Radiation exposure from gallium-67-citrate patients.
(17/2817)
OBJECTIVE: Serial monitoring of patients was performed to determine the radiation exposure contributed by patients injected with 67Ga-citrate to their surroundings. Radiology and nursing staff distance exposure estimates were made for various patient care tasks and imaging tests. METHODS: Fifteen adult patients were surveyed early (mean 4.3 min) and 11 of the 15 were surveyed at 3 d (mean 68.8 h) postinjection. The standard adult lymphoma imaging activity of 333-407 MBq (9-11 mCi) resulted in a range of 3.7-8.1 MBq/kg (0.1-0.22 mCi/kg). Dose rate measurements were made in the anterior, posterior, and left and right lateral projections at the level of the umbilicus, at distances of patient's surface and at 30.5 cm and 100 cm with a calibrated ion chamber. Time of contact-routine task analyses also were obtained for nursing and radiology personnel. Using a radiation survey-derived biexponential pharmacokinetic relationship, radiation exposures were determined for hospital personnel and family members at various times after injection. RESULTS: Based on the study population survey results, the mean instantaneous exposures (microSv/h) for an administered activity of 370 MBq (10 mCi) 67Ga-citrate were determined. The task analyses revealed the maximum patient contact time for any procedure performed at a distance equal to, or less than, 30.5 cm was 30 min. CONCLUSION: The quantitation of radiation exposure scenarios from 67Ga-citrate patients has determined that no special precautions are necessary for medical personnel when performing routine tasks associated with these patients. (+info)
Vaccine storage in the community: a study in central Italy.
(18/2817)
Maintaining the vaccine cold chain is an essential part of a successful immunization programme, but in developed countries faulty procedures may occur more commonly than is generally believed. A survey was conducted in a health district in central Italy to assess the methods of vaccine transportation and storage. Of 52 primary vaccination offices inspected, 39 (76.5%) had a refrigerator for vaccine storage but only 17 (33.3%) kept records of received and stored doses. None of the seven main offices selected for monitoring had a maximum and minimum thermometer and none monitored the internal temperature of the refrigerator. Moreover, other faulty procedures, such as the storage of food and laboratory specimens in vaccine refrigerators and the storage of vaccines on refrigerator door shelves, indicated that the knowledge and practice of vaccine storage and handling were often inadequate. (+info)
Patients' perception and satisfaction with health care professionals at primary care facilities in Trinidad and Tobago.
(19/2817)
This paper endeavours to identify the background characteristics of health centre users in Trinidad and Tobago and their perceptions of the efficiency of the services provided. Multistage sampling was employed to select 1451 users. Data were obtained during structured interviews on regular clinic days. Of the people using the health centres, 80.4% were unemployed and 75.9% were women. People aged over 60 accounted for 25.4% of the sample. Users included a disproportionately high number of persons from the lower socioeconomic categories. The proportions of persons of different ethnic and religious groups closely reflected those in the country's general population. Approximately 74% of the interviewees were satisfied with the performance of the doctors in the health centres. For nurses the satisfaction rating was about 10% higher. The greatest needs for improvement were perceived to be in pharmacists' and doctors' services, with particular reference to waiting times. (+info)
Characteristics of private medical practice in India: a provider perspective.
(20/2817)
Supply factors, depicted by input market conditions and government regulations, and demand factors, depicted by financing mechanisms and utilization patterns, are likely to determine the shape and character of private medical practice. The interaction of this complex set of factors will have considerable implications for the cost access and quality of services offered by this sector. Understanding these characteristics from a provider perspective is imperative to influence the behaviour of providers in this sector. This paper describes some of the important characteristics of private medical practice using a case study of an urban district in India, Ahmedabad, and analyzes their implications. Using survey data of 130 private doctors in the allopathic system, the paper describes broad characteristics of private medical practice using parameters such as growth of private practice, patient load and referrals within the sector, payment methods and determinants, patient concerns, and risks associated with private practice. The paper presents views on the prevalence of various undesirable practices in the private medical sector. It also discusses the awareness of providers about selected important regulations. The findings suggest that growing capital intensity due to cost of location, medical equipment and technology, and financial sources of capital investments are some unfavourable environmental factors experienced by private providers. The findings also indicate a high prevalence of various undesirable practices and low awareness of the objectives of important legislation among practicing doctors. Lack of awareness of important and relevant legislation raises serious questions about the implementation of these laws. The paper identifies the strong need for instituting and implementing an effective continuing medical education programme for practicing doctors, and linking it with their registration and continuation of their license to practice. The paper also suggests that cost of health care, access and quality problems will worsen with the growth of the private sector. The public policy response to check some of the undesirable consequences of this growth is critical and should focus on strengthening the existing institutional mechanisms to protect patients, developing and implementing an appropriate regulatory framework and strengthening the public health care delivery system. The study also discusses various other policy implications arising. (+info)
Needlestick and sharps injuries among health-care workers in Taiwan.
