International Journal of Risk & Safety in Medicine - Volume Pre-press, issue Pre-press

Authors: Grech, Victor | Grech, Peter | Fabri, Stephanie

Article Type: Review Article

Abstract: The world is currently in the throes of the COVID-19 pandemic which has halted the tourism sector and created an unprecedented global economic crisis. This paper will outline economics pertaining to COVID-19 lockdown, recovery and the inevitable competition that will occur between countries for tourists who will be scarcer and therefore more valuable. Countries are competing with a variety of incentives in order to lure visitors. However, persistent first waves that extend into July will put off tourists, further reducing tourism revenues and accelerate job losses and bankruptcies in affected countries. The example of Sweden’s response to COVID-19 in this …regard will be described. Countries that have COVID-19 relatively under control but experience second waves will also manifest negative tourism effects. Governments and public health must act in unison so as to exit lockdown as speedily and as safely as feasible, with COVID-19 rises that are as low and brief as possible in order to better compete in the tourism sector with other countries. Websites are already online comparing not only safety for travellers vis-à-vis COVID-19 but also the incentives offered by different countries in their attempts to woo tourists in this difficult market. Show more

Keywords: COVID-19, tourism, economics, recession, Internet

DOI: 10.3233/JRS-200042

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2020

Authors: Malekzadeh, Roya | Abedi, Ghasem | Abedini, Ehsan | Haghgoshayie, Elaheh | Hasanpoor, Edris | Ghasemi, Matina

Article Type: Research Article

Abstract: BACKGROUND: Receiving safe health care services is among the first rights of patients. Ethical predictability is influential to identify the patient safety concerns in hospitals. OBJECTIVE: This study aimed to ascertain and compare ethical predictability of patient safety in selected hospitals in Mazandaran Province in Iran. METHODS: A cross-sectional design was applied in the current study. By applying the multistage method for sampling, the statistical population consisted of clinical units of selected public, social security, and private hospitals. Out of the 18 public hospitals, five teaching hospitals, nine private and five social security hospitals, one hospital …was randomly selected in Mazandaran Province from each cluster. In total, 938 patients participated in the study. Data entry and analysis was carried out by SPSS version 22 software. RESULTS: The results showed that ethical predictability in social security hospitals was higher than the results in private and public hospitals (p < 0.001). In addition, among the selected dimensions of ethical predictability of patient safety in the selected hospitals, blood management was the highest dimension. Safe drug management, error management, infection control, and safe clinical services were the middle priorities and management and leadership of patient safety had the lowest mean in the ethical predictability of patient safety in the selected hospitals in the province. CONCLUSION: Identifying the factors causing ethical predictability in order to improve patient safety and service quality, is of great help to managers and authorities in the field of health services. Such awareness helps managers to consider these factors in all decision making processes. Show more

Keywords: Ethical predictability, quality of care, patient safety

DOI: 10.3233/JRS-200022

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2020

Authors: Bottari, Carlo

Article Type: Other

DOI: 10.3233/JRS-201005

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-3, 2020

Authors: Zhu, Lin | Reychav, Iris | McHaney, Roger | Broda, Arik | Tal, Yossi | Manor, Orly

Article Type: Research Article

Abstract: BACKGROUND: Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients’ daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE: We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). …METHODS: The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS: A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS: Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable. Show more

Keywords: Patient safety, social network analysis (SNA), latent Dirichlet allocation (LDA), medical adverse event, medical adverse event reporting system, physician, nurse

DOI: 10.3233/JRS-190031

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-26, 2020

Authors: Makovec, Tomaž

Article Type: Article Commentary

Abstract: BACKGROUND: In the case of depression (and other psychiatric disorders), a huge number of scientists have been trying for decades to establish and postulate the disease-based drug concept for antidepressants and these efforts have not born fruits. OBJECTIVE: To show that the discussions about statistical significance of the efficiency of the antidepressants over placebo are non-productive and irrelevant. METHOD: Researching the history of the onset of a chemical imbalance theory in the brain and the launch of antidepressants according to the drug-based disease model was the basis for doubting the appropriateness of using antidepressants in the treatment …of depression. RESULTS: Antidepressants (AD), as their name suggests, are supposed to address a disease-specific model to reverse the neuropathological basis of depression. However, science has not constituted the theory, using various brain imagining techniques or measuring the concentration of serotonin in various body liquids, that depression is characterized by the lack of serotonin in synapses and then created a substance that would block the reuptake of this neurotransmitter or in some other ways elevate its content. CONCLUSION: Even the reductionistic phase of the AD story, the mechanism of action, failed to be consistent so it is unclear how the largest meta-analysis of about 21 antidepressants by Andrea Cipriani et al. appeared in The Lancet. Show more

