新型冠状病毒肺炎期间神经外科医护人员职业暴露的相关因素分析

目的 采用决策试用和评估实验室分析法（DEMATEL）分析我科医护人员在新型冠状病毒肺炎（COVID-19）诊疗过程中职业暴露影响因素，为减少医护人员职业暴露、有效预防和控制病毒传播提供参考。方法 对我科1例COVID-19病人导致11名医务人员感染的事件进行分析。以医院相关科室成立防护质量管理委员会，包括11名专家，以问卷调查的形式请11名专家评分，整理出相关因素25项，然后以DEMATEL相关软件MATLAB R2018b进行计算，得出25项因素之间的影响度（Tr）、被影响度（Tc）、中心度（Mi）、原因度（Ri）。结果 专家问卷回答率为100%，权威程度为0.93。25项影响因素Tr在0.36~3.63，Tc在0.07~2.45，Mi在1.27~5.49，Ri<0有12项，Ri>0有13项，其中人员因素Tr、Mi均最大（Tr=3.63，Mi=5.49）。结论 基于DEMATEL 法对此次感染事件的分析其主要因素是医护人员对COVID-19认知不足，交接班防护意识不强，对相关家属健康宣教不足，自身防护不足，区域划分不明显，其中以防护隔离意识不强为主要相关因素，护理管理者应强化护理人员防护意识，加强防护知识的培训     

Selection of nonlinear interactions by a forward stepwise algorithm: Application to identifying environmental chemical mixtures affecting health outcomes

In this paper, we propose a stepwise forward selection algorithm for detecting the effects of a set of correlated exposures and their interactions on a health outcome of interest when the underlying relationship could potentially be nonlinear. Though the proposed method is very general, our application in this paper remains to be on analysis of multiple pollutants and their interactions. Simultaneous exposure to multiple environmental pollutants could affect human health in a multitude of complex ways. For understanding the health effects of multiple environmental exposures, it is often important to identify and estimate complex interactions among exposures. However, this issue becomes analytically challenging in the presence of potential nonlinearity in the outcome-exposure response surface and a set of correlated exposures. Through simulation studies and analyses of test datasets that were simulated as a part of a data challenge in multipollutant modeling organized by the National Institute of Environmental Health Sciences ( http://www.niehs.nih.gov/about/events/pastmtg/2015/statistical/ ), we illustrate the advantages of our proposed method in comparison with existing alternative approaches. A particular strength of our method is that it demonstrates very low false positives across empirical studies. Our method is also used to analyze a dataset that was released from the Health Outcomes and Measurement of the Environment Study as a benchmark beta-tester dataset as a part of the same workshop.     

Melde- und Informationssystem für bedeutsame Vorkommnisse bei Strahlenanwendungen in der Medizin: Struktur,Zuständigkeiten und Meldekriterien

The increasing frequency and complexity of medical radiation exposures to humans inevitably result in higher risks of harmful unintended or accidental radiation exposures. To ensure a high level of protection and its continuous improvement, the Directive 2013/59/Euratom thus requires to systematically record and analyze both events and near-miss events as well as, in the case of their significance, to disseminate information regarding lessons learned from these events promptly and nationwide to improve radiation protection in medicine. These requirements have been transposed into German legislation by the new radiation protection law and radiation protection ordinance that entered into force simultaneously on December 31^th, 2018. The reporting and information system as provided by these regulations as well as the tasks, duties and powers of the parties involved are presented in the first part of this review article. In the second part, the established application-specified criteria for the significance – and thus the notification requirement - of (near-miss) events are itemized and explicated.