Search results for: equipment care and maintenance

Authors: S. M. C. Kelly, A. Hargreaves, S. Hargreaves

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Introduction: The Can’t intubate, Can’t ventilate emergency scenario is one which has been shown to be managed badly in the past. Reasons identified included gaps in knowledge of the procedure and the emergency equipment used. We aimed to show an increase in confidence amongst anesthetists and operating department practitioners in the technique following a short tea trolley style teaching intervention. Methods: We carried out the teaching on a one-to-one basis. Two Anaesthetists visited each operating theatre during normal working days. One carried out the teaching session and one took over the intra‐operative care of the patient, releasing the listed anaesthetist for a short teaching session. The teaching was delivered to mixture of students and healthcare professionals, both anaesthetists and anaesthetic practitioners. The equipment includes a trolley, an airway manikin, size 10 scalpel, bougie and size 6.0 tracheal tube. The educator discussed the equipment, performed a demonstration and observed the participants performing the procedure. We asked each person to fill out a pre and post teaching questionnaire, stating their confidence with the procedure. Results: The teaching was delivered to 63 participants in total, which included 21 consultant anaesthetists, 23 trainee doctors and 19 anaesthetic practitioners. The teaching sessions lasted on average 9 minutes (range 5– 15 minutes). All participants reported an increase in confidence in both the equipment and technique in front of neck access. Anaesthetic practitioners reported the greatest increase in confidence (53%), with trainee anaesthetists reporting 27% increase and consultant anaesthetists 22%. Overall, confidence in the performance of emergency front of neck access increased by 31% after the teaching session. Discussion: Short ‘Trolley style’ teaching improves confidence in the equipment and technique used for the emergency front of neck access. This is true for students and for consultant anaesthetists. This teaching style is quick with minimal running costs and is relevant for all anesthetic departments.

Keywords: airway teaching, can't intubate can't ventilate, cricothyroidotomy, front-of-neck

Procedia PDF Downloads 122

Authors: Ramachandra C. G., Amarnath. M., Prashanth Pai M., Nagesh S. N.

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The machine's performance level drops down over a period of time due to the wear and tear of its components. The early detection of an emergent fault becomes very vital in order to obtain uninterrupted production in a plant. Maintenance is an activity that helps to keep the machine's performance at an anticipated level, thereby ensuring the availability of the machine to perform its intended function. At present, a number of modern maintenance techniques are available, such as preventive maintenance, predictive maintenance, condition-based maintenance, total productive maintenance, etc. Condition-based maintenance or condition monitoring is one such modern maintenance technique in which the machine's condition or health is checked by the measurement of certain parameters such as sound level, temperature, velocity, displacement, vibration, etc. It can recognize most of the factors restraining the usefulness and efficacy of the total manufacturing unit. This research work is conducted on a Batch Mill in a tire production unit located in the Southern Karnataka region. The health of the mill is assessed using amplitude of vibration as a parameter of measurement. Most commonly, the vibration level is assessed using various points on the machine bearing. The normal or standard level is fixed using reference materials such as manuals or catalogs supplied by the manufacturers and also by referring vibration standards. The Rio-Vibro meter is placed in different locations on the batch-off mill to record the vibration data. The data collected are analyzed to identify the malfunctioning components in the batch off the mill, and corrective measures are suggested.

Keywords: availability, displacement, vibration, rio-vibro, condition monitoring

Procedia PDF Downloads 41

Authors: Benyapa Thitimapong, Najwa Niyomdecha

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This qualitative descriptive research aimed to explore the self-care experiences during pregnancy of Muslim adolescents. Twenty participants were first-time Muslim mothers who had pregnancy experienceห under 20 years of age in three Southern border provinces of Thailand. Participants were selected by purposive sampling with inclusion criteria. Data were collected from the in-depth interview and analyzed using content analysis. The findings revealed that Muslim pregnant adolescents take care of themselves in the context of combining self-care in an Islamic way and conventional medicine. There are 2 subthemes: 1) antenatal care with Tok Bidan and 2) health promotion during pregnancy. The finding will help to understand self-care during pregnancy of Muslim adolescents among three Southern border provinces and can apply to nurse educators as a guide to educate and manage an appropriate self-care program for Muslim pregnant adolescents based on cultural diversity.

