Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.

Enhancing spiral-wound ultrafiltration performance for direct drinking water treatment through operational procedures improvement: A feasible option for the Sao Paulo Metropolitan Region

This work aimed to evaluate the influence of specific operational conditions on the performance of a spiral-wound ultrafiltration pilot plant for direct drinking water treatment, installed at the Guarapiranga's reservoir, in the Sao Paulo Metropolitan Region. Results from operational tests showed that the volume of permeate produced in the combination of periodic relaxation with flushing and chlorine dosage procedures was 49% higher than the volume obtained when these procedures were not used. Two years of continuous operation demonstrated that the ultrafiltration pilot plant performed better during fall and winter seasons, higher permeate flow production and reduced chemical cleanings frequency. Observed behavior seems to be associated with the algae bloom events in the reservoir, which are more frequent during spring and summer seasons, confirmed by chlorophyll-a analysis results. Concentrate clarification using ferric chloride was quite effective in removing NOM and turbidity, allowing its recirculation to the ultrafiltration feed tank. This procedure made it possible to reach almost 99% water recovery considering a single 54-hour recirculation cycle. Water quality monitoring demonstrated that the ultrafiltration pilot plant was quite efficient, and that potential pathogenic organisms, Escherichia coil and total coliforms, turbidity and apparent color removals were 100%, 95.1%, and 91.5%, respectively. (C) 2012 Elsevier B.V. All rights reserved.

Standard procedures for adults in accredited sleep medicine centres in Europe

The present paper describes standardized procedures within clinical sleep medicine. As such, it is a continuation of the previously published European guidelines for the accreditation of sleep medicine centres and European guidelines for the certification of professionals in sleep medicine, aimed at creating standards of practice in European sleep medicine. It is also part of a broader action plan of the European Sleep Research Society, including the process of accreditation of sleep medicine centres and certification of sleep medicine experts, as well as publishing the Catalogue of Knowledge and Skills for sleep medicine experts (physicians, non-medical health care providers, nurses and technologists), which will be a basis for the development of relevant educational curricula. In the current paper, the standard operational procedures sleep medicine centres regarding the diagnostic and therapeutic management of patients evaluated at sleep medicine centres, accredited according to the European Guidelines, are based primarily on prevailing evidence-based medicine principles. In addition, parts of the standard operational procedures are based on a formalized consensus procedure applied by a group of Sleep Medicine Experts from the European National Sleep Societies. The final recommendations for standard operational procedures are categorized either as 'standard practice', 'procedure that could be useful', 'procedure that is not useful' or 'procedure with insufficient information available'. Standard operational procedures described here include both subjective and objective testing, as well as recommendations for follow-up visits and for ensuring patients' safety in sleep medicine. The overall goal of the actual standard operational procedures is to further develop excellence in the practice and quality assurance of sleep medicine in Europe.

Integrating forensic information in a crime intelligence database

Since 2008, Intelligence units of six states of the western part of Switzerland have been sharing a common database for the analysis of high volume crimes. On a daily basis, events reported to the police are analysed, filtered and classified to detect crime repetitions and interpret the crime environment. Several forensic outcomes are integrated in the system such as matches of traces with persons, and links between scenes detected by the comparison of forensic case data. Systematic procedures have been settled to integrate links assumed mainly through DNA profiles, shoemarks patterns and images. A statistical outlook on a retrospective dataset of series from 2009 to 2011 of the database informs for instance on the number of repetition detected or confirmed and increased by forensic case data. Time needed to obtain forensic intelligence in regard with the type of marks treated, is seen as a critical issue. Furthermore, the underlying integration process of forensic intelligence into the crime intelligence database raised several difficulties in regards of the acquisition of data and the models used in the forensic databases. Solutions found and adopted operational procedures are described and discussed. This process form the basis to many other researches aimed at developing forensic intelligence models.

Method to assess and optimise dependability of complex macro-systems: application to a railway signalling system

Achieving a high degree of dependability in complex macro-systems is challenging. Because of the large number of components and numerous independent teams involved, an overview of the global system performance is usually lacking to support both design and operation adequately. A functional failure mode, effects and criticality analysis (FMECA) approach is proposed to address the dependability optimisation of large and complex systems. The basic inductive model FMECA has been enriched to include considerations such as operational procedures, alarm systems. environmental and human factors, as well as operation in degraded mode. Its implementation on a commercial software tool allows an active linking between the functional layers of the system and facilitates data processing and retrieval, which enables to contribute actively to the system optimisation. The proposed methodology has been applied to optimise dependability in a railway signalling system. Signalling systems are typical example of large complex systems made of multiple hierarchical layers. The proposed approach appears appropriate to assess the global risk- and availability-level of the system as well as to identify its vulnerabilities. This enriched-FMECA approach enables to overcome some of the limitations and pitfalls previously reported with classical FMECA approaches.

