Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Mandatory Testing”

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 1,711 records · Page 95Linked to original sources
PubMed1982

The EEC policy in the hazard assessment of new chemicals.

The sheer number of new chemicals produced each year poses problems to ensure that no dangerous products are brought in to use in the Community. Therefore the Council of Ministers of the European Communities has adopted on September 18, 1979 a Community legislation with respect to the notification of new chemicals. This is the so called sixth amendment of the Council directive of 27 June 1967 relating to the classification, packaging and labelling of dangerous substances. The purpose of this directive is to approximate the laws, regulations and administrative provisions of the ten Member States on: a) the notification of new chemical substances and b) the classification, packaging and labelling of substances dangerous to man and the environment which are placed on the market (including imported products) in the Member States of the Community. When giving this pre-marketing notification, the technical dossier requires, amongst others, the results of tests, of physico-chemical properties and toxicological and ecotoxicological parameters, following a three level hierarchical or step-sequence test system based on the quantities of the substances marketed. The first level concerns a mandatory base-set or level 0, the so called Annex VII, followed by a level 1 and level 2 testsystem (Annex VIII).

Animals↗
PubMed1998

Multiresidue determination of beta-lactam antibiotics in milk and tissues with the aid of high-performance liquid chromatographic fractionation for clean up.

Screening of milk shipments for beta-lactam antibiotic residues is mandatory in the USA and is widely used in other countries. Interpretation of positive screening test results has been difficult. Only six beta-lactam antibiotics are approved for use in food-producing animals in the USA but many others are used in other countries. A multiresidue procedure was developed for identification and quantitation of unknown beta-lactam antibiotics. The residues were extracted with acetonitrile and tetraethylammonium chloride. The extract was concentrated by evaporation and filtered. The concentrated extract was then loaded onto an HPLC column in 100% 0.01 M KH2PO4 and eluted with an acetonitrile gradient. Fractions corresponding to analytes of interest were collected and tested for antibiotics using rapid milk screening tests. Fractions testing positive were analyzed by HPLC. The identity of beta-lactams was confirmed by treating a replicate with beta-lactamase.

Animals↗
PubMed1999

Proportional assist ventilation in low birth weight infants with acute respiratory disease: A comparison to assist/control and conventional mechanical ventilation.

OBJECTIVES: To compare the physiologic efficacy and safety aspects of proportional assist (PA), assist/control (A/C), and intermittent mandatory ventilation (IMV) in very low birth weight infants with acute respiratory illness and to test the hypothesis that ventilatory pressure requirements are lower and arterial oxygenation is improved during PA when compared with IMV or A/C at an equivalent inspired oxygen fraction. STUDY DESIGN: Randomized, 3-period, crossover design. METHODS: Thirty-six infants were stratified by birth weight (600 to 750, 751 to 900, and 901 to 1200 g) and exposed to consecutive 45-minute epochs of the 3 modalities in a sequence chosen at random. Tidal volumes of 4 to 6 mL/kg were targeted during A/C and IMV. The IMV rate was matched to the rate during an A/C test period. PA was adjusted to unload the resistance of the endotracheal tube and the disease-related increase in lung elastic recoil. RESULTS: Compared with A/C and IMV, PA maintained similar arterial oxygenation with lower airway and transpulmonary pressures (15% to 44% reduction depending on the index variable). The oxygenation index decreased by 28% during PA. No adverse events were observed. The number and severity of apneic episodes and periods of arterial oxygen desaturations were similar with the 3 modes. Similar results were obtained within each birth weight subgroup. CONCLUSIONS: PA safely maintains gas exchange with smaller transpulmonary pressure changes compared with A/C and IMV. It may therefore offer a way of reducing the incidence of chronic lung disease in low birth weight infants.

Acute Disease↗
PubMed2001

Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure.