Keywords: adolescents, muslim, pregnancy, selfcare

Procedia PDF Downloads 92

Authors: Yousaf Tariq

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There are many reasons which are involved in electronic equipment failure i.e. temperature, humidity, dust, smoke etc. Corrosive gases are also one of the factor which may involve in failure of equipment. Sensitivity of electronic equipment increased when “lead-free” regulation enforced on manufacturers. In data center, equipment like hard disk, servers, printed circuit boards etc. have been exposed to gaseous contamination due to increase in sensitivity. There is a worldwide standard to protect electronic industrial electronic from corrosive gases. It is well known as “ANSI/ISA S71.04 – 1985 - Environmental Conditions for Control Systems: Airborne Contaminants. ASHRAE Technical Committee (TC) 9.9 members also recommended ISA standard in their whitepaper on Gaseous and Particulate Contamination Guideline for data centers. TC 9.9 members represented some of the major IT equipment manufacturers e.g. IBM, HP, Cisco etc. As per standard practices, first step is to monitor air quality in data center. If contamination level shows more than G1, it means that gas-phase air filtration is required other than dust/smoke air filtration. It is important that outside fresh air entering in data center should have pressurization/re-circulated process in order to absorb corrosive gases and to maintain level within specified limit. It is also important that air quality monitoring should be conducted once in a year. Temperature and humidity should also be monitored as per standard practices to maintain level within specified limit.

Keywords: corrosive gases, corrosion, electronic equipment failure, ASHRAE, hard disk

Procedia PDF Downloads 305

Authors: Aditya Manna, Lalit Kumar Khanra, Shyamal Kumar Sarkar

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Introduction: Here in India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. Surveys in India show that two third of cancer patient do not get proper care during the terminal phase of their life. Palliative care through volunteers can make a significant difference in this respect. Objective: To identify and try to solve, to the extent possible, the main difficulties in giving palliative care to the terminal cancer patients of the area. And evaluate the impact of volunteer’s direct care of palliative patients and their families. Methods: Feedback from patients and their relatives regarding the palliative care they receive from nursing home and from volunteers and compare the two. Also feedback from volunteers regarding their positive and negative experience while delivering palliative care service. Then evaluate the data to compare and improve the quality of service. Results: We carried out two studies. One study was undertaken in nursing home palliative care and another was in home setting by volunteers. Both studies were in adult palliative care services. Since January 2015, 496 cases were studied to enquire about their experience in both home based care and nursing home care. Both the studies fulfilled our quality appraisal criteria. One found that those families and patients who received home visits from volunteers were significantly more satisfied. The study highlighted the value of the role of volunteers in better satisfaction of patients and their families. Conclusions: Further research is needed to evaluate the role of volunteers in palliative care and how it can be delivered appropriately and effectively. We also wish to compare our findings with similar studies elsewhere.

Keywords: palliative care, terminal care, cancer, home care

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Authors: Shinhao Yang, Hsiao-Chien Huang, Chin-Hsiang Luo

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The leakage of protective clothing is an important issue in the occupational health field. There is no quantitative method for measuring the leakage of personal protective equipment. This work aims to measure the quantitative leakage of the personal protective equipment by using the fluorochrome aerosol tracer. The fluorescent aerosols were employed as airborne particulates in a controlled chamber with ultraviolet (UV) light-detectable stickers. After an exposure-and-leakage test, the protective equipment was removed and photographed with UV-scanning to evaluate areas, color depth ratio, and aerosol deposition and shielding effects of the areas where fluorescent aerosols had adhered to the body through the protective equipment. Thus, this work built a calculation software for quantitative leakage ratio of protective clothing based on fluorescent illumination depth/aerosol concentration ratio, illumination/Fa ratio, aerosol deposition and shielding effects, and the leakage area ratio on the segmentation. The results indicated that the two-repetition total leakage rate of the X, Y, and Z type protective clothing for subject T were about 3.05, 4.21, and 3.52 (mg/m2). For five-repetition, the leakage rate of T were about 4.12, 4.52, and 5.11 (mg/m2).

Keywords: fluorochrome, deposition, shielding effects, digital image processing, leakage ratio, personal protective equipment

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Authors: R. Schweighoffer, N. Nagy, E. Reeves, B. Liebig

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Due to aging populations, the need for seamless palliative care provision is of central interest for western societies. An essential aspect of palliative care delivery is the quality of collaboration amongst palliative care providers. Therefore, the current research is based on Bainbridge’s conceptual framework, which provides an outline for the evaluation of palliative care provision. This study is the first one to investigate the predictive validity of spatial distribution on the quantity of interaction amongst various palliative care providers. Furthermore, based on the familiarity principle, we examine whether the extent of collaboration influences the perceived quality of collaboration among palliative care providers in urban versus rural areas of Switzerland. Based on a population-representative survey of Swiss palliative care providers, the results of the current study show that professionals in densely populated areas report higher absolute numbers of interactions and are more satisfied with their collaborative practice. This indicates that palliative care providers who work in urban areas are better embedded into networks than their counterparts in more rural areas. The findings are especially important, considering that efficient collaboration is a prerequisite to achieve satisfactory patient outcomes. Conclusively, measures should be taken to foster collaboration in weakly interconnected palliative care networks.

