International Journal of Risk & Safety in Medicine - Volume 10, issue 3
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: The problem of litigation brought against physicians, pharmaceutical companies and pharmacies for alleged injury as a result of drug treatment is an increasing one throughout the world. The shortcomings of litigation as a means of solving conflicts and providing remedies are evident; it is slow, complex, extremely costly, and sometimes unfair. An alternative approach is offered by the various “pharmaceutical insurance” schemes which exists in the Nordic countries, that in Sweden having been operative for the longest period. This critical account of the Nordic systems of compensation may provide a starting point for developing non-litigious approaches to the problem of…drug-induced injury elsewhere. In particular, one may note the manner in which Product Liability Legislation according to the E.C. model and “pharmaceutical insurance” schemes according to the Nordic model can usefully complement one another.
Abstract: In this paper we describe the options of a pharmacoepidemiologic database comprising data on all reimbursed prescriptions taken up at pharmacies in the County of Northern Jutland since 1991 including precise identification of the individual person for whom the medicin was prescribed. The County comprises 487,000 inhabitants equal to approximately 10% of the total Danish population.
Abstract: Viral hepatitis B (HBV) and C (HCV) have been reported to be prevalent among residents of custodial institutions and health-care workers. Among psychiatric inpatients sparse research was undertaken and results are controversial. We designed the present study to evaluate rates of HBV and HCV among psychiatric inpatients and to characterize the “typical” carriers. All newly admitted patients to the Y. Abarbanel Mental Health Center who were judged by the admitting psychiatrist to be at high-risk underwent laboratory tests for acute and chronic HBV and/or HCV. The period covered in the present study was from January 1993 to December 1995. Inclusion…in the high-risk group was based on one (or more) of the following: history of blood transfusion; I.V. drug abuse; homosexuality; promiscuous sexuality; prostitution; positive HIV test. Of 1327 newly admitted patients, 121 (9.1%) were clinically judged to be at risk. Of these 42 (34.7%) were positive for HBV (37/42) or HCV (5/42). The mean age among infected patients was 37.1+11.6 years; the majority were males (30/42) and the most frequent psychiatric illness was schizophrenia (24/42). In more than half (26/42) of the infected patients the clinical judgement of risk was promiscuous sexuality. Although as a group psychiatric patients newly admitted for treatment do not seem to constitute high risk for HBC and/or HCV carries, sexual promiscuosity should prompt psychiatrists to test for possible hepatitis infections in order to reduce risk to other inpatients and staff.
Abstract: The Mashhadi-Jewish community originating in Iran is a closed and ethnically segregated population with a unique history and a high rate of intra-familial marriage among its members. High infection rate (23%) by Human T-Lymphotrophic Virus type-I (HTLV-I) was found in this population. The known modes of HTLV-I transmission are by sexual intercourse, from mother to child in breast milk, via blood transfusion, and by sharing of needles by parenteral drug users. In the present study we examined the presence of HTLV-I infection in high-risk psychiatric patients of Iranian origin in order to evaluate the infection rate in socially isolated subjects.…We screened and examined all (N=42) Iranian-born schizophrenic patients in our center, of whom 17 were Mashhadi subjects (7 females, 10 males, mean age 48.7±13.2 years), and 25 were born in Iran in other cities than Mashhad (12 females, 13 males, mean age 43.2±11.9). Blood samples were tested for HTLV-I antibodies by particle agglutination test. The polymerase chain reaction (PCR) was used to detect HTLV-I proviral DNA sequences from peripheral blood mononuclear cells. One Mashhadi-born Jew (5.9%) was seropositive and PCR-positive for HTLV-I. None of the schizophrenic non-Mashhadi Iranian subjects was positive for HTLV-I by either method. This infection rate in schizophrenic patients of Mashhadi origin is significantly lower than rates reported for the normal Mashhadi community. We suggest that the relative isolation imposed by the stigma associated with mental illness and recurrent psychiatric hospitalizations serve to protect this sub-group from HTLV-I infection.
Keywords: HTLV-I, Mashhadi Jews, schizophrenia, social isolation
Abstract: A study of 456 cervical hip fractures (352 in women and 104 in men) treated with internal fixation with a dynamic hip screw or 3 parallel screws was performed to evaluate the relationship between surgical delay and 3 months mortality rate, fracture healing and risk of wound infection. The duration of the interval between admissiol1 and operation was 26 hours for patients operated with dynamic a hip screw and 33 hours for patients operated with 3 parallel screws. This series seems to suggest that surgical delay did not have a detrimental effect on the 3 months mortality rate, fracture healing…and wound infection. However, old age was associated with increased 3 months mortality, risk of wound infection but not fracture healing.