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Introducción: En Cuba, se prevé realizar la terapia paciente específica del hipertiroidismo. Se han desarrollado una metodología y herramientas computacionales con este propósito. El análisis del riesgo permitirá acometer con calidad y seguridad dicha práctica. Objetivo: Analizar los riesgos radiológicos en la terapia paciente específica del hipertiroidismo en Cuba. Material y Métodos: Se revisó y adaptó el modelo genérico de Medicina Nuclear paciente específica. Con el código cubano SECURE MR-FMEA versión 3.0 se determinaron el riesgo inherente y el residual, se identificaron las etapas del proceso, los sucesos iniciadores, las medidas y causas más contribuyentes, así como las consecuencias para los grupos expuestos. Resultados: Se obtuvo un nivel alto de riesgo que se controló con las medidas adicionadas. Las etapas más significativas son: la adquisición de imágenes pre- y post- tratamiento y la preparación del radiofármaco. Las medidas preventivas más importantes son: mantener una carga de trabajo moderada para el personal, las capacitaciones del físico médico y de los especialistas que realizan las revisiones del proyecto en la etapa de diseño del servicio. Los pacientes tienen consecuencias muy altas en 10,7 por ciento de las secuencias accidentales. Sin embargo, los trabajadores y el público presentan consecuencias medias en 29 por ciento y 16 por ciento, respectivamente. El incumplimiento de prácticas, protocolos, procedimientos o normas es la causa básica de fallo predominante. Conclusiones: Se facilita la toma de decisiones para la implementación del tratamiento paciente específico del hipertiroidismo en Cuba, a partir del empleo de la metodología que se propone en esta investigación(AU)
Introduction: In Cuba, there are plans to conduct patient-specific therapy for hyperthyroidism. A methodology and computational tools have been developed for this purpose. Risk analysis will allow us to undertake this practice with quality and safety. Objective: To analyze the radiological risks in the patient -specific therapy for hyperthyroidism in Cuba. Material and Methods: The generic patient-specific Nuclear Medicine model was reviewed and adapted. Inherent and residual risk were determined with the Cuban code SECURE MR-FMEA version 3.0; the stages of the process, the initiating events, the most contributing measures and causes, and the consequences for the exposed groups were identified. Results: A high level of risk was obtained, which was controlled with additional measures. The most significant stages are the acquisition of pre- and post-treatment images, and the preparation of the radiopharmaceutical. The most important preventive measures are: maintaining a moderate workload of the staff, and the training of the medical physicist and the specialists who perform the project reviews at the stages in service design. Patients have very high consequences in 10,7 percent of accidental sequences. However, the workers and the public show average consequences at 29 percent and 16 percent, respectively. Non-compliance with practices, protocols, procedures or standards is the predominant underlying cause of failure(AU)Conclusions: Decision-making for the implementation of patient-specific therapy for hyperthyroidism in Cuba, based on the use of the methodology proposed in this research, is facilitated(AU)
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Humans , CubaABSTRACT
The study analyzed the application of failure mode and effect analysis(FMEA)in the emergency management of emergent infectious diseases. In February 2020, optimization of emergency management procedures for emergent infectious diseases was identified as the research theme. Subsequently, FMEA was applied to study the emergency management process of emergent infectious diseases and analyze corresponding potential failure modes in an infectious disease hospital. The appraisal identified four prioritized risk exposures to correct, including non-standardized personnel protection, delayed personnel arrival, unqualified specimens and inadequate ward preparation. Accordingly pertinent countermeasures were formulated. Three months after measures were taken, the risk priority numbers of the above four risks were decreased significantly. On the other hand, evident increase was found in the on-duty rate of emergency personnel, the rate of standard protection, the qualification rate of sample collection and disposal, as well as the serviceability rate of respirators, ECG monitors and protective equipment in emergency wards. The application of FMEA is conducive to optimizing the emergency response process of emergent infectious diseases, and to upgrading emergency management at large.
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AIM: To explore the application effect of medical failure mode and effect analysis in the blood sample management of phase I clinical trials, and to provide a basis for improving the quality of blood sample management. METHODS: Convenient sampling was used to draw blood samples from healthy subjects in phase I clinical trials as the research objects. According to whether the medical failure mode and effect analysis method was implemented, they were divided into 3 080 control groups and 3 064 observation groups. The unqualified rate of blood samples, the number of unqualified items, the satisfaction of subjects and the passing rate of the researcher's examination between the two groups were compared. RESULTS: The unqualified rate of blood samples in the control group was 1.95%, and the unqualified rate of blood samples in the observation group was 0.59%. The difference between the two groups was statistically significant (P<0.05). The number of unqualified items in the blood samples of the observation group was lower than that of the control group, and the difference between the two groups was statistically significant (P<0.05). The satisfaction of subjects in the observation group and the passing rate of the investigator were higher than those in the control group, and the difference between the two groups was statistically significant (P<0.05). CONCLUSION: The implementation of medical failure mode and effect analysis not only provides qualified biological samples for the detection and analysis of drug concentration in clinical trials, but also enhances the standardization and specialization of researchers, and contributes to the improvement of the overall quality of clinical trials.
