Relevance of Lead Apron in Medical Imaging Profession

Relevance of Lead Apron in Medical Imaging Profession Introduction Lead aprons are available in the healthcare facilities to provide protection from unnecessary exposure of X-radiation to the patients and workers during radiology procedures usually done for diagnostic purposes. Body is shielded by the protective garment called lead apron from the harmful radiation during the medical imaging. Lead apron is found to be effective in protecting from radiation exposure only when it is worn properly. It is used in a safe and properly inspected environment (Lead Apron Policy, 2012). Protective aprons of 0.25mm lead are worn, while performing fluoroscopy whose body is exposed to 5mR/hr or more. Individuals expected to wear lead aprons or similar radiation protection instruments must inspect these instruments visually for any signs of damage before using them (Lead Apron Policy; California code of regulations, 2012). Principles of Lead Apron Advantages of lead apron It is observed to be effective and appropriate in protecting 95 percent of 80 kVp X-rays. As lead apron causes pain and stress to the back muscles back strain is avoided by wearing a skirt apron around the abdomen. In performing fluoroscopic procedures, wearing lead apron of lead equivalence 0.25mm to 0.5mm is found to decrease scattered X-rays by 95 percent. A thyroid collar is used along with lead apron and it is not required in the case of imaging patients. Every occupation worker exposed to fluoroscopic units higher than 5mrem/hr should wear lead apron. The dose rates that are higher than 5mrem/hr are measured within six feet of the table and it includes the place occupied by fluoroscopist (Lead Apron Policy, 2012). Disadvantages of lead apron Lead apron is not sufficient for protecting 111In or 131I. No shielding is provided for the patients by the lead apron for 137Cs or 131I therapy. In these patients, heavy portable shields are available. Shields are provided for brachytherapy patients in the radiation oncology department. Shields for radioactive iodine therapy patients are provided by health physics department (Lead Apron Policy, 2012). Inventory policy and lead apron inspection According to the joint commission standards, annual inspections have to be performed on the medical equipment by the healthcare organizations. Lead apron inspection and inventory are performed by Stanford hospital Clinics, Lucile Packard Children’s hospital and VA Palo Alto Healthcare system. Some of the recommendations in the apron inspection policy are looking for sagging and deformities or any visible damage, performing annual tactile and visual inspection and holes and cracks are identified by radiography and fluoroscopy. It is important to use manual settings and low technique factors during fluoroscopic examination. It is not recommended to use automatic brightness control as it will drive up the high voltage and tube current, which might result in exposure of unnecessary radiation to the operator and the wear (Lead Apron Policy, 2012). Lead apron is discarded, if the inspection reveals that there is a defect larger than 15 sq. mm on the apron parts shielding an organ or if there is any defect larger than 670 sq. mm along the seam or in the back of the apron and in thyroid shields with defects larger than 11 sq. mm (Lead Apron Policy, 2012). How can the affected technical personnel be protected from the radiation? It is not necessary for the technical personnel to stay closer to the patient in the case of radiography, general computerized tomography and mammography. Staying distant from the patient will prevent the personnel to receive the scattered X-rays from the patient. Structural shielding can also be placed in between the patient and the personnel to avoid the X-rays reaching the personnel. When the personnel are closer to the patient in fluoroscopic examinations as well as in image guided interventions, distance and structural shield will not be able to stop the scattering of the X-rays. In such cases, protective clothing like aprons, spectacles, table- mounted protective curtains, ceiling suspended protective screens and thyroid shields have to be used by the personnel (JL Heron et al., 2010). Based on the lead equivalence and X-ray energy, an apron will terminate 90 percent or more of the incident scattered radiation. The protective aprons are available in various thicknesses and shapes starting from front-only apron to a full coat. The front-only apron will be effective, if the person wearing it is facing the source of the scattered radiation (JL Heron et al., 2010). Radiological workloads differ for various specialities. The concerned protective tools