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The key to patient safety-quality communication.

The outcome for the patient in the study could have become a serious issue for this facility. The patient was still in the facility and was able to provide another sample. As it turned out, the patient had not taken any medication that could have interfered with the culture and sensitivity testing. As we have discussed, patient safety issues are part of the laboratorian's and health-care professional's daily routine. Errors and incidents can be reduced by having clear and simple communication between patients and staff. In addition, open, honest, and direct quality communication without judgment or blame between each person involved in the patient service system is the key to guaranteeing patient safety issues won't occur in your patient practice.

Aged↗

Detecting mycotoxins in agricultural commodities.

It is difficult to obtain precise and accurate estimates of the true mycotoxin concentration of a bulk lot when using a mycotoxin-sampling plan that measures the concentration in a small portion of the bulk lot. A mycotoxin-sampling plan is defined by a mycotoxin test procedure and a defined accept/reject limit. A mycotoxin test procedure is a complicated process and generally consists of several steps: (a) a sample is taken from the lot, (b) the sample is ground (comminuted) in a mill to reduce particle size, (c) a subsample is removed from the comminuted sample, and (d) the mycotoxin is extracted from the comminuted subsample and quantified. Even when using accepted test procedures, there is variability associated with each step of the mycotoxin test procedure. Because of this variability, the true mycotoxin concentration in the lot cannot be determined with 100% certainty by measuring the mycotoxin concentration in a sample taken from the lot. The variability for each step of the mycotoxin test procedure, as measured by the variance statistic, is shown to increase with mycotoxin concentration. Sampling is usually the largest source of variability associated with the mycotoxin test procedure. Sampling variability is large because a small percentage of kernels are contaminated and the level of contamination on a single seed can be very large. Methods to reduce sampling, sample preparation, and analytical variability are discussed.

Aflatoxins↗

[Factors related with accident risks in persons older than 65 years of age in the province of Guadalajara].

OBJECTIVES: We studied the factors that can increase the risk of accidents among elderly persons who had no cognitive deterioration in the province of Guadalajara, Spain. METHODS: A cross-sectional, observational study was made in a primary care setting in which urban and rural areas were differentiated. A questionnaire (confirmed by a pilot study and analysis of the stability of responses using the kappa coefficient) was administered to a randomized, stratified sample in different stages. The sample was proportional in age, sex, and population centers. The variables studied were the cohabitants of the home, type of home, architectural barriers in the home, heating systems, periodic eye and ear checkups, use of corrective lenses and hearing aids, traffic safety, and sociodemographic variables. Data were analyzed using descriptive, analytical, and multivariant statistical procedures and logistical regression. The sample included 473 persons from rural areas and 477 persons from an urban area. The final study sample included 388 persons from rural areas and 392 persons from an urban area. The percentage of losses ranged from 16% (males from a rural area) to 26% (females from a rural area). RESULTS: The type of home differed depending on the area. One-story homes predominated in rural areas. In every case, over 80% of the homes had 1 to 4 architectural barriers, particularly the absence of hand-bars in bathrooms, presence of rugs and carpets, changes in floor level, and stairs. The percentage of elderly persons who underwent eye or hearing checkups less than once a year was over 75% for eye checkups and over 90% for hearing checkups, regardless of the area. Although the use of seatbelts is obligatory, 3% to 7% of the elderly do not use them. CONCLUSIONS: The prevalence of conditions that increase the risk of accidents for persons over 65 was high in our province. This study highlights the need for corrective measures.

Accidents, Home↗

Why do workers behave unsafely at work? Determinants of safe work practices in industrial workers.

