An exploration of undergraduate nursing and physiotherapy students' views regarding education for patient handling.

PubMed

Kneafsey, Rosie; Ramsay, Jill; Edwards, Helen; Callaghan, Helen

2012-12-01

To ascertain the views of undergraduate student nurses and physiotherapists regarding their education in patient handling. Musculo-skeletal injuries are an important cause of staff sickness absence and attrition from the nursing profession and are a recognised problem within the physiotherapy profession. Nurses and physiotherapists are at risk of musculo-skeletal injuries as a result of their role in assisting patients with movement. A questionnaire survey was undertaken of undergraduate nursing and physiotherapy students (n = 371) at one university. Most students agreed that university teaching about moving and handling prepared them for clinical practice (64%). Over a third reported that they had never undertaken a written moving and handling risk assessment in clinical practice (38%). Almost half of the sample (40%) admitted undertaking unsafe moving and handling activities. Half (50%) also stated that they would rather 'fit' into the team than challenge unsafe practice. Almost a third (29%) stated that they had begun to experience pain since becoming a student. There were significant differences between nursing and physiotherapy students. Physiotherapy students were more likely to report being supervised when moving and handling and reported being more assertive about adhering to safe practice. The well-being of both nursing and physiotherapy undergraduate students is threatened when students undertake work placements in clinical settings. University-based education in safe patient handling, though important, can be undermined by workplace settings where unsafe practices occur. Collaboration is needed between university educators, managers and practice-based mentors to support students to maintain safe approaches to moving and handling patients. A third of students reported developing pain since becoming a healthcare student. Students entering their professions already injured may leave the workforce owing to poor physical well-being. It is vital that the

Safe handling practices of cytotoxic drugs: the results of a chapter survey.

PubMed

Mahon, S M; Casperson, D S; Yackzan, S; Goodner, S; Hasse, B; Hawkins, J; Parham, J; Rimkus, C; Schlomer, M; Witcher, V

1994-08-01

To describe how nurses from a local Oncology Nursing Society (ONS) Chapter Implement Occupational Safety and Health Administration (OSHA) guidelines for handling cytotoxic drugs (CDs) in their individual practices and to identify barriers to implementing these guidelines. Mailed survey. ONS chapter in a large midwestern city. 103 nurses, 83 of whom handle CDs. Mean years in oncology nursing was 7.5. Mailed survey consisting of 48 questions on seven topics, as well as demographic questions. Roles in preparation and administration of CDs, management spills, patient care, and use of protective equipment in patient and family education practices; barriers to use of protective practices. Subjects used some protective equipment when preparing and administering CDs, but the type of equipment and its frequency of use did not specifically meet OSHA Guidelines. Rates of compliance with guidelines were better for management of spills and disposal of equipment. Verbal instructions for patients and families were employed but very few provided written instructions or explanations. Barriers to using protective equipment included a lack of time, problems with availability, and concerns about patient reactions. Barriers must be overcome and better safe-handling practices incorporated into practice to ensure the safety of nurses. More education is needed for family members who come into contact with patients receiving CDs. Future research to document the extent of the problem, including stratification of responses according to the quantity and frequency with which a nurse administers CDs. Better, and perhaps more frequent, staff and family education efforts are needed.

American Nurses Association position statement on elimination of manual patient handling to prevent work-related musculoskeletal disorders.

PubMed

In order to establish a safe environment for nurses and patients, the American Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling. Patient handling, such as lifting, repositioning, and transferring, has conventionally been performed by nurses. The performance of these tasks exposes nurses to increased risk for work-related musculoskeletal disorders. With the development of assistive equipment, such as lift and transfer devices, the risk of musculoskeletal injury can be significantly reduced. Effective use of assistive equipment and devices for patient handling creates a safe healthcare environment by separating the physical burden from the nurse and ensuring the safety, comfort, and dignity of the patient.

Practical Tips for the Safe Handling of Micro-organisms in Schools

ERIC Educational Resources Information Center

Holt, G.

1974-01-01

Outlines safe laboratory procedures for the handling of micro-organisms including aseptic technique, manipulation of cultures, and treatment of contaminated equipment. Identifies the principal hazard as the microbial aerosol, explains its possible effects, and describes the appropriate precautions. (GS)

Explaining Consumer Safe Food Handling Through Behavior-Change Theories: A Systematic Review.

PubMed

Young, Ian; Reimer, Danielle; Greig, Judy; Meldrum, Richard; Turgeon, Patricia; Waddell, Lisa

2017-11-01

Consumers often engage in unsafe food handling behaviors at home. Previous studies have investigated the ability of behavior-change theories to explain and predict these behaviors. The purpose of this review was to determine which theories are most consistently associated with consumers' safe food handling behaviors across the published literature. A standardized systematic review methodology was used, consisting of the following steps: comprehensive search strategy; relevance screening of identified references; confirmation of relevance and characterization of relevant articles; risk-of-bias assessment; data extraction; and descriptive analysis of study results. A total of 20 relevant studies were identified; they were mostly conducted in Australia (40%) and the United States (35%) and used a cross-sectional design (65%). Most studies targeted young adults (65%), and none focused on high-risk consumer groups. The outcomes of 70% of studies received high overall risk-of-bias ratings, largely due to a lack of control for confounding variables. The most commonly applied theory was the Theory of Planned Behavior (45% of studies), which, along with other investigated theories of behavior change, was frequently associated with consumer safe food handling behavioral intentions and behaviors. However, overall, there was wide variation in the specific constructs found to be significantly associated and in the percentage of variance explained in each outcome across studies. The results suggest that multiple theories of behavior change can help to explain consumer safe food handling behaviors and could be adopted to guide the development of future behavior-change interventions. In these contexts, theories should be appropriately selected and adapted to meet the needs of the specific target population and context of interest.

Safe handling of cytotoxic compounds in a biopharmaceutical environment.

PubMed

Hensgen, Miriam I; Stump, Bernhard

2013-01-01

Handling cytotoxic drugs such as antibody-drug conjugates (ADCs) in a biopharmaceutical environment represents a challenge based on the potency of the compounds. These derivatives are dangerous to humans if they accidentally get in contact with the skin, are inhaled, or are ingested, either as pure compounds in their solid state or as a solution dissolved in a co-solvent. Any contamination of people involved in the manufacturing process has to be avoided. On the other hand, biopharmaceuticals need to be protected simultaneously against any contamination from the manufacturing personnel. Therefore, a tailor-made work environment is mandatory in order to manufacture ADCs. This asks for appropriate technical equipment to keep potential hazardous substances contained. In addition, clearly defined working procedures based on risk assessments as well as proper training for all personnel involved in the manufacturing process are needed to safely handle these highly potent pharmaceuticals.

Ergonomics and patient handling.

PubMed

McCoskey, Kelsey L

2007-11-01

This study aimed to describe patient-handling demands in inpatient units during a 24-hour period at a military health care facility. A 1-day total population survey described the diverse nature and impact of patient-handling tasks relative to a variety of nursing care units, patient characteristics, and transfer equipment. Productivity baselines were established based on patient dependency, physical exertion, type of transfer, and time spent performing the transfer. Descriptions of the physiological effect of transfers on staff based on patient, transfer, and staff characteristics were developed. Nursing staff response to surveys demonstrated how patient-handling demands are impacted by the staff's physical exertion and level of patient dependency. The findings of this study describe the types of transfers occurring in these inpatient units and the physical exertion and time requirements for these transfers. This description may guide selection of the most appropriate and cost-effective patient-handling equipment required for specific units and patients.

Safe meat-handling knowledge, attitudes and practices of private and government meat processing plants' workers: implications for future policy.

PubMed

Adesokan, H K; Raji, A O Q

2014-03-01

Food-borne disease outbreaks remain a major global health challenge and cross-contamination from raw meat due to poor handling is a major cause in developing countries. Adequate knowledge of meat handlers is important in limiting these outbreaks. This study evaluated and compared the safe meat-handling knowledge, attitudes and practices (KAP) of private (PMPP) and government meat processing plants' (GMPP) workers in south-western Nigeria. This cross sectional study comprised 190 meat handlers (PMPP = 55; GMPP = 135). Data concerning their safe meat-handling knowledge, attitudes and practices as well as their socio-demographic characteristics, such as age, gender and work experience were collected. A significant association was observed between the type of meat processing plants and their knowledge (p = 0.000), attitudes (p = 0.000) and practices (p = 0.000) of safe meat-handling. Meat handlers in the GMPP were respectively, about 17 times (OR = 0.060, 95% CI: 0.018-0.203), 57 times (OR = 0.019, 95% CI: 0.007-0.054) and 111 times (OR = 0.009, 95% CI: 0.001- 0.067) less likely to obtain good knowledge, attitude and practice level of safe meat-handling than those from PMPP. Further, KAP levels were significantly associated with age group, education and work experience (p < 0.05). Study findings suggest the need for future policy in food industry in developing countries to accommodate increased involvement of private sector for improved food safety and quality delivery. Public health education on safe food handling and hygiene should be on the front burner among food handlers in general.

Guidelines for safe handling of hazardous drugs: A systematic review

PubMed Central

Bernabeu-Martínez, Mari A.; Ramos Merino, Mateo; Santos Gago, Juan M.; Álvarez Sabucedo, Luis M.; Wanden-Berghe, Carmina

2018-01-01

Objective To review the scientific literature related to the safe handling of hazardous drugs (HDs). Method Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. Results In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. Conclusions Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion. PMID:29750798

Guidelines for safe handling of hazardous drugs: A systematic review.

PubMed

Bernabeu-Martínez, Mari A; Ramos Merino, Mateo; Santos Gago, Juan M; Álvarez Sabucedo, Luis M; Wanden-Berghe, Carmina; Sanz-Valero, Javier

2018-01-01

To review the scientific literature related to the safe handling of hazardous drugs (HDs). Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.

76 FR 5340 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... inclement weather, NMFS cancelled the Protected Species Safe Handling, Release, and Identification workshop..., 2011, due to inclement weather along the east coast of the United States on the date of the originally...

A physical workload index to evaluate a safe resident handling program for nursing home personnel.

PubMed

Kurowski, Alicia; Buchholz, Bryan; Punnett, Laura

2014-06-01

The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP). Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric. The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods. The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years (-24% versus -2.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value. Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling. The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.

Barriers and Facilitators to Safe Food Handling among Consumers: A Systematic Review and Thematic Synthesis of Qualitative Research Studies

PubMed Central

Young, Ian; Waddell, Lisa

2016-01-01

Foodborne illness has a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home. Several qualitative research studies have been conducted to investigate consumers’ perspectives, opinions, and experiences with safe food handling at home, and these studies provide insights into the underlying barriers and facilitators affecting their safe food handling behaviours. We conducted a systematic review of previously published qualitative studies in this area to synthesize the main across-study themes and to develop recommendations for future consumer interventions and research. The review was conducted using the following steps: comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; thematic synthesis of the results; and quality-of-evidence assessment. A total of 39 relevant articles reporting on 37 unique qualitative studies were identified. Twenty-one barriers and 10 facilitators to safe food handling were identified, grouped across six descriptive themes: confidence and perceived risk; knowledge-behaviour gap; habits and heuristics; practical and lifestyle constraints; food preferences; and societal and social influences. Our overall confidence that each barrier and facilitator represents the phenomenon of interest was rated as high (n = 11), moderate (11), and low (9). Overarching analytical themes included: 1) safe food handling behaviours occur as part of a complex interaction of everyday consumer practices and habituation; 2) most consumers are not concerned about food safety and are generally not motivated to change their behaviours based on new knowledge about food safety risks; and 3) consumers are amenable to changing their safe food handling habits through relevant social pressures. Key implications and recommendations for research, policy and practice are discussed. PMID:27907161

Gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of malaysia.

PubMed

Bin Nordin, R; Araki, S; Sato, H; Yokoyama, K; Bin Wan Muda, W A; Win Kyi, D

2001-01-01

To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice

Gender Difference in Safe and Unsafe Practice of Pesticide Handling in Tobacco Farmers of Malaysia

PubMed Central

BIN NORDIN, Rusli; ARAKI, Shunichi; SATO, Hajime; YOKOYAMA, Kazuhito; BIN WAN MUDA, Wan Abdul Manan; WIN KYI, Daw

2001-01-01

To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice

75 FR 29991 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... certificate in order to fish with or renew their limited-access shark and limited-access swordfish permits... Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and Identification... (NOAA), Commerce. ACTION: Notice of public workshops. SUMMARY: Free Atlantic Shark Identification...

76 FR 59661 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... shark permit and that use longline or gillnet gear may not fish unless both the vessel owner and... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and... Administration (NOAA), Commerce. ACTION: Notice of public workshops. SUMMARY: Free Atlantic Shark Identification...

Assessing and Addressing Safe Food Handling Knowledge, Attitudes, and Behaviors of College Undergraduates

ERIC Educational Resources Information Center

Stein, Susan E.; Dirks, Brian P.; Quinlan, Jennifer J.

2010-01-01

The authors determined the food safety knowledge, attitudes, and behaviors of undergraduates (n = 1122) on an urban college campus using a previously piloted survey tool. Data obtained found that while students reported high levels of confidence in their ability to engage in safe food handling practices, their knowledge and self-reported behaviors…

Trends in U.S. consumers' safe handling and consumption of food and their risk perceptions, 1988 through 2010.

PubMed

Fein, Sara B; Lando, Amy M; Levy, Alan S; Teisl, Mario F; Noblet, Caroline

2011-09-01

Although survey results measuring the safety of consumers' food handling and risky food consumption practices have been published for over 20 years, evaluation of trends is impossible because the designs of published studies are not comparable. The Food Safety Surveys used comparable methods to interview U.S. adults by telephone in 1988, 1993, 2001, 2006, and 2010 about food handling (i.e., cross-contamination prevention) and risky consumption practices (eating raw or undercooked foods from animals) and perceived risk from foodborne illness. Sample sizes ranged from 1,620 to 4,547. Responses were analyzed descriptively, and four indices measuring meat, chicken, and egg cross-contamination, fish cross-contamination, risky consumption, and risk perceptions were analyzed using generalized linear models. The extent of media coverage of food safety issues was also examined. We found a substantial improvement in food handling and consumption practices and an increase in perceived risk from foodborne illness between 1993 and 1998. All indices were stable or declined between 1998 and 2006. Between 2006 and 2010, the two safe food handling practice indices increased significantly, but risk perceptions did not change, and safe consumption declined. Women had safer food handling and consumption practices than men. The oldest and youngest respondents and those with the highest education had the least safe food handling behaviors. Changes in safety of practices over the survey years are consistent with the change in the number of media stories about food safety in the periods between surveys. This finding suggests that increased media attention to food safety issues may raise awareness of food safety hazards and increase vigilance in food handling by consumers.

78 FR 34349 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... January 1, 2007, shark limited-access and swordfish limited- access permit holders who fish with longline... next permit renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

76 FR 34209 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-13

... swordfish or shark permit and that use longline or gillnet gear may not fish unless both the vessel owner... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and... Administration (NOAA), Commerce. ACTION: Notice of public workshops. SUMMARY: Free Atlantic Shark Identification...

78 FR 73500 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... January 1, 2007, shark limited-access and swordfish limited- access permit holders who fish with longline... next permit renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

77 FR 32950 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited-access permits. Additionally, new shark and swordfish limited- access permit applicants who intend to fish with longline or... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

75 FR 8304 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-24

... renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited access permits. Additionally, new shark and swordfish limited access permit applicants who intend to fish with longline or... Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and Identification...

78 FR 15709 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... shark and swordfish limited-access permit applicants who intend to fish with longline or gillnet gear... limited-access swordfish or shark permit and that use longline or gillnet gear may not fish unless both... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

78 FR 54456 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-04

... workshop to fish with, or renew, their swordfish and shark limited-access permits. Additionally, new shark... limited-access swordfish or shark permit and that use longline or gillnet gear may not fish unless both... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

77 FR 55464 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-10

... Workshops Since January 1, 2007, shark limited-access and swordfish limited- access permit holders who fish... shark permit and that use longline or gillnet gear may not fish unless both the vessel owner and... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

77 FR 12574 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... workshop to fish with, or renew, their swordfish and shark limited-access permits. Additionally, new shark...-access swordfish or shark permit and that use longline or gillnet gear may not fish unless both the... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

75 FR 10217 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... first receipt of fish as they are offloaded from a vessel; and fills out dealer reports. Atlantic shark... certificate in order to fish with or renew their limited-access shark and limited-access swordfish permits... Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and Identification...

76 FR 11762 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

... receipt of fish as they are offloaded from a vessel; and who fills out dealer reports. Atlantic shark... swordfish or shark permit and that use longline or gillnet gear may not fish unless both the vessel owner... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

75 FR 53665 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-01

... shark permit and that use longline or gillnet gear may not fish unless both the vessel owner and... course, and obtain a new certificate in order to fish with or renew their limited-access shark and... Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and Identification...

Differences among nursing homes in outcomes of a safe resident handling program

PubMed Central

Kurotvski, Alicia; Gore, Rebecca; Buchholz, Bryan; Punnett, Laura

2018-01-01

A large nursing home corporation implemented a safe resident handling program (SRHP) in 2004–2007. We evaluated its efficacy over a 2-year period by examining differences among 5 centers in program outcomes and potential predictors of those differences. We observed nursing assistants (NAs), recording activities and body postures at 60-second intervals on personal digital assistants at baseline and at 3-month, 12-month, and 24-month follow-ups. The two outcomes computed were change in equipment use during resident handling and change in a physical workload index that estimated spinal loading due to body postures and handled loads. Potential explanatory factors were extracted from post-observation interviews, investigator surveys of the workforce, from administrative data, and employee satisfaction surveys. The facility with the most positive outcome measures was associated with many positive changes in explanatory factors and the facility with the fewest positive outcome measures experienced negative changes in the same factors. These findings suggest greater SRHP benefits where there was lower NA turnover and agency staffing; less time pressure; and better teamwork, staff communication, and supervisory support. PMID:22833329

Adherence to Safe Handling Guidelines by Health Care Workers Who Administer Antineoplastic Drugs

PubMed Central

Boiano, James M.; Steege, Andrea L.; Sweeney, Marie H.

2015-01-01

The toxicity of antineoplastic drugs is well documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE), and barriers to using PPE, the National Institute for Safety and Health (NIOSH) conducted a web survey of health care workers in 2011. The study population primarily included members of professional practice organizations representing health care occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers, and physician offices, respondents reported that they had collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide, and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic drug by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic drug during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was “skin exposure was minimal”; 4% of respondents, however, reported skin contact during handling

Peer coaching and mentoring: a new model of educational intervention for safe patient handling in health care.

PubMed

Alamgir, Hasanat; Drebit, Sharla; Li, Helen Guiyun; Kidd, Catherine; Tam, Helen; Fast, Catherine

2011-08-01

To reduce the risk of patient handling-related musculoskeletal injury, overhead ceiling lifts have been installed in health care facilities. To increase ceiling lift usage for a variety of patient handling tasks, a peer coaching and mentoring program was implemented among the direct care staff in the long-term care subsector in British Columbia, Canada. They received a 4-day training program on body mechanics, ergonomics, patient-handling techniques, ceiling lift usage, in addition to coaching skills. A questionnaire was administered among staff before and after the intervention to evaluate the program's effectiveness. There were 403 and 200 respondents to the pre-intervention and post-intervention questionnaires. In general, staff perceived the peer-coaching program to be effective. The number of staff who reported to be using ceiling lifts "often and always" went higher from 64.5% to 80.5% (<0.001) after coaching program implementation. Furthermore, staff reported that they were using the ceiling lifts for more types of tasks post-intervention. Staff reported that the peer coaching program has increased their safety awareness at work and confidence in using the ceiling lifts. The findings suggest that this educational model can increase the uptake of mechanical interventions for occupational health and safety initiatives. It appears that the training led to a greater awareness of the availability of or increased perceptions of the number of ceiling lifts, presumably through coaches advocating their use. Copyright © 2011 Wiley-Liss, Inc.

Clients' safe food-handling knowledge and risk behavior in a home-delivered meal program.

PubMed

Almanza, Barbara A; Namkung, Young; Ismail, Joseph A; Nelson, Douglas C

2007-05-01

To determine typical handling practices of home-delivered meals, and provide appropriate handling instructions to reduce the risk of foodborne illness by improving consumer handling of home-delivered meals. Once permission was given by the home-delivered meal site directors, clients were provided a voluntary survey and requested by the delivery drivers to complete the self-administered questionnaire. The completed questionnaire was collected by the driver the following day. Because of the special needs of the home-delivered meal populations, the questionnaire was made as easy and convenient to answer as possible. Two hundred fifty-eight male clients (31%) and 575 female clients (69%) whose mean age was 79 years participated in the study. The respondents' safe food-handling practices, food safety knowledge, and demographic information were assessed. Average time for delivery and consumption of meals were also measured. Descriptive statistics (frequency and chi(2) test) of the participants' handling of home-delivered meals, their general food safety knowledge, and demographic information were reported. Delivery time and consumption time were calculated for each subject. Five hundred thirty-six of 869 clients (63%) reported that they ate their meals as soon as they were delivered. Of those clients who did not eat their meals immediately, 234 (82%) stored the cold food in the refrigerator and 142 (58%) stored the hot food in the freezer. More than one-third of the clients (n=277, 35%) reported that they had leftovers and only 34 (15%) ate the leftovers within 2 hours. Significant differences among groups on the basis of a derived food safety knowledge score were observed in terms of whether or not they ate their meal immediately (P

Differences among nursing homes in outcomes of a safe resident handling program.

PubMed

Kurowski, Alicia; Gore, Rebecca; Buchholz, Bryan; Punnett, Laura

2012-01-01

A large nursing home corporation implemented a safe resident handling program (SRHP) in 2004-2007. We evaluated its efficacy over a 2-year period by examining differences among 5 centers in program outcomes and potential predictors of those differences. We observed nursing assistants (NAs), recording activities and body postures at 60-second intervals on personal digital assistants at baseline and at 3-month, 12-month, and 24-month follow-ups. The two outcomes computed were change in equipment use during resident handling and change in a physical workload index that estimated spinal loading due to body postures and handled loads. Potential explanatory factors were extracted from post-observation interviews, investigator surveys of the workforce, from administrative data, and employee satisfaction surveys. The facility with the most positive outcome measures was associated with many positive changes in explanatory factors and the facility with the fewest positive outcome measures experienced negative changes in the same factors. These findings suggest greater SRHP benefits where there was lower NA turnover and agency staffing; less time pressure; and better teamwork, staff communication, and supervisory support. © 2012 American Society for Healthcare Risk Management of the American Hospital Association.

Safe Handling and Use of Flammable and Combustible Materials. Module SH-30. Safety and Health.

ERIC Educational Resources Information Center

Center for Occupational Research and Development, Inc., Waco, TX.

This student module on safe handling and use of flammable and combustible materials is one of 50 modules concerned with job safety and health. This module introduces the student to the hazards of flammable and combustible materials and the measures necessary to control those hazards. Following the introduction, 14 objectives (each keyed to a page…

Varying influences of motivation factors on employees' likelihood to perform safe food handling practices because of demographic differences.

PubMed

Ellis, Jason D; Arendt, Susan W; Strohbehn, Catherine H; Meyer, Janell; Paez, Paola

2010-11-01

Food safety training has been the primary avenue for ensuring food workers are performing proper food handling practices and thus, serving safe food. Yet, knowledge of safe food handling practices does not necessarily result in actual performance of these practices. This research identified participating food service employees' level of agreement with four factors of motivation (internal motivations, communication, reward-punishment, and resources) and determined if respondents with different demographic characteristics reported different motivating factors. Data were collected from 311 food service employees who did not have any supervisory responsibilities. Intrinsic motivation agreement scores were consistently the highest of all four motivational factors evaluated and did not differ across any of the demographic characteristics considered. In contrast, motivation agreement scores for communication, reward-punishment, and resources did differ based on respondents' gender, age, place of employment, job status, food service experience, completion of food handler course, or possession of a food safety certification. In general, respondents agreed that these motivation factors influenced their likelihood to perform various safe food handling procedures. This research begins to illustrate how employees' demographic characteristics influence their responses to various motivators, helping to clarify the complex situation of ensuring safe food in retail establishments. Future research into why employee willingness to perform varies more for extrinsic motivation than for intrinsic motivation could assist food service managers in structuring employee development programs and the work environment, in a manner that aids in improving external motivation (communication, reward-punishment, and resources) and capitalizing on internal motivation.

Work-related musculoskeletal risks associated with nurses and nursing assistants handling overweight and obese patients: A literature review.

PubMed

Choi, Sang D; Brings, Kathryn

2015-01-01

Nurses and nursing assistants are susceptible to work-related musculoskeletal disorders and injuries (WMSDs) due to the increase in overweight and obese patients they are handling on a daily basis. This study aimed to review work-related musculoskeletal hazards and risks associated with handling overweight and obese patients, and summarize the recommended interventions to mitigate musculoskeletal concerns among nurses and nursing assistants. Approximately 350 publications were initially screened and 22 refereed articles were used to synthesize for this study on the bases of inclusion/exclusion relevance and strength of evidence on overweight or obese patient handling. Evidence suggested that the work-related musculoskeletal risks among nurses and nursing assistants included sprains/strains, low back pain, wrist, knee and shoulder injuries. The findings indicated that the WMSD risks increased when nurses and nursing assistants were manually moving or lifting patients, especially when the patients were overweight or obese. The recommended solutions included the lifting/transfer equipment and devices, ergonomic assessments and controls, no-lift policies, and training and education. To alleviate the risk of musculoskeletal disorders and injuries among nurses and nursing assistants handling overweight or obese patients, additional research and development into what safe patient handling interventions suit this growing population needs to be addressed.

Examining the predictive utility of an extended theory of planned behaviour model in the context of specific individual safe food-handling.

PubMed

Mullan, Barbara; Allom, Vanessa; Sainsbury, Kirby; Monds, Lauren A

2015-07-01

In order to minimise the occurrence of food-borne illness, it is recommended that individuals perform safe food-handling behaviours, such as cooking food properly, cleaning hands and surfaces before preparing food, keeping food at the correct temperature, and avoiding unsafe foods. Previous research examining the determinants of safe food-handling behaviour has produced mixed results; however, this may be due to the fact that this research examined these behaviours as a totality, rather than considering the determinants of each behaviour separately. As such, the objective for the present study was to examine the predictors of the four aforementioned safe food-handling behaviours by applying an extended theory of planned behaviour to the prediction of each distinct behaviour. Participants were 170 students who completed theory of planned behaviour measures, with the addition of moral norm and habit strength at time 1, and behaviour measures one week later. While the influence of injunctive and descriptive norm and perceived behavioural control differed between behaviours, it appeared that moral norm was an important predictor of intention to engage in each of the four behaviours. Similarly, habit strength was an important predictor of each of the behaviours and moderated the relationship between intention and behaviour for the behaviour of avoiding unsafe food. The implication of these findings is that examining safe food-handling behaviours separately, rather than as a totality, may result in meaningful distinctions between the predictors of these behaviours. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dazomet Fumigant Safe Handling Guide

EPA Pesticide Factsheets

Dazomet is the active ingredient in Basamid G soil fumigant pesticide. Wear personal protective equipment such as respirators when handling Basamid granules or making an application, mitigate exposures, and recognize signs of vapor inhalation.

Manual handling risks associated with the care, treatment and transportation of bariatric patients and clients in Australia.

PubMed

Cowley, Stephen P; Leggett, Susan

2010-06-01

To gain an understanding of the factors that affect the risks and the adoption of risk control measures during the care of bariatric patients, focus groups were conducted in rural and metropolitan locations in Australia. It was found that the manual handling injury risk to carers is influenced by the design of the environments within which patient movement is undertaken; the limited range of handling equipment available for use with bariatric patients; and the efficacy of organizational procedures and training. Adoption of risk controls is hampered by the absence of a standard definition of the term 'bariatric' and limitations in the use of weight and body mass index in definitions. There are gaps in information flow during the bariatric patient journey through the health-care system and a lack of knowledge about how to safely manage the unique needs of bariatric patients.

Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel.

PubMed

Garg, Arun; Kapellusch, Jay M

2012-08-01

The aim of this study was to evaluate long-term efficacy of an ergonomics program that included patient-handling devices in six long-term care facilities (LTC) and one chronic care hospital (CCH). Patient handling is recognized as a major source of musculoskeletal disorders (MSDs) among nursing personnel, and several studies have demonstrated effectiveness of patient-handling devices in reducing those MSDs. However, most studies have been conducted in a single facility, for a short period, and/or without a comprehensive ergonomics program. Patient-handling devices along with a comprehensive ergonomics program was implemented in six LTC facilities and one CCH. Pre- and postintervention injury data were collected for 38.9 months (range = 29 to 54 months) and 51.2 months (range = 36 to 60 months), respectively. Postintervention patient-handling injuries decreased by 59.8% (rate ratio [RR] = 0.36, 95% confidence interval [CI] [0.28, 0.49], p < .001), lost workdays by 86.7% (RR = 0.16, 95% CI [0.13, 0.18], p < .001), modified-duty days by 78.8% (RR = 0.25, 95% CI [0.22, 0.28], p < .001), and workers' compensation costs by 90.6% (RR = 0.12, 95% CI [0.09, 0.15], p < .001). Perceived stresses to low back and shoulders among nursing staff were fairly low. A vast majority of patients found the devices comfortable and safe. Longer transfer times with the use of devices was not an issue. Implementation of patient-handling devices along with a comprehensive program can be effective in reducing MSDs among nursing personnel. Strategies to expand usage of patient-handling devices in most health care settings should be explored.

Safe practices and financial considerations in using oral chemotherapeutic agents.

PubMed

Bartel, Sylvia B

2007-05-01

Safe handling practices and financial concerns associated with oral chemotherapy in non-traditional settings are discussed. Oral chemotherapy may pose a risk to patients because of a narrow therapeutic index, complex dosing regimen, dispensing by community pharmacists without prescription order review by an oncology pharmacist or nurse, or self-administration in the home or another nontraditional setting, where patient monitoring is infrequent. Errors in prescribing, dispensing, and administration and patient or caregiver misunderstandings are potential problems with the use of oral chemotherapy that need to be addressed when developing safe practices. Changes in Medicare pharmaceutical reimbursement rates and rules need to be monitored because they have the potential to affect patient care and outcomes. Patient assistance programs and advocacy groups can help alleviate financial concerns associated with oral chemotherapy. Consensus guidelines specific to safe handling of oral chemotherapy in the home or other nontraditional setting need to be developed. Also, healthcare providers must understand reimbursement and provide direction to patients when patient assistance programs or advocacy groups can assist with the financial challenges of oral chemotherapy.

An economic analysis of a safe resident handling program in nursing homes.

PubMed

Lahiri, Supriya; Latif, Saira; Punnett, Laura

2013-04-01

Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective. The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the "net-cost model." Among 110 centers, the overall benefit-to-cost ratio was 1.7-3.09 and the payback period was 1.98-1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22-$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22-$308). However, at 49 centers costs exceeded benefits. Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity. Copyright © 2012 Wiley Periodicals, Inc.

An Economic Analysis of a Safe Resident Handling Program in Nursing Homes

PubMed Central

Lahiri, Supriya; Latif, Saira; Punnett, Laura

2018-01-01

Background Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective. Methods The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the “net-cost model”. Results Among 110 centers, the overall benefit-to-cost ratio was 1.7–3.09 and the payback period was 1.98–1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22–$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22–$308). However, at 49 centers costs exceeded benefits. Conclusions Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity. PMID:23203729

Handling small arbovirus vectors safely during biosafety level 3 containment: Culicoides variipennis sonorensis (Diptera:Ceratopogonidae) and exotic bluetongue viruses.

PubMed

Hunt, G J; Tabachnick, W J

1996-05-01

Equipment and procedures are described for biosafety level 3 (BL-3) containment work with small, zoophilic arthropods. BL-3 classified pathogens always must be manipulated in biological safety cabinets. Procedures, including physical barriers and handling methods, that prevent the escape of potentially virus-infected insects are discussed, and the use of a monitoring system for insect security is explained. The inability to recover escaped minute, flying insects poses a major difference from similar work with larger insects, such as mosquitoes. Methods were developed for the safe and secure handling of Culicoides variipennis sonorensis Wirth & Jones infected with exotic bluetongue viruses during BL-3 containment.

Musculoskeletal injuries resulting from patient handling tasks among hospital workers.

PubMed

Pompeii, Lisa A; Lipscomb, Hester J; Schoenfisch, Ashley L; Dement, John M

2009-07-01

The purpose of this study was to evaluate musculoskeletal injuries and disorders resulting from patient handling prior to the implementation of a "minimal manual lift" policy at a large tertiary care medical center. We sought to define the circumstances surrounding patient handling injuries and to identify potential preventive measures. Human resources data were used to define the cohort and their time at work. Workers' compensation records (1997-2003) were utilized to identify work-related musculoskeletal claims, while the workers' description of injury was used to identify those that resulted from patient handling. Adjusted rate ratios were generated using Poisson regression. One-third (n = 876) of all musculoskeletal injuries resulted from patient handling activities. Most (83%) of the injury burden was incurred by inpatient nurses, nurses' aides and radiology technicians, while injury rates were highest for nurses' aides (8.8/100 full-time equivalent, FTEs) and smaller workgroups including emergency medical technicians (10.3/100 FTEs), patient transporters (4.3/100 FTEs), operating room technicians (3.1/100 FTEs), and morgue technicians (2.2/100 FTEs). Forty percent of injuries due to lifting/transferring patients may have been prevented through the use of mechanical lift equipment, while 32% of injuries resulting from repositioning/turning patients, pulling patients up in bed, or catching falling patients may not have been prevented by the use of lift equipment. The use of mechanical lift equipment could significantly reduce the risk of some patient handling injuries but additional interventions need to be considered that address other patient handling tasks. Smaller high-risk workgroups should not be neglected in prevention efforts.

Adverse risk: a 'dynamic interaction model of patient moving and handling'.

PubMed

Griffiths, Howard

2012-09-01

The aim of the present study was to examine patient adverse events associated with sub-optimal patient moving and handling. Few studies have examined the patient's perspective on adverse risk during manual handling episodes. A narrative review was undertaken to develop the 'Dynamic Interaction Model of Patient Moving and Handling' in an orthopaedic rehabilitation setting, using peer-reviewed publications published in English between 1992 and 2010. Five predominant themes emerged from the narrative review: 'patient's need to know about analgesics prior to movement/ambulation'; 'comfort care'; 'mastery of and acceptance of mobility aids/equipment'; 'psychological adjustment to fear of falling'; and 'the need for movement to prevent tissue pressure damage'. Prevalence of discomfort, pain, falls, pressure sores together with a specific Direct Instrument Nursing Observation (DINO) tool enable back care advisers to measure quality of patient manual handling. Evaluation of patients' use of mobility aids together with fear of falling may be important in determining patients' recovery trajectory. Clinical governance places a responsibility on nurse managers to consider quality of care for their service users. 'Dynamic Interaction Model of Nurse-Patient Moving and Handling' provides back care advisers, clinical risk managers and occupational health managers with an alternative perspective to clinical risk and occupational risk. © 2011 Blackwell Publishing Ltd.

Can control banding be useful for the safe handling of nanomaterials? A systematic review

NASA Astrophysics Data System (ADS)

Eastlake, Adrienne; Zumwalde, Ralph; Geraci, Charles

2016-06-01

Control banding (CB) is a risk management strategy that has been used to identify and recommend exposure control measures to potentially hazardous substances for which toxicological information is limited. The application of CB and level of expertise required for implementation and management can differ depending on knowledge of the hazard potential, the likelihood of exposure, and the ability to verify the effectiveness of exposure control measures. A number of different strategies have been proposed for using CB in workplaces where exposure to engineered nanomaterials (ENMs) can occur. However, it is unclear if the use of CB can effectively reduce worker exposure to nanomaterials. A systematic review of studies was conducted to answer the question "can control banding be useful to ensure adequate controls for the safe handling of nanomaterials." A variety of databases were searched to identify relevant studies pertaining to CB. Database search terms included `control,' `hazard,' `exposure,' and `risk' banding as well as the use of these terms in the context of nanotechnology or nanomaterials. Other potentially relevant studies were identified during the review of articles obtained in the systematic review process. Identification of studies and the extraction of data were independently conducted by the reviewers. Quality of the studies was assessed using the methodological index for nonrandomized studies. The quality of the evidence was evaluated using grading of recommendations assessment, development and evaluation (GRADE). A total of 235 records were identified in the database search in which 70 records were determined to be eligible for full-text review. Only two studies were identified that met the inclusion criteria. These studies evaluated the application of the CB Nanotool in workplaces where ENMs were being handled. A total of 32 different nanomaterial handling activities were evaluated in these studies by comparing the recommended exposure controls using

Effects of the Smartphone Application "Safe Patients" on Knowledge of Patient Safety Issues Among Surgical Patients.

PubMed

Cho, Sumi; Lee, Eunjoo

2017-12-01

Recently, the patient's role in preventing adverse events has been emphasized. Patients who are more knowledgeable about safety issues are more likely to engage in safety initiatives. Therefore, nurses need to develop techniques and tools that increase patients' knowledge in preventing adverse events. For this reason, an educational smartphone application for patient safety called "Safe Patients" was developed through an iterative process involving a literature review, expert consultations, and pilot testing of the application. To determine the effect of "Safe Patients," it was implemented for patients in surgical units in a tertiary hospital in South Korea. The change in patients' knowledge about patient safety was measured using seven true/false questions developed in this study. A one-group pretest and posttest design was used, and a total of 123 of 190 possible participants were tested. The percentage of correct answers significantly increased from 64.5% to 75.8% (P < .001) after implementation of the "Safe Patients" application. This study demonstrated that the application "Safe Patients" could effectively improve patients' knowledge of safety issues. This will ultimately empower patients to engage in safe practices and prevent adverse events related to surgery.

Can Control Banding be Useful for the Safe Handling of Nanomaterials? A Systematic Review

PubMed Central

Eastlake, Adrienne; Zumwalde, Ralph; Geraci, Charles

2016-01-01

Objectives Control banding (CB) is a risk management strategy that has been used to identify and recommend exposure control measures to potentially hazardous substances for which toxicological information is limited. The application of CB and level of expertise required for implementation and management can differ depending on knowledge of the hazard potential, the likelihood of exposure, and the ability to verify the effectiveness of exposure control measures. A number of different strategies have been proposed for using CB in workplaces where exposure to engineered nanomaterials (ENMs) can occur. However, it is unclear if the use of CB can effectively reduce worker exposure to nanomaterials. A systematic review of studies was conducted to answer the question “can control banding be useful to ensure adequate controls for the safe handling of nanomaterials.” Methods A variety of databases were searched to identify relevant studies pertaining to CB. Database search terms included ‘control’, ‘hazard’, ‘exposure’ and ‘risk’ banding as well as the use of these terms in the context of nanotechnology or nanomaterials. Other potentially relevant studies were identified during the review of articles obtained in the systematic review process. Identification of studies and the extraction of data were independently conducted by the reviewers. Quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS). The quality of the evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results A total of 235 records were identified in the database search in which 70 records were determined to be eligible for full-text review. Only two studies were identified that met the inclusion criteria. These studies evaluated the application of the CB Nanotool in workplaces where ENMs were being handled. A total of 32 different nanomaterial handling activities were evaluated in these

Predicting intentions to adopt safe home food handling practices. Applying the theory of planned behavior.

PubMed

Shapiro, Michael A; Porticella, Norman; Jiang, L Crystal; Gravani, Robert B

2011-02-01

While most home cooks know about safe home food handling procedures, compliance is generally low and has not been much improved by campaigns. Foodborne disease is a common cause of illness, hospitalization and even death, and many of these illnesses are caused by unsafe home food practices. Using the theory of planned behavior as a model, survey data were analyzed. Perceived behavioral control was the strongest predictor of behavioral intentions for both hand washing and food thermometer use. Subjective norm was the next strongest predictor for thermometer use, while attitude towards the behavior was the next strongest predictor for hand washing. This is consistent with earlier focus group results for thermometer use and suggests some possible strategies for designing future home food safety messages. Copyright © 2010 Elsevier Ltd. All rights reserved.

Predictors of low back pain in nursing home workers after implementation of a safe resident handling programme.

PubMed

Gold, Judith E; Punnett, Laura; Gore, Rebecca J

2017-06-01

Healthcare workers have high rates of low back pain (LBP) related to handling patients. A large chain of nursing homes experienced reduced biomechanical load, compensation claims and costs following implementation of a safe resident handling programme (SRHP). The aim of this study was to examine whether LBP similarly declined and whether it was associated with relevant self-reported occupational exposures or personal health factors. Worker surveys were conducted on multiple occasions beginning with the week of first SRHP introduction (baseline). In each survey, the outcome was LBP during the prior 3 months with at least mild severity during the past week. Robust Poisson multivariable regression models were constructed to examine correlates of LBP cross-sectionally at 2 years (F3) and longitudinally at 5-6 years (F5) post-SRHP implementation among workers also in at least one prior survey. LBP prevalence declined minimally between baseline and F3. The prevalence was 37% at F3 and cumulative incidence to F5 was 22%. LBP prevalence at F3 was positively associated with combined physical exposures, psychological job demands and prior back injury, while frequent lift device usage and 'intense' aerobic exercise frequency were protective. At F5, the multivariable model included frequent lift usage at F3 (relative risk (RR) 0.39 (0.18 to 0.84)) and F5 work-family imbalance (RR=1.82 (1.12 to 2.98)). In this observational study, resident lifting device usage predicted reduced LBP in nursing home workers. Other physical and psychosocial demands of nursing home work also contributed, while frequent intense aerobic exercise appeared to reduce LBP risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions.

PubMed

Fray, Mike; Hignett, Sue

2013-01-01

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation. Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

Expanded Occupational Safety and Health Administration 300 log as metric for bariatric patient-handling staff injuries.

