Developing a Respiratory Protection Program. Understanding the written elements.

1. Respirators can be the last defense for the estimated 5 million employees who use them for protection from dusts and fibers, fumes, mists, gases, vapors, and biological hazards. Because of these potentially lethal respiratory hazards, occupational and environmental health nurses need to be able to determine the need for, understand, develop, update, and implement an actionable respiratory protection program (RPP). 2. Regulated per 29 CFR 1910.134, a written RPP becomes the map or guideline process specific to the workplace that needs to be followed to ensure employee protection. 3. The nine required written elements of a RPP include respirator selection; fit testing; respirator use in routine and emergency situations; respirator maintenance and change schedules; ensuring adequate breathing air supply, quantity, and flow for atmosphere supplying respirators; regular evaluation of program effectiveness; medical evaluation; training employees in the respiratory hazards in routine and emergent situations; and training employees in proper use of the respirator. 4. Occupational and environmental health nurses are in a unique position to be a RPP program administrator, its designated licensed health care professional, or an active member of a team implementing the RPP process.     

Minnesota workplace drug testing. Analysis of policy and procedures

1. An employer's decision whether to drug test or not was found to correlate with the size of the company and how extensively the employer perceives a drug abuse problem exists among its work force. 2. A company's drug testing program must be designed, implemented, and evaluated within a medical-legal framework. This includes issues of: confidentiality, employee actions that trigger a drug test, the presence of a drug and alcohol policy, communicating the program to employees and unions, the employee's rights, the consequences of an employee's positive drug test, and the procedures to be followed when collecting a specimen. 3. Future studies need to explore the issue of dealing with job performance problems; in particular, the cost and effectiveness of employee drug testing vs. the use of discipline alone.     

Drugs and alcohol in the workplace

1. In response to increased costs of drug abuse due to decreased productivity by impaired workers, many corporations, either voluntarily or under federal mandate, have adopted a drug free workplace policy. 2. The main components of an anti-drug program include: management commitment, development of a drug free workplace policy, separate training programs for supervisors and employees, an Employee Assistance Program, and written drug testing procedures. 3. Signs and symptoms of the alcohol and drug abuser in the workplace are subtle. A supervisor or occupational health nurse must be astute to recognize the problem and intervene to provide assistance and counseling before a crisis occurs.     

Benefits of a Pharmacology Antimalarial Reference Standard and Proficiency Testing Program Provided by the Worldwide Antimalarial Resistance Network (WWARN)

Comprehensive assessment of antimalarial drug resistance should include measurements of antimalarial blood or plasma concentrations in clinical trials and in individual assessments of treatment failure so that true resistance can be differentiated from inadequate drug exposure. Pharmacometric modeling is necessary to assess pharmacokinetic-pharmacodynamic relationships in different populations to optimize dosing. To accomplish both effectively and to allow comparison of data from different laboratories, it is essential that drug concentration measurement is accurate. Proficiency testing (PT) of laboratory procedures is necessary for verification of assay results. Within the Worldwide Antimalarial Resistance Network (WWARN), the goal of the quality assurance/quality control (QA/QC) program is to facilitate and sustain high-quality antimalarial assays. The QA/QC program consists of an international PT program for pharmacology laboratories and a reference material (RM) program for the provision of antimalarial drug standards, metabolites, and internal standards for laboratory use. The RM program currently distributes accurately weighed quantities of antimalarial drug standards, metabolites, and internal standards to 44 pharmacology, in vitro, and drug quality testing laboratories. The pharmacology PT program has sent samples to eight laboratories in four rounds of testing. WWARN technical experts have provided advice for correcting identified problems to improve performance of subsequent analysis and ultimately improved the quality of data. Many participants have demonstrated substantial improvements over subsequent rounds of PT. The WWARN QA/QC program has improved the quality and value of antimalarial drug measurement in laboratories globally. It is a model that has potential to be applied to strengthening laboratories more widely and improving the therapeutics of other infectious diseases.     

The UAW-GM health promotion program. Successful outcomes.

