Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Maintenance”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed1981

Exposure of operating room personnel to anaesthetic agents: an examination of the effectiveness of scavenging systems and the importance of maintenance programs.

Ten Alberta hospitals were monitored to assess the exposure of operating room personnel to nitrous oxide, halothane and enflurane during the average work day. Exposure to these agents in operating rooms without scavenging systems was determined to be well above the recommended guidelines. Contaminants were significantly lower in operating rooms with scavenging systems of either the wall suction type or the air-conditioning exhaust type. In the majority of studies, leakage points of anaesthetic gases were found throughout the anaesthesia systems. Where maintenance programs for the anaesthesia equipment were designed for the detection and elimination of leakage, contaminant levels were significantly lower than in those hospitals where the maintenance programs were concerned solely with proper equipment function as it relates to patient care. A regular, frequent maintenance program for all anaesthesia and scavenging systems designed to identify and correct leakage points is therefore recommended. We consider a nitrous oxide monitor to be the ideal tool for detection of leakage.

Air Pollutants↗
PubMed1996

[A survey of operating and recovery room ventilators and monitoring equipment as well as their maintenance].

OBJECTIVE: To survey the monitoring and anaesthetic devices available in a sample of French hospitals and the modalities of their maintenance. STUDY DESIGN AND METHOD: Survey carried out in 21 private and public hospitals (including eight university hospitals), affilated to the French Association for Research in Anaesthesia and Intensive Care (ARAR). RESULTS: More than 84% of all operating theaters were equipped with at least an ECG, a SpO2, and a non invasive blood pressure monitor. The non equipped anaesthesia sites were mainly delivery rooms, plaster cast rooms and X-ray rooms. The figure of recovery room beds was, generally speaking in accordance with the French recommendations. Maintenance policy was not systematic and not budgeted in 72% of the surveyed centres. CONCLUSION: The equipment in most anesthetic sites has significantly increased, however maintenance policy remains still heterogenous.

Anesthesia Recovery Period↗
PubMed2006

Psychological mechanisms in the maintenance of insomnia: arousal, distress, and sleep-related beliefs.

The purpose of this study was to examine whether arousal, distress, and sleep-related beliefs are related to the maintenance of insomnia. From a randomly selected sample from the general population (n=3600), 1936 participants filled out a baseline and 1-year follow-up survey. Logistic regressions were used to investigate whether arousal, distress, and beliefs were related to sleep status (insomnia: n=116; poor sleep: n=222; normal sleep: n=529; good sleep: n=234) over 1 year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. The results showed that beliefs in the long-term negative consequences of insomnia, anxiety, depression, and arousal were significantly related to the maintenance of insomnia (18-72% of the variance). Of the individuals with persistent insomnia, 91% belonged to a cluster characterized by high scores on sleep-related beliefs, anxiety, depression, and arousal, and 9% to a cluster defined by low scores on the mechanisms. This study shows that sleep-related beliefs, anxiety, depression, and arousal are related to the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with insomnia.

Adult↗
PubMed1998

The role of 'know-how' in maintenance activities and reliability in a high-risk process control plant.

Using observation of a maintenance operator's activity and 'the history' that it produced as a basis, we will discuss the role of 'know-how' in maintenance activities, and particularly the problems raised by putting this knowledge into words. Second, we will underline the contribution of this know-how to the operational reliability of the facilities and we will investigate its being taken into account in work instructions. With such issues as a basis, we will conclude with the need for ergonomists to develop modes of interviewing to help people to put know-how into words, so that it is recognized and considered in maintenance activity organization.

Communication↗
PubMed1992

A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults.

Older adults (3 men, 4 women, aged 55 to 68 years) with chronic sleep-maintenance insomnia were treated sequentially with relaxation therapy (RT) and then with a cognitive-behavioral therapy (CBT) specifically designed for alleviating sleep maintenance problems. Sleep diaries and an objective measure of sleep, the sleep assessment device, showed only modest improvements in measures of wake time after sleep onset, sleep efficiency, and night-to-night sleep variability following RT. However, significant improvements in these measures were observed following CBT and at a 3-month follow-up. These findings, considered in conjunction with previous reports, suggest that CBT specifically addresses factors that sustain sleep maintenance complaints. Additional trials of CBT with larger samples are warranted.

Aged↗
PubMed2006

Psychosocial work stressors in the development and maintenance of insomnia: a prospective study.

