RESUMEN
Premature infants or neonates in need of advanced clinical care must be transported to specialized hospitals. Past studies have examined vibrations experienced by patients during transport; however, multiple confounding factors limit the utility of on-road data. Hence, the development of a standardized test environment is warranted. The overall purpose of this project is to characterize vibrations during neonatal patient transport and develop mitigation strategies to reduce exposure. This paper focusses on the development of a laboratory test environment and procedure that enables studying the equipment vibration in a comprehensive and repeatable manner. For the first time, a complete neonatal patient transport system, including a stretcher, has been mounted on an industrial shaker. Results largely validate the system's ability to simulate on-road vibrations with high repeatability.
Asunto(s)
Hospitales Especializados , Vibración , Humanos , Lactante , Recién NacidoRESUMEN
OBJECTIVES: To determine if sound-activated noise meters providing direct audit and visual feedback can reduce sound levels in a level 3 neonatal intensive care unit (NICU). DESIGN/METHODS: Sound levels (in dB) were compared between a 2-month period with noise meters present but without visual signal fluctuation and a subsequent 2â months with the noise meters providing direct audit and visual feedback. RESULTS: There was a significant increase in the percentage of time the sound level in the NICU was below 50â dB across all patient care areas (9.9%, 8.9% and 7.3%). This improvement was not observed in the desk area where there are no admitted patients. There was no change in the percentage of time the NICU was below 45 or 55â dB. CONCLUSIONS: Sound-activated noise meters seem effective in reducing sound levels in patient care areas. Conversations may have moved to non-patient care areas preventing a similar change there.
Asunto(s)
Monitoreo del Ambiente/métodos , Unidades de Cuidado Intensivo Neonatal/normas , Ruido/prevención & control , Acústica/instrumentación , Retroalimentación , Ambiente de Instituciones de Salud/normas , Humanos , Recién Nacido , OntarioRESUMEN
OBJECTIVES: To determine whether implementation of a noise reduction policy followed by the addition of direct audit and feedback reduces noise levels in a tertiary-level neonatal intensive care unit (NICU). STUDY DESIGN: Noise level data was collected in three phases: (1) baseline (preintervention), (2) immediately postimplementation of our noise reduction policy, (3) postunveiling of direct audit and feedback mechanism. SETTING: A level 3 NICU in Ontario, Canada. INTERVENTIONS: Noise reduction policy and a direct audit and feedback mechanism. MAIN OUTCOME MEASURES: Average noise level. RESULTS: The baseline level of noise in our unit consistently exceeds guidelines with an average baseline noise of 49 dB (±1.4). Our intervention resulted in a significant reduction in noise levels for one of the four areas in our NICU [-1.06 dB (-1.52, -0.6)], with a trend towards reduction in a second area (-0.21 dB (-0.6, 0.18)). Unexpectedly, two other areas experienced a significant increase in noise (2.05 dB (1.18, 2.94); 0.85 dB (0.11, 1.59)). CONCLUSIONS: The baseline noise in the NICU consistently exceeds guidelines, but reductions in noise levels are achievable. Nonetheless, more work is needed to find the optimal NICU design and noise reduction strategy.
Asunto(s)
Auditoría Clínica/métodos , Guías como Asunto/normas , Recién Nacido/fisiología , Unidades de Cuidado Intensivo Neonatal/organización & administración , Ruido/efectos adversos , Canadá , Humanos , Ruido/prevención & control , Evaluación de Programas y Proyectos de Salud , Espectrografía del Sonido , Centros de Atención TerciariaRESUMEN
PIP: The author examines the consequences of Brazilian policy designed to encourage the development of frontier regions. Incentives include the provision of free land to the poor and credits to the land-owning class for the development of modern crops. She considers not only the consequences for migration flows but also the social changes inherent in implementing such policies. Data are from fieldwork and from the 1970 and 1980 censuses. (SUMMARY IN ENG)^ieng