Fixed-dose combinations at the front line of multimodal pain management: perspective of the nurse-prescriber

Directory of Open Access Journals (Sweden)

O'Brien J

2013-02-01

Full Text Available Joanne O’Brien,1 Joseph V Pergolizzi Jr,2 Mart van de Laar3, Hans-Ulrich Mellinghoff,4 Ignacio Morón Merchante,5 Srinivas Nalamachu,6 Serge Perrot,7 Robert B Raffa81Department of Pain Medicine, Beaumont Hospital, Beaumont, Dublin, Ireland; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Association of Chronic Pain Patients, Houston, TX; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA; 3Arthritis Center Twente, Enschede, The Netherlands; 4Department of Endocrinology, Diabetology and Osteology, Kantonsspital St Gallen, Switzerland; 5Centro de Salud Universitario Goya, Madrid, Spain; 6Kansas University Medical Center, Kansas City, and International Clinic Research, Leawood, KS, USA; 7Service de Médecine Interne et Consultation de la Douleur, Hôpital Hotel Dieu, Paris Descartes University, Paris, France; 8Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia PA, USAAbstract: Pain should be treated promptly and effectively to restore the patient to full function, avoid pain chronification, and preserve quality of life. A recent pain specialists' meeting discussed the use of different pharmacological treatment options, such as topical analgesics, nonopioid agents (such as paracetamol and nonsteroidal anti-inflammatory drugs, weak and strong opioids, and fixed-dose combination products in the management of moderate to severe pain from different etiologies. One of the topics discussed in, and subsequent to, this meeting was the role of fixed-dose combination products for nurse-prescribers who are in many ways at the front line of managing both acute and chronic pain syndromes. The panel agreed that proper product selection should take into account the patient's age, condition, type of pain, and comorbidities, as well as balance safety with effectiveness. Although nurse-prescribers need to be aware of cumulative paracetamol dosing, fixed-dose

Radiation Dose Risk and Diagnostic Benefit in Imaging Investigations

OpenAIRE

Dobrescu, Lidia; Rădulescu, Gheorghe-Cristian

2015-01-01

The paper presents many facets of medical imaging investigations radiological risks. The total volume of prescribed medical investigations proves a serious lack in monitoring and tracking of the cumulative radiation doses in many health services. Modern radiological investigations equipment is continuously reducing the total dose of radiation due to improved technologies, so a decrease in per caput dose can be noticed, but the increasing number of investigations has determined a net increase ...

Airborne and total gamma absorbed dose rates at Patiala - India

International Nuclear Information System (INIS)

Tesfaye, Tilahun; Sahota, H.S.; Singh, K.

1999-01-01

The external gamma absorbed dose rate due to gamma rays originating from gamma emitting aerosols in air, is compared with the total external gamma absorbed dose rate at the Physics Department of Punjabi University, Patiala. It has been found out that the contribution, to the total external gamma absorbed dose rate, of radionuclides on particulate matter suspended in air is about 20% of the overall gamma absorbed dose rate. (author)

In vivo dosimetry with semiconducting diodes for dose verification in total-body irradiation. A 10-year experience

International Nuclear Information System (INIS)

Ramm, U.; Licher, J.; Moog, J.; Scherf, C.; Kara, E.; Boettcher, H.D.; Roedel, C.; Mose, S.

2008-01-01

Background and purpose: for total-body irradiation (TBI) using the translation method, dose distribution cannot be computed with computer-assisted three-dimensional planning systems. Therefore, dose distribution has to be primarily estimated based on CT scans (beam-zone method) which is followed by in vivo measurements to ascertain a homogeneous dose delivery. The aim of this study was to clinically establish semiconductor probes as a simple and fast method to obtain an online verification of the dose at relevant points. Patients and methods: in 110 consecutively irradiated TBI patients (12.6 Gy, 2 x 1.8 Gy/day), six semiconductor probes were attached to the body surface at dose-relevant points (eye/head, neck, lung, navel). The mid-body point of the abdomen was defined as dose reference point. The speed of translation was optimized to definitively reach the prescribed dose in this point. Based on the entrance and exit doses, the mid-body doses at the other points were computed. The dose homogeneity in the entire target volume was determined comparing all measured data with the dose at the reference point. Results: after calibration of the semiconductor probes under treatment conditions the dose in selected points and the dose homogeneity in the target volume could be quantitatively specified. In the TBI patients, conformity of calculated and measured doses in the given points was achieved with small deviations of adequate accuracy. The data of 80% of the patients are within an uncertainty of ± 5%. Conclusion: during TBI using the translation method, dose distribution and dose homogeneity can be easily controlled in selected points by means of semiconductor probes. Semiconductor probes are recommended for further use in the physical evaluation of TBI. (orig.)

Methods of assessing total doses integrated across pathways

International Nuclear Information System (INIS)

Grzechnik, M.; Camplin, W.; Clyne, F.; Allott, R.; Webbe-Wood, D.

2006-01-01

Calculated doses for comparison with limits resulting from discharges into the environment should be summed across all relevant pathways and food groups to ensure adequate protection. Current methodology for assessments used in the radioactivity in Food and the Environment (R.I.F.E.) reports separate doses from pathways related to liquid discharges of radioactivity to the environment from those due to gaseous releases. Surveys of local inhabitant food consumption and occupancy rates are conducted in the vicinity of nuclear sites. Information has been recorded in an integrated way, such that the data for each individual is recorded for all pathways of interest. These can include consumption of foods, such as fish, crustaceans, molluscs, fruit and vegetables, milk and meats. Occupancy times over beach sediments and time spent in close proximity to the site is also recorded for inclusion of external and inhalation radiation dose pathways. The integrated habits survey data may be combined with monitored environmental radionuclide concentrations to calculate total dose. The criteria for successful adoption of a method for this calculation were: Reproducibility can others easily use the approach and reassess doses? Rigour and realism how good is the match with reality?Transparency a measure of the ease with which others can understand how the calculations are performed and what they mean. Homogeneity is the group receiving the dose relatively homogeneous with respect to age, diet and those aspects that affect the dose received? Five methods of total dose calculation were compared and ranked according to their suitability. Each method was labelled (A to E) and given a short, relevant name for identification. The methods are described below; A) Individual doses to individuals are calculated and critical group selection is dependent on dose received. B) Individual Plus As in A, but consumption and occupancy rates for high dose is used to derive rates for application in

Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia

Science.gov (United States)

Kabbara, Wissam K; Ramadan, Wijdan H; Rahbany, Peggy; Al-Natour, Souhaila

2015-01-01

Background Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged. Objective The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia) in diabetic and nondiabetic patients. Methods A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin) were identified. Patients were mainly recruited from internal medicine floors and intensive care units. Results The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%), followed by levofloxacin (42.4%) and moxifloxacin (7.6%). Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%), followed by ciprofloxacin (39.0%) and moxifloxacin (33.3%). In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was more common with moxifloxacin (11.1%) and levofloxacin (6.0%). Conclusion The major clinical interventions for the future will adjust the dose and duration of therapy with commonly prescribed fluoroquinolones. The incidence of hypoglycemia was less common than hyperglycemia. PMID:25960658

Drug Dosing in Patients with Renal Insufficiency in a Hospital Setting using Electronic Prescribing and Automated Reporting of Estimated Glomerular Filtration Rate

DEFF Research Database (Denmark)

Nielsen, Anita L.; Henriksen, Daniel Pilsgaard; Marinakis, Christianna

2014-01-01

In patients with impaired renal function, drug dose adjustment is often required. Non-adherence to clinical prescribing recommendations may result in severe adverse events. In previous studies, the prevalence rate of non-adherence to recommended dosing has been reported to be 19-67%. Using the cl...... decision support systems should be explored. This article is protected by copyright. All rights reserved....

The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers.

Science.gov (United States)

Schneberk, Todd; Raffetto, Brian; Kim, David; Schriger, David L

2018-06-01

We determine episodic and high-quantity prescribers' contribution to opioid prescriptions and total morphine milligram equivalents in California, especially among individuals prescribed large amounts of opioids. This was a cross-sectional descriptive analysis of opioid prescribing patterns during an 8-year period using the de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database, the California subsection of the prescription drug monitoring program. We took a 10% random sample of all patients and stratified them by the amount of prescription opioids obtained during their maximal 90-day period. We identified "episodic prescribers" as those whose prescribing pattern included short-acting opioids on greater than 95% of all prescriptions, fewer than or equal to 31 pills on 95% of all prescriptions, only 1 prescription in the database for greater than 90% of all patients to whom they gave opioids, fewer than 6 prescriptions in the database to greater than 99% of patients given opioids, and fewer than 540 prescriptions per year. We identified top 5% prescribers by their morphine milligram equivalents per day in the database. We examined the relationship between patient opioid prescriptions and provider type, with the primary analysis performed on the patient cohort who received only short-acting opioids in an attempt to avoid guideline-concordant palliative, oncologic, and addiction care, and a secondary analysis performed on all patients. Among patients with short-acting opioid only, episodic prescribers (14.6% of 173,000 prescribers) wrote at least one prescription to 25% of 2.7 million individuals but were responsible for less than 9% of the 10.5 million opioid prescriptions and less than 3% of the 3.9 billion morphine milligram equivalents in our sample. Among individuals with high morphine milligram equivalents use, episodic prescribers were responsible for 2.8% of prescriptions and 0.6% of total morphine milligram equivalents

Comparative study on skin dose measurement using MOSFET and TLD for pediatric patients with acute lymphatic leukemia.

Science.gov (United States)

Al-Mohammed, Huda I; Mahyoub, Fareed H; Moftah, Belal A

2010-07-01

The object of this study was to compare the difference of skin dose measured in patients with acute lymphatic leukemia (ALL) treated with total body irradiation (TBI) using metal oxide semiconductor field-effect transistors (mobile MOSFET dose verification system (TN-RD-70-W) and thermoluminescent dosimeters (TLD-100 chips, Harshaw/ Bicron, OH, USA). Because TLD has been the most-commonly used technique in the skin dose measurement of TBI, the aim of the present study is to prove the benefit of using the mobile MOSFET (metal oxide semiconductor field effect transistor) dosimeter, for entrance dose measurements during the total body irradiation (TBI) over thermoluminescent dosimeters (TLD). The measurements involved 10 pediatric patients ages between 3 and 14 years. Thermoluminescent dosimeters and MOSFET dosimetry were performed at 9 different anatomic sites on each patient. The present results show there is a variation between skin dose measured with MOSFET and TLD in all patients, and for every anatomic site selected, there is no significant difference in the dose delivered using MOSFET as compared to the prescribed dose. However, there is a significant difference for every anatomic site using TLD compared with either the prescribed dose or MOSFET. The results indicate that the dosimeter measurements using the MOSFET gave precise measurements of prescribed dose. However, TLD measurement showed significant increased skin dose of cGy as compared to either prescribed dose or MOSFET group. MOSFET dosimeters provide superior dose accuracy for skin dose measurement in TBI as compared with TLD.

E-Prescribing Errors in Community Pharmacies: Exploring Consequences and Contributing Factors

Science.gov (United States)

Stone, Jamie A.; Chui, Michelle A.

2014-01-01

Objective To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. Methods Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. Results Pharmacy staff detected 75 e-prescription errors during the 45 hour observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. Conclusion Study findings suggest that a wide range of e-prescribing errors are encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies. PMID:24657055

Total dose and dose rate models for bipolar transistors in circuit simulation.

Energy Technology Data Exchange (ETDEWEB)

Campbell, Phillip Montgomery; Wix, Steven D.

2013-05-01

The objective of this work is to develop a model for total dose effects in bipolar junction transistors for use in circuit simulation. The components of the model are an electrical model of device performance that includes the effects of trapped charge on device behavior, and a model that calculates the trapped charge densities in a specific device structure as a function of radiation dose and dose rate. Simulations based on this model are found to agree well with measurements on a number of devices for which data are available.

Total dose and dose rate radiation characterization of EPI-CMOS radiation hardened memory and microprocessor devices

International Nuclear Information System (INIS)

Gingerich, B.L.; Hermsen, J.M.; Lee, J.C.; Schroeder, J.E.

1984-01-01

The process, circuit discription, and total dose radiation characteristics are presented for two second generation hardened 4K EPI-CMOS RAMs and a first generation 80C85 microprocessor. Total dose radiation performance is presented to 10M rad-Si and effects of biasing and operating conditions are discussed. The dose rate sensitivity of the 4K RAMs is also presented along with single event upset (SEU) test data

Prescribing and evaluating target dose in dose-painting treatment plans

DEFF Research Database (Denmark)

Håkansson, Katrin; Specht, Lena; Aznar, Marianne C

2014-01-01

BACKGROUND: Assessment of target dose conformity in multi-dose-level treatment plans is challenging due to inevitable over/underdosage at the border zone between dose levels. Here, we evaluate different target dose prescription planning aims and approaches to evaluate the relative merit of such p......-painting and multi-dose-level plans. The tool can be useful for quality assurance of multi-center trials, and for visualizing the development of treatment planning in routine clinical practice....... of such plans. A quality volume histogram (QVH) tool for history-based evaluation is proposed. MATERIAL AND METHODS: Twenty head and neck cancer dose-painting plans with five prescription levels were evaluated, as well as clinically delivered simultaneous integrated boost (SIB) plans from 2010 and 2012. The QVH...

A study of different dose calculation methods and the impact on the dose evaluation protocol in lung stereotactic radiation therapy

International Nuclear Information System (INIS)

Takada, Takahiro; Furuya, Tomohisa; Ozawa, Shuichi; Ito, Kana; Kurokawa, Chie; Karasawa, Kumiko; Miura, Kohei

2008-01-01

AAA (analytical anisotropic algorithm) dose calculation, which shows a better performance for heterogeneity correction, was tested for lung stereotactic radiation therapy (SBRT) in comparison to conventional PBC (pencil beam convolution method) to evaluate its impact on tumor dose parameters. Eleven lung SBRT patients who were treated with photon 4 MV beams in our department between April 2003 and February 2007 were reviewed. Clinical target volume (CTV) was delineated including the spicula region on planning CT images. Planning target volume (PTV) was defined by adding the internal target volume (ITV) and set-up margin (SM) of 5 mm from CTV, and then an multileaf collimator (MLC) penumbra margin of another 5 mm was also added. Six-port non-coplanar beams were employed, and a total prescribed dose of 48 Gy was defined at the isocenter point with four fractions. The entire treatment for an individual patient was completed within 8 days. Under the same prescribed dose, calculated dose distribution, dose volume histogram (DVH), and tumor dose parameters were compared between two dose calculation methods. In addition, the fractionated prescription dose was repeatedly scaled until the monitor units (MUs) calculated by AAA reached a level of MUs nearly identical to those achieved by PBC. AAA resulted in significantly less D95 (irradiation dose that included 95% volume of PTV) and minimal dose in PTV compared to PBC. After rescaling of each MU for each beam in the AAA plan, there was no revision of the isocenter of the prescribed dose required. However, when the PTV volume was less than 20 cc, a 4% lower prescription resulted in nearly identical MUs between AAA and PBC. The prescribed dose in AAA should be the same as that in PBC, if the dose is administered at the isocenter point. However, planners should compare DVHs and dose distributions between AAA and PBC for a small lung tumor with a PTV volume less than approximately 20 cc. (author)

p-MOSFET total dose dosimeter

Science.gov (United States)

Buehler, Martin G. (Inventor); Blaes, Brent R. (Inventor)

1994-01-01

A p-MOSFET total dose dosimeter where the gate voltage is proportional to the incident radiation dose. It is configured in an n-WELL of a p-BODY substrate. It is operated in the saturation region which is ensured by connecting the gate to the drain. The n-well is connected to zero bias. Current flow from source to drain, rather than from peripheral leakage, is ensured by configuring the device as an edgeless MOSFET where the source completely surrounds the drain. The drain junction is the only junction not connected to zero bias. The MOSFET is connected as part of the feedback loop of an operational amplifier. The operational amplifier holds the drain current fixed at a level which minimizes temperature dependence and also fixes the drain voltage. The sensitivity to radiation is made maximum by operating the MOSFET in the OFF state during radiation soak.

Determination of the total indicative dose in drinking and mineral waters

International Nuclear Information System (INIS)

Flesch, K.; Schulz, H.; Knappik, R.; Koehler, M.

2006-01-01

In Europe and Germany administrative regulations exist for the surveillance of the total indicative dose of water supplied for human consumption. This parameter, which cannot be analyzed directly, has to be calculated using nuclide specific activity concentration and age specific dose conversion factors and consumption rates. Available calculation methods differ regarding the used radionuclides, consumption rates and whether they use age specific dose conversion factors or not. In Germany administrative guidelines for the determination of the total indicative dose are still not available. As they have analyzed a large number of waters in the past, the authors derive a praxis orientated concept for the determination of the total indicative dose which respects radiological, analytical and hydrochemical aspects as well. Finally it is suggested to handle sparkling waters in the same manner as drinking waters. (orig.)

SU-E-I-91: Reproducibility in Prescribed Dose in AEC CT Scans Due to Table Height, Patient Size, and Localizer Acquisition Order

International Nuclear Information System (INIS)

Winslow, J; Hurwitz, L; Christianson, O; Samei, E

2014-01-01

Purpose: In CT scanners, the automatic exposure control (AEC) tube current prescription depends on the acquired prescan localizer image(s). The purpose of this study was to quantify the effect that table height, patient size, and localizer acquisition order may have on the reproducibility in prescribed dose. Methods: Three phantoms were used for this study: the Mercury Phantom (comprises three tapered and four uniform regions of polyethylene 16, 23, 30, and 37 cm in diameter), acrylic sheets, and an adult anthropomorphic phantom. Phantoms were positioned per clinical protocol by our chief CT technologist or broader symmetry. Using a GE Discovery CT750HD scanner, a lateral (LAT) and posterior-anterior (PA) localizer was acquired for each phantom at different table heights. AEC scan acquisitions were prescribed for each combination of phantom, localizer orientation, and table height; the displayed volume CTDI was recorded for each. Results were analyzed versus table height. Results: For the two largest Mercury Phantom section scans based on the PA localizer, the percent change in volume CTDI from ideal were at least 20% lower and 35% greater for table heights 4 cm above and 4 cm below proper centering, respectively. For scans based on the LAT localizer, the percent change in volume CTDI from ideal were no greater than 12% different for 4 cm differences in table height. The properly centered PA and LAT localizer-based volume CTDI values were within 13% of each other. Conclusion: Since uncertainty in vertical patient positioning is inherently greater than lateral positioning and because the variability in dose exceeds any dose penalties incurred, the LAT localizer should be used to precisely and reproducibly deliver the intended amount of radiation prescribed by CT protocols. CT protocols can be adjusted to minimize the expected change in average patient dose

The impact of pharmacy services on opioid prescribing in dental practice.

Science.gov (United States)

Stewart, Autumn; Zborovancik, Kelsey J; Stiely, Kara L

To compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration. This observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics. A total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P dental practice. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes.

Science.gov (United States)

Norman, Jessica L; Fixen, Danielle R; Saseen, Joseph J; Saba, Laura M; Linnebur, Sunny A

2017-01-01

Women have higher morning serum zolpidem concentrations than men after taking an evening dose, potentially leading to increased risk of harm. On 19 April 2013, the United States Food and Drug Administration required labeling changes for zolpidem, recommending an initial dose of no greater than 5 mg (immediate release) or 6.25 mg (controlled release) per night in women. The primary objective of this study was to compare prescribing practices before and after the 2013 zolpidem labeling change. A secondary objective was to evaluate serious adverse events potentially related to zolpidem. Electronic medical records of adults receiving care through the University of Colorado Health system were accessed for study inclusion if patients were provided a first-time prescription for zolpidem either prior to or after the Food and Drug Administration labeling change. Patients were randomly chosen from eight strata based on age, gender, and date of zolpidem initiation (before/after the labeling change). Demographic and zolpidem prescribing data were collected. Low-dose zolpidem was considered 5 mg (immediate release) or 6.25 mg (controlled release) daily or less. Documentation of potentially related serious adverse events within the patients' records was also evaluated. A total of 400 patients were included in the study. The overall percentage of patients prescribed low-dose zolpidem increased from 44% to 58% after the labeling change (p = 0.0020). In a pre-specified subgroup analysis, the percentage of patients prescribed low-dose zolpidem increased in all groups, including young men (38%-50%, p = 0.23), elderly men (34%-40%, p = 0.53), and elderly women (60%-74%, p = 0.14), but the change was only significant in young women (42%-70%, p = 0.0045). After Food and Drug Administration-mandated labeling changes for zolpidem in 2013, the percentage of overall patients in our health system, and specifically young women, with initial prescriptions for low-dose

Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes

Directory of Open Access Journals (Sweden)

Jessica L Norman

2017-05-01

Full Text Available Background: Women have higher morning serum zolpidem concentrations than men after taking an evening dose, potentially leading to increased risk of harm. On 19 April 2013, the United States Food and Drug Administration required labeling changes for zolpidem, recommending an initial dose of no greater than 5 mg (immediate release or 6.25 mg (controlled release per night in women. Objectives: The primary objective of this study was to compare prescribing practices before and after the 2013 zolpidem labeling change. A secondary objective was to evaluate serious adverse events potentially related to zolpidem. Methods: Electronic medical records of adults receiving care through the University of Colorado Health system were accessed for study inclusion if patients were provided a first-time prescription for zolpidem either prior to or after the Food and Drug Administration labeling change. Patients were randomly chosen from eight strata based on age, gender, and date of zolpidem initiation (before/after the labeling change. Demographic and zolpidem prescribing data were collected. Low-dose zolpidem was considered 5 mg (immediate release or 6.25 mg (controlled release daily or less. Documentation of potentially related serious adverse events within the patients’ records was also evaluated. Results: A total of 400 patients were included in the study. The overall percentage of patients prescribed low-dose zolpidem increased from 44% to 58% after the labeling change (p = 0.0020. In a pre-specified subgroup analysis, the percentage of patients prescribed low-dose zolpidem increased in all groups, including young men (38%–50%, p = 0.23, elderly men (34%–40%, p = 0.53, and elderly women (60%–74%, p = 0.14, but the change was only significant in young women (42%–70%, p = 0.0045. Conclusion: After Food and Drug Administration–mandated labeling changes for zolpidem in 2013, the percentage of overall patients in our health

Out-Patient Prescribing Practices at Mbagathi District Hospital ...

African Journals Online (AJOL)

On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an ...

Pulsed total dose damage effect experimental study on EPROM

International Nuclear Information System (INIS)

Luo Yinhong; Yao Zhibin; Zhang Fengqi; Guo Hongxia; Zhang Keying; Wang Yuanming; He Baoping

2011-01-01

Nowadays, memory radiation effect study mainly focus on functionality measurement. Measurable parameters is few in china. According to the present situation, threshold voltage testing method was presented on floating gate EPROM memory. Experimental study of pulsed total dose effect on EPROM threshold voltage was carried out. Damage mechanism was analysed The experiment results showed that memory cell threshold voltage negative shift was caused by pulsed total dose, memory cell threshold voltage shift is basically coincident under steady bias supply and no bias supply. (authors)

Evaluation of lens dose in medulloblastoma radiotherapy

International Nuclear Information System (INIS)

Oliveira, F.L.; Vilela, E.C.; Sousa, S.A; Lima, F.F. de

2007-01-01

The improvement of the applied radiotherapy techniques in the cranial-spinal therapy, which is used in the cases of medulloblastoma, aims the reduction of the risks of future damages in enclosed critical agencies in the irradiation fields. This work aims to evaluate the lens doses due two common techniques used in medulloblastoma radiotherapy. For this, thermoluminescent dosimeters, previously calibrated, were located in an anthropomorphic phantom (ALDERSON - RANDON Laboratory), in the tumor and lens positions. The employed techniques were as following: (1) angled fields technique and (2) half-beam block technique. The phantom was irradiated five times in each technique with two lateral opposed fields in the brain with a total prescribed dose of 1.5 Gy, followed of two posterior spinal fields with the same prescribed dose, using a 6MV accelerator. The results showed that the doses in the first technique were 0.10 +- 0,04 Gy and, in second one, 0.09 +- 0,02 Gy. It was observed that, independent of the employed technique, the lens doses practically are the same. (author)

Total dose effects on the matching properties of deep submicron MOS transistors

International Nuclear Information System (INIS)

Wang Yuxin; Hu Rongbin; Li Ruzhang; Chen Guangbing; Fu Dongbing; Lu Wu

2014-01-01

Based on 0.18 μm MOS transistors, for the first time, the total dose effects on the matching properties of deep submicron MOS transistors are studied. The experimental results show that the total dose radiation magnifies the mismatch among identically designed MOS transistors. In our experiments, as the radiation total dose rises to 200 krad, the threshold voltage and drain current mismatch percentages of NMOS transistors increase from 0.55% and 1.4% before radiation to 17.4% and 13.5% after radiation, respectively. PMOS transistors seem to be resistant to radiation damage. For all the range of radiation total dose, the threshold voltage and drain current mismatch percentages of PMOS transistors keep under 0.5% and 2.72%, respectively. (semiconductor devices)

Evaluation of accelerated test parameters for CMOS IC total dose hardness prediction

International Nuclear Information System (INIS)

Sogoyan, A.V.; Nikiforov, A.Y.; Chumakov, A.I.

1999-01-01

The approach to accelerated test parameters evaluation is presented in order to predict CMOS IC total dose behavior in variable dose-rate environment. The technique is based on the analytical model of MOSFET parameters total dose degradation. The simple way to estimate model parameter is proposed using IC's input-output MOSFET radiation test results. (authors)

Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia

Directory of Open Access Journals (Sweden)

Kabbara WK

2015-04-01

Full Text Available Wissam K Kabbara,1 Wijdan H Ramadan,1 Peggy Rahbany,2 Souhaila Al-Natour3 1Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon; 2Children’s National Medical Center, Washington, DC, USA; 3Medex Pharmaceutical Company, Beirut, Lebanon Background: Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged.Objective: The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia in diabetic and nondiabetic patients.Methods: A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin were identified. Patients were mainly recruited from internal medicine floors and intensive care units.Results: The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%, followed by levofloxacin (42.4% and moxifloxacin (7.6%. Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%, followed by ciprofloxacin (39.0% and moxifloxacin (33.3%. In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was

Dose equivalent distributions in the AAEC total body nitrogen facility

International Nuclear Information System (INIS)

Allen, B.J.; Bailey, G.M.; McGregor, B.J.

1985-01-01

The incident neutron dose equivalent in the AAEC total body nitrogen facility is measured by a calibrated remmeter. Dose equivalent rates and distributions are calculated by Monte Carlo techniques which take account of the secondary neutron flux from the collimator. Experiment and calculation are found to be in satisfactory agreement. The effective dose equivalent per exposure is determined by weighting organ doses, and the potential detriment per exposure is calculated from ICRP risk factors

Low-dose-rate total lymphoid irradiation: a new method of rapid immunosuppression

International Nuclear Information System (INIS)

Blum, J.E.; de Silva, S.M.; Rachman, D.B.; Order, S.E.

1988-01-01

Total Lymphoid Irradiation (TLI) has been successful in inducing immunosuppression in experimental and clinical applications. However, both the experimental and clinical utility of TLI are hampered by the prolonged treatment courses required (23 days in rats and 30-60 days in humans). Low-dose-rate TLI has the potential of reducing overall treatment time while achieving comparable immunosuppression. This study examines the immunosuppressive activity and treatment toxicity of conventional-dose-rate (23 days) vs low-dose-rate (2-7 days) TLI. Seven groups of Lewis rats were given TLI with 60Co. One group was treated at conventional-dose-rates (80-110 cGy/min) and received 3400 cGy in 17 fractions over 23 days. Six groups were treated at low-dose-rate (7 cGy/min) and received total doses of 800, 1200, 1800, 2400, 3000, and 3400 cGy over 2-7 days. Rats treated at conventional-dose-rates over 23 days and at low-dose-rate over 2-7 days tolerated radiation with minimal toxicity. The level of immunosuppression was tested using allogeneic (Brown-Norway) skin graft survival. Control animals retained allogeneic skin grafts for a mean of 14 days (range 8-21 days). Conventional-dose-rate treated animals (3400 cGy in 23 days) kept their grafts 60 days (range 50-66 days) (p less than .001). Low-dose-rate treated rats (800 to 3400 cGy total dose over 2-7 days) also had prolongation of allogeneic graft survival times following TLI with a dose-response curve established. The graft survival time for the 3400 cGy low-dose-rate group (66 days, range 52-78 days) was not significantly different from the 3400 cGy conventional-dose-rate group (p less than 0.10). When the total dose given was equivalent, low-dose-rate TLI demonstrated an advantage of reduced overall treatment time compared to conventional-dose-rate TLI (7 days vs. 23 days) with no increase in toxicity

Medication prescribing errors in a public teaching hospital in India: A prospective study.

Directory of Open Access Journals (Sweden)

Pote S

2007-03-01

Full Text Available Background: To prevent medication errors in prescribing, one needs to know their types and relative occurrence. Such errors are a great cause of concern as they have the potential to cause patient harm. The aim of this study was to determine the nature and types of medication prescribing errors in an Indian setting.Methods: The medication errors were analyzed in a prospective observational study conducted in 3 medical wards of a public teaching hospital in India. The medication errors were analyzed by means of Micromedex Drug-Reax database.Results: Out of 312 patients, only 304 were included in the study. Of the 304 cases, 103 (34% cases had at least one error. The total number of errors found was 157. The drug-drug interactions were the most frequently (68.2% occurring type of error, which was followed by incorrect dosing interval (12% and dosing errors (9.5%. The medication classes involved most were antimicrobial agents (29.4%, cardiovascular agents (15.4%, GI agents (8.6% and CNS agents (8.2%. The moderate errors contributed maximum (61.8% to the total errors when compared to the major (25.5% and minor (12.7% errors. The results showed that the number of errors increases with age and number of medicines prescribed.Conclusion: The results point to the establishment of medication error reporting at each hospital and to share the data with other hospitals. The role of clinical pharmacist in this situation appears to be a strong intervention; and the clinical pharmacist, initially, could confine to identification of the medication errors.

New Insights into Fully-Depleted SOI Transistor Response During Total Dose Irradiation

International Nuclear Information System (INIS)

Burns, J.A.; Dodd, P.E.; Keast, C.L.; Schwank, J.R.; Shaneyfelt, M.R.; Wyatt, P.W.

1999-01-01

Worst-case bias configuration for total-dose testing fully-depleted SOI transistors was found to be process dependent. No evidence was found for total-dose induced snap back. These results have implications for hardness assurance testing

A drug utilisation study investigating prescribed daily doses of ...

African Journals Online (AJOL)

and drug groups. Design. Retrospective drug utilisation study using data .... drugs that were prescribed 20 or fewer times during the period under ... occurs in women and men at different ages and with different severity. group. On average, men ...

Simulation experiment on total ionization dose effects of linear CCD

International Nuclear Information System (INIS)

Tang Benqi; Zhang Yong; Xiao Zhigang; Wang Zujun; Huang Shaoyan

2004-01-01

We carry out the ionization radiation experiment of linear CCDs operated in unbiased, biased, biased and driven mode respectively by Co-60 γ source with our self-designed test system, and offline test the Dark signal and Saturation voltage and SNR varied with total dose for TCD132D, and get some valuable results. On the basis of above work, we set forth a primary experiment approaches to simulate the total dose radiation effects of charge coupled devices. (authors)

Total dose effects on ATLAS-SCT front-end electronics

CERN Document Server

Ullán, M; Dubbs, T; Grillo, A A; Spencer, E; Seiden, A; Spieler, H; Gilchriese, M G D; Lozano, M

2002-01-01

Low dose rate effects (LDRE) in bipolar technologies complicate the hardness assurance testing for high energy physics applications. The damage produced in the ICs in the real experiment can be underestimated if fast irradiations are carried out, while experiments done at the real dose rate are usually unpractical due to the still high total doses involved. In this work the sensitivity to LDRE of two bipolar technologies proposed for the ATLAS-SCT experiment at CERN is evaluated, finding one of them free of those effects. (12 refs).

Total dose meter development

International Nuclear Information System (INIS)

Brackenbush, L.W.

1986-09-01

This report describes an alarming ''pocket'' monitor/dosimeter, based on a tissue-equivalent proportional counter, that measure both neutron and gamma dose and determines dose equivalent for the mixed radiation field. This report details the operation of the device and provides information on: the necessity for a device to measure dose equivalent in mixed radiation fields; the mathematical theory required to determine dose equivalent from tissue equivalent proportional; the detailed electronic circuits required; the algorithms required in the microprocessor used to calculate dose equivalent; the features of the instrument; program accomplishments and future plans

Single event effects and total ionizing dose effects of typical VDMOSFET devices

International Nuclear Information System (INIS)

Lou Jianshe; Cai Nan; Liu Jiaxin; Wu Qinzhi; Wang Jia

2012-01-01

In this work, single event effects and total ionizing dose effects of typical VDMOSFET irradiated by 60 Co γ-rays and 252 Cf source were studied. The single event burnout and single event gate rupture (SEB/SEGR) effects were investigated, and the relationship between drain-source breakdown voltage and ionizing dose was obtained. The results showed that the VDMOSFET devices were sensitive to SEB and SEGR, and measures to improve their resistance to SEB and SEGR should be considered seriously for their space applications. The drain-source breakdown voltage was sensitive to total ionizing dose effects as the threshold voltage. In assessing the devices' resistance to the total ionizing dose effects, both the threshold voltage and the drain-source breakdown voltage should be taken into account. (authors)

Pocket total dose meter

International Nuclear Information System (INIS)

Brackenbush, L.W.; Endres, G.W.R.

1984-10-01

Laboratory measurements have demonstrated that it is possible to simultaneously measure absorbed dose and dose equivalent using a single tissue equivalent proportional counter. Small, pocket sized instruments are being developed to determine dose equivalent as the worker is exposed to mixed field radiation. This paper describes the electronic circuitry and computer algorithms used to determine dose equivalent in these devices

STUDY OF PRESCRIBING PATTERN OF ANTIMICROBIAL AGENTS IN SELECTED PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN INDIA

Directory of Open Access Journals (Sweden)

Anjan Adhikari

2013-06-01

Full Text Available Antibiotics are the most commonly prescribed drugs in hospitals and their irrational use is one of the important factors for the development and spread of resistance. The objective of this study was to evaluate the antibiotic prescription pattern in the patient attending the tertiary care hospital. It was found that a total of 333 antibiotics where prescribed in 245 prescriptions. The average number of antibiotics per prescription was approximately1.4. The most commonly used antibiotics were moxifloxacin 19.5%, metronidazole 10.4%, amoxicillin + cloxacillin 10.2% and ciprofloxacin 6%. antibiotics were almost equally prescribed to both male and female. 45.5% of the antibiotics shows adherence with the National List of Essential Medicines of India. 76.6% of the antibiotics were single products while 23.4% were fixed dose combination. The most commonly used dosage forms were tablets (57%, drops (23.5% and creams (11.7%.57.3% were prescribed irrationally. Quinolones (48.2% and antifungals (21.5% were the most common types of prescribed antibiotics in which irrationality was found.

The use of paracetamol (acetaminophen) among a community sample of people with chronic non-cancer pain prescribed opioids.

Science.gov (United States)

Hoban, B; Larance, B; Gisev, N; Nielsen, S; Cohen, M; Bruno, R; Shand, F; Lintzeris, N; Hall, W; Farrell, M; Degenhardt, L

2015-11-01

The regular use of simple analgesics in addition to opioids such as paracetamol (or acetaminophen) is recommended for persistent pain to enhance analgesia. Few studies have examined the frequency and doses of paracetamol among people with chronic non-cancer pain including use above the recommended maximum daily dose. To assess (i) the prevalence of paracetamol use among people with chronic non-cancer pain prescribed opioids, (ii) assess the prevalence of paracetamol use above the recommended maximum daily dose and (iii) assess correlates of people who used paracetamol above the recommended maximum daily dose including: age, gender, income, education, pain severity and interference, use of paracetamol/opioid combination analgesics, total opioid dose, depression, anxiety, pain self-efficacy or comorbid substance use, among people prescribed opioids for chronic non-cancer pain. This study draws on baseline data collected for the Pain and Opioids IN Treatment (POINT) study and utilises data from 962 interviews and medication diaries. The POINT study is national prospective cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited from randomly selected pharmacies across Australia. Sixty-three per cent of the participants had used paracetamol in the past week (95% CI = 59.7-65.8). Among the paracetamol users 22% (95% CI = 19.3-24.6) had used paracetamol/opioid combination analgesics and 4.8% (95% CI = 3.6-6.3) had used paracetamol above the recommended maximum daily dose (i.e. > 4000 mg/day). Following binomial logistic regression (χ(2) = 25.98, df = 10, p = 0.004), people who had taken above the recommended maximum daily dose were less likely to have low income (AOR = 0.52, 95% CI = 0.27-0.99), more likely to use paracetamol/opioid combination analgesics (AOR = 2.01, 95% CI = 1.02-3.98) and more likely to take a higher opioid dose (AOR = 1.00, 95% CI = 1.00-1.01). The majority of people with chronic non-cancer pain prescribed

Use of normalized total dose to represent the biological effect of fractionated radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Flickinger, J C; Kalend, A [Pittsburgh University School of Medicine (USA). Department of Radiation Oncology Pittsburg Cancer Institute (USA)

1990-03-01

There are currently a number of radiobiological models to account for the effects of dose fractionation and time. Normalized total dose (NTD) is not another new model but is a previously reported, clinically useful form in which to represent the biological effect, determined by any specific radiobiological dose-fractionation model, of a course of radiation using a single set of standardized, easily understood terminology. The generalized form of NTD reviewed in this paper describes the effect of a course of radiotherapy administered with nonstandard fractionation as the total dose of radiation in Gy that could be administered with a given reference fractionation such as 2 Gy per fraction, 5 fractions per week that would produce an equivalent biological effect (probability of complications or tumor control) as predicted by a given dose-fractionation formula. The use of normalized total dose with several different exponential and linear-quadratic dose-fraction formulas is presented. (author). 51 refs.; 1 fig.; 1 tab.

Use of normalized total dose to represent the biological effect of fractionated radiotherapy

International Nuclear Information System (INIS)

Flickinger, J.C.; Kalend, A.

