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Objective To determine the accuracy of the thermal imaging camera for the detection of vascular insult before the onset of permanent tissue damage. Study design Descriptive study. Place and duration of study Department of Burn and Plastic Surgery, from July to December 2019. Methodology The thermal image was used as an adjunct to clinical assessment in 84 flaps. Both pedicled and free flaps were performed in the study with a frequency of 68 (81%) and 16 (19%), respectively. Flap monitoring was performed regularly for five days by same team of surgeons and nurses. Flap vascularity was assessed by temperature gradient colour coding of thermal image taking the clinical assessment like colour, temperature, capillary refill, as a gold standard. Sensitivity and specificity of the thermal camera were calculated. Results The age range of patients was from 5 years to 55 years. The diagnostic accuracy of thermal imaging camera was calculated to be 96.43% with a sensitivity of 98.7%, specificity of 75%. The positive predictive value was found to be 97.4%, negative predictive value was 85.7%, the false-negative value was 14.3%, and the false-positive value was 2.6%. Conclusion Thermal imaging camera is an effective and useful adjunct for clinical assessment, as it is an easy and contactless technique. Key Words: Flir one, Flap monitoring, Thermal imaging camera.

Objective: To study effectiveness of EUA colour coding system in performing urological procedures during COVID-19 Methodology: It is descriptive Study during three waves of COVID 19, conducted in Department of Urology at Institute of Kidney Diseases Hayatabad Peshawar, Pakistan from March 24, 2020 till March 30, 2021. Total numbers of 3066 operated patients were included in the study. We followed the EUA guidelines of color coding for prioritization of surgical procedures. All the data of the patients and doctors were recorded on structured proforma and was analyzed on SPSS version 20. Results" Total numbers of 3066 surgeries were performed during three waves of COVID 19, that included 937 (30.5 %)) emergency Procedures with code black , 1272 (59.74%) high Priority labeled as code red, 636 (29.8%) as code yellow in intermediate priority and 221 (10.3%) as code green in. Regarding emergency surgeries code black, Obstructive uropathy remained high with 566 patients (60.4 %) patients, Pyonephrosis in 187(19.9%), Genito-urinary trauma in 93 (9.9%), miscellaneous in 91 (9.7%). The 1272 patients with high priority were dominated by Complicated Urolithiasis and High grade Urooncology. The preoperative nasopharyngeal PCR of 206 patients (22 %) in emergency procedures came positive for COVID-19. The rate of positive seroconvesrion was recorded in 82(6%) in high and 9 (1.5%)in intermediate priority and no seroconvesrion was recorded in code green . Conclusion:The EUA guidelines is a useful tool in prioritization of urological procedure.

Haemorrhagic shock is the most common preventable cause of early mortality in polytrauma patients. Road traffic injuries are the most common cause for polytrauma and most commonly include orthopaedic injuries. Hence, orthopaedic trainees and junior orthopaedic surgeons need to be well aware of evaluation and management of haemorrhagic shock in the multiple injured patient. The present narrative review discusses evaluation and current principles in management of haemorrhagic shock in a polytrauma patient. A classification system for haemorrhagic shock based on ATLS guidelines has been described along with novel use of colour coding to facilitate better and effective use of the classification. A treatment algorithm has also been presented for quick reference. The emphasis is to avoid overloading with crystalloid fluids, replacing with blood and blood products (Balanced resuscitation), permissive hypotension, prevent and acutely treat lethal conditions such as hypothermia, acidosis and coagulopathy. The management of haemorrhagic shock in polytrauma patient is quite challenging and require a detailed knowledge of its management. An arbitrary and haphazard management of these patients may lead to severe complications. We have mentioned the broad principles of management of hypovolemic shock in a polytrauma patient.

The Medical Council of India has mandated that two-thirds of the teaching schedules must comprise of interactive teaching sessions. Introduced by Elliot Aronson in 1971 in Texas, USA, ‘Jigsaw’ is an interactive and a cooperative, peer-assisted learning technique. The authors conducted Jigsaw classrooms in 3 different settings and utilized an innovative colour coding technique using coloured stickers. The colour coding helped in the seamless and noiseless movement of the participants from the home group to expert groups thereby ensuring a smooth transition from one step of the Jigsaw to the next. The various steps were able to start without any delay due either to any confusion about which group to join or the time wasted in asking the facilitators or other delegates for directions. The colour coding was especially helpful in the conduct of the final step when students must discuss the given sub-topics in the correct sequence. Despite extensive searching, the authors were unable to find any other instance of utilizing colour coding in a Jigsaw classroom. Based on the positive feedback and the advantages of colour coding, the authors feel that it can be replicated in Jigsaw classrooms across the world for better coordination among the students, saving time in transitioning from one step to the next and ensuring that the discussion sticks to the intended sequence.

