A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE FIELD OF HOSPITAL MANAGEMENT Johannesburg, September 2014 / Background: Although the Free State Psychiatry Complex has collected information on adverse events, the reporting processes have not been consistent, systematic or transparent and this information was not used in the planning process. In addition, there is also a perception that the rate of adverse events is increasing, that these adverse events are not managed adequately and the extent of the problem could not be determined. It was for this reason that this study was found to be necessary to investigate further on patterns of serious adverse event occurrence, to put the argu-ments to a scientific test and be certain about the extent to which contributory factors were associated with the occurrence of these events in the Free State Psychiatry Complex. Aim: The aim of the study was to describe the inpatient-related adverse events and factors contributing to these adverse events reported at the Free State Psychiatry Complex in order to develop effective strategies to prevent and reduce these ad-verse events. Methodology: This was a cross sectional study design based on a retrospective re-view of records of patients who were involved in these adverse events. The study was undertaken at Free State Psychiatric Complex which is a specialized Mental Health Care Establishment from 1 April 2008 to 31 March 2010. All records of re-ported adverse events of all inpatients at Free State Psychiatry Complex were re-viewed and no sampling was done. The study included review of routinely collected hospital information on patients’ records and registers and from the Advance Incident Management System (AIMS). Results: There were 419 Serious Adverse Events reported during 1 April 2008 to 31 March 2010. The most commonly reported SAE’s included Aggressor-Aggressor, Aggression-victim, Behaviour/Human Performance, Accident/occupational health and safety and falls. The Aggression related adverse event type was one of the most common types of SAE’s, constituting 40% of the Serious Adverse Events reported. The Behaviour /Human Performance adverse event type was second in frequency. Other common SAE’s reported during the study period included Medication, Pres-sure ulcer, Clinical Management and Organisation Management. These Serious Ad-verse Events occurred in 5% of the inpatients at Free State Psychiatry Complex and the findings showed an increase rate of 3.3%. Although more than 80% of the ad-verse events gave rise to moderate disability, 2% caused permanent disabling inju-ries and 2% led to death. However, only 15% of the SAE’s caused minor harm to pa-tients. The most Serious Adverse Events occurred in the months of March, Decem-ber and November which indicate that seasonal changes are associated with in-creased risk for Serious Adverse Events. Most SAE’s happened during the day-shift which might be ascribed to the organisational routines such as medication rounds, handover periods and mealtimes. Human and System Adverse Event Error Types accounted for more than 70% of these SAE’s. The study revealed a positive relationship between the patients in the Intellectual disability and Psycho-geriatric specialities and Accident/occupational health and safety as well as falls related adverse event types. There was also a posi-tive correlation between male patients in the age group of 9-38 in the Acute and Fo-rensic Specialities and Aggression- as well Behaviour Performance related Adverse Event Types. The patients diagnosed with Schizophrenia, Substance Induced Psy-chosis and Intellectual Disability was mostly associated with an increased risk for Se-rious Adverse Events. The results showed that co-morbidity, the patient’s disease profile, age, admission classification, organisational routines and seasonal changes are associated are contributory factors too Serious Adverse Events. It supports the premise that human and system errors as well as the profile of the patient are con-tributing to SAE’s. Conclusion: Safety issues in mental health are unique and are in that way different to the safety issues in medical care. Both the patient population and the environment make patient safety in mental health unique. The uniqueness is associated more with the diagnosis, the patient population and with the mental health setting. SAE’s included Aggressor-aggression, Aggressor-victim, Behavior Performance (abscond-ing, self-harm, suicide); Occupational health and safety, falls and other injuries are particularly prominent to mental health patients. Although patient safety in mental health was considered a field of importance, there is still a lack of awareness of the issues as well as a shortage of research and readily available information to guide patient safety systems, practices, policies, and care delivery in mental health. Work is required to establish a clear definition, set priorities, and develop strategies for re-sponding to patient safety concerns. Models of quality improvement are being uti-lized in psychiatry hospitals but the need for evidenced-based quality improvement models for inpatient psychiatric care still exist. Findings from my study showed that Serious Adverse Events are prevalent in Free State Psychiatry Complex and factors significantly associates with the frequency of aggression-, behavior/occupational health and safety and falls related adverse event types. Advancing a quality and safety research agenda for inpatient psychiatric care will guide practice, improve care, and help ensure efficient and effective care. Complicated problems such as the provision of acute psychiatric hospital services require solutions that incorporate depth of understanding the complexities of acute mental illness as well as changes in prevailing attitudes and systems. This study has also highlighted that Serious Adverse Events are contributed by a varied set of contributing and interacting elements, including patient factors, human factors, system factors, and environmental factors. A complex interaction between the mental health environment and the diagnosis/patient population was found which differentiates patient safety from other health sectors is. Understanding this interac-tion and its relationship to patient safety is very important. It is believed that research in scientific advances, systems analysis, education and development, dissemination of guidelines and improved standard of practice is required for reduction of SAE’s (Leappe et al. 1991) This was the first study to systematically evaluate adverse events in a mental health establishment in the Free State province. The researcher hopes that the Department of Health in the Free State Province would utilise the findings of this study to review and to improve the safety programmes on the care, treatment and rehabilitation of the mental health care services.

by Chan Kwai-Ming, Evan. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 45-47.