1990-01-01

There are currently a number of radiobiological models to account for the effects of dose fractionation and time. Normalized total dose (NTD) is not another new model but is a previously reported, clinically useful form in which to represent the biological effect, determined by any specific radiobiological dose-fractionation model, of a course of radiation using a single set of standardized, easily understood terminology. The generalized form of NTD reviewed in this paper describes the effect of a course of radiotherapy administered with nonstandard fractionation as the total dose of radiation in Gy that could be administered with a given reference fractionation such as 2 Gy per fraction, 5 fractions per week that would produce an equivalent biological effect (probability of complications or tumor control) as predicted by a given dose-fractionation formula. The use of normalized total dose with several different exponential and linear-quadratic dose-fraction formulas is presented. (author). 51 refs.; 1 fig.; 1 tab

Dose calculation method with 60-cobalt gamma rays in total body irradiation

International Nuclear Information System (INIS)

Scaff, Luiz Alberto Malaguti

2001-01-01

Physical factors associated to total body irradiation using 60 Co gamma rays beams, were studied in order to develop a calculation method of the dose distribution that could be reproduced in any radiotherapy center with good precision. The method is based on considering total body irradiation as a large and irregular field with heterogeneities. To calculate doses, or doses rates, of each area of interest (head, thorax, thigh, etc.), scattered radiation is determined. It was observed that if dismagnified fields were considered to calculate the scattered radiation, the resulting values could be applied on a projection to the real size to obtain the values for dose rate calculations. In a parallel work it was determined the variation of the dose rate in the air, for the distance of treatment, and for points out of the central axis. This confirm that the use of the inverse square law is not valid. An attenuation curve for a broad beam was also determined in order to allow the use of absorbers. In this work all the adapted formulas for dose rate calculations in several areas of the body are described, as well time/dose templates sheets for total body irradiation. The in vivo dosimetry, proved that either experimental or calculated dose rate values (achieved by the proposed method), did not have significant discrepancies. (author)

Dose and Duration of Opioid Use in Patients with Cancer and Noncancer Pain at an Outpatient Hospital Setting in Malaysia.

Science.gov (United States)

Zin, Che S; Rahman, Norny A; Ismail, Che R; Choy, Leong W

2017-07-01

There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain. This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups. A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group. The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest. © 2016 World Institute of Pain.

Medication errors: prescribing faults and prescription errors.

Science.gov (United States)

Velo, Giampaolo P; Minuz, Pietro

2009-06-01

1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

SU-E-T-515: Field-In-Field Compensation Technique Using Multi-Leaf Collimator to Deliver Total Body Irradiation (TBI) Dose

Energy Technology Data Exchange (ETDEWEB)

Lakeman, T [The State University of New York at Buffalo (United States); Wang, IZ [The State University of New York at Buffalo (United States); Roswell Park Cancer Institute, Buffalo, NY (United States)

2014-06-01

Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient's immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has been used conventionally to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern field-in-field (FIF) technique with the multi-leaf collimator (MLC) to more accurately and efficiently deliver dose to patients in need of TBI. Method: Treatment plans utilizing the FIF technique to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Treatment fields include one pair of opposed open large fields (collimator=45°) with a specific weighting and a succession of smaller fields (collimator=90°) each with their own weighting. The smaller fields are shaped by moving MLC to block the sections of the patient which have already received close to 100% of the prescribed dose. The weighting factors for each of these fields were calculated using the attenuation coefficient of the initial lead compensators and the separation of the patient in different positions in the axial plane. Results: Dose-volume histograms (DVH) were calculated for evaluating the FIF compensation technique. The maximum body doses calculated from the DVH were reduced from the non-compensated 179.3% to 148.2% in the FIF plans, indicating a more uniform dose with the FIF compensation. All calculated monitor units were well within clinically acceptable limits and exceeded those of the original lead compensation plan by less than 50 MU (only ~1.1% increase). Conclusion: MLC FIF technique for TBI will not significantly increase the beam on time while it can substantially reduce the compensator setup time and the potential risk of errors in manually placing lead compensators.

Calculation of midplane dose for total body irradiation from entrance and exit dose MOSFET measurements.

Science.gov (United States)

Satory, P R

2012-03-01

This work is the development of a MOSFET based surface in vivo dosimetry system for total body irradiation patients treated with bilateral extended SSD beams using PMMA missing tissue compensators adjacent to the patient. An empirical formula to calculate midplane dose from MOSFET measured entrance and exit doses has been derived. The dependency of surface dose on the air-gap between the spoiler and the surface was investigated by suspending a spoiler above a water phantom, and taking percentage depth dose measurements (PDD). Exit and entrances doses were measured with MOSFETs in conjunction with midplane doses measured with an ion chamber. The entrance and exit doses were combined using an exponential attenuation formula to give an estimate of midplane dose and were compared to the midplane ion chamber measurement for a range of phantom thicknesses. Having a maximum PDD at the surface simplifies the prediction of midplane dose, which is achieved by ensuring that the air gap between the compensator and the surface is less than 10 cm. The comparison of estimated midplane dose and measured midplane dose showed no dependence on phantom thickness and an average correction factor of 0.88 was found. If the missing tissue compensators are kept within 10 cm of the patient then MOSFET measurements of entrance and exit dose can predict the midplane dose for the patient.

Dosimetry and verification of 60Co total body irradiation with human phantom and semiconductor diodes

Directory of Open Access Journals (Sweden)

Allahverdi Mahmoud

2007-01-01

Full Text Available Total Body Irradiation (TBI is a form of radiotherapy used for patients prior to bone marrow or stem cell transplant to destroy any undetectable cancer cells. The dosimetry characteristics of a 60 Co unit for TBI were studied and a simple method for the calculation of the prescribed dose for TBI is presented. Dose homogeneity was verified in a human phantom. Dose measurements were made in water phantom (30 x 30 x 30 cm 3 , using farmer ionization chamber (0.6 cc, TM30010, PTW and a parallel plate ionization chamber (TM23343, PTW. Point dose measurements for AP/PA irradiation were measured in a human phantom using silicon diodes (T60010L, PTW. The lung dose was measured with an ionization chamber (0.3 cc, TM31013. The validity of the proposed algorithm was checked at TBI distance using the human phantom. The accuracy of the proposed algorithm was within 3.5%. The dose delivered to the mid-lobe of the lung was 14.14 Gy and it has been reduced to 8.16 Gy by applying the proper shield. Dose homogeneity was within ±7% for all measured points. The results indicate that a good agreement between the total prescribed and calculated midplane doses can be achieved using this method. Therefore, it could be possible to use calculated data for TBI treatments.

Review on patients radiation dose and frequency of procedures during medical exposure in Sudan

International Nuclear Information System (INIS)

Abu Baker, Samah Mohamed Nasr

2015-09-01

The aim of this study was to estimate patient dose, the annual frequency and the number of staff and devices in the medical applications of ionizing radiation in Sudan. Survey was conducted on diagnostic radiology, nuclear medicine and radiotherapy. With respect to diagnostic radiology, only patient radiation dose was estimated. The data for diagnostic radiology was obtained from 24 peer reviewed scientific published literatures during the years ( 2006 - 2015). The collected publications included about 64 Sudanese hospitals covering different types of diagnostic exams. A values of the effective dose for pediatrics and adult patients were within the ranges of similar worldwide values published by UNSCEAR report in 2008 with exceptional to fluoroscopy hysterosalpingography for adult patients. For nuclear medicine procedures, questionnaires were distributed to five hospitals representing the whole existing NM department in Sudan at the time of of study. The estimated total annual frequency of diagnostic procedures was 0.2 per 1000 population. The estimated total annual collective and annual per caput effective dose from all NM procedures were 16.268 man Sv and 0.5 μSv, respectively. Comparing the annual per caput effective dose with UNSCEAR value our results was less than the worldwide value and greater than the value for heath care level 111-1 v countries. Questionnaires were also distributed to collect data on radiotherapy procedures performed in the two existing radioisotopes Sudanese hospitals. The prescribed dose and the number of fractions were comparable between the two hospitals. The minimum prescribed dose was 20 Gy with 5 fractions for nasopharynx (NPH) palliative and the maximum prescribed dose was 64 Gy with 32 fractions for prostate.(Author)

Treatment verification and in vivo dosimetry for total body irradiation using thermoluminescent and semiconductor detectors

International Nuclear Information System (INIS)

Oliveira, F.F.; Amaral, L.L.; Costa, A.M.; Netto, T.G.

2014-01-01

The objective of this work is the characterization of thermoluminescent and semiconductor detectors and their applications in treatment verification and in vivo dosimetry for total body irradiation (TBI) technique. Dose measurements of TBI treatment simulation performed with thermoluminescent detectors inserted in the holes of a “Rando anthropomorphic phantom” showed agreement with the prescribed dose. For regions of the upper and lower chest where thermoluminescent detectors received higher doses it was recommended the use of compensating dose in clinic. The results of in vivo entrance dose measurements for three patients are presented. The maximum percentual deviation between the measurements and the prescribed dose was 3.6%, which is consistent with the action level recommended by the International Commission on Radiation Units and Measurements (ICRU), i.e., ±5%. The present work to test the applicability of a thermoluminescent dosimetric system and of a semiconductor dosimetric system for performing treatment verification and in vivo dose measurements in TBI techniques demonstrated the value of these methods and the applicability as a part of a quality assurance program in TBI treatments. - Highlights: • Characterization of a semiconductor dosimetric system. • Characterization of a thermoluminescent dosimetric system. • Application of the TLDs for treatment verification in total body irradiation treatments. • Application of semiconductor detectors for in vivo dosimetry in total body irradiation treatments. • Implementation of in vivo dosimetry as a part of a quality assurance program in radiotherapy

An experimental study on total dose effects in SRAM-based FPGAs

International Nuclear Information System (INIS)

Yao Zhibin; He Baoping; Zhang Fengqi; Guo Hongxia; Luo Yinhong; Wang Yuanming; Zhang Keying

2009-01-01

In order to study testing methods and find sensitive parameters in total dose effects on SRAM-based FPGA, XC2S100 chips were irradiated by 60 Co γ-rays and tested with two test circuit designs. By analyzing the experimental results, the test flow of configuration RAM and bock RAM was given, and the most sensitive parameter was obtained. The results will be a solid foundation for establishing test specification and evaluation methods of total dose effects on SRAM-based FPGAs. (authors)

Application of combined TLD and CR-39 PNTD method for measurement of total dose and dose equivalent on ISS

International Nuclear Information System (INIS)

Benton, E.R.; Deme, S.; Apathy, I.

2006-01-01

To date, no single passive detector has been found that measures dose equivalent from ionizing radiation exposure in low-Earth orbit. We have developed the I.S.S. Passive Dosimetry System (P.D.S.), utilizing a combination of TLD in the form of the self-contained Pille TLD system and stacks of CR-39 plastic nuclear track detector (P.N.T.D.) oriented in three mutually orthogonal directions, to measure total dose and dose equivalent aboard the International Space Station (I.S.S.). The Pille TLD system, consisting on an on board reader and a large number of Ca 2 SO 4 :Dy TLD cells, is used to measure absorbed dose. The Pille TLD cells are read out and annealed by the I.S.S. crew on orbit, such that dose information for any time period or condition, e.g. for E.V.A. or following a solar particle event, is immediately available. Near-tissue equivalent CR-39 P.N.T.D. provides Let spectrum, dose, and dose equivalent from charged particles of LET ∞ H 2 O ≥ 10 keV/μm, including the secondaries produced in interactions with high-energy neutrons. Dose information from CR-39 P.N.T.D. is used to correct the absorbed dose component ≥ 10 keV/μm measured in TLD to obtain total dose. Dose equivalent from CR-39 P.N.T.D. is combined with the dose component <10 keV/μm measured in TLD to obtain total dose equivalent. Dose rates ranging from 165 to 250 μGy/day and dose equivalent rates ranging from 340 to 450 μSv/day were measured aboard I.S.S. during the Expedition 2 mission in 2001. Results from the P.D.S. are consistent with those from other passive detectors tested as part of the ground-based I.C.C.H.I.B.A.N. intercomparison of space radiation dosimeters. (authors)

Electronic prescribing reduces prescribing error in public hospitals.

Science.gov (United States)

Shawahna, Ramzi; Rahman, Nisar-Ur; Ahmad, Mahmood; Debray, Marcel; Yliperttula, Marjo; Declèves, Xavier

2011-11-01

To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence. Medication errors are persistent in today's healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world. Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system. Inpatient records (n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards. Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper-based and electronic prescribing, respectively. Electronic prescribing has a significant effect on the reduction of prescribing errors. Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan. © 2011 Blackwell Publishing Ltd.

Effect of γ-dose rate and total dose interrelation on the polymeric hydrogel: A novel injectable male contraceptive

International Nuclear Information System (INIS)

Jha, Pradeep K.; Jha, Rakhi; Gupta, B.L.; Guha, Sujoy K.

2010-01-01

Functional necessity to use a particular range of dose rate and total dose of γ-initiated polymerization to manufacture a novel polymeric hydrogel RISUG (reversible inhibition of sperm under guidance) made of styrene maleic anhydride (SMA) dissolved in dimethyl sulphoxide (DMSO), for its broad biomedical application explores new dimension of research. The present work involves 16 irradiated samples. They were tested by fourier transform infrared spectroscopy, matrix assisted laser desorption/ionization-TOF, field emission scanning electron microscopy, high resolution transmission electron microscopy, etc. to see the interrelation effect of gamma dose rates (8.25, 17.29, 20.01 and 25.00 Gy/min) and four sets of doses (1.8, 2.0, 2.2 and 2.4 kGy) on the molecular weight, molecular weight distribution and porosity analysis of the biopolymeric drug RISUG. The results of randomized experiment indicated that a range of 18-24 Gy/min γ-dose rate and 2.0-2.4 kGy γ-total doses is suitable for the desirable in vivo performance of the contraceptive copolymer.

Patterns of patient specific dosimetry in total body irradiation

Energy Technology Data Exchange (ETDEWEB)

Akino, Yuichi [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States); Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871 (Japan); McMullen, Kevin P.; Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States)

2013-04-15

Purpose: Total body irradiation (TBI) has been used for bone marrow transplant for hematologic and immune deficiency conditions. The goal of TBI is to deliver a homogeneous dose to the entire body, with a generally accepted range of dose uniformity being within {+-}10% of the prescribed dose. The moving table technique for TBI could make dose uniform in whole body by adjusting couch speed. However, it is difficult to accurately estimate the actual dose by calculation and hence in vivo dosimetry (IVD) is routinely performed. Here, the authors present patterns of patient-specific IVD in 161 TBI patients treated at our institution. Methods: Cobalt-60 teletherapy unit (Model C9 Cobalt-60 teletherapy unit, Picker X-ray Corporation) with customized moving bed (SITI Industrial Products, Inc., Fishers, IN) were used for TBI treatment. During treatment, OneDose{sup TM} (Sicel Technology, NC) Metal Oxide-silicon Semiconductor Field Effect Transistor detectors were placed at patient body surface; both entrance and exit side of the beam at patient head, neck, mediastinum, umbilicus, and knee to estimate midplane dose. When large differences (>10%) between the prescribed and measured dose were observed, dose delivery was corrected for subsequent fractions by the adjustment of couch speed and/or bolus placement. Under IRB exempt status, the authors retrospectively analyzed the treatment records of 161 patients who received TBI treatment between 2006 and 2011. Results: Across the entire cohort, the median {+-} SD (range) percent variance between calculated and measured dose for head, neck, mediastinum, umbilicus, and knee was -2.3 {+-} 10.2% (-66.2 to +35.3), 1.1 {+-} 11.5% (-62.2 to +40.3), -1.9 {+-} 9.5% (-66.4 to +46.6), -1.1 {+-} 7.2% (-35.2 to +42.9), and 3.4 {+-} 12.2% (-47.9 to +108.5), respectively. More than half of treatments were within {+-}10% of the prescribed dose for all anatomical regions. For 80% of treatments (10%-90%), dose at the umbilicus was within {+-}10

Prediction of midline dose from entrance ad exit dose using OSLD measurements for total irradiation

Energy Technology Data Exchange (ETDEWEB)

Choi, Chang Heon; Park, Jong Min; Park, So Yeon; Chun, Min Soo; Han, Ji Hye; Cho, Jin Dong; Kim, Jung In [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

2017-06-15

This study aims to predict the midline dose based on the entrance and exit doses from optically stimulated luminescence detector (OSLD) measurements for total body irradiation (TBI). For TBI treatment, beam data sets were measured for 6 MV and 15 MV beams. To evaluate the tissue lateral effect of various thicknesses, the midline dose and peak dose were measured using a solid water phantom (SWP) and ion chamber. The entrance and exit doses were measured using OSLDs. OSLDs were attached onto the central beam axis at the entrance and exit surfaces of the phantom. The predicted midline dose was evaluated as the sum of the entrance and exit doses by OSLD measurement. The ratio of the entrance dose to the exit dose was evaluated at various thicknesses. The ratio of the peak dose to the midline dose was 1.12 for a 30 cm thick SWP at both energies. When the patient thickness is greater than 30 cm, the 15 MV should be used to ensure dose homogeneity. The ratio of the entrance dose to the exit dose was less than 1.0 for thicknesses of less than 30 cm and 40 cm at 6 MV and 15 MV, respectively. Therefore, the predicted midline dose can be underestimated for thinner body. At 15 MV, the ratios were approximately 1.06 for a thickness of 50 cm. In cases where adult patients are treated with the 15 MV photon beam, it is possible for the predicted midline dose to be overestimated for parts of the body with a thickness of 50 cm or greater. The predicted midline dose and OSLD-measured midline dose depend on the phantom thickness. For in-vivo dosimetry of TBI, the measurement dose should be corrected in order to accurately predict the midline dose.

The Sandia total-dose estimator: SANDOSE description and user guide

International Nuclear Information System (INIS)

Turner, C.D.

1995-02-01

The SANdia total-DOSe Estimator (SANDOSE) is used to estimate total radiation dose to a (BRL-CAT) solid model, SANDOSE uses the mass-sectoring technique to sample the model using ray-tracing techniques. The code is integrated directly into the BRL-CAD solid model editor and is operated using a simple graphical user interface. Several diagnostic tools are available to allow the user to analyze the results. Based on limited validation using several benchmark problems, results can be expected to fall between a 10% underestimate and a factor of 2 overestimate of the actual dose predicted by rigorous radiation transport techniques. However, other situations may be encountered where the results might fall outside of this range. The code is written in C and uses X-windows graphics. It presently runs on SUN SPARCstations, but in theory could be ported to any workstation with a C compiler and X-windows. SANDOSE is available via license by contacting either the Sandia National Laboratories Technology Transfer Center or the author

Marrow toxicity of fractionated vs. single dose total body irradiation is identical in a canine model

International Nuclear Information System (INIS)

Storb, R.; Raff, R.F.; Graham, T.; Appelbaum, F.R.; Deeg, H.J.; Schuening, F.G.; Shulman, H.; Pepe, M.

1993-01-01

The authors explored in dogs the marrow toxicity of single dose total body irradiation delivered from two opposing 60 Co sources at a rate of 10 cGy/min and compared results to those seen with total body irradiation administered in 100 cGy fractions with minimum interfraction intervals of 6 hr. Dogs were not given marrow transplants. They found that 200 cGy single dose total body irradiation was sublethal, with 12 of 13 dogs showing hematopoietic recovery and survival. Seven of 21 dogs given 300 cGy single dose total body irradiation survived compared to 6 of 10 dogs given 300 cGy fractionated total body irradiation. One of 28 dogs given 400 cGy single dose total body irradiation survived compared to none of six given fractionated radiation. With granulocyte colony stimulating factor (GCSF) administered from day 0-21 after 400 cGy total body irradiation, most dogs survived with hematological recovery. Because of the almost uniform success with GCSF after 400 cGy single dose total body irradiation, a study of GCSF after 400 cGy fractionated total body irradiation was deemed not to be informative and, thus, not carried out. Additional comparisons between single dose and fractionated total body irradiation were carried out with GCSF administered after 500 and 600 cGy of total body irradiation. As with lower doses of total body irradiation, no significant survival differences were seen between the two modes of total body irradiation, and only 3 of 26 dogs studied survived with complete hematological recovery. Overall, therefore, survival among dogs given single dose total body irradiation was not different from that of dogs given fractionated total body irradiation (p = .67). Similarly, the slopes of the postirradiation declines of granulocyte and platelet counts and the rates of their recovery in surviving dogs given equal total doses of single versus fractionated total body irradiation were indistinguishable. 24 refs., 3 figs., 2 tabs

Relationship of dose rate and total dose to responses of continuously irradiated beagles

International Nuclear Information System (INIS)

Fritz, T.E.; Norris, W.P.; Tolle, D.V.; Seed, T.M.; Poole, C.M.; Lombard, L.S.; Doyle, D.E.

1978-01-01

Young-adult beagles were exposed continuously (22 hours/day) to 60 Co γ rays in a specially constructed facility. The exposure rates were either 5, 10, 17, or 35 R/day, and the exposures were terminated at either 600, 1400, 2000, or 4000 R. A total of 354 dogs were irradiated; 221 are still alive as long-term survivors, some after more than 2000 days. The data on survival of these dogs, coupled with data from similar preliminary experiments, allow an estimate of the LD 50 for γ-ray exposures given at a number of exposure rates. They also allow comparison of the relative importance of dose rate and total dose, and the interaction of these two variables, in the early and late effects after protracted irradiation. The LD 50 for the beagle increases from 258 rad delivered at 15 R/minute to approximately 3000 rad at 10 R/day. Over this entire range, the LD 50 is dependent upon hematopoietic damage. At 5 R/day and less, no meaningful LD 50 can be determined; there is nearly normal continued hematopoietic function, survival is prolonged, and the dogs manifest varied individual responses in other organ systems. Although the experiment is not complete, interim data allow several important conclusions. Terminated exposures, while not as effective as radiation continued until death, can produce myelogenous leukemia at the same exposure rate, 10 R/day. More importantly, at the same total accumulated dose, lower exposure rates are more damaging than higher rates on the basis of the rate and degree of hematological recovery that occurs after termination of irradiation. Thus, the rate of hematologic depression, the nadir of the depression, and the rate of recovery are dependent upon exposure rate; the latter is inversely related and the former two are directly related to exposure rate

Relationship of dose rate and total dose to responses of continuously irradiated beagles

International Nuclear Information System (INIS)

Fritz, T.E.; Norris, W.P.; Tolle, D.V.; Seed, T.M.; Poole, C.M.; Lombard, L.S.; Doyle, D.E.

1978-01-01

Young-adult beagles were exposed continuously (22 hours/day) to 60 Co gamma rays in a specially constructed facility. The exposure rates were 5, 19, 17 or 35 R/day, and the exposures were terminated at 600, 1400, 2000 or 4000 R. A total of 354 dogs were irradiated; 221 are still alive as long-term survivors, some after more than 2000 days. The data on survival of these dogs, coupled with data from similar preliminary experiments, allow an estimate of the LD 50 for gamma-ray exposures given at a number of exposure rates. They also allow comparison of the relativeimportance of dose rate and total dose, and the interaction of these two variables, in the early and late effects after protracted irradiation. The LD 50 for the beagle increases from 344 R (258 rads) delivered at 15 R/minute to approximately 4000 R (approximately 3000 rads) at 10 R/day. Over this entire range, the LD 50 is dependent upon haematopoietic damage. At 5 R/day and less, no definitive LD 50 can be determined; there is nearly normal continued haematopoietic function, survival is prolonged, and the dogs manifest varied individual responses in the organ systems. Although the experiment is not complete, interim data allow serveral important conclusions. Terminated exposures, while not as effective as irradiation continued until death, can produce myelogenous leukaemia at the same exposure rate, 10 R/day. More importantly, at the same total accumulated dose, lower exposure rates appear more damaging than higher rates on the basis of the rate and degree of haematological recovery that occurs after termination of irradiation. Thus, the rate of haematologic depression, the nadir of the depression and the rate of recovery are dependent upon exposure rate; the latter is inversely related and the first two are directly related to exposure rate. ( author)

The safety of meperidine prescribing in older adults: A longitudinal population-based study.

Science.gov (United States)

Friesen, Kevin J; Falk, Jamie; Bugden, Shawn

2016-05-11

Meperidine (pethidine) is an opioid analgesic that offers little advantage relative to other opioids and several disadvantages including limited potency, short duration of action, and the production of a neurotoxic metabolite (normeperidine) with a long half-life. Older adults are more sensitive to meperidine's side effects and may have diminished renal function which leads to the accumulation of normeperidine. The Institute for Safe Medication Practices has suggested avoiding meperidine in older adults, limiting its dose (≤600 mg/day) and duration of use (≤48 h). The objective of this study was to determine the level of meperidine use in older adults and assess the dosage and duration of meperidine with reference to these safety recommendations. A longitudinal study using administrative healthcare data was conducted to examine meperidine utilization and levels of high dose and extended duration prescribing among persons ≥65 years of age between April 1, 2001, and March 31, 2014 in Manitoba, Canada. The number of meperidine prescriptions, users, duration of treatment, defined daily doses (DDD) dispensed and number of prescribers were determined over the study period. In the Manitoba older adult population there was a marked decline in meperidine users and prescriptions from 2001 to 2014. There was an average use of 26.4 (95 % CI 24.0-28.8) DDDs of meperidine per user per year. While only 3.7 % of the prescriptions exceeded the 600 mg maximum daily dose, 96.7 % of prescriptions exceeded the recommended 2 days of therapy. For the remaining users of meperidine, the amount of meperidine used per person rose from 18.98 to 56.14 DDDs/user/year over the study period. The number of prescribers of meperidine declined throughout the study, but low DDD prescribers declined more quickly than high DDD prescribers. While meperidine use has declined, the remaining use appears to be decreasing in safety, with more meperidine prescribed per user. This seems to be driven by

Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

International Nuclear Information System (INIS)

Healy, W.L.; Lo, T.C.; Covall, D.J.; Pfeifer, B.A.; Wasilewski, S.A.

1990-01-01

Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy

Impact of total ionizing dose on the electromagnetic susceptibility of a single bipolar transistor

International Nuclear Information System (INIS)

Doridant, A.; Jarrix, S.; Raoult, J.; Blain, A.; Dusseau, L.; Chatry, N.; Calvel, P.; Hoffmann, P.

2012-01-01

Space or military electronic components are subject to both electromagnetic fields and total ionizing dose. This paper deals with the electromagnetic susceptibility of a discrete low frequency transistor subject to total ionizing dose deposition. The electromagnetic susceptibility is investigated on both non-irradiated and irradiated transistors mounted in common emitter configuration. The change in susceptibility to 100 MHz-1.5 GHz interferences lights up a synergy effect between near field electromagnetic waves and total ionizing dose. Physical mechanisms leading to changes in signal output are detailed. (authors)

75 deaths in asthmatics prescribed home nebulisers.

Science.gov (United States)

Sears, M R; Rea, H H; Fenwick, J; Gillies, A J; Holst, P E; O'Donnell, T V; Rothwell, R P

1987-02-21

The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.

Reducing dose to the lungs through loosing target dose homogeneity requirement for radiotherapy of non small cell lung cancer.

Science.gov (United States)

Miao, Junjie; Yan, Hui; Tian, Yuan; Ma, Pan; Liu, Zhiqiang; Li, Minghui; Ren, Wenting; Chen, Jiayun; Zhang, Ye; Dai, Jianrong

2017-11-01

It is important to minimize lung dose during intensity-modulated radiation therapy (IMRT) of nonsmall cell lung cancer (NSCLC). In this study, an approach was proposed to reduce lung dose by relaxing the constraint of target dose homogeneity during treatment planning of IMRT. Ten NSCLC patients with lung tumor on the right side were selected. The total dose for planning target volume (PTV) was 60 Gy (2 Gy/fraction). For each patient, two IMRT plans with six beams were created in Pinnacle treatment planning system. The dose homogeneity of target was controlled by constraints on the maximum and uniform doses of target volume. One IMRT plan was made with homogeneous target dose (the resulting target dose was within 95%-107% of the prescribed dose), while another IMRT plan was made with inhomogeneous target dose (the resulting target dose was more than 95% of the prescribed dose). During plan optimization, the dose of cord and heart in two types of IMRT plans were kept nearly the same. The doses of lungs, PTV and organs at risk (OARs) between two types of IMRT plans were compared and analyzed quantitatively. For all patients, the lung dose was decreased in the IMRT plans with inhomogeneous target dose. On average, the mean dose, V5, V20, and V30 of lung were reduced by 1.4 Gy, 4.8%, 3.7%, and 1.7%, respectively, and the dose to normal tissue was also reduced. These reductions in DVH values were all statistically significant (P target dose could protect lungs better and may be considered as a choice for treating NSCLC. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

[Medication reconciliation errors according to patient risk and type of physician prescriber identified by prescribing tool used].

Science.gov (United States)

Bilbao Gómez-Martino, Cristina; Nieto Sánchez, Ángel; Fernández Pérez, Cristina; Borrego Hernando, Mª Isabel; Martín-Sánchez, Francisco Javier

2017-01-01

To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions.

Oral penicillin prescribing for children in the UK: a comparison with BNF for Children age-band recommendations

Science.gov (United States)

Saxena, Sonia; Ismael, Zareen; Murray, Macey L; Barker, Charlotte; Wong, Ian CK; Sharland, Mike; Long, Paul F

2014-01-01

Background The British National Formulary for Children (BNFC) recommends dosing oral penicillins according to age-bands, weight-bands, or weight-based calculations. Because of the rising prevalence of childhood obesity, age-band-based prescribing could lead to subtherapeutic dosing. Aim To investigate actual oral penicillin prescribing by GPs in the UK with reference to the current BNFC age-band recommendations. Design and setting Descriptive analysis of UK prescriptions in the 2010 IMS Disease-Analyzer database (IMS-DA). Method A detailed database analysis was undertaken of oral penicillin prescriptions for 0–18 year olds from the 2010 IMS-DA. The prescription analysis included all available data on formulation, strength (mg), prescription quantity unit, package size, prescribed quantity, and volume. Results Considering amoxicillin alone, no infants (aged penicillins for children in UK primary care, with very few children being prescribed the current national recommended doses. There is an urgent need to review dosing guidelines, in relation to the weights of children today. PMID:24686886

SU-E-T-92: Achieving Desirable Lung Doses in Total Body Irradiation Based On in Vivo Dosimetry and Custom Tissue Compensation

International Nuclear Information System (INIS)

Cui, G; Shiu, A; Zhou, S; Cui, J; Ballas, L

2015-01-01

Purpose: To achieve desirable lung doses in total body irradiation (TBI) based on in vivo dosimetry and custom tissue compensation. Methods: The 15 MV photon beam of a Varian TrueBeam STx linac was used for TBI. Patients were positioned in the lateral decubitus position for AP/PA treatment delivery. Dose was calculated using the midpoint of the separation distance across the patient’s umbilicus. Patients received 200 cGy twice daily for 3 days. The dose rate at the patient’s midplane was approximately 10 cGy/min. Cerrobend blocks with a 5-HVL thickness were used for the primary lung shielding. A custom styrofoam holder for rice-flour filled bags was created based on the lung block cutouts. This was used to provide further lung shielding based on in vivo dose measurements. Lucite plates and rice-flour bags were placed in the head, neck, chest, and lower extremity regions during the treatment to compensate for the beam off-axis output variations. Two patients were included in the study. Patients 1 and 2 received a craniospinal treatment (1080 cGy) and a mediastinum treatment (2520 cGy), respectively, before the TBI. During the TBI nanoDot dosimeters were placed on the patient skin in the forehead, neck, umbilicus, and lung regions for dose monitoring. The doses were readout immediately after the treatment. Based on the readings, fine tuning of the thickness of the rice-flour filled bags was exploited to achieve the desirable lung doses. Results: For both patients the mean lung doses, which took into consideration all treatments, were controlled within 900 +/−10% cGy, as desired. Doses to the forehead, neck, and umbilicus were achieved within +/−10% of the prescribed dose (1200 cGy). Conclusion: A reliable and robust method was developed to achieve desirable lung doses and uniform body dose in TBI based on in vivo dosimetry and custom tissue compensator

SU-E-T-92: Achieving Desirable Lung Doses in Total Body Irradiation Based On in Vivo Dosimetry and Custom Tissue Compensation

Energy Technology Data Exchange (ETDEWEB)

Cui, G; Shiu, A; Zhou, S; Cui, J; Ballas, L [Univ Southern California, Los Angeles, CA (United States)

2015-06-15

Purpose: To achieve desirable lung doses in total body irradiation (TBI) based on in vivo dosimetry and custom tissue compensation. Methods: The 15 MV photon beam of a Varian TrueBeam STx linac was used for TBI. Patients were positioned in the lateral decubitus position for AP/PA treatment delivery. Dose was calculated using the midpoint of the separation distance across the patient’s umbilicus. Patients received 200 cGy twice daily for 3 days. The dose rate at the patient’s midplane was approximately 10 cGy/min. Cerrobend blocks with a 5-HVL thickness were used for the primary lung shielding. A custom styrofoam holder for rice-flour filled bags was created based on the lung block cutouts. This was used to provide further lung shielding based on in vivo dose measurements. Lucite plates and rice-flour bags were placed in the head, neck, chest, and lower extremity regions during the treatment to compensate for the beam off-axis output variations. Two patients were included in the study. Patients 1 and 2 received a craniospinal treatment (1080 cGy) and a mediastinum treatment (2520 cGy), respectively, before the TBI. During the TBI nanoDot dosimeters were placed on the patient skin in the forehead, neck, umbilicus, and lung regions for dose monitoring. The doses were readout immediately after the treatment. Based on the readings, fine tuning of the thickness of the rice-flour filled bags was exploited to achieve the desirable lung doses. Results: For both patients the mean lung doses, which took into consideration all treatments, were controlled within 900 +/−10% cGy, as desired. Doses to the forehead, neck, and umbilicus were achieved within +/−10% of the prescribed dose (1200 cGy). Conclusion: A reliable and robust method was developed to achieve desirable lung doses and uniform body dose in TBI based on in vivo dosimetry and custom tissue compensator.

An electronic intervention to improve safety for pain patients co-prescribed chronic opioids and benzodiazepines.

Science.gov (United States)

Zaman, Tauheed; Rife, Tessa L; Batki, Steven L; Pennington, David L

2018-03-29

Co-prescribing opioids and benzodiazepines increases overdose risk. A paucity of literature exists evaluating strategies to improve safety of co-prescribing. This study evaluated an electronic intervention to improve safety for patients co-prescribed chronic opioids for pain and benzodiazepines at 3 and 6 months. A prospective cohort study was conducted from December 2015 through May 2016 at San Francisco Veterans Affairs Health Care System. A clinical dashboard identified 145 eligible patients prescribed chronic opioids and benzodiazepines. Individualized taper and safety recommendations were communicated to prescribers via electronic medical record progress note and encrypted e-mail at baseline. Primary outcome was number of patients co-prescribed chronic opioids and benzodiazepines. Secondary outcomes included daily dose of opioids and benzodiazepines and number prescribed ≥100 mg morphine equivalent daily dose. Safety outcomes included number with opioid overdose education and naloxone distribution, annual urine drug screening, annual prescription drug monitoring program review, and signed opioid informed consent. Linear mixed models and generalized estimating equations were used to examine within-group change in outcomes between baseline and 3 and 6 months. Among the 145 patients, mean (standard deviation) age was 62 (11) years and 91.7% (133/145) were male. Number co-prescribed significantly decreased from 145/145 (100%) at baseline to 93/139 (67%) at 6-month follow-up (odds ratio [OR] = 0.53, 95% confidence interval [CI]: 0.34-0.81, P = .003). Mean opioid and benzodiazepine doses significantly decreased from 84.61 to 65.63 mg (95% CI: 8.32-27.86, P improve safety for patients co-prescribed chronic opioids for pain and benzodiazepines.

Trends in metformin utilisation and dose appropriateness in Australia.

Science.gov (United States)

Moon, J; Kumar, S S; Graham, G G; Baysari, M T; Williams, K M; Chen, W; Viardot, A; Greenfield, J R; Day, R O

2016-12-01

The study aimed to (1) determine the trends in the utilisation of metformin in Australia, (2) determine the appropriateness of metformin dosing in an Australian teaching hospital and (3) gather the opinions of prescribers on the relationship between metformin dose and renal function. National prescription data between 1990 and 2012 were accessed. A retrospective audit (2008-2012) of metformin doses and patient renal function (20 % random sample of all in-patients prescribed metformin) was conducted at St Vincent's Hospital (SVH), Sydney. Prescribers of metformin were interviewed (semi-structured; consultants at SVH) or surveyed (Australian endocrinologists) to gather their understanding of metformin dosing in relation to renal function. Metformin utilisation increased fivefold nationally between 1995 and 2012. Metformin tended to be under-dosed in SVH patients with normal renal function (83.5 %) and over-dosed in patients with impaired renal function (estimated glomerular filtration rate (eGFR) metformin doses needed to be reduced in renal impairment. Most endocrinologists (61 %) were comfortable prescribing metformin down to eGFRs around 30 mL/min. The use of metformin increased greatly over the period of the study. Metformin is prescribed frequently for patients with eGFR values below the minimal level approved in the product label (60 mL/min). While prescribers expressed their understanding of the need to reduce metformin doses in patients with renal impairment, we found that metformin doses were higher than appropriate in patients with impaired renal function. Metformin may be used safely when renal function is poor provided dosage is appropriately reduced.

Prescribing patterns of hydrocortisone in septic shock: a single-center experience of how surviving sepsis guidelines are interpreted and translated into bedside practice.

Science.gov (United States)

Contrael, Katlynd M; Killian, Alley J; Gregg, Sara R; Buchman, Timothy G; Coopersmith, Craig M

2013-10-01

The Surviving Sepsis Campaign suggests giving hydrocortisone to septic patients only if their "blood pressure is poorly responsive to fluid resuscitation and vasopressor therapy." Because the definition of "poorly responsive" is not provided, the purpose of this study was to identify prescribing triggers for hydrocortisone in septic shock. Retrospective chart review of patients with septic shock over 17 months, who received hydrocortisone, followed by a survey of all intensivists who attended in the study ICUs to determine whether provider attitudes matched clinical practice. Eight ICUs in an academic hospital and a hybrid academic/community hospital. A total of 155 patients with septic shock in whom vasopressors were initiated and hydrocortisone was prescribed. Ninety-nine patients (64%) were already receiving two vasopressors before hydrocortisone was prescribed. An additional 22 patients were on a single high-dose vasopressor prior to corticosteroid initiation. Of patients who survived to have their hydrocortisone dose changed, 57% had their corticosteroids tapered, whereas 43% were abruptly discontinued. Seventy-six percent of patients were no longer on vasopressors when the first dosing change was made. Twenty-seven out of 36 intensivists (75%) completed the survey. The majority (72%) defined "poorly responsive to vasopressors" as the presence of two vasopressors, and 70% stated that they required patients to be off vasopressors prior to altering the corticosteroid dose. Significant variability exists when corticosteroids are prescribed for septic shock, with the most common interpretation in our institution of "poorly responsive to fluid resuscitation and vasopressor therapy" being the presence of two vasopressors. The method and timing of corticosteroid discontinuation also differed among providers. Self-described prescribing patterns from intensivists closely matched their actual behavior, suggesting variability is due to differing interpretations of the

Antiepileptic drug prescribing before, during and after pregnancy: a study in seven European regions.