Keywords: Antidepressants, risk-benefit ratio, meta-analysis

DOI: 10.3233/JRS-190049

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Chhabra, Anuj | Chhabra, Nidhi

Article Type: Case Report

Abstract: BACKGROUND: Paresthesia is defined as a burning or prickling sensation or partial numbness caused by neural injury. OBJECTIVE: The purpose of this paper is to present a rare and unusual case report of odontogenic infection-induced inferior alveolar nerve (IAN) paresthesia along with cutaneous draining sinus on the face of a pediatric patient and to discuss the possible pathophysiologic mechanism of nerve injury. METHODS: A 14-year-old female patient with cutaneous sinus and paresthesia associated with inferior alveolar nerve was enrolled in the study and the clinical and radiological manifestations of sinus lesion were carefully evaluated. …RESULTS: The most appropriate treatment was carried out not only to resolve extraoral sinus but also to ensure progressive healing for the complete resolution of neurological disturbance. CONCLUSION: The simultaneous occurrence of infection and paresthesia strongly suggested a definitive relationship. Therefore, there seems to be a correlation between duration, origin, significance of the injury and the prognosis of paresthesia. Show more

Keywords: Odontogenic infection, paresthesia, inferior alveolar nerve, periapical abscess

DOI: 10.3233/JRS-200025

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2020

Authors: Isles, Mike

Article Type: Review Article

Abstract: BACKGROUND: Pharmaceutical compounding allows individuals with special requirements access to medicines. Compounding can also be used to provide cheaper alternatives to commercially produced medicines which may be less strictly regulated than those commercially produced as they do not require marketing authorisation. OBJECTIVE: This review describes the issues and potential risks associated with compounded medicines and equally importantly identifies best practices. METHODS: To establish reports about lack of effectiveness, adverse events and medication errors occurring with compounded pharmaceuticals, a literature search was conducted of PubMed, Embase and MEDLINE databases for relevant cases in European countries which were …published between 2003 and 2018. Case reports/series that described instances of successful use of compounded medicines over the same period were also identified. RESULTS: Overall, 12 case reports/case series describing problems associated with compounded medicines in Europe have been identified. Sources of patient risk associated with compounded medicines include lack of quality, safety and efficacy data, preparation and labelling errors, and improper storage and handling practices. CONCLUSIONS: Several case reports/series describing instances of overdose, medication errors and adverse events associated with compounded medications were reviewed. The number of affected patients was relatively small, but many were children and two adult patients experienced permanent sequelae. The number of incidents associated with compounded medicines is unknown, and so these numbers should be interpreted with caution. When licensed medicines are available, the use of compounded medicines can put patients at unnecessary risk which should be avoided. Stricter regulation is necessary to prevent similar cases from occurring in the future as the European market for compounded medications grows. Pharmacists can promote best practices in compounding through professional organisations. Future recommended actions are: 1. Stricter regulation is necessary to prevent similar cases from occurring in the future as the European market for compounded medications grows. 2. A comprehensive pan-European survey to gain a greater understanding of compounding procedures and techniques. This would provide valuable information to the benefit of hospital systems and their patients. 3. The results of the survey can then be used to improve the knowledge and quality control of compounded medicines for the good of patient safety. Show more

Keywords: Compounding, medication errors, patient risk, best practice, stricter regulation, complaints procedures, storage stability