This study is aimed at examining whether psychosocial work stressors are related to the development and maintenance of insomnia. A prospective design was used with a baseline and a 1-year follow-up questionnaire (N = 1,530). The results showed that among individuals with no insomnia at baseline, high work demands increased the risk of developing insomnia 1 year later. Among participants with insomnia at baseline, high leader support decreased the risk of still reporting insomnia at follow-up. Finally, low influence over decisions and high work demands were related to the maintenance of insomnia. The results indicate that perceived work stressors are related to the development and maintenance of insomnia. This might have implications for how insomnia is conceptualized as it places work stressors in the model and for how interventions at different stages of insomnia are implemented.

Adult↗
PubMed1978

How do health-maintenance organizations achieve their "savings"?

Health-maintenance organizations have been suggested as a way to stop spiraling medical costs. Although many of the arguments have been largely rhetorical, theoretical considerations suggest that the shift from fee for service to a fixed budget for the providers (physicians and hospitals) will result in substantial savings. Total costs (premium and out-of-pocket) for enrollees are 10 to 40 per cent lower than those for comparable people with health insurance. Enrollees in health-maintenance organizations have about as many ambulatory visits as comparison groups. Most of the cost differences are attributable to hospitalization rates about 30 per cent lower than those of conventionally insured populations. These lower hospitalization rates, in turn, are due almost entirely to lower admission rates; the average lenth of stay shows little difference. There is no evidence that health-maintenance organizations reduce admissions in discretionary or "unnecessary" categories; instead, the data suggest lower admission rates across the board.

Ambulatory Care↗
PubMed2003

The mitotic chromosome is an assembly of rigid elastic axes organized by structural maintenance of chromosomes (SMC) proteins and surrounded by a soft chromatin envelope.

The structure of mitotic chromosomes is still poorly understood. Here we describe the use of a novel approach based on elasticity measurements of a single chromosome for studying the organization of these objects. The data reveal that mitotic chromosomes exhibit a non-homogenous structure consisting of rigid elastic axes surrounded by a soft chromatin envelope. The chemical continuity of DNA, but not RNA, was required for the maintenance of these axes. The axes show a modular structure, and the structural maintenance of chromosomes (SMC) proteins participate in their organization. Topoisomerase II was not involved in either the organization of the axes or the maintenance of the mitotic chromosomes. A model for the assembly and the structure of the mitotic chromosome is proposed. According this model, the chromosome axes are dynamic structures that assemble at the onset and disassemble the end of mitosis, respectively. The SMC proteins, in addition to maintaining axis elasticity, are essential for the determination of the rod-like chromosome shape. The extreme compaction of mitotic chromosomes is determined mainly by the high amount of bivalent ions bound to DNA at mitosis.

Animals↗
PubMed1997

An evaluation of respirator maintenance requirements.

A telephone survey was developed as part of a pilot study to evaluate the inspection, cleaning, maintenance, and storage aspects of respirator protection programs (RPP). Regulations and consensus standards such as those published by the Occupational Safety and Health Administration in the Code of Federal Regulations (CFR) or the American National Standards Institute (ANSI) require or recommend that RPP contain elements that ensure that the respirators provide proper protection. A great deal of research has been done to evaluate the effectiveness of new respirators; however, little research has been conducted to evaluate how respirators behave over time in real industrial settings Respirator inspection, cleaning, maintenance, and storage are significant factors in determining how well a respirator continues to perform. The telephone survey was developed by reviewing the requirements and recommendations of CFR 1910.134 and ANSI Z88.2-1980. Approximately 30 companies were selected based on their use of negative air-purifying respirators. Most of the companies represented the hardgoods manufacturing or service industries. Although the majority of companies were meeting requirements, responses indicated that the following improvements in RPP were necessary: (1) inspection of all respirator parts should be carried out before and after each use, (2) replacement parts should be made readily available on site, (3) regular cleaning should be performed, and (4) more hands-on practice with respirators and their maintenance should be incorporated into training sessions.

Equipment Failure↗
PubMed2005

Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis.