required by a particular department are specified by a radiation protection expert or a medical physicist. The person with high workload in the cardiac laboratory must utilize all the protective tools, while a person in the orthopedic suite might require a front-only apron. If the person is working closer to the patient during imaging and wears an apron, a dosimeter that is fixed under the apron will estimate exposure of rays to the shielded portion and will not properly estimate the exposure of organs and tissues present outside the apron. Two dosimeters fixed inside and outside of the apron will give a good estimate of the effective dose to be used (JL Heron et al., 2010). How far are the lead aprons protective against ionizing radiation? Research studies were done to analyze the qualitative and quantitative aspects of lead aprons with the help of various methods. Eighty five lead aprons were collected from various departments in the hospital and from the district polyclinics where radiation exposure was present. They were collected and brought to the radiology clinic of the hospital to assess their protective nature. Aprons were identified based on the number of years they were used by the personnel, the units from where they have been obtained, number of personnel by whom they were worn, the model, the material by which they are made of and the thickness of lead in the apron (O Oyar and A Kislalioglu, 2012). X-rays were delivered such that 35X35 cm wide area of the lead apron is exposed to the radiation. There was 110cm distance between tube focus and lead apron. The images on the plates exposed on the back of the apron are transferred to films and these films are later evaluated with the help of scratches, cracks, rips and defects that might be present on the lead aprons (O Oyar and A Kislalioglu, 2012). As per the standard method, holes greater than 2mm diameter and cracks longer than 4mm were considered as destruction criteria. The aprons exposed with the same criteria were allotted for dosimeter testing by the ratio of ray absorption. The absorption features were assessed using two tests such as scattering X-rays on the apron directly and indirectly. In both direct and indirect methods, same parameters were used for estimating the radiation by fixing the dosimeters in the front as well as at the back of apron. The doses were evaluated and the absorptions were calculated. The base for apron measurements, ten protective aprons with radiation permeability and various lead thicknesses, Turkish standards institution documents approved quality and durability were chosen. Aprons that were not used before were used as controls. The analyzed aprons were measured individually and the results were noted down (O Oyar and A Kislalioglu, 2012). The results have shown that lead is the material used for radiation protection. Among double-sided lead aprons, skirt-vest lead aprons and frontal protection lead aprons, the frontal protection apron is mostly used. Evaluating the cleanliness of the aprons, 23 were clean and the remaining were either little or too dirty. No significant association was observed between the apron destruction criteria and apron cleaning methods. Evaluating the overall condition of the apron, 45 aprons were in good condition and the remaining was either slightly or extremely worn out (O Oyar and A Kislalioglu, 2012). Highest radiation permeability was observed in extremely worn out aprons and in aprons that were in decent condition. The apron that was worn out very little is least permeable compared to the extremely worn out and those in good condition. Among 58 aprons, 26 were destroyed due to cracks, 14 due to tears and holes, and 18 due to tears. In all these aprons, radiation permeability was more than normal. No significant relationship was observed between radiation permeability and internal structural features of protective lead aprons or total number of apron users. Destruction criteria were significantly associated with apron models. Frontal protection lead apron model was destroyed most often (O Oyar and A Kislalioglu, 2012). The exposure dose was analyzed as 996.1 micro grays on average. For 0.25mm lead aprons, the exposure dose was 51.59 micro grays on average. For 0.5mm lead aprons, exposure dose was 9.891 micrograys on average. Among the indirect measurements, scattered radiation value measured at the distance of 50cm was 2.1 R/h. The indirect radiation measured for 0.25mm lead equivalent apron was evaluated as 1.85 micro grays and that for 0.5mm lead apron was evaluated as 1 microgray (O Oyar and A Kislalioglu, 2012). Some folds and sags were observed on the protective layers of the aprons. Significant radiation permeability difference