Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country

BACKGROUND

Traffic accidents constitute the main cause of death in the first decades of life. Traumatic brain injury is the event most responsible for the severity of these accidents. The SBN started an educational program for the prevention of traffic accidents, adapted from the American model "Think First" to the Brazilian environment, since 1995, with special effort devoted to the prevention of TBI by using seat belts and motorcycle helmets. The objective of the present study was to set up a traffic accident prevention program based on the adapted Think First and to evaluate its impact by comparing epidemiological variables before and after the beginning of the program.

METHODS

The program was executed in Maringá city, from September 2004 to August 2005, with educational actions targeting the entire population, especially teenagers and young adults. The program was implemented by building a network of information facilitators and multipliers inside the organized civil society, with widespread population dissemination. To measure the impact of the program, a specific software was developed for the storage and processing of the epidemiological variables.

RESULTS

The results showed a reduction of trauma severity due to traffic accidents after the execution of the program, mainly TBI.

CONCLUSIONS

The adapted Think First was systematically implemented and its impact measured for the first time in Brazil, revealing the usefulness of the program for reducing trauma and TBI severity in traffic accidents through public education and representing a standardized model of implementation in a developing country.

[Occupational traumatism in blood service: improvement of the safety system]

An analysis of questionnaires used in the institutions of blood service has shown the absence of standards in maintenance of safety of the personnel storing up blood. Most frequent cases of contamination of the personnel with donors' blood was noted when venepunctions were being made, during filling the test-tubes from a tube, utilization of waste products, cutting the tubes and opening the test tubes. Introduction of a system of higher occupational safety of the personnel and successive action of using innovations, up-to-date configuration of hemocontainers with vacuum sampling of the first portion of blood for laboratory investigations and fixed closing the needle allows reduce occupational traumatism in blood service.

[Questions safety and tendency of using genetically modified microorganisms in food, food additives and food derived]

In this article analysis questions of using genetically modified microorganisms in manufacture food production, present new GMM used in manufacture -food ferments; results of medical biological appraisal/ microbiological and genetic expert examination/ of food, getting by use microorganisms or there producents with indication modern of control methods.

Measuring hospital-wide activity volume for patient safety and infection control: a multi-centre study in Japan

Background

In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990's. This has occurred in spite of cost containment efforts. Although government and hospital decision-makers demand comprehensive analysis of these activities at the hospital-wide level, there have been few studies that actually quantify them. Therefore, the aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years.

Methods

Using the conceptual framework of incremental activity corresponding to incremental cost, we defined the scope of patient safety and infection control activities. We then drafted a questionnaire to analyze these realms. After implementing the questionnaire, we conducted several in-person interviews with managers and other staff in charge of patient safety and infection control in seven acute care teaching hospitals in Japan.

Results

At most hospitals, nurses and clerical employees acted as the main figures in patient safety practices. The annual amount of activity ranged from 14,557 to 72,996 person-hours (per 100 beds: 6,240; per 100 staff: 3,323) across participant hospitals. Pharmacists performed more incremental activities than their proportional share. With respect to infection control activities, the annual volume ranged from 3,015 to 12,196 person-hours (per 100 beds: 1,141; per 100 staff: 613). For infection control, medical doctors and nurses tended to perform somewhat more of the duties relative to their share.

Conclusion

We developed a systematic framework to quantify hospital-wide activities for patient safety and infection control. We also assessed the incremental volume of these activities in Japanese hospitals under the reimbursement containment policy. Government and hospital decision makers can benefit from this type of analytic framework and its empirical findings.

Emerging Methods in Comparative Effectiveness and Safety

BACKGROUND

Interest in new methods for comparative effectiveness, drug and patient safety, and related studies is burgeoning. The advent of Medicare Part D for outpatient prescription drugs has drawn significant attention to the need for efficient ways to monitor the potential benefits and harms of pharmaceuticals. These trends prompted the Effective Health Care program at the Agency for Healthcare Research and Quality and its DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) network to examine innovative approaches for such investigations through an invitational symposium in June 2006.

RESULTS

Conference papers covered numerous points about ways to structure both interventional and database-oriented studies, particularly those concerned with adverse drug events, to avoid bias in those studies, and to apply advanced statistical tools to exploit the information from these studies to their fullest. Of particular importance are: (1) using new types of experimental designs, including cluster randomization, delayed designs, pragmatic trials, and practice-based investigations that incorporate the natural variation of data from routine clinical practice; (2) finding efficient ways to use different types of databases-eg, Department of Veterans Affairs files, Centers for Disease Control and Prevention surveillance files, Medicaid claims data, and state hospital data-for examining initiation, persistence, and adherence, and the benefits and adverse events of pharmaceutical use; and (3) inventing or refining ways to decrease the threats to validity of analyses relying on administrative or other observational data, particularly through propensity scoring, inverse probability weighting, risk adjustment, and direct or indirect methods for synthesizing comparative effectiveness information.