BACKGROUND: In a cross-sectional study, we analysed the complex relationship between restless legs syndrome (RLS), insomnia and specific insomnia symptoms and health-related quality of life (QoL) in patients on maintenance dialysis. METHODS: Data were obtained from 333 patients on chronic maintenance dialysis. To assess the prevalence of RLS, we used the RLS Questionnaire (RLSQ). The Athens Insomnia Scale (AIS) was used to assess insomnia and QoL was measured with the Kidney Disease Quality-of-Life Questionnaire. RESULTS: The prevalence of RLS was 14%. The number of comorbid conditions was significantly higher in patients with vs without RLS (median: three vs two; P<0.05). RLS patients were twice as likely to have significant insomnia as patients without RLS (35% vs 16%; P<0.05). Furthermore, RLS was associated with impaired overall sleep quality (median AIS score: 8 vs 4; P<0.01) and poorer QoL. RLS was a significant and independent predictor of several of the QoL domains after statistical adjustment for clinical and socio-demographic covariables. Importantly, this association remained significant even after adjusting for sleep quality. CONCLUSIONS: RLS is associated with poor sleep, increased odds for insomnia and impaired QoL in patients on maintenance dialysis. Based on the present results, we suggest that both sleep-related and sleep-independent factors may confer the effect of RLS on QoL.

Adult↗
PubMed1999

Chronic pain management in a health maintenance organization.

OBJECTIVE: The purpose of this study is to investigate the management of chronic pain in a large health maintenance organization using cognitive-behavioral techniques and a blinded control group. DESIGN: Subjects were randomized into two groups. All participants completed a self-administered baseline questionnaire and were mailed a self-administered 6-month follow-up questionnaire. SETTING: This study examines chronic pain management in a large, established health maintenance organization. PATIENTS: Patients were members of a health maintenance organization, had pain for at least 6 months, and had failed all known treatment regimens. INTERVENTIONS: The treatment group participated in a 16-hour, 8-week class teaching cognitive-behavioral techniques, the relaxation response, meditation, and stress management. The minimal treatment group received a home-study manual. OUTCOME MEASURES: Behavioral outcomes, function, and pain severity and also patient satisfaction were measured. RESULTS: Both the treatment and minimal treatment groups exhibited improvement in pain severity, negative mood, pain affect, and pain interference with the patient's life. CONCLUSION: Gains were achieved in pain severity, negative mood, pain affect, self-control, and pain interference with the patient's life. Other behavioral variables and activity did not improve. Except in self-control, pain affect, and distracting responses from their significant others, the blinded minimal treatment group demonstrated similar findings. Patient satisfaction with treatment strongly favored the treatment group with over 78% of the treatment participants satisfied with the care provided.

Adult↗
PubMedDate not supplied

Lack of residual sedation following middle-of-the-night zaleplon administration in sleep maintenance insomnia.

The present randomized, double-blind, placebo and active-drug controlled, crossover study assessed residual sedation after zaleplon 10 mg, flurazepam 30 mg (as an active control), and placebo, taken during a nocturnal awakening in patients with sleep maintenance insomnia. Twenty-two healthy sleep maintenance insomniacs (11 men; mean age, 42 y) received zaleplon, flurazepam, or placebo after an experimental awakening 3.5 hours after bedtime on two consecutive nights in each of three conditions. Residual sedation was measured with sleep latency testing (5 and 6.5 h postdrug), digit symbol substitution, symbol copying, and subjective sleepiness by visual analog scale, each twice each morning. Zaleplon did not differ from placebo on any measure of residual sedation; flurazepam showed significant sedation on all measures. No residual sedative effects were detected 5 or 6.5 hours after ingestion of zaleplon during the middle of the night by sleep maintenance insomniacs.

Acetamides↗
PubMedDate not supplied

Development of preventive maintenance procedures.

A large number of in-house preventive maintenance (PM) programs, which call for varying degrees of thoroughness in the checkout of patient care instrumentation, are currently in existence throughout the country. This paper discusses the types of preventive maintenance, or PM procedures, which can be used by a clinical engineering department; the rationale for drafting different types of PM procedures in-house; and some long-term considerations affecting hospital-based inspection programs. Three types of PM procedures are described and compared: general checks; generic procedures; and, specific procedures. An outline is provided for writing a PM procedure; and, a call is made for a national guideline for writing preventive maintenance procedures.

Equipment Safety↗
PubMedDate not supplied

An international strategy in medical equipment maintenance.

