Safety Documentation Research Articles

Organization of immunization services for public health

Immunization is a key public health intervention that can help nations attain Goal #3 of the UN Sustainable Development Goals as vaccines already prevent about 2–3 million deaths each year. To be effective, immunization services must be designed and delivered in a way to reach populations who need them, irrespective of who they are and where they live. Effective national immunization systems must have clear plans based on a vision of the future and a step-by-step process on how the vision will be translated into reality. Such plans are structured around eight topics that go beyond vaccine licensure and recommendations, including management, financing, logistics, human resources, service delivery, vaccine supply and quality, disease surveillance, advocacy and communication. The cold chain system is the backbone of any immunization program and consists of a network of equipment, material, people, processes, and financial resources that enable safe transportation of vaccines from the factory to the point of administration to the patient. Immunization service delivery includes any strategies and activities for delivering immunization service to a target population. Introduction of a new vaccine in a country program requires coordinated decision-making, considering the burden of disease, the characteristics of the respective vaccine and the capacity of the immunization system to deliver it. Adverse Events Following Immunization is another key component as documentation of vaccine safety is crucial for trust in a vaccination program. Scientifically valid and timely burden-of-disease surveillance as well as vaccine uptake data are core functions of any vaccination program and needed for information of the public and for timely actions.

Chronic Lymphocytic Leukemia (CLL) Patients Quality of Life (QoL): A Cross-Sectional Analysis of the Italian Experience in the Choice Study during the First Wave of the COVID-19 Pandemic

IntroductionAlthough plenty of data exists on efficacy and safety of CLL drugs, their impact on patients' Health-Related Quality of Life (HRQoL) is largely unknown (1-2). Documentation of drug safety via traditional use of adverse events (AE) in hematology is limited if not complemented with Patient-Reported Outcomes (PRO) measures (3-4). Incorporation of HRQoL PROs is now essential to better evaluate risk-benefit of new therapeutic approaches and it is also highly valued by regulatory stakeholders (5). Most PRO data currently available for CLL patients (pts) came from randomized controlled trial settings (6-7), hence limiting generalizability of findings to CLL real-life patients. CHOICE study was designed to investigate CLL patients' QoL and preference towards different treatment profiles through a Discrete Choice Experiment (DCE) methodology in Italy. Due to the timelines of the study, which started in February 2020, the related data offer an insight into patients' perception and worries during the first wave of the COVID-19 pandemic.MethodsThis cross sectional, multi-center, observational study included CLL patients, treatment naïve during the watch & wait period (W&W) or already TREATED (around 50% each, controlled at site level), who signed the informed consent for study participation. Exclusion criteria were inability to take oral drugs, cognitive disorders that could impair the comprehension of the questionnaires and concomitant treatment for other malignancies.Patients were asked to fill in the following HRQoL questionnaires: EQ-5D-5L, EORTC QLQ-C30 and QLQ CLL-16, as well as a DCE questionnaire, (described elsewhere). Each questionnaire was completed by the patient on a tablet - using an App specifically developed for the study.Results401 pts were enrolled in Italy in 16 hematology centers (Feb - July 2020); 199 W&W and 196 TREATED pts completed the questionnaires and were included in the evaluable population.Main patients' characteristics are shown in Table 1.73.7% of TREATED pts were ON-treatment (30.8% were in 1st-line, 69,2% in further lines) and 26.3% were OFF-treatment; the majority of pts (55,6%) were currently treated with a target therapy (Table1).The EQ-5D-5L questionnaire showed no significant differences between groups. In both groups more than 80% of pts reported low values (1 or 2, indicating no or small impact) on all items. Median VAS was 75 for the TREATED group and 80 for the W&W group (0-100; higher scores indicate higher QoL).QLQ C-30 / CLL-16 scores had very similar results between TREATED and W&W pts suggesting a limited impact of CLL on pts QoL. The median (IQR) QoL Scale was 83.3 (67- 83) for TREATED and 83.3 (67- 92) for W&W pts (0-100; all functional scales had high scores, that represent a better level of functioning; all symptoms' scales had low values, representing a less important symptomatology or problem, Figure 1). The main symptoms reported were fatigue, insomnia, pain, and dyspnea, while the main worry was for “future health” (Figure 1).Distribution of data was statistically different between the 2 groups only for the Role functioning Scale (p=0.024) and the Social Functioning Scale (p=0.003) of QLQ-C30 and for the Infection Scale (p<0.001) of QLQ CLL-16, always with slightly but significantly better results for the W&W group.ConclusionsCHOICE study helps to understand the CLL patients' mindset and feeling in the light of the COVID-19 pandemic impact on health care for this category of pts, highlighting their preferences and worries in a large cohort of pts in Italy, allowing a comparison between TREATED and W&W pts. The main limitation of the study was its cross-sectional design, which does not allow us to evaluate any change in QoL neither with respect to the impact of the pandemic, nor to the effects of the treatment, if any.CLL pts showed a good QoL, as confirmed by both EQ-5D-5L and EORTC QLQ C-30 / CLL-16 scores, with very similar results between TREATED and W&W pts (although slightly better results in the W&W vs TREATED group). The results of the present study are consistent with previous reports, and fatigue was the most reported symptom, while worry for future health was the most relevant score in CLL-16 questionnaire. Hospital accesses reduction that was detected during the pandemic might have influenced patients' response, as well as the extreme attention towards the danger of infections, and might have impacted patients' perception on future health. [Display omitted] DisclosuresTedeschi: Beigene: Honoraria, Speakers Bureau; AstraZeneca: Honoraria, Speakers Bureau; AbbVie: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau. Gozzetti: Janssen: Honoraria; AbbVie: Honoraria. Reda: Beigene: Consultancy; Astra Zeneca: Consultancy; Abbvie: Consultancy; Janssen: Consultancy. Gualberti: AbbVie: Current Employment. Malgieri: AbbVie: Current Employment. Finsinger: AbbVie: Current Employment.

