, still the highest in the world.

  13. A prospective study on the incidence of dog bites and management in a rural Cambodian, rabies-endemic setting.

    Science.gov (United States)

    Ponsich, Aurelia; Goutard, Flavie; Sorn, San; Tarantola, Arnaud

    2016-08-01

    Rabies circulates intensely in Cambodia, mainly affecting rural populations. We conducted a prospective study to estimate the baseline incidence of potentially infective dog bites in rural villages of Siem Reap province, Cambodia. The study was conducted in a convenience sample of 844 families totaling 1779 persons in four villages. The study collected data in a total of 802.3 person-years. Trained village health workers (VHW) exhaustively documented consecutive dog bites at the end of each month. Between May 15th and November 15th, 2011, a total of 40 attacks (43 bites; 1.07 bites per attack) were notified by 39 persons (50% female; one suffered two distinct incidents) to VHW. The all-age attack rate for bites over this 6-month period was 2.3% (CI95%: 1.7-3.1%), with a global incidence rate estimated at 4.84 bites/100 person-years (CI95%: 3.5-6.6). The mean age in bite victims was 20.8±18.9years (median 12.5; interquartile range 6-36; range 1-63). The dog was identified in 39 (97.5%) of cases, being the household dog in 9 (22.5%) of cases. Bites were classified as severe (WHO Category III-broken skin with bleeding) in 33 (82.5%) of cases with a severe dog bites incidence estimated at 4/100 person-years (CI95%: 2.8-5.6). The bites involved the hand or face in 1 (2.5%) case each (both Category III). In 20 incidents (50%), only rice was applied to the wounds. There were no suspected or confirmed human rabies deaths during the study period but one dog died after biting (2 others were lost to follow-up and 14 were put down by their owner). Our study documented an extremely high incidence of dog bites in of rural Cambodian adults and children. Adapted control policies for canine vaccination are urgently needed. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Guide to safe work : fatigue management : an employer's guide to designing and implementing a fatigue management program. 2 ed.

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-02-15

    The impacts of fatigue on workplace safety are now commonly recognized. Many employers now wish to include fatigue management as part of their overall health and safety programs. This guide to fatigue management was written to help companies in the petroleum industry design and implement effective fatigue management programs that reduce incidents and injuries among employees. The guide provided information about workplace fatigue and discussed fatigue management issues and strategies. It was suggested that workplace culture can play a significant role in managing fatigue by allowing fatigue factors to be quickly recognized and managed. Employers who wish to build fatigue management programs should involve all levels of employees, and should consider all workplace practices and procedures. Consideration must also be given to the development of employee competency in managing fatigue. The guide included step-by-step recommendations for implementing a fatigue management program. It was concluded that the benefits of fatigue management include reduced worker absence and turnover, as well as avoiding the costs of safety incidents. 1 tab., 1 fig.

  15. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs

    DEFF Research Database (Denmark)

    Cordtz, René Lindholm; Hawley, Samuel; Prieto-Alhambra, Daniel

    2018-01-01

    person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996-2001) were compared with the bDMARD era (2003-2016) using segmented linear regression interrupted by a 1-year lag period (2002). RESULTS: We identified 30 404 patients with incident RA......OBJECTIVES: To study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark. METHODS: Nationwide register-based cohort...... in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction....

  16. Strategies to alleviate the incidence of ascites in broilers: a review

    Directory of Open Access Journals (Sweden)

    U Aftab

    2005-12-01

    Full Text Available Ascites is a complex problem caused by many interacting factors such as genetics, environment and management. Many nutritional, medicinal and management strategies have been proposed to alleviate the problem. Higher levels of dietary vitamin C and E along with selenium yeast might be beneficial, presumably because of their role in improving cellular integrity. Oils rich in n-3 fatty acids have been shown to reduce pulmonary hypertension and, consequently, ascites incidence. The potential use of flax oil has already been demonstrated, whereas the effects of other oils rich in n-3 fatty acids (fish, linseed and canola oils remain to be investigated. The assessment of the effects of dietary electrolyte balance on ascites incidence seems to be a promising field of research in broiler nutrition. In general, reducing the dietary level of salt (NaCl and adding bicarbonates to the diet and drinking water have been proposed as potential "cost-effective" methods to reduce ascites incidence. The use of nutrients/drug agents that increase the vascular capacity of the lungs or decrease the pulmonary vascular resistance may help to alleviate the problem, but economic and local feed regulations might restrict such use. Diuretics have also shown positive effects, presumably because there is a reduction of sodium and fluid retention in the body; litter humidity however must be closely monitored if diuretics are continuously administered. As the high metabolic rate (fast growth is a major factor contributing to the susceptibility of broilers to ascites, early-age feed or nutrient restriction (qualitative or quantitative or light restriction in order to slow down the growth rate seem practically viable methods, since final body weight is not compromised. Optimization of the house temperature and ventilation in cold weather seem helpful practices to decrease ascites incidence. Under practical conditions, it might be interesting to test the additive effects of

  17. Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management.

    Science.gov (United States)

    Garg, Jalaj; Palaniswamy, Chandrasekar; Lanier, Gregg M

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels. If the electrocardiogram and brain natriuretic peptide level are abnormal, an echocardiogram should be obtained. The role of endomyocardial biopsy for the diagnosis of PPCM is controversial. Patients should be started on diuretics if volume overloaded, and beta-blockers (preferably metoprolol) if no contraindications exist; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy or lactation. There are no standard, universally accepted guidelines for the management of PPCM. Although experimental therapies like bromocriptine, pentoxifylline and immunoglobulins have shown promising results, large double-blind randomized trials are essential to confirm the results of smaller studies. In patients with persistent severe left ventricular (LV) dysfunction, advanced therapies like mechanical circulatory support and heart transplantation should be considered. Owing to recent data demonstrating deterioration of LV systolic function after initial recovery, it is essential to maintain long-term follow up of these patients regardless of initial recovery of LV function. We present a comprehensive review of the literature etiopathogenesis, diagnosis, and management of PPCM.

  18. Adventure Program Risk Management Report: 1998 Edition. Narratives and Data from 1991-1997.

    Science.gov (United States)

    Leemon, Drew, Ed.; Schimelpfenig, Tod, Ed.; Gray, Sky, Ed.; Tarter, Shana, Ed.; Williamson, Jed, Ed.

    The Wilderness Risk Managers Committee (WRMC), a consortium of outdoor schools and organizations, works toward better understanding and management of risks in the wilderness. Among other activities, the WRMC gathers data on incidents and accidents from member organizations and other wilderness-based programs. This book compiles incident data for…

  19. Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Nichols, Linda; Stirling, Christine; Otahal, Petr; Stankovich, Jim; Gall, Seana

    2018-03-01

    Aneurysmal subarachnoid hemorrhage (aSAH) incidence is not well studied. Varied definitions of "subarachnoid hemorrhage" have led to a lack of clarity regarding aSAH incidence. The impact of area-level socioeconomic disadvantage and geographical location on the incidence of aSAH also remains unclear. Using a population-based statewide study, we examined the incidence of aSAH in relation to socioeconomic disadvantage and geographical location. A retrospective cohort study of nontraumatic subarachnoid hemorrhages from 2010 to 2014 was undertaken. Researchers manually collected data from multiple overlapping sources including statewide administrative databases, individual digital medical records, and death registers. Age-standardized rates (ASRs) per 100,000 person years were calculated using the 2001 Australian population. Differences in incidence rate ratios were calculated by age, sex, area-level socioeconomic status, and geographical location using Poisson regression. The cohort of 237 cases (mean age, 61.0 years) with a female predominance of 166 (70.04%) included 159 confirmed aSAH, 52 community-based deaths, and 26 probable cases. The ASR for aSAH was 9.99 (95% confidence interval [CI], 8.69-11.29). A significant association between area-level socioeconomic disadvantage and incidence was observed, with the rate of aSAH in disadvantaged geographical areas being 1.40 times higher than that in advantaged areas (95% CI, 1.11-1.82; P = .012). This study uses a comprehensive search of multiple data sources to define a new baseline of aSAH within an Australian population. This study presents a higher incidence rate of aSAH with socioeconomic variations. As a key risk factor that may explain this paradox, addressing socioeconomic inequalities is important for effective prevention and management interventions. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Yarmohammadian

    2011-01-01

    Full Text Available Background: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS. Methods: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research in-strument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Results: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational, barriers (internal and external of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Conclusions: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authori-ties in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable frame-work and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

  1. The incidence of phlebitis with intravenous amiodarone at guideline dose recommendations.

    Science.gov (United States)

    Slim, Ahmad M; Roth, Jason E; Duffy, Benjamin; Boyd, Sheri Y N; Rubal, Bernard J

    2007-12-01

    Postoperative atrial fibrillation following cardiothoracic surgery is common and frequently managed with intravenous (IV) amiodarone. Phlebitis is the most common complication with peripheral infusion of this agent. Current practice guidelines for peripheral IV administration of phlebitis. The present study examines the incidence of phlebitis in a postoperative patient population given current dose recommendations. A total of 273 patient charts were reviewed. The incidence of phlebitis in patients given IV amiodarone (n = 36) was 13.9% (95% confidence interval, 2.6-25.2%; p = 0.001). Logistic regression analysis with backward elimination of other therapeutic risk factors suggests that the odds ratio for phlebitis using current dose regimens without IV filters is 19-fold greater than baseline risk in this population. Phlebitis remains a significant complication associated with peripheral infusion of amiodarone within recommended dosing limits.

  2. Precursor incident program at EDF

    International Nuclear Information System (INIS)

    Fourest, B.; Maliverney, B.; Rozenholc, M.; Piovesan, C.

    1998-01-01

    The precursor program was started by EDF in 1994, after an investigation of the US NRC's Accident Sequence Precursor Program. Since then, reported operational events identified as Safety Outstanding Events have been analyzed whenever possible using probabilistic methods based on PSAs. Analysis provides an estimate of the remaining protection against core damage at the time the incident occurred. Measuring the incidents' severity enables to detect incidents important regarding safety. Moreover, the most efficient feedback actions can be derived from the main accident sequences identified through the analysis. Therefore, incident probabilistic analysis provides a way to assess priorities in terms of treatment and resource allocation, and so, to implement countermeasures preventing further occurrence and development of the most significant incidents. As some incidents cannot be analyzed using this method, probabilistic analysis can only be one among the methods used to assess the nuclear power plants' safety level. Nevertheless, it provides an interesting complement to classical methods of deterministic studies. (author)

  3. Temporal trends in outpatient management of incident pulmonary embolism and associated mortality.

    Science.gov (United States)

    Klil-Drori, Adi J; Coulombe, Janie; Suissa, Samy; Hirsch, Andrew; Tagalakis, Vicky

    2018-01-01

    In clinical trial settings, outpatient management of pulmonary embolism (PE) is feasible and safe, but less is known on its use in routine care. We determined trends in outpatient management of PE and associated mortality in a large non-select patient population. All residents of Quebec, Canada with a first-ever work-up for suspected PE in the emergency department (ED) over 10years were included. Patients could transition to outpatient management and from unconfirmed to confirmed PE in a time-varying fashion. Comparing the years 2005-9 with 2000-4, we assessed the odds ratio (OR) for outpatient management, and relative risk (RR) for all-cause mortality, readmissions for PE, and major bleeding in 30days. We adjusted the RR for a mortality risk score. Of 15,217 patients included, 7583 were outpatients (7.5% confirmed PE) and 7634 were inpatients (60.6% confirmed PE). In all, 10.9% of patients with confirmed PE were outpatients, but outpatient management of confirmed PE was more likely in the latter study period (OR 1.73, 95%CI 1.44-2.09). Among outpatients with confirmed PE, mortality (RR 0.84, 95%CI 0.15-4.61) and readmission (RR 1.25, 95%CI 0.45-3.48) rates were stable, and only 3 major bleeding events were noted. Inpatients with confirmed PE had stable mortality rates (RR 0.95, 95%CI 0.72-1.24). Outpatient PE management increased over 10years while remaining fairly uncommon. Nevertheless, stable mortality and readmission rates indicate this practice is safe in routine care, and add to the growing evidence in support of outpatient PE management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Living in critical times: The impact of critical incidents on frontline ambulance personnel--a qualitative perspective.

    LENUS (Irish Health Repository)

    Gallagher, Sharon

    2007-01-01

    Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.

  5. Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-Maker Following a Large Scale Nuclear or Radiation Incident

    International Nuclear Information System (INIS)

    Coleman, C. Norman; Koerner, John F.

    2016-01-01

    The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by health-care professionals with biodosimetry assays providing critical supporting data. (authors)

  6. Incidence Trend and Epidemiology of Common Cancers in the Center of Iran.

    Science.gov (United States)

    Rafiemanesh, Hosein; Rajaei-Behbahani, Narjes; Khani, Yousef; Hosseini, Sayedehafagh; Pournamdar, Zahra; Mohammadian-Hafshejani, Abdollah; Soltani, Shahin; Hosseini, Seyedeh Akram; Khazaei, Salman; Salehiniya, Hamid

    2015-07-13

    Cancer is a major public health problem in Iran and many other parts of the world. The cancer incidence is different in various countries and in country provinces. Geographical differences in the cancer incidence lead to be important to conduct an epidemiological study of the disease. This study aimed to investigate cancer epidemiology and trend in the province of Qom, located in center of Iran. This is an analytical cross-sectional study carried out based on re-analysis cancer registry report and the disease management center of health ministry from 2004 to 2008 in the province of Qom. To describe incidence time trends, we carried out join point regression analysis using the software Join point Regression Program, Version 4.1.1.1. There were 3,029 registered cases of cancer during 5 years studied. Sex ratio was 1.32 (male to female). Considering the frequency and mean standardized incidence, the most common cancer in women were breast, skin, colorectal, stomach, and esophagus, respectively while in men the most common cancers included skin, stomach, colorectal, bladder, and prostate, respectively. There was an increasing and significant trend, according to the annual percentage change (APC) equal to 8.08% (CI: 5.1-11.1) for all site cancer in women. The incidence trend of all cancers was increasing in this area. Hence, planning for identifying risk factors and performing programs for dealing with the disease are essential.

  7. Regional comparison of cancer incidence

    International Nuclear Information System (INIS)

    Obralic, N.; Gavrankapetanovic, F.; Dizdarevic, Z.; Duric, O.; Sisic, F.; Selak, I.; Balta, S.; Nakas, B.

    2004-01-01

    Background. Due to specific war and post-war situation in Balkan region, differences in the number, type, development, biological course, treatment of malignant tumours and its outcome are possible. In order to perceive the situation realistically, it is necessary to gather continuously exact data about malignant tumours and compare them with the data from other European and world countries.The aim of the study was to collect and analyse the data on cancer incidence in the region of Sarajevo city, which represents a symbol of difficult times in the recent past, and to compare it to the incidence in the neighbouring countries. Patients and methods. Data on all newly diagnosed cancer cases, permanent residents of Sarajevo Canton, in the years 1999 and 2000 were collected. Crude incidence rate has been calculated according to the years observed, gender and localizations of the disease The data were compared to the cancer registries of Slovenia and Croatia and were observed in the light of specific local situation. Results. The crude cancer incidence of all sites but skin was the highest in both years and by both genders in Croatia. The incidence of the most common tumours (lung and breast cancer) was similar in all three countries. The differences in the incidence between both genders in the Sarajevo canton were registered in laryngeal and urinary bladder cancer, as well as in bone and cartilage sarcoma. Cervical cancer had extremely high incidence and was high up on the incidence list in the Sarajevo canton, which correlates with the data in developing countries. The incidence of other tumours in the post-war period is reaching expected numbers. Conclusions. It is difficult to identify whether the war and post-war stress, irregular and insufficient nutrition during and after the siege of the city of Sarajevo or some other factor influenced the cancer incidence among exposed population. The prevalence of smoking in the whole region is extremely high, in Bosnia and

  8. Global prevalence and incidence of traumatic spinal cord injury

    Directory of Open Access Journals (Sweden)

    Singh A

    2014-09-01

    region (58 per million, and Olmsted County in Minnesota (54.8 per million and were lower than 20 per million in Taipei, Taiwan (14.6 per million, the Rhone-Alpes region in France (12.7 per million, Aragon, Spain (12.1 per million, Southeast Turkey (16.9 per million, and Stockholm, Sweden (19.5 per million. The highest national incidence was 49.1 per million in New Zealand, and the lowest incidences were in Fiji (10.0 per million and Spain (8.0 per million. The majority of studies showed a high male-to-female ratio and an age of peak incidence of younger than 30 years old. Traffic accidents were typically the most common cause of SCI, followed by falls in the elderly population. Conclusion: This review demonstrates that the incidence, prevalence, and causation of SCI differs between developing and developed countries and suggests that management and preventative strategies need to be tailored to regional trends. The rising aging population in westernized countries also indicates that traumatic SCI secondary to falls may become an increasing public health challenge and that incidence among the elderly may rise with increasing life expectancy. Keywords: SCI, causation, epidemiology

  9. Incidence of Congenital Heart Diseases Anomalies in Newborns with Oral Clefts, Zahedan, Iran

    Directory of Open Access Journals (Sweden)

    Noor Mohammad Noori

    2016-09-01

    Full Text Available Background Oral cleft is the most common orofacial congenital anomaly among live births. This anomaly at birth is one of the main causes of children disability and mortality.  Congenital heart disease (CHD is one of the most common anomalies in oral clefts.  This study aimed to assess the incidence of congenital heart diseases anomalies in newborns with oral clefts. Materials and Methods This study performed on 48,692 live born to estimate incidence of oral clefts from 1 st December 2013 to 31 th November 2015 from three general hospitals in Zahedan, The capital city of the Sistan & Baluchestan  province, Iran. All oral cleft patients were under echocardiography to diagnosis the incidence of CHD as associated anomaly. The collected data were processed using SPSS-16. Results The results of the analysis showed that the incidence of cleft lip was higher in boys than girls, while the cleft palate was higher in girls. Lip/palate cleft was higher for boys.  Oral clefts patients accounted of 102 (0.2% with incidence rate of 2.095 per 1000 lives. Of 102 patients 19 (18.62%, 39(35.24% and 44(43.14% were oral lip, oral palate and both respectively. The incidence of CHD in patients with oral clefts was 26.5%, while the incidences for cleft lip, cleft palate and both were 15.79%, 20.51%, and 36.36% respectively. Conclusion From the study concluded that the rate of CHD among children with oral clefts was high compared with the healthy children.  Strongly is suggested the echocardiography for these patients to have early diagnostic of CHD to manage any life-threatening.