BACKGROUND: Vaginal palpation is commonly used in clinical practice to teach and evaluate pelvic floor muscle strength, and several grading systems have been developed. The aim of the present study was to test inter-rater reproducibility of the modified Oxford grading system and compare results from vaginal palpation with squeeze pressure measurement. METHODS: Twenty female physical therapy students, mean age 25.1 years (range 21-38) participated in the study. Two experienced physical therapists conducted the palpation test in random order. Muscle strength was classified according to a 6-point scale (modified Oxford grading system). Results from the palpation test were compared with measurement of vaginal squeeze pressure using a vaginal balloon connected to a fiberoptic microtransducer (Camtech AS, Sandvika, Norway). To ensure validity of pressure measurement only contractions with simultaneous observation of inward movement of the perineum were registered. RESULTS: The inter-rater reliability for vaginal palpation was 0.70 measured by Spearman's rho (p<0.01). Cohen's Kappa was kappa=0.37 (SEM 0.16). There was agreement between the physical therapists in nine subjects (45%). In all but one subject the disagreement was one category. Mean maximal strength for the group was 19.7 cm H2O (95% CI: 16.5-22.9). There were no differences between weak, moderate, good and strong muscle contraction classified by palpation test when comparing results from the vaginal squeeze pressure (p=0.66). CONCLUSIONS: Vaginal palpation is mandatory when teaching correct pelvic floor muscle contraction. However, the present results indicate that the method is not reproducible, sensitive and valid to measure PFM strength for scientific purposes.

Adult↗
PubMed2002

[Flying fitness of patients with cardiovascular diseases].

Air travel of persons with coronary heart disease, heart failure and cyanotic congenital heart disease will be without complications and problems in the most cases. Prerequisite for an uneventful flight are stable cardiac conditions and an extensive cardiac examination including echocardiography and exercise testing before starting the journey. Careful travel planning and timing to reduce travel stress is mandatory. To determine fitness for air travel left heart catheterization is required in most patients with acute coronary syndrome. Patients with an acute coronary syndrome may repatriated with medical escort within the first 2 weeks after the acute event. Patients with a low risk profile can fly with reasonable safety 14 to 21 days after the acute event without medical escort. Fitness to travel may be given within a few days after successful percutaneous coronary intervention in individual cases. Patients with severe acute cardiovascular diseases and an appropriate medical indication may be transferred by air ambulance after acute local medical care and pretransfer stabilisation with ambulance jet under intensive care conditions. In these cases close cooperation between the doctor in charge, cardiologist and cardiologic department respectively and air ambulance is mandatory.

Aerospace Medicine↗
PubMed1996

The New South Wales Driver Assessment Programme: a pilot programme for assessment of drink drivers.

The NSW Driver Assessment Programme operated in Sydney from 1991-94 as a pilot scheme for the medical assessment of drink driver offenders. In this report we describe its functioning and characterize its 2267 participants. Offenders who had been convicted of driving with a blood alcohol concentration of 0.15 g/dL or more, or of refusing a breath test were referred to one of five Driver Assessment Clinics in Sydney. Medical assessment was mandatory before the driver's licence could be renewed. Of the 2267 offenders referred to the Programme, 922 (41%) attended an assessment during the operation of the scheme, with non-attenders having longer disqualification periods than attenders. Among attenders, 691 (75%) were judged fit to drive (i.e. "passed"). There was no significant variation in pass rate between centres. Of the 112 offenders who had laboratory results available from both first and second assessments, 68 (61%) showed a significant reduction in gamma glutamyltransferase (GGT) levels. We conclude that there was evidence of health benefit from the Programme in the fall in GGT levels in 61% repeat attenders. To assess the effects of the scheme on road safety would require prospective data collection on recidivism, road traffic accidents and, if possible, on self-reported drink-driving behaviour.

Journal Article↗
PubMed2002

Structural and process quality in the management of diabetic emergencies in Germany.