Objective To presents a novel clinically oriented system to report stone attenuation on non-contrast computed tomography (NCCT) using colour-coded density-gradients stone mapping and its clinical applications. Patients and methods This study was performed on 50 patients with 63 stones. All patients had a recent history of failed shockwave lithotripsy (SWL) or failed dissolution therapy by alkalinisation of urine for radiolucent stones. A multi-detector NCCT examination of the abdomen and pelvis was performed in all patients. The stones were isolated and displayed in ‘Volume Rendering Technique’ using four-colour encoding. Results Eight patients with failed dissolution therapy for radiolucent stones showed an outer layer of >500 Hounsfield units (HU) or a heterogeneous composition. A total of 42 patients with failed SWL had mean attenuations of 1000 HU) that failed to be clearly demonstrated by the mean HU alone. Conclusion The initial use of a colour-coded density-gradients stone mapping reporting system for stone density on NCCT is useful for explaining failure of SWL or failure of dissolution therapy for radiolucent stones in selected cases. Abbreviations: HU: Hounsfield units; MSD: mean stone density; NCCT: non-contrast computed tomography; PCNL: percutaneous nephrolithotomy; SWL: shockwave lithotripsy; VRT: Volume Rendering Technique

Aim: To compare the shear bond strength values to dentin using different surface treatment of PEEK by sandblasting and acid etching techniques. Methodology: Forty removed human molar teeth (maxillary/mandibular) were used in this investigation. Extracted teeth were cleaned with an ultrasonic scaler (EMS, Switzerland) and kept in a 10% formalin solution to eliminate surface debris. An acrylic resin block of dimensions 10mm x10mm was fabricated using autopolymerising acrylic resin (DPI-RR Cold Cure, India) and the teeth were embedded in the center of block upto complete submergence of the root. Two groups were made (group A and group B), each comprising of 20 blocks and colour coding was done to distinguish the groups. Group A comprised of clear acrylic resin blocks in which the PEEK surfaces were modified by acid etching and group B comprised of pink acrylic resin blocks in which PEEK surface was modified by sandblasting. Results: Mean ± SD of shear bond strength recorded for group A and B was 1.94 and 2.40 Mpa respectively with statistically significant difference as P

Background: Biomedical waste management is integral part of medical microbiology and infection control program in any healthcare institute. Proper management of the waste generated in the healthcare facilities needed to carried out in accordance with the BMWM Rules, 2016. Any loophole in this management can lead to hazardous consequences. Material and Method: more than 100 health care workers participated in this study. A pre formed questionnaire was used to assess the knowledge of all study participants. Also major demographic and occupational variables were recorded and analyzed in this study. Result: most of the participants were having average and good knowledge of BMW. Mean score recorded for this study was 17.82 out of 30 with standard deviation of 5.61. Also majority of participants including housekeeping staff knows about colour coding in BMW management. Conclusion: In conclusion, BMW training should be integral part of continuous medical education in each health care facility. Keywords: Biomedical waste management (BMW), Knowledge, Healthcare workers, Hospital.

True colour vision requires comparing the responses of different spectral classes of photoreceptors. In insects, there is a wealth of data available on the physiology of photoreceptors and on colour-dependent behaviour, but less is known about the neural mechanisms that link the two. The available information in bees indicates a diversity of colour opponent neurons in the visual optic ganglia that significantly exceeds that known in humans and other primates. Here, we present a simple mathematical model for colour processing in the optic lobes of bees to explore how this diversity might arise. We found that the model can reproduce the physiological spectral tuning curves of the 22 neurons that have been described so far. Moreover, the distribution of the presynaptic weights in the model suggests that colour-coding neurons are likely to be wired up to the receptor inputs randomly. The perceptual distances in our random synaptic weight model are in agreement with behavioural observations. Our results support the idea that the insect nervous system might adopt partially random wiring of neurons for colour processing.

Around 8% of the male population and 0.4% of the female population have colour vision deficiencies. Since software design also operates along the coordinates red, green, and blue, computer generated images often create needless problems for those affected. The rainbow-like colour coding used in thermo-imaging and other applications is the subject of this research. There is an alternative to this rainbow spectrum.

‘Growing‐up milks’ (GUMs)—breast‐milk substitutes targeted for young children (aged 12–36 months)—are commonly consumed in Indonesia. The World Health Assembly has stated that GUMs are not necessary for proper growth and development, and recently, the American Academy of Pediatrics declared that such products are not recommended for young children due to their common use of sweeteners. To contribute to the evidence base on the composition of GUMs and their appropriateness for young child diets, this cross‐sectional study documented the declared sugar content and presence of nutrient content claims of 99 GUMs newly launched in Indonesia between January 2017 and May 2019. Sugar content was evaluated against the draft 2018 Codex Alimentarius Standard for Follow‐Up Formula guidance on sugar content and the United Kingdom Food Standard Agency's front‐of‐pack (UK FSA FOP) colour coding system for sugar. Almost all (97%) GUMs contained one or more added sugars. None of the products were fully compliant with all three sugar content recommendations in the draft Codex standard. Seventy‐one per cent of GUMs were determined to have high sugar content according to the UK FSA FOP system. Nutrient content claims were found on 97% of GUMs. Median total sugar content was 7.3 g per 100 ml, similar to sugar content levels in sugar‐sweetened beverages. Many GUMs available in Indonesia claim to offer nutritional benefits; however, the current levels of sugar content in GUMs are a serious concern and are inappropriate for inclusion in the diets of young children.