PubMed

Randall, Stephen B; Pories, Walter J; Pearson, Amy; Drake, Daniel J

2009-01-01

Mobilization of morbidly obese patients poses significant physical challenges to healthcare providers. The purpose of this study was to examine the staff injuries associated with the patient handling of the obese, to describe a process for identifying injuries associated with their mobilization, and to report on the need for safer bariatric patient handling. We performed our study at a 761-bed, level 1 trauma center affiliated with a U.S. medical school. The hospital's Occupational Safety and Health Administration (OSHA) 300 log was expanded to the "E-OSHA 300 log" to specifically identify injuries the staff attributed to bariatric patient handling. The 2007 E-OSHA 300 log was analyzed to identify and describe the frequency, severity, and nature of bariatric versus nonbariatric patient handling injuries. The analyses revealed that during 2007, although patients with a body mass index of > or =35 kg/m(2) constituted <10% of our patient population, 29.8% of staff injuries related to patient handling were linked to working with a bariatric patient. Bariatric patient handling accounted for 27.9% of all lost workdays and 37.2% of all restricted workdays associated with patient handling. Registered nurses and nursing assistants accounted for 80% of the injuries related to bariatric patient handling. Turning and repositioning the patient in bed accounted for 31% of the injuries incurred. The E-OSHA 300 log narratives revealed that staff injuries associated with obese and nonobese patient handling were usually performed using biomechanics and not equipment. Manual mobilization of morbidly obese patients increases the risk of caregiver injury. A tracking indicator on the OSHA 300 logs for staff injury linked to a bariatric patient would provide the ability to compare obese and nonobese patient handling injuries. The E-OSHA 300 log provides a method to identify the frequency, severity, and nature of caregiver injury during mobilization of the obese. Understanding the

Patient handling system for carbon ion beam scanning therapy

PubMed Central

Shirai, Toshiyuki; Takei, Yuka; Furukawa, Takuji; Inaniwa, Taku; Matsuzaki, Yuka; Kumagai, Motoki; Murakami, Takeshi; Noda, Koji

2012-01-01

Our institution established a new treatment facility for carbon ion beam scanning therapy in 2010. The major advantages of scanning beam treatment compared to the passive beam treatment are the following: high dose conformation with less excessive dose to the normal tissues, no bolus compensator and patient collimator/ multi‐leaf collimator, better dose efficiency by reducing the number of scatters. The new facility was designed to solve several problems encountered in the existing facility, at which several thousand patients were treated over more than 15 years. Here, we introduce the patient handling system in the new treatment facility. The new facility incorporates three main systems, a scanning irradiation system (S‐IR), treatment planning system (TPS), and patient handling system (PTH). The PTH covers a wide range of functions including imaging, geometrical/position accuracy including motion management (immobilization, robotic arm treatment bed), layout of the treatment room, treatment workflow, software, and others. The first clinical trials without respiratory gating have been successfully started. The PTH allows a reduction in patient stay in the treatment room to as few as 7 min. The PTH plays an important role in carbon ion beam scanning therapy at the new institution, particularly in the management of patient handling, application of image‐guided therapy, and improvement of treatment workflow, and thereby allows substantially better treatment at minimum cost. PACS numbers: 87.56.‐v; 87.57.‐s; 87.55.‐x PMID:23149784

Metam Sodium and Metam Potassium Fumigant Safe Handling Guide

EPA Pesticide Factsheets

Safety training is required for certified pesticide applicators and handlers to handle soil fumigants. Measures to mitigate exposure include personal protective equipment, air monitoring, respiratory protection, and emergency preparedness.

The influence of ergonomic devices on mechanical load during patient handling activities in nursing homes.

PubMed

Koppelaar, Elin; Knibbe, Hanneke J J; Miedema, Harald S; Burdorf, Alex

2012-07-01

Mechanical load during patient handling activities is an important risk factor for low back pain among nursing personnel. The aims of this study were to describe required and actual use of ergonomic devices during patient handling activities and to assess the influence of these ergonomic devices on mechanical load during patient handling activities. For each patient, based on national guidelines, it was recorded which specific ergonomic devices were required during distinct patient handling activities, defined by transferring a patient, providing personal care, repositioning patients in the bed, and putting on and taking off anti-embolism stockings. During real-time observations over ~60 h among 186 nurses on 735 separate patient handling activities in 17 nursing homes, it was established whether ergonomic devices were actually used. Mechanical load was assessed through observations of frequency and duration of a flexed or rotated trunk >30° and frequency of pushing, pulling, lifting or carrying requiring forces <100 N, between 100 and 230 N, and >230 N from start to end of each separate patient handling activity. The number of patients and nurses per ward and the ratio of nurses per patient were used as ward characteristics with potential influence on mechanical load. A mixed-effect model for repeated measurements was used to determine the influence of ergonomic devices and ward characteristics on mechanical load. Use of ergonomic devices was required according to national guidelines in 520 of 735 (71%) separate patient handling activities, and actual use was observed in 357 of 520 (69%) patient handling activities. A favourable ratio of nurses per patient was associated with a decreased duration of time spent in awkward back postures during handling anti-embolism stocking (43%), patient transfers (33%), and personal care of patients (24%) and also frequency of manually lifting patients (33%). Use of lifting devices was associated with a lower frequency of forces

Materials Handling. Module SH-01. Safety and Health.

ERIC Educational Resources Information Center

Center for Occupational Research and Development, Inc., Waco, TX.

This student module on materials handling is one of 50 modules concerned with job safety and health. It presents the procedures for safe materials handling. Discussed are manual handling methods (lifting and carrying by hand) and mechanical lifting (lifting by powered trucks, cranes or conveyors). Following the introduction, 15 objectives (each…

Patient Involvement in Safe Delivery: A Qualitative Study.

PubMed

Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

2015-09-28

Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013.The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The participants in this research were women before discharge and after delivery. Findings were analyzed using Colaizzi's method. Four categories of factors that could affect patient involvement in safe delivery emerged from our analysis: patient-related (true and false beliefs, literacy, privacy, respect for patient), illness-related (pain, type of delivery, patient safety incidents), health care professional-relatedand task-related factors (behavior, monitoring &training), health care setting-related (financial aspects, facilities). More research is needed to explore the factors affecting the participation of mothers. It is therefore, recommended to: 1) take notice of mother education, their husbands, midwives and specialists; 2) provide pregnant women with insurance coverage from the outset of pregnancy, especially during prenatal period; 3) form a labor pain committee consisting of midwives, obstetricians, and anesthesiologists in order to identify the preferred painless labor methods based on the existing facilities and conditions, 4) carry out research on observing patients' privacy and dignity; 5) pay more attention on the factors affecting cesarean.

Guidelines for safe handling, use and disposal of nanoparticles

NASA Astrophysics Data System (ADS)

Amoabediny, G. H.; Naderi, A.; Malakootikhah, J.; Koohi, M. K.; Mortazavi, S. A.; Naderi, M.; Rashedi, H.

2009-05-01

situations, performing administrative means of control constitute other ways of limiaiting the occupational exposure risks. Accordingly, to minimize the risks from know and unknown health, safety and invironment hazards in research and occupational setting of the country, guideline for safe handling, use and disposal of manopractical has provided.

Safe Hazmat Storage Tips.

ERIC Educational Resources Information Center

Neville, Angela

1996-01-01

Provides a list of recommendations for safely managing hazardous waste containers. Encourages training of employees on the hazards of the wastes they handle and the correct procedures for managing containers. (DDR)

Safe Reentry for False Aneurysm Operations in High-Risk Patients.

PubMed

Martinelli, Gian Luca; Cotroneo, Attilio; Caimmi, Philippe Primo; Musica, Gabriele; Barillà, David; Stelian, Edmond; Romano, Angelo; Novelli, Eugenio; Renzi, Luca; Diena, Marco

2017-06-01

In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Pressure ulcer risk of patient handling sling use.

PubMed

Peterson, Matthew J; Kahn, Julie A; Kerrigan, Michael V; Gutmann, Joseph M; Harrow, Jeffrey J

2015-01-01

Patient handling slings and lifts reduce the risk of musculoskeletal injuries for healthcare providers. However, no published evidence exists of their safety with respect to pressure ulceration for vulnerable populations, specifically persons with spinal cord injury, nor do any studies compare slings for pressure distribution. High-resolution interface pressure mapping was used to describe and quantify risks associated with pressure ulceration due to normal forces and identify at-risk anatomical locations. We evaluated 23 patient handling slings with 4 nondisabled adults. Sling-participant interface pressures were recorded while participants lay supine on a hospital bed and while suspended during typical patient transfers. Sling-participant interface pressures were greatest while suspended for all seated and supine slings and exceeded 200 mm Hg for all seated slings. Interface pressures were greatest along the sling seams (edges), regardless of position or sling type. The anatomical areas most at risk while participants were suspended in seated slings were the posterior upper and lower thighs. For supine slings, the perisacral area, ischial tuberosities, and greater trochanters were most at risk. The duration of time spent in slings, especially while suspended, should be limited.

Salient Features and Outline of the Joint Japanese Guidelines for Safe Handling of Cancer Chemotherapy Drugs

PubMed Central

Kanda, Kiyoko; Hirai, Kazue; Iino, Keiko; Nomura, Hisanaga; Yasui, Hisateru; Kano, Taro; Ichikawa, Chisato; Hiura, Sumiko; Morita, Tomoko; Mitsuma, Ayako; Komatsu, Hiroko

2017-01-01

The purpose of this paper is to introduce the outline and describe the salient features of the “Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs” (hereinafter, “Guideline”), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure. PMID:28966958

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil.

PubMed

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa Sobrinho, Paulo de Souza; da Silva, Daniele Ferreira

2015-06-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets.

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil

PubMed Central

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa, Paulo de Souza; da Silva, Daniele Ferreira

2015-01-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets. PMID:26273278

Safe Handover : Safe Patients - The Electronic Handover System.

PubMed

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS.

Compilation of Requirements for Safe Handling of Fluorine and Fluorine-Containing Products of Uranium Hexafluoride Conversion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ferrada, J.J.

2000-04-03

Public Law (PL) 105-204 requires the U.S. Department of Energy to develop a plan for inclusion in the fiscal year 2000 budget for conversion of the Department's stockpile of depleted uranium hexafluoride (DUF{sub 6}) to a more stable form over an extended period. The conversion process into a more stable form will produce fluorine compounds (e.g., elemental fluorine or hydrofluoric acid) that need to be handled safely. This document compiles the requirements necessary to handle these materials within health and safety standards, which may apply in order to ensure protection of the environment and the safety and health of workersmore » and the public. Fluorine is a pale-yellow gas with a pungent, irritating odor. It is the most reactive nonmetal and will react vigorously with most oxidizable substances at room temperature, frequently with ignition. Fluorine is a severe irritant of the eyes, mucous membranes, skin, and lungs. In humans, the inhalation of high concentrations causes laryngeal spasm and broncospasms, followed by the delayed onset of pulmonary edema. At sublethal levels, severe local irritation and laryngeal spasm will preclude voluntary exposure to high concentrations, unless the individual is trapped or incapacitated. A blast of fluorine gas on the shaved skin of a rabbit causes a second degree burn. Lower concentrations cause severe burns of insidious onset, resulting in ulceration, similar to the effects produced by hydrogen fluoride. Hydrofluoric acid is a colorless, fuming liquid or gas with a pungent odor. It is soluble in water with release of heat. Ingestion of an estimated 1.5 grams produced sudden death without gross pathological damage. Repeated ingestion of small amounts resulted in moderately advanced hardening of the bones. Contact of skin with anhydrous liquid produces severe burns. Inhalation of AHA or aqueous hydrofluoric acid mist or vapors can cause severe respiratory tract irritation that may be fatal. Based on the extreme chemical

Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury.

PubMed

Kurowski, Alicia; Pransky, Glenn; Punnett, Laura

2018-05-21

Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.

Use of Health Belief Model Variables To Examine Self-Reported Food Handling Behaviors in a Sample of U.S. Adults Attending a Tailgate Event.

PubMed

Hanson, Jennifer A; Hughes, Susan M; Liu, Pei

2015-12-01

Unsafe food handling behaviors are common among consumers, and, given the venue, individuals attending a tailgating event may be at risk for foodborne illness. The objective of this study was to measure the association between Health Belief Model variables and self-reported usual food handling behaviors in a convenience sample of men and women at a tailgate event. Participants (n = 128) completed validated subscales for self-reported food handling behaviors (i.e., cross-contamination, sanitation), perceived threat of foodborne illness (i.e., perceived severity, perceived susceptibility), and safe food handling cues to action (i.e., media cues, educational cues). Perceived severity of foodborne illness was associated with safer behaviors related to sanitation (r = 0.40; P < 0.001) and cross-contamination (r = 0.33; P = 0.001). Perceived severity of foodborne illness was also associated with exposure to safe food handling media cues (r = 0.20; P = 0.027) but not with safe food handling educational cues. A large proportion of participants reported that they never or seldom (i) read newspaper or magazine articles about foodborne illness (65.6%); (ii) read brochures about safe ways to handle food (61.7%); (iii) see store displays that explain ways to handle food (51.6%); or (iv) read the "safe handling instructions" on packages of raw meat and poultry (46.9%). Perceived severity of foodborne illness was positively related to both dimensions of safe food handling as well as with safe food handling media cues. Except for the weak correlation between media cues and perceived severity, the relationships between safe food handling cues and perceived threat, as well as between safe food handling cues and behaviors, were nonsignificant. This finding may be due, in part, to the participants' overall low exposure to safe food handling cues. The overall results of this study reinforce the postulate that perceived severity of foodborne illness may influence food handling behaviors.

Handling of Diskus dry powder inhaler in Chinese chronic obstructive pulmonary disease patients.

PubMed

Li, Huaidong; Chen, Yuanyuan; Zhang, Zhaorui; Dong, Xiaoxuan; Zhang, Guogang; Zhang, Hui

2014-06-01

The incorrect handling of Diskus inhalers in Chinese patients with chronic obstructive pulmonary disease (COPD) is not well documented. The present study was conducted to evaluate in detail the handling errors related to the Diskus device, and to elucidate the importance of educating COPD patients on the proper use of the device. A total of 384 COPD patients from a pulmonary clinic in China over a period of 5 years were included in the study. The compliance of COPD patients to the 13 discrete steps of Diskus usage were scored and analyzed by three measures: (1) On day 0, patients were given only a package insert on Diskus, and the handling error rate was assessed. Then the patients were given instruction on the 13-step Diskus procedure until they could demonstrate the proper technique. (2) On days 1, 2, and 3, the observation group was continuously educated on a 13-step procedure, and the percentage of patients who scored 100% for each step was recorded. The control group had no such training. (3) On days 10, 20, and 30, the percentage of all subjects correctly performing the Diskus 13-step inhalation procedure was assessed. Incorrect handling techniques on Diskus usage were widely distributed among Chinese COPD patients. Step 8 ("Inhale forcefully from the beginning, slowly, deeply, and uniformly during the inspiratory phase until the lungs are full") was the most commonly mishandled step (93.8%). The total score and individual step scores of the patients from the observation group were significantly improved during 3-day continuous education. There was also a significantly higher percentage of correctly performed steps in the observation group than in the control group upon assessment on day 10 (96.24% vs. 85.63%, respectively; p<0.01), day 20 (97.31% vs. 86.09%, respectively; p<0.01), and day 30 (98.19% vs. 87.39%, respectively; p<0.01). Handling errors of the Diskus 13-step inhalation procedure were commonly observed in Chinese COPD patients. Continuous

Ground Handling of Batteries at Test and Launch-site Facilities

NASA Technical Reports Server (NTRS)

Jeevarajan, Judith A.; Hohl, Alan R.

2008-01-01

Ground handling of flight as well as engineering batteries at test facilities and launch-site facilities is a safety critical process. Test equipment interfacing with the batteries should have the required controls to prevent a hazardous failure of the batteries. Test equipment failures should not induce catastrophic failures on the batteries. Transportation requirements for batteries should also be taken into consideration for safe transportation. This viewgraph presentation includes information on the safe handling of batteries for ground processing at test facilities as well as launch-site facilities.

Safe syringe disposal is related to safe syringe access among HIV-positive injection drug users.

PubMed

Coffin, Phillip O; Latka, Mary H; Latkin, Carl; Wu, Yingfeng; Purcell, David W; Metsch, Lisa; Gomez, Cynthia; Gourevitch, Marc N

2007-09-01

We evaluated the effect of syringe acquisition on syringe disposal among HIV-positive injection drug users (IDUs) in Baltimore, New York City, and San Francisco (N = 680; mean age 42 years, 62% male, 59% African-American, 21% Hispanic, 12% White). Independent predictors of safe disposal were acquiring syringes through a safe source and ever visiting a syringe exchange program. Weaker predictors included living in San Francisco, living in the area longer, less frequent binge drinking, injecting with an HIV+ partner, peer norms supporting safe injection, and self-empowerment. Independent predictors of safe "handling"-both acquiring and disposing of syringes safely-also included being from New York and being older. HIV-positive IDUs who obtain syringes from a safe source are more likely to safely dispose; peer norms contribute to both acquisition and disposal. Interventions to improve disposal should include expanding sites of safe syringe acquisition while enhancing disposal messages, alternatives, and convenience.

Safe Handover : Safe Patients – The Electronic Handover System

PubMed Central

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS. PMID:26734244

Occupational health and safety aspects of animal handling in dairy production.

PubMed

Lindahl, Cecilia; Lundqvist, Peter; Hagevoort, G Robert; Lunner Kolstrup, Christina; Douphrate, David I; Pinzke, Stefan; Grandin, Temple

2013-01-01

Livestock handling in dairy production is associated with a number of health and safety issues. A large number of fatal and nonfatal injuries still occur when handling livestock. The many animal handling tasks on a dairy farm include moving cattle between different locations, vaccination, administration of medication, hoof care, artificial insemination, ear tagging, milking, and loading onto trucks. There are particular problems with bulls, which continue to cause considerable numbers of injuries and fatalities in dairy production. In order to reduce the number of injuries during animal handling on dairy farms, it is important to understand the key factors in human-animal interactions. These include handler attitudes and behavior, animal behavior, and fear in cows. Care when in close proximity to the animal is the key for safe handling, including knowledge of the flight zone, and use of the right types of tools and suitable restraint equipment. Thus, in order to create safe working conditions during livestock handling, it is important to provide handlers with adequate training and to establish sound safety management procedures on the farm.

Hygienic food handling behaviours. An application of the Theory of Planned Behaviour.

PubMed

Mullan, Barbara A; Wong, Cara L

2009-06-01

It is estimated that 5.4 million Australians get sick annually from eating contaminated food and that up to 20% of this illness results from food handling behaviour. A study was undertaken to investigate the efficacy of the Theory of Planned Behaviour (TPB) including past behaviour in predicting safe food handling intention and behaviour. One hundred and nine participants completed questionnaires regarding their attitudes, perceived behavioural control (PBC), subjective norm, intentions and past behaviour. Behaviour was measured 4 weeks later. The TPB predicted a high proportion of variance in both intentions and behaviour, and past behaviour/habit was found to be the strongest predictor of behaviour. The results of the present study suggest interventions aimed at increasing safe food handling intentions should focus on the impact of normative influences and perceptions of control over their food handling environment; whereas interventions to change actual behaviour should attempt to increase hygienic food handling as a habitual behaviour.

Good practice statements on safe laboratory testing: A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

PubMed

Bowie, Paul; Forrest, Eleanor; Price, Julie; Verstappen, Wim; Cunningham, David; Halley, Lyn; Grant, Suzanne; Kelly, Moya; Mckay, John

2015-09-01

The systems-based management of laboratory test ordering and results handling is a known source of error in primary care settings worldwide. The consequences are wide-ranging for patients (e.g. avoidable harm or poor care experience), general practitioners (e.g. delayed clinical decision making and potential medico-legal implications) and the primary care organization (e.g. increased allocation of resources to problem-solve and dealing with complaints). Guidance is required to assist care teams to minimize associated risks and improve patient safety. To identify, develop and build expert consensus on 'good practice' guidance statements to inform the implementation of safe systems for ordering laboratory tests and managing results in European primary care settings. Mixed methods studies were undertaken in the UK and Ireland, and the findings were triangulated to develop 'good practice' statements. Expert consensus was then sought on the findings at the wider European level via a Delphi group meeting during 2013. We based consensus on 10 safety domains and developed 77 related 'good practice' statements (≥ 80% agreement levels) judged to be essential to creating safety and minimizing risks in laboratory test ordering and subsequent results handling systems in international primary care. Guidance was developed for improving patient safety in this important area of primary care practice. We need to consider how this guidance can be made accessible to frontline care teams, utilized by clinical educators and improvement advisers, implemented by decision makers and evaluated to determine acceptability, feasibility and impacts on patient safety.

[Nursing workers' perceptions regarding the handling of hazardous chemical waste].

PubMed

Costa, Taiza Florêncio; Felli, Vanda Elisa Andres; Baptista, Patrícia Campos Pavan

2012-12-01

The objectives of this study were to identify the perceptions of nursing workers regarding the handling of hazardous chemical waste at the University of São Paulo University Hospital (HU-USP), and develop a proposal to improve safety measures. This study used a qualitative approach and a convenience sample consisting of eighteen nursing workers. Data collection was performed through focal groups. Thematic analysis revealed four categories that gave evidence of training deficiencies in terms of the stages of handling waste. Difficulties that emerged included a lack of knowledge regarding exposure and its impact, the utilization of personal protective equipment versus collective protection, and suggestions regarding measures to be taken by the institution and workers for the safe handling of hazardous chemical waste. The present data allowed for recommending proposals regarding the safe management of hazardous chemical waste by the nursing staff.

Safe medication management in specialized home healthcare - an observational study.

PubMed

Lindblad, Marléne; Flink, Maria; Ekstedt, Mirjam

2017-08-24

Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Skills in Handling Turbuhaler, Diskus, and Pressurized Metered-Dose Inhaler in Korean Asthmatic Patients

PubMed Central

Lee, Sang Min; Chang, Yoon-Seok; Kim, Cheol-Woo; Kim, Tae-Bum; Kim, Sang-Heon; Kwon, Yong-Eun; Lee, Jong-Myung; Lee, Soo-Keol; Jeong, Jae-Won; Park, Jung-Won; Cho, Sang-Heon; Moon, Hee-Bom

2011-01-01

Purpose The objective of this study was to evaluate skills in handling inhalers and factors associated with these skills among patients with asthma who had undergone treatment at special asthma and allergy clinics in Korea. Methods We enrolled 78 subjects who used Turbuhaler and 145 who used Diskus for asthma control at special clinics in 10 university hospitals and visually assessed their skills in handling these inhalers. We also evaluated skills in 137 subjects who had used pressurized metered-dose inhalers (pMDIs) for symptom relief. Age, sex, duration of asthma and inhaler use, smoking status, monthly income, highest grade completed in school and previous instruction for handling inhalers were also measured to evaluate their association with overall inhaler skills. Results Performance grade was inadequate for 12.8% of participants using Turbuhaler, 6.2% for Diskus, and 23.4% for pMDIs. The success rates for each step in handling the inhalers were relatively high except for the "exhale slowly to residual volume" step, in which success rates ranged from 24.2% to 28.5%. Older age, male sex, lower educational grade, and absence of previous instruction for handling inhalers were associated with inadequate inhaler technique in univariate analysis; however, only older age and absence of previous instruction remained significant independent risk factors in multivariate analysis. Conclusions Among Korean asthmatic patients in special asthma and allergy clinics, skills in handling their inhalers were mostly excellent; meanwhile, older age and absence of previous instruction for handling inhalers were associated with inadequate techniques. PMID:21217925

Mentoring staff members as patient safety leaders: the Clarian Safe Passage Program.

PubMed

Rapala, Kathryn

2005-06-01

This article describes a second element of the Synergy Model of Patient Care implemented by Clarian Health Partners of Indiana. The Clarian Safe Passage Program is a unique approach to the promotion of patient safety. In this program, frontline staff nurses are trained to serve as Safe Passage nurses, who are unit-based safety experts. These nurses mentor each other and their peers in acquiring patient safety expertise and promoting a free flow of information to avert actual and potential errors in health care delivery.

Llama medicine. Physical examination, restraint and handling.

PubMed

Fowler, M

1989-03-01

Llamas are generally docile, easily handled domestic animals. Special chutes have been designed for safe, efficient restraint for examination and diagnostic procedures, most of which are commonly performed on other species. Anatomic differences make some of these procedures unique to the llama.

Hospitals prepare plans, drill staff to ensure that potential Ebola patients are identified, isolated, and managed safely.

PubMed

2014-12-01

Hospitals around the country have stepped up their efforts to train staff and implement procedures to ensure the safe identification and management of any patients with signs of Ebola virus disease (EVD). Ronald Reagan UCLA Medical Center in Los Angeles, CA, held an "Ebola preparedness exercise" to give staff an opportunity to walk through the hospital's protocol for handling a simulated patient with EVD. The University of Alabama at Birmingham (UAB) Medical Center has held similar exercises, and is now holding twice-weekly meetings of its leadership team to make sure that all new developments in the Ebola outbreak are communicated. UCLA Medical Center has prepared PPE kits based on the practices developed at Emory University Hospital, which has thus far had the most experience in this country in caring for patients with EVD. The UCLA Health System has adjusted its medical record system so that a red flag is placed on the electronic medical record [EMR] of any patient who has recently traveled to a high-risk area. UAB Medical Center has incorporated what had been a paper-and-pencil screening tool for EVD into its electronic medical record. Training on PPE as well as EVD screening is being provided to first-responders and 911 call center dispatchers in the UAB system.

Uranium hexafluoride: Safe handling, processing, and transporting: Conference proceedings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strunk, W.D.; Thornton, S.G.

This conference seeks to provide a forum for the exchange of information and ideas of the safety aspects and technical issue related to the handling of uranium hexafluoride. By allowing operators, engineers, scientists, managers, educators, and others to meet and share experiences of mutual concern, the conference is also intended to provide the participants with a more complete knowledge of technical and operational issues. The topics for the papers in the proceedings are widely varied and include the results of chemical, metallurgical, mechanical, thermal, and analytical investigations, as well as the developed philosophies of operational, managerial, and regulatory guidelines. Papersmore » have been entered individually into EDB and ERA. (LTN)« less

Structural interaction with transportation and handling systems

NASA Technical Reports Server (NTRS)

1973-01-01

Problems involved in the handling and transportation of finished space vehicles from the factory to the launch site are presented, in addition to recommendations for properly accounting for in space vehicle structural design, adverse interactions during transportation. Emphasis is given to the protection of vehicle structures against those environments and loads encountered during transportation (including temporary storage) which would exceed the levels that the vehicle can safely withstand. Current practices for verifying vehicle safety are appraised, and some of the capabilities and limitations of transportation and handling systems are summarized.

Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

PubMed

Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

2018-04-01

To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

Characteristic values of the lumbar load of manual patient handling for the application in workers' compensation procedures.

PubMed

Jordan, Claus; Luttmann, Alwin; Theilmeier, Andreas; Kuhn, Stefan; Wortmann, Norbert; Jäger, Matthias

2011-05-26

The human spine is often exposed to mechanical load in vocational activities especially in combination with lifting, carrying and positioning of heavy objects. This also applies in particular to nursing activities with manual patient handling. In the present study a detailed investigation on the load of the lumbar spine during manual patient handling was performed. For a total of 13 presumably endangering activities with transferring a patient, the body movements performed by healthcare workers were recorded and the exerted action forces were determined with regard to magnitude, direction and lateral distribution in the time course with a "measuring bed", a "measuring chair" and a "measuring floor". By the application of biomechanical model calculations the load on the lowest intervertebral disc of the lumbar spine (L5-S1) was determined considering the posture and action force data for every manual patient handling. The results of the investigations reveal the occurrence of high lumbar load during manual patient handling activities, especially in those cases, where awkward postures of the healthcare worker are combined with high action forces caused by the patient's mass. These findings were compared to suitable issues of corresponding investigations provided in the literature. Furthermore measurement-based characteristic values of lumbar load were derived for the use in statement procedures concerning the disease no. 2108 of the German list of occupational diseases. To protect healthcare workers from mechanical overload and the risk of developing a disc-related disease, prevention measures should be compiled. Such measures could include the application of "back-fairer" nursing techniques and the use of "technical" and" small aids" to reduce the lumbar load during manual patient handling. Further studies, concerning these aspects, are necessary.

Safe Handling of Radioactive Materials. Recommendations of the National Committee on Radiation Protection. Handbook 92.

ERIC Educational Resources Information Center

National Bureau of Standards (DOC), Washington, DC.

This handbook is designed to help users of radioactive materials to handle the radioactive material without exposing themselves or others to radiation doses in excess of maximum permissible limits. The discussion of radiation levels is in terms of readings from dosimeters and survey instruments. Safety in the handling of radioactive materials in…

Experience with fluorine and its safe use as a propellant

NASA Technical Reports Server (NTRS)

Bond, D. L.; Guenther, M. E.; Stimpson, L. D.; Toth, L. R.; Young, D. L.

1979-01-01

The industrial and the propulsion experience with fluorine and its derivatives is surveyed. The hazardous qualities of fluorine and safe handling procedures for the substance are emphasized. Procedures which fulfill the safety requirements during ground operations for handling fluorinated propulsion systems are discussed. Procedures to be implemented for use onboard the Space Transportation System are included.

29 CFR 1917.16 - Line handling. (See also § 1917.95(b)).

Code of Federal Regulations, 2011 CFR

2011-07-01

... also § 1917.95(b)). (a) In order to provide safe access for handling lines while mooring and unmooring... be used. (b) When stringpiece or apron width is insufficient for safe footing, grab lines or rails... the water edge of a berth and a shed or other structure.) ...

29 CFR 1917.16 - Line handling. (See also § 1917.95(b)).

Code of Federal Regulations, 2010 CFR

2010-07-01

... also § 1917.95(b)). (a) In order to provide safe access for handling lines while mooring and unmooring... be used. (b) When stringpiece or apron width is insufficient for safe footing, grab lines or rails... the water edge of a berth and a shed or other structure.) ...

Abnormal MRI in a patient with 'headache with neurological deficits and CSF lymphocytosis (HaNDL)'.

PubMed

Yilmaz, A; Kaleagasi, H; Dogu, O; Kara, E; Ozge, A

2010-05-01

A 27-year-old woman was admitted to the Emergency Department with right upper-extremity numbness and mild weakness followed by a bifrontal throbbing headache for 30 min, which was similar to a headache lasting for 12 h that had occurred 3 days ago. Laboratory tests were unremarkable except for cerebrospinal fluid (CSF) lymphocytic pleocytosis. On the following day, a headache episode with left hemiparesis and hemihypoaesthesia, left hemifield visio-spatial inattention, anosagnosia and confusion recurred. The headache was diagnosed as headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome according to the criteria of the second edition of the International Classification of Headache Disorders. Simultaneously performed magnetic resonance imaging (MRI) revealed swelling of the grey matter, CSF enhancement in the sulci of the right temporal and occipital regions and hypoperfusion of the same brain regions. During the following 10 days two more similar episodes recurred and during the ensuing 12 months the patient remained headache free. Neuroimaging findings of the HaNDL syndrome are always thought as virtually normal. MRI abnormalities in our patient have not been reported in HaNDL syndrome previously, although they have been reported in hemiplegic migraine patients before. The findings in our case suggest that hemiplegic migraine and HaNDL syndrome may share a common pathophysiological pathway resulting in similar imaging findings and neurological symptoms.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Safe Handling of Oral Antineoplastic Medications: Focus on Targeted Therapeutics in the Home Setting

PubMed Central

Cass, Yaakov; Connor, Thomas H.; Tabachnik, Alexander

2017-01-01

Introduction With the growing number of oral targeted therapies being approved for use in cancer therapy, the potential for long-term administration of these drugs to cancer patients is expanding. The use of these drugs in the home setting has the potential to expose family members and caregivers to them either through direct contact with the drugs or indirectly by exposure to the parent compounds and/or their active metabolites in contaminated patient's waste. Methods A systematic literature review was performed and the known adverse health effect of 32 oral targeted therapeutics is summarized. In particular, the carcinogenicity, genotoxicity, and embryo-foetal toxicity, along with the route of excretion were evaluated. Results Carcinogenicity testing has not been performed on most of the oral targeted therapeutics and the genotoxicity data are mixed. However, the majority of these drugs exhibit adverse reproductive effects, some of which are severe. Currently available data does not permit the possibility of a health hazard from inappropriate handling of drugs and contaminated patients waste to be ignored, especially in a long-term home setting. Further research is needed to understand these issues. Conclusions With the expanding use of targeted therapies in the home setting, family members and caregivers, especially those of reproductive risk age, are, potentially at risk. Overall basic education and related precautions should be taken to protect family members and caregivers from indirect or direct exposure from these drugs. Further investigations and discussion on this subject is warranted. PMID:27009803

76 FR 20509 - Irradiation in the Production, Processing, and Handling of Food

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-13

.... FDA-1998-F-0072] (Formerly 98F-0165) Irradiation in the Production, Processing, and Handling of Food..., Irradiation in the Production, Processing, and Handling of Food (21 CFR part 179), to provide for the safe use... irradiation of fresh shell eggs for the reduction of Salmonella at doses not to exceed 3.0 kiloGray (kGy...

Prudent Practices for Handling Hazardous Chemicals in Laboratories.

ERIC Educational Resources Information Center

National Academy of Sciences-National Research Council, Washington, DC. Assembly of Mathematical and Physical Sciences.

This guide recommends procedures for safe handling and disposal of hazardous substances, along with broad recommendations for developing comprehensive laboratory safety programs. Although specific information is provided, general principles which can be adapted to activities in any laboratory are emphasized. Section 1 focuses on procedures for…

Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults.

PubMed

Abbot, J M; Byrd-Bredbenner, C; Schaffner, D; Bruhn, C M; Blalock, L

2009-04-01

Developing tailored and effective food safety education for young adults is critical given their future roles as caregivers likely to be preparing food for populations who may be at greater risk for foodborne disease (FBD). The objective of this study was to examine the relationship between food safety self-reported food-handling behaviors and cognitions of young adults to observed food-handling behaviors. Participants were 153 young adults (mean age 20.74+/-1.30 s.d.) attending a major American university. Each prepared a meal under observation in a controlled laboratory setting, permitted researchers to observe their home kitchen and completed an online survey assessing food safety knowledge, behavior and psychosocial measures. Descriptive statistics were generated for participants' self-reported food-handling behaviors, psychosocial characteristics, knowledge, food preparation observations and home kitchen observations. Determinants of compliance with safe food-handling procedures while preparing a meal and home food storage/rotation practices were identified using backward regression models. Participants engaged in less than half of the recommended safe food-handling practices evaluated and correctly answered only two-thirds of the food safety knowledge items. They reported positive food safety beliefs and high food safety self-efficacy. Self-reported compliance with cross-contamination prevention, disinfection procedures and knowledge of groups at greatest risk for FBD were the best measures for predicting compliance with established safe food-handling practices. Food safety education directed toward young adults should focus on increasing awareness of FBD and knowledge of proper cross-contamination prevention procedures to help promote better compliance with actual safe food handling.

Human Milk Handling and Storage Practices Among Peer Milk-Sharing Mothers.

PubMed

Reyes-Foster, Beatriz M; Carter, Shannon K; Hinojosa, Melanie Sberna

2017-02-01

Peer milk sharing, the noncommercial sharing of human milk from one parent or caretaker directly to another for the purposes of feeding a child, appears to be an increasing infant-feeding practice. Although the U.S. Food and Drug Administration has issued a warning against the practice, little is known about how people who share human milk handle and store milk and whether these practices are consistent with clinical safety protocols. Research aim: This study aimed to learn about the milk-handling practices of expressed human milk by milk-sharing donors and recipient caretakers. In this article, we explore the degree to which donors and recipients adhere to the Academy of Breastfeeding Medicine clinical recommendations for safe handling and storage. Online surveys were collected from 321 parents engaged in peer milk sharing. Univariate descriptive statistics were used to describe the safe handling and storage procedures for milk donors and recipients. A two-sample t-test was used to compare safety items common to each group. Multivariate ordinary least squares regression analysis was used to examine sociodemographic correlates of milk safety practices within the sample group. Findings indicate that respondents engaged in peer milk sharing report predominantly positive safety practices. Multivariate analysis did not reveal any relationship between safety practices and sociodemographic characteristics. The number of safe practices did not differ between donors and recipients. Parents and caretakers who participate in peer human milk sharing report engaging in practices that should reduce risk of bacterial contamination of expressed peer shared milk. More research on this particular population is recommended.

Biodiesel Handling and Use Guide (Fifth Edition)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alleman, Teresa L.; McCormick, Robert L.; Christensen, Earl D.

2016-11-08

This document is a guide for those who blend, distribute, and use biodiesel and biodiesel blends. It provides basic information on the proper and safe use of biodiesel and biodiesel blends in engines and boilers, and is intended to help fleets, individual users, blenders, distributors, and those involved in related activities understand procedures for handling and using biodiesel fuels.

Biodiesel Handling and Use Guide (Fifth Edition)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alleman, Teresa L.; McCormick, Robert L.; Christensen, Earl D.

This document is a guide for those who blend, distribute, and use biodiesel and biodiesel blends. It provides basic information on the proper and safe use of biodiesel and biodiesel blends in engines and boilers, and is intended to help fleets, individual users, blenders, distributors, and those involved in related activities understand procedures for handling and using biodiesel fuels.

SAFE Medication Management for Patients with Physical Impairments of Stroke, Part One.

PubMed

Yetzer, Elizabeth; Blake, Karen; Goetsch, Nancy; Shook, Mary; St Paul, Marilyn

2015-01-01

This article focuses on the extensive impairments of stroke and their influence on medication management. The impairments of motor skills due to paralysis-loss of mobility and balance, lack of hand-to-mouth coordination, and difficulty swallowing-are discussed. A future article will discuss sensory impairments of vision, hearing, cognition, comprehension, communication, and emotional disorders and how these impairments influence medication management. Each of the impairments are presented and discussed, and possible interventions are proposed. Every patient is an individual and requires variable care plans. Intervention strategies that include tools for patient assessment, practice tips, and devices available to assist the patient and family in safe medication management are presented. Patient outcomes and successes vary, but the strategies outlined will return the patient to as close to previous capabilities as possible. Teaching SAFE (Systematic, Accurate, Functional, Effective) medication management to the patient, family, and caregivers will increase medication safety and decrease the number of adverse effects. The rehabilitation nurse is charged with evaluating the patients' needs and developing strategies to assist them to manage their medications. © 2014 Association of Rehabilitation Nurses.

Oxygen Handling and Cooling Options in High Temperature Electrolysis Plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Manohar S. Sohal; J. Stephen Herring

2008-07-01

Idaho National Laboratory is working on a project to generate hydrogen by high temperature electrolysis (HTE). In such an HTE system, safety precautions need to be taken to handle high temperature oxygen at ~830°C. This report is aimed at addressing oxygen handling in a HTE plant.. Though oxygen itself is not flammable, most engineering material, including many gases and liquids, will burn in the presence of oxygen under some favorable physicochemical conditions. At present, an absolute set of rules does not exist that can cover all aspects of oxygen system design, material selection, and operating practices to avoid subtle hazardsmore » related to oxygen. Because most materials, including metals, will burn in an oxygen-enriched environment, hazards are always present when using oxygen. Most materials will ignite in an oxygen-enriched environment at a temperature lower than that in air, and once ignited, combustion rates are greater in the oxygen-enriched environment. Even many metals, if ignited, burn violently in an oxygen-enriched environment. However, these hazards do not preclude the operations and systems involving oxygen. Oxygen can be safely handled and used if all the materials in a system are not flammable in the end-use environment or if ignition sources are identified and controlled. In fact, the incidence of oxygen system fires is reported to be low with a probability of about one in a million. This report is a practical guideline and tutorial for the safe operation and handling of gaseous oxygen in high temperature electrolysis system. The intent is to provide safe, practical guidance that permits the accomplishment of experimental operations at INL, while being restrictive enough to prevent personnel endangerment and to provide reasonable facility protection. Adequate guidelines are provided to govern various aspects of oxygen handling associated with high temperature electrolysis system to generate hydrogen. The intent here is to present

Safe use of proton pump inhibitors in patients with cirrhosis.

PubMed

Weersink, Rianne A; Bouma, Margriet; Burger, David M; Drenth, Joost P H; Froukje Harkes-Idzinga, S; Hunfeld, Nicole G M; Metselaar, Herold J; Monster-Simons, Margje H; van Putten, Sandra A W; Taxis, Katja; Borgsteede, Sander D

2018-04-24

Proton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in cirrhosis. A systematic literature search identified studies about the safety (i.e. adverse events) and pharmacokinetics of PPIs in cirrhotic patients. This evidence and data from the product information was reviewed by an expert panel who classified drugs as safe; no additional risks known; additional risks known; unsafe; or unknown. Guidance was aimed at the oral use of PPIs and categorized by the severity of cirrhosis, using the Child-Turcotte-Pugh (CTP) classification. A total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having 'no additional risks known'. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole in a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe, because of 4- to 8-fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered. We suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients. This article is protected by copyright. All rights reserved.

Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations.

PubMed

Portnuff, Cory D F; Kleindienst, Samantha; Bogle, Jamie M

2017-09-01

Vestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure. The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing. Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure. The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient's safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient's noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure. VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli. American Academy of Audiology

Handling System for Iridium-192 Seeds

NASA Technical Reports Server (NTRS)

Carpenter, W.; Wodicka, D.

1973-01-01

A complete system is proposed for safe handling of iridium-192 seeds used to internally irradiate malignant growths. A vibratory hopper feeds the seeds onto a transport system for deposit in a magazine or storage area. A circular magazine consisting of segmented plastic tubing with holes in the walls to accommodate the seeds seems feasible. The magazine is indexed to stop and release a seed for calibration and deposition.