  10. Stroke incidence and 30-day and six-month case fatality rates in Udine, Italy: a population-based prospective study.

    Science.gov (United States)

    Janes, Francesco; Gigli, Gian Luigi; D'Anna, Lucio; Cancelli, Iacopo; Perelli, Anna; Canal, Giessica; Russo, Valentina; Zanchettin, Barbara; Valente, Mariarosaria

    2013-10-01

    Stroke incidence in high-income countries is reported to decrease, and new data on stroke incidence and outcome are needed to design stroke services and to ameliorate stroke management. This study is part of a two-year prospective community-based registry of all cerebrovascular events in the district of Udine (153,312 inhabitants), Friuli-Venezia Giulia region, northeast of Italy, between 1 April 2007 and 31 March 2009. Overlapping sources for case finding were used, combining hot and cold pursuit. We identified 784 stroke cases, 640 (81.6%) incident. The crude overall annual incidence rate per 100,000 residents was 256 (95% confidence interval 241-271) for all strokes and 209 (95% confidence interval 195-223) for first-ever strokes. Incidence rate for first-ever strokes was 181 (95% confidence interval 155-211) after adjustment to the 2007 Italian population and 104 (95% confidence interval 88-122) compared with the European standard population. Incidence rates for first-ever strokes was 215 (196-235) for women, 202 (183-223) for men. Crude annual incidence rates per 100,000 population were 167 (153-178) for ischemic stroke, 31 (26-37) for intracerebral hemorrhage, 8.1 (5.7-11.4) for sub-arachnoid hemorrhage, and 4.6 (2.8-7.1) for undetermined stroke. Overall case fatality rates for first-ever stroke were 20.6% at 28 days and 30.2% at 180 days. Our study shows incidence rates higher than previously reported in our region but not supporting the view of higher incidence rates in Northern than in Southern Italy. Results contribute to time-trends analysis on epidemiology, useful for dimensioning services in Italy and show the persistence of a gap between the outcome of stroke in Italy and that of the best performing European countries, urging to adopt better stroke management plans. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  11. Cholestasis in neonates with red cell alloimmune hemolytic disease: incidence, risk factors and outcome.

    Science.gov (United States)

    Smits-Wintjens, Vivianne E H J; Rath, Mirjam E A; Lindenburg, Irene T M; Oepkes, Dick; van Zwet, Erik W; Walther, Frans J; Lopriore, Enrico

    2012-01-01

    Etiology of cholestatic liver disease in neonates with hemolytic disease of the newborn (HDN) has been associated with iron overload due to intrauterine red cell transfusions (IUTs). Data on the incidence and severity of cholestasis in neonates with HDN are scarce, and little is known about pathogenesis, risk factors, neonatal management and outcome. To evaluate incidence, risk factors, management and outcome of cholestasis in neonates with red cell alloimmune hemolytic disease. All (near-) term neonates with HDN due to red cell alloimmunization admitted to our center between January 2000 and July 2010 were included in this observational study. Liver function tests (including conjugated bilirubin) were routinely performed in the neonatal period. We recorded the presence of cholestasis, investigated several potential risk factors and evaluated the management and outcome in affected neonates. A total of 313 infants with red cell alloimmune hemolytic disease treated with or without IUTs were included. The incidence of cholestasis was 13% (41/313). Two risk factors were independently associated with cholestasis: treatment with at least one IUT (OR 5.81, 95% CI 1.70-19.80, p = 0.005) and rhesus D type of alloimmunization (OR 4.66, 95% CI 1.05-20.57, p = 0.042). Additional diagnostic tests to investigate possible causes of cholestasis were all negative. In 5 infants (12%), supportive medical and nutritional therapy was started, and one neonate required iron chelation therapy. Cholestasis occurs in 13% of neonates with HDN due to red cell alloimmunization, and it is independently associated with IUT treatment and rhesus D type of alloimmunization. Copyright © 2012 S. Karger AG, Basel.

  12. Communication report regarding the incident on the residual heat removal system at the nuclear power plant of Civaux May 12, 1998

    International Nuclear Information System (INIS)

    Chadeyron, Philippe

    1999-01-01

    The RRA (Residual Heat Removal System) of unit I had a leak of 280 m 3 while the reactor was shutdown for a period of 5 days, for normal start up tests. The leak was caused by a crack in a weld on a pipe of 25 cm in diameter. The liquid was completely contained within the Reactor Building containment; absolutely nothing leaked outside of the Reactor Building. This incident was classified level 2 on the INES scale. The Communication Immediately following the Incident showed that the efforts towards transparency were rewarding. A few months after the incident, hindsight helps, we can say that the media management of the RRA incident on, May 12th was in the image of its technical management, that is to say well mastered, and outside of the incident itself close to perfect. Obviously, the work we did during crisis exercises reaped its rewards. What is missing to advance to the next level? Maybe a bit of psychology, to attempt to surmise what a leak of radioactive water could represent in the public's eyes as well as the Media's who ignore the 'safety culture' (back-up trains etc.) and who still have fresh in their memories the Chernobyl accident. The vital Experience Feedback we collected and that of the Nuclear Industry since it exists incident after incident, even if immeasurable progress has been made (Civaux is a good example) our technical culture remains a hinderence towards a good estimation of the emotional level that such an incident can cause. Otherwise said, we still have progress to make on measuring the impact of an incident, not on the technical consequences nor the seriousness, but on the psychological impact it may have on the public. Beyond the crisis, this incident also showed how essential it is to dare talking about incidents and Safety Culture before intervening. The intimate enemy of Nuclear Energy is above all the relative ignorance in which the population finds itself. We still have work to do

  13. Cancer incidence in atomic bomb survivors. Part IV: Comparison of cancer incidence and mortality

    International Nuclear Information System (INIS)

    Ron, E.; Preston, D.L.; Mabuchi, Kiyohiko; Thompson, D.E.; Soda, Midori

    1994-01-01

    This report compares cancer incidence and mortality among atomic bomb survivors in the Radiation Effects Research Foundation Life Span Study (LSS) cohort. Because the incidence data are derived from the Hiroshima and Nagasaki tumor registries, case ascertainment is limited to the time (1958-1987) and geographic restrictions (Hiroshima and Nagasaki) of the registries, whereas mortality data are available from 1950-1987 anywhere in Japan. With these conditions, there were 9,014 first primary incident cancer cases identified among LSS cohort members compared with 7,308 deaths for which cancer was listed as the underlying cause of death on death certificates. When deaths were limited to those occurring between 1958-1987 in Hiroshima or Nagasaki, there were 3,155 more incident cancer cases overall, and 1,262 more cancers of the digestive system. For cancers of the oral cavity and pharynx, skin, breast, female and male genital organs, urinary system and thyroid, the incidence series was at least twice as large as the comparable mortality series. Although the incidence and mortality data are dissimilar in many ways, the overall conclusions regarding which solid cancers provide evidence of a significant dose response generally confirm the mortality findings. When either incidence or mortality data are evaluated, significant excess risks are observed for all solid cancers, stomach, colon, liver (when it is defined as primary liver cancer or liver cancer not otherwise specified on the death certificate), lung, breast, ovary and urinary bladder. No significant radiation effect is seen for cancers of the pharynx, rectum, gallbladder, pancreas, nose, larynx, uterus, prostate or kidney in either series. There is evidence of a significant excess of nonmelanoma skin cancer in the incidence data, but not in the mortality series. 19 refs., 2 figs., 10 tabs

  14. Medical support for law enforcement-extended operations incidents.

    Science.gov (United States)

    Levy, Matthew J; Tang, Nelson

    2014-01-01

    As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. This study retrospectively examined the clinical encounters of the Maryland State Police (MSP) Tactical Medical Unit (TMU) during law enforcement extended operations incidents lasting 8 or more hours. In addition, a qualitative analysis was performed on clinical data collected by federal law enforcement agencies during their extended operations. Forty-four percent of missions (455/1,047) supported by the MSP TMU lasted 8 or more hours. Twenty-six percent of these missions (117/455) resulted in at least one patient encounter. Nineteen percent of patient chief complaints (45/238) were related to heat illness/ dehydration. Fifteen percent of encounters (36/238) were for musculoskeletal injury/pain. Eight percent of patients (19/238) had nonspecific sick call (minor illness) complaints. The next most common occurring complaints were cold-related injuries, headache, sinus congestion, and wound/laceration, each of which accounted for 7 percent of patients (16/238), respectively. Analysis of federal law enforcement agencies' response to such events yielded similar clinical encounters. A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints

  15. Pain management after lung surgery

    OpenAIRE

    Maria Frödin; Margareta Warrén Stomberg

    2014-01-01

    Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the partici...

  16. Breast Cancer Incidence and Risk Reduction in the Hispanic Population.

    Science.gov (United States)

    Power, Eric J; Chin, Megan L; Haq, Mohamed M

    2018-02-26

    Breast cancer is the most common non-skin cancer amongst women worldwide and is the fifth leading cause of cancer-related mortality overall. It is also the foremost reason for cancer-related mortality in Hispanic females in the United States (US). Although the current incidence of breast cancer is significantly lower in Hispanics compared to that of non-Hispanic Whites (NHW) and Blacks, (91.9, 128.1, and 124.3 per 100,000, respectively, annually), this may increase if Hispanics develop similar lifestyle behaviors to other American women, in categories such as weight management, age at first birth, number of children, and breastfeeding habits. Stage-for-stage mortality for Hispanics is similar to NHWs, but the mortality rate is not declining as rapidly in this ethnic group. Hispanic women share many of the same risk factors for developing breast cancer as NHWs and Blacks. This suggests that many of the risk reduction strategies used in other racial populations may also benefit this group. Providing education about breast cancer and implementing risk reduction strategies in culturally-aware environments could help keep incidence low and reduce cancer-related mortality. Since Hispanics are the largest minority group in the US, this could have a significant impact on the incidence and mortality nationally.

  17. Agency procedures for the NRC incident response plan. Final report

    International Nuclear Information System (INIS)

    1983-02-01

    The NRC Incident Response Plan, NUREG-0728/MC 0502 describes the functions of the NRC during an incident and the kinds of actions that comprise an NRC response. The NRC response plan will be activated in accordance with threshold criteria described in the plan for incidents occurring at nuclear reactors and fuel facilities involving materials licensees; during transportation of licensed material, and for threats against facilities or licensed material. In contrast to the general overview provided by the Plan, the purpose of these agency procedures is to delineate the manner in which each planned response function is performed; the criteria for making those response decisions which can be preplanned; and the information and other resources needed during a response. An inexperienced but qualified person should be able to perform functions assigned by the Plan and make necessary decisions, given the specified information, by becoming familiar with these procedures. This rule of thumb has been used to determine the amount of detail in which the agency procedures are described. These procedures form a foundation for the training of response personnel both in their normal working environment and during planned emergency exercises. These procedures also form a ready reference or reminder checklist for technical team members and managers during a response

  18. GRAPH-BASED POST INCIDENT INTERNAL AUDIT METHOD OF COMPUTER EQUIPMENT

    Directory of Open Access Journals (Sweden)

    I. S. Pantiukhin

    2016-05-01

    Full Text Available Graph-based post incident internal audit method of computer equipment is proposed. The essence of the proposed solution consists in the establishing of relationships among hard disk damps (image, RAM and network. This method is intended for description of information security incident properties during the internal post incident audit of computer equipment. Hard disk damps receiving and formation process takes place at the first step. It is followed by separation of these damps into the set of components. The set of components includes a large set of attributes that forms the basis for the formation of the graph. Separated data is recorded into the non-relational database management system (NoSQL that is adapted for graph storage, fast access and processing. Damps linking application method is applied at the final step. The presented method gives the possibility to human expert in information security or computer forensics for more precise, informative internal audit of computer equipment. The proposed method allows reducing the time spent on internal audit of computer equipment, increasing accuracy and informativeness of such audit. The method has a development potential and can be applied along with the other components in the tasks of users’ identification and computer forensics.

  19. Decreasing incidence rates of bacteremia

    DEFF Research Database (Denmark)

    Nielsen, Stig Lønberg; Pedersen, C; Jensen, T G

    2014-01-01

    BACKGROUND: Numerous studies have shown that the incidence rate of bacteremia has been increasing over time. However, few studies have distinguished between community-acquired, healthcare-associated and nosocomial bacteremia. METHODS: We conducted a population-based study among adults with first......-time bacteremia in Funen County, Denmark, during 2000-2008 (N = 7786). We reported mean and annual incidence rates (per 100,000 person-years), overall and by place of acquisition. Trends were estimated using a Poisson regression model. RESULTS: The overall incidence rate was 215.7, including 99.0 for community......-acquired, 50.0 for healthcare-associated and 66.7 for nosocomial bacteremia. During 2000-2008, the overall incidence rate decreased by 23.3% from 254.1 to 198.8 (3.3% annually, p incidence rate of community-acquired bacteremia decreased by 25.6% from 119.0 to 93.8 (3.7% annually, p

  20. Incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and solitary cold nodules

    International Nuclear Information System (INIS)

    Ott, R.A.; Calandra, D.B.; McCall, A.; Shah, K.H.; Lawrence, A.M.; Paloyan, E.

    1985-01-01

    The reported incidence of thyroid carcinoma in Hashimoto's thyroiditis varies widely. For this reason the specific subpopulation of patients with Hashimoto's thyroiditis and a solitary cold nodule was analyzed. Between 1972 and 1984 we operated on 146 consecutive patients with solitary cold nodules and Hashimoto's thyroiditis. There were 47 carcinomas, for an incidence of 32%. The mean age of the 146 patients was 43 1/2 years (median 44 years), with 126 females and 20 males. There was a history of prior head and neck radiation exposure in 54 patients, with a 33% incidence of thyroid carcinoma. The 92 patients without a history of radiation exposure had a 31.5% incidence of carcinoma. The frequency of multicentricity (bilateralism) was 33% in the group that underwent radiation and 24% in the group that did not. To date, with a mean follow-up of 4.7 years, there have been no deaths and no evidence of recurrence. In conclusion, we report a 32% incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and a solitary cold nodule, with no apparent difference between the patients with or without a history of radiation exposure, although there was a higher incidence of bilateralism (33% versus 24%) in the carcinomas of the patients with a history of head and neck irradiation. We suggest that the operative management of these patients is total thyroidectomy for those with a history of head and neck radiation and thyroid lobectomy for patients with no history of radiation, followed by contralateral lobectomy if a carcinoma is demonstrated

  1. Statement of nuclear incidents at nuclear installations

    International Nuclear Information System (INIS)

    2002-01-01

    The Health and Safety Executive (HSE) presents the statement of nuclear incidents at nuclear installations published under the Health and Safety Commission's powers derived from section 11 of the Health and Safety at Work, etc. Act 1974. INCIDENT 02/4/1. Harwell (United Kingdom Atomic Energy Authority) On 6 November 2002 during operations in a glove box in B220, the over pressure alarm sounded. The operators evacuated and shortly afterwards the airborne activity monitors also sounded. The building emergency arrangements for airborne activity alarms was initiated to ascertain the source and to manage the operations. An investigation by UKAEA confirmed that a release of Americium 241 into the working area had occurred at a quantity in excess of Schedule 8 column 4 of the Ionising Radiations Regulations 1999 (IRRs). A number of personnel have received intakes including the two operators and the health physics personnel who attended the event. The highest dose (up to 6 mSv.) was received by the Health Physics charge hand. UKAEA placed an embargo on the use of similar systems and have completed their own management investigation and produced an internal report. It concludes that the likely cause of the event was over-pressurisation of the vacuum equipment used in the process. The report also highlights improvements required to the ventilation system in the laboratory and adjoining areas. An action plan has been developed for this work and progress is being made. NIl has followed the UKAEA investigation and carried out its own study including a visit by a ventilation specialist. This has confirmed the problems with the ventilation system. It is a complex issue that may have a wider impact across the building. A letter has been sent to UKAEA detailing a series of short-term requirements and the need to review implications and produce a longer-term action plan. UKAEA is cooperating fully with these requirements. INCIDENT 02/4/2. Dounreay (United Kingdom Atomic Energy

  2. Two 238Pu inhalation incidents

    International Nuclear Information System (INIS)

    Fleming, R.R.; Hall, R.M.

    1978-06-01

    Two employees inhaled significant amounts of 238 Pu in separate unrelated contamination incidents in 1977. Both acute exposure incidents are described and the urine, feces, and in-vivo chest count data for each employee. Case B ( 238 PuNO 3 ) received 24 DTPA treatments beginning the day of the incident while, for medical reasons, Case A ( 238 PuO 2 ) received no therapy

  3. Prostate cancer – development of the incidence and mortality compared to Slovakia with foreign

    International Nuclear Information System (INIS)

    Ondrusova, M.; Ondrus, D.

    2013-01-01

    Introduction and Aims: The 3% secular trend of global growth of the prostate cancer incidence is attributed to the higher and continuously increasing life expectancy of the population especially in the developed countries. The presented paper attempts to analyze the prostate cancer incidence and mortality and possible reasons for any discovered difference in the Slovak Republic compared to selected regions and countries of the world. Results: In the Slovak Republic, the prostate cancer incidence is marked by a rising trend of the age-adjusted incidence from 14.6/100,000 in 1968 (CI 95% ± 1.577) to 44.6/100 000 in 2007 (CI 95% ± 2.256). The mortality values are growing at a slower rate, from 7.2/100,000 in 1968 (CI 95 % ± 1,130), to 13.4/100,000 CI 95 % ± 1,221) in the last year of under evaluation. Over the recent years (2001-2007) there is a drop in the national mortality data in the Slovak Republic. Conclusion: Prostate cancer is one of the most frequent malignant tumors in males, with incidence rising towards western and more developed countries with wide application of the PSA testing, as confirmed also by the analysis of the incidence in the Slovak republic. Prostate cancer mortality is slightly declining or stabilized towards countries with wider application of the PSA testing, as a result of better treatment management. (author)

  4. Cumulative incidence of postoperative severe pain at Hospital Universitario San Jose, Popayan. Preliminar report

    Directory of Open Access Journals (Sweden)

    Ingrid Muñoz

    2013-12-01

    Full Text Available Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU at Hospital Universitario San José of Popayán (HUSJ in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10 were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients. Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients and 1.9% 60 minutes 95%CI [0-4.5] (3 patients. 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

  5. Cancer incidence in Spain, 2015.

    Science.gov (United States)

    Galceran, J; Ameijide, A; Carulla, M; Mateos, A; Quirós, J R; Rojas, D; Alemán, A; Torrella, A; Chico, M; Vicente, M; Díaz, J M; Larrañaga, N; Marcos-Gragera, R; Sánchez, M J; Perucha, J; Franch, P; Navarro, C; Ardanaz, E; Bigorra, J; Rodrigo, P; Bonet, R Peris

    2017-07-01

    Periodic cancer incidence estimates of Spain from all existing population-based cancer registries at any given time are required. The objective of this study was to present the current situation of cancer incidence in Spain. The Spanish Network of Cancer Registries (REDECAN) estimated the numbers of new cancer cases occurred in Spain in 2015 by applying the incidence-mortality ratios method. In the calculus, incidence data from population-based cancer registries and mortality data of all Spain were used. In 2015, nearly a quarter of a million new invasive cancer cases were diagnosed in Spain, almost 149,000 in men (60.0%) and 99,000 in women. Globally, the five most common cancers were those of colon-rectum, prostate, lung, breast and urinary bladder. By gender, the four most common cancers in men were those of prostate (22.4%), colon-rectum (16.6%), lung (15.1%) and urinary bladder (11.7%). In women, the most common ones were those of breast (28.0%), colon-rectum (16.9%), corpus uteri (6.2%) and lung (6.0%). In recent years, cancer incidence in men seems to have stabilized due to the fact that the decrease in tobacco-related cancers compensates for the increase in other types of cancer like those of colon and prostate. In women, despite the stabilization of breast cancer incidence, increased incidence is due, above all, to the rise of colorectal and tobacco-related cancers. To reduce these incident cancer cases, improvement of smoking control policies and extension of colorectal cancer screening should be the two priorities in cancer prevention for the next years.

