Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer

Objective. To examine the feasibility and safety of a low anterior resection of the rectosigmoid plus adjacent pelvic tumour as part of primary cytoreduction for ovarian cancer. Methods. This study included 65 consecutive patients with primary ovarian cancer who had debulking surgery from 1996 through 2000. All patients underwent an en bloc resection of ovarian cancer and a rectosigmoid resection followed by an end-to-end anastomosis. Parameters for safety and efficacy were considered as primary statistical endpoints for the aim of this analysis. Results. Postoperative residual tumour was nil, 1 cm in 14, 34, and 14 patients, respectively. The median postoperative hospital stay was 11 days (range, 6 to 50 days). Intraoperative complications included an injury to the urinary bladder in one patient. Postoperative complications included wound complications (n=14, 21.5%), septicemia (n=9, 13.8%), cardiac complications (n=7, 10.8%), thromboembolic complications (n=5, 7.7%) ileus (n=2, 3.1%) anastomotic leak (n=2, 3.1%) and fistula (n=1, 1.5%). Reasons for a reoperation during the same admission included repair of an anastomotic leak (n=1), postoperative hemorrhage (n=1), and wound debridement (n=1). Wound complications, septicemia, and anastomotic leak formation were more frequent in patients who had a serum albumin level of less than or equal to 30 g/L preoperatively. There was one surgically related mortality in a patient who died from a cerebral vascular accident 2 days postoperatively. Conclusions. An en bloc resection as part of primary cytoreductive surgery for ovarian cancer is effective and its morbidity is acceptably low. (C) 2001 Academic Press.

A risk-based system to penalize and reward line management for occupational safety and health performance

Penalizing line management for the occurrence of lost time injuries has in some cases had unintended negative consequences. These are discussed. An alternative system is suggested that penalizes line management for accidents where the combination of the probability of recurrence and the maximum reasonable consequences such a recurrence may have exceeds an agreed limit. A reward is given for prompt effective control of the risk to below the agreed risk limit. The reward is smaller than the penalty. High-risk accidents require independent investigation by a safety officer using analytical techniques. Two case examples are given to illustrate the system. Continuous safety improvement is driven by a planned reduction in the agreed risk limit over time and reward for proactive risk assessment and control.

Food safety and development of the beef industry in China

Food safety concerns have escalated in China as they have elsewhere, especially in relation to meats. Beef production and consumption has increased proportionately faster than all other meats over the last two decades. Yet the slaughtering, processing and marketing of beef remains, for the most part, extremely primitive when compared with Western beef supply chains. By comparing the economics of household slaughtering with that of various types of abattoirs, this paper explains why household slaughtering and wet markets still dominate beef processing and distribution in China. The negative economic, social and industry development implications of enforcing more stringent food safety regulations are highlighted. The willingness/capacity of consumers to pay the added cost of better inspection and other services to guarantee food safety is investigated. In this context, the paper also evaluates the market opportunities for both domestic and imported Green Beef. The paper questions the merit of policy initiatives aimed at modernising Chinese beef supply chains for the mass market along Western lines. (C) 2002 Elsevier Science Ltd. All rights reserved.

Transport safety for older people: A study of their experiences, perceptions and management needs

With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people. The present study aimed to identify transport options and licensing issues for a group of older people in an Australian community. Ninety-five participants aged 75 and over were interviewed about their driving status and accident record and tested for cognitive ability. After stratification on cognitive level and driver status (current, ex-driver or non-driver), 30 were selected for further in-depth interviews concerning demographics, licence status and impact of change, travel options available and used, and travel characteristics. Considerable reliance on the motor vehicle as the mode of transport and the decision to cease driving were major quality-of-life issues. There was little evidence of planning and support in making the decision to stop driving. Some differences in transport decisions on the basis of cognitive level were evident; however, people with severely compromised cognitive ability (and, therefore, unable to give informed consent) had been excluded. The study suggested the need for resources to assist older people/carers/health professionals to plan for the transition from driver to non-driver and to manage alternative transport options more effectively

The main benefits associated with health and safety management systems certification in Portuguese small and medium enterprises post quality management system certification

The purpose of this study is to characterize how Portuguese Small and Medium Enterprises (SMEs) view the Occupational Health and Safety Management Systems (OHSMSs) certification process, after receiving the Quality Management System (QMS) certification. References were based on the ISO 9001 standard for a QMS and OHSAS 18001 for OHSMS. The method used to evaluate the implemented systems, was by form of questionnaire. Those questioned had to have a certified quality management system, an implemented OHSMS and be a SME. The questionnaire was sent to 300 SMEs; 46 responses were received and validated. Of them, only 12 SMEs had the OHSMS certificate according to OHSAS 18001. Within those 12 companies that participated: 7 SMEs are from the industrial sector; 3 belong to the electricity/telecommunications sector and 2 SMEs are from the trade/services activity sector. The size of the sample was small, but corresponds to Portuguese reality. Moreover, 34 SMEs did not have the OHSMS certificate. The questionnaire requested the main reasons for SMEs to opt for non-certification and it was related with high costs, while the main reasons to certificate were, among others, needed to eliminate or minimize risks to workers. The main benefits that Portuguese SMEs have gained from the referred certifications have been, improved working conditions, ensuring compliance with legislation and better internal communication about risks and hazards. Also presented are the main difficulties in achieving an OHSMS certification including high certification costs, difficulties motivating personnel, difficulties in changing the company’s culture and increased bureaucracy.

Certification and integration of environment with quality and safety – a path to sustained success

According to Wright [1] certification of products and processes began during the 1960’s in the manufacturing industry, as a tool to control and assure the quality/conformity of products and services provided by suppliers to customers/consumers. Thus, the series of ISO 9000 was published first time, in 1987 and it was been created with a flexible character, to be reviewed periodically. Later, were published others normative references, which highlight the ISO 14001 in 1996 and OHSAS 18001 in 1999. This was also, the natural sequence of the certification processes in the organizations, i.e., began with the certification of quality management systems (QMS) followed by the environmental management systems (EMS) and after for the Occupational Health and Safety Management System (OHSMS). Hence, a high percentage of organizations with an EMS, in accordance with the ISO 14001, had also implemented, a certified QMS, in accordance with ISO 9001. At first the implementation of a QMS was particularly relevant in high demanding activity sectors, like the automotive and aeronautical industries, but it has rapidly extended to every activity sector, becoming a common requisite of any company worldwide and a factor of competitiveness and survival. Due to the increasingly demanding environmental legislation in developed countries, companies nowadays are required to seriously take into consideration not only environmental aspects associated to the production chain itself, but also to the life cycle of their products.