International Journal of Risk & Safety in Medicine - Volume 16, issue 4
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: Obstetric practice in Malta has changed dramatically over the last two decades. The study identifies these changing trends that have occurred in the pregnant population in respect to their biological demography and their obstetric problems. Maltese pregnant women have changed their reproductive habits and demonstrate a greater predisposition to having children at a younger age (<20 years) or later in life (>40 years). They are more likely to be primiparous and unmarried. The antenatal course is more likely to be complicated by hypertension, antepartum haemorrhage and diabetes. The pregnancies are more likely to require intervention by induction of labour and…Caesarian section. There appears to be an increasing reluctance to intervene by operative vaginal deliveries. In spite of the increasing antenatal problems, a definite fall in perinatal mortality has been demonstrated, though there appears to be a slightly increased infant morbidity rate in the form of prematurity and its attendant complications.
Abstract: Malaria is an important aspect of public health in endemic countries, not in the least because malaria control is frustrated by the spreading risk of (multi‐)drug resistant malaria. Many strategies and campaigns for malaria control were launched during the last century. However, notwithstanding certain successes, the safety of much of the population the malaria endemic regions is threatened by drug resistant malaria parasites. The current “Global Malaria Control Strategy” aims at application of artemisinin based combination therapy (ACT). Some nations have been particularly successful in applying ACT, such as China, Vietnam, Thailand, and Brazil. Artemisinin derivatives are very effective agents…and safe for human use. Fetal neurotoxicity, as was found in animal experiments, has not been observed in humans, but it is acknowledged that data aggregation and post marketing surveillance are not yet optimal to exclude potential risks by the use of ACT. This paper describes a series studies of the use of artemisinins as monotherapy or in combination with mefloquine or piperaquine, also in comparison to a combination of atovaquone/proguanil for the treatment of P. falciparum and P. vivax malaria in the South of Vietnam.
Abstract: Whilst Human Reliability Analysis (HRA) has been well‐accepted and integrated into the safety management process in other industries, the application of such error analysis techniques to the problem of complication and reaction to treatment and the associated risks in healthcare is rare. Though the scarcity of HRA techniques in health‐care is likely to be due in some part to the safety culture, much is likely to be due to a lack of awareness of the usefulness of the techniques and their applicability to the problem of human error in the clinical context. This review attempts to look at the popular…HRA techniques used in high‐reliability industries, such as petro‐chemical, nuclear and aviation, and consider their feasibility for use in healthcare. Techniques vary in their scope and have been grouped into those that focus on: data collection, task description, task simulation, human error identification and analysis, and human error quantification. Techniques may cover one or more of these aspects, for example, THERP, HEART and SHERPA include both human error identification and analysis, and human error quantification tools. While some areas of healthcare have used certain HRA techniques, there is considerable scope to use others and to apply techniques to other aspects of healthcare not yet explored.
Keywords: Error identification, error analysis, error reduction, healthcare, medical error, patient safety, human reliability assessment, human error