Keywords: collaboration, healthcare networks, palliative care, Switzerland

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Authors: Sonia Mannan, M. Jobair Alam

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The concept of palliative care in Bangladesh largely remained limited to the sympathetic caring of patients with a life-limiting illness. Quality of Life (QoL) issues are rarely practiced in Bangladesh. Furthermore, palliative medicine, in the perspective of holistic palliative care service, does not have its proper recognition in Bangladesh. Apart from those socio-medical aspects, palliative care patients face legal issues that impact their quality of life, including access to health services and social benefits and dealing with other life-transactions of the patients and their families (such as disposing of property; planning for children). This paper is an attempt to articulate these legal dimensions of the right to palliative care in the context of Bangladesh. The major focus of this paper will be founded on the doctrinal analysis of the constitutional provisions and other relevant legislation on the right to health and their judicial interpretation, which is argued to offer a meaningful space for the right to palliative care. This paper will also investigate the gaps in the said legal framework to better secure such care. In conclusion, a few recommendations are made so that the palliative care practices in Bangladesh are better aligned with international standards, and it can respond more humanely to the patients who need palliative care.

Keywords: Bangladesh, constitution, legal regime, palliative care, quality of life

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Authors: Anushree S. Panikkassery

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The paper analyses the pattern and trend of maternal health care in south Indian states. It studies the interstate disparities in terms of maternal health care. It also compares the trends in terms of achieving the target of sustainable development Goal is related to maternal health. The maternal health care (MHC) development is one of the key indicators for the development of health sector in the country and assumes significance from the socioeconomic and developmental perspectives. Maternal health care mainly consists of composite care during pregnancy, child birth as well as postpartum period. Antenatal care, identification, referral and management of high risk pregnancies, safe and healthy child birth and early postnatal care are some of the important issues pertaining to maternal health. Data is collected from national family health survey 1992-93, 1998-99, 2005-06, and 2015-16. A concentration index is used to study the disparities in equity of maternal health among south Indian states. The study shows that there has been an improvement in maternal health care in south Indian states with Kerala topping among the states. But there exist disparities among the south Indian states.

Keywords: antenatal care, disparities, equity, maternal health

Procedia PDF Downloads 351

Authors: Suchitra Chnadrashekhar

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Earlier looked as a support function in an organization information technology has now become a critical utility to manage their daily operations. Organizations are processing huge amount of data which was unimaginable few decades before. This has opened the opportunity for IT sector to help industries across domains to handle the data in the most intelligent manner. Presence of IT has been a leverage for the Oil & Gas industry to store, manage and process the data in most efficient way possible thus deriving the economic value in their day-to-day operations. Proper synchronization between Operational data system and Information Technology system is the need of the hour. Predictive analytics supports oil and gas companies by addressing the challenge of critical equipment performance, life cycle, integrity, security, and increase their utilization. Predictive analytics go beyond early warning by providing insights into the roots of problems. To reach their full potential, oil and gas companies need to take a holistic or systems approach towards asset optimization and thus have the functional information at all levels of the organization in order to make the right decisions. This paper discusses how the use of predictive analysis in oil and gas industry is redefining the dynamics of this sector. Also, the paper will be supported by real time data and evaluation of the data for a given oil production asset on an application tool, SAS. The reason for using SAS as an application for our analysis is that SAS provides an analytics-based framework to improve uptimes, performance and availability of crucial assets while reducing the amount of unscheduled maintenance, thus minimizing maintenance-related costs and operation disruptions. With state-of-the-art analytics and reporting, we can predict maintenance problems before they happen and determine root causes in order to update processes for future prevention.

Keywords: hydrocarbon, information technology, SAS, predictive analytics

Procedia PDF Downloads 321

Authors: Alireza Saidi

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Aside from injuries due to direct contact with hot or cold substances or objects, exposure to extreme temperatures in the workplace involves physical hazards to workers. On the other hand, a poorly acclimatized worker may have reduced performance and alertness and may, therefore, be more vulnerable to the risk of accidents and injuries. Due to the incompatibility of the standards put in place with certain workplaces and the lack of thermoregulation in many protective equipments, thermal strains remain among the physical risks most present in many work sectors. However, many of these problems can be overcome thanks to the potential of intelligent textile technologies allowing intelligent thermoregulation in protective equipment. Nowadays, technologies such as heating elements, cooling elements are applied in products intended for sport and leisure, and research work has been carried out in the integration of temperature sensors and thermal stress detectors in personal protective equipment. However, the usage of all of these technologies in personal protective equipment remains very marginal. This article presents a portrait of the current state of intelligent thermoregulation systems by carrying out a synthesis of technical developments, which is accompanied by a gap analysis of current developments. Thus, the research work necessary for the adaptation and integration of intelligent thermoregulation systems with personal protective equipment is discussed in order to offer a perspective of future developments.

