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Résumé: Objectif. Une démarche de coopération Ville/Hôpital a été initiée pour améliorer la prise en charge des patients en sortie d'hospitalisation et les relations interprofessionnelles. L'objectif est de créer une dynamique et des échanges entre les pharmaciens officinaux et les acteurs hospitaliers pour améliorer la continuité de la prise en charge du patient à sa sortie et proposer des actions correctives et préventives. Méthode. Les prescriptions de sortie des patients hospitalisés sont analysées en recueillant des événements indésirables selon deux méthodes. Les dysfonctionnements rencontrés par la Pharmacie à Usage Intérieur sont collectés via le logiciel de gestion des risques de l'établissement et ceux rencontrés par les officines via les fiches progrès officinales. Résultats. Un Comité de Retour d'Expérience (CREX) entre la Pharmacie à Usage Intérieur (PUI) du Centre Hospitalier de l'Agglomération Montargoise (CHAM) et les officines de l'agglomération a été créé en 2016, avec l'appui du service qualité et gestion des risques de l'établissement. Deux CREX sont organisés par an pour analyser les événements indésirables rencontrés par la PUI et les officines. Depuis 2018, 258 événements indésirables ont été analysés. Les principales difficultés rencontrées par les officinaux sont des erreurs ou des absences de durée (21 %), de dosage (20 %) et de posologie (12 %) sur les ordonnances. Des actions de communication et de sensibilisation ont été mises en œuvre auprès des médecins hospitaliers pour arrêter les prescriptions manuscrites et pour être vigilants sur leurs ordonnances de sortie. Une communication a été engagée entre la PUI et les officines pour les informer lorsqu'un médicament est nouvellement disponible en ville ou d'une rupture de médicament. Conclusion. Ce projet s'inscrit dans une démarche globale d'amélioration des relations ville/hôpital. Objective. A seamless care approach has been initiated to improve Patients' care after hospital discharge and interprofessional relations. The aim was to create and favor exchanges between pharmacists and hospital's stakeholders, to improve the continuity of the patients' care after hospital discharge and to propose corrective and preventive actions. Methods. The patient discharge prescription and adverse events met by hospital and private pharmacies were analyzed. The collection of adverse events was carried out using two methods. The difficulties encountered by the Hospital Pharmacy arewere collected via the institution's risk management software and those encountered by the private pharmacies via the officinal progress document. Results. Experience Feedback Committee (known as Comité de Retour d'Expérience or CREX in French) between Hospital Pharmacy and Montargis community pharmacies was created in 2016, with the support of the quality and risk management department of the hospital. Two CREX a year are organized to analyze adverse events. Since 2018, 258 adverse events have been analyzed. The main difficulties are errors or absences of duration (21%) and dosage (32%). Communication and awareness-raising actions have been implemented with hospital's doctors to stop handwritten prescriptions and to be vigilant about their discharge orders. A communication was initiated between the hospital pharmacy and community pharmacies to inform them about drug shortage. Conclusion. This project of city-hospital cooperation improve the continuity of the patients' care after hospital discharge and interprofessional relations. [ABSTRACT FROM AUTHOR]

Our paper reports on research on risk evaluation and management conducted with three probation services in French- or Italian-speaking cantons in Switzerland. It analyzes how probation officers construct an understanding and evaluation of levels of risk of reoffending for people convicted and serving parts of their sentences in an open environment. Our analysis combines observations of and interviews with probation officers using a method called "instructions to the double", as well as analysis of written records (personal files, evaluation grids). We show that the risk evaluation activity of the probation officers, which we view as a cognitive and social process, draws on different sources. It is characterized by the multiplicity and heterogeneity of the resources mobilized, its dynamic character over the course of the interaction, and its orientation towards risk management. In addition, its validity is also tested in formal or informal collective evaluations. We show, in conclusion, that it does not correspond to the standardized approach advocated in the criminological literature. [ABSTRACT FROM AUTHOR]