The Child Welfare Decategorization Program, August 2010

This Handbook is designed to outline the purposes, goals, structure, and operational procedures for Iowa’s Child Welfare Decategorization Program. The Handbook incorporates experiences gained since the inception of Decategorization in 1987. As with any initiative that began on a pilot basis, Decategorization has been an evolving program in which parameters and procedures have undergone modifications to achieve the desired results. The Handbook serves as a guidebook for implementation and operation of Decategorization and a means of communicating information on program parameters and procedures. Purposes of Decategorization of child welfare and juvenile justice funding is an initiative intended to establish systems of delivering human services based upon client needs to replace systems based upon a multitude of categorical funding programs and funding sources, each with different service definitions and eligibility requirements. Decategorization is designed to redirect child welfare and juvenile justice funding to services which are more preventive, family centered, and community-based in order to reduce use of restrictive approaches that rely on institutional, out-of home, and out-of-community care.

Clinical effectiveness of direct anterior restorations-A meta-analysis.

OBJECTIVES: This is the first meta-analysis on the efficacy of composite resin restorations in anterior teeth. The objective of the present meta-analysis was to verify whether specific material classes, tooth conditioning methods and operational procedures influence the result for Class III and Class IV restorations. MATERIAL AND METHODS: The database SCOPUS and PubMed were searched for clinical trials on anterior resin composites without restricting the search to the year of publication. The inclusion criteria were: (1) prospective clinical trial with at least 2 years of observation; (2) minimal number of restorations at last recall=20; (3) report on drop-out rate; (4) report of operative technique and materials used in the trial, and (5) utilization of Ryge or modified Ryge evaluation criteria. For the statistical analysis, a linear mixed model was used with random effects to account for the heterogeneity between the studies. p-Values smaller than 0.05 were considered to be significant. RESULTS: Of the 84 clinical trials, 21 studies met the inclusion criteria, 14 of them for Class III restorations, 6 for Class IV restorations and 1 for closure of diastemata; the latter was included in the Class IV group. Twelve of the 21 studies started before 1991 and 18 before 2001. The estimated median overall success rate (without replacement) after 10 years for Class III composite resin restorations was 95% and for Class IV restorations 90%. The main reason for the replacement of Class IV restorations was bulk fractures, which occurred significantly more frequently with microfilled composites than with hybrid and macrofilled composites. Caries adjacent to restorations was infrequent in most studies and accounted only for about 2.5% of all replaced restorations after 10 years irrespective of the cavity class. Class III restorations with glass ionomer derivates suffered significantly more loss of anatomical form than did fillings with other types of material. When the enamel was acid-etched and no bonding agent was applied, significantly more restorations showed marginal staining and detectable margins compared to enamel etching with enamel bonding or the total etch technique; fillings with self-etching systems were in between of these two outcome variables. Bevelling of the enamel was associated with a significantly reduced deterioration of the anatomical form compared to no bevelling but not with less marginal staining or less detectable margins. The type of isolation (absolute/relative) had a statistically significant influence on marginal caries which, however, might be a random finding.

Sähköverkkoyhtiön dokumenttien hallinta

Työssä on tutkittu sähköverkkoyhtiön dokumenttien hallintaa, pääosin keskittymällä käytännön dokumentoinnin tilaan ja sen kehittämiseen. Tutkimus perustuu kirjallisuuteen ja haastatteluihin. Kirjallisuuden avulla on selvitetty työn aihepiirin teoriaa. Haastattelujen avulla on kartoitettu dokumentoinnin nykytilaa ja siihen liittyviä ongelmia sekä alalla yleisesti käytössä olevia toimintatapoja. Työssä on käyty läpi dokumenttien hallinnan perusperiaatteet, menetelmät ja dokumentoinnin rooli sähköverkkoyhtiössä. Erityisesti huomiota on kiinnitetty Helsingin Energian HelenVerkko liiketoiminnon dokumentointiin selvittämällä nykytilaa sekä eri yksiköiden vastuualueita ja toimintatapoja. Myös sähköverkkoyhtiön palveluntuottajien roolia on pohdittu dokumentoinnin kannalta. Nykytilanselvityksen perusteella on koottu dokumenttiluettelo, josta ilmenee mitä dokumentteja HelenVerkossa on käytössä. Työssä on esitelty yleisellä tasolla dokumenttienhallintajärjestelmiin liittyviä toiminnallisuuksia sekä kuvattu muutamia referenssiympäristöjä järjestelmien käytöstä. Työn tuloksena on kuvattu sähköverkkoyhtiölle suositeltava dokumenttien hallinnan toimintatapa sekä kuvattu projektisuunnitelman muodossa, miten kyseisessä esimerkkitapauksessa nykytilasta päästään tavoitetilaan. Dokumenttienhallintaprojektin tavoitteena on kehittää HelenVerkon dokumenttien hallintaa toimivammaksi ja käyttöönottaa dokumenttienhallintajärjestelmä.

Effect of the implementation of the Hazard Analysis Critical Control Point (HACCP) prerequisite program in an institutional foodservice unit in Southern Brazil

The aims of this study were to investigate the hygienic practices in the food production of an institutional foodservice unit in Southern Brazil and to evaluate the effect of implementing good food handling practices and standard operational procedures using microbiological hygiene indicators. An initial survey of the general operating conditions classified the unit as regular in terms of compliance with State safety guidelines for food service establishments. An action plan that incorporated the correction of noncompliance issues and the training of food handlers in good food handling practices and standard operational procedures were then implemented. The results of the microbiological analysis of utensils, preparation surfaces, food handlers' hands, water, and ambient air were recorded before and after the implementation of the action plan. The results showed that the implementation of this type of practice leads to the production of safer foods.

