Safety Considerations for the Inpatient Medication-Use Process in Pediatric and Neonatal Patients

The delivery of safe and effective healthcare to pediatric and neonatal patients presents unique challenges to the medication-use system. The diversity of patients within this population and the consequences of ontogeny on pharmacokinetics and pharmacodynamics directly impact the safe use of medications in children and increase the risk of adverse drug events.1 This review will explore the medication-use system for hospitalized children and neonates, discuss vulnerabilities within this system, and provide examples of advancements made to improve the pediatric medication-use system.

Ultrasonic and seismic constraints on crystallographic preferred orientations of the Priestley Glacier shear margin, Antarctica

Crystallographic preferred orientations (CPOs) are particularly important in controlling the mechanical properties of glacial shear margins. Logistical and safety considerations often make direct sampling of shear margins difficult and geophysical measurements are commonly used to constrain the CPOs. We present here the first direct comparison of seismic and ultrasonic data with measured CPOs in a polar shear margin. The measured CPO from ice samples from a 58 m deep borehole in the left lateral shear margin of the Priestley Glacier, Antarctica, is dominated by horizontal c-axes aligned sub-perpendicular to flow. A vertical seismic profile experiment with hammer shots up to 50 m away from the borehole, in four different azimuthal directions, shows velocity anisotropy of both P-waves and S-waves. Matching P-wave data to the anisotropy corresponding to CPO models defined by horizontally aligned c-axes gives two possible solutions for c-axis azimuth, one of which matches the c-axis measurements. If both P-wave and S-wave data are used, there is one best fit for azimuth and intensity of c-axis alignment that matches well the measurements. Azimuthal P-wave and S-wave ultrasonic data recorded in the laboratory on the ice core show clear anisotropy that matches that predicted from the CPO of the samples. With good quality data, azimuthal increments of 30° or less will constrain well the orientation and intensity of c-axis alignment. Our experiments provide a good framework for planning seismic surveys aimed at constraining the anisotropy of shear margins.

Current and investigational therapies for the treatment of refractory ventricular fibrillation

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Esmolol, dual sequential defibrillation, vector change defibrillation, and left stellate ganglion block are presented and reviewed for the treatment of refractory ventricular fibrillation. Summary Although no formal definition has been established for refractory ventricular fibrillation, the literature describes it as a pulseless ventricular arrhythmia that persists despite 3 standard defibrillation attempts, administration of amiodarone 300 mg intravenously, and provision of three 1-mg intravenous doses of epinephrine. Evolving literature surrounding resuscitation in this particular subset of cardiac arrest challenges the efficacy of traditional therapies, such as epinephrine, and suggests that other treatment modalities may improve outcomes. Case reports, case series, and small retrospective studies have pointed to benefit when utilizing a variety of therapies, namely, esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block, in patients with refractory ventricular fibrillation arrest. Conclusion A mounting, although limited, body of evidence suggests that esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block may be effective at terminating refractory ventricular fibrillation and improving patient outcomes. Further evidence is required before these therapies can be adopted as standard practice; however, as key members of the code response team, it is imperative for pharmacists to be familiar with the supporting evidence, safety considerations, and logistical challenges of utilizing these treatments during arrest.

An informed approach to the development of primary care pediatric firearm safety messages

Background Firearm ownership is prevalent in the US and many children spend time in areas where firearms are not stored safely. The AAP recommends firearm safety counseling at pediatric well-visits. Methods We developed and tested six contextual messages to promote safe firearm storage based on: absence of harm, collective appeal to understanding child behavior, pediatrician’s authority, evidence-based, fear appeal, and general safety considerations. One hundred four parents who keep firearms at home were recruited from Amazon Mechanical Turk Prime and viewed video messages and reported behavioral intentions and emotional reactions following each message. Results All six contextual messages were perceived as important and believable and increased parents’ intentions to follow safety advice provided, but also elicited negative emotions. The authority message elicited more negative emotions and resulted in lower intentions to follow safe storage advice. Conclusions Including firearm messages with other child safety advice merits further evaluation. Authority messages should be avoided.

Fuzzy Risk-Based Maintenance Strategy with Safety Considerations for the Mining Industry

Enterprises today are increasingly seeking maintenance management strategies to ensure that their machines run faultlessly. This problem is particularly relevant in the mining sector, due to the demanding working conditions of underground mines and machines and equipment-operating regimes. Therefore, in this article, the authors proposed a new approach to mining machinery maintenance management, based on the concept of risk-based maintenance (RBM) and taking into account safety issues. The proposed method includes five levels of analysis, of which the first level focuses on hazard analysis, while the next three are connected with a risk evaluation. The final level relates to determining the RBM recommendations. The recommendations are defined in relation to the three main improvement areas: maintenance, safety, and resource availability/allocation. The proposed approach is based on the use of fuzzy logic. To present the possibilities of implementing our method, a case study covering the operation of selected mining machinery in a selected Polish underground mine is presented. In the case of mining machinery, fourteen adverse-event scenarios were identified and investigated; general recommendations were also given. The authors have also indicated further directions of research work to optimize system maintenance strategies, based on the concept of risk-based maintenance. Additionally, the discussion about the implementation possibilities of the approach developed herein is provided.

Dosimetry Audit in Modern Radiotherapy

The clinical specialty of radiotherapy is an essential part of the multidisciplinary process of treatment of malignant neoplasms. Modern radiotherapy is a very complex process of treatment planning and delivery of radiation dose. Radiotherapy reached a very high degree of complexity and sophistication and expected to represent an added value for the cancer patients in terms of clinical outcomes and improved radiation protection. The concept of verifying the realized dose in the medical applications of ionizing radiation was introduced in the early 20th century shortly after the first application of X-rays for the treatment of cancer. Dosimetry audit identify areas for improvement and provide confidence in safety and efficacy, which are essential to creating a clinical environment of continuous development and improvement. Over the years, the audits have contributed to good dosimetry practice and accuracy of dose measurements in modern radiotherapy. Dosimetry audit ensures, that the correct therapeutic dose is delivered to the patients undergoing radiotherapy and play a key role in activities to create a good radiation protection and safety culture. Patient safety is of paramount importance to medical staff in radiotherapy centers and safety considerations are an element in all aspects of the day-to-day clinical activities.