An unanticipated difficult airway needs immediate and well-coordinated management to maintain oxygenation and avoid a poor patient outcome. In addition to medical knowledge, technical skills, competencies and performance, human factors contribute substantially to success during unanticipated difficult airway management. Human factors can be influenced by cognitive aids like algorithms. These algorithms can be further enhanced by using a strong visual stimulus like colour coding to provide easy and fast orientation. Colour coding as cognitive aid is recommended in some difficult airway guidelines but the translation into clinical practice is underreported. This article describes the application of colour coding for cognitive aids to facilitate the management of an unanticipated difficult airway and its further local implementation in the form of a colour-coded difficult airway trolley.

A knowledge, attitude and practice cross-sectional survey was conducted among dental practitioners doing private practice in district central, Karachi after checking eligibility and taking their written informed consent. The practitioners were interviewed by the principal investigator with the help of a pre-tested structured questionnaire developed specifically for this study. The study results revealed that 175(88.8%) of the participants were aware that waste management guidelines are applicable to them, 184(93.4%) were aware that healthcare waste is a source of infection whereas 145(73.6%) were aware about the colour coding of healthcare waste bags/containers. Moreover, 165(84.1%) thought that health care waste disposal protocol lessens the chance of injuries and infections whereas 182(92.0%) were in favour of the need to continue medical education about health care waste management. It is recommended that healthcare waste should be segregated and disposed of in a safe manner to protect the people at risk and the environment.

OBJECTIVE: This is a pilot study to assess whether a file-colour-coded triage navigation system for patients on primary chemotherapy improves compliance and adherence and if it decreases defaulting. MATERIALS AND METHODS: All breast cancer patients are discussed in a multidisciplinary meeting. All patients are triaged before starting on primary chemotherapy based on their specific challenges and beliefs and are consulted by the navigation team and contacted before the beginning of treatment and after each chemotherapy session by a navigator in the unit. File stratification for ease of navigation was instituted by a colour code dot into three groups. The three groups are: Code Green: Compliant on treatment. Code Yellow: Side effects on treatment/ considering defaulting. Code Red: Non-compliant. The code red patients were further assessed in terms of reasons for non-adherence or non-compliance: Fear of chemotherapy side effects. The belief that chemotherapy kills the patient. Interest in “alternative treatment regimens”. Other barriers to treatment as identified by the navigators. RESULTS: The system allows the navigation team to focus on which patients require specific navigation and inform the treating oncologists. Code green patients were courtesy called after each chemotherapy session. The code yellow patients had early involvement with the survivorship team to ensure appropriate management of any side effects. Access to the complimentary oncology navigator and complementary health website was instituted. The oncology navigator visited each patient at the oncology unit on the day the patient was due to have chemotherapy. For Code red 1 and 2, a “buddies” network of patients who have been through similar treatment regimens was assigned by the navigation team. This was coordinated by patient navigators (trained counsellors who have had breast cancer treatment). Code red three was managed by a complementary health specialist who understood the value of chemotherapy. For Code red 4, the oncology navigator manages the concerns from finances services to family issues. For the 122 patients in total for primary chemotherapy, stratification was as follows: Code Green=64.8%. Code Yellow=27.0%. Code Red=8.2%. CONCLUSION: This system provides the Multidisciplinary team with the opportunity to improve patient adherence/compliance with primary chemotherapy. 80% of the code red patients eventually agreed to receive the recommended treatment. Navigation enhanced patient supervision, and the coding system improved patient primary chemotherapy adherence. Such a system would benefit larger oncological practices to improve primary chemotherapy adherence by empowering the navigation team to identify patients requiring more intensive navigation supervision.

