Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

Joint optimization of rule placement and traffic engineering for QoS provisioning in software defined network

Software-Defined Network (SDN) is a promising network paradigm that separates the control plane and data plane in the network. It has shown great advantages in simplifying network management such that new functions can be easily supported without physical access to the network switches. However, Ternary Content Addressable Memory (TCAM), as a critical hardware storing rules for high-speed packet processing in SDN-enabled devices, can be supplied to each device with very limited quantity because it is expensive and energy-consuming. To efficiently use TCAM resources, we propose a rule multiplexing scheme, in which the same set of rules deployed on each node apply to the whole flow of a session going through but towards different paths. Based on this scheme, we study the rule placement problem with the objective of minimizing rule space occupation for multiple unicast sessions under QoS constraints. We formulate the optimization problem jointly considering routing engineering and rule placement under both existing and our rule multiplexing schemes. Via an extensive review of the state-of-the-art work, to the best of our knowledge, we are the first to study the non-routing-rule placement problem. Finally, extensive simulations are conducted to show that our proposals significantly outperform existing solutions.

The human side of project management - an investigation of critical chain concepts in the Argentinean Project Environment

The global marketplace is rapidly intensifying. Longer product sales lives, greater profit margins or simply survival, is dependent on management¿s ability to create and lead change. Project Management has become an important competency, combined with other business practices to adapt to the trend of changing conditions. Critical Chain is a relatively new project methodology, elaborated by Eliyahu Goldratt in order to complete projects faster, make more efficient use of resources and securing the project deliverables. The methodology is based on the assumption that traditional project techniques such as CPM and PERT, do not recognize critical human behavior. The methodology claims that many project failures are a direct result of how safety is built into the task delivery times, and then wasted by human behavior such as Student Syndrome, Parkinson Law and Multitasking. However, there has been little or no previous research regarding this topic in the Argentine marketplace. This study intended to investigate to what extent the human behavior concepts of critical chain project management are present, by performing in-depth interviews with Argentine project stakeholders. It appears that the four human behavior concepts are present in Argentina and that the majority of Argentine companies are yet to apply project management techniques.

APPLICATION of THE HAZARD ANALYSIS and CRITICAL CONTROL POINT (HACCP) SYSTEM on THE MUSHROOM PROCESSING LINE FOR FRESH CONSUMPTION

The Hazard Analysis and Critical Control Point (HACCP) is a preventive system that intends to guarantee the safety and harmlessness of food. It improves the quality of products as it eliminates possible defects during the process, and saves costs by practically eliminating final product inspection. This work describes the typical hazards encountered on the mushroom processing line for fresh consumption. Throughout the process, only the reception stage of mushrooms has been considered a critical control point (CCP). The main hazards at this stage were: the presence of unauthorised phytosanitary products; larger doses of such products than those permitted; the presence of pathogenic bacteria or thermo-stable enterotoxins. Putting into practice such knowledge would provide any industry that processes mushrooms for fresh consumption with a self-control HACCP-based system for its own productions.

Darunavir: A Critical Review of Its Properties, Use and Drug Interactions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatigue strength of tungsten inert gas-repaired weld joints in airplane critical structures

In this work the effect of Gas Tungsten Arc Welding (GTAW) repairs on the axial fatigue strength of an AISI 4130 steel welded joint used in airframe critical to the flight-safety was investigated. Fatigue tests were performed at room temperature on 0.89 mm thick hot-rolled plates with constant amplitude and load ratio of R = 0.1, at 20 Hz frequency. Monotonic tensile tests, optical metallography and microhardness, residual stress and weld geometric factors measurements were also performed. The fatigue strength decreased with the number of GTAW repairs, and was related to microstructural and microhardness changes, as well as residual stress field and weld profile geometry factors, which gave origin to high stress concentration at the weld toe. (C) 2011 Elsevier B.V. All rights reserved.

Safety illusion and error trap in a collectively-operated machine accident

Workplace accidents involving machines are relevant for their magnitude and their impacts on worker health. Despite consolidated critical statements, explanation centered on errors of operators remains predominant with industry professionals, hampering preventive measures and the improvement of production-system reliability. Several initiatives were adopted by enforcement agencies in partnership with universities to stimulate production and diffusion of analysis methodologies with a systemic approach. Starting from one accident case that occurred with a worker who operated a brake-clutch type mechanical press, the article explores cognitive aspects and the existence of traps in the operation of this machine. It deals with a large-sized press that, despite being endowed with a light curtain in areas of access to the pressing zone, did not meet legal requirements. The safety devices gave rise to an illusion of safety, permitting activation of the machine when a worker was still found within the operational zone. Preventive interventions must stimulate the tailoring of systems to the characteristics of workers, minimizing the creation of traps and encouraging safety policies and practices that replace judgments of behaviors that participate in accidents by analyses of reasons that lead workers to act in that manner.

