Asunto(s)
Anemia Aplásica/terapia , Trasplante de Células Madre de Sangre Periférica/métodos , Linfocitos T/citología , Quimera por Trasplante , Adolescente , Adulto , Antígenos CD34/metabolismo , Femenino , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas/citología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: We previously presented a systematic and structured approach to acquire an accurate functional model of the patient's process in radiotherapy. This approach relied on new functional structuring patterns, derived from system engineering and knowledge engineering. Additionally, we propose a complementary methodical process for the dysfunctional analysis of the obtained functional model. MATERIALS AND METHODS: The procedure is based on joint implementation of two qualitative methods named "Failure modes and effects analysis" (FMEA) and "Hazard and operability" (HazOp). RESULTS: All the technical, the human and the organizational dimensions of the patient's process are pooled in a unique, exhaustive and detailed dysfunctional analysis. The application of this systematic approach within a particular institution can precisely identify the risks incurred by patients in care, but also highlight the logical sequence between precursor events and incidents. CONCLUSION: The dysfunctional analysis presented in this document will be used for the development still in process of quantified risk models.
Asunto(s)
Modelos Teóricos , Seguridad del Paciente , Radioterapia/efectos adversos , Medición de Riesgo , Gestión de Riesgos , Humanos , Errores Médicos , Evaluación de Procesos, Atención de Salud , Garantía de la Calidad de Atención de SaludRESUMEN
PURPOSE: This document presents a systematic and structured approach for functional modeling for risk analysis in radiotherapy, aiming to reconcile the need, on one hand, for a method that can be applied generally and, on the other hand, for a method that provides a highly precise model. MATERIALS AND METHODS: The approach relies on new functional structuring patterns and flux analysis, derived from system engineering and knowledge engineering. RESULTS: The method affords strong support for the development of detailed models of the patient's process through a department of radiotherapy. Lack of structure of the actual process in a particular department may be easily identified leading to the development of specific procedures for the improvement of security. CONCLUSION: Modeling approach derived from engineering may be used for functional modeling for risk analysis in radiotherapy.
Asunto(s)
Modelos Teóricos , Seguridad del Paciente , Radioterapia/normas , Medición de Riesgo , Gestión de Riesgos , Humanos , Evaluación de Procesos, Atención de Salud , Garantía de la Calidad de Atención de SaludRESUMEN
The impact of the 2009 H1N1-Influenza A (H1N1) pandemic in allogeneic hematopoietic SCT recipients (allo-HSCT) is not yet well defined. Between May 2009 and May 2010, all allo-HSCTs who presented with respiratory symptoms were screened for the presence of the H1N1 virus. Oseltamivir resistance was assessed and chart reviews were performed for all cases. In all, 51 of 248 (20%) allo-HSCT recipients followed at our outpatient clinic were screened. We identified 10 patients with H1N1 infection. Close contact with children was the most commonly suspected mode of transmission. Upper and lower respiratory tract infections were present in eight and five patients, respectively. Lymphopenia (<1 G/L) was the most frequent biological abnormality. High immunosuppression was responsible for severe infection requiring mechanical ventilation associated with prolonged viral shedding in three patients who had significant comorbidities and GvHD. Two of them developed an oseltamivir-resistant strain and both patients died subsequently despite intensive therapy, resulting in a case fatality rate of 20%. In conclusion, although most allo-HSCTs had mild symptoms from H1N1 infection, severe immunosuppression and emergence of oseltamivir resistance were likely responsible for a substantial morbidity, further supporting the need for vaccination and monitoring of close contacts, especially children.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Pandemias , Adulto , Antivirales/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Gripe Humana/tratamiento farmacológico , Gripe Humana/etiología , Persona de Mediana Edad , Oseltamivir/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
The combination of skin induration with clinical features such as dyspnea, facial telangiectasia, digital infarctions and/or dysphagia supports the diagnosis of systemic sclerosis. The oesophageal dysmotility is associated with symptoms which may delay the diagnosis of gastro-oesophageal cancer. Herein we report a case of long standing systemic sclerosis with heartburn and dysphagia symptoms which were monitored closely. Unfortunately, these symptoms delayed the diagnosis of gastric adenocarcinoma. This case prompted us to review the evidence of the association of cancer and systemic sclerosis and if any oncologic evaluation is required during the follow-up of patients affected with systemic sclerosis.