Domino index: A rapid quantification tool for the domino effect in chemical plants

The severity of industrial accidents involving domino effects is widely acknowledged in chemical and process industries. The interdependence of installations and complexity of layouts pose significant challenges for the rapid quantitative assessment of domino effects in large chemical plants. In this study, a set of domino indices was introduced to measure the extent to which a given installation triggered and propagated domino effects, as well as to assess the overall domino effect in a specified area. An accelerated algorithm for domino accident modelling was developed based on Monte Carlo simulations to calculate the domino index. This algorithm can simulate all potential domino accident propagation pathways and the failure frequencies of installations. Two case studies, derived for a hypothetical chemical plant and actual oil-storage facilities, were examined to evaluate the applicability of the method. Furthermore, the method was validated using conditional probability calculations and vertex metrics. The results demonstrated that the proposed domino index is a useful tool for rapidly quantifying domino effects and that it can assist in identifying critical installations, designing plant layouts, and screening hazardous areas. The method and indices can provide guidance for the prevention of severe domino accidents.

[Evaluation of practices through simulation: Implementation of Horror Week in a cytotoxic preparation unit]

OBJECTIVES

The objective of this work is to describe the interest of developing a simulation for the evaluation and improvement of practices through the realization of a horror week in a cytotoxic preparation unit.

METHODS

The simulation was divided into five days, each corresponding to a step in the cytotoxic circuit. Five errors per day were produced and presented to the team in a dedicated room. An observation form was used to collect the errors identified by each person. A satisfaction questionnaire was distributed and a collective debriefing took place remotely.

RESULTS

The average number of errors identified per day was 3.8. The least common errors were reversal of patient height and weight, overloading of the sterilization basket, failure to follow dressing rules in the controlled area, absence of the temperature-monitoring disk, and absence of an opaque bag for photosensitive chemotherapy. The perceived level of difficulty was 3.33/5 and the organization was satisfactory to all participants.

CONCLUSIONS

Horror Week achieved its objectives by raising awareness among professionals of the risks of the chemotherapy circuit. The errors that were found to be the least significant allowed us to develop priority areas for ongoing training for our unit.

What happens when pharmacist independent prescribers lead on medicine management in older people's care homes: a qualitative study

OBJECTIVE

Older people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A randomised controlled trial placed pharmacists, with independent prescribing rights (PIPs), into older people care homes. In the intervention service, PIPs worked with general practitioners (GPs) and care home staff for 6 months, to optimise medicine management at individual resident and care home level. PIP activity included stopping medicines that were no longer needed or where potential harms outweighed benefits. This analysis of qualitative data examines health and social care stakeholders' perceptions of how the service impacted on care home medicine procedures and resident well-being.

DESIGN

Pragmatic research design with secondary analysis of interviews.

SETTING

Primary care pharmacist intervention in older people care homes in England, Scotland and Northern Ireland.

PARTICIPANTS

Recruited from intervention arm of the trial: PIPs (n=14), GPs (n=8), care home managers (n=9) and care home staff (n=6).

RESULTS

There were resonances between different participant groups about potential benefits to care home residents of a medicine service provided by PIPs. There were small differences in perceptions about changes related to communication between professionals. Results are reported through three themes (1) 'It's a natural fit'-pharmacists undertaking medication review in care homes fitted within multidisciplinary care; (2) 'The resident is cared for'-there were subjective improvements in residents' well-being; (3) 'Moving from "firefighting" to effective systems'-there was evidence of changes to care home medicine procedures.

CONCLUSION

This study suggests that pharmacist independent prescribers in primary care working within the multidisciplinary team can manage care home residents' medicines leading to subjective improvements in residents' well-being and medicine management procedures. Care home staff appreciated contact with a dedicated person in the GP practice.

TRIAL REGISTRATION

ISRCTN 17847169.

Medication errors related to high-alert medications in a paediatric university hospital - a cross-sectional study analysing error reporting system data

BACKGROUND

Paediatric patients are prone to medication errors, and only a few studies have explored errors in high-alert medications in children. The present study aimed to investigate the prevalence and nature of medication errors involving high-alert medications and whether high-alert medications are more likely associated with severe patient harm and higher error risk classification compared to other drugs.