In recent years, the Saharan urban centers are particularly affected by natural disasters. They suffered all the more because neither the citizens nor the local authorities were prepared to deal with it, both physically and humanely. The floods that occurred at close intervals in 2004, 2008 and 2009 demonstrated that there were serious problems with the management of such a risk. The urban plans in force had not integrated this dimension and their lax application allowed the construction of housing, and sometimes even public facilities, in the floodplain. Because the Saharan regions are known for their aridity, unprepared officials can nevertheless be explained; but it is more difficult to understand the failures or dysfunctions that accompanied the reconstruction and relocation programs, even though the scale of the disaster quickly proved to be beyond the means of response of local authorities. The circumvention strategies systematically implemented by the “beneficiaries" of aid for the rehabilitation or reconstruction of their homes, as well as by those who obtained social housing to resettle their families, show the lack of consultation between citizens and the departments and administrations responsible. The bureaucratic functioning of the allocation of aid has caused considerable delays in the progress of the work. We wonder in the end about solutions that are conceivable in the short and medium terms to prevent risks whose frequency is likely to become larger, and the applicability, in the Algerian context, of these solutions. [ABSTRACT FROM AUTHOR]

Résumé La conception de règles (lois, normes, directives, procédures, protocoles) et la mise en place d’un management qui vise à la conformité des comportements des opérateurs avec ces règles ont longtemps constitué l’approche dominante pour améliorer la sécurité des systèmes sociotechniques à risques. Cette approche a montré son efficacité à faire progresser la sécurité en permettant aux organisations de se préparer aux risques et aux défaillances prévisibles. Cependant, dans nos systèmes sociotechniques modernes, constamment évolutifs et où la gestion de l’imprévu est devenue la norme, cette approche a montré ses limites. Les prises d’initiative qui s’écartent parfois des règles, se révèlent tout aussi indispensables au maintien de la sécurité que leur respect. Dès lors, si les règles demeurent un élément central du management des risques, l’enjeu n’est plus l’évitement des écarts, mais le monitorage continu de leur usage afin de distinguer les écarts qui constituent une dérive vers l’accident et dont les conditions sous-jacentes de survenue doivent être corrigées, de ceux qui sont le témoin d’une règle devenue inadaptée pour faire face à la situation et dont la poursuite de l’observance pourrait s’avérer dangereuse. The design of rules (laws, norms, policies, procedures, protocols) and the implementation of a management that aimed at conforming the behaviors of operators with these rules has long been the dominant approach to improve safety in socio-technical systems. This approach has proven to be effective in enhancing safety by enabling organizations to cope with predictable risks and failures. However, in our modern and constantly evolving socio-technical systems, where the management of unforeseen situation has become the rule, this approach has shown its limitations: operators’ initiatives, which sometimes deviate from rules, are equally important for maintaining safety. Therefore, while the rules remain a key feature of risk management, the challenge is not the search for total compliance with rules, but the permanent monitoring of their use to detect and distinguish gaps that constitute a drift towards the accident from gaps that highlight that the rule has become inappropriate and which the compliance with may prove dangerous for safety. [ABSTRACT FROM AUTHOR]

Introduction: Nowadays, the circuit of drugs is a plague. This situation may cause serious harm to patients. In this context, we conducted a study with the aim to describe and evaluate the circuit of anticancer drugs in a Tunisian regional hospital. Methods: This is an evaluative study of the risk of anticancer drugs, conducted over a period of 15 days during the year 2014 in the Department of Cancer Research of the Regional Hospital of Gafsa (Tunisia). The evaluation method is based on that conducted by the project "SECURIMED" and developed by the Coordination Committee of the Clinical Evaluation and Quality in Aquitaine (CCECQA) in France. Results: In our study, the observation of anticancer drugs circuit has revealed some deficiencies. We noted that the roles of the various actors are subject sometimes to tasks shifting, which may sometimes be dangerous. The study also revealed a lack and an inadequacy with the standards in terms of the necessary equipment for the preparation of the anticancer drugs. Conclusion: Securing drugs circuit should be a priority included in all national processes and shared by all stakeholders to achieve a premium goal: the quality of care and patient safety. [ABSTRACT FROM AUTHOR]

