Workplace violence in radiology: results of a systematic review.

BACKGROUND: Workplace violence (WPV) is a growing issue in health care with far-reaching consequences for health workers' physical and psychological well-being. While some medical specialities like emergency medicine have always been considered at higher risk for WPV, several studies have also reported its occurrence in radiology. AIMS: This systematic review aimed to comprehensively synthesize the types of WPV in radiology, its psychological impact, and the underlying risk and protective factors. METHODS: We searched five electronic databases (PubMed, Web of Science Core Collection, Scopus, PsycINFO and CINAHL) and additional literature, including grey literature, and established weekly search alerts. Two reviewers independently conducted all methodological steps, involving a third reviewer in case of disagreement. RESULTS: Of the 12 205 retrieved records, 103 full-text articles were evaluated, and 15 studies were included. Across studies, verbal aggression, sexual harassment (mostly against women) and physical violence were experienced by up to 100%, 85% and 46% of health workers, respectively. Perpetrators were patients and patients' caregivers, followed by co-workers. Victims suffered from various psychological symptoms, such as anxiety (22%-54%), fear (6%-39%), depression (32%) and repeated disturbing memories (21%). Risk factors included female gender, understaffing, worker inexperience, poor communication and lengthy waiting times. Social support and security personnel presence were among the identified protective factors. CONCLUSIONS: Health workers are at high risk of experiencing WPV in the radiological setting, with a strong psychological impact. Radiological departments should create a safe healthcare environment that actively manages the identified risk factors and offers psychological support to affected workers.

Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective.

BACKGROUND: In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs). METHODS: A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data. RESULTS: Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions. CONCLUSIONS: Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.

Determination of the Avogadro constant by counting the atoms in a 28Si crystal.

The Avogadro constant links the atomic and the macroscopic properties of matter. Since the molar Planck constant is well known via the measurement of the Rydberg constant, it is also closely related to the Planck constant. In addition, its accurate determination is of paramount importance for a definition of the kilogram in terms of a fundamental constant. We describe a new approach for its determination by counting the atoms in 1 kg single-crystal spheres, which are highly enriched with the 28Si isotope. It enabled isotope dilution mass spectroscopy to determine the molar mass of the silicon crystal with unprecedented accuracy. The value obtained, NA = 6.022,140,78(18) × 10(23) mol(-1), is the most accurate input datum for a new definition of the kilogram.

Effectiveness of intubating laryngeal mask airway (ILMA Fastrach) used by nurses during out of hospital cardiac arrest resuscitation.

OBJECTIVE: ILMA Fastrach is a recognized alternative to classic laryngoscopic intubation. In this study, we evaluated the success rate of intubation with Fastrach, used by emergency nurses who have no experience of field intubation. METHODS: Twelve untrained nurses used Fastrach during 71 out of hospital cardiac arrests (OHCAs). Each step time of resuscitation was recorded. RESULTS: Fastrach effective ventilation was obtained in 97%. Rate of successful intubation was 86%. CONCLUSIONS: ILMA Fastrach is a good alternative to classical laryngoscopic intubation by untrained nurses, even in difficult conditions such as OHCAs.

[The heart in infection and MODS (multiple organ dysfunction syndrome)]. / Das Herz bei Sepsis und MODS.

Dysfunctioning of the heart forms part of the multiple organ dysfunction syndrome (MODS) in sepsis and SIRS. This acute septic cardiomyopathy is often underestimated in degree and relevance, although yet in fact 10% of all sepsis fatalities are due to intractable heart failure. This potentially reversible cardiomyopathy is characterized by a considerable pump failure, is not primarily ischemic, coronary blood flow being normal or even enhanced; left and right ventricle are enlarged as a consequence of an increased ventricular compliance. Damage of the heart can further be aggravated in case of an additional right ventricular impairment due to pulmonary hypertension in ARDS. SIRS-cardiomyopathy in non-infectious MODS has common traits with acute septic cardiomyopathy. The pathogenesis of heart disease in sepsis and SIRS is multifactorial, the endotoxin/TNF-alpha/NO/cGMP-cascade representing a main negative inotropic axis. Therapy of acute septic cardiomyopathy and SIRS-cardiomyopathy at present still is mainly symptomatic (volume substitution, inotropic/vasoactive agents), causal therapeutic principles are, however, put to test in the context of a comprehensive concept of causal sepsis treatment.

Septic complications of 100 abdominal deliveries in the rural tropics.