  6. Incidence of symptomatic osteochondritis dissecans lesions of the knee : A population-based study in Olmsted County

    NARCIS (Netherlands)

    Pareek, A.; Sanders, T. L.; Wu, I. T.; Larson, D. R.; Saris, D. B.F.; Krych, A.J.

    2017-01-01

    Objective: To (1) define population-based incidence of knee Osteochondritis dissecans (OCD) lesions using the population of Olmsted County, (2) examine trends over time, and (3) evaluate rate of surgical management over time. Method: Study population included 302 individuals who were diagnosed with

  7. Modeling the incidence of citrus canker in leaves of the sweet orange variety ‘Pera’

    Directory of Open Access Journals (Sweden)

    Danielle da Silva Pompeu

    2017-01-01

    Full Text Available Citrus canker, caused by the bacterium Xanthomonas citri subsp. citri, is one of the most important diseases of citrus. The use of resistant genotypes plays an important role in the management and control of the disease and is the most environmentally sustainable approach to disease control. Citrus canker incidence was recorded in an experiment on nine genotypes of the sweet orange variety ‘Pera’ grafted on four rootstocks. The experiment was started in 2010 and the incidence of citrus canker on the leaves was recorded on a quarterly basis. The incidence data from the experiment were analyzed using a zero-inflated Beta regression model (RBIZ, which is the appropriate method to describe data with large numbers of zeros. Based on the residual analysis, the data fit the model well. The discrete component of the explanatory variable, rootstock, was not significant as a factor affecting the onset of disease, in contrast with the continuous component, genotype, which was significant in explaining the incidence of citrus canker.

  8. Experience feedback from incidents: methodological and cultural aspects

    International Nuclear Information System (INIS)

    Perinet, R.

    2007-01-01

    EdF has designed some provisions to improve the reliability of human interventions: an increased number of training simulators, management of the quality of interventions, implementation of human factor consultants on each site, improvement in user documentation, development of communication practices, etc. However, despite efforts made in the right direction, the complexity of human behaviour and organisations make it obligatory to follow up the efficacy of these provisions over time in order to ensure that they produce the expected results on work practices. The in-depth analysis by IRSN of events that are significant for safety shows that experience feedback from incidents constitutes a real opportunity to ensure this follow-up. It also highlights the difficulty for licensees to define the temporal context of investigations to carry out, analysing errors committed more in depth and identifying ensuing problems. This article shows that these difficulties are the result of inappropriate methodologies and a lack of skills and availability to carry out the analysis. Finally, it shows that the incident leads to defensive behaviour among those participating in the system that blocks the compilation of information and limits the relevance of analyses. (author)

  9. SU-E-P-07: Retrospective Analysis of Incident Reports at a Radiology Department: Feedback From Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Kakinohana, Y; Toita, T; Heianna, J; Murayama, S [School of medicine, University of the Ryukyus, Nishihara-cho, Okinawa (Japan)

    2015-06-15

    Purpose: To provide an overview of reported incidents that occurred in a radiology department and to describe the most common causal source of incidents. Methods: Incident reports from the radiology department at the University of the Ryukyus Hospital between 2008 and 2013 were collected and analyzed retrospectively. The incident report form contains the following items, causal factors of the incident and desirable corrective actions to prevent recurrence of similar incidents. These items allow the institution to investigate/analyze root causes of the incidents and suggest measures to be taken to prevent further, similar incidents. The ‘causal factors of the incident’ item comprises multiple selections from among 24 selections and includes some synonymous selections. In this study, this item was re-categorized into four causal source types: (i) carelessness, (ii) lack of skill or knowledge, (iii) deficiencies in communication, and (iv) external factors. Results: There were a total of 7490 incident reports over the study period and 276 (3.7%) were identified as originating from the radiology department. The most frequent causal source type was carelessness (62%). The other three types showed similar frequencies (10–14%). The staff members involved in incidents indicate three predominant desirable corrective actions to prevent or decrease the recurrence of similar incidents. These are ‘improvement in communication’ (24%), ‘staff training/education’ (19%), and ‘daily medical procedures’ (22%), and the most frequent was ‘improvement in communication’. Even though the most frequent causal factor was related to carelessness, the most desirable corrective action indicated by the staff members was related to communication. Conclusion: Our finding suggests that the most immediate causes are strongly related to carelessness. However, the most likely underlying causes of incidents would be related to deficiencies in effective communication. At our

  10. Measuring effectiveness of food quality management

    OpenAIRE

    Spiegel, van der, M.

    2004-01-01

    Keywords: effectiveness, food quality management, instrument, quality performance, contextual factors, agri-food production, conceptual model, performance measurement indicators, identification, validation, assessment, quality assurance systems, QA systems, HACCP, Hygiene code, ISO, BRC, GMP, bakery sector.In the last decade several incidents have occurred in the agri-food sector, such as the affairs of dioxin and BSE, whereas also the incidence of food-borne diseases and the production of hi...

  11. 78 FR 38949 - Computer Security Incident Coordination (CSIC): Providing Timely Cyber Incident Response

    Science.gov (United States)

    2013-06-28

    ... exposed to various forms of cyber attack. In some cases, attacks can be thwarted through the use of...-3383-01] Computer Security Incident Coordination (CSIC): Providing Timely Cyber Incident Response... systems will be successfully attacked. When a successful attack occurs, the job of a Computer Security...

  12. Hazmat Yearly Incident Summary Reports

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  13. Updated Decision Support Tool for the Management of Waste and Debris from Radiological Incidents

    International Nuclear Information System (INIS)

    Lemieux, P.; Thorneloe, S.; Hayes, C.; Rodgers, M.; Christman, R.

    2009-01-01

    Unique challenges exist for the handling, transport, and disposal of debris resulting from homeland security incidents, disasters or other national emergencies. Access to guidance for facilitating decision making in the safe and timely disposal of debris is critical to helping restore a community or region and prevent further contamination or spread of disease. For a radiological dispersal device (RDD) or other radiological incident, proper characterization of the quantity, properties, and level of contamination of debris and decontamination residue can have a significant impact on cleanup costs and timelines. A suite of decision support tools (DSTs) is being developed by the U.S. EPA's Office of Research and Development to assist individuals responsible for making decisions associated with handling, transport, treatment, and disposal of such debris. The DSTs are location-specific to help identify specific facilities and contacts for making final disposal decisions. The DSTs provide quick reference to technical information, regulations, and other information to provide decision makers with assistance in guiding disposal decisions that are important for the protection of public health, first responders, and the environment. This tool is being developed in partnership with other U.S. government agencies, EPA program offices, industry, and state and local emergency response programs. (authors)

  14. Application of an incident taxonomy for radiation therapy: Analysis of five years of data from three integrated cancer centres.

    Science.gov (United States)

    Greenham, Stuart; Manley, Stephen; Turnbull, Kirsty; Hoffmann, Matthew; Fonseca, Amara; Westhuyzen, Justin; Last, Andrew; Aherne, Noel J; Shakespeare, Thomas P

    2018-01-01

    To develop and apply a clinical incident taxonomy for radiation therapy. Capturing clinical incident information that focuses on near-miss events is critical for achieving higher levels of safety and reliability. A clinical incident taxonomy for radiation therapy was established; coding categories were prescription, consent, simulation, voluming, dosimetry, treatment, bolus, shielding, imaging, quality assurance and coordination of care. The taxonomy was applied to all clinical incidents occurring at three integrated cancer centres for the years 2011-2015. Incidents were managed locally, audited and feedback disseminated to all centres. Across the five years the total incident rate (per 100 courses) was 8.54; the radiotherapy-specific coded rate was 6.71. The rate of true adverse events (unintended treatment and potential patient harm) was 1.06. Adverse events, where no harm was identified, occurred at a rate of 2.76 per 100 courses. Despite workload increases, overall and actual rates both exhibited downward trends over the 5-year period. The taxonomy captured previously unidentified quality assurance failures; centre-specific issues that contributed to variations in incident trends were also identified. The application of a taxonomy developed for radiation therapy enhances incident investigation and facilitates strategic interventions. The practice appears to be effective in our institution and contributes to the safety culture. The ratio of near miss to actual incidents could serve as a possible measure of incident reporting culture and could be incorporated into large scale incident reporting systems.

  15. The disruption management model.

    Science.gov (United States)

    McAlister, James

    2011-10-01

    Within all organisations, business continuity disruptions present a set of dilemmas that managers may not have dealt with before in their normal daily duties. The disruption management model provides a simple but effective management tool to enable crisis management teams to stay focused on recovery in the midst of a business continuity incident. The model has four chronological primary headlines, which steer the team through a quick-time crisis decision-making process. The procedure facilitates timely, systematic, rationalised and justified decisions, which can withstand post-event scrutiny. The disruption management model has been thoroughly tested within an emergency services environment and is proven to significantly support clear and concise decision making in a business continuity context.

  16. A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations.

    Science.gov (United States)

    Dotson, G Scott; Hudson, Naomi L; Maier, Andrew

    2015-01-01

    Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management.

  17. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    Science.gov (United States)

    Spano, Susanne J; Campagne, Danielle; Stroh, Geoff; Shalit, Marc

    2015-03-01

    Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  18. Incident reporting culture: scale development with validation and reliability and assessment of hospital nurses in Taiwan.

    Science.gov (United States)

    Chiang, Hui-Ying; Hsiao, Ya-Chu; Lin, Shu-Yuan; Lee, Huan-Fang

    2011-08-01

    To examine the psychometric validity and reliability of the incident reporting culture questionnaire (IRCQ; in Chinese) following an exploration of the reporting culture perceived by hospital nurses in Taiwan. Scale development with psychometric examination and a cross-sectional study. Ten teaching hospitals. A total of 1064 nurses participated with an average response rate of 83% between November 2008 and June 2009. The factorial construct, criterion-related validity, homogeneity and stability of the IRCQ were evaluated. The nurses' perceptions of the IRCQ were also explored. The four-factor structure of the 20-item IRCQ had satisfactory construct validity (explained variance: 49.37%), criterion-related validity (r = 0.42; P = 0.001), reliability (Cronbach's alpha: 0.83) and stability (3-week-interval correlation: r = 0.80; P = 0.001). These factors included 'application of learning from errors', 'readiness to provide feedback on incident reports', 'collegial atmospheres of unpleasantness and punishment' (CA) and 'incident management: confidential and system driven'. The nurses perceived a moderate overall reporting culture (mean positive response = 49.25%; range: 67.2-24.94%). They weakly agreed on the CA factor of five items (mean positive response = 24.94%; range: 33.0-17.2%). This study provides empirical evidence for the psychometric properties of the IRCQ and the reporting culture which nurses perceive in Taiwan. To Taiwanese nurses, the reporting culture within their work environments especially as it relates to coworker relations, inter-professional collaboration and non-punitive atmosphere is their major concern. Healthcare administrators should consider nurses' perceptions related to incident reporting when managing underreporting issues.

  19. A Planning Tool for Estimating Waste Generated by a Radiological Incident and Subsequent Decontamination Efforts - 13569

    International Nuclear Information System (INIS)

    Boe, Timothy; Lemieux, Paul; Schultheisz, Daniel; Peake, Tom; Hayes, Colin

    2013-01-01

    Management of debris and waste from a wide-area radiological incident would probably constitute a significant percentage of the total remediation cost and effort. The U.S. Environmental Protection Agency's (EPA's) Waste Estimation Support Tool (WEST) is a unique planning tool for estimating the potential volume and radioactivity levels of waste generated by a radiological incident and subsequent decontamination efforts. The WEST was developed to support planners and decision makers by generating a first-order estimate of the quantity and characteristics of waste resulting from a radiological incident. The tool then allows the user to evaluate the impact of various decontamination/demolition strategies on the waste types and volumes generated. WEST consists of a suite of standalone applications and Esri R ArcGIS R scripts for rapidly estimating waste inventories and levels of radioactivity generated from a radiological contamination incident as a function of user-defined decontamination and demolition approaches. WEST accepts Geographic Information System (GIS) shape-files defining contaminated areas and extent of contamination. Building stock information, including square footage, building counts, and building composition estimates are then generated using the Federal Emergency Management Agency's (FEMA's) Hazus R -MH software. WEST then identifies outdoor surfaces based on the application of pattern recognition to overhead aerial imagery. The results from the GIS calculations are then fed into a Microsoft Excel R 2007 spreadsheet with a custom graphical user interface where the user can examine the impact of various decontamination/demolition scenarios on the quantity, characteristics, and residual radioactivity of the resulting waste streams. (authors)

  20. Pediatric melanoma: incidence, treatment, and prognosis

    Directory of Open Access Journals (Sweden)

    Saiyed FK

    2017-04-01

    Full Text Available Faiez K Saiyed,1 Emma C Hamilton,1 Mary T Austin,1,2 1Department of Pediatric Surgery, McGovern Medical School, 2Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Abstract: The purpose of this review is to outline recent advancements in diagnosis, treatment, and prevention of pediatric melanoma. Despite the recent decline in incidence, it continues to be the deadliest form of skin cancer in children and adolescents. Pediatric melanoma presents differently from adult melanoma; thus, the traditional asymmetry, border irregularity, color variegation, diameter >6 mm, and evolution (ABCDE criteria have been modified to include features unique to pediatric melanoma (amelanotic, bleeding/bump, color uniformity, de novo/any diameter, evolution of mole. Surgical and medical management of pediatric melanoma continues to derive guidelines from adult melanoma treatment. However, more drug trials are being conducted to determine the specific impact of drug combinations on pediatric patients. Alongside medical and surgical treatment, prevention is a central component of battling the incidence, as ultraviolet (UV-related mutations play a central role in the vast majority of pediatric melanoma cases. Aggressive prevention measures targeting sun safety and tanning bed usage have shown positive sun-safety behavior trends, as well as the potential to decrease melanomas that manifest later in life. As research into the field of pediatric melanoma continues to expand, a prevention paradigm needs to continue on a community-wide level. Keywords: melanoma, pediatric, adolescent, childhood

  1. Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study

  2. Implementation of a standardized out-of-hospital management method for Parkinson dysphagia

    Directory of Open Access Journals (Sweden)

    Hongying Wei

    Full Text Available Summary Objective: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD patients with dysphagia. Method: Two-hundred seventeen (217 voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Results: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01. Conclusion: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

  3. Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations

    Directory of Open Access Journals (Sweden)

    Knight Marian

    2012-02-01

    Full Text Available Abstract Background Amniotic fluid embolism (AFE is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent differences in the incidence, with studies estimating the incidence of AFE to be more than three times higher in North America than Europe. The aim of this study was to examine population-based regional or national data from five high-resource countries in order to investigate incidence, risk factors and outcomes of AFE and to investigate whether any variation identified could be ascribed to methodological differences between the studies. Methods We reviewed available data sources on the incidence of AFE in Australia, Canada, the Netherlands, the United Kingdom and the USA. Where information was available, the risk factors and outcomes of AFE were examined. Results The reported incidence of AFE ranged from 1.9 cases per 100 000 maternities (UK to 6.1 per 100 000 maternities (Australia. There was a clear distinction between rates estimated using different methodologies. The lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities; rates obtained from retrospective analysis of population discharge databases were significantly higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis. Older maternal age and induction of labour were consistently associated with AFE. Conclusions Recommendation 1: Comparisons of AFE incidence estimates should be restricted to studies using similar methodology. The recommended approaches would be either population-based database studies using additional criteria to exclude false positive cases, or tailored data collection using existing specific population-based systems. Recommendation 2: Comparisons of AFE incidence between and within countries would be facilitated by development of an agreed case definition and an agreed set of criteria to minimise inclusion of false positive cases for

  4. Poster - 27: Incident Learning Practices in Ontario

    Energy Technology Data Exchange (ETDEWEB)

    Angers, Crystal; Medlam, Gaylene; Liszewski, Brian; Simniceanu, Carina [The Ottawa Hospital Cancer Centre, Mississauga Halton/Central West Regional Cancer Center, Odette Cancer Centre, Cancer Care Ontario (Canada)

    2016-08-15

    Purpose: The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation. Methods: The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharing incident learning practices. A summary of the incident learning practices across Ontario has been compiled. Results: Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in-house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly. Conclusions: Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR-RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.

  5. Poster - 27: Incident Learning Practices in Ontario

    International Nuclear Information System (INIS)

    Angers, Crystal; Medlam, Gaylene; Liszewski, Brian; Simniceanu, Carina

    2016-01-01

    Purpose: The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation. Methods: The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharing incident learning practices. A summary of the incident learning practices across Ontario has been compiled. Results: Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in-house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly. Conclusions: Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR-RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.

  6. Incidents/accidents classification and reporting in Statoil.

    Science.gov (United States)

    Berentsen, Rune; Holmboe, Rolf H

    2004-07-26

    Based on requirements in the new petroleum regulations from Norwegian Petroleum Directorate (NPD) and the realisation of a need to improve and rationalise the routines for reporting and follow up of incidents, Statoil Exploration & Production Norway (Statoil E&P Norway) has formulated a new strategy and process for handling of incidents/accidents. The following past experiences serve as basis for the changes made to incident reporting in Statoil E&P Norway; too much resources were spent on a comprehensive handling and analysis of a vast amount of incidents with less importance for the safety level, taking the focus away from the more severe and important issues at hand, the assessment of "Risk Factor", i.e. the combination of recurrence frequency and consequence, was difficult to use. The high degree of subjectivity involved in the determination of the "Risk Factor" (in particular the estimation of the recurrence frequency) resulted in poor data quality and lack of consistency in the data material. The new system for categorisation and handling of undesirable incidents was established in January 2002. The intention was to get a higher degree of focus on serious incidents (injuries, damages, loss and near misses), with a thorough handling and follow-up. This is reflected throughout the handling of the serious incidents, all the way from immediate notification of the incident, through investigation and follow-up of corrective and preventive actions. Simultaneously, it was also an objective to rationalise/simplify the handling of less serious incidents. These incidents are, however, subjected to analyses twice a year in order to utilize the learning opportunity that they also provide. A year after the introduction of this new system for categorisation and follow-up of undesirable incidents, Statoil's experiences are predominantly good; the intention to get a higher degree of focus on serious incidents (injuries, damages, loss and near misses), has been met, the data

  7. Risk factors associated with incidence and persistence of frequent headaches.

    Science.gov (United States)

    Marklund, Susanna; Häggman-Henrikson, Birgitta; Wänman, Anders

    2014-11-01

    Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6). The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.