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Restoration of the endodontically treated teeth is complicated by the fact that much or all of the coronal tooth structure has been destroyed by caries, previous restorations and the endodontic access preparation. Post-andcore has been most commonly used when insufficient dentin remains. Methods: Fourty translucent glass fiber post (Tenax fiber Trans Coltene Whaledent) of diameter 1.3 mm and 40 extracted premolars were used. Post were divided into 4 groups of 10 each depending on the pre –treatment of post surface.In Group 1: Multilink N primer A & B was applied on post surface and root dentin for 15 sec, (Control group), group 2 : Monobond S primer was applied for 60 sec, followed by multilink N primer A & B, Group 3: Immersion in 30% H2O2 for 5min, rinsing and application of Monobond S Primer (silane) and multilink N primer A & B and Group 4: application of 25% polyacrylic acid for 5 sec, rinsing, silane and multilink N primer A & B dual cure adhesive. The specimens were then sectioned horizontally into 1- mm-thick post-dentin sections. The post space (9mm) were divided into 3 halves: the coronal, middle and the apical third.The push out bond strength (MPa) were measured using a universal testing machine at a crosshead speed of 0.5mm/sec.Failure mode of each debonded specimen were analyzed using a stereomicroscope. Maximum failure mode were adhesive failure between post and resin cement. Results: The bond strength values were higher in group 3 and group 4 compared to group 2 and group 1. Conclusion: The pre-treatment of fiber post increases bond strength between fiber post and root dentin.
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Objective To investigate IMRT planning process using the combined application of failure modes and effects analysis ( FMEA) and fault tree analysis ( FTA) by reference to the report of Task Group 100 of the AAPM, and stablish and optimize the quality. Methods A multidisciplinary team detailed the process mapping of IMRT planning using Eclipse TPS. The team evaluated the potential failure modes ( FMs ) of every process step. The evaluation was divided into two groups according to whether quality management ( QM) was considered. For every FM, occurrence ( O) , severity ( S) and detectability ( D) by consensus were evaluated, and the product of O, S and D yielded the risk priority number ( RPN) , which permitted the ranking of the FMs. Finally, FTA was used to determine the root factors contributing to the riskiest failure modes. Results The IMRT plan process consisted of 10 major sub-processes and 33 steps, which amounted to 47 failure modes. For the group without quality management, the RPN of FMs was between 13. 2-271. 8, 27 of which had RPN≥80, and 18 FMs had S≥8. For the group with quality management, the RPN of FMs was between 11. 2-158. 4, 11 of which had RPN≥80. The difference of RPN between the two groups was statistically significant ( RPN of the group without QM=101. 17±66. 34, RPN of the group with QM=59. 54±35. 64, t=8. 501, P<0. 05). Finally, FTA was used to determine the root factors contributing to the FMs, i. e., prescription dose definition and importing images. Conclusions The FMEA and FTA methods are operable and practical, which can systematically and comprehensively analyze the potential failures and risks existing in the process of IMRT plan. And the FMEA and FTA can contribute to establish and optimize the quality management program in radiotherapy.
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Objective@#To investigate IMRT planning process using the combined application of failure modes and effects analysis (FMEA) and fault tree analysis (FTA) by reference to the report of Task Group 100 of the AAPM, and stablish and optimize the quality.@*Methods@#A multidisciplinary team detailed the process mapping of IMRT planning using Eclipse TPS. The team evaluated the potential failure modes (FMs) of every process step. The evaluation was divided into two groups according to whether quality management (QM) was considered. For every FM, occurrence (O), severity (S) and detectability (D) by consensus were evaluated, and the product of O, S and D yielded the risk priority number (RPN), which permitted the ranking of the FMs. Finally, FTA was used to determine the root factors contributing to the riskiest failure modes.@*Results@#The IMRT plan process consisted of 10 major sub-processes and 33 steps, which amounted to 47 failure modes. For the group without quality management, the RPN of FMs was between 13.2-271.8, 27 of which had RPN≥80, and 18 FMs had S≥8. For the group with quality management, the RPN of FMs was between 11.2-158.4, 11 of which had RPN≥80. The difference of RPN between the two groups was statistically significant (RPN of the group without QM=101.17±66.34, RPN of the group with QM=59.54±35.64, t=8.501, P<0.05). Finally, FTA was used to determine the root factors contributing to the FMs, i. e., prescription dose definition and importing images.@*Conclusions@#The FMEA and FTA methods are operable and practical, which can systematically and comprehensively analyze the potential failures and risks existing in the process of IMRT plan. And the FMEA and FTA can contribute to establish and optimize the quality management program in radiotherapy.
