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PubMedDate not supplied

Testing decisional balance and self-efficacy applied to workers' use of hearing protection.

BACKGROUND: The continued prevalence of low rates of hearing protection device (HPD) use by workers exposed to hazardous noise requires ongoing efforts to investigate ways to increase HPD use. OBJECTIVE: The aim of this study was to investigate the utility of the Transtheoretical Model (TTM) for research with factory workers' use of HPDs, specifically focusing on the model suppositions related to the constructs of decisional balance and self-efficacy. METHODS: Using secondary analysis, pretest measures were obtained through a randomized controlled clinical trial of an intervention to increase use of HPDs. The sample included in the analyses were factory workers (N = 1,245) exposed to hazardous noise in a Midwestern automotive manufacturing plant. Using analysis of variance (ANOVA), the TTM constructs pros, cons, and self-efficacy of HPD use were examined across stages. RESULTS: Using ANOVA, significant variance was found across stages of HPD use. Pros, cons, and self-efficacy significantly differed by stage of HPD use in predicted patterns: pros, F(4, 1240) = 46.29, p < .001; cons, F(4, 1240) = 17.14, p < .001; and self-efficacy F(4, 1240) = 7.32, p < .001. The crossover effect of pros and cons occurred in the preparation stage, as expected. CONCLUSIONS: Support was found for the presence of conceptually distinct stages of HPD use and the TTM predictions for decisional balance and self-efficacy across stages. Performance of the TTM constructs within current research on HPD use presents opportunities for increased tailoring of training for factory workers on use of HPDs.

Analysis of Variance↗
PubMed1991

Effect of work load and respirator wear on postural stability, heart rate, and perceived exertion.

The effects on postural stability (sway) were investigated for different work loads under conditions of wearing a full facepiece respirator and not wearing any respiratory protection device. Fifteen subjects accomplished light (40 W), moderate (85 W), and heavy (125 W) work loads under the two conditions. Measurements of postural sway were made immediately after each load by using a multicomponent, strain gage-type force platform. Changes in each subject's movement pattern of the center of pressure were quantitated and compared to their initial baseline sway tests. Each subject's heart rate and perceived exertion were also recorded during each condition. A statistically significant effect (p = 0.007) caused by work load was observed for total length of sway with or without a respirator. An interaction approaching statistical significance (p = 0.056) between work load and respirator use was found. This indicated that sway increased more quickly and in a more consistently linear fashion with increasing work load under the respirator condition (p = 0.02) compared to the nonrespirator condition. The results from the respirator condition showed linear increases in postural sway length across the entire range of work loads, but sway length in the nonrespirator condition showed an increase only at 125-W work loads. The greater increase in sway during the postural balance test could be attributable to the increasing work load-induced proprioceptive fatigue effect on the nervous system's ability to process signals from proprioception systems incongruent with body sway. The heart rate was significantly higher during respirator wear (an increase in heart rate averaging 5.62 beats/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

The epidemiology of ocular trauma in Singapore: perspective from the emergency service of a large tertiary hospital.

PURPOSE: To describe the epidemiology of ocular trauma from the perspective of the emergency service of a large tertiary hospital in Singapore. METHODS: A prospective survey was conducted over a 3 month period (August to October 1997) on all patients seen at the ophthalmic unit at the Singapore General Hospital's emergency service. Data on clinical presentation, type and cause of injury and use of eye protective devices (EPD) were collected via a standardised interview and examination. RESULTS: A total of 870 persons presented with a diagnosis of ocular trauma, out of the 1,631 patients seen during the study period. Compared with non-trauma cases, trauma cases were more likely to be male (odds ratio (OR): 4.2, 95% confidence interval (95% CI): 3.2, 5.4), non-residents (OR: 6.2, 95% CI: 3.7, 10.5), younger than 40 years of age (OR: 3.2, 95% CI: 2.7, 4.1) and less likely to require follow-up or hospital admission (OR: 0.2, 95% CI: 0.2, 0.3). The three most common types of injuries were superficial foreign body (58.2%), corneal abrasion (24.9%) and blunt trauma (12.6%), while open globe injury occurred in only 17 cases (2%). Comparison with a 10% random sample of all cases seen in the previous 9 months (n = 284) revealed no significant time variation in the types of injuries (p = 0.63). Work-related injuries accounted for 590 (71.4%) cases, where grinding, cutting metal and drilling were the specific activities in more than 90% of the cases. In appropriate settings, only 21.7% of patients with work-related injuries used EPD; 43.7% were provided with EPD, but did not use them at the time of injury; and the remaining 34.6% reported that EPD were not provided. CONCLUSIONS: Ocular trauma at the emergency service level in Singapore involved mainly young non-resident men, were work-related and associated with well-defined activities, and were generally minor. The low prevalence of EPD use reinforces the need for a review of the design and implementation of occupational eye safety programmes, especially among non-resident workers.