Colour coding is defined as the systematic, standard application of color to aid in classification and identification.1 Colour coding in health care is mainly used for better enhancement, differentiation, systematic classification. Colour coding is used in various fields of medicine for different purpose. Techniques used commonly are colour differentiation and colour matching.2Colour coded growth chart is an important tool for the classification of malnutrition and used as a diagnostic aid for Health care workers and educational tool for mother in child care.3 Rapid categorization of victims during mass casualties follows colour coding and decides medical action required. Red tag indicates critical patients demanding immediate action, yellow tag indicates non-ambulatory patients between critical and minor categories requiring urgent action, green tag for ambulatory patients who need minor care and black tag implies expired patients.4

Background: Lack of adequate knowledge regarding bio-medical waste management leads to health risks as well as environment apprehension. Proper handling and disposal of bio-medical waste is therefore very important. The present study aimed to assess the knowledge and practice of bio-medical waste management among the health care personnel in selected primary health care centres in Lucknow. Methods: This was a Cross-Sectional study conducted among health care personnel working at the Primary Health Centres. A total of 89 health care personnel comprising of doctors, nurses, health workers, laboratory technicians, pharmacists and class IV workers were interviewed with a pre-designed and pretested semi-structured questionnaire. Results: About 35.0% of the staff nurses, 56.2% of paramedical staff and none of the class IV workers had complete knowledge about colour coding and segregation of bio medical waste. As compared to other health care personal, only 18.8% of class IV workers had heard about universal precautions, while 45.4% were concerned about needle stick injury. None of the class IV workers had ever received training for BMW management. Proportion of staff nurses, paramedical staff and class IV immunized for Hep B Vaccine was 50%, 21.8% and 9.1% respectively. Conclusions: The study revealed lack of knowledge and awareness about bio-medical waste management amongst primary healthcare workers which results in inadequate handling and management, thereby exposing them as well as the general public to health and environmental hazards.

This paper presents the perceptions of health workers (HWs) on medical waste management (MWM) issues in Tanzanian hospitals. The perceived total waste generation rates were lower than the actual measurements. Administrators perceived lower rates than implementers. The results indicated three categories of medical waste which are given due attention, that is, sharps waste, pathological and infectious waste. Other wastes like radioactive, chemical, pharmaceutical, pressurized containers receive very little attention. Container colour coding and labelling was negligible, while improvised containers are still in use. Medical waste is transported within hospitals manually, with little efforts on mechanized transportation. Poor waste storage was observed, while the prominent medical waste treatment technologies are medium temperature incinerators. Off-site transportation of medical waste is practiced, where the waste is finally dumped or buried. The hospitals are currently utilizing public-private partnership schemes for MWM in only one aspect of off-site transportation. Three main problems which require high attention include: Weaknesses in hospital management, poor MWM infrastructure, and lack of skills and knowledge on MWM among HWs. Knowledge and awareness among HWs on health hazards associated with poor MWM is low (with exception of cholera, HIV and typhoid). Few PPE types are supplied and used in the hospitals, leading to poor diseases prevention. There is also low knowledge among HWs on administrative issues related to MWM in Tanzanian hospitals.

Aim: To study the awareness, attitude, practice and facilities among the different categories of dental laboratories in Abha city.Materials and Methods:A total of 80 dental technicians were surveyed in the study. The dental laboratories included in the study were teaching institute (Group I), Government Hospital (Group II), Private Dental Clinic (Group III) and Independent laboratory (Group IV). The pre-tested anonymous questionnaire was used to understand knowledge, attitude, facilities, practice and orientation regarding biomedical waste management.Results:The knowledge of biomedical waste categories, colour coding and segregation was better among Group I (55-65%) and Group II (65-75%). The lowest standard of waste disposal was practiced at Group IV (15-20%) and Group III (25-35%). The availability of disposal facilities was poor at Group IV. The continuous education on biomedical waste management lacked in all the Groups.Conclusion: The significant improvement in disposal facilities was required at Group III and Group IV laboratories. All dental technicians were in need of regular training of biomedical waste management.Clinical Significance: The dental laboratories are an integral part of dental practice. The dental laboratories are actively involved in the generation, handling and disposal of biomedical waste. Hence, it is important to assess the biomedical waste management knowledge, attitude, facilities and practice among different categories of dental laboratories.

Objectives To assess the dentist's awareness about dental care waste management. To know the various methods of bio-medical waste disposal practiced by private dental practitioners in Chennai City. To assess the awareness of dentists regarding colour coding of biomedical wastes. Materials and Methods A cross sectional questionnaire study was conducted among 250 private dental practitioners selected by simple random sampling. A pretested questionnaire consisting of 28 close ended questions divided into two sections was used. Results Out of 250 participants 167(66.8%) were males and 83(33.2%) were females. About 14.8% of the dentists were not aware of the different categories of bio-medical waste generated in their clinic. About 28% of the dentists were not aware of the bio-medical waste management law in India and the same number (28%) were not aware of the colour coding for different types of biomedical wastes. Conclusion The present study indicates that the majorities of the dental practitioners were not aware of the different categories of biomedical waste and are not practicing the appropriate method of waste disposal. There is an urgent need for continuing dental education on dental care waste management for the dental practitioners.

