Aerosol box for intubation of patients with suspected COVID-19: simulation study / Caja de aerosol para la intubación de pacientes con sospecha de COVID-19: Un estudio de simulación

Abstract Introduction Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.

Resumen Introducción La intubación endotraqueal es un procedimiento que se relaciona con alto nivel de exposición al virus de COVID-19, llevando a la búsqueda de alternativas para disminuir el riesgo de contaminación, entre ellas la llamada Caja de aerosoles. Objetivo Comparar el tiempo y dificultad en la intubación orotraqueal usando la caja de aerosoles en escenarios simulados. Metodología Estudio observacional, con participación de 33 médicos anestesiólogos y residentes de anestesia; se compararon los grupos en tiempo y dificultad de intubación con uso de laringoscopio convencional Macintosh y videolaringoscopio McGRATH™ MAC (Medtronic) utilizando la caja de aerosoles y sin ella. Para determinar el rendimiento en la maniobra de intubación se calcularon Hazard ratios crudos, se construyó modelo multivariado de Regresion de Cox ajustado por años de experiencia como anestesiólogo y dificultades durante el procedimiento. Resultados La caja de aerosoles aumentó en promedio el tiempo en segundos para la intubación con video-laringoscopio en 7,57 (DE: 8,33) y con Macintosh 6,62 (DE: 5,74). Se llevaron a cabo 132 intubaciones, 121 exitosas en el primer intento y 6 fallidas (4 con el uso de la caja de aerosoles). 16 participantes reconocieron alguna dificultad al manipular la caja (48,48 %). Con el uso de Macintosh se identificó tendencia a la intubación más rápido que con el videolaringoscopio (HRc: 1,36 [IC 95 %: 0,64-2,88]; HR ajustado: 2,20 [IC 95 %: 0,73-6,62]). Conclusiones Utilizar la caja de aerosoles y equipo de protección personal en un escenario simulado dificulta la maniobra de intubación y puede prolongar el tiempo de ejecución.

Metodología para evaluar el nivel de protección respiratoria de mascarillas y respiradores ante partículas similares a las que transmiten el SARS-CoV-2 / Methodology for evaluating the level of respiratory protection of masks and respirators against particles similar to those that transmit SARS-CoV-2

RESUMEN Objetivo: Desarrollar una metodología para evaluar el nivel de protección respiratoria de respiradores, mascarillas quirúrgicas y mascarillas comunitarias que usa la población peruana, usando partículas de un tamaño similar a las que contienen al virus activo del SARS-CoV-2. Materiales y métodos: Se ha determinado una relación lineal directa entre el logaritmo de la concentración de partículas suspendidas en aire y el tiempo transcurrido; por lo cual es posible comparar la cantidad de partículas internas y externas a la mascarilla o respirador en un mismo periodo y conocer el porcentaje de protección respiratoria de cada muestra evaluada. Resultados: Se ha logrado implementar una metodología para evaluar el nivel de protección respiratoria ante aerosoles menores a 5,0 µm. Asimismo, el empleo de accesorios como ligas o ajustadores detrás de cabeza y nuca, y el uso de clips nasales robustos, incrementan significativamente el nivel de protección respiratoria ante partículas con alta probabilidad de contener al SARS-CoV-2. Conclusiones: Se observa una concordancia entre los valores de protección respiratoria obtenidos y los esperados, considerando el nivel de filtración del material empleado de cada mascarilla quirúrgica o respirador, y su nivel de ajuste. Se observó un incremento significativo en los niveles de protección respiratoria.

ABSTRACT Objective: To develop a methodology for evaluating the level of respiratory protection provided by respirators, surgical masks and community face masks used by the Peruvian population; protection was evaluated against particles of a size similar to those containing active SARS-CoV-2 virus. Materials and methods: A direct linear relationship has been determined between the logarithm of the concentration of airborne particles and the elapsed time; thus, it is possible to compare the quantity of particles inside and outside of the mask or respirator in the same time period, as well as to obtain the percentage of respiratory protection for each evaluated sample. Results: A methodology was established to evaluate the level of respiratory protection against aerosols smaller than 5.0 μm. Also, the use of accessories such as rubber bands or adjusters behind the head and neck, and the use of robust nasal clips, significantly increased the level of respiratory protection against particles with a high probability of containing SARS-CoV-2. Conclusions: We found concordance between the obtained respiratory protection values and those expected, considering the filtration level of the material used for each surgical mask or respirator, as well as the tightness. A significant increase in the levels of respiratory protection was observed.