OBJECTIVE: Although acute complications of diabetes account for approximately 3% of all emergency calls, clinically relevant indicators of structural and process quality in the management of diabetic emergencies have not yet been studied. The purpose of this investigation was, therefore, to collect representative data on these indicators for the whole of Germany. METHODS: Standardized questionnaires comprising 20 items were sent to all 312 emergency medical services in Germany. Apart from demographic data, information was obtained about the diagnostic materials and drugs carried by the ambulances, methods of blood glucose measurement, the level of qualification of the emergency teams, the frequency of diabetic emergencies, and the need for further training. RESULTS: The return rate of the questionnaires was 55%, corresponding to 172 emergency medical service districts serving a total population of 45.3 million. The data revealed deficits with regard to structural and process quality. Thus, only 6% of ambulances carried glucagon and only 11% ketone test strips. In 57% capillary blood was used for glucose determination, in 17% visually read test strips were still used. While in some districts hospital admission after hypoglycaemic episodes was mandatory even for patients well educated about their diabetes, in other districts multimorbid patients on oral antidiabetics were sometimes only treated at the emergency scene. Emergency medical technicians increasingly carried out both the diagnosis and treatment of diabetic emergencies. CONCLUSIONS: The structural and process quality of the management of diabetic emergencies in Germany is in need of improvement. The most important factor is continuing education of the entire emergency team.

Acute Disease↗
PubMed2002

Iron fortification: country level experiences and lessons learned.

Iron fortification has been used to enhance iron intake in many developed countries for more than 50 years, but only in the last decade has this strategy been applied on a large scale to other parts of the world. Iron fortification of rice is being instituted in the Philippines. Initially, the rice will be produced in government-controlled rice mills and sold at low cost mainly to low income families. Efforts to improve the technology (using coating or extrusion techniques) are currently underway to reduce cost and minimize losses during storage and washing. Effectiveness and feasibility studies are required to test the new technologies and processing/distribution systems. In Venezuela in 1993, the government instituted a mandatory program of iron fortification to enrich precooked corn flour followed by the voluntary fortification of wheat flour. Surveys in school children subsequently showed a sharp drop in iron deficiency. Fortification of fish sauce in Vietnam has shown promising initial results in reducing anemia among anemic, nonpregnant female factory workers. Iron-fortified soy sauce has been shown to reduce anemia in initial studies in children in China, and a large-scale efficacy trial is now underway. These examples indicate that iron fortification of staple foods and condiments holds great promise for the prevention of iron deficiency.

Adolescent↗
PubMedDate not supplied

Safety of plasma derivatives.

In clinical treatment practice of substitution therapy involving a plasma component, numerous aspects related to recipient's safety are relevant to the physician. Since viral contaminants may be present in the donor blood, safety begins in the institution collecting raw plasma where donors are inquired about any unusual behavior that may potentially threaten safety. Other measures that could lead to exclusion of a donation are positive serological tests for HIV and hepatitis B and C. In this context, meticulously accurate logistics are mandatory. During the course of manufacture of plasma products, viral inactivation procedures have been adopted based on chemical and physical principles. The distinct effects of these depend on methodology and the types of virus in question. An important safety measure relates to establishing that the label value of content corresponds to the in vivo recovery of the reconstituted plasma derivative and, by inference, the clinical efficacy of the product. In patients deficient in plasma coagulation factors, treatment may trigger the development of functionally inhibiting alloantibodies against the factor needed for substitution which is a significant clinical complication. The reported incidences of such inhibitors have varied greatly. No clear relationship between their frequency and the type of concentrate used have been established. However, recent experience has shown an unexpected increase in inhibitors in a regional subset of previously stable patients when shifted from a dry-heat-inactivated concentrate to a pasteurized version of the same concentrate. Hence, the possible introduction of neoantigens is important. In the early era of concentrate use, side effects to treatment were often observed like alloimmune hemolytic anemia and various degrees of anaphylactoid reactions. With the appearance of concentrates of increased purity that contain less unwarranted proteins, side effects of this kind have been rare. In conclusion, safety of plasma derivatives by today's standards is not a single entity, but a long chain of interdependent issues, each of which needs full attention to protect patients from mild and serious treatment complications.

