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THE prolonged strike in which the hospital porters and other ancillary staff were recently involved was an unhappy and uncharacteristic episode in the life of the hospitals, where a friendly spirit of co-operation is usually to be found among all grades of staff. Indeed, in the early phase of the dispute there were doctors and nurses as well as members of the public who had considerable sympathy for the underpaid hospital workers whose pay rise had been caught in the freeze, but their sympathy began to run out when sick patients had to be turned away from hospitals and as . . .

This is a revised version of a paper presented at the American Sociological Association Meetings, New York, New York, September 3, 1976. The research for this paper was made possible by funding from the Sloan Foundation to the School of Engineering, University of Wisconsin, Madison, for the study of the social impact of technology. We are indebted to Professor Theodore Bernstein of the University of Wisconsin School of Engineering and Dr. Kenneth Mylrea of the University of Arizona, Tucson, for their invaluable help both in technical expertise and practical experience in the medical device field. We would also like to express our appreciation to Ms. Vicki Bor and Mr. Michael Retzer for their assistance in obtaining interviews and historical records. Finally, Mayer Zald gave helpful criticism of an earlier draft.

Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

A method to modify existing temperature alarm systems on blood bank refrigerators is described. This provides an accurate and convenient method for monitoring the temperature alarm system outside of the refrigerator.

A retrospective survey of patients with sarcoidosis has revealed a 7.5 times greater number of nurses with the condition than expected. Nurses may be especially susceptible to sarcoidosis.

A two-year retrospective study of patient assaults on staff in a large British psychiatric hospital was conducted. An upward trend in assaults was noted. Information on high risk locations, and high risk time periods is presented. Characteristics of both the assaultative patients and the victim population are presented and discussed.

To overcome current problems in reporting large numbers of laboratory results in a coherent manner, this hospital has installed a PDP-12 computer system. This instrument is free-standing, dedicated only to laboratory use, and is a “turnkey” operation. All reports, including cumulative patient summaries, billing reports, worklists, specimen labels, venipuncture lists, etc., are obtained from the computer. Communication with the computer is in English-language conversational mode. In this article the computer system is described and evaluated. The work-flow is diagrammed and a new type of requisition is presented. Information is provided for selecting the size and characteristics of a computer system for a laboratory. The considerable difficulties inherent in the successful establishment of such a system and its costs in a laboratory are discussed.

Peripheral blood lymphocytes of hospital personnel handling cytostatic drugs showed no elevation of structural chromosomal aberrations or sister-chromatid exchanges (SCE) over the baseline. The urine of the probands did not induce SCE in peripheral lymphocytes in vitro.

Even though administrators must have effective staff-management procedures to ensure implementation of desired programs, many traditional staff-management proceudres remain unevaluated. This study investigated the effectiveness of three such procedures. The administrator of an institution for the retarded (1) sent a memo instructing all staff to lead daily recreational activities, (2) sponsored a workshop teaching staff to lead such activities, and (3) assigned staff activity leaders and provided performance feedback to staff by publicly posting the daily average number of active residents on each ward. Neither the memo nor the workshops motivated staff to lead activities, but after staff were scheduled to lead such activities and given performance feedback, the average daily number of residents engaged in activities on four wards for 95 retarded persons increased from seven to 32. The administration of this facility has adopted similar procedures to maintain such activities on all wards.

Six villages in Lofa County, north-west Liberia, and one near the coast were surveyed for the presence of indirect fluorescent antibodies (IFA) to Lassa virus (LV). Prevalences were similar among males and females, and among various age groups. The prevalence of IFA positive sera, 6.4%, in two roadside villages was significantly higher than in two matched villages "in the bush", 1.9%. It was also higher in Gbanwei, a roadside village which did not maintain traditional sanitary measures, than in Zuwulo, similarly located but with maintenance of clean-swept areas without shrubbery or rubble between the houses. In another pair of villages, the one adjacent to a Mission Clinic with a very high prevalence of IFA positive staff members had significantly higher prevalence, 14.1%, than did the other, a roadside village with 5.1% seropositives. LV antibodies were also found in 4.3% of the inhabitants of a small coastal village near Robertsfield International Airport. Though LV infections are more common in villages in which traditional practices have been modified, they are present even in villages which are relatively unchanged. In the former they appear to be continuous while sporadic in the latter. The prevalences of IFA in the villages with the highest rates are about one third of what is found in personnel of hospitals near them, suggesting that hospital staff members acquire infections from patients as well as from the communities in which they live.

