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PubMed2001

The dose-area product and assessment of the occupational dose in interventional radiology.

This study used dose-area product (DAP) data to determine the relationship between the dose received by radiologists and the DAP. The working conditions were simulated by phantom measurements. The doses of scattered radiation were measured using various scattering angles, distances and tube voltages. The calculated doses of scattered radiation were compared with the measured doses of scattered radiation. To test the validity of using such data for assessing occupational doses, the scatter dose on the radiologist or cardiologist was calculated from the DAP using the measured scatter factors. The dose to the lenses of the eyes may exceed the annual limit, and may therefore restrict the number of interventional procedures. A relation between the DAP and the occupational dose is difficult to establish, especially because staff doses are associated with the use of protective devices, positions of projections with respect to the patient, and working methods. However, the DAP may provide a good reference value for the dosimetric monitoring of staff.

Air Pollution, Radioactive↗
PubMed1996

Hazards to the orthopaedic trauma surgeon: occupational exposure to HIV and viral hepatitis (a review article).

The risk of transmission of blood-borne pathogens is directly related to the prevalence of the infectious disease in the physician's patient population, the infectivity after a single exposure, and the frequency and nature of exposure. After reading this material the reader should understand the guidelines for risk prevention of human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus transmission as published by the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) and be better able to evaluate and choose personal protective devices for use while caring for patients. To date there have been no documented cases of HIV seroconversion from solid-bore needle puncture or aerosolized transmission from an HIV-positive patient to a physician in the operating room. However, the authors and the Orthopaedic Trauma Association urge all physicians who have sustained an occupational seroconversion to communicate with the CDC so that prevention guidelines and health-care worker protection can be improved. Regardless, all physicians performing invasive procedures must reevaluate their techniques to determine what procedures can be modified or new instruments developed to reduce the risk of exposure.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Hearing loss among operating engineers in American construction industry.

OBJECTIVE: Occupational noise exposure and noise-induced hearing loss (NIHL) among construction workers has long been recognized as a problem in the United States, yet little is known about the prevalence of NIHL among American construction workers. The purpose of this study was to determine the prevalence and characteristics of hearing loss among operating engineers (OEs) who operate heavy construction machinery. METHOD: As a part of hearing protection intervention, an audiometric test was conducted for both ears at frequencies 0.5 through 8 kHz in the soundproof booth. Prior to the audiometric test, a paper-pencil pre-hearing test questionnaire was administered and an otoscopic examination was completed. Prevalence of hearing loss was determined based on hearing threshold levels (HTLs) in the worst ear with a low fence of 25 dB. RESULT: A total of 623 workers were included in the analysis and they were predominantly middle-aged Caucasian males (mean age = 43 years, Caucasian = 90%, male = 92%). Over 60% of OEs showed hearing loss in the noise-sensitive higher frequencies of 4 and 6 kHz. The rate of hearing loss was particularly higher among workers who reported longer years of working in the construction industry. Workers showed significantly poorer hearing in the left ear, and a typical characteristic of NIHL, a V-notch at 4 or 6 kHz, was not shown in this population. Thirty-eight percent reported ringing/buzzing in the ear and 62% indicated having problems in understanding what people say in loud noise. Average reported use of hearing protection devices (HPDs) was 48% of the time they were required to be used. Significant inverse relationship was found between higher frequency (4-6 kHz) hearing loss and use of HPDs (r =-0.134, p < 0.001). Workers using HPDs more had significantly better hearing than those who did not. CONCLUSION: The study demonstrated a significant NIHL problem and low use of HPDs in OEs. An effective hearing conservation program, including a periodic audiometric testing and hearing protection intervention, for this study population should be in place.

Adult↗
PubMed2005

SARS (severe acute respiratory syndrome): reflective practice of a nurse manager.