Improving safety-planning in patients admitted with self-harm

AimsSelf-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.MethodThe PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.ResultFollowing initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.ConclusionCreating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.

Management of cluster headache and other trigeminal autonomic cephalalgias in pregnancy and breastfeeding.

Many clinicians lack experience in managing trigeminal autonomic cephalalgias (TACs) in pregnancy and lactation. In addition to cluster headache, TACs include hemicrania continua, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/autonomic symptoms (SUNCT/SUNA). Treating these rare, severe headache conditions often requires off-label drugs that have uncertain teratogenic potential. In the last few years, several new treatment options and safety documentation have emerged, but clinical guidelines are lacking. This narrative review aimed to provide an updated clinical guide and good clinical practice recommendations for the management of these debilitating headache disorders in pregnancy and lactation.

영국 주거공간의 피난안전 기준에 관한 연구

This paper aims to investigate fire safety and the means of escape in the realm of interior space, particularly in dwellinghouses in order to build the standard of institutional regulations and design plans in Korea. For this, this paper examines the current regulations on the means of escape in the dwelling space in the UK. Fires in residential spaces account for 25% of the country’s total fires and over 40% of all casualties. As a part of methods to reduce casualties, a re-examination of the fire safety is necessary, and the social safety net must be established through proposals for improvement of the standards of the escape route in dwellings. The documentation of fire safety, such as Approved Document B, Building Act and Fire safety in purpose-built blocks of flats provide a specific regulation on fire safety in dwellings in the UK. The standards were classified into housing and apartments. Fire alarm, the details of horizontal and vertical escape routes according to the height of the building and the number of stairs were investigated. Therefore, this paper will contribute to supporting the Korean escape route used as a framework that can improve the current regulation of the fire safety and solve various problems that occur in the interior construction on fires and regulations in Korea.