was not observed between folded aprons and non-folded aprons. The protected dose was measured as 60.20+/-22.96 micro grays for unfolded 0.5mm lead equivalent aprons. The protected dose was 50.36+/- 22.96 micro grays for folded 0.5mm aprons, 50.36+/- 22.96 micro grays for 0.25mm lead equivalent aprons. For folded 0.25mm aprons, the dose was evaluated as 46+/-19.05 micrograys (O Oyar and A Kislalioglu, 2012). Discussion The aprons that were used for protecting against scattered ionizing radiation are made using lead embedded in rubber fabric, which is the mixture of lead-rubber or lead-vinyl. These aprons possess the thickness of 0.25mm to 0.5mm. They are costly and are of great importance when used and stored properly. It is an expert view that these aprons are not often preserved and taken care of, and they are folded carelessly, which could be reasons for them to lose protective ability. The research study first done in Turkey by Oyar and Kislalioglu in a quality certified hospital with a control standard and the measurements were taken for quantitative and qualitative radiation exposure values from the protective lead aprons (O Oyar and A Kislalioglu, 2012). It is estimated that 0.5mm thick lead aprons will be able to absorb higher than 90 percent of irradiation at the dose of 150kVp. The similar apron must be able to absorb higher than 99 percent of the irradiation dose at 70kVp (Radiation issue notes, 2008). In some of the studies on absorption ratio of protective aprons, research has revealed that either indirect or direct X-ray absorption ratio of aprons must be measured separately (Christodoulou EG, 2003; Muir S, 2005). Though the actual purpose of lead apron is to protect against indirect X-radiation, in the study done by Oyar and Kislalioglu, the results from direct radiation exposure measurements might be more beneficial in the evaluations due to wider spectrum width. Direct measurements were accepted to provide better results from the evaluations of ray absorption by the lead aprons. If lead aprons are not stored properly, they will lose the protecting quality and radiation protection ability is reduced for that apron gradually. The storage racks for lead aprons are available in various styles and configurations to fulfill the necessities of the medical facility (Universal medical, 2014). Medical professionals interested to wear lead aprons or other radiation protection instruments must have their protective garments checked well for any damages like rips and tears, cracks in the lead lining and sagging lead before their use. Proper lead apron storage will extend the apron life by preventing the lead lining damage and the external fabric damage. Lead aprons have to be hung by the apron hangers instead of folding them. Damages can result even if the apron storage is incorrect. Organizing the aprons properly will make the tracking process and the State or Joint commission inspection easier. Inspection of aprons will improve their organization (Universal medical, 2014). Usually, it is a common practice to place half apron at the back of the patient during the erect chest radiograph to protect the patient from radiation dose from tube leakage and room scatter. Most of the back scatter from the patient is a part of the internal scatter that might affect gonads and other tissues. Half apron will have least effect from patient dose and they make the patients to realize that precautions taken will protect them from unnecessary exposure (Lead garments (Felmlee JP et al., 1991). Use of lead shield is made mandatory for gonadal protection in most of the X-ray departments. If the gonads are present nearer the primary X-ray beam, gonadal shielding is very much necessary. Even if the X-ray field is not near the gonads, gonadal shield is given as the deterrent for the pediatric patients. According to the national recommendations associated with shielding of patients from radiation exposure during imaging, lead aprons were not significantly reducing radiation dose. Dental radiation policies indicate that implementing all the routine precautions will not demand the use of lead aprons on the patient. Later, lead aprons were considered as reducing the radiation dose, from several diagnostic X-ray procedures, to the reproductive organs. Radiation can cause germ cell mutations which might be carried to the next generations. Lead aprons have a precautionary role in reducing the radiation dose (Felmlee JP et al., 1991). The protective clothing worn by the radiographers consists of lead and other metals like tungsten, barium, tin and antimony. The clothing will help in shielding the personnel from radiation. The metals in the radiation protective clothing are equivalently