International Journal of Risk & Safety in Medicine - Volume 4, 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: Liver transplantation offers the chance of a life-saving intervention for many terminal liver patients. At the present time, the survival rate is high and the quality of survival is good. That does not alter the fact that this technology – like so many others – has a number of unintentioned side-effects. Consideration of these side-effects should be included in a careful evaluation of the technology. As part of a broad evaluation of the Dutch Liver Transplant Programme in Groningen answers were sought to the following questions: (1) With what psycho-social problems are transplanted patients confronted? (2) What does it…mean for a patient to be rejected for transplantation? (3) What are the experiences of (the next-of-kin of) patients when the technology fails? The research subjects comprised patients as well as their families. The methods used were interviews and questionnaires. From the results it appears that one-third of the transplanted patients had to deal with serious psychological problems. For rejected patients the decision not to operate was a heavy blow. Most of these nevertheless succeeded in re-establishing an acceptable level of well being, provided they survived for some time. According to one-third of the relatives of patients who died following transplantation, the patients' involvement in the programme hampered the acceptance of their loss; feelings of bitterness were common among them. It is concluded that the negative side-effects of liver transplant technology can never be eliminated completely, but that there are several ways to curtail them. Some of these are briefly discussed.
Abstract: The review is based on an analysis of anonymous case record material at the London Office of a United Kingdom medical protection organisation for the 5-year period 1982–1986, in which death was associated with general surgical procedures. A total of 16 cases were analysed. The majority of deaths occurred in the course of elective procedures, the patients were relatively young (average age 48.4 years) and the doctors involved were primarily of consultant grade. While the types of procedure and the proximate causes of death were varied there were a number of common factors contributing to patient deaths, principally inadequate pre-operative…assessment (4 cases), inadequate post-operative management (3 cases) and lack of experience with particular surgical procedures (3 cases). The results are discussed in terms of their relation to the findings of the National Confidential Inquiry into Perioperative Deaths. Suggestions are made concerning training, communication and the introduction of critical incident monitoring into surgical practice.
Keywords: Complications (mortality), Litigation, Surgery, Critical incidents, Training
Abstract: In India there are over 65000 pharmaceutical formulations on the market. Many of them are available without prescription over the counter. There are no legal restrictions enforced to restrain school children from purchasing or procuring drugs for their personal use. The present study shows that with an increase in the flow of medical information available to school children through various media, these children will gain some knowledge as to the use of drugs, though remaining unaware of the risks which they involve or the limits to their safety. This constitutes a danger to parents, physicians and society at large.
Abstract: German psychiatrists proposed the extermination of mental patients before Hitler came to power. Then in Nazi Germany, organized psychiatry implemented involuntary eugenical sterilization and euthanasia, ultimately killing up to 100000 German mental patients. The six psychiatric euthanasia centers utilized medical professionals, fake death certificates, gas chambers disguised as showers, and the mass burning of corpses. Psychiatrists from the euthanasia program also participated in the first formalized murders in the concentration camps. Inmates were “diagnosed” on euthanasia forms and sent to the psychiatric euthanasia centers. These facilities later provided the training, personnel and technology for the larger extermination camps.…Medical observers from the United States and Germany at the Nuremberg trials concluded that the holocaust might not have taken place without psychiatry. This paper summarizes psychiatric participation in events leading to the holocaust, and analyzes the underlying psychiatric principles that anticipated, encouraged, and paved the way for the Nazi extermination program.
Keywords: Euthanasia, German psychiatry, Holocaust, Biological psychiatry
Abstract: Nuclear medicine offers many diagnostic possibilities for which there are no adequate alternatives. The growing contribution of nuclear procedures to diagnostic medicine, however, has an additional effect: the radiation on normal tissues. Accurate estimations of the radiation dose and the related risks is required to weigh the advantages against the disadvantages due to a certain nuclear procedure in a specific situation. In this review the aspects of dose calculation (dosimetry) and dose-effect relation are discussed. Also the current opinion about dose limits will be dealt with. Particularly specialists for internal diseases should be aware of these considerations.