Blood Coagulation Factors↗
PubMed2001

A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation.

OBJECTIVE: To determine whether synchronized nasal intermittent positive pressure ventilation (SNIPPV) would decrease extubation failure compared with nasal continuous positive airway pressure (NCPAP) in preterm infants being ventilated for respiratory distress syndrome (RDS). METHODS: Infants who were </=34 weeks' gestational age and who were ventilated for RDS were randomized to either SNIPPV or NCPAP after extubation. The criteria for extubation were peak inspiratory pressure of </=16 cm H(2)O, positive end expiratory pressure of </=5 cm H(2)O, intermittent mandatory ventilation rate of 15 to 25, and fraction of inspired oxygen </=0.35. Pulmonary function tests (PFT) were obtained before extubation. After extubation, blood gases were monitored for a minimum of 72 hours. Success was defined as remaining in the selected mode of treatment or demonstrating improvement (switching to oxyhood/nasal cannula/room air) by 72 hours. RESULTS: Thirty-two (94%) of 34 infants were extubated successfully with the use of SNIPPV versus 18 (60%) of 30 with the use of NCPAP (P <.01). There was no difference in apnea/bradycardia episodes in the 2 groups during the 72-hour study period. Among 55 infants who had PFT, 80% (8 of 10) with dynamic lung compliance of >/=0.5 mL/kg/cm H(2)O and expiratory airway resistance of </=70 cm H(2)O/L/s were extubated successfully. In infants with poor lung function (dynamic lung compliance: <0.5 mL/kg/cm H(2)O; expiratory airway resistance: >70 cm H(2)O/L/s), successful extubation was seen in 93% (27 of 29) in the SNIPPV group and 60% (15 of 25) in the NCPAP group. When weight was controlled for at the time of extubation, the odds of success in the SNIPPV group were 21.1 times higher (95% confidence interval: 3.4, 130.1) than that of the NCPAP group. CONCLUSIONS: SNIPPV is more effective than NCPAP in weaning infants with RDS from the ventilator. PFT may be useful in predicting successful extubation.

Female↗
PubMedDate not supplied

Changes in pCO2 during air medical transport of children with closed head injuries.

OBJECTIVES: Because low partial pressure of carbon dioxide (pCO2) can be associated with posttraumatic cerebral ischemia, we conducted a study to determine whether the pCO2 level in ventilated children with closed head injuries transported by a trained team to tertiary care was optimally maintained during transport and determine whether hand-bagging or mechanical ventilation resulted in more optimal pCO2 levels after transport. METHODS: We reviewed the hospital charts and transport records of all infants and children who had sustained a head injury and were transported by a specialized pediatric transport paramedic team to a single tertiary care facility during a 12-month period. All children were intubated and ventilated either mechanically or manually. Outcome measures were final pCO2 before transport and first pCO2 on arrival in the PICU. RESULTS: Twenty-nine children (age 0.6 to 16 years, mean 7.3, median 6) met the criteria. Fourteen patients were hand-bagged (HB), and 15 were mechanically ventilated (MV). Eleven patients (5 HB and 6 MV) started in the target pCO2 range of 35 to 40 mmHg. After transport, nine patients (all MV) had pCO2 within the target range (P < 0.01). Duration of transport (mean 63 minutes, range 15-200 minutes) did not contribute to the final pCO2 level. CONCLUSION: MV improves management of pCO2 during interfacility transport. HB significantly increases the incidence of suboptimal pCO2 and hence the risk of suboptimal cerebral blood flow. MV appears mandatory, and monitoring CO2 in transit (end-tidal or preferably point-of-care testing) should further reduce the likelihood of secondary complications from cerebral ischemia.

Adolescent↗
PubMed1992

[Aspirin and heparin in the fibrinolytic treatment of acute myocardial infarction].

