Guidelines For Safe Use Research Articles

Nurses’ Compliance with Safety Guidelines for the Use of Antineoplastic Agents, Observable Symptoms, and Stress from Occupational Exposure

Purpose This study was done to identify the relationship between nurses’ compliance with safety guidelines for the use of antineoplastic agents, observable symptoms, and stress from occupational exposure. Methods The participants were 172 nurses from six general hospitals in a metropolitan area. They had administered antineoplastic agents at least three months prior to the study. Data were collected using self-report questionnaires, and then analyzed using SPSS/WIN 23.0 for descriptive statistics, t-test, one-way ANOVA, Scheffé method, and Pearson correlation coefficient. Results The average score on the guideline for safety compliance was 87.75 points out of a total of 100. The average score for observable symptoms of exposure to antineoplastic agents was 30.12 (28~56) points, and that for mean stress was 33.52 (15~60) points. Observable symptoms and stress from occupational exposure showed a statistically significant positive correlation (r=0.34, p<.001). Conclusion To increase the degree of compliance with safety guidelines for antineoplastic agents, hospitals should lower the chance of exposure to antineoplastic agents, as well as minimize the observable symptoms and stress from occupational exposure. Periodic education and policy support are needed to improve compliance with safety guidelines for antineoplastic agent use. 주요어: í•­ì•”ì œ, ì•ˆì „ê´€ë¦¬, 이행, 자각증상, ìŠ¤íŠ¸ë ˆìŠ¤ Key words: Antineoplastic agents, Safety, Compliance, Symptoms, Stress

A Review of Auto-Injector Pen Safety and Preventative Strategies

Reports of auto-injector pen injuries have increased over the past decade. However, the true incidence of these injuries is unknown. We present the case of an accidental digital self-injection by a dermatologist whilst he was trying to administer the medication to a patient presenting with anaphylaxis as an example of a typical auto-injector injury. Additionally, we discuss safety issues, commonly reported injuries of accidental self-injection, and review the safety guidelines for use of a common auto-injector pen. Finally, we explore common barriers to proper auto-injector handling and suggested preventative strategies in order to decrease injuries caused by auto-injectors.

Canadian Association of Optometrists/Canadian Ophthalmological Society Joint Position Statement

The prevalence of electronic screen-related ocular symptoms in adult users is estimated to be as high as 50–90%. While the corresponding statistic in children is not known, the use of electronic screens by children has become more commonplace (at both home and school), begins earlier in childhood than in the past, and can last for long periods of time.&#x0D; The prevalence of electronic-screen symptoms in adults and the resultant guidelines for safe use should not be automatically applied to children. The visual and physical systems of children are different than those of adults, and still developing. In addition, children use screens differently and for different tasks. This policy reviews the current literature on ocular and visual symptoms related to electronic-screen use in children and provides evidence-based guidelines for safe use. The effect of screen-time on other cognitive and developmental milestones is beyond the scope of this statement.

Residual Characteristics of Pesticides Used for Powdery Mildew Control on Greenhouse Strawberry

This study was conducted to investigate the dissipation and residual characteristics of fungicides used for powdery mildew control for strawberry and establishment of guideline for safe use of fungicides based on MRLs as Korea, Japan and Codex. The fungicides were sprayed onto the crop in triplicate at recommended dose. Strawberry samples were harvested at 1, 3, 5, 7, 9, 11 and 13 days after treatment boscalid, kresoxim-methyl, pyraclostrobin, and pyrimethanil were extracted with QuEChERS method, clean-up with NH2 SPE cartridge and residue were analyzed by HPLC/DAD. Limit of detections and quantifications were 0.01 and 0.03 mg/kg for 4 fungicides. Average recoveries were 92.9~99.2% with RSD≤5% for all analytes. The biological half-lives of boscalid, kresoxim-methyl, pyraclostrobin and pyrimethanil in strawberry after treatment were 6.2, 4.0, 6.1 and 6.6 days at recommended dose, respectively. As the results, 4 experimental pesticides were not exceeded MRLs of domestic and exporting countries in experimental periods. This study provide important information that can contribute safety measures to produce strawberry as not exceeded MRLs through the safe use of pesticides.

