Review of allergic reactions from use of chlorhexidine on medical products in clinical settings over 40 years: Risks and mitigations

2021 ◽  
pp. 1-15
Author(s):  
Bahgat Z. Gerges ◽  
Joel Rosenblatt ◽  
Y-Lan Truong ◽  
Ruth A. Reitzel ◽  
Isaam Raad
Keyword(s):  
Infection Prevention ◽  
Case Reports ◽  
Severe Allergic Reaction ◽  
Clinical Settings ◽  
Allergic Reactions ◽  
Medical Settings ◽  
Medical Products ◽  
Product Categories ◽  
Over 40 Years ◽  
And Training

Abstract Chlorhexidine is an antimicrobial agent widely used for infection prevention in medical settings. Nevertheless, allergic reactions ranging from mild to severe have been reported following its use. In this review, we analyzed all case reports published between the introduction of chlorhexidine and the end of 2019 for allergic responses associated with the use of medical devices and or other medical products containing chlorhexidine (CHX) to ascertain the prevalence of severe CHX allergic reactions and what practices might best mitigate those risks. In total, 77 publications containing 124 reported cases of allergic reactions were grouped into 3 product categories, catheters, semisolids, and fluid products. The country, type of reaction, route of sensitization, allergy confirmation, and intervention or mitigation was extracted for each case. Overall, 30 cases were associated with catheters, 46 cases were associated with semisolid products, and 48 cases were associated with the use of other medical products. Severe cases were managed with intravenous fluids, steroids, and epinephrine (adrenaline). None of the reported cases were fatal. The allergy risks can be mitigated by better warning and training clinicians and by recording and screening patient histories for CHX presensitization from prior exposure. For patients undergoing pre-use blood tests, IgE antibody screens can also be performed. Finally, as a precaution in the event a rare severe allergic reaction occurs, procedure carts and rooms can be prestocked with injectable epinephrine and other rapidly acting anti-inflammatory medications.

scholarly journals Missing the mark: Current practices in teaching the male urogenital examination to Canadian undergraduate medical students

2016 ◽  
Vol 10 (7-8) ◽  
pp. 281
Author(s):  
Kristen McAlpine ◽  
Stephen Steele
Keyword(s):  
Medical Students ◽  
Clinical Training ◽  
Clinical Skills ◽  
Medical Schools ◽  
Clinical Settings ◽  
Undergraduate Medical Students ◽  
Canadian Medical School ◽  
Competency Based ◽  
English Speaking ◽  
And Training

<p><strong>Introduction:</strong> The urogenital physical examination is an important aspect of patient encounters in various clinical settings. Introductory clinical skills sessions are intended to provide support and alleviate students’ anxiety when learning this sensitive exam. The techniques each Canadian medical school uses to guide their students through the initial urogenital examination has not been previously reported.</p><p><strong>Methods:</strong> This study surveyed pre-clerkship clinical skills program directors at the main campus of English-speaking Canadian medical schools regarding the curriculum they use to teach the urogenital examination.</p><p><strong>Results:</strong> A response rate of 100% was achieved, providing information on resources and faculty available to students, as well as the manner in which students were evaluated. Surprisingly, over onethird of the Canadian medical schools surveyed failed to provide a setting in which students perform a urogenital examination on a patient in their pre-clinical years. Additionally, there was no formal evaluation of this skill set reported by almost 50% of Canadian medical schools prior to clinical training years.</p><p><strong>Conclusions:</strong> To ensure medical students are confident and accurate in performing a urogenital examination, it is vital they be provided the proper resources, teaching, and training. As we progress towards a competency-based curriculum, it is essential that increased focus be placed on patient encounters in undergraduate training. Further research to quantify students’ exposure to the urogenital examination during clinical years would be of interest. Without this commitment by Canadian medical schools, we are doing a disservice not only to the medical students, but also to our patient population.</p>

Nonsedated Magnetic Resonance Imaging for Visualization of the Velopharynx in the Pediatric Population

2021 ◽  
pp. 105566562110573
Author(s):  
Katelyn J. Kotlarek ◽  
Thomas J. Sitzman ◽  
Jessica L. Williams ◽  
Jamie L. Perry
Keyword(s):  
Pediatric Population ◽  
Velopharyngeal Insufficiency ◽  
Limited Attention ◽  
Behavioral Adaptation ◽  
Clinical Settings ◽  
Success Rates ◽  
Resonance Imaging ◽  
Provider Training ◽  
Pediatric Mri ◽  
And Training

Background Non-sedated MRI is gaining traction in clinical settings for visualization of the velopharynx in children with velopharyngeal insufficiency. However, the behavioral adaptation and training aspects that are essential for successful pediatric MRI have received limited attention. Solution We outline a program of behavioral modifications combined with patient education and provider training that has led to high success rates for non-sedated velopharyngeal MRI in children.