Buying & Using Medicine Safely

MedlinePlus

... Generic Drugs - Patient Education Resources Patient and Prescriber materials: Videos, PSAs, factsheets and more. Spotlight Drugs@FDA Index to Drug-Specific Information Protecting Yourself Safe Disposal of Medicines Generic Medicines – safe, effective and ...

Guidelines for design and safe handling of curved I-shaped steel girders.

DOT National Transportation Integrated Search

2010-02-01

The purpose of this set of guidelines is to summarize recommendations from work : completed as part of the Texas Department of Transportation (TxDOT) Research Project 0-5574 : entitled "Curved Plate Girder Design for Safe and Economic Construction." ...

The safe and responsible disposal of unused controlled drugs.

PubMed

Ahmed, Iftikhar; Majeed, Amer

There are well-defined legal requirements for the safe storage, handling and disposal of controlled drugs (CDs): The Misuse of Drugs Act 1971, and Safer Management of Controlled Drugs (Department of Health, 2007). Clinical staff involved in the prescription and administration of CDs to patients are responsible and accountable for the appropriate disposal of these drugs because of the risk of substance abuse. A review of current practice, as followed by staff involved in the use and disposal of CDs, has been evaluated in a multi-centre audit. This audit showed that a wide variation in attitude towards disposal of CDs exists among medical and non-medical staff, and that the sample hospitals are falling short of meeting proposed standards.

BONUS Gas Handling System

NASA Astrophysics Data System (ADS)

Ferrer, James

2004-10-01

The BONUS experiment, at the Thomas Jefferson National Accelerator Facility aims to measure structure functions of the neutron via electron scattering. In order to overcome the unavailability of a neutron target, the BONUS collaboration will use a deuterium target. By detecting the recoil (spectator) proton in coincidence with the scattered electron, the kinematics of the electron-neutron interaction will be fully determined, thus overcoming theoretical complications that arise when extracting neutron cross sections. In order to detect low energy recoil protons, in the 70-100 MeV/c range, a (6 cm-radius) radial time projection chamber (RTPC) will be used. The BONUS RTPC is based on the gas electron multiplier (GEM) technology recently developed at CERN. One of the key components of this detector is the gas handling system, designed and built to deliver the correct mixture of gas to the detector safely, accurately, and reliably. The building and testing of this system is the major contribution of James Madison University to the BONUS collaboration. This poster provides a general overview of the BONUS detector, focusing on the gas handling system.

A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste.

PubMed

Le, Aurora B; Hoboy, Selin; Germain, Anne; Miller, Hal; Thompson, Richard; Herstein, Jocelyn J; Jelden, Katelyn C; Beam, Elizabeth L; Gibbs, Shawn G; Lowe, John J

2018-02-01

The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste-contaminated with EVD and other highly infectious pathogens-is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Orientation of handle for successful prosthetic treatment in patients with an anatomic compromise after a maxillectomy.

PubMed

Sumita, Yuka I; Hattori, Mariko; Elbashti, Mahmoud E; Taniguchi, Hisashi

2017-05-01

This clinical technique provides a key procedure for successful prosthetic treatment in patients with an anatomical compromise after a maxillectomy. When making a preliminary impression, the clinician must keep the handle of the stock tray parallel to the patient's interpupillary line extraorally to maintain the correct position of the tray and to make a record of the inclination of the occlusal plane. This simple consideration during this first step of making a preliminary impression can be an important guide for both dentists and dental technicians. Information about the correct positioning of the tray and the inclination of the occlusal plane obtained by using a stock tray handle will greatly reduce the stress experienced by dentists, dental technicians, and patients during the fabrication of the prosthesis and will ultimately lead to successful prosthetic treatment in patients with anatomic compromise resulting from a maxillectomy. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Hazardous materials: chemistry and safe handling aspects of flammable, toxic and radioactive materials. A course of study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, M.W.

1983-01-01

The subject of this dissertation is a one semester, three credit course designed for students who have taken at least twelve credits college chemistry, and for high school teachers as a continuing education course. The need for such a course arises from the increased concern for safety in recent years and the introduction of many regulations of which the working chemist should be aware, notably those issued by the Occupational Safety and Health Administration. A few colleges have recently started to offer courses in laboratory safety to undergraduate and graduate chemistry students. Thus, there is a need for the developmentmore » of courses in which chemical safety is taught. This course is divided into three units: 1) flammable materials; 2) toxic materials; and 3) radioactive materials. Each unit is self contained and could be taught separately as a one credit course. The material necessary for lecture presentation is given in the text of this dissertation: there are about seven topics in each unit. The chemical properties of selected substances are emphasized. Examples of governmental regulations are given, and there are sample examination questions for each unit and homework assignments that require the use of reference sources. Laboratory exercises are included to enable students to gain experience in the safe handling of hazardous chemicals and of some equipment and instruments used to analyze and study flammable, toxic and radioactive materials.« less

Detection of some safe plant-derived foods for LTP-allergic patients.

PubMed

Asero, Riccardo; Mistrello, Gianni; Roncarolo, Daniela; Amato, Stefano

2007-01-01

Lipid transfer protein (LTP) is a widely cross-reacting plant pan-allergen. Adverse reactions to Rosaceae, tree nuts, peanut, beer, maize, mustard, asparagus, grapes, mulberry, cabbage, dates, orange, fig, kiwi, lupine, fennel, celery, tomato, eggplant, lettuce, chestnut and pineapple have been recorded. To detect vegetable foods to be regarded as safe for LTP-allergic patients. Tolerance/intolerance to a large spectrum of vegetable foods other than Rosaceae, tree nuts and peanut was assessed by interview in 49 subjects monosensitized to LTP and in three distinct groups of controls monosensitized to Bet v 1 (n = 24) or Bet v 2 (n = 18), or sensitized to both LTP and birch pollen (n = 16), all with a history of vegetable food allergy. Patients and controls underwent skin prick test (SPT) with a large spectrum of vegetable foods. The absence of IgE reactivity to foods that were negative in both clinical history and SPT was confirmed by immunoblot analysis and their clinical tolerance was finally assessed by open oral challenge (50 g per food). All patients reported tolerance and showed negative SPT to carrot, potato, banana and melon; these foods scored positive in SPT and elicited clinical symptoms in a significant proportion of patients from all three control groups. All patients tolerated these four foods on oral challenge. Immunoblot analysis confirmed the lack of IgE reactivity to these foods by LTP-allergic patients. Carrot, potato, banana and melon seem safe for LTP-allergic patients. This finding may be helpful for a better management of allergy to LTP.

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study

PubMed Central

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-01

Introduction Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. Methods This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. Ethics and dissemination This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. PMID:28132001

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies.

PubMed

Hegewald, Janice; Berge, Wera; Heinrich, Philipp; Staudte, Ronny; Freiberg, Alice; Scharfe, Julia; Girbig, Maria; Nienhaus, Albert; Seidler, Andreas

2018-03-09

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE ® /PubMed ® , EMBASE ® , Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL ® ) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68-0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low.

Tritium handling experience at Atomic Energy of Canada Limited

DOE Office of Scientific and Technical Information (OSTI.GOV)

Suppiah, S.; McCrimmon, K.; Lalonde, S.

2015-03-15

Canada has been a leader in tritium handling technologies as a result of the successful CANDU reactor technology used for power production. Over the last 50 to 60 years, capabilities have been established in tritium handling and tritium management in CANDU stations, tritium removal processes for heavy and light water, tritium measurement and monitoring, and understanding the effects of tritium on the environment. This paper outlines details of tritium-related work currently being carried out at Atomic Energy of Canada Limited (AECL). It concerns the CECE (Combined Electrolysis and Catalytic Exchange) process for detritiation, tritium-compatible electrolysers, tritium permeation studies, and tritiummore » powered batteries. It is worth noting that AECL offers a Tritium Safe-Handling Course to national and international participants, the course is a mixture of classroom sessions and hands-on practical exercises. The expertise and facilities available at AECL is ready to address technological needs of nuclear fusion and next-generation nuclear fission reactors related to tritium handling and related issues.« less

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study.

PubMed

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-27

Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Tests of protective clothing for the safe handling of pressurized lamps

NASA Technical Reports Server (NTRS)

Ewashinka, J. G.

1975-01-01

Tests were made to find a clothing material combination for use in handling high-pressure lamps. Monofilament nylon, ballistic nylon, and ballistic felt grouped into various multilayer combinations and chromed leather were positioned around and 30 cm (12 in.) away from exploding high-pressure lamps of different manufacturers and wattages. The results are: (1) 5024 nylon/ballistic felt/5024 nylon in a layered configuration was not penetrated by fragments of lamps as large as 6.5 kW; (2) this layered combination is lightweight and pliable and offers greater mobility and comfort to the user than previous protective clothing; and (3) Lexan plastic 1.6 mm (1/6 in.) thick to be used for face shield material showed no penetration for lamps as large as 20 kW.

The safe home project.

PubMed

Arphorn, Sara; Jiraniratisai, Sopaphan; Rungtakul, Rungsri; Phutta, Nikom

2011-12-01

The Thai Health Promotion Foundation supported the Improvement of Quality of Life of Informal Workers project in Ban Luang District, Amphur Photaram, Ratchaburi Province. There were many informal workers in Ban Luang District. Sweet-crispy fish producers in Ban Luang were the largest group among the sweet-crispy fish producers in Thailand. This project was aimed at improving living and working conditions of informal workers, with a focus on the sweet-crispy fish group. Good practices of improved living and working conditions were used to help informal workers build safe, healthy and productive work environments. These informal workers often worked in substandard conditions and were exposed to various hazards in the working area. These hazards included risk of exposure to hot work environment, ergonomics-related injuries, chemical hazards, electrical hazards etc. Ergonomics problems were commonly in the sweet-crispy fish group. Unnatural postures such as prolonged sitting were performed dominantly. One hundred and fifty informal workers participated in this project. Occupational health volunteers were selected to encourage occupational health and safety in four groups of informal workers in 2009. The occupational health volunteers trained in 2008 were farmers, beauty salon workers and doll makers. The occupational health and safety knowledge is extended to a new informal worker group: sweet-crispy fish producer, in 2009. The occupational health and safety training for sweet-crispy fish group is conducted by occupational health volunteers. The occupational health volunteers increased their skills and knowledge assist in to make safe home and safe community through participatory oriented training. The improvement of living and working condition is conducted by using a modified WISH, Work Improvement for Safe Home, checklist. The plans of improvement were recorded. The informal workers showed improvement mostly on material handling and storage. The safe uses and safe

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?—A Systematic Review of Intervention Studies

PubMed Central

Hegewald, Janice; Berge, Wera; Heinrich, Philipp; Staudte, Ronny; Freiberg, Alice; Scharfe, Julia; Girbig, Maria; Nienhaus, Albert; Seidler, Andreas

2018-01-01

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE®/PubMed®, EMBASE®, Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL®) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68–0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low. PMID:29522440

Safe Handling of Snakes in an ED Setting.

PubMed

Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

2017-01-01

Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED. A local snake consultation vendor and zoo Herpetologist assisted with development of a process for snake identification and disposal. All snakes have been identified and securely disposed of using the newly implemented process and no safety incidents have been reported. Other emergency department settings may consider developing a standardized process for snake disposal using listed specialized consultants combined with local resources and suppliers to promote employee and patient safety. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

APIC position paper: safe injection, infusion, and medication vial practices in health care.

PubMed

Dolan, Susan A; Felizardo, Gwenda; Barnes, Sue; Cox, Tracy R; Patrick, Marcia; Ward, Katherine S; Arias, Kathleen Meehan

2010-04-01

Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings. 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks.

PubMed

Nelson, Audrey; Matz, Mary; Chen, Fangfei; Siddharthan, Kris; Lloyd, John; Fragala, Guy

2006-08-01

Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment. The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy. A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs. The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically

CE: Can Your Older Patients Drive Safely?

PubMed

Staplin, Loren; Lococo, Kathy H; Mastromatto, Tia; Sifrit, Kathy J; Trazzera, Kathleen M

2017-09-01

: In many areas of the world, driving is an essential part of life and for reasons of comfort, convenience, and security remains the primary mode of transportation among older adults. Both normal aging and diseases that are more prevalent in advanced age can substantially reduce older drivers' functional abilities, elevating their risk of involvement in motor vehicle accidents and serious injury or death. Identifying and intervening with older drivers at increased crash risk is an important aspect of preventive medicine. The authors discuss the specific driving risks adults face as they age and how nurses can raise older patients' awareness of these risks. They also discuss the importance of connecting older adults to community resources that may help them continue driving safely for a longer period or find alternative transportation options.

[Clinical Handling of Patients with Dissociative Disorders].

PubMed

Okano, Kenichiro

2015-01-01

This paper discusses the way informed psychiatrists are expected to handle dissociative patients in clinical situations, with a specific focus on dissociative identity disorders and dissociative fugue. On the initial interview with dissociative patients, information on their history of trauma and any nascent dissociative symptoms in their childhood should be carefully obtained. Their level of stress in their current life should also be assessed in order to understand their symptomatology, as well as to predict their future clinical course. A psychoeducational approach is crucial; it might be helpful to give information on dissociative disorder to these patients as well as their family members in order to promote their adherence to treatment. Regarding the symptomatology of dissociative disorders, detailed symptoms and the general clinical course are presented. It was stressed that dissociative identity disorder and dissociative fugue, the most high-profile dissociative disorders, are essentially different in their etiology and clinical presentation. Dissociative disorders are often confused with and misdiagnosed as psychotic disorders, such as schizophrenia. Other conditions considered in terms of the differential diagnosis include borderline personality disorder as well as temporal lobe epilepsy. Lastly, the therapeutic approach to dissociative identity disorder is discussed. Each dissociative identity should be understood as potentially representing some traumatically stressful event in the past. The therapist should be careful not to excessively promote the creation or elaboration of any dissociative identities. Three stages are proposed in the individual psychotherapeutic process. In the initial stage, a secure environment and stabilization of symptoms should be sought. The second stage consists of aiding the "host" personality to make use of other more adaptive coping skills in their life. The third stage involves coaching as well as continuous awareness of

Monitoring Moving Queries inside a Safe Region

PubMed Central

Al-Khalidi, Haidar; Taniar, David; Alamri, Sultan

2014-01-01

With mobile moving range queries, there is a need to recalculate the relevant surrounding objects of interest whenever the query moves. Therefore, monitoring the moving query is very costly. The safe region is one method that has been proposed to minimise the communication and computation cost of continuously monitoring a moving range query. Inside the safe region the set of objects of interest to the query do not change; thus there is no need to update the query while it is inside its safe region. However, when the query leaves its safe region the mobile device has to reevaluate the query, necessitating communication with the server. Knowing when and where the mobile device will leave a safe region is widely known as a difficult problem. To solve this problem, we propose a novel method to monitor the position of the query over time using a linear function based on the direction of the query obtained by periodic monitoring of its position. Periodic monitoring ensures that the query is aware of its location all the time. This method reduces the costs associated with communications in client-server architecture. Computational results show that our method is successful in handling moving query patterns. PMID:24696652

A Review of Toxicity and Use and Handling Considerations for Guanidine, Guanidine Hydrochloride, and Urea.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ertell, Katherine GB

2006-03-27

This is a technical report prepared for Oregon Sustainable Energy, LLC, under Agreement 06-19 with PNNL's Office of Small Business Programs. The request was to perform a review of the toxicity and safe handling of guanidine. The request was later amended to add urea. This report summarizes the toxicity data available in the scientific literature and provides an interpretation of the results and recommendations for handling these compounds.

Adoption of the B2SAFE EUDAT replication service by the EPOS community

NASA Astrophysics Data System (ADS)

Cacciari, Claudio; Fares, Massimo; Fiameni, Giuseppe; Michelini, Alberto; Danecek, Peter; Wittenburg, Peter

2014-05-01

B2SAFE is the EUDAT service for moving and replicating data between sites and storage systems for different purposes. The goal of B2SAFE is to keep the data from a repository safe by replicating it across different geographical and administrative zones according to a set of well-defined policies. It is also a way to store large volumes of data permanently at those sites which are providing powerful on-demand data analysis facilities. In particular, B2SAFE operates on the domain of registered data where data objects are referable via persistent identifiers (PIDs). B2SAFE is more than just copying data because the PIDs must be carefully managed when data objects are moved or replicated. The EUDAT B2SAFE Service offers functionality to replicate datasets across different data centres in a safe and efficient way while maintaining all information required to easily find and query information about the replica locations. The information about the replica locations and other important information is stored in PID records, each managed in separate administrative domains. The B2SAFE Service is implemented as an iRODS module providing a set of iRODS rules or policies to interface with the EPIC handle API and uses the iRODS middleware to replicate datasets from a source data (or community) centre to a destination data centre. The definition of the dataset(s) to replicate is flexible and up to the communities using the B2SAFE service. While the B2SAFE is internally using the EPIC handle API, communities have the choice to use any PID system they prefer to assign PIDs to their digital objects. A reference to one or more EUDAT B2SAFE PIDs is returned by the B2SAFE service when a dataset is replicated. The presentation will introduce the problem space of B2SAFE, presents the achievements that have been made during the last year for enabling communities to make use of the B2SAFE service, demonstrates a EPOS use cases, outlines the commonalities and differences between the policies

Safe patient care - safety culture and risk management in otorhinolaryngology.

PubMed

St Pierre, Michael

2013-12-13

Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their

[Safe patient care: safety culture and risk management in otorhinolaryngology].

PubMed

St Pierre, M

2013-04-01

Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum

Food Handling Behaviors Observed in Consumers When Cooking Poultry and Eggs.

PubMed

Maughan, Curtis; Chambers, Edgar; Godwin, Sandria; Chambers, Delores; Cates, Sheryl; Koppel, Kadri

2016-06-01

Previous research has shown that many consumers do not follow recommended food safety practices for cooking poultry and eggs, which can lead to exposure to Salmonella and Campylobacter. Past research has been done primarily through surveys and interviews, rather than observations. The objective of this project was to determine through observations whether consumers follow food safety guidelines. Consumers (n = 101) divided among three locations (Manhattan, KS; Kansas City, MO area; and Nashville, TN) were observed as they prepared a baked whole chicken breast, a pan-fried ground turkey patty, a fried egg, and scrambled eggs. The end point temperature for the cooked products was taken (outside the view of consumers) within 30 s after the consumers indicated they were finished cooking. Thermometer use while cooking was low, although marginally higher than that of some previous studies: only 37% of consumers used a thermometer for chicken breasts and only 22% for turkey patties. No one used a thermometer for fried or scrambled eggs. Only 77% of the chicken and 69% of the turkey was cooked to a safe temperature (165°F [74°C]), and 77% of scrambled and 49% of fried eggs reached a safe temperature (160°F [71°C]). Safe hand washing was noted in only 40% of respondents after handling the chicken breast and 44% after handling the ground turkey patty. This value decreased to 15% after handling raw eggs for fried eggs and to 17% for scrambled eggs. These results show that there is a high prevalence of unsafe behaviors (undercooking and poor hand washing technique) when cooking poultry and eggs and a great need for improvement in consumer behavior with poultry and eggs.

Safe gas handling and system design for the large scale production of amorphous silicon based solar cells

NASA Astrophysics Data System (ADS)

Fortmann, C. M.; Farley, M. V.; Smoot, M. A.; Fieselmann, B. F.

1988-07-01

Solarex is one of the leaders in amorphous silicon based photovoltaic production and research. The large scale production environment presents unique safety concerns related to the quantity of dangerous materials as well as the number of personnel handling these materials. The safety measures explored by this work include gas detection systems, training, and failure resistant gas handling systems. Our experiences with flow restricting orifices in the CGA connections and the use of steel cylinders is reviewed. The hazards and efficiency of wet scrubbers for silane exhausts are examined. We have found it to be useful to provide the scrubbler with temperature alarms.

A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care.

PubMed

Niemann, Dorothee; Bertsche, Astrid; Meyrath, David; Koepf, Ellen D; Traiser, Carolin; Seebald, Katja; Schmitt, Claus P; Hoffmann, Georg F; Haefeli, Walter E; Bertsche, Thilo

2015-01-01

To prevent medication errors in drug handling in a paediatric ward. One in five preventable adverse drug events in hospitalised children is caused by medication errors. Errors in drug prescription have been studied frequently, but data regarding drug handling, including drug preparation and administration, are scarce. A three-step intervention study including monitoring procedure was used to detect and prevent medication errors in drug handling. After approval by the ethics committee, pharmacists monitored drug handling by nurses on an 18-bed paediatric ward in a university hospital prior to and following each intervention step. They also conducted a questionnaire survey aimed at identifying knowledge deficits. Each intervention step targeted different causes of errors. The handout mainly addressed knowledge deficits, the training course addressed errors caused by rule violations and slips, and the reference book addressed knowledge-, memory- and rule-based errors. The number of patients who were subjected to at least one medication error in drug handling decreased from 38/43 (88%) to 25/51 (49%) following the third intervention, and the overall frequency of errors decreased from 527 errors in 581 processes (91%) to 116/441 (26%). The issue of the handout reduced medication errors caused by knowledge deficits regarding, for instance, the correct 'volume of solvent for IV drugs' from 49-25%. Paediatric drug handling is prone to errors. A three-step intervention effectively decreased the high frequency of medication errors by addressing the diversity of their causes. Worldwide, nurses are in charge of drug handling, which constitutes an error-prone but often-neglected step in drug therapy. Detection and prevention of errors in daily routine is necessary for a safe and effective drug therapy. Our three-step intervention reduced errors and is suitable to be tested in other wards and settings. © 2014 John Wiley & Sons Ltd.

Oncology pharmacy units: a safety policy for handling hazardous drugs and related waste in low- and middle-income African countries-Angolan experience.

PubMed

da Conceição, Ana Vaz; Bernardo, Dora; Lopes, Lygia Vieira; Miguel, Fernando; Bessa, Fernanda; Monteiro, Fernando; Santos, Cristina; Oliveira, Blasques; Santos, Lúcio Lara

2015-01-01

In African countries, higher rates of late-stage cancers at the time of first diagnosis are a reality. In this context, hazardous drugs (HDs), such as chemotherapy, play an important role and have immense benefits for patients' treatment. HDs should be handled under specific conditions. At least a class 5 environment primary engineering control (PEC), physically located in an appropriate buffer area, is mandatory for sterile HDs compounding, as well as administrative control, personal protective equipment, work practices and other engineering and environmental controls, in order to protect the environment, patient, and worker. The aim of this study is to describe the Angolan experience regarding the development of oncology pharmacy units and discuss international evidence-based guidelines on handling HDs and related waste. Measures to incorporate modern and economical solutions to upgrade or build adequate and safe facilities and staff training, in order to comply with international guidelines in this area, are crucial tasks for African countries of low and middle income.

The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer.

PubMed

Teoh, Anthony Yuen Bun; Chiu, Philip Wai Yan; Kok, Amy Siu Yan; Wong, Simon Kin Hung; Ng, Enders Kwok Wai

2015-03-01

The use of laparoscopic repair for perforated peptic ulcer (PPU) was shown to be safe and recommended in low-risk patients. However, whether the approach is safe to apply to high-risk patients is uncertain. This was a retrospective study of all patients with PPU admitted between January 2002 and December 2012. The laparoscopy-first approach (LFA) was adopted as a routine for all patients. The outcomes of LFA for PPU were reviewed and assessed to determine if the approach was safe in high-risk patients. Three hundred and seventy three patients that suffered from PPU were included into the study and 50.9% received laparoscopic repair. There was a significant increase in the number of operations performed yearly by the LFA (P < 0.001). 25.2% of the patients had a Boey score of ≥2. High-risk patients that received LFA suffered from larger ulcers (P < 0.001) with more severe contamination (P = 0.006) that required conversion (P = 0.002) when compared to the low-risk patients. When compared to open surgery, more high-risk patients in the open group had ASA grade ≥3 (P = 0.007) and suffered from mortality (P = 0.001). The only significant predictor to mortality in high-risk patients was ASA grade ≥3 (P = 0.014). The adoption of LFA in patients suffering from PPU was associated with acceptable rates of mortality and morbidity. The approach could also be selectively adopted in patients with Boey score ≥2 provided their ASA grading is low and hemodynamically stable.

[Patient-controlled Analgesia (PCA): an Overview About Methods, Handling and New Modalities].

PubMed

Abrolat, Marie; Eberhart, Leopold H J; Kalmus, Gerald; Koch, Tilo; Nardi-Hiebl, Stefan

2018-04-01

Patient-controlled analgesia (PCA) is one of the well established methods for the treatment of postoperative pain. A cochrane-review concluded that PCA is associated with better postoperative pain ratings and improved patient-satifaction compared to traditional way of administering opioids. Some prerequisites concerning patient selection, education of the patient and the medical staff, and supervision during PCA therapy are mandatory for a safe use of PCA. Current PCA modalities (intravenous and epidural routes of application) are expanded by newer, less invasive routes of drug administration, e.g. by the iontophoretic transdermal and the sublingual route. Their role in improving safety and the quality of pain therapy on the one hand side, and costs on the other hand side are discussion. Georg Thieme Verlag KG Stuttgart · New York.

Does revealing contextual knowledge of the patient's intention help nurses' handling of nurse calls?

PubMed

Klemets, Joakim; Toussaint, Pieter

2016-02-01

An inherent part of nurses' work is to handle nurse calls that often cause challenging interruptions to ongoing activities. In situations when nurses are interrupted by a nurse call, they need to decide whether to continue focusing on the task at hand or to abort and respond to the nurse call. The difficult decision is often influenced by a number of factors and can have implications for patient safety and quality of care. The study investigates how technology could be designed to support nurses' handling of nurse calls by allowing patients to communicate a more contextualised message revealing their intention to the nurse when issuing a nurse call. Through a qualitative methodology employing a scenario-based design approach, three different nurse call system concepts are evaluated by nurses from different departments of a Norwegian university hospital. Nurses find the uncertainty of not knowing the reason behind a nurse call stressful in situations where they are required to prioritise either the calling patient or a patient they are currently nursing. Providing information about a patient's intention behind a nurse call influences the nurse's decision to various degrees depending on the situation in which they find themselves and the information that is communicated. The nurses' reflections suggested that the message communicated should be designed to contain neither too little nor too much information about the patient's needs. A nurse call system that allows nurses to discern the reason behind a nurse call allows them to make a more accurate decision and relieves stress. In particular, the information communicated would reduce uncertainty and lessen nurses' dependence on other factors in their decision. The design of such a system should, however, carefully consider the needs of the department in which it is deployed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

AORN ergonomic tool 2: positioning and repositioning the supine patient on the OR bed.

PubMed

Waters, Thomas; Short, Manon; Lloyd, John; Baptiste, Andrea; Butler, Lorraine; Petersen, Carol; Nelson, Audrey

2011-04-01

Positioning or repositioning a patient on the OR bed in preparation for a surgical procedure presents a high risk for musculoskeletal disorders, such as low-back and shoulder injuries, for perioperative personnel. Safe patient handling requires knowledge of current ergonomic safety concepts, scientific evidence, and equipment and devices to ensure that neither the patient nor the caregiver is at risk for injury. AORN Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed provides guidelines that enable perioperative personnel to determine safe methods for positioning and repositioning a patient in the semi-Fowler, lateral, or lithotomy position in preparation for surgery. Published by Elsevier Inc.

Handling Practices of Fresh Leafy Greens in Restaurants: Receiving and Training†

PubMed Central

COLEMAN, ERIK; DELEA, KRISTIN; EVERSTINE, KAREN; REIMANN, DAVID; RIPLEY, DANNY

2015-01-01

Multiple foodborne illness outbreaks have been associated with the consumption of fresh produce. Investigations have indicated that microbial contamination throughout the farm-to-fork continuum often contributed to these outbreaks. Researchers have hypothesized that handling practices for leafy greens in restaurants may support contamination by and proliferation and amplification of pathogens that cause foodborne illness outbreaks. However, limited data are available on how workers handle leafy greens in restaurants. The purpose of this study was to collect descriptive data on handling practices of leafy greens in restaurants, including restaurant characteristics, types of leafy greens used, produce receipt, and food safety training and certification. As a federal collaborative partner with the Environmental Health Specialists Network (EHS-Net) of the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA) recommended that EHS-Net participants survey handling practices for leafy greens in restaurants. The recommendations in the FDA’s Guide to Minimize Microbial Food Safety Hazards of Leafy Greens are significant to this study for comparison of the results. The survey revealed that appropriate handling procedures assist in the mitigation of other unsafe handling practices for leafy greens. These results are significant because the FDA guidance for the safe handling of leafy greens was not available until 2009, after the survey had been completed. The information provided from this study can be used to promote additional efforts that will assist in developing interventions to prevent future foodborne illness outbreaks associated with leafy greens. PMID:24290691

Health Care Ergonomics: Contributions of Thomas Waters.

PubMed

Poole Wilson, Tiffany; Davis, Kermit G

2016-08-01

The aim of this study was to assess the contributions of Thomas Waters's work in the field of health care ergonomics and beyond. Waters's research of safe patient handling with a focus on reducing musculoskeletal disorders (MSDs) in health care workers contributed to current studies and prevention strategies. He worked with several groups to share his research and assist in developing safe patient handling guidelines and curriculum for nursing students and health care workers. The citations of articles that were published by Waters in health care ergonomics were evaluated for quality and themes of conclusions. Quality was assessed using the Mixed Methods Appraisal Tool and centrality to original research rating. Themes were documented by the type of population the citing articles were investigating. In total, 266 articles that referenced the top seven cited articles were evaluated. More than 95% of them were rated either medium or high quality. The important themes of these citing articles were as follows: (a) Safe patient handling is effective in reducing MSDs in health care workers. (b) Shift work has negative impact on nurses. (c) There is no safe way to manually lift a patient. (d) Nurse curriculums should contain safe patient handling. The research of Waters has contributed significantly to the health care ergonomics and beyond. His work, in combination with other pioneers in the field, has generated multiple initiatives, such as a standard safe patient-handling curriculum and safe patient-handling programs. © 2016, Human Factors and Ergonomics Society.

Dairy cow handling facilities and the perception of Beef Quality Assurance on Colorado dairies.

PubMed

Adams, A E; Olea-Popelka, F J; Grandin, T; Woerner, D R; Roman-Muniz, I N

2014-02-01

A survey was conducted on Colorado dairies to assess attitudes and practices regarding Dairy Beef Quality Assurance (DBQA). The objectives were to (1) assess the need for a new handling facility that would allow all injections to be administered via DBQA standards; (2) establish if Colorado dairy producers are concerned with DBQA; and (3) assess differences in responses between dairy owners and herdsmen. Of the 95 dairies contacted, 20 (21%) agreed to participate, with a median herd size of 1,178. When asked to rank the following 7 traits--efficiency, animal safety, human safety, ease of animal handling, ease of operation, inject per Beef Quality Assurance (BQA) procedures, and cost--in order of priority when designing a new handling facility, human and animal safety were ranked highest in priority (first or second) by the majority of participants, with ease of animal handling and efficiency ranked next. Interestingly, the administration of injections per BQA standards was ranked sixth or seventh by most participants. Respondents estimated the average annual income from the sale of cull cows to be 4.6% of all dairy income, with 50% receiving at least one carcass discount or condemnation in the past 12 mo. Although almost all of the participating dairy farmers stated that the preferred injection site for medications was the neck region, a significant number admitted to using alternate injection sites. In contrast, no difference was found between responses regarding the preferred and actual location for intravenous injections. Although most participating producers are aware of BQA injection guidelines, they perceive efficiency as more important, which could result in injections being administered in locations not promoted by BQA. Dairy owners and herdsmen disagreed in whether or not workers had been injured in the animal handling area in the last 12 mo. Handling facilities that allow for an efficient and safe way to administer drugs according to BQA guidelines and

29 CFR 1919.75 - Determination of crane or derrick safe working loads and limitations in absence of manufacturer's...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Determination of crane or derrick safe working loads and limitations in absence of manufacturer's data. 1919.75 Section 1919.75 Labor Regulations Relating to Labor... Certification of Shore-Based Material Handling Devices § 1919.75 Determination of crane or derrick safe working...

29 CFR 1919.75 - Determination of crane or derrick safe working loads and limitations in absence of manufacturer's...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Determination of crane or derrick safe working loads and limitations in absence of manufacturer's data. 1919.75 Section 1919.75 Labor Regulations Relating to Labor... Certification of Shore-Based Material Handling Devices § 1919.75 Determination of crane or derrick safe working...

Interprofessional teaching project with nursing and physical therapy students to promote caregiver and patient safety.

PubMed

von der Lancken, Shelley; Levenhagen, Kim

2014-12-01

Nurse educators must adjust curricula to meet the dynamic and critical changes in the health care environment, and to recognize the risk of injury our educational approach has on safety, team effectiveness, and culture change. Interprofessional collaboration and simulation are key components in the preparation of our students. Utilizing the interprofessional alliance model, an experience to promote collaborative relationships among nursing and physical therapy (PT) students to improve patient and caregiver safety was developed. Through this model, PT students taught safe patient-handling skills in a simulated setting to undergraduate nursing students. The majority of nursing students (N=351) from 2009–2014 strongly agreed or agreed that they were confident in the skills taught by the PT students and provided an overall course rating of outstanding or above average. This educational model, which includes simulation and safe patient handling, was a valuable addition to the curriculum, reinforcing the significance of developing collaborative relationships. Copyright 2014, SLACK Incorporated.

Handling qualities related to stall/spin accidents of supersonic fighter aircraft

NASA Technical Reports Server (NTRS)

Anderson, S. B.

1984-01-01

This paper reviews the handling qualities which influence the high angle of attack (AOA) behavior of supersonic fighter aircraft in order to obtain a clearer understanding of the causes of stall/spin accidents. The results show that, because modern fighters suffer more serious consequences when control is lost, good handling qualities are essential for safe operation at high AOA. Relaxed static stability used on some fighter aircraft can result in control problems at high AOA owing to inertia coupling and the difficulty of a recovery from a deep stall. Indications are that the use of departure/spin resistance and an automatic spin prevention system will greatly improve the safety record for modern supersonic fighters.

Development and evaluation of online video teaching resources to enhance student knowledge of livestock handling.

PubMed

Klupiec, C; Pope, S; Taylor, R; Carroll, D; Ward, M H; Celi, P

2014-07-01

To evaluate the effectiveness of online audiovisual materials to support the acquisition of animal handling skills by students of veterinary and animal science. A series of video clips (Livestock Handling modules) demonstrating livestock handling procedures was created and delivered online to students enrolled in the Faculty of Veterinary Science, University of Sydney. The effectiveness of these modules for supporting student learning was evaluated via an online survey. The survey also sought feedback on how students could be better prepared for handling livestock. The survey indicated that students found the videos a useful part of their learning experience, particularly by familiarising them with correct handling procedures and emphasising the importance of safety when handling livestock. Students also highlighted that online delivery supported flexible learning. Suggested improvements of the Livestock Handling modules centred around broadening the content of the videos and improving the user-friendliness of online access. Student feedback regarding how the Faculty could better prepare them for livestock handling was dominated by requests for more opportunities to practise animal handling using live animals. The Livestock Handling audiovisual tool is a valuable supplementary resource for developing students' proficiency in safe and effective handling of livestock. However, the results also clearly reveal a perception by students that more hands-on experience is required for acquisition of animal handling skills. These findings will inform future development of the Faculty's animal handling program. © 2014 Australian Veterinary Association.

Mixed-Methods Evaluation of Real-Time Safety Reporting by Hospitalized Patients and Their Care Partners: The MySafeCare Application.

PubMed

Collins, Sarah A; Couture, Brittany; Smith, Ann DeBord; Gershanik, Esteban; Lilley, Elizabeth; Chang, Frank; Yoon, Cathy; Lipsitz, Stuart; Sheikh, Aziz; Benneyan, James; Bates, David W

2018-04-27

The aims of the study were to evaluate the amount and content of data patients and care partners reported using a real-time electronic safety tool compared with other reporting mechanisms and to understand their perspectives on safety concerns and reporting in the hospital. This study used mixed methods including 20-month preimplementation and postimplementation trial evaluating MySafeCare, a web-based application, which allows hospitalized patients/care partners to report safety concerns in real time. The study compared MySafeCare submission rates for three hospital units (oncology acute care, vascular intermediate care, medical intensive care) with submissions rates of Patient Family Relations (PFR) Department, a hospital service to address patient/family concerns. The study used triangulation of quantitative data with thematic analysis of safety concern submissions and patient/care partner interviews to understand submission content and perspectives on safety reporting. Thirty-two MySafeCare submissions were received with an average rate of 1.7 submissions per 1000 patient-days and a range of 0.3 to 4.8 submissions per 1000 patient-days across all units, indicating notable variation between units. MySafeCare submission rates were significantly higher than PFR submission rates during the postintervention period on the vascular unit (4.3 [95% confidence interval = 2.8-6.5] versus 1.5 [95% confidence interval = 0.7-3.1], Poisson) (P = 0.01). Overall trends indicated a decrease in PFR submissions after MySafeCare implementation. Triangulated data indicated patients preferred to report anonymously and did not want concerns submitted directly to their care team. MySafeCare evaluation confirmed the potential value of providing an electronic, anonymous reporting tool in the hospital to capture safety concerns in real time. Such applications should be tested further as part of patient safety programs.This is an open-access article distributed under the terms of the

Sodium Handling Technology and Engineering Design of the Madison Dynamo Experiment.

NASA Astrophysics Data System (ADS)

Kendrick, R.; Forest, C. B.; O'Connell, R.; Wright, A.; Robinson, K.

1998-11-01

A new liquid metal MHD experiment is being constructed at the University of Wisconsin to test several key predictions of dynamo theory: magnetic instabilities driven by sheared flow, the effects of turbulence on current generation, and the back-reaction of the self-generated magnetic field on the fluid motion which brings saturation. This presentation describes the engineering design of the experiment, which is a 0.5 m radius spherical vessel, filled with liquid sodium at 150 degrees Celsius. The experiment is designed to achieve a magnetic Reynolds number in excess of 100, which requires approximately 80 Hp of mechanical drive, producing flow velocities in sodium of 15 m/s through impellers. Handling liquid sodium offers a number of technical challenges, but routine techniques have been developed over the past several decades for safely handling large quantities for the fast breeder reactor. The handling strategy is discussed, technical details concerning seals and pressurazation are presented, and safety elements are highlighted.

Thermodynamic processes associated with frostbite in the handling of liquid nitrogen

NASA Astrophysics Data System (ADS)

Johnson, W. L.; Cook, C. R.

2014-01-01

It is often taught that exposure to liquid nitrogen will cause frostbite or more severe damage to exposed skin tissue. However, it is also demonstrated that a full hand can be briefly immersed in liquid nitrogen without damage. To better understand and possibly visualize the effects of human tissue exposure to liquid nitrogen, a series of tests were conducted using simulated hands and arms composed of molded gelatin forms. The simulated hands and arms were immersed, sprayed, or splashed with liquid nitrogen both with and without state of the art personal protective equipment. Thermocouples were located within the test articles to allow for thermal mapping during the freezing process. The study is aimed to help understand frostbite hazards and the time constants involved with the handling of liquid nitrogen to improve future safety protocols for the safe handling of cryogenic fluids. Results of the testing also show the limits to handling liquid nitrogen while using various means of protection.

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database.

PubMed

Cortegiani, Andrea; Madotto, Fabiana; Gregoretti, Cesare; Bellani, Giacomo; Laffey, John G; Pham, Tai; Van Haren, Frank; Giarratano, Antonino; Antonelli, Massimo; Pesenti, Antonio; Grasselli, Giacomo

2018-06-12

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. ClinicalTrials.gov, NCT02010073

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

PubMed Central

2011-01-01

Background Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored. Methods We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews. Results Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members. Conclusions We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries. PMID:21914183

Feeling safe during an inpatient hospitalization: a concept analysis.

PubMed

Mollon, Deene

2014-08-01

This paper aims to explore the critical attributes of the concept feeling safe. The safe delivery of care is a high priority; however; it is not really known what it means to the patient to 'feel safe' during an inpatient hospitalization. This analysis explores the topic of safety from the patient's perspective. Concept analysis. The data bases of CINAHL, Medline, PsychInfo and Google Scholar for the years 1995-2012 were searched using the terms safe and feeling safe. The eight-step concept analysis method of Walker and Avant was used to analyse the concept of feeling safe. Uses and defining attributes, as well as identified antecedents, consequences and empirical referents, are presented. Case examples are provided to assist in the understanding of defining attributes. Feeling safe is defined as an emotional state where perceptions of care contribute to a sense of security and freedom from harm. Four attributes were identified: trust, cared for, presence and knowledge. Relationship, environment and suffering are the antecedents of feeling safe, while control, hope and relaxed or calm are the consequences. Empirical referents and early development of a theory of feeling safe are explored. This analysis begins the work of synthesizing qualitative research already completed around the concept of feeling safe by defining the key attributes of the concept. Support for the importance of developing patient-centred models of care and creating positive environments where patients receive high-quality care and feel safe is provided. © 2014 John Wiley & Sons Ltd.

Unique and massive Chernobyl cranes for deconstruction activities in the new safe confinement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parameswaran, N. A. Vijay; Chornyy, Igor; Owen, Rob

2013-07-01

On 26 April 1986, the worst nuclear power plant accident in history occurred at the Chernobyl plant in Ukraine (then part of the Soviet Union). The destruction of Unit 4 sent highly radioactive fallout over Belarus, Russia, Ukraine, and Europe. The object shelter-a containment sarcophagus-was built in November 1986 to limit exposure to radiation. However, it has only a planned 25-year lifespan and would probably not survive even a moderate seismic event in a region that has more than its share of such events. It was time to take action. One of the largest tasks that are in progress ismore » the design and construction of the New Safe Confinement (NSC). The NSC is an engineered enclosure for the entire object shelter that includes a suite of process equipment. The process equipment will be used for the dismantling of the destroyed Chernobyl Nuclear Power Plant Unit. One of the major mechanical handling systems to be installed in the new safe confinement is the Main Cranes System. The planned decontamination and decommissioning or dismantling activities will require the handling of heavily shielded waste disposal casks containing nuclear fuel as well as lifting and transporting extremely large structural elements. These activities, to be performed within the new safe confinement, will require large and sophisticated cranes. The article will focus on the current progress of the new safe confinement and of the main cranes system for the decommissioning or dismantling activities. (authors)« less

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.