There is now extensive evidence of activation of platelet and the coagulation cascade with coronary thrombosis, and further activation with exogenous thrombolysis. Administration of aspirin and heparin has been shown to improve mortality when combined with thrombolytic therapy in acute myocardial infarction, probably by enhancing lysis and reducing subsequent reocclusion of infarct related artery. Most studies have evaluated the effect of aspirin or heparin in combination with streptokinase. These results can probably be extrapolated to rtPA, as it has much shorter, half live, and induces lower systemic lytic state. Although aspirin and heparin have been tested independently, they probably have a synergistic action post fibrinolysis. With current information it is mandatory to include aspirin in the treatment of AMI, with or with out thrombolytic treatment. Intravenous administration of heparin seems justified, specially if rtPA is used as fibrinolytic agent. Potent new drugs capable of inhibiting platelets an the coagulation cascade emerge as a promising future. Until their effect is clinically proven, aspirin and i.v. heparin should remain as adjunctive therapy to fibrinolytic treatment in AMI.

Aspirin↗
PubMed2005

[How to detect impending cardiac insufficiency].

The characteristic leading symptoms of heart failure are a reduction in physical performance, dyspnea and the development of edema. At this point, such examinations as an ECG and determination of various laboratory parameters become mandatory. For the differential diagnostic exclusion of a pulmonary cause of respiratory distress, lung function tests and chest X-rays are needed. If heart failure is suspected clinically, echocardiography is the most important noninvasive method for identifying a cardiac functional disorder. With the aid of this examination, systolic function, diastolic filling, myocardial thickness and valve function can be evaluated. Cardiac catheterization is emportant to determine the underlying causes of heart failure and to plan therapy.

Cardiac Catheterization↗
PubMed1991

Prevalence of hepatitis B virus (HBV) markers and human immunodeficiency virus (HIV) in employees of a blood transfusion centre.

Blood bank staff, 8 out of 25 (32%) have been exposed to hepatitis B virus (HBV) and the prevalence of HBV markers in blood bank employees handling high risk subjects show hepatitis B surface antigen (n = 1), hepatitis B surface antibody (n = 7), hepatitis B core antibody (n = 6) and combined hepatitis B surface antibody and hepatitis B core antibody (n = 6) seropositivity but all are negative to human immunodeficiency virus (HIV). Serum alanine aminotransferase was raised in the employees than normal subjects and it is suggestive of sub-clinical hepatitis. The employees of blood bank should be trained for proper handling of test materials and must be periodically monitored for HBV and HIV. Immunisation for HBV is mandatory only for the employees of transfusion centre which handles high risk subjects.

Biomarkers↗
PubMed1994

[Aluminum poisoning in dialysis patients--diagnosis and therapy].

Three different dialysis procedures have been investigated and compared with respect to the efficacy of aluminium elimination in intoxicated dialysis patients. For this purpose ten patients with increased serum aluminium have been treated for two months with the chelator DFO. The effect of DFO on the aluminium clearance has been investigated. In spite of difficult conditions during studies due to an unexpected cumulation of severe adverse effects of DFO, some statements given here may be of value for the care of hemodialysis patients: 1. Both, the commonly used cuprophan filters as well as the newer highly permeable dialysis membranes like the polysulfone membrane used in our study, permit a steady but low elimination of aluminium during a dialysis session without significant difference in efficacy. A prerequisite, however, is a very low level of aluminium in the dialysate. 2. DFO induces a dose-dependent mobilization of aluminium accumulated in the tissue. The level of plasma aluminium increases distinctly, dialysable aluminium-DFO complexes are produced, and marked amounts of aluminium can thus be eliminated by the use of DFO. 3. IF DFO is used, even the economical cuprophan membrane CF1511 may lead to a satisfactory elimination rate of aluminium. Equal increase of elimination rate is achieved whether the Cuprophan membrane CF1511 is combined with the hemoperfusion filter Alukart or the highly permeable polysulfone membrane F60 is used alone. This is of importance particularly in cases of severe intoxication with aluminium. The polysulfon dialysator may be preferred to conventional membranes combined with hemoperfusion because of the simpler handling. 4. In order to prevent accumulation of aluminium in dialysis patients, besides the use of dialysates poor in aluminium, phosphate binders containing aluminium should be avoided completely if possible. They may be replaced by the two phosphate binders calcium carbonate and calcium acetate and a diet poor in phosphates. The use of aluminium-containing phosphate-binders should be restricted to exceptional cases such as patients with hypercalcemia, severe intolerance of calcium-containing phosphate-binders or patients with hyperphosphatemia that cannot be treated otherwise. 5. Finally, regular controls of plasma aluminium levels are mandatory in dialysed patients. In cases with an increase over 50 micrograms/l and positive DFO test, DFO treatment should be initiated. Low doses of 10 mg/kg body weight DFO per week are actually in use for those cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2001