Accidents, Occupational↗
PubMed2001

Preventive care in the emergency department: a systematic literature review on emergency department-based interventions that address smoke detectors in the home.

OBJECTIVES: To assess the effectiveness of an emergency department (ED)-based strategy to identify and counsel selected patients about the importance of an operational smoke detector in the home and to offer a graded recommendation regarding such a strategy. METHODS: A systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. Two Medline combined searches were performed using the following terms: emergency medical services and counseling, protective devices and smoke detectors, accidents, home, burns, fires, and residential fires. A free-text search of indexed and nonindexed citations in Emergency Medical Abstracts from 1977 to 1999 and a search of the Cochrane Library were also performed. In addition, reviewers performed independent Medline searches and suggested four additional studies. Studies selected for inclusion in this systematic review were required to meet the following criteria: 1) report ED-based research and 2) address the topic of fire and burn prevention with some pertinent discussion of ED-based interventions. The initial inclusion criteria had restricted studies to those that reported the results of counseling strategies for smoke detectors. The authors later decided to consider, as indirectly relevant, studies that did not investigate counseling strategies. Data from the selected studies were extracted using the template form, and the validity and applicability of the results to emergency practice were assessed. Recommendations were derived following criteria developed by a systematic review of preventive interventions in the ED. RESULTS: Six articles were closely reviewed. Four of the six studies met the inclusion criteria. One other study that did not meet the inclusion criteria was also considered. No study focused specifically on the counseling of ED patients about smoke detectors. CONCLUSIONS: Following the criteria of the graded recommendations used for the parent project. a recommendation cannot be made either for or against an ED-based strategy to counsel patients on the importance of smoke detectors. No studies located in our review directly assessed the effectiveness of such a strategy. Based on the retrospective case series study of the potential opportunity for a home fire safety intervention during an emergency medical services visit and the Safe Block Project study, it may be worthwhile to consider further research on the effectiveness of systems-level/structural interventions, with a targeted focus on strategies that attempt to overcome barriers associated with active interventions.

Emergency Service, Hospital↗
PubMed2004

Rotational acceleration measurements--evaluating helmet protection.

PURPOSE: Current helmet testing standards do not address the rotational components of an impact to the head. We describe a new testing paradigm used to measure the rotational acceleration of a headform and a protective helmet following an impact to the head in the horizontal plane. This impact simulation allows for the testing of currently available head protection devices in conditions thought to be important for the generation of cerebral concussion. The degree to which a particular helmet dampens rotational acceleration, and thus protects against concussion, can be assessed. METHODS: Our testing device consists of a pneumatic piston that provides a measured impact to a standard headform. Four different helmets were tested using the described paradigm. RESULTS: Acceleration curves for each helmet and the corresponding headform are presented. CONCLUSIONS: Clear differences in rotational acceleration were demonstrated. Possible avenues of further investigation are discussed.

Acceleration↗
PubMed2004

International carotid stenting study: protocol for a randomised clinical trial comparing carotid stenting with endarterectomy in symptomatic carotid artery stenosis.