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Objective To explore the effect of failure mode and effect analysis (FMEA)in the safety management of digestive endoscopic specimens. Methods From April to November 2016, the specimens by biopsy from the patients in the department of gastrointestinal endoscopy were assigned as the control group, where conventional sample management was used and those from December 2016 to July 2017 were all included in the intervention group, where FMEA was used to find the failure mode and improvement plan was worked out. The FMEA team was set up to discuss and determine the high risk factors leading to the safety management defects in the digestive endoscopy center and calculate the risk priority number (RPN). According to the potential risk factors, we optimized and implemented continuous improvement of the specimen safety management process. Results After the implementation of FMEA,the RPNs in the top 6 failure modes were less than 125,the risk coefficient value dropped from 126~175 to 0~40.The specimen error rate after the implementation of FMEA was statistically significantly lower than that before the implementation (P<0.001). Conclusion The FMEA reduces the incidence of specimen failure and improves the quality of the management of digestive endoscopy.
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The aim of this study was to measure the shear bond strength (SBS) of different adhesive systems to calcium silicate-based materials (Biodentine and RetroMTA). Eighty cylindrical acrylic blocks, with a hole (5.0 mm diameter, 2.0 mm height) in each, were prepared. The holes were filled with Biodentine (BD) and RetroMTA (RMTA), and the specimens were divided into 2 groups. Each group was classified into 4 subgroups: Clearfil™ SE (CSE) ; AQ bond (AQ) ; All bond universal Self-etch (ABU-SE) ; and All bond universal Total-etch (ABU-TE). After the application of different adhesive systems, composite resin (Z350) was applied over BD and RMTA. The SBS was measured using a universal testing machine, and the data were compared using the Kruskal-Wallis test and the Mann-Whitney test. The highest and lowest values of SBS were observed for BD-ABU-SE and RMTA-AQ, respectively. No significant differences were found in the SBS between ABU-TE and ABU-SE and between ABU-TE and CSE to BD and RMTA. According to the data, BD showed a higher SBS than did RMTA when BD and RMTA are compared in the same adhesive agents. Further, among all groups, composite resin with ABU-SE showed better bond strength to BD and RMTA.
Subject(s)
Adhesives , CalciumABSTRACT
Objective To study the application effectiveness of healthcare failure modes and effects analysis before the secure transportation of post anesthesia care unit(PACU) patients. Methods A total of 689 general anesthesia post-operative patients who had been recovered in PACU and transported between January to December in 2015 by convenience sampling were divided into 2 groups to receive nursed by traditional method before transportation (contrast group, 346 cases) or nursed both with traditional way and healthcare failure modes and effects analysis method to analyze (observation group, 343 cases). The Medical Risk Priority Number (RPN), Status of Failure modes and satisfaction value of physicians and nurses were compared. Results The RPN value of observation group had been cut down from (229.00 ± 52.91) points to (57.14 ± 16.04) points, there was significant difference (t=7.58, P=0.01). The occurrence rate of failure mode of observation group was 2.62%(9/343), which was obviously lower than 19.36%(67/346) of contrast group, there was significant difference (χ2=49.19, P<0.01). The satisfaction rate of observation has improved significantly from 74.36%(58/78) to 93.59%(73/78), there was significant difference (χ2=10.72, P<0.01).Conclusions Healthcare failure modes and effects analysis management method could find out the failure mode of PACU patient before the secure transportation in time, could decrease the effect of failure mode and would continuously improve the quality of PACU nursing service .
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OBJECTIVES: The purpose of this study was to compare the microshear bond strength (uSBS) of two total-etch and four self-etch adhesive systems and a flowable resin to enamel. MATERIALS AND METHODS: Enamels of sixty human molars were used. They were divided into one of six equal groups (n = 10) by adhesives used; OS group (One-Step Plus), SB group (Single Bond), CE group (Clearfil SE Bond), TY group (Tyrian SPE/One-Step Plus), AP group (Adper Prompt L-Pop) and GB group (G-Bond). After enamel surfaces were treated with six adhesive systems, a flowable composite resin (Filek Z 350) was bonded to enamel surface using Tygon tubes. the bonded specimens were subjected to uSBS testing and the failure modes of each group were observed under FE-SEM. RESULTS: 1. The uSBS of SB group was statistically higher than that of all other groups, and the uSBS of OS, SE and AP group was statistically higher than that of TY and GB group (p < 0.05). 2. The uSBS for TY group was statistically higher than that for GB group (p < 0.05). 3. Adhesive failures in TY and GB group and mixed failures in SB group and SE group were often analysed. One cohesive failure was observed in OS, SB, SE and AP group, respectively. CONCLUSIONS: Although adhesives using the same step were applied the enamel surface, the uSBS of a flowable resin to enamel was different.