Use Of Appropriate Equipment Research Articles

Prevention and management of complications following robot-assisted radical cystectomy: lessons learned after >250 consecutive cases

Numerous case series of robot-assisted radical cystectomy have emerged which describe complication rates comparable to open series. However, various reports have outlined preoperative factors as predictors of postoperative complications. Understanding these factors and the methods to optimize the perioperative care of the robotic cystectomy patient is essential for successful outcomes. In this topic paper, we briefly review the literature surrounding complication rates following robot-assisted radical cystectomy as well as describe our experience after >250 cases, outlining our suggestions for avoidance of surgical complications when building a practice that incorporates this technique. Due to numerous variables, there are a number of intra-operative considerations, including patient selection, perioperative care pathway, intra-operative technique, and equipment choice that we have found to decrease post-operative complications and improve patient outcomes. Through careful patient selection, use of appropriate equipment and perioperative surgical management, robotic cystectomy is a feasible procedure with excellent perioperative results.

Intravenous therapy: preparation and administration of IV medicines

The aim of this article is to review the preparation and administration of intravenous (IV) therapy and to outline safe standards of practice. This article reviews the preparation for the procedure and then outlines actions for preparing--the patient, the practitioner, the environment and equipment, and then the medication--before describing the administration of any IV medication, whether via a bolus, intermittent or continuous route. A review of errors in IV therapy indicated calculation skill and a wide knowledge is required, while the National Patient Safety Agency (NPSA) (2010) highlighted omited and delayed medications as the second largest cause of medication incidents. Therefore the Royal College of Nursing (RCN) (2010) suggested each practitioner must have knowledge of the principles of reconstituting, including aseptic technique, compatibility (physical, chemical, and therapeutic), stability, storage, labelling, interactions, dosage, calculations and the use of appropriate equipment. Furthermore, Finlay (2004) advocated that training must also include the management of anaphylaxis. The necessity for safe and consistent IV practice is endosed and explored through Crimlisk et al's (2009) nine rights of IV medications, and Billings and Kowalski's (2005) mnemonic (CATS:PRRR).

Intravenous therapy: preparation and administration of IV medicines

The aim of this article is to review the preparation and administration of intravenous (IV) therapy and to outline safe standards of practice. This article reviews the preparation for the procedure and then outlines actions for preparing—the patient, the practitioner, the environment and equipment, and then the medication—before describing the administration of any IV medication, whether via a bolus, intermittent or continuous route. A review of errors in IV therapy indicated calculation skill and a wide knowledge is required, while the National Patient Safety Agency (NPSA) (2010) highlighted omitted and delayed medications as the second largest cause of medication incidents. Therefore, the Royal College of Nursing (RCN) (2010) suggested each practitioner must have knowledge of the principles of reconstituting, including aseptic technique, compatibility (physical, chemical and therapeutic), stability, storage, labelling, interactions, dosage, calculations and the use of appropriate equipment. Furthermore, Finlay (2004) advocated that training must also include the management of anaphylaxis. The necessity for safe and consistent IV practice is endorsed and explored through Crimlisk et al's (2009) nine rights of IV medications, and Billings and Kowalski's (2005) mnemonic (CATS:PRRR).

Pediatric Arterial Interventions

The spectrum of pediatric vascular pathology differs from the adult population and it varies greatly to include congenital and acquired disorders. Although catheter-directed angiography remains the gold standard, most vascular conditions in the child can be adequately diagnosed with magnetic resonance angiography, computed tomographic angiography, or duplex/Doppler ultrasonography with only a few exceptions, such as intrarenal arterial stenosis, small vessel vasculitides, and visceral vascular malformations. The advancement of catheter and wire technology has made it increasingly possible for complex arterial interventions to be performed in children, including embolization, angioplasty with stent insertion, thrombolysis, and endovascular neurological procedures. More angiographic procedures are being performed with the aim of also being therapeutic. Special considerations in children include the use of appropriate equipment and adequate dosing of contrast and of the various medications used during angiography, particularly in patients less than 15 kg in weight. This article will focus on the management of renovascular hypertension, liver transplant hepatic arterial intervention, and the use of carbon dioxide gas as a contrast agent in the child.

0209: Ultrasound Guided Percutaneous Nephrostomy

Percutaneous nephrostomy (PCN) is usually a straightforward procedure, with a target success rate of 98% for dilated collecting systems and a major complication rate of 1%-4%. Optimizing patient preparation and imaging, and the use of appropriate equipment, increases technical success and minimizes complications.

