INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE最新文献

Background: The research is placed in the context of interdisciplinary medical-legal studies on the importance of promoting physical activity as a public health tool.

Objective: The aim was to highlight the tools that can be used by EU members for planning interventions aimed at overcoming the consequences of the COVID-19 pandemic and for responding to a future crisis.

Methods: First, the medical resources relating to the indirect and direct effects of the COVID-19 pandemic are analysed. Then, the results are compared with the measures of the EU bodies to verify the correspondence of the scientific arrests, with the political-regulatory interventions.

Results: It was found that the prolonged closure of sports centres and the contagion from COVID-19 produce affects the body in a way that can only be recovered by motor activity. However, in the EU, there does not exist a regulatory harmonization about health issues that can directly impose the Members to implement their legislation to promote motor activity.

Conclusions: The signing of the Rome Declaration at the Global Health Summit on 21 May 2021 constitutes an important and concrete commitment for the exchange in the medical-scientific field, and for an effective co-design of intervention strategies for the relaunch of physical activity within projects such as EU4Health and the two-year HealthyLifestyle4All campaign.

Background: The improvement of health represents a goal for all countries in the world in a global way and, compared to earlier stages of development, there is a significant focus by the public health system on community and home-based services in particular.

Objective: This objective was reaffirmed during the last World Health Summit (May 2021), at which the leaders of the G20 countries, together with other member states, signed the "Declaration of Rome".

Methods: The paper contains the study of the impact that the COVID-19 pandemic has determined on the organization of the health system, through the study of the data provided by the main national and international organizations in the health field.

Results: It emerged that the field of personal, family and community care are certainly an area of growth for nursing, which also in the European context, is showing an increase importance given to services and care activities outside the hospital and home in particular. In all of this, the roles that nurses can assume are differentiated and articulated.

Conclusions: In the complexity of this perspective, families and community seem to emerge as a point of reference for a nursing care that is certainly going through a decisive moment in the slow, but inexorable path towards the emancipation of its disciplinary status and the development of its ability to provide new, original and autonomous responses to the needs of the assisted population.

Background: Discharge summaries (DCS) are vital in facilitating handover to community colleagues. Unfortunately, at Whittington Health, General Practitioners (GPs) found it difficult to identify relevant information in DCS, and use of medical jargon meant patients did not understand details of their admission. With this quality improvement project, the team aimed to improve DCS to enhance patient-centered care.

Objective: The aim of this quality improvement project (QIP) was to improve the quality of DCS by critiquing the ones produced within our trust and implementing various interventions.

Methods: Multiple Plan-Do-Study-Act (PDSA) cycles were completed. A multi-disciplinary meeting was conducted to identify the needs of each party in a DCS. A new template was subsequently launched. Teaching was conducted and educational leaflets were disseminated hospital-wide. Quality of written communication was audited quarterly, and evaluated against quality indicators. Problems with DCS were identified via GP and patient feedback, and these became the focus of subsequent PDSA cycles.

Results: From March 2019 to February 2020, all the audited categories improved, with an overall improvement from 67% to 92%. We also received positive feedback from GPs.

Conclusions: Quality of DCS can be improved with appropriate interventions, leading to improved patient care. A similar PDSA cycle could be utilized elsewhere to achieve similar results.

Background: The health sector has long been affected by programs, actions, plans to digitize data and care processes with a view to better protecting individual health, as well as public health, resulting in a slow and uneven development of different and often incompatible national services.

Objective: This paper aims to explore the grounds behind the urgency of turning the digital priority into concrete actions, as acknowledged by political leaders in the Rome Declaration, by explaining the capacity of digital tools to enhance healthcare management and the current obstacles.

Methods: It considers the progressive extension of the EU institutions' scope of action during the pandemic, the related supporting financial strategies launched and some examples of digital contact tracing systems.

Results: It emerged that the pandemic highlighted the inadequacy of purely national policies and the advantages of leveraging the digital health data processing for governance, surveillance and response to cross-border and global threats.

Conclusions: Considering what emerged during the pandemic and the solemn commitment of the world's major political leaders, the solution to the still existing technical and organizational interoperability issues will no longer be postponed.

Background: With the majority of antibiotics being prescribed in primary care it is of utmost importance that antimicrobial stewardship principles are adhered to in order to slow down the incidence of antimicrobial resistance.

