Magnetic nanostructured agents for the mitigation of mycotoxins and cyanotoxins in the food chain

Natural toxins, such as mycotoxins and cyanotoxins, can contaminate food and feed, leading to toxicity in humans and animals. This study focused on using nine magnetic nanostructured agents to remove the main types of toxins. Initially, the efficacy of these materials was evaluated in water solutions, revealing that composites with sizes below 3 mm, containing magnetite, activated carbon, esterified pectin, and sodium alginate, removed up to 90% of mycotoxins and cyanotoxins with an adsorption of 873 ng/g. The application of the nanostructures was then assessed in beer, milk, Distillers Dried Grains with Solubles and water contaminated with cyanobacteria. The presence of matrix slightly decreases the adsorption capacity for some toxins. The maximum toxin removal capacity was calculated with cyanotoxins, composites achieved a removal of up to 0.12 mg/g, while nanocomposites (15 μm) reached 36.6 mg/g. Therefore, these findings point out the potential for using nanotechnology in addressing natural toxins contamination.

Perceived impacts of stressful events on train driver performance

Acute stress exposure can significantly impact a train driver's capacity to maintain safe train operations. However, research examining how train drivers perceive the impacts of acute stressors is limited. This study investigated train driver perceptions regarding performance impacts of stressful events and potential strategies for reducing negative impacts. 71 Australian train drivers were presented with three stressful event scenarios via an online survey and asked to rate the impacts on driving performance. Results showed that participants perceived that stress would enhance performance, but that impacts differed depending on the event type. The findings suggest that train drivers may not be subjectively aware of negative impacts of acute stress, which has important practical implications for risk management following an incident. Qualitative results revealed the most frequently reported stress impact related to cognition. Practical implications and future research directions to prevent and manage stressful event exposure are discussed.

Assessment of Needlestick and Sharps Injuries (NSSIs) Amongst Orthopaedic Surgeons in Clinical Practice: A Pan-India Cross-Sectional Study

Introduction

Needlestick and sharps injuries (NSSIs) represent an existential occupational hazard risk to orthopaedic surgeons during their career due to the interaction with various devices, instruments and bone fragments. Consequently, NSSIs have the potential to transmit infections such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) leading to serious illness. The purpose of this cross-sectional study was to identify the clinical settings predisposing orthopaedic surgeons to NSSIs and assess their adherence to safety protocols in the Indian context.

Materials and Methods

An online cross-sectional survey of 618 orthopaedic surgeons in India, stratified by experience into two groups: under five years and with 5 years or more was undertaken. The data were collected via an expert-validated online questionnaire to evaluate demographic distribution, injury characteristics, knowledge of safety protocols, and adherence to these protocols. Descriptive statistics summarized the data, Chi-square tests assessed variable associations, and odds ratios were computed for significant variables. Ethical integrity was maintained via electronic informed consent and for confidentiality assurances.

Results

The study revealed that orthopaedic surgeons with less than 5 years of clinical experience had higher risks for NSSIs as compared to those with 5 or more years of clinical practice. Conversely, the latter group was more susceptible to bone spike injuries and viral positive needlestick incidents. The analysis shows that whilst the more experienced practitioners displayed greater proficiency in the application of universal precautions and NSSI prevention, they were also less likely to report injuries, often due to discomfiture. Risk profiles were consistent across different practice settings and affiliations, regardless of experience level.

Conclusion

This cross-sectional study reveals less experienced orthopaedic surgeons face higher risks of NSSIs, possibly due to inadequate education or awareness. More experienced practitioners encounter distinct risks, likely owing to long-term exposure and traditional practices. There is an immediate need to raise awareness of the potential risks of NSSIs, enhanced education, appropriate training, collaboration with the hospital risk management team and developing a culture of transparent reporting to mitigate these risks. The emphasis should be on reducing the incidence and fostering open reporting of NSSIs to protect clinicians and promote health safety.