Repeatability of monolithic HPLC columns while using a flow program

Fast HPLC methods are becoming more and more important. Using monolithic HPLC columns for fast separations, a flow program can be applied for further decrease in the total run time. An interesting issue was whether the flow program affects repeatability. The investigated method was a generic assay for the oral antidiabetic drugs glibenclamide and glimepiride in the presence of two of their degradation products. A flow program ranging from 5.0 to 9.9 mL/min had been set up to decrease the run time to approximately 1.7 min. Within-day RSD% (n = 40) for both retention times and peak areas were less than 1%. At flow rates higher than 7 mL/min, repeatability was impaired to some extent. It became mainly noticeable through the day-to-day precision (n = 60) which showed RSD% up to 2%. However, further investigations indicated that this was rather related to pump inefficiency at high flow rates than to the flow program as such. Presuming the use of appropriate equipment, qualified for high flow rates, the application of a flow program for shortening the run time is absolutely reasonable and does not affect repeatability.

Effects of logging in the southern boreal peatlands of Manitoba, Canada

To evaluate changes in surface water chemistry, peat, and the plant community in logged peatlands, we compared plots in 1–4 year old (class I) and 9–12 year old (class II) clearcuts with plots in wooded controls. Indicator species were significantly different between wooded and clear-cut plots but not between clear-cut plot age classes. Surface waters in class I clearcuts had significantly higher temperature and nutrients compared with controls, and this was attributed to warming of the soil, which resulted in faster decomposition and greater nutrient availability. Hummocks, important peatland plant microhabitats, were reduced in height in all clearcuts because of compaction and abrasion. These abiotic changes caused a shift in the plant community. Total plant diversity was approximately 30% higher on clearcuts and consisted primarily of herbs, particularly grasses. However, bryophyte and lichen diversity and cover was greatest in wooded controls. Picea mariana (Mill.) BSP regeneration was not compromised by clear-cutting and was greater in class II clearcuts. Greater diversity and cover of Salix species in class II clearcuts suggests stable shrub community formation, which may be persistent and may slow succession. The use of appropriate equipment to minimize site disturbances while the ground is frozen may reduce long-term shifts in the plant community.

Primary teachers’ views and descriptions regarding some science activities

The views and the descriptions of 228 primary teachers on the use and the carrying out of some chemistry-related practical activities were studied. The research took place in the context of an in-service training course. As research tool, a questionnaire was used, where tasks dealing with three hands-on activities on chemistry topics, were included. According to the results, teachers had generally both the necessary knowledge to carry out such activities and the ability to describe procedures with the use of appropriate equipment and materials, to a satisfactory degree. However, their responses ranged from a more correct and complete level to a more generally descriptive and incomplete level. Results also suggest that, the gender and the use of science activities in school had an impact on their descriptions. [Chem. Educ. Res. Pract., 2007, 8 (1), 52-60]

Ergonomics and the Bariatric Patient

As more bariatric patients with weight-associated health complications enter the health care system, a successful patient handling program must be incorporated from the outset. Preparation through staff, patient, and family education contributes to the program's success. A commitment to reducing injuries and improving the quality of care should be reflected through the use of appropriate equipment, processes, training, and work practices. An active system for handling all patients, especially the morbidly obese, is something all hospitals should strive for to reduce caregiver and patient injury.

Biomechanical Analysis of Tibial Torque and Knee Flexion Angle

Knee injuries are common in sports activities. Understanding the mechanisms of injury allows for better treatment of these injuries and for the development of effective prevention programmes. Tibial torque and knee flexion angle have been associated with several mechanisms of injury in the knee. This article focuses on the injury to the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL) and the meniscus of the knee as they relate to knee flexion angle and tibial torque. Hyperflexion and hyperextension with the application of tibial torque have both been implicated in the mechanism of ACL injury. A combination of anterior tibial force and internal tibial torque near full extension puts the ACL at high risk for injury. Hyperflexion also increases ACL force; however, in this position, internal and external tibial torque only minimally increase ACL force. Several successful prevention programmes have been based on these biomechanical factors. Injury to the PCL typically occurs in a flexed or hyperflexed knee position. The effects of application of a tibial torque, both internally and externally, remains controversial. Biomechanical studies have shown an increase in PCL force with knee flexion and the application of internal tibial torque, while others have shown that PCL-deficient knees have greater external tibial rotation. The meniscus must endure greater compressive loads at higher flexion angles of the knee and, as a result, are more prone to injury in these positions. In addition, ACL deficiency puts the meniscus at greater risk for injury. Reducing the forces on the ACL, PCL and meniscus during athletic activity through training, the use of appropriate equipment and safe surfaces will help to reduce injury to these structures.