mixed with polyvinyl chloride or synthetic rubber. Sheets of nylon fabric coated with urethane are placed against the side of lead impregnated rubber in between the two and five sheets of metal-impregnated rubber or PVC. These materials are cut as a pattern and sewn to create a protective garment. The manufacturers of these garments alter the sheet number, metal percentage, rubber or PVC grade and the metal mixture affecting the durability, weight, flexibility and radiation absorption efficiency (Felmlee JP et al., 1991). Normally, lead apron is not used for the patients undergoing medical procedures associated with radiation as the area of interest will not be protected. Lead aprons are mostly recommended for those who are exposed to the radiation by being in their occupation. If the apron is worn between the direct X-ray beam and the patient, then 90 percent of the rays are prevented from entering the patient’s body. Therefore, it is not practical for putting apron on the body part that is of interest to the physician (Felmlee JP et al., 1991). As per the standards put forward by the Joint Commission, healthcare organizations have to perform inspections on the medical instrumentation along with the lead aprons. Health department of State also should have a regulation for inspecting the lead aprons. Titanium is used as the shielding material in the titanium aprons. Other materials used in the aprons are barium and bismuth. The shielding properties of the material can be assessed by their mass coefficient and linear attenuation coefficient. Mass attenuation coefficient for the elements is found by physical reference data website of National institute of standards and technology (Felmlee JP et al., 1991). Conclusion As the X-ray imaging is being used continuously all through the world, this technology has created new challenges for occupational protection for the medical staff from radiation. In many of the X-ray procedures, it is necessary for the medical staff to stay closer to the patients, while performing the imaging. Therefore, there is potential for the staff to get exposed to the radiation and it has become extremely important for them to implement certain restrictions to prevent themselves from radiation exposure. Lead aprons decrease the radiation dose to the gonads from various diagnostic X-ray procedures. Radiation can cause mutations in the reproductive cells, which might be transferred to the future generations. Protective clothing worn by the radiographers consists of lead and other metals, like tungsten, barium, tin and antimony. These metals are mixed with polyvinylchloride to create a protective garment. The number of sheets, metal percentage, rubber grade and metal mixture in different ratios will show impact on the flexibility, durability, radiation absorption, weight and efficiency of the protection sheets. Lead aprons are highly effective in absorbing diagnostic X-rays to the body parts shielded by the apron. The effectiveness is energy dependent and averages to about 90 to 95 percent. Irrespective of whether the radiation personnel have worn the lead apron or not, the exposure allowed on the body is ruled by exposure limits. Apart from the lead aprons, mobile shielding is also helpful in protecting the body from radiation. References [1] Christodoulou EG, Goodsitt MM, Larson SC, Darner KL, Satti J, Chan HP. Evaluation of the  transmitted exposure through lead equiv aprons used in a radiology department, including the  contribution from backscatter. Med Phys 2003; 30:1033–1038. [2] Felmlee JP, McGough PF, Morin RL, Classic KL. Hand dose measurements in interventional  radiology. Health Phys 1991; 60(2):265-267. Retrieved from  http://hps.org/publicinformation/ate/faqs/leadgarmentsfaq.html# [3] John Le Heron, Renato Padovani, Ian Smith, Renate Czarwinski. Radiation Protection of  Medical Staff. European journal of Radiology. 2010; 76:20-23. [4] Kevin Jaquith. 5 reasons why you should use lead apron storage racks. Universal Medical.  2014. Retrieved from http://blog.universalmedicalinc.com/5-reasons-why-you-should-use- lead-apron-storage-racks/ [5] Lead Apron policy. Radiation protection guidance for hospital staff. Prepared for Stanford  hospital and Clinics, Lucile Packard children’s hospital and Veterans affairs Palo Alto Health  care system 2010. [6] Muir S, McLeod R, Dove R. Light-weight lead apronslight on weight, protection or  labelling accuracy? Australas Phys Eng Sci Med 2005; 28:128–130. [7] Orhan Oyar, Arzu Kislalioglu. How protective are the lead aprons we use against ionizing  radiation? Diagn Interv Radiol. 2012; 18:147-152. [8] Proper selection, care, quality control and disposal of lead aprons. Radiation issue notes  2008.