Influence of the ratio of particulate autogenous bone graft/platelet-rich plasma on bone healing in critical-size defects: a histologic and histometric study in rat calvaria

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

As possibilidades de uso de ferramentas da informática: software para análise de dados qualitativos e ISD

The objective of the present article is to identify and discuss the possibilities of using qualitative data analysis software in the framework of procedures proposed by SDI (socio-discursive interactionism), emphasizing free distribuited software or free versions of commercial software. A literature review of software for qualitative data analysis in the area of social sciences and humanities, focusing on language studies is presented. Some tools, such as: Wef-tQDA, MLCT, Yoshikoder and Tropes are examined with their respective features and functions. The software called Tropes is examined in more detail because of its particular relation with language and semantic analysis, as well as its embeded classification of linguistic elements such as, types of verbs, adjectives, modalizations, etc. Although trying to completely automate an SDI based analysis is not feasible, the programs appear to be powerful helpers in analyzing specific questions. Still, it seems important to be familiar with software options and use different applications in order to obtain a more diversified vision of the data. It is up to the researcher to be critical of the analysis provided by the machine.

Bone healing in critical-size defects treated with platelet-rich plasma: a histologic and histometric study in rat calvaria

Background and objective: The purpose of this study was to analyze histologically the influence of autologous platelet-rich plasma on bone healing in surgically created critical-size defects in rat calvaria.Material adn Methods: Thirty-two rats were divided into two groups: the control group (group C) and the platelet-rich plasma group. An 8-mm-diameter critical-size defect was created in the calvarium of each animal. In group C the defect was filled by a blood clot only. In the platelet-rich plasma group, 0.35 mL of platelet-rich plasma was placed in the defect and covered by 0.35 mL of platelet-poor plasma. Both groups were divided into subgroups (n = 8) and killed at either 4 or 12 wk postoperatively. Histometric (using image-analysis software) and histologic analyses were performed. The amount of new bone formed was calculated as a percentage of the total area of the original defect. Percentage data were transformed into arccosine for statistical analysis (analysis of variance, Tukey, p < 0.05).Results: No defect completely regenerated with bone. The platelet-rich plasma group had a statistically greater amount of bone formation than group C at both 4 wk (17.68% vs. 7.20%, respectively) and 12 wk (24.69% vs. 11.65%, respectively) postoperatively.Conclusion: Within the limits of this study, it can be concluded that platelet-rich plasma placed in the defects and covered by platelet-poor plasma significantly enhanced bone healing in critical-size defects in rat calvaria.

GIS_EM (Geographic information system for environmental monitoring) - A software implemented at Paulínia refinery (REPLAN) for management of environmental data

The computational program called GIS_EM (Geographic Information System for Environmental Monitoring), a software devised to manage geographic information for monitoring soil, surface, and ground water, developed for use in the Health, Safety, and Environment Division of Paulinia Refinery is presented. This program enables registering and management of alphanumeric information pertaining to specific themes such as drilling performed for sample collection and for installation of monitoring wells, geophysical and other tests, results of chemical analyses of soil, surface, and groundwater, as well as reference values providing orientation for soil and water quality, such as EPA, Dutch List, etc. Management of such themes is performed by means of alphanumeric search tools, with specific filters and, in the case of spatial search, through the selection of spatial elements (themes) in map view. Documents existing in digital form, such as reports, photos, maps, may be registered and managed in the network environment. As the system centralizes information generated upon environmental investigations, it expedites access to and search of documents produced and stored in the network environment, minimizing search time and the need to file printed documents. This is an abstract of a paper presented at the AIChE Annual Meeting and Fall Showcase (Cincinnati, OH 10/30/2005-11/4/2005).

Effects of LLLT in combination with bisphosphonate on bone healing in critical size defects: A histological and histometric study in rat calvaria

The purpose of this study was to analyze histologically the effect of low-level laser therapy (LLLT) in combination with bisphosphonate on bone healing in surgically created critical size defects (CSD) in rat calvaria. One hundred Wistar female rats sham operated (sham) and ovariectomized (Ovx) were maintained untreated for 1 month to allow for the development of osteopenia in the Ovx animals. A CSD was made in the calvarium of each rat, and the animals were divided into five groups according to following treatments: (1) sham rats (control), (2) Ovx rats, (3) Ovx rats treated with LLLT, (4) Ovx rats treated with bisphosphonate, and (5) Ovx rats treated with bisphosphonate and LLLT. Groups 4 and 5 were irrigated with 1 ml of bisphosphonate, and groups 3 and 5 were submitted to LLLT (GaAlAs), 660 nm, 24 J, and 0.4285 W/cm2 on the CSD. Ten animals of each treatment were killed at 30 and 60 days. Histomorphometric assessments, using image analysis software, and histological analyses were performed. No defect was completely regenerated with the bone. Histometrically, it can be observed that groups 3 (37.49 ± 1.94%, 43.11 ± 2.39%) and 5 (35.05 ± 1.57%, 41.07 ± 1.89%) showed a significant bone neoformation when compared to groups 1 (16.81 ± 1.57%, 27.54 ± 1.49%), 2 (11.68 ± 0.98%, 22.51 ± 1.05%), and 4 (14.62 ± 1.70%, 25.67 ± 1.41%) in all experimental periods (P < 0.05). It was possible to conclude that the LLLT associated or not with bisphosphonate treatment was effective for stimulating bone formation in CSD in the calvaria of rats submitted to ovariectomy. © 2012 Springer-Verlag London Ltd.

Previsão de ondas geradas por ventos em águas interiores e sua alteração devido à presença de vegetação aquática em margens de lagos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação da ferramenta de visualização de software SoftVisOAH como apoio à depuração de programas: um experimento controlado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diuron-induced rat urinary bladder carcinogenesis: Mode of action and human relevance evaluations using the International Programme on Chemical Safety framework

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)