Assessment of suspected dementia.

At the Second Canadian Consensus Conference on Dementia (CCCD) (February, 1998), a group of neurologists, geriatricians, and psychiatrists met to consider guidelines for evaluation of dementia in Canada. This review paper formed a background paper for their discussion of dementia diagnosis. These experts from across the country concluded that diagnosis of suspected dementia cases continued to rest on skilled clinical assessment. Mental status exam, preferably in some quantifiable form, has become an essential part of the assessment. Selected laboratory tests are advisable in all cases (CBC, TSH, electrolytes, calcium, and glucose), but the CCCD continued to advise that CT scanning was mandatory only in selected cases where clinical findings pointed to another possibility besides Alzheimer's disease. The growing list of other diagnostic measures with potential usefulness in diagnosis of Alzheimer's disease or dementia in general was reviewed, but the evidence was judged as insufficient to support routine use of these tests by physicians. As new treatments for Alzheimer's disease become available, neurologists face new diagnostic challenges--differentiating Mild Cognitive Impairment, Frontotemporal dementias and Mixed dementias, and Lewy Body Dementia. Guidelines to aid in differential diagnosis are presented.

Aged↗
PubMed1995

Mandated life versus mandatory death: New York's disgraceful partner notification record.

In New York City in 1993, there were some 18,000 positive HIV tests but only 350 partner notifications completed by the New York City Health Department. The bleak disparity between these two numbers should haunt us all. We will never know for certain how many lives could have been saved by universally available notification services, but looking at the results of current, obstructive New York State notification law and policy, we have to know we are facing an enormous public health failure. In states and cities with well-established notification programs, between 50 and 90% of HIV-positive clients cooperate voluntarily with notification and, typically, 90% of partners contacted seek HIV-testing and preventive counseling. There are no differences in cooperation based on race, gender or sexual orientation. In New York, urgently required reform means legislation to mandate that notification services are offered to all people who test positive and to require the state to supply enough trained personnel to undertake sensitive notification and counselling. With Black and Latina women--most of whom are mothers--now at the highest risk for sexual HIV infection, New York's refusal to undertake the life-saving policies common elsewhere has not only resulted in a horrible abandonment of a very vulnerable population, but also accelerated the orphaning of children at unprecedented rates.

Child↗
PubMed1994

Proficiency testing in parasitology. An educational tool to improve laboratory performance.

In 1977, the Laboratory Proficiency Testing Program began testing laboratories that examine samples for gastrointestinal parasites and operated with little change in the subsequent 17 years. Four surveys, each containing four samples, are distributed each year to every currently licensed medical laboratory in Ontario. Participation is mandatory. Survey results indicate a remarkable improvement in laboratory performance during this period. Improvement is believed to result from a combination of the voluntary withdrawal from testing by laboratories with poor performance and the improved performance of the others. The extensive educational services devised and carried out by the Parasitology Committee is believed to have been a significant factor leading to this improvement.

Data Collection↗