Understanding cooperative contact tracing: Factors explored through privacy management theories

This study investigates the factors influencing the comfort level of the general public when disclosing personal information for the coronavirus disease 2019 contact tracing. This is a secondary analysis of the American Trends Panel, a national probability-based online panel of American adults, with data collected by the Pew Research Center between July 13 and 19, 2020. Grounded in privacy management theories, ordered logistic regression analyses examined three types of information disclosure: places visited, names of contacts, and location data from cell phones. Key independent variables measured trust in the stakeholders' ability to protect data and perceived risks to health and finances. The findings suggest that higher levels of trust in entities' data security capabilities can predict individuals' comfort levels when disclosing personal data. Additionally, the participants were more comfortable with noncommercial data use, especially when it was used by researchers and state and local officials. However, financial threats showed variations in sharing certain types of data. Individuals were less likely to feel at ease sharing contact tracing data as concerns about personal finances increased. Similarly, when individuals perceived threats to the U.S. economy, they were less likely to feel comfortable sharing their location data from cell phones, which might have been perceived as intrusive. Public health outreach efforts should account for individual differences and the nature of the information requested in commercial and noncommercial contexts. Future studies can enhance the explanatory capacity of data disclosure models by incorporating additional relevant contextual and environmental variables.

Enhancing patient safety in radiotherapy: Implementation of a customized electronic checklist for radiation therapists

Introduction

The radiotherapy workflow involves the collaboration of multiple professionals and the execution of several steps to results in an effective treatment. In this study, we described the clinical implementation of an electronic checklist, developed to standardize the process of the chart review prior to the first treatment fraction by the radiation therapists (RTTs).

Materials and Methods

A customized electronic checklist was developed based on the recommendations of American Association of Physicists in Medicine (AAPM) Task Groups 275 and 315 and integrated into the Record and Verify System (RVS). The checklist consisted of 16 items requiring binary (yes/no) responses, with mandatory completion and review by RTTs prior to treatment. The utility of the checklist and its impact on workflow were assessed by analysing checklist reports, and by soliciting feedback to RTTs through an anonymized survey.

Results

During the first trial phase, from June to November 2023, 285 checklists were completed with a 98% compilation rate and 94.4% review rate. Forty errors were detected, mainly due to missing signed treatment plans and absence of Beam's Eye View documentation. Ninety percent of detected errors were fixed before the treatment start. In 4 cases, the problem could not be fixed before the first fraction, resulting in a suboptimal first treatment. The feedback survey showed that RTTs described the checklist as useful, with minimal impact on workload, and supported its implementation.

Discussion

The introduction of a customized electronic checklist improved the detection and correction of errors, thereby enhancing patient safety. The positive response from RTTs and the minimal impact on workflow underscore the value of the checklist as standard practice in radiotherapy departments.

The Obstetrics and Gynecology Hospitalist: Risk Management Implications

The concept of a 24/7 in-house obstetrician, serving as an obstetrics and gynecology (Ob/Gyn) hospitalist, provides a safety-net for obstetric and gynecologic events that may need immediate intervention for a successful outcome. The addition of an Ob/Gyn hospitalist role in the perinatal department mitigates loss prevention, a key precept of risk management. Inherent in the role of the Ob/Gyn hospitalist are the important patient safety and risk management principles of layers of back-up, enhanced teamwork and communications, and immediate availability.

Considerations for occupational risk management during pregnancy: A summary of a continuing education course

Women comprise approximately 40% of the global workforce, and many women continue to work during pregnancy. Although occupational exposure limit values (OELVs) are intended to protect all workers, many OELVs may have been established without consideration of the unique changes in pregnant workers, and many chemicals lack OELVs altogether. A short educational course was developed to address the informational needs of health professionals who have responsibility to ensure a safe workplace for pregnant employees. The course was designed to raise awareness of the key elements in risk management and their application to the pregnant worker, such as physiological changes of pregnancy that influence susceptibility to exposures; guidance for nonclinical data interpretation; exposure assessment and control strategies; and risk management in practice in a diverse regulatory environment. This paper summarizes the course content and is intended to support informed risk management decision making to protect the health of pregnant workers and their offspring.

Strategies for adapting under pressure: an interview study in intensive care units

BACKGROUND

Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure.

METHODS

We conducted qualitative semi-structured interviews with 20 senior multidisciplinary healthcare professionals from intensive care units (ICUs) in 4 major hospitals in the UK. The interviews explored the everyday pressures faced by intensive care staff and the strategies they use to adapt. A thematic template analysis approach was used to analyse the data based on our previously empirically developed taxonomy of pressures and strategies.