AIMS: To explore the relation between safety climate (workers' perceptions regarding management's attitudes towards occupational safety and health) and workers' behaviour at work. METHODS: Cross sectional survey of workers at the pottery industry in Castellon, Spain. Sampling was stratified by plant size and workers' gender, according to data on the working population at this setting. A total of 734 production workers were interviewed. Information was collected on safety climate and workers' behaviour towards occupational risks with a specific questionnaire. A safety climate index (SCI, scale 0-100) was constructed adding scores for each item measuring safety climate in the questionnaire. Workers' unsafe behaviour was analysed for the different safety climate index levels. RESULTS: Mean score for SCI was 71.90 (SD 19.19). There were no differences in SCI scores according to age, gender, education, children at charge, seniority at work, or type of employment. Small workplaces (<50 workers) showed significantly worse SCI (mean 67.23, SD 19.73) than the largest factories (>200 workers). Lower levels of SCI (SCI <50) were related to workers' unsafe behaviours (full/high accord with the statement "I excessively expose myself to hazards in my work", adjusted odds ratio ORa 2.79, 95% CI 1.60 to 4.88), and to lack of compliance with safety rules (ORa 12.83, 95% CI 5.92 to 27.80). CONCLUSIONS: Safety climate measures workers' perception of organisational factors related to occupational health and safety (for example, management commitment to risk prevention or priorities of safety versus production). In this study these factors are strongly associated with workers' attitudes towards safety at work. Longitudinal studies can further clarify the relation between safety climate and workers' behaviour regarding occupational safety and health.

Accidents, Occupational↗

[Involvement of veterinary medicine in, and its responsibility for, the microbiological safety of foods of animal origin (author's transl)].

Epidemiological data indicate that, in the majority of outbreaks, the aetiology of diseases of microbial origin transmitted by foods is the "dual failure": poor sanitary handling in addition to storage of perishable items at temperatures allowing of microbial proliferation. For statistical reasons, sampling and examination of final products is completely ineffective as a means to obtain safe foods and meals. Dependable assurance of microbiological safety of foods should rather be attained by the application of Good Manufacturing Practices. The shared responsibility for reliable, uninterrupted preventive safeguarding of the food chain calls for cooperation between line workers of various disciplines. Microbiological examination of final product samples is still meaningful in order to monitor Good Manufacturing Practices. Reference values ("standards" with which data obtained can be compared are essential for this purpose. Theri establishment, based on product sample surveys of factories previously examined for reliable operation of approved procedures, is outlined.

Bacterial Infections↗

Fungal drivers of mycotoxin contamination in wheat: Early warning and plasma-based control.

Mycotoxin contamination in wheat is a major food safety concern; however, quantitative evidence linking fungal community signals, mycotoxin exceedance risk, and wheat quality traits in naturally contaminated wheat remains limited. In this study, wheat samples were collected from mycotoxin-prone monitoring sites under unusually rainy conditions in 2022 to explore early-warning indicators and post-harvest mitigation strategies. According to the National Food Safety Standard of China GB 2761-2017, aflatoxin B1 (AFB1), deoxynivalenol (DON), and zearalenone (ZEN) exceeded the maximum limits in 52.24, 47.76, and 23.88% of samples, respectively; 38.81% exceeded the reference EU threshold for T-2 toxin, and 46.27% showed co-contamination with at least two mycotoxins above their respective thresholds. Although Alternaria, Cladosporium, and Epicoccum dominated the fungal community, Fusarium abundance was significantly associated with DON contamination and Fusarium-damaged kernels (FDKs). Mediation analysis identified DON as a significant mediator linking Fusarium abundance to FDKs, accounting for 68.41% of the total effect. In addition, Fusarium abundance above 3.70% showed strong predictive performance for DON exceedance, with an area under the curve of 0.906, indicating its potential as an early-warning indicator. Culture-based assays confirmed the toxigenic potential of Aspergillus and Fusarium isolates under simulated temperature and moisture conditions. After optimization using a toxin-spiked wheat flour model, dielectric barrier discharge cold plasma degraded AFB1, DON, and ZEN by 29.30-35.68%, disrupted the morphology of toxigenic fungi, and did not significantly affect wheat quality. This study provides practical insights into mycotoxin risk warning and post-harvest mitigation in wheat.

Triticum↗

Sun safety behaviours of alpine skiers and snowboarders in the western United States.