1. The success of the LifeSteps program may rest in the UAW and GM leadership's vision to use a high level joint steering committee, a day to day working committee, third party program providers, support of confidentiality throughout the entire program, and a comprehensive data driven decision making system. 2. The program design is a multiplatform method of program delivery to a diverse and nationwide population of the active and retired employees and dependents (more than 1 million individuals older than age 18). They receive an annual health risk appraisal, telephone access to a registered nurse 24 hours a day. LifeSteps website, a quarterly health information newsletter and a health care book sent to each of the households, and access to a telephonic audiotape library. 3. A pilot program has a more intense design of low risk maintenance and high risk reduction programs specifically for all active employees who work in the pilot locations. A telephonic program for behavior change is available only to high risk individuals in the total pilot population of active and retired employees and dependents. 4. The major success criterion for the LifeSteps program is helping workers, former employees, and their families maintain or achieve low risk status. The increased number of employees at low risk status (4% gain the second year and a 2% gain from the second to the third year) documents the improved health status of the population. Moreover, of surveyed participants and nonparticipants, 85% supported program continuation and 74% said they had an improved opinion of the UAW and GM due to the program.     

Medical surveillance program evaluation. Successful program.

1. This program evaluation case example describes changes made to a medical/health surveillance program that resulted in cost savings while increasing services to employees. 2. An integrated computerized recordkeeping system provided immediate feedback to nurse and employee when testing was conducted at distant locations. 3. By offering voluntary health promotion activities simultaneously with a regulatory mandated health/medical surveillance program, employees were able to do "one stop shopping" for programs that had previously been offered separately.     

A worksite diabetes prevention program: two-year impact on employee health.

The purpose of this study was to determine the 2-year impact of a worksite-based diabetes prevention program. Thirty-seven pre-diabetic and previously undiagnosed diabetic employees participating in a 12-month worksite diabetes prevention program were included. Weight, body mass index, waist circumference, oral glucose tolerance testing, fasting insulin, blood lipids, and aerobic fitness had improved significantly after 6 months. Much of this improvement continued through 12 months. One year following the intervention, oral glucose tolerance and aerobic fitness had improved significantly. Of the 22 employees remaining in the study through 24 months, more than half had normal results on glucose tolerance testing. Worksite diabetes prevention programs may reduce blood glucose below pre-diabetic and diabetic levels. Improvements in diabetes risk factors persisted for at least 2 years in most of these employees.     

Causes of unsatisfactory performance in proficiency testing

BACKGROUND: Proficiency testing (PT) provides a measure of the effectiveness of laboratory quality assurance programs. Test reports are released from processes that the laboratory judges to be in conformance with quality specifications; an evaluation of unsatisfactory performance (UNSAT) by a PT provider is an unexpected outcome for the laboratory. An understanding of the root cause(s) of testing errors provides an opportunity for the continuous improvement of laboratory services. METHODS: We used participant data from the New York State Department of Health PT program to characterize the quality of testing in the toxicology specialty. Outcomes from laboratory investigations into causes of UNSAT and information on quality control practices collected from all program participants were used to identify the root causes of error. RESULTS: Two classes of error were encountered: spurious test results caused by lapses in standard operating procedures and instrument malfunctions (300 per million assays) and common-cause analytic error (7000 per million assays or 0.7% rate of UNSAT). Causes of spurious results included inaccurate mathematical correction for specimen dilution, misinterpretation of instrument codes, and instrument sampling errors. Calibration drift was most frequently cited as the common-cause analytic error. Approximately one-half of the laboratories used an allowable error for the quality control of analytical systems that exceeded the threshold error specified by manufacturers for stable instrument performance. CONCLUSIONS: The causes of spurious results suggest the need for ongoing competency testing of analysts where analyst intervention is required in an otherwise automated process, and for continued diligence in mistake-proofing instrument design. The intrinsic quality of laboratory testing is unlikely to improve until the allowable error in quality control is consistent with manufacturer specifications for stable system performance.     