Objective: Broad spectrum antibiotic prescribing is often seen as a proxy marker of increasing resistance within a population and so it is important that they are used sparingly, to avoid drug-resistant bacteria developing.

Method: In Tameside and Glossop a novel approach, using quality improvement methods, was employed to allow the behaviour change to be sustained for a longer period. Practices submitted monthly broad spectrum usage data, and if over a set target they were required to submit a "deep dive".

Results: A 10.6% reduction of broad spectrum antibiotic usage was seen over the 2019-20 financial year.

Conclusion: Over time the number of practices submitting a deep dive reduced and clinicians saw the deep dive as method to peer review their prescribing. Putting the practice staff in control of their own prescribing, allowed for a better method to sustain the improvement.

Background: The Global Health Summit was held in Rome on 21 May 2021, co-hosted by the European Commission and Italy, as chair of the G20. Leaders, heads of regional and international organizations met to share lessons learned from the COVID-19 pandemic and to define the path ahead.

Objective: The present paper analyses the Rome Declaration as the first global health programme shared among the G20 Member States and based on the One-Health approach.

Methods: Documents such as preparatory work, official documents and observations from international organizations were analysed in order to provide a comprehensive review of the Rome Declaration.

Results: Core principles of the Rome Declarations have emerged as well as the goal to improve cooperation among existing international organisations and national authorities.

Conclusions: Governments' future decisions will be the key to determine the end of the pandemic. The interconnected impacts on health, the environment, and social and economic dimensions will be a central theme of the overall narrative aiming at bringing the G20 process towards achieving a more inclusive and sustainable society.

Background: In the COVID-19 pandemic, coordination was certainly late, also due to the scarcity of information disseminated at the very beginning of the pandemic, when countries were inevitably taken by surprise. The lack of information, mainly attributable to the country from which everything seems to have started, has produced a huge delay and numerous uncertainties in the feedback of the WHO and international organizations.

Objective: The inevitably relevant issue, from a legal point of view, concerns the legitimacy, formal or in any case shared, of the authority in charge of coordinating reactions and policies. The paper analyses the current legislation, soft and hard law, and the undertaken policies concerning emergency responses.

Methods: International and EU legislation analysis.

Results: The G20 understood that sustainable, flexible and agile funding systems for health emergencies are essential elements of pandemic prevention, preparedness and response. In EU there are many regulations about coordination and response to emergencies in practice in the EU and the Regulation (EU) 2021/522 (EU4Health programme), broadly extends the Union's competence in the field of health and has the objective of strengthening the Union's capacity for prevention, preparedness and rapid response in the event of serious cross-border threats to health.

Conclusions: It is essential to formalize, within international agreements, the institutionalization of relationships, procedures, and the possible recognition of the reference figure. If in the European Union, at least partially, the protocols are there (even if the COVID-19 emergency has blown them up in principle), certainly in relations with non-EU countries the story is complicated, requiring specific agreements. This is the goal of the path started by the Rome Declaration of 21 May 2021 within the G20 - Global Health Summit.

Background: Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties.

Objective: The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England.

Method: We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes.

Results: We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest "wrong implants" (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 "wrong-site surgery" incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each.

Conclusion: We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.

Background: Induced abortion is a medical practice that has always been much discussed all over the world. Abortion is allowed in most European countries at the request of the woman with limitations that are imposed mainly by the gestational age. However, there are legislative differences between European countries which impose stringent limits on the use of induced abortion.

Objective: This article analyzes the European legislation on abortion, with a particular focus on countries in which there have been recent legislative changes in recent years, and the possible consequent risk of inequality among European women.

Methods: Government and ministerial websites of the countries analyzed have been consulted to investigate abortion laws in Europe. In addition, the Global Abortion Policies Database of the World Health Organization was also consulted for a regulatory comparison.

Results: The differences between the various European countries are considerable. Although guaranteed by most legislation, abortion remains a fragile right in some European countries.

Conclusion: Different legislation in the various countries of Europe causes difficulties for women who want to have an abortion but who reside in states where there are strict limits to abortion. In addressing the issue of induced abortion, we must not forget that the center of this practice is the woman. For this reason, it is essential to apply a reasoning based on respect for women's rights: freedom, health, and self-determination.