Résumé La gestion des risques est une des composantes fondamentales de la réussite d’une entreprise, que ce soit en termes économique, sociétal, ou environnemental. La gestion des risques est une activité d’autant plus importante pour les entreprises que l’enjeu de sécurité optimale des produits et services est grand. Ceci est le cas particulièrement pour les établissements du secteur de la santé. Le management des risques apparaît donc comme un outil d’aide à la décision et un moyen pour garantir la pérennité d’une organisation. Dans ce contexte, quelles méthodes et démarches mettre en œuvre pour gérer les risques d’une organisation ? À travers cet état de l’art, nous nous intéressons à la notion de risque et au processus de gestion des risques. Ensuite nous nous focalisons sur les différentes méthodes de gestion des risques et les critères de choix entre ces différentes méthodes. Enfin nous mettons en avant le besoin de compléter ces méthodes par une démarche systémique et globale notamment à travers l’évaluation des risques par les audits. Risk management is a fundamental component of any successful company, whether it is in economic, societal or environmental aspect. Risk management is an especially important activity for companies that optimal security challenge of products and services is great. This is the case especially for the health sector institutions. Risk management is therefore a decision support tool and a means to ensure the sustainability of an organization. In this context, what methods and approaches implemented to manage the risks? Through this state of the art, we are interested in the concept of risk and risk management processes. Then we focus on the different methods of risk management and the criteria for choosing among these methods. Finally we highlight the need to supplement these methods by a systemic and global approach including through risk assessment by the audits. [ABSTRACT FROM AUTHOR]

Résumé Les arboviroses, des maladies virales transmises par des arthropodes hématophages, sont responsables de syndromes fébriles parfois accompagnés de manifestations hémorragiques ou neurologiques. Les activités humaines ont favorisé l’émergence de ces virus, originellement zoonotiques, la domestication des principaux vecteurs et leur dissémination à travers le monde. L’épidémiologie des arboviroses, transmises par des moustiques du genre Aedes , a connu d’importantes modifications au cours de la dernière décennie, notamment en lien avec la dissémination intercontinentale d’ Aedes albopictus . Nous abordons ici les conséquences épidémiologiques de l’invasion par cette espèce de l’Afrique centrale et de l’Europe dans un contexte de globalisation des virus. Dans ces zones, le risque de transmission est modulé par des phénomènes d’adaptation virus-vecteurs ainsi que par des phénomènes environnementaux tels que les facteurs climatiques. Face à ces nouveaux risques, il est primordial de développer les capacités de veilles entomologique et virologique, d’évaluation du risque, d’anticipation des risques épidémiques afin de développer de stratégies de prévention et de contrôle des épidémies. Arboviruses – viruses transmitted by haematophagous arthropods – are responsible for febrile syndromes, which sometimes include haemorrhagic or neurological symptoms. Human activities have facilitated the emergence of these originally zoonotic viruses and the domestication and spread throughout the world of their major vectors. The last decade has seen significant changes in the epidemiology of arboviruses transmitted by mosquitoes of the genus Aedes , particularly in relation to the intercontinental spread of Aedes albopictus . Here, we address the epidemiological consequences of the invasion by this species into Central Africa and Europe in a context of viral globalization. The risk of transmission in these areas is influenced by virus-vector adaptation phenomena as well as environmental phenomena including climate. Faced with these new risks, it is essential to develop competences in entomological and virological surveillance, risk assessment and forecasting of epidemic risk in order to develop strategies for the prevention and control of epidemics. [ABSTRACT FROM AUTHOR]