RESULTS

The principal source of pressure described was a shortage of staff with the necessary skills and experience to care for the increased numbers and complexity of patients which, in turn, increased staff workload and reduced patient flow. Strategies were categorised into anticipatory (in advance of anticipated pressures) and on the day. The dynamic and unpredictable demands on ICUs meant that strategies were mostly deployed on the day, most commonly by flexing staff, prioritisation of patients and tasks and increasing modes of communication and support.

CONCLUSIONS

ICU staff use a wide variety of adaptive strategies at times of pressure to minimise risk and maintain a reasonable standard of care for patients. These findings provide the foundation for a portfolio of strategies, which can be flexibly employed when under pressure. There is considerable potential for training clinical leaders and teams in the effective use of adaptive strategies.

Risk analysis applied to the process of managing medical single use devices in a hospital pharmacy department

INTRODUCTION

During the COVID-19 pandemic, single use medical devices' supply (SUMD) was marked by repetitive and unforeseen interruptions. The present study aimed to determine the risks related to the processes of management of medical devices in our CHU according to a method of failure mode, effect and criticality analysis (FMECA).

METHODS

Qualified healthcare professionals were recruited to form a multidisciplinary consensus committee. By analyzing the process map, all failure modes, causes and consequences were identified through brainstorming meetings. They were then classified taking into account the criticality index (CI) calculated according to three parameters: frequency, severity, and detectability. The prioritization was carried out by considering the mean and the median values of the CI as limits. Corrective and preventive actions were then proposed.

RESULTS

A total of 49 failure modes were identified, accumulating 4466 criticality points. The most critical step is that relating to the inter-depot order with a CI equal to 783 points. An action plan was developed, allows us to control 64% of the overall criticality of the risks linked to the process. Three main lines of action have been proposed: continuous training, especially for managerial and administrative tasks, logistical improvement (architectural reorganization and implementation of systems for securing the circuit of SUMDs) and support for the digitization of hospital pharmacy.

CONCLUSION

The FMECA is a consensual method, which makes it possible to propose actions in order to reduce the risks linked to the process of managing medical devices. Optimizing the estimation of needs, strengthening communication with stakeholders and securing the circuit are essential to guarantee the availability of SUMDs for the benefit of the patient.

Evaluation of the effectiveness of three different interventions on older driver safety over a 12-month period: study protocol for a randomised controlled trial

INTRODUCTION

The growing population of older drivers presents challenges for road safety attributed to age-related declines and increased crash fatality rates. However, enabling older people to maintain their health and independence through continued safe driving is important. This study focuses on the urgent need for cost-effective interventions that reduce crash risk while supporting older drivers to remain driving safely for longer. Our study aims to evaluate the effectiveness of three behavioural interventions for older driver safety. These include an online road-rules refresher workshop, tailored feedback on driving performance and two tailored driving lessons.

METHODS AND ANALYSIS

A single-blind three-parallel group superiority randomised controlled trial will be conducted with 198 urban licensed drivers aged 65 years and older, allowing for 4% attrition. This sample size provides 80% power to detect a difference with an alpha of 0.05. Participants will be selected based on a standardised on-road test that identifies them as moderately unsafe drivers. Interventions, spanning a 3-month period, aim to improve driving safety. Their effectiveness will be assessed through a standardised on-road assessment of driving safety at 3 months (T1) and 12 months postintervention (T2). Additionally, monthly self-reported driving diaries will provide data on crashes and incidents.This trial has the potential to identify cost-effective approaches for improving safety for older drivers and contribute to evidence-based health policy, clinical practice and guidelines.

ETHICS AND DISSEMINATION

Ethical approval was obtained by the University of New South Wales Human Research Ethics Committee (HC190439, 22 August 2019). The results of the study will be disseminated in peer-reviewed journals and research conferences.

TRIAL REGISTRATION NUMBER

ACTRN12622001515785.