Blood Brain Barrier Essay -- Biology

The brain is permeated by a vast network of tiny blood vessels called capillaries- so tiny and thin that blood cells have to pass through in single file. In the brain alone there are enough capillaries that if you laid them all out end to end they would stretch from Tucson to Tijuana. These capillaries are surrounded by a single layer of cells. That layer of cells forms a barrier between the capillaries and the cells and fluid of the brain. These barrier-forming cells are called "endothelial cells". You can think of "endothelial" as a synonym for "lining" or even just "barrier". When we use the phrase Blood Brain Barrier, (which for obvious reasons we'll refer to as BBB from here on out!), we're talking about all of these endothelial ("barrier") cells collectively. Function of the BBB The cell membranes of the BBB contain transport proteins. If the brain is a nightclub, the transport proteins are bouncers. They decide who gets in, and who gets kicked out. On this website we'll be introducing you to the most important transport proteins- OATP, MDR1, and MDR2. Don't let all the acronyms intimidate you- read carefully and you'll be fine. If the nightclub/bouncer analogy doesn't work for you, you could also think of them as little vacuum pumps and blowers. An extremely detailed view of their actual mechanisms is beyond current knowledge. Importance of the BBB Without the BBB, undesirable molecules could freely diffuse from the capillaries to the fluid that surrounds the brain cells. These undesirable molecules include: TOXINS- poisons taken in from the environment. IONS- that might upset the delicate electrochemical gradients of the cerebral fluid. ACIDS and BASES- that might upset the cerebral ... ...aks down the BBB, so the mice infected with GBS lacking this toxin developed less bacterial meningitis than those infected with the normal GBS. -Doran says: Ââ€Å"These findings demonstrate a novel function of the blood-brain barrier, to act as a sentry that detects the threat of a bacterial pathogen and responds by triggering an immune response to clear the infection. 3. Neuwalt- Researches treatment of brain tumors with chemotherapy, hard because of the BBB (natural defense against chemical transport into the brain) introduction of chemicals to the brain by shrinking endothelial cells that make up the BBB with a concentrated sugar solution that creates gaps in the BBB allowing chemicals to enter (called Blood-Brain Barrier Disruption Therapy) project tenfold to a hundredfold more successful than normal chemotherapy and intra-arterial chemotherapy (Neuwalt, 1998)

Spinal Immobilisation

Spinal Immobilisation: A Literature Review A review of the literature regarding spinal immobilisation has been undertaken using databases for PubMed, MEDLINE, CINAHL, OVID and Cochrane EBM. Reviews were electronically searched using the subject headings â€Å"spinal injuries†, â€Å"spinal immobilisation† and â€Å"management of spinal injuries†. The results generated by the search were limited to English language articles and reviewed for relevance to the topic. The aim of this literature review is to compare and contrast the views on spinal immobilisation and to achieve a better knowledge of evidence based practice.According to Chiles and Cooper (1996) spinal injury should always be suspected in patients with severe systemic trauma, patients with minor trauma who report spinal pain or have sensory or motor symptoms, and patients with an impaired level of consciousness after trauma. According to Caroline (2008) the primary goal of spinal immobilisation is to pre vent further injuries. Good initial and acute management is crucial no matter the degree of damage (Sheerin and Gillick, 2004). The purpose of immobilisation in suspected spinal trauma is to maintain a neutral position and avoid displacement and secondary neurological injury (Vickery, 2001).Means of immobilisation include holding the head in the midline, log rolling the person, the use of backboards and special mattresses, cervical collars, sandbags and straps (Kwan, Bunn & Roberts 2009). The Advanced Life Support Group supports the use of the long spinal board (backboard) for spinal immobilisation, despite knowledge of pressure problems and poor immobilisation in some patient groups. The spinal board was originally developed as an extrication device using its smooth surface to allow a person to be slid out of a vehicle.However, it is difficult to remove the patient from the board in the field and therefore the patient is most commonly transported to the A & E department on the spin al board (Cooke, 1998). There is considerable variation in the best technique for pre-hospital cervical spine immobilisation (Vickery, 2001). Some have advised the use 1 to 1. 