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Journal of Lower Genital Tract Disease Apr 2020The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities...
UNLABELLED
The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities recommend 1 of 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, 5-year return to regular screening) based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for the many different combinations of current and recent past screening results. This article supports the main guidelines presentation by presenting and explaining the risk estimates that supported the guidelines.
METHODS
From 2003 to 2017 at Kaiser Permanente Northern California (KPNC), 1.5 million individuals aged 25 to 65 years were screened with human papillomavirus (HPV) and cytology cotesting scheduled every 3 years. We estimated immediate and 5-year risks of CIN 3+ for combinations of current test results paired with history of screening test and colposcopy/biopsy results.
RESULTS
Risk tables are presented for different clinical scenarios. Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. The immediate and 5-year risks of CIN 3+ used to decide clinical management are shown.
CONCLUSIONS
The new risk-based guidelines present recommendations for the management of abnormal screening test and histology results; the key risk estimates supporting guidelines are presented in this article. Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables.
Topics: Adult; Aged; California; Consensus; Early Detection of Cancer; Female; Humans; Middle Aged; Papillomaviridae; Practice Guidelines as Topic; Risk Assessment; Risk Management; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 32243308
DOI: 10.1097/LGT.0000000000000529 -
La Clinica Terapeutica 2021Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in...
Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in the next years does not seem to be manifestly unfounded. For this reason, it is wise for healthcare professionals to already be aware that any violation of the interests underlying the legislation in question entails a ruling on civil and/or criminal liability. It is therefore necessary to identify the most suitable means to prevent undue harm occurring, partly to exempt healthcare professionals and hospitals from compensation costs, thereby providing them with recourse to insurance coverage. Healthcare facility organisations must adopt Risk Management techniques as a tool to simultaneously guarantee the effectiveness of health services (in this case), the efficiency of the management economy, and finally compliance with all legally required precautions. This will relegate the occurrence of an adverse event to remote and unpredictable hypotheses, thus guaranteeing useful recourse to insurance coverage to compensate any harm that does occur.
Topics: Compensation and Redress; Delivery of Health Care; Health Personnel; Humans; Liability, Legal; Risk Management
PubMed: 33346331
DOI: 10.7417/CT.2021.2285 -
World Journal of Emergency Surgery :... 2017In the USA alone, around 22 million patients annually discuss the need for surgical procedure with their surgeon. On a global scale, more than 200 million patients are... (Review)
Review
In the USA alone, around 22 million patients annually discuss the need for surgical procedure with their surgeon. On a global scale, more than 200 million patients are exposed to the risk of undergoing a surgical procedure every year. A crucial part of the informed consent process for surgery is the understanding of risk, the probability of complications, and the predicted occurrence of adverse events. Ironically, risk quantification, risk stratification, and risk management are not necessarily part of a surgeon's core skillset, considering the lengthy surgical training curriculum towards technical excellence. The present review was designed to provide a concise historic perspective on the evolution of our current understanding of risk and probability, which represent the key underlying pillars of the shared decision-making process between surgeons and patients when discussing surgical treatment options.
Topics: Decision Making; History, 15th Century; History, 16th Century; History, 17th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Physician-Patient Relations; Probability; Risk; Risk Management
PubMed: 28293279
DOI: 10.1186/s13017-017-0125-6 -
The Journal of International Medical... Jan 2020
Topics: Animals; Humans; Pharmaceutical Preparations; Risk Assessment; Risk Management
PubMed: 29726289
DOI: 10.1177/0300060518771424 -
Sensors (Basel, Switzerland) Aug 2021Addressing cyber and privacy risks has never been more critical for organisations. While a number of risk assessment methodologies and software tools are available, it...
