scholarly journals Evaluation of electronic medication management systems on inpatient omitted dose rates at 2 acute metropolitan hospitals

2021 ◽  
Author(s):  
Paul Wembridge ◽  
Miranda Ng
Keyword(s):  
Dose Rate ◽  
Medication Management ◽  
Management Systems ◽  
Eligibility Criteria ◽  
Baseline Rate ◽  
Dose Rates ◽  
Lower Baseline ◽  
Support Tools ◽  
Administration Time ◽  
Administration Error

Rationale, aim and objectives: Medication error is common and the most common form of administration error is omission. Implementation of Electronic Medication Management systems (eMMS) has been hypothesized to decrease the rate of omitted doses due to the creation of a number of forcing functions and decision support tools however there is limited evidence currently available in the literature to support this assumption. This study therefore aims to ascertain if implementation of eMMS at 2 acute metropolitan hospitals reduces the rate of omitted doses Method: A retrospective cohort study was undertaken pre and post implementation of eMMS. Patients meeting eligibility criteria had all medication charts from their admission reviewed and an omitted dose rate calculated. For each omitted dose identified; medication name, imprest availability, dispensing history, administration time and frequency were recorded. Results: 386 patients met eligibility criteria for this study (11,796 opportunities for omission). The implementation of eMMS was associated with a significant reduction in omitted doses (3.6% vs 1.8% p<0.01). Benefit was not consistent among subgroups. eMMS implementation at the hospital with the higher baseline omitted dose rate was associated with a significant reduction in omitted doses (5.8% vs 0.9% p<0.01) but not at the hospital with a lower baseline rate (2.7% vs 2.4% p=0.3). The most common times for an omitted dose to occur were 0800 (33%) and 2000 (18%). The most common frequencies for an omitted dose were daily (35%) and twice daily (32%). Conclusion: The introduction of eMMS was associated with a decrease rate of omitted doses. Greatest benefit is likely to occur in areas with a high baseline rate of omission.

scholarly journals Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room: An Instant Operator Risk Chart for Daily Practice

2021 ◽  
pp. 152660282110074
Author(s):  
Quirina M. B. de Ruiter ◽  
Frans L. Moll ◽  
Constantijn E. V. B. Hazenberg ◽  
Joost A. van Herwaarden
Keyword(s):  
Radiation Dose ◽  
Dose Rate ◽  
Effect Size ◽  
Radiation Risk ◽  
Dose Limit ◽  
Access Site ◽  
Femoral Access ◽  
Dose Rates ◽  
Rate Prediction ◽  
Operator Dose

Introduction: While the operator radiation dose rates are correlated to patient radiation dose rates, discrepancies may exist in the effect size of each individual radiation dose predictors. An operator dose rate prediction model was developed, compared with the patient dose rate prediction model, and converted to an instant operator risk chart. Materials and Methods: The radiation dose rates (DRoperator for the operator and DRpatient for the patient) from 12,865 abdomen X-ray acquisitions were selected from 50 unique patients undergoing standard or complex endovascular aortic repair (EVAR) in the hybrid operating room with a fixed C-arm. The radiation dose rates were analyzed using a log-linear multivariable mixed model (with the patient as the random effect) and incorporated varying (patient and C-arm) radiation dose predictors combined with the vascular access site. The operator dose rate models were used to predict the expected radiation exposure duration until an operator may be at risk to reach the 20 mSv year dose limit. The dose rate prediction models were translated into an instant operator radiation risk chart. Results: In the multivariate patient and operator fluoroscopy dose rate models, lower DRoperator than DRpatient effect size was found for radiation protocol (2.06 for patient vs 1.4 for operator changing from low to medium protocol) and C-arm angulation. Comparable effect sizes for both DRoperator and DRpatient were found for body mass index (1.25 for patient and 1.27 for the operator) and irradiated field. A higher effect size for the DRoperator than DRpatient was found for C-arm rotation (1.24 for the patient vs 1.69 for the operator) and exchanging from femoral access site to brachial access (1.05 for patient vs 2.5 for the operator). Operators may reach their yearly 20 mSv year dose limit after 941 minutes from the femoral access vs 358 minutes of digital subtraction angiography radiation from the brachial access. Conclusion: The operator dose rates were correlated to patient dose rate; however, C-arm angulation and changing from femoral to brachial vascular access site may disproportionally increase the operator radiation risk compared with the patient radiation risk. An instant risk chart may improve operator dose awareness during EVAR.

