El uso de glucocorticoides en neumonía grave adquirida de la comunidad

La neumonía es la inflamación del parénquima pulmonar debida a un agente infeccioso.Cuando afecta a la población no ingresada en un hospital, se denomina neumonía adquirida en la comunidad(NAC). La NAC grave suele representar entre el 3 y 18% de las NAC hospitalizadas con una mortalidadentre el 21 y 54%. Para evaluar la gravedad de la NAC se utilizan los criterios PSI (Pneumonia severityIndex). Los corticoesteroides son hormonas esteroideas, participan en diferentes procesos regulando lainflamación, el sistema inmunitario, así como la respuesta del organismo al estrés, etc. Los corticoidessintéticos y semisintéticos se utilizan en numerosos procesos patológicos.METODOLOGÍA: Desde la exposición de un escenario clínico, se planteó una pregunta estructurada paraluego realizar una búsqueda bibliográfica, con el objetivo de dar respuesta a la pregunta sobre si el uso decorticoterapia adyuvante en pacientes con NAC grave disminuye la mortalidad y la necesidad de asistenciarespiratoria mecánica.Se realizó una búsqueda en PubMed y se seleccionó el artículo: “Efficacy and safety of glucocorticoids inthe treatment of severe community-acquired pneumonia”ANALISIS DEL ARTICULO: Se realizó un análisis definiendo los valores de riesgo absoluto, riesgorelativo y el número necesario a tratar del grupo problema y grupo control tomando en cuenta las variablesmortalidad y necesidad de asistencia respiratoria mecánica. Por otro lado, se determinó el odds ratio con surespectivo intervalo de confianza del 95%.RECOMENDACIÓN FINAL: se recomienda el uso de corticoterapia adyuvante como tratamiento contrala NAC grave

Human & Organizational Factors impact on risk level in an NG treatment and storage plant

The VIRTHUALIS project (Virtual Reality and Human factors Applications for Improving Safety) is a European Research Project on Industrial Safety. It aims at producing an innovative technology that integrates Virtual Reality and the most advanced Human & Organizational Factors concepts to improve safety in production plants and storage sites, by addressing end-users' practical safety issues regarding safety analysis (Risk Assessment and Accident Investigation), Training, and Operational Safety Management. A specific Case Study has been designed in order to relate Human and Organizational Factors to operators' response time—considered as the measure of the potential consequences magnitude—on the detection and containment of a gas leakage in a section of a pressure-reduction Station. Specifically, a sensitivity analysis on Common Performance Conditions (CPCs)—divided into nine "families", as defined in CREAM methodology—in order to verify and to rank their influence on the operator response time, has been performed. A Virtual Environment reproducing the plant section and the Control Room has been designed allowing the safety analyst—controlling the simulation via a Supervisor station—to perform the sensitivity analysis. Control functions and strategies allowing the analyst—via the supervisor station—to manipulate (i.e., either improve or worsen) each CPC's rate around nominal value inside the Virtual Environment, have been also designed and agreed. Experiments were run with a variation of one CPC at time and holding all the other eight on their nominal valu

Human reliability analysis for reducing risk in an LPG treatment and storage plant

International audienceVIRTHUALIS is a European Research Project on Industrial Safety with the overall objective of evaluating and, where possible, reducing the risk level in production plants and storage sites with the integration of Virtual Reality and Human Factors methods. For the estimation of Human Error Probabilities a specific tool has been developed named the Fuzzy Probability Estimator (FPE). The application of the FPE tool in a specific case study is presented in this paper. The specific case study aims at analyzing the start-up of a gas turbine used to drive the compressor of the butane/propane refrigeration section of an LPG storage and treatment complex. The example chosen is the case of oil leakage at the coupling of the turbine with the compressor. Specifically detailed through bow-tie analysis, the action it refers to is the operator visual check of the coupling area. Performance Shaping Factors (PSFs) that influence operators' reliability have been identified and rated for the specific site according to expert judgment and on site observations from human factor experts.The PSFs are linked to specific task deviations and, in relation to those and to the need to observe how they influence the task, the design of VIRTHUALIS simulation experiments is performe

A compound methodology to assess the impact of human and organizational factors impact on the risk level of hazardous industrial plants

This paper presents a compound methodology devised to relate Human and Organizational Factors (HOFs) to operators' response time in critical operations within hazardous industrial plants. The methodology has been based on a sensitivity analysis of the nine "families" of the Common Performance Conditions (CPCs), as defined in the CREAM technique, in order to verify and rank their influence on the operators' response time. To prove the methodology, a series of pilot experiments have been designed and performed so that human response is evaluated in a Virtual Environment (VE) reproducing the control room and a specific plant section. This environment enables the analyst controlling the simulation to perform the sensitivity analysis acting through a supervisory station and manipulating the control functions in order to vary each CPC rate around its nominal value. Experiments were run with the variation of one CPC at a time aiming at the detection and containment operation of a gas leakage in a pressure-reduction NG terminal. The whole case study has been run within the framework of the VIRTHUALIS EU projec