Cuidados de enfermagem com o protetor ocular de recém-nascidos submetidos à fototerapia / Nursing care with the eye protector of newborns submitted to phototherapy / Atención de enfermería con protección ocular para recién nacidos sometidos a fototerapia

Objetivo: Avaliar os cuidados de enfermagem com o protetor ocular em recém-nascidos. Método: Estudo investigatório descritivo, com abordagem qualitativa, realizado em hospital-escola, localizado na cidade de Fortaleza-Ceará, Brasil, janeiro a fevereiro de 2016. Participaram do estudo 15 enfermeiras que prestavam cuidados a recém-nascidos em fototerapia, na Unidade de Cuidados Intermediários e Terapia Intensiva. A coleta dos dados ocorreu por meio de entrevista não estruturada. Resultados: O protetor ocular é utilizado na prevenção de lesão na retina de recém-nascidos, sendo que existem riscos na utilização desse artefato e, para evitar danos, são realizados cuidados essenciais direcionados aos recém-nascidos sob fototerapia. Conclusão: Os cuidados que as enfermeiras prestam aos recém-nascidos são realizados de forma sistematizada, aliando humanização e tecnologia.(AU)

Objective: To evaluate nursing care with eye protection for newborns. Method: Descriptive investigative study, with a qualitative approach, carried out in a teaching hospital, located in the city of Fortaleza-Ceará, Brazil, January to February 2016. The study included 15 nurses who cared for newborns undergoing phototherapy, at the Intermediate Care and Intensive Care. Data collection took place through unstructured interviews. Results: The eye protector is used to prevent injury to the retina of newborns, and there are risks in the use of this artifact and, to avoid damage, essential care directed to newborns under phototherapy is performed. Conclusion: The care that nurses provide to newborns is carried out in a systematic way, combining humanization and technology.(AU)

Objetivo: Evaluar los cuidados de enfermería con protección ocular para recién nacidos. Método: Estudio descriptivo de investigación, con abordaje cualitativo, realizado en un hospital universitario, ubicado en la ciudad de Fortaleza-Ceará, Brasil, de enero a febrero de 2016. Participaron del estudio 15 enfermeras que asistieron a recién nacidos en fototerapia, en el Intermedio. Cuidados y cuidados intensivos. La recolección de datos se realizó mediante entrevistas no estructuradas. Resultados: El protector ocular se utiliza para prevenir daños en la retina del recién nacido, existen riesgos en el uso de este artefacto y, para evitar daños, se realizan cuidados esenciales dirigidos al recién nacido sometido a fototerapia. Conclusión: La atención que brindan las enfermeras al recién nacido se realiza de manera sistemática, combinando humanización y tecnología.(AU)

Compromiso cutáneo secundario al uso del equipo de protección contra COVID-19 en el personal de la salud / Secondary skin manifestations on the use of COVID-19 protection equipment in health professional

Resumen Desde la declaración de pandemia del coronavirus el mundo entero ha encaminado sus esfuerzos a ayudar a mitigar sus efectos, especialmente el personal de la salud. En ese intento por ayudar, buscan evitar su propio contagio por medio del uso de materiales de protección como mascarillas, gafas y guantes. Aunque protectores, éstos materiales y sus componentes pueden ser altamente perjudiciales para la piel, causando dermatitis de contacto, ulceraciones y erosiones. En esta revisión se abordan dichas manifestaciones y se proponen medidas para prevenirlas o tratarlas.

Abstract Since the declaration of coronavirus as a pandemic the entire world has directed its efforts to help mitigate the effects of it to the best of its ability, especially health personnel. In that attempt to help, we seek to avoid their own contact through the use of protective materials such as masks, goggles, and gloves. Although protective, this equipmment and its components can be highly damaging to the skin, causing contact dermatitis. This review addresses manifestations and reviews measures to prevent and cure them.