The purpose of an actuarial instrument is to generate a score or numeric index that can be used to predict the probability of an event. The Level of Service / Case Management Inventory (LS/CMI), which is an inventory of the level of service and the management of cases, is part of the last generation of risk-assessment actuarial tools. The predictive validity studies that have been conducted on tools such as the LS/CMI and the Level of Service Inventory- Revised (LSI-R) could not determine satisfactorily the metrological properties of the items that comprise them. The analysis in the present article fills a gap in the writings of specialists by exploiting scientific advancements in measurement theory to the benefit of criminology. The sample was drawn from evaluations carried out at two different times, February 2007 or March 2008, of two groups: 2,670 inmates and 1,837 people serving sentences in the community. The assessments focused primarily on the 43 items operationalizing the eight components of risk that comprise the structure of Part 1 of the LS/ CMI. The results of these assessments have helped target some items that are problematic when it comes to discrimination and redundancy. [ABSTRACT FROM AUTHOR]

Résumé La transfusion est un acte médical délégué couramment effectué en unités de soins. L’hémovigilance nationale, suite à des évènements indésirables graves, dispose d’une réglementation fournie. Le recueil des données centralisées dans la base nationale e-FIT et son analyse nous permettent de détecter les dysfonctionnements survenant au décours de l’acte transfusionnel. La sécurité transfusionnelle repose sur un respect strict des étapes d’un processus qui va de la prescription des produits sanguins labiles et des examens immuno-hématologiques érythrocytaires nécessaires jusqu’à l’administration de PSL au receveur et à son suivi. Dans la circulaire relative à l’acte transfusionnel, plusieurs étapes du processus, moins explicites, peuvent être interprétées différemment par les professionnels et être à l’origine de dysfonctionnements graves. La protocolisation de la pose de la transfusion et de sa surveillance, permettrait d’uniformiser sa réalisation et son suivi de manière sécurisée et d’éviter un risque potentiel chez le patient. Blood transfusion is currently a delegated medical act in patient care services. Following severe adverse events, hemovigilance now disposes of a dense regulation. Data collection and analysis in the national hemovigilance “e-FIT” database allow detection of errors or malfunctions in the transfusion act. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. In the circular relative to the transfusion act, many steps of the transfusion process, less explicit, can be interpreted differently by health care professionals and thus lead to errors or severe adverse events. Standardization of procedures for the transfusion act and its surveillance would increase their safety and avoid potential risks for the patient. [ABSTRACT FROM AUTHOR]

Résumé: Les vigilances sanitaires sont apparues au fil du temps. Certaines possèdent un échelon régional, et toutes se trouvent regroupées à l'Agence nationale de sécurité du médicament et des produits de santé. Avec la certification des établissements de santé (ES), la coordination des vigilances a évolué : son existence semblait facultative dans la première version de la certification, puis s'est imposée aux ES dans les versions suivantes, en précisant les actions à entreprendre. En parallèle, la gestion des risques au sein d'un établissement de santé est en plein essor. La coordination des vigilances trouve avantage dans le partage d'un système déclaratif commun avec la gestion des risques associés aux soins. La collaboration de la coordination des vigilances et de la gestion des risques permet d'élaborer une cartographie a priori des risques, de mettre en place des analyses des évènements indésirables et d'utiliser la notion de criticité dans le cadre d'une culture sécuritaire globale pour l'établissement de santé. [ABSTRACT FROM AUTHOR]