Science.gov (United States)

Charlton, Rachel; Garne, Ester; Wang, Hao; Klungsøyr, Kari; Jordan, Sue; Neville, Amanda; Pierini, Anna; Hansen, Anne; Engeland, Anders; Gini, Rosa; Thayer, Daniel; Bos, Jens; Puccini, Aurora; Nybo Andersen, Anne-Marie; Dolk, Helen; de Jong-van den Berg, Lolkje

2015-11-01

The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in seven population-based electronic healthcare databases. Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice Research Datalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and 2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancy and the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy and was lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prevalence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI95 49-52%) and was lowest in the Netherlands (43/10 000; CI95 33-54%) and highest in Wales (60/10 000; CI95 54-66%). In Denmark, Norway and the two UK databases lamotrigine was the most commonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequently prescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from 1.0% (CI95 0.3-1.8%) in Emilia Romagna to 33.5% (CI95 28.7-38.4%) in Wales. The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care

Estimation of the total absorbed dose by quartz in retrospective conditions

International Nuclear Information System (INIS)

Correcher, V.; Delgado, A.

2003-01-01

The estimation of the total absorbed dose is of great interest in areas affected by a radiological accident when no conventional dosimetric systems are available. This paper reports about the usual methodology employed in dose reconstruction from the thermoluminescence (TL) properties of natural quartz, extracted from selected ceramic materials (12 bricks) picked up in the Chernobyl area. It has been possible to evaluate doses under 50mGy after more than 11 years later since the radiological accident happened. The main advance of this fact is the reduction of the commonly accepted limit dose estimation more than 20 times employing luminescence methods. (Author) 11 refs

Antipsychotic treatment dosing profile in patients with schizophrenia evaluated with electronic monitoring (MEMS®).

Science.gov (United States)

Acosta, Francisco J; Ramallo-Fariña, Yolanda; Bosch, Esperanza; Mayans, Teresa; Rodríguez, Carlos J; Caravaca, Ana

2013-05-01

Although the Medication Event Monitoring System (MEMS®) device offers accurate information on treatment dosing profile, such profile has never been studied in patients with schizophrenia. Enhancing our knowledge on this issue would help in developing intervention strategies to improve adherence to antipsychotic treatment in these patients. 74 outpatients with schizophrenia were monitored with the MEMS device for a 3-month period, for evaluation of antipsychotic treatment dosing profile, possible influence of medication schedule-related variables, adherence to treatment--considering dose intake within prescribed timeframes--and possible Hawthorne's effect of using the MEMS device. Dose-omission gaps occurred in 18.7% of monitoring days, most frequently during weekends, almost significantly. Almost one-third of prescribed doses were taken out of prescribed time. Neither the prescribed number of daily doses nor the indicated time of the day for dose intake (breakfast, dinner), were associated with correct antipsychotic dosing. Excess-dose was rare in general, and more frequent out of prescribed dose timeframe. No Hawthorne's effect was found for the MEMS device. Adherence reached only 35% according to a definition that included dose intake within prescribed timeframes. Antipsychotic treatment dosing was considerably irregular among patients with schizophrenia. Strategies to reduce dose-omission gaps and increase dosing within prescribed timeframes seem to be necessary. Gaining knowledge on precise oral antipsychotic dosing profiles or the influence of schedule-related variables may be useful to design strategies towards enhancing adherence. There appears to be no Hawthorne's effect associated with the use of MEMS devices in outpatients with schizophrenia. Copyright © 2013 Elsevier B.V. All rights reserved.

Total Risk Management for Low Dose Radiation Exposures

International Nuclear Information System (INIS)

Simic, Z.; Mikulicic, V.; Sterc, D.

2012-01-01

health. This view is supported with numerous evidences, and explained with beneficial effects from the increased activity of immune system activated with small radiation exposures. Finally, theory in between is that small doses are less than linearly proportionally harmful and that they are presenting a much smaller risks than according to the LNT. This view is derived from the use of different evidences. Difficulties to find one single theory about effects of small radiation doses are related to existence of huge variability and uncertainty in the evidence data. This is very hard experimental and theoretical problem. It will require lots of additional research to reduce these uncertainties and find final theory. This might be too late for the number of people affected in different ways with current single most conservative LNT approach. The problem with the conservative LNT regulatory approach is resulting in enormous additional costs of nuclear energy and medical applications. Which is reasonable and acceptable during the regular operation when source is high and concentrated. But, this becomes unreasonable huge economic burden after accidents and for cleanups with nuclear facilities. Similar problem arises with restriction of medical examinations and treatments based on over conservative risk estimate. Special circumstances are with evacuated people from contaminated areas where they are on the one side saved from small radiation exposures, and on the other side exposed to years of life away from their home and with numerous direct and indirect additional risks (i.e., stress, social problems, etc.). It seems reasonable that some alternative (total) risk management approach might be much more suitable for this situation. Evacuation of people from contaminated area with small doses sources should not be done when that induces larger risks from even what is expected from radiation based on LNT. Similar total risk management could be also applied for with medical

Dose evaluation of TPS according to treatment sites in IMRT

International Nuclear Information System (INIS)

Kim, Jin Man; Kim, Jong Sik; Hong, Chae Seon; Park, Ju Young; Park, Su Yeon; Ju, Sang Gyu

2013-01-01

This study executed therapy plans on prostate cancer (homogeneous density area) and lung cancer (non-homogeneous density area) using radiation treatment planning systems such as Pinnacle 3 (version 9.2, Philips Medical Systems, USA) and Eclipse (version 10.0, Varian Medical Systems, USA) in order to quantify the difference between dose calculation according to density in IMRT. The subjects were prostate cancer patients (n=5) and lung cancer patients (n=5) who had therapies in our hospital. Identical constraints and optimization process according to the Protocol were administered on the subjects. For the therapy plan of prostate cancer patients, 10 MV and 7Beam were used and 2.5 Gy was prescribed in 28 fx to make 70 Gy in total. For lung cancer patients, 6 MV and 6Beam were used and 2 Gy was prescribed in 33 fx to make 66 Gy in total. Through two therapy planning systems, maximum dose, average dose, and minimum dose of OAR (Organ at Risk) of CTV, PTV and around tumor were investigated. In prostate cancer, both therapy planning systems showed within 2% change of dose of CTV and PTV and normal organs (Bladder, Both femur and Rectum out) near the tumor satisfied the dose constraints. In lung cancer, CTV and PTV showed less than 2% changes in dose and normal organs (Esophagus, Spinal cord and Both lungs) satisfied dose restrictions. However, the minimum dose of Eclipse therapy plan was 1.9% higher in CTV and 3.5% higher in PTV, and in case of both lungs there was 3.0% difference at V5 Gy. Each TPS according to the density satisfied dose limits of our hospital proving the clinical accuracy. It is considered more accurate and precise therapy plan can be made if studies on treatment planning for diverse parts and the application of such TPS are made

Theoretical considerations for SRAM total-dose hardening

International Nuclear Information System (INIS)

Francis, P.; Flandre, D.; Colinge, J.P.

1995-01-01

The theoretical hardness against total dose of the six-transistor SRAM cell is investigated in detail. An explicit analytical expression of the maximum tolerable threshold voltage shift is derived for two cross-coupled inverters. A numerical method is used to explore the hardness of the read and write operations. Both N- and P-channel access transistors designs are considered and their respective advantages are compared. The study points out that the radiation hardness mainly relies on the technology. Results obtained with the very robust Gate-All-Around process are finally presented

Psychotropic prescribing in seriously violent men with schizophrenia or personality disorder in a UK high security hospital.

Science.gov (United States)

Stone-Brown, Keir; Naji, Mahmood; Francioni, Alex; Myers, Kyle; Samarendra, Harsh; Mushtaq-Chaudhry, Haseeb; Heslop, Stephen; Sengupta, Samrat; Ross, Callum C; Larkin, Fintan; Das, Mrigendra

2016-02-01

To analyze antipsychotic prescribing patterns in a UK high security hospital (HSH) that treats seriously violent men with either schizophrenia or personality disorder and examine how different groups consented to treatment and prescribing for metabolic conditions. We hypothesized that there would be high prevalence of antipsychotic polypharmacy, and high-dose antipsychotic and clozapine prescribing. HSHs treat seriously violent, mentally disordered offenders, and the extant literature on prescribing patterns in forensic settings is sparse. Prescribing and clinical data on all 189 patients in a UK HSH were collected from the hospital's databases. Data were analyzed using SPSS. The population was split into the following groups: schizophrenia spectrum disorder (SSD-only), personality disorder (PD-only), and comorbid schizophrenia spectrum disorder and PD. The majority (93.7%) of all patients were prescribed at least one antipsychotic, and (27.5%) were on clozapine. Polypharmacy was prevalent in 22.2% and high-dose antipsychotic in 27.5%. Patients on clozapine were more likely to be prescribed antidiabetic, statins, or antihypertensive medication. Patients in the PD-only group were more likely to be deemed to have the capacity to consent to treatment and be prescribed clozapine in contrast to the SSD-only group. Rates of clozapine and high-dose antipsychotic prescribing were higher than in other psychiatric settings, while polypharmacy prescribing rates were lower. Higher clozapine prescribing rates may be a function of a treatment-resistant and aggressive population. A higher proportion of PD-only patients consented to treatment and received clozapine compared with in-house SSD-only as well as other psychiatric settings. Implications of the findings are discussed.

Prescribing psychotropic drugs to adults with an intellectual disability

Science.gov (United States)

Trollor, Julian N; Salomon, Carmela; Franklin, Catherine

2016-01-01

SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975

Medication prescribing errors in the medical intensive care unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Science.gov (United States)

Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

Medication errors (MEs) are important problems in all hospitalized populations, especially in intensive care unit (ICU). Little is known about the prevalence of medication prescribing errors in the ICU of hospitals in Ethiopia. The aim of this study was to assess medication prescribing errors in the ICU of Tikur Anbessa Specialized Hospital using retrospective cross-sectional analysis of patient cards and medication charts. About 220 patient charts were reviewed with a total of 1311 patient-days, and 882 prescription episodes. 359 MEs were detected; with prevalence of 40 per 100 orders. Common prescribing errors were omission errors 154 (42.89%), 101 (28.13%) wrong combination, 48 (13.37%) wrong abbreviation, 30 (8.36%) wrong dose, wrong frequency 18 (5.01%) and wrong indications 8 (2.23%). The present study shows that medication errors are common in medical ICU of Tikur Anbessa Specialized Hospital. These results suggest future targets of prevention strategies to reduce the rate of medication error.

Study of total ionization dose effects in electronic devices

International Nuclear Information System (INIS)

Nidhin, T.S.; Bhattacharyya, Anindya; Gour, Aditya; Behera, R.P.; Jayanthi, T.

2018-01-01

Radiation effects in electronic devices are a major challenge in the dependable application developments of nuclear power plant instrumentation and control systems. The main radiation effects are total ionization dose (TID) effects, displacement damage dose (DDD) effects and single event effects (SEE). In this study, we are concentrating on TID effects in electronic devices. The focus of the study is mainly on SRAM based field programmable gate arrays (FPGA) along with that the devices of our interest are voltage regulators, flash memory and optocoupler. The experiments are conducted by exposing the devices to gamma radiation in power off condition and the degradation in the performances are analysed

Evaluation of prescriber responses to pharmacogenomics clinical decision support for thiopurine S-methyltransferase testing.

Science.gov (United States)

Ubanyionwu, Samuel; Formea, Christine M; Anderson, Benjamin; Wix, Kelly; Dierkhising, Ross; Caraballo, Pedro J

2018-02-15

Results of a study of prescribers' responses to a pharmacogenomics-based clinical decision support (CDS) alert designed to prompt thiopurine S -methyltransferase (TPMT) status testing are reported. A single-center, retrospective, chart review-based study was conducted to evaluate prescriber compliance with a pretest CDS alert that warned of potential thiopurine drug toxicity resulting from deficient TPMT activity due to TPMT gene polymorphism. The CDS alert was triggered when prescribers ordered thiopurine drugs for patients whose records did not indicate TPMT status or when historical thiopurine use was documented in the electronic health record. The alert pop-up also provided a link to online educational resources to guide thiopurine dosing calculations. During the 9-month study period, 500 CDS alerts were generated: in 101 cases (20%), TPMT phenotyping or TPMT genotyping was ordered; in 399 cases (80%), testing was not ordered. Multivariable regression analysis indicated that documentation of historical thiopurine use was the only independent predictor of test ordering. Among the 99 patients tested subsequent to CDS alerts, 70 (71%) had normal TPMT activity, 29 (29%) had intermediate activity, and none had deficient activity. The online resources provided thiopurine dosing recommendations applicable to 24 patients, but only 3 were prescribed guideline-supported doses after CDS alerts. The pretest CDS rule resulted in a large proportion of neglected alerts due to poor alerting accuracy and consequent alert fatigue. Prescriber usage of online thiopurine dosing resources was low. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Characterization of Radiation Hardened Bipolar Linear Devices for High Total Dose Missions

Science.gov (United States)

McClure, Steven S.; Harris, Richard D.; Rax, Bernard G.; Thorbourn, Dennis O.

2012-01-01

Radiation hardened linear devices are characterized for performance in combined total dose and displacement damage environments for a mission scenario with a high radiation level. Performance at low and high dose rate for both biased and unbiased conditions is compared and the impact to hardness assurance methodology is discussed.

A long-term risk-benefit analysis of low-dose aspirin in primary prevention.

Science.gov (United States)

Wu, I-Chen; Hsieh, Hui-Min; Yu, Fang-Jung; Wu, Meng-Chieh; Wu, Tzung-Shiun; Wu, Ming-Tsang

2016-02-01

The long-term risk-benefit effect of occasional and regular use of low-dose aspirin (≤ 100 mg per day) in primary prevention of vascular diseases and cancers was calculated. One representative database of 1 000 000 participants from Taiwan's National Health Insurance scheme in 1997-2000 was used. The potential study subjects were those aged 30-95 years, were found not to have been prescribed aspirin before 1 January 2000, but to have first been prescribed low-dose aspirin (≤ 100 mg per day) after that date and were followed up to 31 December 2009. Participants prescribed low-dose aspirin risk. A total of 1720 pairs were analysed. During the study period, haemorrhage and ischaemia occurred in 25 (1·45%) and 67 participants (3·90%) in occasional users and 69 (4·01%) and 100 participants (5·81%) in regular users, whereas cancer occurred in 32 participants (1·86%) in occasional users and 26 participants (1·51%) in regular users. The crude and adjusted net clinical risks of low-dose aspirin use between the two frequency of users (≥ 80% vs. prevention against major vascular diseases and cancer. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

Assessing pediatrics residents' mathematical skills for prescribing medication: a need for improved training.

Science.gov (United States)

Glover, Mark L; Sussmane, Jeffrey B

2002-10-01

To evaluate residents' skills in performing basic mathematical calculations used for prescribing medications to pediatric patients. In 2001, a test of ten questions on basic calculations was given to first-, second-, and third-year residents at Miami Children's Hospital in Florida. Four additional questions were included to obtain the residents' levels of training, specific pediatrics intensive care unit (PICU) experience, and whether or not they routinely double-checked doses and adjusted them for each patient's weight. The test was anonymous and calculators were permitted. The overall score and the score for each resident class were calculated. Twenty-one residents participated. The overall average test score and the mean test score of each resident class was less than 70%. Second-year residents had the highest mean test scores, although there was no significant difference between the classes of residents (p =.745) or relationship between the residents' PICU experiences and their exam scores (p =.766). There was no significant difference between residents' levels of training and whether they double-checked their calculations (p =.633) or considered each patient's weight relative to the dose prescribed (p =.869). Seven residents committed tenfold dosing errors, and one resident committed a 1,000-fold dosing error. Pediatrics residents need to receive additional education in performing the calculations needed to prescribe medications. In addition, residents should be required to demonstrate these necessary mathematical skills before they are allowed to prescribe medications.

Benefits of online in vivo dosimetry for single-fraction total body irradiation

Energy Technology Data Exchange (ETDEWEB)

Eaton, David J., E-mail: davideaton@nhs.net [Department of Radiotherapy, Royal Free Hospital, London (United Kingdom); Warry, Alison J. [Department of Radiotherapy Physics, University College London Hospital, London (United Kingdom); Trimble, Rachel E.; Vilarino-Varela, Maria J.; Collis, Christopher H. [Department of Radiotherapy, Royal Free Hospital, London (United Kingdom)

2014-01-01

Use of a patient test dose before single-fraction total body irradiation (TBI) allows review of in vivo dosimetry and modification of the main treatment setup. However, use of computed tomography (CT) planning and online in vivo dosimetry may reduce the need for this additional step. Patients were treated using a supine CT-planned extended source-to-surface distance (SSD) technique with lead compensators and bolus. In vivo dosimetry was performed using thermoluminescent dosimeters (TLDs) and diodes at 10 representative anatomical locations, for both a 0.1-Gy test dose and the treatment dose. In total, 28 patients were treated between April 2007 and July 2013, with changes made in 10 cases (36%) following test dose results. Overall, 98.1% of measured in vivo treatment doses were within 10% of the prescribed dose, compared with 97.0% of test dose readings. Changes made following the test dose could have been applied during the single-fraction treatment itself, assuming that the dose was delivered in subportions and online in vivo dosimetry was available for all clinically important anatomical sites. This alleviates the need for a test dose, saving considerable time and resources.

Benefits of online in vivo dosimetry for single-fraction total body irradiation

International Nuclear Information System (INIS)

Eaton, David J.; Warry, Alison J.; Trimble, Rachel E.; Vilarino-Varela, Maria J.; Collis, Christopher H.

2014-01-01

Use of a patient test dose before single-fraction total body irradiation (TBI) allows review of in vivo dosimetry and modification of the main treatment setup. However, use of computed tomography (CT) planning and online in vivo dosimetry may reduce the need for this additional step. Patients were treated using a supine CT-planned extended source-to-surface distance (SSD) technique with lead compensators and bolus. In vivo dosimetry was performed using thermoluminescent dosimeters (TLDs) and diodes at 10 representative anatomical locations, for both a 0.1-Gy test dose and the treatment dose. In total, 28 patients were treated between April 2007 and July 2013, with changes made in 10 cases (36%) following test dose results. Overall, 98.1% of measured in vivo treatment doses were within 10% of the prescribed dose, compared with 97.0% of test dose readings. Changes made following the test dose could have been applied during the single-fraction treatment itself, assuming that the dose was delivered in subportions and online in vivo dosimetry was available for all clinically important anatomical sites. This alleviates the need for a test dose, saving considerable time and resources

Dose received by radiation workers in Australia, 1991

Energy Technology Data Exchange (ETDEWEB)

Morris, N D

1994-07-01

Exposure to radiation can cause genetic defects or cancer. People who use sources of radiation as part of their employment are potentially at a greater risk than others owing to the possibility of their being continually exposed to small radiation doses over a long period. In Australia, the National Health and Medical Research Council has established radiation protection standards and set annual effective dose limits for radiation workers in order to minimise the chance of adverse effects occurring. These standards are based on the the recommendations of the International Commission on Radiological Protection (ICRP 1990). In order to ensure that the prescribed limits are not exceeded and to ensure that doses are kept to a minimum, some sort of monitoring is necessary. The primary purpose of this report is to provide data on the distribution of effective doses for different occupational categories of radiation worker in Australia. The total collective effective dose was found to be of the order of 4.9 Sv for a total of 34750 workers. 9 refs., 16 tabs., 6 figs.

Dose received by radiation workers in Australia, 1991

International Nuclear Information System (INIS)

Morris, N.D.

1994-07-01

Exposure to radiation can cause genetic defects or cancer. People who use sources of radiation as part of their employment are potentially at a greater risk than others owing to the possibility of their being continually exposed to small radiation doses over a long period. In Australia, the National Health and Medical Research Council has established radiation protection standards and set annual effective dose limits for radiation workers in order to minimise the chance of adverse effects occurring. These standards are based on the the recommendations of the International Commission on Radiological Protection (ICRP 1990). In order to ensure that the prescribed limits are not exceeded and to ensure that doses are kept to a minimum, some sort of monitoring is necessary. The primary purpose of this report is to provide data on the distribution of effective doses for different occupational categories of radiation worker in Australia. The total collective effective dose was found to be of the order of 4.9 Sv for a total of 34750 workers. 9 refs., 16 tabs., 6 figs

The total dose effects on the 1/f noise of deep submicron CMOS transistors

International Nuclear Information System (INIS)

Hu Rongbin; Wang Yuxin; Lu Wu

2014-01-01

Using 0.18 μm CMOS transistors, the total dose effects on the 1/f noise of deep-submicron CMOS transistors are studied for the first time in mainland China. From the experimental results and the theoretic analysis, we realize that total dose radiation causes a lot of trapped positive charges in STI (shallow trench isolation) SiO 2 layers, which induces a current leakage passage, increasing the 1/f noise power of CMOS transistors. In addition, we design some radiation-hardness structures on the CMOS transistors and the experimental results show that, until the total dose achieves 750 krad, the 1/f noise power of the radiation-hardness CMOS transistors remains unchanged, which proves our conclusion. (semiconductor devices)

Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions

Directory of Open Access Journals (Sweden)

Adam C Pomerleau

2016-11-01

Full Text Available INTRODUCTION: Our study sought to examine the opioid analgesic (OA prescribing decisions of emergency department (ED providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication, and hypothetical analgesic-prescribing decisions for their patients, family members, and themselves for different painful conditions. RESULTS: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]. A majority of these providers (82%; 95% CI = [77-87] took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71] agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25] would for an adult patient, 13% (95% CI = [10-16] would for an adult family member, and 6% (95% CI = [4-8] indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89] would prescribe OA for an adult patient, 75% (95% CI = [71-79] for an adult family member, and 52% (95% CI = [47-57] would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. CONCLUSION: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA

Serum protein concentration in low-dose total body irradiation of normal and malnourished rats

International Nuclear Information System (INIS)

Viana, W.C.M.; Lambertz, D.; Borges, E.S.; Neto, A.M.O.; Lambertz, K.M.F.T.; Amaral, A.

2016-01-01

Among the radiotherapeutics' modalities, total body irradiation (TBI) is used as treatment for certain hematological, oncological and immunological diseases. The aim of this study was to evaluate the long-term effects of low-dose TBI on plasma concentration of total protein and albumin using prematurely and undernourished rats as animal model. For this, four groups with 9 animals each were formed: Normal nourished (N); Malnourished (M); Irradiated Normal nourished (IN); Irradiated Malnourished (IM). At the age of 28 days, rats of the IN and IM groups underwent total body gamma irradiation with a source of cobalt-60. Total protein and Albumin in the blood serum was quantified by colorimetry. This research indicates that procedures involving low-dose total body irradiation in children have repercussions in the reduction in body-mass as well as in the plasma levels of total protein and albumin. Our findings reinforce the periodic monitoring of total serum protein and albumin levels as an important tool in long-term follow-up of pediatric patients in treatments associated to total body irradiation. - Highlights: • Low-dose total body irradiation (TBI) in children have repercussions in their body-mass. • Long-term total protein and albumin levels are affected by TBI. • The monitoring of total protein and albumin levels are useful in the follow-up of TBI pediatric patients.

Characterization of Phenolic Compounds in Pinus laricio Needles and Their Responses to Prescribed Burnings

Directory of Open Access Journals (Sweden)

Lila Ferrat

2007-07-01

Full Text Available Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i the short term (one to three months and medium term (three years effects of prescribed burning, and ii the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

Characterization of phenolic compounds in Pinus laricio needles and their responses to prescribed burnings.

Science.gov (United States)

Cannac, Magali; Pasqualini, Vanina; Greff, Stéphane; Fernandez, Catherine; Ferrat, Lila

2007-07-30

Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled) burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i) the short term (one to three months) and medium term (three years) effects of prescribed burning, and ii) the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

Worst-Case Bias During Total Dose Irradiation of SOI Transistors

International Nuclear Information System (INIS)

Ferlet-Cavrois, V.; Colladant, T.; Paillet, P.; Leray, J.-L; Musseau, O.; Schwank, James R.; Shaneyfelt, Marty R.; Pelloie, J.L.; Du Port de Poncharra, J.

2000-01-01

The worst case bias during total dose irradiation of partially depleted SOI transistors (from SNL and from CEA/LETI) is correlated to the device architecture. Experiments and simulations are used to analyze SOI back transistor threshold voltage shift and charge trapping in the buried oxide

Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views.

Science.gov (United States)

Stenner, Karen; Carey, Nicola; Courtenay, Molly

2009-04-01

This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology. The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals. Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data. Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased. Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

Science.gov (United States)

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-08-01

To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; chi(2) test). A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

Estimation of the dose distribution within, and total dose to, the body of an acutely overexposed person

International Nuclear Information System (INIS)

Beer, G.P. de; Feather, J.I.; Oude, A. de; Language, A.E.

1981-01-01

In a case of accidental overexposure of a person, it is important to obtain a reliable value of the whole body dose as well as of the dose distribution within the body. Any follow-up treatment based only on the clinical effects as and when they appear, may result in insufficient or even erroneous therapy. In this respect knowledge of total dose and its distribution within the body may be a valuable aid in deciding on the follow-up treatment, taking into account the latent nature of the clinical effects. The calculated whole body dose and its distribution within the body of a person overexposed to a 192 Ir radiography source, are compared to experimentally determined values. In both cases the calculated values prove to be of sufficient accuracy to serve as an aid in decisions on the follow-up treatment. (author)

High-dose total-body irradiation and autologous marrow reconstitution in dogs: dose-rate-related acute toxicity and fractionation-dependent long-term survival

International Nuclear Information System (INIS)

Deeg, H.J.; Storb, R.; Weiden, P.L.; Schumacher, D.; Shulman, H.; Graham, T.; Thomas, E.D.

1981-01-01

Beagle dogs treated by total-body irradiation (TBI) were given autologous marrow grafts in order to avoid death from marrow toxicity. Acute and delayed non-marrow toxicities of high single-dose (27 dogs) and fractionated TBI (20 dogs) delivered at 0.05 or 0.1 Gy/min were compared. Fractionated TBI was given in increments of 2 Gy every 6 hr for three increments per day. Acute toxicity and early mortality (<1 month) at identical total irradiation doses were comparable for dogs given fractionated or single-dose TBI. With single-dose TBI, 14, 16, and 18 Gy, respectively, given at 0.05 Gy/min, 0/5, 5/5, and 2/2 dogs died from acute toxicity; with 10, 12, and 14 Gy, respectively, given at 0.1 Gy/min, 1/5, 4/5, and 5/5 dogs died acutely. With fractionated TBI, 14 and 16 Gy, respectively, given at 0.1 Gy/min, 1/5, 4/5, and 2/2 dogs died auctely. Early deaths were due to radiation enteritis with or without associated septicemia (29 dogs; less than or equal to Day 10). Three dogs given 10 Gy of TBI at 0.1 Gy/min died from bacterial pneumonia; one (Day 18) had been given fractionated and two (Days 14, 22) single-dose TBI. Fifteen dogs survived beyond 1 month; eight of these had single-dose TBI (10-14 Gy) and all died within 7 months of irradiation from a syndrome consisting of hepatic damage, pancreatic fibrosis, malnutrition, wasting, and anemia. Seven of the 15 had fractionated TBI, and only one (14 Gy) died on Day 33 from hepatic failure, whereas 6 (10-14 Gy) are alive and well 250 to 500 days after irradiation. In conclusion, fractionated TBI did not offer advantages over single-dose TBI with regard to acute toxicity and early mortality; rather, these were dependent upon the total dose of TBI. The total acutely tolerated dose was dependent upon the exposure rate; however, only dogs given fractionated TBI became healthy long-term survivors

Respiratory drugs prescribed off-label among children in the outpatient clinics of a hospital in Malaysia.

Science.gov (United States)

Mohamad, Nurul Fadilah; Mhd Ali, Adliah; Mohamed Shah, Noraida

2015-02-01

Prescribing medicines in an unlicensed and off-label manner for children is a widespread practice around the world. To determine the extent and predictors of off-label respiratory drug prescriptions for children in the outpatient clinics of a hospital in Malaysia. Outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre, a tertiary teaching hospital in Malaysia. The pharmacy-based computer system and medical records of the patients were utilized to collect data from 220 pediatric patients who were prescribed at least one respiratory drug from July 2011 to December 2011. Characteristics of the off-label respiratory drug prescriptions were measured. A total of 134 children (60.9 %) received at least one respiratory drug prescribed in an off-label manner. The most common reasons for the off-label prescribing of drugs were off-label use by indication (31.5 %), followed by higher than the recommended dose (24.9 %) and lower than the recommended frequency (17.1 %). Diphenhydramine was the most common respiratory drug prescribed off-label. The number of medications prescribed was the only significant predictor of off-label prescription of respiratory drugs. Pediatric patients receiving 4-6 medications were 7.8 times more likely to receive at least one off-label respiratory drug compared to pediatric patients that received 1-3 medications (OR 7.8, 95 % CI 1.74-37.44). There was substantial prescribing of respiratory drugs for children in an off-label manner at the outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre. This highlights the need for more research to be carried out on respiratory drugs in the pediatric population.

Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Retrospective analysis of 29 medulloblastoma patients

International Nuclear Information System (INIS)

Scobioala, Sergiu; Kittel, Christopher; Ebrahimi, Fatemeh; Wolters, Heidi; Eich, Hans Theodor; Parfitt, Ross; Matulat, Peter; Am Zehnhoff-Dinnesen, Antoinette

2017-01-01

To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (D mean ), and total cisplatin dose. In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though D mean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m 2 , with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when D mean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies. (orig.) [de

Analysis of Out Door Patients' Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India.

Science.gov (United States)

Shelat, Prakash R; Kumbar, Shivaprasad Kalakappa

2015-03-01

Prescription is document through which doctor, patient and pharmacist are communicated. Many a times if these documents are not properly written or misinterpreted it can affect management of patients. WHO established prescribing indicators to analyse prescription and promoted rational use of drugs and better management of patients. To study the prescription pattern according to WHO prescribing indicators among private hospitals. The observational, prospective study carried out at different private hospitals at metro city in Western India to study the prescription pattern among private hospital. Study was conducted at different private hospitals of metro city. A total of 250 prescriptions of outdoor patients from various departments of private hospitals were collected for a period of three months (August to October) 2012 and evaluated. The study was analysed using Z-test. Patient details like age and gender was not written in all (100%) prescriptions. It was noticed that dose, direction of drug and duration of treatment was not completely written in 90%, 74% and 80% of prescriptions respectively. Abbreviations were used in all (100%) prescriptions. Doctor's medical registration number was mentioned in 0% prescriptions. Total 869 drugs were prescribed in 250 prescriptions. Average number of drug prescribed was 3.38±1.79 (Mean±SD). It was reported that Group II (3 to 4 encoutner) was significantly higher as compared to Group I (less than or equal to 2 encoutner) and Group III( more than four encounter). It was significantly (pprivate hospitals and antibiotics was commonly prescribed in private sector. Therefore, strict policy to good prescribing practice and strict antibiotic policy in outdoor patients are required to promote rational use of drugs.

A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

Science.gov (United States)

Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

2015-09-01

Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital

NARCIS (Netherlands)

H.L.P. Hurkmans (Henri); J.B.J. Bussmann (Hans); R.W. Selles (Ruud); E. Benda (Eric); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

2007-01-01

textabstractOBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip

Dose rate and total dose dependence of the 1/f noise performance of a GaAs operational amplifier during irradiation

International Nuclear Information System (INIS)

Hiemstra, D.M.

1995-01-01

A pictorial of a sectioned view of the torus of the International Thermonuclear Experimental Reactor (ITER) is shown. Maintenance and inspection of the reactor are required to be performed remotely. This is due to the high gamma radiation environment in vessel during inspection and maintenance activities. The custom GaAs operational amplifier is to be used to readout sensors on the in-vessel manipulator and inspection equipment. The gamma dose rate during maintenance and inspection is anticipated to be 3 Mrad(GaAs)/hour. Here, dose rate and total dose dependence of the 1/f noise performance of a custom GaAs MESFET operational amplifier during irradiation are presented. Dose rate dependent 1/f noise degradation during irradiation is believed to be due to electron trapping in deep levels, enhanced by backgating and shallow traps excited during irradiation. The reduction of this affect with accumulated total dose is believed to be due a reduction of deep level site concentration associated with substitutional oxygen. Post irradiation 1/f noise degradation is also presented.The generation-recombination noise observed post irradiation can be attributed to the production of shallow traps due to ionizing radiation

Validity of the Prescriber Information in the Danish National Prescription Registry

DEFF Research Database (Denmark)

Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta

2016-01-01

The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded...... in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2,000 non-electronic prescriptions...... at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% Confidence Interval (CI): 20...

Total skin high-dose-rate electron therapy dosimetry using TG-51

International Nuclear Information System (INIS)

Gossman, Michael S.; Sharma, Subhash C.

2004-01-01

An approach to dosimetry for total skin electron therapy (TSET) is discussed using the currently accepted TG-51 high-energy calibration protocol. The methodology incorporates water phantom data for absolute calibration and plastic phantom data for efficient reference dosimetry. The scheme is simplified to include the high-dose-rate mode conversion and provides support for its use, as it becomes more available on newer linear accelerators. Using a 6-field, modified Stanford technique, one may follow the process for accurate determination of absorbed dose

Estimation of the total effective dose from low-dose CT scans and radiopharmaceutical administrations delivered to patients undergoing SPECT/CT explorations

International Nuclear Information System (INIS)

Montes, C.; Hernandez, J.; Gomez-Caminero, F.; Garcia, S.; Martin, C.; Rosero, A.; Tamayo, P.

2013-01-01

Hybrid imaging, such as single photon emission computed tomography (SPECT)/CT, is used in routine clinical practice, allowing coregistered images of the functional and structural information provided by the two imaging modalities. However, this multimodality imaging may mean that patients are exposed to a higher radiation dose than those receiving SPECT alone. The study aimed to determine the radiation exposure of patients who had undergone SPECT/CT examinations and to relate this to the Background Equivalent Radiation Time (BERT). 145 SPECT/CT studies were used to estimate the total effective dose to patients due to both radiopharmaceutical administrations and low-dose CT scans. The CT contribution was estimated by the Dose-Length Product method. Specific conversion coefficients were calculated for SPECT explorations. The radiation dose from low-dose CTs ranged between 0.6 mSv for head and neck CT and 2.6 mSv for whole body CT scan, representing a maximum of 1 year of background radiation exposure. These values represent a decrease of 80-85% with respect to the radiation dose from diagnostic CT. The radiation exposure from radiopharmaceutical administration varied from 2.1 mSv for stress myocardial perfusion SPECT to 26 mSv for gallium SPECT in patients with lymphoma. The BERT ranged from 1 to 11 years. The contribution of low-dose CT scans to the total radiation dose to patients undergoing SPECT/CT examinations is relatively low compared with the effective dose from radiopharmaceutical administration. When a CT scan is only acquired for anatomical localization and attenuation correction, low-dose CT scan is justified on the basis of its lower dose. (author)

Optimization of total arc degree for stereotactic radiotherapy by using integral biologically effective dose and irradiated volume

International Nuclear Information System (INIS)

Lim, Do Hoon; Kim, Dae Yong; Lee, Myung Za; Chun, Ha Chung

2001-01-01

To find the optimal values of total arc degree to protect the normal brain tissue from high dose radiation in stereotactic radiotherapy planning. With Xknife-3 planning system and 4 MV linear accelerator, the authors planned under various values of parameters. One isocenter, 12, 20, 30, 40, 50, and 60 mm of collimator diameters, 100 deg, 200 deg, 300 deg, 400 deg, 500 deg, 600 deg, of total arc degrees, and 30 deg or 45 deg of arc intervals were used. After the completion of planning, the plans were compared each other using V 50 (the volume of normal brain that is delivered high dose radiation) and integral biologically effective dose. At 30 deg of arc interval, the values of V 50 had the decreased pattern with the increase of total arc degree in any collimator diameter. At 45 deg arc interval, up to 400 deg of total arc degree, the values of V 50 decreased with the increase of total arc degree, but at 500 deg and 600 deg of total arc degrees, the values increased. At 30 deg of arc interval, integral biologically effective dose showed the decreased pattern with the increase of total arc degree in any collimator diameter. At 45 deg arc interval with less than 40 mm collimator diameter, the integral biologically effective dose decreased with the increase of total arc degree, but with 50 and 60 mm of collimator diameters, up to 400 deg of total arc degree, integral biologically effective dose decreased with the increase of total arc degree, but at 500 deg and 600 deg of total arc degrees, the values increased. In the stereotactic radiotherapy planning for brain lesions, planning with 400 deg of total arc degree is optimal. Especially, when the larger collimator more than 50 mm diameter should be used, the uses of 500 deg and 600 deg of total arc degrees make the increase of V 50 and integral biologically effective dose, Therefore stereotactic radiotherapy planning using 400 deg of total arc degree can increase the therapeutic ratio and produce the effective outcome

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

Science.gov (United States)

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (Psupplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (Psupplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, Psupplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

Social determinants of prescribed and non-prescribed medicine use

Directory of Open Access Journals (Sweden)

García-Altés Anna

2010-05-01

Full Text Available Abstract Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively. The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%. In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%. A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.

Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia.