Keywords: personal protective equipment, smart textiles, thermoregulation, thermal strain

Procedia PDF Downloads 82

Authors: Omran Al Balushi, Haitham Al Rawahi

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Enterprise Asset Management (eAM) has been implemented across different Generation, Transmission and Distribution subsidiaries in Nama Group companies. As part of Nama group, Oman Electricity Transmission Company (OETC) was the first company to implement this system. It was very important for OETC to implement and maintain such a system to achieve its business objectives and for effective operations, which will also support the delivery of the asset management strategy. Enterprise Asset Management (eAM) addresses the comprehensive asset maintenance requirements of Oman Electricity Transmission Company (OETC). OETC needs to optimize capacity and increase utilization, while lowering unit production. E-AM will enable OETC to adopt this strategy. Implementation of e-AM has improved operation performance with preventive and scheduled maintenance as well as it increased safety. Implementation of e-AM will also enable OETC to create optimal asset management strategy which will increase revenue and decrease cost by effectively monitoring operational data such as maintenance history and operation conditions. CMMS (Computerised Maintenance Management System) is the main software and the back-bone of e-AM system. It is used to provide an improved working practice to properly establish information and data flow related to maintenance activities. Implementation of e-AM system was one of the factors that supported OETC to achieve ISO55001 Certificate on fourth quarter of 2016. Also, full implementation of e-AM system will result in strong integration between CMMS and Geographical Information Systems (GIS) application and it will improve OETC to build a reliable maintenance strategy for all asset classes in its Transmission network. In this paper we will share our experience and knowledge of implementing such a system and how it supported OETC’s management to make decisions. Also we would highlight the challenges and difficulties that we encountered during the implementation of e-AM. Also, we will list some features and advantages of e-AM in asset management, preventive maintenance and maintenance cost management.

Keywords: CMMS, Maintenance Management, Asset Management, Maintenance Strategy

Procedia PDF Downloads 110

Authors: Khalid M. Albarkoly, Kenneth S. Park

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The substantial development of the construction industry has forced the cement industry, its major support, to focus on achieving maximum productivity to meet the growing demand for this material. Statistics indicate that the demand for cement rose from 1.6 billion metric tons (bmt) in 2000 to 4bmt in 2013. This means that the reliability of a production system needs to be at the highest level that can be achieved by good maintenance. This paper studies the extent to which the implementation of RCM is needed as a strategy for increasing the reliability of the production systems component can be increased, thus ensuring continuous productivity. In a case study of four Libyan cement factories, 80 employees were surveyed and 12 top and middle managers interviewed. It is evident that these factories usually breakdown more often than once per month which has led to a decline in productivity, they cannot produce more than 50% of their designed capacity. This has resulted from the poor reliability of their production systems as a result of poor or insufficient maintenance. It has been found that most of the factories’ employees misunderstand maintenance and its importance. The main cause of this problem is the lack of qualified and trained staff, but in addition, it has been found that most employees are not found to be motivated as a result of a lack of management support and interest. In response to these findings, it has been suggested that the RCM strategy should be implemented in the four factories. The paper shows the importance of considering the development of maintenance strategies through the implementation of RCM in these factories. The purpose of it would be to overcome the problems that could reduce the level of reliability of the production systems. This study could be a useful source of information for academic researchers and the industrial organisations which are still experiencing problems in maintenance practices.

Keywords: Libyan cement industry, reliability centred maintenance, maintenance, production, reliability

Procedia PDF Downloads 359

Authors: Yi-Jiun Chou, Ying-Hsuan Li, Yi-Jung Liu, Hsin-Yu Chiang, Hsuan-Ching Wang

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Background: Patients received therapeutic hypothermia (TH) after resuscitation from cardiac arrest are more dependent on continue and intensive nursing care. It involves many difficult steps, especially achieving target body temperature. To our best knowledge, there is no consensus or recommended standards on nursing practice of TH. Aim: The aim of this study is to increase the completion rate of nursing care at therapeutic hypothermia. Methods: We took five measures: (1) Amendment of nursing standards of therapeutic hypothermia; (2) Amendment of TH checklist items to nursing records; (3) Establishment of monitor procedure; (4) Design each period of TH care reminder cards; (5) Providing in-service training sections of TH for ICU nursing staff. Outcomes: The completion rate of nursing care at therapeutic hypothermia increased from 78.1% to 89.3%. Conclusion: The project team not only increased the completion rate but also improved patient safety and quality of care.