Skin cancer is epidemic. Sun safety behaviours of skiers and snowboarders have not been investigated despite prolonged exposure at high altitudes. A sample of 156 adult alpine skiers and snowboarders at 14 high-altitude ski resorts in the western United States were interviewed during 1996-97 to ascertain their sun protective actions and exposure. Few of the adults said they received any messages over their entire lifespan regarding sun safety while skiing or snowboarding. Sun protective behaviour was variable: it was negatively associated with being male, younger, a snowboarder, exposed to prevention messages, and being in cold, windy and cloudy weather, and positively related to chair-lift elevation, skin sun sensitivity and prior sunburning while skiing or snowboarding. Prevention programs should target the young, males, novices and snowboarders, and advocate protection throughout the season and during inclement weather.

Adolescent↗

A brain bank in a neuropathology laboratory (with some emphasis on diagnostic criteria).

The Brain Bank of La Salpêtrière Hospital (Paris) is implanted in a neuropathology laboratory. It is multipurpose, prospective, and "free of charge" for the users. Protocols are prospectively established, in collaboration with the neuroscientists. One of our major difficulties in the collection of cases concerns presently the controls: the neurological status of patients coming from Neurology departments has usually been correctly assessed but those patients are bad controls. The normality of the neurological status of patients dying in other departments is difficult to assess retrospectively. A general autopsy is performed in each case. Several systematic sampling and fixation procedures are currently in use; their pros and cons are discussed. The main safety problem we are confronted with is the risk of HIV and Jakob-Creutzfeldt transmission. We try to standardize our diagnostic procedures; criteria used in Alzheimer's disease, Parkinson's disease, Huntington's chorea are briefly reviewed. We plan, in the future, to standardize our procedures for control cases. The Brain Bank has had a very positive impact on the way this neuropathology laboratory works: it introduced new techniques; on the other hand, the adequate processing and diagnosis of the samples was, in many aspects, simplified by the collaboration with the neuropathology department. The demand for human brain samples is steadily increasing in Neuroscience, for at least 2 reasons: 1. some diseases are specifically human and lack adequate animal models (Alzheimer's disease, multisystem atrophy), or animal models may appear irrelevant in some aspects (multiple sclerosis) or finally, results obtained in animal models may have to be confronted with human pathology (AIDS ...) 2. many aspects of human neuroanatomy can not be extrapolated from animal data There are many ways of organizing a brain bank and no golden standard (Swaab et al., 1989): the neuroscientist himself may collect the samples in a given pathology or the neuropathologists may modify their practice to provide adequate samples to the neuroscientists. When the neuroscientist himself collects his own samples, he obviously proceeds more rapidly. However, he is confronted with the difficult problem of the controls, which require both a clinical follow-up and a pathological check up of the tissues, both of which may be difficult to obtain in a research unit. In our opinion, the neuropathologists are the natural "brain bankers": they are indeed naturally "rich", their job being precisely to collect human samples, in connection with the clinicians.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain↗

Functional and safety aspects of Enterococci isolated from different Spanish foods.

The incidence and diversity of enterococci in retail food samples of meat, dairy and vegetable origin was investigated. Enterococci were present, at concentrations of 10(1) to 10(4) CFU/g. Fifty selected isolates from food samples grouped in two separate clusters by RAPD analysis. Cluster G1 (72% of the isolates) contained the E. faecium CECT 410T type strain, and also showed a high degree of genetic diversity. Cluster G2 (28% of the isolates) contained the E. faecalis CECT 481T type strain and was genetically more homogeneous. Virulence traits (haemolysin, gelatinase or DNAse activities, or the presence of structural genes cylL, ace, asal and esp) were not detected. All isolates were sensitive to the antibiotics ampicillin, penicillin, gentamicin, streptomycin and chloramphenicol. A high pecentage of isolates were resistant to erythromycin and rifampicin. Many isolates showed intermediate sensitivity to several antibiotics (tetracycline, ciprofloxacin, levofloxacin, or quinupristin/dalfopristin). Vancomycin and teicoplanin resistance was detected in one strain, but vanA, vanB, vanC1, vanC2 or vanC3 genes were not detected. Many of the isolates showed functional properties of food or health relevance. Production of antimicrobial substances was detected in 17 of the isolates, and 14 of them carried structural genes for enterocins A, B and/or P.