Kinetics of DNA Repair Under Chronic Irradiation at Low and Medium Dose Rates in Repair Proficient and Repair Compromised Normal Fibroblasts

2021 ◽  
Author(s):  
Elena K. Zaharieva ◽  
Megumi Sasatani ◽  
Kenji Kamiya
Keyword(s):  
Dna Damage ◽  
Dna Repair ◽  
Dose Rate ◽  
Dose Response ◽  
Chronic Irradiation ◽  
Dose Rates ◽  
Chronic Radiation ◽  
Damage Repair ◽  
Kinetics Of ◽  
Medium Dose

We present time and dose dependencies for the formation of 53BP1 and γH2AX DNA damage repair foci after chronic radiation exposure at dose rates of 140, 250 and 450 mGy/day from 3 to 96 h, in human and mouse repair proficient and ATM or DNA-PK deficient repair compromised cell models. We describe the time/dose-response curves using a mathematical equation which contains a linear component for the induction of DNA damage repair foci after irradiation, and an exponential component for their resolution. We show that under conditions of chronic irradiation at low and medium dose rates, the processes of DNA double-strand breaks (DSBs) induction and repair establish an equilibrium, which in repair proficient cells manifests as a plateau-shaped dose-response where the plateau is reached within the first 24 h postirradiation, and its height is proportionate to the radiation dose rate. In contrast, in repair compromised cells, where the rate of repair may be exceeded by the DSB induction rate, DNA damage accumulates with time of exposure and total absorbed dose. In addition, we discuss the biological meaning of the observed dependencies by presenting the frequency of micronuclei formation under the same irradiation conditions as a marker of radiation-induced genomic instability. We believe that the data and analysis presented here shed light on the kinetics of DNA repair under chronic radiation and are useful for future studies in the low-to-medium dose rate range.

Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Betty A McGee ◽  
Melissa Stephenson
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Median Time ◽  
Survival Data ◽  
Stroke Patients ◽  
Eligibility Criteria ◽  
Before And After ◽  
Administration Time ◽  
System Data ◽  
The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

scholarly journals COMPREHENSIVE MEDICATION MANAGEMENT SERVICES IN A BRAZILIAN SPECIALITY PHARMACY: A QUALITATIVE ASSESSMENT

2017 ◽  
Vol 9 (3) ◽  
pp. 227 ◽  
Author(s):  
Kirla Barbosa Detoni ◽  
Mariana Martins Gonzaga Do Nascimento ◽  
Isabela Viana Oliveira ◽  
Mateus Rodrigues Alves ◽  
Manoel Machuca GonzÁles ◽  
...  
Keyword(s):  
Participant Observation ◽  
Patient Flow ◽  
Medication Management ◽  
Implementation Process ◽  
Ethnographic Study ◽  
Qualitative Assessment ◽  
Healthcare Team ◽  
Structured Interviews ◽  
Eligibility Criteria ◽  
Manager Support

Objective: To understand and describe the implementation process of a comprehensive medication management (CMM) service in a public speciality pharmacy in Brazil.Methods: Ethnographic study conducted over 17 mo (September 2014 to February 2016) in a public speciality pharmacy. Semi-structured interviews were conducted with twelve participants. Notes on field journals, resulting from participant observation conducted by the two pharmacists directly responsible for the service implementation, were also used as a source of data.Results: Ten important conditions to improve the success of CMM service implementation were identified: manager support; evaluation of physical and material resources; evaluation of human resources practitioners’ characteristics and knowledge about the theoretical framework of CMM services; time dedicated to CMM services; redefining the work process; defining patient eligibility criteria to CMM service; defining patient flow to CMM service; communication with healthcare team; integration with the staff; and marketing the service internally.Conclusion: The results unveiled by this article can be used by pharmacists and managers as a tool to optimize the implementation of CMM services in different healthcare settings. These conditions do not consist the only aspects necessary to ensure the success of the service; however, they can contribute to optimize the implementation process of the practice

scholarly journals Serum Metabolomic Alterations Associated with Cesium-137 Internal Emitter Delivered in Various Dose Rates