BACKGROUND: Carotid stenting avoids general anaesthesia, cranial nerve injury and the discomforts of surgical treatment of carotid stenosis. A systematic review of the randomised trials showed no overall difference in the major risks of endovascular treatment for carotid stenosis compared with surgery, but the confidence intervals were wide and both methods carried a significant risk of stroke. The use of protection devices appears to improve the safety of endovascular treatment, but there are little randomised data available about long-term outcomes. We have therefore set up an international, multicentre, randomised, controlled, open, prospective clinical trial, namely the International Carotid Stenting Study (ICSS), also known as CAVATAS-2. The objectives of the ICSS are to compare the risks, benefits and cost-effectiveness of a treatment policy of referral for carotid stenting compared with referral for carotid endarterectomy. METHODS: Centres are required to have a team with audited expertise in carotid endarterectomy and stenting procedures, including at least one neurologist or stroke physician, a surgeon and an interventionalist. Attendance at a carotid stenting training course is required. Centres with more limited experience can join the trial as probationary centres, but stenting must then be proctored by an experienced interventionalist. Symptomatic patients are included over the age of 40 years with atherosclerotic carotid stenosis, suitable for both stenting and surgery, and are randomised in equal proportions between carotid endarterectomy and stenting. Stents and other devices are chosen for use at the discretion of the interventionalists but must be approved by the devices committee. The protocol recommends that a cerebral protection system should be used whenever the operator thinks one can be safely deployed. The combination of aspirin and clopidogrel is recommended to cover stenting procedures. Standard or eversion endarterectomy is allowed using local or general anaesthesia, shunts or patches. All patients will receive best medical care. Patients will be followed up by neurologists at 30 days after treatment, 6 months after randomisation and then annually up to 5 years after randomisation. The primary outcome measure is the difference in the long-term rate of fatal or disabling stroke in any territory between patients randomised to stenting or surgery. Secondary outcome measures include any stroke, myocardial infarction or death within 30 days of treatment, treatment- related cranial nerve palsy or haematoma. Restenosis (>70%) on ultrasound follow-up, economic measures and quality of life will also be analysed. The sample size is estimated at 1,500 patients, which will provide 95% confidence intervals of +/- 3.0 percentage points for the outcome measure of 30-day disabling stroke and death rate and +/- 3.3 percentage points for the outcome measure of death or stroke during follow-up. The trial office monitors outcome events at individual centres and a rate of events above a given threshold triggers a blinded assessment of the events, submitted to the chairman of the data-monitoring committee. CONCLUSIONS: The ICSS protocol incorporates a number of novel features to ensure patient safety, including the concept of probationary centres, proctoring of inexperienced investigators and monitoring of individual centre results on an ongoing basis. The protocol is also designed to mirror routine clinical practice as far as possible, so that the results will be widely applicable and relevant to determining the place of carotid stenting in clinical practice in the future.

Carotid Stenosis↗
PubMed1984

Protecting eyes.

Explore the source record for details and available documents.

Anesthesia↗
PubMed1990

Attenuation performance of four hearing protectors under dynamic movement and different user fitting conditions.

An experiment was conducted to determine the effects of movement activities and alternative fitting procedures on protection levels afforded by four hearing protection devices (HPDs). Psychophysical attenuation measurements at nine one-third-octave bands from 125 to 8000 Hz were obtained prior to, during, and following a 2-hr wearing stint that included periods of either highly kinematic but controlled work activity or vigorous temporomandibular movement. The 40 subjects, who were nonusers of HPDs, initially fit the protectors according to either the instructions on the package (i.e., subject fit) or after receiving interactive training on proper fit (i.e., trained fit). Thereafter no further protector adjustments were allowed during the wearing period. The subject-fit condition resulted in significantly lower protection levels, from 4 to 14 dB, at 1000 Hz and below for a premolded polymer earplug, a user-molded foam earplug, and a double protector consisting of a muff over the foam plug. The muff alone was significantly more resilient to fitting effects on attenuation than were the plugs. Movement activity caused up to a 6-dB significant reduction in frequency-specific attenuation over time for the premolded plug, muff, and muff-plug combination. The compliant foam earplug was largely resistant to either type of movement effect but did benefit more than the other devices from use of the trained-fit procedure. Implications of the results for hearing protector testing protocol, device selection, and user training are discussed.

Adult↗
PubMed2003

Carotid stenting with filter protection. Correlation of ACT values with angiographic and histopathologic findings.

BACKGROUND AND PURPOSE: Filter cerebral protection during carotid stenting has been proposed as a new tool to reduce brain embolism. Angiographic findings (filter patency), pathological analysis of the collected materials inside the filters and coagulation parameters were analyzed to identify potential down sides in the use of these protection devices. METHODS: 29 consecutive endovascular treatments with filter cerebral protection in 27 patients affected by symptomatic internal carotid stenosis>70% were considered. Angiographic findings, activated clotting times and histopathologic specimens were recorded and correlated. RESULTS: Satisfactory dilatation of the stenosis was always achieved with a complication rate of 3% (1 transient neurological deficit). During the procedure, 9 filters (31%) appeared occluded, with temporary flow impairment. Histopathologic examination demonstrated material inside the filters in 86% of cases but this material was fibrin alone in 38% and plaque debris in 48%. Significant statistical correlation (p=0.009) was found between low activated clotting time and occlusion of the filter. CONCLUSION: Distal protection filters can collect plaque fragments occurring during carotid stenting. Significant proportion of the debris found in the filters consisted of thrombotic material. Precise monitoring of heparin anticoagulation is recommended to prevent filter occlusion.