Cluster Analysis↗

Seasonal variation of Opisthorchis viverrini infection in cyprinoid fish in north-east Thailand: implications for parasite control and food safety.

Reported is the seasonal pattern of Opisthorchis viverrini metacercariae in cyprinoid fish in north-east Thailand. Samples of fish were collected in 1991-92 at monthly intervals from two areas-Khon Kaen Province, where the opisthorchiasis transmission rate was high, and Mahasarakham Province, where the rate was low. Metacercarial loads in both study areas had similar seasonal patterns. High burdens occurred in the late rainy season and winter (July to January) with low burdens during the summer (March to June). The average burden for Puntius leiacanthus in Khon Kaen was 1.68 metacercariae per fish (127.43 per kg), higher than for all species of cyprinoid fish from the low transmission area. The intensities of infection among P. leiacanthus and Cyclocheilichthys armatus collected in Mahasarakham were comparable, but lower than the intensity of Hampala dispar (0.75 metacercariae per fish) concurrently sampled from the same area (P < 0.05). There was no significant difference in metacercarial load per kg between fish species from Mahasarakham. The results indicate that seasonal variation in metacercariae was a common phenomenon in areas with both high and low endemicity of infection. Also, the metacerarial load in fish was positively associated with infection levels among humans.

Animals↗

Seeking Safety plus Exposure Therapy: an outcome study on dual diagnosis men.

This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues include self-harm, suicidality, perpetration of violence against others, and HIV risk behaviors. This study appears to be the first outcome trial to address a sample of civilian men with PTSD and SUD using manualized psychosocial treatment. It evaluates a novel combination treatment, Seeking Safety plus Exposure Therapy-Revised. The former is a coping skills treatment designed for PTSD and SUD; the latter is an adaptation of Foa's exposure therapy, modified for PTSD and SUD. In this small sample (n = 5) outpatient pilot trial, patients with current PTSD and current SUD were offered 30 sessions over five months, with the option to select how much of each type of treatment they preferred. Outcome results showed significant improvements in drug use; family/social functioning; trauma symptoms; anxiety; dissociation; sexuality; hostility; overall functioning; meaningfulness; and feelings and thoughts related to safety. Trends indicating improvement on 11 other outcome variables were also found. Treatment attendance, satisfaction, and alliance were extremely high. The need for further evaluation using more rigorous methodology is discussed.

Adult↗

Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: review of current approaches.

BACKGROUND: Emerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases. DISCUSSION: The principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems. SUMMARY: Risk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations.

Animal Diseases↗

Once-weekly administration of 50 mg etanercept in patients with active rheumatoid arthritis: results of a multicenter, randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the safety, efficacy, and pharmacokinetics of 50 mg etanercept administered subcutaneously once weekly in adult patients with active rheumatoid arthritis (RA). METHODS: Four hundred twenty RA patients were randomized to receive, in a blinded manner, the study drug for up to 16 weeks: 214 patients received 50 mg etanercept once weekly, 153 received 25 mg etanercept twice weekly, and 53 received placebo for 8 weeks followed by 25 mg etanercept twice weekly for 8 weeks. Efficacy and safety were assessed at weeks 8 and 16. Pharmacokinetic analyses were performed on serum samples from patients at selected study sites. The primary efficacy end point was achievement of the American College of Rheumatology (ACR) 20% improvement criteria (ACR20 response) at week 8. RESULTS: An ACR20 response was achieved at week 8 by 50% of the patients receiving 50 mg etanercept once weekly, by 49% of the patients receiving 25 mg etanercept twice weekly, and by 19% of the patients in the placebo group (P </= 0.0001 for each etanercept group versus placebo). Similarly, achievement of the ACR50 response was attained by 18% of patients in each of the 2 etanercept groups, compared with 6% of patients in the placebo group (P < 0.03 for each comparison). Pharmacokinetics of the 2 etanercept regimens were similar at steady state. No clinically significant differences in efficacy or safety were observed between the 2 etanercept groups. CONCLUSION: Safety, efficacy, and pharmacokinetics were comparable between the 2 etanercept dosing regimens. Thus, comparable clinical outcomes are to be expected when patients are treated with etanercept administered either as 50 mg once weekly or as 25 mg twice weekly.