AIMS AND OBJECTIVES: This paper describes the reflective practice of a nurse manager in Hong Kong in supporting frontline nurses to overcome the crisis of SARS. BACKGROUND: SARS infection was a crisis for everyone in endemic areas because of its threat to physical and emotional health. Hong Kong was the second leading endemic area in the world. Inadequate supplies of protective devices and the death of a nurse infected with SARS triggered nurses' negative emotions. METHODS: A model of structured reflection was adopted to examine one's practice. A problem-solving model for crisis intervention was integrated into the reflective stage of structured reflection. RESULTS: Promotion of nurses' safety and emotional stability were the major goals in handling the crisis. Strategies were employed including self-awareness, empowerment and team building, information sharing, provision of personal protective equipment and emotional support for frontline nurses. CONCLUSIONS: SARS infection threatens the physical and emotional health of nurses. From a positive perspective, such a crisis created an opportunity to learn and grow in terms of ethical, personal and aesthetic arenas. RELEVANCE TO CLINICAL PRACTICE: SARS epidemic raised worldwide attention and challenged the Hong Kong's health care system. Reflective practice is useful to guide and examine nurses' professional action during the crisis, and to put the experience into a learning perspective.

Adaptation, Psychological↗
PubMed2006

Do device characteristics impact outcome in carotid artery stenting?

OBJECTIVES: The study was conducted to identify patient and procedural parameters that negatively impact the 30-day rates for stroke, death and transient ischemic attack (TIA) after carotid artery stenting (CAS) and that might be modified or further studied in future efforts to improve CAS. METHODS: This was a retrospective investigation of a dual-center CAS database of 701 consecutive CAS patients (414 men; mean age, 72.4 +/- 8.4). A subset of patient-related, lesion-related, or procedure-related variables (age >or=80, left sided lesion, symptomatic, nicotine abuse, hypertension, diabetes mellitus, other peripheral vascular disease, hypercholesterolemia, embolic protection devices usage, predilation, ulcerated lesion, echolucent plaque, restenosis after surgery) were analyzed for association with occurrence of stroke, death, or TIA <or=30 days after CAS. The odds ratio (OR) and 95% confidence interval (CI) and P value were calculated for each variable to predict adverse outcome. RESULTS: The overall combined rate of stroke, death, and TIA within this database was 3.7% at 30 days. In the total population of 701 patients, only the OR of 2.7 for hypercholesterolemia (95% CI, 1.0 to 7.3; P = .041) was found to be significant. Subgroup analysis of the 304 symptomatic patients (43%) showed that open-cell stent designs and concentric EPD designs yielded an OR of 4.1 (95% CI, 1.4 to 12, P = .0136) and 3.3 (95% CI, 1.016 to 10, P = .0525), respectively, for 30-day stroke/death/TIA within this database. Analysis of open-cell stent designs and concentric EPD designs in patients with echolucent lesions yielded an OR of 3.1 (95% CI,1.2 to 8.2, P = .0343) and 3.7 (95% CI, 1.3 to 10, P = .0174), respectively, for 30-day stroke/death/TIA. CONCLUSIONS: We conclude that increased analysis of device design variables may be necessary. Particularly in symptomatic patients or with echolucent lesions, closed-cell design and eccentric filters seem superior. Prospective investigation comparing open-cell vs closed-cell stents and eccentric vs concentric filter devices may be warranted.

Aged↗
PubMed2005

[Clinical efficacy and safety of emergent percutaneous coronary intervention for vein-grafts in the patients with acute myocardial infarction: comparison between age groups].

OBJECTIVE: To evaluate the efficacy and the safety of emergent primary percutaneous coronary intervention (PCI) in the saphenous vein bypass graft (SVBG) of acute myocardial infarction (AMI), and compare the results between aged -patients with non-aged patients. METHODS: Three hundred and nine consecutive AMI patients with culprit SVBG vessels, were analysed, including aged patients 213 cases(>or=70 years old), non-aged patients 96 cases(<70 years old), underwent the emergent primary PCI after confirmed below TIMI III perfusion(TIMI 0-TIMI II) in coronary angiographies. The immediate results and in-hospital outcomes were compared between two groups. RESULTS: Procedural successful rate, re-occlusion rate, and emergency re-CABG had no significant differences between two groups. The rate of slow-flow/no-reflow and in-hospital mortality rate were significantly higher in elderly group (19.7% vs 10.4%, 9.4% vs 4.2%, both P<0.05), with no difference in the rate of the using of distal protection devices between two groups. The comparison of the rate of direct stenting in slow-flow/no-reflow subgroup with normal-flow subgroup, had not showed statistic difference (73.5% vs 67.3%, P>0.05). There was no statistic difference of heavy hemorrhage between two different age groups. CONCLUSION: The primary PCI for the elderly AMI patients with infarction-related SVBG vessels, has higher risks in slow-flow/no-reflow and the mortality, even with using the distal protection devises and direct stents implantation.