Support for staff support groups: A role for group analysts

2019 ◽  
Vol 52 (3) ◽  
pp. 339-349 ◽  
Author(s):  
Kenneth Bledin
Keyword(s):  
Support Groups ◽  
Psychology Training ◽  
Clinical Settings ◽  
Staff Support ◽  
Clinical Psychology Training ◽  
Clinical Environments ◽  
Training Courses ◽  
Training Opportunities ◽  
And Training ◽  
Quantitative Evaluations

Clinical psychologists in NHS settings are often called upon to facilitate ‘staff groups’. A survey of psychologists’ self-reported experiences of facilitating such groups indicated average levels of relevant training, moderate levels of confidence, but only average levels of effectiveness. The value and validity of quantitative evaluations of this kind are discussed. The findings suggest that more group therapies-related teaching and training are needed in clinical psychology training courses and in clinical environments in the NHS and other clinical settings. Group analysts are well placed to encourage, support and provide teaching and training opportunities such as these.

scholarly journals Empowering Your Presentation Skills

2014 ◽  
Vol 8 (1) ◽  
pp. 100-104
Author(s):  
Hoi Ho ◽  
Michael S Cardwell ◽  
J Hector Aranda ◽  
Rene Hernandez
Keyword(s):  
Medical Education ◽  
Medical Curriculum ◽  
Imaging Modality ◽  
Point Of Care ◽  
Faculty Members ◽  
Clinical Settings ◽  
Web Based ◽  
User Friendly ◽  
And Training ◽  
Selection Of

ABSTRACT As technology continues evolving, ultrasonography has become increasingly the imaging modality of choice in many different clinical settings including hospital, clinic and point of care. Similarly, the expansion of internet has revolutionized the medical curriculum and training of the entire medical education continuum: undergraduate medical education, graduate medical education and continuing medical education. More importantly, technology and internet have transformed the traditional teacher-dependent classroom-based teaching into the learneroriented web-based learning. To empower the presentation, whether classroom-based or web-based, it's essential that faculty members apply principles of adult learning throughout the session. Newer version of PowerPoint (PPT) is powerful and user-friendly. However, faculty members should be familiar with fundamental guidelines for appropriate selection of fonts, character sizes, background colors, charts, graphs, animation and multimedia. In general, PowerPoint presentations prepared on Windowsbased computers can be run on Mac computers; however, presenters should be aware of compatibility issues across platform such as fonts or multimedia formats. Faculty can also easily turn the PowerPoint presentation into a powerful and interactive teaching tool of ultrasonography for unlimited number of learners by following simple guidelines of using PowerPoint and having minimum resources and technical support for software of voice over presentation, such as Camtasia or Captivate. How to cite this article Cardwell MS, Aranda JH, Hernandez R, Ho H. Empowering Your Presentation Skills. Donald School J Ultrasound Obstet Gynecol 2014;8(1):100-104.

Guidelines for Air & Ground Transport of Neonatal and Pediatric Patients Manual

2015 ◽  
Author(s):  
◽  
Janice Romito ◽  
S. Niccole Alexander
Keyword(s):  
Performance Improvement ◽  
Health Care Professionals ◽  
Pediatric Patients ◽  
Transport Systems ◽  
Editorial Team ◽  
Clinical Settings ◽  
Policies And Procedures ◽  
Sample Position ◽  
Hospital Systems ◽  
And Training

Completely revised and updated, the new 4th edition includes must-have information and guidelines for health care professionals and hospital systems interested in developing transport systems and improving the transport care they deliver. Authored by leading experts in transport medicine, the editorial team is devoted to ensuring that appropriate evidence-based conclusions and recommendations are included, when available, for the clinical and administrative subjects presented. The 4th edition covers all aspects of air and ground transport - from team organization and training to equipment selection, quality improvement, safety, ethics and much more. Content highlights: All chapters thoroughly reviewed and updated by the leading authorities in transport medicine New chapter on telemedicine covering equipment and teleconferencing, telemedicine in other clinical settings, regulations and reimbursement, and more Expanded sections on driving performance improvement, risk management, and bioethics Updated Web resources Handy tools include sample position descriptions, sample transport medicine transfer agreement, policies and procedures, and more

