PubMed · 11633952
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J Antall. 1978. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11633952/
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OBJECTIVES: To identify the current state of knowledge, current uncertainties and future needs related to the diagnosis of disorders associated with the use of vibratory hand-held tools. METHOD: An international workshop was convened with invited experts, medical doctors, scientists and engineers familiar with hand-transmitted vibration and the diagnosis of vascular, neurological and musculoskeletal disorders. This paper records the general conclusions from four panel discussions. RESULTS: For the most common vascular disorder (vibration-induced white finger), the principal symptom and sign involves attacks of well-demarcated finger blanching (Raynaud's phenomenon); low finger systolic blood pressure following cooling is indicative of vibration-induced white finger and zero finger systolic blood pressure can confirm an attack of Raynaud's phenomenon. For neurological disorders, some symptoms can exist without detectable signs and some signs can exist without symptoms; numbness and tingling are commonly reported but neurological changes may be present without these symptoms. The pathogenesis of musculoskeletal disorders in users of vibratory tools is not clear; symptoms may include pain that may not be associated with abnormal results in objective tests. For both neurological and musculoskeletal disorders, a thorough neuromuscular and skeletal examination is required; diagnosis must consider the work history and medical history, the results of physical examination and any objective tests in addition to other factors (e.g. age, smoking, alcohol, systemic disorders, medication and neurotoxic agents) that might have contributed to symptoms, signs and test results. CONCLUSIONS: While vibration-induced white finger is caused by vibration, some neurological and musculoskeletal disorders are the result of work with vibratory tools where the separate roles of vibration, repetitive movements, grip and push forces, non-neutral postures and any other ergonomic stressors are often unclear. Such disorders may be more easily identified as being caused by the work rather than by exposure to hand-transmitted vibration per se. A person found to have developed disorders induced by either vibration or the work situation should not be returned to the same vibration exposure or work without any changes expected to lessen the risks.
A second meeting on reduced intensity allogeneic stem cell transplants (RI-HSCT) was convened in Zurich in February 2001 and focused on transplant-related mortality (TRM) and graft-versus-host disease (GVHD). Retrospective and prospective studies from the EBMT, national groups and single institutions included over 900 patients: the incidence of acute GVHD grade III-IV was 12% (1-17%), extensive chronic GVHD 42% (25-51%) and TRM 20% (14-38%). Conditioning regimens could be classified into four major groups based on (1) total body irradiation (TBI) 200 cGy, (2) busulfan 8 mg/kg, (3) thiotepa 10 mg/kg, and (4) melphalan 140 mg/m(2): most of these regimens are given in association with fludarabine in different doses and use mobilized peripheral blood as a source of stem cells. The incidence of TRM is similar if not identical for all four regimens, whereas the risk of acute GVHD and chronic GVHD may vary with different protocols. Reduced intensity transplant programs are being explored in patients above the age of 60 and in patients with solid tumors: encouraging results are being recorded in individual patients. Overall these data confirm that allogeneic HSCT can be performed in elderly patients, although a TRM of approximately 15% must be expected and is age dependent. A high rate of extensive chronic GVHD is seen and should be followed carefully. The term mini- or micro-transplant is probably misleading and one should refer to this procedure as an allogeneic HSCT and further classify the intensity of the conditioning regimen.
The workshop is one of a number of strategies that can be used to disseminate information. This study set out to evaluate the effectiveness of the workshop as a method of disseminating information which had as its aim the introduction of new practices. A series of workshops, attended by G and H grade nurses, were carried out in a large teaching Hospital in England. The information which was disseminated concerned recruitment and retention activities for nurses which had been proposed in recent government documents, in particular in the Strategy for Nursing in England 'Making a Difference' by the UK Department of Health. Two sample groups of 25 nurses (workshop attendees and non-attendees) were interviewed. The interviews took place shortly after the workshops and were repeated 7 months later. The first set of interviews explored the nurses' intention to implement changes in their clinical areas and the second set of interviews identified actual change. The findings from the study suggests that the workshops were an effective means of producing changes in practice. However, the interviews also identified the value of personal engagement, especially in relation to meeting individual human needs, which were facilitated through the workshop. These emotions appeared to have an influence on the success of the nurses in implementing change and it is proposed that these outcomes should be considered when determining the benefits of a dissemination strategy.