Recommendations for the use of everolimus in de novo kidney transplantation: False beliefs, myths and realities

The immunosuppressive combination most commonly used in de novo kidney transplantation comprises a calcineurin inhibitor (CI), tacrolimus, a mycophenolic acid derivative and steroids. The evidence which underlies this practice is based in the Symphony trial with controlled follow-up of one year, in which no comparator group included the combination CI-mTOR inhibitor. Different high-quality clinical trials support the use of everolimus as a standard immunosuppressive drug associated with reduced exposure of a CI in kidney transplantation. This combination could improve health related outcomes in kidney transplantation recipients.The present recommendations constitute an attempt to summarise the scientific evidence supporting this practice, discuss false beliefs, myths and facts, and offer specific guidelines for safe use, avoiding complications.

Recomendaciones para el uso de everolimus en trasplante renal de novo: falsas creencias, mitos y realidades

The immunosuppressive combination most commonly used in de novo kidney transplantation comprises a calcineurin inhibitor (CI), tacrolimus, a mycophenolic acid derivative and steroids. The evidence which underlies this practice is based in the Symphony trial with controlled follow-up of one year, in which no comparator group included the combination CI-mTOR inhibitor. Different high-quality clinical trials support the use of everolimus as a standard immunosuppressive drug associated with reduced exposure of a CI in kidney transplantation. This combination could improve health related outcomes in kidney transplantation recipients.The present recommendations constitute an attempt to summarise the scientific evidence supporting this practice, discuss false beliefs, myths and facts, and offer specific guidelines for safe use, avoiding complications.

Guideline Implementation: Energy-Generating Devices, Part 2—Lasers

Lasers have been used in the OR for many years and are essential tools in many different types of procedures. However, laser beams that come into contact with unintended targets directly or via reflection can cause injury to patients or personnel or pose other hazards, such as fires. The new AORN “Guideline for safe use of energy-generating devices” provides guidance on the use of all energy-generating devices in the OR. This article focuses on key points of the guideline that address the safe use of lasers. These include the components of the laser safety program, the responsibilities of the personnel in roles specific to use of a laser, laser safety measures, and documentation of laser use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Guideline Implementation: Energy-Generating Devices, Part 1—Electrosurgery

Energy-generating devices are standard equipment in the surgical suite, with electrosurgical units being the most common type of electrical device used in the OR. Prevention of injuries to patients and personnel related to the use of energy-generating devices is a key component of the perioperative nurse’s role. The AORN “Guideline for safe use of energy-generating devices” provides guidance on the use and maintenance of devices that deliver energy in the forms of radiofrequency waves, ultrasound waves, or lasers. This article focuses on key points of the guideline, which address precautions specific to electrosurgical units, patients with implanted electronic devices, and minimally invasive surgery, and documentation of the use of energy-generating devices. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Marijuana on the Mind? The Impact of Marijuana on Cognition, Brain Structure, and Brain Function, and Related Public Policy Implications

Although marijuana (MJ) has been used for thousands of years, the public’s opinion of MJ has shifted drastically over the past century, leaving many wondering about its potential risks and benefits. This article summarizes research detailing the impact of recreational MJ and related variables (frequency, magnitude, potency, and mode of MJ use) on cognition, brain structure, and brain function. MJ use, particularly at young ages, has been reported to undermine cognition, as well as alter brain structure and function. Furthermore, we discuss how data from recreational MJ studies, as well as more recent medical marijuana (MMJ) research findings, relate to legalization efforts. Considerations for policymakers, such as age limits, guidelines for safe use, and the therapeutic potential of certain constituents of MJ (i.e., cannabidiol), are also outlined. In recent years, policy has outpaced science; important areas in need of further research are noted.

Current state of the art of computer-guided implant surgery.