Science.gov (United States)

Donyai, Parastou

2017-10-01

Dementia can result in cognitive, noncognitive and behavioural symptoms which are difficult to manage. Formal guidelines for the care and management of dementia in the UK state that antipsychotics should only be prescribed where fully justified. This is because inappropriate use, particularly problematic in care-home settings, can produce severe side effects including death. The aim of this study was to explore the use of fallacious arguments in professionals' deliberations about antipsychotic prescribing in dementia in care-home settings. Fallacious arguments have the potential to become unremarkable discourses that construct and validate practices which are counter to guidelines. This qualitative study involved interviews with 28 care-home managers and health professionals involved in caring for patients with dementia. Potentially fallacious arguments were identified using qualitative content analysis and a coding framework constructed from existing explanatory models of fallacious reasoning. Fallacious arguments were identified in a range of explanations and reasons that participants gave for in answer to questions about initiating, reducing doses of and stopping antipsychotics in dementia. The dominant fallacy was false dichotomy. Appeal to popularity, tradition, consequence, emotion, or fear, and the slippery slope argument was also identified. Fallacious arguments were often formulated to present convincing cases whereby prescribing antipsychotics or maintaining existing doses (versus not starting medication or reducing the dose, for example) appeared as the only acceptable decision but this is not always the case. The findings could help health professionals to recognise and mitigate the effect of logic-based errors in decisions about the prescribing of antipsychotics in dementia. © 2016 Royal Pharmaceutical Society.

Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement

DEFF Research Database (Denmark)

Jørgensen, C C; Pitter, F T; Kehlet, H

2017-01-01

Background: Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated. Methods: From October 2013, the departments reporting to the prospective Lundbeck Foundation....... Conclusions: In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS >4 days, readmissions or infectious complications in TKA patients without contraindications....

Enhancement of Transistor-to-Transistor Variability Due to Total Dose Effects in 65-nm MOSFETs

CERN Document Server

Gerardin, S; Cornale, D; Ding, L; Mattiazzo, S; Paccagnella, A; Faccio, F; Michelis, S

2015-01-01

We studied device-to-device variations as a function of total dose in MOSFETs, using specially designed test structures and procedures aimed at maximizing matching between transistors. Degradation in nMOSFETs is less severe than in pMOSFETs and does not show any clear increase in sample-to-sample variability due to the exposure. At doses smaller than 1 Mrad( SiO2) variability in pMOSFETs is also practically unaffected, whereas at very high doses-in excess of tens of Mrad( SiO2)-variability in the on-current is enhanced in a way not correlated to pre-rad variability. The phenomenon is likely due to the impact of random dopant fluctuations on total ionizing dose effects.

The Pattern of Antibiotic Prescribing by Dental Practitioners in Zagreb, Croatia.

Science.gov (United States)

Perić, Marina; Perković, Ivana; Romić, Martina; Simeon, Paris; Matijević, Jurica; Mehičić, Goranka Prpić; Krmek, Silvana Jukić

2015-06-01

Bacterial resistance is considered a consequence of misuse or overuse of antibiotics. Dentistry significantly contributes to this increasing public health problem. The aim of this cross-sectional study was to examine the pattern of antibiotics prescribed by Croatian dentists in Zagreb area. Out of 220 Doctors of Dental Medicine (DMDs) from Zagreb 110 responded to survey. Prior to the research an ethical approval was obtained. Participants were directly contacted. The questionnaire consisted of two parts: general data on DMDs and the part concerning indications, duration, type and dosage of antibiotic therapy. Data were processed using MS Excel and SPSS for Windows, Version 17.0. Statistical significance was tested by Fisher's exact test, chi-square test, Mann-Whitney U test and Spearman's rank correlation at the level of statistical significance p<0.05. During the period of two months, the doctors prescribed antibiotics to 1,500 patients, 690 (46%) were men and 810 (54%) women. The most often prescribed antibiotics were penicillin (72.5% of patients), represented mostly by amoxicillin in combination with clavulanic acid (57.6%). The most common indication for the prescribed antibiotics was periapical or periodontal abscess (44%). Definite clinical indication (71.2%) was stated as the most common reason for antibiotic prescription. Antibiotic therapy usually lasted 7 days (62.9%). The doctors prescribed daily doses of antibiotics according to the instructions for the use of specific drugs. The examined subjects prescribe antibiotics according to the curriculum taught at the School of Dental Medicine for majority of types, doses and duration of the treatments, although antibiotics over-prescription in cases without medical indication was observed. The national guidelines on antibiotic regimens are required in order to reduce unnecessary antibiotic use. Copyright© by the National Institute of Public Health, Prague 2015.

Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.

Science.gov (United States)

Galvin, Sandra; Callan, Aoife; Cormican, Martin; Duane, Sinead; Bennett, Kathleen; Murphy, Andrew W; Vellinga, Akke

2015-07-02

The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators. Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis. Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the

A prospective, open-label study of low-dose total skin electron beam therapy in mycosis fungoides

DEFF Research Database (Denmark)

Kamstrup, Maria R; Specht, Lena; Skovgaard, Gunhild L

2008-01-01

causes and did not complete treatment. Acute side effects included desquamation, xerosis, and erythema of the skin. No severe side effects were observed. CONCLUSION: Low-dose total skin electron beam therapy can induce complete and partial responses in Stage IB-II mycosis fungoides; however, the duration......PURPOSE: To determine the effect of low-dose (4 Gy) total skin electron beam therapy as a second-line treatment of Stage IB-II mycosis fungoides in a prospective, open-label study. METHODS AND MATERIALS: Ten patients (6 men, 4 women, average age 68.7 years [range, 55-82 years......]) with histopathologically confirmed mycosis fungoides T2-T4 N0-N1 M0 who did not achieve complete remission or relapsed within 4 months after treatment with psoralen plus ultraviolet-A were included. Treatment consisted of low-dose total skin electron beam therapy administered at a total skin dose of 4 Gy given in 4...

Laboratory Bioaccumulation, Depuration And Total Dose Rate Of Waterborne Th-232 In Freshwater Fish Of Anabas Testudineus

International Nuclear Information System (INIS)

Zal U'yun Wan Mahmood; Norfaizal Mohamed; Nita Salina Abu Bakar

2014-01-01

Preliminary results on the study of bioaccumulation, depuration and total dose rate of Th-232 in the whole body of Anabas testudineus are presented. The objective of this study was to evaluate the effect of Th-232 concentration activity on the laboratory bioaccumulation, depuration and total dose rate in Anabas testudineus. Anabas testudineus adults were exposed to different waterborne Th-232 levels: 0 BqL -1 (control), 50 BqL -1 and 100 BqL -1 for 30 day (uptake phase), followed by exposure to radionuclide-free water for 30 days (loss phase). Radionuclide concentration ratios between the whole body levels and water levels, percentage of Th-232 remaining in fish were calculated and total dose rates using ERICA Assessment Tool were also estimated. The results showed the increase of waterborne Th-232 concentration corresponded to a progressive increase of Th accumulation and total dose rate (internal and external) in the whole body of Anabas testudineus. Considering the ERICA dose rate screening value of 10 μGyh -1 , the findings can be concluded the estimated of total dose rate (< 5 μGyh -1 ) in Anabas testudineus is in order of small magnitude. Nevertheless, these preliminary results showed that the Anabas testudineus has a potential to accumulate thorium. (author)

The impact of a closed‐loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before‐and‐after study

Science.gov (United States)

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-01-01

Objectives To assess the impact of a closed‐loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants Before‐and‐after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention Closed‐loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results Prescribing errors were identified in 3.8% of 2450 medication orders pre‐intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre‐intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre‐intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions A closed‐loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication‐related tasks increased. PMID:17693676

Total dose induced latch in short channel NMOS/SOI transistors

International Nuclear Information System (INIS)

Ferlet-Cavrois, V.; Quoizola, S.; Musseau, O.; Flament, O.; Leray, J.L.; Pelloie, J.L.; Raynaud, C.; Faynot, O.

1998-01-01

A latch effect induced by total dose irradiation is observed in short channel SOI transistors. This effect appears on NMOS transistors with either a fully or a partially depleted structure. It is characterized by a hysteresis behavior of the Id-Vg characteristics at high drain bias for a given critical dose. Above this dose, the authors still observe a limited leakage current at low drain bias (0.1 V), but a high conduction current at high drain bias (2 V) as the transistor should be in the off-state. The critical dose above which the latch appears strongly depends on gate length, transistor structure (fully or partially depleted), buried oxide thickness and supply voltage. Two-dimensional (2D) numerical simulations indicate that the parasitic condition is due to the latch of the back gate transistor triggered by charge trapping in the buried oxide. To avoid the latch induced by the floating body effect, different techniques can be used: doping engineering, body contacts, etc. The study of the main parameters influencing the latch (gate length, supply voltage) shows that the scaling of technologies does not necessarily imply an increased latch sensitivity. Some technological parameters like the buried oxide hardness and thickness can be used to avoid latch, even at high cumulated dose, on highly integrated SOI technologies

Dosimetric evaluation of total marrow irradiation using 2 different planning systems

International Nuclear Information System (INIS)

Nalichowski, Adrian; Eagle, Don G.; Burmeister, Jay

2016-01-01

This study compared 2 different treatment planning systems (TPSs) for quality and efficiency of total marrow irradiation (TMI) plans. The TPSs used in this study were VOxel-Less Optimization (VoLO) (Accuray Inc, Sunnyvale, CA) using helical dose delivery on a Tomotherapy Hi-Art treatment unit and Eclipse (Varian Medical Systems Inc, Palo Alto, CA) using volumetric modulated arc therapy (VMAT) dose delivery on a Varian iX treatment unit. A total dose of 1200 cGy was prescribed to cover 95% of the planning target volume (PTV). The plans were optimized and calculated based on a single CT data and structure set using the Alderson Rando phantom (The Phantom Laboratory, Salem, NY) and physician contoured target and organ at risk (OAR) volumes. The OARs were lungs, heart, liver, kidneys, brain, and small bowel. The plans were evaluated based on plan quality, time to optimize the plan and calculate the dose, and beam on time. The resulting mean and maximum doses to the PTV were 1268 and 1465 cGy for VoLO and 1284 and 1541 cGy for Eclipse, respectively. For 5 of 6 OAR structures the VoLO system achieved lower mean and D10 doses ranging from 22% to 52% and 3% to 44%, respectively. Total computational time including only optimization and dose calculation were 0.9 hours for VoLO and 3.8 hours for Eclipse. These times do not include user-dependent target delineation and field setup. Both planning systems are capable of creating high-quality plans for total marrow irradiation. The VoLO planning system was able to achieve more uniform dose distribution throughout the target volume and steeper dose fall off, resulting in superior OAR sparing. VoLO's graphics processing unit (GPU)–based optimization and dose calculation algorithm also allowed much faster creation of TMI plans.

Dosimetric evaluation of total marrow irradiation using 2 different planning systems

Energy Technology Data Exchange (ETDEWEB)

Nalichowski, Adrian, E-mail: nalichoa@karmanos.org [Karmanos Cancer Center, Detroit, MI (United States); Eagle, Don G. [Wayne State University School of Medicine, Detroit, MI (United States); Burmeister, Jay [Karmanos Cancer Center, Detroit, MI (United States); Wayne State University School of Medicine, Detroit, MI (United States)

2016-10-01

This study compared 2 different treatment planning systems (TPSs) for quality and efficiency of total marrow irradiation (TMI) plans. The TPSs used in this study were VOxel-Less Optimization (VoLO) (Accuray Inc, Sunnyvale, CA) using helical dose delivery on a Tomotherapy Hi-Art treatment unit and Eclipse (Varian Medical Systems Inc, Palo Alto, CA) using volumetric modulated arc therapy (VMAT) dose delivery on a Varian iX treatment unit. A total dose of 1200 cGy was prescribed to cover 95% of the planning target volume (PTV). The plans were optimized and calculated based on a single CT data and structure set using the Alderson Rando phantom (The Phantom Laboratory, Salem, NY) and physician contoured target and organ at risk (OAR) volumes. The OARs were lungs, heart, liver, kidneys, brain, and small bowel. The plans were evaluated based on plan quality, time to optimize the plan and calculate the dose, and beam on time. The resulting mean and maximum doses to the PTV were 1268 and 1465 cGy for VoLO and 1284 and 1541 cGy for Eclipse, respectively. For 5 of 6 OAR structures the VoLO system achieved lower mean and D10 doses ranging from 22% to 52% and 3% to 44%, respectively. Total computational time including only optimization and dose calculation were 0.9 hours for VoLO and 3.8 hours for Eclipse. These times do not include user-dependent target delineation and field setup. Both planning systems are capable of creating high-quality plans for total marrow irradiation. The VoLO planning system was able to achieve more uniform dose distribution throughout the target volume and steeper dose fall off, resulting in superior OAR sparing. VoLO's graphics processing unit (GPU)–based optimization and dose calculation algorithm also allowed much faster creation of TMI plans.

ETHICAL PRACTICES IN DRUG PRESCRIBING. A COMPARATIVE STUDY BETWEEN DOCTORS’ AND PHARMACISTS’ OPINION ABOUT DRUG PRESCRIBING IN ROMANIA

Directory of Open Access Journals (Sweden)

LASZLO-ZOLTAN SZTANKOVSZKY

2015-11-01

Full Text Available The prescription of drugs is influenced by a number of factors with a great impact upon the health of the main beneficiaries of health services. The purpose of the study is to identify the perception of doctors and pharmacists on drug prescription practices adopted by doctors. Material and Methods: a number of 349 subjects (149 pharmacists and 200 doctors answered a survey about the perception of drug dispensing in Romania. Variables like age, work environment (urban, rural, length of employment were taken into account. Results: When prescribing a treatment, 93% of doctors follow the standard treatment protocol for the given diagnosis and 93,5% of them are declaring that personal resources are the main source for training while the percent appreciated by pharmacists is evaluated to 65,78%. A total of 50% of doctors are considering other criteria than the treatment when prescribing a drug (financial contribution for the patient or National Health Insurance House. A total of 59% of doctors are recommending overthe-counter products while pharmacists consider that is happening in more than 70% of the cases. Conclusions: There are differences of opinion between doctors and pharmacists regarding doctor’s practices of prescribing drugs to their patients, like: kinds of sponsorship for the continuing education, the relationship with the pharmaceutical representative or the frequency of prescribing over-the-counter products or supplements when they are recommending a certain treatment.

SU-E-T-357: Electronic Compensation Technique to Deliver Total Body Dose

Energy Technology Data Exchange (ETDEWEB)

Lakeman, T [State University of New York at Buffalo, Buffalo, NY (United States); Wang, I; Podgorsak, M [State University of New York at Buffalo, Buffalo, NY (United States); Roswell Park Cancer Institute, Buffalo, NY (United States)

2015-06-15

Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient’s immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has conventionally been used to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Methods: Treatment plans utilizing electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two, specifically weighted, pair of opposed fields. One pair of open, large fields (collimator=45°), to encompass the patient’s entire anatomy, and one pair of smaller fields (collimator=0°) focused only on the thicker midsection of the patient. The optimal fluence for each one of the smaller fields was calculated at a patient specific penetration depth. Irregular surface compensators provide a more uniform dose distribution within the smaller opposed fields. Results: Dose-volume histograms (DVH) were calculated for the evaluating the electronic compensation technique. In one case, the maximum body doses calculated from the DVH were reduced from the non-compensated 195.8% to 165.3% in the electronically compensated plans, indicating a more uniform dose with the region of electronic compensation. The mean body doses calculated from the DVH were also reduced from the non-compensated 120.6% to 112.7% in the electronically compensated plans, indicating a more accurate delivery of the prescription dose. All calculated monitor units were well within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not substantially increase the beam on time while it can significantly reduce the compensator

Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data.

Science.gov (United States)

Ashworth, Mark; White, Patrick; Jongsma, Hannah; Schofield, Peter; Armstrong, David

2016-01-01

Concerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. To determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. Retrospective cross-sectional study of general practices in England. Data were obtained from the General Practice Patient Survey (GPPS) in 2012 (2.7 million questionnaires in England; 982 999 responses; response rate 36%); the national Quality and Outcomes Framework dataset for England, 2011-2012 (8164 general practices); and general practice and demographic characteristics. Standardised measures of antibiotic prescribing volumes were obtained for each practice in England during 2012-2013, together with 12 other nationally available prescribing variables. The role of antibiotic prescribing volume was identified as a determinant of GPPS scores and adjusted for demographic and practice factors using multiple linear regression. The final dataset consisted of 7800 (95.5%) practices. A total of 33.7 million antibiotic prescriptions were issued to a registered population of 53.8 million patients. Antibiotic prescribing volume was a significant positive predictor of all 'doctor satisfaction' and 'practice satisfaction' scores in the GPPS, and was the strongest predictor of overall satisfaction out of 13 prescribing variables. A theoretical 25% reduction in antibiotic prescribing volume would be associated with 0.5-1.0% lower patient satisfaction scores, a drop of 3-6 centile points in national satisfaction ranking. Patients were less satisfied in practices with frugal antibiotic prescribing. A cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction. © British Journal of General Practice 2016.

Use of a concise prescription for specifying absolute dose distribution in external beam radiation therapy

International Nuclear Information System (INIS)

Viggers, D.A.; Shalev, S.

1989-01-01

Radiation therapy dose distributions are usually calculated relative to some normalization point to which a prescribed dose in grays is to be delivered. Often the radiation therapist requests that the prescribed dose be delivered to some other point(s), such as the 90% isodose. Therefore the prescribed dose is not well defined. Furthermore, this procedure leaves the shape of the dose distribution unspecified. The authors have used a dose prescription specifying the volumes of target and nontarget tissue that must lie within dose limits stated in grays. These dose-volume limits determine the magnitude and shape of the dose distribution. The prescription is well defined while allowing the absolute dose at a chosen point to be adjusted so that the dose distribution satisfies the prescription

Drug Use Evaluation of Three Widely Prescribed Antibiotics in a

Directory of Open Access Journals (Sweden)

Mehdi Mohammadi

2015-10-01

Full Text Available Background: Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching hospital in Iran.  The results of this study may be of help for clinicians to improve the patient care.Methods: Patients who received parenteral ceftazidim, vancomycin and amikacin from December2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined Daily Dose (DDD of each drug extracted from Anatomic and Therapeutic Chemical classification system (ATC/DDD and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD.Results: The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86% received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90% and 44 patients (88%. The renal function tests (Blood Urea Nitrogen, Serum Creatinin were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group.Conclusion: The results of this study indicate the need to establish continuing medical education (CME courses for physicians to familiarize them with standards required to use and monitor these agents.

Linac-based total body irradiation (TBI) with volumetric modulated arc therapy (VMAT)

Science.gov (United States)

Tas, B.; Durmus, I. F.; Okumus, A.; Uzel, O. E.

2017-02-01

To evaluate dose distribution of Volumetric modulated arc therapy (VMAT) planning tecnique using Versa HD® lineer accelerator to deliver Total Body Irradiation (TBI) on the coach. Eight TBI patient's Treatment Planning System (TPS) were performed with dual arc VMAT for each patient. The VMAT-TBI consisted of three isocentres and three dual overlapping arcs. The prescribed dose was 12 Gy. Mean dose to lung and kidney were restricted less than 10 Gy and max. dose to lens were restricted less than 6 Gy. The plans were verified using 2D array and ion chamber. The comparison between calculation and measurement were made by γ-index analysis and absolute dose. An average total delivery time was determined 923±34 seconds and an average MU was determined 2614±228 MUs for dual arc VMAT. Mean dose to lungs was 9.7±0.2 Gy, mean dose to kidneys was 8.8±0.3 Gy, max. dose to lens was 5.5±0.3 Gy and max. dose was 14.6±0.3 Gy, HI of PTV was 1.13±0.2, mean dose to PTV was 12.6±1.5 Gy and mean γ-index pass rate was %97.1±1.9. The results show that the tecnique for TBI using VMAT on the treatment coach is feasible.

A possible method using baseline hormonal levels to prescribe the appropriate oral therapeutic radioiodine dosage for Graves' disease

International Nuclear Information System (INIS)

Nakajo, Masayuki; Tsuchimochi, Shinsaku; Jinguji, Megumi; Tanabe, Hiroaki; Umanodan, Tomoichi; Nakabeppu, Yoshiaki

2007-01-01

The purpose of this study was to retrospectively examine the correlations of hormonal ratios with radioiodine I-131 therapeutic parameters and the potentiality of prescribing the therapeutic I-131 target dosage for an individual patient with Graves' disease using baseline serum levels of thyroid hormones. Serum T3, T4, and FT4 levels 6 and 12 months after I-131 therapy/baseline levels (hormonal ratios) were calculated for a total of 68 therapeutic courses in 57 patients with Graves' disease. The therapeutic parameters were absorbed dose (Gy), dose concentration (μCi/g) and oral dose (mCi). Linear regression analysis was performed for correlating hormonal ratios (X) and therapeutic parameters (Y). Significant (P<0.05) negative correlations of the hormonal ratios were observed with absorbed dose (R -0.50 for T3, -0.61 for T4, and -0.46 for FT4 at 6 months, and -0.29 for T3, -0.44 for T4 at 12 months) and dose concentration (R -0.57 for T3, -0.58 for T4, and -0.49 for FT4 at 6 months and -0.27 for T3, -0.27 for T4 at 12 months), but not with oral dose at 6 months and 12 months or the absorbed dose and dose concentration for FT4 at 12 months. The correlations were higher at 6 months than at 12 months and in serum T4 than in serum T3 and FT4. The formulae for serum T4 at 6 months were as follows: Y (Gy)=109-53X and Y (μCi/g)=109-52X. These results suggest that the hormonal ratios are significantly correlated with the absorbed dose and dose concentration. The formulae for serum T4 at 6 months may serve to prescribe the individual oral dosage for Graves' disease, although the correlation coefficients are about -0.6. (author)

Low-dose total skin electron beam therapy for cutaneous lymphoma : Minimal risk of acute toxicities.

Science.gov (United States)

Kroeger, Kai; Elsayad, Khaled; Moustakis, Christos; Haverkamp, Uwe; Eich, Hans Theodor

2017-12-01

Low-dose total skin electron beam therapy (TSEBT) is attracting increased interest for the effective palliative treatment of primary cutaneous T‑cell lymphoma (pCTCL). In this study, we compared toxicity profiles following various radiation doses. We reviewed the records of 60 patients who underwent TSEBT for pCTCL between 2000 and 2016 at the University Hospital of Munster. The treatment characteristics of the radiotherapy (RT) regimens and adverse events (AEs) were then analyzed and compared. In total, 67 courses of TSEBT were administered to 60 patients. Of these patients, 34 (51%) received a standard dose with a median surface dose of 30 Gy and 33 patients (49%) received a low dose with the median surface dose of 12 Gy (7 salvage low-dose TSEBT courses were administered to 5 patients). After a median follow-up of 15 months, the overall AE rate was 100%, including 38 patients (57%) with grade 2 and 7 (10%) with grade 3 AEs. Patients treated with low-dose TSEBT had significantly fewer grade 2 AEs than those with conventional dose regimens (33 vs. 79%, P dose regimen compared to those with the conventional dose regimens (6 vs. 15%, P = 0.78). Multiple/salvage low-dose TSEBT courses were not associated with an increased risk of acute AEs. Low-dose TSEBT regimens are associated with significantly fewer grade 2 acute toxicities compared with conventional doses of TSEBT. Repeated/Salvage low-dose TSEBT, however, appears to be tolerable and can even be applied safely in patients with cutaneous relapses.

A system for the quality audit of treatment dose delivery in radiotherapy

International Nuclear Information System (INIS)

Williams, J.R.; Bradnam, M.S.; McCurrach, G.M.; Deehan, C.; Johnston, S.

1991-01-01

Treatment planning is a process requiring the cooperation of a number of different staff groups. The possibility for error is well recognised and quality control procedures are necessary to ensure that the chances of errors in planning leading to incorrect treatments are as low as possible. An audit system is described which is based on the calculation of the dose delivered to the patient using the parameters set for treatment as input data. The calculated dose is compared with the prescribed dose and errors greater than a defined limit are flagged. During a period of 19 months during which this audit procedure has been operating a total of 14 errors in excess of 5 percent were discovered and corrected, this is approximately 0.5 percent of the total number of plans checked. (author). 10 refs.; 1 fig.; 1 tab

Topical antibiotic monotherapy prescribing practices in acne vulgaris.

Science.gov (United States)

Hoover, William D; Davis, Scott A; Fleischer, Alan B; Feldman, Steven R

2014-04-01

The aim of this study is to evaluate the frequency of dosing topical antibiotics as monotherapy in the treatment of acne vulgaris, and physician specialty prescribing these medications. This study is a retrospective review of all visits with a sole diagnosis of acne vulgaris (ICD-9-CM code 706.1) found on the National Ambulatory Medical Care Survey (NAMCS) in 1993-2010. We recorded the number of visits surveyed where acne vulgaris was the sole diagnosis, number of visits where topical antibiotics were the only treatment prescribed, and the specialty of physician in each encounter. Topical erythromycin or clindamycin were the sole medication prescribed in 0.81% of the visits recorded, with 60% of these prescriptions arising from dermatologists and 40% from non-dermatologists. The trend of prescribing topical antibiotic monotherapy is declining (p acnes to topical antibiotic regimens has led to the need to re-evaluate the use of topical antibiotics in the treatment of acne vulgaris. While the rate of topical antibiotic monotherapy is declining, their use should be reserved for situations where the direct need for antibiotics arises. If a clinician feels that antibiotics are a necessary component to acne therapy, they should be used as part of a combination regimen.

Prevalence and Correlates of “High Dose” Antipsychotic Prescribing ...

African Journals Online (AJOL)

of 1000 mg/day is considered as high dose prescribing. Furthermore ... genetic variations.[16] ... Annals of Medical and Health Sciences Research | Jan-Mar 2013 | Vol 3 | Issue 1 |. 63 ... the unreliability of the CPZeq criteria in the view of an increasing use of ... We obtained ethical clearance from the Ethics and Research.

Clinical study on the adriamycin induced cardiomyopathy using the cardiac magnetic resonance imaging. Total dose and cardiac dysfunction

International Nuclear Information System (INIS)

Yamaguchi, Kyoko; Teraoka, Kunihiko; Hirano, Masaharu

2001-01-01

We studied cardiac functional disorders caused by Adoriamycin using gadolinium (Gd) contrast cine MRI. Forty-eight patients were given ACT (31 men and 17 women; mean age, 52±15 years). First, the relationship between dose and the left ventricular volume, cardiac function, left ventricular cardiac mass and localized wall motion were examined in all patients. Patients given a total dose of 300 mg/m 2 or higher were assigned to the high dose group and those given doses under 300 mg/m 2 to the low dose group. The same parameters were studied in both groups and compared. A 1.5-Tesla superconductive MRI was used for all studies. Cine images of the long and short axes at the papillary muscle level were obtained by ECG R-wave synchronized Gd contrast cine MRI. Left ventricular volume and cardiac function were analyzed using the long-axis cine images and the wall thickness in diastole and systole was measured at each site using the short-axis cine images. The percentage of wall thickness was calculated at each site. The mean ACT dose was 273.3±218.2 mg/m 2 . In all patients the total dose directly correlated with ESVI and inversely correlated with the ejection fraction (EF). In the high dose group, the total dose and EF were inversely correlated, but no significant differences were observed in the low dose group. In the high dose group, the ESVI was significantly greater and the SVI and EF were more significantly reduced than in the low dose group. In the high dose group, the thickness of the anterior, lateral and posterior walls, excluding the septum, was significantly lower than in the low dose group. However, changes in wall thickness were not significantly different between the groups. Gd contrast cine MRI was useful in examining cardiac functional disorders caused by anthracyclines. The total dose of anthracycline correlated directly with the ESVI, and inversely with the EF. A total dose of 300 mg/m 2 appeared to be the borderline dose beyond which there were

Clinical study on the adriamycin induced cardiomyopathy using the cardiac magnetic resonance imaging. Total dose and cardiac dysfunction

Energy Technology Data Exchange (ETDEWEB)

Yamaguchi, Kyoko; Teraoka, Kunihiko; Hirano, Masaharu [Tokyo Medical Coll. (Japan)

2001-05-01

We studied cardiac functional disorders caused by Adoriamycin using gadolinium (Gd) contrast cine MRI. Forty-eight patients were given ACT (31 men and 17 women; mean age, 52{+-}15 years). First, the relationship between dose and the left ventricular volume, cardiac function, left ventricular cardiac mass and localized wall motion were examined in all patients. Patients given a total dose of 300 mg/m{sup 2} or higher were assigned to the high dose group and those given doses under 300 mg/m{sup 2} to the low dose group. The same parameters were studied in both groups and compared. A 1.5-Tesla superconductive MRI was used for all studies. Cine images of the long and short axes at the papillary muscle level were obtained by ECG R-wave synchronized Gd contrast cine MRI. Left ventricular volume and cardiac function were analyzed using the long-axis cine images and the wall thickness in diastole and systole was measured at each site using the short-axis cine images. The percentage of wall thickness was calculated at each site. The mean ACT dose was 273.3{+-}218.2 mg/m{sup 2}. In all patients the total dose directly correlated with ESVI and inversely correlated with the ejection fraction (EF). In the high dose group, the total dose and EF were inversely correlated, but no significant differences were observed in the low dose group. In the high dose group, the ESVI was significantly greater and the SVI and EF were more significantly reduced than in the low dose group. In the high dose group, the thickness of the anterior, lateral and posterior walls, excluding the septum, was significantly lower than in the low dose group. However, changes in wall thickness were not significantly different between the groups. Gd contrast cine MRI was useful in examining cardiac functional disorders caused by anthracyclines. The total dose of anthracycline correlated directly with the ESVI, and inversely with the EF. A total dose of 300 mg/m{sup 2} appeared to be the borderline dose beyond

Cobalt-60 total body irradiation dosimetry at 220 cm source-axis distance

International Nuclear Information System (INIS)

Glasgow, G.P.; Mill, W.B.

1980-01-01

Adults with acute leukemia are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous marrow transplants. For TBI, patients seated in a stand angled 45 0 above the floor are treated for about 2 hours at 220 cm source-axis distance (SAD) with sequential right and left lateral 87 cm x 87 cm fields to a 900 rad mid-pelvic dose at about 8 rad/min using a 5000 Ci cobalt unit. Maximum (lateral) to minimum (mid-plane) dose ratios are: hips--1.15, shoulders--1.30, and head--1.05, which is shielded by a compensator filter. Organ doses are small intestine, liver and kidneys--1100 rad, lung--1100 to 1200 rad, and heart--1300 rad. Verification dosimetry reveals the prescribed dose is delivered to within +-5%. Details of the dosimetry of this treatment are presented

GTV-based prescription in SBRT for lung lesions using advanced dose calculation algorithms

International Nuclear Information System (INIS)

Lacornerie, Thomas; Lisbona, Albert; Mirabel, Xavier; Lartigau, Eric; Reynaert, Nick

2014-01-01

The aim of current study was to investigate the way dose is prescribed to lung lesions during SBRT using advanced dose calculation algorithms that take into account electron transport (type B algorithms). As type A algorithms do not take into account secondary electron transport, they overestimate the dose to lung lesions. Type B algorithms are more accurate but still no consensus is reached regarding dose prescription. The positive clinical results obtained using type A algorithms should be used as a starting point. In current work a dose-calculation experiment is performed, presenting different prescription methods. Three cases with three different sizes of peripheral lung lesions were planned using three different treatment platforms. For each individual case 60 Gy to the PTV was prescribed using a type A algorithm and the dose distribution was recalculated using a type B algorithm in order to evaluate the impact of the secondary electron transport. Secondly, for each case a type B algorithm was used to prescribe 48 Gy to the PTV, and the resulting doses to the GTV were analyzed. Finally, prescriptions based on specific GTV dose volumes were evaluated. When using a type A algorithm to prescribe the same dose to the PTV, the differences regarding median GTV doses among platforms and cases were always less than 10% of the prescription dose. The prescription to the PTV based on type B algorithms, leads to a more important variability of the median GTV dose among cases and among platforms, (respectively 24%, and 28%). However, when 54 Gy was prescribed as median GTV dose, using a type B algorithm, the variability observed was minimal. Normalizing the prescription dose to the median GTV dose for lung lesions avoids variability among different cases and treatment platforms of SBRT when type B algorithms are used to calculate the dose. The combination of using a type A algorithm to optimize a homogeneous dose in the PTV and using a type B algorithm to prescribe the

The Role of Electron Transport and Trapping in MOS Total-Dose Modeling

International Nuclear Information System (INIS)

Flament, O.; Fleetwood, D.M.; Leray, J.L.; Paillet, P.; Riewe, L.C.; Winokur, P.S.

1999-01-01

Deep and shallow electron traps form in irradiated thermal SiO 2 as a natural response to hole transport and trapping. The density and stability of these defects are discussed, as are their implications for total-dose modeling

The Role of Electron Transport and Trapping in MOS Total-Dose Modeling

International Nuclear Information System (INIS)

Fleetwood, D.M.; Winokur, P.S.; Riewe, L.C.; Flament, O.; Paillet, P.; Leray, J.L.

1999-01-01

Radiation-induced hole and electron transport and trapping are fundamental to MOS total-dose models. Here we separate the effects of electron-hole annihilation and electron trapping on the neutralization of radiation-induced charge during switched-bias irradiation for hard and soft oxides, via combined thermally stimulated current (TSC) and capacitance-voltage measurements. We also show that present total-dose models cannot account for the thermal stability of deeply trapped electrons near the Si/SiO 2 interface, or the inability of electrons in deep or shallow traps to contribute to TSC at positive bias following (1) room-temperature, (2) high-temperature, or (3) switched-bias irradiation. These results require revisions of modeling parameters and boundary conditions for hole and electron transport in SiO 2 . The nature of deep and shallow electron traps in the near-interfacial SiO 2 is discussed

Effects of prescription depth, cylinder size, treatment length, tip space, and curved end on doses in high-dose-rate vaginal brachytherapy

International Nuclear Information System (INIS)

Li Shidong; Aref, Ibrahim; Walker, Eleanor; Movsas, Benjamin

2007-01-01

Purpose: To determine the effects of the prescription depth, cylinder size, treatment length, tip space, and curved end on high-dose-rate vaginal brachytherapy (HDR-VBT) of endometrial cancer. Methods and Materials: Treatment plans were prescribed and optimized based on points at the cylinder surface or at 0.5-cm depth. Cylinder sizes ranging from 2 to 4 cm in diameter, and treatment lengths ranging from 3 to 8 cm were used. Dose points in various depths were precisely defined along the cylinder dome. The given dose and dose uniformity to a depth of interest were measured by the mean dose (MD) and standard deviation (SD), respectively, among the dose points belonging to the depth. Dose fall-off beyond the 0.5 cm treatment depth was determined by the ratio of MD at 0.75-cm depth to MD at 0.5-cm depth. Results: Dose distribution varies significantly with different prescriptions. The surface prescription provides more uniform doses at all depths in the target volume, whereas the 0.5-cm depth prescription creates larger dose variations at the cylinder surface. Dosimetric uncertainty increases significantly (>30%) with shorter tip space. Extreme hot (>150%) and cold spots (<60%) occur if no optimization points were placed at the curved end. Conclusions: Instead of prescribing to a depth of 0.5 cm, increasing the dose per fraction and prescribing to the surface with the exact surface points around the cylinder dome appears to be the optimal approach

The influence of x-ray energy on lung dose uniformity in total-body irradiation

International Nuclear Information System (INIS)

Ekstrand, Kenneth; Greven, Kathryn; Wu Qingrong

1997-01-01

Purpose: In this study we examine the influence of x-ray energy on the uniformity of the dose within the lung in total-body irradiation treatments in which partial transmission blocks are used to control the lung dose. Methods and Materials: A solid water phantom with a cork insert to simulate a lung was irradiated by x-rays with energies of either 6, 10, or 18 MV. The source to phantom distance was 3.9 meters. The cork insert was either 10 cm wide or 6 cm wide. Partial transmission blocks with transmission factors of 50% were placed anterior to the cork insert. The blocks were either 8 or 4 cm in width. Kodak XV-2 film was placed in the midline of the phantom to record the dose. Midplane dose profiles were measured with a densitometer. Results: For the 10 cm wide cork insert the uniformity of the dose over 80% of the block width varied from 6.6% for the 6 MV x-rays to 12.2% for the 18 MV x-rays. For the 6 cm wide cork insert the uniformity was comparable for all three x-ray energies, but for 18 MV the central dose increased by 9.4% compared to the 10 cm wide insert. Conclusion: Many factors must be considered in optimizing the dose for total-body irradiation. This study suggests that for AP/PA techniques lung dose uniformity is superior with 6 MV irradiation. The blanket recommendation that the highest x-ray energy be used in TBI is not valid for all situations

Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology.

Science.gov (United States)

Nag, Subir; Demanes, D Jeffrey; Hagan, Michael; Rivard, Mark J; Thomadsen, Bruce R; Welsh, James S; Williamson, Jeffrey F

2011-10-01

The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. The working group found that the current definition of ME in §35.3045 as "the total dose delivered differs from the prescribed dose by 20 percent or more" was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered.

Nephrology comanagement and the quality of antibiotic prescribing in primary care for patients with chronic kidney disease: a retrospective cross-sectional study.

Science.gov (United States)

Zhu, Justin X G; Nash, Danielle M; McArthur, Eric; Farag, Alexandra; Garg, Amit X; Jain, Arsh K

2018-04-12

In primary care, patients with chronic kidney disease (CKD) are frequently prescribed excessive doses of antibiotics relative to their kidney function. We examined whether nephrology comanagement is associated with improved prescribing in primary care. In a retrospective propensity score-matched cross-sectional study, we studied the appropriateness of antibiotic prescriptions by primary care physicians to Ontarians ≥66 years of age with CKD Stages 4 and 5 (estimated glomerular filtration rate <30 mL/min/1.73 m2 not receiving dialysis) from 1 April 2003 to 31 March 2014. Comanagement was defined as having at least one outpatient visit with a nephrologist within the year prior to antibiotic prescription date. We compared the rate of appropriately dosed antibiotics in primary care between 3937 patients who were comanaged by a nephrologist and 3937 patients who were not. Only 1184 (30%) of 3937 noncomanaged patients had appropriately dosed antibiotic prescriptions prescribed by a primary care physician. Nephrology comanagement was associated with an increased likelihood that an appropriately dosed prescription was prescribed by a primary care physician; however, the magnitude of the effect was modest [1342/3937 (34%); odds ratio 1.20 (95% confidence interval 1.09-1.32); P < 0.001]. The majority of antibiotics prescribed by primary care physicians are inappropriately dosed in CKD patients, whether or not a nephrologist is comanaging the patient. Nephrologists have an opportunity to increase awareness of appropriate dosing of medications in primary care through the patients they comanage.

A first-principles approach to total-dose hardness assurance

International Nuclear Information System (INIS)

Fleetwood, D.M.