METHODS

This study was a cross-sectional report of self-reported medication errors in a paediatric university hospital in 2018-2020. Medication error reports involving high-alert medications were investigated by descriptive quantitative analysis to identify the prevalence of different drugs, Anatomical Therapeutic Chemical groups, administration routes, and the most severe medication errors. Crosstabulation and Pearson Chi-Square (χ2) tests were used to compare the likelihood of more severe consequences to the patient and higher error risk classification between medication errors involving high-alert medications and other drugs.

RESULTS

Among the reported errors (n = 2,132), approximately one-third (34.8%, n = 743) involved high-alert medications (n = 872). The most common Anatomical Therapeutic Chemical subgroups were blood substitutes and perfusion solutions (B05; n = 345/872, 40%), antineoplastic agents (L01; n = 139/872, 16%), and analgesics (N02; n = 98/872, 11%). The majority of high-alert medications were administered intravenously (n = 636/872, 73%). Moreover, IV preparations were administered via off-label routes (n = 52/872, 6%), such as oral, inhalation and intranasal routes. Any degree of harm (minor, moderate or severe) to the patient and the highest risk classifications (IV-V) were more likely to be associated with medication errors involving high-alert medications (n = 743) when compared to reports involving other drugs (n = 1,389).

CONCLUSIONS

Preventive risk management should be targeted on high-alert medications in paediatric hospital settings. In these actions, the use of intravenous drugs, such as parenteral nutrition, concentrated electrolytes, analgesics and antineoplastic agents, and off-label use of medications should be prioritised. Further research on the root causes of medication errors involving high-alert medications and the effectiveness of safeguards is warranted.

Association of fat-to-muscle ratio with non-alcoholic fatty liver disease: a single-centre retrospective study

OBJECTIVES

Sarcopenia is a known risk factor for non-alcoholic fatty liver disease (NAFLD). Studies evaluating the association between the fat-to-muscle ratio (FMR) and NAFLD are limited. Therefore, the aim of our study was to investigate the association between FMR and NAFLD.

DESIGN

A retrospective study was conducted on individuals who underwent health examination at Wuhan Union Hospital between January 2020 and November 2021. Clinical data were collected from electronic medical records.

SETTING

Wuhan Union Hospital, Wuhan, China.

PARTICIPANTS

1592 participants aged ≥40 years who underwent body composition analysis and liver ultrasonography were retrospectively reviewed.

OUTCOME MEASURES

Liver ultrasonography was used to assess liver steatosis, and the fibrosis-4 index was used to calculate the risk scores for liver fibrosis. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction model was used to calculate ASCVD risk scores.

RESULTS

The FMR was significantly higher in individuals with NAFLD than in those without NAFLD (p<0.001). The prevalence of NAFLD gradually increased from FMR tertile 1 (reference) to tertile 2 (OR=1.49, 95% CI 1.13 to 1.97) and tertile 3 (OR=2.85, 95% CI 2.08 to 3.90). In addition, patients with NAFLD in FMR tertile 3 had a significantly higher risk of liver fibrosis (OR=4.48, 95% CI 2.12 to 9.50) and ASCVD (OR=4.63, 95% CI 2.62 to 8.19) than those in FMR tertile 1 after adjustment for multiple confounders.

CONCLUSION

In this study, we found a significant association between FMR and NAFLD. A higher FMR indicates a higher risk of NAFLD in the study population and a higher risk of liver fibrosis and ASCVD in NAFLD patients.

Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation

OBJECTIVES

We evaluated the causal effects of high-risk versus low-risk pregnancy at the first antenatal care (ANC) visit on the occurrence of complications during pregnancy and labour or delivery among women in Kenya.

METHODS

We designed a quasi-experimental study using observational data from a large mobile health wallet programme, with the exposure as pregnancy risk at the first ANC visit, measured on a binary scale (low vs high). Complications during pregnancy and at labour or delivery were the study outcomes on a binary scale (yes vs no). Causal effects of the exposure were examined using a double-robust estimation, reported as an OR with a 95% CI.