The invention of computerized axial tomography (now known as computerized tomography) and developments of interactive software to allow virtual planning, with the aim to guide the surgery precisely toward a specific target, has dramatically improved general, as well as oral, surgery. Virtual dental implant planning allows for a prosthetically driven approach, resulting in the best possible design of the prosthesis, better esthetics, optimized occlusion and loading. This approach has also changed the surgical paradigm of using extensive flaps to obtain a proper view of the surgical area because flapless implant surgery, with or without immediate loading, has become more predictable. Two types of guided implant surgery protocols - static and dynamic - are described in the literature. The static approach, better known as computer-guided surgery, refers to the use of a tissue-supported surgical template. This reproduces the virtual implant position directly from computerized tomographic data and this information can be converted to guide templates to be used during surgery, with or without raising a mucoperiosteal flap. Dynamic guided surgery, also called navigation, reproduces the virtual implant position directly from computerized tomographic data and uses motion-tracking technology to guide the implant osteotomy preparation. As the technology developed further, different levels of evidence were presented that showed various degrees of accuracy. Several protocols for guided surgery are available in the literature and are distinguished by different guide production techniques, methods of support and drilling/placement protocols. Currently, implant planning software using cone-beam computerized tomography data has made it possible to plan the optical implant position virtually the optimal implant position, taking the surrounding vital anatomic structures and future prosthetic requirements into consideration. This paper summarizes the evolution and ongoing trends in digital and virtual planning and in implant surgery. The purpose of this overview was to clarify the different concepts in guided surgery and their respective advantages, disadvantages and limitations. The outcome of guided surgery is assessed in terms of implant survival, precision and complications. Clinical cases are given to demonstrate briefly the workflow and clinical guidelines for safe use of these approaches.

Use of Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Relation to Cardiovascular Events. A Systematic Pharmacoepidemiological Review.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used, having numerous indications. However, despite their therapeutic role, they are associated with serious cardiovascular (CV) adverse events. Objectives-Methods: This review comprising recent observational studies and metaanalyses over the past few years aims at updating the assessment of CV adverse events, namely stroke, myocardial infarction (MI), CV death, atrial fibrillation (AF), serious bleeding and heart failure related to the use of 4 of the most widely prescribed NSAIDs: ibuprofen, naproxen, diclofenac and mefenamic acid. The best safety profile related to MI was found for naproxen, while the worst safety profile, with excessively increased risk for stroke, MI and major bleeding, was for diclofenac. Naproxen showed higher risk for major bleeding than ibuprofen and the risk for stroke was slightly higher than ibuprofen. Regarding heart failure, ibuprofen presented the highest risk while the highest risk for AF was attributed to the current use of diclofenac. There are few data related to mefenamic acid, which showed a strong association with increased risk for stroke and a moderately increased risk for MI. Further research is needed in order to devise new guidelines for safer use of NSAIDs.

Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: A cohort study of beach goers in Brazil?

Regulating recreational water exposure to pathogens within the tropics is a major public health and economic concern. Although numerous epidemiological studies estimating the risk to recreational marine water exposure have been conducted since the 1950s, few studies have been done in the tropics. Furthermore, many have suggested that the use of fecal indicator bacteria for monitoring recreational water quality in temperate regions is not appropriate in the tropics. We analyzed a large cohort study of five beaches in Sao Paulo, Brazil, conducted during consecutive weekends in the summer of 1999 that estimated risk to water, sand, and food exposures. Enterococci and Escherichia coli concentrations were measured each day of the study. Elevated risks were estimated for both swimming (OR = 1.36 95% CI: 1.05–1.58) and sand contact (OR = 1.29 95% CI 1.05–1.58). A 1 log increase in enterococci concentration was associated with an 11% increase in risk (OR = 1.11 95% CI: 1.04–1.19). For E. coli a 1-log increase in concentration was associated with 19% increase in risk (OR = 1.19 95% CI: 1.14–1.28). Most countries with beaches in the tropics are lower or middle income countries (LMIC) and rely on tourism as a major source of income. We present data that suggests fecal indicator bacteria such as enterococci are an appropriate indicator of risk in tropical urban settings where contamination is coming from predominantly human sources. Additional studies in tropical settings could help inform and refine guidelines for safe use of recreational waters.

Nitrous oxide – does it still have a place in veterinary anaesthesia?

ABSTRACTAre you afraid of nitrous oxide? Do you wonder what will happen if you use it? Nitrous oxide has been around for over 200 years, but it is used much less in veterinary anaesthesia nowadays. This article provides a brief review of its history, advantages and disadvantages, and guidelines for safe use. We argue that it is still a useful drug as long as a number of safety precautions are followed.

