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High-risk Environment (high-risk + environment)
Selected AbstractsIncident Monitoring in Emergency Departments An Australian ModelACADEMIC EMERGENCY MEDICINE, Issue 11 2000FIFEM, John Vinen FACEM Abstract. The specialty-based study of incidents, adverse events, and errors in medicine has largely occurred in anesthesia and to a lesser extent in intensive care and psychiatry. Few studies have specifically addressed the problem in emergency medicine (EM). Because of the significant risks, the resulting adverse outcome, and the high degree of preventability of errors occurring in the emergency department (ED), it is essential that an incident monitoring system be part of the ED's risk management program. The combination of time pressure, uncertainty, complexity, and workload means the ED is a high-risk environment. The delivery of high-quality emergency care is dependent on having an effective patient processing system in place and, because EM is a "systems-dependent" specialty, the environment lends itself to improvements to the system (re-engineering) to improve the safety of the environment given that the majority of errors in the ED are probably the result of failures of the system. This paper describes an existing incident monitoring system that has recently been adopted by six EDs in Australia. It was developed as a result of a similar successful program in anesthesia, and funded by the Federal Department of Health of Australia. Incorporating incident monitoring and analysis to identify causative factors of incidents and the subsequent implementation of corrective strategies as part of the ED risk management program may result in improvement in the quality of care through a reduction in the frequency of incidents. [source] Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non-diabetic on haemodialysisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2006S. Ocak Summary Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end-stage renal disease. Haemodialysis (HD) treatment constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end-stage renal disease. The serum markers of HCV infection were tested by a second-generation enzyme-linked immunosorbent assay test for antibodies and by qualitative reverse-transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti-HCV antibodies and HCV RNA was found to be 12.7% (34/267) and 10.1% (27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non-diabetic patients [20.8% (14/67) vs. 10% (20/200)] (p < 0.05). The mean period on dialysis of anti-HCV-positive patients with type 2 DM was shorter than that observed for anti-HCV-positive non-diabetic patients (43.9 ± 9.8 months vs. 59.7 ± 28.4 months) (p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non-diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non-diabetic HD patients. [source] Trauma and amputations in 19th century miners from Kimberley, South AfricaINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 3 2010A. E. Van der Merwe Abstract Trauma is the result of violent accidental or therapeutic events that cause physical or psychological injury. The frequencies and types of trauma within a population can give important information regarding their lifestyle as well as the quantity and quality of medical care available to them. The purpose of this study was to assess the incidence of trauma in the Gladstone sample population with regards to the presence of interpersonal violence a hazardous working environment strenuous working requirements and the availability of medical care. The individuals studied here were diamond miners from Kimberley dating to the late 19th century. A total of 107 well-preserved skeletons were excavated from unmarked graves after accidental discovery. This sample included 86 males 15 females and 6 individuals of unknown sex. The majority of individuals (71%) were between 19 and 45 years of age. The remains were most likely those of migrant mine workers of low socioeconomic status who had passed away at the local hospitals. All bones were visually assessed for macroscopic indications of traumatic bone alterations and compared to standard palaeopathological texts and photographs. A total of 27% (n,=,28) of the individuals in the sample presented with well-healed healing or perimortem fractures. Fractures to the skull encompassed 49% (n,=,20) of all the fractures that were observed. A total of six (6%) amputations were noted. Spondylolysis was observed in 7% (n,=,7) of the individuals within the sample and longstanding subluxation was noted in two individuals. The high incidences of cranial fractures within this population are suggestive of high levels of interpersonal violence while long bone fractures spondylolysis and evidence of longstanding subluxations are indicative of the strenuous work requirements and the high-risk environment to which these individuals were exposed. When considering the presence of well-reduced fractures and healed amputations it seems that adequate medical care was available to at least some members of this community. Copyright © 2009 John Wiley & Sons Ltd. This article was published online on 17 February 2009. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected 3 November 2009. [source] The adolescent origins of substance use disordersINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue S1 2008Matt McGue Abstract Although early use of alcohol during adolescence has been consistently associated with increased risk of alcoholism in adulthood, the specific mechanisms that underlie this association remain unclear. We describe a program of epidemiological twin-family research that shows that early use of alcohol is best conceptualized as an indicator of a more general propensity to engage in adolescent problem behavior. Adolescent problem behavior, in turn, is a risk factor for a broad range of adult externalizing disorders, of which alcoholism is but one manifestation. These findings are shown to be consistent with a dual-process model whereby early adolescent problem behavior is associated with increased risk of adult psychopathology because both are indicators of a common inherited liability and because early adolescent problem behavior increases the likelihood an adolescent is exposed to high-risk environments. We conclude with a discussion of the importance of cross-cultural research, which may be especially informative for identifying the consequences of early adolescent drinking. Copyright © 2008 John Wiley & Sons, Ltd. [source] The physiology of predator stress in free-ranging preyJOURNAL OF ANIMAL ECOLOGY, Issue 6 2009Evan L. Preisser M.J. Sheriff, C.J. Krebs & R. Boonstra (2009) The sensitive hare: sublethal effects of predator stress on reproduction in snowshoe hares. Journal of Animal Ecology, 78, 1249,1258. Ecologists have only begun to understand the physiological mechanisms underlying individual- and population-level responses of prey- to predator-related stress. Sheriff, Krebs and Boonstra advance this field by providing evidence that predator-induced increases in glucorticoid concentrations in wild female snowshoe hares (Lepus americanus) impact both litter size and offspring condition. They hypothesize that the glucocorticoid-mediated effects on reproduction provides an adaptive benefit: mothers ,programming' their offspring to be timid and risk-averse in high-risk environments should increase their survival probability. This research illuminates the connection between stress physiology and population-level changes and demonstrates the surprisingly far-reaching impact of predation risk. [source] Social Information Processing, Moral Reasoning, and Emotion Attributions: Relations With Adolescents' Reactive and Proactive AggressionCHILD DEVELOPMENT, Issue 6 2009William F. Arsenio Connections between adolescents' social information processing (SIP), moral reasoning, and emotion attributions and their reactive and proactive aggressive tendencies were assessed. One hundred mostly African American and Latino 13- to 18-year-olds from a low-socioeconomic-status (SES) urban community and their high school teachers participated. Reactive aggression was uniquely related to expected ease in enacting aggression, lower verbal abilities, and hostile attributional biases, and most of these connections were mediated by adolescents' attention problems. In contrast, proactive aggression was uniquely related to higher verbal abilities and expectations of more positive emotional and material outcomes resulting from aggression. Discussion focused on the utility of assessing both moral and SIP-related cognitions, and on the potential influence of low-SES, high-risk environments on these findings. [source] | ||||||||||