  8. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2006-04-01

    Full Text Available Abstract Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.

  9. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Science.gov (United States)

    Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

    2006-01-01

    Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

  10. Using total quality management approach to improve patient safety by preventing medication error incidences*.

    Science.gov (United States)

    Yousef, Nadin; Yousef, Farah

    2017-09-04

    Whereas one of the predominant causes of medication errors is a drug administration error, a previous study related to our investigations and reviews estimated that the incidences of medication errors constituted 6.7 out of 100 administrated medication doses. Therefore, we aimed by using six sigma approach to propose a way that reduces these errors to become less than 1 out of 100 administrated medication doses by improving healthcare professional education and clearer handwritten prescriptions. The study was held in a General Government Hospital. First, we systematically studied the current medication use process. Second, we used six sigma approach by utilizing the five-step DMAIC process (Define, Measure, Analyze, Implement, Control) to find out the real reasons behind such errors. This was to figure out a useful solution to avoid medication error incidences in daily healthcare professional practice. Data sheet was used in Data tool and Pareto diagrams were used in Analyzing tool. In our investigation, we reached out the real cause behind administrated medication errors. As Pareto diagrams used in our study showed that the fault percentage in administrated phase was 24.8%, while the percentage of errors related to prescribing phase was 42.8%, 1.7 folds. This means that the mistakes in prescribing phase, especially because of the poor handwritten prescriptions whose percentage in this phase was 17.6%, are responsible for the consequent) mistakes in this treatment process later on. Therefore, we proposed in this study an effective low cost strategy based on the behavior of healthcare workers as Guideline Recommendations to be followed by the physicians. This method can be a prior caution to decrease errors in prescribing phase which may lead to decrease the administrated medication error incidences to less than 1%. This improvement way of behavior can be efficient to improve hand written prescriptions and decrease the consequent errors related to administrated

  11. Incidence of hyperthyroidism in Sweden.

    Science.gov (United States)

    Abraham-Nordling, Mirna; Byström, Kristina; Törring, Ove; Lantz, Mikael; Berg, Gertrud; Calissendorff, Jan; Nyström, Helena Filipsson; Jansson, Svante; Jörneskog, Gun; Karlsson, F Anders; Nyström, Ernst; Ohrling, Hans; Orn, Thomas; Hallengren, Bengt; Wallin, Göran

    2011-12-01

    The incidence of hyperthyroidism has been reported in various countries to be 23-93/100,000 inhabitants per year. This extended study has evaluated the incidence for ~40% of the Swedish population of 9 million inhabitants. Sweden is considered to be iodine sufficient country. All patients including children, who were newly diagnosed with overt hyperthyroidism in the years 2003-2005, were prospectively registered in a multicenter study. The inclusion criteria are as follows: clinical symptoms and/or signs of hyperthyroidism with plasma TSH concentration below 0.2 mIE/l and increased plasma levels of free/total triiodothyronine and/or free/total thyroxine. Patients with relapse of hyperthyroidism or thyroiditis were not included. The diagnosis of Graves' disease (GD), toxic multinodular goiter (TMNG) and solitary toxic adenoma (STA), smoking, initial treatment, occurrence of thyroid-associated eye symptoms/signs, and demographic data were registered. A total of 2916 patients were diagnosed with de novo hyperthyroidism showing the total incidence of 27.6/100,000 inhabitants per year. The incidence of GD was 21.0/100,000 and toxic nodular goiter (TNG=STA+TMNG) occurred in 692 patients, corresponding to an annual incidence of 6.5/100,000. The incidence was higher in women compared with men (4.2:1). Seventy-five percent of the patients were diagnosed with GD, in whom thyroid-associated eye symptoms/signs occurred during diagnosis in every fifth patient. Geographical differences were observed. The incidence of hyperthyroidism in Sweden is in a lower range compared with international reports. Seventy-five percent of patients with hyperthyroidism had GD and 20% of them had thyroid-associated eye symptoms/signs during diagnosis. The observed geographical differences require further studies.

  12. Incidence of ascariasis in gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Woo; Rhee, Hak Song; Bahk, Yong Whee [St Mary' s Hospital Catholic Medical College, Seoul (Korea, Republic of)

    1972-09-15

    Prompted by the finding that the radiological incidence of small bowel ascariasis in the patient with gastric carcinoma was unexpectedly lower than the incidence in the normal population, a clinical study was performed to investigate possible relationship between gastric carcinoma and intestinal ascariasis. As a preliminary survey, we reviewed the radiological incidence of ascariasis in a total of 2,446 cases of upper GI series performed at the Department of Radiology, St Mary's Hospital Catholic Medical College. These included 1,573 normal subjects, 146 gastric carcinoma patients, 100 benign gastric ulcer and 249 duodenal ulcer patients and 378 other upper GI diseases. Following the preliminary study, a more accurate parasitologic study was conducted in another 578 normal subjects and 51 gastric carcinoma patients. The radiological incidences of ascaiasis in normal subjects and gastric carcinoma patients were 15.1% and 28.1%, respectively. The incidence of overall helminthiasis including ascaris lumbricoides, trichocephalus trichiurus and trichostrongyloides orientalis in normal subjects of the present series was 73.5%. This figure is virtually the same with 69.1% of the general population incidence reported by Kim, et al. (1971), but the incidence in gastric carcinoma patients was 94.1%. The high incidence pattern of overall helminthiasis in gastric carcinoma patients is, however, reversed as for as ascariasis is concerned. Thus, the incidence of ascariasis of gastric carcinoma patients was much lower than that of normal subjects (9.8% vs 19.4%). From the present observation, it is postulated that there can be some possible antagonistic relationship between evolution of gastric carcinoma and small bowel infestation of ascaris lumbricoides.

  13. Incidence of ascariasis in gastric carcinoma

    International Nuclear Information System (INIS)

    Kim, Jong Woo; Rhee, Hak Song; Bahk, Yong Whee

    1972-01-01

    Prompted by the finding that the radiological incidence of small bowel ascariasis in the patient with gastric carcinoma was unexpectedly lower than the incidence in the normal population, a clinical study was performed to investigate possible relationship between gastric carcinoma and intestinal ascariasis. As a preliminary survey, we reviewed the radiological incidence of ascariasis in a total of 2,446 cases of upper GI series performed at the Department of Radiology, St Mary's Hospital Catholic Medical College. These included 1,573 normal subjects, 146 gastric carcinoma patients, 100 benign gastric ulcer and 249 duodenal ulcer patients and 378 other upper GI diseases. Following the preliminary study, a more accurate parasitologic study was conducted in another 578 normal subjects and 51 gastric carcinoma patients. The radiological incidences of ascaiasis in normal subjects and gastric carcinoma patients were 15.1% and 28.1%, respectively. The incidence of overall helminthiasis including ascaris lumbricoides, trichocephalus trichiurus and trichostrongyloides orientalis in normal subjects of the present series was 73.5%. This figure is virtually the same with 69.1% of the general population incidence reported by Kim, et al. (1971), but the incidence in gastric carcinoma patients was 94.1%. The high incidence pattern of overall helminthiasis in gastric carcinoma patients is, however, reversed as for as ascariasis is concerned. Thus, the incidence of ascariasis of gastric carcinoma patients was much lower than that of normal subjects (9.8% vs 19.4%). From the present observation, it is postulated that there can be some possible antagonistic relationship between evolution of gastric carcinoma and small bowel infestation of ascaris lumbricoides

  14. Air traffic management evaluation tool

    Science.gov (United States)

    Sridhar, Banavar (Inventor); Sheth, Kapil S. (Inventor); Chatterji, Gano Broto (Inventor); Bilimoria, Karl D. (Inventor); Grabbe, Shon (Inventor); Schipper, John F. (Inventor)

    2012-01-01

    Methods for evaluating and implementing air traffic management tools and approaches for managing and avoiding an air traffic incident before the incident occurs. A first system receives parameters for flight plan configurations (e.g., initial fuel carried, flight route, flight route segments followed, flight altitude for a given flight route segment, aircraft velocity for each flight route segment, flight route ascent rate, flight route descent route, flight departure site, flight departure time, flight arrival time, flight destination site and/or alternate flight destination site), flight plan schedule, expected weather along each flight route segment, aircraft specifics, airspace (altitude) bounds for each flight route segment, navigational aids available. The invention provides flight plan routing and direct routing or wind optimal routing, using great circle navigation and spherical Earth geometry. The invention provides for aircraft dynamics effects, such as wind effects at each altitude, altitude changes, airspeed changes and aircraft turns to provide predictions of aircraft trajectory (and, optionally, aircraft fuel use). A second system provides several aviation applications using the first system. Several classes of potential incidents are analyzed and averted, by appropriate change en route of one or more parameters in the flight plan configuration, as provided by a conflict detection and resolution module and/or traffic flow management modules. These applications include conflict detection and resolution, miles-in trail or minutes-in-trail aircraft separation, flight arrival management, flight re-routing, weather prediction and analysis and interpolation of weather variables based upon sparse measurements. The invention combines these features to provide an aircraft monitoring system and an aircraft user system that interact and negotiate changes with each other.

  15. Statement of nuclear incidents: statement of incidents at nuclear installations: third quarter 1990

    International Nuclear Information System (INIS)

    1990-01-01

    A summary of nuclear incidents occuring at nuclear installations in Britain between 1st July 1990 and 30th September 1990 is presented here, as published by the Health and Safety Executive, two occurring at Harwell Laboratory and one at Winfrith. None of the incidents caused danger to the public, and doses to site workers were not significant. (UK)

  16. Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998-2006

    International Nuclear Information System (INIS)

    Mak, Kimberley S.; Lee, Leslie K.; Mak, Raymond H.; Wang, Shuang; Pile-Spellman, John; Abrahm, Janet L.; Prigerson, Holly G.; Balboni, Tracy A.

    2011-01-01

    Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding. Results: We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58). Conclusions: In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC

  17. Reactor incident status 1981 annual report

    International Nuclear Information System (INIS)

    Kiser, S.H.

    1982-01-01

    Reactor Incident followup action is summarized through periodic status reports. This annual report summarizes action taken or anticipated for Reactor Incidents through December 1981. Incidents for which action has been completed, have been deleted from the report. Quarterly addende will update the report by tabulating incidents for each three month period through the coming year. The report consists of a part for the P, K, and C Reactors. Each reactor part is divided into three sections: Further Technical Analysis or Followup Needed; Funding and/or Implementation Needed; and No Further Technical Analysis Anticipated

  18. Managing Coastal Pollution

    International Nuclear Information System (INIS)

    Quevenco, R.

    2010-01-01

    Concern over the growing incidence of pollution in the Caribbean has been on the rise, as it has the potential to affect livelihoods dependent on fishing and tourism. The IAEA's Department of Technical Cooperation launched a regional project on the use of nuclear techniques to address coastal management issues in the Caribbean.

  19. Comparative Incidence of Conformational, Neurodegenerative Disorders.

    Directory of Open Access Journals (Sweden)

    Jesús de Pedro-Cuesta

    Full Text Available The purpose of this study was to identify incidence and survival patterns in conformational neurodegenerative disorders (CNDDs.We identified 2563 reports on the incidence of eight conditions representing sporadic, acquired and genetic, protein-associated, i.e., conformational, NDD groups and age-related macular degeneration (AMD. We selected 245 papers for full-text examination and application of quality criteria. Additionally, data-collection was completed with detailed information from British, Swedish, and Spanish registries on Creutzfeldt-Jakob disease (CJD forms, amyotrophic lateral sclerosis (ALS, and sporadic rapidly progressing neurodegenerative dementia (sRPNDd. For each condition, age-specific incidence curves, age-adjusted figures, and reported or calculated median survival were plotted and examined.Based on 51 valid reported and seven new incidence data sets, nine out of eleven conditions shared specific features. Age-adjusted incidence per million person-years increased from ≤1.5 for sRPNDd, different CJD forms and Huntington's disease (HD, to 1589 and 2589 for AMD and Alzheimer's disease (AD respectively. Age-specific profiles varied from (a symmetrical, inverted V-shaped curves for low incidences to (b those increasing with age for late-life sporadic CNDDs and for sRPNDd, with (c a suggested, intermediate, non-symmetrical inverted V-shape for fronto-temporal dementia and Parkinson's disease. Frequently, peak age-specific incidences from 20-24 to ≥90 years increased with age at onset and survival. Distinct patterns were seen: for HD, with a low incidence, levelling off at middle age, and long median survival, 20 years; and for sRPNDd which displayed the lowest incidence, increasing with age, and a short median disease duration.These results call for a unified population view of NDDs, with an age-at-onset-related pattern for acquired and sporadic CNDDs. The pattern linking age at onset to incidence magnitude and survival might

  20. Comparative Incidence of Conformational, Neurodegenerative Disorders

    Science.gov (United States)

    de Pedro-Cuesta, Jesús; Rábano, Alberto; Martínez-Martín, Pablo; Ruiz-Tovar, María; Alcalde-Cabero, Enrique; Almazán-Isla, Javier; Avellanal, Fuencisla; Calero, Miguel

    2015-01-01

    Background The purpose of this study was to identify incidence and survival patterns in conformational neurodegenerative disorders (CNDDs). Methods We identified 2563 reports on the incidence of eight conditions representing sporadic, acquired and genetic, protein-associated, i.e., conformational, NDD groups and age-related macular degeneration (AMD). We selected 245 papers for full-text examination and application of quality criteria. Additionally, data-collection was completed with detailed information from British, Swedish, and Spanish registries on Creutzfeldt-Jakob disease (CJD) forms, amyotrophic lateral sclerosis (ALS), and sporadic rapidly progressing neurodegenerative dementia (sRPNDd). For each condition, age-specific incidence curves, age-adjusted figures, and reported or calculated median survival were plotted and examined. Findings Based on 51 valid reported and seven new incidence data sets, nine out of eleven conditions shared specific features. Age-adjusted incidence per million person-years increased from ≤1.5 for sRPNDd, different CJD forms and Huntington's disease (HD), to 1589 and 2589 for AMD and Alzheimer's disease (AD) respectively. Age-specific profiles varied from (a) symmetrical, inverted V-shaped curves for low incidences to (b) those increasing with age for late-life sporadic CNDDs and for sRPNDd, with (c) a suggested, intermediate, non-symmetrical inverted V-shape for fronto-temporal dementia and Parkinson's disease. Frequently, peak age-specific incidences from 20–24 to ≥90 years increased with age at onset and survival. Distinct patterns were seen: for HD, with a low incidence, levelling off at middle age, and long median survival, 20 years; and for sRPNDd which displayed the lowest incidence, increasing with age, and a short median disease duration. Interpretation These results call for a unified population view of NDDs, with an age-at-onset-related pattern for acquired and sporadic CNDDs. The pattern linking age at onset to

  1. Making sense in the edge of chaos : a framework for effective initial response efforts to large-scale incidents

    OpenAIRE

    Renaud, Cynthia E.

    2010-01-01

    CHDS State/Local Approved for public release; distribution is unlimited A review of response efforts to 9/11 revealed considerable challenges to resolving an event of this magnitude. To cope with these challenges, the federal government created the National Incident Management System (NIMS), an organizational structure intended to manage resources and channel communication between disparate agencies working together to solve a catastrophic crisis. Yet, first responders who have bee...

  2. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.

    Science.gov (United States)

    Panagioti, Maria; Blakeman, Thomas; Hann, Mark; Bower, Peter

    2017-05-30

    Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Nuclear power plant operating experiences from the IAEA / Nea incident reporting system 2002-2005

    International Nuclear Information System (INIS)

    2006-01-01

    The Incident Reporting System (IRS) is an essential element of the international operating experience feedback system for nuclear power plants. The IRS is jointly operated and managed by the Nuclear Energy Agency (NEA), a semi-autonomous body within the Organisation for Economic Co-operation and Development (OECD), and the International Atomic Energy Agency (IAEA), a specialized agency within the United Nations System. (author)

  4. [Early onset pneumonia after successful resuscitation : Incidence after mild invasive hypothermia therapy].

    Science.gov (United States)

    Erath, J W; Hodrius, J; Bushoven, P; Fichtlscherer, S; Zeiher, A M; Seeger, F H; Honold, J

    2017-09-01

    Targeted temperature management (TTM) represents an effective therapy to improve neurologic outcome in patients who survive an out-of-hospital cardiac arrest (OHCA). First publications about this therapy reported a higher incidence of infections in patients who underwent TTM induced by external cooling devices. Whether intravascular cooling devices are also associated with an increased infection rate has not been investigated so far. In a single center retrospective study, the incidence of early onset pneumonia (EOP) in OHCA patients with or without intravascular TTM at 33 °C target temperature for 24 h who survived at least 24 h after admission was analyzed. A total of 68 OHCA survivors (mean age 65 ± 15 years) were included in this analysis. The most common causes of OHCA were myocardial infarction (35 %), primary ventricular fibrillation (24 %), asystole (15 %), and pulmonary embolism (7 %). Of those, 32 patients (48 %) received TTM. The overall incidence of EOP was 38 %. Incidence of EOP did not differ significantly between groups, was more frequent in the group without TTM (42 % vs. 34 %, p = 0.57) and had no impact on mortality (hazard ratio = 1.02; 95 % confidence interval 0.25-4.16; p = 0.97). Intravascular TTM at 33 °C with a cooling catheter is not associated with more infective complications in OHCA patients. This finding underscores the safety of TTM.

  5. Management Outcomes of Abruptio Placentae at Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    BACKGROUND: The objective of this study is to determine incidence, risk factors and management outcomes of abruptio placentae (AP) and comparing them with cases without AP who delivered within the same period. METHODS: A 10 year retrospective study of AP managed at Nnamdi Azikiwe University Teaching ...

  6. Emergency management and the nuclear terrorism threat

    International Nuclear Information System (INIS)

    DeVito, D.A.; Suiter, L.

    1987-01-01

    Counterterrorism is not the province of the emergency manager. Generally law enforcement has that role. Instead, the emergency manager's role is crisis management; the responsibility is to be the focal point for the chief executive officer (mayor, governor, or national executive) regarding the protection of the population. Managers must be able to gather and synthesize sufficient information, rapidly and accurately, on which to base sound decisions. To do so, they must have a highly efficient, coordinated emergency management organization in place at the state and local levels of government, and there must be a workable plan for emergency operations that integrates all public safety forces into an effective response to all types of emergencies. A major goal of emergency management is to ensure that government is in control and that the public perceives that the system is working. All states have an emergency management organization at the state level, as do most counties and large cities. However, some states and local governments, particularly those that have nuclear power plants within their borders, are better staffed, equipped, and trained than others to deal with nuclear incidents. States with nuclear facilities have an emergency management organization, an emergency plan, and adequate communications, equipment, and trained personnel to handle a nuclear accident or incident at a plant. 21 references

  7. Security incidents on the Internet, 1989--1995

    Energy Technology Data Exchange (ETDEWEB)

    Howard, J.D.