Elective carotid artery stenting with distal embolic protection

@#Objective: It is aimed to present our experience in carotid artery stenting with attention to the patient selection, technique, success rate, perioperative complications, and efficacy. Methods: Patients presented with carotid stenosis treated by stenting were included. Symptomatic patients were defined as having a history of transient ischemic attack or stroke in the last 6 months. Patients with symptomatic carotid stenosis of at least 50% or asymptomatic carotid stenosis of at least 70% detected by catheter angiography were accepted for treatment. Distal embolic protection devices were used in all patients. Technical success was defined as the luminal patency at least 70%. Results: The study consisted of 94 patients with 98 procedures and the mean age was 66.38±11.13 years. The mean stenosis rate was 74.52±13.44%. A total of 109 stents were used in 97 procedures, and closed-cell design was used in 87.2% versus open-cell design in 12.8%. Technical success and complication rate were 98.9% and 8.2%, respectively. The mean follow-up period was 14.92±10.76 months. Conclusion: Carotid artery stenting with use of distal embolic protection devices is widely accepted, safe, feasible, less invasive when compared to surgery and can be performed successfully especially in patients with high risk factors.

Utilidad de la antropometría facial en la selección de tallas de respiradores: Estudio piloto en trabajadores peruanos de construcción civil / Utility of facial anthropometry in selecting respirator size: a pilot study in civil construction workers

Las dimensiones antropométricas faciales son usadas para predecir la talla del respirador de trabajadores expuestos a agentes químicos inhalatorios; sin embargo, la característica multirracial de la población peruana no ha sido evaluada respecto a las tallas de los respiradores en el mercado. Objetivo: Determinar si el uso de las dimensiones antropométricas faciales es útil para determinar la talla de los respiradores de media cara, en un grupo de trabajadores peruanos de construcción civil. Material y métodos: Estudio piloto, transversal, analítico, realizado en 117 trabajadores en quienes se utilizó la longitud de la cara y la anchura de la boca, para determinar la talla del respirador de media cara de tres marcas y su verificación con pruebas de ajuste. Se consideró los parámetros faciales porque son puntos sensibles de fuga de aire para las pruebas de ajuste. Resultados: La media de la longitud de la cara en 12,2 ± 0,6 cm y la media del ancho de la boca fue de 5,3 ± 0,6 cm. Luego se hacer las pruebas de ajuste, se observó que pasó satisfactoriamente la marca A, mientras que en las marcas B y C se obtuvo dificultad para el ajuste en varias variables. Conclusión: Las dimensiones antropométricas faciales pueden ser usadas para la selección de la talla del respirador, sin embargo, deberá considerarse la marca del respirador.

Facial anthropometric features are used to predict the size of respirators in workers exposed to inhalatory chemical products. However, the multiracial features of the Peruvian population has not been taken into account in this process. Objective: to determine whether the use of facial anthropometric measurements is useful to select the size of half-face respirators in civil construction workers. Methods: A cross-sectional study was conducted in 117 workers in whom the length of the face and widening of the mouth was used to determine the size of three half- face respirators. Results: Mean length of face was 12.2 ± 0.6 cm and mean of mouth widening was 5.3 ± 0.6 cm. After performing adjustment, only brand A passed the evaluation, the B and C brands had difficulties in adjusting to several variables. Conclusion: Facial anthropometric features can be used to select the size of respirators.