Mathematical model are applied to predict the sensitivity of climate to changes produced by natural phenomena and human activities. In this paper Air Pollution Deterministic Index Modeling (APDIM) for Pakistan is developed with the practical implication in Quetta City. The modeling is based on deterministic model and Pollution Indices to monitor the Ambient Air condition in Quetta City. The novelty of the model is adding a coefficient in the basic deterministic formula. The values of the coefficient balance the theoretical and experimental validations for Ambient Air. The tool gives the alerts about the weather conditions in simple indices or colour coding displays. These indices indicate the air pollution situation in the city by a single number or colour code. The application of the applied model is done in Quetta city, six criteria pollutants (CO, SOx, NOx, O3, TSP and PM10) are chosen for modeling according to the WHO criteria which have harmful health effect on the communities. The results of the modeling indicate that the gases (CO, SOx, NOx, and O3) are touching the boundary of satisfactory to un-satisfactory zone. The cause of concern is TSP and PM10, which lies in the hazardous zone. APDIM is an important tool of decision making, which determine the risk assessment for communities. The aim of the tool is to inform the general public of the local area about the severity of ambient air pollution, and the possible health hazard it causes, particularly on vulnerable groups or people with existing cardiac, lungs and breathing diseases. Further the tool helps the environmentalists and policy makers to modify the policy and strategies according to the provided air data.

Background In order to provide services for children with disabilities which are family focused, strengthening and enabling families in addition to meeting the child's identified needs, it is important to understand families' lives. This study investigates whether time‐use diaries can provide an acceptable tool to explore the daily lives of parents with a disabled child. Methods A precoded time‐use diary divided into 15 min time slots was designed. Father–mother pairs with a preschool child with either autism (ASD) or technology dependence (TD) were asked to complete a 7‐day diary independently, over the same time period. Each parent was then interviewed separately to ascertain their experiences of using the diary. Participants were identified through their involvement with a Child Development Centre. Results Twenty‐six parents (13 father–mother pairs) were invited to participate. Eighteen parents agreed to be involved; 16 completed the diaries and interviews. Three father–mother pairs in the ASD group and one father–mother pair in the TD group declined to be involved. One father–mother pair from the TD group withdrew from the study. Of the 18 parents who agreed to participate, 15 found the diaries acceptable and either easy or straightforward to complete. One parent with dyslexia and one who described himself as a non‐reader completed the diaries successfully, finding the colour coding helpful. Parents spent between 10 and 60 min a day completing the diaries, with the median 20–30 min. The diaries provided information on the total amount of time spent on different activities and how much time parents spent together, with their other children, at home or elsewhere. Conclusion The time‐use diaries designed for this study were acceptable to the majority of parents and provided detailed information about their daily lives.

International Journal of Paediatric Dentistry 2010; 20: 353–360 Background. The in vitro methods used for the assessment of the severity of molar-incisor hypomineralisation (MIH) are not available for clinicians faced with questions regarding the severity in clinical cases, and the best management approach. Aim. To assess whether there is a relation between the severity of the defects in MIH enamel (represented by reduction in the mineral density) and the clinical presentation (represented by the colour of the defect and its laser fluorescence). Design. The colour of enamel was recorded (normal, white, yellow or brown) in specific areas for ten extracted first permanent molars with MIH defects and ten extracted sound teeth. Laser fluorescence (LF) and mineral density (MD) were measured for the same areas. A mixed model, using sample/tooth as a random effect, was used to estimate the relationship between the MD and the colour-coding, and between the MD and LF readings. Results. The between-samples correlation coefficient for the colour coding and the MD was 0.99 (P

Background: Since intra-bony pathologies might jeopardize implant outcome, their preoperative detection is crucial. Material and methods: In sixteen human cadaver bloc sections from upper and lower jaws, artificial defects with progressively increasing size (n=7) have been created. From each respective defect, analogue and digital intra-oral radiographs were taken, the latter processed via a periodontal filter and afterwards presented in black-white as well as in colour, resulting in three sets of 7 images per bloc section. Eight observers were asked to diagnosis an eventual defect on randomly presented radiographs, and at another occasion to rank each set based on the defect size. Results: The clinicians were only able to identify a defect, when the junctional area was involved, except for bony pieces with a very homogeneous structure. Conclusion: For longitudinal evaluation of healing bone (e.g. after tooth extraction), colour digital images can be recommended. These observations indicate that intra-oral radiographs are not always reliable for the detection of any intra-bony defect.

In the diagnosis of deep vein thrombosis compression B-mode sonography and colour coded Duplex-sonography both are reported to give excellent results in sensitivity and specificity in comparison to phlebography. Therefore value and cost effectiveness of colour coded Duplex-sonography versus compression B-mode sonography are questionable. In our examinations with colour coded Duplex-scanning done one 116 patients in comparison to phlebography we achieved corresponding results to the values of present publications (sensitivity in the leg was 100%, in the calf 89%; specificity in the leg was 94%, in the calf 91%). In earlier examinations with compression B-mode sonography done on 64 patients we were less successful in gaining these results in comparison to phlebography: sensitivity was 76% and specificity was 88% in the iliaco-, femoro-, popliteal region. We discuss the limitations of the compression test in our experiences and point out the advantages of colour coding under special situations.