5 inches of padding under the head as standard, others have advised that judgement on the use of padding be based on visual inspection (Butman, McSwain & McConnell, 1986). Conversely, several rauma texts recommend placing the patient directly against the spinal board (McSwain, 1989). In the United Kingdom, the vacuum mattress is predominately used by mountain rescue teams as it is believed to provide better overall protection of an injured casualty and is perceived to be safer and easier to transport over the terrain encountered in these situations (Herzenberg, Hensinger and Dederick, 1989). In a recent study by Luscombe and Williams (2002), it was shown that the vacuum mattress prevents significantly more movement in the longitudinal and lateral planes when subjected to a gradual tilt.Perceived comfort levels are significantly better with the vacuum mattress that with the backboard. Chan, Goldburg & Mason (1996) reviewed the use of the long spinal board and its association with pressure injury, unsatisfactory immobilisation and positioning, and the pain that it can cause (Chan, Goldburg & Tascone, 1994). A study by Lovell and Evans (1994) indicated that while a casualty resides on a backboard it may possibly lead to pressure sores in those who have sustained injury to the spinal cord. The amount of time casualties remain on backboards can exacerbate the problems of pain and pressure.Ambulance journeys and waits in accident and emergency may be lengthy and there may be long distances involved in getting to hospital (Lerner & Moscati, 2000). In addition to pressure injury and poor immobilisation, the backboard may be the cause of pain even in otherwise healthy patients, leading to unnecessary investigations, radiographs and potential ambiguity regarding the cause of pain (Chan, Goldburgh & Mason, 1996). The evidence suggests that the backboard itself is not ideal and far from a gold standard.This has led to the suggestion that the backboard should not be the preferred surface for the transfer of patients with spinal injuries (Main & Lovell, 1996). According to Vickery (2001) however, the spinal board is considered to be the gold standard for spinal immobilisation during the pre-hospital phase of trauma management. For some patients, effective spinal immobilisation is beneficial and can also be vital in preventing the devastating effects of cord damage however it has been suggested that for many the excessive use of this preventative measure may not be prudent or necessary.It has been estimated that over 50% of trauma patients with no complaint of neck or back pain were transported with full spinal immobilisation (McHugh & Taylor 1998). Inappropriate spinal immobilisation may lead to patients experiencing unnecessary pain, skin ulceration, aspiration and respiratory compromise, which in turn may lead to further unnecessary procedures, a longer hospital stay which then incurs increasing costs to the National Health Service (Kwan, Bunn & Roberts, 2001).Shooman & Rushambuza (2009) report that immobilisation is a crucial part of the management of a trauma patient. They believe that if the mechanism of injury is uncertain, the patient should remain immobilised until further imaging even if there are no symptoms of spinal instability after log rolling. However, in a recent study by Pandie, Shepherd & Lamont (2010) they concluded that on its own, standard immobilisation techniques appear to be inadequate to maintain the cervical spine in the neutral position.One argument for keeping the patient on a spinal board is that it facilitates an urgent turn should vomiting occur (Vickery 2001). Spinal immobilisation is used throughout the world however the clinical benefits of pre-hospital spinal immobilisation have been put under scrutiny. It has been argued that spinal cord damage is done at the time of impact and that subsequent movement is generally not sufficient to cause further damage (Hauswald, Ong, Tandberg & Omar 1998).In contrast, in-line stabilisation of the neck, also termed ‘neutral alignment’, is usually enhanced by using immobilisation blocks and straps that fix the patient’s head and neck to a spinal board. In-line head and neck immobilisation is important during the transfer period to hospital and remains an important part of the care of the patient (Sheerin, 2005). Butler and Bates (2001), disagree with this and suggest that cervical collars are of no additional benefit to patients already immobilised using a long spine board with straps.In a recent report it was found that many patients brought to A & E automatically had a cervical collar applied ‘as a precaution’. This usually means that the victim has been involved in an accident that could possible cause a cervical injury, although the patient shows no signs or symptoms of such an injury (Sexton, 1999). Immobilisation in suspected spinal trauma must be initiated at the scene of an accident and continued until unstable spinal injuries are ruled out.Adequacy of spinal immobilisation must be reviewed during the primary survey in the A & E department (Vickery, 2001). Once the patient has reached A & E, the spinal board should be removed as soon as possible once the patient is laterally transferred from the ambulance trolley onto an A & E or resuscitation trolley (Vickery, 2001). The early removal of spinal boards and cervical collars is advocated by spinal units (Sexton, 1999). Complications associated with prolonged use of the spinal board include pressure ulcer development, pain and discomfort (Vickery, 2001).Vickery (2001) also suggests a partial solution would be recommended that the backboard should be removed as soon as possible after arrival in the A & E department, ideally after the primary survey and res uscitation phases. Hickey (2003) agrees with this, it is vital that following initial assessment, the patient is removed from the spinal board. Porter and Allison (2003) support this by suggesting that the patient should be then transferred and nursed on an