Health and Occupational Injury Experienced by Latinx Child Farmworkers in North Carolina, USA.

Children as young as 10 years old are hired to work on farms in the United States (U.S.). These children are largely Latinx. Using interview data collected from 202 North Carolina Latinx child farmworkers in 2017, this analysis documents the heath characteristics and occupational injuries of Latinx child farmworkers and delineates characteristics associated with their health and occupational injuries. Latinx child farmworkers include girls (37.6%) and boys (62.4%), aged 10 to 17 years, with 17.8% being migrant farmworkers. Three-quarters reported receiving medical and dental care in the past year. Respiratory (15.8%) and vision (20.3%) problems were prevalent. Girls more than boys, and younger more than older children had greater health service utilization. Occupational injuries were common, with 26.2% reporting a traumatic injury, 44.1% a dermatological injury, 42.6% a musculoskeletal injury, and 45.5% heat-related illness in the past year. Age increased the odds of reporting work injuries and heat-related illness, and being a non-migrant reduced the odds of reporting work injuries. These results emphasize the need for greater documentation of child farmworker occupational health and safety. They underscore the need to change occupational safety policy to ensure that children working in agriculture have the same protections as those working in all other U.S. industries.

A consideration of two models of health and safety training for undergraduate chemists

An initial pilot evaluation is presented of students’ awareness of health and safety training provision, and a comparison of two models of health and safety training after a curriculum redesign. The old model focussed on students generating their own COSHH with highly variable approaches to checking understanding across our curriculum. The new model shifted the focus more on student understanding with a more harmonious approach using research-standard safety documentation and assessment processes. The new system has elements of research-connected teaching and authenticity with students finding the research-standard materials accessible. In terms of preparedness, each model has its benefits and some suggestions for future practice are presented.

562 Triage Surveys Are a Safe and Efficient Method to Streamline Utilization of Direct Access Endoscopy

INTRODUCTION: Direct Access Endoscopy (DAE) is a process by which Gastroenterology (GI) practices provide patients with access to endoscopic intervention without incurring delays in awaiting GI clinic visits. Medstar Georgetown University Hospital (MGUH) employs the DAE mechanism through a triage system called Discussed with Patient (DWP) survey which is a screening questionnaire administered by central scheduling to determine which patients are low enough risk to safely bypass a pre-procedural clinic visit. This study was designed to evaluate safety and efficacy of our DWP triage system. METHODS: We performed a retrospective chart review of outpatient endoscopic procedures using our department's procedure scheduling system and electronic medical record system. Inclusion criteria included colonoscopy and EGD procedures performed by MGUH GI attendings from October 1-31, 2018 (total 23 working days). To focus data analysis, other procedures (i.e.; ERCP, EUS, MRCP, Flex sig) were excluded. We then analyzed patient demographics, indication for procedure, and safety documentation recorded within triage surveys. RESULTS: 727 total endoscopic procedures were analyzed. Sixty-five percent (479/727) of the study population was screened with a DWP prior to procedure. Of this population, a large majority (355, or 74%) did not require a pre-procedural GI clinic visit. Assuming an average of 30 minutes per pre-procedural visit, we estimated this accounted for a total of 177 hours of clinic time saved. Of the 479 cases scheduled by the direct access pathway, 120 (25%) had clear documentation of the DWP triage survey positively affecting patient care including adjustment of anticoagulation regimen (n = 29, 24%) and guidance on obtaining cardiac, renal, or pulmonary clearance (n = 23, 19%). CONCLUSION: The DWP triage survey utilized by our institution is an effective method to provide direct access endoscopy to a large population while eliminating unnecessary pre-procedural GI clinic visits for low-risk patients. The benefit of this intervention is evidenced by the estimated 177 hours saved per month. In addition, the DWP serves as a safety screen that allows for physicians and ancillary staff to make crucial adjustments that optimize patient safety prior to procedure. Strengths of this study include the large number of procedures analyzed and a wide distribution of MGUH endoscopists. Limitations of this study include lack of post-procedural safety outcomes.

