Effective Maintenance

It is essential to practice good design of all open systems by adhering to set guidelines. A well-planned and effective maintenance program is of prime importance. 

Preventive maintenance is maintenance carried out at predetermined intervals to reduce the probability of failure or performance degradation. An effective maintenance system should be one that achieves its objectives in minimizing downtime, i.e. the period of time in which the equipment is not in a condition to perform its function. 

An effective maintenance system depends upon it being adequately resourced. Maintenance resources include people with appropriate skills, replacement parts and materials, access to support from OEMs when needed, and the funds to purchase this material. If the equipment is no longer supported by the OEM, then you may need to cannibalize old machines or manufacture the parts yourself. This can be a problem since you may not have a new part from which to take measurements. At some point you need to decide whether it is more economical to maintain the old equipment than to buy new. Your inventory control system needs to account for equipment spares and to adjust spares holding based on usage. 

The plant engineer and his maintenance manager will establish whoever carries out the work, basic strategy, programming and procedures. Inspection checklists and record sheets are necessary for systematic location of critical elements/potential defects and setting out frequencies of inspection. Computers and work processors are an obvious aid to effective maintenance management. Inspection-based preventive methods are demonstrably cost effective. 

Bilges and ballast waters are one of the most difficult areas of this nature to deal with, especially in machinery spaces, since not only are they almost impossible to keep dry or even to dry out while the offshore installation is in operation, but effective maintenance of protective coatings at ail areas is in any case quite impossible except at major overhauls and refits, because of inaccessibility or very high temperatures and humidities. Good initial... 

The H2RAs may be effective maintenance therapy for patients with mild disease.5 The PPIs are first choice for maintenance treatment of moderate to severe GERD.22 Preliminary data suggest that on demand maintenance therapy may be effective for some patients.1 With on-demand therapy, patients takes their PPIs only when symptoms occur. However,... 

Not recommended due to increased adverse effects Maintenance dose ... 

Levetiracetam Unknown Loading dose Not recommended due to excessive adverse effects Maintenance dose 1 000-3000 mg/day. Start at 1 000 mg/day and titrate upward as indicated by response Half-life Not established 6-8 hours Apparent volume of distribution 0.5-0.7 L/kg Protein binding less than 10% Primary elimination route 70% renal 30% hepatic Somnolence, dizziness Depression... 

For atypical or alarm symptoms, obtain endoscopy (if possible) to evaluate mucosa. Give a trial of a proton pump inhibitor. If symptoms are relieved, consider MT. Proton pump inhibitors are tire most effective maintenance therapy in patients with atypical symptoms, complications, and erosive disease. 

Most patients require standard doses to prevent relapses. H2RAs may be an effective maintenance therapy in patients with mild disease. The PPIs are the drugs of choice for maintenance treatment of moderate to severe esophagitis. Usual once-daily doses are omeprazole 20 mg, lansoprazole 30 mg, rabeprazole 20 mg, or esomeprazole 20 mg. Lower doses of a PPI or alternate-day regimens may be effective in some patients with less severe disease. 

The facility should be maintained in a way that cost-effectively controls the probability of failure-induced incidents and their likely consequences. A cost-effective maintenance program allocates maintenance resources according to the level of risk. 

A maintenance organization with leadership that can implement and support an effective maintenance program and appropriately trained personnel who will consistently "do the job right the first time, on time."... 

CHLORPROMAZiNE Individualize dosage based on condition severity. Increase dosage until symptoms are controlled, then gradually reduce dosage to the lowest effective maintenance level. Increase parenteral dosage only if hypotension has not occurred. 

Psychotic disorders - Maximum improvement may not be seen for weeks or even months. Continue optimum dosage for 2 weeks, then gradually reduce to lowest effective maintenance level 200 mg/day is not unusual. Some patients require higher dosages (eg, 800 mg/day is not uncommon in discharged... 

For the predictive maintenance VIP to be effective, maintenance personnel from the project owner s organization must be involved in determining key predictive maintenance requirements. Suppliers of critical equipment items (i.e., compressors) are also important participants in this process. 

Hypertension PO For patients not receiving diuretics, initial dose is 7.5 mg once a day 1 hr before meals. Adjust according to BP effect. Maintenance 7.5-30 mg a day in 1-2 divided doses 1 hr before meals. 

IV. Effective maintenance and change control The vah-dation of a system apphes to the code and applications in use at a given time. Almost immediately after the release of a system into normal operations Copyright 2003 Marcel Dekker, Inc. 

Pimozide is FDA-labeled for Tourette s disorder and is particularly interesting in that it is a highly specific DA antagonist that may produce fewer adverse effects than haloperidol. In open studies with adequate doses, this agent has demonstrated efficacy for acute schizophrenia. Several double-blind trials comparing pimozide with other neuroleptics also found it to be an equally effective maintenance therapy ( 34, 35, 36, 37 and 38). We consider this agent to be as effective as the other standard agents, with the same, but perhaps less severe, side effects. 

Davis JM, Andriukaitis S. The natural course of schizophrenia and effective maintenance drug treatment. J Clin Psychopharmacol 1986 6(suppl 1) 2S-10S. 

What is clear is that without some form of effective maintenance treatment, the relapse rate is substantial (i.e., greater than 50% within the first 12 months after acute remission). Thus, prospective trials are needed to address questions such as which factors predict the likelihood of a good response to maintenance medication versus maintenance ECT and which combination strategies are best to prevent relapse after a successful acute ECT trial ( 1). 

McDonald WM, Phillips VL, Figiel GS, et al. Cost-effective maintenance treatment of resistance geriatric depression. Psychiatr Ann 1998 28 47-52. 

For more than 40 years, lithium has been the standard drug therapy for bipolar disorder, primarily because of the quantity and the quality of evidence supporting its role as an effective maintenance and prophylactic treatment. This latter point is a very important consideration, given the recurrent nature of this disorder. Thus, clinicians must choose the optimal strategy for acute treatment with the realization that most patients will need to continue drug therapy indefinitely. In addition, there is support for maintenance lithium s beneficial impact on the suicide rate in bipolar patients ( 73, 74). The author of these reports notes that the lower suicide risk associated with lithium treatment may be due to the following ... 

Available evidence suggests that due to this better tolerability, SSRIs are the best choice for patients with PD ( 113). SSRIs also offer benefits of ease of dosing and no safety or dependence problems. This contrasts with the poor tolerance associated with TCAs and with dependence problems associated with BZDs ( 114). In addition, because of the longer half-life, fluoxetine at doses ranging from 10 to 60 mg administered once weekly appears to be an effective maintenance treatment for patients with PD whose successful initial treatment was with daily fluoxetine (115). 

Treatment with a leukotriene-receptor antagonist, particularly montelukast, is widely prescribed, especially by primary care providers. Taken orally, leukotriene-receptor antagonists are easy to use and appear to be used more regularly than inhaled corticosteroids. They are rarely associated with troublesome side effects. Maintenance therapy with a leukotriene antagonist or with cromolyn or nedocromil appears to be roughly as effective as maintenance therapy with theophylline. Because of concerns over the possible long-term toxicity of systemic absorption of inhaled corticosteroids, this maintenance therapy is widely used for treating children in the USA. 

However, site services and infrastructure are not only a major driver of cost competitiveness. Some of the services are also crucial for improving plant effectiveness. Maintenance performance, for instance, can have a huge impact on plant output. Unplanned breakdowns, often caused by failure to implement the most effective maintenance strategy or by poor execution, can lead to as much as a 20 percent loss in overall equipment effectiveness (OEE see also Chapter 18). On the utilities side, significant cost advantages can be captured, e.g., by providing... 

---