Résumé: Si elles ne sont pas arrêtées avant transfusion, les erreurs de délivrance peuvent avoir des conséquences graves pour les patients. L'étude des déclarations d'incidents de la chaîne transfusionnelle montre que le risque de défaillance est important, en particulier sur les étapes de sélection du patient dans le logiciel de délivrance, de colisage et de remise des PSL au coursier. Les analyses de ces dysfonctionnements font état le plus souvent d'erreurs ű humaines Ƈ par mauvaise application des procédures. Ces erreurs sont favorisées par des causes systémiques : nombreuses interfaces avec l'ensemble des acteurs de la chaîne transfusionnelle, rupture entre les systèmes d'information, stress de l'urgence et autocontrôles visuels en cascade. Des pistes d'amélioration peuvent être proposées dans l'organisation des tâches, l'ergonomie du poste de travail, l'amélioration des systèmes d'information de délivrance et la formation à la prise en charge des urgences. Mais une réflexion coordonnée de l'ensemble des acteurs impliqués dans la prise en charge transfusionnelle des patients est impérative pour réduire les risques liés aux interfaces. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010. Objectives: Since we have had computer systems in our department for several years, we performed an evaluation of practice to assess the impact of both the computer-based help and the updating of knowledge in physicians as tools to improve the application of guidelines for surgical antibiotic prophylaxis. Study design: Clinical audits. Methods: Three clinical audits have therefore been performed before an implementation of computer-based help for clinical decisions and a clinical update for physicians, immediately after, and two years after this combined procedure (2322, 2678 and 2863 patients, respectively). Results: There was an enhancement of clinical practices and compliance to guidelines secondary to the beginning of computer-based prescription (55 to 81%, P <0.05). However, a weaning effect was observed with longer intervals between clinical update and surgical procedure, in association with increased omissions of antibiotic prophylaxis. Conclusion: Computer-based help for clinical decision and prescription seems to be a useful tool for surgical antibiotic prophylaxis but it should be accompanied by direct regular educational measures to update protocols and databases. [Copyright &y& Elsevier]

Abstract: Objective: To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients’ safety. Data sources: A review of English and French articles in Medline database (1990–2011) related to MMC in the ICU. Keywords used: “morbidity (and) mortality conference(s)”, “intensive care unit”, “intensive/critical care medicine”. Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d’Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. Study selection: Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. Data extraction: Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. Data synthesis: Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. Conclusion: Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients’ mortality and morbidity. [Copyright &y& Elsevier]

Abstract: Objective: Burnout is one of the main chronic health problems with negative consequences on health care givers but also on quality of care. The main goal of Physician Health Survey was to study the frequency of burnout among salaried physicians and pharmacists and to compare anesthesiologists and intensivists (AI) with other practitioners (OP). The secondary end points were to analyze risk factors of burnout in each group. Material and methods: An anonymous, self-administered questionnaire was diffused via a specific website. Burnout was measured using the Copenhagen Burnout Inventory (CBI). Several different factors were examined: work/family conflict, salary satisfaction, quality of teamwork, interpersonal relationships, workplace influence, workload and perceived health. The role of each factor was calculated by multivariate logistic regression and comparisons were made between AI and OP. Results: Among the 3196 responses, CBI revealed an elevated score of burnout in 38.4% in AI and in 42.4% in OP. In each group, a great gap was displayed between the CBI results and the self-assessment of burnout (15%). Among AI, risk factors of burnout were high quantitative demand (ORadj=3.40; CI95 1,34–8,63), Work/family conflict (ORadj=; 3.12 CI95 1.60–6.08), low quality of teamwork (ORadj=1.99; CI951.14–3.47) and tense Relation within team (ORadj=1.92; CI95 1.25–2.95). All these factors are observed also among OP. Female gender, young age and dissatisfaction with pay have significant influence but different in the two groups. Claims of recurrent harassment by superiors is a risk factor for burnout only for the AP (adj.OR=1.83; CI95 1.04–3.22). Discussion: Burnout affected near one about two salaried physicians and pharmacists in France. AI were not more concerned by burnout than OP but all of whom have difficulty identifying their own levels of psychological stress and burnout. Decreasing the level of different risk factors i.e. by improving the quality of teamwork should lead to reduce burnout frequency. [Copyright &y& Elsevier]

Abstract: Pathogen inactivation of blood products represents a global and major paradigm shift in transfusion medicine. In the next near future, it is likely that most blood products will be inactivated by various physicochemical approaches. The concept of blood safety will be challenged as well as transfusion medicine practice, notably for donor selection or biological qualification. In this context, it seems mandatory to develop analytical economic approaches by assessing costs-benefits ratio of blood transfusion as well as to set up cohorts of patients based on hemovigilance networks allowing rigorous scientific analysis of the benefits and the risks of blood transfusion at short- and long-term. [Copyright &y& Elsevier]