In many developing countries, the growth in maintenance services has lagged far behind the rate of increase in medical equipment use. Urgent attention to maintenance services is required by district health facilities supporting primary healthcare. To date, most international assistance has been devoted to training technicians who are usually associated with major hospitals. A change of strategy is necessary to place priority on training technicians and on strengthening capabilities to maintain basic, essential medical equipment in district health facilities. Not only would such an approach meet urgent current needs, it would take less time to benefit a larger sector of the population, and it can also facilitate the development of higher maintenance capabilities. The advantages are illustrated by examining an empirical model. This strategy is in full support of the global goal to achieve "Health for All by The Year 2000."

Developing Countries↗
PubMed1996

Medicaid health maintenance organizations. Can they reduce program spending?

A randomized trial to evaluate the Florida site of the Program for Prepaid Managed Care showed that the plan, a staff model health maintenance organization, was successful in attracting Medicaid enrollees. The evaluation established that the health maintenance organization was able to limit members' utilization. The savings were in the form of lower likelihood of using care. The amount of services received, once care was initiated, was the same in both fee-for service Medicaid and health maintenance organizations. The authors detected no differences in inpatient use or costs. Additionally, they found evidence that the plan attracted sicker than average enrollees, so this reduced utilization translates into Medicaid program savings.

Adolescent↗
PubMed2004

Maintenance treatment of insomnia: what can we learn from the depression literature?

Insomnia and depression are common problems with profound public health consequences. When left untreated, both conditions have high rates of persistence and recurrence. Maintenance treatment for depression is fairly well established, but there is no evidence-based consensus regarding the safety and efficacy of maintenance therapy for insomnia. Consequently, long-term treatment of insomnia is driven primarily by the individual choices of patients and their clinicians. This article compares and contrasts the current state of research in the maintenance therapy of depression and insomnia and highlights gaps in the insomnia literature.

Behavior Therapy↗
PubMedDate not supplied

Antidepressant pharmacotherapy: economic evaluation of fluoxetine, paroxetine and sertraline in a health maintenance organization.

The present study was designed to compare direct health service expenditures, for the treatment of depression, among patients enrolled in a health maintenance organization, and prescribed one of three selective serotonin reuptake inhibitors, fluoxetine, paroxetine or sertraline. Information regarding depression-related health service use was derived from the computer archive of a network-model health maintenance organization system serving 700,000 beneficiaries. A total of 744 health maintenance organization beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to determine the incremental influence of selected demographic, clinical, financial and provider characteristics on health service expenditures related to the treatment of depression (ICD-9-CM, or DSM-IV code 296.2) 1 year after the start of antidepressant pharmacotherapy. Multivariate findings indicate that treatment with paroxetine increases average expenditures for physician visits ($31.93; P < or = 0.05), psychiatric visits ($19.33; NS), laboratory tests ($2.35; P < or = 0.05), hospitalizations ($85.33; P < or = 0.05), psychiatric hospitalizations ($82.01; P < or = 0.05), and antidepressant pharmacotherapy ($63.72; P < or = 0.05), for a total per capita increase in health service use of $284.68 (P < or = 0.05), compared with treatment with fluoxetine. Sertraline treatment increases average expenditures for physician visits ($21.74; P < or = 0.05), psychiatric visits ($56.79; P < or = 0.05), laboratory tests ($1.21; P < or = 0.05), hospitalizations ($70.59; P < or = 0.05), psychiatric hospitalizations ($95.75; P < or = 0.05), and antidepressant pharmacotherapy ($69.85; P < or = 0.05), for a total per capita increase in health service use of $315.96 (P < or = 0.05), compared with treatment with fluoxetine. Economic comparisons between paroxetine and sertraline did not demonstrate any significant differences in expenditures for the health services examined.

1-Naphthylamine↗
PubMedDate not supplied

Case study: a medicaid health maintenance organization quality initiative for behavioral health.

The purpose of this case study is to assess a Medicaid health maintenance organization quality initiative designed to screen new members for behavioral health treatment needs on enrollment. New members were screened by the health maintenance organization, which then informed the for-profit managed care organization responsible for the management of the mental health and substance abuse benefit of its findings. Other than the screening, there were no contractual expectations. The managed care organization was given only the names of individuals who "screened positive," but was not required to act on the screening results. Twenty percent of newly enrolled Medicaid health maintenance organization members were screened, and 2.5% were identified to have behavioral health and substance abuse treatment needs. As Medicaid managed care is responsible for the health care of low-income beneficiaries who are inherently vulnerable, it is important to make every effort to evaluate the impact of a quality project meant to improve their treatment.

Adult↗