Summary Background and objectives: The potential for increased drug administration errors during the transition to the International Colour Coding syringe labelling system has been highlighted. The purpose of this study was to assess the potential effects before their introduction into our department. Methods: Thirty-one anaesthetists, 19 with no previous practical experience of the new labelling system (Group 1), and 12 with previous experience (Group 2), volunteered to induce general anaesthesia for a standardized simulated patient in a designated theatre. They were presented with a scenario designed to suggest the need for a rapid sequence induction and provided with drug syringes labelled with the International Colour Coding system. All drug administrations were recorded. Active error was defined as the injection of the wrong drug. Latent error was defined as the selection of a syringe in error but stopping short of administering the drug. Results: In Group 1 a total of 107 drug injections were recorded of which 1 (0.9%) was an active error and 16 (15%) involved latent errors. Eleven anaesthetists (58%) performed at least one latent error. Group 2 had an error rate of 3%, a 6.9 (1.3–26.7) fold reduction in the rate of error ( P = 0.023). Conclusions: Although only one drug was given in active error, latent errors occurred in 15% of drug administrations. The only factor conferring protection against error was prior experience of the new labelling system. The period of transition to the International Colour Coding syringe labelling system represents a time of increased risk of drug administration error.

Summary When most emergency medical caregivers are asked about the type of patients who truly inspire fear, more often than not, the answer is "children". Why is there this inverse relationship between the age of the patient and the caregiver's level of anxiety? Perhaps the answer to this question is that while emergency personnel regularly provide medical and trauma care for adults, many of us see critically ill children or pediatric trauma patients only on a rare, if not very rare, basis. 2–6 Recognising the effect of this anxiety has led to ongoing efforts to find ways to minimise the source of these stressors. This article will review the history, present status, and hopeful future of the Broselow tape – which was initially designed to assist in the quick and accurate estimation of weight in cases of pediatric trauma – with a specific focus on its applications for pediatric trauma care.

Objective: In recent years, there has been increasing use of analytical and graphical methods to assist the monitoring of outcomes in adult cardiac surgery. In this paper, we present extensions to the basic VLAD methodology that add flexibility and assist in its interpretation. Methods: Using techniques from probability theory, we have devised graphical tools whereby deviations from expected outcomes can be monitored to see how likely they are to have occurred by chance. The methods are based upon pre-operative assessments of risk and use exact analytical techniques. Results: These tools allow deviations from expected outcomes to be readily assessed and compared with the distribution of chance outcomes. Appropriate colour coding allows interpretation in terms of a temperature gradient. Conclusions: Exact analysis methods based on the use of pre-operative risk assessment provide a useful means for assisting the interpretation of VLAD charts. Such analysis has the advantage that it is applicable even for relatively short series of operations. Also, it takes specific account of the heterogeneity of case mix when quantifying the variability that is expected. By displaying the overall history of outcomes in a visually intuitive manner, it complements the more formal tools for detecting isolated good and bad runs that are available. q 2004 Elsevier B.V. All rights reserved.

At least one in 10 patients experience adverse events while receiving hospital care. Many of the errors are related to laboratory diagnostics. Efforts to reduce laboratory errors over recent decades have primarily focused on the measurement process while pre- and post-analytical errors including errors in sampling, reporting and decision-making have received much less attention. Proper sampling and additives to the samples are essential. Tubes and additives are identified not only in writing on the tubes but also by the colour of the tube closures. Unfortunately these colours have not been standardised, running the risk of error when tubes from one manufacturer are replaced by the tubes from another manufacturer that use different colour coding. EFLM therefore supports the worldwide harmonisation of the colour coding for blood collection tube closures and labels in order to reduce the risk of pre-analytical errors and improve the patient safety.

Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.

The history of ultrasonography of the head and neck region begins in the 1970s, initially with one-dimensional A-scan examinations and later on with two-dimensional imaging using linear and compound scanners. In the early 1980s dynamic developments took place, not only in terms of the technical possibilities presented by ultrasonography but also in terms of broadened medical applications in all specialties. Progressing from analog to digital image processing, colour coding and combining B-mode with Doppler technology provided for improved topographic, structural and functional analysis. All this highlights the importance of ultrasonography in the armamentarium of clinical and imaging diagnostics.

