A cohort study was conducted in Montreal (1988--1992) to test whether working in home care as a home maker entails a higher risk of developing low back pain than working in long term care hospitals as a nursing aide; and to investigate which risk factors may contribute to low back pain. Data from 978 self-administered questionnaires were analysed. Home makers suffered more than nursing aides from low back pain attributed to work. The adjusted odds ratios for home makers were: 1.63 (95% CI = 1.03--2.58) for a first episode of low back pain during 1998--1992, 2.43 (95% CI = 1.05--5.60) for disabling low back pain in 1992, 1.51 (95% CI = 1.13--2.02) for ever having low back pain as of 1992. The study subjects were divided into two cohorts, incident (newly hired persons during 1988--1992) and prevalent (at work in 1988 and in 1992). There was an excess risk of low back pain in the incident cohort; none in the prevalent cohort. The risk of low back pain was shown to decrease with increasing age, help to move patients, adequate equipment in the bedrooms, sufficient space in the bathrooms of patients. The risk increased with convalescent post-op patients, transfers of patients, seniority greater than 5 years, delivery of children, need of a patient-lift. Disabling low back pain could be reduced by introducing the following preventive measures: adequate bedroom equipment, help to move patients, training, sufficient space in the bathrooms, less transfers of patients.

Fatigue in the minerals industry of Western Australia is a greatly under-recognised issue that has serious potential consequences for shift workers at work and at home. A review of fatigue literature demonstrates the elusive nature of fatigue. It is something that most people have probably experienced at some time in their lives. It is a diffuse sensation that is accompanied by feelings of lethargy and a lack of interest in any activity. A general sensation of weariness is a major symptom of fatigue. Fatigue cannot be measured directly and subjective estimates have to be relied upon. Potentially life threatening consequences can result when shift workers perform under the influence of fatigue. Fatigue and sleepiness have the power to kill if not treated with the respect they deserve. A cross-sectional survey of five underground mines was conducted to obtain a better understanding of their fatigue risk management strategies and the views of managers and shift workers on their sleep and shift schedules. Four mines provided information on their fatigue risk management procedures. Ten underground mining crews comprising 147 shift workers provided their views by an anonymous survey questionnaire administered at each mine at the start of shift. Shift worker sleep at the five mines compared well with mines in Tasmania, New South Wales and Queensland. However, it was found that frequently waking earlier than intended was the most widely reported sleep concern for shift workers on day shift, night shift and days off. Falling asleep while on day shift and on night shift demonstrates that fatigue is an issue that can occur on day shift as well as night shift. Fatigue is not an issue that is confined to night shift. Mine fitness for work procedures focused primarily on: shift schedules, hours of work and drug and alcohol issues. The level of detail provided on fatigue risk management was considered to be less than adequate when compared with the three previous issues and fatigue risk management documentation sourced from the minerals industry and the transport industry. The survey data and fitness for work procedures provided by four mines suggests that considerably more work needs to be done to recognise and address sleep quantity and quality, as well as sleepiness and fatigue experienced by shift workers while on shift and at home on rest days. There is a serious need for the Western Australian minerals industry to recognise the vital importance of sleep to shift workers during their shift schedule and rest days. There needs to be a concerted and on-going campaign by the industry to raise and maintain the awareness of sleep as a key element in fitness for duty.

No description available.

This work undertook the examination of the perceived barriers that exist to the management of occupational noise exposure in the workplace. Exposure to excessive levels of noise results in cumulative damage to the hearing mechanism of the ear and a subsequent hearing loss. This hearing loss is permanent and does not recover over time. Initially the conventional method of addressing or controlling noise exposure was through Hearing Conservation Programs and more recently through Occupational Noise Management Programs that take more of a risk management approach. However, the numbers of new hearing loss claims submitted through the various ???workcover??? and ???worksafe??? authorities in Australia continue to remain very high. Hearing loss claims rank within the top two in number of new claims each year. The research conducted shows that there are four main barriers perceived by individuals that work against the institution of effective preventive action. These four main barriers in order of priority are hearing protectors, information, culture and management, and are themselves each composed of several lesser factors. Each of the barriers was examined more closely in an attempt to better understand how they operate and the potential to discover how they may be overcome. To briefly summarise the main barriers: 1) Hearing protectors are uncomfortable, impede communication and are unpleasant to wear; 2) Individuals would like more information on noise reduction and for this information to be supplied by management; 3) workplace and management culture needs to be supportive of occupational health and safety in general and with the implementation of supportive preventive measures in particular; and 3) management needs to be seen to place importance on occupational health and safety in the workplace in general and the reduction of excessive noise in particular. By being aware of the barriers and operation the design of future more effective intervention or better noise management programs should be possible.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

Fatigue in the minerals industry of Western Australia is a greatly under-recognised issue that has serious potential consequences for shift workers at work and at home. A review of fatigue literature demonstrates the elusive nature of fatigue. It is something that most people have probably experienced at some time in their lives. It is a diffuse sensation that is accompanied by feelings of lethargy and a lack of interest in any activity. A general sensation of weariness is a major symptom of fatigue. Fatigue cannot be measured directly and subjective estimates have to be relied upon. Potentially life threatening consequences can result when shift workers perform under the influence of fatigue. Fatigue and sleepiness have the power to kill if not treated with the respect they deserve. A cross-sectional survey of five underground mines was conducted to obtain a better understanding of their fatigue risk management strategies and the views of managers and shift workers on their sleep and shift schedules. Four mines provided information on their fatigue risk management procedures. Ten underground mining crews comprising 147 shift workers provided their views by an anonymous survey questionnaire administered at each mine at the start of shift. Shift worker sleep at the five mines compared well with mines in Tasmania, New South Wales and Queensland. However, it was found that frequently waking earlier than intended was the most widely reported sleep concern for shift workers on day shift, night shift and days off. Falling asleep while on day shift and on night shift demonstrates that fatigue is an issue that can occur on day shift as well as night shift. Fatigue is not an issue that is confined to night shift. Mine fitness for work procedures focused primarily on: shift schedules, hours of work and drug and alcohol issues. The level of detail provided on fatigue risk management was considered to be less than adequate when compared with the three previous issues and fatigue risk management documentation sourced from the minerals industry and the transport industry. The survey data and fitness for work procedures provided by four mines suggests that considerably more work needs to be done to recognise and address sleep quantity and quality, as well as sleepiness and fatigue experienced by shift workers while on shift and at home on rest days. There is a serious need for the Western Australian minerals industry to recognise the vital importance of sleep to shift workers during their shift schedule and rest days. There needs to be a concerted and on-going campaign by the industry to raise and maintain the awareness of sleep as a key element in fitness for duty.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6588. Adviser: Julia Faucett.