Developing an institutional control framework for contaminated sites in China: An analytical case study

Institutional controls, as an important measure for risk management of contaminated sites, is widely used in site management by the United States, Canada and European countries. At present, some regions in China have also begun to explore the implementation of institutional controls, but its path, safeguard mechanism, and tracking evaluation are still unclear. Based on China's unique contaminated site remediation control system and land management system, this paper proposes a framework for the whole life cycle institutional controls of China's contaminated sites: (1) evaluate the need for institutional controls; (2) establish the objectives of institutional controls; (3) identify the restrictive requirements of institutional controls; (4) establish the implementation form of institutional controls; and (5) regularly review the effectiveness of institutional controls. To demonstrate the applicability of the institutional control framework, a case demonstration study was conducted at a petrochemical contaminated site in China. By analyzing the information on residual pollutants after the implementation of risk management measures at the site, the exposure pathways and hazards in case of re-release, and the engineering facilities, we proposed eight restrictive requirements, including the prohibition of disturbing and damaging the clean and planted soil layers of the site and the protection of long-term monitoring wells. At the same time, we constructed a multi-departmental pathway to implement institutional controls in conjunction with ecological environment, natural resources and housing departments to ensure effective implementation of institutional controls. Eventually, we summarized a set of replicable and generalizable institutional controls application models, which provide valuable theoretical and practical support for China and other local governments in the implementation of institutional controls at contaminated sites.

Field validation as a means for continual monitoring of approved test kit's fitness for purpose in the commercial market

Testing accuracy of a chemical contaminant requires use of a testing platform that conforms to validation criteria outlined in quality literature and standards. This study explores the application of commercial field data measured by qualified analysts using a United States Department of Agriculture - Federal Grain Inspection Service approved kit for measuring fumonisin in maize to augment method validation procedures. Analysts from seven grain testing facilities were qualified in official USDA sampling, sample preparation, and testing methodology using the Charm LF-FUMQ-WETS5. A duplicate sample was tested in the Office of the Texas State Chemist (OTSC) laboratory using UPLC-MS-MS. Data were subject to four statistical techniques using continuous and categorical methodology. This approach enabled researchers to explore if a single test or multiple comparisons were best suited to assess a field kit's fitness for purpose across facility, toxin level, and year. The study concluded that a paired t-test and correlation analysis provided a quick and meaningful evaluation of kit performance. The correct placement of samples within the correct bin (violative versus non-violative) aligns well with market forces and regulatory compliance. The results of this study also provide a useful tool to assess all field kits' performance at the beginning of the harvest season and subsequent years. The combination of statistical techniques presented in this research is an important tool in assessing mycotoxin field test kits fitness for purpose and represents a key step in a continuous improvement-quality systems process meant to protect the feed and food supply.

Latest developments of generative artificial intelligence and applications in ophthalmology

The emergence of generative artificial intelligence (AI) has revolutionized various fields. In ophthalmology, generative AI has the potential to enhance efficiency, accuracy, personalization and innovation in clinical practice and medical research, through processing data, streamlining medical documentation, facilitating patient-doctor communication, aiding in clinical decision-making, and simulating clinical trials. This review focuses on the development and integration of generative AI models into clinical workflows and scientific research of ophthalmology. It outlines the need for development of a standard framework for comprehensive assessments, robust evidence, and exploration of the potential of multimodal capabilities and intelligent agents. Additionally, the review addresses the risks in AI model development and application in clinical service and research of ophthalmology, including data privacy, data bias, adaptation friction, over interdependence, and job replacement, based on which we summarized a risk management framework to mitigate these concerns. This review highlights the transformative potential of generative AI in enhancing patient care, improving operational efficiency in the clinical service and research in ophthalmology. It also advocates for a balanced approach to its adoption.

Lateral versus supine position for tracheal extubation among infants after intraabdominal surgery: A randomised controlled trial

In this prospective randomised controlled trial, we compared the impact of the lateral versus supine position for tracheal extubation among infants aged two months to two years after intraabdominal surgery on the incidence of respiratory adverse events that may occur after extubation. The anaesthesia protocol was standardised. Among the 120 infants included (60 in each group), the demographic and perioperative data were comparable between both groups. The incidence of perioperative respiratory adverse events after tracheal extubation was 21.6% and 5% in the supine and lateral position groups, respectively, with p = 0.007 and odds ratio = 3.87; 95% confidence interval: 1.18-12.6. Lateral position also reduced the incidence of airway obstruction with p = 0.004 and odds ratio = 11.8; 95% confidence interval: 1.46-95.3 and oxygen desaturation below 92% with p = 0.008 and odds ratio = 11.8; 95% confidence interval: 1.46-95. The lateral position seems to be practical and beneficial for tracheal extubation among infants.