(21/2817)
Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high. (+info)
Validation of a questionnaire for assessing physical work load.
(22/2817)
OBJECTIVES: Reliable, valid, and compatible methods are required for exploring the complex interactive effects of psychosocial and physical stressors on complaints and disorders. An instrument for assessing physical work load that integrates information from a biomechanical model of lumbar load is presented and validated. METHODS: Four hundred and fifty-five people working in nursing homes for elderly people in Germany filled out the developed questionnaire 3 times within 1 year. Test-retest reliability was calculated, and validity was checked several times. Relationships with other, theoretically related and unrelated variables were examined. RESULTS: The test-retest reliability of the questionnaire measures was about 0.65. The convergent and discriminant validity was satisfactory, and the questionnaire was able to separate professional subgroups with different physical work loads. The Spearman rank-order correlations between physical load and musculoskeletal complaints were about 0.30. CONCLUSIONS: The method developed in this study is a reliable and valid instrument for assessing physical work load. The integration of statistical methods from psychological testing and theory in the development of methods exploring the effects of physical work load is advocated. (+info)
Health care worker disability due to latex allergy and asthma: a cost analysis.
(23/2817)
OBJECTIVES: The reported prevalence of occupational allergy to natural rubber latex is 8% to 17%, and that of latex-induced occupational asthma is 2.5% to 6%. Conversion of medical facilities to "latex-safe" can reduce employee sensitization, impairment, and disability. The purpose of this study was to determine the cost of a latex-safe approach, compared with that of continued latex glove use, and to identify the level of worker disability required to make the latex-safe approach financially preferable to a health care institution. METHODS: The costs of 2 strategies--latex-safe vs the status quo--were calculated from the perspective of 3 health care institutions. A break-even point was calculated for each facility. RESULTS: In all facilities, the cost of using nonlatex gloves exceeded the cost of using latex gloves. In all 3 facilities, however, 1% or fewer of those at risk would have to become fully disabled or fewer than 2% would have to become partially disabled for the continued use of latex gloves to exceed the cost of the latex-safe approach. CONCLUSION: Health care facilities, regardless of size, are likely to benefit financially from becoming latex-safe even if latex-related disability levels are extremely low. (+info)
Colorectal cancer prevention. An approach to increasing compliance in a faecal occult blood test screening programme.
(24/2817)
STUDY OBJECTIVE: The assessment of the uptake of colorectal cancer screening offered in a workplace setting. DESIGN: Employees were offered a free faecal occult blood test (Haemoccult). A repeat letter was sent two months later to non-responders. Those with positive tests were invited for colonoscopy. Compliance was measured according to age, sex, and occupational group and the effects of reinviting non-compliers investigated. SETTING: Leicester General Hospital, a large university teaching hospital. PARTICIPANTS: 990 employees aged 41 to 65 years. MAIN RESULTS: Total compliance was 46% with women participating more than men (49% v 34%, chi 2 = 12.2, p < 0.001). The difference was mostly because of women aged 41 to 50 years complying more than their male counterparts (48% v 24%, chi 2 = 15.5, p < 0.0001). Participation was highest in clinical support staff (56%), nurses (52%), and clerical workers (46%). Uptake by doctors (26%) and managers (26%) was significantly lower than by clinical support staff and nurses (chi 2 > 5.5, p < 0.02). Remailing raised compliance slightly from 43.6% to 46.3%. Four employees (1%) had positive faecal occult blood tests but three were negative on repeat testing with dietary restrictions. CONCLUSIONS: The government favours the development of health promotion programmes as stated in its document "Health at work in the NHS". The response in this study, showed methods to increase compliance must be developed if such programmes are to be successful. As uptake was similar to that in several community based programmes in general practice, workplace based programmes could offer a complementary method of delivering screening. (+info)