Maintenance and sustained use of insecticide-treated bednets and curtains three years after a controlled trial in western Kenya.
In large experimental trials throughout Africa, insecticide-treated bednets and curtains have reduced child mortality in malaria-endemic communities by 15%-30%. While few questions remain about the efficacy of this intervention, operational issues around how to implement and sustain insecticide-treated materials (ITM) projects need attention. We revisited the site of a small-scale ITM intervention trial, 3 years after the project ended, to assess how local attitudes and practices had changed. Qualitative and quantitative methods, including 16 focus group discussions and a household survey (n = 60), were employed to assess use, maintenance, retreatment and perceptions of ITM and the insecticide in former study communities. Families that had been issued bednets were more likely to have kept and maintained them and valued bednets more highly than those who had been issued curtains. While most households retained their original bednets, none had treated them with insecticide since the intervention trial was completed 3 years earlier. Most of those who had been issued bednets repaired them, but none acquired new or replacement nets. In contrast, households that had been issued insecticide-treated curtains often removed them. Three (15%) of the households issued curtains had purchased one or more bednets since the study ended. In households where bednets had been issued, children 10 years of age and younger were a third as likely to sleep under a net as were adults (relative risk (RR) = 0. 32; 95% confidence interval (95%CI) = 0.19, 0.53). Understanding how and why optimal ITM use declined following this small-scale intervention trial can suggest measures that may improve the sustainability of current and future ITM efforts. (+info)
Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.
Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment. (+info)
Specifications for equipment used for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/ American Thoracic Society.
The aim of this position paper is to define minimal performance criteria for the separate items comprising equipment used to measure respiratory function in infants together with overall performance criteria for the assembled pieces of such equipment. These guidelines cover numerous aspects including: 1) safety, 2) documentation and maintenance of equipment, 3) physical characteristics of mechanical parts and signal transducers, and 4) data acquisition. Further, validation procedures for individual components as well as for the integrated equipment are recommended. Adherence to these guidelines should ensure that infant lung function measurements can be performed with an acceptable degree of safety, precision and reproducibility. They will also facilitate multicentre collection of data and performance of clinical investigations. Manufacturers of infant respiratory function equipment should make every effort to comply with these guidelines, which represent the current standards of paediatric health professionals in this field. (+info)
Asthma risk, cleaning activities and use of specific cleaning products among Spanish indoor cleaners.
OBJECTIVES: Recent studies have shown an excess risk of asthma for cleaners, but it is not clear which cleaning-related exposures induce or aggravate asthma. METHODS: Risk factors for asthma were studied among indoor cleaners participating in the Spanish part of the European Community Respiratory Health Survey in 1992. In 1998, 78 of the 91 subjects reporting cleaning-related jobs in 1992 were identified. Of these, 67 indoor cleaners were interviewed by telephone about their cleaning activities and their use of cleaning products in 1992. These data were related to asthma prevalence in 1992, and the cleaners were compared with a reference group of office workers. RESULTS: Asthma prevalence was 1.7 times higher [95% confidence interval (95% CI) 1.1-2.6] among the cleaners than among the referents, being highest among private home cleaners (3.3, 95% CI 1.9-5.8). The prevalence of housedust mite sensitization amounted to 28% for the home cleaners and was significantly (P<0.01) higher than for other indoor cleaners (3%), but similar to the corresponding prevalence of office workers (22%). More than half of the cleaners reported work-related respiratory symptoms. The asthma risk of the home cleaners was mainly associated with kitchen cleaning and furniture polishing, with the use of oven sprays and polishes. CONCLUSIONS: The asthma risk of Spanish cleaners is primarily related to the cleaning of private homes. This relationship may be explained by the use of sprays and other products in kitchen cleaning and furniture polishing. (+info)
The use and maintenance of visible light activating units in general practice.
AIM: The present study to investigate the use, care and maintenance of light units in everyday clinical practice was undertaken to complement light unit emission surveys, with a view to developing a protocol for light unit use and care in everyday clinical practice. METHOD: The investigative work comprised a survey of selected practices in the Blackburn area with follow-up practice visits to examine light units in situ, and to glean additional information in respect of light unit use and care in the practice environment. RESULTS: Completed questionnaires were returned by 54 of 77 selected practices--a 70% response, including information in relation to 164 light units. Subsequently, 100 (61%) of these light units were examined in 42 practices according to a standardised protocol. The use and care of the light units included in the study was found to be very variable. In addition to finding that 28 (28%) had inadequate light output (<300 mW/cm2), many of the light units were found to be damaged or repaired (47, 47%). Thirty five (35%) of the light units inspected were found to have varying amounts of material adherent to the light guide exit portal. CONCLUSION: It is concluded that practitioners should address practical aspects of their increasing reliance on light units, and to this end, guidance is offered on visible light curing and the care and maintenance of light units. (+info)
Quality assurance in health care: missions, goals, activities.
The most challenging mission of medical personnel today is quality assurance in health care. To meet this challenge, the essential elements of a six-phase system for total quality control for the medical laboratory are outlined under the headings of design control, incoming material control, process control, output control, reliability control, and special verification studies. Review of existing goals and activities of programs related to this mission indicates both problems and rich opportunities for individual laboratory professionals and their organizations. For effective implementation of this mission, the laboratory professionals will have to create the atmosphere of a collegium where all interested scientists communicate across disciplines to eliminate the systematic biases and improve the accuracy, precision, and specificity of clinical laboratory measuring systems, to assure medically meaningful and useful assay results for the broad spectrum of health care that is necessary for the well, the near-well, and the sick. (+info)
Sphygmomanometers in use in general practice: an overlooked aspect of quality in patient care.
OBJECTIVES: To assess the condition, accuracy and safety of mercury and anaeroid sphygmomanometers in use in general practice and to pilot a scheme for sphygmomanometer maintenance within the district. DESIGN: Instruments were checked on site according to set protocols which related to established guidelines and standards and data were entered into a specially designed database. Mercury sphygmomanometers were removed to the laboratory for servicing. Practices received written feedback on the condition of each instrument checked, repairs undertaken and advice, where necessary, for further work required. Participant views on the scheme were sought. MATERIALS AND METHODS: A total of 472 instruments (75.4% mercury) located in 86 general practices (87.8% of practices participated) in a health district in the West Midlands. Instruments were checked against 28 (mercury) and 25 (anaeroid) quality standards and (for mercury instruments) against British Hypertension Society guidelines. RESULTS: 69.1% of mercury and 95.7% of anaeroid instruments checked, had no service records. Of the remainder, only 29 mercury (8.1%) and one anaeroid (0.9%) had a record of a check or service within the previous 12 months. None of the instruments met all of the relevant quality standards and 14 (3.9%) mercury and seven (6.1%) anaeroid instruments met less than half. A large proportion of mercury sphygmomanometers tested had defects likely to affect recommended measurement technique. Only two-thirds were accurate at all pressure levels tested. Only 38.8% of anaeroid instruments were accurate at all test pressure levels. CONCLUSIONS: The level of defects noted could have an impact on diagnosis and monitoring of hypertension. (+info)
Is home renovation or repair a risk factor for exposure to lead among children residing in New York City?
Children can be lead poisoned when leaded paint is disturbed during home renovation or repair. We conducted a case-control study to assess the association between elevated blood lead levels (BLLs) in children younger than 5 years of age and renovation or repair of homes built before 1950 in New York City. In 1998, we interviewed parents of 106 case children (BLLs >/= 10 micro g/dL) and 159 control children (BLLs +info)