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High-risk Situations (high-risk + situation)
Selected AbstractsEffects of alcohol on risk-taking during simulated drivingHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 3 2002Scott E. Burian Abstract The effect of alcohol on judgement or conscious risk-taking may increase the likelihood of an automobile accident. This study examined the direct effects of penalty severity and alcohol on risk-taking in a novel simulated-driving lane-choice task. Thirteen male social drinkers received alcohol (0.3,g/kg, 0.5,g/kg, 0.8,g/kg) or placebo during each of four test sessions in a randomized, within subject design. In repeated trials, subjects selected, then drove through a cone-defined lane. Contingent upon performance, points were added (+,5 for the narrower lane, +,3 for the wider lane) and taken away (,,1, ,,3, or ,,5 points per hit cone) after each trial. Risk-taking was defined as a selection of the narrower-width lane. The frequency of risk-taking decreased as the penalty increased. The 0.5,g/kg dose, compared to other alcohol doses or placebo, significantly increased risk-taking in the high-risk (5-point penalty) condition. This finding suggests that breath alcohol concentrations within current legal standards can alter a driver's decision-making such that the willingness to enter a high-risk situation is increased. Copyright © 2002 John Wiley & Sons, Ltd. [source] Reduced interleukin-12 release from stimulated monocytes in patients with sepsis after major cancer surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010D. MOKART Background: Major cancer surgery is a high-risk situation for sepsis in the post-operative period. The aim of this study was to assess the relation between the monocyte production of IL-12 and the development of post-operative sepsis in patients undergoing major cancer surgery. Methods: In 19 patients undergoing major cancer surgery, the production of cytokines by basal and lipolysaccharide (LPS)-stimulated monocytes was measured before and after (from day 1 to day 3 and day 7) surgery. Seven of them developed a post-operative sepsis. Ten healthy volunteers were used as controls for the assessment of pre-operative values. Results: Before surgery, the production of interleukin (IL)-12 p40 by LPS-stimulated monocytes was similar in the patients and the healthy volunteers. The production of IL-12 p40 by unstimulated monocytes was higher in the patients than in the healthy volunteers. IL-12 production did not differ between the septic and the non-septic patients. After surgery, the production of IL-12 p40 was dramatically reduced in the LPS-stimulated monocytes of the septic patients from day 1 to day 3, as compared with that of the non-septic patients. Before surgery, the production of IL-6, IL-10, and IL-1 receptor antagonist (IL-1ra) in the patients was significantly higher than that of the healthy volunteers for both stimulated and unstimulated monocytes. After surgery, the production of these cytokines by both stimulated and unstimulated monocytes of the septic patients was similar to that of the non-septic patients. Intragroup analysis showed significant changes for IL-6, IL-10, and IL-1ra under all conditions, with the exception of changes in unstimulated monocytes of septic patients that were not significant for IL-10 release. Conclusion: After surgery, the septic patients showed drastic failure to up-regulate monocyte LPS-stimulated production of IL-12 p40. [source] Individualized assessment and treatment program for alcohol dependence: results of an initial study to train coping skillsADDICTION, Issue 11 2009Mark D. Litt ABSTRACT Aims Cognitive,behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment. Design Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an individualized assessment and treatment program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists with a detailed understanding of patients' coping strengths and deficits. Setting Out-patient treatment. Participants A total of 110 alcohol-dependent men and women. Measurements Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Time-line follow-back procedures were also used to record drinking at baseline and post-treatment. Findings IATP yielded higher proportion of days abstinent (PDA) at post-treatment (P < 0.05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses and less drinking in high-risk situations, as recorded by experience sampling at post-treatment. Post-treatment coping response rates were associated with decreases in drinking. Conclusions The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting a high risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol-dependent patients. [source] Safe medication practice: attitudes of medical students about to begin their intern yearMEDICAL EDUCATION, Issue 4 2008Ian D Coombes Objectives, Interns are expected to prescribe effectively and safely. This study aimed to assess medical students' perceptions of their readiness to prescribe, associated risks and outcome if involved in an error, as well as their perceptions of available support. Methods, We carried out a survey of 101 students prior to their intern year using a structured questionnaire. An indication of agreement with 21 closed statements was sought. Thematic clusters were identified by factor analysis. Results, Most students (84) felt they would be able to prescribe for most simple complaints and complete discharge prescriptions (81). In high-risk situations, fewer students felt comfortable with prescribing: only 54 felt sufficiently confident to prescribe warfarin and 66 felt confident enough to order i.v. fluids. Many felt support such as guidelines was available (87) and that, if in doubt, they could clarify instructions and seek advice. Students were aware of errors occurring within the medication system; however, most (99) believed that the medicines they prescribed would be safely administered. There was a mixed perception of medication errors: 40 felt that their prescribing errors would not be dealt with constructively and 79 indicated that a culture existed at their hospitals where clinicians would be blamed if they made a prescribing error. Conclusions, At the end of medical school education and prior to assuming responsibility for prescribing, students felt unprepared and perceived that negative outcomes would result if they were involved in errors. These findings indicate that much more work is needed to prepare doctors to prescribe safely, improve the safety of prescribing systems and address the issue of blame. [source] Achieving a Safety Culture in ObstetricsMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 6 2009Erin DuPree MD Abstract Preventable maternal and neonatal mortalities still occur, despite the wonders of today's technologically advanced healthcare system. Delivering high-quality, consistent care is the goal of every provider. Yet, obstetrical practice, in which unpredictable events and high-risk situations are the norm, is particularly vulnerable to medical errors. Obstetrics departments should be striving for a climate of patient safety, one that includes a just, reporting, and learning culture. This article discusses the various components of a safety culture as well as some of the advances that are being made in the field to improve the quality of care in obstetrics. Mt Sinai J Med 76:529-538, 2009. © 2009 Mount Sinai School of Medicine [source] Medical Malpractice: Utilization of Layered Simulation for Resident EducationACADEMIC EMERGENCY MEDICINE, Issue 11 2008Nathaniel Ryan Schlicher MD Abstract Objectives:, The authors present a novel approach to the use of simulation in medical education with a two-event layered simulation. A patient care simulation with an adverse outcome was followed by a simulated deposition. Methods:, Senior residents in an academic emergency medicine (EM) program were solicited as simulation research volunteers. Other than stating that the research involved adverse outcomes, no identifying information was given. Seven volunteers participated in a simulation involving a forced error (nurse confederate gave an incorrect medication dose). Six weeks later based on the initial simulation, one physician completed a simulated deposition in a teaching conference conducted by a licensed attorney with malpractice experience. The audience, consisting of residents, attendings, and students, watched a recording of the patient care, witnessed the deposition, and evaluated the experience using a 17-question survey with 5-point Likert scales. Results:, Participants felt that overall the training program was a useful educational tool (mean ± standard deviation [SD] Likert score = 4.63 ± 0.49) that would change aspects of their practice (3.31 ± 0.85). Participants stated that they would be more careful in their documentation (3.88 ± 0.60), review high-risk situations with staff (4.00 ± 0.71), and monitor more carefully for errors (3.95 ± 0.74). There was increased fear of the litigation process (3.95 ± 1.18), but participants felt the experience would help improve the risk profile of their practices (3.71 ± 0.68). Conclusions:, A novel approach to medical education was successful in changing attitudes and provided an expanded educational experience for participants. Layered simulation can be successfully incorporated into educational programs for numerous issues including medical malpractice. [source] | ||||||||||