Abstract: Transfusion is indeed associated with risks that are diverse in nature. Besides, the society expects a risk- and vice-exempt transfusion. During the recent past years, there have been three levels of safety implementation in transfusion: a generalized risk assessment policy; a mastering of processes; standard quality engineering. However, these safety measures have impacts in several ways, such as management and organization, inventory, economics and possibly ethics. All these issues are addressed in the present essay as well as the possible effect of pathogen reduction procedures. [Copyright &y& Elsevier]

Summary: Hemapheresis is made up of a set of essential methods for modern medical practices. Applicated to donors, they allow production of labile blood products as well as raw material for plasma products industrial manufacturing; applicated to patients, they are indispensable for the treatment of many pathologies. Conditions for their implementation are very variable according to the teams who have few tools at their disposal to access, standardize and make reliable their activity. Therefore, an approach has been initiated by the Institut National de la Transfusion Sanguine and the Hemapheresis French Society to develop a guide which primary goal is to help teams evaluate themselves in different areas of their responsabilities. The generalization of the evaluation of professional practices in all activities and specialities required recently by the third iteration of the certification procedure of health institutions and a new law about French health system reinforce us in our approach. Finally, hemapheresis is not whithout risks, neither for donors nor for patients, which now encourages us to analyze sharply our procedures, to identify risk situations and develop means of prevention. This second step is already a current news for us. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This article summarizes functioning and results of anaesthesia adverse effects reporting system over its first 18 months, from August 2006 to February 2008. Study design: Monocentric retrospective study. Methods: Reporting system is available 24/24h, 7/7 to every employee with an individual password. A committee with anaesthesiologists, nurses and risk management engineer examines every notification by two months. We evaluated number of reports, type of reporter, type of dysfunction reported and solutions. Numerical data are compared with a Student t test or X 2 test. A p-value of less than 0.05g being considered as statistically significant. Results: One hundred and eighty-five reports were registered for the first 18 months (1% of anesthesia activity) with a slowdown with time (p =0.02). Eighty-six percent of the statements were made by anesthesiologists, but some physicians had never reported. Malfunctions shared between different services (identity, operating room organisation) are rarely solved (67%) compared to specific anesthesia problems (93%) (p <0.001). Conclusion: The reporting system is simple and available but some professionals don’t declare, generating reporting bias. This network underlines major general dysfunctions (identity) but ways to solve are limited to date. [Copyright &y& Elsevier]

Abstract: Analysing adverse events is part of the medical practice in so far as the part it plays is outstanding in terms of feedback and improved healthcare safety. The integrated implementation of this practice is based on a four-dimensional system: strategic (corporate policies), cultural (safety-oriented cultural mindset), structural (dedicated organization and resources) and technical (methodologies and utilities). Two case studies illustrate the sequencing process from selecting the to-be-analyzed event down to figuring out the appropriate action plan. Beyond the visible and obvious origin, thanks to the implemented methods such as causal tree or ALARM method, far-fetched analysis elements and identified factors likely to explain events can be discovered. Comments on the role and terms of feedback are also hereto expressed. [Copyright &y& Elsevier]

Abstract: Incidents and accidents analysis is one part of risk management in healthcare organisations. It is based on methods such as healthcare process analysis and the Association of Litigation and Risk Management (ALARM) method, to understand not only immediate causes but also root causes. The goal is to implement relevant remedial and preventive actions to secure healthcare processes. The hospital''s risk management unit has to be involved in the methodological analysis of every grade zero transfusion incident. The system is based on a retrospective analysis process in compliance with the French National Authority for Health''s ongoing requirements for risk reactive approach, allowing to identify failures and start relevant actions. Healthcare teams should overcome difficulties in order to be totally involved in the process. Human factors recognition, establishment of clear and effective communication between individuals and critical points of control should provide optimum quality care services that are safe and free of unnecessary risks. [Copyright &y& Elsevier]