Patient Safety in the Traditional and Evolving Nontraditional Office Setting.

Patient safety remains a concern for practice in traditional office settings as well as emerging forms of telehealth. Effective leadership is required to establish a culture of safety in office practice, with all staff undergoing appropriate credentialing and privileging. Key areas of focus for office safety are documentation and follow-up of patient encounters, medication safety, and surgical safety. Medication safety standards include prescribed medications, office administered injections and samples given to patients. Similar rules of patient safety apply to both hospital-based and office-based surgical procedures. Telehealth will present new challenges for maintaining patient safety, for which more study is needed.

Developing and assessing electronic checklists for safety mindfulness, workload, and performance

PurposeThe aim of this study is to propose a set of innovative principles for the effective design of electronic checklists to enhance safety mindfulness (a specific safety mindful mindset that offers the opportunity to operate more preemptively during routine quality assurance tasks) and discuss some of our preliminary results from testing our proposed electronic checklist with dosimetrists and physicists. Methods and materialsA multidisciplinary team designed, developed, and evaluated the utility of the electronic checklist (vs paper-based checklist) to promote safety mindfulness. Subjective workload was measured at the end of each assessment/scenario. Performance was quantified on the basis of discovery of purposefully embedded errors, time to complete the scenario, and additional concerns that were documented by the participants. ResultsUse of the electronic checklist was associated with decreases in time to scenario completion (P < .01) and increases in documentation of additional patient safety and plan quality concerns (P = .04) but had no significant impact on the recognition of purposefully embedded errors or perceptions of workload. ConclusionsOur proposed principles for the design of electronic checklists may improve the efficiency of quality assurance procedures while enhancing users’ safety mindfulness. Future research is needed to better understand the utility of our proposed design principles on patient safety from a long-term use perspective.

Seizure care in the emergency department. Identifying and bridging the gaps. A study of care and outcomes from 644 seizure presentations

Care for seizures in an emergency department setting can be variable, and there are disparities in access to onward specialist referral. The purpose of this study was to evaluate the utilization and implementation of an evidence-based seizure care pathway in a busy urban tertiary referral center. A total of 644 seizure presentations over two time points were examined. Initial pathway utilization rates were low at 26.2% but increased to 61.6% after environmental barriers had been addressed. We found that patients placed on the care pathway had higher rates of neurological examination, documentation of safety and legal guidelines as regards driving, and lower rates of seizure readmission. Twelve patients not placed on the pathway had passed away at follow-up (1.86%); the cause of death were related to significant comorbidities rather than the seizures themselves though in five, seizures could potentially have been a contributing factor. For the first time we have demonstrated that an evidence-based guideline for seizure management can be implemented in Ireland and used to standardize care for seizures in the emergency department improving documentation rates and clinical evaluation.

Ayurveda formulations: A roadmap to address the safety concerns

It is a matter of serious concern that the number of case reports pointing at a possible association between the clinical toxicity and the use of Ayurveda formulations is increasing significantly over the years in scientific medical literature. Though most of these cases are connected with the presence of heavy metals such as lead, mercury and arsenic in these formulations, there are also reports suggesting toxicity due to the presence of toxic chemicals of herbal origin. In the year 2008, the Government of India took an initiative of establishing the National Pharmacovigilance Programme for Ayurveda, Siddha and Unani drugs in a structured way. However, due to lack of sustained support, this program has now become defunct. This issue is of vital importance and needs to be addressed effectively on a priority basis. In this communication, we propose the following crucial policy interventions to be introduced at different levels: a. Amendments to Drug and Cosmetic Act, b. Issuing consumer guidelines, c. Issuing prescription guidelines, d. Issuing clinical monitoring guidelines, e. Implementation of good manufacturing guidelines, f. Promoting documentation of clinical safety, g. Identifying the sources of contamination, and, h. Provision for stringent punishment. If these policy interventions are taken up and implemented, a significant positive change in the scenario can be expected in the near future.