The appropriate use of equipment for moving and handling patients

A case study reported on BBC Radio 4 highlighted the lack of knowledge and understanding that is associated with lifting patients in and out of bed and onto chairs. A lady remained seated in her wheelchair for 22 months because the local authority did not allow her carers to lift her and never considered supplying appropriate equipment that would have allowed them to lift her in safety. The authority had a responsibility to care for this lady and, as there is a vast range of equipment available, to allow someone to develop a life-threatening pressure ulcer is both unnecessary and disgraceful. It is important to learn about the available equipment and to understand how it can be applied in practice to offer quality of life to the patient and to prevent pressure damage occurring. This article describes the case study and offers some suggestions for the type of equipment that could have been provided in this case.

Evaluation of traditional lecture versus medical simulation training in airway management

Study objectives: Traditional forms of medical education in airway management have included topical lectures and practice using mannequins and handling of equipment in an attempt to familiarize the trainees with the skills necessary to manage an airway appropriately. However, retention of airway skills has been unsatisfactory unless frequently reinforced and practiced. Quantification of the percentage of retention from traditional methodology has not been previously described. The purpose of this study is to try to quantify airway skills retention using a traditional lecture model and then testing of the trainees using a high-fidelity patient simulator. Methods: One hundred sixty-eight medical students were enrolled in the study and given a standard airway management lecture including handling of endotracheal tubes, laryngoscopes, Ambu ® bags, and oral and nasal airways. Intubation practice was performed on standard and larger-than-life mannequins to facilitate the ability to intubate. Approximately 1 week later, the students were tested on a clinical encounter that involved airway compromise and the need for appropriate airway management. These sessions were digitally recorded with the consent of the participants, and analysis of airway management was obtained. The analysis was limited to practical handling of the airway equipment. Students were given credit for correct airway management if they knew and demonstrated appropriate use of an AMBU bag, correct use of oral and nasal airways, and correct use of laryngoscopes and endotracheal tubes. They were not given credit if they were unable to assemble the laryngoscope or did not know how to hold or place an AMBU bag or how or where to place the endotracheal tube. Students were given feedback after all sessions. Results: Sixty-four (38%) of 168 students failed to appropriately manage the airway equipment during the patient simulation. This failure occurred despite prompting by the nursing staff and educator during the simulation encounter. Appropriate use of equipment, indications for use of specific equipment, and correct applications were demonstrated to the student during debriefing. Conclusion: High-fidelity patient simulation provides a detailed and practical tool to assess and monitor effectiveness of training methods. The relatively high failure rate so soon after a detailed lecture and practical session demonstrates the need for improvement in traditional educational methodology. The high levels of stress associated with high-fidelity patient simulation reproduce real-life patient encounters and reflect the difficulty in performance under stress. Future study is needed to evaluate subsequent performance after a longer period of time.

Safety considerations for in vitro toxicology testing.

A range of hazards may be encountered in in vitro toxicology laboratory work. Such hazards are primarily chemical reagents for which the level of risk, particularly with long-term exposure, may be difficult to ascertain. Cells and tissues may also present biosafety concerns and it is important that risk assessments are prepared for each procedure before commencing project work. Ideally control measures should be simple and combine the use of appropriate equipment with documented procedures supported by risk assessments. In any laboratory staff and procedures change significantly over time, thus monitoring of procedures (including waste disposal) and a comprehensive training programme for all staff are essential components to assure both the quality and safety of laboratory work.

Critical Care Transport: Outcome Evaluation After Interfacility Transfer and Hospitalization

Study objective: To test the hypothesis that interfacility transfer is not associated with increased mortality, duration of stay, or readmission within 7 days. Methods: We matched 3,298 patients who were hospitalized for chest pain or related complaints in Kaiser Permanente medical centers after transfer from the emergency department of a nonplan hospital (transported patients) with 3,298 patients of the same gender and age (±5 years) and with the same principal diagnosis who were hospitalized within 6 months without transfer in the same Kaiser Permanente medical center (directly admitted patients). Patients were compared in terms of outcome measures: in-hospital deaths, continued care in another facility, readmission within 7 days, in-patient length of stay (LOS), and LOS in special care units. Results: The adjusted odds ratios for in-hospital mortality and readmission within 7 days were 1.0 (95% confidence interval, .8 to 1.4) and .9 (95% confidence interval, .7 to 1.2), respectively. The adjusted mean difference in LOS was –.1 days (95% confidence interval, –.2 to .1). Transported and directly admitted cardiac patients were also compared for all examined outcome measures at each of 10 medical centers. At a few medical centers, we observed significant difference in LOS, special care LOS, and continued care in another facility. However, all these differences were small, and most were probably random errors. Conclusion: Conservative patient selection criteria, pretransfer stabilization, and the use of appropriate equipment and medical personnel have resulted in the interfacility transfer program’s achieving its goal of transferring high-risk patients without adverse impact on clinical outcomes or resource use. [Selevan JS, Fields WW, Chen W, Petitti DB, Wolde-Tsadik G: Critical care transport: Outcome evaluation after interfacility transfer and hospitalization. Ann Emerg Med January 1999;33:33-43.]