Age Factors↗
PubMed2003

Inadvertent dilation of a saphenous vein graft stenosis by the PercuSurge GuardWire distal protection balloon.

Distal embolization protection devices are fast becoming an integral part of percutaneous vein graft interventions. The distal elastomeric balloon of the PercuSurge GuardWire system is supposed to be atraumatic to the vessel wall. We report the inadvertent dilation of a moderate distal stenosis at the site of GuardWire balloon inflation while intervening on a critical proximal saphenous vein graft stenosis. This case illustrates that plaque compression and potential vessel wall trauma might occur during the inflation of the PercuSurge GuardWire distal protection balloon.

Aged↗
PubMed1981

The prevention of orofacial sports injuries in the adolescent.

Custom-made mouthguards are effective in reducing orofacial injuries to junior players. A significant reduction or total elimination of these injuries can be expected when mouthguards are used. An acceptable custom-made mouthguard can be constructed for every adolescent; therefore, they can and should be used in contact sport at junior level. This will help young people to become accustomed to these protective devices at an early age. It is important that first mouthguards are comfortable and that adaptations are done whenever needed to ensure that the recipients will want to continue to use these devices. Sports bodies and coaches should do more to enforce the use of mouthguards at all levels. The high incidence of injuries to the oral region makes their use essential. The time has now come for the use of mouthguards to be made compulsory by contact sports authorities, first, for all senior teams, and subsequently for high school and even primary school pupils. Most parents and many dentists are still unaware of injury hazards and (more importantly) the protection available. A team dentist, where there is a possibility of dental injury, is the ideal situation. One dentist can easily be the team dentist for a number of teams, acting as professional adviser, fitting and adjusting mouthguards and ensuring that trauma (or dental disease) is treated by the player's own dentist.

Adolescent↗
PubMed2005

Update on current registries and trials of carotid artery angioplasty and stent placement.

Stroke remains the leading cause of disability in adults and the third leading cause of death in the US. Carotid artery (CA) occlusive disease is the primary pathophysiological source of 10 to 20% of all strokes. Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke in patients with both symptomatic and asymptomatic extracranial CA stenosis. Carotid artery angioplasty and stent placement has recently emerged as an alternative to CEA for primary and secondary prevention of stroke related to CA stenosis. With the advent of the embolic protection device, the safety of CA angioplasty and stent placement has approached, if not surpassed, that of CEA. In particular, the former has come to be considered as a first-line therapy in the management of CA stenotic disease in individuals at high risk for complications related to surgical intervention. Preliminary data from multiple registries have demonstrated that CA angioplasty and stent placement is an effective means of treating CA stenosis. The results of the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy trial have demonstrated that this modality has a significant role in the management of CA disease in symptomatic and asymptomatic patients with risk factors for high rates of surgery-related morbidity or mortality. With the completion of the Carotid Revascularization Endarterectomy versus Stent Trial, the role of CA angioplasty and stent placement in the prevention of stroke in all individuals with significant CA stenosis should be better demarcated. This treatment modality promises to assume a central role in stroke prophylaxis in patients with CA disease who are at high risk for complications related to surgery.

Angioplasty↗
PubMed1999

Highlights from the past decade of interventional device research.

The last decade of research and implementation in the interventional device arena has brought about an unprecedented improvement in the ability to safely and effectively treat coronary artery disease. This explosion of technology is not over; there remain questions to be answered and patient subsets whose care can be improved upon. Our understanding of the restenosis process has helped guide research in the appropriate directions, and by 2010 restenosis after a coronary intervention will most likely be of historic interest only. With the addition of thrombus removal catheters and protection devices, treatment of problematic high-risk lesions will also be improved upon. The effect of these devices on acute patient care and long-term outcomes, including quality of life, will be profound.

Angioplasty, Balloon, Coronary↗
PubMed1995

Dentistry and tuberculosis in the 1900s.