Risk management for viral clearance: A case study on adoption of platform validation approach and risk management of process changes

Viral clearance (VC) studies are routinely required prior to entering clinical trials or for commercial launch of biopharmaceuticals. With increasing prior knowledge and experience, platform validation can be used to eliminate some VC studies and such strategy has been updated into industry guidelines, such as ICH Q5A (R2). In addition, process changes can happen during life-cycle management of a product. In these circumstances, high-risk process parameters need to be identified and corresponding control strategies need to be defined to ensure viral safety of the product. This work describes the design of a science-based risk management tool and how this tool is employed for platform validation and process change scenarios.

Patient safety reporting and learning system of Catalonia (SNiSP Cat): a health policy initiative to enhance culture, leadership and professional engagement

Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021-2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027 (QPSS Plan Cat).

METHODS

Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023-2027.

RESULTS

The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013-2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients' falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients' falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data.

CONCLUSIONS

The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027.

Role of remediation in cases of serious misconduct before UK healthcare regulators: a qualitative study

BACKGROUND

The raison d'etre of healthcare profession regulators across the globe is to protect patients and the public from the risk of harm. In cases of serious misconduct, remediation is deemed to be an important factor when considering the risk of harm from a practitioner under investigation. Yet, we know very little about how regulators account for remediation in their decision-making, and whether it is consistent with the aim of risk reduction. This paper explores the role of remediation in decision-making in cases of serious misconduct before UK healthcare regulators.

METHODS

We conducted interviews with 21 participants from across eight of the nine UK healthcare profession regulators, covering a range of roles in the decision-making process in misconduct cases. Interviews were conducted remotely by video call and digitally transcribed. Data were analysed using the framework analysis method. The initial framework was developed from existing literature and guidance documents from the regulators, and was subsequently refined through the various rounds of coding.

RESULTS

Remediation influenced decision-making in three ways: (1) Some types of misconduct were deemed more inherently remediable than others. In cases involving dishonesty or sexual misconduct, remediation was less likely to serve as a mitigating factor. (2) Decision-makers often view remediation as a proxy indicator of practitioner insight. (3) Whether a practitioner had demonstrated their commitment to change through undergoing remediation was more likely to feed into decision-making at the point where current impairment was under consideration.

CONCLUSIONS

Remediation plays a key role in decision-makers' judgements in cases of misconduct, particularly when these cases relate to clinical misconduct. In such cases, remediation informs judgements on the levels of practitioner insight and the risk of such misconduct being repeated. Our results suggest a need to develop remediation interventions that are explicitly geared towards the regulatory function of developing practitioner insight. Regulators should also consider the structure of their fitness to practise processes and whether there are appropriate opportunities for judgements on remediation to feed into decisions and to facilitate balanced and proportionate outcomes.

Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing

The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.

Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards

OBJECTIVES

This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards.

RESEARCH METHODOLOGY/DESIGN

Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded.

SETTING

The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included.

MAIN OUTCOME MEASURES

The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes.

RESULTS

In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion.

CONCLUSION

The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety.

IMPLICATIONS FOR CLINICAL PRACTICE

The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

A proposed framework for defining the relationship between complexity, project categorization, and project risk management: Case study of a medical company in Morocco

Recent financial crises have highlighted the utmost importance of implementing risk management practices, as exemplified by the profound repercussions of the COVID-19 pandemic. Moreover, we witnessed the rise of various initiatives within the medical sector, specifically in the fields of biomedicine, hospitals, and pharmaceuticals, across Africa, with a notable emphasis on Morocco. The government in Morocco has implemented measures to foster investment and encourage participation from companies and stakeholders. Taking into account an indeterminate and volatile future, it becomes imperative for organizations to establish robust risk management strategies to navigate successfully through these uncertainties. This research paper concentrates on the convergence of complexity, project categorization, and risks. We propose a novel approach to the implementation of the Risk Management Process, utilizing the Enterprise Risk Management framework. By establishing Risk Management rules within the context of a "complex" project, we observed enhanced performance and improved risk management through the holistic consideration of interdependencies rather than treating them as separate entities. Additionally, to substantiate this interdependency, we conducted a comparative analysis of the project's risk and complexity between 2020 and 2022.