The contagion effect of public debt on monetary policy: the Brazilian experience

This paper attempts to explain why the Brazilian inter-bank interest rate is so high compared with rates practiced by other emerging economies. The interplay between the markets for bank reserves and government securities feeds into the inter-bank rate the risk premium of the Brazilian public debt.

A reconstrução do marco regulatório do sistema financeiro do Brasil: os mercados de capitais, de seguros e previdência privada

The major objective of this paper is to identify, in the light of economic theory and of recent Brazilian and foreign institutional experiences, the best alternative for the reform of the regulatory framework of the domestic financial system, encompassing capital markets, insurance and private complementary social welfare. This paper is divided into four sections: in the first part, we identify the changes in the international and domestic financial systems, currently in an accelerated process of integration (search for similar rules and standards) and convergence (leveling of operational procedures). Next, we evaluate the potential impact of this new environment upon Brazilian economic development. In the second part, we analyze the concept of financial markets efficiency, where a contractualist view of the relationship involving suppliers and consumers of financial services is exposed. We also identify the major differences of focus among the several trends of regulation of the capital markets, insurance and private complementary social welfare In the third part, we present the concepts and the functions of a typical regulatory agency and alternative models of market regulation. In particular, we explore the differences between a regulatory model in which there are several regulatory agencies, each acting in segmented markets, as opposed to one in which there is single agency that regulates, supervises and oversees ali the indicated markets. In the forth and last part, we analyze the Brazilian case, attempting to identify, in the view of economic theory and recent experiences in other countries of the world, the best alternative for reforming present legislation. The basic recommended conclusion is to undertake studies that lead to the establishment of a single regulatory agency, congregating the functions currently performed by the Brazilian Securities Commission (CVM), the Superintendency of Private Insurance (Susep) and the Secretariai of Complementary Welfare (SPC).

The contagion effect of public debt on monetary policy: the brazilian experience

This paper attempts to explain why the Brazilian inter-bank interest rate is so high compared with rates practiced by other emerging economies. The interplay between the markets for bank reserves and government securities feeds into the inter-bank rate the risk premium of the Brazilian public debt.

Marcas, passagens e condensações : (des)encaminhamentos de um processo de gravura

Marcas, passagens e condensações: (des) encaminhamentos de um processo de gravura é uma pesquisa em Poéticas Visuais que articula questões provenientes de uma prática artística com base na gravura e uma produção textual. Investigam-se as possibilidades de potencializar o vazio e o cheio através da gravação de matrizes com instrumentos de corte e da gravação com fogo. Os procedimentos operatórios de cortar, queimar e condensar originaram a impressão das matrizes sobre suportes de papéis e de parafina. As imagens dessa produção gráfica resultaram em uma série de obras denominadas de Carbonizados, Sílex e Luas Negras, cujas ações instauradoras propiciaram diferentes etapas de gravação e impressão: marcas, passagens e condensações que foram analisadas a partir dos conceitos operatórios identificados no processo de criação. O estudo conduz a aproximações com obras de artistas contemporâneos e articula referenciais na História da Arte e na fenomenologia, propiciando o inter-relacionamento da prática com a teoria e vice-versa.

Plano setorial: a construção de estratégias para implementação do plano diretor de Natal

The Sectoral Plan was inserted as an urban instrument in Master Plan of Natal (LC82/07), since then it has been deepened. It is guided to the equitable distribution of the benefits of urbanization, aimed the efetivation of the Right to the City and the Environmental function of property in the context of urban planning. Thereby, the Sectoral Plan was inserted into the perspective of promoting a favorable field for applying articulated of instruments defined in the Master Plan, and them with urban interventions, through the deepening of macrozoning - coming out of dimension of the city and going to a small fraction of the urban by reducing scaling - facilitating democratic management in accordance with the City Statute. However, the absence of regulation and the conceptual and operational fragility of the instrument, approached it of other existent experiences and instruments, limiting its application and evaluation. Considering the innovative nature of the instrument and the intense social participation, we inquire about conceptual and operational elements which could give greater effectiveness to Sector Plan in construction? Guided by that question, this dissertation aim to understand the nature and operational procedures of Sectoral Plan, seeking to do indications about the conceptual and operational aspects of implementing a Sector Plan. The neighborhood of Ponta Negra was selected as empirical universe because it was the first sector defined in the Master Plan. This research adopts reference authors who´s make reflection and insights about the matrix of Urban Reform, whose principles constitute the basis of the trajectory of revision of urban planning in Brazil since the 1980s, highlighting Raquel Rolnik, Nelson Saule Júnior and Orlando Alves dos Santos Júnior. For the local monitoring, we use the authors Alexsandro Ferreira Cardoso Silva, Rosa Maria Pinheiro Oliveira e Marise Costa da Souza Duarte, in order to understand the growth dynamics of Natal, lawfully and urbanistically