The possibility that gram-negative bacilli (GNB) are part of the nontransient flora on hands was examined by using a broth rinse technique to detect low titers of GNB after a hygienic hand wash with soap and water. A total of 100 nurses who had direct patient contact and 40 controls without patient contact had a similar rate of recovery of GNB (46 and 55%, respectively). GNB persisted on the hands of 10 nurses throughout five successive hand washes with soap and water. Hand cultures were obtained daily from 12 nurses before and after a work shift in a surgical intensive care unit. GNB were recovered from 57% of individuals before patient contact and from only 24% after the work shift. Nontransient GNB on the hands of hospital personnel are a potential reservoir for hospital strains, and patient contact is not an obvious source for the acquisition of nontransient GNB.

The introduction of test strips for measurement of blood glucose has led to their widespread use by medical and paramedical staff outside the central laboratory. While many users have developed ad hoc schemes of training and quality control, formal guidelines have not been presented. This paper makes recommendations on various aspects of extra-laboratory blood glucose measurement in hospitals, but not in the home, with the aim of improving the safety and reliability of results. It is recommended that: 1. a formal programme of training should be devised by staff in the laboratory together with those in the diabetes service and others as appropriate; 2. laboratory and diabetes staff should train, assess, and approve more senior users who would then take responsibility for the training and performance of more junior colleagues; 3. all users should demonstrate their competence at regular intervals; 4. there should be a quality assurance programme arranged by the laboratory which tests the performance of the operator and the equipment; 5. laboratory staff, in consultation with users, should be responsible for the selection and purchase of equipment; 6. equipment should be cleaned and maintained on a regular basis by users.

Attaining adulthood has always been a difficult process in the management and guidance of our adolescent populations. The stress of chronic illness during this developmental stage cna complicate an already overpowering dilemma in adolescents struggling for independence. Too often, health care professionals react to the adolescent patient out of context. In managing their care, it is important to understand the framework of child development theory and also become aware of our own feelings in relating to adolescents. Adolescents have their own concepts of illness and hospitalization that must be assessed in formulating a comprehensive management plan. Taking all of these dynamics into account, hospital staff can present a more educational and preventative approach that involves that adolescent in helping him cope with his development during a vulnerable time.

From 1975 through 1982, the South Florida Hospital Consortium for Infection Control provided consultative and educational services to personnel of 20 community hospitals. To evaluate program efficacy, outbreak frequencies were compared at 11 hospitals with 5 to 8 years of experience through 1982. Annual outbreak rates during the first 4 membership years were compared with those of subsequent years, by service. Each hospital served as its own control. Outbreaks were most frequent in critical care and orthopedic-general surgery patients, and among hospital personnel. Critical care outbreaks occurred more often in hospitals classified as oncology centers (P

Description d'un programme d'installation de consultations psychiatriques dans les hopitaux et services de medecine courante dans le Tiers Monde (Ouganda): organisation d'un service d'urgences, diagnostic des maladies organiques et fonctionnelles, traitement des malades atteints de nevrose, attitudes vis-a-vis de la sante mentale, problemes de l'enfance, stages de formation

The development and use of a guide for postpartum and infant care teaching is discussed, including the rationale, methods, and advantages of using this tool at two hospitals of different sizes. Also discussed are the preparation of personnel, ongoing development, and extended uses of the guide.

