Bücher zum Thema „Safety logiciel“

Ensuring epidemiological safety as a component of the quality and safety of medical ser-vices requires the introduction of new methods of prevention, diagnosis and treatment of health care-associated infections (HAIs) into clinical practice.The high prevalence of HAIs in medical organizations of various specialties, significant damage to the health of the population, the economy and the demographic situation all over the world determine the relevance of their prevention at the present time.Conference abstracts were submitted by leading epidemiologists, young researchers and medical practitioners. The published materials contain data on the organization of epidemio-logical surveillance of HAIs, methods of their diagnosis and epidemiological investigation, on the sensitivity of etiological agents to antibiotics, bacteriophages and disinfectants, examples of complex measures for the non-specific prevention of nosocomial infections.Conference abstracts are of interest to epidemiologists, hygienists, microbiologists, specialists of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, disinfectologists, teachers of secondary and higher educational institutions.

This article reviews scholarship on the history and historiography of slavery in the early republic and antebellum United States. During the colonial period, slavery was present in varying degrees throughout what would become the United States. In the wake of the American Revolution, however, slavery became the ‘peculiar institution’ of the South. In the North, where the slave population was small and less crucial to the functioning of the economy, states took the revolutionary ideals of liberty and equality to their logical conclusion, each passing either an immediate or gradual emancipation law by 1804. Further south, especially in the Chesapeake, slavery was weakened as revolutionary-era runaways and manumissions depleted the slave population. Yet, with the fading of the revolution's egalitarian rhetoric and the invention of the cotton gin that made it possible to extract safely and efficiently the delicate fibres from short-staple cotton, the institution of slavery would not only persevere but become entrenched and expand across the southern United States. The antebellum decades witnessed the movement of slaves south and west with the advance of the cotton frontier.

‘Everything has structure’ considers the fundamental nature and role of structure and the relationship of structural engineering with other engineering disciplines and with architecture. Decision making is driven by the purpose of a man-made structure and how ‘fitness for purpose’ is realised. There is a need to understand how forces flow through a structure in order to ensure it meets its primary purpose of being strong and safe whilst at the same time meeting many other needs such as affordability, aesthetic, and regulatory and environmental criteria. The best structures are a harmony of architecture and engineering—where form and function are one and the flow of forces is logical.

This book provides, without the use of specialist language, a description of diagnostic reasoning and error and a discussion of steps that could improve diagnostic accuracy. Drawing on work in cognitive psychology, it presents the key characteristics of human reasoning. It notes that complex cognitive tasks such as medical diagnosis require a synergy of intuition and analytical thinking and introduces the concept of bias. The book considers the value of current classifications of disease, the meaning of diagnostic thresholds, and the potential for overdiagnosis. It examines the role of the patient-centred approach in this context. It develops a description of the diagnostic process, provides illustrative examples and metaphors, and refers to the dual-process model. It suggests that medical training does not consistently provide a coherent account of diagnostic thinking and the associated risks of error. It considers the role of probability in diagnostic reasoning, noting the contribution and the limitations of both informal and mathematical estimates. It refers to clear evidence that error in medical diagnosis is a prevalent and potent cause of harm and may result from systems factors or cognitive glitches such as bias and logical fallacy. It presents cases with commentaries, highlighting the cognitive processes in diagnostic successes, near misses, and disasters. It concludes with proposals for change, notably in institutional culture; in professional culture, education, and training; and in the structure of medical records. The book advocates the development and deployment of computerized diagnostic decision support. It argues that these changes could significantly enhance patient safety.

Malignant hypertension (MH) is recognized clinically by elevated blood pressure together with retinal haemorrhages or exudates with or without papilloedema (grades III or IV hypertensive retinopathy); and may constitute a hypertensive emergency or crisis when complicated by evidence of end-organ damage including microangiopathic haemolysis, encephalopathy, left ventricular failure, and renal failure. Though reversible, it remains a significant cause of end-stage renal failure, and of cardiovascular and cerebrovascular morbidity and mortality in developing countries.MH can complicate pre-existing hypertension arising from diverse aetiologies, but most commonly develops from essential hypertension. The absolute level of blood pressure appears not to be critical to the development of MH, but the rate of rise of blood pressure may well be relevant in the pathogenesis. The pathogenesis of this transformation remains unclear.The pathological hallmark of MH is the presence of fibrinoid necrosis (medial vascular smooth muscle cell necrosis and fibrin deposition within the intima) involving the resistance arterioles in many organs. Fibrinoid necrosis is not specific to MH and this appearance is seen in other conditions causing a thrombotic microangiopathy such as haemolytic uraemic syndrome, scleroderma renal crisis, antiphospholipid syndrome, and acute vascular rejection post transplant. MH can both cause a thrombotic microangiopathy (TMA) but can also complicate underlying conditions associated with TMA.The pathophysiological factors that interact to generate and sustain this condition remain poorly understood. Risk factors include Afro-Caribbean race, smoking history, younger age of onset of hypertension, previous pregnancy, and untreated hypertension associated with non-compliance or cessation of antihypertensive therapy.Evidence from clinical studies and animal models point to a central role for the intrarenal renin–angiotensin system (RAS) in MH; there is good evidence for renal vasoconstriction and activation of the renal paracrine RAS potentiating MH once established; however, there may also be a role in the predisposition of MH suggested by presence of increased risk conferred by an ACE gene polymorphism in humans and polymorphisms for both ACE and AT1 receptor in an animal model of spontaneous MH. Other vasoactive mediators such as the endothelin and the inflammatory response may be important contributing to and increasing endothelial damage. There have been no randomized controlled trials to define the best treatment approach, but progressive lowering of pressures over days is considered safest unless made more urgent by critical clinical state. It seems logical to introduce ACE inhibition cautiously and early, but in view of the risk of rapid pressure lowering some recommend delay.