International Journal of Risk & Safety in Medicine - Volume 11, issue 2
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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: Objective: To complete a review of the published literature of reported airbag injuries to automobile passengers in order to identify a potential injury mechanism that occurs when pregnant women are front passengers of vehicles equipped with an airbag. We review and discuss our own experience with a case of injuries sustained by a restrained, 30‐week‐pregnant woman driver associated with airbag deployment. Data sources: We searched MEDLINE and supplementary bibliographies, assessing all reports using the term “airbag injuries” published from 1974 to December 1997. Results: In Vehicle crash testing, airbags have shown exceptionally good performance in their ability to…maintain dummy response values to levels generally regarded as tolerable to human beings. Although airbags are effective supplemental restraint systems and have saved many lives, airbags have the potential to inflict serious injuries. Pregnant women deserve special consideration with regard to injuries sustained from deployment of an airbag module. When the occupant is in the path of a deploying airbag, the deployment energy is added to the crash energy potentially causing direct injury to the occupant. Due to the proximity of the enlarged abdomen to the airbag module, a woman in the later stages of pregnancy has a substantially increased risk of sustaining an injury as a direct consequence of the airbag deployment. Conclusion: Each new innovation requires knowledge of its proper use and limitations, as well its risks and misuses. In the overwhelming majority of cases, airbags can significantly reduce the severity of injuries sustained in a frontal collision. However, in pregnant women the possibility exists for injuries associated with airbag deployment, and this technology has yet to be critically evaluated for the use with this population in particular. Some suggestions that obstetricians should tell their patients include first, and most obviously, to wear the seat belt including the shoulder belt. As for avoiding injuries from the airbag deployment it might be of benefit to move the seat as far from the dashboard as possible in order to increase the distance to the abdomen. Once it is possible to deactivate the airbag, in view of the possible hazards involved with inappropriate deployment of the airbag, it seems that it would be advantageous for the highly pregnant woman to do so. *12pt
Abstract: Purpose: The aim of this study was to assess our experience with anastomotic iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms. Materials and methods: The case records of 6 patients who underwent 6 arterial reconstructive procedures for anastomotic iliac aneurysms from January 1989 to December 1995 were identified in our prospective vascular database and reviewed. Result: Five patients presented with a painful abdominal mass and one patient was asymptomatic. The average delay between the original operation and the development of the anastomotic aneurysms was 14 years. Aneurysmorrhaphy with…graft interposition was the most common procedure. The one week perioperative mortality was two out of six. Out of 6 patients, 6 patients (100%) were transfused with a total of 51 units (average 8 units per operation, range from 6 to 12 units). The average measured intraoperative blood loss was 3400 ml (2000 to 5300 ml). The average pre‐operative haemoglobin was 7.8 mmol/l (range 6.6 to 9.1 mmol/l). The average post‐operative haemoglobin was 6.5 mmol/l (range 5.5 to 7.1 mmol/l). Conclusions: Anastomtic iliac aneurysm is a late but dangerous condition with a high perioperative mortality. Large volumes of blood should be avaible.
Abstract: Reports of adverse effects (AEs) of complementary and alternative medicine are frequently dismissed by proponents as being either vanishingly rare occurrences or mere anecdotes. To investigate this, reports of suspected AEs were solicited (a) from 1521 general practitioners (GPs) in England and (b) from members of the general public. 686 of GPs responded (45%) to a postal survey: 37% of respondents gave a total of 291 reports of non‐serious AEs. Serious suspected AEs were reported by 78 GPs (11% of respondents) in 96 separate reports. Of these, 28 cases were serious direct AEs of the manipulative therapies – mostly manipulation…of the spine – and 21 were serious indirect AEs involving misadvice/misdiagnosis by homoeopaths. Analysis of 121 AE reports from the general public revealed that 32 people had consulted a doctor for their AE and that 7 serious cases (6 involving AEs to manipulation and 1 to acupuncture) could be confirmed from the medical records. Thus, there is evidence that serious adverse effects can occur and that their incidence may be higher than previously assumed. Complementary therapies, like other health care interventions, should not be assumed to be risk‐free.
Abstract: The long period of social and political transition in Russia, which began in 1991 and still continues, has created major problems as regards drug supply and use. Structures and practices which existed before that time have been disrupted, but there has as yet been no attainment of a new balance. The problems are reviewed and some of the efforts which are being made in a single administrative district to identify problems and ensure the best possible use of drugs are reported.
Abstract: Light treatment is the most effective therapy for sufferers from seasonal affective disorder (SAD), the winter type. Although side effects and risks are rare, the therapist should be aware of them, and of the contraindications to such therapy which have been advanced.
Abstract: We report a case of neonatal neuroblastoma occurring in a boy who had been exposed in utero to progestagens. The potential role of therapeutic products administered during pregnancy in the occurrence of neuroblastoma is reviewed, with emphasis on sex hormones and in particular progestagens. Despite the recognition of the fact that neuroblastoma is the most frequent solid tumour in the first year of life and also that treatments with progestagens in pregnancy are common in several countries, therefore potentially leading to co‐incidental association, some arguments in favour of a causal link come from the few epidemiological studies validly assessing…this association. Also discussed is a possible association of childhood malignancy with threatened abortion or uterine contractions, as some sort of disturbed hormonal status may be a risk factor for both threatened abortion and child cancer.