Recommendations, investigations

There are four overriding principles that are used to influence accident investigation recommendations ... 

Describe why accident investigation recommendations must include recommendations to improve the management system. 

Should studies be limited to those which appear in peer-reviewed publications Peer review is considered the primary method for quality control in scientific publishing. Some investigators recommend that only those studies that are published in peer-reviewed publications be considered in meta-analysis. Although this may seem an attractive option, it might produce an even more highly biased selection of studies. 

Once the likely causes of an incident have been identified, investigation teams evaluate what can be done to help prevent recurrence. The incident investigation recommendations are the product of this evaluation. This chapter addresses types of recommendations, some attributes of good recommendations, methods to document and present recommendations, and management s responsibilities. 

Each recommendation should he brief (two or three lines only), sufficient to identify a particular topic, and individually numbered to facilitate management of follow-up and resolution. If appropriate, each recommendation should have appended a cross-reference number to enable a fuller explanation, description, or argument to be extracted from other sections of the report in support of the recommendations. Some investigators recommend adding a column to the table entitled Evidence which allows the team to tie in important pieces of evidence to the findings and identified causes. In effect, this column answers the questions, How do we know this Why do we believe this is a cause ... 

Reduce loading (bolus) doses - Reduce loading (bolus) doses in patients with congestive heart failure (CHF) or reduced cardiac output and in the elderly. However, some investigators recommend the usual loading dose be administered and only the maintenance dosage be reduced. 

Like alprazolam, clonazepam may cause treatment-emergent depression in some patients. Pollack et al. (42) also reported that only 10% of their patients who remained on clonazepam had a history of depression, although 47% lost to follow-up and 30% who eventually required alternate treatment had histories of dysthymia or depression. Of 31 patients without a prior history of affective illness, depression developed in three on low daily dosages (0.75, 1.5, and 2 mg), one was switched to alprazolam, and the others responded to the addition of desipramine or imipramine. These investigators recommend that, until further data are available, PD patients with chronic or concurrent depression should not be given clonazepam alone and that those in whom depression develops during clonazepam therapy should have their dose lowered or an adjunctive antidepressant added. 

Preparation of Solutions.—When the conductances of a scries of solutions of a given electrolyte are being measured, it is the custom to determine the conductance of the water first. Some investigators recommend that measurements should then commence with the most concentrated solution of the scries, in order to diminish the possibility of error resulting from the adsorption of solute from the more dilute solutions by the finely divided platinum on the electrodes. When working with cells of the flask type it is the general practice, however, to fill the cell with a known amount of pure solvent, and then to add successive small quantities of a concentrated solution of the electrolyte, of known con-... 

Based on investigators recommendations, the effects of increasing doses of HBOC-201 were assessed in two subsequent studies.After the induction of anesthesia, collection of 1 L of blood, and the infusion of 1 L of RL solution, 24 patients (12 in each study) were randomly assigned to receive, within 30 min, a 6.9- or 9.2-ml/kg dose of either HBOC-201 or 6% HES. (Patients infused with Hb received either 0.9 or 1.2gHb/kg, respectively.) Then, patients received an additional 500 ml of RL solution to maintain intravascular volume. As before, patient data relative to systemic and pulmonary arterial pressures and arterial and mixed venous blood gases were used to calculate... 

The CNS effects of methanol are substantially less severe than those of ethanol. Methanol is oxidized by Ever alcohol dehydrogenase (at about one tenth the rate of ethanol) to formaldehyde. Formaldehyde in turn is rapidly oxidized by aldehyde dehydrogenase to formic acid, which may cause serious acidosis and optic neuropathy, resulting in blindness or death.Serum formate concentrations correlate better with the degree of acidosis and the severity of CNS and ocular toxicity than do serum methanol concentrations. Therefore some investigators recommend the measurement... 

Colleague recommendations Investigator recommendations Scientific and medical literature Physician directories Speakers at professional meetings... 

In this analysis, the formation of the highly colored product of the reaction served both to confirm the probable presence of arsenic and to provide a reliable estimate of its concentration in the deer and in the grass. On the basis of their results, the investigators recommended that the use of arsenical herbicides be suspended in the... 

A written report of the complaint, investigation, recommendations for action where relevant, and outcome should be available to the procurement agency. 

This chapter. summarizes existing studies on OP-induced neurotoxicity in viin) and critically evaluates the strengths, weaknesses, and further opportunities offered by such studies. A brief overview of concepts of in vitro ncurotoxi-cology i.s presented, followed by analysis of neuronal and glial effects of OP compounds in vitro that may be related to neurotoxicity, such as esterase inhibition, neurite extension, and several additional biochemical end points. The novel use of cell cultures to test for enzymatic remediation of OP neurotoxicity is described as a new area for investigation. Recommendations for future studies that would increase the value of in vitro studies arc also proposed. 

Many investigators recommend that columns used for paired-ion chromatography should be dedicated for this application and should not be used for regular reversed-phase chromatography. The reason for this is not clear. Apparently, ion-pairing reagents are difficult to remove from silica-based reversed-phase packings. 

A human study indicated that hibiscus has mixed effects on the urinary excretion of diclofenac, with excretion increased in some patients and reduced in others (Fakeye et al. 2007). Another human study indicated that hibiscus juice may reduce the bioavailability of chloroquine, with effects of hibiscus similar to those of lemonade and a tamarind beverage. Investigators recommended not taking... 

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