Keywords: therapeutic hypothermia, nursing, critical care, quality of care

Procedia PDF Downloads 388

Authors: Arah Abubakar Saidu, Audu Rufai, Abdulkadir Mohammed, Ibrahim Yakubu Umar, Idris Abubakar Mohammed

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The study determined the contents for the maintenance and troubleshooting of an anti-lock braking system for automobile craftsmen in Nigeria. Two research questions were raised and answered and two null hypotheses were formulated and tested at a .05 level of significance. The study adopted a descriptive survey research design. The study was conducted in Federal Capital Territory (FCT), Abuja, Kaduna, Kano, Lagos and Plateau States, Nigeria. The targeted population for the study was 99 consisting of all 43 non-teaching Subject Matter Experts (SMEs). The study utilized the whole population of the study. The instruments used for data collection were Anti-lock Braking System Maintenance and Troubleshooting Contents Questionnaire (ABSMTQ). Mean was used to analyze data that answered research questions and Z-test was used in testing the null hypotheses. Findings revealed, among others, that 81 items as content for the maintenance of ABS and 61 items as content for troubleshooting ABS for automobile craftsmen in Nigeria. Based on the findings of the study, the recommended, among others, that the National Board for Technical Education should include the contents for the maintenance and troubleshooting ABS in Motor Vehicle Mechanic Works curriculum used for training automobile craftsmen through the process of curriculum review in order to equip them with the competencies in troubleshooting and maintenance of ABS.

Keywords: anti-lock braking system, maintenance, troubleshooting, automobile craftsmen

Procedia PDF Downloads 60

Authors: Reza Lotfalian, Sudarshan Martins, Peter Radziszewski

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The effect of reliability on life-cycle cost, including initial and maintenance cost of a system is studied. The failure probability of a component is used to calculate the average maintenance cost during the operation cycle of the component. The standard deviation of the life-cycle cost is also calculated as an error measure for the average life-cycle cost. As a numerical example, the model is used to study the average life cycle cost of an electric motor.

Keywords: initial cost, life-cycle cost, maintenance cost, reliability

Procedia PDF Downloads 566

Authors: Maryam Gallab, Hafida Bouloiz, Youness Chater, Mohamed Tkiouat

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The aim of this paper is to present a model based on multi-agent systems in order to manage the maintenance activities and to ensure the reliability and availability of machines just with the required resources (operators, tools). The interest of the simulation is to solve the complexity of the system and to find results without cost or wasting time. An implementation of the model is carried out on the AnyLogic platform to display the defined performance indicators.

Keywords: maintenance, complexity, simulation, multi-agent systems, AnyLogic platform

Procedia PDF Downloads 278

Authors: Atif Mahmood, Mohammad Inayatullah Khan Babar

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Communication infrastructure has been installed, operated, and maintained all over the world according to defined electrical safety standards for separate or joint structures. These safety standards have been set for the safeguard of public, utility workers (employees and contractors), utility facilities, electrical communication equipment’s connected to the utility facilities and other facilities or premise adjacent to utility facilities. Different communication utilities in Pakistan use standards of different countries due to the absence of Common National Electrical Safety Standards of Pakistan. It is really important to devise a framework for implementation of a uniform standard for strict compliance. In this context, it is important to explore the compliance of safety standards for communication conductors and equipment for separate or joint structures for which NESC standards are taken as reference. Specific reference to grounding techniques including grounding AC/DC systems and its frames, leaving Fences, Messenger wires and special circuits used for the protection for lightning etc, ungrounded so recommendations are also given after in-depth analysis of current technical practices for the installation and maintenance of communication infrastructure.

Keywords: utility facilities, grounding electrodes, special circuits, grounding conductor

Procedia PDF Downloads 315

Authors: Tomasz Kosicki

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The subject of the presentation will be the administrative and legal instruments of disciplining maintenance debtors adopted by the Polish legislator, the substantive legal bases of which were adopted in the Act of 7 September 2007 on assistance to persons entitled to maintenance (Journal of Laws of 2022, item 1205). These provisions are complemented by procedural regulations resulting from the Act of 14 June 1960 - Code of Administrative Procedure (Journal of Laws of 2021, item 735, as amended). The first part of the paper will focus on the administrative proceedings regarding the recognition of the debtor as evading maintenance obligations. The initiation of this procedure ex officio is preceded by a number of actions by public administration bodies, including Conducting a maintenance interview with the debtor, during which his health and professional situation and the reasons for non-payment of maintenance are determined, Professional activation in a situation where the lack of payment of maintenance results from the lack of employment. The reasons for initiating the above-mentioned administrative proceedings ex officio will be indicated, taking into account the current views of the judicial decisions. The second part of the paper will focus on the instrument of retaining the driving license of the debtor, who was previously found to be evading maintenance. The author points out that the detention of the driving license is one of the types of administrative sanctions of a very severe nature. Doubts of a constitutional nature will also be highlighted, as well as those concerning the effectiveness of this legal instrument and the protection of the debtor's rights. The thesis will be presented that the administrative procedure for the retention of a driving license does not fulfill its role and especially does not affect the collection of maintenance obligations from debtors. All the considerations will be based on the current and most representative views of the literature on the subject and the jurisprudence of Polish administrative courts.