1995-01-01

A first-principles approach to radiation hardness assurance was described that provides the technical background to the present US and European total-dose radiation hardness assurance test methods for MOS technologies, TM 1019.4 and BS 22900. These test methods could not have been developed otherwise, as their existence depends not on a wealth of empirical comparisons of IC data from ground and space testing, but on a fundamental understanding of MOS defect growth and annealing processes. Rebound testing should become less of a problem for advanced MOS small-signal electronics technologies for systems with total dose requirements below 50--100 krad(SiO 2 ) because of trends toward much thinner gate oxides. For older technologies with thicker gate oxides and for power devices, rebound testing is unavoidable without detailed characterization studies to assess the impact of interface traps on devices response in space. The QML approach is promising for future hardened technologies. A sufficient understanding of process effects on radiation hardness has been developed that should be able to reduce testing costs in the future for hardened parts. Finally, it is hoped that the above discussions have demonstrated that the foundation for cost-effective hardness assurance tests is laid with studies of the basic mechanisms of radiation effects. Without a diligent assessment of new radiation effects mechanisms in future technologies, one cannot be assured that the present generation of radiation test standards will continue to apply

Comparison of Psychotropic Drug Prescribing Quality between Zagreb, Croatia and Sarajevo, B&H.

Science.gov (United States)

Polić-Vižintin, Marina; Štimac, Danijela; Čatić, Tarik; Šostar, Zvonimir; Zelić, Ana; Živković, Krešimir; Draganić, Pero

2014-12-01

The purpose of this paper was to compare outpatient consumption and quality of psychotropic drug prescribing between Croatia and Bosnia & Herzegovina 2006-2010. Data on drug utilization from Zagreb Municipal Pharmacy and Sarajevo Public Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic-Chemical methodology. Total utilization of psychopharmaceuticals increased in both cities; however, it was higher in Zagreb than in Sarajevo throughout the study period. The utilization of psycholeptics increased in Zagreb by 2.4% (from 74.5 to 76.3 DDD/TID) and in Sarajevo by 3.8% (from 62.4 to 64.8 DDD/TID). The utilization of anxiolytics decreased in Zagreb by 2.1% and in Sarajevo by even 18.7%. The utilization of antidepressants increased in both cities with predominance of SSRI over TCA utilization, greater in Sarajevo (96.6%) than in Zagreb (10.2%). The anxiolytic/antidepressant ratio decreased by 11.1% in Zagreb (from 2.87 to 2.55) and by 58.7% in Sarajevo (from 5.66 to 2.34). Outpatient utilization of antipsychotics increased significantly in Sarajevo, predominated by typical ones, whereas in Zagreb the utilization of antipsychotics was stable, predominated by atypical ones. In Croatia and Bosnia & Herzegovina, there was an obvious tendency to follow western trends in drug prescribing, as demonstrated by the increased use of antidepressants and reduced use of anxiolytics. Despite some improvement observed in the prescribing quality, high use of antipsychotics with dominance of typical antipsychotics in Sarajevo points to the need of prescribing guidelines for antipsychotics.

Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients.

Science.gov (United States)

Popoola, Victor O; Lau, Brandyn D; Tan, Esther; Shaffer, Dauryne L; Kraus, Peggy S; Farrow, Norma E; Hobson, Deborah B; Aboagye, Jonathan K; Streiff, Michael B; Haut, Elliott R

2018-03-15

Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated. Overall, 12.7% of all medication doses prescribed to patients in the study cohort ( n = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], p < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, p < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications. Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Tolerance of the human spinal cord to single dose radiosurgery

International Nuclear Information System (INIS)

Ryu, S.; Zhu, G.; Yin, F.-F.; Ajlouni, M.; Kim, J.H.

2003-01-01

Tolerance of the spinal cord to the single dose of radiation is not well defined. Although there are cases of human spinal cord tolerance from re-irradiation to the same cord level, the information about the tolerance of human spinal cord to single large dose of radiosurgery is not available. We carried out spinal radiosurgery to treat spinal metastasis and studied the single dose tolerance of the human spinal cord in an ongoing dose escalation paradigm. A total of 39 patients with 48 lesions of spinal metastasis were treated with single dose radiosurgery at Henry Ford Hospital. The radiosurgery dose was escalated from 8 Gy to 16 Gy at 2 Gy increment. The radiation dose was prescribed to periphery of the spinal tumor. The radiation dose to the spinal cord was estimated by computerized dosimetry. The median follow-up time was 10 months (range 6-18 months) from the radiosurgery. The endpoint of the study was to demonstrate the efficacy of the spinal radiosurgery and to determine the tolerance of human spinal cord to single dose radiosurgery. The dose to the spinal cord was generally less than 50 % of the prescribed radiation dose. The volume of the spinal cord that received higher than this dose was less than 20 % of the anterior portion of the spinal cord. Maximum single dose of 8 Gy was delivered to the anterior 20 % of the spinal cord in this dose escalation study. The dose volume histogram will be presented. There was no acute or subacute radiation toxicity detected clinically and radiologically during the maximum follow-up of 20 months. Further dose escalation is in progress. The single tolerance dose of the human spinal cord appears to be at least 8 Gy when it was given to the 20 % of the cord volume, although the duration of follow up is not long enough to detect severe late cord toxicity. This study offers a valuable radiobiological basis of the normal spinal cord tolerance, and opens spinal radiosurgery as a safe treatment for spinal metastasis

Total dose hardness of a commercial SiGe BiCMOS technology

International Nuclear Information System (INIS)

Van Vonno, N.; Lucas, R.; Thornberry, D.

1999-01-01

Over the past decade SiGe HBT technology has progress from the laboratory to actual commercial applications. When integrated into a BiMOS process, this technology has applications in low-cost space systems. In this paper, we report results of total dose testing of a SiGe/CMOS process accessible through a commercial foundry. (authors)

Simulation of Shielding Effects on the Total Dose Observed in TDE of KISAT-1

Directory of Open Access Journals (Sweden)

Sung-Joon Kim

2001-06-01

Full Text Available The threshold voltage shift observed in TDE (Total Dose Experiment on board the KITSAT-1 is converted into dose (rad(SiO2 usinsg the result of laboratory calibration with Co-60 gamma ray source in KAERI (Korea Atomic Energy Research Institute. Simulation using the NASA radiation model of geomagnetosphere verifies that the dose difference between RADFET1 and RADFET3 observed on KITSAT-1 comes from the difference in shielding thickness at the position of these RADFETs.

PRESCRIBING PATTERN OF NON-STEROIDAL ANTI ...

African Journals Online (AJOL)

2015-03-01

Mar 1, 2015 ... Design: A total of 3800 prescriptions containing. NSAIDs were analyzed for information on drug name, the number of NSAIDs per prescription, the presence of ACE inhibitors and diuretics alongside. NSAIDs and NSAIDs prescribed in generic or brand names. Results: The results showed that Aspirin was ...

Dose absorbed in the fetus by radioactive drugs prescribed

International Nuclear Information System (INIS)

Rojo, A.M.; Gomez Parada, I.; Di Trano, J.L.

1998-01-01

This work aims to review existing guidelines on the hypothesis that must be taken into account when calculating impact from the dose on the fetus for widely employed radioactive drugs. Recent research is added giving data on placenta transference linked to pregnancy term. The most widely used diagnostic and therapeutic practices are analyzed comparing the dose impact on the fetus with limits internationally accepted. This will allow having the necessary tools to answer questions concerning radiological risks due to the administration of radioactive drugs to pregnant women

Inclusion of Radiation Environment Variability in Total Dose Hardness Assurance Methodology

Science.gov (United States)

Xapsos, M. A.; Stauffer, C.; Phan, A.; McClure, S. S.; Ladbury, R. L.; Pellish, J. A.; Campola, M. J.; LaBel, K. A.

2016-01-01

Variability of the space radiation environment is investigated with regard to parts categorization for total dose hardness assurance methods. It is shown that it can have a significant impact. A modified approach is developed that uses current environment models more consistently and replaces the radiation design margin concept with one of failure probability during a mission.

Prescribing pattern of general practitioners for osteoarthritis in primary care settings in Bolu, Turkey

International Nuclear Information System (INIS)

Kartal, M.; Maral, I.; Coskun, O.

2007-01-01

Objective was to assess the drug preferences of primary care physicians for osteoarthritis (OA) in comparison with the current guidelines and their reflections in the cost of prescriptions. Data were collected from all primary health care centers in Bolu, Turkey during from November 2002 from patient polyclinic logbooks. Drugs prescribed were classified according to the Anatomical Therapeutical Chemical Classification system for comparison purposes. Gender, age and health insurance of patients were analyzed for drug preferences and costs. Forty-eight primary care physicians prescribed 1047 drugs for 507 OA patients with total cost of $10,254. Anti-inflammatory and antirheumatic products were the leading group accounting for 59.6% of the prescribed drugs, and 84.1% of the total expenditure. Paracetamol, the most commonly recommended in the guidelines, constituted 6.9% of all prescribed drugs and 0.9% of the total cost. Drug preferences showed a statistical difference among the health insurance types while drugs cost showed statistical significance among the gender and health insurance types. Cyclooygenase-2-specific inhibitors were the most commonly prescribed subgroup, constituting 23.2% of prescribed drugs and 62.6% of the total expenditure. Paracetamol in practice was not the first-line drug preferred by primary care physicians. Drug prescription data showed that the preference of drugs was affected by health insurance types and the gender of patients in favor of expensive new drugs. There is a need for improvement of drug prescriptions to reflect current recommendations and guidelines. (author)

Evaluation of the knowledge of physicians prescribing CT examinations on the radiation protection of patients

International Nuclear Information System (INIS)

Gervaise, A.; Pernin, M.; Naulet, P.; Portron, Y.; Lapierre-Combes, M.; Esperabe-Vignau, F.

2011-01-01

Purpose: To evaluate the knowledge of physicians prescribing CT examinations on the radiation protection of patients. Materials and methods: A questionnaire was distributed to all clinicians on medical staff who prescribe CT examinations. Several questions related to their prescription pattern and their knowledge of radiation protection. Results: Forty-four questionnaires were analyzed. While 70% of physicians claimed that they considered the risks from exposure to ionizing radiation when prescribing a CT examination, only 25% informed their patients about those risks. Knowledge of the radiation dose delivered during CT evaluation of the abdomen and pelvis was poorly understood and the risks related to small doses of radiation were grossly underestimated. Finally, only a third of clinicians had received training with regards to radiation protection. Conclusion: While most clinicians claim that they consider the risks from exposure to ionizing radiation when prescribing a CT examination, the risks are either not well known or not known at all. Increased formation of clinicians with regards to the radiation protection of patients, maybe through a dedicated clinical rotation while in medical school, could be a solution to improve the knowledge of hospital clinicians with regards to radiation protection. (authors)

Emesis as a Screening Diagnostic for Low Dose Rate (LDR) Total Body Radiation Exposure.

Science.gov (United States)

Camarata, Andrew S; Switchenko, Jeffrey M; Demidenko, Eugene; Flood, Ann B; Swartz, Harold M; Ali, Arif N

2016-04-01

Current radiation disaster manuals list the time-to-emesis (TE) as the key triage indicator of radiation dose. The data used to support TE recommendations were derived primarily from nearly instantaneous, high dose-rate exposures as part of variable condition accident databases. To date, there has not been a systematic differentiation between triage dose estimates associated with high and low dose rate (LDR) exposures, even though it is likely that after a nuclear detonation or radiologic disaster, many surviving casualties would have received a significant portion of their total exposure from fallout (LDR exposure) rather than from the initial nuclear detonation or criticality event (high dose rate exposure). This commentary discusses the issues surrounding the use of emesis as a screening diagnostic for radiation dose after LDR exposure. As part of this discussion, previously published clinical data on emesis after LDR total body irradiation (TBI) is statistically re-analyzed as an illustration of the complexity of the issue and confounding factors. This previously published data includes 107 patients who underwent TBI up to 10.5 Gy in a single fraction delivered over several hours at 0.02 to 0.04 Gy min. Estimates based on these data for the sensitivity of emesis as a screening diagnostic for the low dose rate radiation exposure range from 57.1% to 76.6%, and the estimates for specificity range from 87.5% to 99.4%. Though the original data contain multiple confounding factors, the evidence regarding sensitivity suggests that emesis appears to be quite poor as a medical screening diagnostic for LDR exposures.

Comparison of equations for dosing of medications in renal impairment.

Science.gov (United States)

Khanal, Aarati; Peterson, Gregory M; Jose, Matthew D; Castelino, Ronald L

2017-06-01

The aim of this study is to determine the concordance among the Cockcroft-Gault, the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in hypothetical dosing of renally cleared medications. A total of 2163 patients prescribed at least one of the 31 renally cleared drugs under review were included in the study. Kidney function was estimated using the three equations. We compared actual prescribed dosages of the same drug with recommended dosages based on the kidney function as calculated by each of the equations and applying dosing recommendations in the Australian Medicines Handbook. There was a significant difference in the kidney function values estimated from the three equations (P < 0.001). Despite the good overall agreement in renal drug dosing, we found selected but potentially important discrepancies among the doses rendered from the equations. The CKD-EPI equation non-normalized for body surface area had a greater rate of concordance with the Cockcroft-Gault equation than the Modification of Diet in Renal Disease equation for renal drug dosing. There is need for a long-term multi-centre study in a diverse population to define the clinical effects of the discrepancies among the equations for drug dosing. Given the greater concordance of the non-normalized CKD-EPI equation with the Cockcroft-Gault equation for dosing, the recommendation by Kidney Health Australia and the United States National Kidney Disease Education Program that 'dosing based on either eCrCl or an eGFR with body surface area normalization removed are acceptable' seems suitable and practicable for the purpose of dosing of non-critical drugs in the primary care setting. © 2016 Asian Pacific Society of Nephrology.

Unit of measurement used and parent medication dosing errors.

Science.gov (United States)

Yin, H Shonna; Dreyer, Benard P; Ugboaja, Donna C; Sanchez, Dayana C; Paul, Ian M; Moreira, Hannah A; Rodriguez, Luis; Mendelsohn, Alan L

2014-08-01

Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship. Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site. Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2-4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03-3.5) dose; associations greater for parents with low health literacy and non-English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon-associated measurement errors. Findings support a milliliter-only standard to reduce medication errors. Copyright © 2014 by the American Academy of Pediatrics.

Concordance with prescribing information dosage recommendations for dipeptidyl-peptidase-4 inhibitors among type 2 diabetes mellitus patients with moderate to severe chronic kidney disease.

Science.gov (United States)

Huang, Huan; Shetty, Sharash; Bauer, Elise; Lang, Kathleen

2018-06-01

To estimate the proportion of patients with moderate to severe chronic kidney disease (CKD) whose initial dipeptidyl-peptidase-4 inhibitor (DPP4-i) dosage was concordant with prescribing information (label) recommendations in the United States. Adult patients with type 2 diabetes mellitus (T2DM) who initiated a DPP4-i (linagliptin, sitagliptin, saxagliptin) between 1 January 2011 and 30 June 2014 were identified using electronic medical records and administrative claims, with index date being the date of first observed DPP4-i treatment. Patients were required to have chronic kidney disease (CKD) stage 3b, 4 or 5 (estimated Glomerular Filtration Rate [eGFR] value <45 ml/min/1.73 m 2 ) during the 12 month pre-index period. Patients were classified as concordant or not concordant based on whether the first prescribed dose was consistent with label recommendations. Demographics, clinical characteristics, resource use and costs during pre-index were evaluated by DPP4-i concordance status. Of the 492 patients (323 sitagliptin, 57 saxagliptin, 112 linagliptin), 36.2% were prescribed doses that were not concordant with label recommendations (44.9% for sitagliptin, 57.9% for saxagliptin and 0% for linagliptin [which does not require dosage adjustment]). Concordant patients were slightly older (mean age 71 years vs. 68, p = .01) but had similar gender distribution (55% vs. 60% female, p = .31) compared to those who were not concordant. They had lower general health status (Charlson Comorbidity Score 2.6 vs. 2.2, p = .03), and had similar pre-index all-cause total costs ($25,245 vs. $21,972, p = .68) and lower pre-index T2DM-related costs ($1618 vs. $1922, p = .05). More than a third of DPP4-i patients with CKD stage 3b or higher were prescribed doses not concordant with DPP4-i label dosage recommendations.

Analysis of Surface Dose Refer to Distance between Beam Spoiler and Patient in Total Body Irradiation

International Nuclear Information System (INIS)

Choi, Jong Hwan; Kim, Jong Sik; Choi, Ji Min; Shin, Eun Hyuk; Song, Ki Won; Park, Young Hwan

2007-01-01

Total body irradiation is used to kill the total malignant cell and for immunosuppression component of preparatory regimens for bone-marrow restitution of patients. Beam spoiler is used to increase the dose to the superficial tissues. This paper finds the property of the distance between beam spoiler and patient. Set-up conditions are 6 MV-Xray, 300 MU, SAD = 400 cm, field size = 40 x 40 cm 2 . The parallel plate chamber located in surface, midpoint and exit of solid water phantom. The surface dose is measured while the distance between beam spoiler and patient is altered. Because it should be found proper distance. The solid water phantom is fixer and beam spoiler is moving. Central dose of phantom is 10.7 cGy and exit dose is 6.7 cGy. In case of distance of 50 cm to 60 cm between beam spoiler and solid water phantom, incidence dose is 14.58-14.92 cGy. Therefore, The surface dose was measured 99.4-101% with got near most to the prescription dose. In clinical case, distance between beam spoiler and patient affect surface dose. If once 50-60 cm of distance between beam spoiler and patient, surface dose of patient got near prescription dose. It would be taken distance between beam spoiler and patient into account in clinical therapy.

submitter Dose prescription in carbon ion radiotherapy: How to compare two different RBE-weighted dose calculation systems

CERN Document Server

Molinelli, Silvia; Mairani, Andrea; Matsufuji, Naruhiro; Kanematsu, Nobuyuki; Inaniwa, Taku; Mirandola, Alfredo; Russo, Stefania; Mastella, Edoardo; Hasegawa, Azusa; Tsuji, Hiroshi; Yamada, Shigeru; Vischioni, Barbara; Vitolo, Viviana; Ferrari, Alfredo; Ciocca, Mario; Kamada, Tadashi; Tsujii, Hirohiko; Orecchia, Roberto; Fossati, Piero

2016-01-01

Background and purpose: In carbon ion radiotherapy (CIRT), the use of different relative biological effectiveness (RBE) models in the RBE-weighted dose $(D_{RBE})$ calculation can lead to deviations in the physical dose $(D_{phy})$ delivered to the patient. Our aim is to reduce target $D_{phy}$ deviations by converting prescription dose values. Material and methods: Planning data of patients treated at the National Institute of Radiological Sciences (NIRS) were collected, with prescribed doses per fraction ranging from 3.6 Gy (RBE) to 4.6 Gy (RBE), according to the Japanese semi-empirical model. The $D_{phy}$ was Monte Carlo (MC) re-calculated simulating the NIRS beamline. The local effect model (LEM)_I was then applied to estimate $D_{RBE}$. Target median $D_{RBE}$ ratios between MC + LEM_I and NIRS plans determined correction factors for the conversion of prescription doses. Plans were re-optimized in a LEM_I-based commercial system, prescribing the NIRS uncorrected and corrected $D_{RBE}$. Results: The MC ...

Radiobiological modelling of dose-gradient effects in low dose rate, high dose rate and pulsed brachytherapy

International Nuclear Information System (INIS)

Armpilia, C; Dale, R G; Sandilos, P; Vlachos, L

2006-01-01

This paper presents a generalization of a previously published methodology which quantified the radiobiological consequences of dose-gradient effects in brachytherapy applications. The methodology uses the linear-quadratic (LQ) formulation to identify an equivalent biologically effective dose (BED eq ) which, if applied uniformly to a specified tissue volume, would produce the same net cell survival as that achieved by a given non-uniform brachytherapy application. Multiplying factors (MFs), which enable the equivalent BED for an enclosed volume to be estimated from the BED calculated at the dose reference surface, have been calculated and tabulated for both spherical and cylindrical geometries. The main types of brachytherapy (high dose rate (HDR), low dose rate (LDR) and pulsed (PB)) have been examined for a range of radiobiological parameters/dimensions. Equivalent BEDs are consistently higher than the BEDs calculated at the reference surface by an amount which depends on the treatment prescription (magnitude of the prescribed dose) at the reference point. MFs are closely related to the numerical BED values, irrespective of how the original BED was attained (e.g., via HDR, LDR or PB). Thus, an average MF can be used for a given prescribed BED as it will be largely independent of the assumed radiobiological parameters (radiosensitivity and α/β) and standardized look-up tables may be applicable to all types of brachytherapy treatment. This analysis opens the way to more systematic approaches for correlating physical and biological effects in several types of brachytherapy and for the improved quantitative assessment and ranking of clinical treatments which involve a brachytherapy component

To prescribe codeine or not to prescribe codeine?

Science.gov (United States)

Fleming, Marc L; Wanat, Matthew A

2014-09-01

A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.

Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients.

Directory of Open Access Journals (Sweden)

Chia-Chen Hsu

Full Text Available Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings.Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as "special oral formulations". A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August. During the intervention period, prescription changes in response to a warning were logged and analyzed.A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23-0.31, P<0.001. In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%.The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system

Influence of burn-in on total-ionizing-dose effect of SRAM device

International Nuclear Information System (INIS)

Liu Minbo; Yao Zhibin; Huang Shaoyan; He Baoping; Sheng Jiangkun

2014-01-01

The influence of Burn-in on the total-ionizing-dose (TID) effect of SRAM device was investigated. SRAM devices of three different feature sizes were selected and irradiated by "6"0Co source with or without pre-irradiation Burn-in. Some parameters for radiation effect of SRAM device such as upset data, were measured, and the influence on the TID effect of different feature size SRAM devices with or without pre-irradiation Burn-in was obtained. The influence of different temperature Burn-in on radiation resistant capability of SRAM device was studied for 0.25 μm SRAM device. The results show that the smaller the device feature size is, the better the radiation-resistant capability of SRAM device is and the weaker the influence of Burn-in is. And the higher Burn-in temperature is, the more serious the influence of Burn-in on the total-dose radiation effect is. (authors)

Total dose hardening of buried insulator in implanted silicon-on-insulator structures

International Nuclear Information System (INIS)

Mao, B.Y.; Chen, C.E.; Pollack, G.; Hughes, H.L.; Davis, G.E.

1987-01-01

Total dose characteristics of the buried insulator in implanted silicon-on-insulator (SOI) substrates have been studied using MOS transistors. The threshold voltage shift of the parasitic back channel transistor, which is controlled by charge trapping in the buried insulator, is reduced by lowering the oxygen dose as well as by an additional nitrogen implant, without degrading the front channel transistor characteristics. The improvements in the radiation characteristics of the buried insulator are attributed to the decrease in the buried oxide thickness or to the presence of the interfacial oxynitride layer formed by the oxygen and nitrogen implants

Acute pain management: acetaminophen and ibuprofen are often under-dosed.

Science.gov (United States)

Milani, Gregorio P; Benini, Franca; Dell'Era, Laura; Silvagni, Davide; Podestà, Alberto F; Mancusi, Rossella Letizia; Fossali, Emilio F

2017-07-01

Most children with pain are managed by either acetaminophen or ibuprofen. However, no study has so far investigated if children are prescribed adequate doses of acetaminophen or ibuprofen in emergency department. Aim of this retrospective study was to investigate the prevalence of under-dosage of these drugs in children presenting with pain in emergency department. Children initially prescribed with acetaminophen or ibuprofen for pain management were included. The χ 2 automatic interaction detection method was used considering the percentage variation from the minimum of the appropriate dose as dependent variable while prescribed drug, age, gender, body weight, type of hospital (pediatric or general), and availability of internal guidelines on pediatric pain management in the emergency department as independent variables. Data on 1471 children managed for pain were available. Under-dosage was prescribed in 893 subjects (61%), of whom 577 were prescribed acetaminophen and 316 ibuprofen. The use of acetaminophen suppositories, body weight 40 kg, and the use of oral ibuprofen identified clusters of children associated with under-dosage prescription. Prescription of acetaminophen and ibuprofen was frequently under-dosed. The use of suppositories, lower and higher body weight, and the use of ibuprofen were associated with under-dosage. Under-dosing may reflect prescription of anti-pyretic doses. Agenzia Italiana del Farmaco-Observational Study Register (RSO). Registration code: PIERRE/1 What is Known: • Pain is frequent in children presented to emergency department. • International recommendations on pain management are often not implemented. What is New: • Acetaminophen and ibuprofen were frequently underdosed in children prescribed for pain in the Italian emergency departments. • Under-dosage may be related to the habit of using acetaminophen and ibuprofen in the recommended range for fever treatment.

Enchanced total dose damage in junction field effect transistors and related linear integrated circuits

International Nuclear Information System (INIS)

Flament, O.; Autran, J.L.; Roche, P.; Leray, J.L.; Musseau, O.

1996-01-01

Enhanced total dose damage of Junction Field-effect Transistors (JFETs) due to low dose rate and/or elevated temperature has been investigated for elementary p-channel structures fabricated on bulk and SOI substrates as well as for related linear integrated circuits. All these devices were fabricated with conventional junction isolation (field oxide). Large increases in damage have been revealed by performing high temperature and/or low dose rate irradiations. These results are consistent with previous studies concerning bipolar field oxides under low-field conditions. They suggest that the transport of radiation-induced holes through the oxide is the underlying mechanism. Such an enhanced degradation must be taken into account for low dose rate effects on linear integrated circuits

An improved standard total dose test for CMOS space electronics

International Nuclear Information System (INIS)

Fleetwood, D.M.; Winokur, P.S.; Riewe, L.C.; Pease, R.L.

1989-01-01

The postirradiation response of hardened and commercial CMOS devices is investigated as a function of total dose, dose rate, and annealing time and temperature. Cobalt-60 irradiation at ≅ 200 rad(SiO 2 )/s followed by a 1-week 100 degrees C biased anneal and testing is shown to be an effective screen of hardened devices for space use. However, a similar screen and single-point test performed after Co-60 irradiation and elevated temperature anneal cannot be generally defined for commercial devices. In the absence of detailed knowledge about device and circuit radiation response, a two-point standard test is proposed to ensure space surviability of CMOS circuits: a Co-60 irradiation and test to screen against oxide-trapped charge related failures, and an additional rebound test to screen against interface-trap related failures. Testing implications for bipolar technologies are also discussed

[Clinical applications of dosing algorithm in the predication of warfarin maintenance dose].

Science.gov (United States)

Huang, Sheng-wen; Xiang, Dao-kang; An, Bang-quan; Li, Gui-fang; Huang, Ling; Wu, Hai-li

2011-12-27

To evaluate the feasibility of clinical application for genetic based dosing algorithm in the predication of warfarin maintenance dose in Chinese population. The clinical data were collected and blood samples harvested from a total of 126 patients undergoing heart valve replacement. The genotypes of VKORC1 and CYP2C9 were determined by melting curve analysis after PCR. They were divided randomly into the study and control groups. In the study group, the first three doses of warfarin were prescribed according to the predicted warfarin maintenance dose while warfarin was initiated at 2.5 mg/d in the control group. The warfarin doses were adjusted according to the measured international normalized ratio (INR) values. And all subjects were followed for 50 days after an initiation of warfarin therapy. At the end of a 50-day follow-up period, the proportions of the patients on a stable dose were 82.4% (42/51) and 62.5% (30/48) for the study and control groups respectively. The mean durations of reaching a stable dose of warfarin were (27.5 ± 1.8) and (34.7 ± 1.8) days and the median durations were (24.0 ± 1.7) and (33.0 ± 4.5) days in the study and control groups respectively. Significant differences existed in the durations of reaching a stable dose between the two groups (P = 0.012). Compared with the control group, the hazard ratio (HR) for the duration of reaching a stable dose was 1.786 in the study group (95%CI 1.088 - 2.875, P = 0.026). The predicted dosing algorithm incorporating genetic and non-genetic factors may shorten the duration of achieving efficiently a stable dose of warfarin. And the present study validates the feasibility of its clinical application.

Revisiting Low-Dose Total Skin Electron Beam Therapy in Mycosis Fungoides

Energy Technology Data Exchange (ETDEWEB)

Harrison, Cameron, E-mail: cameronh@stanford.edu [Department of Dermatology, Stanford Cancer Center, Stanford, California (United States); Young, James; Navi, Daniel [Department of Dermatology, Stanford Cancer Center, Stanford, California (United States); Riaz, Nadeem [Department of Radiation Oncology, Stanford Cancer Center, Stanford, California (United States); Lingala, Bharathi; Kim, Youn [Department of Dermatology, Stanford Cancer Center, Stanford, California (United States); Hoppe, Richard [Department of Radiation Oncology, Stanford Cancer Center, Stanford, California (United States)

2011-11-15

Purpose: Total skin electron beam therapy (TSEBT) is a highly effective treatment for mycosis fungoides (MF). The standard course consists of 30 to 36 Gy delivered over an 8- to 10-week period. This regimen is time intensive and associated with significant treatment-related toxicities including erythema, desquamation, anhydrosis, alopecia, and xerosis. The aim of this study was to identify a lower dose alternative while retaining a favorable efficacy profile. Methods and Materials: One hundred two MF patients were identified who had been treated with an initial course of low-dose TSEBT (5-<30 Gy) between 1958 and 1995. Patients had a T stage classification of T2 (generalized patch/plaque, n = 51), T3 (tumor, n = 29), and T4 (erythrodermic, n = 22). Those with extracutaneous disease were excluded. Results: Overall response (OR) rates (>50% improvement) were 90% among patients with T2 to T4 disease receiving 5 to <10 Gy (n = 19). In comparison, OR rates between the 10 to <20 Gy and 20 to <30 Gy subgroups were 98% and 97%, respectively. There was no significant difference in median progression free survival (PFS) in T2 and T3 patients when stratified by dose group, and PFS in each was comparable to that of the standard dose. Conclusions: OR rates associated with low-dose TSEBT in the ranges of 10 to <20 Gy and 20 to <30 Gy are comparable to that of the standard dose ({>=} 30 Gy). Efficacy measures including OS, PFS, and RFS are also favorable. Given that the efficacy profile is similar between 10 and <20 Gy and 20 and <30 Gy, the utility of TSEBT within the lower dose range of 10 to <20 Gy merits further investigation, especially in the context of combined modality treatment.

Application of a Novel Dose-Uncertainty Model for Dose-Uncertainty Analysis in Prostate Intensity-Modulated Radiotherapy

International Nuclear Information System (INIS)

Jin Hosang; Palta, Jatinder R.; Kim, You-Hyun; Kim, Siyong

2010-01-01

Purpose: To analyze dose uncertainty using a previously published dose-uncertainty model, and to assess potential dosimetric risks existing in prostate intensity-modulated radiotherapy (IMRT). Methods and Materials: The dose-uncertainty model provides a three-dimensional (3D) dose-uncertainty distribution in a given confidence level. For 8 retrospectively selected patients, dose-uncertainty maps were constructed using the dose-uncertainty model at the 95% CL. In addition to uncertainties inherent to the radiation treatment planning system, four scenarios of spatial errors were considered: machine only (S1), S1 + intrafraction, S1 + interfraction, and S1 + both intrafraction and interfraction errors. To evaluate the potential risks of the IMRT plans, three dose-uncertainty-based plan evaluation tools were introduced: confidence-weighted dose-volume histogram, confidence-weighted dose distribution, and dose-uncertainty-volume histogram. Results: Dose uncertainty caused by interfraction setup error was more significant than that of intrafraction motion error. The maximum dose uncertainty (95% confidence) of the clinical target volume (CTV) was smaller than 5% of the prescribed dose in all but two cases (13.9% and 10.2%). The dose uncertainty for 95% of the CTV volume ranged from 1.3% to 2.9% of the prescribed dose. Conclusions: The dose uncertainty in prostate IMRT could be evaluated using the dose-uncertainty model. Prostate IMRT plans satisfying the same plan objectives could generate a significantly different dose uncertainty because a complex interplay of many uncertainty sources. The uncertainty-based plan evaluation contributes to generating reliable and error-resistant treatment plans.

The usefulness of metal markers for CTV-based dose prescription in high-dose-rate interstitial brachytherapy

International Nuclear Information System (INIS)

Yoshida, Ken; Mitomo, Masanori; Nose, Takayuki; Koizumi, Masahiko; Nishiyama, Kinji; Yoshida, Mineo

2002-01-01

We employ a clinical target volume (CTV)-based dose prescription for high-dose-rate (HDR) interstitial brachytherapy. However, it is not easy to define CTV and organs at risk (OAR) from X-ray film or CT scanning. To solve this problem, we have utilized metal markers since October 1999. Moreover, metal markers can help modify dose prescription. By regulating the doses to the metal markers, refining the dose prescription can easily be achieved. In this research, we investigated the usefulness of the metal markers. Between October 1999 and May 2001, 51 patients were implanted with metal markers at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), Osaka National Hospital (ONH) and Sanda City Hospital (SCH). Forty-nine patients (head and neck: 32; pelvis: 11; soft tissue: 3; breast: 3) using metal markers were analyzed. During operation, we implanted 179 metal markers (49 patients) to CTV and 151 markers (26 patients) to OAR. At treatment planning, CTV was reconstructed judging from the metal markers, applicator position and operation records. Generally, we prescribed the tumoricidal dose to an isodose surface that covers CTV. We also planned to limit the doses to OAR lower than certain levels. The maximum normal tissue doses were decided 80%, 150%, 100%, 50% and 200% of the prescribed doses for the rectum, the urethra, the mandible, the skin and the large vessel, respectively. The doses to the metal markers using CTV-based dose prescription were generated. These were compared with the doses theoretically calculated with the Paris system. Treatment results were also investigated. The doses to the 158 metal markers (42 patients) for CTV were higher than ''tumoricidal dose''. In 7 patients, as a result of compromised dose prescription, 9 markers were lower than the tumoricidal dose. The other 12 markers (7%) were excluded from dose evaluation because they were judged as miss-implanted. The doses to the 142 metal markers (24 patients) for OAR were lower

Rationalising prescribing

DEFF Research Database (Denmark)

Wadmann, Sarah; Bang, Lia Evi

2015-01-01

Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interac...

General practitioner attitudes towards prescribing aspirin to carriers of Lynch Syndrome: findings from a national survey.

Science.gov (United States)

Smith, Samuel G; Foy, Robbie; McGowan, Jennifer; Kobayashi, Lindsay C; Burn, John; Brown, Karen; Side, Lucy; Cuzick, Jack

2017-10-01

A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p Lynch Syndrome patient in practice (OR 1.44, 95% CI 1.01-2.05, p = 0.045). GPs report limited awareness of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, prescribing guidance and strategies to educate GPs should be developed.

Compendium of Total Ionizing Dose and Displacement Damage for Candidate Spacecraft Electronics for NASA

Science.gov (United States)

Cochran, Donna J.; Boutte, Alvin J.; Chen, Dakai; Pellish, Jonathan A.; Ladbury, Raymond L.; Casey, Megan C.; Campola, Michael J.; Wilcox, Edward P.; Obryan, Martha V.; LaBel, Kenneth A.;

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

Directory of Open Access Journals (Sweden)

Vladimir Zivanovic

Full Text Available In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S and medical (M wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia, in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1% than on the M (63.2% and 36.9% wards. The percentage of MDR A. baumannii was not different between S (93.7% and M (79.5% wards. An overall antibiotics consumption (defined daily doses/100 bed-days during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%. The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%, inappropriate dose interval (70.6% vs. 16.9% or duration of therapy (72.5% vs. 23.1%, a non-documented stop/review data (73.6% vs. 16.9% and divergence from guidelines (71.9% vs. 23.1%. Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards.

Methotrexate osteopathy in long-term, low-dose methotrexate treatment for psoriasis and rheumatoid arthritis

NARCIS (Netherlands)

Zonneveld, I. M.; Bakker, W. K.; Dijkstra, P. F.; Bos, J. D.; van Soesbergen, R. M.; Dinant, H. J.

1996-01-01

In dermatology and rheumatology, methotrexate is frequently prescribed in low dosages per week; in oncology, high dosages per week are prescribed. Methotrexate osteopathy was first reported in children with leukemia treated with high doses of methotrexate. In animal studies, low doses of

Total effective dose equivalent associated with fixed uranium surface contamination

International Nuclear Information System (INIS)

Bogard, J.S.; Hamm, R.N.; Ashley, J.C.; Turner, J.E.; England, C.A.; Swenson, D.E.; Brown, K.S.

1997-04-01

This report provides the technical basis for establishing a uranium fixed-contamination action level, a fixed uranium surface contamination level exceeding the total radioactivity values of Appendix D of Title 10, Code of Federal Regulations, part 835 (10CFR835), but below which the monitoring, posting, and control requirements for Radiological Areas are not required for the area of the contamination. An area of fixed uranium contamination between 1,000 dpm/100 cm 2 and that level corresponding to an annual total effective dose equivalent (TEDE) of 100 mrem requires only routine monitoring, posting to alert personnel of the contamination, and administrative control. The more extensive requirements for monitoring, posting, and control designated by 10CFR835 for Radiological Areas do not have to be applied for these intermediate fixed-contamination levels

Off-label psychotropic prescribing for young persons in medium security.

Science.gov (United States)

Haw, C; Stubbs, J

2010-10-01

Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.