Addressing cyber and privacy risks has never been more critical for organisations. While a number of risk assessment methodologies and software tools are available, it is most often the case that one must, at least, integrate them into a holistic approach that combines several appropriate risk sources as input to risk mitigation tools. In addition, cyber risk assessment primarily investigates cyber risks as the consequence of vulnerabilities and threats that threaten assets of the investigated infrastructure. In fact, cyber risk assessment is decoupled from privacy impact assessment, which aims to detect privacy-specific threats and assess the degree of compliance with data protection legislation. Furthermore, a Privacy Impact Assessment (PIA) is conducted in a proactive manner during the design phase of a system, combining processing activities and their inter-dependencies with assets, vulnerabilities, real-time threats and Personally Identifiable Information (PII) that may occur during the dynamic life-cycle of systems. In this paper, we propose a cyber and privacy risk management toolkit, called AMBIENT (Automated Cyber and Privacy Risk Management Toolkit) that addresses the above challenges by implementing and integrating three distinct software tools. AMBIENT not only assesses cyber and privacy risks in a thorough and automated manner but it also offers decision-support capabilities, to recommend optimal safeguards using the well-known repository of the Center for Internet Security (CIS) Controls. To the best of our knowledge, AMBIENT is the first toolkit in the academic literature that brings together the aforementioned capabilities. To demonstrate its use, we have created a case scenario based on information about cyber attacks we have received from a healthcare organisation, as a reference sector that faces critical cyber and privacy threats.
Topics: Computer Security; Privacy; Risk Assessment; Risk Management
PubMed: 34450935
DOI: 10.3390/s21165493 -
Marine Pollution Bulletin Oct 2021Several risk management frameworks have been introduced in the literature for maritime Pollution Preparedness and Response (PPR). However, in light of the actual needs... (Review)
Review
Several risk management frameworks have been introduced in the literature for maritime Pollution Preparedness and Response (PPR). However, in light of the actual needs of the competent authorities, there is still a lack of framework that is established on a sound risk conceptual basis, addresses the different risk management decision-making contexts of organizations, and provides tools for various risk management questions of this field. To alleviate the limits of existing approaches, this paper introduces a new risk management framework for this purpose, which was developed in cooperation with the competent authorities and other maritime experts. The framework adopts the risk-informed decision-making strategy and includes three aligned components. The first component provides a unified theoretical risk concept to the framework through an interpretation of the Society for Risk Analysis risk approach. The second consists of four ISO 31000:2018 standard based processes focused on different risk management decision-making contexts of the PPR organizations. The third comprises a set of practical risk assessment tools to generate the needed information. A case study provides an example of the functionality of this framework with integrated data from the northern Baltic Sea. To conclude, a risk concept is provided for the PPR authorities and their stakeholders as well as processes for managing the risk and tools for its assessment.
Topics: Environmental Pollution; Risk Assessment; Risk Management
PubMed: 34303060
DOI: 10.1016/j.marpolbul.2021.112724 -
Drug Safety Apr 2021Global adoption of risk management principles outlined in the International Conference on Harmonisation (ICH) E2E guideline and the Council for International...
Global adoption of risk management principles outlined in the International Conference on Harmonisation (ICH) E2E guideline and the Council for International Organizations of Medical Sciences (CIOMS) Working Group VI guidance introduced greater proactivity and consistency into the practice of pharmacovigilance and benefit-risk management throughout the lifecycle of a drug. However, following the release of these guidelines there have been important advances in the science and practice of risk minimisation itself, especially in terms of how risk minimisation measures (RMMs) are designed, implemented, disseminated and evaluated for effectiveness in real-world healthcare settings. In this article, we describe how the field of design, implementation, dissemination and evaluation of RMMs has advanced in recent years while highlighting current areas of challenge and possible solutions. Where possible we cite global examples to demonstrate how evidence-based approaches have informed the development of RMMs. In this context, while taking into consideration local healthcare system policies and national legislations, we conclude with a call for a global effort to harmonise certain areas that focus on, but are not limited to, standardising certain terms and definitions, consistent application of robust methodologies, and outline of best practices for risk minimisation design, implementation, and dissemination.
Topics: Forecasting; Humans; Pharmacovigilance; Risk Assessment; Risk Management
PubMed: 33565024
DOI: 10.1007/s40264-020-01033-z -
Fertility and Sterility Dec 2013Drs. Meldrum and de Ziegler contrast medicine with the ultra-safe industry of aviation. Analogous to the "right patient, right side, and right organ" procedures already...