Metabolites ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 270
Author(s):  
Heng-Hong Li ◽  
Yun-Tien Lin ◽  
Evagelia C. Laiakis ◽  
Maryam Goudarzi ◽  
Waylon Weber ◽  
...  
Keyword(s):  
Dose Rate ◽  
Cumulative Dose ◽  
Low Dose ◽  
Biological Effects ◽  
Serum Samples ◽  
Dose Rates ◽  
Sphingosine 1 Phosphate ◽  
Cesium 137 ◽  
Dose Rate Effect ◽  
Medium Dose

Our laboratory and others have use radiation metabolomics to assess responses in order to develop biomarkers reflecting exposure and level of injury. To expand the types of exposure and compare to previously published results, metabolomic analysis has been carried out using serum samples from mice exposed to 137Cs internal emitters. Animals were injected intraperitoneally with 137CsCl solutions of varying radioactivity, and the absorbed doses were calculated. To determine the dose rate effect, serum samples were collected at 2, 3, 5, 7, and 14 days after injection. Based on the time for each group receiving the cumulative dose of 4 Gy, the dose rate for each group was determined. The dose rates analyzed were 0.16 Gy/day (low), 0.69 Gy/day (medium), and 1.25 Gy/day (high). The results indicated that at a cumulative dose of 4 Gy, the low dose rate group had the least number of statistically significantly differential spectral features. Some identified metabolites showed common changes for different dose rates. For example, significantly altered levels of oleamide and sphingosine 1-phosphate were seen in all three groups. On the other hand, the intensity of three amino acids, Isoleucine, Phenylalanine and Arginine, significantly decreased only in the medium dose rate group. These findings have the potential to be used in assessing the exposure and the biological effects of internal emitters.

scholarly journals Investigation of dose-rate effects and cell-cycle distribution under protracted exposure to ionizing radiation for various dose-rates

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Yusuke Matsuya ◽  
Stephen J. McMahon ◽  
Kaori Tsutsumi ◽  
Kohei Sasaki ◽  
Go Okuyama ◽  
...  
Keyword(s):  
Cell Cycle ◽  
Ionizing Radiation ◽  
Dose Rate ◽  
Cell Cycle Distribution ◽  
Dose Rates ◽  
Dose Rate Effects ◽  
Rate Effects

scholarly journals Reversal of epidural xylazine in Egyptian water buffalo (Bubalus bubalis) with atipamezole

2021 ◽  
Vol 24 (3) ◽  
pp. 376-382
Author(s):  
M. M Shokry ◽  
A. H. Elkasapy
Keyword(s):  
Side Effects ◽  
Dose Rate ◽  
Water Buffalo ◽  
Bubalus Bubalis ◽  
Total Recovery ◽  
Dose Rates ◽  
Recovery Times ◽  
The Mean

The reversal of epidural xylazine, induced with IV atipamezole was evaluated in 15 buffaloes. Atipamezole at different dose rates (5, 10 and 15 µg/kg) injected 30 minutes after epidural xylazine provoked visible signs of arousal shortly after inection in all buffaloes without any side effects. The mean arousal times were 4.8±0.84 min, 2.4±0.24 min and 2.0±0.00 min while the mean total recovery times were 61.0±2.6 min, 33.0±3.7 min and 32.0±4.3 min following doses of 5, 10 and 15 µg/kg atipamezole respectively. The heart, respiratory and ruminal rates were mildly influenced. Overall, the IV atipamezole at a dose rate of 10 µg/kg was found effective and satisfactory for reversing the analgesic, sedative and cardiopulmonary depression effects induced by epidural xylazine administration in buffaloes.