Time- and dose-dependent effects of total-body ionizing radiation on muscle stem cells

Science.gov (United States)

Masuda, Shinya; Hisamatsu, Tsubasa; Seko, Daiki; Urata, Yoshishige; Goto, Shinji; Li, Tao-Sheng; Ono, Yusuke

2015-01-01

Exposure to high levels of genotoxic stress, such as high-dose ionizing radiation, increases both cancer and noncancer risks. However, it remains debatable whether low-dose ionizing radiation reduces cellular function, or rather induces hormetic health benefits. Here, we investigated the effects of total-body γ-ray radiation on muscle stem cells, called satellite cells. Adult C57BL/6 mice were exposed to γ-radiation at low- to high-dose rates (low, 2 or 10 mGy/day; moderate, 50 mGy/day; high, 250 mGy/day) for 30 days. No hormetic responses in proliferation, differentiation, or self-renewal of satellite cells were observed in low-dose radiation-exposed mice at the acute phase. However, at the chronic phase, population expansion of satellite cell-derived progeny was slightly decreased in mice exposed to low-dose radiation. Taken together, low-dose ionizing irradiation may suppress satellite cell function, rather than induce hormetic health benefits, in skeletal muscle in adult mice. PMID:25869487

Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

LENUS (Irish Health Repository)

Cahir, Caitriona

2010-05-01

Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

Effectiveness of Three Different Walking Prescription Durations on Total Physical Activity in Normal- and Overweight Women

Directory of Open Access Journals (Sweden)

Yves Schutz

2014-08-01

Full Text Available Objective: While there is a dose-response relationship between physical activity (PA and health benefit, little is known about the effectiveness of different PA prescriptions on total daily PA. Aim: To test, under real-life conditions and using an objective, non-invasive measurement technique (accelerometry, the effect of prescribing additional physical activity (walking only of different durations (30, 60 and 90 min/day on compliance (to the activity prescribed and compensation (to total daily PA. Participants in each group were prescribed 5 sessions of walking per week over 4 weeks. Methods: 55 normal-weight and overweight women (mean BMI 25 ± 5 kg/m2, height 165 ± 1 cm, weight 68 ± 2 kg and mean age 27 ± 1 years were randomly assigned to 3 prescription groups: 30, 60 or 90 min/day PA. Results: Walking duration resulted in an almost linear increase in the number of steps per day during the prescription period from an average of about 10,000 steps per day for the 30-min prescription to about 14,000 for the 90-min prescription. Compliance was excellent for the 30-min prescription but decreased significantly with 60-min and 90-min prescriptions. In parallel, degree of compensation subsequent to exercise increased progressively as length of prescription increased. Conclusion: A 30-min prescription of extra walking 5 times per week was well tolerated. However, in order to increase total PA further, much more than 60 min of walking may need to be prescribed in the majority of individuals. While total exercise ‘volume' increased with prescriptions longer than 30 min, compliance to the prescription decreased and greater compensation was evident.

[Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital].

Science.gov (United States)

Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa

2011-12-01

Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

[Evaluation of the knowledge of physicians prescribing CT examinations on the radiation protection of patients].

Science.gov (United States)

Gervaise, A; Esperabe-Vignau, F; Pernin, M; Naulet, P; Portron, Y; Lapierre-Combes, M

2011-01-01

To evaluate the knowledge of physicians prescribing CT examinations on the radiation protection of patients. A questionnaire was distributed to all clinicians on medical staff who prescribe CT examinations. Several questions related to their prescription pattern and their knowledge of radiation protection. Forty-four questionnaires were analyzed. While 70% of physicians claimed that they considered the risks from exposure to ionizing radiation when prescribing a CT examination, only 25% informed their patients about those risks. Knowledge of the radiation dose delivered during CT evaluation of the abdomen and pelvis was poorly understood and the risks related to small doses of radiation were grossly underestimated. Finally, only a third of clinicians had received training with regards to radiation protection. While most clinicians claim that they consider the risks from exposure to ionizing radiation when prescribing a CT examination, the risks are either not well known or not known at all. Increased formation of clinicians with regards to the radiation protection of patients, maybe through a dedicated clinical rotation while in medical school, could be a solution to improve the knowledge of hospital clinicians with regards to radiation protection. Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.

Analytical models for total dose ionization effects in MOS devices.

Energy Technology Data Exchange (ETDEWEB)

Campbell, Phillip Montgomery; Bogdan, Carolyn W.

2008-08-01

MOS devices are susceptible to damage by ionizing radiation due to charge buildup in gate, field and SOI buried oxides. Under positive bias holes created in the gate oxide will transport to the Si / SiO{sub 2} interface creating oxide-trapped charge. As a result of hole transport and trapping, hydrogen is liberated in the oxide which can create interface-trapped charge. The trapped charge will affect the threshold voltage and degrade the channel mobility. Neutralization of oxidetrapped charge by electron tunneling from the silicon and by thermal emission can take place over long periods of time. Neutralization of interface-trapped charge is not observed at room temperature. Analytical models are developed that account for the principal effects of total dose in MOS devices under different gate bias. The intent is to obtain closed-form solutions that can be used in circuit simulation. Expressions are derived for the aging effects of very low dose rate radiation over long time periods.

Target dose study of effects of changes in the AAA calculation resolution on lung SABR plan

International Nuclear Information System (INIS)

Kim, Dae Il; Son, Sang Jun; Ahn, Bum Seok; Jung, Chi Hoon; Yoo, Suk Hyun

2014-01-01

Changing the calculation grid of AAA in Lung SABR plan and to analyze the changes in target dose, and investigated the effects associated with it, and considered a suitable method of application. 4D CT image that was used to plan all been taken with Brilliance Big Bore CT (Philips, Netherlands) and in Lung SABR plan(Eclipse TM ver10.0.42, Varian, the USA), use anisotropic analytic algorithm(AAA, ver.10, Varian Medical Systems, Palo Alto, CA, USA) and, was calculated by the calculation grid 1.0, 3.0, 5.0 mm in each Lung SABR plan. Lung SABR plan of 10 cases are using each of 1.0 mm, 3.0 mm, 5.0 mm calculation grid, and in case of use a 1.0 mm calculation grid V98 of the prescribed dose is about 99.5%±1.5%, Dmin of the prescribed dose is about 92.5±1.5% and Homogeneity Index(HI) is 1.0489±0.0025. In the case of use a 3.0 mm calculation grid V98 dose of the prescribed dose is about 90±4.5% , Dmin of the prescribed dose is about 87.5±3% and HI is about 1.07±1. In the case of use a 5.0 mm calculation grid V98 dose of the prescribed dose is about 63±15%, Dmin of the prescribed dose is about 83±4% and HI is about 1.13±0.2, respectively. The calculation grid of 1.0 mm is better improves the accuracy of dose calculation than using 3.0 mm and 5.mm, although calculation times increase in the case of smaller PTV relatively. As lung, spread relatively large and low density and small PTV, it is considered and good to use a calculation grid of 1.0 mm

Fast method for in-flight estimation of total dose from protons and electrons using RADE Minstrument on JUICE

Science.gov (United States)

Hajdas, Wojtek; Mrigakshi, Alankrita; Xiao, Hualin

2017-04-01

The primary concern of the ESA JUICE mission to Jupiter is the harsh particle radiation environment. Ionizing particles introduce radiation damage by total dose effects, displacement damages or single events effects. Therefore, both the total ionizing dose and the displacement damage equivalent fluence must be assessed to alert spacecraft and its payload as well as to quantify radiation levels for the entire mission lifetime. We present a concept and implementations steps for simplified method used to compute in flight a dose rate and total dose caused by protons. We also provide refinement of the method previously developed for electrons. The dose rates values are given for predefined active volumes located behind layers of materials with known thickness. Both methods are based on the electron and proton flux measurements provided by the Electron and Proton Detectors inside the Radiation Hard Electron Monitor (RADEM) located on-board of JUICE. The trade-off between method accuracy and programming limitations for in-flight computations are discussed. More comprehensive and precise dose rate computations based on detailed analysis of all stack detectors will be made during off-line data processing. It will utilize full spectral unfolding from all RADEM detector subsystems.

Secondary radiation dose during high-energy total body irradiation

Energy Technology Data Exchange (ETDEWEB)

Janiszewska, M.; Raczkowski, M. [Lower Silesian Oncology Center, Medical Physics Department, Wroclaw (Poland); Polaczek-Grelik, K. [University of Silesia, Medical Physics Department, Katowice (Poland); Szafron, B.; Konefal, A.; Zipper, W. [University of Silesia, Department of Nuclear Physics and Its Applications, Katowice (Poland)

2014-05-15

The goal of this work was to assess the additional dose from secondary neutrons and γ-rays generated during total body irradiation (TBI) using a medical linac X-ray beam. Nuclear reactions that occur in the accelerator construction during emission of high-energy beams in teleradiotherapy are the source of secondary radiation. Induced activity is dependent on the half-lives of the generated radionuclides, whereas neutron flux accompanies the treatment process only. The TBI procedure using a 18 MV beam (Clinac 2100) was considered. Lateral and anterior-posterior/posterior-anterior fractions were investigated during delivery of 2 Gy of therapeutic dose. Neutron and photon flux densities were measured using neutron activation analysis (NAA) and semiconductor spectrometry. The secondary dose was estimated applying the fluence-to-dose conversion coefficients. The main contribution to the secondary dose is associated with fast neutrons. The main sources of γ-radiation are the following: {sup 56}Mn in the stainless steel and {sup 187}W of the collimation system as well as positron emitters, activated via (n,γ) and (γ,n) processes, respectively. In addition to 12 Gy of therapeutic dose, the patient could receive 57.43 mSv in the studied conditions, including 4.63 μSv from activated radionuclides. Neutron dose is mainly influenced by the time of beam emission. However, it is moderated by long source-surface distances (SSD) and application of plexiglass plates covering the patient body during treatment. Secondary radiation gives the whole body a dose, which should be taken into consideration especially when one fraction of irradiation does not cover the whole body at once. (orig.) [German] Die zusaetzliche Dosis durch sekundaere Neutronen- und γ-Strahlung waehrend der Ganzkoerperbestrahlung mit Roentgenstrahlung aus medizinischen Linearbeschleunigern wurde abgeschaetzt. Bei der Emission hochenergetischer Strahlen zur Teletherapie finden hauptsaechlich im Beschleuniger

Clinical application of a OneDose MOSFET for skin dose measurements during internal mammary chain irradiation with high dose rate brachytherapy in carcinoma of the breast.

Science.gov (United States)

Kinhikar, Rajesh A; Sharma, Pramod K; Tambe, Chandrashekhar M; Mahantshetty, Umesh M; Sarin, Rajiv; Deshpande, Deepak D; Shrivastava, Shyam K

2006-07-21

In our earlier study, we experimentally evaluated the characteristics of a newly designed metal oxide semiconductor field effect transistor (MOSFET) OneDose in-vivo dosimetry system for Ir-192 (380 keV) energy and the results were compared with thermoluminescent dosimeters (TLDs). We have now extended the same study to the clinical application of this MOSFET as an in-vivo dosimetry system. The MOSFET was used during high dose rate brachytherapy (HDRBT) of internal mammary chain (IMC) irradiation for a carcinoma of the breast. The aim of this study was to measure the skin dose during IMC irradiation with a MOSFET and a TLD and compare it with the calculated dose with a treatment planning system (TPS). The skin dose was measured for ten patients. All the patients' treatment was planned on a PLATO treatment planning system. TLD measurements were performed to compare the accuracy of the measured results from the MOSFET. The mean doses measured with the MOSFET and the TLD were identical (0.5392 Gy, 15.85% of the prescribed dose). The mean dose was overestimated by the TPS and was 0.5923 Gy (17.42% of the prescribed dose). The TPS overestimated the skin dose by 9% as verified by the MOSFET and TLD. The MOSFET provides adequate in-vivo dosimetry for HDRBT. Immediate readout after irradiation, small size, permanent storage of dose and ease of use make the MOSFET a viable alternative for TLDs.

Ir-192 HDR transit dose and radial dose function determination using alanine/EPR dosimetry

International Nuclear Information System (INIS)

Calcina, Carmen S Guzman; Almeida, Adelaide de; Rocha, Jose R Oliveira; Abrego, Felipe Chen; Baffa, Oswaldo

2005-01-01

Source positioning close to the tumour in high dose rate (HDR) brachytherapy is not instantaneous. An increment of dose will be delivered during the movement of the source in the trajectory to its static position. This increment is the transit dose, often not taken into account in brachytherapeutic treatment planning. The transit dose depends on the prescribed dose, number of treatment fractions, velocity and activity of the source. Combining all these factors, the transit dose can be 5% higher than the prescribed absorbed dose value (Sang-Hyun and Muller-Runkel, 1994 Phys. Med. Biol. 39 1181-8, Nath et al 1995 Med. Phys. 22 209-34). However, it cannot exceed this percentage (Nath et al 1995). In this work, we use the alanine-EPR (electron paramagnetic resonance) dosimetric system using analysis of the first derivative of the signal. The transit dose was evaluated for an HDR system and is consistent with that already presented for TLD dosimeters (Bastin et al 1993 Int. J. Radiat. Oncol. Biol. Phys. 26 695-702). Also using the same dosimetric system, the radial dose function, used to evaluate the geometric dose degradation around the source, was determined and its behaviour agrees better with those obtained by Monte Carlo simulations (Nath et al 1995, Williamson and Nath 1991 Med. Phys. 18 434-48, Ballester et al 1997 Med. Phys. 24 1221-8, Ballester et al 2001 Phys. Med. Biol. 46 N79-90) than with TLD measurements (Nath et al 1990 Med. Phys. 17 1032-40)

Fractionated total body irradiation and autologous bone marrow transplantation in dogs: Hemopoietic recovery after various marrow cell doses

International Nuclear Information System (INIS)

Bodenburger, U.; Kolb, H.J.; Thierfelder, S.; Netzel, B.; Schaeffer, E.; Kolb, H.

1980-01-01

Hemopoietic recovery was studied in dogs given 2400 R fractionated total body irradiation within one week and graded doses of cryopreserved autologous bone marrow. Complete hemopoietic recovery including histology was observed after this dose and sufficient doses of marrow cells. Doses of more than 5.5 x 10 7 mononuclear marrow cells/kg body weight were sufficient for complete recovery in all dogs, 1.5 to 5.5 x 10 7 cells/kg were effective in some of the dogs and less than 1.5 x 10 7 cells/kg were insufficient for complete recovery. Similarly, more than 30000 CFUsub(c)/kg body weight were required for hemopoietic recovery. The optimal marrow cell dose which has been defined as the minimal dose required for the earliest possible recovery of leukocyte and platelet counts was 7-8 x 10 7 mononuclear marrow cells/kg body weight. It has been concluded that fractionated total body irradiation with 2400 R dose not require greater doses of marrow cells for hemopoietic reconstitution than lower single doses and that the hemopoietic microenvironment is not persistently disturbed after this dose. (author)

Modelling normal tissue isoeffect distribution in conformal radiotherapy of glioblastoma provides an alternative dose escalation pattern through hypofractionation without reducing the total dose

International Nuclear Information System (INIS)

Mangel, L.; Skriba, Z.; Major, T.; Polgar, C.; Fodor, J.; Somogyi, A.; Nemeth, G.

2002-01-01

The purpose of this study was to prove that by using conformal external beam radiotherapy (RT) normal brain structures can be protected even when applying an alternative approach of biological dose escalation: hypofractionation (HOF) without total dose reduction (TDR). Traditional 2-dimensional (2D) and conformal 3-dimensional (3D) treatment plans were prepared for 10 gliomas representing the subanatomical sites of the supratentorial brain. Isoeffect distributions were generated by the biologically effective dose (BED) formula to analyse the effect of conventionally fractionated (CF) and HOF schedules on both the spatial biological dose distribution and biological dose-volume histograms. A comparison was made between 2D-CF (2.0 Gy/day) and 3D-HOF (2.5 Gy/day) regimens, applying the same 60 Gy total doses. Integral biologically effective dose (IBED) and volumes received biologically equivalent to a dose of 54 Gy or more (V-BED54) were calculated for the lower and upper brain stem as organs of risk. The IBED values were lower with the 3D-HOF than with the 2D-CF schedule in each tumour location, means 22.7±17.1 and 40.4±16.9 in Gy, respectively (p<0.0001). The V-BED54 values were also smaller or equal in 90% of the cases favouring the 3D-HOF scheme. The means were 2.7±4.8 ccm for 3D-HOF and 10.7±12.7 ccm for 2D-CF (p=0.0006). Our results suggest that with conformal RT, fraction size can gradually be increased. HOF radiotherapy regimens without TDR shorten the treatment time and seem to be an alternative way of dose escalation in the treatment of glioblastoma

Modelling normal tissue isoeffect distribution in conformal radiotherapy of glioblastoma provides an alternative dose escalation pattern through hypofractionation without reducing the total dose

Energy Technology Data Exchange (ETDEWEB)

Mangel, L.; Skriba, Z.; Major, T.; Polgar, C.; Fodor, J.; Somogyi, A.; Nemeth, G. [National Research Inst. for Radiobiology and Radiohygiene, Budapest (Hungary)

2002-04-01

The purpose of this study was to prove that by using conformal external beam radiotherapy (RT) normal brain structures can be protected even when applying an alternative approach of biological dose escalation: hypofractionation (HOF) without total dose reduction (TDR). Traditional 2-dimensional (2D) and conformal 3-dimensional (3D) treatment plans were prepared for 10 gliomas representing the subanatomical sites of the supratentorial brain. Isoeffect distributions were generated by the biologically effective dose (BED) formula to analyse the effect of conventionally fractionated (CF) and HOF schedules on both the spatial biological dose distribution and biological dose-volume histograms. A comparison was made between 2D-CF (2.0 Gy/day) and 3D-HOF (2.5 Gy/day) regimens, applying the same 60 Gy total doses. Integral biologically effective dose (IBED) and volumes received biologically equivalent to a dose of 54 Gy or more (V-BED54) were calculated for the lower and upper brain stem as organs of risk. The IBED values were lower with the 3D-HOF than with the 2D-CF schedule in each tumour location, means 22.7{+-}17.1 and 40.4{+-}16.9 in Gy, respectively (p<0.0001). The V-BED54 values were also smaller or equal in 90% of the cases favouring the 3D-HOF scheme. The means were 2.7{+-}4.8 ccm for 3D-HOF and 10.7{+-}12.7 ccm for 2D-CF (p=0.0006). Our results suggest that with conformal RT, fraction size can gradually be increased. HOF radiotherapy regimens without TDR shorten the treatment time and seem to be an alternative way of dose escalation in the treatment of glioblastoma.

Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

Science.gov (United States)

Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

2014-01-01

Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

Relative effect of radiation dose rate on hemopoietic and nonhemopoietic lethality of total-body irradiation

International Nuclear Information System (INIS)

Peters, L.J.; McNeill, J.; Karolis, C.; Thames, H.D. Jr.; Travis, E.L.

1986-01-01

Experiments were undertaken to determine the influence of dose rate on the toxicity of total-body irrdiation (TBI) with and without syngeneic bone-marrow rescue in mice. The results showed a much greater dose-rate dependence for death from nonhemopoietic toxicity than from bone-marrow ablation, with the ratio of LD 50 's increasing from 1.73 at 25 cGy/min to 2.80 at 1 cGy/min. At the higher dose rates, dose-limiting nonhemopoietic toxicity resulted from late organ injury, affecting the lungs, kidneys, and liver. At 1 cGy/min the major dose-limiting nonhemopoietic toxicity was acute gastrointestinal injury. The implications of these results in the context of TBI in preparation for bone-marrow transplantation are discussed. 15 refs., 4 figs

Dose characteristics of total-skin electron-beam irradiation with six-dual electron fields

International Nuclear Information System (INIS)

Choi, Tae Jin; Kim, Jin Hee; Kim, Ok Bae

1998-01-01

To obtain the uniform dose at limited depth to entire surface of the body, the dose characteristics of degraded electron beam of the large target-skin distance and the dose distribution of the six-dual electron fields were investigated. The experimental dose distributions included the depth dose curve, spatial dose and attenuated electron beam were determined with 300 cm of Target-Skin Distance (TSD) and full collimator size (35x35 cm 2 on TSD 100 cm) in 4 MeV electron beam energy. Actual collimated field size of 105 cmx105 cm at the distance of 300 cm could include entire hemibody. A patient was standing on step board with hands up and holding the pole to stabilize his/her positions for the six-dual fields technique. As a scatter-degrader, 0.5 cm of acrylic plate was inserted at 20 cm from the body surface on the electron beam path to induce ray scattering and to increase the skin dose. The Full Width at Half Maximum(FWHM) of dose profile was 130 cm in large field of 105x105 cm 2 . The width of 100±10% of the resultant dose from two adjacent fields which were separated at 25 cm from field edge for obtaining the dose uniformity was extended to 186 cm. The depth of maximum dose lies at 5 mm and the 80% depth dose lies between 7 and 8 mm for the degraded electron beam by using the 0.5 cm thickness of acrylic absorber. Total skin electron beam irradiation (TSEBI) was carried out using the six dual fields has been developed at Stanford University. The dose distribution in TSEBI showed relatively uniform around the flat region of skin except the protruding and deeply curvatured portion of the body, which showed excess of dose at the former and less dose at the latter. The percent depth dose, profile curves and superimposed dose distribution were investigated using the degraded using the degraded electron beam through the beam absorber. The dose distribution obtained by experiments of TSEBI showed within±10% difference excepts the protruding area of skin which needs a

Composite depth dose measurement for total skin electron (TSE) treatments using radiochromic film

International Nuclear Information System (INIS)

Gamble, Lisa M; Farrell, Thomas J; Jones, Glenn W; Hayward, Joseph E

2003-01-01

Total skin electron (TSE) radiotherapy is routinely used to treat cutaneous T-cell lymphomas and can be implemented using a modified Stanford technique. In our centre, the composite depth dose for this technique is achieved by a combination of two patient positions per day over a three-day cycle, and two gantry angles per patient position. Due to patient morphology, underdosed regions typically occur and have historically been measured using multiple thermoluminescent dosimeters (TLDs). We show that radiochromic film can be used as a two-dimensional relative dosimeter to measure the percent depth dose in TSE radiotherapy. Composite depth dose curves were measured in a cylindrical, polystyrene phantom and compared with TLD data. Both multiple films (1 film per day) and a single film were used in order to reproduce a realistic clinical scenario. First, three individual films were used to measure the depth dose, one per treatment day, and then compared with TLD data; this comparison showed a reasonable agreement. Secondly, a single film was used to measure the dose delivered over three daily treatments and then compared with TLD data; this comparison showed good agreement throughout the depth dose, which includes doses well below 1 Gy. It will be shown that one piece of radiochromic film is sufficient to measure the composite percent depth dose for a TSE beam, hence making radiochromic film a suitable candidate for monitoring underdosed patient regions

Clinical application of a OneDose(TM) MOSFET for skin dose measurements during internal mammary chain irradiation with high dose rate brachytherapy in carcinoma of the breast

International Nuclear Information System (INIS)

Kinhikar, Rajesh A; Sharma, Pramod K; Tambe, Chandrashekhar M; Mahantshetty, Umesh M; Sarin, Rajiv; Deshpande, Deepak D; Shrivastava, Shyam K

2006-01-01

In our earlier study, we experimentally evaluated the characteristics of a newly designed metal oxide semiconductor field effect transistor (MOSFET) OneDose(TM) in-vivo dosimetry system for Ir-192 (380 keV) energy and the results were compared with thermoluminescent dosimeters (TLDs). We have now extended the same study to the clinical application of this MOSFET as an in-vivo dosimetry system. The MOSFET was used during high dose rate brachytherapy (HDRBT) of internal mammary chain (IMC) irradiation for a carcinoma of the breast. The aim of this study was to measure the skin dose during IMC irradiation with a MOSFET and a TLD and compare it with the calculated dose with a treatment planning system (TPS). The skin dose was measured for ten patients. All the patients' treatment was planned on a PLATO treatment planning system. TLD measurements were performed to compare the accuracy of the measured results from the MOSFET. The mean doses measured with the MOSFET and the TLD were identical (0.5392 Gy, 15.85% of the prescribed dose). The mean dose was overestimated by the TPS and was 0.5923 Gy (17.42% of the prescribed dose). The TPS overestimated the skin dose by 9% as verified by the MOSFET and TLD. The MOSFET provides adequate in-vivo dosimetry for HDRBT. Immediate readout after irradiation, small size, permanent storage of dose and ease of use make the MOSFET a viable alternative for TLDs. (note)

Advances in the implementation of helical tomotherapy-based total marrow irradiation with a novel field junction technique

Energy Technology Data Exchange (ETDEWEB)

Zeverino, Michele, E-mail: michele.zeverino@istge.it [Medical Physics Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy); Agostinelli, Stefano; Taccini, Gianni; Cavagnetto, Francesca; Garelli, Stefania; Gusinu, Marco [Medical Physics Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy); Vagge, Stefano; Barra, Salvina; Corvo, Renzo [Radiation Oncology Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy)

2012-10-01

Given the limitations in the travel ability of the helical tomotherapy (HT) couch, total marrow irradiation (TMI) has to be split in 2 segments, with the lower limbs treated with feet first orientation. The aim of this work is to present a planning technique useful to reduce the dose inhomogeneity resulting from the matching of the 2 helical dose distributions. Three HT plans were generated for each of the 18 patients enrolled. Upper TMI (UTMI) and lower TMI (LTMI) were planned onto the whole-body computed tomography (CT) and on the lower-limb CT, respectively. A twin lower TMI plan (tLTMI) was designed on the whole-body CT. Agreement between LTMI and tLTMI plans was assessed by computing for each dose-volume histogram (DVH) structure the {gamma} index scored with 1% of dose and volume difference thresholds. UTMI and tLTMI plans were summed together on the whole-body CT, enabling the evaluation of dose inhomogeneity. Moreover, a couple of transition volumes were used to improve the dose uniformity in the abutment region. For every DVH, a number of points >99% passed the {gamma} analysis, validating the method used to generate the twin plan. The planned dose inhomogeneity at the junction level resulted within {+-}10% of the prescribed dose. Median dose reduction to organs at risk ranged from 30-80% of the prescribed dose. Mean conformity index was 1.41 (range 1.36-1.44) for the whole-body target. The technique provided a 'full helical' dose distribution for TMI treatments, which can be considered effective only if the dose agreement between LTMI and tLTMI plans is met. The planning of TMI with HT for the whole body with adequate dose homogeneity and conformity was shown to be feasible.

Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".

Science.gov (United States)

Charani, E; Castro-Sanchez, E; Sevdalis, N; Kyratsis, Y; Drumright, L; Shah, N; Holmes, A

2013-07-01

There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of "noninterference" in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a "prescribing etiquette," which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

Science.gov (United States)

Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

2018-01-01

Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

In vivo dosimetry with silicon diodes in total body irradiation

International Nuclear Information System (INIS)

Oliveira, F.F.; Amaral, L.L.; Costa, A.M.; Netto, T.G.

2014-01-01

The aim of this work is the characterization and application of silicon diode detectors for in vivo dosimetry in total body irradiation (TBI) treatments. It was evaluated the diode response with temperature, dose rate, gantry angulations and field size. A maximum response variation of 2.2% was obtained for temperature dependence. The response variation for dose rate and angular was within 1.2%. For field size dependence, the detector response increased with field until reach a saturation region, where no more primary radiation beam contributes for dose. The calibration was performed in a TBI setup. Different lateral thicknesses from one patient were simulated and then the calibration factors were determined by means of maximum depth dose readings. Subsequent to calibration, in vivo dosimetry measurements were performed. The response difference between diode readings and the prescribed dose for all treatments was below 4%. This difference is in agreement as recommended by the International Commission on Radiation Units and Measurements (ICRU), which is ±5%. The present work to test the applicability of a silicon diode dosimetry system for performing in vivo dose measurements in TBI techniques presented good results. These measurements demonstrated the value of diode dosimetry as a treatment verification method and its applicability as a part of a quality assurance program in TBI treatments. - Highlights: ► Characterization of a silicon diode dosimetry system. ► Application of the diodes for in vivo dosimetry in total body irradiation treatments. ► Implementation of in vivo dosimetry as a part of a quality assurance program in radiotherapy

Tumor Volume-Adapted Dosing in Stereotactic Ablative Radiotherapy of Lung Tumors

Energy Technology Data Exchange (ETDEWEB)

Trakul, Nicholas; Chang, Christine N.; Harris, Jeremy [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Chapman, Christopher [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of Michigan School of Medicine, Ann Arbor, MI (United States); Rao, Aarti [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Davis, School of Medicine, Davis, CA (United States); Shen, John [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Irvine, School of Medicine, Irvine, CA (United States); Quinlan-Davidson, Sean [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario (Canada); Filion, Edith J. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Departement de Medecine, Service de Radio-Oncologie, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Wakelee, Heather A.; Colevas, A. Dimitrios [Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); Whyte, Richard I. [Department of Cardiothoracic Surgery, Division of General Thoracic Surgery, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); and others

2012-09-01

Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18-25 Gy) (Group 1), and larger tumors (gross tumor volume {>=}12 mL) received multifraction regimens with BED {>=}100 Gy (total dose, 50-60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

Association between Pre-Operative Cefazolin Dose and Surgical Site Infection in Obese Patients.

Science.gov (United States)

Peppard, William J; Eberle, David G; Kugler, Nathan W; Mabrey, Danielle M; Weigelt, John A

A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI). We conducted a retrospective review of adult patients ≥100 kg who were prescribed cefazolin as surgical prophylaxis between September 1, 2012 and May 31, 2013 at an academic medical center. Patients were excluded if cefazolin was prescribed but not administered, had a known infection at the site of surgery, or inappropriately received cefazolin prophylaxis based on surgical indication. The SSIs were identified by documentation of SSI in the medical record or findings consistent with the standard Centers for Disease Control and Prevention definition. Inpatient and outpatient records up to 90 days post-operative were reviewed for delayed SSI. Four hundred eighty-three surgical cases were identified in which pre-operative cefazolin was prescribed. Forty-seven patients were excluded leaving a total of 436 patients for final analysis: 152 in the cefazolin two gram group and 284 in the three gram group. Baseline demographics were similar between groups with a mean follow-up duration of 77 days for both groups. Unadjusted SSI rates were 7.2% and 7.4% (odds ratio [OR] 0.98, p = 0.95), for the two gram and three gram groups, respectively. When differences in follow-up between groups were considered and logistic regression was adjusted with propensity score, there remained no difference in SSI rates (OR 0.87, 95% confidence interval 0.36-2.06, p = 0.77). In otherwise similar obese surgical patients weighing ≥100 kg, the administration of a pre-operative cefazolin two gram dose is

Failure-probability driven dose painting

International Nuclear Information System (INIS)

Vogelius, Ivan R.; Håkansson, Katrin; Due, Anne K.; Aznar, Marianne C.; Kristensen, Claus A.; Rasmussen, Jacob; Specht, Lena; Berthelsen, Anne K.; Bentzen, Søren M.

2013-01-01

Purpose: To demonstrate a data-driven dose-painting strategy based on the spatial distribution of recurrences in previously treated patients. The result is a quantitative way to define a dose prescription function, optimizing the predicted local control at constant treatment intensity. A dose planning study using the optimized dose prescription in 20 patients is performed.Methods: Patients treated at our center have five tumor subvolumes from the center of the tumor (PET positive volume) and out delineated. The spatial distribution of 48 failures in patients with complete clinical response after (chemo)radiation is used to derive a model for tumor control probability (TCP). The total TCP is fixed to the clinically observed 70% actuarial TCP at five years. Additionally, the authors match the distribution of failures between the five subvolumes to the observed distribution. The steepness of the dose–response is extracted from the literature and the authors assume 30% and 20% risk of subclinical involvement in the elective volumes. The result is a five-compartment dose response model matching the observed distribution of failures. The model is used to optimize the distribution of dose in individual patients, while keeping the treatment intensity constant and the maximum prescribed dose below 85 Gy.Results: The vast majority of failures occur centrally despite the small volumes of the central regions. Thus, optimizing the dose prescription yields higher doses to the central target volumes and lower doses to the elective volumes. The dose planning study shows that the modified prescription is clinically feasible. The optimized TCP is 89% (range: 82%–91%) as compared to the observed TCP of 70%.Conclusions: The observed distribution of locoregional failures was used to derive an objective, data-driven dose prescription function. The optimized dose is predicted to result in a substantial increase in local control without increasing the predicted risk of toxicity

The differences in the incidence of diabetes mellitus and prediabetes according to the type of HMG-CoA reductase inhibitors prescribed in Korean patients.

Science.gov (United States)

Kim, Tong Min; Kim, Hyunah; Jeong, Yoo Jin; Baik, Sun Jung; Yang, So Jung; Lee, Seung-Hwan; Cho, Jae-Hyoung; Lee, Hyunyong; Yim, Hyeon Woo; Choi, In Young; Yoon, Kun-Ho; Kim, Hun-Sung

2017-10-01

Very few studies conducted in Korea have investigated the relationship between statins and the incidence of diabetes. Therefore, we analyzed the progression from normal blood glucose to prediabetes and then to diabetes mellitus (DM) according to the type, intensity, and dose of statin prescribed. Data of patients who were first prescribed statins between 2009 and 2011 were extracted from electronic medical records. Patients with normal blood glucose or prediabetes were observed for 4 years after initiation of statin therapy. A total of 2890 patients were included in our study and analyzed on the basis of the first statin they were prescribed. The incidence rate of DM in patients with prediabetes was 1.72 times that of patients with normal glucose levels (odds ratio = 1.72, 95% confidence interval = 1.41-2.10, P prediabetes, the incidence rate of prediabetes was significantly lower in patients prescribed pitavastatin (odds ratio = 0.62, 95% confidence interval = 0.40-0.96, P = .031) compared to that in patients prescribed atorvastatin. Regarding the progression from normal blood glucose or prediabetes to DM, there were no significant differences among all statins. Lower DM incidence in patients prescribed pitavastatin appears to be primarily because of the lower rate of progression from normal blood glucose to prediabetes. These findings indicate that avoiding statins because of DM risk is unjustified and that clinicians should prescribe statins from the appropriate potency group. Copyright © 2017 John Wiley & Sons, Ltd.

Monte-Carlo Method Python Library for dose distribution Calculation in Brachytherapy

Energy Technology Data Exchange (ETDEWEB)

Randriantsizafy, R D; Ramanandraibe, M J [Madagascar Institut National des Sciences et Techniques Nucleaires, Antananarivo (Madagascar); Raboanary, R [Institut of astro and High-Energy Physics Madagascar, University of Antananarivo, Antananarivo (Madagascar)

2007-07-01

The Cs-137 Brachytherapy treatment is performed in Madagascar since 2005. Time treatment calculation for prescribed dose is made manually. Monte-Carlo Method Python library written at Madagascar INSTN is experimentally used to calculate the dose distribution on the tumour and around it. The first validation of the code was done by comparing the library curves with the Nucletron company curves. To reduce the duration of the calculation, a Grid of PC's is set up with listner patch run on each PC. The library will be used to modelize the dose distribution in the CT scan patient picture for individual and better accuracy time calculation for a prescribed dose.

Monte-Carlo Method Python Library for dose distribution Calculation in Brachytherapy

International Nuclear Information System (INIS)

Randriantsizafy, R.D.; Ramanandraibe, M.J.; Raboanary, R.

2007-01-01

The Cs-137 Brachytherapy treatment is performed in Madagascar since 2005. Time treatment calculation for prescribed dose is made manually. Monte-Carlo Method Python library written at Madagascar INSTN is experimentally used to calculate the dose distribution on the tumour and around it. The first validation of the code was done by comparing the library curves with the Nucletron company curves. To reduce the duration of the calculation, a Grid of PC's is set up with listner patch run on each PC. The library will be used to modelize the dose distribution in the CT scan patient picture for individual and better accuracy time calculation for a prescribed dose.

SU-E-J-174: Adaptive PET-Based Dose Painting with Tomotherapy

International Nuclear Information System (INIS)

Darwish, N; Mackie, T; Thomadsen, B

2014-01-01

Purpose: PET imaging can be converted into dose prescription directly. Due to the variability of the intensity of PET the image, PET prescription maybe superior over uniform dose prescription. Furthermore, unlike the case in image reconstruction of not knowing the image solution in advance, the prescribed dose is known from a PET image a priori. Therefore, optimum beam orientations are derivable. Methods: We can assume the PET image to be the prescribed dose and invert it to determine the energy fluence. The same method used to reconstruct tissue images from projections could be used to solve the inverse problem of determining beam orientations and modulation patterns from a dose prescription [10]. Unlike standard tomographic reconstruction of images from measured projection profiles, the inversion of the prescribed dose results in photon fluence which may be negative and therefore unphysical. Two-dimensional modulated beams can be modelled in terms of the attenuated or exponential radon transform of the prescribed dose function (assumed to be the PET image in this case), an application of a Ram-Lak filter, and inversion by backprojection. Unlike the case in PET processing, however, the filtered beam obtained from the inversion represents a physical photon fluence. Therefore, a positivity constraint for the fluence (setting negative fluence to zero) must be applied (Brahme et al 1982, Bortfeld et al 1990) Results: Truncating the negative profiles from the PET data results in an approximation of the derivable energy fluence. Backprojection of the deliverable fluence is an approximation of the dose delivered. The deliverable dose is comparable to the original PET image and is similar to the PET image. Conclusion: It is possible to use the PET data or image as a direct indicator of deliverable fluence for cylindrical radiotherapy systems such as TomoTherapy

Three-dimensional Finite Elements Method simulation of Total Ionizing Dose in 22 nm bulk nFinFETs

Energy Technology Data Exchange (ETDEWEB)

Chatzikyriakou, Eleni, E-mail: ec3g12@soton.ac.uk; Potter, Kenneth; Redman-White, William; De Groot, C.H.

2017-02-15

Highlights: • Simulation of Total Ionizing Dose using the Finite Elements Method. • Carrier generation, transport and trapping in the oxide. • Application in three-dimensional bulk FinFET model of 22 nm node. • Examination of trapped charge in the Shallow Trench Isolation. • Trapped charge dependency of parasitic transistor current. - Abstract: Finite Elements Method simulation of Total Ionizing Dose effects on 22 nm bulk Fin Field Effect Transistor (FinFET) devices using the commercial software Synopsys Sentaurus TCAD is presented. The simulation parameters are extracted by calibrating the charge trapping model to experimental results on 400 nm SiO{sub 2} capacitors irradiated under zero bias. The FinFET device characteristics are calibrated to the Intel 22 nm bulk technology. Irradiation simulations of the transistor performed with all terminals unbiased reveal increased hardness up to a total dose of 1 MRad(SiO{sub 2}).

Prescribed burning supports grassland biodiversity - A multi-species study

Science.gov (United States)

Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

2017-04-01

During ancient times, fire was an important factor shaping European landscapes. Nowadays, prescribed burning can be one of the most effective conservation tools for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. In a prescribed burning experiment, we studied the effects of fire on dry alkaline grasslands. We tested whether autumn prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in Hungary: in three sites, prescribed burning was applied in November 2011, while three sites remained unburnt. We studied the effects of fire on soil characteristics, plant biomass and on the vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soluble salt content increased significantly in the burnt sites, but soil pH, organic matter, potassium and phosphorous did not change. We found that prescribed fire had several positive effects from the nature conservation viewpoint. Diversity and the number of flowering shoots were higher, and the cover of the dominant grass was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control ones. Our findings suggest that prescribed burning fire did not harm arthropods; species-level analyses showed that out of the most abundant invertebrate species, the abundance of ten was not affected, one decreased and one increased after burning. Our findings highlight that mosaic prescribed fire is a viable management tool in open landscapes, because it supports plant diversity and does not threaten arthropods.