PubMed

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

Clinicopathological characteristic and clinical handling of the patients with 2 cm or less gastric GISTs.

PubMed

Kataoka, Mikinori; Kawai, Takashi; Ikemiyagi, Hidekazu; Fujii, Takashi; Fukuzawa, Mari; Fukuzawa, Masakatsu; Kubota, Keisuke; Yoshida, Masashi; Suzuki, Shinji; Kitajima, Masaki

2013-01-01

We previously reported that safety and efficacy of mucosal cutting biopsy for diagnosing included 2 cm or less gastric GISTs. However, there have been no reports stating the clinicopathological characteristic and clinical handling of the patients with 2 cm or less gastric GISTs. The aim of our study is to investigate the clinicopathological characteristic and clinical handling of the patients with 2 cm or less gastric GISTs. The 19 patients diagnosed with GIST by mucosal cutting biopsy were divided into 2 groups: Group I; subjects were GISTs with 2 cm or less, Group II; subjects were GISTs >2 cm. We compared the 2 groups in terms of mean age, tumor size, tumor site, histopathological risk grade. In cases that underwent surgery with a diagnosis of GIST, we compared the pre- and postoperative histopathological diagnosis, and the histopathlogical risk grade within each group. The mean age and tumor size were significantly higher in Group I than in Group II. Meanwhile, there were no significant differences between the 2 groups, sex ratio, tumor site. All lesions were at histopathological risk grade at very low risk and low risk respectively. In 17 patients with GIST who underwent surgery, the histopathological diagnoses, immunostaining were in agreement with those from the mucosal cutting biopsy specimens in all cases, but mitotic count of one patient was not in agreement in group II. The 2 cm or less gastric GISTs diagnosed with histpathlogical very low risk can be considered acceptable to follow-up.

Near elimination of ventricular pacing in SafeR mode compared to DDD modes: a randomized study of 422 patients.

PubMed

Davy, Jean-Marc; Hoffmann, Ellen; Frey, Axel; Jocham, Kurt; Rossi, Stefano; Dupuis, Jean-Marc; Frabetti, Lorenzo; Ducloux, Pascale; Prades, Emmanuel; Jauvert, Gaël

2012-04-01

SafeR performance versus DDD/automatic mode conversion (DDD/AMC) and DDD with a 250-ms atrioventricular (AV) delay (DDD/LD) modes was assessed toward ventricular pacing (Vp) reduction. After a 1-month run-in phase, recipients of dual-chamber pacemakers without persistent AV block and persistent atrial fibrillation (AF) were randomly assigned to SafeR, DDD/AMC, or DDD/LD in a 1:1:1 design. The main endpoint was the percentage of Vp (%Vp) at 2 months and 1 year after randomization, ascertained from device memories. Secondary endpoints include %Vp at 1 year according to pacing indication and 1-year AF incidence based on automatic mode switch device stored episodes. Among 422 randomized patients (73.2±10.6 years, 50% men, sinus node dysfunction 47.4%, paroxysmal AV block 30.3%, bradycardia-tachycardia syndrome 21.8%), 141 were assigned to SafeR versus 146 to DDD/AMC and 135 to DDD/LD modes. Mean %Vp at 2 months was 3.4±12.6% in SafeR versus 33.6±34.7% and 14.0±26.0% in DDD/AMC and DDD/LD modes, respectively (P<0.0001 for both). At 1 year, mean %Vp in SafeR was 4.5±15.3% versus 37.9±34.4% and 16.7±28.0% in DDD/AMC and DDD/LD modes, respectively (P<0.0001 for both). The proportion of patients in whom Vp was completely eliminated was significantly higher in SafeR (69%) versus DDD/AMC (15%) and DDD/LD (45%) modes (P<0.0001 for both), regardless of pacing indication. The absolute risk of developing permanent AF or of remaining in AF for >30% of the time was 5.4% lower in SafeR than in the DDD pacing group (ns). In this selected patient population, SafeR markedly suppressed unnecessary Vp compared with DDD modes. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma

PubMed Central

2018-01-01

Objectives Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. Materials and Methods This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients. Results The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction. Conclusion Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option. PMID:29535964

General thoracic surgery is safe in patients taking clopidogrel (Plavix).

PubMed

Cerfolio, Robert James; Minnich, Douglas J; Bryant, Ayesha S

2010-11-01

The objective of this study was to assess the safety of general thoracic surgery in patients taking antiplatelet (clopidogrel) therapy. A prospective study was conducted of consecutive patients who underwent general thoracic surgery and who were taking clopidogrel perioperatively. They were matched using a propensity score from our prospective database of 11,768 patients. Intraoperative and postoperative outcomes were compared. Between January 2009 and April 2010 there were 33 patients on clopidogrel at the time of surgery and 132 controls. The most common procedures were thoracotomy with lobectomy in 11 patients (robotic in 1), video-assisted wedge resection in 6, mediastinoscopy in 4, and Ivor Lewis esophagogastrectomy in 2. Epidurals were not used. There was no intraoperative morbidity or bleeding in primary thoracotomy; however, 2 of the 4 patients who underwent redo thoracotomy had bleeding that required transfusions. None of the 8 patients receiving clopidogrel who had a coronary artery stent and underwent lobectomy had a perioperative myocardial infarction whereas 5 of the 14 control patients undergoing lobectomy who had a coronary artery stent did (P = .05). Otherwise, morbidity, mortality, and length of stay were no different. Patients who are receiving clopidogrel and who have a coronary artery stent placed can safely undergo general thoracic surgery. The widely held belief that surgery cannot be performed without bleeding is untrue. This new finding not only eliminates much of the preoperative dilemma posed by these patients but also may reduce their risk of a postoperative myocardial infarction. However, patients who require a redo thoracotomy may be at increased risk of bleeding. Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

SAFE HANDLING OF FOODS

EPA Science Inventory

Microbial food-borne illnesses pose a significant health problem in Japan. In 1996 the world's largest outbreak of Escherichia coli food illness occurred in Japan. Since then, new regulatory measures were established, including strict hygiene practices in meat and food processi...

A cross-sectional study of sputum handling by and supervision of patients with pulmonary tuberculosis treated at home in China.

PubMed

Mei, L; Tobe, R G; Geng, H; Ma, Y B; Li, R Y; Wang, W B; Selotlegeng, L; Wang, X Z; Xu, L Z

2012-12-01

Disposal of sputum from patients with pulmonary tuberculosis (TB) who are treated at home is an important aspect of preventing the spread of TB. However, few studies have examined disposal of sputum by patients with TB who are treated at home. Patients with pulmonary TB who are treated at home were surveyed regarding sputum handling and supervision. A cross-sectional survey of a representative sample of patients with pulmonary TB who are treated at home was conducted in Shandong Province. Participants were individuals with TB who had been registered with a local agency responsible for TB control. Participants completed a questionnaire with both qualitative and quantitative questions. How sputum was handled was determined and factors associated with sputum disposal were analyzed using a non-parametric test, logistic regression, and content analysis. Responses were received from 720 participants. Patients expectorated sputum 4.56 ± 10.367 times a day, and 68.6% of patients responded that they correctly disposed of their sputum. Supervision as part of TB control focused on the efforts of health agencies and paid little attention to waste management by patients. A non-parametric test showed that sputum disposal was significantly associated with gender, age, education, sputum smear results, attitudes toward waste management, and attitudes toward supervision (all p < 0.05). Logistic regression analysis showed that gender (OR = 0.482, 95% CI: 0.329-0.704), sputum smear results (OR = 1.300, 95% CI: 1.037-1.629), and level of education (OR = 0.685, 95% CI: 0.528-0.889) were associated with receipt of TB health education (all p < 0.05). Sputum handling by and supervision of patients with pulmonary TB who are treated at home is severely wanting. From a policy perspective, special attention should be given to the definition, details, and methods of supervision of waste management by patients with TB to give them relevant health education and enhance their willingness to be

Survey of responsible handling of local anesthetic in Indian dental operatory

PubMed Central

Rooban, Thavarajah; Rao, Umadevi Krishnamohan; Joshua, Elizabeth; Ranganathan, Kannan

2013-01-01

Background: Dental operatory requires handling of numerous toxic fluids such as denture acrylic monomer, alcohol and formalin for effective oral care delivery. The efficacy and responsible handling of such fluids has not been analyzed among Indian dentists and this study aims to address this lacunae. Materials and Methods: Closed ended questionnaire was distributed through email to Indian dentists in July 2012. After inclusion/exclusion criteria, 1484 practitioners constituted the study group with a response rate of 52%. Statistics: SPSS® Version 17.0 (SPSS-IBM Inc., IL, USA) was used to carry out statistical analysis. Descriptive statistics were presented. Chi square test was used to identify the association between the parameters; P ≤ 0.05 was considered as statistically significant. Results: Males (80.8%), undergraduates (78%), exclusive practitioners (81.2%), urban practitioners (68.5%) were the predominant respondents. Predominant of the respondents (97%) used local anesthetic (LA) from bottles. Eight percent have encountered instances of injecting formalin instead of LA in their settings. Safe disposal rules and regulations (P ≤ 0.05), opinion on injecting the other fluids instead of LA as a severe negligent act (P ≤ 0.05) were statistically significant between age groups. Educational status did not appear to influence the outcome. Only a third of the respondents were aware of the rules and regulations for safe disposal of empty LA bottles while 49.1% were not aware of them and willing to learn. Discussion: The lacunae in responsible handling of toxic fluids need to be addressed to prevent inadvertent and negligence suits against dentists, highlighting the need through continuing dental education programmes. PMID:24255564

Reducing Mouse Anxiety during Handling: Effect of Experience with Handling Tunnels

PubMed Central

Gouveia, Kelly; Hurst, Jane L.

2013-01-01

Handling stress is a well-recognised source of variation in animal studies that can also compromise the welfare of research animals. To reduce background variation and maximise welfare, methods that minimise handling stress should be developed and used wherever possible. Recent evidence has shown that handling mice by a familiar tunnel that is present in their home cage can minimise anxiety compared with standard tail handling. As yet, it is unclear whether a tunnel is required in each home cage to improve response to handling. We investigated the influence of prior experience with home tunnels among two common strains of laboratory mice: ICR(CD-1) and C57BL/6. We compared willingness to approach the handler and anxiety in an elevated plus maze test among mice picked up by the tail, by a home cage tunnel or by an external tunnel shared between cages. Willingness to interact with the handler was much greater for mice handled by a tunnel, even when this was unfamiliar, compared to mice picked up by the tail. Once habituated to handling, C57BL/6 mice were most interactive towards a familiar home tunnel, whereas the ICR strain showed strong interaction with all tunnel handling regardless of any experience of a home cage tunnel. Mice handled by a home cage or external tunnel showed less anxiety in an elevated plus maze than those picked up by the tail. This study shows that using a tunnel for routine handling reduces anxiety among mice compared to tail handling regardless of prior familiarity with tunnels. However, as home cage tunnels can further improve response to handling in some mice, we recommend that mice are handled with a tunnel provided in their home cage where possible as a simple practical method to minimise handling stress. PMID:23840458

Reducing mouse anxiety during handling: effect of experience with handling tunnels.

PubMed

Gouveia, Kelly; Hurst, Jane L

2013-01-01

Handling stress is a well-recognised source of variation in animal studies that can also compromise the welfare of research animals. To reduce background variation and maximise welfare, methods that minimise handling stress should be developed and used wherever possible. Recent evidence has shown that handling mice by a familiar tunnel that is present in their home cage can minimise anxiety compared with standard tail handling. As yet, it is unclear whether a tunnel is required in each home cage to improve response to handling. We investigated the influence of prior experience with home tunnels among two common strains of laboratory mice: ICR(CD-1) and C57BL/6. We compared willingness to approach the handler and anxiety in an elevated plus maze test among mice picked up by the tail, by a home cage tunnel or by an external tunnel shared between cages. Willingness to interact with the handler was much greater for mice handled by a tunnel, even when this was unfamiliar, compared to mice picked up by the tail. Once habituated to handling, C57BL/6 mice were most interactive towards a familiar home tunnel, whereas the ICR strain showed strong interaction with all tunnel handling regardless of any experience of a home cage tunnel. Mice handled by a home cage or external tunnel showed less anxiety in an elevated plus maze than those picked up by the tail. This study shows that using a tunnel for routine handling reduces anxiety among mice compared to tail handling regardless of prior familiarity with tunnels. However, as home cage tunnels can further improve response to handling in some mice, we recommend that mice are handled with a tunnel provided in their home cage where possible as a simple practical method to minimise handling stress.

Long-term treatment with tenofovir in Asian-American chronic hepatitis B patients is associated with abnormal renal phosphate handling.

PubMed

Tien, Connie; Xu, Jason J; Chan, Linda S; Chang, Mimi; Lim, Carolina; Lee, Sue; Huh, Brian; Shinada, Shuntaro; Bae, Ho S; Fong, Tse-Ling

2015-02-01

Increased risk of defective urinary phosphate reabsorption and osteoporosis has been reported in HIV and chronic hepatitis B (CHB) patients treated with tenofovir disoproxil fumarate (TDF). Goals of this study were to evaluate the prevalence of renal phosphate wasting and abnormal bone mineral density in CHB patients taking TDF compared to CHB patients treated with entecavir (ETV) and untreated CHB patients. This is a cross-sectional study of 146 consecutive Asian-American CHB patients who were treatment naïve (n = 60) or treated with either TDF (n = 42) or ETV (n = 44). Proximal tubular handling of phosphate was assessed by the maximal rate of tubular reabsorption of phosphate (TmPO4) divided by glomerular filtration rate (GFR) (TmPO4/GFR). Bone mineral density (BMD) was measured using dual X-ray absorptiometry. TmPO4/GFR was similar among CHB patients treated with TDF compared to untreated patients and patients taking ETV. However, among patients treated with ≥18 months of TDF or ETV, prevalence of abnormal TmPO4/GFR was higher among patients treated with TDF compared to ETV (48.5 % (16/33) vs. 12.5 % (3/24), p = 0.005). Overall prevalence of osteoporosis in this cohort of CHB patients was 14 %, with no significant difference between the three groups. Renal phosphate handling did not correlate with osteoporosis. Chronic hepatitis B patients treated with ≥18 months of TDF experienced an increased risk of proximal tubular dysfunction. TDF did not increase the risk of osteoporosis. Longitudinal studies are needed to confirm these findings.

Capsule Endoscopy in Patients with Implantable Electromedical Devices is Safe

PubMed Central

Harris, Lucinda A.; Hansel, Stephanie L.; Rajan, Elizabeth; Srivathsan, Komandoor; Rea, Robert; Crowell, Michael D.; Fleischer, David E.; Pasha, Shabana F.; Gurudu, Suryakanth R.; Heigh, Russell I.; Shiff, Arthur D.; Post, Janice K.; Leighton, Jonathan A.

2013-01-01

Background and Study Aims. The presence of an implantable electromechanical cardiac device (IED) has long been considered a relative contraindication to the performance of video capsule endoscopy (CE). The primary aim of this study was to evaluate the safety of CE in patients with IEDs. A secondary purpose was to determine whether IEDs have any impact on images captured by CE. Patients and Methods. A retrospective chart review of all patients who had a capsule endoscopy at Mayo Clinic in Scottsdale, AZ, USA, or Rochester, MN, USA, (January 2002 to June 2010) was performed to identify CE studies done on patients with IEDs. One hundred and eighteen capsule studies performed in 108 patients with IEDs were identified and reviewed for demographic data, method of preparation, and study data. Results. The most common indications for CE were obscure gastrointestinal bleeding (77%), anemia (14%), abdominal pain (5%), celiac disease (2%), diarrhea (1%), and Crohn's disease (1%). Postprocedure assessments did not reveal any detectable alteration on the function of the IED. One patient with an ICD had a 25-minute loss of capsule imaging due to recorder defect. Two patients with LVADs had interference with capsule image acquisition. Conclusions. CE did not interfere with IED function, including PM, ICD, and/or LVAD and thus appears safe. Additionally, PM and ICD do not appear to interfere with image acquisition but LVAD may interfere with capsule images and require that capsule leads be positioned as far away as possible from the IED to assure reliable image acquisition. PMID:23710168

Estimating time available for sensor fusion exception handling

NASA Astrophysics Data System (ADS)

Murphy, Robin R.; Rogers, Erika

1995-09-01

In previous work, we have developed a generate, test, and debug methodology for detecting, classifying, and responding to sensing failures in autonomous and semi-autonomous mobile robots. An important issue has arisen from these efforts: how much time is there available to classify the cause of the failure and determine an alternative sensing strategy before the robot mission must be terminated? In this paper, we consider the impact of time for teleoperation applications where a remote robot attempts to autonomously maintain sensing in the presence of failures yet has the option to contact the local for further assistance. Time limits are determined by using evidential reasoning with a novel generalization of Dempster-Shafer theory. Generalized Dempster-Shafer theory is used to estimate the time remaining until the robot behavior must be suspended because of uncertainty; this becomes the time limit on autonomous exception handling at the remote. If the remote cannot complete exception handling in this time or needs assistance, responsibility is passed to the local, while the remote assumes a `safe' state. An intelligent assistant then facilitates human intervention, either directing the remote without human assistance or coordinating data collection and presentation to the operator within time limits imposed by the mission. The impact of time on exception handling activities is demonstrated using video camera sensor data.

Observation of High School Students' Food Handling Behaviors: Do They Improve following a Food Safety Education Intervention?

PubMed

Diplock, Kenneth J; Dubin, Joel A; Leatherdale, Scott T; Hammond, David; Jones-Bitton, Andria; Majowicz, Shannon E

2018-06-01

Youth are a key audience for food safety education. They often engage in risky food handling behaviors, prepare food for others, and have limited experience and knowledge of safe food handling practices. Our goal was to investigate the effectiveness of an existing food handler training program for improving safe food handling behaviors among high school students in Ontario, Canada. However, because no schools agreed to provide control groups, we evaluated whether behaviors changed following delivery of the intervention program and whether changes were sustained over the school term. We measured 32 food safety behaviors, before the intervention and at 2-week and 3-month follow-up evaluations by in-person observations of students ( n = 119) enrolled in grade 10 and 12 Food and Nutrition classes ( n = 8) and who individually prepared recipes. We examined within-student changes in behaviors across the three time points, using mixed effects regression models to model trends in the total food handling score (of a possible 32 behaviors) and subscores for "clean" (17 behaviors), "separate" (14 behaviors), and "cook" (1 behavior), adjusting for student characteristics. At baseline, students ( n = 108) averaged 49.1% (15.7 of 32 behaviors; standard deviation = 5.8) correct food handling behaviors, and only 5.5% (6) of the 108 students used a food thermometer to check the doneness of the chicken (the "cook" behavior). All four behavior score types increased significantly ∼2 weeks postintervention and remained unchanged ∼3 months later. Student characteristics (e.g., having taken a prior food handling course) were not significant predictors of the total number of correctly performed food handling behaviors or of the "clean" or "separate" behaviors, working or volunteering in a food service establishment was the only characteristic significantly associated with food thermometer use (i.e., "cook"). Despite the significant increase in correct behaviors, students continued to

Moving and handling education in the community: technological innovations to improve practice.

PubMed

Wanless, Stephen; Page, Andrea

2009-12-01

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than sound educational theory. The purpose of this article is to summarize current evidence for educational interventions designed to reduce primary care staff injuries: a significant problem for decades. Evidence suggests that the current 'classroom' teaching of moving and handling is ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal injuries in health professionals (Freitag et al, 2007). The authors discuss potential solutions through moving and handling-related motion capture simulation and the use of e-learning to promote an understanding of the principles associated with patient handling tasks.

Prognostic study of cardiac events in Japanese high risk hemodialysis patients using I-BMIPP-SPECT: B-SAFE study design.

PubMed

Hasebe, Naoyuki; Moroi, Masao; Nishimura, Masato; Hara, Kazuhiro; Hase, Hiroki; Hashimoto, Akiyoshi; Kumita, Shinichiro; Haze, Kazuo; Momose, Mitsuru; Nagai, Yoji; Sugimoto, Tokuichiro; Kusano, Eiji; Akiba, Takashi; Nakata, Tomoaki; Nishimura, Tsunehiko; Tamaki, Nagara; Kikuchi, Kenjiro

2008-12-01

Cardiovascular disease is the leading cause of morbidity and mortality in patients undergoing hemodialysis. Such patients frequently develop complications such as asymptomatic coronary artery disease (CAD). Accordingly, CAD must ideally be diagnosed at an early stage to improve prognosis. Although myocardial perfusion single photon emission computed tomography (SPECT) is valuable for diagnosing CAD, the stress test is not always applicable to patients on hemodialysis. Thus, we proposed a multicenter, prospective cohort study called "B-SAFE" to investigate the applicability of resting (123)I-labeled beta-methyl-iodophenylpentadecanoic acid ((123)I-BMIPP)-SPECT will be used to diagnose cardiac disease and evaluate the prognosis of hemodialysis patients by imaging myocardial fatty acid metabolism. B-SAFE began enrolling patients from June 2006 at 48 facilities. We performed (123)I-BMIPP-SPECT on 702 hemodialysis patients with risk factors for CAD until 30 November 2007 and plan to follow up for three years. The primary endpoints will be cardiac death and sudden death. This study should end in 2010.

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

PubMed

Alamgir, Hasanat; Li, Olivia Wei; Yu, Shicheng; Gorman, Erin; Fast, Catherine; Kidd, Catherine

2009-09-01

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

Method for making a low density polyethylene waste form for safe disposal of low level radioactive material

DOEpatents

Colombo, P.; Kalb, P.D.

1984-06-05

In the method of the invention low density polyethylene pellets are mixed in a predetermined ratio with radioactive particulate material, then the mixture is fed through a screw-type extruder that melts the low density polyethylene under a predetermined pressure and temperature to form a homogeneous matrix that is extruded and separated into solid monolithic waste forms. The solid waste forms are adapted to be safely handled, stored for a short time, and safely disposed of in approved depositories.

Automated blood-sample handling in the clinical laboratory.

PubMed

Godolphin, W; Bodtker, K; Uyeno, D; Goh, L O

1990-09-01

The only significant advances in blood-taking in 25 years have been the disposable needle and evacuated blood-drawing tube. With the exception of a few isolated barcode experiments, most sample-tracking is performed through handwritten or computer-printed labels. Attempts to reduce the hazards of centrifugation have resulted in air-tight lids or chambers, the use of which is time-consuming and cumbersome. Most commonly used clinical analyzers require serum or plasma, distributed into specialized containers, unique to that analyzer. Aliquots for different tests are prepared by handpouring or pipetting. Moderate to large clinical laboratories perform so many different tests that even multi-analyzers performing multiple analyses on a single sample may account for only a portion of all tests ordered for a patient. Thus several aliquots of each specimen are usually required. We have developed a proprietary serial centrifuge and blood-collection tube suitable for incorporation into an automated or robotic sample-handling system. The system we propose is (a) safe--avoids or prevents biological danger to the many "handlers" of blood; (b) small--minimizes the amount of sample taken and space required to adapt to the needs of satellite and mobile testing, and direct interfacing with analyzers; (c) serial--permits each sample to be treated according to its own "merits," optimizes throughput, and facilitates flexible automation; and (d) smart--ensures quality results through monitoring and intelligent control of patient identification, sample characteristics, and separation process.

Sprag Handle Wrenches

NASA Technical Reports Server (NTRS)

Vranishm, John M.

2010-01-01

Sprag handle wrenches have been proposed for general applications in which conventional pawl-and-ratchet wrenches and sprag and cam "clickless" wrenches are now used. Sprag handle wrenches are so named because they would include components that would function both as parts of handles and as sprags (roller locking/unlocking components). In comparison with all of the aforementioned conventional wrenches, properly designed sprag handle wrenches could operate with much less backlash; in comparison with the conventional clickless wrenches, sprag handle wrenches could be stronger and less expensive (because the sprags would be larger and more easily controllable than are conventional sprags and cams).

[Prevention of adverse effects in latex allergic patients: organizing a latex safe operating theatre].

PubMed

Bonalumi, Sabrina; Barbonaglia, Patrizia; Bertocchi, Carmen

2006-01-01

In 2001 the General Health Direction of Region Lombardia approved (decree n. 22303) a guideline for the prevention of latex allergic reactions in patients and health care workers. This document provides general recommendations in order to standardize behaviors in regional health care facilities. The reason is due to a rise in the incident of reactions to latex products in the last 20 years. Nowadays the prevalence is higher in certain risk groups (subjected to frequent and repeated exposures) rather than the general population. The aim of the project was to organize a latex safe operating theatre in the Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena of Milan (Fondazione) and to standardize behaviors in order to prevent adverse effects in latex allergic patients. Thanks to the literature review and the creation of a multidisciplinar team, we produced a protocol. Therefore, we requested manufacturers the certification of the latex content of their products. Results and conclusion. When latex allergic patients need to undergone surgery in our hospital, a latex safe operating theatre is organized by personnel following a multidisciplinar protocol. No allergic reactions were experienced during surgical procedures after the creation of an environment as free as possible from latex contamination. The project will involve an emergency room, one room or more of a ward and of the outpatients department.

Transportation and handling loads

NASA Technical Reports Server (NTRS)

Ostrem, F. E.

1971-01-01

Criteria and recommended practices are presented for the prediction and verification of transportation and handling loads for the space vehicle structure and for monitoring these loads during transportation and handling of the vehicle or major vehicle segments. Elements of the transportation and handling systems, and the forcing functions and associated loads are described. The forcing functions for common carriers and typical handling devices are assessed, and emphasis is given to the assessment of loads at the points where the space vehicle is supported during transportation and handling. Factors which must be considered when predicting the loads include the transportation and handling medium; type of handling fixture; transport vehicle speed; types of terrain; weather (changes in pressure of temperature, wind, etc.); and dynamics of the transportation modes or handling devices (acceleration, deceleration, and rotations of the transporter or handling device).

Electromyography tests in patients with implanted cardiac devices are safe regardless of magnet placement.

PubMed

Ohira, Masayuki; Silcox, Jade; Haygood, Deavin; Harper-King, Valerie; Alsharabati, Mohammad; Lu, Liang; Morgan, Marla B; Young, Angela M; Claussen, Gwen C; King, Peter H; Oh, Shin J

2013-01-01

We compared the problems or complications associated with electrodiagnostic testing in 77 patients with implanted cardiac devices. Thirty tests were performed after magnet placement, and 47 were performed without magnet application. All electrodiagnostic tests were performed safely in all patients without any serious effect on the implanted cardiac devices with or without magnet placement. A significantly higher number of patient symptoms and procedure changes were reported in the magnet group (P < 0.013). No statistical difference was found in the testing difficulty or ECG changes. The magnet group patients had an approximately 11-fold greater risk of symptoms than those in the control group. Our data do not support a recommendation that magnet placement is necessary for routine electrodiagnostic testing in patients with implanted cardiac devices, as long as our general and specific guidelines are followed. Copyright © 2012 Wiley Periodicals, Inc.

Employee and customer handling of nicotine-containing e-liquids in vape shops.

PubMed

Garcia, Robert; Allem, Jon Patrick; Baezconde-Garbanati, Lourdes; Unger, Jennifer Beth; Sussman, Steve

2016-01-01

Vape shops sell electronic cigarettes and related products such as e-liquids, which may contain nicotine. Direct contact with nicotine can lead to adverse health effects, and few regulations exist on how nicotine is handled in vape shops. This study examined how customers and employees come into contact with, and handle, nicotine-containing e-liquids in vape shops with the goal of informing potential future regulation of nicotine handling in vape shops. Data were collected from 77 vape shops in the Los Angeles basin. Characteristics of the shops were documented by employee interviews and in store observations. Data collection was focused on shops located in areas with high concentrations of communities of interest; 20 shops from African-American communities, 17 from Hispanic communities, 18 from Korean communities, and 22 from non-Hispanic White communities. Half of the vape shops allowed customers to sample e-liquids with nicotine. Most of the shops (83%) provided self-service sampling stations for customers. A majority of shop employees (72%) reported that spills of e-liquids containing nicotine had occurred in the past. While 64% of the shops provided safety equipment, only 34% provided equipment for proper nicotine handling. Furthermore, 62% of shop employees reported handling nicotine without gloves or other safety equipment. Regulation on the handling of nicotine by customers and vape shop employees is important to prevent unsafe practices and subsequent injury. The frequent occurrence of spills and limited availability of safety equipment in vape shops highlights the need for the creation and enforcement of regulations to protect employees and customers. Appropriate safety training and equipment should be provided to employees to prevent accidental exposure to nicotine. Information on ways to safely handle nicotine should be communicated to vape shop employees and customers.

Employee and customer handling of nicotine-containing e-liquids in vape shops

PubMed Central

Garcia, Robert; Allem, Jon Patrick; Baezconde-Garbanati, Lourdes; Unger, Jennifer Beth; Sussman, Steve

2017-01-01

INTRODUCTION Vape shops sell electronic cigarettes and related products such as e-liquids, which may contain nicotine. Direct contact with nicotine can lead to adverse health effects, and few regulations exist on how nicotine is handled in vape shops. This study examined how customers and employees come into contact with, and handle, nicotine-containing e-liquids in vape shops with the goal of informing potential future regulation of nicotine handling in vape shops. METHODS Data were collected from 77 vape shops in the Los Angeles basin. Characteristics of the shops were documented by employee interviews and in store observations. Data collection was focused on shops located in areas with high concentrations of communities of interest; 20 shops from African-American communities, 17 from Hispanic communities, 18 from Korean communities, and 22 from non-Hispanic White communities. RESULTS Half of the vape shops allowed customers to sample e-liquids with nicotine. Most of the shops (83%) provided self-service sampling stations for customers. A majority of shop employees (72%) reported that spills of e-liquids containing nicotine had occurred in the past. While 64% of the shops provided safety equipment, only 34% provided equipment for proper nicotine handling. Furthermore, 62% of shop employees reported handling nicotine without gloves or other safety equipment. CONCLUSIONS Regulation on the handling of nicotine by customers and vape shop employees is important to prevent unsafe practices and subsequent injury. The frequent occurrence of spills and limited availability of safety equipment in vape shops highlights the need for the creation and enforcement of regulations to protect employees and customers. Appropriate safety training and equipment should be provided to employees to prevent accidental exposure to nicotine. Information on ways to safely handle nicotine should be communicated to vape shop employees and customers. PMID:28660255

Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal.

PubMed

Ahn, Jin Hwan; Oh, Irvin

2004-09-01

Arthroscopic resection of irreparable bucket-handle tears of the medial meniscus is a commonly performed procedure. Adequate visualization of the posterior horn of the medial meniscus can be a challenging task with the conventional use of the anterior portal. An attempt to resect the posterior horn in a blind fashion may result in iatrogenic damage of the articular cartilage in the posterior compartment, over-resection of a remnant meniscus, or an insufficient resection of the torn fragment. We describe the use of the posteromedial portal for an accurate visualization and resection of the posterior attachment of a bucket-handle tear for arthroscopic partial meniscectomy, as well as detection of other injuries that may be involved in the posteromedial compartment, while avoiding injury to other intra-articular structures during the arthroscopic procedure. We found that the use of the posteromedial portal is a safe and efficient method in removing a bucket-handle tear of the medial meniscus in one piece.

78 FR 27303 - Irradiation in the Production, Processing, and Handling of Animal Feed and Pet Food; Electron...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

...-0178] Irradiation in the Production, Processing, and Handling of Animal Feed and Pet Food; Electron Beam and X-Ray Sources for Irradiation of Poultry Feed and Poultry Feed Ingredients AGENCY: Food and... amending the regulations for irradiation of animal feed and pet food to provide for the safe use of...

A SAFE PROTOCOL FOR RAPID DESENSITIZATION IN PATIENTS WITH CYSTIC FIBROSIS AND ANTIBIOTIC HYPERSENSITIVITY

PubMed Central

Legere, Henry J.; Palis, Ross I.; Bouza, Tito Rodriguez; Uluer, Ahmet Z.; Castells, Mariana C.

2009-01-01

Background CF patients often demonstrate hypersensitivity to one or multiple antibiotics due to frequent and repeated exposures. Attempts at antibiotic desensitization in this population are historically complicated by higher reaction rates, failure to complete the procedure and consequent withholding of first-line therapy. This study evaluates the outcomes of a rapid desensitization protocol developed at our institution. Methods We retrospectively reviewed the medical records of 15 patients undergoing 52 rapid antibiotic desensitizations at Brigham and Women’s Hospital and Children’s Hospital Boston utilizing our protocol. Results Mean FEV1 % predicted was 44.1 (SD 16.5), with two patients at <30% and one patient desensitized during bilateral lung transplantation. Adverse reactions during desensitization occurred in 13.4%, and most were mild. 100% of patients completed the protocol and ultimately tolerated subsequent full-strength antibiotic courses. Conclusions CF patients with antibiotic hypersensitivity can safely receive first-line antibiotics via our rapid desensitization protocol, including those with severe obstructive lung disease. PMID:19740711

Is Fasting for Ramadan Safe in Patients with Mechanical Cardiac Valves?

PubMed

Yildirim, Ersin; Secen, Ozlem; Uku, Okkes; Nail Bilen, Mehmet; Kutlu Karadag, Makbule

2017-03-01

The study aim was to investigate the safety and effects of fasting during Ramadan on the International Normalized Ratio (INR) in patients with mechanical cardiac valves. A total of 105 patients admitted to the authors' hospital between June and October 2015, who had history of prosthetic valve replacement, was investigated. The patients were allocated to two groups: those fasting during Ramadan (n = 42) and those not fasting (n = 63). All patients were examined by a cardiologist, and the clinical findings and complaints for the past three months were evaluated. The INR, complete blood count (CBC) and a basic biochemical panel were monitored for all patients. The mean corpuscular volume (MCV) of the fasting group was significantly higher than that of the non- fasting group (87.59 ± 6.39 (μm3) versus 84.28 ± 6.387 (μm3); p = 0.011). Other CBC parameters and basic biochemical values did not differ significantly different between groups. Neither were significant differences noted in INR values during Ramadan (fasting group 2.87 ± 0.97; non-fasting group 2.73 ± 0.78; p = 0.50) and at routine control one month later (fasting group 3.07 ± 1.55; non-fasting group 2.94 ± 1.03; p = 0.601). No significant differences related to increased rates of hospitalization, valvular dysfunction on echocardiography, thrombus, embolism, bleeding and clinical complaints were identified between the groups. Fasting during Ramadan had no adverse effects on the INR of patients, and appears to be safe for patients with mechanical prosthetic cardiac valves.

An accelerated diagnostic protocol for the early, safe discharge of low-risk chest pain patients.

PubMed

Altherwi, Tawfeeq; Grad, Willis B

2015-07-01

Can an accelerated 2-hour diagnostic protocol using the cardiac troponin I (cTnI) measurement as the only biomarker be implemented to allow an earlier and safe discharge of low-risk chest pain patients? Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012;59(23):2091-8. To determine whether an accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge using cTnI as the sole biomarker.

Enoxaparin can be used safely in patients with severe thrombocytopenia due to intensive chemotherapy regimens.

PubMed

Herishanu, Yair; Misgav, Mudi; Kirgner, Ilya; Ben-Tal, Ofira; Eldor, Amiram; Naparstek, Ella

2004-07-01

Treatment with intensive chemotherapy regimens is frequently complicated by severe thrombocytopenia. During the period of severe thrombocytopenia, anticoagulant treatment is not uncommonly indicated for thromboembolic events or thromboprophylaxis in these patients. We report 10 hematological patients treated with intensive chemotherapy protocols that were anticoagulated with enoxaparin for catheter related central venous thrombosis and thromboprophylaxis. During the period of severe thrombocytopenia the dosages of enoxaparin were reduced and no major bleeding occurred. Based on our experience we suggest that reduced dosages of low molecular weight heparins may be used relatively safely during transient severe thrombocytopenia.

Hypothenar hammer syndrome from ice hockey stick-handling.

PubMed

Zayed, Mohamed A; McDonald, Joey; Tittley, Jacques G

2013-11-01

Ulnar artery thrombosis and hypothenar hammer syndrome are rare vascular complications that could potentially occur with repeated blows or trauma to the hand. Although initially reported as an occupational hazard among laborers and craftsmen, it has been observed more recently among recreationalists and athletes. Until now, it has never been reported as a complication in ice hockey players. In this case report, a 26-year-old Canadian professional ice hockey player presented with acute dominant right hand paleness, coolness, and pain with hand use. The patient used a wooden hockey stick with a large knob of tape at the end of the handle, which he regularly gripped in the palm of his right hand to help with face-offs and general stick-handling. Sonographic evaluation demonstrated no arterial flow in the distal right ulnar artery distribution, and ulnar artery occlusion with no aneurysmal degeneration was confirmed by magnetic resonance angiogram. Intraarterial thrombolytic therapy was initiated, and subsequent serial angiograms demonstrated significant improvement in distal ulnar artery flow as well as recanalization of right hand deep palmar arch and digital arteries. The patient's symptoms resolved, and he was maintained on therapeutic anticoagulation for 3 months prior to returning to playing ice hockey professionally, but with a padded glove and no tape knob at the handle tip. This case highlights a unique presentation of hockey stick-handling causing ulnar artery thrombosis that was likely from repeated palmar hypothenar trauma. Appropriate diagnostic imaging, early intraarterial thrombolysis, and postoperative surveillance and follow-up were crucial for the successful outcome in this patient. Copyright © 2013 Elsevier Inc. All rights reserved.

Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

PubMed

Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

2015-07-01

Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

Safe pill-dispensing.

PubMed

Testa, Massimiliano; Pollard, John

2007-01-01

Each patient is supplied with a smart-card containing a Radio Frequency IDentification (RFID) chip storing a unique identification code. The patient places the Smart-card on a pill-dispenser unit containing an RFID reader. The RFID chip is read and the code sent to a Base-station via a wireless Bluetooth link. A database containing both patient details and treatment information is queried at the Base-station using the RFID as the search key. The patient's treatment data (i.e., drug names, quantities, time, etc.) are retrieved and sent back to the pill-dispenser unit via Bluetooth. Appropriate quantities of the required medications are automatically dispensed, unless the patient has already taken his/her daily dose. Safe, confidential communication and operation is ensured.

Handling And Safety Aspects Of Fiber Optic Laser Beam Delivery Systems

NASA Astrophysics Data System (ADS)

Schonborn, K.-H.; Wodrich, W.

1988-06-01

Using lasers for therapeutic applications is getting more and more accepted. In ophthalmology Ar-lasers for intraocular applications are quite common. The Nd:YAG-laser is used as a high power tool in connection with silica fibers for different extracorporal and intracorporal applications. The CO2-laser is the cutting laser, one problem being the beam transmission: The state of the art in fibers is not sufficient up to now. Because of the high power used safety against laser radiation hazard is of great importance. The safety in laser use is primarily dependent on the surgeons cautiousness, e.g. using laser protection goggels, observing that the spot of the aiming beam is present etc. On the other hand the laser and fiber system has to be inherently safe by appropriate technical means as far as possible. An additional aspect adding to safety is the handling: With easier system handling less attention of the surgeon is necessary for driving the apparatus. Thus he can concentrate on the patient and on the procedure. In considering the fiber system one important point in handling and safety is the coupling of the fiber to the laser head. The development philosophy in this coupling may be divided into two groups: - one is trying to use standard connectors which were initially developed for data transmission; - the other is using special connectors. One example of the first group is the guiding of the laser beam from the Ar-laser to the slit-lamp in ophtalmology. Here the well-known F-SMA connectors together with a special fiber with adapted numerical aperture are used. The advantage of such a system is the low price of the connector. For high power lasers such as the clinical Nd:YAG lasers with 40 to 150 W those connectors are not suitable. Up to now every laser manufacturer developed his own connector system in this field.

Consumer food handling in the home: a review of food safety studies.

PubMed

Redmond, Elizabeth C; Griffith, Christopher J

2003-01-01

Epidemiological data from Europe, North America, Australia, and New Zealand indicate that a substantial proportion of foodborne disease is attributable to improper food preparation practices in consumers' homes. International concern about consumer food safety has prompted considerable research to evaluate domestic food-handling practices. The majority of consumer food safety studies in the last decade have been conducted in the United Kingdom and Northern Ireland (48%) and in the United States (42%). Surveys (questionnaires and interviews), the most frequent means of data collection, were used in 75% of the reviewed studies. Focus groups and observational studies have also been used. One consumer food safety study examined the relationship between pathogenic microbial contamination from raw chicken and observed food-handling behaviors, and the results of this study indicated extensive Campylobacter cross-contamination during food preparation sessions. Limited information about consumers' attitudes and intentions with regard to safe food-handling behaviors has been obtained, although a substantial amount of information about consumer knowledge and self-reported practices is available. Observation studies suggest that substantial numbers of consumers frequently implement unsafe food-handling practices. Knowledge, attitudes, intentions, and self-reported practices did not correspond to observed behaviors, suggesting that observational studies provide a more realistic indication of the food hygiene actions actually used in domestic food preparation. An improvement in consumer food-handling behavior is likely to reduce the risk and incidence of foodborne disease. The need for the development and implementation of food safety education strategies to improve specific food safety behaviors is reviewed in this paper.

Handling and restraint.

PubMed

Donovan, John; Brown, Patricia

2006-07-01

For the safety of the handler and the animal, proper methods for handling and restraining laboratory animals should be followed. Improper handling can result in increased stress and injury to the animal. In addition, the handler risks injury from bite wounds or scratches inflicted when the animal becomes fearful or anxious. By using sure, direct movements with a determined attitude, the animal can be easily handled and restrained. Animals can be restrained either manually or in a plastic restrainer. The protocols in this unit describe handling and manual restraint of mice, rats, hamsters, and rabbits. Alternate protocols describe restraint using the plastic restrainer.