Keywords: maintenance debtor, administrative proceedings, detention of driving license, administrative sanction, polish administrative law, public administration

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Authors: Rui Li, Min Wen, Kim Bang Salling

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For the modern railways, maintenance is critical for ensuring safety, train punctuality and overall capacity utilization. The cost of railway maintenance in Europe is high, on average between 30,000 – 100,000 Euros per kilometer per year. In order to reduce such maintenance expenditures, this paper presents a mixed 0-1 linear mathematical model designed to optimize the predictive railway tamping activities for ballast track in the planning horizon of three to four years. The objective function is to minimize the tamping machine actual costs. The approach of the research is using the simple dynamic model for modelling condition-based tamping process and the solution method for finding optimal condition-based tamping schedule. Seven technical and practical aspects are taken into account to schedule tamping: (1) track degradation of the standard deviation of the longitudinal level over time; (2) track geometrical alignment; (3) track quality thresholds based on the train speed limits; (4) the dependency of the track quality recovery on the track quality after tamping operation; (5) Tamping machine operation practices (6) tamping budgets and (7) differentiating the open track from the station sections. A Danish railway track between Odense and Fredericia with 42.6 km of length is applied for a time period of three and four years in the proposed maintenance model. The generated tamping schedule is reasonable and robust. Based on the result from the Danish railway corridor, the total costs can be reduced significantly (50%) than the previous model which is based on optimizing the number of tamping. The different maintenance strategies have been discussed in the paper. The analysis from the results obtained from the model also shows a longer period of predictive tamping planning has more optimal scheduling of maintenance actions than continuous short term preventive maintenance, namely yearly condition-based planning.

Keywords: integer programming, railway tamping, predictive maintenance model, preventive condition-based maintenance

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Authors: Chang Yu Chuan

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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.

Keywords: body-turning and positioning, incidence density, nursing, pressure sore

Procedia PDF Downloads 244

Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Alan Crowle, Philpp Thies

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As the floating offshore wind turbine industry continues to develop and grow, the capabilities of established port facilities need to be assessed as to their ability to support the expanding construction and installation requirements. This paper assesses current infrastructure requirements and projected changes to port facilities that may be required to support the floating offshore wind industry. Understanding the infrastructure needs of the floating offshore renewable industry will help to identify the port-related requirements. Floating Offshore Wind Turbines can be installed further out to sea and in deeper waters than traditional fixed offshore wind arrays, meaning that it can take advantage of stronger winds. Separate ports are required for substructure construction, fit-out of the turbines, moorings, subsea cables and maintenance. Large areas are required for the laydown of mooring equipment; inter-array cables, turbine blades and nacelles. The capabilities of established port facilities to support floating wind farms are assessed by evaluation of the size of substructures, the height of wind turbine with regards to the cranes for fitting of blades, distance to offshore site and offshore installation vessel characteristics. The paper will discuss the advantages and disadvantages of using large land-based cranes, inshore floating crane vessels or offshore crane vessels at the fit-out port for the installation of the turbine. Water depths requirements for import of materials and export of the completed structures will be considered. There are additional costs associated with any emerging technology. However part of the popularity of Floating Offshore Wind Turbines stems from the cost savings against permanent structures like fixed wind turbines. Floating Offshore Wind Turbine developers can benefit from lighter, more cost-effective equipment which can be assembled in port and towed to the site rather than relying on large, expensive installation vessels to transport and erect fixed bottom turbines. The ability to assemble Floating Offshore Wind Turbines equipment onshore means minimizing highly weather-dependent operations like offshore heavy lifts and assembly, saving time and costs and reducing safety risks for offshore workers. Maintenance might take place in safer onshore conditions for barges and semi-submersibles. Offshore renewables, such as floating wind, can take advantage of this wealth of experience, while oil and gas operators can deploy this experience at the same time as entering the renewables space The floating offshore wind industry is in the early stages of development and port facilities are required for substructure fabrication, turbine manufacture, turbine construction and maintenance support. The paper discusses the potential floating wind substructures as this provides a snapshot of the requirements at the present time, and potential technological developments required for commercial development. Scaling effects of demonstration-scale projects will be addressed, however, the primary focus will be on commercial-scale (30+ units) device floating wind energy farms.

Keywords: floating wind, port, marine construction, offshore renewables

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Authors: Tomasz Kosicki

Abstract:

The subject of the presentation will be the administrative and legal instruments of disciplining maintenance debtors adopted by the Polish legislator, the substantive legal bases of which were adopted in the Act of 7 September 2007 on assistance to persons entitled to maintenance (Journal of Laws of 2022, item 1205). These provisions are complemented by procedural regulations resulting from the Act of 14 June 1960 - Code of Administrative Procedure (Journal of Laws of 2021, item 735, as amended). The first part of the paper will focus on the administrative proceedings regarding the recognition of the debtor as evading maintenance obligations. The initiation of this procedure ex officio is preceded by a number of actions by public administration bodies, including Conducting a maintenance interview with the debtor, during which his health and professional situation and the reasons for non-payment of maintenance are determined, Professional activation in a situation where the lack of payment of maintenance results from the lack of employment. The reasons for initiating the above-mentioned administrative proceedings ex officio will be indicated, taking into account the current views of the judicial decisions. The second part of the paper will focus on the instrument of retaining the driving license of the debtor, who was previously found to be evading maintenance. The author points out that the detention of the driving license is one of the types of administrative sanctions of a very severe nature. Doubts of a constitutional nature will also be highlighted, as well as those concerning the effectiveness of this legal instrument and the protection of the debtor's rights. The thesis will be presented that the administrative procedure for the retention of a driving license does not fulfill its role and especially does not affect the collection of maintenance obligations from debtors. All the considerations will be based on the current and most representative views of the literature on the subject and the jurisprudence of Polish administrative courts.