Intensive care unit (ICU) monitors have alarm options to intimate the staff of critical incidents but these alarms needs to be adjusted in every patient. With this objective in mind, this study was done among resident doctors, with the aim of assessing the existing attitude among resident doctors towards ICU alarm settings. This study was conducted among residents working at ICU of a multispeciality centre, with the help of a printed questionnaire. The study involved 80 residents. All residents were in full agreement on routine use of ECG, pulse oximeter, capnograph and NIBP monitoring. 86% residents realised the necessity of monitoring oxygen concentration, apnoea monitoring and expired minute ventilation monitoring. 87% PGs and 70% SRs routinely checked alarm limits for various parameters. 50% PGs and 46.6% SRs set these alarm limits. The initial response to an alarm among all the residents was to disable the alarm temporarily and try to look for a cause. 92% of PGs and 98% of SRs were aware of alarms priority and colour coding. 55% residents believed that the alarm occurred due to patient disturbance, 15% believed that alarm was due to technical problem with monitor/sensor and 30% thought it was truly related to patient′s clinical status. 82% residents set the alarms by themselves, 10% believed that alarms should be adjusted by nurse, 4% believed the technical staff should take responsibility of setting alarm limits and 4% believed that alarm levels should be pre-adjusted by the manufacturer. We conclude that although alarms are an important, indispensable, and lifesaving feature, they can be a nuisance and can compromise quality and safety of care by frequent false positive alarms. We should be familiar of the alarm modes, check and reset the alarm settings at regular interval or after a change in clinical status of the patient.

A survey of 35 hospitals in the United Kingdom has uncovered a wide variety of syringe drug labels. Use of different systems in different hospitals may result in wrong drug administrations, particularly when trainees move from one hospital to another. There is an urgent need to standardise the colour coding of syringe labels in the United Kingdom. Such standards are already in place in Australia, New Zealand and in the United States of America. This survey of syringe drug labels highlights the existing risks and recommendations for change are made.

Objective : To quantify first-pass enhancement of cervix carcinoma using fast dynamic MRI. To assess the accuracy of dynamic contrast-enhanced colour-coded MRI for determining tumour invasion into surrounding pelvic tissues. Methods : Gadolinium enhanced dynamic MRI at one image every 2 s was performed in 47 patients with cervical carcinoma and five controls. First-pass contrast enhancement of cervix carcinoma and surrounding pelvic tissues was quantified. Automated colour-coded images were constructed using the dynamic parameters slope, amplitude and timing of enhancement. Of 47 patients, 28 underwent surgery and colour coded images were correlated with histological findings. Results : First-pass contrast enhancement imaging of cervix carcinoma required a temporal resolution of dynamic MRI of one image every 3–4s. Cervix carcinoma firstpass was more rapid and intense than that of other pelvic tissues ( P P >0.05). Binary colour coding, however, was not reliable for tumour delineation or for accurate assessment of tumour invasion into the parametria or the bladder wall. Overestimation of the extent of tumour invasion occurred in 15, 16 and nine out of 28 patients, respectively, using amplitude, slope and timing of enhancement as parameters. Conclusion : Dynamic contrast-enhanced colour-coded MRI of cervix carcinoma has limited value for assessing the extent of tumour spread and tumour staging.

Colour coded warnings on the labels of drugs for anxiety and insomnia to alert users to their potential adverse effects on driving have not reduced road traffic crashes associated with these medicines, data from a French national programme have shown.1 Ten years ago France introduced a national system of colour coding medicines to highlight their effects on driving performance, having found that benzodiazepines …

Until now, no single recording system for urinary incontinence has found widespread acceptance. The Queen Elizabeth Graphical Assessment for Urinary Incontinence has been developed to display the pattern of voiding on an hourly basis over a four day period. Colour coding of the chart indicates clearly whether the patient is incontinent, continent or able to remain continent with the help of staff or carers. The system can be used in the initial assessment of urinary incontinence and also in monitoring progress in any subsequent treatment interventions. In established urinary incontinence in the nursing home setting, the chart has been used in the documentation for Resident Classification Instrument ratings. The format is simple to use and can be applied to hospital, residential care and home settings.

ObjectiveCanadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers’ selection of products lowv. high in sodium.DesignParticipants were randomly assigned to one of five experimental conditions: (i) control condition with no FOP label; (ii) basic numeric FOP label; (iii) numeric FOP label with ‘high’ and ‘low’ sodium content descriptors; (iv) detailed Traffic Light (TL) label with colour coding, content descriptors and numeric information; and (v) simple TL label with no numeric information. Participants were shown pairs of grocery products that varied in sodium content and told they could choose a free sample. Selection of the low-sodiumv. the high-sodium product was the primary behavioural outcome, in addition to ratings of effectiveness, understanding, liking and believability.SettingWaterloo, Ontario, Canada.SubjectsAdults (n430) aged ≥18 years, recruited from community settings.ResultsParticipants in the three FOP conditions with ‘high/low’ sodium content descriptors were significantly more likely to choose the lower-sodium product compared with the control group. The detailed TL label was ranked most effective at helping participants select low-sodium products, and was rated significantly higher than other formats in liking, understanding and believability. Product selection did not differ significantly across sociodemographic groups.ConclusionsFOP labels that include content descriptors may be more effective in helping consumers to select lower-sodium products. TL labels, which incorporate content descriptors and colour coding, should be considered for future FOP labelling initiatives.