It was hypothesised that previous experience of working with issues concerning sexuality and clients with learning disabilities, knowledge, and overall experience of working with the client group would influence decisions professional staff made concerning sexuality and risk. A questionnaire was devised comprising the following four sections: 1. Demographic details. 2. Changes in levels of promotion / protection of clients since qualifying in a profession. 3. Knowledge questions concerning issues of sexuality. 4. Scenario based questions relating to sexuality and relationship issues- The questionnaires were completed by 78 professional members of community learning disability teams. A significant positive correlation was found between knowledge scores and scenarios cores, indicating that the more knowledgeable the individual is the more protective they are of clients. Additionally, a significant positive correlation was found between the amount of experience dealing specifically with sexual relationships and knowledge scores. A significant negative correlation was found between the amount of experience gained in dealing with clients experiencing heterosexual relationships and the score gained in the scenario concerning that issue. A significant negative correlation was also found between the amount of experience gained in dealing with sexual health issues and the score in the relevant scenario. This indicates that the more experience the participant has in dealing with heterosexual relationships and issues around sexually transmitted diseases, the more promoting they are when assessing the risks in a related scenario. A polarisation of views was noted in the scoring of some of the scenarios. The clinical implications are discussed as well as possible improvements in questionnaire design. Suggestions are made concerning directions for future research.

The purpose of this study was to evaluate a multifactorial caries risk assessment model by comparing the risk factor scores with caries increment. Secondary data analysis included a chart review of 434 dental patients in which basic caries risk scores, total risk score and caries increment were collected. ANOVA and logistic regression were conducted to assess the statistical significance of the difference between caries increments across categories of risk factors. Mean tooth caries increments of the risk groups were 0.20±0.8 (low), 1.13±1.59 (moderate), 2.09±2.63 (high), which were statistically significant (p<0.001). Past and present caries experience, carbohydrates, mucogingival bleeding index, and stimulated salivary flow showed statistically significant associations with caries increment (p<0.05) but the total risk score proved to be the most powerful predictor of future caries activity (p<0.001). The multifactorial etiology of caries necessitates the use of a risk assessment model that includes various factors that contribute to caries development.

The purpose of this study was to evaluate a multifactorial caries risk assessment model by comparing the risk factor scores with caries increment. Secondary data analysis included a chart review of 434 dental patients in which basic caries risk scores, total risk score and caries increment were collected. ANOVA and logistic regression were conducted to assess the statistical significance of the difference between caries increments across categories of risk factors. Mean tooth caries increments of the risk groups were 0.20±0.8 (low), 1.13±1.59 (moderate), 2.09±2.63 (high), which were statistically significant (p<0.001). Past and present caries experience, carbohydrates, mucogingival bleeding index, and stimulated salivary flow showed statistically significant associations with caries increment (p<0.05) but the total risk score proved to be the most powerful predictor of future caries activity (p<0.001). The multifactorial etiology of caries necessitates the use of a risk assessment model that includes various factors that contribute to caries development.

Many infrastructure networks rely on each other to deliver utilities and services to the community. In the event of a disaster, these networks can sustain significant damage. It is therefore important to identify interdependencies among networks to mitigate the disaster consequences. In 2003, Public Safety Canada (PSC) and NSERC initiated the Joint Infrastructure Interdependencies Research Program (JIIRP) for this purpose. The research was carried out at six Universities across Canada including the University of British Columbia (UBC). The aim of JIIRP at UBC was to study infrastructure interdependencies during disasters in order to aid in decision making. This involved the development disaster simulation methodology and tool, and the implementation of a case study. UBC's Point Grey campus was used as case study. The campus is located in southwestern British Columbia, a known seismic zone, therefore earthquake disaster scenario was chosen. Reasonable estimations of the expected seismic damage and losses are required in order to simulate a realistic disaster scenario. For this reason, in this thesis, seismic risk assessment was carried out for the buildings at UBC. This involved the development of a building database, the assessment of the expected level of damage to the structural and nonstructural building components, and the estimation of monetary, human and functionality losses. Buildings in the database were classified into prototypes and the damage was estimated for several levels ofintensity using damage probability matrices. As expected, the most vulnerable buildings on campus were those containing unreinforced masonry. These buildings make up 7% of the buildings on campus. The least vulnerable buildings were multi-family residential woodbuildings which account for 27% of the buildings on campus. Losses were estimated following the damage assessments. Casualties were estimated for three times of day. 2PM was determined to be the critical time of day as the campus population is the greatest at this time. Monetary loss and functionality trends were examined with respect to earthquake intensity and it was shown that for moderate intensity earthquakes, the losses depend primarily on nonstructural damage, while structural damage plays the most important role for higher intensities.

