合并精神疾病患者剖宫产术麻醉优化与医患安全保障

合并精神疾病患者接受剖宫产术时,由于此类患者的特殊性,患者以及其家属、医务人员心理表现都有别于普通情况。合理遵守此类患者的如下麻醉方案优化原则：麻醉操作可以实施原则、麻醉效能有效控制原则、避免诱发或加重精神疾病原则、患者无痛和新生儿安全原则、术后镇痛衔接原则、全程心理干预原则和替代麻醉预案制定原则,同时科学制定患者围术期如下管理规章制度：应急程序的及时启动、患者家属及监护人的沟通与知情同意、麻醉前后特定病房或医疗单位的建立和麻醉医疗期间医患合法权益的保障,只有这样医患双方安危和权益才能得到最佳保障。     

Investigating the individual and organisational predictors of work-related driving crash involvement in Ethiopia

The rate of road traffic injury and death in Ethiopia is at a critical level when compared to rates in high-income countries. Considering the enormity of this issue, research is to identify groups of high-risk road users and the factors contributing to their crash involvement. This study focuses on work-related drivers. This study explores driving behaviour as a mediator of the relationship between organisational and individual attribute factors and self-reported crashes in a sample of 213 work-related drivers in Addis Ababa, Ethiopia. The hypothesised framework identifies driving behaviour as the most proximal determinant of self-reported crashes, and safety values, role overload and self-efficacy as antecedents of driving behaviour. With the exception of the relationship between self-efficacy and driving behaviour, all the hypothesised relationships were supported. We make recommendations for intervention approaches that are theoretically focused and sensitive to the cultural context.     

Temporal fluctuations in driving demand: The effect of traffic complexity on subjective measures of workload and driving performance

Traffic density has been shown to be a factor of traffic complexity which influences driver workload. However, little research has systematically varied and examined how traffic density affects workload in dynamic traffic conditions. In this driving simulator study, the effects of two dynamically changing traffic complexity factors (Traffic Flow and Lane Change Presence) on workload were examined. These fluctuations in driving demand were then captured using a continuous subjective rating method and driving performance measures. The results indicate a linear upward trend in driver workload with increasing traffic flow, up to moderate traffic flow levels. The analysis also showed that driver workload increased when a lane change occurred in the drivers’ forward field of view, with further increases in workload when that lane change occurred in close proximity. Both of these main effects were captured via subjective assessment and with driving performance parameters such as speed variation, mean time headway and variation in lateral position. Understanding how these traffic behaviours dynamically influence driver workload is beneficial in estimating and managing driver workload. The present study suggests possible ways of defining the level of workload associated with surrounding traffic complexity, which could help contribute to the design of an adaptive workload estimator.     

Similarities between self-reported road safety behavior of teenage drivers and their perceptions concerning road safety behavior of their parents

The study investigated 401 19-year-olds, who were licensed car drivers in Lithuania. The focus of the survey was on the self-reported road safety behaviors of teenage drivers and their perceptions of their parents’ road safety behaviors, in order to assess behavioral similarities between teenagers and their parents. The survey also investigated whether parents and teenagers discuss issues of driving safely, and whether there is an association between these conversations and driving restrictions.According to teenagers’ reporting, road safety behavior of teenage drivers and their parents often is similar: most of them break the speed limit, drive when feeling fatigued, use a cell phone when driving, and do not fasten the seat belt as a passenger in the back seat. The study indicated that there is a positive moderate correlation between road safety behaviors of teenagers and their parents, as reported by the teenagers. A majority of teenagers report that they discuss road safety factors, driving safely and driving behavior with their parents. Based on teenager reports, the parents, who discuss road safety issues with their children, are more likely to apply restrictions on teenagers’ driving.     

Positive organizational behavior and safety in the offshore oil industry: Exploring the determinants of positive safety climate

Much research has now documented the substantial influence of safety climate on a range of important outcomes in safety critical organizations, but there has been scant attention to the question of what factors might be responsible for positive or negative safety climate. The present paper draws from positive organizational behavior theory to test workplace and individual factors that may affect safety climate. Specifically, we explore the potential influence of authentic leadership style and psychological capital on safety climate and risk outcomes. Across two samples of offshore oil-workers and seafarers working on oil platform supply ships, structural equation modeling yielded results that support a model in which authentic leadership exerts a direct effect on safety climate, as well as an indirect effect via psychological capital. This study shows the importance of leadership qualities as well as psychological factors in shaping a positive work safety climate and lowering the risk of accidents.     

Examining the effect of visual treatments on truck drivers’ time-to-arrival judgments of motorcycles at T-intersections

An automobile–motorcycle crash most commonly results when an automobile pulls out of a side road into the path of an oncoming motorcycle and violates the motorcyclist’s right-of-way. One of the reasons for this could be that motorists misjudged the motorcycle arrival time. Motorcyclists are particularly vulnerable to injury in crashes with truck due to substantial differences in vehicle mass, protection degree and speed. We investigated truck drivers’ judgments of motorcycle time-to-arrival (TTA) across a number of visual treatments. Participants watched a series of video clips captured at a T-intersection, and they were instructed to respond by clicking the computer mouse at the time they estimated the front wheels of an oncoming vehicle (motorcycle or car) to reach the T-intersection. The results showed that, at long distance between the target motorcycle and the viewer, the motorcycle with daytime running headlights (DRH) was estimated to arrive sooner than the motorcycle whose motorcyclist wore a black helmet with a reflective sticker. However, the opposite is true at a short distance. We also found that a motorcyclist wearing a white helmet and riding a motorcycle with DRH, as well as a motorcyclist wearing a white helmet and white outfit, would improve truck drivers’ judgment with respect to motorcycle TTA. Consequently, truck drivers would be less likely to pull out into a small gap in front of a motorcycle, resulting in a higher safety margin for the motorcycle.     