Disruptions in the food supply chain: A literature review

Disruptions in the food supply chain are events that affect the flow of products and can be caused by extreme weather, natural disasters, conflicts, pandemics, and political situations, among others. These events can significantly impact food products' availability, quality, and cost, creating risks to the well-being of local populations and livelihoods. The specific literature on food supply chains needs to address other approaches to risk categorisation, which allow for establishing reference frameworks focused on the general classification of types of disruption and parameters related to solution methods. In this paper, we present a literature review to analyse the disruptions in the food supply chain. We classified 74 papers according to the types of disruptions, stakeholders, response level, supply chain echelon, solution methods, goals, and related considerations. The review results showed that the most common disruptions in the food supply chain are climatic, biological and environmental, logistics and infrastructure, and supply. The results of this review allow us to suggest some new research directions.

Gathering, agriculture, and exchange: an ethnoecological approach to the study of food patterns and feedstuff sources in communities of the Central Andes, Peru

BACKGROUND

Historically, the Andean people have experienced uncertainty in terms of the availability of food resources because of climatic and ecological variations that are typical of mountainous environments. Risk management strategies, including the diversified and complementary use and management of species and ecosystems at different elevations, have faced such uncertainty. The current effects of climate change on food security motivate studies on subsistence adaptative strategies. TEK offers extraordinary experience and local biocultural memory to meet present and future needs. From an ethnoecological perspective, we aim to identify the variety of local foods in Andean communities, their cultural and nutritional value for local people, their use frequencies, and their forms to obtain them from different environments, productive systems, and interchanges. We expected to identify traditional Andean diversified subsistence patterns despite the pressure of modern food and interchange systems.

METHODS

This study was conducted in two communities in the highlands of the Department of Huánuco, Peru. We conducted 24 semistructured interviews with households sampled through the snowball method. We asked about their daily life food, plant and animal components of diet, frequencies and seasons in which they are consumed, and ways to obtain them. We complemented the information through ethnobotanical collection of wild, weedy, and ruderal edible plants and records on domestic and wild animals included in the diet.

RESULTS

We recorded 37 crop species, 13 domestic animals, 151 wild, weedy, and ruderal food plant species, the 3 most commonly consumed wild animals, and 52 processed products obtained from local stores and markets. The main crops are potato and maize, while the main domestic animals included in the diet are cattle, pigs, and sheep. Rice, pasta, and bread are the main raw and processed foods included in the diet. Crops represent nearly half of the food consumed and purchased (in kg/year), and tubers and cereals provide most of the kilocalories, carbohydrates and proteins. Wild, weedy, and ruderal plants are consumed in relatively low amounts and at relatively low frequencies per species, but overall, they constitute a significant proportion of the kg of annually consumed food (14.4% in Cani and 9.6% in Monte Azul). Knowledge and use of these resources play a key role in local cuisine and nutrition.

CONCLUSION

The current food patterns studied are based on diverse diets, including multiple feedstuffs, sources, and practices to obtain them, which reflects the traditional Andean subsistence pattern. The increasing adoption of processed food has influenced the declining consumption of local food, mainly among young people. Communication and policies to promote local food, emphasizing the role of wild plants and their adequate consumption, and provide information on their nutritional value are recommended to support efforts toward food sovereignty and conservation of Andean biocultural diversity.

Postoperative delirium in oral and maxillofacial surgery: a scoping review

BACKGROUND

Postoperative delirium (POD) in the oral and maxillofacial settings has gained more attention in recent decades. Due to advances in medical technology, treatment possibilities have expanded treatment for elderly and frail patients. This scoping review explores the correlation between POD and oral and maxillofacial surgery, summarizing screening and management protocols and identifying risk factors in this surgical field.

METHODS

This review follows the Scoping Review extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR). A comprehensive literature search was performed using multiple databases, focusing on articles published from 2002 to 2023 that discuss delirium in oral and maxillofacial surgery settings. The review was registered beforehand in the Open Science Framework ( https://osf.io/r2ebc ).

RESULTS

From the initial 644 articles, 68 met the inclusion criteria. These studies highlighted the significant heterogeneity in POD diagnosis methods. The review identifies multiple risk factors across the preoperative, intraoperative, and postoperative phases that influence the occurrence of POD. Significant and independent risk factors in multiple regression analysis were highlighted, creating a clinical prediction list for the occurrence of POD.