Types of Hearing Protection Devices and Application / 대한이비인후과학회지

Since noise-induced hearing loss (NIHL) is one of prevalent issues in the occupational settings, hearing protection device (HPD) has been widely used to reduce noise exposure levels and to prevent developing NIHL. This review study aimed to introduce several types of the HPD in terms of current trends, its variety and functions, and application. Including a brief history of the HPD, we explain its two types, i.e., passive and active functions, in the first part of main body. The passive HPD has a flat attenuation across the overall frequency range, whereas the active HPD effectively preserves communication components such as meaningful speech with low intensity stimuli while filtering out the high levels of noise. In the second part of the main body, we discuss some negative issues of hearing functions when users are wearing the HPD. In detail, the active HPD does not much degrade the hearing performance for speech detection/recognition and sound source localization compared to the passive HPD. Rather, reduced sound (or music) quality is improved with active one in general. In the final part, we mention that although various applications in the special fields such as factory, mining, army, airplane, and music have been demonstrated, the usage and awareness of HPD in occupational aspect may not follow its fast technological development. Furthermore, most people do not know about either importance or use method of HPD in the non-occupational setting. For these reasons, we conclude that hearing professionals have to access the latest trends of the HPD and to increase their knowledge on it, and thus they should provide the best HPD prescription for the public as well as employees who have to protect their ears from hazard noise impacts.

Late Coil Migration after Embolization of Cerebral Aneurysms ­ Case Series

Background Coil migration after cerebral aneurysm embolization is a very rare complication. It can take place early or late in the postoperative period, evolving asymptomatic and causing severe neurological deficits. Ruptured aneurysms of anterior communicant artery were the most frequent reported examples in the literature. Case Report We report three cases of patients with unruptured aneurysms treated with coils and remodeling balloon technique. The first case was that of a left posterior communicating artery aneurysm with coil migration to a distal cortical branch of ipsilateral middle cerebral artery (MCA). The patient had mild paresthesia in the arm for a few days. The second one was a fenestrated basilar artery aneurysm with coil migration to the P2 segment of the left posterior cerebral artery. The patient was fully asymptomatic. The third case was a MCA aneurysm with coil migration to the M3 segment. There were no ischemic complications, and all patients underwent a new endovascular procedure. Conclusions Coil migration is a rare but not always severe complication. Antiplatelet agents are recommended even if the coil migration is asymptomatic.

Introdução A migração de coil após embolização de aneurisma cerebral é uma complicação muito rara. Ela pode ocorrer no período pós-operatório tanto precoce quanto tardio, evoluindo assintomático ou causando graves déficits neurológicos. Aneurismas rotos da artéria comunicador anterior foram os exemplos mais frequentes relatados na literatura. Relato de Caso Relatamos três casos de pacientes com aneurismas não rotos tratados com coils e técnica de remodelagem com balão. O primeiro caso foi de um aneurisma de artéria comunicante posterior com migração do coil para um ramo cortical distal da artéria cerebral média (ACM) ipsilateral. A paciente apresentou parestesia leve no braço por alguns dias. O segundo foi um aneurisma de artéria basilar fenestrada com migração de coil para o segmento P2 da artéria cerebral posterior esquerda. O paciente ficou totalmente assintomático. O terceiro caso foi de um aneurisma de ACM com migração do coil para o segmento M3. Não houve complicações isquêmicas, e todos os pacientes foram submetidos a novo procedimento endovascular. Conclusões Migração de coil é uma complicação rara, mas nem sempre grave. Antiagregantes plaquetários são recomendados mesmo se a migração do coil for assintomática.

Low Common Carotid Artery Systolic Occlusion Pressure and Symptomatic Carotid Artery Stenosis Are Associated with Development of Neurologic Intolerance during Proximal Protected Carotid Artery Stenting

BACKGROUND AND OBJECTIVES: Neurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS. METHODS: We retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017. RESULTS: We included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p = 0.003), absence of anterior communicating artery (p = 0.015) and low common carotid artery occlusion pressure (CCAOP, p < 0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p = 0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p < 0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours. CONCLUSIONS: About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.

Avaliação do protetor auditivo em situação real de trabalho pelo método field Microphone-in-real-ear / Evaluation of the hearing protector in a real work situation using the field-microphone-in-real-ear method