The number of new cases--or incidence--of tuberculosis is increasing in nearly every region of the world. A number of forces have resulted in the increased incidence of TB in developed countries, including the HIV epidemic, homelessness, and emigration from highly endemic regions. Although the number of new cases in Canada is relatively constant, the TB experience in the United States serves as a reminder that this situation could change rapidly. The appearance of multidrug-resistant tuberculosis has added to the urgency of situation. The basic methods of preventing TB transmission include preventing the release of the organism into the air, removing the organism from the air, and preventing the inhalation of the organism. Identifying and appropriately treating every person with active tuberculosis is an extremely important component of the control strategy; adequate ventilation, filtering air, and ultraviolet germicidal irradiation are methods used to remove the organism from the air; and masks and other personal protective devices, such as high-efficiency particulate air filters (HEPA), have been suggested as a means of preventing inhalation of the organism. In addition, identifying new TB infections and using chemoprophylaxis often prevents infection from progressing to active disease. Given the route by which tuberculosis is transmitted, it is necessary for both dentists and allied dental personnel to be aware of the risks they may face in day-to-day practice, and the means by which they can protect themselves and their patients.

Air Microbiology↗
PubMed1990

Occupational risks of (meth)acrylate compounds in embedding media for electron microscopy.

(Meth)acrylates are the main constituents of embedding media widely used in electron microscopy research for low-temperature embedding of biological tissue. (Meth)acrylates toxicology is still incompletely understood and therefore an estimation of health hazards involved in handling must be inaccurate. (Meth)acrylate monomers are known to be harmful to skin and other tissues and may sensitize workers. Since low-temperature electron microscopy techniques have gained popularity in research laboratories, it is important to establish safety rules for handling the (meth)acrylate-containing solutions. The aim of our report is to review briefly the toxicological properties and occupational hazards of the chemicals involved, summarize our own experiences with resins and protective devices in this respect, give guidelines for safe embedding and pass on these data to all interested researchers in order that workers are not discouraged from using (meth)acrylate embedding media, but know the risks and how to minimize them.

Animals↗
PubMed2001

The use of mechanical devices as adjuncts to intracoronary stenting.

A number of mechanical adjuncts to intracoronary stenting are now available to the interventional cardiologist. These devices have assisted in the development of a safer and more effective stenting practice. Intravascular ultrasound-guided stenting has been shown to reduce the rate of subacute thrombosis and subsequent restenosis. It allows a greater appreciation of lesion structure and severity so that an appropriate intervention strategy can be devised. Debulking techniques may allow the optimal deployment of stents so that restenosis is reduced; however, the results of large randomized studies are still awaited. The use of thrombectomy and distal embolization protection devices is emerging as a safer alternate to stenting alone in difficult patient subsets, such as those with thrombus-laden lesions and degenerated vein grafts. Doppler and pressure wires may be useful in determining optimal stent deployment and predict subsequent patient outcomes. An understanding of the indications and limitations of these devices is of increasing importance to the interventional cardiologist as the coming decade threatens to yield an impressive array of high-tech innovations.

Cardiac Surgical Procedures↗
PubMed2006

Computer-aided forensics: metal object detection.

Recently, forensic investigators1 have started using diagnostic radiology devices (MRI, CT) to acquire image data from cadavers. This new technology, called the virtual autopsy, has the potential to provide a low cost, non-invasive alternative or supplement to conventional autopsies. New image processing techniques are being developed to highlight forensically relevant information in the images. One such technique is the detection and characterization of metal objects embedded in the cadaver. Analysis of this information across a population with similar causes of death can lead to developing improved safety and protection devices with a corresponding reduction in deaths.

Autopsy↗
PubMed2005

Technologist radiation exposure in routine clinical practice with 18F-FDG PET.