The beginning of the second decade of the era of patient safety: Implications and roles for the clinical laboratory and laboratory professionals

Providing high quality, effective laboratory services is not new to the laboratory profession. The laboratory began examining its analytical quality in the 1920s when the American Society of Clinical Pathologists (ASCP) began a voluntary proficiency testing (PT) program with that was the predecessor of the College of American Pathologist's current PT program. The program focuses primarily on analytic quality, 1 of the 3 phases of what has become known as the “total testing process,” a cyclical process conceptualized by the Centers for Disease Control (CDC) that provides a framework for assessing quality of laboratory services. Laboratory testing is particularly essential in the practice of medical genetics. The translation of human genomic research into clinical practice has resulted in a rapidly expanding portfolio of DNA-based tests for heritable conditions and markers of drug metabolism. This creates an opportunity for laboratory professionals with genetic training but also brings with it a threat to the quality of care that might result from inappropriate use of unfamiliar, costly and inappropriate testing. As for conventional laboratory tests, there is the need to identify and control all phases of the “total genetic testing process.” An agenda for the second decade of the era of patient safety must be developed and here we offer a few key areas for practice improvement in laboratory medicine.     

Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center

ObjectiveTo estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel.MethodsThe Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board–approved protocol, only includes employees who have further authorized their records for use in research.ResultsA total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were “reactive” and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group.ConclusionThe seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.     

Drug discovery, drug development and the emerging world of pharmacogenomics: prospecting for information in a data-rich landscape

Drug development is a very expensive and inefficient process. Currently, it takes on average 15 years and costs approximately US $500 million to bring a new drug to market, with the pharmaceutical industry spending more than US $20 billion in identifying and developing drugs in 1998. Twenty-two percent of this total was spent on screening assays and toxicity testing. Yet the rapidly accelerating advances in high-throughput technologies, including screening and robotics, combinatorial chemistry, and genomics makes this an extremely data-rich environment. Add to that the new paradigms of pharmacogenomics and 'customized medicine', and the question is, are we helping or hurting our cause? Clearly, interpreting this flood of data and turning it into useful information is our next great hurdle. By extending the pharmacogenomic paradigm to the drug discovery process, this paper intends to put the scope of the problem into context.     

An overview of the human immunodeficiency virus featuring laboratory testing for drug resistance.

The human immunodeficiency virus (HIV) pandemic is unique in human history in its rapid spread, its persistence, and the depth of its impact. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that approximately 65 million people have been infected with HIV since the beginning of the epidemic. During this time, approximately 25 million people have died from acquired immune deficiency syndrome AIDS. HIV-associated morbidity and mortality was substantially reduced during the last decade following the introduction of highly active antiretroviral therapy (HAART). In spite of the striking success of HAART in treating HIV infection, many patients experience treatment failure as genetic changes emerge in the virus leading to drug resistance. Laboratory testing for drug resistance in HIV strains is now used in combination with other methods to guide antiretroviral therapy. The purpose of this report is to review the background information on HIV with the focus on the problem of drug resistance and to describe the laboratory methods of testing for drug resistance in HIV strains.     

Developing an employee cardiovascular fitness program

Employee fitness programs, which have become increasingly popular in industrial settings, particularly over the past decade, are now also gaining favour in the hospital environment. Whereas employers are interested in the positive relationships between physical fitness, absenteeism and work performance, employees, as a result of participation in fitness activities, enjoy a more positive outlook on life. This paper discusses several points which might be considered during the development of a fitness program for employees, such as: persuading administrators of the need; generating employee interest; pre-testing participants; and actual program planning. The organization of the program -- it frequency and duration, and the warm-up, training and cool-down periods -- is also outlined.     

Educating supervisors of employees with diabetes.

The worksite presents special challenges not only for employees with diabetes, but also for their supervisors. Supervisors wonder whether certain behaviors are willful misconduct or indicative of health problems, as well as if and how to accommodate employees with diabetes to meet the needs of the employees and the company, within the law. The purpose of this research was to pilot test an innovative educational program for supervisors of employees with diabetes to benefit employees' health and diabetes control while meeting the legal requirements of the Americans with Disabilities Act (ADA). Nine supervisors completed a 6-hour program that included innovative teaching strategies--"living the life" of a person with diabetes for 2 days and case studies to practice decision making according to the ADA. The program increased supervisors' reported self-efficacy for supervising employees with diabetes and should improve work life for employees with diabetes, ultimately decreasing employers' health care costs.     