PIP: This paper examines the nature of abdominal deliveries in 100 women who presented at the Holy Family Hospital in Ghana, suffering from delivery complications. The main indicator disease for surgery was cephalic- pelvic distortion, previous cesarian section, ruptured uterus, and placenta previa with hemorrhage. The most common septic complication of abdominal deliveries is purulent wound infections. 4 deaths occurred, within 48 hours of surgery, and none of the survivors developed pelvic abscess. Sepsis is the most important factor in maternal morbidity and mortality; risk factors associated with delivery of C-section include inadequate antenatal care, anemia, poor socioeconomic status, prolonged labor with ruptured membranes. However this information must be weighed in the context of the existing environment. Most of the cases present to the hospital in severe distress, having been in labor for many hours. Therefore, it is important to provide comprehensive education through primary health care to traditional birth attendants on issues surrounding pregnancies. For the purpose of prevention of sepsis, prophylactic antibiotics should be used on mothers showing evidence of complications, and more importantly, they should be aggressively administered to those women having ruptured membranes.^ieng

[Microbiological characteristics in rats given cariogenic diet following the application of fluoride containing toothpastes]. / Mikrobiologische Charakteristika bei mit kariogener Diät ernährten Ratten nach Applikation fluoridhaltiger Zahnpasten

The paper deals with experimental research work carried out on Wistar rats, regarding the effect of fluoride tooth-pastes in varying compounds on microflora in the oral cavity. The findings show that the most favourable effect on the microbial situation in the Cavum oris is exerted by fluoride tooth-pastes prepared on a calcium-free basis.

[The fluoride content in the crowns of molars following application of fluoride-containing toothpastes]. / Der Fluoranteil in Koronalteil von Rattenmolaren nach Applikation fluoridhaltigen Zahnpasten

The paper describes chemical-analytical research into the fluorine content in the coronal parts of molars of rats after fluoride tooth-pastes made up of differing ingredients were used. On the basis of the findings, recommendations are made as to ways of clinically testing the tooth-pastes.

[Cariostatic effect of calcium-, phosphorus- and fluoride-containing toothpastes in animal experiments]. / Untersuchungen über den kariostatischen Effekt kalzium-, phosphor- und fluoridhaltiger Zahnpasten im Tierexperiment

The paper described the results of experiment performed on animals concerning the effect of fluoride tooth-pastes on a calcium-phosphate and sodium-phophate basis in the field of caries prevention. The caries infection is ascertained for varying test durations on the basis of serial grindings. It turns out that the anti-carieseffect of fluoride is greatly diminished if soluble calcium salts are present in the paste.

[Chemical and radioisotope studies of the metabolism in mineralized tissues following use of calcium-, phosphate-, and fluoride-containing toothpastes]. / Chemische and radioisotopische Untersuchungen des Stoffwechsels in mineralisierten Geweben der Ratte nach Anwendunkg kalzium-, phosphat-, und fluoridhaltiger Zahnpasten

During experimental research work carried out on animals with a view to clearing up the caries-forming processes, metabolic disturbances could be detected in the hard tissues of teeth after administering a cariogenic diet. The aim of the present work was to investigate the effects of tooth-pastes with calcium, phosphate and fluoride content upon changes in metabolic processes, and thus to clarify the mechanism of the anti-cariogenic effect exerted by fluoride tooth-pastes.

[Acute beta 1-selective beta-receptor blocker nebivolol poisoning in attempted suicide]. / Akute Intoxikation mit dem beta 1-selektiven beta-Rezeptorenblocker Nebivolol in suizidaler Absicht.

HISTORY AND ADMISSION FINDINGS: A 17-year-old girl had swallowed 80-100 tablets of Nebivolol, 5 mg each, with suicidal intent. She was referred to hospital 8 hours later by an emergency duty physician. On admission she was sweaty and pale, but there were no other obvious abnormalities. Neurological examination revealed decreased responsiveness and slowed movements. She was known to have type 1 diabetes mellitus. INVESTIGATIONS: Blood pressure was 105/55 mmHg, the ECG showed sinus bradycardia of 55 beats/min. Biochemical tests revealed hypoglycaemia (2.1 mmol/l), hypokalaemia (3.4 mmol/l) and respiratory failure (pO2 6.16 kPa, O2 saturation 82%, pCO2 6.55 kPA). Heart and lung were unremarkable on physical examination as were chest radiogram and echocardiogram. Plasma level of nebivolol was 480 ng/ml on admission (therapeutic range 88-195 ng/ml). TREATMENT AND COURSE: After gastric lavage and administration of charcoal and sodium sulphate a temporary pacemaker was connected and glucagon infused intravenously as an antidote. The cardiovascular state stabilized with falling plasma level of nebivolol. Glucose was administered initially, but transient intravenous insulin infusion became necessary to counteract hyperglycaemia. The patient was transferred from the intensive care unit in a stable cardiovascular state after 2 days. CONCLUSION: This case demonstrates that swallowing 400-500 mg nebivolol, resulting in a plasma level of 480 ng/ml, need not be fatal. But the outcome in this patient should not be taken as necessarily applying to similar cases. It depends on the individual patient's metabolic state whether higher plasma levels might be reached with the same amount of ingested nebivolol.