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PubMed2005

Knowledge of risk management strategies, and information and risk management preferences of women at increased risk for ovarian cancer.

Little research is available on the level of knowledge about ovarian cancer risk management options in women at increased risk for this disease. The study objectives were to evaluate this together with the information and ovarian cancer risk management preferences of high-risk women. One hundred and twenty-nine women were assessed after their attendance at one of six familial cancer clinics in relation to knowledge of surveillance and/or preventative strategies for reduction of ovarian cancer risk, preferences for particular strategies, and information preferences. Screening was selected by 57 (44%) women as the preferred risk management option. One hundred and five women (82%) indicated a wish for as much information as possible about ovarian cancer, including both good and bad outcomes and 114 (89%) reported a preference for sharing treatment decisions with their health professional. Participants' knowledge about ovarian cancer risk management options was significantly associated with educational levels (Z = -3.2, p=0.001) and whether or not ovarian cancer was included in the family history (Z = -2.3, p = 0.018). Findings from this present study indicate that women at increased risk of ovarian cancer who attend familial cancer clinics want as much information as possible about this disease and they want to be involved in the decision-making process. Women who reported a lower level of education (no post-school qualifications) may be most likely to benefit from additional educational strategies designed to supplement genetic counseling to improve their knowledge levels.

Adult↗
PubMed2004

Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward.

Previous research shows that too often acute psychiatric inpatient care is neither safe nor therapeutic for patients. Earlier studies focused on promoting safety through good ward design, staff being able to anticipate and prevent violence, and use of medication. The current evidence base overwhelmingly reflects a staff perspective on risk management, and there is little evidence on how service users cope in this environment or about the strategies they employ to manage the risks they face or pose to others. This paper presents findings on this from two studies: (a) ethnographic research on three UK acute psychiatric wards, undertaken between 2000 and 2002, and (b) a content analysis of qualitative data from a 1999/2000 survey of psychiatric wards in England. Findings show that while some users perceive their ward to be comparatively safe--given the crisis they were in before being admitted--it is nonetheless a volatile environment in which risks are concentrated. Many risks, such as physical assault, are attributable to other patients. However, they are better understood as an outcome of the interplay between a range of interactional and contextual factors: for example, low staffing levels/minimal or poor surveillance may increase the risk of assault. Users were found to employ 10 strategies to manage risk on the ward, including actively avoiding risky situations/individuals, seeking staff protection, and getting discharged. Integral to these strategies are the risk assessments that patients make of one another. These findings shed light on how people cope while living in one of the most anxiety-inducing institutions of a 'risk management society'. Service users routinely take an active role in making a safe environment for themselves, in part because they cannot rely on staff to do this for them. Future clinical practice guidelines should consider how to harness what users are already doing to manage risk.

Acute Disease↗
PubMed1990

Legal aspects of orthodontic practice: risk management concepts. Performing a risk management audit of your practice.

In this and succeeding issues of the AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party. Readers' comments may be addressed to Dr. Donald E. Machen, 5801 Beacon St., Pittsburgh, PA 15217.

Costs and Cost Analysis↗
PubMed1999

[Risk management program in a health facility using a project approach: transfusion risk management].

Risk management in the hospital, which is one of the referentiels of the ANAES accreditation manual, may be considered on two levels. Firstly, risk management may be approached globally, in the same way as it is tackled in the accreditation process. Secondly, risk management may be more definite. A specific risk chosen in accordance with the priorities of a particular plan may be dealt with individually. In this respect, the tranfusion process allows the risk management method to be tested and developed. f1

Blood Banks↗
PubMed1995

A framework for identifying and managing risk in the operating theatre.

There is much advice available about the development of risk management strategies within the NHS. There are booklets and magazines and there are many management consultancies willing to give advice on the development of strategies. NATN is also working on the development of advice on risk management within the operating theatre department and a document should be available at Congress this year. It was felt, however, that it may be useful to hear a little about the specific experience of the development of a strategy within one operating theatre area and Andrea Simpson, Directorate Nurse Manager for Clinical Services, West Lothian NHS Trust has recorded the development within the directorate. There has been some additional comment from the Director of Nursing and Quality within the Trust, Libby Campbell, who is responsible for risk management there.

Humans↗
PubMed2003

Managing risk in telemedicine.

Whenever something novel is introduced there are problems of implementation and operation, which may be formally expressed as risks. A comprehensive methodology has been developed to assess these risks, but it has not yet been extensively applied in the health sector. Until now, health has appropriately concentrated on the detection and reduction of clinical incidents in established services. However, there is strategic value in looking more broadly at the process of risk management. This is relevant to risk management in telemedicine.

Algorithms↗
PubMed1995

Managing risk to reduce costs.

Historically, medical malpractice has been the focus of risk management because of the high cost of malpractice insurance premiums and claims. By employing risk control and risk financing in nonclinical as well as clinical areas, however, risk management also can be used to reduce costs associated with workers' compensation and liabilities arising from purchasing arrangements and managed care contracting.

Financial Management, Hospital↗
PubMed1997

Managing risks in subacute care.

Risk management should improve the quality of care and clinical outcomes as well as prevent litigation. A systematic risk-management program needs objectives, goals, benchmarks and a continuous quality improvement approach. Three basic tenets help: quality, evaluation and utilization management.

Quality of Health Care↗
PubMed1998

The critical role of social work in risk management.

If they are included in cases early enough, social workers can help agencies manage risk, protect patients, and avoid litigation. These professionals offer unique skills that agencies should tap into more consistently to reap the benefits of better risk management.

Case Management↗
PubMed2006

A call for international harmonization in therapeutic risk management.

Therapeutic risk management is required to ensure that the benefits of a particular drug outweigh the risks in general practice. Current risk management strategies and handling of risk management and pharmacovigilance issues differ across borders. Differences in key regulatory decisions on the same product around the world, including the handling of safety issues with cisapride, dofetilide, and isotretinoin, bring into question the robustness of these decisions and the procedures currently in place to manage the risks to the public of products with potentially unfavorable risk-benefit balances. These differences may be partly due to differences in health care systems, regulatory requirements and procedures, and cultures. Greater international harmonization in approaches to risk management potentially would improve safety of medicines around the world by developing a greater uniformity in acquiring and interpreting risk-benefit evidence. The appropriateness and effectiveness of risk management interventions in different regions should be examined, and international strategies should be 'fine-tuned' for each regional health care setting. Recently issued international guidance on risk management and pharmacovigilance may help to improve consistency of decision-making around the world and promote better international communication and collaboration.

Drug Therapy↗