    1995-12-31

    This paper presents an analysis of trends in Internet security based on an investigation of 4,299 Internet security-related incidents reported to the CERT{reg_sign} Coordination Center (CERT{reg_sign}/CC) from 1989 through 1995. Prior to this research, knowledge of actual Internet security incidents was limited and primarily anecdotal. This research: (1) developed a taxonomy to classify Internet attacks and incidents, (2) organized, classified, and analyzed CERT{reg_sign}/CC incident records, (3) summarized the relative frequency of the use of tools and vulnerabilities, success in achieving access, and results of attacks, (4) estimated total Internet incident activity, (5) developed recommendations for Internet users and suppliers, and (6) developed recommendations for future research. With the exception of denial-of-service attacks, security incidents were found to be increasing at a rate less than Internet growth. Estimates showed that most, if not all, severe incidents were reported to the CERT{reg_sign}/CC, and that more than one out of three above average incidents (in terms of duration and number of sites) were reported. Estimates also indicated that a typical Internet site was involved in, at most, around one incident (of any kind) per year, and a typical Internet host in, at most, around one incident in 45 years. The probability of unauthorized privileged access was around an order of magnitude less likely. As a result, simple and reasonable security precautions should be sufficient for most Internet users.

  8. Gender in the Management Education Classroom: A Collaborative Learning Journey

    Science.gov (United States)

    Bilimoria, Diana; O'Neil, Deborah A.; Hopkins, Margaret M.; Murphy, Verena

    2010-01-01

    In this article, the authors describe a classroom incident and their subsequent learnings about effectively managing issues of gender diversity in an MBA course titled "Women in Organizations." The authors employ Kolb's learning cycle as a framework for describing the incident ("concrete experience"), reflecting on and discussing what occurred…

  9. Incidence of work injuries amongst Danish adolescents and their association with work environment factors.

    Science.gov (United States)

    Rasmussen, Kurt; Hansen, Claus D; Nielsen, Kent J; Andersen, Johan H

    2011-02-01

    The objective was to examine the incidence of work accidents that required medical attention among Danish adolescents and to identify possible work environment factors associated with such accidents. We collected information in two questionnaire rounds (2004 and 2007) from a birth cohort comprising all adolescents born in 1989 (n = 3,687) living in Ringkjøbing County, Denmark. The questionnaire contained items on self-reported number of accidents and number of working hours in both rounds and on work environment factors in the second round. Approximately 5% of the adolescents who held a job, experienced a work injury at the age of 17. This equals an incidence of 65 accidents per million working hours. Most adolescents had decent working conditions, although nearly half reported that their work was heavy, monotonous or psychologically demanding. Heavy work, high psychological demands and low social support increased the risk of experiencing work injuries after adjustment for a number of factors. The incidence of work injuries among adolescents appears to be higher than the incidence among their older colleagues. Lack of social support from management significantly raised adolescents' risk of experiencing a work injury. This suggests that more direct supervision may be a good way of preventing accidents in this age group. Copyright © 2010 Wiley-Liss, Inc.

  10. Concussion Incidence and Recurrence in Professional Australian Football Match-Play: A 14-Year Analysis

    Directory of Open Access Journals (Sweden)

    Nathan Gibbs

    2017-01-01

    Full Text Available Background. Concussion incidence rates in professional Australian football may be underreported due to the injury classification definition. A myriad of factors contribute to concussion risk; however, there is limited long-term surveillance in Australian football. This study analysed concussion in one Australian football team over an extended period. Method. Match-play concussion injuries in one team (n=116 participants were diagnosed and treated by the team physician over 14 years. Analysis of factors related to concussion including matches played, time of day and season, and return to play provided an insight into occurrence and recurrence rates. Results. 140 concussions were recorded (17.6 per 1000 player match hours. A strong relationship was evident between matches played and concussion incidence (r=0.70 and match conditions did not negatively affect the concussion rate. Whether an athlete returned to play in the same match or suffered a loss-of-consciousness concussion (p=0.84, their ensuing rate of concussion was not affected. Conclusion. Concussion in professional Australian football was related to the number of matches played. Further, neither previous incidence nor loss of consciousness affected future concussion risk. This study provides ecologically valid evidence of the concussion incidence rate in professional Australian football and has implications for the management of athletes sustaining concussion injuries.

  11. Risk and course of motor complications in a population-based incident Parkinson's disease cohort.

    Science.gov (United States)

    Bjornestad, Anders; Forsaa, Elin B; Pedersen, Kenn Freddy; Tysnes, Ole-Bjorn; Larsen, Jan Petter; Alves, Guido

    2016-01-01

    Motor complications may become major challenges in the management of patients with Parkinson's disease. In this study, we sought to determine the incidence, risk factors, evolution, and treatment of motor fluctuations and dyskinesias in a population-representative, incident Parkinson's disease cohort. In this prospective population-based 5-year longitudinal study, we followed 189 incident and initially drug-naïve Parkinson's disease patients biannually for detailed examination of dyskinesias and motor fluctuations as defined by the Unified Parkinson's disease Rating Scale. We performed Kaplan-Meier survival and Cox regression analyses to assess cumulative incidence and risk factors of these motor complications. The 5-year cumulative incidence of motor complications was 52.4%. Motor fluctuations occurred in 42.9% and dyskinesias in 24.3%. Besides higher motor severity predicting both motor fluctuations (p = 0.016) and dyskinesias (p motor fluctuations (p = 0.001), whereas female gender predicted dyskinesias (p = 0.001). Actual levodopa dose at onset of motor fluctuations (p = 0.037) or dyskinesias (p 0.1) independently predicted development of motor complications. Motor fluctuations reversed in 37% and dyskinesias in 49% of patients on oral treatment and remained generally mild in those with persistent complications. No patients received device-aided therapies during the study. More than 50% in the general Parkinson's disease population develop motor complications within 5 years of diagnosis. However, they remain mild in the vast majority and are reversible in a substantial proportion of patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Bleeding after expandable nitinol stent placement in patients with esophageal and upper gastrointestinal obstruction: incidence, management, and predictors.

    Science.gov (United States)

    Oh, Se Jin; Song, Ho-Young; Nam, Deok Ho; Ko, Heung Kyu; Park, Jung-Hoon; Na, Han Kyu; Lee, Jong Jin; Kang, Min Kyoung

    2014-11-01

    Placement of self-expandable nitinol stents is useful for the treatment of esophageal and upper gastrointestinal (GI) obstruction. However, complications such as stent migration, tumor overgrowth, and bleeding occur. Although stent migration and tumor overgrowth are well documented in previous studies, the occurrence of bleeding has not been fully evaluated. To evaluate the incidence, management strategies, and predictors of bleeding after placement of self-expandable nitinol stents in patients with esophageal and upper GI obstruction. We retrospectively reviewed the medical records and results of computed tomography and endoscopy of 1485 consecutive patients with esophageal and upper GI obstructions who underwent fluoroscopically guided stent placement. Bleeding occurred in 25 of 1485 (1.7%) patients 0 to 348 days after stent placement. Early stent-related bleeding occurred in 10 patients (40%) and angiographic embolization was used for 5/10. Late bleeding occurred in 15 patients (60%) and endoscopic hemostasis was used for 7/15. Twenty-two of 25 (88%) patients with bleeding had received prior radiotherapy and/or chemotherapy. Bleeding is a rare complication after placement of expandable nitinol stents in patients with esophageal and upper GI obstruction, but patients with early bleeding may require embolization for control. Care must be exercised on placing stents in patients who have received prior radiotherapy or chemotherapy. © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Detecting Terrorism Incidence Type from News Summary

    DEFF Research Database (Denmark)

    Nizamani, Sarwat; Memon, Nasrullah

    2012-01-01

    The paper presents the experiments to detect terrorism incidence type from news summary data. We have applied classification techniques on news summary data to analyze the incidence and detect the type of incidence. A number of experiments are conducted using various classification algorithms...... and results show that a simple decision tree classifier can learn incidence type with satisfactory results from news data....

  14. HFETR operation management

    International Nuclear Information System (INIS)

    Liu Rong; Yang Shuchun; Peng Jun; Zhou Shoukang

    2003-01-01

    Experiences and work methods with High Flux Engineering Test Reactor (HFETR) operation are introduced, which have been accumulated in a long period of operation, in the aspects as reactor operation, test, maintenance, operator training and incident management. It's clear that the safety operation of HFETR has been ensured, and the methods are valid. (authors)

  15. A Planning Tool for Estimating Waste Generated by a Radiological Incident and Subsequent Decontamination Efforts - 13569

    Energy Technology Data Exchange (ETDEWEB)

    Boe, Timothy [Oak Ridge Institute for Science and Education, Research Triangle Park, NC 27711 (United States); Lemieux, Paul [U.S. Environmental Protection Agency, Research Triangle Park, NC 27711 (United States); Schultheisz, Daniel; Peake, Tom [U.S. Environmental Protection Agency, Washington, DC 20460 (United States); Hayes, Colin [Eastern Research Group, Inc, Morrisville, NC 26560 (United States)

    2013-07-01

    Management of debris and waste from a wide-area radiological incident would probably constitute a significant percentage of the total remediation cost and effort. The U.S. Environmental Protection Agency's (EPA's) Waste Estimation Support Tool (WEST) is a unique planning tool for estimating the potential volume and radioactivity levels of waste generated by a radiological incident and subsequent decontamination efforts. The WEST was developed to support planners and decision makers by generating a first-order estimate of the quantity and characteristics of waste resulting from a radiological incident. The tool then allows the user to evaluate the impact of various decontamination/demolition strategies on the waste types and volumes generated. WEST consists of a suite of standalone applications and Esri{sup R} ArcGIS{sup R} scripts for rapidly estimating waste inventories and levels of radioactivity generated from a radiological contamination incident as a function of user-defined decontamination and demolition approaches. WEST accepts Geographic Information System (GIS) shape-files defining contaminated areas and extent of contamination. Building stock information, including square footage, building counts, and building composition estimates are then generated using the Federal Emergency Management Agency's (FEMA's) Hazus{sup R}-MH software. WEST then identifies outdoor surfaces based on the application of pattern recognition to overhead aerial imagery. The results from the GIS calculations are then fed into a Microsoft Excel{sup R} 2007 spreadsheet with a custom graphical user interface where the user can examine the impact of various decontamination/demolition scenarios on the quantity, characteristics, and residual radioactivity of the resulting waste streams. (authors)

  16. The effect of crop protection strategy on pest and beneficials incidence in protected crops.

    Science.gov (United States)

    Lourenço, I; Rodrigues, S; Figueiredo, E; Godinho, M C; Marques, C; Amaro, F; Mexia, A

    2002-01-01

    This study took place in the Oeste region from 1996-1999 and it intended to analyse if the crop protection strategy followed by the farmer influenced the arthropod incidence and the natural control in protected vegetable crops under Mediterranean conditions. The observations were made fortnightly (Autumn/Winter) or weekly (Spring/Summer) in 30-60 plants/parcel (1 plant/35 m2) in order to evaluate incidences. Samples of pests and natural enemies were collected for systematic identification in two greenhouses for each protection strategy (traditional chemical control (TCC), integrated pest management (IPM) and pest control allowed in organic farming (OF)) in lettuce, tomato, green beans and cucumber. Data on incidence of mites, aphids, caterpillars, leafminers, whiteflies, thrips and respective natural enemies were registered as well as phytosanitary treatments performed (farmers' information and/or in loco traces). The leafminers were the pest whose incidence more often presented significant statistical differences between the studied protection strategies. In relation to this pest, the main results obtained were: a higher feeding punctures incidence in TCC than in IPM; higher incidence of adults, mines and feeding punctures in TCC than in OF; and a higher mines' incidence in IPM than in OF. Both in TCC and IPM high percentages of plants with mines were found although without an adult proportional presence. In the first case this was due to the repeatedly phytosanitary treatments applied; in the second case it was due to the natural control, since in IPM and OF greenhouses the collected larvae were mostly parasitized or dead. In spite of the fact these two strategies have as final result a similar mines and adults incidence, their production and environmental costs are quite different. Significant differences at the beneficials' population level between TCC greenhouses and IPM or OF greenhouses were found. As the farmers did no biological treatments these

  17. Management of pancreatic cancer in the elderly.

    Science.gov (United States)

    Higuera, Oliver; Ghanem, Ismael; Nasimi, Rula; Prieto, Isabel; Koren, Laura; Feliu, Jaime

    2016-01-14

    Currently, pancreatic adenocarcinoma mainly occurs after 60 years of age, and its prognosis remains poor despite modest improvements in recent decades. The aging of the population will result in a rise in the incidence of pancreatic adenocarcinoma within the next years. Thus, the management of pancreatic cancer in the elderly population is gaining increasing relevance. Older cancer patients represent a heterogeneous group with different biological, functional and psychosocial characteristics that can modify the usual management of this disease, including pharmacokinetic and pharmacodynamic changes, polypharmacy, performance status, comorbidities and organ dysfunction. However, the biological age, not the chronological age, of the patient should be the limiting factor in determining the most appropriate treatment for these patients. Unfortunately, despite the increased incidence of this pathology in older patients, there is an underrepresentation of these patients in clinical trials, and the management of older patients is thus determined by extrapolation from the results of studies performed in younger patients. In this review, the special characteristics of the elderly, the multidisciplinary management of localized and advanced ductal adenocarcinoma of the pancreas and the most recent advances in the management of this condition will be discussed, focusing on surgery, chemotherapy, radiation and palliative care.

  18. Incidence and Nature of Medical Attendance Injuries in English Community Rugby Union

    Science.gov (United States)

    Roberts, Simon P.; Trewartha, Grant; England, Mike; Stokes, Keith A.

    2014-01-01

    Background: Previous research has identified injury patterns during community-level rugby union match play, but none have investigated the frequency and reasons for on-field injury management. Purpose: To establish the frequency, reasons, and patterns of on-field injury management in English community rugby, including differences between different levels of play. Study Design: Descriptive epidemiology study. Methods: Over 3 seasons, injury information was collected from 46 (2009-2010), 67 (2010-2011), and 76 (2011-2012) English community clubs (Rugby Football Union [RFU] levels 3-9). Club injury management staff reported information for all medical attendances during match play, including details on the injury site and type, playing position (seasons 2010-2011 and 2011-2012 only), and whether the player was removed from play. Clubs were subdivided into groups A (RFU levels 3 and 4 [mainly semiprofessional]; n = 39), B (RFU levels 5 and 6 [mainly amateur]; n = 71), and C (RFU levels 7-9 [social and recreational]; n = 79) to differentiate playing levels. Results: The overall medical attendance incidence was 229 per 1000 player-match hours (95% CI, 226-232), with 45 players removed per 1000 player-match hours (95% CI, 44-46). Attendance incidence for group A (294 per 1000 player-match hours; 95% CI, 287-301) was higher compared with group B (213; 95% CI, 208-218; P < .001) and C (204; 95% CI, 200-209; P < .001). There was a higher incidence of attendances to forwards (254; 95% CI, 249-259) compared with backs (191; 95% CI, 187-196; P < .001). The head was the most common specific site of injury (55 per 1000 player-match hours; 95% CI, 53-57) but the lower limb region overall accounted for most attendances (87; 95% CI, 85-89) and the greatest chance of removal from the pitch (22; 95% CI, 21-23). Conclusion: With the likelihood of 1 injury for each team per match severe enough for the player to leave the pitch and with at least 1 attendance for a head injury per match

  19. Method for investigating management impact to causes and consequences of specific hazards MIMIX

    Energy Technology Data Exchange (ETDEWEB)

    Heikkilae, J; Rouhiainen, V; Suokas, J [VTT Manufacturing Technology, Tampere (Finland). Safety Engineering; Rasmussen, B [Risoe National Lab., Roskilde (Denmark)

    1996-12-31

    Method for Investigating Management Impact to Causes and Consequences of Specific Hazards (MIMIX) is a new method for the identification of deficiencies in managerial means and practices used for maintaining and improving safety in a plant. MIMIX is a part of TOMHID methodology which is aimed for overall identification of hazards in a chemical plant. However, MIMIX can be used independently. This report includes guidelines for carrying out a MIMIX analysis. Some experiences from TOMHID analysis case studies, forms and other supporting material (appendix A) and an example of the preparation of incident scenarios (appendix B) are also included in the report. MIMIX consists of three main stages: preparation of incident scenarios, worker interviews and management interviews. A couple of incident scenarios are prepared to support the worker interviews. In each worker interview, such undesired conditions in the plant which promote errors and violations affecting the incident described in a scenario are identified. Deficiencies in managerial means and practices used for correcting the identified undesired conditions are investigated with management interviews. (author)

  20. Method for investigating management impact to causes and consequences of specific hazards MIMIX

    Energy Technology Data Exchange (ETDEWEB)

    Heikkilae, J.; Rouhiainen, V.; Suokas, J. [VTT Manufacturing Technology, Tampere (Finland). Safety Engineering; Rasmussen, B. [Risoe National Lab., Roskilde (Denmark)

    1995-12-31

    Method for Investigating Management Impact to Causes and Consequences of Specific Hazards (MIMIX) is a new method for the identification of deficiencies in managerial means and practices used for maintaining and improving safety in a plant. MIMIX is a part of TOMHID methodology which is aimed for overall identification of hazards in a chemical plant. However, MIMIX can be used independently. This report includes guidelines for carrying out a MIMIX analysis. Some experiences from TOMHID analysis case studies, forms and other supporting material (appendix A) and an example of the preparation of incident scenarios (appendix B) are also included in the report. MIMIX consists of three main stages: preparation of incident scenarios, worker interviews and management interviews. A couple of incident scenarios are prepared to support the worker interviews. In each worker interview, such undesired conditions in the plant which promote errors and violations affecting the incident described in a scenario are identified. Deficiencies in managerial means and practices used for correcting the identified undesired conditions are investigated with management interviews. (author)

  1. Real time freeway incident detection.

    Science.gov (United States)

    2014-04-01

    The US Department of Transportation (US-DOT) estimates that over half of all congestion : events are caused by highway incidents rather than by rush-hour traffic in big cities. Real-time : incident detection on freeways is an important part of any mo...

  2. True incidence of vestibular schwannoma?

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Tos, Mirko; Thomsen, Jens

    2010-01-01

    The incidence of diagnosed sporadic unilateral vestibular schwannomas (VS) has increased, due primarily to more widespread access to magnetic resonance imaging.......The incidence of diagnosed sporadic unilateral vestibular schwannomas (VS) has increased, due primarily to more widespread access to magnetic resonance imaging....