Adult↗

Operative ultrasound using an echogenic loop snare for intrauterine pathology.

A technique for resecting intrauterine tissue was performed in nine women, each of whom had intrauterine pathology on sonohysterogram. The uterine cavity was entered with a 12F intrauterine access catheter with a 3-ml balloon that was placed in the cervical canal or lower uterine segment. A 5F echogenic loop snare was passed through the access catheter and resection was attempted under ultrasound guidance. Biopsy samples underwent pathologic examination for definitive diagnosis. Seven of nine patients had adequate resection or biopsy tissue, but in two the loop snare could not secure the base of the lesion. All procedures were well tolerated. Average operating time was about 27 minutes (range 18-43 min), with no complications. Operative ultrasound makes it possible to resect and biopsy intrauterine pathology. In selected patients, this procedure is a cost-effective alternative to hysteroscopy.

Adult↗

The use of a safety harness does not affect body sway during quiet standing.

BACKGROUND: Postural sway during quiet standing reduces when somatosensorial information is provided by an active or passive "light touch" of different body parts with a surface. The contact of the safety harness with the body could induce a similar effect, leading to an undesirable side effect in the balance evaluation. METHODS: This study investigated if a safety harness system, commonly used in balance studies, affects body sway during the balance evaluation. Healthy adults stood as quietly as possible for 60s in a comfortable position on a force plate. First, we performed an experiment on the light-touch effect with 10 subjects to determine the necessary sample size for the main investigation. Then, 60 subjects completed four tasks where the use of the safety harness and the visual information were manipulated. Area, root-mean square, speed, and frequency of the center of pressure displacement were analyzed. FINDINGS: A light touch decreased postural sway on both visual conditions but there was no effect of the use of a safety harness on sway when quietly standing, independent of the visual information. Postural sway increased on both somatosensorial conditions when the visual information was not provided. INTERPRETATION: This result shows that the safety harness does not interfere with the evaluation what is of major importance to methodological aspects of balance evaluation.

Adult↗

[Guidelines for electronic-data-processing-controlled serial diagnosis of donor blood samples].

UNLABELLED: Increasing performance figures and the necessity to save expenses oblige transfusion services to automatize their donors' laboratory examination. Sufficient hard- and software for sample distribution and processing is now available. Following aspects should be regarded when switching to automatic serial screening: SAFETY: The identity of blood-donor, donation and laboratory result will be achieved by machine readable labeling and on-line communication between working-stations and central administration. Flexibility: Easy automatic selective laboratory screening will be possible using special barcodes including sample identification and working orders. A modular hardware concept with easily accessible programming control allows it to implement new devices or methods. Ergonomy: Automatic sample processing including selective screening and simultaneous operating robotic sample processors increase working quality, sample output and time benefits. Economy: Improved working conditions will result in saving reagents and compensating staff limitations.

Blood Banks↗

Evaluation of 1-(9-anthracenylmethyl) piperazine for the analysis of isocyanates in spray-painting operations.

A new reagent, 1-(9-anthracenylmethyl)piperzine (MAP), was used for the derivatization of airborne 1,6-hexamethylene diisocyanate (HDI) and polyisocyanates generated during spray-painting operations. The new reagent, which offers enhanced sensitivity and uniformity of response to both the monomeric and oligomeric forms of HDI, was compared directly with 1-(2-methoxyphenyl)piperazine (MOP), the currently employed derivatizing reagent used in the National Institute for Occupational Safety and Health Method 5521. Both the validity of the side-by-side sampling protocol and the efficacy of two derivatizing reagents were evaluated in field studies. The analytical results indicate that there is no significant difference at the 95% confidence level in the concentration of polyisocyanate in the aerosol as determined by two impingers containing MAP and a third containing MOP when these are positioned in a side-by-side-by-side arrangement.

Air Pollutants, Occupational↗