OBJECTIVE: The use of 18F-FDG for clinical PET studies increases technologist radiation dose exposure because of the higher gamma-radiation energy of this isotope than of other conventional medical gamma-radiation-emitting isotopes. Therefore, 18F-FDG imaging necessitates stronger radiation protection requirements. The aims of this study were to assess technologist whole-body and extremity exposure in our PET department and to evaluate the efficiency of our radiation protection devices (homemade syringe drawing device, semiautomated injector, and video tracking of patients). METHODS: Radiation dose assessment was performed for monodose as well as for multidose 18F-FDG packaging with both LiF thermoluminescence dosimeters (TLD) and electronic personal dosimeters (ED) during 5 successive 18F-FDG PET steps (from syringe filling to patient departure). RESULTS: The mean +/- SD total effective doses received by technologists (n = 50) during all of the working steps were 3.24 +/- 2.1 and 3.01 +/- 1.4 microSv, respectively, as measured with ED and TLD (345 +/- 84 MBq injected). These values were confirmed by daily TLD technologist whole-body dose measurements (2.98 +/- 1.8 microSv; 294 +/- 78 MBq injected; n = 48). Finger irradiation doses during preparation of single 18F-FDG syringes were 204.9 +/- 24 and 198.4 +/- 23 microSv with multidose vials (345 +/- 93 MBq injected) and 127.3 +/- 76 and 55.9 +/- 47 microSv with monodose vials (302 +/- 43 MBq injected) for the right hand and the left hand, respectively. The protection afforded by the semiautomated injector, estimated as the ratio of the doses received by TLD placed on the syringe shield and on the external face of the injector, was near 2,000. CONCLUSION: These results showed that technologist radiation doses in our PET department were lower than those reported in the literature. This finding may be explained by the use of a homemade syringe drawing device, a semiautomated injector, and patient video tracking, allowing a shorter duration of contact between the technologist and the patient. Extrapolation of these results to an annual dose (4 patients per day per technologist) revealed that the annual extrapolated exposure values remained under the authorized limits for workers classified to work in a radioactivity-controlled area.

Allied Health Personnel↗
PubMed1993

The design, effectiveness and acceptability of the arm sleeve for the prevention of body fluid contamination during obstetric procedures.

OBJECTIVES: 1. To design a device that would reduce contamination of staff during obstetric procedures. 2. To undertake clinical trials to assess the effectiveness and acceptability of such a device. DESIGN: A prospective study. The arm sleeve is made of a nonwoven material laminated on polyethylene film making it waterproof. It has an elastomeric cuff with adhesive that ensures a watertight seal between it and the glove. SETTING: Delivery suite in a teaching hospital. METHODS: Doctors and midwives were requested to wear the sleeve on top of the standard gown and gloves. Each user was assessed for blood contamination at the end of the procedure and a questionnaire detailing the extent of contamination and the views of the user was completed. RESULTS: Eighty questionnaires were completed. The contamination of arms and hands was 3.8% and 5%, respectively. Eighty-nine percent thought the sleeve had served its purpose and 76% said they would use it regularly. CONCLUSIONS: The sleeve is an effective protective device which complements the glove and gown. We recommend that it should be used during all obstetric procedures.

Blood↗
PubMed2005

Blood lead and erythrocyte protoporphyrin levels in association with smoking and personal hygienic behaviour among lead exposed workers.

AIMS: To investigate the effects of smoking and personal hygienic behaviour on blood lead (BPb) and free erythrocyte protoporphyrin levels (FEP) in lead exposed workers. METHODS: Subjects were 105 lead exposed male workers in a battery recycling plant during the years 2000-03. BPb and FEP were measured as part of the ongoing occupational surveillance. Each worker completed a questionnaire for assessment of smoking and four measures of personal hygienic behaviour (glove and mask use, hand and face washing before meals during working hours). RESULTS: Statistically significant decreases in mean BPb and FEP occurred during the three years. The proportion of BPb reduction in the non-smoking workers was significantly higher (mean 24.3%) than in the smoking workers (15.3%). When the workers were classified into three groups (excellent, good, and poor) based on the four personal hygienic behavioural indicators, the greatest decreases of BPb and FEP were observed in the non-smoking workers of the excellent group. CONCLUSIONS: The consistent use of protection devices and cleanliness at work appeared to contribute to the lowering of BPb and FEP. Cessation of smoking in the workplace was also of importance.

Adult↗
PubMed2006

Angioplasty and stenting to treat occlusive vascular disease.

The advent of effective percutaneous treatment of occlusive vascular lesions by angioplasty and stenting is one of the most important contributions to medical care early in the 21st century. Evaluation of angioplasty and stenting procedures is still in a very early phase. New types of stents and other technologies and devices are being continuously developed and there is a definite learning curve. The experience, training, and number of procedures clearly relate to outcomes, and many different specialists are still learning and so far have not had optimal experience. This review provides an overview of studies that have examined the efficacy of stenting in conjunction with balloon angioplasty for carotid atherosclerosis compared with endarterectomy. Also discussed are angioplasty/stenting of other neck arteries and intracranial arteries and the key issues surrounding percutaneous intervention, including patient selection criteria, clinical assessment of lesions most suitable for treatment, the use of distal protective devices and drug-eluting stents, and recommendations for physician selection.

Angioplasty, Balloon↗