scholarly journals EVALUATION OF RADIATION DOSE RATE OF RSG-GAS REACTOR

2018 ◽  
Vol 24 (3) ◽  
Author(s):  
Amir Hamzah ◽  
Hery Adrial ◽  
Subiharto Subiharto
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Dose Rate ◽  
Nuclear Reactor ◽  
Area Measurement ◽  
Radiation Dose Rate ◽  
Safety Level ◽  
Modeling And Analysis ◽  
Dose Rates ◽  
Limit Value

EVALUATION OF RADIATION DOSE RATE OF RSG-GAS REACTOR. The RSG-GAS reactor has been operated for 30 years. Since the nuclear reactor has been operated for a long time, aging process on its components may occur. One important parameter for maintaining the safety level of the RSG-GAS reactor is to maintain radiation exposure as low as possible, especially in the working area. The evaluation results should be able to demonstrate that the radiation exposure of the RSG-GAS is still safe for workers, communities and the surrounding environments. The purpose of this study is to evaluate radiation exposure in the working area to ensure that the operation of RSG-GAS is still safe for the next 10 years. The scope of this work is confirming the calculation results with the measured radiation dose in the RSG-GAS reactor working area. Measurement of radiation exposure is done by using the installed equipments at some points in the RSG-GAS working area and a portable radiation exposure measurement equipment. The calculations include performance of a modeling and analysis of dose rate distribution based on the composition and geometry data of RSG-GAS by using MCNP.  The analysis results show that the maximum dose rate at Level 0 m working area of RSG-GAS reactor is 3.0 mSv/h with a deviation of 6%, which is relatively close to the measurement value. The evaluation results show that the dose rate in RSG-GAS working area is below the limit value established by the Nuclear Energy Regulatory Agency of Indonesia (BAPETEN) of 10 mSv/h (for the average effective dose of 20 mSv/year). Therefore, it is concluded that the dose rate in RSG-GAS working area is safe for personnel..Kata kunci: dose rates, RSG-GAS, radiation safety, MCNP.

The effects of high dose rates of ionizing radiations on solutions of iron and cerium salts

1960 ◽  
Vol 255 (1283) ◽  
pp. 490-508 ◽  
Keyword(s):  
Hydrogen Peroxide ◽  
Dose Rate ◽  
Ferrous Sulphate ◽  
High Dose ◽  
Oh Radicals ◽  
Dose Rates ◽  
Reaction Zones ◽  
Constant Dose ◽  
Ceric Sulphate ◽  
Ionizing Radiations

The electron beam generated by a 15 MeV linear accelerator has been employed to induce reactions in aerated aqueous solutions of 1 to 25 mM ferrous sulphate, and of 0⋅1 to 1 mM ceric sulphate. The radiation was delivered in pulses of 1⋅3 μ s duration and over a range of dose rates from 0⋅5 to 20000 rads/pulse. Radiation yields at constant dose rate were compared with the aid of a chemical dose monitor. A system of two thin, widely spaced, irradiation vessels was employed to determine the variation of yield of any one system over successive known ranges of dose rate. The yield of ferric sulphate in the iron system was found to decrease with increasing dose rate in the range 0⋅01 to 10 krads/pulse by an overall factor of 0⋅85, and was appreciably dependent on the initial concentrations of dissolved oxygen and of ferrous sulphate at high dose rates. Yields of hydrogen and of hydrogen peroxide were practically independent of dose rate. The observations have been interpreted on the basis of inter-radical reactions which occur when the reaction zones of neighbouring clusters overlap. The following reactions can account for all the data: OH + Fe 2+ → Fe 3+ + OH ¯ , (1) H + O 2 → HO 2 , (2) H + OH → H 2 O. (7) The values k 1 / k 7 = 0⋅0062, and k 2 / k 7 = 0⋅22 are reasonably consistent with the observations. In the ceric sulphate system the yield of cerous sulphate increases progressively over the range 0⋅01 to 10 krads/pulse by an overall factor of 1⋅4. The data accord with the view that at high dose rates OH radicals react with them selves ultimately to form hydrogen peroxide, in competition with their normal reaction with cerous sulphate.

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