Partnership Between an Educational Institution and a Healthcare Agency—Lessons Learned: Part I

PURPOSE.  The purpose of this paper is to provide a model of a partnership program between a major educational institution and a large community medical center that has become a win–win situation for both, which enabled the former to double its undergraduate nursing (BSN) program when it was on the verge of reducing enrollments by 33% because of repeated financial cuts, and a healthcare agency (HCA) to find a creative way of hiring BSN-educated registered nurses in perpetuity, thus reducing their $2 million a month recruitment expenses.
PROCESS.  This was a 5-year, $15 million partnership between California State University, Long Beach, School of Nursing and Long Beach Memorial Medical Center/Miller Children's Hospital. The HCA contributed the $10 million in funds and in in-kind contributions in the form of facilities and adjunct clinical professors, and the university contributed the $5 million, all in in-kind contribution by doubling the lecture classes without additional cost. The project started in the spring of 2004.
CONCLUSION.  To date, eight groups have graduated from this program for a total of 288 additional BSN graduates. Retention rate has been a minimum of 95%. Over 95% of the graduates have been hired by the participating HCA. Indeed, it has been a win–win situation for both.     

Economic appraisal of Sirex Wood Wasp (Sirex noctilio) control in Australian pine plantations

Sirex noctilio (Sirex) is an exotic wood wasp and a pest of Pinus that has been in Australia for 65 years. Our study quantified expenditure on Sirex control between 1952 and 2014 through the National Sirex Control program, and costed the impact of three major outbreaks where large-scale tree mortality occurred. We estimate the combined cost of the program and the outbreaks at $34.5 million (net present value using a 1952 baseline and a 5% discount rate). Expenditure on the program was estimated at $24.8 million, while the combined plantation timber losses from the three studied outbreaks — Pittwater, Delatite and the Green Triangle — were valued at $9.7 million. Much higher expenditure values were generated when discounting was limited to the year that the outbreaks commenced. The outbreak at Pittwater, Tasmania commenced in 1952 and had estimated losses of $5.7 million or $5161 ha^?1. This outbreak provided the best insight into the potential of Sirex to impact timber values under a ‘no control’ scenario. The Sirex outbreak in the Green Triangle, which commenced in 1987, was costed at $21.6 million. It was Australia’s largest outbreak and occurred at a time when proven control methods were available. Study of the National Sirex Control program highlights the threats that exotic pests pose to Pinus plantations in Australia. Where realised, these threats can translate to major timber loses and costly control programs.     

Educational needs of employed family caregivers of older adults: Evaluation of a workplace project

Family members provide 80% of care for older adults in the United States. Many family caregivers are employed either full or part time. For employed caregivers, personal health, job performance, and the ability to advance their career are affected by the weight of their caregiving responsibilities. Some find it necessary to quit their jobs. Employed caregivers report a need for caregiving information; however, they seldom think of their workplace as a valuable resource. Results of the second of a 3-phase research and service project are discussed. Based on a needs assessment completed by employees of a large institution, educational sessions were offered during 3 consecutive months. Thirty-five employees attended 1 or more sessions. The sessions were evaluated highly on a 5-point Likert-type scale for usefulness of information, quality of presentation, and value of session. Sharing project results with the employing institution's human resources department yielded commitment to integrate caregiver education and referral into a newly organized work-life program. When properly managed, such workplace programs can provide needed assistance to employed caregivers. A nurse working with older adults is an ideal provider to initiate and manage this kind of program.     

Are we approaching the post-blockbuster era? Pharmacodiagnostics and rational drug development

In the future, it may be a pharmacodiagnostic test that decides which drug to choose for the individual patient and, to a much lesser extent, the average results from large randomized clinical trials or the marketing efforts of the pharmaceutical companies. Personalized medicine or stratified medicine should be regarded as the 21st Century's answer to the rational use of drugs--the right drug for the right patient at the right time. The new molecular diagnostic methods will provide the pharmaceutical companies with a powerful tool that will enable them to make a more objective decision with respect to their drug development. Furthermore, introducing pharmacodiagnostic testing in a drug development program could lead to a considerable reduction in both development costs and time. The change from blockbuster medicine to stratified and personalized medicine must be regarded as a major challenge for pharmaceutical companies, but also a challenge that could lead to a much more rational drug development process.