The family physician and industrial hygiene

Family physicians are increasingly being called on to become involved in the health care of workers in local industries. Many family physicians are the sole providers of occupational health care in their communities, yet their formal training is usually deficient in some of the more specialized aspects of occupational medicine. Treating work-related injuries and exposures to hazardous substances may require analyses of work sites that many family physicians have neither the time nor the expertise to perform adequately. Industrial hygienists are the consultants who are qualified to assess potential occupational hazards and are trained to perform a comprehensive analysis of the work environment as it relates to worker health. This analysis may include the measurement of potentially hazardous substances, such as ambient air concentrations of particulate matter and toxic gases, and recommendations for prevention of exposures. Two cases are presented to illustrate how valuable a consultation with an industrial hygienist can be to the family physician.     

Updating of hygiene standards for carbon disulfide based on health risk assessment

OBJECTIVES: Clinicians are more and more frequently studying fetal blood flow velocity curves recorded by Doppler ultrasound in vital organs such as the placenta and fetal brain to evaluate fetal well-being. We have therefore developed a mathematical model of the utero-placental and fetal circulations which could be used for teaching and for a better understanding of regulatory mechanisms. METHODS: The model is based on two basic elements-an arterial segment and a bifurcation-and we have reproduced the major arteries of the feto-maternal circulation combining these basic elements. The mathematical model of the system is based on the Navier-Stokes equations. The peripheral areas such as the brain, kidneys and placenta are modeled by a simple Windkessel model and the model computes instantaneous flow and pressure at any point in the fetal arterial tree and the uterine arteries. RESULTS: We have compared the computed instantaneous flow curves and pressure with in vivo data and our results agree with the findings in physiological situations and in gravidic hypertension. CONCLUSIONS: Our model provides new interesting insights into fetal hemodynamics such as a better understanding of the mismatch impedance phenomena and is a promising model for the study of blood redistribution mechanisms in hypoxic situations.     

The use of the universal theory of hygienic standards in military hygiene

On the basis of an abound practice of hygiene standardization, the authors have elaborated a system of fundamental tenets and premises that correspond to the requirements of a universal theory. It includes norms and standards for a living organisms and the environment. The hygiene standardization foundation is based on the principles of guarantee, social-biological balance, complex and dynamics. The tenets stated in the article confirm interrelation and character of the hygiene standards theory formulation and its prognostic function.     

Beyond the guidelines of ethical/legal standards: Update.

Ethical issues in practice are viewed as dynamic questions that evolve from changes occurring both outside and within the profession. New questions have arisen from (1) changes in public attitudes, (2) changes in economic circumstances, (3) increased diversity in styles and standards of professional practice, and (4) psychologist functioning in new settings such as the public media. Enforcement and proactive ethical action strategies are discussed in the contexts of clinical training facilities, placement or internship agencies, peer review committees, licensing boards, and ethics committees. The dilemmas of the individual practitioner in confrontation with other practitioners or in public advocacy roles are discussed. The need for openness to collegial consultation is stressed, and expanded roles for ethics committees are offered to fill this void. (French abstract) (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

National standards for general practice

A set of standards for Australian general practices has been developed through a 4 year project conducted by The Royal Australian College of General Practitioners. An orderly, iterative process was adopted to ensure comprehensive consultation with general practitioners, other health professionals, consumers and governments. The draft standards were field tested in 199 randomly selected urban and rural practices. Results of this field testing showed that the standards have content validity, that they can be measured reliably and that the practice visit protocol is feasible. The standards are calibrated to define the minimum acceptable features of general practices expected for the mid 1990s. The standards have been adopted by Australian General Practice Accreditation Limited as the basis for a voluntary system of practice accreditation.     

The legal implications of clinical practice guidelines

In the past several years, considerable attention has been focused on clinical practice guidelines. They are developed to foster improved clinical care and to increase clinical efficiency. The legal implications of developing and following guidelines are not yet clear. The author argues that properly formulated guidelines could reduce the burdens of preventing and resolving malpractice claims.     

Putting psychiatric nursing standards into clinical practice

1. The nursing service of a 640-bed acute care teaching hospital consistently put standards of care and practice into actual nursing care by implementing a computerized nursing care plan (NCP) system. 2. Staff nurses worked with clinical specialists to write/revise standards for their specialty areas. These facility specific standards of care and practice were incorporated into the computerized NCP system. 3. The result of the computerization was legible NCPs in only a few minutes. These NCPs direct patient care based on generic and specialty nursing practice standards and promote equitable care for all patients.     

Ethical and legal issues in AIDS-related practice.

The AIDS epidemic has presented many new ethical dilemmas regarding psychologists' obligations to their clients and third parties. Both ethical and legal norms remain unsettled in regard to most of these dilemmas. In general, psychologists should strive to protect the privacy of their clients and to promote the welfare of individuals affected by AIDS. When compelling interests of third parties lead to a different result, intrusions on clients' interests should be no greater than necessary. Although a lack of training about AIDS may limit psychologists' competence and constrict their duties to people with AIDS, the duty remains for clinicians to obtain training to remediate such gaps in knowledge or skills and to advocate for resources and protection from discrimination for people affected by AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The scope of professional practice from a legal perspective

Individual nurses are professionally accountable for ensuring that no act or omission on their part is detrimental to patient safety and for recognising any limits in their individual skill and competence. Nurses need to consider these professional obligations in the context of what they can legally be required to do by their employers under their contracts of employment.     

Suggestions for the uses of psychological devices in accord with legal and ethical standards.

Suggests that some traditional psychological practices no longer conform to current legal and ethical requirements and that several ethical standards in the official publications of the American Psychological Association are applicable to the use of psychological devices. In the treatment of problems with possible organic causes, collaborative relationships with physicians may be required. The Food and Drug Administration's recent classification of some psychological devices (e.g., biofeedback equipment) as medical devices is likely to impose new standards upon the distribution and use of psychological devices similar to those now required for medical devices. Failure to conform to these standards may be considered as evidence of negligent treatment under some state laws. Finally, these standards suggest that public statements and announcements about devices should be based upon scientifically acceptable evidence and that psychologists should not participate for personal gain in the commercial promotion of a proprietary or single-source device to the public. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of industrial tempering on the composition of complex cast iron

The chemical composition of the metallic base and carbides in complex cast iron is investigated in the laboratory. The iron is studied before and after heat treatment in industrial conditions. The redistribution of elements in the metallic base and in eutectic and secondary carbides is determined.     

PEA: working towards standards of good practice in the NHS

At the beginning of the year Stuart Whitaker described a pilot study for the national audit of pre-employment assessment in the NHS. Having completed the project he now presents its findings with a call for the introduction of standards of good practice.