RESUMO
Since 2017, IRSN has been developing a new proactive risk analysis method. The Work Complexity Sharing and Exploration Spaces (EPECT in French) were tested for the first time in 2020 in the radiotherapy department of the Gustave Roussy Institute. The EPECT method makes it possible to anchor the analysis of risks incurred by patients in daily work situations and to involve the top management. The time required to involve the teams is comparable to or even less than that required for a conventional risk analysis. The cost/benefit ratio of the method seems to be advantageous because it provides access to numerous information on daily activities, which makes it possible to improve the safety of patient care in radiotherapy. The information gathered allows relevant actions to be envisaged at both the technical and organizational levels, and to be linked to departmental projects.
Assuntos
Segurança do Paciente , Serviço Hospitalar de Radiologia , Radioterapia , Medição de Risco/métodos , Análise Custo-Benefício , França , Humanos , Melhoria de Qualidade , Radioterapia (Especialidade) , Fatores de TempoRESUMO
The increasing complexity of radiotherapy work situations (technological developments, dynamics of change, increased constraints, evolution of collective actions, of professions, of interfaces between people, of human-machine interfaces, etc.) and the limits of traditional FMEA method (Failure Mode and Effects Analysis) for analysing the risks incurred by radiotherapy patients generate difficulties in identifying how the work situations of a healthcare team can generate risky situations for patients. This observation has led us to develop a new method of risk analysis: the Work Complexity Sharing and Exploration Spaces (EPECT in French). The objective of this article is to better secure a care process (making practices more reliable, updating prescribed work, defining preventive and corrective measures, continuing reflections) based on an understanding of the complexity of radiotherapy work situations and a change in our way of thinking about risks.
Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Radioterapia/efeitos adversos , Gestão da Segurança/métodos , Análise de Sistemas , Terminologia como Assunto , Humanos , Relações Interpessoais , Sistemas Homem-Máquina , Pesquisa Operacional , Objetivos Organizacionais , Segurança do Paciente , Radioterapia/métodos , Radioterapia/tendências , Medição de RiscoRESUMO
BACKGROUND: Campaigns designed to promote sun protection often fail to induce long-term changes in behaviour. There is limited information on patients with low compliance to sun protection recommendations from dermatologists. OBJECTIVES: To characterize dermatology patients at higher risk of low compliance to sun protection measures, and to investigate the relationship between sun protection behaviour, knowledge about accurate sun protection recommendations, ultraviolet (UV)-associated risks and level of UV exposure. METHODS: An anonymous self-administered multiple-choice questionnaire was distributed by dermatologists to patients receiving a sunscreen prescription. Four domains were explored: sun protection behaviour, sun protection knowledge, level of UV exposure and knowledge about UV-associated risks. We modelled sun protection behaviour and determined factors associated with low compliance to sun protection measures. RESULTS: In total 2215 questionnaires were analysed. Patients stratified by risk who better complied with sun protection measures had a better knowledge of UV-associated risks (mean score 14·45 ± 3·20 vs. 12·75 ± 3·29 and 11·20 ± 3·80, P < 0·0001) and sun protection measures (mean score 12·08 ± 2·79 vs. 10·68 ± 3·11 and 9·00 ± 3·63, P < 0·0001). Patients who better complied with sun protection measures also reported higher levels of sun exposure (mean score 4·24 ± 2·26 vs. 4·02 ± 2·05 and 3·34 ± 2·14, P < 0·0001). Factors associated with low adherence to sun protection behaviour were age below 20 or over 64 years, male sex, lower knowledge about accurate sun protection recommendations and UV-associated risks, and low UV exposure. CONCLUSIONS: This study shows the complex relationship between UV exposure, knowledge about UV-associated risks, and knowledge about sun protection recommendations and behaviour. Future skin cancer prevention programmes should focus on specific populations with low sun protection behaviour and high UV exposure.
Assuntos
Cooperação do Paciente/estatística & dados numéricos , Dermatopatias/prevenção & controle , Protetores Solares/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Transtornos de Fotossensibilidade/prevenção & controle , Transtornos de Fotossensibilidade/psicologia , Fatores de Risco , Dermatopatias/psicologia , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/psicologia , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos , Adulto JovemAssuntos
Taxa de Filtração Glomerular/efeitos dos fármacos , Indóis/farmacologia , Rim/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Sulfonamidas/farmacologia , Adulto , Idoso , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Indóis/efeitos adversos , Indóis/uso terapêutico , Rim/fisiopatologia , Masculino , Melanoma/tratamento farmacológico , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Estudos Retrospectivos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , VemurafenibRESUMO
INTRODUCTION: Primary parvovirus B19 infection may present a wide variety of dermatological features. We report two cases of parvovirus infection presenting as flexural erythema of baboon syndrome induced by various drugs, but associated with purpuric or oedematous features. CASE REPORTS: A pregnant 23-year-old woman at 39 weeks of amenorrhoea and a 49-year-old woman consulted for flexural eruption in a setting of fever. In both cases, clinical examination revealed erythematosus rash in the major skin folds, with vesicles and elements of purpura in the former patient and bullous oedema in the latter. In both cases, the diagnosis of primary parvovirus B19 infection was confirmed by positive PCR screening of viral genome and by seroconversion after two weeks. The skin lesions regressed spontaneously within several days. DISCUSSION: Although initially linked solely with systemic drug toxicity, baboon syndrome has since been reported in connection with other allergens (drug reactions, contact dermatitis, viral and streptococcal infection). Among these causes, parvovirus B19 infection merits particular interest.
Assuntos
Eritema Infeccioso/patologia , Parvovirus B19 Humano , Complicações Infecciosas na Gravidez/patologia , Adulto , Feminino , Humanos , GravidezRESUMO
BACKGROUND: Basal cell carcinoma is the most common carcinoma of the skin and is usually found on the head and neck. We report an unusual case of basal cell carcinoma presenting as a chronic leg ulcer, with underlying bone involvement. CASE REPORT: A 70-year-old woman presented with a 15-year history of leg ulcer refractory to treatment. Because of the exuberant granulation tissue on the base and the indurated edges of this circumferential leg ulcer, several biopsies were taken from the edge and the base of the ulcer. Histological examination revealed infiltrative basal cell carcinoma. Treatment consisted of surgical excision of 80% of the primary lesion and coverage with a split-thickness skin graft. Examination of the surgical piece revealed invasion of bone by the carcinoma. The remainder of the lesion not accessible to surgery was irradiated. DISCUSSION: There is a need for awareness among all doctors of the clinical signs evocative of malignant transformation of a leg ulcer so that a skin biopsy may be performed for suspicious ulcers. Our case is distinguished by the underlying invasion of bone by basal cell carcinoma, as attested by imaging and histology.