Quantifying drivers’ comfort-zone and dread-zone boundaries in left turn across path/opposite direction (LTAP/OD) scenarios

The aim of this study is to quantify drivers’ comfort- and dread-zone boundaries in left-turn-across-path/opposite-direction (LTAP/OD) scenarios. These scenarios account for a large fraction of traffic fatalities world-wide. The comfort zone is a dynamic spatiotemporal envelope surrounding the vehicle, within which drivers feel comfortable and safe. The dread zone, a novel concept, describes a zone with a smaller safety margin that drivers will not voluntarily enter, but can push themselves into when conditions provide additional motivation (e.g., when hurried). Quantifying comfort- and dread-zone boundaries in the context of turning left before or after an oncoming vehicle has the potential to inform and improve both the design and driver acceptance of advanced driver assistance systems (ADAS) and autonomous vehicles.Using a within-subject design, a test-track experiment was conducted with drivers turning an instrumented vehicle left across the path of an oncoming vehicle. The oncoming vehicle was a self-propelled full-sized computer-controlled balloon vehicle going straight at a constant speed (50 km/h). The driver assumed full control of the instrumented vehicle approximately 20 m before the intersection and had to make the decision to turn left before or after the oncoming balloon vehicle. There were two experimental conditions, comfortable driving and hurried driving. Measures for each turn included post-encroachment time (PET), lateral acceleration, and self-reports of comfort and risk. Drivers consistently accepted shorter time gaps and higher lateral accelerations when hurried. We interpret these findings to suggest that drivers invoke two dynamic, contextually-defined safety margins. The first is the comfort-zone boundary, a limit which drivers do not voluntarily cross without extra motives. The second is the dread-zone boundary, a more distant limit which drivers do not voluntarily cross even with extra motives. Grouping the responses (high/low) to the driver behavior questionnaire (DBQ) improved the ability to predict the dread-zone boundary PET given the comfort-zone boundary PET.     

机构伦理视域下安徽省某三级医院不良事件管理策略研究

医疗质量安全一直是国内外共同关注的话题,其中不良事件的管理是医院质量安全的核心议程,而现有的归因和治理模式对不良事件的分析不充分,是对不良事件的“误诊”。通过收集汇总医院不良事件电子上报系统中2 588例事件,从事件发生类型、严重程度、发生人员和变动情况进行系统分析,基于机构伦理逻辑分析医疗机构伦理准则、伦理氛围、伦理激励,尝试从系统层面构建机构伦理视域下不良事件管理策略模型,为医疗质量改进和安全管理提供参考。

     

异种器官移植技术中的伦理问题面面观

目前,有关异种器官移植技术的伦理问题讨论的既有文献大多集中于该技术试验阶段。从受体、供体及社会的维度,讨论异种器官移植技术的试验及临床应用阶段可能引发的伦理问题,这些问题包括：受体的人格同一性危机,生理不相容引发医疗安全问题;供体动物的道德权利问题,生物安全问题;异种器官利用的公平可及问题,技术的滥用问题,受体的“污名化”问题。对上述伦理问题进行深入的伦理讨论和辨析,为异种器官移植技术的研究提供科学合理的方向,也将有助于该技术成熟后,合伦理的推广应用。

     

Cognitive Behavior Therapy for Women With Generalized Anxiety Disorder in the Perinatal Period: Impact on Problematic Behaviors

Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder among women in the perinatal period (pregnancy to one year postpartum). Recent studies have examined the relationship between problematic behaviors and GAD symptoms. Studies in nonperinatal samples indicate that adults with GAD engage in avoidance and safety behaviors and these behaviors are associated with greater symptom severity. Little research has examined the use of problematic behaviors among pregnant or postpartum women. However, preliminary research suggests that these behaviors may have a negative impact on both anxious women and their children. Our aim was to examine the extent to which women with GAD in pregnancy or the postpartum engage in problematic behaviors and whether cognitive behavioral therapy is effective in reducing these behaviors. Fifty-eight women with GAD in pregnancy or postpartum were recruited from a larger clinical trial (Clinicaltrials.gov ID NCT02850523) evaluating the effectiveness of group-based cognitive behavioral therapy (CBGT) for perinatal anxiety disorders. The results indicated that women with perinatal GAD reported high levels of avoidance and safety behaviors and greater engagement in these behaviors was associated with higher levels of worry and related symptoms. CBGT was effective in reducing GAD symptoms and problematic behaviors and a bidirectional relationship was found between changes in worry and problematic behaviors during treatment. Limitations and future directions are discussed.