RESUMO Objetivo Avaliar a eficácia da atenuação de um protetor auditivo em uma situação real de trabalho utilizando o método f-Microphone-in-real-ear (f-MIRE). Métodos Participaram 18 indivíduos, de ambos os gêneros (média de idade 47,17±8 anos). No local de trabalho, foi realizada a avaliação do nível pessoal de atenuação do Protetor Auditivo (PA) pelo método Field Microphone-in-Real-Ear (f-MIRE), seguido por orientações sobre a importância do uso do PA, higienização, armazenamento e treinamento para sua colocação efetiva. Resultados As análises mostraram que houve atenuação estatisticamente significante para todos os dados coletados (ruído total, por banda de frequência e dose) quando comparados os níveis de ruído no microfone lapela e no microfone sonda. Na comparação entre os valores de atenuação fornecidos pelo fabricante e os encontrados neste estudo, observou-se valores maiores para o fabricante em todas as bandas de frequência. Não houve diferença para os níveis de ruído nas diferentes atividades e horários avaliados. Conclusão Os achados do presente estudo possibilitaram conhecer o nível pessoal de atenuação do protetor auditivo durante uma situação real de trabalho, que estava dentro dos limites de tolerância. Também foi possível coletar informações sobre o ruído do ambiente em que esses trabalhadores estão expostos, onde observamos situações nas quais esse nível ultrapassava os valores de segurança, sendo assim recomendável o uso do PA. É importante que mais estudos sejam realizados utilizando o método f-MIRE, pois pode ser um aliado para avaliar a eficácia da atenuação do PA no local de trabalho.

ABSTRACT Purpose To evaluate the effectiveness of the attenuation of a hearing protector (HP) in a real work situation using the field-microphone-in-real-ear method (f-MIRE). Methods Eighteen individuals of both genders (mean age of 47.17±8 years) participated in this study. In the workplace, the personal attenuation level of the HP was assessed using the f-MIRE method, followed by orientation about the importance of using the HP, cleaning and storing the device, and training for effective placement. Results The analyses showed a significant statistic attenuation for all of the collected data (total noise, by frequency band and dose) when the noise levels in the lapel microphone and the probe microphone were compared. In the comparison of the attenuation values provided by the manufacturer and those found in this study, we observed higher values for the manufacturer in all frequency bands. No difference was observed for the noise levels in the different activities and times evaluated. Conclusion The findings of this study enabled us to know the personal level of attenuation of the HP during a real work situation, which was within the limits of tolerance. It was also possible to collect information about the environmental noise to which these workers are exposed. We noticed situations where this level exceeded the safety values, and therefore it is recommended the use of the HP. It is important that more studies are conducted using the f-MIRE method, because it may be an ally to assess the effectiveness of the HP attenuation in the workplace.

Medio militar y trastornos auditivos inducidos por ruido / The military environment and noise-induced hearing impairments

En el medio militar el personal se ve sometido a los más altos niveles de ruido; se considera que las detonaciones de las armas de fuego superan en intensidad a todos los ruidos industriales. Este trabajo pretende abordar los factores de riesgo y vulnerabilidad asociados a la exposición al ruido en el ambiente militar, los aspectos más actuales relacionados con la lesión auditiva inducida por ruido y su protección. Se realizó una revisión de los artículos más representativos mediante la base de datos Medline e Hinari, se empleó para la búsqueda y creación de la bibliografía el gestor personal de referencias bibliográficas Procite, referencias al tema en revistas, tesis y referencias en Internet mediante el buscador Google. Los resultados reafirman la vulnerabilidad del personal militar a padecer algún tipo de lesión del aparato auditivo inducida por ruido, originado por los niveles de ruido elevado que se producen en el medio militar, la necesidad de enfocar de forma multidisciplinaria este tipo de lesiones y la importancia de implementar sistemas de protección auditiva eficientes, con el fin de elevar la calidad de vida de los expuestos a ruido y evitar que se produzca la discapacidad auditiva, considerando que la mejor opción es su prevención.

Extremely high noise levels are characteristic of the military environment. Firearm detonations are considered to exceed the intensity of any industrial noise. The paper approaches the risk factors and vulnerabilities associated with exposure to noise in the military environment, as well as the most recent notions about noise-induced hearing injury and hearing protection. A review was conducted of the most representative papers on the topic using databases Medline and Hinari. Bibliography lists were searched for and created using Procite personal bibliographic reference manager. Google search engine was used to find references to the topic in journals, theses and Internet references. Results confirm the vulnerability of military personnel to suffer from noise-induced hearing injuries resulting from the high noise levels occurring in the military environment, the need to approach such injuries in a multidisciplinary manner, and the importance of implementing efficient hearing protection systems, with a view to improving the quality of life of persons exposed to noise and preventing hearing impairment, based on the certainty that prevention is always the best option.