CONCLUSION

It is crucial to preoperatively identify patients at risk for POD and actively modify these risks throughout the patient's hospital stay. Implementing nonpharmacological preventive measures for at-risk patients is recommended to decrease the incidence of POD. Future research should focus on creating standardized specialty-specific protocols incorporating validated assessment tools and addressing the full spectrum of risk factors associated with POD.

Predicting postacute phase anaemia after aneurysmal subarachnoid haemorrhage: nomogram development and validation

BACKGROUND

Anaemia is a severe and common complication in patients with aneurysmal subarachnoid haemorrhage (aSAH). Early intervention for at-risk patients before anaemia occurs is indicated as potentially beneficial, but no validated method synthesises patients' complicated clinical features into an instrument. The purpose of the current study was to develop and externally validate a nomogram that predicted postacute phase anaemia after aSAH.

METHODS

We developed a novel nomogram for aSAH patients to predict postacute phase anaemia (3 days after occurrence of aSAH, prior to discharge) on the basis of demographic information, imaging, type of treatment, aneurysm features, blood tests and clinical characteristics. We designed the model from a development cohort and tested the nomogram in external and prospective validation cohorts. We included 456 aSAH patients from The First Affiliated Hospital for the development, 220 from Sanmen People's Hospital for external validation and a prospective validation cohort that included 13 patients from Hangzhou Red Cross Hospital. We assessed the performance of the nomogram via concordance statistics and evaluated the calibration of predicted anaemia outcome with observed anaemia occurrence.

RESULTS

Variables included in the nomogram were age, treatment method (open surgery or endovascular therapy), baseline haemoglobin level, fasting blood glucose level, systemic inflammatory response syndrome score on admission, Glasgow Coma Scale score, aneurysm size, prothrombin time and heart rate. In the validation cohort, the model for prediction of postacute phase anaemia had a c-statistic of 0.910, with satisfactory calibration (judged by eye) for the predicted and reported anaemia outcome. Among forward-looking forecasts, our predictive model achieved an 84% success rate, which showed that it has some clinical practicability.

CONCLUSIONS

The developed and validated nomogram can be used to calculate individualised anaemia risk and has the potential to serve as a practical tool for clinicians in devising improved treatment strategies for aSAH.

Risk assessment of clinical trial protocols: a tool for hospital pharmacists to reduce human error in experimental drug management

BACKGROUND AND OBJECTIVES

Hospital pharmacists collaborate in clinical trials by managing the reception, conservation, distribution, return and destruction of the investigational medical products (IMP). However, errors can happen during the simultaneous management of multiple trials because each clinical trial stipulates its own method for managing the drug under study. In order to promote optimal management by hospital pharmacists, we developed a method for calculating a risk of error index for each experimental protocol, and wrote standard procedures for managing trials assigned low, moderate and high risk levels, to provide hospital pharmacists with a systematic tool for reducing human error in the management of IMPs for multiple clinical trials.

METHODS

Calculation of this risk of error index (ρ) entails four factors: the pharmacological risk of error (φ) inherent in the pharmacological characteristics and route of administration of the IMP (carcinogenic, mutagenic, cytotoxic nature of the drug, parental or non-parenteral administration), the technological risk of error (α) involved should drug compounding be required, the risk of error related to the number of patients enrolled (np) and the risk of error intrinsic to the protocol (π) when it involves placebos, randomisation or other factors. We developed the formula [Formula: see text] to define trials as low (ρ<50), moderate (51<ρ<150) and high risk (ρ>151) for hospital pharmacist error.

RESULTS

Calculations of this formula for 60 active trials indicated that seven (11.7%) of the protocols were low risk of hospital pharmacist error, 43 (71.7%) were moderate risk and 10 (16.6%) were high risk. For each of these categories (low, moderate and high risk) we have outlined standard procedures in order to minimise the occurrence of any errors.

CONCLUSIONS

Following validation of our formula and standard procedures by the ISMETT Research Institute, we are promoting the use of the tool in other clinical centres as we believe it can help hospital pharmacists minimise the risk of error in managing experimental drugs for clinical trials.