Objective To evaluate the efficacy and safety of rifampicin plus pyrazinamide versus isoniazid for prevention of tuberculosis among persons with or without HIV-infection respectively. Methord Meta-analysis of randomized controlled trials(RCT) and quasi-randomized controlled trials(quasi RCT) that compared rifampicin plus pyrazinamide for 2-3 months with isoniazid for 6-12 months. Endpoints were development of active tuberculosis, severe adverse effects, and death. Treatment effects were summarized as risk difference (RD) with 95% confidence interval (CI). Results Three trials conducted in HIV-infected patients and 3 trials conducted in HIV-uninfected persons were identified. The rates of tuberculosis in the rifampicin plus pyrazinamide group were similar to that in the isoniazid group, whether the subjects were HIV-infected patients or not (for HIV-infected patients: pooled RD= 0%, 95%CI: -1% to 2%, P=0.89; for HIV-uninfected persons: pooled RD=0%, 95%CI: -2% to 1%, P=0.55). There was no difference in mortality between the two treatment groups (for HIV-infected patients: pooled RD=-1%, 95%CI: -4% to 2%, P=0.53; for HIV-uninfected persons: pooled RD=0%, 95%CI: -1% to 1%, P=1.00). However, both subgroup analyses showed that a higher incidence of all severe adverse events was associated with rifampicin plus pyrazinamide than isoniazid among HIV-uninfected persons (one: RD=29%, 95%CI: 13% to 46%; P=0.000 5; another: RD=7%, 95%CI: 4% to 10%; Plt;0.000 1). Conclusion Rifampicin plus pyrazinamide is equivalent to isoniazid in terms of efficacy and mortality in the treatment of latent tuberculosis infection. However, this regimen increases risk of severe adverse effects compared with isoniazid in HIV-uninfected persons.
Objective To provide reference for medical risk management by evidence-based evaluation of the status of coal-mining risk management in China. Methods We searched databases of EI (1969 to 2005), SDOS (1995 to 2005), Vip (1989 to 2005), Wanfang (up to 2005), and CNKI (1994 to 2005), as well as some official websites, for English and Chinese articles related to coal-mining safety, risk management, precaution, and response to mine disasters in China. Results Total of 19 articles, including 9 official documents, 4 research articles, and 6 expert comments were included. Recently the number of coal-mining disasters has declined in China, but still much larger than that in US. The safety status of small coal mines (90% of total coal mines in China) was much more severe. The response and precaution system of coal mining disaster in China was poor. Conclusion Medical service in China may take the following measures based on lessons from coal mining industry to improve its risk management: ① Strengthen the management of small clinics (68.24% of total medical organizations in China); ② Train doctors and nurses to upgrade their perception of medical risk; ③ Establish self-report system of medical malpractices, errors, and accidents.
Objective By reviewing and analyzing the experiences and lessons of American hurricane risk management, this study aims to explore the possible application of constructing the system for medical risk management in China. Methods We searched the EI database (1969 to 2005), OVID database (1966 to 2005), Superstar electronic library and some websites such as Federal Emergency Management Agency (FEMA), National Oceanic and Atmospheric Administration (NOAA), and Centre for Disease Control and Prevention (CDC). The retrieved articles were screened independently by two reviewers according to the inclusion and exclusion criteria. The included articles were classified and the quality was ranked. Results Total of 227 articles and 1 book met the eligibility criteria. The articles related to risk prediction occupy 73.13%. The American hurricane database can be traced back to 1886. Disaster Relief Act was promulgated in 1950, and there were various types of policies for disaster risk management. The FEMA, set up in 1979, played a key role in disaster risk management. The precaution was announced according to the different levels of hurricane risk, and the forecasts were mainly made by NOAA. The American government and some non-governmental organizations were involved in hurricane emergent responses concerning both physical and mental health of the public. In addition, there were many methods to evaluate and predict hurricane risk. The main lessons from hurricane Katrina risk management lay inunderestimation of the risk and political discrimination. Conclusion There are both distinctive advantages and disadvantages in the present status of American hurricane risk management. As the monitoring and precaution system of medical risk management in China are still in an initial stage, we can learn the experience and lessons from American hurricane risk management to construct and run our system of medical risk management better.
Objective To provide reference for medical risk management by systematically reviewing the hterature on aviation risk management abroad. Methods We searched the SCOPUS database and related websites, and handsearched related journals, for literatures on the history, experience, and models of aviation risk management, and their relationship to medical risk management. Rationale and method of evidence-based science were used to appraise and analyze the included hterature. Results Aviation and medical industry were both with the characteristics of high technology, high risk, and high professional. The aviation risk management system including the unique information reporting system, risk analyzing tools and models covered the whole process of information collecting, analyzing and managing, and with the emphasis on systematical construction. Conclusions Medical risk management in China should base on its own characteristics, taking the following experiences from aviation risk management into account： （1） establishing incident and shght ~fistake reporting system, with management mechanism and legal support. Pilot experiments should be practiced in high-risk department; （2） developing a training model hke Crew Resources Management（ CRM）, emphasizing non-technical skills training; （3） reinforcing staff and environment management for the control of human-origin risk; （4） constructing database for better information collection and analysis, developing and using perspective analyzing tools; （5） assessing the safety culture of medical organization with the tools used by aviation industry, and taking the experience of aviation safety culture construction.