Empirical Investigation of Safety Practices in the Large Scale Construction Industry in Sri Lanka

Area of the Study This study attempts to identify the current safety issues in the construction field, identify effectiveness of the safety strategies used by the construction field and to propose effective and preventive safety strategies . Problem of the Study The research problem addressed under this study is to identify the real safety practices of the construction industry in Sri Lanka. Method of the Study The existing literature, experts’ opinions and the authors’ experience were reviewed to find the safety issues and safety strategies. Based on knowledge gained from these sources, a detailed questionnaire was developed aiming the main objective of identifying safety strategies used in the industry. For this study 40 ongoing large building construction sites were selected as the survey sample. In proposing effective and preventive safety strategies, the Pearson’s Correlation between identified severe issues and safety strategies was used. Findings of the Study Poor safety documentation, lesser safety education and awareness and lesser provision of resources and insurance policies were identified as most severe issues in the construction industry in Sri Lanka. Safety strategies like safety signs and symbols, prohibition of unhealthy drugs, alcohol at workplace and providing safety manuals, handouts and first aid toolkits to workers and management were identified as most effectively practicing safety strategies in large scale construction industry in Sri Lanka. To overcome the current severe safety issues four effective and preventive safety strategies; safety specialized training, accident Insurance policy, safety planning; pre project and pre task and safety meetings were proposed considering the strong positive relationship with safety issues that had been identified. Conclusion of the Study In order to avoid or to minimize the safety issues that are severe in the construction industry Sri Lanka, implementation of above strategies become utmost important because they would prevent the most critical safety issues that are experienced by the large scale construction industry in Sri Lanka. Integration of all these can be produced skilled and self-disciplined personnel into this field. Thereby, the industry can establish the safety culture in construction sites in Sri Lanka. Keywords: Construction Industry, Safety Issues, Safety Strategies

Food Safety Document Classification Using LSTM-based Ensemble Learning

Food Safety Document Classification Using LSTM-based Ensemble Learning

New Molecular Surrogate Assay for Genotoxicity Assessment of Gene Therapy Vectors (SAGA)

The variety of gene therapy vectors for a multitude of different diseases has increased tremendously over the years. However, a number of patients that underwent gene therapy in different trials developed hematological malignancy caused by integration of the provirus in the vicinity of proto-oncogenes. These severe adverse advents prompted intense research efforts towards safer gene therapy, leading to the removal of the long terminal repeat enhancer elements and the use of internal promoters in retroviral vectors. Still, a bottleneck of transition from basic research to clinical application is the test for safety of integrating retro- and lentiviral vectors.Instead of laborious in vivo models with limited predictive value, in vitro assays to screen for insertional mutagenesis are strongly desirable. A decade ago, our lab developed the in vitro immortalization (IVIM) assay to quantify the genotoxic potential of viral vectors, which has been widely used to complete preclinical safety documentation of newly developed integrating vector systems. Despite general acceptance in the field of hematopoietic gene therapy, bias for insertional mutants of the myeloid lineage, a low sensitivity and a long assay run time are clear limitations.We now developed the molecular surrogate assay for genotoxicity assessment (SAGA). The new test is more robust, sensitive and biologically informative. As input we used murine lineage-negative hematopoietic stem and progenitor cells (HSPC) that were cultured as described for the IVIM assay. The murine HSPC were transduced with a number of different gammaretro- and lentiviral vectors, including vectors that have been employed in clinical trials for X-SCID and Wiskott-Aldrich Syndrome. After 14 days, whole mRNA was isolated from transduced and non-transduced samples and analyzed by Agilent custom microarrays (n=86) and qPCR from nine independent SAGA assays. We applied several Machine Learning algorithms to derive a core set of genes which distinguishes transformed from non-transformed samples in each individual SAGA assay. This set of genes from the individual analysis was further analyzed to derive a core set of genes that is able to robustly separate transformed from non-transformed samples in all assays performed. In order to account for platform-specific effects we validated all microarray results by conventional qPCR-methodology. The SAGA gene set was then cross-validated in an independent validation cohort of SAGA-assays that were not part of the SAGA-training set from which the signature was derived from.The SAGA assay was used to quantify the mutagenic potential of several benchmark vectors. It correctly assigned a high mutagenic potential to vectors (MFG.yc and CMMP.WASP) which led to serious adverse events (SAEs) in clinical trials. Most importantly, the SAGA assay reliably scored high for mutagenic vectors, even when the vector did not transform in IVIM-assays conducted in parallel, demonstrating the higher sensitivity of the SAGA-principle. In contrast, SIN lentiviral vectors with weaker internal promoters (LV.EFS.yc and LV.EFS.ADA) showed no enrichment of the SAGA-core signature and hence scored much safer in the SAGA test. We present the results for these vectors side-by-side either using IVIM or SAGA. In summary, we generated an advanced version of the currently used in vitro insertional mutagenesis screening system by integrating a molecular read-out which enhances reproducibility, sensitivity and reduces assay duration, paving the way for a better preclinical risk assessment of gene therapy vectors. DisclosuresNo relevant conflicts of interest to declare.

Abstract CT105: Randomized trial of dendritic vs tumor cell patient-specific vaccines: 5-year analysis

Abstract Eltrapuldencel-T (CLBS20) consists of autologous dendritic cells loaded with antigens from irradiated, self-renewing, autologous tumor cells that potentially present the entire repertoire of unique patient-specific tumor-associated antigens resulting from nonsynonymous mutations in each patient's melanoma tumor cell line. In a single-arm phase 2 trial, metastatic melanoma patients treated with s.c. injections of CLBS20 had a 2-year overall survival (OS) of 73% (NCT00948480). In a randomized phase 2 trial (NCT00436930), 2-year OS was 72% compared to 31% for a tumor cell vaccine (TCV) consisting of irradiated cancer cells from an autologous tumor cell line. Mild local injection site reactions was the most common toxicity. This report focuses on 5-year follow up data from the randomized trial. During October 2007 to February 2011 42 patients were randomized 1:1 to receive CLBS20 or TCV. After resection of a metastatic tumor, if/when a cell line was established, patients were eligible for randomization if/when they were referred by their managing physician. Both products were mixed in 500 micrograms GM-CSF and injected s.c. weekly for three weeks, then monthly for up to 5 months. Cell lines were successfully established rapidly enough for possible clinical use for 78/183 (43%); 42/78 (54%) patients were referred for randomization. The median time from tumor submission to cell line success was 3.0 months, then 2.5 weeks for safety testing and documentation, then another 3.7 months to randomization. At the time of tumor harvest 24 patients were stage 4 and 18 were recurrent stage 3; at randomization 33 were stage 4 and 9 stage 3. Trends toward imbalances of baseline characteristics were biased against the CLBS20 arm (elevated LDH, detectable disease, brain metastases). There were no differences in tumor resection site, days in cell culture, or days to randomization. Because of leukapheresis and dendritic cell production for CLBS20, the median time from randomization to first dose was 43 days for CLBS20 vs 8 days for TCV. All patients were treated as randomized; survival was calculated from randomization date. At this analysis, 33 (79%) were dead and the 9 survivors had been followed 5 years. OS was higher in the CLBS20 arm: median 42.2 vs 19.9 months for all and 40.4 vs 16.9 for stage 4 patients, and in subsets defined by measurable disease, and serum LDH. The only variable associated with 3-year OS was randomization to CLBS20 (p = 0.018). A patient with refractory progressive measurable disease experienced a delayed complete response that was ongoing at 5 years. In an era before widespread use of anti-BRAF/anti-MEK and anti-checkpoint agents, CLBS20 monotherapy was associated with encouraging 5-year OS. Because of its unique mechanism of action, absence of toxicity, and apparent benefit regardless of tumor burden, CLBS20 is worthy of further evaluation as a monotherapy or in combination with other anti-melanoma therapies. Citation Format: Robert O. Dillman, Edward F. McClay, Thomas T. Amatruda, Carol DePriest, Denysha J. Carbonell, Andrew N. Cornforth. Randomized trial of dendritic vs tumor cell patient-specific vaccines: 5-year analysis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT105.

식품절단기 사용 사업장의 사고성 재해 특성에 따른 개선방안 연구

Abstract The past five years, industrial accidents due to food process ing machinery have been occurred 725 cases, injury by the food cutter occurred 390 cases in its. On this study, to prevent food cutter injury, an attempt is made to present the improved documentation of fun damental safety of the food cutter workplace through the injury analysis of food cutter injury and surveys on band saw machine business field. Analyzing the result of 390 cases on food cutter injury, amputation, cut, puncture occupied 75.1 percent (293 cases), compressed occupied 23.3% (91 cases), also it showed constant component without reference to gender, age, scale of work place, service period. In the survey, lack of concentration for workers have been pointed out as the biggest factor in the cause of band saw machine injury. Meanwhile, such as the EU and Japan, whereas pr esents safety standards about band saw machines that are tailored to each country, on the other ha nd, South Korea doesn't provide the standards. To prevent the food cutter injury, safety standards need to be established in consideration of amputation, cut, puncture, compressed injury and financial supp ort is required to procure protective equipment at each place of business.Keyword : food processing machine, band saw machine, industrial accident, safety standard

Especially Targeted Traffic Survey from ADR Category of Road Tunnel Point of View

The most famous traffic survey in Slovakia is national counting of traffic which is performed since 1963 and in periodical five-year intervals since 1980. It is very extensive traffic survey focused on traffic volume on all sections of highways, speedways, roads of first and second category and selected sections of roads of third category. A lot of other traffic surveys are also performed with different purposes. A special traffic survey has to be carried out before its put in operation due to working out of road tunnel safety documentation, especially due to risk analysis to determinate road tunnel category in regard of dangerous goods transport.

Archives Management and Permanent Storage of Documents

Modern digital archives are modern archives which in big computer devices (servers), preserve archived original document overlooking the moment is produced. Archives in Kosovo assessment of archival documents make in two directions. First; selection of classical documents (on paper) with the value to be transformed into digital documents, and second; selection of contemporary documents produced by institutions of computer and internet era. Management of these digital documents requires procedures and professional standards for its storage and processing by the archive, in order to be ready to serve researchers and interested parties. Access to digital documents should be fast, simple procedures, providing documentation from the penetration of ‘hackers’ and people badly intention. To fulfil its mission digital document should ensure and complement the appearance of the original document. Since the user does not have the option of intervention and change in the document. Should work in protect emblem, which protects the entire area of the document in the form of molten seal, which also shows the ownership of certain archive. Safety documentation and document base by external users will be able to organize, deposit and stored at three levels: Server (1) be stored (saved) archival documents for use by the applicant; Server (2) stored data of the first and simultaneously updates added by continuous processing of new documents; and Server (3) is not accessible from outside through digital network, but stored all digital archive documentation and from here there should be no often exit. In Server 3 only entered document and stored as recent bank. From there, the document will be drawn only if it is missing or damaged document on server 1 and 2.Thus, through this categorization could be provided for long time electronic documents (digital), until to new modern inventions of modern digitalization technology that would ensure the preservation of documents for the ‘real’ long-term or permanent time.

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures. Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation. We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group (P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed. This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.