Abstract: The sanitary vigilances represent a permanent sanitary surveillance. They signal, enregister, treat and investigate the adverse events occurring through the use of health products. They assure the traceability of these health products and the management of the sanitary alerts. The sanitary vigilances are part of the sanitary security. They are optimized when coordinated and integrated to the global risk management process of the health care establishments. [Copyright &y& Elsevier]

L'interrogation centrale de cet article est la suivante: dans le - très risqué - contexte kinois, quelles sont les stratégies mises en œuvre par les maraîchers et que révèlent ces stratégies sur les capacités de ces derniers? Les deux premières sections posent les bases conceptuelles de l'analyse, en plaçant la question des risques au cœur de l'approche par les capacités et en proposant une approche faisant des stratégies des personnes un proxy acceptable de leurs capacités. Les troisième et quatrième sections confrontent cette discussion théorique aux données recueillies lors d'un travail de terrain mené dans trois périmètres maraîchers de Kinshasa. [ABSTRACT FROM AUTHOR]

Abstract: Investigation of adverse outcomes in obstetrics and gynaecology requires a systematic and systemically oriented approach. The main objective of these assessments is to decrease their incidence. Lethal complications in obstetrics and gynaecological surgery have become so rare in developed countries that we have to grapple mainly with severe morbidities. A model for such investigation is presented, based on answers to 3 questions: What? How? and Why? These questions correspond to 3 components of quality assurance: Outcome, Process, and Structure, respectively. Aspects of Reason''s model of accidents are also included, in the form of "active failures" and "latent conditions." The latter are divided into basic contributory factors, 4 of which are derived from a model of human factors influencing behaviour in anaesthesia or flight-crew environments. To illustrate its basic nature, the model is applied to anonymized cases of surgical complications. Application of the model to the reactive investigation of close calls is discussed, as is application to the proactive interrogation of the care system for the presence and nature of hazards that pose threats to safety. [Copyright &y& Elsevier]

Abstract: The use of medical devices within hyperbaric chambers has always been slowed down by the specific difficulties of this environment. Indeed, installing a medical device within a pressure level much higher than atmospheric pressure and in an oxygen enriched atmosphere is an interesting challenge. In fact, few manufacturers dare engage in this way. Besides, for many years numerous working groups have emerged in hyperbaric medecine. Currently a european standard is being finalized and based on a risk analysis identifying, among other things, a certain number of potential hazards. They can potentially generate dangers during the use of a hyperbaric chamber. Installing a medical device in a hyperbaric chamber is not an easy thing to do. Indeed, the risks induced by a use in a hyperbaric chamber cannot be minimized. Furthermore the medical device must not cause additional risks within the chamber or, anyway, the risks must be evaluated, reduced and accepted. Consequently, prior to installing a medical device, this study proposes a methodology which enables to evaluate the risk management concerning the use of a medical device. Once the methodology completed, the manager of hyperbaric oxygen therapy unit is able to decide whether to install the device or not. [Copyright &y& Elsevier]

Records from REEM’s database of medication errors were studied. REEM is a voluntary medication error reporting program, specifically designed for French hospitals and health care systems and supported by AAQTE with the focus of collecting, analyzing, learning and ultimately reducing medication errors. REEM uses the NCC MERP index for categorizing medication errors. Records of medication errors submitted to REEM by participating health care institutions were analyzed for error category indexing (whether a medication error actually occurred, whether it affected the patient, and if so, the effect it had), node (the stage of the medication use process where the error occurred), type of error, causes, contributing factors and drugs involved. The article presents the results of analysis of 458 reports of medication errors. Errors that affected the patient were seen in 47,4% of the records, and 23,5% of them have contributed to or resulted in harm, and 1,1% in death. The contribution of the different causes of errors (drugs, order and human factors) and associated factors are discussed. This analysis of 458 medication errors reported by health professionnals to REEM produced detailed informations on the scope and nature of medication errors and the means to understand and learn about human factors and propose systemic management of medication error risk, to study and prevent actual medication errors and propose practical solutions that may be applicable to hospitals, and also to drive local quality improvement efforts and improve patient safety. [ABSTRACT FROM AUTHOR]