Preliminary Guidelines for Safe and Effective Use of Repetitive Transcranial Magnetic Stimulation in Moderate to Severe Traumatic Brain Injury

Transcranial magnetic stimulation has generated extensive interest within the traumatic brain injury (TBI) rehabilitation community, but little work has been done with repetitive protocols, which can produce prolonged changes in behavior. This is partly because of concerns about the safety of repetitive transcranial magnetic stimulation (rTMS) in subjects with TBI, particularly the risk of seizures. These risks can be minimized by careful selection of the rTMS protocol and exclusion criteria. In this article, we identify guidelines for safe use of rTMS in subjects with TBI based on a review of the literature and illustrate their application with a case study. Our subject is a 48-year-old man who sustained a severe TBI 5 years prior to beginning rTMS for the treatment of post-TBI depression. After a 4-week baseline period, we administered daily sessions of low-frequency stimulation to the right dorsolateral prefrontal cortex for 6 weeks. After stimulation, we performed monthly assessments for 3 months. The Hamilton Depression Rating Scale (HAMD) was our primary outcome measure. The stimulation was well tolerated and the patient reported no side effects. After 6 weeks of stimulation, the patient's depression was slightly improved, and these improvements continued through follow-up. At the end of follow-up, the patient's HAMD score was 49% of the average baseline score.

Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: Prescribing patterns according to pain prevalence and adherence to clinical guidelines

The evidence on the patterns of nonsteroidal anti-inflammatory drug (NSAID) use according to pain prevalence and clinical guidelines in older people is sparse. This cross-sectional study examined the patterns of NSAID use according to pain prevalence and concordance with clinical guideline recommendations for safe NSAID use in older people, in relation to duration of use, patterns of use, concomitant use of proton pump inhibitors (PPIs), and prevalence of specific drug interactions. Community-dwelling men (n=1696) age ⩾70years living in Sydney were studied. 8.2% (n=139) of participants reported regular NSAID use compared with 2.9% (n=50) reporting as-needed use. The mean treatment duration for regular NSAID use was 4.9years, suggesting long-term rather than short-term use as recommended by the guidelines. Although guidelines recommend use of PPIs together with an NSAID, only 25.2% of regular NSAID users reported PPI use. Regular NSAID users were significantly more likely to report use of opioid analgesics (P<.0001) compared with nonregular users. In relation to pain prevalence, regular NSAID users were significantly more likely to report chronic pain (P<.0001), recent pain (P=.0001), and chronic intrusive pain (P<.0001) compared with nonregular users. The findings of this study indicate that NSAID prescribing practices do not align with clinical guidelines for safe use in older people. This difference between the guideline recommendations and what is happening in the real world should be explored further.

NSAIDs in the Older Patient: Balancing Benefits and Harms

The older person is more likely to have pain since degenerative diseases and the effects of cancer are more common after 65 years of age. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used due to perceived safety, relatively low cost and over-the-counter availability. This brief review describes the necessity for, but risks of, NSAIDs in the older patient. A literature search was undertaken using PubMed and search terms including pain, aging, treatment, nonsteroidal anti-inflammatory drugs, arthritis, older patient, and guidelines. Pain complaints are common in the older population. Low back pain and osteoarthritis affects over two thirds of this group. Patients and clinicians are increasingly wary about treatment since no medication appears to be safe. Older patients opting for no treatment may have worsening function including decreased sleep, mobility, socialization, and increased depression. Ninety percent of all prescription NSAIDs are taken by patients over 65. Guidelines for safe use are available but frequently not followed by the practitioner including the FDA recommended "lowest dose possible for your treatment … for the shortest time needed." NSAIDs can be an effective treatment option for many older persons but caution should be exercised in this often fragile population.

256 Impact of a campaign on the correct use of protective personal equipment in car body repair shops

IntroductionSignificant exposure to hexamethylene diisocyanate (HDI) might occur during spray painting in car body repair shops. Since HDI induces asthma it should be used in properly designed spray booths wearing...

CEM43°C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels?