Handling and restraint.

PubMed

Donovan, John; Brown, Patricia

2004-09-01

For the safety of the handler and the animal, proper methods for handling and restraining laboratory animals should be followed. Improper handling can result in increased stress and injury to the animal. In addition, the handler risks injury from bite wounds or scratches inflicted when the animal becomes fearful or anxious. By using sure, direct movements with a determined attitude, the animal can be easily handled and restrained. Animals can be restrained either manually or in a plastic restrainer. The protocols in this unit describe handling and manual restraint of mice, rats, hamsters, and rabbits. Alternate protocols describe restraint using the plastic restrainer.

Is exercise training safe and beneficial in patients receiving left ventricular assist device therapy?

PubMed

Alsara, Osama; Perez-Terzic, Carmen; Squires, Ray W; Dandamudi, Sanjay; Miranda, William R; Park, Soon J; Thomas, Randal J

2014-01-01

Because a limited number of patients receive heart transplantation, alternative therapies, such as left ventricular assist device (LVAD) therapy, have emerged. Published studies have shown that LVAD implantation, by itself, improves exercise tolerance to the point where it is comparable to those with mild heart failure. The improvement in exercise capacity is maximally achieved 12 weeks after LVAD therapy and can continue even after explantation of the device. This effect varies, depending on the type of LVAD and exercise training. The available data in the literature on safety and benefits of exercise training in patients after LVAD implantation are limited, but the data that are available suggest that training trends to be safe and have an impact on exercise capacity in LVAD patients. Although no studies were identified on the role of cardiac rehabilitation programs in the management of LVAD patients, it appears that cardiac rehabilitation programs offer an ideal setting for the provision of supervised exercise training in this patient group.

Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey.

PubMed

Edery, E G

2017-05-27

To investigate how first opinion small animal veterinary surgeons in the UK handled chemotherapeutic agents, a questionnaire was distributed at the 2014 British Small Animal Veterinary Association congress and by internet. Chemotherapy was regularly offered by 70.4 per cent of the respondents. Gold standards defined according to available guidelines for safe handling of antineoplastic drugs were poorly followed by general practitioners with only 2 per cent of respondents complying with all of them. Dedicated facilities for preparation and administration of cytotoxic drugs were variably available among participants. The level of training of staff indirectly involved in handling chemotherapy was appropriate in less than 50 per cent of practices. No association was found between demographic characteristics of the sampled population and the decision to perform chemotherapy. The results of this study raise concerns about the safety of the veterinary staff in first opinion practices involved in handling chemotherapy. British Veterinary Association.

Easy and safe coated optical fiber direct connection without handling bare optical fiber

NASA Astrophysics Data System (ADS)

Saito, Kotaro; Kihara, Mitsuru; Shimizu, Tomoya; Kurashima, Toshio

2015-06-01

We propose a novel field installable splicing technique for the direct connection of 250 μm diameter coated optical fiber that does not require bare optical fiber to be handled. Our proposed technique can realize a low insertion loss over a wide field installation temperature range of -10-40 °C. The keys to coated optical fiber direct connection are a cleaving technique and a technique for removing coated optical fiber. As the cleaving technique, we employed a method where the fiber is stretched and then a blade is pushed perpendicularly against the stretched fiber. As a result we confirmed that fiber endfaces cleaved at -10-40 °C were all mirror endfaces. With the removal technique, the coating is removed inside the connecting component by incorporating a circular cone shaped coating removal part. A mechanical splice based on these techniques successfully achieved a low insertion loss of less than 0.11 dB and a return loss of more than 50 dB at -10, 20, and 40 °C. In addition, the temperature cycle characteristics were stable over a wide temperature range of -40-75 °C.

Safe sex

MedlinePlus

... sex; Sexually transmitted - safe sex; GC - safe sex; Gonorrhea - safe sex; Herpes - safe sex; HIV - safe sex; ... contact. STIs include: Chlamydia Genital herpes Genital warts Gonorrhea Hepatitis HIV HPV Syphilis STIs are also called ...

Outpatient management of low-risk patients with upper gastrointestinal bleeding: can we safely extend the Glasgow Blatchford Score in clinical practice?

PubMed

Mustafa, Zia; Cameron, Allan; Clark, Elaine; Stanley, Adrian J

2015-05-01

The Glasgow Blatchford Score (GBS) is a validated prognostic score for patients presenting with upper gastrointestinal (GI) bleeding (UGIB). The score predicts the need for therapeutic intervention or death, and studies have suggested that outpatient management is safe for patients with a GBS of zero. Our aim was to assess whether we could safely extend the threshold for outpatient management to patients with GBS≤1. Following assessment of our historical data, our UGIB protocol was changed to recommend outpatient management for patients with a GBS≤1, unless required for other reasons. Data on all patients presenting with UGIB over the following 12 months were prospectively recorded, including GBS and clinical Rockall scores. Adverse outcomes were defined by a 30-day combined endpoint of death, endotherapy, interventional radiology, surgery or transfusion. Negative predictive value (NPV) of GBS≤1 for adverse outcomes in UGIB was calculated. A total of 514 patients presented with UGIB in the 12 month study period. Of the patients, 183 (35.6%) had GBS≤1 (111, GBS=0; 72, GBS=1). Of these, 88 (48.1%) were managed as outpatients, and none had an adverse outcome. Of the 95 (51.9%) patients with GBS≤1 managed as inpatients, 80 (84.2%) had comorbidities requiring inpatient care. Within this admitted group with GBS≤1, one patient required transfusion and one died from a nongastrointestinal malignancy. GBS≤1 had an NPV of 99.45% (95% confidence interval 95.53-99.97%) in predicting adverse outcomes within 30 days. GBS≤1 has a high NPV for adverse outcomes in UGIB. This suggests outpatient management of patients with UGIB and that GBS≤1 is safe in our population.

Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system.

PubMed

Kaneyama, Shuichi; Sugawara, Taku; Sumi, Masatoshi

2015-03-15

Clinical trial for midcervical pedicle screw insertion using a novel patient-specific intraoperative screw guiding device. To evaluate the availability of the "Screw Guide Template" (SGT) system for insertion of midcervical pedicle screws. Despite many efforts for accurate midcervical pedicle screw insertion, there still remain unacceptable rate of screw malpositioning that might cause neurovascular injuries. We developed patient-specific SGT system for safe and accurate intraoperative screw navigation tool and have reported its availability for the screw insertion to C2 vertebra and thoracic spine. Preoperatively, the bone image on computed tomography was analyzed and the trajectories of the screws were designed in 3-dimensional format. Three types of templates were created for each lamina: location template, drill guide template, and screw guide template. During the operations, after engaging the templates directly with the laminae, drilling, tapping, and screwing were performed with each template. We placed 80 midcervical pedicle screws for 20 patients. The accuracy and safety of the screw insertion by SGT system were evaluated using postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw breach of pedicle wall. All templates fitted the laminae and screw navigation procedures proceeded uneventfully. All screws were inserted accurately with the mean screw deviation from planned trajectory of 0.29 ± 0.31 mm and no neurovascular complication was experienced. We demonstrated that our SGT system could support the precise screw insertion in midcervical pedicle. SGT prescribes the safe screw trajectory in a 3-dimensional manner and the templates fit and lock directly to the target laminae, which prevents screwing error along with the change of spinal alignment during the surgery. These advantages of the SGT system guarantee the high accuracy in screw insertion, which allowed surgeons to insert

Why Oats Are Safe and Healthy for Celiac Disease Patients.

PubMed

Gilissen, Luud J W J; van der Meer, Ingrid M; Smulders, Marinus J M

2016-11-26

The water-insoluble storage proteins of cereals (prolamins) are called "gluten" in wheat, barley, and rye, and "avenins" in oat. Gluten can provoke celiac disease (CD) in genetically susceptible individuals (those with human leukocyte antigen (HLA)-DQ2 or HLA-DQ8 serotypes). Avenins are present at a lower concentration (10%-15% of total protein content) in oat as compared to gluten in wheat (80%-85%). The avenins in the genus Avena (cultivated oat as well as various wild species of which gene bank accessions were analyzed) are free of the known CD immunogenic epitopes from wheat, barley, and rye. T cells that recognize avenin-specific epitopes have been found very rarely in CD patients. CD patients that consume oats daily do not show significantly increased levels of intraepithelial lymphocyte (EIL) cells. The safety and the positive health effects of the long-term inclusion of oats in the gluten-free diet have been confirmed in long-term studies. Since 2009 (EC 41/2009) and 2013 (FDA) oat products may be sold as gluten-free in several countries provided a gluten contamination level below 20 ppm. Introduction of oats in the gluten-free diet of celiac patients is advised after the recovery of the intestine. Health effects of oat consumption are reflected in European Food Safety Authority (EFSA)- and Food and Drug Administration (FDA)-approved health claims. Oats can form a healthy, nutritious, fiber-rich, and safe complement to the gluten-free diet.

[Handling skills and utilization of hearing aids].

PubMed

Gimsing, S

1995-12-11

Seven hundred and fifty adult patients possessing hearing aids were interviewed with regard to utilization and handling skills. Although 71% were full-time users and 18% were part-time users, only 32% could handle their aids competently. Inhabitants of the county's major town clearly managed their aids better than residents of the remainder of the catchment area, despite the fact that 85% of the former group never sought counselling by hearing therapists. It is concluded that not only the traditional audiology professions, but also staff from other branches of the health and social services should participate more actively in the care of the hearing impaired.

Strategies for safe injections.

PubMed Central

Battersby, A.; Feilden, R.; Stoeckel, P.; Da Silva, A.; Nelson, C.; Bass, A.

1999-01-01

In 1998, faced with growing international concern, WHO set out an approach for achieving injection safety that encompassed all elements from patients' expectations and doctors' prescribing habits to waste disposal. This article follows that lead and describes the implications of the approach for two injection technologies: sterilizable and disposable. It argues that focusing on any single technology diverts attention from the more fundamental need for health services to develop their own comprehensive strategies for safe injections. National health authorities will only be able to ensure that injections are administered safely if they take an approach that encompasses the whole system, and choose injection technologies that fit their circumstances. PMID:10680247

Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain?

PubMed

Mathews, Timothy J; Churchhouse, Antonia M D; Housden, Tessa; Dunning, Joel

2012-02-01

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'is the addition of ketamine to morphine patient-controlled analgesia (PCA) following thoracic surgery superior to morphine alone'. Altogether 201 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This consisted of one systematic review of PCA morphine with ketamine (PCA-MK) trials, one meta-analysis of PCA-MK trials, four randomized controlled trials of PCA-MK, one meta-analysis of trials using a variety of peri-operative ketamine regimes and two cohort studies of PCA-MK. Main outcomes measured included pain score rated on visual analogue scale, morphine consumption and incidence of psychotomimetic side effects/hallucination. Two papers reported the measurements of respiratory function. This evidence shows that adding ketamine to morphine PCA is safe, with a reported incidence of hallucination requiring intervention of 2.9%, and a meta-analysis finding an incidence of all central nervous system side effects of 18% compared with 15% with morphine alone, P = 0.31, RR 1.27 with 95% CI (0.8-2.01). All randomized controlled trials of its use following thoracic surgery found no hallucination or psychological side effect. All five studies in thoracic surgery (n = 243) found reduced morphine requirements with PCA-MK. Pain scores were significantly lower in PCA-MK patients in thoracic surgery papers, with one paper additionally reporting increased patient satisfaction. However, no significant improvement was found in a meta-analysis of five papers studying PCA-MK in a variety of surgical settings. Both papers reporting respiratory outcomes found improved oxygen saturations and PaCO(2) levels in PCA-MK patients following thoracic surgery

Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring.

PubMed

Wall, Simeon H; Lee, Michael R

2016-12-01

Separation, aspiration, and fatty equilibration (SAFE) liposuction uses a process approach to body contouring and minimizes injury to surrounding structures. The multistep process allows for (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The purpose of this study was to review both outcomes and complications of primary SAFE liposuction. Retrospective chart review was completed of patients undergoing SAFE liposuction from January of 2006 to January of 2011. Patient selection was limited to those undergoing liposuction alone with no adjuvant excisional procedures. Data were collected regarding demographics, body mass index, operative details, and outcomes. Seven hundred thirty-four patients were identified as having undergone SAFE liposuction. One hundred twenty-nine patients were found to have been treated with liposuction alone. Patient age ranged from 18 to 42 years and body mass index ranged from 18 to 42 kg/m (mean, 26.3 kg/m). Seven patients (5.4 percent) underwent treatment of the face and neck, six patients (4.7 percent) underwent treatment of upper extremities, 13 patients (10.1 percent) underwent treatment of the chest, 20 patients (15.5 percent) underwent treatment of lower extremities, 32 patients (24.8 percent) underwent treatment of the circumferential trunk, and 51 patients (39.5 percent) underwent treatment of circumferential trunk and additional area(s). No major complications occurred. Five of the 129 patients (3.87 percent) developed the minor complication of seroma formation. SAFE liposuction is a multistep process approach to body contouring consisting of (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The results of this study show such technique to be safe and effective. Therapeutic, IV.

An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors.

PubMed

Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T

2015-09-01

We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

How to Handle Radioisotopes Safely.

ERIC Educational Resources Information Center

Sulcoski, John W.

This booklet is one in a series of instructional aids designed for use by elementary and secondary school science teachers. The various units and forms of radioactive materials used by teachers are first considered. Then, the quantities of radioisotopes that a person may possess without a license from the Atomic Energy Commission (AEC) are…

Safe Exploration Algorithms for Reinforcement Learning Controllers.

PubMed

Mannucci, Tommaso; van Kampen, Erik-Jan; de Visser, Cornelis; Chu, Qiping

2018-04-01

Self-learning approaches, such as reinforcement learning, offer new possibilities for autonomous control of uncertain or time-varying systems. However, exploring an unknown environment under limited prediction capabilities is a challenge for a learning agent. If the environment is dangerous, free exploration can result in physical damage or in an otherwise unacceptable behavior. With respect to existing methods, the main contribution of this paper is the definition of a new approach that does not require global safety functions, nor specific formulations of the dynamics or of the environment, but relies on interval estimation of the dynamics of the agent during the exploration phase, assuming a limited capability of the agent to perceive the presence of incoming fatal states. Two algorithms are presented with this approach. The first is the Safety Handling Exploration with Risk Perception Algorithm (SHERPA), which provides safety by individuating temporary safety functions, called backups. SHERPA is shown in a simulated, simplified quadrotor task, for which dangerous states are avoided. The second algorithm, denominated OptiSHERPA, can safely handle more dynamically complex systems for which SHERPA is not sufficient through the use of safety metrics. An application of OptiSHERPA is simulated on an aircraft altitude control task.

Data Safe Havens and Trust: Toward a Common Understanding of Trusted Research Platforms for Governing Secure and Ethical Health Research

PubMed Central

Nicholls, Jacqueline; Dobbs, Christine; Sethi, Nayha; Cunningham, James; Ainsworth, John; Heaven, Martin; Peacock, Trevor; Peacock, Anthony; Jones, Kerina; Laurie, Graeme; Kalra, Dipak

2016-01-01

In parallel with the advances in big data-driven clinical research, the data safe haven concept has evolved over the last decade. It has led to the development of a framework to support the secure handling of health care information used for clinical research that balances compliance with legal and regulatory controls and ethical requirements while engaging with the public as a partner in its governance. We describe the evolution of 4 separately developed clinical research platforms into services throughout the United Kingdom-wide Farr Institute and their common deployment features in practice. The Farr Institute is a case study from which we propose a common definition of data safe havens as trusted platforms for clinical academic research. We use this common definition to discuss the challenges and dilemmas faced by the clinical academic research community, to help promote a consistent understanding of them and how they might best be handled in practice. We conclude by questioning whether the common definition represents a safe and trustworthy model for conducting clinical research that can stand the test of time and ongoing technical advances while paying heed to evolving public and professional concerns. PMID:27329087

Routine handling methods affect behaviour of three-spined sticklebacks in a novel test of anxiety.

PubMed

Thompson, Ralph R J; Paul, Elizabeth S; Radford, Andrew N; Purser, Julia; Mendl, Michael

2016-06-01

Fish are increasingly popular subjects in behavioural and neurobiological research. It is therefore important that they are housed and handled appropriately to ensure good welfare and reliable scientific findings, and that species-appropriate behavioural tests (e.g. of cognitive/affective states) are developed. Routine handling of captive animals may cause physiological stress responses that lead to anxiety-like states (e.g. increased perception of danger). In fish, these may be particularly pronounced when handling during tank-to-tank transfer involves removal from water into air. Here we develop and use a new combined scototaxis (preference for dark over light areas) and novel-tank-diving test, alongside conventional open-field and novel-object tests, to measure the effects of transferring three-spined sticklebacks (Gasterosteus aculeatus) between tanks using a box or net (in and out of water respectively). Preference tests for dark over light areas confirmed the presence of scototaxis in this species. Open-field and novel-object tests failed to detect any significant differences between net and box-handled fish. However, the combined diving and scototaxis detected consistent differences between the treatments. Net-handled fish spent less time on the dark side of the tank, less time in the bottom third, and kept a greater distance from the 'safe' bottom dark area than box-handled fish. Possible explanations for this reduction in anxiety-like behaviour in net-handled fish are discussed. The combined diving and scototaxis test may be a sensitive and taxon-appropriate method for measuring anxiety-like states in fish. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Enteral Feeding Set Handling Techniques.

PubMed

Lyman, Beth; Williams, Maria; Sollazzo, Janet; Hayden, Ashley; Hensley, Pam; Dai, Hongying; Roberts, Cristine

2017-04-01

Enteral nutrition therapy is common practice in pediatric clinical settings. Often patients will receive a pump-assisted bolus feeding over 30 minutes several times per day using the same enteral feeding set (EFS). This study aims to determine the safest and most efficacious way to handle the EFS between feedings. Three EFS handling techniques were compared through simulation for bacterial growth, nursing time, and supply costs: (1) rinsing the EFS with sterile water after each feeding, (2) refrigerating the EFS between feedings, and (3) using a ready-to-hang (RTH) product maintained at room temperature. Cultures were obtained at baseline, hour 12, and hour 21 of the 24-hour cycle. A time-in-motion analysis was conducted and reported in average number of seconds to complete each procedure. Supply costs were inventoried for 1 month comparing the actual usage to our estimated usage. Of 1080 cultures obtained, the overall bacterial growth rate was 8.7%. The rinse and refrigeration techniques displayed similar bacterial growth (11.4% vs 10.3%, P = .63). The RTH technique displayed the least bacterial growth of any method (4.4%, P = .002). The time analysis in minutes showed the rinse method was the most time-consuming (44.8 ± 2.7) vs refrigeration (35.8 ± 2.6) and RTH (31.08 ± 0.6) ( P < .0001). All 3 EFS handling techniques displayed low bacterial growth. RTH was superior in bacterial growth, nursing time, and supply costs. Since not all pediatric formulas are available in RTH, we conclude that refrigerating the EFS between uses is the next most efficacious method for handling the EFS between bolus feeds.

Safe single-dose administration of propofol in patients with established Brugada syndrome: a retrospective database analysis.

PubMed

Flamée, Panagiotis; De Asmundis, Carlo; Bhutia, Jigme T; Conte, Giulio; Beckers, Stefan; Umbrain, Vincent; Verborgh, Christian; Chierchia, Gian-Battista; Van Malderen, Sophie; Casado-Arroyo, Rubén; Sarkozy, Andrea; Brugada, Pedro; Poelaert, Jan

2013-12-01

Propofol is an anesthetic drug with a very attractive pharmacokinetic profile, which makes it the induction agent of choice, especially in day-case surgery. Data on its potential proarrhythmic effects in patients with Brugada syndrome (BS) patients are still lacking. The aim of our study was to investigate whether a single dose of propofol triggered any adverse events in consecutive high-risk patients with BS. All consecutive patients with BS having undergone an implantable cardiac defibrillator implantation under general anesthesia were eligible for this study. The anesthetic chart of each patient was reviewed, and the occurrence of malignant arrhythmic events as well as the need for defibrillation during induction and maintenance of anesthesia was investigated. Further monitoring of the patient comprised five-lead electrocardiogram (ECG), pulse oxymetry, and continuous carbon dioxide monitoring through side sampling from the ventilator tubes. Anesthesia was induced with propofol and sufentanyl. Injection of propofol occurred in a single-shot bolus-as often performed by most anesthetists-over a few seconds. Anesthesia was maintained with volatile anesthetics (sevoflurane or desflurane) in an oxygen-air mixture. From 1996 to 2011, 57 high-risk patients with BS (35 males; mean age: 43 ± 16 years) underwent an automated implantable cardioverter defibrillator implantation at our center using propofol as induction drug of general anesthesia. Three patients had a history of spontaneous type I ECG, three had aborted sudden death, and 51 had a history of recurrent or unexplained syncope. The induction dose ranged between 0.8 mg/kg and 5.0 mg/kg (2.2 ± 0.7 mg/kg). Only one case received propofol to maintain anesthesia. The surgical procedure involved an anesthetic period of 75 ± 25 minutes. No patient developed a malignant rhythm during induction and maintenance of anesthesia. All patients were then safely discharged from the postanesthetic care unit after 1 hour. No

Development of safe infrared gas lasers

NASA Astrophysics Data System (ADS)

Mainuddin; Singhal, Gaurav; Tyagi, R. K.; Maini, A. K.

2013-04-01

Infrared gas lasers find application in numerous civil and military areas. Such lasers are therefore being developed at different institutions around the world. However, the development of chemical infrared gas lasers such as chemical oxygen iodine lasers (COIL) involves the use of several hazardous chemicals. In order to exploit full potential of these lasers, one must take diligent care of the safety issues associated with the handling of these chemicals and the involved processes. The present paper discusses the safety aspects to be taken into account in the development of these infrared gas lasers including various detection sensors working in conjunction with a customized data acquisition system loaded with safety interlocks for safe operation. The developed safety schemes may also be implemented for CO2 gas dynamic laser (GDL) and hydrogen fluoride-deuterium fluoride (HF-DF) Laser.

Safe corridors for K-wiring in phalangeal fractures.

PubMed

Rex, C; Vignesh, R; Javed, M; Balaji, Subba Chandra; Premanand, C; Zakki, Syed Ashfaque

2015-01-01

Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.

Microarray analysis of peripheral blood lymphocytes from ALS patients and the SAFE detection of the KEGG ALS pathway

PubMed Central

2011-01-01

Background Sporadic amyotrophic lateral sclerosis (sALS) is a motor neuron disease with poorly understood etiology. Results of gene expression profiling studies of whole blood from ALS patients have not been validated and are difficult to relate to ALS pathogenesis because gene expression profiles depend on the relative abundance of the different cell types present in whole blood. We conducted microarray analyses using Agilent Human Whole Genome 4 × 44k Arrays on a more homogeneous cell population, namely purified peripheral blood lymphocytes (PBLs), from ALS patients and healthy controls to identify molecular signatures possibly relevant to ALS pathogenesis. Methods Differentially expressed genes were determined by LIMMA (Linear Models for MicroArray) and SAM (Significance Analysis of Microarrays) analyses. The SAFE (Significance Analysis of Function and Expression) procedure was used to identify molecular pathway perturbations. Proteasome inhibition assays were conducted on cultured peripheral blood mononuclear cells (PBMCs) from ALS patients to confirm alteration of the Ubiquitin/Proteasome System (UPS). Results For the first time, using SAFE in a global gene ontology analysis (gene set size 5-100), we show significant perturbation of the KEGG (Kyoto Encyclopedia of Genes and Genomes) ALS pathway of motor neuron degeneration in PBLs from ALS patients. This was the only KEGG disease pathway significantly upregulated among 25, and contributing genes, including SOD1, represented 54% of the encoded proteins or protein complexes of the KEGG ALS pathway. Further SAFE analysis, including gene set sizes >100, showed that only neurodegenerative diseases (4 out of 34 disease pathways) including ALS were significantly upregulated. Changes in UBR2 expression correlated inversely with time since onset of disease and directly with ALSFRS-R, implying that UBR2 was increased early in the course of ALS. Cultured PBMCs from ALS patients accumulated more ubiquitinated proteins

Managing drugs safely.

PubMed

van den Anker, John N

2005-02-01

There is hard data to show that newborn infants are more likely than adults to experience adverse reactions to drugs. Paradoxically, drug-related legislation to ensure safe and effective drug use in humans neglected neonates until 2002, when the Best Pharmaceuticals Act for Children was signed into law in the USA. The situation for neonates should now catch up with that for adults and neonates will be prescribed more licensed drugs in the near future. If we are to be able to analyze the underlying system errors to improve the safe use of drugs in the studied patient population, reporting of adverse drug events and reactions needs to happen in a blame free environment. In addition, computerized physician order entry will certainly further improve the current situation by preventing errors in ordering, transcribing, verifying, and transmitting medication orders.

The Effect of Immunologically Safe Plasma Rich in Growth Factor Eye Drops in Patients with Sjögren Syndrome.

PubMed

Sanchez-Avila, Ronald Mauricio; Merayo-Lloves, Jesus; Riestra, Ana Cristina; Anitua, Eduardo; Muruzabal, Francisco; Orive, Gorka; Fernández-Vega, Luis

2017-06-01

The objective was to provide preliminary information about the efficacy and safety of immunologically safe plasma rich in growth factor (immunosafe PRGF) eye drops in the treatment of moderate to severe dry eye in patients with primary and secondary Sjögren's syndrome (SS) and to analyze the influence of several variables on treatment outcomes. This retrospective study included patients with SS. All patients were treated with previously immunosafe PRGF eye drops to reduce the immunologic component contents. Ocular Surface Disease Index (OSDI) scale, best-corrected visual acuity (BCVA), visual analog scale (VAS) frequency, and VAS severity outcome measures were evaluated before and after treatment with immunosafe PRGF. The potential influence of some patient clinical variables on results was also assessed. Safety assessment was also performed reporting all adverse events. Twenty-six patients (12 patients with primary SS, and 14 patients suffering secondary SS) with a total of 52 affected eyes were included and evaluated. Immunosafe PRGF treatment showed a significant reduction (P < 0.05) in OSDI scale (41.86%), in BCVA (62.97%), in VAS frequency (34.75%), and in VAS severity (41.50%). BCVA and VAS frequency scores improved significantly (P < 0.05) after concomitant treatment of PRGF with corticosteroids. Only 2 adverse events were reported in 2 patients (7.7% of patients). Signs and symptoms of dry eye syndrome in patients with SS were reduced after treatment with PRGF-Endoret eye drops. Immunosafe PRGF-Endoret is safe and effective for treating patients with primary and secondary SS.

Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients.

PubMed

Napoli, Anthony M; Arrighi, James A; Siket, Matthew S; Gibbs, Frantz J

2012-03-01

Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62) and 33% (95% CI, 31-35), respectively. In all, 51% (95% CI, 48-54) received stress testing (52% nuclear stress, 39% stress echocardiogram, 5% exercise, 4% other). In all, 0.9% patients (n = 10, 95% CI, 0.4-1.5) were diagnosed with a non-ST elevation myocardial infarction and 2.2% (n = 23, 95% CI, 1.3-3) with acute coronary syndrome. There was 1 (95% CI, 0%-0.3%) case of a 30-day major adverse cardiovascular events. The 51% stress test utilization rate was less than the range reported in previous CPU studies (P < 0.05). Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates.

Quality assurance: recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implants.

PubMed

Kato, Hirokazu; Kondo, Motoharu; Imada, Hajime; Kuroda, Masahiro; Kamimura, Yoshitsugu; Saito, Kazuyuki; Kuroda, Kagayaki; Ito, Koichi; Takahashi, Hideaki; Matsuki, Hidetoshi

2013-05-01

This article is a redissemination of the previous Japanese Quality Assurance Guide guidelines. Specific absorption rate and temperature distribution were investigated with respect to various aspects including metallic implant size and shape, insertion site, insertion direction, blood flow and heating power, and simulated results were compared with adverse reactions of patients treated by radio frequency capacitive-type heating. Recommended guidelines for safe heating methods for patients with metallic implants are presented based on our findings.

Determination of a safe INR for joint injections in patients taking warfarin.

PubMed

Bashir, M A; Ray, R; Sarda, P; Li, S; Corbett, S

2015-11-01

With an increase in life expectancy in 'developed' countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.

Understanding feline behavior and application for appropriate handling and management.

PubMed

Rodan, Ilona

2010-11-01

Feline handling in the veterinary hospital is important to protect both people and cats. Restraint has been used to enable us to perform our duties as veterinarians. With increased knowledge of feline behavior and how cats react to fear, newer information provides us with safer handling techniques. With safer and more respectful handling based on understanding the nature of cats and their communication, we can improve feline health care in our hospitals, the human-animal-veterinarian bond, and the welfare of both cats and people. This article explains important aspects of feline communication and how our actions affect cats. By understanding the cat, we can improve our handling techniques to prevent fear and pain for our feline patients, and thus make our veterinary practices more feline friendly and safer for our clients, their cats, and veterinary staff. Copyright © 2010 Elsevier Inc. All rights reserved.

Handling of peripheral intravenous cannulae: effects of evidence-based clinical guidelines.

PubMed

Ahlqvist, Margary; Bogren, Agneta; Hagman, Sari; Nazar, Isabel; Nilsson, Katarina; Nordin, Karin; Valfridsson, Berit Sunde; Söderlund, Mona; Nordström, Gun

2006-11-01

This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.

Free-flap harvesting from paralytic limbs of poliomyelitis patients--a safe and feasible option.

PubMed

Chan, R C L; Liu, H L; Chan, Y W

2012-06-01

Many patients who had childhood poliomyelitis are still suffering from the late sequalae of the condition. Free-flap harvesting from the paralytic limbs from these patients is a logical approach for functional preservation. However, concerns have been raised regarding its safety due to its hypoplastic vascular system and potential donor site healing problems. A 53-year-old man with known childhood poliomyelitis presented with left facial sarcoma. After wide excision, the defect was reconstructed with a dual-island fasciocutaneous-free anterolateral thigh flap harvested from his paralytic limb. The pedicle and perforators were found to be no different from those in normal limbs. His recovery was smooth without complications. On the basis of our experience and current evidence in the literature, we believe that free-flap harvesting from the paralytic lower limb in poliomyelitis patients is a safe option that incurs no additional risk and allows maximal function preservation. Copyright © 2011. Published by Elsevier Ltd.

Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient.

PubMed

Corvin, Stefan; Sturm, Wolfgang; Schlatter, Evelin; Anastasiadis, Aristotelis; Kuczyk, Markus; Stenzl, Arnulf

2005-09-01

The acceptance of open retroperitoneal lymph node dissection (RPLND) for stage I and II nonseminomatous testicular cancer has decreased because of the intraoperative and postoperative morbidity of the procedure. Laparoscopic RPLND is a minimally invasive and safe alternative for low-stage germ-cell tumors. It is, however, technically demanding and should therefore be performed only in experienced centers. The purpose of the present study was to evaluate the waterjet technique for laparoscopic RPLND. A series of 18 patients with clinical stage I testis cancer (group A) and 7 patients who had received chemotherapy for stage II disease (group B) underwent laparoscopic RPLND at our institution. The procedure was performed identically to the open approach using the modified template according to Weissbach and associates. The waterjet was used for removal of lymphatic tissue from the aorta and the vena cava, as well as from the sympathetic trunk. The operation was completed in all patients without conversion to open surgery. The mean operating time was 232 +/- 48 minutes. The waterjet was able to remove lymphatic tissue easily and atraumatically. At pressures of 20 bar, the lymph-node capsule remained completely intact, thus avoiding tumor-cell spread. Antegrade ejaculation could be preserved in all patients, who, to date, show no evidence of disease. The waterjet allows the safe and complete removal of lymphatic tissue, leaving vulnerable anatomic structures intact. It can decrease the learning curve of laparoscopic RPLND and contribute to better acceptance of this procedure.

Rush immunotherapy for wasp venom allergy seems safe and effective in patients with mastocytosis.

PubMed

Verburg, M; Oldhoff, J M; Klemans, R J B; Lahey-de Boer, A; de Bruin-Weller, M S; Röckmann, H; Sanders, C; Bruijnzeel-Koomen, C A F M; Pasmans, S G M A; Knulst, A C

2015-11-01

Patients with mastocytosis and wasp venom allergy (WA) may benefit from venom immunotherapy (VIT). However, fatal insect sting reactions have been described in mastocytosis patients despite previous immunotherapy. We investigated the safety and efficacy of (rush) VIT in patients with mastocytosis and WA. To investigate the safety and efficacy of (rush) VIT in patients with mastocytosis and WA. We describe nine patients with cutaneous mastocytosis and WA who received VIT. Cutaneous mastocytosis was confirmed by histopathology and systemic mastocytosis was diagnosed according to World Health Organization criteria. VIT was given according to a rush protocol. Given the difference in safety and efficacy of VIT in patients with WA and honeybee venom allergy, we reviewed the literature for VIT with the focus on WA patients with mastocytosis and addressed the difference between patients with cutaneous versus systemic mastocytosis. Nine patients had WA and mastocytosis, of whom six had cutaneous mastocytosis, two combined cutaneous and systemic mastocytosis and one systemic mastocytosis. All patients received rush IT with wasp venom. Most patients had only mild local side effects, with no systemic side effects during the course of VIT. One patient had a systemic reaction upon injection on one occasion, during the updosing phase, with dyspnoea and hypotension, but responded well to treatment. Immunotherapy was continued after temporary dose adjustment without problems. Two patients with a previous anaphylactic reaction were re-stung, without any systemic effects. VIT is safe in cutaneous mastocytosis patients with WA, while caution has to be made in case of systemic mastocytosis. VIT was effective in the patients who were re-stung.

Safe and rapid resolution of severe hypertriglyceridaemia in two patients with intravenous insulin.

PubMed

Triay, J M; Day, A; Singhal, P

2010-09-01

To rapidly reduce serum triglyceride to a safe serum level. Severe hypertriglyceridaemia is associated with uncontrolled diabetes, obesity and poor physical activity. Even moderate increases in triglyceride levels (> 5mmol/L) confer an increased risk of pancreatitis and coronary artery disease. We present two patients with diabetes and serum triglyceride levels of greater than 85mmol/L despite polypharmacy intervention. 72-hour intravenous insulin infusion was administered. Serum triglyceride levels fell to 9.4 and 4.6 mmol/L respectively, without adverse events and sustained effect over several months. We suggest the use of intravenous insulin infusion where lifestyle and oral drug therapies have failed can impact on severe hypertriglyceridaemia.

Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review.

PubMed

Hidalgo de la Cruz, M; Domínguez Rubio, R; Luque Buzo, E; Díaz Otero, F; Vázquez Alén, P; Orcajo Rincón, J; Prieto Montalvo, J; Contreras Chicote, A; Grandas Pérez, F

2017-04-17

HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability.

PubMed

Szulc, P; Naylor, K; Hoyle, N R; Eastell, R; Leary, E T

2017-09-01

The National Bone Health Alliance (NBHA) recommends standardized sample handling and patient preparation for C-terminal telopeptide of type I collagen (CTX-I) and N-terminal propeptide of type I procollagen (PINP) measurements to reduce pre-analytical variability. Controllable and uncontrollable patient-related factors are reviewed to facilitate interpretation and minimize pre-analytical variability. The IOF and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified PINP and CTX-I in blood to be the reference markers of bone turnover for the fracture risk prediction and monitoring of osteoporosis treatment. Although used in clinical research for many years, bone turnover markers (BTM) have not been widely adopted in clinical practice primarily due to their poor within-subject and between-lab reproducibility. The NBHA Bone Turnover Marker Project team aim to reduce pre-analytical variability of CTX-I and PINP measurements through standardized sample handling and patient preparation. Recommendations for sample handling and patient preparations were made based on review of available publications and pragmatic considerations to reduce pre-analytical variability. Controllable and un-controllable patient-related factors were reviewed to facilitate interpretation and sample collection. Samples for CTX-I must be collected consistently in the morning hours in the fasted state. EDTA plasma is preferred for CTX-I for its greater sample stability. Sample collection conditions for PINP are less critical as PINP has minimal circadian variability and is not affected by food intake. Sample stability limits should be observed. The uncontrollable aspects (age, sex, pregnancy, immobility, recent fracture, co-morbidities, anti-osteoporotic drugs, other medications) should be considered in BTM interpretation. Adopting standardized sample handling and patient preparation procedures will significantly reduce controllable pre

[Prevention of medication errors in healthcare transition of patients treated with apomorphine].

PubMed

Ucha Sanmartin, M; Martín Vila, A; López Vidal, C; Caaamaño Barreiro, M; Piñeiro Corrales, G

2014-05-01

The transition of patients between different levels of care process is a particular risk in the production of medication errors. The aim of this paper is to analyze the role of the pharmacist in preventing errors transition care to ensure a safe and cross pharmacotherapy of patients.Transversal, observational and descriptive study in a University Hospital that has a pharmacy service that integrates specialized inpatient care and health centers. Transition of care a patient treated with Apormorfina was analyzed to determine the keypoints of action of the pharmacist. Demographics, disease and medication history, and care transition episodes were collected through the pharmacy program and electronics history.The pharmacist did tasks adapting, reconciliation, management and reporting of medication to the health care team to prevent medication errors in care transition of patients treated with drugs requiring special handling .In conclusion, this work represents perfectly the key role of the pharmacist as coordinator of safe and transverse pharmacotherapy of patients. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

CARRIER/CASK HANDLING SYSTEM DESCRIPTION DOCUMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

E.F. Loros

2000-06-23

The Carrier/Cask Handling System receives casks on railcars and legal-weight trucks (LWTs) (transporters) that transport loaded casks and empty overpacks to the Monitored Geologic Repository (MGR) from the Carrier/Cask Transport System. Casks that come to the MGR on heavy-haul trucks (HHTs) are transferred onto railcars before being brought into the Carrier/Cask Handling System. The system is the interfacing system between the railcars and LWTs and the Assembly Transfer System (ATS) and Canister Transfer System (CTS). The Carrier/Cask Handling System removes loaded casks from the cask transporters and transfers the casks to a transfer cart for either the ATS or CTS,more » as appropriate, based on cask contents. The Carrier/Cask Handling System receives the returned empty casks from the ATS and CTS and mounts the casks back onto the transporters for reshipment. If necessary, the Carrier/Cask Handling System can also mount loaded casks back onto the transporters and remove empty casks from the transporters. The Carrier/Cask Handling System receives overpacks from the ATS loaded with canisters that have been cut open and emptied and mounts the overpacks back onto the transporters for disposal. If necessary, the Carrier/Cask Handling System can also mount empty overpacks back onto the transporters and remove loaded overpacks from them. The Carrier/Cask Handling System is located within the Carrier Bay of the Waste Handling Building System. The system consists of cranes, hoists, manipulators, and supporting equipment. The Carrier/Cask Handling System is designed with the tooling and fixtures necessary for handling a variety of casks. The Carrier/Cask Handling System performance and reliability are sufficient to support the shipping and emplacement schedules for the MGR. The Carrier/Cask Handling System interfaces with the Carrier/Cask Transport System, ATS, and CTS as noted above. The Carrier/Cask Handling System interfaces with the Waste Handling Building System for

Home treatment with Elaprase and Naglazyme is safe in patients with mucopolysaccharidoses types II and VI, respectively.

PubMed

Bagewadi, S; Roberts, J; Mercer, J; Jones, S; Stephenson, J; Wraith, J E

2008-12-01

Enzyme replacement therapy for lysosomal storage disorders has made an important contribution to improving the quality of life of affected patients. The treatment, however, is invasive and onerous, involving weekly or biweekly intravenous infusions of product over a 3-4 h period. Such therapy can be extremely disruptive of normal family life and the provision of a safe, home treatment regimen is greatly appreciated by affected families. In this report we demonstrate the safety of home treatment with Elaprase for mucopolysaccharidosis type II (17 patients) and Naglazyme for mucopolysaccharidosis type VI (6 patients). Careful patient selection, an experienced home care company and a detailed management plan for potential anaphylaxis and infusion-associated reactions are important components in a successful home treatment programme.

Handling Procedures of Vegetable Crops

NASA Technical Reports Server (NTRS)

Perchonok, Michele; French, Stephen J.

2004-01-01

The National Aeronautics and Space Administration (NASA) is working towards future long duration manned space flights beyond low earth orbit. The duration of these missions may be as long as 2.5 years and will likely include a stay on a lunar or planetary surface. The primary goal of the Advanced Food System in these long duration exploratory missions is to provide the crew with a palatable, nutritious, and safe food system while minimizing volume, mass, and waste. Vegetable crops can provide the crew with added nutrition and variety. These crops do not require any cooking or food processing prior to consumption. The vegetable crops, unlike prepackaged foods, will provide bright colors, textures (crispy), and fresh aromas. Ten vegetable crops have been identified for possible use in long duration missions. They are lettuce, spinach, carrot, tomato, green onion, radish, bell pepper, strawberries, fresh herbs, and cabbage. Whether these crops are grown on a transit vehicle (e.g., International Space Station) or on the lunar or planetary surface, it will be necessary to determine how to safely handle the vegetables while maintaining acceptability. Since hydrogen peroxide degrades into water and oxygen and is generally recognized as safe (GRAS), hydrogen peroxide has been recommended as the sanitizer. The objective of th is research is to determine the required effective concentration of hydrogen peroxide. In addition, it will be determined whether the use of hydrogen peroxide, although a viable sanitizer, adversely affects the quality of the vegetables. Vegetables will be dipped in 1 % hydrogen peroxide, 3% hydrogen peroxide, or 5% hydrogen peroxide. Treated produce and controls will be stored in plastic bags at 5 C for up to 14 days. Sensory, color, texture, and total plate count will be measured. The effect on several vegetables including lettuce, radish, tomato and strawberries has been completed. Although each vegetable reacts to hydrogen peroxide differently, the

Long-term treatment with oral sildenafil is safe and improves functional capacity and hemodynamics in patients with pulmonary arterial hypertension.