Drs. Meldrum and de Ziegler contrast medicine with the ultra-safe industry of aviation. Analogous to the "right patient, right side, and right organ" procedures already instituted widely throughout medicine, they emphasize the extreme importance and methods for identification and tracking of specimens and recipients for assisted reproductive technology (ART) procedures. One of the authors describes his experience with a formal "ISO" accreditation process that standardizes most aspects of risk and safety management. Because risk and safety management has yet to be commonly extended into physicians' offices and that is where ART procedures are usually recommended and carried out, detailed suggestions are offered regarding ways to reduce risk and maximize safety in that environment. Finally, a suggestion is made for establishment of a Clinical Safety Board for ART so adverse events are reported and investigated, promoting educative efforts and preventive strategies to enhance future patient safety.
Topics: Female; Humans; Infertility; Male; Medical Errors; Patient Safety; Pregnancy; Pregnancy, Multiple; Reproductive Techniques, Assisted; Risk Management; Safety Management
PubMed: 24200108
DOI: 10.1016/j.fertnstert.2013.10.003 -
Accident; Analysis and Prevention Feb 2022Fatigue Risk Management Systems (FRMS) are a data-driven set of management practices for identifying and managing fatigue-related safety risks. This approach also... (Review)
Review
OBJECTIVE
Fatigue Risk Management Systems (FRMS) are a data-driven set of management practices for identifying and managing fatigue-related safety risks. This approach also considers sleep and work time, and is based on ongoing risk assessment and monitoring. This narrative review addresses the effectiveness of FRMS, as well as barriers and enablers in the implementation of FRMS. Furthermore, this review draws on the literature to provide evidence-based policy guidance regarding FRMS implementation.
METHODS
Seven databases were drawn on to identify relevant peer-reviewed literature. Relevant grey literature was also reviewed based on the authors' experience in the area. In total, 2129 records were screened based on the search strategy, with 231 included in the final review.
RESULTS
Few studies provide an evidence-base for the effectiveness of FRMS as a whole. However, FRMS components (e.g., bio-mathematical models, self-report measures, performance monitoring) have improved key safety and fatigue metrics. This suggests FRMS as a whole are likely to have positive safety outcomes. Key enablers of successful implementation of FRMS include organisational and worker commitment, workplace culture, and training.
CONCLUSIONS
While FRMS are likely to be effective, in organisations where safety cultures are insufficiently mature and resources are less available, these systems may be challenging to implement successfully. We propose regulatory bodies consider a hybrid model of FRMS, where organisations could choose to align with tight hours of work (compliance) controls. Alternatively, where organisational flexibility is desired, a risk-based approach to fatigue management could be implemented.
Topics: Accidents, Traffic; Fatigue; Humans; Risk Management; Safety Management; Sleep
PubMed: 34756484
DOI: 10.1016/j.aap.2021.106398 -
Contrast Media & Molecular Imaging 2022Cardiovascular medicine patients have complex conditions and rapid progress. They will cause a variety of complications during the illness and are difficult to care for....
Cardiovascular medicine patients have complex conditions and rapid progress. They will cause a variety of complications during the illness and are difficult to care for. In addition, the above departments have many treatment tools, complex nursing points, and nursing risks. Scientific risk management should be carried out to avoid the occurrence of adverse events. Existing studies incorporating nursing risk management into cardiovascular health care are incomplete. This paper aims to explore the analysis and research methods of nursing cardiovascular medicine applications and effects evaluation based on nursing risk management and deep learning. Through the observation and experiment of grouping 100 cardiovascular medicine patients in a hospital, the total satisfaction degree of the experimental group reached 90%, and the control group was only 48%, which is quite different in comparison. The factors affecting the occurrence of nursing risk have the characteristics of multiplicity, instability, and uncertainty. Therefore, in order to improve the nursing effect and the rescue rate, it is imperative to strengthen the nursing risk management and, at the same time, reduce the patient's physical pain and nursing risk.
Topics: Humans; Risk Management; Research Design
PubMed: 36299830
DOI: 10.1155/2022/9253868