Learning from prescribing errors

OpenAIRE

Dean, B

2002-01-01



 The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...

The effect of electronic medical record system use on communication between pharmacists and prescribers.

Science.gov (United States)

Singer, Alexander; Duarte Fernandez, Roberto

2015-10-28

The Electronic Medical Record (EMR) is becoming increasingly common in health care settings. Research shows that EMRs have the potential to reduce instances of medication errors and improve communication between pharmacists and prescribers; however, more research is required to demonstrate whether this is true. This study aims to determine the effect of a newly implemented EMR system on communication between pharmacists and primary care clinicians. A retrospective chart analysis of primary care EMR data comparing faxed pharmacy communications captured before and after the implementation of an EMR system at an academic family medicine clinic. Communication requests were classified into the following various categories: refill accepted, refill denied, clarification, incorrect dose, interaction, drug insurance/coverage application, new prescription request, supplies request, continued care information, duplicate fax substitution, opioid early release request, confirmation by phone call, and other. The number and percentage of clarification requests, interaction notifications, and incorrect dose notifications were lower after the implementation of the EMR system. The number and percentage of refills accepted and new prescription requests increased after the implementation of the EMR system. The implementation of an EMR in an academic family medicine clinic had a significant effect on the volume of communication between pharmacists and prescribers. The amount of clarification requests and incorrect dosing communications decreased after EMR implementation. This suggests that EMRs improve prescribing safety. The increased amount of refills accepted and new prescription requests post EMR implementation suggests that the EMR is capable of changing prescription patterns.

South African medical students’ perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers?

Directory of Open Access Journals (Sweden)

Sean Wasserman,

2017-05-01

Full Text Available Background. Education of medical students has been identified by the World Health Organization as an important aspect of antibiotic resistance (ABR containment. Surveys from high-income countries consistently reveal that medical students recognise the importance of antibiotic prescribing knowledge, but feel inadequately prepared and require more education on how to make antibiotic choices. The attitudes and knowledge of South African (SA medical students regarding ABR and antibiotic prescribing have never been evaluated. Objective. To evaluate SA medical students’ perceptions, attitudes and knowledge about antibiotic use and resistance, and the perceived quality of education relating to antibiotics and infection. Methods. This was a cross-sectional survey of final-year students at three medical schools, using a 26-item self-administered questionnaire. The questionnaires recorded basic demographic information, perceptions about antibiotic use and ABR, sources, quality, and usefulness of current education about antibiotic use, and questions to evaluate knowledge. Hard-copy surveys were administered during whole-class lectures. Results. A total of 289 of 567 (51% students completed the survey. Ninety-two percent agreed that antibiotics are overused and 87% agreed that resistance is a significant problem in SA – higher proportions than those who thought that antibiotic overuse (63% and resistance (61% are problems in the hospitals where they had worked (p<0.001. Most reported that they would appreciate more education on appropriate use of antibiotics (95%. Only 33% felt confident to prescribe antibiotics, with similar proportions across institutions. Overall, prescribing confidence was associated with the use of antibiotic prescribing guidelines (p=0.003, familiarity with antibiotic stewardship (p=0.012, and more frequent contact with infectious diseases specialists (p<0.001. There was an overall mean correct score of 50% on the knowledge

Dose compensation of the total body irradiation therapy

International Nuclear Information System (INIS)

Lin, J.-P.; Chu, T.-C.; Liu, M.-T.

2001-01-01

The aim of the study is to improve dose uniformity in the body by the compensator-rice and to decrease the dose to the lung by the partial lung block. Rando phantom supine was set up to treat bilateral fields with a 15 MV linear accelerator at 415 cm treatment distance. The experimental procedure included three parts. The first part was the bilateral irradiation without rice compensator, and the second part was with rice compensator. In the third part, rice compensator and partial lung block were both used. The results of thermoluminescent dosimeters measurements indicated that without rice compensator the dose was non-uniform. Contrarily, the average dose homogeneity with rice compensator was measured within ±5%, except for the thorax region. Partial lung block can reduce the dose which the lung received. This is a simple method to improve the dose homogeneity and to reduce the lung dose received. The compensator-rice is cheap, and acrylic boxes are easy to obtain. Therefore, this technique is suitable for more studies

Patient-controlled oral analgesia for postoperative pain management following total knee replacement.

Science.gov (United States)

Kastanias, Patti; Gowans, Sue; Tumber, Paul S; Snaith, Kianda; Robinson, Sandra

2010-01-01

To investigate whether patient-controlled oral analgesia (PCOA) used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN)-administered oral analgesia. Patients who underwent an elective total knee replacement at a quaternary care centre (Toronto Western Hospital, Toronto, Ontario) were randomly assigned to either PCOA or RN-administered short-acting oral opioids on postoperative day 2. Subjects in the RN group called the RN to receive their prescribed short-acting opioid. Subjects in the PCOA group kept a single dose of their prescribed oral opioid at their bedside and took this dose when they felt they needed it, to a maximum of one dose every 2 h. Study outcomes, collected on postoperative day 2, included pain (measured by the Brief Pain Inventory - Short Form), patient satisfaction (measured by the Pain Outcome Questionnaire Satisfaction subscale - component II), opioid use (oral morphine equivalents), opioid side effects (nausea, pruritus and/or constipation) and knee measures (maximum passive knee flexion and pain at maximum passive knee flexion, performed on the operative knee). Study outcomes were analyzed twice. First, for a subset of 73 subjects who remained in their randomly assigned group (PCOA group, n=36; RN group, n=37), randomized analyses were performed. Second, for the larger sample of 88 subjects who were categorized by their actual method of receiving oral opioids (PCOA group, n=41; RN group, n=47), as-treated analyses were performed. There were no differences in study outcomes between the PCOA and RN groups in either analysis. PCOA was not superior to RN administration on study outcomes. However, PCOA did not increase opioid use or pain. PCOA remains an important element in the patient-centred care facility.

Dental students′ compliance with antibiotic prescribing guidelines for dental infections in children

Directory of Open Access Journals (Sweden)

Yee Chen Wong

2016-01-01

Full Text Available Context: To investigate the antibiotic prescribing training received by dental students, clinical experience in treating child patients, awareness of antibiotic prescribing guidelines, preparedness in antibiotic prescribing, and compliance with antibiotic prescribing guidelines for the management of dental infections in children. Methods: This was a cross-sectional study involving final year dentals students from Malaysian and Asian dental schools. A self-administered questionnaire consisting of five clinical case scenarios was e-mailed to all final year students at selected dental schools. Students′ responses were compared for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association. Compliance in each scenario was tested for association with their preparedness in antibiotic prescribing, previous training on antibiotic prescribing and awareness of antibiotic prescribing guidelines using Chi-square test. Data collected were analyzed using SPSS statistics version 20. Results: A total of 108 completed responses were received. About 74 (69% students were from Malaysian dental schools. The compliance rate with prescribing guidelines ranged from 15.7% to 43.5%. Those attending Malaysian dental schools (47.3% and those who had treated child patient more often (46.3% were more likely (P < 0.05 to be aware of the guidelines. Those who had received antibiotic prescribing training (21.3% were more likely to think they were well prepared in antibiotic prescribing (P < 0.05. Conclusions: Final year dental students had low awareness and compliance with antibiotic prescribing guidelines. Further research is needed to investigate how compliance with the guidelines may be enhanced.

Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy.

Science.gov (United States)

Blumenthal, Kimberly G; Shenoy, Erica S; Varughese, Christy A; Hurwitz, Shelley; Hooper, David C; Banerji, Aleena

2015-10-01

Self-reported penicillin allergy infrequently reflects an inability to tolerate penicillins. Inpatients reporting penicillin allergy receive alternative antibiotics that might be broader spectrum, more toxic, or less effective. To develop and assess a clinical guideline for the general inpatient provider that directs taking a history and prescribing antibiotics for patients with penicillin or cephalosporin allergy. A guideline was implemented to assist providers with assessing allergy history and prescribing antibiotics for patients with reported penicillin or cephalosporin allergy. The guideline used a standard 2-step graded challenge or test dose. A quasi-experimental study was performed to assess safety, feasibility, and impact on antibiotic use by comparing treatment 21 months before guideline implementation with 12 months after guideline implementation. Significantly more test doses to β-lactam antibiotics were performed monthly after vs before guideline implementation (median 14.5, interquartile range 13-16.25, vs 2, interquartile range 1-3.25, P  .5) between periods. Guideline-driven test doses decreased alternative antimicrobial therapy after the test dose, including vancomycin (68.3% vs 37.2%, P penicillin or cephalosporin allergy was associated with an almost 7-fold increase in the number of test doses to β-lactams without increased adverse drug reactions. Patients assessed with guideline-driven test doses were observed to have significantly decreased alternative antibiotic exposure. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

[Temporary recommendation for use on off-label baclofen: viewpoint of Prescribers of the CAMTEA system].

Science.gov (United States)

Rolland, Benjamin; Deheul, Sylvie; Danel, Thierry; Bence, Camille; Blanquart, Marie-Christine; Bonord, Alexandre; Semal, Robin; Briand, Thierry; Sochala, Michel; Dubocage, Christelle; Dupriez, François; Duquesne, Damien; Gibour, Bernard; Loosfeld, Xavier; Henebelle, Dorothée; Henon, Michael; Vernalde, Elodie; Matton, Christian; Bacquet, Jean-Eudes; Molmy, Lucie; Sarasy, François; Simioni, Nicolas; Richez, Cécile; Gentil-Spinosi, Laure; Vosgien, Véronique; Yguel, Jacques; Ledent, Thierry; Auffret, Marine; Wilquin, Maroussia; Ziolkowski, Danièle; Sochala, Michel; Gautier, Sophie; Bordet, Régis; Cottencin, Olivier

2015-01-01

The use of high dose baclofen for alcohol-dependence emerged in France from 2008 based on empirical findings, and is still off-label. However, due to the rapid increase in this prescribing practice, the French health authorities have decided to frame it using an extraordinary regulatory measure named "temporary recommendation for use" (TRU). Baclofen prescribers from CAMTEA, a regional team-based off-label system for supervising baclofen prescribing, which was developed much prior to the TRU, discuss herein the pros and cons of this measure and the applicability of its different aspects in the daily clinical practice. © 2014 Société Française de Pharmacologie et de Thérapeutique.

Design of spray dried insulin microparticles to bypass deposition in the extrathoracic region and maximize total lung dose.

Science.gov (United States)

Ung, Keith T; Rao, Nagaraja; Weers, Jeffry G; Huang, Daniel; Chan, Hak-Kim

2016-09-25

Inhaled drugs all too often deliver only a fraction of the emitted dose to the target lung site due to deposition in the extrathoracic region (i.e., mouth and throat), which can lead to increased variation in lung exposure, and in some instances increases in local and systemic side effects. For aerosol medications, improved targeting to the lungs may be achieved by tailoring the micromeritic properties of the particles (e.g., size, density, rugosity) to minimize deposition in the mouth-throat and maximize the total lung dose. This study evaluated a co-solvent spray drying approach to modulate particle morphology and dose delivery characteristics of engineered powder formulations of insulin microparticles. The binary co-solvent system studied included water as the primary solvent mixed with an organic co-solvent, e.g., ethanol. Factors such as the relative rate of evaporation of each component of a binary co-solvent mixture, and insulin solubility in each component were considered in selecting feedstock compositions. A water-ethanol co-solvent mixture with a composition range considered suitable for modulating particle shell formation during drying was selected for experimental investigation. An Alberta Idealized Throat model was used to evaluate the in vitro total lung dose of a series of spray dried insulin formulations engineered with different bulk powder properties and delivered with two prototype inhalers that fluidize and disperse powder using different principles. The in vitro total lung dose of insulin microparticles was improved and favored for powders with low bulk density and small primary particle size, with reduction of deposition in the extrathoracic region. The results demonstrated that a total lung dose >95% of the delivered dose can be achieved with engineered particles, indicating a high degree of lung targeting, almost completely bypassing deposition in the mouth-throat. Copyright © 2016 Elsevier B.V. All rights reserved.

Total Skin Electron Beam Therapy in the Treatment of Mycosis Fungoides: A Review of Conventional and Low-Dose Regimens.

Science.gov (United States)

Chowdhary, Mudit; Chhabra, Arpit M; Kharod, Shivam; Marwaha, Gaurav

2016-12-01

Mycosis fungoides (MF) is the most prevalent subtype of cutaneous T-cell lymphoma, which is characterized by the proliferation of CD4 + T cells. While often an indolent disease, most patients eventually develop progression from isolated patches to tumors and finally nodal or visceral involvement. Treatment choice is largely based on disease burden, though prognostic factors such as disease stage, patient age, and extracutaneous involvement must be taken into consideration. Radiotherapy represents one of the most effective therapeutic modalities in the treatment of MF. Lymphocytes are exquisitely radiosensitive, and excellent responses are observed even with low doses of radiation. Total skin electron beam therapy (TSEBT) is a special technique that allows for the homogenous irradiation of the entire skin. There are well-documented radiation dose-response relationships for achieving a complete response. As such, TSEBT doses ≥ 30 Gy comprise the current standard of care. Although highly effective, most patients experience recurrent disease even after conventional-dose (≥ 30 Gy) TSEBT. In addition, toxicity is cumulatively dose dependent, and there is reluctance to administer multiple courses of conventional-dose TSEBT. Consequently, there has been renewed interest in determining the utility of TSEBT at lower total (≤ 30 Gy) doses. Advantages of low-total-dose (with standard dose per fraction) TSEBT include a shortened treatment course, the potential to minimize the risk of adverse events, and the opportunity to allow for retreatment in cases of disease recurrence. This comprehensive review compares the impact of different TSEBT dosing schemes on clinical outcomes of MF. Copyright © 2016 Elsevier Inc. All rights reserved.

Intralesional Versus Oral Chloroquine in Cutaneous Leishmaniasis: Comparison of Outcome, Duration of Treatment and Total Dose of Drug

International Nuclear Information System (INIS)

Hanif, M. M.; Akram, K.; Mustafa, G.

2016-01-01

Objective: To compare intralesional versus oral chloroquine in cutaneous leishmaniasis and determine the cure rate, duration of treatment, and total dose of drug. Study Design: Randomized controlled study. Place and Duration of Study: Department of Dermatology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2013 to June 2014. Methodology: Consecutive 86 patients of cutaneous leishmaniasis, with single to multiple lesions of various sizes were enrolled and divided randomly into group A and B for the purpose of intralesional and oral chloroquine administration, respectively to compare the effect of the two routes on duration of treatment and total dose of the drug. SPSS version 16 was used for data analysis after data entry into it. Quantitative variables like, duration, cost and total dose of treatment were calculated as mean and standard deviation and compared by using T-test. P-value of less than 0.05 was taken as significant. Results: Cure rate was 100% in both groups towards the end of treatment. Mean duration of treatment was 9.17 ± 3 weeks in intralesional (A) group as against 11.37 ± 3 weeks in oral (B) group (p = 0.0028). Mean total dose of the drug given to each patient in group A was 5.8 ± 0.5 gm and in group B, it was 19.2 ± 1.5 gm, which is significantly higher (p=0.001). The total cost of treatment in group A was Rs. 90 ± 8 and in group B it was Rs. 91 ± 1 (p=0.446). Conclusion: Duration of treatment is significantly shorter and total dose is lesser with intralesional compared to oral chloroquine in treatment of cutaneous leishmaniasis. (author)

A 5-year retrospective audit of prescribing by a critical care outreach team.

Science.gov (United States)

Wilson, Mark

2018-05-01

UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

Staff radiation doses during eight years in a nuclear medicine radiopharmacy

International Nuclear Information System (INIS)

Jansen, S.E.; Aswegen, A. van; Loetter, M.G.; Herbst, C.P.; Otto, A.C.; Orange Free State Univ., Bloemfontein

1994-01-01

Staff working in the radiopharmacy and nursing staff responsible for injecting radionuclides are being monitored constantly in our department. We report here on the effective doses and doses to the hands received by staff at two hospitals during 8 years from January 1985 to December 1992. In addition to the doses determined monthly by the South African Bureau of Standards' Radiation Protection Service (SABS), radiation doses received to the hands and whole body were measured every week using lithium fluoride thermoluminescent dosimetry (TLD). The highest total radiation dose received in any one year by any one person at hospital A was 233.53 mSv to the hands, and 10.20 mSv and 8.37 mSv to the whole body depending on the dosemeter used. The corresponding values for hospital B were 54.05 mSv to the hands and 6.94 mSv and 4.43 mSv to the whole body. If only one radiographer should do all the work calculated highest dose received would be 447.06 mSv to the hands and 9.68 mSv SABS effective dose. The radiation doses to staff were well within the limits prescribed. (Author)

Prescribing trends for dabigatran etexilate in primary care.

LENUS (Irish Health Repository)

McCullagh, L

2012-05-01

At the time of the analysis, dabigatran etexilate was licensed, in Ireland, for thromboprophylaxis in adults after elective total hip- and total knee-replacement only. A retrospective review (January 2010 to June 2011) of the National General Medical Services Prescription Database showed that 1929 patients had received prescriptions for dabigatran etexilate. Of these, 42% had received it for longer than the licensed maximum duration (at that time) of 35 days. The Eastern Health board dabigatran etexilate cohort (n = 510) was analysed further. Here 64.5% had received the drug for longer than 35 days. Seventy-six (32.5%) of the 234 patients who had received more than 90 days of dabigatran etexilate had concurrently received rate\\/rhythm control therapy. Likewise, 47 (31%) of the 152 patients who had received more than 180 days of dabigatran etexilate had been co-prescribed rate\\/rhythm control therapy. It is possible that dabigatran etexilate had been prescribed for stroke prevention in atrial fibrillation.

Recent Total Ionizing Dose and Displacement Damage Compendium of Candidate Electronics for NASA Space Systems

Science.gov (United States)

Cochran, Donna J.; Boutte, Alvin J.; Campola, Michael J.; Carts, Martin A.; Casey, Megan C.; Chen, Dakai; LaBel, Kenneth A.; Ladbury, Raymond L.; Lauenstein, Jean-Marie; Marshall, Cheryl J.;

Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

DEFF Research Database (Denmark)

Lunn, Troels; Kristensen, Billy Bjarne; Andersen, Lasse

2011-01-01

Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.......Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied....

Practices in prescribing protein substitutes for PKU in Europe

DEFF Research Database (Denmark)

Aguiar, A; Ahring, K; Almeida, M F

2015-01-01

BACKGROUND: There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS: A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein...

The effect of low-dose total body irradiation on tumor control

International Nuclear Information System (INIS)

Sakamoto, Kiyohiko; Miyamoto, Miyako; Watabe, Nobuyuki.

1987-01-01

Total body irradiation (TBI) is considered to bring about an immunosuppressive effect on an organism, on the basis of data obtained from sublethal doses of TBI. However, there are no data on how low-dose TBI affects an organism. Over the last five years, we have been studying the effects of low-dose TBI on normal or tumor-bearing mice and the immunological background of these effects. In experimental studies, an increase in the TD50 value (the number of cells required for a tumor incidence of 50 %) in mice exposed to 10 rad was recognized and showed a remarkable increase at 6 hours to 15 hours after irradiation. TBI of 10 rad also showed an enhancement effect on tumor cell killing when given 12 hours before local tumor irradiation. In order to clarify the mechanism of this kind of effect, some immunological studies were performed using several immunological procedures, and the results suggested that 10 rad of TBI caused increasing tumor immunity in irradiated mice. Clinical trials in some patients with advanced tumors are now being undertaken on the basis of these experimental data, and the effect of TBI on tumor control appears promising, although it is too early to draw conclusions. (author)

Improved consistency in dosing anti-tuberculosis drugs in Taipei, Taiwan.

Science.gov (United States)

Chiang, Chen-Yuan; Yu, Ming-Chih; Shih, Hsiu-Chen; Yen, Muh-Yong; Hsu, Yu-Ling; Yang, Shiang-Lin; Lin, Tao-Ping; Bai, Kuan-Jen

2012-01-01

It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007-2010 were investigated to assess whether interventions on dosing were effective. Lists of all notified culture positive TB cases in 2007-2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007-2010 (pTaipei City has remarkably improved after health authorities implemented a series of interventions.

Synergistic effects of total ionizing dose on single event upset sensitivity in static random access memory under proton irradiation

International Nuclear Information System (INIS)

Xiao Yao; Guo Hong-Xia; Zhang Feng-Qi; Zhao Wen; Wang Yan-Ping; Zhang Ke-Ying; Ding Li-Li; Luo Yin-Hong; Wang Yuan-Ming; Fan Xue

2014-01-01

Synergistic effects of the total ionizing dose (TID) on the single event upset (SEU) sensitivity in static random access memories (SRAMs) were studied by using protons. The total dose was cumulated with high flux protons during the TID exposure, and the SEU cross section was tested with low flux protons at several cumulated dose steps. Because of the radiation-induced off-state leakage current increase of the CMOS transistors, the noise margin became asymmetric and the memory imprint effect was observed. (interdisciplinary physics and related areas of science and technology)

Chinese Herbal Medicines – Comparison of Doses Prescribed in ...

African Journals Online (AJOL)

Huan Dong Lu, Beijing 100029, China. *For correspondence: Email: fuyanlingbucm@126.com; Tel: (+86) 10-6428-6307; Fax: (+86) 10-6422-0858 ... pharmacopoeia, accounting for 57.14 % (32/56). The top three factors influencing dose ... herbal combination, property of Chinese herbs, quality of medicinal, have a strong ...

Validation and dosimetric evaluation employing the techniques of TL and OSL of thermoluminescent materials for application in the dosimetry of clinical beams of electrons used in total irradiation of the skin - TSI

International Nuclear Information System (INIS)

Almeida, Shirlane Barbosa de

2017-01-01

In vivo dosimetry has become an important role for the treatment of total skin irradiation within a rigorous quality assurance program that should be an integral part of the radiotherapy departments. TSI dosimetry is difficult because of the complexity of the treatment in assessing dose uniformity and measuring the dose absorbed at shallow depths throughout the skin surface extent, resulting in a wide variation in dose distribution. The TLDs have proven to be very useful for the distribution and verification of the dose prescribed for the patient as the dose may differ from place to place due to patient body geometry, overlapping of structures and asymmetries of the radiation field. The use of TLDs in vivo can identify variations in the prescribed dose because its measurement accuracy and great precision. Several types of dosimeters have been used in the radiotherapy sectors, the most commonly used are Lithium Fluride (TLD-100), where it obtains a long history in this type of application. New dosimetric materials have gained great importance in the dosimetry of clinical electron beams, such as Dysprosium-doped Calcium Sulphate (TL) and Carbon doped (OSL) based Aluminum Oxide, This work evaluates the performance of the respective thermoluminescent dosimeters and the optically stimulated luminescence in the dosimetry of clinical electron beams used in total irradiation of the skin. (author)

Influence of Routine MV CBCT Usage on Dose Distribution in Pelvic Radiotherapy

International Nuclear Information System (INIS)

Faj, D.; Kasabasic, M.; Ivkovic, A.; Tomas, I.; Jurkovic, S.

2013-01-01

The pelvic radiotherapy is a standard treatment for patients with cervical, uterine and rectal carcinomas. During radiation treatment open tabletop device or bellyboard is used to reduce the side effects of healthy surrounding tissue. Patients are continually adjusting to the bellyboard during the treatment which causes geometrical and dosage uncertainties and influences the results of the treatment. Therefore, to reduce these uncertainties, megavoltage cone-beam computed tomography (MV CBCT) system is used. The objective of this research was to evaluate the image acquisition dose delivered to patients from MV CBCT. MV CBCT imaging was simulated on 15 patients using 3D treatment planning software XiO (CMS Inc., St. Louis, MO). The influence of the routine MV CBCT usage on treatment plan was investigated by analyzing the changes in dose volume histograms, mean values and maximum doses in the planning volumes. Simulations have shown that daily usage of MV CBCT causes differences in the dose volume histograms. Moreover, for every patient mean value exceeded prescribed tolerance (±1% of the prescribed dose) and maximum value exceeded recommended maximum of 107% of the prescribed dose. The results have shown that MV CBCT dose to the patient should be a part of the RT plan.(author)

Total-dose hardness assurance for low earth orbit

International Nuclear Information System (INIS)

Maurer, R.H.; Suter, J.J.

1987-01-01

The Low Earth Orbit radiation environment has two significant characteristics that make laboratory simulation exposures difficult: (1) a low dose rate and (2) many cycles of low dose accumulation followed by dose-free annealing. Hardness assurance considerations for this environment are discussed and related to data from the testing of Advanced Low Power Schottky and High-speed CMOS devices

Application of a Pelletron accelerator to study total dose radiation effects on 50 GHz SiGe HBTs

Energy Technology Data Exchange (ETDEWEB)

Praveen, K.C.; Pushpa, N.; Naik, P.S. [Department of Studies in Physics, University of Mysore, Manasagangotri, Mysore 570 006 (India); Cressler, John D. [School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA (United States); Tripathi, Ambuj [Inter University Accelerator Centre (IUAC), New Delhi 110 067 (India); Gnana Prakash, A.P., E-mail: gnanaprakash@physics.uni-mysore.ac.in [Department of Studies in Physics, University of Mysore, Manasagangotri, Mysore 570 006 (India)

2012-02-15

Highlights: Black-Right-Pointing-Pointer Total dose effects of 50 MeV Li3+ ion on 50 GHz SiGe HBTs is investigated. Black-Right-Pointing-Pointer Ion irradiated results were compared with Co-60 gamma results. Black-Right-Pointing-Pointer 50 MeV Li ions create more damage in E-B spacer oxide when compared to Co-60 gamma radiation. Black-Right-Pointing-Pointer Co-60 gamma radiation create more damage in STI oxide when compared to 50 MeV Li ions. Black-Right-Pointing-Pointer Worst case total dose radiation effects can be studied using Pelletron accelerator facilities. - Abstract: We have investigated the effects of 50 MeV lithium ion irradiation on the DC electrical characteristics of first-generation silicon-germanium heterojunction bipolar transistors (50 GHz SiGe HBTs) in the dose range of 600 krad to 100 Mrad. The results of 50 MeV Li{sup 3+} ion irradiation on the SiGe HBTs are compared with 63 MeV proton and Co-60 gamma irradiation results in the same dose range in order to understand the damage induced by different LET species. The radiation response of emitter-base (EB) spacer oxide and shallow trench isolation (STI) oxide to different irradiation types are discussed in this paper. We have also focused on the efficacy in the application of a Pelletron accelerator to study total dose irradiation studies in SiGe HBTs.

Tumor Volume-Adapted Dosing in Stereotactic Ablative Radiotherapy of Lung Tumors

International Nuclear Information System (INIS)

Trakul, Nicholas; Chang, Christine N.; Harris, Jeremy; Chapman, Christopher; Rao, Aarti; Shen, John; Quinlan-Davidson, Sean; Filion, Edith J.; Wakelee, Heather A.; Colevas, A. Dimitrios; Whyte, Richard I.

2012-01-01

Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18–25 Gy) (Group 1), and larger tumors (gross tumor volume ≥12 mL) received multifraction regimens with BED ≥100 Gy (total dose, 50–60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

[Computer-aided prescribing: from utopia to reality].

Science.gov (United States)

Suárez-Varela Ubeda, J; Beltrán Calvo, C; Molina López, T; Navarro Marín, P

2005-05-31

To determine whether the introduction of computer-aided prescribing helped reduce the administrative burden at primary care centers. Descriptive, cross-sectional design. Torreblanca Health Center in the province of Seville, southern Spain. From 29 October 2003 to the present a pilot project involving nine pharmacies in the basic health zone served by this health center has been running to evaluate computer-aided prescribing (the Receta XXI project) with real patients. All patients on the center's list of patients who came to the center for an administrative consultation to renew prescriptions for medications or supplies for long-term treatment. Total number of administrative visits per patient for patients who came to the center to renew prescriptions for long-term treatment, as recorded by the Diraya system (Historia Clinica Digital del Ciudadano, or Citizen's Digital Medical Record) during the period from February to July 2004. Total number of the same type of administrative visits recorded by the previous system (TASS) during the period from February to July 2003. The mean number of administrative visits per month during the period from February to July 2003 was 160, compared to a mean number of 64 visits during the period from February to July 2004. The reduction in the number of visits for prescription renewal was 60%. Introducing a system for computer-aided prescribing significantly reduced the number of administrative visits for prescription renewal for long-term treatment. This could help reduce the administrative burden considerably in primary care if the system were used in all centers.

IAEA/ WHO TLD postal dose intercomparison results in Bangladesh

International Nuclear Information System (INIS)

Mollah, A.S.; Bhuiyan, N.U.; Rahman, S.

2001-01-01

Full text: For the accurate delivery of prescribed dose to the patients, high precision and accuracy in radiation dosimetry is required. The hospital/medical physicist is responsible for the accurate delivery of whole planned radiation doses to the patients prescribed by the radio therapist. The proper delivery of radiation doses depends upon the accurate output measurements of doses from the therapy machines. In Bangladesh, only six 60 Co units and five deep therapy machines are in use. Some more are expected to be installed soon. Still in 2001, none of the Government radiotherapy centers in Bangladesh was properly equipped with medical physicists as well as radiotherapy dosimetry equipment. Bangladesh Atomic Energy Commission (BAEC) is responsible for radiation safety in Bangladesh and BAEC has assigned Secondary Standard Dosimetry Laboratory (SSDL) of Bangladesh for providing dosimetry calibration to all radiotherapy centers in Bangladesh. The output measurements of therapy machines are performed once in a year by SSDL and the results are compared by participating in the annual TLD postal dose intercomparison program organized by IAEA/WHO SSDL Network. The absorbed dose to water is determined using IAEA dosimetry protocol (TRS 277 and 381) and water phantom of size 30 x 30 x 30 cm 3 , The measurements of SSDL are traceable to NPL of UK. The accuracy achieved in SSDL, Bangladesh has been found better than ± 3.5%, which is within the prescribed limit of dosimetry standard of IAEA. The methodology of output dose measurements in different radiotherapy centers in Bangladesh is described along with the IAEA/WHO intercomparison results

Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

Directory of Open Access Journals (Sweden)

Marić Nađa P.

2012-01-01

Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

Estimation of the transit dose component in high dose rate brachytherapy

International Nuclear Information System (INIS)

Garcia Romero, A.; Millan Cebrian, E.; Lozano Flores, F.J.; Lope Lope, R.; Canellas Anoz, M.

2001-01-01

Current high dose rate brachytherapy (HDR) treatment planning systems usually calculate dose only from source stopping positions (stationary component), but fails to account for the administered dose when the source is moving (dynamic component or transit dose). Numerical values of this transit dose depends upon the source velocity, implant geometry, source activity and prescribed dose. In some HDR treatments using particular geometry the transit dose cannot be ignored because it increases the dose at the prescriptions points and also could increase potential late tissue complications as predicted by the linear quadratic model. International protocols recommend to verify this parameter. The aim of this paper has been to establish a procedure for the transit dose calculation for the Gammamed 12i equipment at the RT Department in the Clinical University Hospital (Zaragoza-Spain). A numeric algorithm was implemented based on a dynamic point approximation for the moving HDR source and the calculated results for the entrance-exit transit dose was compared with TLD measurements made in some discrete points. (author) [es

Clinical responses after total body irradiation by over permissible dose of γ-rays in one time

International Nuclear Information System (INIS)

Jiang Benrong; Wang Guilin; Liu Huilan; Tang Xingsheng; Ai Huisheng

1990-01-01

The clinical responses of patients after total body over permissilbe dose γ-ray irradiation were observed and analysed. The results showed: when the dose was above 5 cGy, there was some immunological depression, but no significant change in hematopoietic functions. 5 cases showed some transient changes of ECG, perhaps due to vagotonia caused by psychological imbalance, One case vomitted 3-4 times after 28 cGy irradiation, this suggested that a few times of vomitting had no significance in the estimation of the irradiated dose and the whole clinical manifestations must be concretely analysed

Intravascular ultrasound based dose assessment in endovascular brachytherapy

International Nuclear Information System (INIS)

Catalano, Gianpiero; Tamburini, Vittorio; Colombo, Antonio; Nishida, Takahiro; Parisi, Giovanni; Mazzetta, Chiara; Orecchia, Roberto

2003-01-01

Background: the role of endovascular brachytherapy in restenosis prevention is well documented. Dose is usually prescribed at a fixed distance from the source axis by angiographic quantification of vessel diameter. Recently, intravascular ultrasound (IVUS) was introduced in dose prescription, allowing a better evaluation of the vessel anatomy. This study retrospectively explores the difference between prescription following angiographic vessel sizing and delivered dose calculated with IVUS. Methods and results: Seventeen lesions were studied with IVUS, identifying on irradiated segment, three sections on which measuring minimal and maximal distance from the centre of IVUS catheter to the adventitia; using dedicated software, corresponding doses were calculated. The dose ranged widely, with maximal and minimal values of 71.6 and 4.9 Gy; furthermore, heterogeneity in dose among different sections was observed. In the central section, the maximal dose was 206% of the one prescribed with the QCA model at 2 mm from the source axis, while the minimal dose was 96%. In proximal and distal sections, respective values were 182, 45, 243, and 122%. Conclusions: Our analysis confirmed the dose inhomogeneity delivered with an angiographic fixed-dose prescription strategy. A dose variation was found along the irradiated segment due to the differences in vessel thickness. IVUS emerged as an important tool in endovascular brachytherapy, especially for irregular-shaped vessels

Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

Directory of Open Access Journals (Sweden)

John H. Burton

2016-05-01

Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

Science.gov (United States)

Yeh, James S; Franklin, Jessica M; Avorn, Jerry; Landon, Joan; Kesselheim, Aaron S

2016-06-01

Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed. Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol. Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011. The exposure variable was a physician's industry payments as listed in the Massachusetts database. The outcome was the physician's rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians' industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments. Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not. Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

Clinical implementation of total skin electron irradiation treatment with a 6 MeV electron beam in high-dose total skin electron mode

International Nuclear Information System (INIS)

Lucero, J. F.; Rojas, J. I.

2016-01-01

Total skin electron irradiation (TSEI) is a special treatment technique offered by modern radiation oncology facilities, given for the treatment of mycosis fungoides, a rare skin disease, which is type of cutaneous T-cell lymphoma [1]. During treatment the patient’s entire skin is irradiated with a uniform dose. The aim of this work is to present implementation of total skin electron irradiation treatment using IAEA TRS-398 code of practice for absolute dosimetry and taking advantage of the use of radiochromic films.

Clinical implementation of total skin electron irradiation treatment with a 6 MeV electron beam in high-dose total skin electron mode

Energy Technology Data Exchange (ETDEWEB)

Lucero, J. F., E-mail: fernando.lucero@hoperadiotherapy.com.gt [Universidad Nacional de Costa Rica, Heredia (Costa Rica); Hope International, Guatemala (Guatemala); Rojas, J. I., E-mail: isaac.rojas@siglo21.cr [Centro Médico Radioterapia Siglo XXI, San José (Costa Rica)

2016-07-07

Total skin electron irradiation (TSEI) is a special treatment technique offered by modern radiation oncology facilities, given for the treatment of mycosis fungoides, a rare skin disease, which is type of cutaneous T-cell lymphoma [1]. During treatment the patient’s entire skin is irradiated with a uniform dose. The aim of this work is to present implementation of total skin electron irradiation treatment using IAEA TRS-398 code of practice for absolute dosimetry and taking advantage of the use of radiochromic films.

Low-dose dual-energy cone-beam CT using a total-variation minimization algorithm

International Nuclear Information System (INIS)

Min, Jong Hwan

2011-02-01

Dual-energy cone-beam CT is an important imaging modality in diagnostic applications, and may also find its use in other application such as therapeutic image guidance. Despite of its clinical values, relatively high radiation dose of dual-energy scan may pose a challenge to its wide use. In this work, we investigated a low-dose, pre-reconstruction type of dual-energy cone-beam CT (CBCT) using a total-variation minimization algorithm for image reconstruction. An empirical dual-energy calibration method was used to prepare material-specific projection data. Raw data at high and low tube voltages are converted into a set of basis functions which can be linearly combined to produce material-specific data using the coefficients obtained through the calibration process. From much fewer views than are conventionally used, material specific images are reconstructed by use of the total-variation minimization algorithm. An experimental study was performed to demonstrate the feasibility of the proposed method using a micro-CT system. We have reconstructed images of the phantoms from only 90 projections acquired at tube voltages of 40 kVp and 90 kVp each. Aluminum-only and acryl-only images were successfully decomposed. We evaluated the quality of the reconstructed images by use of contrast-to-noise ratio and detectability. A low-dose dual-energy CBCT can be realized via the proposed method by greatly reducing the number of projections

Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years

Directory of Open Access Journals (Sweden)

Lloyd D Hughes

2016-01-01

Full Text Available Introduction: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice. Materials and Methods: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients′ age, gender, name of the prescribed drug(s, and total number of prescriptions in this class over the year were extracted. Results: The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n = 109 in 2007, 70.5% (n = 122 in 2011, and 51.7% (n = 138 in 2015 (P = 0.006. The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n = 39 in 2007, 46.2% (n = 80 in 2011, and 52.4% (n = 140 in 2015 (P = 0.001. There was a significant increase in the number of patients prescribed melatonin (P = 0.020. Discussion: This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall. Conclusion: Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations.

US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.

Science.gov (United States)

Hicks, Lauri A; Bartoces, Monina G; Roberts, Rebecca M; Suda, Katie J; Hunkler, Robert J; Taylor, Thomas H; Schrag, Stephanie J

2015-05-01

Appropriate antibiotic prescribing is an essential strategy to reduce the spread of antibiotic resistance. US prescribing practices have not been thoroughly characterized. We analyzed outpatient antibiotic prescribing data to identify where appropriate antibiotic prescribing interventions could have the most impact. Oral antibiotic prescriptions dispensed during 2011 were extracted from the IMS Health Xponent database. The number of prescriptions and census denominators were used to calculate prescribing rates. Prescription totals were calculated for each provider specialty. Regression modeling was used to examine the association between socioeconomic and population health factors and prescribing rates. Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons). Penicillins and macrolides were the most common antibiotic categories prescribed. The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P 1.0). Efforts to characterize antibiotic prescribing practices should focus on the South census region and family practitioners. Further understanding of the factors leading to high prescribing among key target populations will inform appropriate prescribing interventions. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Compendium of Current Total Ionizing Dose and Displacement Damage Results from NASA GSFC and NEPP

Science.gov (United States)

Topper, Alyson D.; Campola, Michael J.; Chen, Dakai; Casey, Megan C.; Yau, Ka-Yen; Label, Kenneth A.; Cochran, Donna J.; O'Bryan, Martha V.