PubMed

Michelakis, Evangelos D; Tymchak, Wayne; Noga, Michelle; Webster, Linda; Wu, Xi-Chen; Lien, Dale; Wang, Shao-Hua; Modry, Dennis; Archer, Stephen L

2003-10-28

The prognosis and functional capacity of patients with pulmonary arterial hypertension (PAH) is poor, and there is a need for safe, effective, inexpensive oral treatments. A single dose of sildenafil, an oral phosphodiesterase type-5 (PD-5) inhibitor, is an effective and selective pulmonary vasodilator in PAH. However, the long-term effects of PD-5 inhibition and its mechanism of action in human pulmonary arteries (PAs) are unknown. We hypothesized that 3 months of sildenafil (50 mg orally every 8 hours) added to standard treatment would be safe and improve functional capacity and hemodynamics in PAH patients. We studied 5 consecutive patients (4 with primary pulmonary hypertension, 1 with Eisenmenger's syndrome; New York Heart Association class II to III). Functional class improved by > or =1 class in all patients. Pretreatment versus posttreatment values (mean+/-SEM) were as follows: 6-minute walk, 376+/-30 versus 504+/-27 m, P<0.0001; mean PA pressure, 70+/-3 versus 52+/-3 mm Hg, P<0.007; pulmonary vascular resistance index 1702+/-151 versus 996+/-92 dyne x s x cm(-5) x m(-2), P<0.006. The systemic arterial pressure was unchanged, and no adverse effects occurred. Sildenafil also reduced right ventricular mass measured by MRI. In 7 human PAs (6 cardiac transplant donors and 1 patient with PAH on autopsy), we showed that PD-5 is present in PA smooth muscle cells and that sildenafil causes relaxation by activating large-conductance, calcium-activated potassium channels. This small pilot study suggests that long-term sildenafil therapy might be a safe and effective treatment for PAH. At a monthly cost of 492 dollars Canadian, sildenafil is more affordable than most approved PAH therapies. A large multicenter trial is indicated to directly compare sildenafil with existing PAH treatments.

Alumina Handling Dustiness

NASA Astrophysics Data System (ADS)

Authier-Martin, Monique

Dustiness of calcined alumina is a major concern, causing undesirable working conditions and serious alumina losses. These losses occur primarily during unloading and handling or pot loading and crust breaking. The handling side of the problem is first addressed. The Perra pulvimeter constitutes a simple and reproducible tool to quantify handling dustiness and yields results in agreement with plant experience. Attempts are made to correlate dustiness with bulk properties (particle size, attrition index, …) for a large number of diverse aluminas. The characterization of the dust generated with the Perra pulvimeter is most revealing. The effect of the addition of E.S.P. dust is also reported.

The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

PubMed Central

Pulitanó, Carlo; Crawford, Michael; Ho, Phong; Gallagher, James; Joseph, David; Stephen, Michael; Sandroussi, Charbel

2013-01-01

Background Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. Methods Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. Results A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. Conclusions The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation. PMID:23458108

The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution.

PubMed

Pulitanó, Carlo; Crawford, Michael; Ho, Phong; Gallagher, James; Joseph, David; Stephen, Michael; Sandroussi, Charbel

2013-08-01

Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation. © 2013 International Hepato-Pancreato-Biliary Association.

Criticality Safety Evaluation of the LLNL Inherently Safe Subcritical Assembly (ISSA)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Percher, Catherine

2012-06-19

The LLNL Nuclear Criticality Safety Division has developed a training center to illustrate criticality safety and reactor physics concepts through hands-on experimental training. The experimental assembly, the Inherently Safe Subcritical Assembly (ISSA), uses surplus highly enriched research reactor fuel configured in a water tank. The training activities will be conducted by LLNL following the requirements of an Integration Work Sheet (IWS) and associated Safety Plan. Students will be allowed to handle the fissile material under the supervision of LLNL instructors. This report provides the technical criticality safety basis for instructional operations with the ISSA experimental assembly.

Ergonomic material-handling device

DOEpatents

Barsnick, Lance E.; Zalk, David M.; Perry, Catherine M.; Biggs, Terry; Tageson, Robert E.

2004-08-24

A hand-held ergonomic material-handling device capable of moving heavy objects, such as large waste containers and other large objects requiring mechanical assistance. The ergonomic material-handling device can be used with neutral postures of the back, shoulders, wrists and knees, thereby reducing potential injury to the user. The device involves two key features: 1) gives the user the ability to adjust the height of the handles of the device to ergonomically fit the needs of the user's back, wrists and shoulders; and 2) has a rounded handlebar shape, as well as the size and configuration of the handles which keep the user's wrists in a neutral posture during manipulation of the device.

A cross-sectional study to assess inhalation device handling and patient satisfaction in COPD

PubMed Central

Miravitlles, Marc; Montero-Caballero, Jéssica; Richard, Frank; Santos, Salud; Garcia-Rivero, Juan Luis; Ortega, Francisco; Ribera, Xavier

2016-01-01

Delivery of inhaled medications via an inhaler device underpins the effectiveness of treatment for patients with chronic obstructive pulmonary disease (COPD). Correct inhaler technique among patients is also a predictor of achieving treatment compliance and adherence. Reporting of patient satisfaction with inhalers is therefore gaining increasing attention and is now recognized as an important patient-reported outcome in clinical trials involving patients with COPD or asthma. In this cross-sectional study, we use the validated Patient Satisfaction and Preference Questionnaire (PASAPQ) to assess the handling and satisfaction for Respimat® Soft Mist™ Inhaler (SMI) compared with the Breezhaler® dry powder inhaler (DPI) among patients with COPD in Spain. Patients were already assigned to therapy with either SPIRIVA® (tiotropium) Respimat® or with Hirobriz®/Onbrez®/Oslif® (indacaterol) Breezhaler® for at least 3 but not more than 6 months before completing the PASAPQ at a single visit to the study site. The primary endpoint of the trial was the mean total PASAPQ score. Secondary endpoints were the performance score domain of the PASAPQ, the convenience score domain of the PASAPQ, and the overall satisfaction score of the PASAPQ. For the primary endpoint, the mean PASAPQ total score in the Respimat® and Breezhaler® groups was 80.7 and 79.9, respectively (difference of 0.8, 95% confidence interval [CI] −2.9 to 4.5; P=0.67). The mean total performance scores were 82.5 and 78.2 (difference of 4.3, 95% CI −0.3 to 8.9; P=0.06), and the mean total convenience scores were 78.6 and 81.9 (difference of −3.3, 95% CI −7.0 to 0.4; P=0.08) for the Respimat® and Breezhaler® groups, respectively. Patients gave the Respimat® SMI and the Breezhaler® DPI overall satisfaction PASAPQ scores of 6.0 and 5.9, respectively, which shows that patients were satisfied with these inhalers. PMID:27013871

Standards should be applied in the prevention and handling of missing data for patient-centered outcomes research: a systematic review and expert consensus.

PubMed

Li, Tianjing; Hutfless, Susan; Scharfstein, Daniel O; Daniels, Michael J; Hogan, Joseph W; Little, Roderick J A; Roy, Jason A; Law, Andrew H; Dickersin, Kay

2014-01-01

To recommend methodological standards in the prevention and handling of missing data for primary patient-centered outcomes research (PCOR). We searched National Library of Medicine Bookshelf and Catalog as well as regulatory agencies' and organizations' Web sites in January 2012 for guidance documents that had formal recommendations regarding missing data. We extracted the characteristics of included guidance documents and recommendations. Using a two-round modified Delphi survey, a multidisciplinary panel proposed mandatory standards on the prevention and handling of missing data for PCOR. We identified 1,790 records and assessed 30 as having relevant recommendations. We proposed 10 standards as mandatory, covering three domains. First, the single best approach is to prospectively prevent missing data occurrence. Second, use of valid statistical methods that properly reflect multiple sources of uncertainty is critical when analyzing missing data. Third, transparent and thorough reporting of missing data allows readers to judge the validity of the findings. We urge researchers to adopt rigorous methodology and promote good science by applying best practices to the prevention and handling of missing data. Developing guidance on the prevention and handling of missing data for observational studies and studies that use existing records is a priority for future research. Copyright © 2014 Elsevier Inc. All rights reserved.

Safe surgical technique for associated acetabular fractures

PubMed Central

2013-01-01

Associated acetabular fractures are challenging injuries to manage. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve high-quality care of patients with such challenging injuries is extremely steep. This first article in the Journal’s “Safe Surgical Technique” section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures. PMID:23414782

Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study.

PubMed

Azevedo, L S; Lasmar, E P; Contieri, F L C; Boin, I; Percegona, L; Saber, L T S; Selistre, L S; Netto, M V P; Moreira, M C V; Carvalho, R M; Bruno, R M; Ferreira, T C A; David-Neto, E

2012-06-01

Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life-threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine. A questionnaire was sent to all associated doctors to the Brazilian Organ Transplantation Association through its website, calling for reports of organ transplanted patients who have been vaccinated against YF. Twelve doctors reported 19 cases. None had important side effects. Only one had slight reaction at the site of YFV injection. Eleven patients were male. Organs received were 14 kidneys, 3 hearts, and 2 livers. Twelve patients received organs from deceased donors. Mean age at YFV was 45.6 ± 13.6 years old (range 11-69); creatinine: 1.46 ± 0.62 mg/dL (range 0.8-3.4); post-transplant time: 65 ± 83.9 months (range 3-340); and time from YFV at the time of survey: 45 ± 51 months (range 3-241). Immunosuppression varied widely with different drug combinations: azathioprine (7 patients), cyclosporine (8), deflazacort (1), mycophenolate (10), prednisone (11), sirolimus (3), and tacrolimus (4). YFV showed no important side effects in this cohort of solid organ transplanted patients. However, owing to the small number of studied patients, it is not possible to extend these findings to the rest of the transplanted population, assuring safety. Therefore, these data are not strong enough to safely recommend YFV in organ transplanted recipients, as severe, even life-threatening side effects may occur. © 2011 John Wiley & Sons A/S.

Percutaneous nephrolithotomy with one-shot dilation method: Is it safe in patients who had open surgery before?

PubMed

Süelözgen, Tufan; Isoglu, Cemal Selcuk; Turk, Hakan; Yoldas, Mehmet; Karabicak, Mustafa; Ergani, Batuhan; Boyacioglu, Hayal; Ilbey, Yusuf Ozlem; Zorlu, Ferruh

2016-01-01

This study aimed to evaluate whether one-shot dilatation technique is as safe in patients with a history of open-stone surgery as it is in patients without previous open-stone surgery. Between January 2007 and February 2015, 82 patients who underwent percutaneous nephrolithotomy (PNL) surgery with one-shot dilation technique who previously had open-stone surgery were retrospectively reviewed and evaluated (Group 1). Another 82 patients were selected randomly among patients who had PNL with one-shot dilation technique, but with no history of open renal surgery (Group 2). Age, gender, type of kidney stone, duration of surgery, radiation exposure time, and whether or not there was any bleeding requiring perioperative and postoperative transfusion were noted for each patient. The stone-free rates, operation and fluoroscopy time, and peroperative and postoperative complication rates were similar in both groups (p>0.05). Our experience indicated that PNL with one-shot dilation technique is a reliable method in patients with a history of open-stone surgery.

Organizing Safe Transitions from Intensive Care

PubMed Central

Häggström, Marie; Bäckström, Britt

2014-01-01

Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients' transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient's care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach. PMID:24782924

Associate Degree in Nursing-to-Bachelor of Science in Nursing Graduates' Education and Their Perceived Ability to Keep Patients Safe.

PubMed

Anbari, Allison Brandt; Vogelsmeier, Amy

2018-05-01

Associate Degree in Nursing (ADN)-to-Bachelor of Science in Nursing (BSN) programs are designed to advance the ADN-prepared RNs' clinical reasoning and analytical skills. However, little is known about exactly how their BSN education may improve their clinical practice, specifically in the area of patient safety. During semi-structured one-to-one interviews, ADN-to-BSN graduates were asked about their educational process and the perceived affect their education made on their ability to keep patients safe. Content analysis were used to identify emerging themes and categories. Three themes emerged from the data: (a) an unaltered approach to keeping patients safe, (b) experience as an ADN matters, and (c) BSN degree as a stepping stone. The call to increase the number of BSN-prepared nurses at the bedside is supported in the evidence and noteworthy of pursuit. However, as ADN-to-BSN programs increase in numbers to meet this demand, the outcomes of graduates need to be considered. [J Nurs Educ. 2018;57(5):300-303.]. Copyright 2018, SLACK Incorporated.

The absent bow tie sign in bucket-handle tears of the menisci in the knee.

PubMed

Helms, C A; Laorr, A; Cannon, W D

1998-01-01

Bucket-handle tears of the menisci are one of the most frequently missed diagnoses in MR examinations of the knee. This article describes the "absent bow tie sign," which can be used to identify bucket-handle tears on routine MR examinations of the knee. The arthroscopic surgical reports (n = 350) from a single orthopedic surgeon's practice during a 24-month period were examined for patients who had a diagnosis of bucket-handle tear and who underwent MR imaging before surgery (n = 32). The MR examinations were retrospectively evaluated for the presence of a bow tie sign. The bow tie sign was considered normal when two sagittal images showed the body segment (a bow tie appearance). The bow tie sign was considered abnormal, consistent with a bucket-handle tear, when only one or no body segment was seen (the absent bow tie sign). Coronal images were evaluated for a truncated meniscus. Also, each MR examination was scrutinized for a displaced fragment and a double posterior cruciate ligament (PCL) sign. Thirty-three bucket-handle tears were found at arthroscopy in 32 patients. One patient had tears of the medial and lateral menisci. The absent bow tie sign was seen in 32 of the 33 cases (sensitivity, 97%) and correlated with the medial or lateral meniscus that was reported torn at arthroscopy. The single false-negative result occurred in a patient with a nondisplaced bucket-handle tear. The findings in 31 contralateral normal menisci were all negative for an absent bow tie sign (specificity, 100%). A displaced fragment was found in 30 (94%) of 32 cases. The coronal images showed a truncated meniscus in 21 (64%) of 33 cases. A double PCL sign was seen in 10 (30%) of 33 cases. The absent bow tie sign is an easily applied finding that can be used with good sensitivity to diagnose bucket-handle tears of the menisci on MR imaging. This sign has a higher accuracy rate than other findings common with bucket-handle tears, such as displaced fragments, a truncated appearance of

[Rural work and health risks: a review into de "safe use" of pesticides in Brazil].

PubMed

de Abreu, Pedro Henrique Barbosa; Alonzo, Herling Gregorio Aguilar

2014-10-01

The paradigm of the "safe use" of pesticides is based on measures to control risks in the handling of these products. However, studies carried out in various regions of Brazil reveal a situation of widespread exposure and health damages among rural workers, revealing the ineffectiveness of this paradigm. This work presents a critical review of the "safe use" approach for pesticides in scientific papers published in Brazil in the past 15 years. Results indicate that these studies do not address, simultaneously, all the work activities that involve exposure and risk of intoxication (acquisition, transportation, storage, preparation and application, final disposal of empty containers and sanitization of contaminated clothes/ PPEs), nor do they comprehensively address the "safe use" measures recommended in safety manuals, which are mandatory for each activity. A total of 25 studies were selected and analyzed, revealing a high number of results and analyses regarding activities of preparation and application and final disposal of empty containers. The range of the approaches was seen to be timely in the six work activities. For future studies, a broader approach of the "safe use" of pesticides is recommended, seeking to reveal the complete infeasibility of this safety paradigm.

Implementing AORN recommended practices for a safe environment of care.

PubMed

Hughes, Antonia B

2013-08-01

Providing a safe environment for every patient undergoing a surgical or other invasive procedure is imperative. AORN's "Recommended practices for a safe environment of care" provides guidance on a wide range of topics related to the safety of perioperative patients and health care personnel. The recommendations are intended to provide guidance for establishing best practices and implementing safety measures in all perioperative practice settings. Perioperative nurses should be aware of risks related to musculoskeletal injuries, fire, equipment, latex, and chemicals, among others, and understand strategies for reducing the risks. Evidence-based recommendations can give practitioners the tools to guide safe practice. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Nurses' use of hazardous drug-handling precautions and awareness of national safety guidelines.

PubMed

Polovich, Martha; Martin, Susan

2011-11-01

To determine patterns of personal protective equipment (PPE) used by oncology nurses while handling hazardous drugs (HDs) and to assess knowledge of the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert and its effect on precaution use. Descriptive, correlational. The Oncology Nursing Society 31st Annual Congress in Boston, MA, in 2006. 330 nurses who prepared and/or administered chemotherapy. Nurses described HD safe-handling precaution use by self-report survey. The availability and use of biologic safety cabinets and PPE. Respondents were well educated (57% had a bachelor's degree or more), experienced (X = 19, SD = 10.2 years in nursing and X = 12, SD = 7.9 years in oncology), and certified (70%; majority OCN®). Forty-seven percent of respondents were aware of the NIOSH Alert. Thirty-five percent of all participants and 93% of nurses in private practice settings reported preparing chemotherapy. Glove use (95%-100%) was higher than that reported in earlier studies, and gown use for drug preparation (65%), drug administration (50%), and handling excretions (23%) have remained unchanged. Double-gloving was rare (11%-18%). Nurses in private practices were less likely to have chemotherapy-designated PPE available, use PPE, and use spill kits for HD spills. Nurses have adopted glove use for HD handling; however, gown use remains comparatively low. Chemotherapy-designated PPE is not always provided by employers. Nurses lack awareness of current safety guidelines. Nurses must know about the risks of HD exposure and ways to reduce exposure. Employers must provide appropriate PPE and encourage its use. Alternative methods of disseminating safety recommendations are needed.

Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

PubMed

Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

2018-01-01

Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position.

PubMed

Abdel, Matthew P; von Roth, Philipp; Jennings, Matthew T; Hanssen, Arlen D; Pagnano, Mark W

2016-02-01

Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40° ± 10° and 15° ± 10°, respectively, represent a "safe zone" as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice. From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44° ± 8° with 84% within the safe zone for inclination. Mean anteversion was 15° ± 9° with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p < 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.9; p

[Hazardous materials and work safety in veterinary practice. 1: Hazardous material definition and characterization, practice documentation and general rules for handling].

PubMed

Sliwinski-Korell, A; Lutz, F

1998-04-01

In the last years the standards for professional handling of hazardous material as well as health and safety in the veterinary practice became considerably more stringent. This is expressed in various safety regulations, particularly the decree of hazardous material and the legislative directives concerning health and safety at work. In part 1, a definition based on the law for hazardous material is given and the potential risks are mentioned. The correct documentation regarding the protection of the purchase, storage, working conditions and removal of hazardous material and of the personal is explained. General rules for the handling of hazardous material are described. In part 2, particular emphasis is put on the handling of flammable liquids, disinfectants, cytostatica, pressurised gas, liquid nitrogen, narcotics, mailing of potentially infectious material and safe disposal of hazardous waste. Advice about possible unrecognized hazards and references is also given.

Potassium handling with dual renin-angiotensin system inhibition in diabetic nephropathy.

PubMed

Van Buren, Peter N; Adams-Huet, Beverley; Nguyen, Mark; Molina, Christopher; Toto, Robert D

2014-02-01

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are the cornerstones of pharmacologic therapy in diabetic nephropathy. Mineralocorticoid receptor blockers reduce proteinuria as single agents or add-on therapy to other renin-angiotensin-aldosterone system-inhibiting drugs in these patients. The long-term benefits and ultimate role of mineralocorticoid receptor blockers in diabetic nephropathy remain unknown. A clinical trial previously showed that the kalemic effect of spironolactone is higher than losartan when added to lisinopril in patients with diabetic nephropathy. The purpose of this study was to investigate if renal potassium handling was primarily responsible for that observation. In a blinded, randomized, three-arm placebo-controlled clinical trial, 80 participants with diabetic nephropathy taking lisinopril (80 mg) were randomized to spironolactone (25 mg daily), losartan (100 mg daily), or placebo (trial dates from July of 2003 to December of 2006). Serum potassium, aldosterone, and 24-hour urine sodium, potassium, and creatinine were measured over 48 weeks. Differences were analyzed with repeated measures mixed models. Mean follow-up serum potassium was 5.0 mEq/L for spironolactone, 4.7 mEq/L for losartan (P=0.05 versus spironolactone), and 4.5 mEq/L for placebo (P<0.001 versus spironolactone; P=0.03 versus losartan). The difference in serum potassium was 0.23 mEq/L for losartan versus placebo (P=0.02), 0.43 mEq/L for spironolactone versus placebo (P<0.001), and 0.2 mEq/L for spironolactone versus losartan (P=0.05). Serum and urine potassium excretion and secretion rates were similar between groups throughout the study. Spironolactone raised serum potassium more than losartan in patients with diabetic nephropathy receiving lisinopril, despite similar renal sodium and potassium excretion. This finding suggests that extrarenal potassium homeostasis contributes to hyperkalemia in these patients. A better understanding of

Students' Strategies for Exception Handling

ERIC Educational Resources Information Center

Rashkovits, Rami; Lavy, Ilana

2011-01-01

This study discusses and presents various strategies employed by novice programmers concerning exception handling. The main contributions of this paper are as follows: we provide an analysis tool to measure the level of assimilation of exception handling mechanism; we present and analyse strategies to handle exceptions; we present and analyse…

Potential exposure to Australian bat lyssavirus is unlikely to prevent future bat handling among adults in South East Queensland.

PubMed

Young, M K; Banu, S; McCall, B J; Vlack, S; Carroll, H; Bennett, S; Davison, R; Francis, D

2018-02-01

Despite ongoing public health messages about the risks associated with bat contact, the number of potential exposures to Australian bat lyssavirus (ABLV) due to intentional handling by members of the general public in Queensland has remained high. We sought to better understand the reasons for intentional handling among these members of the public who reported their potential exposure to inform future public health messages. We interviewed adults who resided in a defined geographic area in South East Queensland and notified potential exposure to ABLV due to intentional handling of bats by telephone between 1 January 2012 and 31 December 2013. The participation rate was 54%. Adults who reported they had intentionally handled bats in South East Queensland indicated high levels of knowledge and perception of a moderately high risk associated with bats with overall low intentions to handle bats in the future. However, substantial proportions of people would attempt to handle bats again in some circumstances, particularly to protect their children or pets. Fifty-two percent indicated that they would handle a bat if a child was about to pick up or touch a live bat, and 49% would intervene if a pet was interacting with a bat. Future public health communications should recognize the situations in which even people with highrisk perceptions of bats will attempt to handle them. Public health messages currently focus on avoidance of bats in all circumstances and recommend calling in a trained vaccinated handler, but messaging directed at adults for circumstances where children or pets may be potentially exposed should provide safe immediate management options. © 2017 Blackwell Verlag GmbH.

Scalp cooling to prevent alopecia after chemotherapy can be considered safe in patients with breast cancer.

PubMed

van den Hurk, C J G; van de Poll-Franse, L V; Breed, W P M; Coebergh, J W W; Nortier, J W R

2013-10-01

With modern scalp cooling equipment cytotoxic damage of hair root cells can be prevented in half of the patients with cancer at high risk of alopecia. However, traditionally doubt has existed whether scalp cooling might facilitate hiding and disseminating scalp skin metastases and thus decrease survival. We discuss this risk using frequency data on metastases in breast cancer from observational and autopsy studies and the Munich cancer registry. They showed the incidence of scalp skin metastases to be very low and not differ between scalp-cooled (0.04-1%) and non scalp-cooled (0.03-3%) patients with breast cancer and in need of chemotherapy. We found it rather unlikely that the incidence of scalp skin metastases might increase at all after scalp cooling, whereas a very small proportion of patients receiving chemotherapy are at risk to develop metastases at this site. Scalp cooling can thus safely be offered to patients treated with alopecia-inducing chemotherapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices.

PubMed

Defendorf, Charles M; Paul, Sindy; Scott, George J

2018-05-01

Hepatitis C virus (HCV) infection poses significant adverse health effects. Improper use of vials, needles, syringes, intravenous bags, tubing, and connectors for injections and infusions is a current preventable cause of iatrogenic HCV transmission. Numerous cases have demonstrated the need for continued vigilance and the widespread nature of this iatrogenic infection risk across a variety of medical practice settings in the United States. Failure to implement the evidence-based Centers for Disease Control and Prevention (CDC) infection prevention guidelines exposes patients to preventable harm. The guidelines establish the requirement to notify patients in cases of suspected virus transmission, as well as to screen those patients who would not otherwise have been at risk for HCV seroconversion and other bloodborne pathogens. Legal and regulatory ramifications, including state, criminal, and tort laws, hold physicians and other health care professionals accountable to use safe injection practices. This article reviews the major health risks of HCV infection, significant effects of iatrogenic infection transmission, CDC guidelines for safe injection practices, and legal regulations and ramifications designed to promote safe injection practices.

Technology to promote safe mobility in the elderly.

PubMed

Nelson, Audrey; Powell-Cope, Gail; Gavin-Dreschnack, Deborah; Quigley, Pat; Bulat, Tatjana; Baptiste, Andrea S; Applegarth, Shawn; Friedman, Yvonne

2004-09-01

New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies

46 CFR 111.106-13 - Cargo handling devices or cargo pump rooms handling flammable or combustible cargoes.

Code of Federal Regulations, 2014 CFR

2014-10-01

... pierced by fixed lights, drive shafts, and pump-engine control rods, provided that the shafts and rods are... 46 Shipping 4 2014-10-01 2014-10-01 false Cargo handling devices or cargo pump rooms handling... OSVs § 111.106-13 Cargo handling devices or cargo pump rooms handling flammable or combustible cargoes...

Laboratory testing in management of patients with suspected Ebolavirus disease: infection control and safety.

PubMed

Gilbert, G L

2015-08-01

If routine laboratory safety precautions are followed, the risk of laboratory-acquired infection from handling specimens from patients with Ebolavirus disease (EVD) is very low, especially in the early 'dry' stage of disease. In Australia, border screening to identify travellers returning from EVD-affected west African countries during the 2014-2015 outbreak has made it unlikely that specimens from patients with unrecognised EVD would be sent to a routine diagnostic laboratory. Australian public health and diagnostic laboratories associated with hospitals designated for the care of patients with EVD have developed stringent safety precautions for EVD diagnostic and other tests likely to be required for supportive care of the sickest (and most infectious) patients with EVD, including as wide a range of point-of-care tests as possible. However, it is important that the stringent requirements for packaging, transport and testing of specimens that might contain Ebolavirus--which is a tier 1 security sensitive biology agent--do not delay the diagnosis and appropriate management of other potentially serious but treatable infectious diseases, which are far more likely causes of a febrile illness in people returning from west Africa. If necessary, urgent haematology, biochemistry and microbiological tests can be performed safely, whilst awaiting the results of EVD tests, in a PC-2 laboratory with appropriate precautions including: use of recommended personal protective equipment (PPE) for laboratory staff; handling any unsealed specimens in a class 1 or II biosafety cabinet; using only centrifuges with sealed rotors; and safe disposal or decontamination of all used equipment and laboratory waste.

Cool and Safe: Multiplicity in Safe Innovation at Unilever

ERIC Educational Resources Information Center

Penders, Bart

2011-01-01

This article presents the making of a safe innovation: the application of ice structuring protein (ISP) in edible ices. It argues that safety is not the absence of risk but is an active accomplishment; innovations are not "made safe afterward" but "safe innovations are made". Furthermore, there are multiple safeties to be accomplished in the…

Patient safety in nursing education: contexts, tensions and feeling safe to learn.

PubMed

Steven, Alison; Magnusson, Carin; Smith, Pam; Pearson, Pauline H

2014-02-01

Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning. Copyright © 2014

Oral Surgical Procedures Performed Safely in Patients With Head and Neck Arteriovenous Malformations: A Retrospective Case Series of 12 Patients.

PubMed

Karim, Abdul Basit; Lindsey, Sean; Bovino, Brian; Berenstein, Alejandro

2016-02-01

This case series describes patients with head and neck arteriovenous malformations who underwent oral and maxillofacial surgical procedures combined with interventional radiology techniques to minimize blood loss. Twelve patients underwent femoral cerebral angiography to visualize the extent of vascular malformation. Before the surgical procedures, surgical sites were devascularized by direct injection of hemostatic or embolic agents. Direct puncture sclerotherapy at the base of surgical sites was performed using Surgiflo or n-butylcyanoacrylate glue. Surgical procedures were carried out in routine fashion. A hemostatic packing of FloSeal, Gelfoam, and Avitene was adapted to the surgical sites. Direct puncture sclerotherapy with Surgiflo or n-butylcyanoacrylate glue resulted in minimal blood loss intraoperatively. Local application of the FloSeal, Gelfoam, and Avitene packing sustained hemostasis and produced excellent healing postoperatively. Patients with arteriovenous malformations can safely undergo routine oral and maxillofacial surgical procedures with minimal blood loss when appropriate endovascular techniques and local hemostatic measures are used by the interventional radiologist and oral and maxillofacial surgeon. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Helicopter Handling Qualities

NASA Technical Reports Server (NTRS)

1982-01-01

Helicopters are used by the military and civilian communities for a variety of tasks and must be capable of operating in poor weather conditions and at night. Accompanying extended helicopter operations is a significant increase in pilot workload and a need for better handling qualities. An overview of the status and problems in the development and specification of helicopter handling-qualities criteria is presented. Topics for future research efforts by government and industry are highlighted.

Safe Sleep Practices of Kansas Birthing Hospitals

PubMed Central

Ahlers-Schmidt, Carolyn R.; Schunn, Christy; Sage, Cherie; Engel, Matthew; Benton, Mary

2018-01-01

Background Sleep-related death is tied with congenital anomalies as the leading cause of infant mortality in Kansas, and external risk factors are present in 83% of these deaths. Hospitals can impact caregiver intentions to follow risk-reduction strategies. This project assessed the current practices and policies of Kansas hospitals with regard to safe sleep. Methods A cross-sectional survey of existing safe sleep practices and policies in Kansas hospitals was performed. Hospitals were categorized based on reported delivery volume and data were compared across hospital sizes. Results Thirty-one of 73 (42%) contacted hospitals responded. Individual survey respondents represented various hospital departments including newborn/well-baby (68%), neonatal intensive care unit (3%) and other non-nursery departments or administration (29%). Fifty-eight percent of respondents reported staff were trained on infant safe sleep; 44% of these held trainings annually. High volume hospitals tended to have more annual training than low or mid volume birth hospitals. Thirty-nine percent reported a safe sleep policy, though most of these (67%) reported never auditing compliance. The top barrier to safe sleep education, regardless of delivery volume, was conflicting patient and family member beliefs. Conclusions Hospital promotion of infant safe sleep is being conducted in Kansas to varying degrees. High and mid volume birth hospitals may need to work more on formal auditing of safe sleep practices, while low volume hospitals may need more staff training. Low volume hospitals also may benefit from access to additional caregiver education materials. Finally, it is important to note hospitals should not be solely responsible for safe sleep education. PMID:29844848

Electric versus manual tooth brushing among neuroscience ICU patients: is it safe?

PubMed

Prendergast, Virginia; Hagell, Peter; Hallberg, Ingalill Rahm

2011-04-01

Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU). As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission. Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial η(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001). In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.

Unique Chernobyl Cranes for Deconstruction Activities in the New Safe Confinement - 13542

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parameswaran, N.A. Vijay; Chornyy, Igor; Owen, Rob

2013-07-01

The devastation left behind from the Chernobyl nuclear power plant (ChNPP) Unit 4 accident which occurred on April 26, 1986 presented unparalleled technical challenges to the world engineering and scientific community. One of the largest tasks that are in progress is the design and construction of the New Safe Confinement (NSC). The NSC is an engineered enclosure for the entire object shelter (OS) that includes a suite of process equipment. The process equipment will be used for the dismantling of the destroyed Chernobyl Nuclear Power Plant (ChNPP) Unit. One of the major mechanical handling systems to be installed in themore » NSC is the Main Cranes System (MCS). The planned decontamination and decommissioning or dismantling (D and D) activities will require the handling of heavily shielded waste disposal casks containing nuclear fuel as well as lifting and transporting extremely large structural elements. These activities, to be performed within the NSC, will require large and sophisticated cranes. The article will focus on the unique design features of the MCS for the D and D activities. (authors)« less

Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention

PubMed Central

Lawton, Rebecca; Sheard, Laura; Armitage, Gerry; Cocks, Kim; Buckley, Hannah; Corbacho, Belen; Reynolds, Caroline; Marsh, Claire; Moore, Sally; Watt, Ian; Wright, John

2017-01-01

Objective To evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention. Design A multicentre cluster randomised controlled trial. Setting Clusters were 33 hospital wards within five hospitals in the UK. Participants All patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition. Intervention The ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings. Measurements Primary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS). Results Intervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention. Limitations Adherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure. Conclusions Patients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components. Trial registration number ISRCTN07689702; pre-results. PMID:28159854

Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention.

PubMed

Lawton, Rebecca; O'Hara, Jane Kathryn; Sheard, Laura; Armitage, Gerry; Cocks, Kim; Buckley, Hannah; Corbacho, Belen; Reynolds, Caroline; Marsh, Claire; Moore, Sally; Watt, Ian; Wright, John

2017-08-01

To evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention. A multicentre cluster randomised controlled trial. Clusters were 33 hospital wards within five hospitals in the UK. All patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition. The ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings. Primary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS). Intervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention. Adherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure. Patients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components. ISRCTN07689702; pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Midas® Fumigant Safe Handling Guide

EPA Pesticide Factsheets

Handlers or applicators should wear personal protective equipment including respirator and chemical-resistant gloves when working with this soil fumigant, be trained according to the Worker Protection Standard (WPS), and know signs of pesticide exposure.

177Lu-octreotate, alone or with radiosensitising chemotherapy, is safe in neuroendocrine tumour patients previously treated with high-activity 111In-octreotide.

PubMed

Hubble, Daniel; Kong, Grace; Michael, Michael; Johnson, Val; Ramdave, Shakher; Hicks, Rodney John

2010-10-01

The aim of this retrospective study was to determine whether patients with previous peptide receptor radionuclide therapy using high-activity (111)In-pentetreotide can be safely treated with (177)Lu-octreotate and whether addition of radiosensitising chemotherapy increases the toxicity of this agent. Records of 27 patients (aged 17-75) who received 69 (median 3 per patient) (177)Lu-octreotate administrations, including 29 in conjunction with radiosensitising infusional 5-fluorouracil (5-FU) (n = 27), or capecitabine (n = 2), between October 2005 and July 2007 subsequent to 1-8 prior cycles of (111)In-pentetreotide therapy were analysed. Toxicity was assessed during and at 8-12 weeks post-treatment, with further long-term assessments including survival status reviewed till death or study close-out date of 1 November 2009. Reduction in blood counts was most marked following the first dose of (177)Lu-octreotate but at early follow-up the only major haematological toxicity was a single case of grade 4 lymphopaenia. Both the presence of bone metastases and the administration of chemotherapy tended to result in greater reduction in blood counts, but these differences did not reach statistical significance. On long-term follow-up, 16 patients (59%) are alive with median overall survival of 36 months (32-44 months from first (177)Lu-octreotate therapy). None of the recorded deaths was directly related to treatment toxicity. One patient had late grade 4 anaemia and thrombocytopaenia secondary to bone marrow failure from progressive infiltration by tumour. No other significant long-term haematological toxicities were recorded and no leukaemia was observed. No renal toxicity was observed on serial serum creatinine or radionuclide glomerular filtration rate (GFR) determination on initial or long-term follow-up. (177)Lu-octreotate is a safe and well-tolerated therapy for patients who have previously been treated with (111)In-pentetreotide and can be safely combined with

Losartan/hydrochlorothiazide combination is safe and effective for morning hypertension in Very-Elderly patients.

PubMed

Uchiwa, Hiroki; Kai, Hisashi; Iwamoto, Yoshiko; Anegawa, Takahiro; Kajimoto, Hidemi; Fukuda, Kenji; Imaizumi, Tsutomu; Fukumoto, Yoshihiro

2018-01-01

Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the prevalence of morning hypertension increases with age, treatment of morning hypertension has not been established, particularly in Very-Elderly patients. We compared the safety and efficacy of a losartan/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension between Very-Elderly (≥75 years) and Young/Elderly patients (<75 years). This study was a subanalysis of the Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy study, in which patients with morning hypertension (≥135/85 mmHg) received a 50-mg losartan/12.5-mg HCTZ combination tablet (combination therapy) or 100-mg losartan (high-dose therapy) for 3 months. High adherence rates and few adverse effects were observed in Very-Elderly patients receiving combination (n = 32) and high-dose (n = 34) therapies and in Young/Elderly patients receiving combination (n = 69) and high-dose (n = 66) therapies. Baseline morning systolic BP (SBP) was similar in both age groups receiving either therapy. Morning SBP was reduced by 20.2 and 18.1 mmHg with combination therapy and by 7.1 and 9.1 mmHg with high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Morning BP target (<135/85 mmHg) was achieved in 40.6% and 55.1% by combination therapy and in 14.7% and 24.2% by high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Neither therapy changed renal function and serum potassium in Very-Elderly patients. In conclusion, the losartan/HCTZ combination was safe and effective in controlling morning hypertension in Very-Elderly as well as Young/Elderly patients. In addition, combination therapy was also superior to high-dose therapy for lowering morning SBP in Very-Elderly patients.

[Safe school].

PubMed

Liberal, Edson Ferreira; Aires, Roberto Tschoepke; Aires, Mariana Tschoepke; Osório, Ana Carla de Albuquerque

2005-11-01

To review the strategies to make school a safe environment. The paper first addresses the social context of accidents and violence in the school environment, and makes recommendations, based on the literature data, for the implementation of safe schools. Articles published between 1993 and 2005 in the MEDLINE database. Brazilian epidemiological and literature data have also been searched. There is growing evidence that intervention has multiple components, focusing on health education practices, with the participation of the whole community. The aim of those interventions is to help students and community members to adopt healthy and safe behaviors. Schools are taking on an increasing role in health promotion, disease prevention, and injury prevention. In the context of prevention of external causes of morbidity and mortality, it is important to recognize a risky environment, places, and risk behaviors as favorable to injury and violence, as well as the concept of accident as something one can avoid. Implementation of safe schools represents a promising new direction for school-based preventive work. It is important to note that a safe school should intervene not only in its physical structure, but it should also make it as safe as possible by gathering the school community through health education, and mainly encouraging healthy behavior.

7 CFR 1210.307 - Handle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan Definitions § 1210.307 Handle. Handle means to grade, pack...

7 CFR 1210.307 - Handle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan Definitions § 1210.307 Handle. Handle means to grade, pack...

7 CFR 1210.307 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan Definitions § 1210.307 Handle. Handle means to grade, pack...

7 CFR 1210.307 - Handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan Definitions § 1210.307 Handle. Handle means to grade, pack...

Investigation of safe-life fail-safe criteria for the space shuttle

NASA Technical Reports Server (NTRS)

1972-01-01

An investigation was made to determine the effects of a safe-life design approach and a fail-safe design approach on the space shuttle booster vehicle structure, and to recommend any changes to the structural design criteria. Two configurations of the booster vehicle were considered, one incorporating a delta wing (B-9U configuration) and the other a swept wing (B-16B configuration). Several major structural components of the booster were studied to determine the fatigue life, safe-life, and fail-safe capabilities of the baseline design. Each component was investigated to determine the practicability of applying a safe-life or fail-safe design philosophy, the changes such design approaches might require, and the impact of these changes on weight, cost, development plans, and performance.

Grain Handling and Storage.

ERIC Educational Resources Information Center

Harris, Troy G.; Minor, John

This text for a secondary- or postecondary-level course in grain handling and storage contains ten chapters. Chapter titles are (1) Introduction to Grain Handling and Storage, (2) Elevator Safety, (3) Grain Grading and Seed Identification, (4) Moisture Control, (5) Insect and Rodent Control, (6) Grain Inventory Control, (7) Elevator Maintenance,…

Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort.

PubMed

de Boissieu, P; Mahmoudi, R; Hentzien, M; Toquet, S; Novella, J-L; Blanchard, F; Jolly, D; Dramé, M

2015-06-01

To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department. Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi). 8 university teaching hospitals and one regional, non-academic hospital in France. Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included. At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations. Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01). Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.

Bevacizumab Plus Radiosurgery for Nonsquamous Non-Small Cell Lung Cancer Patients with Brain Metastases: Safe Combination?

PubMed

Guinde, Julien; Carron, Romain; Tomasini, Pascale; Greillier, Laurent; Régis, Jean; Barlesi, Fabrice

2017-11-01

In the context of bronchial cancers, the brain is one of the most frequent sites for metastases. Local treatments of these metastases have evolved and are often combined to obtain greater efficiency, while the main objective remains to reduce the symptoms. Radiosurgery is currently used as a primary option for patients harboring few numbers of small to middle-sized brain metastases. In nonsquamous non-small cell lung cancer (NSCLC), chemotherapy is often associated with bevacizumab. Our goal was to assess the safety of this early combination. Six patients with advanced nonsquamous NSCLC were treated with radiosurgery for the management of their brain metastases (n = 40), followed within <4 weeks by a treatment with bevacizumab. No systemic or cerebral adverse event of grade 3 (intratumoral or parenchymal hemorrhage) or unexpected toxicity secondary to bevacizumab has been indexed. Radiosurgery may be safely combined with bevacizumab quite early on for patients with nonsquamous NSCLC with brain metastases. Copyright © 2017 Elsevier Inc. All rights reserved.

Preemptive intravenous immunoglobulin allows safe and timely administration of antineoplastic therapies in patients with multiple myeloma and parvovirus B19 disease.