Nowadays, information system is recognised as one of the key points of the management strategy. An information system is regarded conceptualised as a mean to link 3 aspects of a firm (structure, organisation rules and staff). Its design and implementation have to meet the objectives of medical and economical evaluation, especially risk management objectives. In order to identify, analyse, reduce and prevent the occurence of adverse events, and also to measure the efficacy and efficiency of the production of care services, the design of information systems should be based on a process analysis in order to describe and classify all the working practices within the hospital. According to various methodologies (usually top-down analysis), each process can be divided into activities. Each activity (especially each care activity) can be described according to its potential risks and expected results. For care professionals performing a task, the access to official or internal guidelines and the adverse events reporting forms has also to be defined. Putting together all the elements of such a process analysis will contribute to integrate, into daily practice, the management of risks, supported by the information system. [Copyright &y& Elsevier]

Because it symbolizes henceforth the sanitary risk and fears which are linked to it, the blood transfusion must master the potential or real risks associated to its practice. The analysis of these risks leads to confirm the initial selection phase of candidates for blood donation as an always original stage of the blood transfusion safety towards the identified infectious risks, but also mainly towards the emergent or modelled risks. The evaluation of the current system of prevention leads to consider two potential dangers: the ineffectiveness of the selection because of the lack of meaning given to this stage, and the donors'' disaffection caused by badly accepted or badly justified deferrals. The deficit of meaning can be due to an insufficient information of the population as for the policy of collective prevention of transfusion-transmitted infectious diseases. It can be worsened by the construction of the pre-donation interview which can appear as a succession of questions without visible links. This paper suggests risk analysis to blood transfusion, and a reflection to improve this important stage of blood product safety approach represente by the selection of candidates to a blood donation. [Copyright &y& Elsevier]

Abstract: Observation of medical practices still show that, in some institutions, obtaining consent could be in the mode of a trivialization, or even some administrative automaticity. To ensure a truly informed choice, this article explains why the information in the sensitive field of reproductive medicine and perinatology should remain an act of care and relationship. It outlines why medical information issued to couples must take into account not only validated data, but also the doubts and uncertainties. This is especially true when risk management because the meaning we give to the acceptance of risk is not simply the result of a calcul of probability but also the result of a social construction. All signed consent and collected outside of such an approach to quality and completeness of the information would be considered questionable. [Copyright &y& Elsevier]

Abstract: The Alps-Mediterranean division of the French blood establishment (EFS Alpes-Mediterranée) has implemented a risk management program. Within this framework, the labile blood product distribution process was assessed to identify critical steps. Subsequently, safety measures were instituted including computer-assisted decision support, detailed written instructions and control checks at each step. Failure of these measures to prevent an incident underlines the vulnerability of the process to the human factor. Indeed root cause analysis showed that the incident was due to underestimation of the danger by one individual. Elimination of this type of risk will require continuous training, testing and updating of personnel. Identification and reporting of nonconformities will allow personnel at all levels (local, regional, and national) to share lessons and implement appropriate risk mitigation strategies. [Copyright &y& Elsevier]

What will be the evolution of blood transfusion in the next 10 years? What are the scientific and medical arguments to help the decision makers to propose the developments? Many scientific and clinical studies show that blood substitutes are not ready for use in man. So, for a long time, blood collection in man will still be a necessity to prepare cell concentrates (red blood cells and platelets) and fresh frozen plasma. During this period, blood safety will be based on development of testing technics and preparation processes of blood products. Another major point will be a better clinical use of blood derivates. Cellular therapy will be probably only a way of diversification in blood transfusion centers in partnership with hospitals. [Copyright &y& Elsevier]