Histology safety: now and then

Histology safety usually focuses on general laboratory issues, but this article concentrates on the hazards affecting the individual histotech and their evolution in the last half a century. Using the information from a survey especially designed for the occasion, the hazards were divided into 4 groups, and their prevalence was expressed as percentages for national and foreign laboratories. All the laboratories received a "safety index" (SI) with an average value of 0.77 +/- 0.11 for 63 national laboratories and 0.69 +/- 0.13 for 22 foreign laboratories, these 2 averages being statistically different (P < .02). The historical evolution of the SI required answering the same questionnaire retrospectively, and so it was done for 17 laboratories with an SI average of 0.27 +/- 0.12 for 1955/1989 and 0.77 +/- 0.13, almost 3 times larger for 1990/2007, with improvement of all safety issues. The technological, organizational, and regulatory advances before 1989 showed an unremarkable effect on the SI, and the only circumstance considered as the driving force behind the almost triple increment of the SI during 1990/2007 was the awareness that the AIDS epidemic instilled in the minds and consciences of the medical laboratory personnel in general. Even after almost tripling the average SI value in 2007, national histology laboratories obtained a grade average of "C+" only, leaving room for improvement.

AHA Environmental Assessment 2008

Based on research and data from 60 nationally recognized sources, this annual tool identifies health care trends to help hospitals develop their strategic plans.

Economic growth and the incidence of occupational injuries in Austria

OBJECTIVES

The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria.

METHODS

The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries.

RESULTS

Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries.

CONCLUSIONS

Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown.

Perioperative patient safety: correct patient, correct surgery, correct side--a multifaceted, cross-organizational, interventional study

BACKGROUND

It is important to ensure a patient-safe environment in the perioperative setting. With this in mind, a "patient-safety first" philosophy was adopted within our operating room service.

METHODS

During the first phase of the interventional study (2001-2002), we defined and executed the organizational and educational aspects of the intervention. Thereafter, the implementation phase (2003-2005) was performed. According to our zero tolerance policy, in the event that a major error in patient readiness for anesthesia and surgery was found in the operating room holding area, the patient would be returned to the parent department ("failure") and the surgical procedure delayed until the major error was corrected.

RESULTS

The data of 15,856 patients were recorded. During the 3-yr implementation period, 112 patients (0.71%) were returned to the department. A statistically significant (P < 0.002) reduction in major errors was recorded when comparing the year 2003 to the years 2004 and 2005 (1.04, 0.59, and 0.49% for the years 2003, 2004, and 2005, respectively). Furthermore, stepwise logistic regression demonstrated a time-dependant significant decrease in the incidence of a major error that resulted from inadequate patient preparation (odds ratio = 1.48, 95% CI: 1.16-1.87). In addition, the mean time between failures was 6.6, 11.2, and 14.7 days for the years 2003, 2004, and 2005, respectively (P < 0.03). Finally, a significant (P < 0.0001) improvement in patient preparation over time, as well as the overall probability that the patient preparation score = 100% (P < 0.001), were demonstrated.

CONCLUSIONS

Education and increased awareness can decrease perioperative errors. However, even with a carefully designed policy in place, an error-free environment was not achieved. Therefore, monitoring and system analysis should be performed on a continuing basis.

A Dialogue on the Future of Nursing Practice

PURPOSE

The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice.

METHODS

The methods used are observation, reflection, dialogue, and proposed actions.

FINDINGS

The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility.

CONCLUSIONS

This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue.

NURSING IMPLICATIONS

The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.

A roadmap to diffuse ergonomic innovations in the construction industry: there is nothing so practical as a good theory

Despite the availability of resources and practices that would reduce work-related morbidity and mortality in the construction industry, their diffusion to workers has been slow, partly because the ties between management and trade workers are weak. In promoting an innovation, it is necessary to target the stakeholders who will be making the decisions related to it. The authors' focus is on ergonomics, but their observations may be applied more broadly to other areas of intervention-effectiveness research.

Recent developments in the application of risk analysis to waste technologies

The European waste sector is undergoing a period of unprecedented change driven by business consolidation, new legislation and heightened public and government scrutiny. One feature is the transition of the sector towards a process industry with increased pre-treatment of wastes prior to the disposal of residues and the co-location of technologies at single sites, often also for resource recovery and residuals management. Waste technologies such as in-vessel composting, the thermal treatment of clinical waste, the stabilisation of hazardous wastes, biomass gasification, sludge combustion and the use of wastes as fuel, present operators and regulators with new challenges as to their safe and environmentally responsible operation. A second feature of recent change is an increased regulatory emphasis on public and ecosystem health and the need for assessments of risk to and from waste installations. Public confidence in waste management, secured in part through enforcement of the planning and permitting regimes and sound operational performance, is central to establishing the infrastructure of new waste technologies. Well-informed risk management plays a critical role. We discuss recent developments in risk analysis within the sector and the future needs of risk analysis that are required to respond to the new waste and resource management agenda.