Risk assessment procedures for mixtures of polycyclic aromatic hydrocarbons (PAHs) present a problem due to the lack of available potency and toxicity data on mixtures and individual compounds. This study examines the toxicity of parent compound PAHs and binary mixtures of PAHs in order to bridge the gap between component assessment and mixture assessment. Seven pure parent compound PAHs and four binary mixtures of PAHs were examined in the Salmonella/Microsome Mutagenicity Assay, a Gap Junction Intercellular Communication (GJIC) assay and the 7-ethoxyresorufin-O-deethylase assay (EROD). These assays were chosen for their ability to measure specific toxic endpoints related to the carcinogenic process (i.e. initiation, promotion, progression). Data from these assays was used in further studies to build Quantitative Structure-Activity Relationships (QSARs) to estimate toxic endpoints and to test the additive assumption in PAH mixtures. These QSAR models will allow for the development of bioassay based potential potencies (PPB) or toxic equivalency factors (TEFs) that are derived not only from bioassay data, but also from structure, activity, and physical/chemical properties. These models can be extended to any environmental media to evaluate risk to human health from exposures to PAHs.

The study of this project includes nomenclature, methodologies for risk assessment, and the exchange of information on human and ecological toxicology studies in nanotechnology research. The goals are: (1) collecting domestic and international nanotechnology relevant to toxicity information, (2) establishing the flow chart of nanotechnology risk assessment, (3) making suggestions of methodologies for risk assessment on nanotechnology, and (4) establishing the structure of nanoparticles risk management for reference to future nanotechnology risk management. Nanopartilces, quantum dots, fullerenes and carbon nanotubes has been collected in Toxicological information of nanomaterials. This study has established the Precautionary Principle and the preliminary framework for health risk assessment, which could prevent or reduce risks before the completed development of the potential danger, and reply the appeal for developing a standard methodology for risk assessment which is made by European Commission during the Brussels Conference of 2004. Exchange of informations of nanotoxicology allows contact between domestic and international researchers. The methodologies for risk assessment establishes framework for health assessment of risks which could be used to be the direction to develop the internal risks assessment, and is advantageous to the government in management of the risks of nanotechnology.

Six types of aerosol samplers were evaluated experimentally in a test chamber with polydisperse fly ash. The Andersen sampler overestimates the mass of small particles due to particle bounce between stages and therefore provides a conservative estimate of respirable particulate mass and thoracic particulate mass. The TSP sampler provides an unbiased estimate of total particulate mass. TSP/CCM provides no information below ESD 2 µm and therefore underestimates respirable particulate mass. The PM10 sampler provides a reasonable estimate of the thoracic particulate fraction. The RespiCon sampler provides an unbiased estimate of respirable, thoracic, and inhalable fractions. DustTrak and SidePak monitors provide relative particle concentrations instead of absolute concentrations because it could not be calibrated for absolute particle concentrations with varying particle shape, composition, and density. Six sampler technologies were used to evaluate airborne dust concentrations released from oilfield pipe rattling operations. The task sampled was the removal of scale deposited on the inner wall of the pipe before it was removed from service in a producing well. The measured mass concentrations of the aerosol samplers show that a Gaussian plume model is applicable to the data of pipe rattling operations for finding an attainment area. It is estimated that workers who remain within 1 m of the machine centerline and directly downwind have an 8-hour TWA exposure opportunity of (13.3 ± 9.7) mg/m3 for the Mud Lake pipe scale and (11.4 ± 9.7) mg/m3 for the Lake Sand pipe scale at 95 % confidence. At distances more than 4 m downwind from the machine centerline, dust concentrations are below the TWA-TLV of 10 mg/m3 for the worker in both scales. At positions crosswind or upwind from the machine centerline there is no measurable exposure. Available data suggest that the attainment area for the public starts at about 9 m downwind from the machine centerline in both scales, as 24 hour average concentrations at these distances are smaller than the 0.15 mg/m3, the NAAQS for unrestricted public access. The PSD of the suspended plume is dominated by particles smaller than ESD 50 µm.

Thesis (Ph.D.)--University of Texas at Dallas, 2008. / Includes vita. Includes bibliographical references (leaves 91-99)