A Description of Factors Affecting Hazardous Waste Workers' Use of Respiratory Protective Equipment

This article describes the first phase of a study that was designed to gain an understanding of hazardous waste workers' attitudes and beliefs about the use of respiratory protective equipment. Exploratory, open-ended interviews were conducted among 28 respirator users at a US Department of Energy facility. Subjects were asked to describe their knowledge, attitudes, and beliefs about their risks to hazards at their worksites and to discuss their use of respiratory protective equipment. A detailed content analysis of the interviews resulted in the generation of a taxonomy of issues and concerns which fell into three general categories: 1) Knowledge, Beliefs, and Attitudes, 2) Physical and Psychological Effects, and 3) External Influences. Knowledge, Beliefs, and Attitudes included Training, Fit Testing, Medical Clearance, Work Exposures, Respirator Use, and Vulnerability to Disease. Physical and Psychological Effects included Somatic/Health Effects, Personal Comfort, Visual Effects, Fatigue, Communication, and Anxiety. External Influences included Structural Environment, Quality and Availability of Equipment, Other PPEs, Co-Worker Influence, Supervisor Influence, and Organizational Culture. The findings from this study have important implications to training and education programs. Effective respiratory protection programs depend on a knowledge of the factors that affect workers' use of equipment. This study suggests that efforts to assure equipment comfort and fit, to assist workers who see and hear less well as a result of their equipment, and to develop strategies to allay worker anxiety when wearing equipment should all be components of a program. An organizational culture that supports and abets the appropriate use of equipment is also a critical element in a successful program.

The Learning of Motor Control: Biomechanical considerations

Summary This paper explores some of the biomechanical implications of learning postural control in the upright position. From these considerations, a strategy is proposed for promoting accurate control learning by motor-impaired individuals, which has an inbuilt system of clinical audit. It is shown that the use of appropriate equipment may increase treatment efficiency, while simultaneously reducing manpower demands. The implications of these proposals are discussed and clinical evidence of successful application is cited.

Treadmill Exercise Testing: Treadmill Installation and Training Protocols Used for Clinical Evaluations of Equine Athletes

The use of motorized treadmills has made it possible to evaluate equine poor performance with sophisticated diagnostic techniques during peak exercise. Treadmill exercise tests currently being used for clinical evaluations include treadmill gait analysis, dynamic hoof balancing, endoscopic evaluation of upper airway function, and exercise performance profiling. Large motorized treadmills (1 to 1.5 m in width and 4 to 5 m in length) are best suited for clinical evaluations. Ideally, the treadmill should be installed in-ground using a pit. This type of installation results in the tread surface being at the same level as the surrounding floor. A standard protocol should always be used to train horses to exercise on a treadmill. Training should be designed to introduce the horse to procedures required for a specific clinical evaluation gradually.

Continuing medical education (Dermatologic surgery): Cryosurgery of basal cell carcinoma

Cryosurgery is now a widely accepted modality for the treatment of basal cell carcinomas. This article presents a practical approach to using cryosurgery for this purpose in the dermatologist's office. Understanding the cryobiologic basis of cryosurgery is a prerequisite. Aspects of treatment covered include selection and use of appropriate equipment, indications and contraindications for specific tumors, preoperative preparation, various treatment technics with clinical and instrumental depth-dose monitoring, postoperative care, cure rate, and cosmetic and functional end results. The overall results obtained by cryosurgery compare favorably with those obtained by other modalities. Cryosurgery is the treatment of choice for some basal cell carcinomas and a satisfactory alternate treatment for others.

Verbrauchssenkung für großtechnische NH3‐Anlagen durch Wärmerückgewinnung im Abhitzesystem

AbstractEnergy savings in industrial NH3 plant by heat recovery in the waste heat system. Minimization of energy consumption is nowadays a primary goal in the design of NH3 plant. In this context two aspects are particularly important: first, the process steps and their combination must be selected in such a way that the level of energy that has to be supplied to the plant is kept low from the very beginning; second, heat recovery must be optimized by the choice of process conditions and use of appropriate equipment. An industrial NH3 plant built according to these principles can operate at a consumption of as low as 29.5 GJ/t NH3, using proven processes and equipment. The first plant of this new generation with a capacity of 1120 t/d is currently under construction for Canadian Industries Ltd. (CIL) in Canada.