emergency trolley with head immobilisation and straps applied.This in turn should minimise the risk of pressure ulcer formation which is prevalent in patients with spinal cord injury (Sheerin and Gillick, 2004). Vickery (2001) also suggests that where a spinal injury is suspected, prompt and safe removal of the spinal board is mandatory, these are patients that are at the greatest risk of developing pressure sores. Vickery (2001) continues to say that spinal board immobilisation on the board may be inadequate ending with tragic consequences.Observational studies in the US have shown that immobilisation by rigid collars may cause airway difficulties, increased intracranial pressure (Davies, Deakin & Wilson, 1996), increased risk o f aspiration (Butman, 1996), and skin ulceration (Hewitt, 1994). Caroline (2008) also suggests that complete spinal immobilisation is painful, especially over pressure points and can also be a cause of airway constriction which in turn creates an increased risk of aspiration. It has been reported that many trauma patients do not suffer from spinal instability and will not benefit from spinal immobilisation (Orledge, 1998).The value of routine pre-hospital spinal immobilisations are questionable due to any benefits of immobilisation being outweighed by the risks (Kwan, Bunn & Roberts, 2009). Kwan, Bunn & Roberts (2009) have already indicated that inappropriate immobilisation is contributing to the increasing budget of the NHS. Dimond (2001) agrees and claims that litigation claims are increasing against the NHS. Society is becoming less tolerant of mistakes or inadequate service and litigation claims are now becoming an accepted part of daily life (Vukmir, 2004).In contrast, a study in the USA has indicated that due to the fear of litigation, over five million patients receive spinal immobilisation every year (Orledge & Pepe 1998). In this current media inclined era, media attention for high profile claims against the NHS organisations is at a high. Although most of the evidence in literature is regarding claims against hospital specialities, there have been few claims written about claims against the ambulance service (Hulbert, Riddle & Longstaff 1996).However, there may be few documented claims against the ambulance service there have been a significant number of claims settled by ambulance trusts (Vukmir, 2004). In conclusion, there are many different points of views by many authors on the subject of spinal immobilisation. Many argue that the need to immobilise suspected head, neck and spinal trauma is a priority due to the potential life threatening incident. This way of thinking has been supported by many of the authors.Others however have stated that each incident needs to be individualised as the necessity of using spinal immobilisation is increasingly being inappropriately used. Methods of spinal immobilisation are also highly debatable, calling the clinical professional to use their own training and judgements when deciding how to transfer each individual patient. It was highlighted by many authors that it was necessary for patients to be removed from the spinal board as soon as possible when being cared for within the hospital setting as this reduces the possibilities of further trauma and pressure sores.It became quite clear when conducting this research that many health professionals are now very aware of the potential to become a target for the all too common blame culture that is so prevalent in today’s society. The fear of litigation may be the cause for the higher usage of spinal immobilisation although there is limited research at this time but within the next few years we may in fact see a rise in claims against t he Ambulance Service.There is evidence that inappropriate and prolonged use of spinal immobilisation can be very detrimental to the patient’s welfare, there is a vast amount of research to suggest the need to use spinal immobilisation in most head, neck and spinal trauma. Effective and appropriate use of spinal immobilisation is best practice in all situations and should be used wisely and competently by a trained professional.

How Helen Keller Helped to Improve the World of the...

Without doubt, Helen Keller is now a household name in nearly every part of the world (too bad she could never hear it.) Helen Keller faced many childhood and adulthood difficulties, and remains to be seen as an extremely positive influence for all women. From my perspective, she was a hardworking activist with her own personal views and opinions despite her ailments. Keller is a true role model for all women – especially those with their own diseases or disabilities. Feminists of all ages could look to the path Keller made for them in the world of women suffrage and equality. One of the things I found to be the most astounding about Helen Keller was how many organizations she had a hand in founding. To start, her own organization, Helen†¦show more content†¦Keller is accredited with helping to pave the road for womans right to vote, and the right to use birth control. She was also one of the main supporters of turning America toward socialism and equality, and was a strong supporter of pacifism. Keller actually protested against World War I in favor of the pacifist route, as she concluded that the war was only to benefit JP Morgan, as he had loaned so much money to the British overtime. Her views