Actitudes acerca de la protección auditiva y pérdida de la audición en trabajadores de una planta compresora de gas costa-afuera / Attitudes about hearing protection and hearing loss in workers at a gas compression plant offshore

Objetivo: Determinar las actitudes y creencias de los trabajadores respecto de la protección auditiva y la pérdida de la audición por ruido como parte de una actividad del Programa de Protección Auditiva de un Centro de Trabajo. Método: Se realizó un estudio transversal observacional en un Centro Procesador de aceite crudo y gas natural, costa afuera del estado de Campeche, México. Resultados: La percepción de la susceptibilidad de la pérdida auditiva inducida por el ruido en el grupo de trabajadores fue del 100%. Respecto de percibir la severidad de las consecuencias de la pérdida auditiva inducida por ruido 15% estuvo de acuerdo y 85% totalmente de acuerdo. Del beneficio del uso de los dispositivos como medida preventiva a la pérdida de audición, 90% estuvo totalmente de acuerdo que es importante usar protectores auditivos cada vez que se está trabajando con ruido fuerte, el 10% consideró estar de acuerdo. Conclusión: El estudio de las creencias e intenciones de los trabajadores evidenció un elemento cognoscitivo establecido respecto del ruido como condicionante de la susceptibilidad para pérdida auditiva con el consecuente uso de los dispositivos de protección auditiva como medida preventiva. Sin embargo, se requiere mayor entrenamiento en el plano de la autosuficiencia ya que la mitad de los trabajadores no sabe cuándo los tapones necesitan ser reemplazados. Por otra parte, existen situaciones de tipo administrativo que requieren atención como son la nula posibilidad para los trabajadores de seleccionar dispositivos de protección de los oídos una vez que solo tienen disponibles tapones auditivos.

Objective: Determining the attitudes and beliefs of workers on hearing protection and hearing loss due to noise as part of an activity Hearing Protection Programme of Work Center. Method: An observational cross-sectional study on a crude oil and natural gas Processing Center off shore the state of Campeche, Mexico. Results: The perception of susceptibility hearing loss induced by noise in the group of workers was 100%. Regarding perceive the severity of the consequences of hearing loss induced by noise, 15% agreed and 85% strongly agree. About the benefit of using the devices as a preventive measure against hearing loss, 90% strongly agreed that it is important to wear hearing protection whenever you are working with loud noise, 10% considered agree. Conclusion: The study of the beliefs and intentions of the workers showed a cognitive element established in respect of noise as a condition of susceptibility of hearing loss and the consequent use of hearing protection devices as a precaution. However, more training is required at the level of self-sufficiency half since workers do not know when the plugs need to be replaced. On the other hand, there are situations of administrative nature that require attention such as the non-existent possibility for workers to select hearing protection devices once only earplugs are available.

Application of cerebral protection devices in carotid artery stenting / 国际外科学杂志

Carotid artery stenosis is one of the most important reasons for stroke. Carotid artery stenting possesses more advantages with less damage and pain for patients, which has becaome the most effective treatment for carotid artery stensis, and the use of review the issues related to te carotid artery stenting under cerebral protection. With the accomplishment of many successful large scale clinical trials carried out by multiple centers, it is believed that carotid artery stenting with cerebral protection plays important orle in the prevevtion and treatment of cerebral stroke initiated by carotid artery stenosis.