PubMed

Katragadda, L; Shahid, Z; Restrepo, A; Muzaffar, J; Alapat, D; Anaissie, E

2013-08-01

Parvovirus B19 (B19) disease is a rare cause of anemia in cancer patients and often goes unrecognized, causing delays in anticancer therapy. A retrospective review was carried out of the records of patients with multiple myeloma who underwent melphalan-based autologous stem cell transplantation (MEL-ASCT) and developed B19 infection (January 2009-December 2011). Cases were defined by the presence of clinical and laboratory findings consistent with B19 disease in patients with repeatedly positive plasma quantitative polymerase chain reaction for parvovirus. Six patients qualified as cases; 5 presented with trilineage cytopenias (chronic in 1) and 1 with anemia later progressing to pancytopenia. Transfusion-dependent thrombocytopenia led to testing in 5 patients. Two of these patients also had manifestations of autoimmune disease. Therapy with intravenous immunoglobulin (IVIG) resulted in clinical and hematologic response in all; however, 1 patient, whose white blood cell counts and serum hemoglobin levels improved, required splenectomy for persistent thrombocytopenia. All patients required additional IVIG for recurrent B19 disease. Although viral load at diagnosis did not correlate with the severity of cytopenia, its decrease was associated with response during 17 of 20 evaluable episodes (P = 0.02). Preemptive IVIG allowed the safe administration of chemotherapy in 3 patients, including MEL-ASCT in 1. Parvovirus B19 can cause severe disease in myeloma patients including ASCT recipients. Thrombocytopenia - not anemia - was the leading presentation and may be associated with autoimmune conditions. Patients with unexplained cytopenias, particularly when prolonged, should undergo testing for circulating parvovirus. A reduction in viral load was associated with response to IVIG, although additional therapy was needed for recurrent disease. Most importantly, preemptive IVIG allowed for safe and timely administration of antineoplastic therapy in patients with ongoing B

When place and time matter: How to conduct safe inter-hospital transfer of patients

PubMed Central

Sethi, Divya; Subramanian, Shalini

2014-01-01

Inter-hospital transfer (IHT) of patients is often needed for diagnostic or therapeutic interventions. However, the transfer process carries its own risks as a poorly and hastily conducted transfer could lead to adverse events. In this article, we have reviewed literature on the key elements of IHT process including pre-transfer patient stabilization. We have also discussed various modes of transfer, physiological effects of transfer, possible adverse events and how to avoid or mitigate these. Even critically ill-patients can be transported safely by experienced and trained personnel using appropriate equipment. The patient must be maximally stabilized prior to transfer though complete optimization may be possible only at the receiving hospital. Ground or air transport may be employed depending on the urgency, feasibility and availability. Meticulous pre-transfer check and adherence to standard protocols during the transfer will help keep the entire process smooth and event free. The transport team should be trained to anticipate and manage any possible adverse events, medical or technical, during the transfer. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency or casualty. Documentation of the transfer process and transfer of medical record and investigation reports are important for maintaining continuity of medical care and for medico-legal purposes. PMID:24665250

Keeping patients safe in healthcare organizations: a structuration theory of safety culture.

PubMed

Groves, Patricia S; Meisenbach, Rebecca J; Scott-Cawiezell, Jill

2011-08-01

This paper presents a discussion of the use of structuration theory to facilitate understanding and improvement of safety culture in healthcare organizations. Patient safety in healthcare organizations is an important problem worldwide. Safety culture has been proposed as a means to keep patients safe. However, lack of appropriate theory limits understanding and improvement of safety culture. The proposed structuration theory of safety culture was based on a critique of available English-language literature, resulting in literature published from 1983 to mid-2009. CINAHL, Communication and Mass Media Complete, ABI/Inform and Google Scholar databases were searched using the following terms: nursing, safety, organizational culture and safety culture. When viewed through the lens of structuration theory, safety culture is a system involving both individual actions and organizational structures. Healthcare organization members, particularly nurses, share these values through communication and enact them in practice, (re)producing an organizational safety culture system that reciprocally constrains and enables the actions of the members in terms of patient safety. This structurational viewpoint illuminates multiple opportunities for safety culture improvement. Nurse leaders should be cognizant of competing value-based culture systems in the organization and attend to nursing agency and all forms of communication when attempting to create or strengthen a safety culture. Applying structuration theory to the concept of safety culture reveals a dynamic system of individual action and organizational structure constraining and enabling safety practice. Nurses are central to the (re)production of this safety culture system. © 2011 Blackwell Publishing Ltd.

Is ciprofloxacin safe in patients with solitary kidney and upper urinary tract infection?

PubMed

Gluhovschi, Gheorghe; Gadalean, Florica; Gluhovschi, Cristina; Velciov, Silvia; Petrica, Ligia; Bob, Flaviu; Bozdog, Gheorghe; Kaycsa, Adriana

2016-12-01

susceptibility). In SK patients, renal tubular biomarkers, especially NAG, allow monitoring of tubular injury and impose caution in prescribing ciprofloxacin treatment, mainly to patients at risk. Ciprofloxacin is relatively safe regarding its nephrotoxicity, while caution is required in vulnerable patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Safe Zones: Creating LGBT Safe Space Ally Programs

ERIC Educational Resources Information Center

Poynter, Kerry John; Tubbs, Nancy Jean

2008-01-01

This article discusses model LGBT Safe Space Ally programs. These programs, often called "Safe Zones," include self selected students, faculty, and employees who publicly show support by displaying stickers, signs, and other identifiable items. Issues covered in the article include history, development, training, membership, assessment, and…

7 CFR 905.9 - Handle or ship.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Handle or ship. 905.9 Section 905.9 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... TANGELOS GROWN IN FLORIDA Order Regulating Handling Definitions § 905.9 Handle or ship. Handle or ship...

7 CFR 948.8 - Handle or ship.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Handle or ship. 948.8 Section 948.8 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... Order Regulating Handling Definitions § 948.8 Handle or ship. Handle or ship means to transport, sell...

7 CFR 905.9 - Handle or ship.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Handle or ship. 905.9 Section 905.9 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... TANGELOS GROWN IN FLORIDA Order Regulating Handling Definitions § 905.9 Handle or ship. Handle or ship...

7 CFR 905.9 - Handle or ship.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Handle or ship. 905.9 Section 905.9 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... TANGELOS GROWN IN FLORIDA Order Regulating Handling Definitions § 905.9 Handle or ship. Handle or ship...

7 CFR 948.8 - Handle or ship.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Handle or ship. 948.8 Section 948.8 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Order Regulating Handling Definitions § 948.8 Handle or ship. Handle or ship means to transport, sell...

7 CFR 905.9 - Handle or ship.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Handle or ship. 905.9 Section 905.9 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... TANGELOS GROWN IN FLORIDA Order Regulating Handling Definitions § 905.9 Handle or ship. Handle or ship...

7 CFR 948.8 - Handle or ship.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Handle or ship. 948.8 Section 948.8 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Order Regulating Handling Definitions § 948.8 Handle or ship. Handle or ship means to transport, sell...

7 CFR 948.8 - Handle or ship.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Handle or ship. 948.8 Section 948.8 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... Order Regulating Handling Definitions § 948.8 Handle or ship. Handle or ship means to transport, sell...

Are special read alignment strategies necessary and cost-effective when handling sequencing reads from patient-derived tumor xenografts?

PubMed

Tso, Kai-Yuen; Lee, Sau Dan; Lo, Kwok-Wai; Yip, Kevin Y

2014-12-23

Patient-derived tumor xenografts in mice are widely used in cancer research and have become important in developing personalized therapies. When these xenografts are subject to DNA sequencing, the samples could contain various amounts of mouse DNA. It has been unclear how the mouse reads would affect data analyses. We conducted comprehensive simulations to compare three alignment strategies at different mutation rates, read lengths, sequencing error rates, human-mouse mixing ratios and sequenced regions. We also sequenced a nasopharyngeal carcinoma xenograft and a cell line to test how the strategies work on real data. We found the "filtering" and "combined reference" strategies performed better than aligning reads directly to human reference in terms of alignment and variant calling accuracies. The combined reference strategy was particularly good at reducing false negative variants calls without significantly increasing the false positive rate. In some scenarios the performance gain of these two special handling strategies was too small for special handling to be cost-effective, but it was found crucial when false non-synonymous SNVs should be minimized, especially in exome sequencing. Our study systematically analyzes the effects of mouse contamination in the sequencing data of human-in-mouse xenografts. Our findings provide information for designing data analysis pipelines for these data.

FUEL HANDLING MECHANISM

DOEpatents

Koch, L.J.; Hutter, E.

1960-02-01

A remotely operable handling device specifically adapted for the handling of vertically disposed fuel rods in a nuclear reactor was developed. The device consists essentially of an elongated tubular member having a gripping device at the lower end of the pivoted jaw type adapted to grip an enlarged head on the upper end of the workpiece. The device includes a sensing element which engages the enlarged head and is displaced to remotely indicate when the workpiece is in the proper position to be engaged by the jaws.

Association of water handling and child feeding practice with childhood diarrhoea in rural community of Southern Nepal.

PubMed

Acharya, Dilaram; Singh, Jitendra K; Adhikari, Mandira; Gautam, Salila; Pandey, Pragya; Dayal, Vinita

Diarrhoea is a major cause of childhood morbidity and mortality globally. While the childhood diarrhoea and its association with child feeding, and hygiene, hand washing and water treatment are studied elsewhere, the association of water handling and child feeding with childhood diarrhoea is an understudied area in Nepal. This study aimed to investigate the association of water handling and child feeding practice with childhood diarrhoea among children of one to five years of age in Southern, Nepal. A cross-sectional study was conducted in the Dhanusha district of Southern Nepal in 2013. A total of 284 mother-child pairs were selected using systemic random sampling. A four-week prevalence of childhood diarrhoea was reported using frequency distribution. The association of childhood diarrhoea with water handling and child feeding practices was ascertained using multiple logistic regressions after adjusting for potential confounders. The result of the study demonstrated that the four-week prevalence of childhood diarrhoea was 36.6%. Our finding showed that unsafe water handling practices were associated independently with childhood diarrhoea: untreated water (aOR 3.55; 95% CI: 1.13-11.10), uncovered water (aOR 2.14; 95% CI: 1.09-4.19). Similarly, partial breast feeding (aOR 4.35; 95% CI: 1.87-10.12) was also associated with higher odds of childhood diarrhoea. One third of children in Southern Nepal still had diarrhoea within the four weeks preceding the survey. As poor water handling and sub optimal infant feeding practice were major risk factors contributing to such a high burden of the disease, health promotion strategies such as promotion of safe water handling, improved hygiene and child feeding practices are recommended for the prevention of childhood diarrhoea in Southern Terai of Nepal. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

7 CFR 58.443 - Whey handling.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Whey handling. 58.443 Section 58.443 Agriculture... Procedures § 58.443 Whey handling. (a) Adequate sanitary facilities shall be provided for the handling of whey. If outside, necessary precautions shall be taken to minimize flies, insects and development of...

7 CFR 945.9 - Ship or handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Ship or handle. 945.9 Section 945.9 Agriculture... DESIGNATED COUNTIES IN IDAHO, AND MALHEUR COUNTY, OREGON Order Regulating Handling Definitions § 945.9 Ship or handle. Ship or handle means to pack, sell, consign, transport or in any other way to place...

7 CFR 927.8 - Ship or handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Ship or handle. 927.8 Section 927.8 Agriculture... Order Regulating Handling Definitions § 927.8 Ship or handle. Ship or handle means to sell, deliver, consign, transport or ship pears within the production area or between the production area and any point...

7 CFR 927.8 - Ship or handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Ship or handle. 927.8 Section 927.8 Agriculture... Order Regulating Handling Definitions § 927.8 Ship or handle. Ship or handle means to sell, deliver, consign, transport or ship pears within the production area or between the production area and any point...

7 CFR 945.9 - Ship or handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Ship or handle. 945.9 Section 945.9 Agriculture... DESIGNATED COUNTIES IN IDAHO, AND MALHEUR COUNTY, OREGON Order Regulating Handling Definitions § 945.9 Ship or handle. Ship or handle means to pack, sell, consign, transport or in any other way to place...

7 CFR 927.8 - Ship or handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Ship or handle. 927.8 Section 927.8 Agriculture... Order Regulating Handling Definitions § 927.8 Ship or handle. Ship or handle means to sell, deliver, consign, transport or ship pears within the production area or between the production area and any point...

7 CFR 945.9 - Ship or handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Ship or handle. 945.9 Section 945.9 Agriculture... DESIGNATED COUNTIES IN IDAHO, AND MALHEUR COUNTY, OREGON Order Regulating Handling Definitions § 945.9 Ship or handle. Ship or handle means to pack, sell, consign, transport or in any other way to place...

7 CFR 927.8 - Ship or handle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Ship or handle. 927.8 Section 927.8 Agriculture... Order Regulating Handling Definitions § 927.8 Ship or handle. Ship or handle means to sell, deliver, consign, transport or ship pears within the production area or between the production area and any point...

7 CFR 927.8 - Ship or handle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Ship or handle. 927.8 Section 927.8 Agriculture... Order Regulating Handling Definitions § 927.8 Ship or handle. Ship or handle means to sell, deliver, consign, transport or ship pears within the production area or between the production area and any point...

Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective.

PubMed

Le Page, Philip; Smialkowski, Ania; Morton, Jonathan; Fenton-Lee, Douglas

2013-12-01

The laparoscopic approach to repair of inguinal hernia has proven advantages over open repair. Repair of more technically challenging hernias, such as patients previously receiving prostatectomy, has been less studied and may not have these advantages. We aimed to compare safety, feasibility, and clinical outcomes for repairs in patients who previously underwent prostatectomy to control subjects. We undertook a case-control study using a prospectively collected database. From 2004, all patients were routinely offered totally extraperitoneal laparoscopic repair. All patients who had a history of previous prostatectomy were identified and compared to a matched control group. Both operative and follow-up data were analyzed. Of 987 patients undergoing surgery during this time period, 52 prostatectomy patients were identified (44% open, 44% robotic, 3% laparoscopic) and matched to 102 control subjects. Accounting for bilateral repairs, 203 hernia repairs had been performed. Patients were well matched for age and American Society of Anesthesiologists score. Operative time was longer for prostatectomy patients (mean, 70 vs. 52 min, p < 0.0001); however, this reduced over time when comparing the first and second half prostatectomy patients (77 vs. 63 min, p = 0.144). Overall, there were no intraoperative or major postoperative complications and only one conversion (prostatectomy group). No significant differences were found for rates of minor postoperative complications, length of stay, or recurrence (n = 1, control group). No difference was observed for chronic pain, and all patients in each group reported satisfaction with surgery at contemporary follow-up. In experienced hands, totally extraperitoneal inguinal hernia repair for patients previously having undergone prostatectomy is safe and has equivalent outcomes to patients not having undergone prostatectomy, and is an option to open repair. Understandably, slightly longer operative times may be justified, given the

Feeling safe and motivated to achieve better health: Experiences with a partnership-based nursing practice programme for in-home patients with chronic obstructive pulmonary disease.

PubMed

Leine, Marit; Wahl, Astrid Klopstad; Borge, Christine Råheim; Hustavenes, Magne; Bondevik, Hilde

2017-09-01

To explore chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme in the home setting. Patients with chronic obstructive pulmonary disease suffer from psychological and physiological problems, especially when they return home after hospitalisation from exacerbation. Many express a need for information and knowledge about chronic obstructive pulmonary disease. Partnership as practice is a patient-centred framework providing an individualised practice for each patient. This study intends to achieve a nuanced and improved understanding of chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme comprising home visits from a respiratory nurse after hospital discharge, alongside interdisciplinary collaboration. This study has a qualitative design with interviews. Six individual semi-structured interviews collected in 2012-2013 constitute the material. Interviews were recorded, transcribed to written text and analysed using systematic text condensation. Three key themes were identified: to be seen, talked with and understood; healthcare support at home-continuity, practical support and facilitation; and exchange of knowledge. However, there were two generic themes that permeated the material: feeling safe and comforted, and motivation to achieve better health. Patients with chronic obstructive pulmonary disease can experience feeling safe and comforted, and be motivated to make changes in order to achieve better health after participating in a partnership-based nursing practice programme that includes home visits from a respiratory nurse and interdisciplinary cooperation after hospital discharge. To feel safe is of great importance, and how this relates to the patient's ability to cope with illness should be explored in further research. The results suggest that the partnership-based nursing practice programme that includes home visits and interdisciplinary

Nonspecific abdominal pain is a safe diagnosis.

PubMed

Pennel, David John Laurie; Goergen, Nina; Driver, Chris P

2014-11-01

The aim of this study is to assess if a clinical diagnosis of nonspecific abdominal pain (NSAP) is safe and if patients with this initial diagnosis are likely to require further investigation or surgical intervention. 3323 patients admitted with NSAP from July 1990 to September 2012 utilizing a prospective database of all surgical admissions were included. Readmission over the period of the study and specifically within 30 days of their initial presentation was identified together with any invasive investigation or surgical intervention. 319 children (9.6%) were subsequently readmitted with abdominal pain at some point during the study period. Of these, 78 (2.3%) were readmitted within 30 days. 118 (3.5%) children subsequently had an operation or invasive investigation some point following their initial admission. Of these 33 (0.6%) had the procedure within 3 months of the initial admission. 13 patients had an appendicectomy within 3 months of the initial presentation. Of these histology confirmed appendicitis in 8 patients. This gives an overall incidence of "missed" appendicitis of 0.2 % (8/3323). This study confirms that a clinical diagnosis of nonspecific abdominal pain (NSAP) is safe in a pediatric population and the risk of "missing" appendicitis is only 0.2%. Patients and/or parents can be confidently reassured that the risk of missing organic pathology is very low. Copyright © 2014 Elsevier Inc. All rights reserved.

Anatomical Basis for Safe and Effective Volumization of the Temple.

PubMed

Breithaupt, Andrew D; Jones, Derek H; Braz, Andre; Narins, Rhoda; Weinkle, Susan

2015-12-01

One of the earliest but often unaddressed signs of facial aging is volume loss in the temple. Treatment of the area can produce satisfying results for both patient and practitioner. Safe injection requires explicit knowledge of the anatomy to avoid complications related to the multitude of vessels that course throughout the region at various depths. The authors aim to detail the anatomy of the area and provide a safe and easy-to-follow method for injection. The authors review the relevant anatomy of the temporal region and its application to cosmetic filler injections. The authors describe an easy-to-follow approach for a safe and effective injection window based on numerous anatomical studies. Injection in this area is not without risk, including potential blindness. The authors review the potential complications and their treatments. Hollowing of the temple is an early sign of aging that, when corrected, can lead to significant patient and practitioner satisfaction. Proper anatomically knowledge is required to avoid potentially severe complications. In this study, the authors present a reliable technique to safely and effectively augment this often undertreated area of the aging face.

Positioning of the patient during shoulder surgery: an inexpensive, safe and easy technique.

PubMed

Van Tongel, Alexander; Hardeman, François; Karelse, Anne; de Wilde, Lieven

2013-01-01

The knowledge of shoulder pathology has improved tremendously in the last decades, and shoulder surgery is increasingly performed because of new treatment options and better operative results. Nowadays most surgical shoulder procedures are performed in the sitting or semi-sitting (beach chair) position. Stability of the patient and the ability to flex, extend and rotate the shoulder during surgery are crucial to improve exposure of the surgical field and lower the risk of perioperative complications. We developed an easy, safe and inexpensive surgical set-up providing a very good posterior, superior and anterior access to the shoulder in the sitting or semi-sitting position. In this technique, the patient is placed supine with the head at the foot end of the table and the body positioned slightly eccentrically with the back being supported by the leg plate contralateral to the operative side, avoiding any contact with the scapula of the operative side. A neck support is attached on an extra bar at the contralateral side and accommodated to the patient's lordosis. Next, the leg plate on the operative side is removed, and the head and the body are secured to the table with adhesive dressing. This way a stable positioning of the patient is obtained during the whole procedure, and the shoulder girdle is completely free. The set-up can accommodate patients of different stature and weight without the need to adapt the technique. This position also gives the possibility to provide an excellent radiographic view of the shoulder during operative fracture treatment. Our technique further allows a significant reduction in costs. A surgical table, extra bar, additional arm support and neck support are usually available and can be used in different settings, without the need for a specific shoulder table.

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring

PubMed Central

Syed, Shahbaz; Gatien, Mathieu; Perry, Jeffrey J.; Chaudry, Hina; Kim, Soo-Min; Kwong, Kenneth; Mukarram, Muhammad; Thiruganasambandamoorthy, Venkatesh

2017-01-01

BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring intervention in the emergency department or within 8 hours of presentation to the emergency department. We calculated diagnostic characteristics for the clinical prediction rule. RESULTS: We included 796 patients (mean age 63.8 yr, 55.8% male, 8.9% admitted to hospital). Fifteen patients (1.9%) had an arrhythmia, and the rule performed with the following characteristics: sensitivity 100% (95% confidence interval [CI] 78.2%–100%) and specificity 36.4% (95% CI 33.0%–39.6%). Application of the Ottawa Chest Pain Cardiac Monitoring Rule would have allowed 284 out of 796 patients (35.7%) to be safely removed from cardiac monitoring. INTERPRETATION: We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources. PMID:28246315

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient.

PubMed

Liaw, Sok Ying; Zhou, Wen Tao; Lau, Tang Ching; Siau, Chiang; Chan, Sally Wai-Chi

2014-02-01

Communication and teamwork between doctors and nurses are critical for optimal patient care. Simulation and interprofessional team learning are emerging as significant learning strategies to promote teamwork and communication between different health professionals. The aim of the study is to describe the development, implementation and evaluation of a simulation-based interprofessional educational (Sim-IPE) program, using a presage-process-product (3P) model, for improving medical and nursing students' communication skills in caring of a patient with physiological deterioration. The program was conducted using full-scale simulation and communication strategies adapted from Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). 127 medical and nursing students participated in a 3-hour small group interprofessional learning that incorporated simulation scenarios of deteriorating patients. Pre and post-tests were conducted to assess the students' self-confidence in interprofessional communication and perception in interprofessional learning. After the training, the students completed a satisfaction questionnaire. Both medicine and nursing groups demonstrated a significant improvement on post-test score from pre-test score for self-confidence (p<.0001) and perception (p<.0001) with no significant differences detected between the two groups. The participants were highly satisfied with their simulation learning. The Sim-IPE has better prepared the medical and nursing students in communicating with one another in providing safe care for deteriorating patient. In addition, it has improved their perception towards interprofessional learning. This pre-registration interprofessional education could prepare them for more comprehensive interprofessional team learning at post-registration level. Copyright © 2014 Elsevier Ltd. All rights reserved.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

PubMed

Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary. Copyright © 2014 Mosby, Inc. All rights reserved.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures

PubMed Central

Speicher, Paul J.; Ganapathi, Asvin M.; Englum, Brian R.; Vaslef, Steven N.

2015-01-01

general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary. PMID:24947641

HAND TRUCK FOR HANDLING EQUIPMENT

DOEpatents

King, D.W.

1959-02-24

A truck is described for the handling of large and relatively heavy pieces of equipment and particularly for the handling of ion source units for use in calutrons. The truck includes a chassis and a frame pivoted to the chassis so as to be operable to swing in the manner of a boom. The frame has spaced members so arranged that the device to be handled can be suspended between or passed between these spaced members and also rotated with respect to the frame when the device is secured to the spaced members.

Complaint handling in healthcare: expectation gaps between physicians and the public; results of a survey study.

PubMed

Friele, R D; Reitsma, P M; de Jong, J D

2015-10-01

Patients who submit complaints about the healthcare they have received are often dissatisfied with the response to their complaints. This is usually attributed to the failure of physicians to respond adequately to what complainants want, e.g. an apology or an explanation. However, expectations of complaint handling among the public may colour how they evaluate the way their own complaint is handled. This descriptive study assesses expectations of complaint handling in healthcare among the public and physicians. Negative public expectations and the gap between these expectations and those of physicians may explain patients' dissatisfaction with complaints procedures. We held two surveys; one among physicians, using a panel of 3366 physicians (response rate 57 %, containing all kinds of physicians like GP's, medical specialist and physicians working in a nursing home) and one among the public, using the Dutch Healthcare Consumer Panel (n = 1422, response rate 68 %). We asked both panels identical questions about their expectations of how complaints are handled in healthcare. Differences in expectation scores between the public and the physicians were tested using non-parametric tests. The public have negative expectations about how complaints are handled. Physician's expectations are far more positive, demonstrating large expectation gaps between physicians and the public. The large expectation gap between the public and physicians means that when they meet because of complaint, they are likely to start off with opposite expectations of the situation. This is no favourable condition for a positive outcome of a complaints procedure. The negative public preconceptions about the way their complaint will be handled will prove hard to change during the process of complaints handling. People tend to see what they thought would happen, almost inevitably leading to a negative judgement about how their complaint was handled.

Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

PubMed Central

Parker, Elizabeth K.; Faruquie, Sahrish S.; Anderson, Gail; Gomes, Linette; Kennedy, Andrew; Wearne, Christine M.; Kohn, Michael R.; Clarke, Simon D.

2016-01-01

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations. Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review. Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047; p = 0.039). No statistical significance was found between electrolytes and calories provided during refeeding. Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome. PMID:27293884

A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong.

PubMed

Yip, Y

2001-12-01

Low back pain (LBP) remains a common and costly problem among the nursing profession. Several studies have indicated that LBP is attributed to mentally straining or demanding work, fatigue or exhaustion or general work satisfaction. This study aims to measure the magnitude of LBP among Hong Kong nurses and its association with the work-related psychological strain and patients handling activities. RESEARCH METHODS AND MEASURES: A cross-sectional study of Hong Kong hospital nurses was conducted. Three hundred and seventy-seven nurses were recruited from six district hospitals. They were registered nurses or enrolled nurses working full-time for at least 1 month in the current ward. One hundred and seventy-eight (47.2%) study subjects were randomly selected from two district hospitals and 199 (52.8%) study nurses made up the convenience sample. Possible bias from psychological distress, socio-demographics and lifestyle factors was controlled for. Data were collected by face-to-face interviews. The data included work factors (both psychological stress and patient handling activities related to work), demographics, psychological distress and lifestyle factors and the occurrence of LBP. Of the 377 nurses interviewed, 153 (40.6%) reported having LBP within the last 12 months. With symptoms of LBP as the outcome, risks were increased where nurses self-reported that they only occasionally or never enjoyed their work [adjusted odds ratio (OR) 2.07], where frequent manual repositioning of patients on the bed was required (adjusted OR 1.84) and where they were required to assist patients while walking (adjusted OR 2.11) after adjustment for other potential confounders. The results indicate that an association exists between work stress, manual lifting and LBP prevalence. The main route to prevention of LBP among nurses is likely to lie in improved ergonomics and psychological health in their work place. Good posture and correct transferring techniques in ward situations

Laparoscopic appendicectomy: safe and useful for training.

PubMed Central

Duff, S. E.; Dixon, A. R.

2000-01-01

Debate exists about the benefits of laparoscopic appendicectomy when compared to a conventional open procedure. The majority of appendices are removed by the open route in the UK. We report a series of 132 cases of suspected appendicitis managed laparoscopically: 112 (85%) of the patients had acute appendicitis, the remaining 20 (15%) had non-appendiceal pathology. The median operative time was 30 min and there were no conversions to an open operative procedure. The median postoperative stay was two days. Complications were seen in two patients. The published evidence comparing laparoscopic and open appendicectomy is contradictory. Our series shows that laparoscopic appendicectomy is a safe procedure with low morbidity; it is also an excellent training tool in laparoscopic technique and, with sufficient experience, takes no longer than an open procedure. Negative appendicocecotomies are most common in women of fertile age and can be associated with significant morbidity; therefore, laparoscopy should be used to make the diagnosis and, if appendicitis is the cause, the appendix could safely be removed laparoscopically. However, the choice between open and laparoscopic procedure is a subjective decision for the patient and their surgeon. Laparoscopic appendicectomy cannot be regarded as the gold standard. PMID:11103154

Handling an Asthma Flare-Up

MedlinePlus

... Videos for Educators Search English Español Handling an Asthma Flare-Up KidsHealth / For Kids / Handling an Asthma ... español Cómo controlar las crisis asmáticas What's an Asthma Flare-Up? If you have asthma , you probably ...

7 CFR 1205.312 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE COTTON RESEARCH AND PROMOTION Cotton Research and Promotion Order Definitions § 1205.312 Handle. Handle means to harvest, gin, warehouse, compress, purchase, market, transport, or otherwise acquire ownership or control of cotton. [31 FR 16758...

7 CFR 983.14 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE PISTACHIOS GROWN IN CALIFORNIA, ARIZONA, AND NEW MEXICO Definitions § 983.14 Handle. Handle means to engage in: (a) Receiving pistachios; (b) Hulling and drying pistachios; (c) Further preparing pistachios by sorting, sizing, shelling, roasting...

7 CFR 1219.11 - Handle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH, AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.11 Handle. Handle means to pack, process, transport, purchase, or in any other way to place or cause Hass avocados...

7 CFR 1219.11 - Handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH, AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.11 Handle. Handle means to pack, process, transport, purchase, or in any other way to place or cause Hass avocados...

7 CFR 1219.11 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH, AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.11 Handle. Handle means to pack, process, transport, purchase, or in any other way to place or cause Hass avocados...

7 CFR 1219.11 - Handle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH, AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.11 Handle. Handle means to pack, process, transport, purchase, or in any other way to place or cause Hass avocados...

Safe Schools, Safe Communities.

ERIC Educational Resources Information Center

Lewis, Julie E.; Pickett, Dean; Pulliam, Janet L.; Schwartz, Richard A.; St. Germaine, Anne-Marie; Underwood, Julie; Worona, Jay

Schools must work together with agencies, groups, and individuals to eliminate the forces leading children to violence. Chapter 1, "School Safety: Working Together to Keep Schools Safe," stresses the importance of community collaboration in violence prevention. Effective prevention requires sharing information about students, consistent…

Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study.

PubMed

Bellani, Giacomo; Laffey, John G; Pham, Tài; Madotto, Fabiana; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; Bumbasirevic, Vesna; Piquilloud, Lise; van Haren, Frank; Larsson, Anders; McAuley, Daniel F; Bauer, Philippe R; Arabi, Yaseen M; Ranieri, Marco; Antonelli, Massimo; Rubenfeld, Gordon D; Thompson, B Taylor; Wrigge, Hermann; Slutsky, Arthur S; Pesenti, Antonio

2017-01-01

Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. To determine whether, during NIV, the categorization of ARDS severity based on the Pa O 2 /Fi O 2 Berlin criteria is useful. The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the Pa O 2 /Fi O 2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome. Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on Pa O 2 /Fi O 2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a Pa O 2 /Fi O 2 lower than 150 mm Hg. NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a Pa O 2 /Fi O 2 lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).

Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy.

PubMed

Deviseti, Pravalika; Pujari, Vinayak S

2016-02-01

Wolff-Parkinson-White (WPW) syndrome is an uncommon cardiac condition where there is an abnormal band of atrial tissue connecting atria and ventricles which can electrically bypass atrioventricular node. The anaesthetic management in these patients is challenging as life threatening complications can occur perioperatively like paroxysmal supraventricular tachycardia and atrial fibrillation. Also, regional anaesthetic technique like subarachnoid block is a safe and cost effective alternative to general anaesthesia as it avoids polypharmacy. We report the successful anaesthetic management of Wolff Parkinson White syndrome in a primi with hydatiform mole posted for suction and evacuation.

Factors affecting compliance with moving and handling policy: Student nurses' views and experiences.

PubMed

Cornish, Jocelyn; Jones, Anne

2010-03-01

The limited literature available suggests that there continues to be poor compliance by nurses with moving and handling regulations [Swain, J., Pufahl, E., Williamson, G., 2003. Do they practise what we teach? A survey of manual handling practice amongst student nurses. Journal of Clinical Nursing 12(2), 297-306; Jootun, D., MacInnes, A., 2005. Examining how well students use correct handling procedures. Nursing Times 101(4), 38-40; Smallwood, J., 2006. Patient handling: student nurses' views. Learning in Health and Social Care 5(4), 208-219; Cornish, J., Jones, A., 2007. Evaluation of moving and handling training for pre-registration nurses and its application to practice. Nurse Education in Practice 7(3), 128-134]. This paper presents the final phase of a study in which student nurses' reports of their experience in practice are drawn upon to identify possible reasons for a lack of compliance with moving and handling policy. Focus groups were conducted using a topic guide comprising themes generated from the previous two phases of this study; a questionnaire survey and unstructured interviews [Cornish, J., Jones, A., 2007. Evaluation of moving and handling training for pre-registration nurses and its application to practice. Nurse Education in Practice 7(3), 128-134]. Seventeen pre-registration students participated, representing adult, child and mental health branches from both Degree and Diploma programmes Examples of poor practice set the context for the students' experiences. Factors affecting both compliance with poor practice or compliance with moving and handling regulations leading to good practice, are identified. Methods for the management of difficult moving and handling situations are also revealed. The study informs future developments in training and support mechanisms for students in practice. Copyright 2009 Elsevier Ltd. All rights reserved.

7 CFR 1216.12 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE PEANUT PROMOTION, RESEARCH, AND INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.12 Handle. Handle means... peanuts and in the shipment (except as a common or contract carrier of peanuts owned by another) or sale...

7 CFR 1216.12 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE PEANUT PROMOTION, RESEARCH, AND INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.12 Handle. Handle means... peanuts and in the shipment (except as a common or contract carrier of peanuts owned by another) or sale...

7 CFR 926.9 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and... REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.9 Handle. Handle... cranberries or processed cranberries up to, but not including, the retail level. Effective Date Note: At 71 FR...

Options and processes for spent catalyst handling and utilization.

PubMed

Marafi, M; Stanislaus, A

2003-07-18

The quantity of spent hydroprocessing catalysts discarded as solid wastes in the petroleum refining industries has increased remarkably in recent years due to a rapid growth in the hydroprocessing capacity to meet the rising demand for low-sulfur fuels. Due to their toxic nature, spent hydroprocessing catalysts have been branded as hazardous wastes, and the refiners are experiencing pressure from environmental authorities to handle them safely. Several alternative methods such as reclamation of metals, rejuvenation and reuse, disposal in landfills and preparation of useful materials using spent catalysts as raw materials are available to deal with the spent catalyst problem. The technical feasibility as well as the environmental and economic aspects of these options are reviewed. In addition, details of two bench-scale processes, one for rejuvenation of spent hydroprocessing catalysts, and the other for producing non-leachable synthetic aggregate materials that were developed in this laboratory, are presented in this paper.

Improving patient knowledge and safe use of opioids: a randomized controlled trial.

PubMed

McCarthy, Danielle M; Wolf, Michael S; McConnell, Ryan; Sears, Jill; Chevrier, Allison; Ahlstrom, Eric; Engel, Kirsten G; Cameron, Kenzie A; Adams, James G; Courtney, D Mark

2015-03-01

The use of opioid analgesics in the United States has significantly increased in recent years. However, there is minimal consensus on what discharge counseling should accompany these high-risk prescriptions and large variations in what is done in practice. The objective of this study was to evaluate the effect of a dual-modality (written and spoken) literacy-appropriate educational strategy on patients' knowledge of and safe use of opioid analgesics. This was a prospective, randomized controlled trial. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new prescriptions for hydrocodone-acetaminophen were enrolled. Patients were randomized to receive either usual care or the educational intervention. The educational intervention was a one-page information sheet about hydrocodone-acetaminophen, which was both given to the patients and read aloud by the research assistant (nonblinded). Follow-up phone calls were conducted 4 to 7 days after the visit to assess patient knowledge about the medication and self-report of activities associated with safety of use (e.g., double-dipping with acetaminophen, storage, use with alcohol or while driving). A total of 274 patients were enrolled; 210 completed follow-up (110 usual care and 100 intervention). No significant differences in baseline characteristics emerged between the study arms; 42% were male, and 51% were white, with a median age of 43 years. Half of patients had non-back pain orthopedic injuries (49.5%). On follow-up, overall knowledge was poor, with only 28% able to name both active ingredients in the medication. The intervention group had better knowledge of precautions related to taking additional acetaminophen (usual care 18.2%, 95% confidence interval [CI] = 10.9% to 25.5% vs. intervention 38%, 95% CI = 28.3% to 47.7%; difference = 27.6, 95% CI of difference = 21.5 to 33.7) and knowledge of side effects (usual care median = 1, interquartile range [IQR] 0 to 2 vs. intervention median = 2

Moments of speaking and silencing: Nurses share their experiences of manual handling in healthcare.

PubMed

Kay, Kate; Evans, Alicia; Glass, Nel

2015-01-01

Nursing care involves complex patient handling tasks, resulting in high musculoskeletal injury rates. Epidemiological studies from the 1980s estimated a lifetime prevalence of lower back injuries for nurses between 35 and 80%. National and international studies continue to mirror these findings. Despite the development of programs intended to reduce manual handling injuries, sustainable solutions remain elusive. This paper reports on a study of nurses speaking about their perspectives on current manual handling practices. Qualitative research conducted in 2012 investigated nurses' perceptions and experiences relating to manual handling in the healthcare context and their participation in injury prevention programs. There were two research methods: semi-structured interviews and researcher reflective journaling. The research was framed in critical emancipatory methodology. Thirteen nurses from two Australian states participated in the study. Thematic analysis revealed an overarching theme of 'power relations' with a subcategory of '(mis)power' that comprised two subthemes, these being 'how to practice' and 'voicing practice issues'. Specifically, this paper explores nurses verbalising their views in the workplace and responses which left them feeling silenced, punished and disillusioned. The findings suggest that the sociopolitical context within which nurses practice impacts upon their ability to voice concerns or ideas related to manual handling. Inclusion of nurses in the manual handling dialogue may generate an expanded understanding of, and the potential to transform, manual handling practices in healthcare environments.

The natural angle between the hand and handle and the effect of handle orientation on wrist radial/ulnar deviation during maximal push exertions.

PubMed

Young, Justin G; Lin, Jia-Hua; Chang, Chien-Chi; McGorry, Raymond W

2013-01-01

The purpose of this experiment was to quantify the natural angle between the hand and a handle, and to investigate three design factors: handle rotation, handle tilt and between-handle width on the natural angle as well as resultant wrist radial/ulnar deviation ('RUD') for pushing tasks. Photographs taken of the right upper limb of 31 participants (14 women and 17 men) performing maximal seated push exertions on different handles were analysed. Natural hand/handle angle and RUD were assessed. It was found that all of the three design factors significantly affected natural handle angle and wrist RUD, but participant gender did not. The natural angle between the hand and the cylindrical handle was 65 ± 7°. Wrist deviation was reduced for handles that were rotated 0° (horizontal) and at the narrow width (31 cm). Handles that were tilted forward 15° reduced radial deviation consistently (12-13°) across handle conditions. Manual materials handling (MMH) tasks involving pushing have been related to increased risk of musculoskeletal injury. This study shows that handle orientation influences hand and wrist posture during pushing, and suggests that the design of push handles on carts and other MMH aids can be improved by adjusting their orientation to fit the natural interface between the hand and handle.

7 CFR 1207.307 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.307 Handle. Handle means to grade, pack, process, sell, transport, purchase, or in any other way to place potatoes or cause potatoes to be placed in the...

7 CFR 1219.11 - Handle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Handle. 1219.11 Section 1219.11 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS.... Handle means to pack, process, transport, purchase, or in any other way to place or cause Hass avocados...

21 CFR 820.140 - Handling.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Handling. 820.140 Section 820.140 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES..., contamination, or other adverse effects to product do not occur during handling. ...

9 CFR 3.118 - Handling.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Handling. 3.118 Section 3.118 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine...

9 CFR 3.118 - Handling.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Handling. 3.118 Section 3.118 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine...

9 CFR 3.118 - Handling.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Handling. 3.118 Section 3.118 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine...

9 CFR 3.118 - Handling.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Handling. 3.118 Section 3.118 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine...

9 CFR 3.118 - Handling.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Handling. 3.118 Section 3.118 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine...

7 CFR 1207.307 - Handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.307 Handle. Handle means to grade, pack, process, sell, transport, purchase, or in any other way to place potatoes or cause potatoes to be placed in the...

7 CFR 1207.307 - Handle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.307 Handle. Handle means to grade, pack, process, sell, transport, purchase, or in any other way to place potatoes or cause potatoes to be placed in the...

7 CFR 1207.307 - Handle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.307 Handle. Handle means to grade, pack, process, sell, transport, purchase, or in any other way to place potatoes or cause potatoes to be placed in the...

7 CFR 1207.307 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.307 Handle. Handle means to grade, pack, process, sell, transport, purchase, or in any other way to place potatoes or cause potatoes to be placed in the...

Safe swallowing and communicating for ventilated intensive care patients with tracheostoma: implementation of the Passy Muir speaking valve

PubMed

Fröhlich, Martin R; Boksberger, Heidi; Barfuss-Schneider, Claudia; Liem, Esther; Petry, Heidi

2017-01-01

Background: Between 4 to 45 % of intensive care patients suffer from prolonged ventilator dependence. Due to impeded weaning, verbal communication is impossible. The tracheal cannula affects breathing and swallowing. The Passy Muir speaking valve (PMV) allows patients on ventilators to speak. It counteracts pharyngeal as well as laryngeal desensitization and prevents an insufficient swallowing reflex. Aim and methods: To implement the PMV, we conducted a multiprofessional practice- and quality development project. The objective was to ensure safe swallowing and communicating for ventilated patients with tracheostoma. Results: Intensive care nurses, doctors and physiotherapists assessed patient safety as being high. In nine patients with 51 PMV applications, we observed three undesirable events in terms of dyspnea and oxygen desaturation. On one occasion, it was necessary to remove the PMV. Conclusion: A combination of mandatory training for the entire treatment team, presence of two professionals during PMV application, and a newly developed guiding document resulted in a high level of patient safety. By means of PMV, ventilated intensive care patients are able to communicate verbally and to swallow better. Complications can be identified early and solved effectively.