Keywords: maintenance debtor, administrative proceedings, detention of driving license, administrative sanction, polish administrative law, public administration

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Authors: Katie E. Jennings

Abstract:

The interactions between family dynamics and environmental factors with mental health vulnerability in individuals are well known and are a theme for on-going research and debate. The impact upon mental health issues and forensic issues on family dynamics, experience, and emotional wellbeing cannot be over-Emphasised. For forensic patients with diagnosed mental disorders, these relationships and environments may have also been functionally linked to the development and maintenance of those disorders; with significant adverse childhood experiences being a common feature of many Patient’s histories. Mental health hospitals remove the patient from their home environments and provide treatment outside of these relationships and often outside of the home area. There is, therefore, a major focus on Services ensuring that patients are able to build and maintain relationships with family and friends, requiring services to involve families in Patients' care and treatment wherever possible. There are standards set by Government and clinical bodies that require absolute demonstration of the inclusion of family and friends in all aspects of the care and treatment of forensic patients. For some patients and family members, this push to take on a “role” in care can be unhelpful, extremely stressful, and has constant implications for the potential delicate reparation of relationships. Based on work undertaken for over 20 years in forensic mental health settings, this paper explores the positive psychology approach to a dimensional model to family inclusion in mental health care that learns from family court work and allows for the maintenance of relationships to be at both proximal and Distil levels; to prevent the replication of abuse, decrease the need for falsehoods and assist the recovery of all. The model is based on allowing families to choose to not be involved or be involved in different ways if this is seen to be more helpful. It also allows patients to choose the level of potential involvement that they would find helpful, and for this to be reviewed at a timeframe agreed by all parties, rather than when the next survey is due or the patient has a significant care meeting. This paper is significant as there is a lack of research to support services to use a positive psychology approach to work in this area, the assumption that being asked to be involved must be positive for all seems naïve at best for this patient group. Work relating to the psychology of family can significantly contribute to the development of knowledge in this area. The development of a dimensional model will support choice within families and assist in the development of more honest and open relationships.

Keywords: family dynamics, forensic, mental disorder, positive psychology

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Authors: Shang-Sin Shiu, Shu-I Chin, Hsiu-Ju Chen, Ru-Yu Lien

Abstract:

The Hospice and Palliative Care Act has undergone three revisions, making it less challenging for terminal patients to withdraw life support systems. However, the adequacy of care before withdraw is a crucial factor in end-of-life medical treatment. The author observed that intensive care unit (ICU) nursing staff often rely on simple flowcharts or word of mouth, leading to inadequate preparation and failure to meet patient needs before withdraw. This results in confusion or hesitation among those executing the process. Therefore, there is a motivation to improve the withdraw of patient care processes, establish standardized procedures, ensure the accuracy of removal execution, enhance end-of-life care self-efficacy for nursing staff, and improve the overall quality of care. The investigation identified key issues: the lack of applicable guidelines for ICU care for withdraw from life-sustaining, insufficient education and training on withdraw and end-of-life care, scattered locations of withdraw-related tools, and inadequate self-efficacy in withdraw from life-sustaining care. Solutions proposed include revising withdraw care processes and guidelines, integrating tools and locations, conducting educational courses, and forming support groups. After the project implementation, the accuracy of removal cognition improved from 78% to 96.5%, self-efficacy in end-of-life care after removal increased from 54.7% to 93.1%, and the correctness of care behavior progressed from 27.7% to 97.8%. It is recommended to regularly conduct courses on removing life support system care and grief consolation to enhance the quality of end-of-life care.

