PubMed · 2346175
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R D Grainger. 1990. Making better decisions.. https://doi.org/10.1097/00000446-199006000-00006
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Training of the non-technical skills that are crucial to effective management of emergency situations is an issue that is currently receiving increasing emphasis in the petrochemical sector. A case study is presented of the explosion and fires at the Texaco Refinery, Milford Haven, UK, which occurred in July 1994 (HSE, The explosion and fires at the Texaco Refinery, Milford Haven, 24 July 1994. HSE: London, 1997), with particular focus on the human factors aspects of the event. A key issue identified by the official report into this incident was the importance of emergency management training. This paper outlines a novel, low-fidelity training intervention, the tactical decision game (TDG), which is designed to enhance the non-technical skills (decision making, situation awareness, communication and co-ordination, teamwork, and stress management) required for emergency management. It is proposed that enhanced learning of these non-technical skills, through experience and directed practice following repeated exposure to TDGs, will lead to more efficient emergency management, particularly when dealing with hazardous materials.
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Although the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, share a common lipid-lowering effect, there are differences within this class of drugs. The low-density lipoprotein (LDL) cholesterol-lowering efficacy, pharmacokinetic properties, drug-food interactions, and cost can vary widely, thus influencing the selection of a particular statin as a treatment option. The statins that produce the greatest percentage change in LDL cholesterol levels are atorvastatin and simvastatin. Atorvastatin and fluvastatin are least affected by alterations in renal function. Fewer pharmacokinetic drug interactions are likely to occur with pravastatin and fluvastatin, because they are not metabolized through the cytochrome P450 (3A4) system. The most cost-effective statins, based on cost per percentage change in LDL cholesterol levels, are fluvastatin, cerivastatin, and atorvastatin. Awareness of these differences may assist in the selection or substitution of an appropriate statin for a particular patient.