Hand-arm vibration: Swedish carpenters' perceptions of health and safety management.

BACKGROUND: Workers in the construction industry are highly exposed to vibration from handheld equipment, which can have negative effects on the nerves and blood vessels in the hands. Employers in this industry often fail to comply with legislation regarding vibration exposure. AIMS: To assess carpenters' perceptions of proactive health and safety (H&S) management regarding hand-arm vibration exposure at construction sites in Sweden. METHODS: The carpenters answered a questionnaire on their perception of the implementation of H&S management, on symptoms indicating injury and on the use of vibrating equipment. RESULTS: One hundred and ninety-four carpenters from 4 construction companies and 18 construction sites completed the questionnaire. Attitudes to H&S management were generally positive. However, 36% of the carpenters reported that the H&S regulations and routines did not function in practice, and 40% claimed they did not receive necessary information on the exposure and effects of vibration. Most respondents (74%) perceived a high risk of injury in general in their work. Younger carpenters, carpenters employed at smaller companies and carpenters with symptoms indicating injury or with higher vibration exposure reported more negative perceptions. CONCLUSIONS: In general, the carpenters were positive about management's commitment to H&S management. However, the results indicate deficiencies in the way in which this commitment is applied in practice at the workplace. This highlights the importance of raising awareness concerning vibration exposure and possible injuries, and strengthening proactive H&S programmes, especially in smaller companies.

Financial analysis of telecardiology used in a correctional setting.

The aim of this study is to evaluate the cost savings of 3 years of telecardiology used in a prison. This study compares the cost per visit of providing cardiology services by telemedicine (telecardiology) to patients at Powhatan Correctional Center of the Virginia Department of Corrections (PCC) and the cost of providing traditional cardiology services at the cardiology clinic of the Medical College of Virginia Campus of Virginia Commonwealth University (MCV Campus). During 1996 to 1998, telecardiology visits increased from 24 per year to 86. In this study, lower use of telecardiology services in 1996 resulted in higher cost per visit of $189. This was $45 more than the cost of traditional cardiology in the cardiology clinic at the MCV Campus. In 1997 and 1998, however, higher utilization of telecardiology services decreased the cost per visit to $135 and $132, respectively. This resulted in a cost saving with telecardiology of $15 per visit in 1997 and $46 per visit in 1998. Because the vast proportion of telemedicine operating costs are fixed, increased utilization causes reduced cost per visit and results in a cost saving compared with providing these services via a non-telemedicine program.

Cost-minimization analysis: A follow-up study of a telemedicine program.

OBJECTIVE: To present the follow-up findings to a cost-benefit analysis of telemedicine subspecialty services provided between the Powhatan Correctional Center (PCC) of the Virginia Department of Corrections and the Medical College of Virginia Campus of Virginia Commonwealth University (MCV Campus). METHODS: Costs included those of operating the telemedicine system, transportation, litigation avoidance, and the medical care itself. RESULTS: Over a 12-month study period, the total number of consults completed through telemedicine was 290. The cost per visit of treating inmates at the MCV Campus clinics was $401. The cost per visit of treating inmates at PCC via telemedicine was $387, a net saving of $14 per visit with the use of telemedicine. CONCLUSION: As a result of implementing telemedicine, the Department of Corrections for the State of Virginia was able to achieve a cost saving of $14 per visit. Nonmonetary cost savings, such as greater security and increased access to care, should be considered a net benefit as well.

A review of gentamicin use in neonates.

Gram-negative sepsis contributes significantly to neonatal morbidity and mortality. Gentamicin is an aminoglycoside antibiotic used in the treatment of gram-negative infections. However, developmental differences of the neonate (compared with the older child or adult) influence the drug's disposition in the body. Administration, distribution, elimination, as well as susceptibility to toxicities may be altered in the neonatal period because of these pharmacokinetic differences. A literature review reveals pharmacokinetic differences of the neonate that affect gentamicin dosing. Nursing considerations affected by the developmental differences of the neonate include knowing appropriate dosages and routes of administration, pathophysiological and pharmacological conditions that affect gentamicin disposition, serum monitoring, and evaluation of adverse reactions and toxicities.