RESULTS

We studied 4419 women aged 10-49 years (mean, 25.6±6.27 years), with the majority aged 20-29 years (53.4%) and rural residents (87.4%). Of 3271 women with low-risk pregnancy at the first ANC visit, 833 (25.5%) had complications during pregnancy while 1074 (32.8%) had complications at labour/delivery. Conversely, of 1148 women with high-risk pregnancy at the first ANC visit, 343 (29.9%) had complication during pregnancy while 488 (42.5%) had complications at labour delivery. Multivariable adjusted analysis showed that women with high-risk pregnancy at the time of first ANC attendance had a higher occurrence of pregnancy during pregnancy (adjusted OR (aOR) 1.22, 95% CI 1.02 to 1.46) and labour or delivery (aOR 1.20, 95% CI 1.03 to 1.41). In the double-robust estimation, a high-risk pregnancy at first ANC visit increased the occurrence of complications during pregnancy (OR 1.23, 95% CI 1.04 to 1.46) and labour or delivery (OR 1.24, 95% CI 1.07 to 1.45).

CONCLUSION

Women with a high-risk pregnancy at the first ANC visit have an increased occurrence of complications during pregnancy and labour or delivery. These women should be identified early for close and appropriate obstetric and intrapartum monitoring and care to ensure maternal and neonatal survival.

Differences in lipid and blood pressure measurements between individuals with type 1 diabetes and the general population: a cross-sectional study

OBJECTIVES

Cardiovascular disease (CVD) is a precarious complication of type 1 diabetes (T1D). Alongside glycaemic control, lipid and blood pressure (BP) management are essential for the prevention of CVD. However, age-specific differences in lipid and BP between individuals with T1D and the general population are relatively unknown.

DESIGN

Cross-sectional study.

SETTING

Six diabetes outpatient clinics and individuals from the Lifelines cohort, a multigenerational cohort from the Northern Netherlands.

PARTICIPANTS

2178 adults with T1D and 146 22 individuals without diabetes from the general population.

PRIMARY AND SECONDARY OUTCOME MEASURES

Total cholesterol, low-density lipoprotein cholesterol (LDL-cholesterol), systolic BP (SBP) and diastolic BP (DBP), stratified by age group, glycated haemoglobin category, medication use and sex.

RESULTS

In total, 2178 individuals with T1D and 146 822 without diabetes were included in this study. Total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in individuals with T1D in comparison to the background population. When stratified by age and medication use, total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in the T1D population. Men with T1D achieved lower LDL-cholesterol levels both with and without medication in older age groups in comparison to women. Women with T1D had up to 8 mm Hg higher SBP compared with the background population, this difference was not present in men.

CONCLUSIONS

Lipid and BP measurements are not comparable between individuals with T1D and the general population and are particularly unfavourable for BP in the T1D group. There are potential sex differences in the management of LDL-cholesterol and BP.

Patients' and clinicians' views on the appropriate use of safety-netting advice in consultations-an interview study from Sweden

BACKGROUND

A promising approach to manage clinical uncertainty and thereby reduce the risk of preventable diagnostic harm is to use safety-netting advice (ie, communicating structured information to patients about when and where to reconsult healthcare).

AIM

To explore clinicians' and patients' views on when and how safety-netting can be successfully applied in primary-care and emergency-care settings.

DESIGN AND SETTING

An exploratory qualitative research design; we performed focus groups and interviews in a Swedish setting.

PARTICIPANTS

Nine physicians working in primary or emergency care and eight patients or caregivers participated. The participants were an ethnically homogeneous group, originating from Western European or Australian backgrounds.

METHOD

Data were analysed inductively, using the framework method. The results are reported according to the Standards for Reporting Qualitative Research guidelines for reporting qualitative research.

RESULTS

In order to manage diagnostic uncertainty using safety-netting, clinicians and patients emphasised the need to understand the preconditions for the consultation (ie, the healthcare setting, the patient's capacity and existing power imbalance). Furthermore, participants raised the importance of establishing a mutual understanding regarding the patient's perspective and the severity of the situation before engaging in safety-netting advice.

CONCLUSION

The establishment of a shared mental model between clinician and patient of the preconditions for the clinical encounter is a vital factor affecting how safety-netting advice is communicated and received and its ability to support patients in problem detection and planning after the visit. We suggest that successful safety-netting can be viewed as a team activity, where the clinician and patient collaborate in monitoring how the patient's condition progresses after the care visit. Furthermore, our findings suggest that to be successfully implemented, safety-netting advice needs to be tailored to the clinical context in general and to the patient-clinician encounter in particular.