Ações educativas com enfoque positivo em programa de conservação auditiva e sua avaliação / Positive focus in educational interventions in a hearing conservation program and its evaluation

OBJETIVO: avaliar o conhecimento adquirido pelos trabalhadores de uma empresa frigorífica após uma ação educativa sobre proteção auditiva. MÉTODOS: foram comparadas as atitudes, intenções e comportamentos de proteção da audição adotados por 61 trabalhadores pré e pós-treinamento, avaliando a efetividade das mensagens através do uso de estímulos positivos. Foram utilizados os questionários "Crenças e Atitudes sobre Proteção Auditiva e Perda Auditiva", os quais foram aplicados antes e após a intervenção na forma de treinamento coletivo. RESULTADOS: os escores dos questionários sobre a percepção de suscetibilidade de adquirir uma perda auditiva e a percepção de obstáculos para uma ação preventiva se mostraram associados às variáveis sexo e tempo de empresa; a percepção de severidade das conseqüências de uma perda auditiva associada ao nível de ruído; normas sociais associada ao tempo de empresa, e a auto-eficácia associada ao resultado da audiometria. CONCLUSÃO: o treinamento com enfoque positivo ocasionou mudanças significativas na percepção de benefícios e de obstáculos de uma ação preventiva em comparação ao grupo de trabalhadores que não recebeu treinamento. Esse estudo possibilitará uma intervenção cujo foco será nas áreas consideradas mais deficitárias com a elaboração de propostas e materiais mais específicos e eficazes para os treinamentos que fazem parte do Programa de Conservação Auditiva. O uso de um questionário sobre as crenças e atitudes como o selecionado permite a identificação de temas que necessitam de clarificação em ações educativas.

PURPOSE: to evaluate the efficacy of an educational intervention on hearing protection in a group of 61 workers at a meat packing company. METHODS: one group of workers participated in a training session that used positive messages; the other group of workers received no intervention. The two versions of the NIOSH "Beliefs and Attitudes on Hearing Loss Prevention" questionnaire were used to assess changes before and after the intervention. Workers who received the training using positive messages showed significant changes in their perception of the benefits and obstacles to preventive action in comparison with the group that did not receive any intervention. RESULTS: the post-test scores for perception of susceptibility to developing a hearing loss and obstacles to preventive actions were significantly associated with gender and tenure; perception of severity of the consequences of a hearing loss was associated with noise level; social norms were associated with tenure; and self-efficacy was associated with audiometric thresholds. CONCLUSION: this study will make easier the development of interventions focused on the areas where workers lack information, and allow for educational materials for hearing loss prevention programs to be appropriately addressed to relevant obstacles. The use of a questionnaire on beliefs and attitudes such as the one selected for this study allows the identification of issues that require clarification in educational interventions.

Clinical Experiences with the Percusurge(r) for the Coronary Lesions with Intracoronary Thrombus

BACKGROUND AND OBJECTIVES: During coronary angioplasty, a distal embolization of the intracoronary thrombus is associated with an increased risk of myocardial infarction and mortality. Recently, distal protection devices have been tested for distal embolization with varying success. Here we report the experiences with one of the distal protection devices, Percusurge(r). SUBJECTS AND METHODS: From January 2001 to August 2001, 5 cases of a Percusurge(r) being used in patients with intracoronary thrombus were experienced during the angioplasty (male:4, female:1). Both the pre- and post-procedural clinical findings of the patients, the angiographic findings, the number of acute complications, the presence of biochemical marker such as CK-MB, and any in-hospital cardiac events were reviewed. RESULTS: Percusurge(r) was used in the right coronary artery (RCA) in 4 cases and in the saphenous vein graft in 1. The clinical diagnosis included stable angina (2 patients), non-Q wave myocardial infarction (1 patient), and Q-wave myocardial infarction (2 patients). The patients showed a TIMI 0 or 1 flow in 4 patients with a RCA lesion and TIMI 3 flow in 1 patient with a saphenous vein graft lesion. However, the TIMI 3 flow was recovered in all cases after the intervention. The CK-MB level did not show any significant changes between the pre- and post-procedure in 4 cases (11.2 +/- 3.2 U/L vs 10.2 +/- 2.1 U/L). However, one of the distal branchs was totally occluded by the distal embolization of the thrombus, and the CK-MB level increased from 2.1 U/L to 22.7 U/L. Otherwise, no procedure-related complications or major in-hospital cardiac events were observed. CONCLUSION: The use of the distal protection device, Percusurge(r), may reduce both the procedural and clinical complications during a coronary intervention in the thrombus-containing lesion. However, a large prospective study is needed to define the role of the distal protection device.