Average wages from 2,275 general hospitals in metropolitan areas across the U.S. were used to test for a wage gradient descending from hospitals in the central city through those in urbanized and finally non-urbanized areas of each county-defined metropolitan area. Significant gradients were found in MSAs of all sizes. Urbanized-area wages were 3 to 6 percent lower than those in central cities of the same metropolitan area. Non-urbanized suburban wages were 10 to 12 percent lower than those in central cities. The explanations for the gradients differ somewhat between large and small areas. For example, while the relative mix of high-wage and low-wage occupations in each hospital is a significant explanatory variable for wages in all metropolitan area sizes, the relative use of part-time workers is not significant in those metropolitan areas with fewer than 250,000 people. Relative crime in each hospital's city is highly significant in explaining relative wages only for areas with populations of more than one million.

The role of the hospital administrator regarding the implementation and maintenance of programs for the prevention and control of nosocomial infections in U.S. hospitals is discussed. Data obtained in the Study on the Efficacy of Nosocomial Infection Control provide the basis for describing the backgrounds, demographic characteristics, functions, and potential functions of this official as s/he interacts with members of the infection control committee and other hospital staff. The infection control program of a hospital must have the support of the hospital administrator to be effective.

The quality and reliability of four desk top analysers were evaluated. In the context of an outpatient clinic, intensive care unit, and a mock up of a physician9s office. Seventeen nurses, 14 physicians, and 12 medical office personnel took part in the study. The instruments and tests evaluated were Reflotron (glucose, cholesterol, triglycerides, gamma-glutamyl transferase), Seralyzer (creatinine, glucose, potassium, aspartate aminotransferase), Vision (glucose, (creatinine, glucose, potassium, aspartate aminotransferase), Vision (glucose, urea, cholesterol, triglycerides alkaline phosphatase, uric acid), and DT60 (sodium, potassium, glucose, amylase, uric acid and creatinine). Of the 320 tests performed on the Vision, only two differed by more than 10% between the specialist staff and other groups. For those performed on the Seralyzer, 95 of 254 results differed by more than 10%, 19 of 199 by more than 10% for the Reflotron, and 50 of 318 by more than 10% for the DT60. In general, the nurses were more adept at using the analysers than the physicians and medical office personnel.

Health care workers in the Royal Newcastle Hospital, in surrounding hospitals and pathology services, and in a large mental institution were surveyed to determine the prevalence of hepatitis B markers. The aim of the study was to identify the groups of workers at particular risk of contracting hepatitis B in order to determine which workers would benefit most from a programme of vaccination against hepatitis B. Although the prevalence of hepatitis B markers in the Newcastle health care workers was higher than that in the control subjects, this rate did not approach the high rates previously reported in overseas studies.

Le staff des hopitaux psychiatriques long sejour est souvent le lieu de la prise de decision de la poursuite ou non d'une relation sexuelle entre des patients hospitalises. Les auteurs rapportent un programme mis au point sur ce sujet qui represente une premiere tentative pour approcher les multiples facettes de la sexualite humaine qui se manifeste dans un hopital psychiatrique long sejour. Son but est d'aider le personnel soignant a formuler des reponses saines, humaines et logiques aux patients, lors des situations problematiques

During a recent hepatitis B vaccination program among high-risk health care workers, the major sources of information about the vaccine were an in-service informational program, discussion with co-workers, and professional journals. Little or no information was obtained from the lay media or the product brochure. Two thirds of the personnel to whom the vaccine was offered accepted the vaccine. The major reason for accepting the vaccine was a perceived high-risk of contracting hepatitis B. In contrast, one third of the high-risk individuals offered the vaccine declined the opportunity. The major reason for not accepting the vaccine was concern with potential side effects. This information would have been helpful during the planning phase of the program.

Interviews with patients and staff of the New York Hospital Burn Unit in which they discuss their reactions to a variety of unit milieu stresses were videotaped. These were then edited together and played back at staff conference. This intervention increased staff awareness of unit stresses, facilitated discussion about these stresses among surgeons, nurses, and ancillary staff and enhanced the staff-liaison alliance in ways that other psychiatric liaison techniques failed. The psychologic attributes of film are reviewed in an attempt to account for the special impact of videotape in this liaison psychiatry setting.

Sabotage of MCBIS by hospital staff endangers and disrupts the delivery of inpatient health care. Wide-spread interference, along with other implementation problems, cripples the ability of MCBIS to function properly and affects health care costs and quality of services.