Cryosupernatant and Solvent Detergent Fresh Frozen Plasma (Octaplas, Octapharma) Usage in Acute Thrombotic Thrombocytopenic Purpura-Review of 50 Episodes.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4139-4139
Author(s):  
Marie Scully ◽  
Michael Flynn ◽  
Jenny Berryman ◽  
Samuel J. Machin
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Fresh Frozen Plasma ◽  
Severe Allergic Reaction ◽  
Central Vein ◽  
Allergic Reactions ◽  
Refractory Disease ◽  
Thrombocytopenic Purpura ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Thrombotic thrombocytopenic purpura (TTP) is an acute, life threatening disorder. The mainstay of treatment is plasma exchange (PEX) as a source of ADAMTS 13. In the UK, 20–25% of all plasma consumed is in patients with TTP. In our protocol (up until 31st December 2005) apheresis was initially with cryosupernatant (National Blood Service, UK) unless patients had a previous severe allergic reaction or refractory disease. Apheresis therefore continued with Solvent-Detergent Fresh Frozen Plasma (S/D FFP) Octaplas, (Octapharma, Vienna Austria) virally inactivated plasma, available throughout Europe. We reviewed 50 acute TTP episodes involving 32 patients. Thirteen episodes used cryosupernatant only and in 15 episodes, treatment started with cryosupernatant and changed to Octaplas. The reasons for changing were refractory disease in 2 episodes and major or recurrent allergic reactions to cryosupernatant in 13 cases. Once Octaplas had been used, it was continued on further admissions. In 22 episodes, Octaplas was used exclusively; in 4 cases as physicians choice and in the remaining due to previous reactions to cryosupernatant. The total volume of cryosupernatant used was 508250mls, 27.6% of all plasma; total volume of Octaplas was 1327600mls, 72.4% of all plasma. Citrate mediated reactions associated with symptomatic hypocalcaemia during apheresis were present in 11% of Octaplas and 20% of cryosupernatant. Acute or delayed urticarial or allergic reactions were noted in 5% of Octaplas and 10% cryosupernatant procedures. A particular complication of apheresis is central line infection. There were 21 line infections and in 43% of cases the infection was associated with a reduction in platelet count < 150 × 109/L. In all 50 episodes, the only documented thrombosis was a superficial non central vein in a patient who had received Octaplas. Prevention of venous thrombosis is by use of thromboembolic stockings, low dose aspirin and low molecular weight heparin in patients when platelet counts >50 × 109/L. In episodes receiving only cryosupernatant or Octaplas, there was no significant difference in the median number of PEX to remission, 7(3–14) and 8.5 (5–30) respectively. Baseline viral screen in all episodes was negative after discharge following an acute TTP episode. In conclusion: cryosupernatant and S/D FFP (Octaplas) appear equally efficacious. However, the risk of allergic/urticarial reactions was twice as common with cryosupernatant, as were citrate reactions. Milder allergic reactions to cryosupernatant are possibly higher, but may have been treated with antihistamines and data not recorded. There was no documented viral transmission with either product.

Practitioner Perspectives on Animal-Assisted Counseling

2018 ◽  
Vol 40 (1) ◽  
pp. 43-57 ◽  
Author(s):  
Elizabeth Kjellstrand Hartwig ◽  
Quinn Koelfgen Smelser
Keyword(s):  
Mental Health ◽  
Survey Instrument ◽  
Mental Health Practitioners ◽  
Clinical Settings ◽  
Clinical Issues ◽  
Training And Supervision ◽  
Health Practitioners ◽  
Education Training ◽  
And Training

The field of animal-assisted counseling (AAC) is burgeoning. However, there is a paucity of research on the perspectives of mental health practitioners regarding its practice and the experience and training needed to effectively utilize AAC with clients. The purpose of this study was to explore how practitioners perceive AAC and its role in clinical settings. Perceptions of 300 mental health practitioners were assessed using a researcher-developed survey instrument. Findings indicated that a majority of practitioners (91.7%) view AAC as a legitimate counseling modality. Practitioners identified client age ranges and the top five clinical issues that would benefit from AAC. While only 12.0% of respondents had received training in AAC, 57.0% of respondents reported interest in receiving AAC training. Respondents identified types of AAC education, training, and supervision that would be sufficient for clinicians to utilize AAC. The findings from this study contribute to the emerging literature on AAC.

scholarly journals Perioperative latex hypersensitivity reactions: an integrative literature review

2012 ◽  
Vol 20 (2) ◽  
pp. 411-420 ◽  
Author(s):  
Aline Nair Biaggio Mota ◽  
Ruth Natalia Teresa Turrini
Keyword(s):  
Literature Review ◽  
Case Reports ◽  
Primary Source ◽  
Allergic Reactions ◽  
Hypersensitivity Reactions ◽  
Anesthetic Induction ◽  
Prevalence Studies ◽  
Latex Gloves ◽  
Anesthetic Drugs ◽  
History Of

This article characterizes hypersensitivity reactions during anesthetic-surgical procedures. This integrative literature review was conducted in the LILACS, CINAHL, COCHRANE and MEDLINE databases including papers published from 1966 to September 2011. A total of 17 case reports, two prevalence studies and one cohort study were identified. Latex reactions were mainly type III and the primary source of intraoperative reaction was latex gloves. The average time for clinical manifestation was 59.8 minutes after anesthetic induction; 44.4% of patients reported a reaction to latex at the pre-anesthetic evaluation. It was determined that the history of allergic reactions to latex obtained in the pre-anesthetic evaluation does not ensure the safety of patients if the staff is inattentive to the severity of the issue. There is also a tendency to initially attribute the anaphylactic event to the anesthetic drugs.

Sign in / Sign up

Export Citation Format

Share Document