A novel climate and health decision support platform: Approach, outputs, and policy considerations

BACKGROUND

The adverse health impacts of climate change are increasingly apparent and the need for adaptation activities is pressing. Risks, drivers, and decision contexts vary significantly by location, and high-resolution, place-based information is needed to support decision analysis and risk reduction efforts at scale.

METHODS

Using the Intergovernmental Panel on Climate Change (IPCC) risk framework, we developed a causal pathway linking heat with a composite outcome of heat-related morbidity and mortality. We used an existing systematic literature review to identify variables for inclusion and the authors' expert judgment to determine variable combinations in a hierarchical model. We parameterized the model for Washington state using observational (1991-2020 and June 2021 extreme heat event) and scenario-driven temperature projections (2036-2065), compared outputs against relevant existing indices, and analyzed sensitivity to model structure and variable parameterization. We used descriptive statistics, maps, visualizations and correlation analyses to present results.

RESULTS

The Climate and Health Risk Tool (CHaRT) heat risk model contains 25 primary hazard, exposure, and vulnerability variables and multiple levels of variable combinations. The model estimates population-weighted and unweighted heat health risk for selected periods and displays estimates on an online visualization platform. Population-weighted risk is historically moderate and primarily limited by hazard, increasing significantly during extreme heat events. Unweighted risk is helpful in identifying lower population areas that have high vulnerability and hazard. Model vulnerability correlate well with existing vulnerability and environmental justice indices.

DISCUSSION

The tool provides location-specific insights into risk drivers and prioritization of risk reduction interventions including population-specific behavioral interventions and built environment modifications. Insights from causal pathways linking climate-sensitive hazards and adverse health impacts can be used to generate hazard-specific models to support adaptation planning.

Longitudinal adherence to breast cancer surveillance following cancer genetic testing in an integrated health care system

PURPOSE

Screening with mammography and breast magnetic resonance imaging (MRI) is an important risk management strategy for individuals with inherited pathogenic variants (PVs) in genes associated with increased breast cancer risk. We describe longitudinal screening adherence in individuals who underwent cancer genetic testing as part of usual care in a vertically integrated health system.

METHODS

We determined the proportion time covered (PTC) by annual mammography and breast MRI for individuals with PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, and ATM. We determined time covered by biennial mammography beginning at age 50 years for individuals who received negative results, uncertain results, or with PVs in genes without specific breast cancer screening recommendations.

RESULTS

One hundred and forty individuals had PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, or ATM. Among these individuals, average PTC was 48% (range 0-99%) for annual screening mammography and 34% (range 0-100%) for annual breast MRI. Average PTC was highest for individuals with PVs in CHEK2 (N = 14) and lowest for individuals with PVs in TP53 (N = 3). Average PTC for biennial mammography (N = 1,027) was 49% (0-100%).

CONCLUSION

Longitudinal screening adherence in individuals with PVs in breast cancer associated genes, as measured by the proportion of time covered, is low; adherence to annual breast MRI falls below that of annual mammography. Additional research should examine screening behavior in individuals with PVs in breast cancer associated genes with a goal of developing interventions to improve adherence to recommended risk management.

Risk-adjusted management in catheterization procedures for non-ST-segment elevation myocardial infarction: A standard operating procedure pilot study

BACKGROUND

The effects of standardized risk-adjusted periprocedural management of cardiac catheterization procedures in Non-ST segment elevation myocardial infarction (NSTEMI) remain unknown. We implemented a standard operating procedure (SOP) specifying risk assessment (RA, using National Cardiovascular Data Registry (NCDR) risk models) and risk-adjusted management (RM, e.g. intensified monitoring) in 2018 and aimed to investigate staff SOP adherence and associations with patient outcomes.

METHODS AND RESULTS

All 430 invasively managed NSTEMI patients (mean age 72y; 70.9% male) in 2018 were analyzed for staff SOP adherence and in-hospital clinical outcomes. 207 patients (48.1%; RM+) received both RA and RM; 92 patients (21.4%; RM-) received RA but no RM; 131 patients (30.5%; RA-) received neither RA nor RM. Lower staff adherence to RA was associated with emergency settings (51.9% (RA-) vs. 22.1% (RA+); p<0.01), presentation in cardiogenic shock (17.6% (RA-) vs. 6.4% (RA+); p<0.01) and invasive mechanical ventilation (12.2% (RA-) vs. 3.3% (RA+); p<0.01). Early sheath removal (87.9% (RM+) vs. 56.5% (RM-); p<0.01) and intensified monitoring (p<0.01) were more frequent in the RM+ group. All-cause mortality was not different (1.4% (RM+) vs. 4.3% (RM-); p=0.13), but there were fewer major bleeding events with associated with RM (2.4% (RM+) vs. 12% (RM-); p<0.01), which remained independently associated with RM in a multivariate logistic regression model correcting for confounders (p<0.01).