Aged↗
PubMed2004

A cardiologist in the carotids.

Carotid endarterectomy for stroke prevention has been the standard of care for 50 years in patients with extra-cranial carotid bifurcation disease. Over the past decade, carotid stenting has emerged as a viable alternative to surgery. Combined with filter embolic protection devices, both a randomized control trial (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy registry [SAPPHIRE]) as well as registry data (ACCULINK for Revascularization of Carotids in High Risk Patients registry [ARCHeR] and Registry Study to evaluate the Neuroshield Bare-Wire Cerebral Protection System and X-Act Stent in patients at high risk for Carotid Endarterectomy [SECuRITY]) have compared favorably to endarterectomy in patients at high risk for operative revascularization. Conditions associated with high operative risk included patients with significant cardiac, pulmonary, and renal disease; previous neck operation; previous radiation; and anatomically difficult surgical access. On the basis of these results, a carotid stent system approved by the Food and Drug Administration (FDA) is anticipated in 2004. Although this will be a welcome addition to endarterectomy in the armamentarium of therapeutic options for patients with carotid disease, several challenges lie ahead. Coverage and reimbursement for the carotid stenting has been severely restricted to include only those procedures performed as part of an FDA investigational device exemption trial protocol, and a national noncoverage decision will have to be reckoned with before broader coverage can be put into place (assuming FDA approval). In addition, the level of national expertise in carotid endovascular intervention is limited, and training will need to be tailored to the three specialties likely to perform the procedure: cardiology, radiology, and vascular surgery. Each of these specialties will have specific, and different, requirements for their training, further complicating the task of education.

Blood Vessel Prosthesis Implantation↗
PubMed2004

[Treatment of carotid stenosis: angioplasty, a reasoned choice].

UNLABELLED: MASTERING THE SURGICAL ACT: Over the last decade, the technique of carotid angioplasty has progressed and it can now be considered as mastered thanks to the combination of platelet antiaggregants, miniaturisation of the material, stenting and the use of cerebral protection devices. POTENTIAL COMPLICATIONS: Notably the occurrence of cerebral embolism despite protection. Haemorrhagic complications are also possible. After a delay of 6 months, the re-stenosis rate is of around 10%. RESULTS OF RANDOMISED STUDIES: These globally demonstrate the equivalence between endoluminal treatment and surgery, notably in patients at high surgical risk. IN PRACTICE: Carotid angioplasty can be proposed in cases of severe non-atheromatous stenosis localised away from the bifurcation. It is contraindicated in the case of asymptomatic atheromatous stenosis without surgical comorbidity and when the particular anatomic conditions complicate catheterism of the carotid axis.

Angioplasty↗
PubMed1994

[Clinical nurse-specialist: the ideal ... and reality].

Nursing practice carries very high emotional cost consequences which are sometimes difficult if not impossible to handle. The more exposed nurses have become to theories of nursing and the need for individualized care, the weaker and more ill-defined have become their coping and protective devices. In shaking off the paternalist hand of medicine, the protection it provided has gone with it, and little has been done to replace it from within nursing itself. Therefore a Clinical Nurse Specialist is needed to stimulate growth through interaction in a safe and stimulating relationship based on openness and trust. The CNS can be a mentor, inspirer, investor and supporter--a model of effective nursing practice. The ability to reduce stress through individual insight and self awareness may be the best method for nurses to lead more fulfilling lifestyles. A system providing for CNS in nursing may be the vehicle for providing this.

Clinical Competence↗
PubMedDate not supplied

Retinopathy after solar eclipse, 1995.

BACKGROUND: Visual damage following direct sighting of the solar eclipse is a well established clinical entity. In spite of warnings in the media, a number of people attempted to observe the solar eclipse. Consequently, some developed visual damage. METHODS: Twenty-one patients were referred to the Solar Eclipse Cell at our centre. Their demographic and clinical features were evaluated. RESULTS: Foveal findings correlated with the duration of exposure and frequency of watching the eclipse. Six patients had used protective devices for viewing the eclipse. More than 47% eyes had discernible fundus lesions. CONCLUSION: Lasting visual damage can follow a solar retinal burn with little or no protection from the viewing devices. Prevention remains the best treatment and there is a need to educate the public in this regard.

Adolescent↗