  3. How to minimise the incidence of transport-related problem behaviours in horses: a review.

    Science.gov (United States)

    York, Amanda; Matusiewicz, Judith; Padalino, Barbara

    2017-01-01

    This review aims to provide practical outcomes on how to minimise the incidence of transport-related problem behaviours (TRPBs) in horses. TRPBs are unwanted behaviours occurring during different phases of transport, most commonly, a reluctance to load and scrambling during travelling. TRPBs can result in injuries to horses and horse handlers, horse trailer accidents, disruption of time schedules, inability to attend competitions, and poor performance following travel. Therefore, TRPBs are recognised as both a horse-related risk to humans and a human-related risk to horses. From the literature, it is apparent that TRPBs are common throughout the entire equine industry, and a YouTube keyword search of 'horse trailer loading' produced over 67,000 results, demonstrating considerable interest in this topic and the variety of solutions suggested. Drawing upon articles published over the last 35 years, this review summarises current knowledge on TRPBs and provides recommendations on their identification, management, and prevention. It appears that a positive human-horse relationship, in-hand pre-training, systematic training for loading and travelling, appropriate horse handling, and the vehicle driving skills of the transporters are crucial to minimise the incidence of TRPBs. In-hand pre-training based on correct application of the principles of learning for horses and horse handlers, habituation to loading and travelling, and self-loading appear to minimise the risk of TRPBs and are therefore strongly recommended to safeguard horse and horse-handler health and welfare. This review indicates that further research and education with respect to transport management are essential to substantially decrease the incidence of TRPBs in horses.

  4. Incidence of epilepsy in Ferrara, Italy.

    Science.gov (United States)

    Cesnik, Edward; Pedelini, Francesco; Faggioli, Raffaella; Monetti, Vincenza Cinzia; Granieri, Enrico; Casetta, Ilaria

    2013-12-01

    Few studies have been carried out in the same area at different times, allowing an assessment of the incidence of epilepsy (E.), including all ages, over time. The available data on temporal trend show a decrease in E. incidence in childhood and an increase in the elderly. We sought to update the incidence of E. in the province of Ferrara, where a previous study estimated an incidence rate of 33.1 per 100,000, 35.8, if standardized to the European population. Newly diagnosed patients aged up to 14 years were drawn from a community-based prospective multi-source registry, and adult onset E. cases were collected through multiple overlapping sources of case collection. Cases were included and classified according to ILAE recommendations. During the study period (2007-2008), 141 newly diagnosed cases (66 men and 75 women) living in the study area were identified. The crude incidence rate was 46.1 per 100,000 person-years (95 % CI 39.0-54.5), 35.5 (95 % CI 28.0-43.0) if adjusted to the European population. The incidence of childhood and adolescence epilepsy was 57.0 per 100,000 person-years (95 % CI 33.8-90.0), lower than that reported in our previous study, and it was 44.8 (95 % CI 37.4-53.6) for adult onset E., which is significantly higher as compared to our previous study. The overall incidence of E. in northern Italy is stable over time. We detected a significant decrease in incidence of childhood and adolescence E. and an increase in adult-onset E. The burden of epilepsy will increase as the population continues to age.

  5. Anaesthetic and critical care management of thoracic injuries.

    Science.gov (United States)

    Round, J A; Mellor, A J

    2010-09-01

    Thoracic wounding has been a relatively common presentation of military wounds throughout modern conflict. When civilian casualties are included the incidence has remained constant at around 10%, although the frequency and severity of wounds to combatants has been altered by modern body armour. Whilst thoracic injury has a high initial mortality on the battlefield, those surviving to reach hospital frequently have injuries that only require simple management. In addition to penetrating ballistic injury, blunt chest trauma frequently occurs on operations as a result of road traffic collisions or tertiary blast injury. The physiological impact of thoracic wounds, however, is often great and survivors often require intensive care management and, where available, complex strategies to ensure oxygenation and carbon dioxide removal. This review examines the incidence and patterns of thoracic trauma and looks at therapeutic options for managing these complex cases.

  6. Prevention and management of accidental foreign body ingestion and aspiration in orthodontic practice

    Directory of Open Access Journals (Sweden)

    Umesan UK

    2012-05-01

    Full Text Available Uday Kumar Umesan,1 Kui Lay Chua,1 Priya Balakrishnan21National Dental Centre, 2Kg Kiarong, Bandar Seri Begawan, Brunei DarussalamAbstract: Among the myriad emergencies that could arise in the dental clinical setting there are a few that occur occasionally despite being entirely preventable. Ingestion or aspiration of dental materials, appliances, or instruments comprises this category. Regardless of incidence, foreign body ingestion or aspiration episodes are recognized as potential complications in the specialty of orthodontics. Despite their infrequent occurrence, the morbidity from a single incident and the amount of specialty medical care that may be needed to manage such incidents is too high to ignore. There is also the associated risk of malpractice litigation given the fact that these incidents are preventable. At present, no clear guidelines exist regarding prevention of this emergency in practice. This article attempts to review relevant literature and aims to formulate certain recommendations based on best available evidence to minimize the incidence of such events, while also suggesting guidelines toward making their management more effective. A flow chart outlining management options and strategies to aid the clinician in the event of such an emergency is also presented.Keywords: foreign bodies, ingestion, orthodontics, respiratory aspiration, orthodontic appliances

  7. Application of an aviation model of incident reporting and investigation to the neurosurgical scenario: method and preliminary data.

    Science.gov (United States)

    Ferroli, Paolo; Caldiroli, Dario; Acerbi, Francesco; Scholtze, Maurizio; Piro, Alfonso; Schiariti, Marco; Orena, Eleonora F; Castiglione, Melina; Broggi, Morgan; Perin, Alessandro; DiMeco, Francesco

    2012-11-01

    Incident reporting systems are universally recognized as important tools for quality improvement in all complex adaptive systems, including the operating room. Nevertheless, introducing a safety culture among neurosurgeons is a slow process, and few studies are available in the literature regarding the implementation of an incident reporting system within a neurosurgical department. The authors describe the institution of an aviation model of incident reporting and investigation in neurosurgery, focusing on the method they have used and presenting some preliminary results. In 2010, the Inpatient Safety On-Board project was developed through cooperation between a team of human factor and safety specialists with aviation backgrounds (DgSky team) and the general manager of the Fondazione Istituto Neurologico Carlo Besta. In 2011, after specific training in safety culture, the authors implemented an aviation-derived prototype of incident reporting within the Department of Neurosurgery. They then developed an experimental protocol to track, analyze, and categorize any near misses that happened in the operating room. This project officially started in January 2012, when a dedicated team of assessors was established. All members of the neurosurgical department were asked to report near misses on a voluntary, confidential, and protected form (Patient Incident Reporting System form, Besta Safety Management Programme). Reports were entered into an online database and analyzed by a dedicated team of assessors with the help of a facilitator, and an aviation-derived root cause analysis was performed. Since January 2012, 14 near misses were analyzed and classified. The near-miss contributing factors were mainly related to human factors (9 of 14 cases), technology (1 of 14 cases), organizational factors (3 of 14 cases), or procedural factors (1 of 14 cases). Implementing an incident reporting system is quite demanding; the process should involve all of the people who work within

  8. Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication.

    Science.gov (United States)

    Ghobrial, George M; Harrop, James S; Sasso, Rick C; Tannoury, Chadi A; Tannoury, Tony; Smith, Zachary A; Hsu, Wellington K; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; De Giacomo, Anthony F; Jobse, Bruce C; Rahman, Ra'Kerry K; Thompson, Sara E; Riew, K Daniel

    2017-04-01

    Retrospective multi-institutional case series. The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections. A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections. A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities. The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to

  9. [Notification of incidents related to patient safety in hospitals in Catalonia, Spain during the period 2010-2013].

    Science.gov (United States)

    Oliva, Glòria; Alava, Fernando; Navarro, Laura; Esquerra, Miquel; Lushchenkova, Oksana; Davins, Josep; Vallès, Roser

    2014-07-01

    The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was

  10. Waste Management Decision-Making Process During a Homeland Security Incident Response

    Science.gov (United States)

    A step-by-step guide on how to make waste management-related decisions including how waste can be minimized, collected and treated, as well as where waste can be sent for staging, storage and final disposal.

  11. Radiation incidents in dentistry

    International Nuclear Information System (INIS)

    Lovelock, D.J.

    1996-01-01

    Most dental practitioners act as their own radiographer and radiologist, unlike their medical colleagues. Virtually all dental surgeons have a dental X-ray machine for intraoral radiography available to them and 40% of dental practices have equipment for dental panoramic tomography. Because of the low energy of X-ray equipment used in dentistry, radiation incidents tend to be less serious than those associated with other aspects of patient care. Details of 47 known incidents are given. The advent of the 1985 and 1988 Ionising Radiation Regulations has made dental surgeons more aware of the hazards of radiation. These regulations, and general health and safety legislation, have led to a few dental surgeons facing legal action. Because of the publicity associated with these court cases, it is expected that there will be a decrease in radiation incidents arising from the practice of dentistry. (author)

  12. Incidents with hazardous radiation sources; Zwischenfaelle mit gefaehrlichen Strahlenquellen

    Energy Technology Data Exchange (ETDEWEB)

    Schoenhacker, Stefan [Bundesministerium fuer Inneres, Traiskirchen (Austria). Abt. 1/9 - Zivilschutzschule

    2016-07-01

    Incidents with hazardous radiation sources can occur in any country, even those without nuclear facilities. Preparedness for such incidents is supposed to fulfill globally agreed minimum standards. Incidents are categorized in incidents with licensed handling of radiation sources as for material testing, transport accidents of hazardous radiation sources, incidents with radionuclide batteries, incidents with satellites containing radioactive inventory, incidents wit not licensed handling of illegally acquired hazardous radiation sources. The emergency planning in Austria includes a differentiation according to the consequences: incidents with release of radioactive materials resulting in restricted contamination, incidents with release of radioactive materials resulting in local contamination, and incidents with the hazard of e@nhanced exposure due to the radiation source.

  13. Annual incidence and standardized incidence ratio of cerebrovascular accidents in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Mok, C C; Ho, L Y; To, C H

    2009-01-01

    To study the annual incidence and standardized incidence ratio (SIR) of cerebrovascular accident (CVA) in patients with systemic lupus erythematosus (SLE). The annual incidence of CVA from 1999 to 2007 in a longitudinal cohort of SLE patients was calculated each year and compared with that of the regional population within the same study period. Age-specific SIRs and outcome of CVA in SLE patients were also studied. In 2007, there were 490 SLE patients in our cohort. The mean annual incidence of CVA between 1999 and 2007 was 6.45/1000 patients and no obvious trend over time was observed. Of the 20 CVAs in patients with SLE, 18 (90%) were ischaemic stroke whereas two (10%) were haemorrhagic stroke. The mean SIR of all types of CVA in SLE patients was 2.02 [95% confidence interval (CI) 1.30-3.81; p = 0.002]. The SIR of ischaemic stroke decreased with age and the stroke incidence was no longer significantly higher than that of the population in patients aged >or= 60 years. Haemorrhagic stroke occurred mainly in younger SLE patients. The duration of hospitalization and the mortality rate for CVA was non-significantly higher in SLE than in non-SLE patients. The incidence of CVA in SLE remained constant over the 8 years between 1999 and 2007. Younger SLE patients are at substantially increased risk of CVA compared to age-matched population. The duration of hospitalization and the mortality rate for CVA are similar in SLE and non-SLE patients.

  14. Incidents Associated with Gas Operation

    Directory of Open Access Journals (Sweden)

    Szer J.

    2017-06-01

    Full Text Available This article shows incidents associated with the use of gas as an energy carrier. It presents selected incidents which have occurred in Poland and around the world in recent decades. Based on this, consequences of gas and air mixture explosions were analysed as well. The article presents the main causes of gas incidents which have taken place, as per instances which are similar worldwide. Incidents associated with the use of gas are not frequent, but at the same time very tragic as they often lead to illness or even death. In Poland, in the last twenty years, construction area disasters caused by gas explosions account for only 5% of all which have occurred, but the number of fatalities resulting from these cases is approximately 14%. The number of individuals injured reached 39% of all construction disaster victims. Considering all these facts, it is necessary to undertake wide preventive measures in order to increase safety in the use of gaseous fuels.

  15. Making sense of diversity in the workplace: organizational justice and language abstraction in employees' accounts of diversity-related incidents.

    Science.gov (United States)

    Roberson, Quinetta M; Stevens, Cynthia Kay

    2006-03-01

    To discern patterns of employee sense-making about workplace diversity, the authors analyzed 751 natural language accounts of diversity incidents from 712 workers in one department of a large organization. Six generic incident types emerged: discrimination, representation, treatment by management, work relationships, respect between groups, and diversity climates. Consistent with hypotheses, incidents that respondents viewed as negative, accounts from women, and those involving members of respondents' in-groups were more likely to cite justice issues. Partially consistent with research on the linguistic intergroup bias, both negative and positive accounts involving out-group members and accounts from men were more likely to be expressed using abstract verb forms. The authors discuss future opportunities to integrate research on diversity, justice, and the linguistic category model.

  16. Identification and prioritization of effective factors in fire incidents preparation programs

    Directory of Open Access Journals (Sweden)

    M. Arvan

    2016-04-01

    Full Text Available One of the major challenges in mega cities is the degree of the preparedness of organizations, institutions and people in facing with critical conditions and their immediate reaction according to pre-defined instructions. Identification of priorities and acting accordingly is an undeniable factor in urban crisis management. The purpose of this research was to identify the priorities of preparedness and readiness to immediate responses in case of large fire incident occurrence in the urban areas. District 9 of Tehran municipality was selected as a case study. Considering the Specific regional conditions of this area such as high population, old unstable housing constructions, presence of Mehr-abad air port at the heart of the district, and the gas transmission pipeline mark this district as a vulnerable area to fire incidents. According to the crisis management readiness index, 2 types of questionnaires were distributed among members of the crisis department and fire rescue forces of the district 9. The results reviled that the most important priorities were basic training to residents, equipping the gas valves with automatic cut off switches in an emergency situation, training the responsible personnel to act efficiently in the early hours of accident and performing maneuvers. SPSS software was used for statistical analysis and Cranach’s alpha coefficient was used to test the reliability of the questionnaire and to test the hypotheses single-sample T -test was used.

  17. Experience feedback committee in emergency medicine: a tool for security management.

    Science.gov (United States)

    Lecoanet, André; Sellier, Elodie; Carpentier, Françoise; Maignan, Maxime; Seigneurin, Arnaud; François, Patrice

    2014-11-01

    Emergency departments are high-risk structures. The objective was to analyse the functioning of an experience feedback committee (EFC), a security management tool for the analysis of incidents in a medical department. We conducted a descriptive study based on the analysis of the written documents produced by the EFC between November 2009 and May 2012. We performed a double analysis of all incident reports, meeting minutes and analysis reports. During the study period, there were 22 meetings attended by 15 professionals. 471 reported incidents were transmitted to the EFC. Most of them (95%) had no consequence for the patients. Only one reported incident led to the patient's death. 12 incidents were analysed thoroughly and the committee decided to set up 14 corrective actions, including eight guideline writing actions, two staff trainings, two resource materials provisions and two organisational changes. The staff took part actively in the EFC. Following the analysis of incidents, the EFC was able to set up actions at the departmental level. Thus, an EFC seems to be an appropriate security management tool for an emergency department. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Approaches to the management of antenatally diagnosed congenital tumours

    International Nuclear Information System (INIS)

    Mahony, Rhona; McParland, Peter

    2009-01-01

    Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents. (orig.)

  19. Approaches to the management of antenatally diagnosed congenital tumours

    Energy Technology Data Exchange (ETDEWEB)

    Mahony, Rhona; McParland, Peter [National Maternity Hospital, Department of Fetal and Maternal Medicine, Dublin (Ireland)

    2009-11-15

    Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents. (orig.)

  20. Incidence and cost of medications dispensed despite electronic medical record discontinuation.

    Science.gov (United States)

    Baranowski, Patrick J; Peterson, Kristin L; Statz-Paynter, Jamie L; Zorek, Joseph A

    2015-01-01

    To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization. Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company. Pharmacist-led quality improvement project using retrospective chart review. Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD. Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event. 7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74. Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.

  1. Predicting incident size from limited information

    International Nuclear Information System (INIS)

    Englehardt, J.D.

    1995-01-01

    Predicting the size of low-probability, high-consequence natural disasters, industrial accidents, and pollutant releases is often difficult due to limitations in the availability of data on rare events and future circumstances. When incident data are available, they may be difficult to fit with a lognormal distribution. Two Bayesian probability distributions for inferring future incident-size probabilities from limited, indirect, and subjective information are proposed in this paper. The distributions are derived from Pareto distributions that are shown to fit data on different incident types and are justified theoretically. The derived distributions incorporate both inherent variability and uncertainty due to information limitations. Results were analyzed to determine the amount of data needed to predict incident-size probabilities in various situations. Information requirements for incident-size prediction using the methods were low, particularly when the population distribution had a thick tail. Use of the distributions to predict accumulated oil-spill consequences was demonstrated

  2. Epidemiology of road traffic incidents in Peru 1973-2008: incidence, mortality, and fatality.

    Science.gov (United States)

    Miranda, J Jaime; López-Rivera, Luis A; Quistberg, D Alex; Rosales-Mayor, Edmundo; Gianella, Camila; Paca-Palao, Ada; Luna, Diego; Huicho, Luis; Paca, Ada

    2014-01-01

    The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973-2008, as well as their relationship to population trends such as economic growth. Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43-5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15-0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09-1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita. The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs.

  3. Epidemiology of road traffic incidents in Peru 1973-2008: incidence, mortality, and fatality.

    Directory of Open Access Journals (Sweden)

    J Jaime Miranda

    Full Text Available The epidemiological profile and trends of road traffic injuries (RTIs in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973-2008, as well as their relationship to population trends such as economic growth.Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43-5.31 on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15-0.43, while among adults the fatality rate increased by 1.25 (95% CI 1.09-1.43. Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP per capita.The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs.

  4. Sectorial Group for Incident Analyses (GSAI)

    International Nuclear Information System (INIS)

    Galles, Q.; Gamo, J. M.; Jorda, M.; Sanchez-Garrido, P.; Lopez, F.; Asensio, L.; Reig, J.

    2013-01-01

    In 2008, the UNESA Nuclear Energy Committee (CEN) proposed the creation of a working group formed by experts from all Spanish NPPs with the purpose of jointly analyze relevant incidents occurred in each one of the plants. This initiative was a response to a historical situation in which the exchange of information on incidents between the Spanish NPP's was below the desired level. In june 2009, UNESA's Guide CEN-29 established the performance criteria for the so called Sectorial Group for Incident Analyses (GSAI), whose activity would be coordinated by the UNESA's Group for Incident Analyses (GSAI), whose activity would be coordinated by the UNESA's Group of Operating Experience, under the Operations Commission (COP). (Author)

  5. Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates.

    Science.gov (United States)

    Hunter, Wynn G; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-03-31

    Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010-2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson's Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost--discussion of the patient's OoP costs for a healthcare service; (b) Cost/Coverage--discussion of the patient's OoP costs or insurance coverage; (c) Cost of Illness- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24% of clinic visits contained cost conversation (OOP Cost, Cost/Coverage, Cost of Illness, respectively; P cost conversation varied significantly depending on the definition used. Our findings and proposed definitions may assist in retrospective interpretation and prospective design of investigations on this topic.