CONCLUSION

In an all-comer patient cohort with NSTEMI, staff adherence to risk-adjusted periprocedural management was independently associated with fewer major bleeding events. Staff adherence to SOP-specified risk assessment was frequently neglected in more critical clinical situations.

Farm-level data on production systems, farmer- and farm characteristics of apple growers in Switzerland

We here present survey data from apple growers across Switzerland. Data from 245 apple growers was collected, using an online survey in French and German in 2022. The sampled growers represent 24.4% from total land under apples. Apple production is one of the most economically relevant and pesticide intensive crops. Hence, the focus of the survey is on growers' pest management decisions and marketing strategies. Survey data contains details on growers' agronomic practices such as grown cultivars, pest management against fungi, insects, and weeds, as well as pesticide use for cosmetic purposes. Moreover, we collected information on pest management after harvest, i.e. storage loss strategies. Marketing characteristics include the sales channel chosen as well as labels used and contract arrangements with buyers. Moreover, detailed data about farm management strategies, behavioral factors, as well as other farm- and farmer characteristics was collected. Survey data is matched with a rich set of environmental data, i.e. precipitation, temperature, and apple scab infection risk.

Dynamic exposure and body burden models for per- and polyfluoroalkyl substances (PFAS) enable management of food safety risks in cattle

With increasing global focus on planetary boundaries, food safety and quality, the presence of per- and polyfluoroalkyl substances (PFAS) in the food chain presents a challenge for the sustainable production and supply of quality assured food. Consumption of food is the primary PFAS exposure route for the general population. At contaminated sites, PFAS have been reported in a range of agricultural commodities including cattle. Consumer exposure assessments are complicated by the lack of validated modelling approaches to estimate PFAS bioaccumulation in cattle. Previous studies have shown that PFAS bioaccumulation in livestock is influenced by environmental, spatial and temporal factors that necessitate a dynamic modelling approach. This work presents an integrated exposure and population toxicokinetic (PopTK) model for cattle that estimates serum and tissue concentrations of PFAS over time. Daily exposures were estimated from intakes of water, pasture, and soil, and considered animal growth, seasonal variability (pasture moisture content and temperature) and variable PFAS concentrations across paddocks. Modelled serum and tissue estimates were validated against monitoring data from Australian and Swedish cattle farms. The models were also used to develop and test practical management options for reducing PFAS exposure and to prioritise remediation for farms. Model outputs for exposure management scenarios (testing cattle rotation and targeted supplementation of feed and water) showed potential for marked reductions in consumer exposures from cattle produce.

A comprehensive study on surveillance outcomes of a male population followed at a hereditary breast cancer high-risk consultation at a Portuguese tertiary hospital

INTRODUCTION

Men born with pathogenic/likely pathogenic variants in genes associated with the Hereditary Breast and Ovarian Cancer Syndrome have a higher risk to develop breast cancer and other cancers (such as prostate cancer) and should undergo adequate surveillance protocols in highly specialized Centers.

METHODS

A retrospective study was conducted to assess these genetic variants' epidemiological and phenotypical manifestations in male carriers, as well as the efficacy of the surveillance protocol and compliance toward it through a survey. During follow-up, a genetic panel for testing was implemented, the starting age for surveillance was delayed, and the six-month screening interval was extended to annual.

RESULTS

A total of 104 men from a tertiary hospital's High-Risk Consultation were included, 102 with positive genetic testing for BRCA1 (n = 31), BRCA2 (n = 55), both BRCA2 and another gene (n = 5), CDH1 (n = 2), CHEK2 (n = 4), NF1 (n = 1), RAD51C (n = 4), and an additional two men with no actionable genetic variant identified. The follow-up period ranged from 1 to 13 years, and only one man developed cancer. Survey responses from 48 men in active surveillance showed that more than half recognizes their carrier status and consequent surveillance impact on their life, including the risk of transmission to offspring, fear of future cancer, meaningful distress, and feeling of injustice. Biannual surveillance was not actively detecting more cancer disease cases, confirming the adequacy of the currently implemented protocol CONCLUSION: With support of Genetics to fulfill the current gaps in high-risk management, the proposed redefinition of surveillance protocol would adapt it to the population needs and concerns.

Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review

Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.

Application of machine learning approaches in predicting clinical outcomes in older adults - a systematic review and meta-analysis

BACKGROUND

Machine learning-based prediction models have the potential to have a considerable positive impact on geriatric care.

DESIGN

Systematic review and meta-analyses.

PARTICIPANTS

Older adults (≥ 65 years) in any setting.

INTERVENTION

Machine learning models for predicting clinical outcomes in older adults were evaluated. A random-effects meta-analysis was conducted in two grouped cohorts, where the predictive models were compared based on their performance in predicting mortality i) under and including 6 months ii) over 6 months.

OUTCOME MEASURES

Studies were grouped into two groups by the clinical outcome, and the models were compared based on the area under the receiver operating characteristic curve metric.

RESULTS

Thirty-seven studies that satisfied the systematic review criteria were appraised, and eight studies predicting a mortality outcome were included in the meta-analyses. We could only pool studies by mortality as there were inconsistent definitions and sparse data to pool studies for other clinical outcomes. The area under the receiver operating characteristic curve from the meta-analysis yielded a summary estimate of 0.80 (95% CI: 0.76 - 0.84) for mortality within 6 months and 0.81 (95% CI: 0.76 - 0.86) for mortality over 6 months, signifying good discriminatory power.

CONCLUSION

The meta-analysis indicates that machine learning models display good discriminatory power in predicting mortality. However, more large-scale validation studies are necessary. As electronic healthcare databases grow larger and more comprehensive, the available computational power increases and machine learning models become more sophisticated; there should be an effort to integrate these models into a larger research setting to predict various clinical outcomes.

A participatory ergonomics intervention to re-design work and improve the musculoskeletal health of paramedics: protocol for a cluster randomised controlled trial

BACKGROUND

In this paper, we present the protocol for a cluster randomised controlled trial to evaluate the effectiveness and implementation of a participative risk management intervention to address work-related musculoskeletal disorders (WMSDs). The aims of the study include to evaluate the implementation process and the impact of the intervention on work related musculoskeletal pain and discomfort and exposure to physical and psychosocial hazards in paramedics over a 12-month period.

METHODS

The intervention in this study is to implement A Participative Hazard Identification and Risk Management (APHIRM) toolkit in an ambulance service. Eighteen work groups containing eligible participants (registered paramedics) will be randomised into the intervention or wait-list control arm in one of three rolling recruitment periods. The APHIRM toolkit survey will be offered at baseline and 12 months later, to all current eligible participants in each work group allocated to the trial. The intervention work groups will receive the remainder of the APHIRM toolkit procedures. Identifying data about individual participants will not be collected in the survey, to protect participant privacy and encourage participation. Changes in primary (musculoskeletal pain and discomfort) and secondary (exposure to physical and psychosocial hazards at work) outcomes measured in the survey will be analysed comparing the baseline and follow up response of the cluster. A process evaluation is included to analyse the implementation and associated barriers or facilitators.

DISCUSSION

This study is important in providing a comprehensive approach which focusses on both physical and psychosocial hazards using worker participation, to address WMSDs, a well-known and significant problem for ambulance services. The effectiveness of the intervention in work groups will be rigorously evaluated. If significant positive results are observed, the intervention may be adopted in ambulance services, both nationally and internationally.

TRIAL REGISTRATION

ISRCTN77150219. Registered 21 November 2021.

Self-harm risk screening on prison entry: assessing the predictive validity of self-harm history and recent ideation in men and women

PURPOSE

Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.

DESIGN/METHODOLOGY/APPROACH

A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.

FINDINGS

Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.

PRACTICAL IMPLICATIONS

Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

Addressing the second victim phenomenon in Israeli health care institutions

BACKGROUND

The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence.

METHODS

A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs.

RESULTS

Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager.