We report our experience with colour Doppler sonography (CDS) in 20 normal subjects and 25 patients with intraocular space-occupying lesions. The technique provided an in vivo cross-section of the vascular topography of space-occupying lesions in real time. Colour coding and spectral analysis helped to determine the direction and pattern of blood flow. CDS was found to be a useful diagnostic adjuvant, a guide to the treatment protocol, and helped in monitoring the progress of the disease. In conditions of the eye where unclear media hindered a clinical evaluation, CDS sonography was a safe, easily reproducible and non-invasive investigative tool. With further technical advances in waveform analysis and quantitative assessment, CDS holds promise as an investigative modality of choice in the future.

Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is ‘object communication’, the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contribution towards improvement of patient outcomes, deserves consideration.

The importance of colour-coded asthma treatment in patient education is well accepted. Traditionally, reliever medication inhalers are blue in colour and preventer inhalers brown.1 This custom is not always followed and the inconsistencies in the colour of inhalers create a lot of confusion. Marketing of the same medication in different colour inhalers and introduction of new drugs and combinations contributed to this predicament. The confusion created by the introduction of generic salbutamol in UK in orange-coloured inhalers has been previously discussed.2 Salbutamol in some countries comes in white inhalers with a blue cap. The colour coding of caps is never reliable as patients can easily change these …

Colour is a good way to diff erentiate tablets and their containers because it enables more immediate recognition than do words printed on labels or embossed onto tablets. Moreover, patients with poor vision or those not wearing their reading glasses can have diffi culty reading print on labels or tiny low-contrast embossed text on tablets. However, 8% of men and 0·4% of women have impaired colour-vision, of whom half are unable to recognise the main colours used in colour coding. In a survey of 100 people with impaired colour-vision, 2% reported that they had confused their medication because they had mistaken the colour of tablets. The appearance of warfarin tablets and containers to individuals with moderate or severe red–green defi ciencies of colour vision are shown in the fi gure. The pink tablet appears blue and the green tablet appears grey. Doctors and pharmacists should only use colour to instruct patients on how to identify tablets if they know that the patient has normal colour vision. People with red–green colour defi ciency can recognise yellow, blue, grey, and white—perhaps manufacturers should incorporate this information into guidelines about the use of colour for tablet identifi cation.

Stains and dyes are frequently used to emphasise tissue structures for viewing under microscopy but few simple objective quantification methods exist. We describe the derivation of a mathematical formula enabling calculation of the relative contribution of three different coloured components to an image, which can be applied to rapid batch assessment of tissue sections for quantification of area proportions of differently stained elements. In order to validate this method, termed Reverse Colour Coding (RCC), we compared RCC estimations with known area proportions in artificially created images to calculate absolute accuracy, and compared RCC with panel visual estimation (VE) for the assessment of actual NCAM-stained muscle slides. Our results indicate that RCC has an absolute accuracy of 98-98.5% and superior inter-observer agreement and both inter- and intra-observer variability compared with VE. Results also suggest that cognitive bias occurring with VE may be eliminated by use of RCC. We submit RCC as a more accurate and less labour-intensive method of quantifying area proportions of stained tissues on microscopic images.

The concept of fast and slow signals interacting by non-linear lateral processing at the inner plexiform layer and its suitable mathematical formulation, allows for a coherent interpretation of simple, complex and colour coding ganglion retinal cells of various representative vertebrates. In its simplest formulation, the processing can be expressed through non-linear spatio-temporal transformations. The formulations result in a coherent unified conceptual frame to interprete signal processing in vertebrates' retinae.

Introduction:During the 1999 conflict in Kosovo, an estimated 850,000 people were displaced from Kosovo. Many thousands of these people arrived in the Former Yugoslav Republic of Macedonia (FYROM), for whom a humanitarian evacuation programme (HEP) was conducted by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM). More than 91,000 people were moved to third countries under this programme.Methods:A health assessment tool was designed, validated, and implemented to document the health status of the refugees prior to departure. The IOM evaluated 41,652 pre-travel “fitness to travel” medical assessments for refugees transported by the Organization. A colour coding system for fitness-to-travel was used to clearly identify refugees to the receiving health authorities according to their health condition at the time of departure.Results:A total of 41,652 fitness-to-travel assessments were performed between 05 April and 25 June 1999, and were entered into a database. There were 21,923 females and 19,566 males. The average age was 25.3 years (women, 26 years; men, 24.3 years). Of these assessments, 4,647 (11.2%) individuals who were deemed fit-to-travel required medical assessment at the host destination, and of those 1,204 required urgent care. The majority of health complaints were acute respiratory tract infections and hypertension.Conclusions:A rapid and efficient system for fitness-to-travel was created to assist in the management of health issues related to the urgent and mass movement of refugees. The collected health information was of use to health-care planners during the crisis and for those responsible for the health-care of newly arrived refugees. The lessons learned have implications for future similar operations and for the development of research and education programs for both the refugees and the host recipient nations.