Hypoglycemia and safe driving.

PubMed

Ahmed, Almoutaz A

2010-01-01

The lack of awareness of the effects of hypoglycemia on safe driving is a real issue for diabetic patients and a challenge for health care providers. Taking the form of questions and answers, this review addresses the issue of road traffic accidents and drivers with type 1 diabetes mellitus. While there is little evidence showing higher accident rates among diabetic drivers, there is research indicating that hypoglycemia compromises driving performance, resulting in slower response times and reduced cognitive function. Unawareness of an early fall in plasma glucose is another important issue that affects some diabetic drivers. The driver with type 1 diabetes is obliged to check their blood glucose before driving. The physician's duty is to familiarize the patient with the risk of hypoglycemia. If hypoglycemic unawareness is present, the physician should advise the patient to stop driving until the condition is reversed. The doctor should consider informing authorities if he concludes there is a risk and the driver cannot be persuaded to stop driving.

Evaluation of pharmacokinetics, user handling, and tolerability of peginterferon alfa-2a (40 kDa) delivered via a disposable autoinjector device

PubMed Central

Varunok, Peter; Lawitz, Eric; Beavers, Kimberly L; Matusow, Gary; Leong, Ruby; Lambert, Nathalie; Bernaards, Coen; Solsky, Jonathan; Brennan, Barbara J; Wat, Cynthia; Bertasso, Anne

2011-01-01

Background Peginterferon alfa-2a (40 kDa) is currently administered using a prefilled syringe. The peginterferon alfa-2a disposable autoinjector is a new safety-engineered device designed to facilitate injection and reduce the risk of needlestick injuries. The analysis of two open-label Phase I trials evaluated the pharmacokinetics, successful administration, and tolerability of peginterferon alfa-2a when using the autoinjector. The studies were performed to support the filing and registration of the autoinjector device. Methods In trial 1, 50 healthy adult subjects received one 180 μg dose of peginterferon alfa-2a via the autoinjector. Serial blood samples were collected predose, up to 336 hours following drug administration, and at follow-up (28 ± 3 days post-dosing) for noncompartmental pharmacokinetic analysis. Trial 2 randomized 60 adult patients with chronic hepatitis C to 180 μg peginterferon alfa-2a once weekly by the autoinjector or prefilled syringe for 3 weeks followed by the alternative device (prefilled syringe or autoinjector, respectively) for 3 weeks. Patients also received ribavirin. Administration by the devices was evaluated under direct observation by a study staff member and by patient subjective assessment. Results In trial 1, following a single dose of peginterferon alfa-2a, the maximum plasma concentration was 16.1 ± 5.3 ng/mL (mean ± standard deviation), and area under the concentration time curve (0–168 hours) was 1996 ± 613 ng · hour/mL, similar to that reported using a vial/syringe or prefilled syringe. In trial 2, few patients showed handling difficulties with either device. Generally, patients were observed to be more satisfied and confident, followed instructions better, and successfully initiated injection with the autoinjector versus the prefilled syringe. Patients reported the autoinjector to be more convenient and easier to use. No pain or discomfort was experienced using the autoinjector. The autoinjector safety profile

Safe Practices for Copy and Paste in the EHR

PubMed Central

Lehmann, Christoph U.; Michel, Jeremy; Solomon, Ronni; Possanza, Lorraine; Gandhi, Tejal

2017-01-01

Summary Background Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). Objective To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. Methods The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. Results The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Conclusion Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate

Outcomes after repair of chronic bucket-handle tears of medial meniscus.

PubMed

Espejo-Reina, Alejandro; Serrano-Fernández, José Miguel; Martín-Castilla, Belén; Estades-Rubio, Francisco Javier; Briggs, Karen K; Espejo-Baena, Alejandro

2014-04-01

The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes. A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al. Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases. This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17

WASTE HANDLING BUILDING ELECTRICAL SYSTEM DESCRIPTION DOCUMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

S.C. Khamamkar

2000-06-23

The Waste Handling Building Electrical System performs the function of receiving, distributing, transforming, monitoring, and controlling AC and DC power to all waste handling building electrical loads. The system distributes normal electrical power to support all loads that are within the Waste Handling Building (WHB). The system also generates and distributes emergency power to support designated emergency loads within the WHB within specified time limits. The system provides the capability to transfer between normal and emergency power. The system provides emergency power via independent and physically separated distribution feeds from the normal supply. The designated emergency electrical equipment will bemore » designed to operate during and after design basis events (DBEs). The system also provides lighting, grounding, and lightning protection for the Waste Handling Building. The system is located in the Waste Handling Building System. The system consists of a diesel generator, power distribution cables, transformers, switch gear, motor controllers, power panel boards, lighting panel boards, lighting equipment, lightning protection equipment, control cabling, and grounding system. Emergency power is generated with a diesel generator located in a QL-2 structure and connected to the QL-2 bus. The Waste Handling Building Electrical System distributes and controls primary power to acceptable industry standards, and with a dependability compatible with waste handling building reliability objectives for non-safety electrical loads. It also generates and distributes emergency power to the designated emergency loads. The Waste Handling Building Electrical System receives power from the Site Electrical Power System. The primary material handling power interfaces include the Carrier/Cask Handling System, Canister Transfer System, Assembly Transfer System, Waste Package Remediation System, and Disposal Container Handling Systems. The system interfaces with the MGR

50 CFR 14.111 - Handling.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION..., EXPORTATION, AND TRANSPORTATION OF WILDLIFE Standards for the Humane and Healthful Transport of Wild Mammals and Birds to the United States § 14.111 Handling. (a) Care shall be exercised to avoid handling the...

Fluid handling equipment: A compilation

NASA Technical Reports Server (NTRS)

1976-01-01

Devices and techniques used in fluid-handling and vacuum systems are described. Section 1 presents several articles on fluid lines and tubing. Section 2 describes a number of components such as valves, filters, and regulators. The last section contains descriptions of a number of innovative fluid-handling systems.

SLUG HANDLING DEVICES

DOEpatents

Gentry, J.R.

1958-09-16

A device is described for handling fuel elements of a neutronic reactor. The device consists of two concentric telescoped contalners that may fit about the fuel element. A number of ratchet members, equally spaced about the entrance to the containers, are pivoted on the inner container and spring biased to the outer container so thnt they are forced to hear against and hold the fuel element, the weight of which tends to force the ratchets tighter against the fuel element. The ratchets are released from their hold by raising the inner container relative to the outer memeber. This device reduces the radiation hazard to the personnel handling the fuel elements.

Family caregivers' experience of activities of daily living handling in older adult with stroke: a qualitative research in the Iranian context.

PubMed

Hesamzadeh, Ali; Dalvandi, Asghar; Bagher Maddah, Sadat; Fallahi Khoshknab, Masoud; Ahmadi, Fazlollah; Mosavi Arfa, Nazila

2017-09-01

Patients with stroke require additional support from family to live independently in the area of activities of daily living. Family members are usually the main caregivers of stroke patients. Comprehensive explanation of ADL handling from family caregivers' view is lacking. This study explores and describes family caregivers' experiences about the strategies to handle activities of daily living (ADL) dependency of elderly patient with stroke in the Iranian context. A qualitative content analysis approach was conducted to analyse data. Nineteen family caregivers participated in the study from multiple physiotherapy clinics of physiotherapy in Sari (Iran) between September 2013 and May 2014. Data were generated through in-depth interviews, and content analysis method was used to analyse the data and determine themes. The findings show that family caregivers manage the ADL dependency of their elderly stroke patients through seven strategies including encouraging physical movements, providing personal hygiene, nutritional consideration, facilitating religious activities, filling leisure time, and facilitating transfer and assisting in financial issues. Family has an important role in handling of elderly stroke patients' ADL dependency. Health practitioners can take benefit from the findings to help the stroke families play more active role in the handling ADL dependency of their patients after stroke. © 2016 Nordic College of Caring Science.

Analysis of multiple activity manual materials handling tasks using A Guide to Manual Materials Handling.

PubMed

Mital, A

1999-01-01

Manual handling of materials continues to be a hazardous activity, leading to a very significant number of severe overexertion injuries. Designing jobs that are within the physical capabilities of workers is one approach ergonomists have adopted to redress this problem. As a result, several job design procedures have been developed over the years. However, these procedures are limited to designing or evaluating only pure lifting jobs or only the lifting aspect of a materials handling job. This paper describes a general procedure that may be used to design or analyse materials handling jobs that involve several different kinds of activities (e.g. lifting, lowering, carrying, pushing, etc). The job design/analysis procedure utilizes an elemental approach (breaking the job into elements) and relies on databases provided in A Guide to Manual Materials Handling to compute associated risk factors. The use of the procedure is demonstrated with the help of two case studies.

Information Handling is the Problem

NASA Technical Reports Server (NTRS)

Malin, Jane T.

2001-01-01

This slide presentation reviews the concerns surrounding the automation of information handling. There are two types of decision support software that supports most Space Station Flight Controllers. one is very simple, and the other is very complex. A middle ground is sought. This is the reason for the Human Centered Autonomous and Assistant Systems Testbed (HCAAST) Project. The aim is to study flight controllers at work, and in the bigger picture, with particular attention to how they handle information and how coordination of multiple teams is performed. The focus of the project is on intelligent assistants to assist in handling information for the flight controllers.

7 CFR 926.9 - Handle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.9 Handle. Handle... contract carrier of cranberries owned by another person) fresh or processed cranberries produced within or outside the United States or in any other way to place fresh or processed cranberries into the current of...

7 CFR 926.9 - Handle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.9 Handle. Handle... contract carrier of cranberries owned by another person) fresh or processed cranberries produced within or outside the United States or in any other way to place fresh or processed cranberries into the current of...

7 CFR 926.9 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.9 Handle. Handle... contract carrier of cranberries owned by another person) fresh or processed cranberries produced within or outside the United States or in any other way to place fresh or processed cranberries into the current of...

7 CFR 926.9 - Handle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.9 Handle. Handle... contract carrier of cranberries owned by another person) fresh or processed cranberries produced within or outside the United States or in any other way to place fresh or processed cranberries into the current of...

Women of low socioeconomic status living with diabetes: Becoming adept at handling a disease.

PubMed

Boonsatean, Wimonrut; Dychawy Rosner, Irena; Carlsson, Anna; Östman, Margareta

2015-01-01

The objective of this study was to explore how Thai women of low socioeconomic status handle their type 2 diabetes. A qualitative interpretative method was used to study 19 women with type 2 diabetes in a suburban community in Thailand. Data were collected via semi-structured interviews and were analysed using inductive and constructive processes. Participants' lives underwent many changes between their initial diagnoses and later stages when they became adept at handling diabetes. Two themes emerged, which involved (1) the transition to handling diabetes and (2) the influences of the social environment. The first theme encompassed confronting the disease, reaching a turning point in the process of adaptation and developing expertise in handling diabetes. The second theme involved threats of loss of status and empowerment by families. These findings showed that becoming adept at handling diabetes required significant changes in women's behaviours and required taking advantage of influences from the social environment. The process of developing expertise in handling diabetes was influenced by both inner and outer factors that required adjustment to learn to live with diabetes. Furthermore, the reductions found in women's social statuses when they become patients in the healthcare system might pose a barrier to women of low socioeconomic status becoming adept at handling diabetes. However, the experiences of empowerment received from the women's families acted as a powerful strategy to strengthen their handling of the disease. To develop accessible and sensitive health care for this population, it is important to pay attention to these findings.

7 CFR 996.4 - Handle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DOMESTIC AND IMPORTED PEANUTS MARKETED IN THE UNITED STATES Definitions § 996.4 Handle. Handle means to... imported peanuts and in the shipment (except as a common or contract carrier of peanuts owned by another) or sale of cleaned-inshell or shelled peanuts or other activity causing peanuts to enter into human...

A new approach to handling incoming verifications.

PubMed

Luizzo, Anthony; Roy, Bill; Luizzo, Philip

2016-10-01

Outside requests for data on current or former employees are handled in different ways by healthcare organizations and present considerable liability risks if a corporate policy for handling such risks is not in place. In this article, the authors present a strategy for responsible handling of sensitive information.

9 CFR 114.11 - Storage and handling.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Storage and handling. 114.11 Section... BIOLOGICAL PRODUCTS § 114.11 Storage and handling. Biological products at licensed establishments shall be protected at all times against improper storage and handling. Completed product shall be kept under...

9 CFR 114.11 - Storage and handling.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Storage and handling. 114.11 Section... BIOLOGICAL PRODUCTS § 114.11 Storage and handling. Biological products at licensed establishments shall be protected at all times against improper storage and handling. Completed product shall be kept under...

9 CFR 114.11 - Storage and handling.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Storage and handling. 114.11 Section... BIOLOGICAL PRODUCTS § 114.11 Storage and handling. Biological products at licensed establishments shall be protected at all times against improper storage and handling. Completed product shall be kept under...

14 CFR 25.489 - Ground handling conditions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Ground handling conditions. 25.489 Section... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Ground Loads § 25.489 Ground handling conditions... ground handling conditions). No wing lift may be considered. The shock absorbers and tires may be assumed...

14 CFR 25.489 - Ground handling conditions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Ground handling conditions. 25.489 Section... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Ground Loads § 25.489 Ground handling conditions... ground handling conditions). No wing lift may be considered. The shock absorbers and tires may be assumed...

Fast, Safe, Propellant-Efficient Spacecraft Motion Planning Under Clohessy-Wiltshire-Hill Dynamics

NASA Technical Reports Server (NTRS)

Starek, Joseph A.; Schmerling, Edward; Maher, Gabriel D.; Barbee, Brent W.; Pavone, Marco

2016-01-01

This paper presents a sampling-based motion planning algorithm for real-time and propellant-optimized autonomous spacecraft trajectory generation in near-circular orbits. Specifically, this paper leverages recent algorithmic advances in the field of robot motion planning to the problem of impulsively actuated, propellant- optimized rendezvous and proximity operations under the Clohessy-Wiltshire-Hill dynamics model. The approach calls upon a modified version of the FMT* algorithm to grow a set of feasible trajectories over a deterministic, low-dispersion set of sample points covering the free state space. To enforce safety, the tree is only grown over the subset of actively safe samples, from which there exists a feasible one-burn collision-avoidance maneuver that can safely circularize the spacecraft orbit along its coasting arc under a given set of potential thruster failures. Key features of the proposed algorithm include 1) theoretical guarantees in terms of trajectory safety and performance, 2) amenability to real-time implementation, and 3) generality, in the sense that a large class of constraints can be handled directly. As a result, the proposed algorithm offers the potential for widespread application, ranging from on-orbit satellite servicing to orbital debris removal and autonomous inspection missions.

Catheter-based intervention for symptomatic patient with severe mitral regurgitation and very poor left ventricular systolic function - Safe but no room for complacency.

PubMed

Loh, Poay Huan; Bourantas, Christos V; Chan, Pak Hei; Ihlemann, Nikolaj; Gustafsson, Fin; Clark, Andrew L; Price, Susanna; Mario, Carlo Di; Moat, Neil; Alamgir, Farqad; Estevez-Loureiro, Rodrigo; Søndergaard, Lars; Franzen, Olaf

2015-11-26

Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation (MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous MitraClip(®) can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures.

Catheter-based intervention for symptomatic patient with severe mitral regurgitation and very poor left ventricular systolic function - Safe but no room for complacency

PubMed Central

Loh, Poay Huan; Bourantas, Christos V; Chan, Pak Hei; Ihlemann, Nikolaj; Gustafsson, Fin; Clark, Andrew L; Price, Susanna; Mario, Carlo Di; Moat, Neil; Alamgir, Farqad; Estevez-Loureiro, Rodrigo; Søndergaard, Lars; Franzen, Olaf

2015-01-01

Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation (MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous MitraClip® can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures. PMID:26635930

Safe sex self-efficacy and safe sex practice in a Southern United States College

PubMed Central

Addoh, Ovuokerie; Sng, Eveleen; Loprinzi, Paul D.

2017-01-01

Background: The purpose of this study was to assess the association between safe sex self-efficacy and safe-sex practice in a Southern college setting. Methods: Multivariable logistic regression models were used to examine the association between safe sex self-efficacy in four domains (mechanics, partner disapproval, assertiveness, intoxicants) and safe sex practice (outcome variable). Results: For every 1-unit increase in the composite condom use self-efficacy score, there was an 8% increase in the odds of being beyond the median safe-sex practice score (odds ration [OR]: 1.08, 95% CI: 1.02-1.15). Additionally, for every 1-unit increase in intoxicants self-efficacy score, there was a 31% increase in the odds of being beyond the median safe-sex practice score (OR: 1.31, 95% CI: 1.08-1.58). Conclusion: A greater degree of safe-sex self-efficacy is associated with increased odds of safe-sex practice. These findings are informative for the development of targeted approaches to foster safe-sex behavior in Southern US colleges. PMID:28326287

Llama handling and training.

PubMed

McGee, M

1994-07-01

This article offers insights into the relationship of llama owners to their animals and the role of veterinarians as part of the animal care team. The effect of human behavior and handling techniques on llama behavior and marketability are discussed. Progressive ideas for nonforceful llama handling equipment, procedures, and training ideas are outlined in detail. Included are specific training plans for routine herd management chores such as injections and toenail trimming. This article is useful for both veterinarians and llama owners.

DroidSafe

DTIC Science & Technology

2016-12-01

branches of our work . 3.1 Understanding Sensitive API Call and API Information Usage Android applications are written in a type- safe language (Java...directly invoke resolved targets. Because DroidSafe works with a comprehensive model of the Android environment , it supports precise resolution of...STATEMENT. FOR THE CHIEF ENGINEER: / S / / S / MARK K. WILLIAMS WARREN H. DEBANY, JR. Work Unit Manager

A Safe Ride to School; A Safe Ride Home.

ERIC Educational Resources Information Center

Illinois State Board of Education, Springfield.

Text and illustrations are used to teach safe school bus riding practices. The guide begins with instructions to parents or guardians to set a good example of safe behavior, and to help children learn safety rules and be on time. Instructions to children concern obeying the bus driver, boarding the bus, riding the bus, crossing the road, and using…

Ergonomics of disposable handles for minimally invasive surgery.

PubMed

Büchel, D; Mårvik, R; Hallabrin, B; Matern, U

2010-05-01

The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (approximately 20%) and during precise maneuvering and targeting (approximately 20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more

The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study.

PubMed

O'Hara, Jane K; Lawton, Rebecca J; Armitage, Gerry; Sheard, Laura; Marsh, Claire; Cocks, Kim; McEachan, Rosie R C; Reynolds, Caroline; Watt, Ian; Wright, John

2016-11-28

There is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement. We conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised. Recruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co

Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study.

PubMed

Laffey, John G; Madotto, Fabiana; Bellani, Giacomo; Pham, Tài; Fan, Eddy; Brochard, Laurent; Amin, Pravin; Arabi, Yaseen; Bajwa, Ednan K; Bruhn, Alejandro; Cerny, Vladimir; Clarkson, Kevin; Heunks, Leo; Kurahashi, Kiyoyasu; Laake, Jon Henrik; Lorente, Jose A; McNamee, Lia; Nin, Nicolas; Palo, Jose Emmanuel; Piquilloud, Lise; Qiu, Haibo; Jiménez, Juan Ignacio Silesky; Esteban, Andres; McAuley, Daniel F; van Haren, Frank; Ranieri, Marco; Rubenfeld, Gordon; Wrigge, Hermann; Slutsky, Arthur S; Pesenti, Antonio

2017-08-01

Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO 2 ) to the fractional concentration of oxygen in inspired air (F i O 2 ) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of

Dynamic stability and handling qualities tests on a highly augmented, statically unstable airplane

NASA Technical Reports Server (NTRS)

Gera, Joseph; Bosworth, John T.

1987-01-01

Initial envelope clearance and subsequent flight testing of a new, fully augmented airplane with an extremely high degree of static instability can place unusual demands on the flight test approach. Previous flight test experience with these kinds of airplanes is very limited or nonexistent. The safe and efficient flight testing may be further complicated by a multiplicity of control effectors that may be present on this class of airplanes. This paper describes some novel flight test and analysis techniques in the flight dynamics and handling qualities area. These techniques were utilized during the initial flight envelope clearance of the X-29A aircraft and were largely responsible for the completion of the flight controls clearance program without any incidents or significant delays.

Immediate Titanium Mesh Implantation for Patients with Postcraniotomy Neurosurgical Site Infections: Safe and Aesthetic Alternative Procedure?

PubMed

Ehrlich, Gregory; Kindling, Stefanie; Wenz, Holger; Hänggi, Daniel; Schulte, Dirk Michael; Schmiedek, Peter; Seiz-Rosenhagen, Marcel

2017-03-01

Surgical site infection (SSI) is one of the main complications after craniotomy. The incidence is up to 11% in the literature. The established procedure is debridement, removal of the bone flap, and delayed cranioplasty. Delayed cranioplasty has several disadvantages. A promising approach is the immediate titanium mesh implantation at the time of wound revision. We report our experience with this technique regarding outcome measured by reinfection rates and patient satisfaction. Patients treated in our department from January 2013 to October 2014 with SSI after craniotomy for brain tumor, trauma, or vascular pathologies were prospectively collected. In all these patients, immediate titanium mesh implantation after bone flap removal was performed. Primary outcome parameters were the reinfection rate and patient satisfaction via self-designed questionnaires in a follow-up period >3 months. Twenty-four patients were included within the study period. Main risk factors causing SSI were previous steroid medication (62.5%), cranial radiation therapy (42%), cerebrospinal fluid fistula after initial surgery (12.5%), and diabetes mellitus (25%). The follow-up was >3 months after titanium mesh cranioplasty (mean 4.6 months; range 3-6 months). No recurrent infection was detected in the study group. In 2 cases, reoperation was necessary. The returning questionnaires showed a high satisfaction rate with the cosmetic result. Our small series seems to confirm that immediate titanium mesh implantation for patients with postcraniotomy SSI is a cost-effective, safe, and cosmetically suitable alternative to delayed cranioplasty in selected patients without hydrocephalus or persistent cerebrospinal fluid fistula. Copyright © 2016 Elsevier Inc. All rights reserved.

14 CFR 158.49 - Handling of PFC's.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Handling of PFC's. 158.49 Section 158.49... PASSENGER FACILITY CHARGES (PFC'S) Collection, Handling, and Remittance of PFC's § 158.49 Handling of PFC's... amount of PFC revenue in the covered air carrier's account at the time the bankruptcy petition is filed...

14 CFR 158.49 - Handling of PFC's.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Handling of PFC's. 158.49 Section 158.49... PASSENGER FACILITY CHARGES (PFC'S) Collection, Handling, and Remittance of PFC's § 158.49 Handling of PFC's... amount of PFC revenue in the covered air carrier's account at the time the bankruptcy petition is filed...

14 CFR 158.49 - Handling of PFC's.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Handling of PFC's. 158.49 Section 158.49... PASSENGER FACILITY CHARGES (PFC'S) Collection, Handling, and Remittance of PFC's § 158.49 Handling of PFC's... amount of PFC revenue in the covered air carrier's account at the time the bankruptcy petition is filed...

14 CFR 158.49 - Handling of PFC's.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Handling of PFC's. 158.49 Section 158.49... PASSENGER FACILITY CHARGES (PFC'S) Collection, Handling, and Remittance of PFC's § 158.49 Handling of PFC's... amount of PFC revenue in the covered air carrier's account at the time the bankruptcy petition is filed...

14 CFR 158.49 - Handling of PFC's.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Handling of PFC's. 158.49 Section 158.49... PASSENGER FACILITY CHARGES (PFC'S) Collection, Handling, and Remittance of PFC's § 158.49 Handling of PFC's... amount of PFC revenue in the covered air carrier's account at the time the bankruptcy petition is filed...

Ground data handling for LANDSAT-D

NASA Technical Reports Server (NTRS)

Lynch, T. J.

1976-01-01

The present plans for the LANDSAT D ground data handling are described in relationship to the mission objectives and the planned spacecraft system. The end to end data system is presented with particular emphasis on the data handling plans for the new instrument, the Thematic Mapper. This instrument generates ten times the amount of data per scene as the present Multispectral Scanner, and this resulting data rate and volume are discussed as well as possible new data techniques to handle them such as image compression.

Mooring and ground handling rigid airships

NASA Technical Reports Server (NTRS)

Walker, H., Jr.

1975-01-01

The problems of mooring and ground handling rigid airships are discussed. A brief history of Mooring and Ground Handling Rigid Airships from July 2, 1900 through September 1, 1939 is included. Also a brief history of ground handling developments with large U. S. Navy nonrigid airships between September 1, 1939 and August 31, 1962 is included wherein developed equipment and techniques appear applicable to future large rigid airships. Finally recommendations are made pertaining to equipment and procedures which appear desirable and feasible for future rigid airship programs.

Renal creatinine handling in very old patients with chronic renal disease.

PubMed

Musso, Carlos G; Michelángelo, Hernán; Vilas, Manuel; Martinez, Bernardo; Bonetto, Alberto; Jauregui, Ricardo; Algranati, Luis

2011-09-01

Renal creatinine handling is basically the result of its glomerular filtration and proximal tubular secretion. However, creatinine reabsorption has been documented in certain conditions, such as premature babies, newborns, and healthy elderly people. Additionally, it is known that there is an increase in the proportion of secreted creatinine in chronic renal disease. In this paper, we report our studies on the characteristic reabsorption pattern of creatinine in the elderly with chronic renal disease. We studied twenty-seven volunteers with chronic kidney disease, eleven of whom were young and the rest were very old (age > 75 years old). We measured creatinine clearance without (Ccr) and with cimetidine (CcrWC) and Ccr/CcrWC ratio from each volunteer, in timed urine samples. Then, Ccr, CcrWC, and Ccr/CcrWC ratio were compared between young and very old people in two chronic kidney disease subgroups: stages II-III and stages IV-V. Statistical analysis was performed applying a non-parametric test (Wilcoxon). We observed a tendency towards a lower Ccr/CcrWC ratio in the very old stage II-III group compared with the young one: 1 (0.96-1.26) (very old) vs 1.3 (1.1-1.5) (young), P = 0.09, on the contrary, there was no significant difference in Ccr/CcrWC ratio between very old and young person with stage IV-V CKD: 1.66 (1.41-2.21) (young) vs 1.77 (1.1-2.7) (young), P = NS. Creatinine secretion pattern in very old patients with advanced chronic renal disease is similar to that observed in young ones with similar level of CKD.

Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients.

PubMed

Tan, Ferdinand Frederik Som Ling; Schiere, Sjouke; Reidinga, Auke C; Wit, Fennie; Veldman, Peter Hjm

2015-01-01

Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block. Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion. Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day. A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.

[Prevention and handling of missing data in clinical trials].

PubMed

Jiang, Zhi-wei; Li, Chan-juan; Wang, Ling; Xia, Jie-lai

2015-11-01

Missing data is a common but unavoidable issue in clinical trials. It not only lowers the trial power, but brings the bias to the trial results. Therefore, on one hand, the missing data handling methods are employed in data analysis. On the other hand, it is vital to prevent the missing data in the trials. Prevention of missing data should take the first place. From the perspective of data, firstly, some measures should be taken at the stages of protocol design, data collection and data check to enhance the patients' compliance and reduce the unnecessary missing data. Secondly, the causes of confirmed missing data in the trials should be notified and recorded in detail, which are very important to determine the mechanism of missing data and choose the suitable missing data handling methods, e.g., last observation carried forward (LOCF); multiple imputation (MI); mixed-effect model repeated measure (MMRM), etc.

Endovascular repair of thoracic aortic traumatic transections is a safe method in patients with complicated injuries.

PubMed

Rahimi, Saum A; Darling, R Clement; Mehta, Manish; Roddy, Sean P; Taggert, John B; Sternbach, Yaron

2010-10-01

Historically thoracic aortic rupture secondary to trauma was treated with cardiopulmonary bypass and open surgery. With the advent of endovascular grafting, physicians have the ability to reconstruct the thoracic aortic transection using a less invasive technique. In this study, we examine our experience with stent graft repair of thoracic transections secondary to trauma. The medical records of patients treated at a level I trauma center from 2005 to 2008 were reviewed. Those patients who had an aortic transection treated with an endograft were identified and evaluated for in-hospital mortality and morbidity and concurrent injuries. Demographics, procedural details, and outcomes were analyzed. Over a 3-year period, 18 thoracic aortic transections secondary to trauma were identified in patients with a mean age of 43 (range, 16-80). Primary technical success was 100%. None of the patients required explant or open repair during this time period. In-hospital mortality was 2 of 18 (11%); all patients had multiple trauma including long bone fractures. The subclavian artery origin was covered by the stent graft in 9 of the 18 patients. The mean estimated blood loss per procedure was 222 cc. No patient in this series had postoperative paraplegia. Follow-up ranged from 1 to 50 months with an average of 13 months. There have been no late explantation or device failures identified. Endovascular repair of traumatic thoracic aortic transections can be performed safely with a relatively low mortality and morbidity and should be the procedure of choice for patients presenting with traumatic thoracic aortic ruptures. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Use Medicines Safely

MedlinePlus

... Medicines Safely Print This Topic En español Use Medicines Safely Browse Sections The Basics Overview Prescription Medicines ... Medicines 1 of 7 sections The Basics: Prescription Medicines There are different types of medicine. The 2 ...

Rotorcraft handling-qualities design criteria development

NASA Technical Reports Server (NTRS)

Aiken, Edwin W.; Lebacqz, J. Victor; Chen, Robert T. N.; Key, David L.

1988-01-01

Joint NASA/Army efforts at the Ames Research Center to develop rotorcraft handling-qualities design criteria began in earnest in 1975. Notable results were the UH-1H VSTOLAND variable stability helicopter, the VFA-2 camera-and-terrain-board simulator visual system, and the generic helicopter real-time mathematical model, ARMCOP. An initial series of handling-qualities studies was conducted to assess the effects of rotor design parameters, interaxis coupling, and various levels of stability and control augmentation. The ability to conduct in-flight handling-qualities research was enhanced by the development of the NASA/Army CH-47 variable-stability helicopter. Research programs conducted using this vehicle include vertical-response investigations, hover augmentation systems, and the effects of control-force characteristics. The handling-qualities data base was judged to be sufficient to allow an update of the military helicopter handling-qualities specification, MIL-H-8501. These efforts, including not only the in-house experimental work but also contracted research and collaborative programs performed under the auspices of various international agreements. The report concludes by reviewing the topics that are currently most in need of work, and the plans for addressing these topics.

Handling of drug-related emergencies: an evaluation of emergency medical dispatch.

PubMed

Tonje, Lorem; Elisabeth, Saether; Lars, Wik

2009-02-01

Documenting the quality of emergency dispatch centres handling of emergency calls regarding intoxicated unconscious patients. Interview with eight emergency dispatch centre directors and a nationwide survey among 313 dispatchers in Norway were performed. In addition, a customized scoring system was used to evaluate dispatcher log recordings of real cases. The recordings were compared with information from corresponding ambulance records. Ninety-nine percent of the dispatchers stated that they used the Norwegian protocol for medical emergencies and 89% of them found it useful. The interviews, the survey, and the recordings, however, documented frequent deviation from the protocol. This instructs ambulance dispatch for any unconscious patient, but 21% stated that they would not dispatch any resource for an unconscious patient without further survey in alcohol-related cases. This was significantly more often (P<0.05) than for the narcotic, combination and prescription - drug-related cases with 4, 10 and 7%, respectively. The recordings revealed deviation from the protocol with dispatchers only determining the patients' level of consciousness and respiratory status in 64 and 70% of the cases, respectively. For 16% of the cases, the dispatcher did not ask the caller about consciousness at all, even though these patients later were found with reduced consciousness. On the basis of the interviews and the survey, cases were handled according to guidelines. The log recordings, however, disclosed deviation from the protocol. Alcohol intoxication was associated with higher rate of deviation from the protocol compared with other intoxications.

Ontological approach for safe and effective polypharmacy prescription

PubMed Central

Grando, Adela; Farrish, Susan; Boyd, Cynthia; Boxwala, Aziz

2012-01-01

The intake of multiple medications in patients with various medical conditions challenges the delivery of medical care. Initial empirical studies and pilot implementations seem to indicate that generic safe and effective multi-drug prescription principles could be defined and reused to reduce adverse drug events and to support compliance with medical guidelines and drug formularies. Given that ontologies are known to provide well-principled, sharable, setting-independent and machine-interpretable declarative specification frameworks for modeling and reasoning on biomedical problems, we explore here their use in the context of multi-drug prescription. We propose an ontology for modeling drug-related knowledge and a repository of safe and effective generic prescription principles. To test the usability and the level of granularity of the developed ontology-based specification models and heuristic we implemented a tool that computes the complexity of multi-drug treatments, and a decision aid to check the safeness and effectiveness of prescribed multi-drug treatments. PMID:23304299

Safe use of chemicals for sterilization in healthcare.

PubMed

Warburton, P Richard

2012-01-01

Chemical sterilization is necessary for temperature sensitive items that cannot be sterilized with steam. These chemical sterilants are by their nature hazardous; otherwise, they would not function well. Modern sterilizers and associated equipment are designed so that these chemicals can be used safely. Whether through mechanical failure, wear and tear, or user error, leaks do sometimes occur. The maximum chemical exposure is determined by OSHA permissible exposure limits, if available, and if not available, employers should use recognized standards. Employers have a duty to ensure safe work environment and take appropriate action to mitigate potential risks. Employers should therefore assess the hazards of the chemicals used, the potential modes for leakage, means for identifying leaks and the risk of exposure of employees. Ideally, work practices should be developed by healthcare facilities so that sterile processing employees know what to do in case of a chemical leak or spill, and how to safely use these chemicals to ensure their own, and patient safety.

Hypoglycemia and safe driving

PubMed Central

Ahmed, Almoutaz A.

2010-01-01

The lack of awareness of the effects of hypoglycemia on safe driving is a real issue for diabetic patients and a challenge for health care providers. Taking the form of questions and answers, this review addresses the issue of road traffic accidents and drivers with type 1 diabetes mellitus. While there is little evidence showing higher accident rates among diabetic drivers, there is research indicating that hypoglycemia compromises driving performance, resulting in slower response times and reduced cognitive function. Unawareness of an early fall in plasma glucose is another important issue that affects some diabetic drivers. The driver with type 1 diabetes is obliged to check their blood glucose before driving. The physician’s duty is to familiarize the patient with the risk of hypoglycemia. If hypoglycemic unawareness is present, the physician should advise the patient to stop driving until the condition is reversed. The doctor should consider informing authorities if he concludes there is a risk and the driver cannot be persuaded to stop driving. PMID:21060159

SU-E-I-97: Smart Auto-Planning Framework in An EMR Environment (SAFEE)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, B; Chen, S; Mutaf, Y

2014-06-01

Purpose: Our Radiation Oncology Department uses clinical practice guidelines for patient treatment, including normal tissue sparing and other dosimetric constraints. These practice guidelines were adapted from national guidelines, clinical trials, literature reviews, and practitioner's own experience. Modern treatment planning systems (TPS) have the capability of incorporating these practice guidelines to automatically create radiation therapy treatment plans with little human intervention. We are developing a software infrastructure to integrate clinical practice guidelines and radiation oncology electronic medical record (EMR) system into radiation therapy treatment planning system (TPS) for auto planning. Methods: Our Smart Auto-Planning Framework in an EMR environment (SAFEE) usesmore » a software pipeline framework to integrate practice guidelines,EMR, and TPS together. The SAFEE system starts with retrieving diagnosis information and physician's prescription from the EMR system. After approval of contouring, SAFEE will automatically create plans according to our guidelines. Based on clinical objectives, SAFEE will automatically select treatment delivery techniques (such as, 3DRT/IMRT/VMAT) and optimize plans. When necessary, SAFEE will create multiple treatment plans with different combinations of parameters. SAFEE's pipeline structure makes it very flexible to integrate various techniques, such as, Model-Base Segmentation (MBS) and plan optimization algorithms, e.g., Multi-Criteria Optimization (MCO). In addition, SAFEE uses machine learning, data mining techniques, and an integrated database to create clinical knowledgebase and then answer clinical questions, such as, how to score plan quality or how volume overlap affects physicians' decision in beam and treatment technique selection. Results: In our institution, we use Varian Aria EMR system and RayStation TPS from RaySearch, whose ScriptService API allows control by external programs. These

Picture Me Safe

ERIC Educational Resources Information Center

Irvin, Daniel W.

1977-01-01

The validity of well-written articles can be destroyed by poor illustration, especially when the pictures show unsafe practices. The responsibility lies with the author to provide clear printable pictures showing safe working environments and safe practices. (Editor)

The Safe Correction Angle of Osteotomy at T12 and L1 for Ankylosing Spondylitis Kyphosis: Patients With 2-level Osteotomy.

PubMed

Liu, Chao; Yu, Wen; Zheng, Guoquan; Guo, Yue; Song, Kai; Tang, Xiangyu; Wang, Zheng; Wang, Yan; Zhang, Yonggang

2017-08-01

This is a retrospective clinical study. To investigate the correction angle and safety of the spinal osteotomy at the T12 or L1 vertebra. Monosegment subtraction osteotomy cannot effectively correct severe kyphosis in ankylosing spondylitis (AS), generally 2-level spinal osteotomy was taken for achieving expected correction. According to literature, the T12 or L1 were usually taken as the upper spinal osteotomy vertebra. Because of the canalis vertebralis at the T12 and L1 were spinal cord and medullary cone, so the spinal osteotomy at the T12 or L1 vertebra were more dangerous than at lower level. The correction angle and safety of the spinal osteotomy at the T12 or L1 vertebra have not yet been reported. From July 2009 to 2014, 33 patients in our department with severe AS kyphosis underwent 2-level pedicle subtraction osteotomy were studied. Preoperative and postoperative relevant parameters and complications were recorded. The upper spinal osteotomy was taken at the T12 vertebra for 10 patients. The upper spinal osteotomy was taken at the L1 vertebra for 23 patients. The mean amount of correction of T12 and L1 was 26.230 and 27.952 degrees, respectively. All patients could walk with orthophoria and lie horizontally postoperatively. No deadly vascular and neurological lesion occurred. Performing pedicle subtraction osteotomy at T12 and L1 can safely achieve a mean correction of 26.230 and 27.952 degrees, respectively. Two-level osteotomy was safely and advocated for correcting severe AS kyphosis. Level III.

Exception handling for sensor fusion

NASA Astrophysics Data System (ADS)

Chavez, G. T.; Murphy, Robin R.

1993-08-01

This paper presents a control scheme for handling sensing failures (sensor malfunctions, significant degradations in performance due to changes in the environment, and errant expectations) in sensor fusion for autonomous mobile robots. The advantages of the exception handling mechanism are that it emphasizes a fast response to sensing failures, is able to use only a partial causal model of sensing failure, and leads to a graceful degradation of sensing if the sensing failure cannot be compensated for. The exception handling mechanism consists of two modules: error classification and error recovery. The error classification module in the exception handler attempts to classify the type and source(s) of the error using a modified generate-and-test procedure. If the source of the error is isolated, the error recovery module examines its cache of recovery schemes, which either repair or replace the current sensing configuration. If the failure is due to an error in expectation or cannot be identified, the planner is alerted. Experiments using actual sensor data collected by the CSM Mobile Robotics/Machine Perception Laboratory's Denning mobile robot demonstrate the operation of the exception handling mechanism.

Postproduction Handling and Administration of Protein Pharmaceuticals and Potential Instability Issues.

PubMed

Nejadnik, M Reza; Randolph, Theodore W; Volkin, David B; Schöneich, Christian; Carpenter, John F; Crommelin, Daan J A; Jiskoot, Wim

2018-04-14

The safety and efficacy of protein pharmaceuticals depend not only on biological activity but also on purity levels. Impurities may be process related because of limitations in manufacturing or product related because of protein degradation occurring throughout the life history of a product. Although the pharmaceutical biotechnology industry has made great progress in improving bulk and drug product manufacturing as well as company-controlled storage and transportation conditions to minimize the level of degradation, there is less control over the many factors that may subsequently affect product quality after the protein pharmaceuticals are released and shipped by the manufacturer. Routine handling or unintentional mishandling of therapeutic protein products may cause protein degradation that remains unnoticed but can potentially compromise the clinical safety and efficacy of the product. In this commentary, we address some potential risks associated with (mis)handling of protein pharmaceuticals after release by the manufacturer. We summarize the environmental stress factors that have been shown to cause protein degradation and that may be encountered during typical handling procedures of protein pharmaceuticals in a hospital setting or during self-administration by patients. Moreover, we provide recommendations for improvements in product handling to help ensure the quality of protein pharmaceuticals during use. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer.

PubMed

Siddiq, Somiah; Cartlidge, David; Stephen, Sarah; Sathasivam, Hans P; Fox, Hannah; O'Hara, James; Meikle, David; Iqbal, Muhammad Shahid; Kelly, Charles G; Robinson, Max; Paleri, Vinidh

2018-05-12

Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.

Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study.

PubMed

Smith, Margaret Coulter; O'May, Fiona; Tropea, Savina; Berg, Jackie

2016-10-01

guidelines to specific patients/contexts. Patients' experiences of moving and handling have received limited attention. Increased focus on musculoskeletal conditions and moving and handling implications is required. © 2016 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases

PubMed Central

Reimers, Mallory; Ernst, Neysa; Bova, Gregory; Nowakowski, Elaine; Bukowski, James; Ellis, Brandon C.; Smith, Chris; Sauer, Lauren; Dionne, Kim; Carroll, Karen C.; Maragakis, Lisa L.; Parrish, Nicole M.

2016-01-01

ABSTRACT In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste. PMID:27927920

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.