Physical capability limits for right-angle power tool operation.

Automotive assembly operations require power tools to secure fasteners and these operations have been linked to increased risk of musculoskeletal disorders. This work was designed to develop physical capability limits for direct current right-angle power tool (RAPT) operations using psychophysics. Forty females fastened joints of different hardness's using three fastening strategies, at three fastening frequencies. Participants chose to fasten, independent of orientation, joints up to 89 (10.6) Nm using Atlas Copco's TurboTight®, compared to 51.8 (8.1) Nm using Atlas Copco's Quickstep and 48.6 (10.2) Nm using Stanley's Automatic Tightening Control. The differences between fastening strategies were not as large when fastening soft joints; 59.2 (16.2), 52.3 (14.6), and 53.5 (11.3) Nm, respectively. As fastening frequency increased, participants chose lower target torque magnitudes to fasten. Based on this work, RAPT manufactures can adjust fastening strategies to improve their tool's ergonomics performance. Practitioner summary: Fastening tasks was identified as posing an injury risk to workers performing automotive assembly, yet presently there are no published physical capability limits for direct current right-angle power tool operation. Using a psychophysical methodology, physical capability limits for RAPT fastenings were established for different joint hardness, fastening frequencies and RAPT position/orientation.

Evaluation of the National Healthcare Safety Network Hemovigilance Module for transfusion-related adverse reactions in the United States.

INTRODUCTION: The National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) collects data on the frequency, severity, and imputability of transfusion-associated adverse events. These events contribute to significant morbidity and mortality among transfusion patients. We report results from the first systematic assessment of eight attributes of the HM. MATERIALS AND METHODS: Standard methods were used to assess the HM. Evaluation data included training materials, system modification history, and facility survey information. A concordance analysis was performed using data from the Baystate Medical Center's (Springfield, MA) electronic transfusion reporting system. RESULTS: In 2016, system representativeness remained low, with 6% (277 of 4690) of acute care facilities across 43 jurisdictions enrolled in the HM. In 2016, 48% (2147 of 4453) and 89% (3969 of 4,453) of adverse reactions were reported within 30 and 90 days of the reaction date, respectively, compared to 21% (109 of 511) and 56% (284 of 511) in 2010, demonstrating improved reporting timeliness. Data quality from most reactions was adequate, with 10% (45 of 442) misclassified transfusion-associated circulatory overload reactions, and no incomplete transfusion-transmitted infection data reported from 2010 to 2013. When compared to the Baystate system to assess concordance, 43% (24 of 56) of NHSN-reported febrile reactions were captured in both systems (unweighted kappa value, 0.47; confidence interval, 0.33-0.61). CONCLUSION: Since the 2010 HM pilot, improvements have led to enhanced simplicity, timeliness, and strengthened data quality. The HM serves an important and unique role despite incomplete adoption nationwide. Facility efforts to track and prevent transfusion-associated adverse events through systems like the NHSN HM are a key step toward improving transfusion safety in the United States.

Enhancing hemotherapy safety through pertinent diagnostic testing and electronic "provisional diagnosis" reporting: expanding roles for blood bank technologists in biovigilance and patient safety.

BACKGROUND: Suspected transfusion reaction (STR) investigations are foundational for biovigilance. Diagnostic evaluations performed by blood banks may prolong turnaround times (TATs) for final STR results reporting. We identified a quality improvement opportunity using diagnostic testing reflex algorithms and our hospital's patient electronic health record to enhance TATs regarding one aspect of STR results reporting. STUDY DESIGN AND METHODS: We conducted a descriptive quality improvement study of reported STR cases investigated by our hospital's blood bank from March 1, 2014, to December 31, 2016, using data obtained from consult reports/quality improvement databases examining the number and types of diagnostic algorithm reflex activations performed and the TATs for an electronic provisional diagnosis reporting (PDXR) related to them. RESULTS: A total of 461 STR events occurred during the study interval, of which 150 involved no reflex testing. In the remainder of cases (n = 311), a total of 448 reflex activations occurred. In those cases in which PDXR occurred (n = 446), the median PDXR TAT during the first month of implementation was 325 minutes, which progressively decreased to 70 minutes or less approximately 1 year after implementation. By the last quarter of 2015, median TATs were 60 minutes or less in length, where they remained for the duration of the study. CONCLUSION: Technologists using targeted diagnostic reflex arcs to expedite laboratory testing along with STR electronic PDXR improve communication and timely results/information dissemination, potentially aiding bedside hemotherapy-related clinical decision making.

Mental health. Double troubles.

Patients with a dual diagnosis are extremely challenging to work with. Several agencies are often involved, and patients may fall through gaps in service. Local improvement teams have been slow to implement guidance produced in 2002 and there is a shortage of specialist psychiatrists, but evidence of good practice is emerging.

Mental Health. In search of a blueprint.

Some PCTs are also providing mental health services, at odds with the policy of being commissioners only. PCTs are trying different models for mental health services, raising provision and care pathway issues. One compromise could be to put the provider at arm's length within the organisation.

Mental health. 'People who really want to do this make a difference'.

Birmingham's early intervention in psychosis service is the type the government would like to see across England, but roll-out can at best be described as patchy. Models of provision vary widely--from a standalone service to one fully integrated with other youth provision in the area. Research suggests early intervention could save as much as 53 percent on the cost of a conventional service.

Board development. A clearer picture.

--Non-executive board members often take up their positions with little or no previous experience of the NHS. --The NHS Appointments Commission's acclaimed training programme for employees new to the NHS has been running for two years. Along with formal training, board chairs are also offered access to mentors.