DOI: 10.3233/JRS-200002

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-12, 2020

Authors: Omar, Islam | Shirazy, Mohamed | Omar, Mayar | Chaari, Anis

Article Type: Research Article

Abstract: BACKGROUND: Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. OBJECTIVE: The aim of this project was to reduce the infection rates in the adult ICU to the benchmark levels. METHOD: An internal audit was conducted as a result of the high infection rates in the adult ICU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We opted to introduce a …change in the staff uniform laundry in addition to a campaign to improve hand hygiene compliance using a multimodality approach. Moreover, we conducted training on aseptic techniques in ventilation, urinary catheter, and central lines insertion. Finally, we changed the ventilator filter to a higher quality brand that meets the standard specifications. Infection rates were monitored before and after the proposed changes. RESULTS: There was a marked reduction in ventilator-associated pneumonia; however, it did not lower the benchmark rates. Catheter line-associated bloodstream infection declined from above to below the benchmark. Catheter-associated urinary tract infection rates were below the benchmark; however, they showed a noticeable reduction. Hand hygiene adherence showed an improvement from 80% to 84%. However, this was below the predetermined target level of 90%. CONCLUSIONS: A multimodal approach is necessary to improve hand hygiene adherence. In-hospital laundry is safer to control nosocomial infections. Quality improvement is a continuous process that guarantees a proper healthcare service as per the quality chasm. Show more

Keywords: Nosocomial, hospital-acquired, infections, intensive treatment unit, audit, healthcare quality, ventilator acquired pneumonia, central line-associated bloodstream infection (CLABSI), Catheter-associated urinary tract infection (CAUTI)

DOI: 10.3233/JRS-190028

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Akavipat, Phuping | Eiamcharoenwit, Jatuporn | Punjasawadwong, Yodying | Pitimana-aree, Siriporn | Sriraj, Wimonrat | Laosuwan, Prok | Viengteerawat, Somchai | Wasinwong, Wirat

Article Type: Research Article

Abstract: Background: Despite the improvement of anesthetic-related modalities, the incidence of unintended intraoperative awareness remains at around 0.005–0.038%. Objective: We aimed to describe the intraoperative awareness incidents that occurred across Thailand between January–December, 2015. Methods: Observational data was collected from 22 hospitals throughout Thailand. The awareness category was selected from incident reports according to the Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study database and descriptive statistics were analyzed. The awareness characteristics and the related factors were recorded. Results: A total of nine intraoperative awareness episodes from 2000 incidents were observed. The intraoperative awareness …results were as follows: experience of pain (38.1%), perception of sound (33.3%), perception of intubation (9.5%) and feeling of paralysis (14.3%). The observed factors that affect intraoperative awareness were anesthesia-related (100%), patient-related (55.5%), surgery-related (22.2%) and systematic process-related (22.2%). The contributing factors were situational inexperience (77.8%) and inappropriate patient evaluation (44.4%). An awareness of anesthetic performer (100%) and experience (88.9%) were defined as incident-mitigating factors. The suggested corrective strategies were quality assurance activity (88.9%), improved supervision (44.4%) and equipment utilization (33.3%), respectively. Conclusion: Nine intraoperative awareness incidents were observed, however the causes were preventable. The anesthetic component seems to be the most influential to prevent these events. Show more

Keywords: Complication, risk, unintentional awareness, national audit project

DOI: 10.3233/JRS-200023

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Alanagreh, Lo’ai | Alzoughool, Foad | Atoum, Manar

Article Type: Article Commentary

Abstract: The emerging COVID-19 pandemic poses a threat to the global health care system. Given the lack of antiviral therapies or vaccines for the disease, the antimalarial drug hydroxychloroquine (HCQ) obtained much attention as a treatment for COVID-19. However, there are limited and uncertain clinical data to support the beneficial effect of this drug in COVID-19 treatment. HCQ has several side effects and warnings, including blindness, heart failure, and renal toxicity, even with recommended doses. For severe cases of COVID-19 or in patients with preexisting conditions, administering such a drug could be fatal, particularly when taken at high doses or in …combination with other antibiotics. However, further well-designed studies that would address the optimal dose, duration of treatment, possible side effects, and long-term usage outcomes are needed to make the final decision. In this paper, we aim to discuss the risk of using HCQ in treating COVID-19 patients, including its possible side effects. Show more

Keywords: Hydroxychloroquine, COVID-19

DOI: 10.3233/JRS-200024

Citation: International Journal of Risk & Safety in Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2020