  6. A critical incident reporting system in anaesthesia.

    Science.gov (United States)

    Madzimbamuto, F D; Chiware, R

    2001-01-01

    To audit the recently established Critical Incident Reporting System in the Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe Medical School. The system was set up with the purpose of improving the quality of care delivered by the department. Cross sectional study. A critical incident was defined as 'any adverse and reversible event in theatre, during or immediately after surgery that if it persisted without correction would cause harm to the patient'. The anaesthetic or recovery room staff filled a critical incident form anonymously. Data was collected from critical incident reporting forms for analysis. The anaesthetic service in the two teaching hospitals of Harare Central and Parirenyatwa General Hospitals. Between May and October 2000, 62 completed critical incident forms were collected. The nature of the incident and the monitoring used were recorded, the cause was classified as human, equipment or monitoring failure and the outcome for each patient reported. There was no formal system for reminding staff to fill in their critical incident forms. A total of 14,165 operations were performed over the reporting period: 62 critical incident forms were collected, reporting 130 incidents, giving a rate of 0.92% (130/14,165). Of these, 42 patients were emergencies and 20 elective. The incidents were hypotension, hypoxia, bradycardia, ECG changes, aspiration, laryngospasm, high spinal, and cardiac arrest. Monitoring present on patients who had critical incidents was: capnography 57%, oxymetry 90% and ECG 100%. Other monitors are not reported. Human error contributed in 32/62 of patients and equipment failure in 31/62 of patients. Patient outcome showed 15% died, 23% were unplanned admissions to HDU while 62% were discharged to the ward with little or no adverse outcome. Despite some under reporting, the critical incident rate was within the range reported in the literature. Supervision of juniors is not adequate, especially on call. The

  7. Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study)

    DEFF Research Database (Denmark)

    Dawood, Farah Z; Khan, Faraaz; Roediger, Mollie P

    2013-01-01

    the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ± 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men......Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from...... and women separately, and values in the upper quartile were considered as a widened angle (values >74° for women and >93° for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11...

  8. Does community-wide chronic kidney disease management improve patient outcomes?

    Science.gov (United States)

    Rayner, Hugh C; Baharani, Jyoti; Dasgupta, Indranil; Suresh, Vijayan; Temple, Robert M; Thomas, Mark E; Smith, Steve A

    2014-03-01

    The number of patients starting renal replacement therapy (RRT) is increasing in England, as it is worldwide. Improvements in the management of chronic kidney disease (CKD) across communities to alter this trend are a public health priority. We have prospectively studied changes in the incidence and modality of treatment for end-stage renal disease following the introduction of a CKD management programme in the West Midlands region of England. Nephrology service to approximately 700 000 adult population of mixed ethnicity in urban and suburban areas, many with social deprivation. The programme was introduced in stages between 2003 and 2006 and comprised primary care education and financial incentives, personal clinical reports written directly to patients following every consultation, routine laboratory estimated glomerular filtration rate (eGFR) reporting, eGFR graph surveillance to identify and monitor patients at risk, multidisciplinary pre-RRT care and conservative care. Prevalent patients: 10 552 with CKD and 8509 without CKD with diabetes. access to nephrology care, trends in RRT incidence and starting modality, place of death without RRT. Incident count was adjusted for changes in the local adult population recorded in national censuses. Ninety-one per cent of patients aged ≥75 years with incident CKD stage 5 were known to a nephrologist. The population-adjusted incident RRT rate peaked in 2005 and then declined; the proportion starting with transplant, peritoneal dialysis or haemodialysis by arterio-venous fistula increased to 63% by 2012 (P = 0.001 versus 2005). Fifty-two per cent of patients receiving planned conservative care without dialysis died out of hospital. Following the introduction of a community-wide systematic CKD management programme, the population-adjusted incidence of RRT reduced, modality of initiation of RRT improved and a majority of patients receiving planned conservative care without dialysis died out of hospital.

  9. Increasing incidence of diabetes after gestational diabetes

    DEFF Research Database (Denmark)

    Lauenborg, Jeannet; Hansen, Torben; Jensen, Dorte Møller

    2004-01-01

    To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes.......To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes....

  10. Invasive cancer incidence - Puerto Rico, 2007-2011.

    Science.gov (United States)

    O'Neil, Mary Elizabeth; Henley, S Jane; Singh, Simple D; Wilson, Reda J; Ortiz-Ortiz, Karen J; Ríos, Naydi Pérez; Torres Cintrón, Carlos R; Luna, Guillermo Tortolero; Zavala Zegarra, Diego E; Ryerson, A Blythe

    2015-04-17

    Cancer is a leading cause of morbidity and death in Puerto Rico. To set a baseline for identifying new trends and patterns of cancer incidence, Puerto Rico Central Cancer Registry staff and CDC analyzed data from Puerto Rico included in U.S. Cancer Statistics (USCS) for 2007-2011, the most recent data available. This is the first report of invasive cancer incidence rates for 2007-2011 among Puerto Rican residents by sex, age, cancer site, and municipality. Cancer incidence rates in Puerto Rico were compared with those in the U.S. population for 2011. A total of 68,312 invasive cancers were diagnosed and reported in Puerto Rico during 2007-2011. The average annual incidence rate was 330 cases per 100,000 persons. The cancer sites with the highest cancer incidence rates included prostate (152), female breast (84), and colon and rectum (43). Cancer incidence rates varied by municipality, particularly for prostate, lung and bronchus, and colon and rectum cancers. In 2011, cancer incidence rates in Puerto Rico were lower for all cancer sites and lung and bronchus, but higher for prostate and thyroid cancers, compared with rates within the U.S. Identifying these variations can aid evaluation of factors associated with high incidence, such as cancer screening practices, and development of targeted cancer prevention and control efforts. Public health professionals can monitor cancer incidence trends and use these findings to evaluate the impact of prevention efforts, such as legislation prohibiting tobacco use in the workplace and public places and the Puerto Rico Cessation Quitline in decreasing lung and other tobacco-related cancers.

  11. Primary care management of food allergy and food intolerance.

    Science.gov (United States)

    Garzon, Dawn Lee; Kempker, Tara; Piel, Pamela

    2011-12-16

    The incidence of food allergies is steadily increasing. Due to potentially life-threatening complications, it is important that primary care providers recognize and appropriately manage these disorders. This article includes a discussion of the current evidence-based guidelines for the diagnosis, screening, and management of food allergies.

  12. IPMA Standard Competence Scope in Project Management Education

    Science.gov (United States)

    Bartoška, Jan; Flégl, Martin; Jarkovská, Martina

    2012-01-01

    The authors of the paper endeavoured to find out key competences in IPMA standard for educational approaches in project management. These key competences may be used as a basis for project management university courses. An incidence matrix was set up, containing relations between IPMA competences described in IPMA competence baseline. Further,…

  13. Pediatric tinnitus: Incidence of imaging anomalies and the impact of hearing loss.

    Science.gov (United States)

    Kerr, Rhorie; Kang, Elise; Hopkins, Brandon; Anne, Samantha

    2017-12-01

    Guidelines exist for evaluation and management of tinnitus in adults; however lack of evidence in children limits applicability of these guidelines to pediatric patients. Objective of this study is to determine the incidence of inner ear anomalies detected on imaging studies within the pediatric population with tinnitus and evaluate if presence of hearing loss increases the rate of detection of anomalies in comparison to normal hearing patients. Retrospective review of all children with diagnosis of tinnitus from 2010 to 2015 ;at a tertiary care academic center. 102 pediatric patients with tinnitus were identified. Overall, 53 patients had imaging studies with 6 abnormal findings (11.3%). 51/102 patients had hearing loss of which 33 had imaging studies demonstrating 6 inner ear anomalies detected. This is an incidence of 18.2% for inner ear anomalies identified in patients with hearing loss (95% confidence interval (CI) of 7.0-35.5%). 4 of these 6 inner ear anomalies detected were vestibular aqueduct abnormalities. The other two anomalies were cochlear hypoplasia and bilateral semicircular canal dysmorphism. 51 patients had no hearing loss and of these patients, 20 had imaging studies with no inner ear abnormalities detected. There was no statistical difference in incidence of abnormal imaging findings in patients with and without hearing loss (Fisher's exact test, p ;= ;0.072.) CONCLUSION: There is a high incidence of anomalies detected in imaging studies done in pediatric patients with tinnitus, especially in the presence of hearing loss. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Bladder management methods and urological complications in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2011-01-01

    Full Text Available Background: The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI and other urological complications in spinal cord injury patients (SCI, and to compare the incidence of these complications with different bladder management subgroups. Materials and Methods: 545 patients (386 males and 159 females of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. Results: The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%, urethritis (n=78, 14.3%, periurethral abscess (n=45, 8.2%, epididymorchitis (n=44, 8.07%, urethral false passage (n=22, 4.03%, urethral fistula (n=11, 2%, lithiasis (n=23, 4.2%, hematuria (n=44, 8.07%, stress incontinence (n=60, 11%, and pyelonephritis (n=6, 1.1%. Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. Conclusions

  15. Risk management of radiation therapy. Survey by north Japan radiation therapy oncology group

    International Nuclear Information System (INIS)

    Aoki, Masahiko; Abe, Yoshinao; Yamada, Shogo; Hareyama, Masato; Nakamura, Ryuji; Sugita, Tadashi; Miyano, Takashi

    2004-01-01

    A North Japan Radiation Oncology Group (NJRTOG) survey was carried out to disclose the risk management of radiation therapy. During April 2002, we sent questionnaires to radiation therapy facilities in northern Japan. There were 31 replies from 27 facilities. Many incidents and accidents were reported, including old cases. Although 60% of facilities had a risk management manual and/or risk manager, only 20% had risk management manuals for radiation therapy. Eighty five percent of radiation oncologists thought that incidents may be due to a lack of manpower. Ninety percent of radiation oncologists want to know the type of cases happened in other facilities. The risk management system is still insufficient for radiation therapy. We hope that our data will be a great help to develop risk management strategies for radiation therapy for all radiation oncologists in Japan. (author)

  16. Incidence and survival patterns of rare anal canal neoplasms using the surveillance epidemiology and end results registry.

    Science.gov (United States)

    Metildi, Cristina; McLemore, Elisabeth C; Tran, Thuy; Chang, David; Cosman, Bard; Ramamoorthy, Sonia L; Saltzstein, Sidney L; Sadler, Georgia Robins

    2013-10-01

    Small cell, neuroendocrine tumors, and melanoma of the anus are rare. Limited data exist on the incidence and management for these rare tumors. A large, prospective, population-based database was used to determine incidence and survival patterns of rare anal neoplasms. The Surveillance, Epidemiology and End Results registry was queried to identify patients diagnosed with anal canal neoplasms. Incidence and survival patterns were evaluated with respect to age, sex, race, histology, stage, and therapy. We identified 7078 cases of anal canal neoplasms: melanoma (n = 149), neuroendocrine (n = 61), and small cell neuroendocrine (n = 26). Squamous cell carcinoma (SCC) (n = 6842) served as the comparison group. Anal melanoma (AM) demonstrated the lowest survival rate at 2.5 per cent. Neuroendocrine tumors (NETs) demonstrated similar survival as SCC (10-year survival for regional disease of 25 and 22.3%, respectively). Ten-year survival of small cell NETs resembled AM (5.3 vs 2.5%). Age 60 years or older, sex, black race, stage, and surgery were independent predictors of survival. This study presents the largest patient series of rare anal neoplasms. NETs of the anal canal demonstrate similar survival patterns to SCC, whereas small cell NETs more closely resemble AM. Accurate histologic diagnosis is vital to determine treatment and surgical management because survival patterns can differ among rare anal neoplasms.

  17. Waste Management Fault Tree Data Bank (WM): 1992 status report

    International Nuclear Information System (INIS)

    Baughman, D.F.; Hang, P.; Townsend, C.S.

    1993-01-01

    The Risk Assessment Methodology Group (RAM) of the Nuclear Process Safety Research Section (NPSR) maintains a compilation of incidents that have occurred in the Waste Management facilities. The Waste Management Fault Tree Data Bank (WM) contains more than 35,000 entries ranging from minor equipment malfunctions to incidents with significant potential for injury or contamination of personnel. This report documents the status of the WM data bank including: availability, training, source of data, search options, and usage, to which these data have been applied. Periodic updates to this memorandum are planned as additional data or applications are acquired

  18. Congenital Hypothyroidism: Increased Incidence in Yazd Province, Iran

    Directory of Open Access Journals (Sweden)

    M. Noori-Shadkam

    2012-07-01

    Full Text Available Introduction: Congenital hypothyroidism (CH is one of the most common preventable causes of mental retardation. Its worldwide incidence is estimated to be one in 2500-5500 births. Assessment of thyroid gland in neonates is critical. The aims of this study were to demonstrate the incidence of CH in neonates born in Yazd province, Iran in 1389 (2010 and compare the results with other reported studies and investigate biochemical characteristics of affected infants. Materials & Methods: This is an analytical descriptive cross-sectional study. The study was conducted on all infants (13022 births born in 1389 (March 2010-March 2011. Thyroid stimulating hormone (TSH was measured using ELISA technique. Results: Forty five infants suffered from congenital hypothyroidism with an overall incidence of one in 289 live births. Twenty five of the diagnosed infants were males (incidence 1:261 and twenty were females (incidence 1:325. The incidence of CH in boys was more than girls (P-value = 0.295. The highest incidence of CH was observed in spring followed by summer and the lowest incidence was in autumn followed by winter (P-value=0.000. Conclusion: The CH incidence was 10.3 to 13.8 times more than other countries. The highest CH incidence was in spring followed by summer and the lowest incidence was in autumn followed by winter. It is important that a larger size of cases need to be screened and more information on the aetiology of the affected infants to be obtained

  19. Lightning incidents in Mongolia

    Directory of Open Access Journals (Sweden)

    Myagmar Doljinsuren

    2015-11-01

    Full Text Available This is one of the first studies that has been conducted in Mongolia on the distribution of lightning incidents. The study covers a 10-year period from 2004 to 2013. The country records a human death rate of 15.4 deaths per 10 million people per year, which is much higher than that of many countries with similar isokeraunic level. The reason may be the low-grown vegetation observed in most rural areas of Mongolia, a surface topography, typical to steppe climate. We suggest modifications to Gomes–Kadir equation for such countries, as it predicts a much lower annual death rate for Mongolia. The lightning incidents spread over the period from May to August with the peak of the number of incidents occurring in July. The worst lightning affected region in the country is the central part. Compared with impacts of other convective disasters such as squalls, thunderstorms and hail, lightning stands as the second highest in the number of incidents, human deaths and animal deaths. Economic losses due to lightning is only about 1% of the total losses due to the four extreme weather phenomena. However, unless precautionary measures are not promoted among the public, this figure of losses may significantly increase with time as the country is undergoing rapid industrialization at present.

  20. Critical Steps in Learning From Incidents: Using Learning Potential in the Process From Reporting an Incident to Accident Prevention

    NARCIS (Netherlands)

    Drupsteen, L.; Groeneweg, J.; Zwetsloot, G.I.J.M.

    2013-01-01

    Many incidents have occurred because organisations have failed to learn from lessons of the past. This means that there is room for improvement in the way organisations analyse incidents, generate measures to remedy identified weaknesses and prevent reoccurrence: the learning from incidents process.

  1. Epistaxis in children: approach and management

    African Journals Online (AJOL)

    Chantel

    of epistaxis by the age of 5 years. In the age group 6 -. 10 years the incidence increases to. 56%. Although .... Digital (nose picking). Foreign body/ rhinolith .... Ointment. Advice. Refer to haematologist. Manage accordingly/. Refer to ENT surgeon.

  2. Classification of medication incidents associated with information technology.

    Science.gov (United States)

    Cheung, Ka-Chun; van der Veen, Willem; Bouvy, Marcel L; Wensing, Michel; van den Bemt, Patricia M L A; de Smet, Peter A G M

    2014-02-01

    Information technology (IT) plays a pivotal role in improving patient safety, but can also cause new problems for patient safety. This study analyzed the nature and consequences of a large sample of IT-related medication incidents, as reported by healthcare professionals in community pharmacies and hospitals. The medication incidents submitted to the Dutch central medication incidents registration (CMR) reporting system were analyzed from the perspective of the healthcare professional with the Magrabi classification. During classification new terms were added, if necessary. The principal source of the IT-related problem, nature of error. Additional measures: consequences of incidents, IT systems, phases of the medication process. From March 2010 to February 2011 the CMR received 4161 incidents: 1643 (39.5%) from community pharmacies and 2518 (60.5%) from hospitals. Eventually one of six incidents (16.1%, n=668) were related to IT; in community pharmacies more incidents (21.5%, n=351) were related to IT than in hospitals (12.6%, n=317). In community pharmacies 41.0% (n=150) of the incidents were about choosing the wrong medicine. Most of the erroneous exchanges were associated with confusion of medicine names and poor design of screens. In hospitals 55.3% (n=187) of incidents concerned human-machine interaction-related input during the use of computerized prescriber order entry. These use problems were also a major problem in pharmacy information systems outside the hospital. A large sample of incidents shows that many of the incidents are related to IT, both in community pharmacies and hospitals. The interaction between human and machine plays a pivotal role in IT incidents in both settings.

  3. SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

    2014-06-15

    Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, including 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy.

  4. SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

    International Nuclear Information System (INIS)

    Yang, R; Wang, J

    2014-01-01

    Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, including 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy

  5. Incidence and prevalence of epilepsy in Denmark

    DEFF Research Database (Denmark)

    Christensen, Jakob; Vestergaard, Mogens; Pedersen, Marianne G

    2007-01-01

    registered with epilepsy between 1977 and 2002. RESULTS: Between 1977 and 2002 the average incidence of epilepsy was 68.8 new epilepsy patients per 100,000 person-years at risk. However, the incidence changed with calendar time and increased steeply from 1990 to 1995, probably due to changes in diagnostic...... system and inclusion of outpatients. From 1995 to 2002 the incidence rate was reasonable constant with an average of 83.3 new cases per 100,000 person-years at risk, except for patients over 60 years of age where we observed an increase in incidence with calendar time. The age-specific incidence rates...... declined from a high level in children to a low level between 20 and 40 years of age, and thereafter a gradual increase was seen. The incidence rate was slightly higher in men than in women except for the age range 10-20 years. About 2% of the population was diagnosed with epilepsy at some point during...