To define thresholds of safe local temperature increases for MR equipment that exposes patients to radiofrequency fields of high intensities for long duration. These MR systems induce heterogeneous energy absorption patterns inside the body and can create localised hotspots with a risk of overheating. The MRI + EUREKA research consortium organised a "Thermal Workshop on RF Hotspots". The available literature on thresholds for thermal damage and the validity of the thermal dose (TD) model were discussed. The following global TD threshold guidelines for safe use of MR are proposed: 1. All persons: maximum local temperature of any tissue limited to 39°C 2. Persons with compromised thermoregulation AND (a) Uncontrolled conditions: maximum local temperature limited to 39°C (b) Controlled conditions: TD < 2CEM43°C 3. Persons with uncompromised thermoregulation AND (a) Uncontrolled conditions: TD < 2CEM43°C (b) Controlled conditions: TD < 9CEM43°C The following definitions are applied: Controlled conditions A medical doctor or a dedicated trained person can respond instantly to heat-induced physiological stress Compromised thermoregulation All persons with impaired systemic or reduced local thermoregulation • Standard MRI can cause local heating by radiofrequency absorption. • Monitoring thermal dose (in units of CEM43°C) can control risk during MRI. • 9CEM43°C seems an acceptable thermal dose threshold for most patients. • For skin, muscle, fat and bone,16CEM43°C is likely acceptable.

Improving the Durability of Digital Flexible Ureteroscopes

To present the damage to digital flexible ureteroscopes after 1 year of use in a tertiary stone center and our strategy to reduce the damage. Data regarding all procedures performed with 3 new digital flexible ureteroscopes (Olympus URF-V) were collected. We examined the conditions under which the damage occurred and retrieved the manufacturer's repair reports. Two study groups were created. Group 1 included all the procedures performed before the introduction of a set of guidelines for safe use of the digital flexible ureteroscopes and a stepwise credentialing process for new surgeons. Group 2 included all the procedures performed thereafter. A total of 141 procedures were performed in 122 patients. Five events of damage occurred in the first study group and were related to working in maximum deflection. In the second group only 3events occurred. The damage affected the angulation system, working channel, or body shaft. No damage occurred to the imaging system of any ureteroscope. The changes that were made after the first 5 months of use resulted in a significant prolongation of the number of uses before damage occurred for every ureteroscope (10.6 vs 21.6 uses before damage, P= .035). The optical system of the new digital ureteroscopes is very durable; however, the overall longevity depends on the correct handling of their use. By following the proposed guidelines for safe use and with monitored training of new users, these instruments can have a significantly longer lifespan.

A prospective observational study of medication errors in general medicine department in a tertiary care hospital

The aim of the study was to evaluate the incidence of medication error and to categorize medication error in the general medicine department of a tertiary hospital. Thus, the study aims to promote safety in medication use and ensure quality in the healthcare service by effective utilization of a clinical pharmacist. The study objective was to detect and categorize medication errors, to ensure rational drug use in the hospital, to make recommendations for doctors, nurses, and patients to promote safe use of medications. The study was conducted in inpatients in the general medicine department of a 350-bed multispecialty tertiary care referral hospital located in South India. It is a prospective observational study where data were collected using a data collection form which included patient demographic details, drug details, and criteria for identifying errors, its categorization, and the details of drugs involved in errors. Complete details of patients and medications were recorded through a review of medication charts, reviewing prescriptions, visiting nursing stations and the pharmacy, and personal interviews with patients and bystanders. Collected details were then evaluated to detect the prescribing, administration, dispensing error and drug interactions and were then recorded, suggesting necessary steps to prevent recurrence of reported medication errors. The study was conducted in 311 patients, where 168 were males (54%) and 143 were females (46%). Out of 311 cases, 36 cases (11.57%) had at least one error. The total number of errors found was 67, among which administration errors (28.35%) were the most frequently occurring types of errors, which was followed by prescribing errors (22.38%), dispensing errors (8.9%) and drug interaction, patient errors and other types of errors collectively contributed to the remaining portion. A total of 2742 medications were prescribed to 106 patients and the average number of medications per patient was found to be 8.8. The involvement of a particular medication class to the medication errors showed that the antimicrobial agents were contributing a maximum of (26.8%), which was followed by cardiovascular agents (20.8%). In third place were nonsteroidal anti-inflammatory drugs (11.9%) followed very closely by central nervous system drugs and gastrointestinal drugs (7.4%). The total percentage of drug interaction was 40.29%. Most interactions were of moderate type belonging to category C of medication errors. The study helps to assess the incidence of medication error and to categorize medication error. In the general medicine department, the majority of patients were geriatrics who are more prone to errors, thus guidelines for safe use of medications in geriatrics should be strictly implemented to prevent medication errors. Antimicrobials are the major class of drugs involved in medication errors, thus this study recommends strict implementations of antibiotic policy in the hospital.