Health care risk reduction

Policy makers, practitioners, and scholars from a variety of disciplines have recently embraced a new approach to risk reduction in health care—a "systems approach"—without proposing any specific reforms of medical liability law. The Institute of Medicine (IOM) placed its imprimatur on this approach in its recent reports (Kohn et al., 2000 IOM, 2001). In its simplest form, a systems approach to risk reduction in health care posits that an injury to a patient is often the manifestation of a latent error in the system of providing care. In other words, a medical mishap is the proverbial "accident waiting to happen" because the injury-preventing tools currently deployed, including medical liability law, are aimed at finding the individuals at fault rather than the systemic causes of error. Coexistence of a systems approach to error reduction and medical liability law as a conceptual framework for policy makers implies that the latter is likely to evolve in an incremental fashion as the former makes more visible different aspects of the medical error problem. 

To ensure that anyone found to be AB+ already has the facts about HIV and AIDS, risk-reduction, health care, etc. This information will have to be repeated after the test result is known, but it is more likely to be properly understood if first presented before the individual is in the state of shock likely to be engendered by a positive result. 

The gains for society of improved chemicals control may be substantial, though not easy to quantify in monetary terms. They include, for example, reduced costs for health care as a result of fewer accidents with chemicals, fewer acute health effects caused by poisonings, skin corrosion or bums, reduced risk for chronic effects such as allergies, cancer, etc. Furthermore, improved chemicals control will lead to a reduction of costs for remediation of environmental damage and of other costs following from emissions, e.g. water and soil pollution due to accidents or misuse of chemicals. 

In the first study, 4425 patients hospitalized with acute myocardial infarction who used NSAIDs were compared with 17 700 controls in a large health-care database in the USA (51). Multivariate models were constructed to control for potential confounders. A quarter of the cases and controls had also filled a prescription for an NSAID in the 6 months before the study. Overall, the NSAID users had the same risk of acute myocardial infarction as non-users, but naproxen users had a significantly lower risk of acute myocardial infarction compared with those who were not taking NSAIDs (adjusted OR = 0.84 95% Cl = 0.72, 0.98). The cardioprotective effect of naproxen was very modest compared with aspirin (a 44% reduction in the risk of acute myocardial infarction in the Physician Health Study (54)). 

In previous publications. Ecological and Toxicological Association of Dyes and Organic Pigments Manufacturers (ETAD) has addressed the importance of workplace risk reduction by evaluating carefully human health hazard and occupational exposure [2-4]. This chapter addresses the environmental exposure assessment as a complementary information to data on ecotoxicological hazard profiles of colorants. 

It is likely that nevirapine induces the metabolism of the components of the oral contraceptive by cytochrome P450 isoenzymes. Although it is not known whether these modest reductions in levels would reduce the anti-ovulatory efficacy of the combined oral contraceptive, it would be prudent to assume they could. The manufacturers recommend that combined oral contraceptives and other hormonal methods of birth control should not be used as the sole method of contraception in women taking nevirapine. They suggest that a barrier method (e.g. condoms) should also be used, and note that this is also advisable to reduce the risk of HTV transmission. The Faculty of Family Planning and Reproductive Health Care (FFPRHC) Clinical Effectiveness Unit notes that nevirapine can induce liver enzymes and may reduce the levels of ethinylestradiol and progestogens. They therefore recommend that their guidance on hormonal contraceptives and liver enzyme inducers is followed, see Hormonal contraceptives + Antiepileptics Barbiturates or Phenytoin , p.985 for fiir-ther detail. 

Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risks what pediatric health care providers should know. Pediatr 112 951-957 Greess H, Wolf H, Baum U et al (2000) Dose reduction in computed tomography by attenuation-based on-line modulation of tube current evaluation of six anatomical regions. Eur Radiol 10 391-394 Greess H, Nbmayr A, Wolf H et al (2002) Dose reduction in CT examination of children by an attenuation-based online modulation of tube current (CARE dose). Eur Radiol 12 1571-1576... 

Accidental exposures to potentially infective blood and body fluids are common in health care despite risk reduction policies [5, 6]. The greatest risk of blood-borne infections is posed by percutaneous injuries either by sticking with a needle or cutting with a sharp object. This may happen during the medical procedure performed to the patient or by handling used instruments afterwards. 

Prevention strategies for risk reduction are implemented before a risk event occurs. Reducing the probability of an adverse risk has intrinsic welfare benefits and increases people s expected income and reduces their income variance. Preventive interventions include measures designed to reduce risks in the labor market (the risk of unemployment, for instance), preventive health care measures (such as vaccination, use of mosquito nets, or information campaigns), and the development and implementation of standards (such... 

Patient safety is a major concern in heaith care systems woridwide. Patients with serious conditions, muitimorbidity, and with intense and fragmented health care utilization, like end-stage renal disease (ESRD) patients, are at increased risk for suffering adverse events. In this chapter, the fundamental terms and concepts of patient safety are introduced. Essential epidemiological data relating to the frequency of adverse events and medical errors are provided. The chapter reports important safety threats for ESRD patients and describes examples of key innovations which contribute to patient safety. Recommendations and risk reduction strategies to improve care of ESRD patients are presented. 

There is growing concern over the potential risks to human health and the environment arising from leather goods. Dye manufacturers and tanneries are concerned about effluent, air pollution, containers and packaging [56]. In the light of the relatively important contribution to leather dyeing of azo dyes that can yield hazardous arylamines on reduction, careful guidance on the selection of dyes for leather is essential, with emphasis on procurement from reliable sources and the utilisation of liquid formulations to minimise... 

B. Indications and use Xigrix is indicated for the reduction of mortahty in adult patients with severe sepsis (sepsis associated with acute organ dysfunction) who have a high risk of death [as determined by the acute physiology and chronic health evaluation (APACHE) score, the most widely used method of assessing the severity of illness in acutely ill patients in intensive care units]. 

Reduce child mortality Reduction of the indoor air pollution that contributes to respiratory infections that account for up to 20 % of child deaths reduction in the need for gathering and preparing traditional fuels that exposes children to health risks and reduces time spent in child care modem energy leads to fewer bums, accidents and house hres provision of nutritious cooked food, space heating and boiled water contribute to better health cold chain provision allows access to vaccines. 

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