  6. Incident reviews in UK maternity units: a systematic appraisal of the quality of local guidelines.

    Science.gov (United States)

    Shah, Anjali; Mohamed-Ahmed, Olaa; Peirsegaele, Philippe; McClymont, Charlotte; Knight, Marian

    2015-03-14

    Maternity care is recognised as a particularly high-risk speciality that is subject to investigation and inquiry, and improvements in risk management have been recommended. However, the quality of guidelines for local reviews of maternity incidents is unknown. The aim of the study is to appraise the quality of local guidance on conducting reviews of severe maternity incidents in the National Health Service. Guidelines for incident reviews were requested from all 211 consultant-led maternity units in the UK during 2012. The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to evaluate the quality of guidelines. The methods used for reviewing an incident, the people involved in the review and the methods for disseminating the outcomes of the reviews were also examined. Guidelines covering 148 (70%) of all NHS maternity units in the UK were received for evaluation. Most guidelines (55%) received were of good or high quality. The median score on 'scope and purpose' (86%), concerned with the aims and target population of the guideline, was higher than for other domains. Median scores were: 'stakeholder involvement' (representation of users' views) 56%, 'rigour of development' (process used to develop guideline) 34%, 'clarity of presentation' 78%, 'applicability' (organisational and cost implications of applying guideline) 56% and 'editorial independence' 0%. Most guidelines (81%) recommended a range of health professionals review serious maternity incidents using root cause analysis. Findings were most often disseminated at meetings, in reports and in newsletters. Many guidelines (69%) stated lessons learnt from incidents would be audited. Overall, local guidance for the review of maternity incidents was mostly of good or high quality. Stakeholder participation in guideline development could be widened, and editorial independence more clearly stated. It was unclear in over a quarter of guidelines whether changes in practice in response

  7. Assessment of BED HIV-1 incidence assay in seroconverter cohorts: effect of individuals with long-term infection and importance of stable incidence.

    Directory of Open Access Journals (Sweden)

    Janet M McNicholl

    Full Text Available BACKGROUND: Performance of the BED assay in estimating HIV-1 incidence has previously been evaluated by using longitudinal specimens from persons with incident HIV infections, but questions remain about its accuracy. We sought to assess its performance in three longitudinal cohorts from Thailand where HIV-1 CRF01_AE and subtype B' dominate the epidemic. DESIGN: BED testing was conducted in two longitudinal cohorts with only incident infections (a military conscript cohort and an injection drug user cohort and in one longitudinal cohort (an HIV-1 vaccine efficacy trial cohort that also included long-term infections. METHODS: Incidence estimates were generated conventionally (based on the number of annual serocoversions and by using BED test results in the three cohorts. Adjusted incidence was calculated where appropriate. RESULTS: For each longitudinal cohort the BED incidence estimates and the conventional incidence estimates were similar when only newly infected persons were tested, whether infected with CRF01_AE or subtype B'. When the analysis included persons with long-term infections (to mimic a true cross-sectional cohort, BED incidence estimates were higher, although not significantly, than the conventional incidence estimates. After adjustment, the BED incidence estimates were closer to the conventional incidence estimates. When the conventional incidence varied over time, as in the early phase of the injection drug user cohort, the difference between the two estimates increased, but not significantly. CONCLUSIONS: Evaluation of the performance of incidence assays requires the inclusion of a substantial number of cohort-derived specimens from individuals with long-term HIV infection and, ideally, the use of cohorts in which incidence remained stable. Appropriate adjustments of the BED incidence estimates generate estimates similar to those generated conventionally.

  8. Ionospheric Oblique Incidence Soundings by Satellites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The oblique incidence sweep-frequency ionospheric sounding technique uses the same principle of operation as the vertical incidence sounder. The primary difference...

  9. Evaluation of bovine coronavirus antibody levels, virus shedding, and respiratory disease incidence throughout the beef cattle production cycle

    Science.gov (United States)

    Objective- Determine how levels of serum antibody to bovine coronavirus (BCV) are related to virus shedding patterns and respiratory disease incidence in beef calves at various production stages. Animals- 890 crossbred beef calves from four separately managed herds at the U.S. Meat Animal Research C...

  10. Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview.

    Science.gov (United States)

    Alotaibi, Abdulellah; Perry, Lin; Gholizadeh, Leila; Al-Ganmi, Ali

    2017-12-01

    This study aimed to report on the trends in incidence and prevalence rates of diabetes mellitus in Saudi Arabia over the last 25 years (1990-2015). A descriptive review. A systematic search was conducted for English-language, peer reviewed publications of any research design via Medline, EBSCO, PubMed and Scopus from 1990 to 2015. Of 106 articles retrieved, after removal of duplicates and quality appraisal, 8 studies were included in the review and synthesised based on study characteristics, design and findings. Studies originated from Saudi Arabia and applied a variety of research designs and tools to diagnosis diabetes. Of the 8 included studies; three reported type 1 diabetes and five on type 2 diabetes. Overall, findings indicated that the incidence and prevalence rate of diabetes is rising particularly among females, older children/adolescent and in urban areas. Further development are required to assess the health intervention, polices, guidelines, self-management programs in Saudi Arabia. Copyright © 2017. Published by Elsevier Ltd.

  11. [Preliminary results of an anonymous internet-based reporting system for critical incidents in ambulatory primary care].

    Science.gov (United States)

    Brun, A

    2005-03-01

    To learn from errors is not always easy, especially if they happened to others! This paper describes the organization and management of a critical incident reporting system for primary care physicians in Switzerland and reports about the difficulties and experiences during the first 18 months since the start of the program. It seems to be particularly difficult to enhance the attentiveness of physicians for apparently harmless daily critical incidents and to motivate them to report it even in an anonymous reporting system. As incentives for more intensive participation there are the hope for comments on reported cases by other participants and the expectation that reported errors will be avoided by the readers.

  12. Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012.

    Science.gov (United States)

    Barber, P Alan; Krishnamurthi, Rita; Parag, Varsha; Anderson, Neil E; Ranta, Annemarei; Kilfoyle, Dean; Wong, Edward; Green, Geoff; Arroll, Bruce; Bennett, Derrick A; Witt, Emma; Rush, Elaine; Minsun Suh, Flora; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priyakumari; Feigin, Valery L

    2016-09-01

    There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA). The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded. There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36-43), and attack rate was 63 (95% confidence interval, 59-68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure-lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation. This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required. © 2016 American Heart Association, Inc.

  13. Incidence and Residual Risk of HIV, HBV and HCV Infections Among Blood Donors in Tehran.

    Science.gov (United States)

    Saber, Hamid Reza; Tabatabaee, Seyed Morteza; Abasian, Ali; Jamali, Mostafa; SalekMoghadam, Ebadollah; Hajibeigi, Bashir; Alavian, Seyed Moayed; Mirrezaie, Seyed Mohammad

    2017-09-01

    Estimation of residual risk is essential to monitor and improve blood safety. Our epidemiologic knowledge in the Iranian donor population regarding transfusion transmitted viral infections (TTIs), is confined to a few studies based on prevalence rate. There are no reports on residual risk of TTIs in Iran. In present survey, a software database of donor records of Tehran Blood Transfusion Center (TBTC) was used to estimate the incidence and residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, by applying the incidence rate/window period (IR-WP) model. A total of 1,207,155 repeat donations was included in the analysis and represented a mean of 8.4 donations per donor over 6 years. The incidence amongst repeat donors was estimated by dividing the number of confirmed seroconverting donors by the total number of person-years at risk. The residual risk was calculated using the incidence/window period model. Incidence rate and residual risk for HBV, HCV and HIV infections were calculated for total (2005-2010) and two consecutive periods (2005-2007 and 2008-2010) of the study. According to the IR-WP model, overall residual risk for HIV and HCV in the total study period was 0.4 and 12.5 per million units, respectively and for HBV 4.57/100,000 donations. The incidence and residual risk of TTIs, calculated on TBTC's blood supply was low and comparable with developed countries for HIV infection but high for HCV and HBV infections. Blood safety may therefore be better managed by applying other techniques like nucleic acid amplification tests.

  14. Incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and solitary cold nodules

    Energy Technology Data Exchange (ETDEWEB)

    Ott, R.A.; Calandra, D.B.; McCall, A.; Shah, K.H.; Lawrence, A.M.; Paloyan, E.

    1985-12-01

    The reported incidence of thyroid carcinoma in Hashimoto's thyroiditis varies widely. For this reason the specific subpopulation of patients with Hashimoto's thyroiditis and a solitary cold nodule was analyzed. Between 1972 and 1984 we operated on 146 consecutive patients with solitary cold nodules and Hashimoto's thyroiditis. There were 47 carcinomas, for an incidence of 32%. The mean age of the 146 patients was 43 1/2 years (median 44 years), with 126 females and 20 males. There was a history of prior head and neck radiation exposure in 54 patients, with a 33% incidence of thyroid carcinoma. The 92 patients without a history of radiation exposure had a 31.5% incidence of carcinoma. The frequency of multicentricity (bilateralism) was 33% in the group that underwent radiation and 24% in the group that did not. To date, with a mean follow-up of 4.7 years, there have been no deaths and no evidence of recurrence. In conclusion, we report a 32% incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and a solitary cold nodule, with no apparent difference between the patients with or without a history of radiation exposure, although there was a higher incidence of bilateralism (33% versus 24%) in the carcinomas of the patients with a history of head and neck irradiation. We suggest that the operative management of these patients is total thyroidectomy for those with a history of head and neck radiation and thyroid lobectomy for patients with no history of radiation, followed by contralateral lobectomy if a carcinoma is demonstrated.

  15. Emergency preparedness and response in the Commonwealth of Pennsylvania - the Three Mile Island incident

    International Nuclear Information System (INIS)

    Henderson, O.K.

    1981-01-01

    This paper addresses the emergency response mechanism and legal basis in effect in the Commonwealth of Pennsylvania at the time of the Three Mile Island incident. It reviews the sequence of events as they directly affected the Pennsylvania Emergency Management Agency and examines the method used by the Agency to discharge its responsibilities. Finally, the paper lists some of the lessons learned from the Three Mile Island experience. (author)

  16. Complications of gynecologic and obstetric management

    International Nuclear Information System (INIS)

    Newton, M.; Newton, E.R.

    1987-01-01

    This book examines the incidence, diagnosis and management of complications associated with interventions used in gynecology and obstetrics. These are encountered in all phases of gynecologic and therapeutic procedures, radiation therapy, drug therapy and pre- and post-treatment care

  17. The Three-Mile Island incident

    International Nuclear Information System (INIS)

    Davies, L.M.

    1979-10-01

    A description is given of the engineering design principles of the PWR (Pressurized Water Reactor) of the Three Mile Island-2 power plant. The successive stages of the incident are recounted, with diagrammatic illustrations, and graphs showing the reactor coolant system parameters at various times after the incident. The consequential events and core damage are discussed. (U.K.)

  18. Management of sinonasal complications after endoscopic orbital decompression for Graves' orbitopathy.

    Science.gov (United States)

    Antisdel, Jastin L; Gumber, Divya; Holmes, Janalee; Sindwani, Raj

    2013-09-01

    Endoscopic orbital decompression (EnOD) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid (CSF) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients. Retrospective review. Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined. The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years (SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega-antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae. Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Increase of Prostate Cancer Incidence in Martinique

    Directory of Open Access Journals (Sweden)

    Dominique Belpomme

    2011-01-01

    Full Text Available Prostate cancer incidence is steadily increasing in many developed countries. Because insular populations present unique ethnic, geographical, and environmental characteristics, we analyzed the evolution of prostate cancer age-adjusted world standardized incidence rates in Martinique in comparison with that of metropolitan France. We also compared prostate cancer incidence rates, and lifestyle-related and socioeconomic markers such as life expectancy, dietary energy, and fat supply and consumption, with those in other Caribbean islands, France, UK, Sweden, and USA. The incidence rate of prostate cancer in Martinique is one of the highest reported worldwide; it is continuously growing since 1985 in an exponential mode, and despite a similar screening detection process and lifestyle-related behaviour, it is constantly at a higher level than in metropolitan France. However, Caribbean populations that are genetically close to that of Martinique have generally much lower incidence of prostate cancer. We found no correlation between prostate cancer incidence rates, life expectancy, and diet westernization. Since the Caribbean African descent-associated genetic susceptibility factor would have remained constant during the 1980–2005, we suggest that in Martinique some environmental change including the intensive use of carcinogenic organochlorine pesticides might have occurred as key determinant of the persisting highly growing incidence of prostate cancer.

  20. [Program for lowering the incidence of pressure sores in neurosurgical patients].

    Science.gov (United States)

    Chang, Chau-Hui; Chen, Hui-Ling; Chen, Hsiang-Chi

    2007-12-01

    Pressure sores are one of the well known problems that occur in hospitals. As the literature on the subject indicates, a lot of money is expended in managing this problem every year, and 12-66% of pressure sores are caused during surgery. Patients who undergo neurosurgical procedures are susceptible to pressure sores because of lengthy operations. We collected data on patients with pressure sores who underwent surgery between May 2004 and August 2004, and found that the incidence of pressure sore in neurosurgical patients was 9.5%, which was the highest among all surgical patients. This project was developed to solve the problem of pressure sores by setting up standard preventive procedures, a nursing follow up system and continuing education courses, and utilizing cotton rolls to pad sites of pressure sores. The incidence of pressure sore in neurosurgical patients was reduced from 9.5% to 7% after the improvement project was carried out. The more concerned nurses are about pressure sores, the better the quality of operative nursing care.

  1. Decline in overall, smear-negative and HIV-positive TB incidence while smear-positive incidence stays stable in Guinea-Bissau 2004-2011

    DEFF Research Database (Denmark)

    Lemvik, G; Rudolf, F; Vieira, F

    2014-01-01

    OBJECTIVE: To calculate Tuberculosis (TB) incidence rates in Guinea-Bissau over an 8-year period. METHODS: Since 2003, a surveillance system has registered all TB cases in six suburban districts of Bissau. In this population-based prospective follow-up study, 1205 cases of pulmonary TB were...... identified between January 2004 and December 2011. Incidence rates were calculated using census data from the Bandim Health and Demographic Surveillance System (HDSS). RESULTS: The overall incidence of pulmonary TB was 279 per 100 000 person-years of observation; the male incidence being 385, and the female...... 191. TB incidence rates increased significantly with age in both sexes, regardless of smear or HIV status. Despite a peak with unknown cause of 352 per 100 000 in 2007, the overall incidence of pulmonary TB declined over the period. The incidence of HIV infected TB cases declined significantly from...

  2. Error management process for power stations

    International Nuclear Information System (INIS)

    Hirotsu, Yuko; Takeda, Daisuke; Fujimoto, Junzo; Nagasaka, Akihiko

    2016-01-01

    The purpose of this study is to establish 'error management process for power stations' for systematizing activities for human error prevention and for festering continuous improvement of these activities. The following are proposed by deriving concepts concerning error management process from existing knowledge and realizing them through application and evaluation of their effectiveness at a power station: an entire picture of error management process that facilitate four functions requisite for maraging human error prevention effectively (1. systematizing human error prevention tools, 2. identifying problems based on incident reports and taking corrective actions, 3. identifying good practices and potential problems for taking proactive measures, 4. prioritizeng human error prevention tools based on identified problems); detail steps for each activity (i.e. developing an annual plan for human error prevention, reporting and analyzing incidents and near misses) based on a model of human error causation; procedures and example of items for identifying gaps between current and desired levels of executions and outputs of each activity; stages for introducing and establishing the above proposed error management process into a power station. By giving shape to above proposals at a power station, systematization and continuous improvement of activities for human error prevention in line with the actual situation of the power station can be expected. (author)

  3. Cognitive simulation of incident risks in the structure of loading and transport enterprise

    Science.gov (United States)

    Shishkina, S. V.; Pristupa, Yu D.; Pavlova, L. D.; Fryanov, V. N.

    2017-09-01

    Organizational and technical system of a manufacturing enterprise was identified, which includes three subsystems: main production, industrial and social infrastructure. Based on the results of cognitive modeling, significant system concepts were identified that reduce the risks of incidents. The internal control influences formed in accordance with level of competence of heads of services, departments, sections, dispatchers, acting on the basis of regulations, job profiles. The second concept influencing the enterprise management system is personnel, which is assessed by the compliance of competencies of crane operators, loader operators, slingers, loaders, and acceptance/delivery agents to job responsibilities and labor functions. At a low level of professional competencies, the personnel does not fully comply with job duties and labor functions, the risk of an incident is maximal. The application of cognitive modeling allows us to identify the essential elements that ensure stable functioning of the system as a whole.

  4. Examining critical care nurses' critical incident stress after in hospital cardiopulmonary resuscitation (CPR).

    Science.gov (United States)

    Laws, T

    2001-05-01

    The object of this study was to determine if critical care nurses' emotional responses to having performed cardiopulmonary resuscitation were indicative of critical incident stress. A descriptive approach was employed using a survey questionnaire of 31 critical care nurses, with supportive interview data from 18 of those participants. Analysis of the data generated from the questionnaire indicated that the respondents experienced thought intrusion and avoidance behaviour. A majority of those interviewed disclosed that they had experienced a wide range of emotional stressors and physical manifestations in response to having performed the procedure. The findings from both questionnaire and interview data were congruent with signs of critical incident stress, as described in the literature. This has been found to be detrimental to employees' mental health status and, for this reason, employers have a duty of care to minimise the risk of its occurrence and to manage problems as they arise.

  5. Therapeutic applications of radioactive 131iodine: Procedures and incidents with capsules

    International Nuclear Information System (INIS)

    Al Aamri, Marwa; Ravichandran, Ramamoorthy; Binukumar, John Pichy; Al Balushi, Naima

    2016-01-01

    Treatments for thyrotoxicosis and carcinoma thyroid are carried out by oral administration of radioactive iodine ( 131 I) in the form of liquid or capsules. The liquid form of 131 I has higher risk factors such as vapourization, spillage and need for management of higher activity wastes. Use of 131 I in capsule form simplify procedures of handling compared to liquid form of 131 I. The guidelines of safe handling and quality assurance aspects for therapeutic use 131 I are well outlined by International Atomic Energy Agency (IAEA) reports. A few unusual incidents with I-131 capsules encountered in the past need to be highlighted from health physics point of view. In Royal Hospital, Oman, I-131 is imported in capsules, and the total activity handled/year steadily increased over 10 years. Discrete activities range from 185 MBq (5 mCi) up to 7.4 GBq (200 mCi). In four incidents deviations in standard operational procedures were recorded. Nature of incidents is described as follows: (1) After assay of activity, the capsule was directly put in the lead container with missing of inner cap. (2) Patient poured water in the Perspex tube, when the capsule was handed over to her, making an emergency situation. (3) In 3 high activity capsules (2 nos 2.96 GBq, 1 no. 4.26 GBq), observed sticky behavior in capsule holder on the 2 nd day post receipt, which were in order on the 1 st day. (4) A capsule could not be swallowed by a patient, which was taken back from the mouth. Monitoring of patient later did not show residual ingested activity. The report documents some of the unusual incidents for information to other centers engaged in such radioactive administrations

  6. Using incident reports to inform the prevention of medication administration errors.

    Science.gov (United States)

    Härkänen, Marja; Saano, Susanna; Vehviläinen-Julkunen, Katri

    2017-11-01

    To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters' perceptions of how to prevent medication administration errors have rarely been analysed. This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free-text descriptions include reporters' views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Reporters' views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines;