Non-availability Of Equipment Research Articles

Cardiac output monitoring - invasive and noninvasive.

The purpose of this article is to review various contemporary cardiac output (CO) measurement technologies available and their utility in critically ill patients. CO measurement devices can be invasive, minimally invasive, or noninvasive depending upon their method of CO measurement. All devices have pros and cons, with pulmonary artery catheter (PAC) being the gold standard. The invasive techniques are more accurate; however, their invasiveness can cause more complications. The noninvasive devices predict CO via mathematical modeling with several assumptions and are thus prone to errors in clinical situations. Recently, PAC has made a comeback into clinical practice especially in cardiac intensive care units (ICUs). Critical care echocardiography (CCE) is an upcoming tool that not only provides CO but also helps in differential diagnosis. Lack of proper training and nonavailability of equipment are the main hindrances to the wide adoption of CCE. PAC thermodilution for CO measurement is still gold standard and most suitable in patients with cardiac pathology and with experienced user. CCE offers an alternative to thermodilution and is suitable for all ICUs; however, structural training is required.

Awareness And Utilization of Universal Precaution Measures Among Health Care Workers in Ogoja General Hospital

Background: Health care workers are at high risk of needle stick injuries and blood-borne pathogens as they perform their clinical activities. They are exposed to blood-borne infections by pathogens, such as Human Immune Deficiency Virus (HIV), Hepatitis B, and Hepatitis C viruses from sharps injuries and contact with blood and other body fluids. Various studies on awareness, knowledge, and compliance with universal precautions have revealed many factors that hinder the effective utilization of universal precautions. Lack of knowledge; lack of time; forgetfulness; lack of Personnel Protective Equipment; uncomfortable equipment; skin irritation, a conflict between the need to provide care and self-protection; distance to necessary equipment, lack of training, and poor electricity supply are among factors that have been identified to influence utilization of universal precautions. This study investigated the level of utilization of universal precautions and how the mitigating factors influence the utilization of universal precautions in Ogoja General Hospital. Aim: This research assessed the level of awareness and utilization of universal precaution measures among health care workers in General Hospital, Ogoja. The study was guided by three specific objectives and two research hypotheses. Method: The descriptive design method was used for this study. Instruments for data collection were self-structured validated questionnaire and observation checklist. Total population of one hundred and forty-five (145) respondents were used for the sample due to small size, hence no sampling was done. The one hundred and forty-five (140) validated questionnaires were administered and one hundred and twenty (120) were retrieved giving a response rate of 82.8%. Data were analyzed using simple percentages and Chi- Square contingency table. Results: The study results showed that 100% of health care workers in General Hospital, Ogoja were aware of universal precaution measures. The respondents utilized universal precautions; 100% of the workers washed their hands, 82.5% used safety boxes. However, 80% did not recap needles. Results further revealed that the major factor hindering compliance with universal precaution was the non-availability of equipment with a 76.7% response rate. This was followed by lack of training. 46.7% of the respondents believed that lack of training was responsible for non-compliance. It was discovered that workers, patients, and family members were protected from contracting infection with the effective implementation of hand hygiene. Inferential statistics of chi-square was used to test the hypothesis (p<0.05). The test of hypothesis established a significant relationship between awareness and utilization of universal precautions. Test of hypothesis also confirmed a significant relationship between non-availability of equipment and utilization of universal precautions. Conclusion: The study concluded that healthcare workers are aware of universal precaution measures and utilize same to render care to patients. It also concluded that availability of equipment is significantly related to the level of utilization of universal precautions. Recommendation: It was recommended that health workers should be provided with the appropriate equipment and that workshops be held periodically on universal precaution with same being included in the continuing education curriculum of all health workers. The study finally suggested further studies in other general hospitals in southern Nigeria.

Barreiras para a prática de atividades físicas entre usuários de substâncias psicoativas

Objetivo: Verificar as barreiras que influenciam a não realização de atividade física no tempo livre entre usuários de substâncias psicoativas.
 Método: 144 indivíduos com média de idade de 44.3±12.6 anos foram entrevistados respondendo um questionário que verifica as barreiras para a prática de atividades físicas. Foi aplicado o teste Qui-quadrado de independência aceitando um p<0.05 como significativo.
 Resultados: Os dados mostraram que há associação entre as sentenças do questionário e o padrão de resposta dos indivíduos [x2(13)=193.88; p≤0.001]. Foi encontrada significância como barreira para prática de atividade física o cansaço físico, falta de companhia, falta de incentivo familiar e acometimento de dores leves ou mal-estar. Por outro lado, a falta de tempo, fator climático, não disponibilidade no ambiente, não disponibilidade de equipamento e falta de habilidade física foram apontados, significativamente, como não serem barreiras para a prática de atividade física em usuários de substâncias psicoativas.
 Conclusão: A partir destes dados será possível estabelecer estratégias mais efetivas para a promoção da prática de atividade física nesta população.

Airway anomalies in paediatric congenital heart diseases: Utility of bedside fibreoptic flexible bronchoscopy

Background : Acute respiratory diseases are common neonatal conditions leading to neonatal intensive care unit admissions (NICU). Noisy respiration with increased work of breathing, persistent need for respiratory assistance and persistent radiological opacities prompts evaluation by fibreoptic flexible bronchoscopy (FFB). FFB has several benefits in neonates, however, this modality is not widely used due to lack of expertise or non-availability of equipment. We present our 7 years of experience with neonatal FFB. Methods : A retrospective, medical chart search study was conducted at a tertiary care multispecialty hospital, in neonates who underwent FFB over a period of 7 years (2011-2017). Results : Total 88 bronchoscopies were performed in 83 neonates admitted in the NICU. Median birth weight and gestational age were 2600 grams (range 820- 3660) and 37 weeks (range 26-41). Median age at the time of FFB was 27.5 days (range 1-152). While 51 procedures were done transnasally, 37 bronchoscopies were done through endotracheal tube. Most common co-morbid condition noted was congenital heart diseases (20.4%). Indications included persistent oxygen requirement (32/88) lung collapse (21/88), stridor (27/88), extubation failure (4/88), recurrent apnea (2/88) and suspected airway anomaly (2/88). Tracheobronchitis (8/32) and tracheobronchomalacia (8/32) were the common findings in neonates with prolonged oxygen requirement. Most common cause of stridor in neonates was laryngomalacia (16/27) followed by subglottic stenosis (4/27). Myriad of congenital airway anomalies could be diagnosed by FFB including laryngomalacia (18/88) choanal atresia (4/88), laryngeal cleft (4/88), tracheoesophageal fistula (TEF) (4/88), and one each of pyriform stenosis, laryngeal web, vocal cord paresis, absent tracheal ring and complete tracheal rings. Radiological improvement was seen in 17/21 (80.9%) cases of lung collapse after FFB. Bronchoalveolar lavage was done in 52 procedures, and microbiological yield was obtained in 16 (30.7%). Change in medical management by either, adding systemic steroids or changing antibiotics, after FFB was done in 35/88 occasions. Surgical intervention were undertaken in 15 cases (17%), including tracheostomies (9/15), TEF repair (4/15), lateralization of vocal cord (1/15), excision of laryngeal web (1/15). Transient hypoxemia was seen in (4/88) occasions while 83/88 cases did not suffer any complications. Conclusion : Airway anomalies are common in newborns and their early detection by FFB can be beneficial for optimum management. FFB can be used as an important diagnostic tool that can guide medical and surgical interventions in NICU.

Airway anomalies detected in neonates by fibreoptic flexible bronchoscopy: Experience of 7 years

Background : Acute respiratory diseases are common neonatal conditions leading to neonatal intensive care unit admissions (NICU). Noisy respiration with increased work of breathing, persistent need for respiratory assistance and persistent radiological opacities prompts evaluation by fibreoptic flexible bronchoscopy (FFB). FFB has several benefits in neonates, however, this modality is not widely used due to lack of expertise or non-availability of equipment. We present our 7 years of experience with neonatal FFB. Methods : A retrospective, medical chart search study was conducted at a tertiary care multispecialty hospital, in neonates who underwent FFB over a period of 7 years (2011-2017). Results : Total 88 bronchoscopies were performed in 83 neonates admitted in the NICU. Median birth weight and gestational age were 2600 grams (range 820- 3660) and 37 weeks (range 26-41). Median age at the time of FFB was 27.5 days (range 1-152). While 51 procedures were done transnasally, 37 bronchoscopies were done through endotracheal tube. Most common co-morbid condition noted was congenital heart diseases (20.4%). Indications included persistent oxygen requirement (32/88) lung collapse (21/88), stridor (27/88), extubation failure (4/88), recurrent apnea (2/88) and suspected airway anomaly (2/88). Tracheobronchitis (8/32) and tracheobronchomalacia (8/32) were the common findings in neonates with prolonged oxygen requirement. Most common cause of stridor in neonates was laryngomalacia (16/27) followed by subglottic stenosis (4/27). Myriad of congenital airway anomalies could be diagnosed by FFB including laryngomalacia (18/88) choanal atresia (4/88), laryngeal cleft (4/88), tracheoesophageal fistula (TEF) (4/88), and one each of pyriform stenosis, laryngeal web, vocal cord paresis, absent tracheal ring and complete tracheal rings. Radiological improvement was seen in 17/21 (80.9%) cases of lung collapse after FFB. Bronchoalveolar lavage was done in 52 procedures, and microbiological yield was obtained in 16 (30.7%). Change in medical management by either, adding systemic steroids or changing antibiotics, after FFB was done in 35/88 occasions. Surgical intervention were undertaken in 15 cases (17%), including tracheostomies (9/15), TEF repair (4/15), lateralization of vocal cord (1/15), excision of laryngeal web (1/15). Transient hypoxemia was seen in (4/88) occasions while 83/88 cases did not suffer any complications. Conclusion : Airway anomalies are common in newborns and their early detection by FFB can be beneficial for optimum management. FFB can be used as an important diagnostic tool that can guide medical and surgical interventions in NICU.

The Impact of Risk in Ethiopian Construction Project Performance

The overall aim of this work is to increase the understanding of risk’s impact on civil work construction project performance. Then deeper understanding is expected to contribute a more effective risk management practice and, therefore, a better project output and better value for project stakeholders. The risk factors are identified from the literature review, and then data were collected by a major tool questionnaire and focused group discussions. Statistical Package for the Social Sciences (SPSS) program was used to analyze the data and generate statistical measures. For each risk factor probability of occurrence as well as consequences (impact) of their occurrence and the risk level are resulted. From the findings it concludes that the main risk factors that affect the project performance very high are equipment/material failure, labor poor productivity, the non-availability of equipment and material. The very low identified risk levels are injuries, earthquake winds; and land slide rock falls. Finally as from the respondents and impact levels of risk; the analysis revealed that the risk management is not practiced very well.

Manutenção corretiva: Um procedimento para estabelecimento de indicadores para gestão de ações na área de manutenção e operações.

O objetivo desse trabalho foi mostrar um procedimento utilizando métodos estatísticos para categorização dos equipamentos com intuito de estabelecer prioridades na gestão para área da manutenção de uma empresa de corte e distribuição de aço, que possui em seu parque industrial equipamentos com características e tempos de vida diferentes. Para isto foi sistematizado um procedimento com uso de ferramentas estatísticas para agrupamento dos equipamentos conforme suas características e histórico de manutenção. O procedimento resultou na determinação e caracterização de cada equipamento quanto ao seu estado atual em relação ao tempo e quantidade de paradas. Esse trabalho demonstrou a viabilidade do uso de um modelo de classificação dos equipamentos para uma melhor visualização do comportamento de cada equipamento. Possibilita que a área de manutenção possa estabelecer estimativas de previsões de paradas, baseados em experiências anteriores, podendo inclusive estabelecer padrões estatísticos de serviços. Os resultados podem ser utilizados tanto para suportar a decisões nas áreas de manutenção e planejamento da produção. Também demonstrou que a análise estatística permite que as decisões sejam tomadas em função de critérios, que tem maior impacto no processo e que apresentam menor grau de variabilidade.

When a checklist is not enough: How to improve them and what else is needed

ObjectivesChecklists are being introduced to enhance patient safety, but the results have been mixed. The goal of this research is to understand why time-outs and checklists are sometimes not effective in preventing surgical adverse events and to identify additional measures needed to reduce these events. MethodsA total of 380 consecutive patients underwent complex cardiac surgery over a 24-month period between November 2011 and November 2013 at an academic medical center, out of a total of 529 cardiac cases. Elective isolated aortic valve replacements, mitral valve repairs, and coronary artery bypass graft surgical procedures (N = 149) were excluded. A time-out was conducted in a standard fashion in all patients in accordance with the World Health Organization surgical checklist protocol. Adverse events were classified as anything that resulted in an operative delay, nonavailability of equipment, failure of drug administration, or unexpected adverse clinical outcome. These events and their details were collected every week and analyzed using a systemic causal analysis technique using a technique called CAST (causal analysis based on systems theory). This analytic technique evaluated the sociotechnical system to identify the set of causal factors involved in the adverse events and the causal factors explored to identify reasons. Recommendations were made for the improvement of checklists and the use of system design changes that could prevent such events in the future. ResultsThirty events were identified. The causal analysis of these 30 adverse events was carried out and actionable events classified. There were important limitations in the use of standard checklists as a stand-alone patient safety measure in the operating room setting, because of multiple factors. Major categories included miscommunication between staff, medication errors, missing instrumentation, missing implants, and improper handling of equipment or instruments. An average of 3.9 recommendations were generated for each adverse event scenario. ConclusionsTime-outs and checklists can prevent some types of adverse events, but they need to be carefully designed. Additional interventions aimed at improving safety controls in the system design are needed to augment the use of checklists. Customization of checklists for specialized surgical procedures may reduce adverse events.

An Investigation into Participation Trends by Wheelchair Sports Players at the Zimbabwe Paralympic Games

Introduction: Disability or the disablement process is manifested in the interaction between the individual and his/her environment. There are general regulations for accessibility inside a building, among such are: Entrance doors, service desk, lifts, stairs, corridors, water closet (WC), and dressing rooms. This research was guided by the United Nations (UN) Accessibility for the Disabled: A Design Manual for a Barrier Free Environment, a document by the UN High Commission for human rights, designed to guide and set standards for built environment accessibility by the disabled. The International Paralympic Committee (IPC) recognises 6 different disability groups: amputees, athletes with Cerebral Palsy (CP), blind or visually impaired athletes, spinal cord injured athletes, athletes with an intellectual/learning disability, other athletes (les autres) with a physical disability who do not fit into the above 5 categories. This research focused on amputees, spinal cord injured athletes and the other athletes with a physical disability e.g. as a result of polio or accidents, who participate in wheel chair basketball and/or tennis. This study aimed at identify problems associated with access to Zimbabwean sport facilities by disabled consumers. The researcher observed that wheelchair sports is failing to attract participants because of challenges faced in accessing sporting facilities, due to: Challenges faced in transport/road usage, to and from sporting facilities. Non adaptation of the sports facilities. Non availability of equipment, e.g. the wheel chairs and rackets. Lack of access to equipment. Methods: Randomly selected wheelchair sports players from Zimbabwe are interviewed and group discussions carried out. Seventy (70) respondents 47 (67.1%) males and 23 (32.9%) females participated. The majority (62.9%) are above 25 years of age, only 22.9% are 20 years or below, all the females taking part in this research were over 30 years old. Results and Discussion: The results are that the barriers to participation are a result of an unfriendly and non-adapted transport system, poverty, nature of occupation, lack of access to equipment and non-adapted facilities providing health and safety risks over and above accessibility challenges. Conclusion and Recommendations: This research revealed a list of barriers to wheelchair sports participation opening avenues for further research in the areas of mainstreaming and Paralympic sports participation in Zimbabwe.

Knowledge and Practice of Standard Precautions and Awareness Regarding Post-Exposure Prophylaxis for HIV among Interns of a Medical College in West Bengal, India

To assess the knowledge of interns on standard precautions and post-exposure prophylaxis for HIV, and identify the gap between knowledge and practice relating to standard precautions, as well as determining the perceived barriers against adherence to standard precautions. The study was conducted on 130 interns of 2010-11 batch from a government-run medical college in Kolkata, India. All participants completed a self-administered questionnaire with items relating to basic components of standard precautions and post-exposure prophylaxis for HIV. The questionnaire also included open ended questions relating to reasons for non-adherence to the practice of standard precautions along with additional space for specific comments, if any. Poor adherence in the use of personal protective equipment, hand washing, safe handling and disposal of needles and sharp objects were found to be among the practices for which the interns expressed correct knowledge. While the main reasons for non-adherence were found to be clumsiness in handling needles, wearing gloves, feeling uncomfortable when wearing aprons, impracticality of regular hand-washing and non-availability of equipment. Although the majority of the respondents (84.6%) expressed awareness of washing sites of injured with soap and water, approximately 32.3% did not know that antiseptics could cause more damage. Also, only 63.8% expressed awareness of reporting any incidence of occupational exposure, while knowledge on post-exposure prophylaxis regimens was generally found to be poor. The considerable gap between knowledge and practice of standard precautions and inadequate knowledge of post-exposure prophylaxis emphasizes the need for continuous onsite training of interns with supportive supervision and monitoring of their activities.

P04.01 ‘The 6 Million Dollar Man’: An unusual case of adaptative commensalism with multidrug resistant bacteria in a surgical patient treated for 18 months

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S15 Methods: 350 peripheral IV cannula insertions were studied in three NHS organisations. Equipment problems during cannulation were recorded and staff interviewed to identify causes. Results: Out of the 350 cannulation procedures, 47 incidents of equipment problems (Table 1) were recorded during 46 cannulation procedures. This equates to a reliability of 87% across the three organisations. Interviews revealed a variety of causes including problems with supply of the right size of cannula, lack of tourniquets and a lack of sharps bins to dispose of the needles. Often staff found work-arounds to deal with these problems. Table 1: Summary of non-availability of equipment across the whole study