were that of peace and education, and she wished to aid Americas continuing wish of security, freedom, and prosperity. Keller was one of the best spokeswoman of the 20th century time period, and she was one of the few who suffered an ailment such as her own. Thankfully, Kellers efforts did not go unnoticed. I believe that Keller would be extremely proud of the leaps this country has made to overcome womans suffrage. Officially, the Nineteenth Amendment, which condoned the right to vote regardless of what gender the citizen is, was passed o the 26th of August in 1920. (ourdocuments.gov) In addition to woman rights finally being recognized, women have gained at least some recognition in equality today (though they are not paid the same amount as men in most fields of employment.) The world has also made bounds foreword in the field of disabilities. Across the country, schools focusing on the same kind of disabilitiesShow MoreRelatedHelen Keller: A True Hero Essay1200 Words   |  5 PagesAll the world is full of suffering. It is also full of overcoming said Helen Keller, a woman who faced many obstacles in her life (Fun). Most people dont dedicate their lives to help others, especially if they have disabilities themselves, but Helen Keller is a different story. At 19 months old, Helen Keller was diagnosed with a disease that led her to be deaf and blind. A true hero is someone who is dedicated to help others in need no matter the circumstances/struggle he or she faces, neverRead MoreHelen Keller: An Idol to Deaf People?2987 Words   |  12 Pages HELEN KELLER AN IDOL TO DEAF PEOPLE? Rona M. Stanley HIS 331: History of the American Deaf Community December 1, 2013 As children, many of us watched â€Å"The Miracle Worker,† the movie that showcased Helen Keller as a deaf blind child in need of communication. Through the movie, we came to admire and sympathize for this character as the movie portrays her perseverance to overcome her disabilities instead of resigning to them. The love and bond between her and her teacher, Anne SullivanRead MoreThe Story of My Life2883 Words   |  12 PagesThe Story of My Life by: Helen Keller I. INTRODUCTION Helen Keller overcame different difficult obstacles of deafness and blindness to become an influential lecturer and social activist. She has become, in American culture, an icon of perseverance, respected and honored by readers, historians, and activists. Helen began working on The Story of My Life while she was a student at Radcliffe College, and it was first published in installments in Ladies’ Home Journal. Helping her was an editorRead MoreThe Alabama Institute For Deaf And Blind1761 Words   |  8 Pagesresources available for people with disabilities that offer assistance and programs to meet their everyday needs. The Alabama Institute for Deaf and Blind serves as an educational resource for individuals who are deaf, blind, deaf-blind, and multi-disabled. I decided to research this agency because it has been referenced in my communicative disorders classes. As a future speech language pathologist, I want to learn about this agency and discover the programs it offers to help me with my future clientsRead MoreBenefits Of Technology For Disabled Children1836 Words   |  8 Pagesto Support Students with Autism Spectrum Disorders in the Writing Process: A Pilot Study† that focused on the benefits of technology for di sabled children. Although the article talked about students with disabilities, they specifically focused on students with Autism Spectrum Disorders (ASD). The article showed that the use of technological tools to write helped the children with the disability tremendously. In general, â€Å"the handwriting of children with ASD has been found to be lower quality, specificallyRead MoreDisability Is Not Inability3972 Words   |  16 Pagesneeds or even discriminations at some points, they have acquired education and benefitted from it to lead meaningful lives as those of the `normal` people. Therefore, before we have a look at these disabilities, how these learners have overcome their disabilities to acquire education and how have they benefitted from it, it is important to start by knowing what disability actually is. What is disability? The WHO defines disabilities as: Disabilities is an umbrella term, covering: †¢ Impairments- problemsRead MoreEssay special education11975 Words   |  48 Pagesfulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.   Handicap considers the persons participation in their social context.   For example, if there is a wheel-chair access ramp at work, a disabled person may not be handicapped in coming to work there.   Here are some examples: Impairment - Speech production; Disability - Speaking clearly enough to be understood; Handicap - Communication I - Hearing; D - Understanding; H - Communication Read MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesCreating a Positive Work Environment 22 †¢ Improving Ethical Behavior 22 Coming Attractions: Developing an OB Model 23 An Overview 23 †¢ Inputs 24 †¢ Processes 25 †¢ Outcomes 25 Summary and Implications for Managers 30 S A L Self-Assessment Library How Much Do I Know About Organizational Behavior? 4 Myth or Science? â€Å"Most Acts of Workplace Bullying Are Men Attacking Women† 12 An Ethical Choice Can You Learn from Failure? 24 glOBalization! Does National Culture Affect Organizational Practices? 30 Point/Counterpoint