CONCLUSIONS

Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

Implementation of a pragmatic emergency department patients' own medications (POM) procedure to improve medication safety: An interrupted time series

BACKGROUND

Patients' Own Medications (POMs) are useful to inform clinical decision-making, best possible medication history documentation, and ensure timely medication administration. A procedure was developed for managing POMs specifically in the emergency department (ED) and short stay unit. This study evaluated the impact of this procedure on process and patient safety outcomes.

METHODS

An interrupted time-series was undertaken in a metropolitan ED/short stay unit between November 2017 and September 2021. Pre-implementation and during each of four post-implementation time-periods, data were collected at unannounced times on approximately 100 patients taking medications prior to presentation. Endpoints included proportion of patients with POMs stored in green POMs bags, in standardised locations, and proportion who self-medicated without nurses knowing.

RESULTS

Following procedure implementation, POMs were stored in standardised locations for 45.9 % of patients. Proportion of patients with POMs stored in green bags increased from 6.9 % to 48.2 % (difference 41.3 %, p < 0.001). Patient self-administration without nurses' knowledge declined from 10.3 % to 2.3 % (difference 8.0 %, p = 0.015). POMs were infrequently left in ED/short stay unit after discharge.

CONCLUSIONS

The procedure has standardised POMs storage, but room for further improvement remains. Although POMs were not locked away and were readily available to clinicians, patient self-medication without nurses' knowledge declined.

Crisis management for Patient Safety Officers: lessons learned from the Covid-19 pandemic

BACKGROUND

There is no consensus for the role definition for Patient Safety Officers (PSOs) in healthcare during pandemics or other crises as opposed to their routine activities. This study aimed to examine the contribution of personality traits and systemic factors on the performance of PSOs during the pandemic, and to compare these variables during the first and third waves of the Covid-19 pandemic in Israel.

METHODS

This cross-sectional study invited 117 PSOs to complete a questionnaire addressing their role during the Covid-19 pandemic. The questionnaire included items concerning: Personal and socio-demographic characteristics; Uncertainty; Personal initiative; Burnout; Professional functioning; Patient Safety and Risk Management policies and practices; Organizational functioning; and Personal Involvement in risk management activities. Qualitative data was collected by two open-ended questions.

RESULTS

A total of 78 PSOs (67%) completed the questionnaire. The results revealed that many PSOs reduced their involvement in risk management processes or even left their position temporarily in order to return to their primary specialization as clinicians. Only 51.3% and 57.7% reported practicing risk management in the first and third waves, respectively. The three main factors that kept PSOs functioning were managerial support, mobilization of their team, and the belief in the importance of their position.

CONCLUSIONS

A crisis generates uncertainty, a plethora of frequent and urgent tasks, and the need to adapt policy to changing circumstances and to the increased risks. The risk manager must be a member of the crisis management team and participate in every important discussion in order to represent essential staff and patient safety issues and ensure that these are fully addressed already in the early stages of planning.

A dynamic approach to supply chain reconfiguration and ripple effect analysis in an epidemic

The COVID-19 pandemic has illustrated the unprecedented challenges of ensuring the continuity of operations in a supply chain as suppliers' and their suppliers stop producing due the spread of infection, leading to a degradation of downstream customer service levels in a ripple effect. In this paper, we contextualize a dynamic approach and propose an optimal control model for supply chain reconfiguration and ripple effect analysis integrated with an epidemic dynamics model. We provide supply chain managers with the optimal choice over a planning horizon among subsets of interchangeable suppliers and corresponding orders; this will maximize demand satisfaction given their prices, lead times, exposure to infection, and upstream suppliers' risk exposure. Numerical illustrations show that our prescriptive forward-looking model can help reconfigure a supply chain and mitigate the ripple effect due to reduced production because of suppliers' infected workers. A risk aversion factor incorporates a measure of supplier risk exposure at the upstream echelons. We examine three scenarios: (a) infection limits the capacity of suppliers, (b) the pandemic recedes but not at the same pace for all suppliers, and (c) infection waves affect the capacity of some suppliers, while others are in a recovery phase. We illustrate through a case study how our model can be immediately deployed in manufacturing or retail supply chains since the data are readily accessible from suppliers and health authorities. This work opens new avenues for prescriptive models in operations management and the study of viable supply chains by combining optimal control and epidemiological models.