Keywords: the intensive care unit (ICU) patients, nursing staff, withdraw life support systems, self-efficacy

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Authors: Haatembo Mooya

Abstract:

Cross-culturally, exclusive maternal care of infants is an exception, rather than a rule. In most traditional non-Western societies, child care is shared within the family while in most middle class Western societies parents tend to rely more on ‘hired hands’ for support. In both contexts however, a common caregiver is the sibling. Despite this, the phenomenon of sib-care has remained relatively understudied. Cultural and gender differences in sib-care and attachment were explored using a retrospective survey instrument comparing Zambian and Dutch college students. The total study sample (N = 394) comprised of 200 Zambian students from the University of Zambia and 194 Dutch students from Leiden University, the Netherlands. We tested four main hypotheses. Firstly, we hypothesized that the Zambian subjects performed more sib-care than Dutch subjects. Secondly we hypothesized that female participants performed more sib-care than males participants, both among the Zambian and Dutch subjects, especially when parents are not at home. Thirdly, we hypothesized that larger family size was associated with more sib-care. Finally, we hypothesized that securely attached participants performed more sib-care than their less securely attached peers. Results indicated that sib-care was prevalent in both Zambian and Dutch samples. Zambian subjects performed more sib-care than Dutch subjects, with females performing more sib-care than males, both when parents were at home (F(2, 244) = 62.09, p < .01) and when parents were not at home (F(2, 237) = 51.28, p < .01). We also found that family size and attachment related avoidance and anxiety were not significant predictors of sib-care. It is concluded that sib-care is understudied, not only in Africa but also in Western societies and that females perform more sib-care than males, especially when the parents are not at home. In addition, attachment related avoidance and anxiety appear to be more related to the quality than the quantity of sib-care provided.

Keywords: sibling, sib-care, attachment, Africa, Zambia, the Netherlands

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Authors: Khaled Ayfi

Abstract:

In industrial oxygen systems at high temperature and high pressure, contamination by solid particles is one of the principal causes of ignition hazards. Indeed, gas can sweep away particles, generated by corrosion inside the pipes or during maintenance operations (welding residues, careless disassembly, etc.) and produce accumulations at places where the gas velocity decrease. Moreover, in such an environment rich in oxygen (oxidant), particles are highly reactive and can ignite system walls more actively and at higher temperatures. Oxidation based thermal effects are responsible for mechanical properties lost, leading to the destruction of the pressure equipment wall. To deal with this problem, a numerical analysis is done regarding a sample representative of a wall subjected to pressure and temperature. The validation and analysis are done comparing the numerical simulations results to experimental measurements. More precisely, in this work, we propose a numerical model that describes the thermomechanical behavior of thin metal disks under pressure and subjected to laser heating. This model takes into account the geometric and material nonlinearity and has been validated by the comparison of simulation results with experimental measurements.

Keywords: ignition, oxygen, numerical simulation, thermomechanical behavior

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Authors: Peter Brink

Abstract:

Much of the research examining sexuality in long-term care focus on individual experiences, specifically their past, present, and future lived experiences. We know little about long-term care home policies, how they relate to the LGBT community, or how accommodating long-term care homes are to the LGBT+ community. In many ways, residents who identify as LGBT+ have been invisible in long-term care homes. Up until the not-to-distant past, homosexuality was illegal, and discrimination was acceptable. Canada’s LGBT population has also suffered because of the HIV/AIDS epidemic. For these and other reasons, members of the LGBT community might resist entering long-term care or attempt to keep their sexuality secret. The goal of any long-term care home is to be a welcoming place, to display signs of inclusion, and to help residents and staff feel that they are embraced. From the perspective of the long-term care home, it is possible that many of these facilities do not necessarily see the need to mention gender identity or sexual orientation in their welcoming materials. However, from the perspective of the invisible minority, it may be important that these homes be more than just welcoming. This study examined the role of institutional policies in long-term care for residents who identify as LGBT.

Keywords: long-term care, LGBT, HIV/AIDS, policy

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Authors: Miriam Colleran, Barbara Sheehy-Skeffington

Abstract:

Background: Patients with intellectual disabilities have specific palliative care needs, which can affect how resources and services are planned for this type of patient population. Aim: The purpose of this practice review is to assess the indications for, numbers of and outcomes of care for adults with intellectual disabilities referred to a specialist palliative care service over a two-year period. Service utilization aspects considered included the frequency of home visits by a specialist palliative care doctor or clinical nurse specialist and the number of hospice admissions that occurred for the patients. Method: A retrospective review was carried out of persons 18 years and older with intellectual disabilities referred to a specialist palliative care service. A manual review was carried out of the register using the place of residence and diagnosis in addition to the patients known to the clinicians who had intellectual disabilities. Results: 16 persons with intellectual disabilities were identified as being referred during that time. However, this may be an underestimate. 8 women and 8 men were referred with an age range of 50 to 81 years old. 4 patients referred did not have home visits from the specialist palliative care team. A range of 2 to 12 phone calls per person occurred by the specialist palliative care team regarding this cohort of patients. For some patients, the care is ongoing. Sadly, other patients died. Conclusion: Providing specialist palliative care for adults with intellectual disabilities is an important element of palliative care. Further research is necessary, and education to inform, support and empower specialist palliative care professionals in optimizing palliative and end-of-life care for persons with intellectual disabilities and to inform service development and provision.

Keywords: palliative care, intellectual disabilities, service planning, practice review

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