Safe launch of a robotically assisted mitral valve repair program in a single center: experience of initial 20 cases under the Center for Minimally Invasive Surgery

Robotically assisted mitral valve repair was approved by the Japanese government in April 2018. However, understanding robotic surgery involves steep learning curves of surgeons and dedicated cardiac teams. The Center for Minimally Invasive Surgery (CMIS) of Tottori University Hospital is a multidisciplinary organization established in 2011 with seven surgical departments. In this study, we report strategies for improving the safety of robotic surgery in the CMIS and early results of robotic mitral valve repair at our hospital. We reviewed the first 20 patients who underwent robotic primary mitral valve repair, including concomitant procedures, from October 2019 to September 2021 under the supervision of the CMIS. Before starting the program, the CMIS requires setting console time limit to 180 min and implementing risk management strategies through simulation training for various mechanical failures. Mitral valve repair was completed in all patients. There was no in-hospital or 30-day mortality. No conversion to median sternotomy was necessary. The analysis of mitral pathology revealed 1 case of functional mitral regurgitation, 12 cases of posterior lesions, 3 cases of anterior lesions, 3 cases of bileaflet lesions, and 1 case of commissural lesion. The average cross-clamp time was 133 ± 27 min. Sixteen cases had trace mitral regurgitation postoperatively, and 4 cases had mild mitral regurgitation. The median (interquartile range) postoperative hospital stay was 10 (8.5-12.5) days. Robotically assisted mitral valve repair was performed safely with assistance from the multidisciplinary CMIS, and the early results were satisfactory without compromising clinical outcomes.

Assessment of cyanotoxins in water and fish in an African freshwater lagoon (Lagoon Aghien, Ivory Coast) and the application of WHO guidelines

In comparison with northern countries, limited data are available on the occurrence and potential toxicity of cyanobacterial blooms in lakes and ponds in sub-Saharan countries. With the aim of enhancing our knowledge on cyanobacteria and their toxins in Africa, we performed a 17-month monitoring of a freshwater ecosystem, Lagoon Aghien (Ivory Coast), which is used for multiple practices by riverine populations and for drinking water production in Abidjan city. The richness and diversity of the cyanobacterial community were high and displayed few variations during the entire survey. The monthly average abundances ranged from 4.1 × 104 to 1.8 × 105 cell mL-1, with higher abundances recorded during the dry seasons. Among the five cyanotoxin families analyzed (anatoxin-a, cylindrospermopsin, homoanatoxin, microcystins, saxitoxin), only microcystins (MC) were detected with concentrations ranging from 0 to 0.364 μg L-1 in phytoplankton cells, from 32 to 1092 μg fresh weight (FW) kg-1 in fish intestines, and from 33 to 383 μg FW kg-1 in fish livers. Even if the MC concentrations in water and fish are low, usually below the thresholds defined in WHO guidelines, these data raise the issue of the relevance of these WHO guidelines for sub-Saharan Africa, where local populations are exposed throughout the year to these toxins in multiple ways.

Towards facing uncertainties in biofuel supply chain networks: a systematic literature review

Biofuel supply chains (BSCs) face diverse uncertainties that pose serious challenges. This has led to an expanding body of research focused on studying these challenges. Hence, there is a growing need for a comprehensive review that summarizes the current studies, identifies their limitations, and provides essential advancements to support scholars in the field. To overcome these limitations, this research aims to provide insights into managing uncertainties in BSCs. The review utilizes the Systematic Reviews and Meta-Analyses (PRISMA) method, identifying 205 papers for analysis. This study encompasses three key tasks: first, it analyses the general information of the shortlisted papers. Second, it discusses existing methodologies and their limitations in addressing uncertainties. Lastly, it identifies critical research gaps and potential future directions. One notable gap involves the underutilization of machine learning techniques, which show potential for risk identification, resilient planning, demand prediction, and parameter estimations in BSCs but have received limited attention. Another area for investigation is the potential of agent-based simulation, which can contribute to analysing resilient policies, evaluating resilience, predicting parameters, and assessing the impact of emerging technologies on BSC resilience in the twenty-first century. Additionally, the study identifies the omission of various realistic assumptions, such as backward flow, lateral transshipments, and ripple effects in BSC. This study highlights the complexity of managing uncertainties in BSCs and emphasizes the need for further research and attention. It contributes to policymakers' understanding of uncertain sources and suitable approaches while inspiring researchers to address limitations and generate breakthrough ideas in managing BSC uncertainties.