2017-01-01

Total ionizing dose and displacement damage testing was performed to characterize and determine the suitability of candidate electronics for NASA space utilization. Devices tested include opto-electronics, digital, analog, linear bipolar devices, and hybrid devices.

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

Science.gov (United States)

Goldblum, O M

2001-02-01

The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. This study is the first effort to

Test methods of total dose effects in very large scale integrated circuits

International Nuclear Information System (INIS)

He Chaohui; Geng Bin; He Baoping; Yao Yujuan; Li Yonghong; Peng Honglun; Lin Dongsheng; Zhou Hui; Chen Yusheng

2004-01-01

A kind of test method of total dose effects (TDE) is presented for very large scale integrated circuits (VLSI). The consumption current of devices is measured while function parameters of devices (or circuits) are measured. Then the relation between data errors and consumption current can be analyzed and mechanism of TDE in VLSI can be proposed. Experimental results of 60 Co γ TDEs are given for SRAMs, EEPROMs, FLASH ROMs and a kind of CPU

Variations in Metformin Prescribing for Type 2 Diabetes.

Science.gov (United States)

Goldberg, Tiffany; Kroehl, Miranda E; Suddarth, Kathleen Heist; Trinkley, Katy E

2015-01-01

Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. © Copyright 2015 by the American Board of Family Medicine.

Inappropriate prescribing: criteria, detection and prevention.

LENUS (Irish Health Repository)

O'Connor, Marie N

2012-06-01

Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs.

Science.gov (United States)

Newman-Casey, Paula Anne; Woodward, Maria A; Niziol, Leslie M; Lee, Paul P; De Lott, Lindsey B

2018-03-01

To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. Retrospective cross-sectional study. Eye care providers prescribing medications through Medicare Part D in 2013. Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). Total cost of brand and generic medications prescribed by eye care providers. Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P total cost, P total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). Eye care providers prescribe more brand

Concentration of total proteins in blood plasma of chickens hatched from irradiated eggs with low dose gamma radiation

International Nuclear Information System (INIS)

Vilic, M.; Kraljevic, P.; Miljanic, S.; Simpraga, M.

2005-01-01

It is known that low-dose ionising radiation may have stimulating effects on chickens. Low doses may also cause changes in the concentration of blood plasma total proteins, glucose and cholesterol in chickens. This study investigates the effects of low dose gamma-radiation on the concentration of total proteins in the blood plasma of chickens hatched from eggs irradiated with a dose of 0.15 Gy on incubation days 7 and 19. Results were compared with the control group (chickens hatched from non-irradiated eggs). After hatching, all other conditions were the same for both groups. Blood samples were drawn from the heart, and later from the wing vein on days 1, 3, 5, 7,10, 20, 30 and 42. The concentration of total proteins was determined spectrophotometrically using Boehringer Mannheim GmbH optimised kits. The concentration of total proteins in blood plasma in chickens hatched from eggs irradiated with 0.15 Gy on incubation day 7 showed a statistically significant decrease on the sampling day 3 (P less than 0.05) and 7 (P less than 0.01). The concentration of total proteins in blood plasma in chickens hatched from eggs irradiated with 0.15 Gy on incubation day 19 showed a statistically significant increase only on sampling day 1 (P less than 0.05). These results suggest that exposure of eggs to 0.15 Gy of gamma-radiation on the 7th and 19th day of incubation could produce different effects on the protein metabolism in chickens.(author)

Re-distribution of brachytherapy dose using a differential dose prescription adapted to risk of local failure in low-risk prostate cancer patients

DEFF Research Database (Denmark)

Rylander, Susanne; Polders, Daniel; Steggerda, Marcel J

2015-01-01

BACKGROUND AND PURPOSE: We investigated the application of a differential target- and dose prescription concept for low-dose-rate prostate brachytherapy (LDR-BT), involving a re-distribution of dose according to risk of local failure and treatment-related morbidity. MATERIAL AND METHODS: Our study......- and dose prescription concept of prescribing a lower dose to the whole gland and an escalated dose to the GTV using LDR-BT seed planning was technically feasible and resulted in a significant dose-reduction to urethra and bladder neck....

High dose rate (HDR) and low dose rate (LDR) interstitial irradiation (IRT) of the rat spinal cord

International Nuclear Information System (INIS)

Pop, Lucas A.M.; Plas, Mirjam van der; Skwarchuk, Mark W.; Hanssen, Alex E.J.; Kogel, Albert J. van der

1997-01-01

Purpose: To describe a newly developed technique to study radiation tolerance of rat spinal cord to continuous interstitial irradiation (IRT) at different dose rates. Material and methods: Two parallel catheters are inserted just laterally on each side of the vertebral bodies from the level of Th 10 to L 4 . These catheters are afterloaded with two 192 Ir wires of 4 cm length each (activity 1-2.3 mCi/cm) for the low dose rate (LDR) IRT or connected to the HDR micro-Selectron for the high dose rate (HDR) IRT. Spinal cord target volume is located at the level of Th 12 -L 2 . Due to the rapid dose fall-off around the implanted sources, a dose inhomogeneity across the spinal cord thickness is obtained in the dorso-ventral direction. Using the 100% reference dose (rate) at the ventral side of the spinal cord to prescribe the dose, experiments have been carried out to obtain complete dose response curves at average dose rates of 0.49, 0.96 and 120 Gy/h. Paralysis of the hind-legs after 5-6 months and histopathological examination of the spinal cord of each irradiated rat are used as experimental endpoints. Results: The histopathological damage seen after irradiation is clearly reflected the inhomogeneous dose distribution around the implanted catheters, with the damage predominantly located in the dorsal tract of the cord or dorsal roots. With each reduction in average dose rate, spinal cord radiation tolerance is significantly increased. When the dose is prescribed at the 100% reference dose rate, the ED 50 (induction of paresis in 50% of the animals) for the HDR-IRT is 17.3 Gy. If the average dose rate is reduced from 120 Gy/h to 0.96 or 0.49 Gy/h, a 2.9- or 4.7-fold increase in the ED 50 values to 50.3 Gy and 80.9 Gy is observed; for the dose prescribed at the 150% reference dose rate (dorsal side of cord) ED 50 values are 26.0, 75.5 and 121.4 Gy, respectively. Using different types of analysis and in dependence of the dose prescription and reference dose rate, the �

Prescribing patterns for upper respiratory tract infections: a prescription-review of primary care practice in Kedah, Malaysia, and the implications.

Science.gov (United States)

Rezal, Rabiatul Salmi; Hassali, Mohamed Azmi; Alrasheedy, Alian A; Saleem, Fahad; Yusof, Faridah Aryani Md; Kamal, Mardhiyah; Mohd Din, Rosminah; Godman, Brian

2015-01-01

It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014. A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122). Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department.

Science.gov (United States)

Hitti, Eveline; Tamim, Hani; Bakhti, Rinad; Zebian, Dina; Mufarrij, Afif

2017-08-01

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period. Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02). A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Drug prescribing and use among elderly people in Spain.

Science.gov (United States)

Mas, X; Laporte, J R; Frati, M E; Busquet, L; Arnau, J M; Ibañez, L; Séculi, E; Capellà, D; Arbonés, G

1983-05-01

As a result of the lack of an adequate regulation, the supply and the use of medicines is irrational in Spain. In order to know the characteristics of the prescription and use of drugs among the elderly, two drug utilization studies were carried out. The first study was an analysis of 981 prescriptions from an outpatient clinic of the Spanish Social Security. The results show that a high proportion of fixed-dose combinations were prescribed and that drugs without any demonstrated therapeutic value are often prescribed for the elderly. The second study was a survey of 389 individuals randomly chosen among people affiliated with a pensioners' club. The results show that drug use is highly prevalent among the elderly, that many medicines without any demonstrated benefit are being taken, and that potentially harmful drugs were being used by a high proportion of patients without medical follow-up. The prevalence of the use of some particular groups of drugs is also presented.

DOSE-ESCALATED EXTERNAL BEAM RADIOTHERAPY DURING HORMONO-RADIOTHERAPY FOR PROSTATE CANCER

Directory of Open Access Journals (Sweden)

Yu. V. Gumenetskaya

2016-01-01

Full Text Available Introduction. The introduction of modern technologies of conformal external beam radiotherapy (EBRT into clinical practice for the treatment of prostate cancer requires proper quality assurance measures as well as a careful analysis of both the efficacy and toxicity data of treatments. The purpose of this study was to inves- tigate tolerance and the immediate efficacy of conformal dose-escalated EBRT during hormono-radiotherapy for prostate cancer. material and methods. The study involved 156 prostate cancer patients treated with EBRT. Among them, 30 patients received a total dose of 70 Gy, and in 126 patients the total dose was esca- lated to 72-76 Gy (median total dose - 74.0 Gy. Fifty-nine patients received intensity modulated radiation therapy. Results. The prescribed course of treatment was completed in all the patients with prostate cancer. Acute radiation-induced bladder reactions (RTOG were observed in 50 (32.1 % patients, of whom 48 (30.8 % experienced grade I reactions, and 2 (1.3 % experienced grade II reactions. Eighteen (11.5 % patients had radiation-induced rectum reactions, not above grade I. The development of grade II dysuric phenomena necessitated treatment interruption only in two patients. Of 9 (5.8 % patients who had late bladder complica- tions (RTOG/EORTC, 8 (5.1 % patients developed grade I complications, and one (0.6 % patient developed grade II complications. Of 11 (7.1 % patients who had rectum complications, 8 (5.1 % patients developed grade I complications, and 3 (1.9 % patients developed grade II complications. No patients experienced the increase in toxicity of treatment during dose escalation up to a total dose exceeding 70 Gy. During the follow-up period, only one patient developed recurrent disease. Conclusion. The results of our study suggest acceptable levels of toxicity following a continuous course of dose-escalated EBRT given in conjunction with hormono-radiotherapy to prostate cancer patients. Further

American brachytherapy society recommends no change for prostate permanent implant dose prescriptions using iodine-125 or palladium-103

International Nuclear Information System (INIS)

Rivard, M.J.; Butler, W.M.; Merrick, G.S.; Devlin, P.M.; Hayes, J.K.; Hearn, R.A.; Lief, E.P.; Meigooni, A.S.; Williamson, J.F.

2008-01-01

Purpose - In 2004, the American Association of Physicists in Medicine (AAPM) issued a report outlining recommended 125 I and 103 Pd datasets for consistency in calculating brachytherapy dose distributions. In 2005, to aid evaluating the clinical impact of implementing these datasets, the AAPM assessed the historical dependence of how prescribed doses differed from administered doses for 125 I and 103 Pd for permanent implantation of the prostate. Consequently, the American Brachytherapy Society (ABS) considered the nature of these changes towards issuing recommended dose prescriptions for 125 I and 103 Pd interstitial brachytherapy implants for mono-therapy and standard boosts. Methods and materials - An investigation was performed of the 2005 AAPM analysis to determine changes in administered dose while affixing prescribed dose using 2004 AAPM 125 I and 103 Pd brachytherapy dosimetry datasets for prostate implants. For 125 I and 103 Pd, administered dose would change by +1.4% and +4.2%, respectively. The biological and societal impact of changing prescribed dose was considered. Results - Based on the need for clinical constancy and in recognition of overall uncertainties, the ABS recommends immediate implementation of the 2004 AAPM consensus brachytherapy dosimetry datasets and no changes to 125 I and 103 Pd dose prescriptions at this time. Conclusions - Radiation oncologists should continue to prescribe mono-therapy doses of 145 Gy and 125 Gy for 125 I and 105 Pd, respectively, and standard boost doses of 100-110 Gy and 90-100 Gy for 125 I and 103 Pd, respectively. (authors)

The integral biologically effective dose to predict brain stem toxicity of hypofractionated stereotactic radiotherapy

International Nuclear Information System (INIS)

Clark, Brenda G.; Souhami, Luis; Pla, Conrado; Al-Amro, Abdullah S.; Bahary, Jean-Paul; Villemure, Jean-Guy; Caron, Jean-Louis; Olivier, Andre; Podgorsak, Ervin B.

1998-01-01

Purpose: The aim of this work was to develop a parameter for use during fractionated stereotactic radiotherapy treatment planning to aid in the determination of the appropriate treatment volume and fractionation regimen that will minimize risk of late damage to normal tissue. Materials and Methods: We have used the linear quadratic model to assess the biologically effective dose at the periphery of stereotactic radiotherapy treatment volumes that impinge on the brain stem. This paper reports a retrospective study of 77 patients with malignant and benign intracranial lesions, treated between 1987 and 1995, with the dynamic rotation technique in 6 fractions over a period of 2 weeks, to a total dose of 42 Gy prescribed at the 90% isodose surface. From differential dose-volume histograms, we evaluated biologically effective dose-volume histograms and obtained an integral biologically-effective dose (IBED) in each case. Results: Of the 77 patients in the study, 36 had target volumes positioned so that the brain stem received more than 1% of the prescribed dose, and 4 of these, all treated for meningioma, developed serious late damage involving the brain stem. Other than type of lesion, the only significant variable was the volume of brain stem exposed. An analysis of the IBEDs received by these 36 patients shows evidence of a threshold value for late damage to the brain stem consistent with similar thresholds that have been determined for external beam radiotherapy. Conclusions: We have introduced a new parameter, the IBED, that may be used to represent the fractional effective dose to structures such as the brain stem that are partially irradiated with stereotactic dose distributions. The IBED is easily calculated prior to treatment and may be used to determine appropriate treatment volumes and fractionation regimens minimizing possible toxicity to normal tissue

Dose conformation to the spine during palliative treatments using dynamic wedges

Energy Technology Data Exchange (ETDEWEB)

Ormsby, Matthew A., E-mail: Matthew.Ormsby@usoncology.com [West Texas Cancer Center at Medical Center Hospital, Odessa, TX (United States); Herndon, R. Craig; Kaczor, Joseph G. [West Texas Cancer Center at Medical Center Hospital, Odessa, TX (United States)

2013-07-01

Radiation therapy is commonly used to alleviate pain associated with metastatic disease of the spine. Often, isodose lines are manipulated using dynamic or physical wedges to encompass the section of spine needing treatment while minimizing dose to normal tissue. We will compare 2 methods used to treat the entire thoracic spine. The first method treats the thoracic spine with a single, nonwedged posterior-anterior (PA) field. Dose is prescribed to include the entire spine. Isodose lines tightly conform to the top and bottom vertebrae, but vertebrae between these 2 received more than enough coverage. The second method uses a combination of wedges to create an isodose line that mimics the curvature of the thoracic spine. This “C”-shaped curvature is created by overlapping 2 fields with opposing dynamic wedges. Machine constraints limit the treatment length and therefore 2 isocenters are used. Each of the 2 PA fields contributes a portion of the total daily dose. This technique creates a “C”-shaped isodose line that tightly conforms to the thoracic spine, minimizing normal tissue dose. Spinal cord maximum dose is reduced, as well as mean dose to the liver, esophagus, and heart.

Does IMRT increase the peripheral radiation dose? A comparison of treatment plans 2000 and 2010

International Nuclear Information System (INIS)

Salz, Henning; Eichner, Regina; Wiezorek, Tilo

2012-01-01

It has been reported in several papers and textbooks that IMRT treatments increase the peripheral dose in comparison with non-IMRT fields. But in clinical practice not only open fields have been used in the pre-IMRT era, but also fields with physical wedges or composed fields. The aim of this work is to test the hypothesis of increased peripheral dose when IMRT is used compared to standard conformal radiotherapy. Furthermore, the importance of the measured dose differences in clinical practice is discussed and compared with other new technologies for the cases where an increase of the peripheral dose was observed. For cancers of the head and neck, the cervix, the rectum and for the brain irradiation due to acute leukaemia, one to four plans have been calculated with IMRT or conformal standard technique (non-IMRT). In an anthropomorphic phantom the dose at a distance of 30 cm in cranio-caudal direction from the target edge was measured with TLDs using a linear accelerator Oncor registered (Siemens) for both techniques. IMRT was performed using step-and-shoot technique (7 to 11 beams), non-IMRT plans with different techniques. The results depended on the site of irradiation. For head and neck cancers IMRT resulted in an increase of 0.05 - 0.09% of the prescribed total dose (Dptv) or 40 - 70 mGy (Dptv = 65 Gy), compared to non-IMRT technique without wedges or a decrease of 0.16% (approx. 100 mGy) of the prescribed total dose compared to non-IMRT techniques with wedges. For the cervical cancer IMRT resulted in an increased dose in the periphery (+ 0.07% - 0.15% of Dptv or 30 - 70 mGy at Dptv = 45 Gy), for the rectal cancer in a dose reduction (0.21 - 0.26% of Dptv or 100 - 130 mGy at Dptv = 50 Gy) and for the brain irradiation in an increase dose (+ 0.05% of Dptv = 18 Gy or 9 mSv). In summary IMRT does not uniformly cause increased radiation dose in the periphery in the model used. It can be stated that these dose values are smaller than reported in earlier papers

The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio.

Science.gov (United States)

Weiner, Scott G; Baker, Olesya; Poon, Sabrina J; Rodgers, Ann F; Garner, Chad; Nelson, Lewis S; Schuur, Jeremiah D

2017-12-01

The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians. We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids. Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect. In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our

Low-dose total skin electron beam therapy for cutaneous lymphoma. Minimal risk of acute toxicities

Energy Technology Data Exchange (ETDEWEB)

Kroeger, Kai; Elsayad, Khaled; Moustakis, Christos; Haverkamp, Uwe; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiation Oncology, Muenster (Germany)

2017-12-15

Low-dose total skin electron beam therapy (TSEBT) is attracting increased interest for the effective palliative treatment of primary cutaneous T-cell lymphoma (pCTCL). In this study, we compared toxicity profiles following various radiation doses. We reviewed the records of 60 patients who underwent TSEBT for pCTCL between 2000 and 2016 at the University Hospital of Munster. The treatment characteristics of the radiotherapy (RT) regimens and adverse events (AEs) were then analyzed and compared. In total, 67 courses of TSEBT were administered to 60 patients. Of these patients, 34 (51%) received a standard dose with a median surface dose of 30 Gy and 33 patients (49%) received a low dose with the median surface dose of 12 Gy (7 salvage low-dose TSEBT courses were administered to 5 patients). After a median follow-up of 15 months, the overall AE rate was 100%, including 38 patients (57%) with grade 2 and 7 (10%) with grade 3 AEs. Patients treated with low-dose TSEBT had significantly fewer grade 2 AEs than those with conventional dose regimens (33 vs. 79%, P < 0.001). A lower grade 3 AE rate was also observed in patients who had received the low-dose regimen compared to those with the conventional dose regimens (6 vs. 15%, P = 0.78). Multiple/salvage low-dose TSEBT courses were not associated with an increased risk of acute AEs. Low-dose TSEBT regimens are associated with significantly fewer grade 2 acute toxicities compared with conventional doses of TSEBT. Repeated/Salvage low-dose TSEBT, however, appears to be tolerable and can even be applied safely in patients with cutaneous relapses. (orig.) [German] Eine niedrigdosierte Ganzhautelektronenbestrahlung (TSEBT) wird vermehrt zur effektiven palliativen Behandlung von Patienten mit primaer kutanen T-Zell-Lymphomen (pCTCL) eingesetzt. In dieser Studie vergleichen wir die Toxizitaetsprofile verschiedener Dosiskonzepte. Untersucht wurden 60 zwischen 2000 und 2016 am Universitaetsklinikum Muenster mittels TSEBT

Total skin electron irradiation: evaluation of dose uniformity throughout the skin surface

International Nuclear Information System (INIS)

Anacak, Yavuz; Arican, Zumre; Bar-Deroma, Raquel; Tamir, Ada; Kuten, Abraham

2003-01-01

In this study, in vivo dosimetic data of 67 total skin electron irradiation (TSEI) treatments were analyzed. Thermoluminescent dosimetry (TLD) measurements were made at 10 different body points for every patient. The results demonstrated that the dose inhomogeneity throughout the skin surface is around 15%. The homogeneity was better at the trunk than at the extratrunk points, and was worse when a degrader was used. There was minimal improvement of homogeneity in subsequent days of treatment

The use of prescribed and non-prescribed medication by Dutch children.

NARCIS (Netherlands)

Dijk, L. van; Lindert, H. van

2002-01-01

Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes

OpenAIRE

Norman, Jessica L; Fixen, Danielle R; Saseen, Joseph J; Saba, Laura M; Linnebur, Sunny A

2017-01-01

Background: Women have higher morning serum zolpidem concentrations than men after taking an evening dose, potentially leading to increased risk of harm. On 19 April 2013, the United States Food and Drug Administration required labeling changes for zolpidem, recommending an initial dose of no greater than 5 mg (immediate release) or 6.25 mg (controlled release) per night in women. Objectives: The primary objective of this study was to compare prescribing practices before and after the 2013 zo...

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

International Nuclear Information System (INIS)

Yaparpalvi, R; Mynampati, D; Kuo, H; Garg, M; Tome, W; Kalnicki, S

2016-01-01

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V_2_0 and V_5 to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm"3. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V_2_0 (+3.1%) and V_5 (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates attributable to algorithm

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

Energy Technology Data Exchange (ETDEWEB)

Yaparpalvi, R; Mynampati, D; Kuo, H; Garg, M; Tome, W; Kalnicki, S [Montefiore Medical Center, Bronx, NY (United States)

2016-06-15

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V{sub 20} and V{sub 5} to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm{sup 3}. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V{sub 20} (+3.1%) and V{sub 5} (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates

A Validation Study of Homeopathic Prescribing and Patient Care Indicators

Directory of Open Access Journals (Sweden)

Munmun Koley

2014-10-01

Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

A Validation Study of Homeopathic Prescribing and Patient Care Indicators

Science.gov (United States)

Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim

2014-01-01

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development. PMID:25379474

Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice

DEFF Research Database (Denmark)

Aabenhus, Rune; Siersma, Volkert Dirk; Sandholdt, Håkon

2017-01-01

practice-related factors driving high antibiotic prescribing rates. Results: We included 98% of general practices in Denmark (n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case...... prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. Conclusions: An apparent...

Drug formularies--good or evil? A view using prescribing analyses and cost trends data.

Science.gov (United States)

Chapman, S

1994-01-01

In the UK, the drugs bill has almost trebled in the last 10 years and is consuming an increasing proportion of the total National Health Service spend. If the drugs bill can be limited, greater funds will be available for other areas of the health service. Therefore, cost containment measures which include prescribing from a formulary or generic prescribing are now widely encouraged. Prescribing analyses and cost trends data generated from pharmacists sending dispensed general practitioners' prescriptions to a central point for reimbursement are a valuable tool in the assessment of prescribing habits and can be used by general practitioners when preparing a formulary. In the West Midlands, such data have been used to identify areas of growth in cardiovascular drugs and problem areas where prescribing an expensive formulation has led to a dramatic increase in costs.

What do providers want to know about opioid prescribing? A qualitative analysis of their questions.

Science.gov (United States)

Cushman, Phoebe A; Liebschutz, Jane M; Hodgkin, Joseph G; Shanahan, Christopher W; White, Julie L; Hardesty, Ilana; Alford, Daniel P

2017-01-01

In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for Treatment," "Initiating Therapy, Modifying Dosing, and Discontinuing Use," "Managing Therapy," "Counseling Patients and Caregivers about Safe Use," "General Drug Information," and "Specific Drug Information." Based on the FDA Blueprint, Boston University School of Medicine's "Safe and Competent Opioid Prescribing Education" (SCOPE of Pain) offers live trainings for physicians and other prescribers. During trainings, participants submit written questions about the curriculum and/or their clinical experiences. The objective was to compare themes that arose from questions asked by SCOPE of Pain participants with content of the FDA Blueprint in order to evaluate how well the Blueprint answers prescribers' concerns. The authors conducted qualitative analyses of all 1309 questions submitted by participants in 29 trainings across 16 states from May 2013 to May 2015, using conventional content analysis to code the questions. Themes that emerged from participants' questions were then compared with the Blueprint. Most themes fell into the topic categories of the Blueprint. Five main themes diverged: Participants sought information on (1) safe alternatives to opioids, (2) overcoming barriers to safe opioid prescribing, (3) government regulations of opioid prescribing, (4) the role of marijuana in opioid prescribing, and (5) maintaining a positive provider-patient relationship while prescribing opioids. In addition to learning the mechanics of safe opioid prescribing, providers want to understand government regulations and effective patient communication skills. Aware of the limitations of opioids in managing chronic pain, providers seek advice

Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

Science.gov (United States)

Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

2015-01-01

Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

Reducing antibiotic prescribing in Australian general practice: time for a national strategy.

Science.gov (United States)

Del Mar, Christopher B; Scott, Anna Mae; Glasziou, Paul P; Hoffmann, Tammy; van Driel, Mieke L; Beller, Elaine; Phillips, Susan M; Dartnell, Jonathan

2017-11-06

In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs' access to near-patient diagnostic testing, and public awareness campaigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.

Prescribing patterns of antihypertensive drugs in geriatric population in tertiary care hospital

Directory of Open Access Journals (Sweden)

Renoy Philip

2016-03-01

Full Text Available Hypertension is one of the major chronic diseases with high mortality and morbidity in the today’s world. Present study was to assess the prescribing pattern of antihypertensive medications in geriatric population suffering mainly from hypertension with or without co morbidities like Diabetes Mellitus (DM. A prospective observational study was carried out for a period of six months in an in-patient general medicine department. Elderly patients who have been diagnosed with pure hypertension as per JNC 7 guidelines and hypertension with co- morbid condition like diabetes mellitus and patients receiving or prescribed with antihypertensive drugs were included. A total of 150 prescriptions were analyzed. The present study revealed that there were 93 patients with pure Hypertension and 57 patients with co morbid conditions like Diabetes Mellitus (DM. Among antihypertensive drugs in pure hypertensive cases, 53.76% of cases were prescribed with monotherapy, followed by 46.23% by combination therapy. The commonly prescribed antihypertensive monotherapy is calcium channel blockers. The most commonly prescribed combination therapy in severe cases was angiotensin receptor blockers with diuretics. This prescribing pattern of antihypertensives was as per Joint National Committee-7report on hypertension. In case of geriatric patients suffering from hypertension with Type 2 diabetes mellitus, most commonly prescribed antihypertensive as monotherapy was found to be amlodipine and combination therapy was telmisartan + hydrochlorothiazide.

Non-intercepted dose errors in prescribing anti-neoplastic treatment

DEFF Research Database (Denmark)

Mattsson, T O; Holm, B; Michelsen, H

2015-01-01

BACKGROUND: The incidence of non-intercepted prescription errors and the risk factors involved, including the impact of computerised order entry (CPOE) systems on such errors, are unknown. Our objective was to determine the incidence, type, severity, and related risk factors of non-intercepted pr....... Strategies to prevent future prescription errors could usefully focus on integrated computerised systems that can aid dose calculations and reduce transcription errors between databases....

IMRT: Improvement in treatment planning efficiency using NTCP calculation independent of the dose-volume-histogram

International Nuclear Information System (INIS)

Grigorov, Grigor N.; Chow, James C.L.; Grigorov, Lenko; Jiang, Runqing; Barnett, Rob B.

2006-01-01

The normal tissue complication probability (NTCP) is a predictor of radiobiological effect for organs at risk (OAR). The calculation of the NTCP is based on the dose-volume-histogram (DVH) which is generated by the treatment planning system after calculation of the 3D dose distribution. Including the NTCP in the objective function for intensity modulated radiation therapy (IMRT) plan optimization would make the planning more effective in reducing the postradiation effects. However, doing so would lengthen the total planning time. The purpose of this work is to establish a method for NTCP determination, independent of a DVH calculation, as a quality assurance check and also as a mean of improving the treatment planning efficiency. In the study, the CTs of ten randomly selected prostate patients were used. IMRT optimization was performed with a PINNACLE3 V 6.2b planning system, using planning target volume (PTV) with margins in the range of 2 to 10 mm. The DVH control points of the PTV and OAR were adapted from the prescriptions of Radiation Therapy Oncology Group protocol P-0126 for an escalated prescribed dose of 82 Gy. This paper presents a new model for the determination of the rectal NTCP ( R NTCP). The method uses a special function, named GVN (from Gy, Volume, NTCP), which describes the R NTCP if 1 cm 3 of the volume of intersection of the PTV and rectum (R int ) is irradiated uniformly by a dose of 1 Gy. The function was 'geometrically' normalized using a prostate-prostate ratio (PPR) of the patients' prostates. A correction of the R NTCP for different prescribed doses, ranging from 70 to 82 Gy, was employed in our model. The argument of the normalized function is the R int , and parameters are the prescribed dose, prostate volume, PTV margin, and PPR. The R NTCPs of another group of patients were calculated by the new method and the resulting difference was <±5% in comparison to the NTCP calculated by the PINNACLE3 software where Kutcher's dose

Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

NARCIS (Netherlands)

de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

The review of radiation effects of γ total dose in CMOS circuits

International Nuclear Information System (INIS)

Chen Panxun; Gao Wenming; Xie Zeyuan; Mi Bang

1992-01-01

Radiation performances of commercial and rad-hard CMOS circuits are reviewed. Threshold voltage, static power current, V in -V out characteristic and propagation delay time related with total dose are presented for CMOS circuits from several manufacturing processes. The performance of radiation-annealing of experimental circuits had been observed for two years. The comparison has been made between the CMOS circuits made in China and the commercial RCA products. 60 Co γ source can serve as γ simulator of the nuclear explosion

Optimization of equivalent uniform dose using the L-curve criterion

International Nuclear Information System (INIS)

Chvetsov, Alexei V; Dempsey, James F; Palta, Jatinder R

2007-01-01

Optimization of equivalent uniform dose (EUD) in inverse planning for intensity-modulated radiation therapy (IMRT) prevents variation in radiobiological effect between different radiotherapy treatment plans, which is due to variation in the pattern of dose nonuniformity. For instance, the survival fraction of clonogens would be consistent with the prescription when the optimized EUD is equal to the prescribed EUD. One of the problems in the practical implementation of this approach is that the spatial dose distribution in EUD-based inverse planning would be underdetermined because an unlimited number of nonuniform dose distributions can be computed for a prescribed value of EUD. Together with ill-posedness of the underlying integral equation, this may significantly increase the dose nonuniformity. To optimize EUD and keep dose nonuniformity within reasonable limits, we implemented into an EUD-based objective function an additional criterion which ensures the smoothness of beam intensity functions. This approach is similar to the variational regularization technique which was previously studied for the dose-based least-squares optimization. We show that the variational regularization together with the L-curve criterion for the regularization parameter can significantly reduce dose nonuniformity in EUD-based inverse planning

Optimization of equivalent uniform dose using the L-curve criterion

Energy Technology Data Exchange (ETDEWEB)

Chvetsov, Alexei V; Dempsey, James F; Palta, Jatinder R [Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385 (United States)

2007-09-21

Optimization of equivalent uniform dose (EUD) in inverse planning for intensity-modulated radiation therapy (IMRT) prevents variation in radiobiological effect between different radiotherapy treatment plans, which is due to variation in the pattern of dose nonuniformity. For instance, the survival fraction of clonogens would be consistent with the prescription when the optimized EUD is equal to the prescribed EUD. One of the problems in the practical implementation of this approach is that the spatial dose distribution in EUD-based inverse planning would be underdetermined because an unlimited number of nonuniform dose distributions can be computed for a prescribed value of EUD. Together with ill-posedness of the underlying integral equation, this may significantly increase the dose nonuniformity. To optimize EUD and keep dose nonuniformity within reasonable limits, we implemented into an EUD-based objective function an additional criterion which ensures the smoothness of beam intensity functions. This approach is similar to the variational regularization technique which was previously studied for the dose-based least-squares optimization. We show that the variational regularization together with the L-curve criterion for the regularization parameter can significantly reduce dose nonuniformity in EUD-based inverse planning.

Optimization of equivalent uniform dose using the L-curve criterion.

Science.gov (United States)

Chvetsov, Alexei V; Dempsey, James F; Palta, Jatinder R

2007-10-07

Optimization of equivalent uniform dose (EUD) in inverse planning for intensity-modulated radiation therapy (IMRT) prevents variation in radiobiological effect between different radiotherapy treatment plans, which is due to variation in the pattern of dose nonuniformity. For instance, the survival fraction of clonogens would be consistent with the prescription when the optimized EUD is equal to the prescribed EUD. One of the problems in the practical implementation of this approach is that the spatial dose distribution in EUD-based inverse planning would be underdetermined because an unlimited number of nonuniform dose distributions can be computed for a prescribed value of EUD. Together with ill-posedness of the underlying integral equation, this may significantly increase the dose nonuniformity. To optimize EUD and keep dose nonuniformity within reasonable limits, we implemented into an EUD-based objective function an additional criterion which ensures the smoothness of beam intensity functions. This approach is similar to the variational regularization technique which was previously studied for the dose-based least-squares optimization. We show that the variational regularization together with the L-curve criterion for the regularization parameter can significantly reduce dose nonuniformity in EUD-based inverse planning.

Stereotactic intracranial radiotherapy: Dose prescription

International Nuclear Information System (INIS)

Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

2012-01-01

The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

The biological effects of high dose total body irradiation in beagle dogs

International Nuclear Information System (INIS)

Luo Qingliang; Liu Xiaolan; Hao Jing; Xiong Guolin; Dong Bo; Zhao Zhenhu; Xia Zhengbiao; Qiu Liling; Mao Bingzhi

2002-01-01

Objective: To evaluate the biological effects of Beagle dogs irradiated by γ-rays at different doses. Methods: All Beagle dogs were divided into six groups and were subjected respectively to total-body irradiation (TBI) with a single dose of 6.5, 5.5, 5.0, 4.5, 3, 5 and 2.5 Gy γ-rays delivered by 60 Co sources at 7.224 x 10 -2 C/kg per minute. The general condition, blood cell counts and bone marrow cell CFC assays were observed. Results: Vomiting occurred at 0.5 to 2 hours after TBI in all groups. In 6.5 Gy group 3/5 dogs had blood-watery stool and 1/5 in 5.5 Gy group had watery stool. Diarrhea occurred in all other animals. Only one dog in 2.5 Gy group survived, all of others died. in order of decreasing irradiation dosage, the average survival time was 5.0, 8.0, 9.3, 9.5, 10.5 and 14.1 days, respectively. Conclusions: According to the clinical symptoms, leukocyte count and survival time of the dogs, the irradiation dose which will induce very severe hematopoietic radiation syndrome in Beagle dogs is 4.5 to 5.0 Gy

Two dose-estimation models CSA-N288.1 and Nureg 1.109, 1.113 - compared for chronic aquatic releases from nuclear facilities

Energy Technology Data Exchange (ETDEWEB)

Sheppard, S.C. [ECOMatters Inc., Pinawa, Manitoba (Canada); Klukas, M.H. [Atomic Energy of Canada Limited, Chalk River, Ontario (Canada); Peterson, S.-R. [Lawrence Livermore National Lab., Livermore, California (United States)

2000-04-01

Both the Canadian Standards Association (CSA) and the United States Nuclear Regulatory Commission (US-NRC) have published guidelines for the calculation of doses to the public due to emissions from nuclear facilities. In the sale of CANDU reactors overseas, either of these guidelines may be used as part of the approval process in the recipient country. This study compares the aquatic exposure pathways described in the guidelines. These include direct consumption of contaminated water and food, and exposure to contaminated sediments. The CSA and US-NRC guidelines for estimating dilution of aquatic emissions are of a general nature and the choice of model used to quantify dilution is left to the user. The models prescribed for the different exposure pathways by these two regulatory guides are similar in many attributes. Many of the recommended parameter values are identical and many of the formulations are either identical, or become identical under general conditions. However, despite these similarities, there is substantial variation between dose estimates for a common case. These differences are limited to certain nuclides and exposure pathways and are primarily due to differences in parameter values prescribed by the guidelines. The total dose from all pathways and from all nuclides for the case considered is within a factor of 1.3 for the two models. The convergence in results for the total dose for all radionuclides largely reflects the similarity in the way the models deal with the dominant dose contributor, tritium. Considering the results for each radionuclide, however, the models differ more and on average the CSA model estimates a 20-fold higher dose. (author)

The use of Fricke dosimeter to determine the absorbed dose from brachytherapy equipment in the Northeastern Brazil

International Nuclear Information System (INIS)

Souza, Vivianne Lucia B.; Cunha, Manuela S.; Figueiredo, Marcela D.C.; Santos, Carla D.A.; Rodrigues, Kelia R.G.; Lira, Gabriela B.S.; Silva, Danubia B.; Melo, Roberto T.

2011-01-01

This paper describes the practical results of an assessment of the situation of brachytherapy services throughout the Northeast. A Fricke dosimetry system capable of verifying the dose absorbed in water, prepared by researchers from the Regional Center of Nuclear Sciences was brought to public hospitals in the Northeast. The system not only evaluates if the applied (measured) dose is close to the calculated (prescribed) dose, but is also capable of verifying human errors and/or mechanical or the International Atomic Energy Agency (IAEA) standards regarding the percentage of allowed difference between the prescribed dose and dose measurement. (author)

Reduction of the scatter dose to the testicle outside the radiation treatment fields

International Nuclear Information System (INIS)

Kubo, H.; Shipley, W.U.

1982-01-01

A technique is described to reduce the dose to the contralateral testicle of patients with testis tumors during retroperitoneal therapy with 10 MV X-rays. When a conventional clam-shell shielding device was used, the dose to the testis from the photons scattered by the patient and the collimator jaws was found to be about 1.6% of the prescribed midplane dose. A more substantial gonadal shield made of low melting Ostalloy, that reduced further the dose from internal scattered X rays, was therefore designed. A 10 cm thick lead scrotal block above the scrotum immediately outside the field is shown to reduce the external scattered radiation to negligible levels. Using the shield and the block, it is possible to reduce the dose to the testicle to one-tenth of one percent of the prescribed midplane dose

Reduction of the scatter dose to the testicle outside the radiation treatment fields

International Nuclear Information System (INIS)

Kubo, H.; Shipley, W.U.

1982-01-01

A technique is described to reduce the dose to the contralateral testicle of patients with testis tumors during retroperitoneal therapy with 10 MV X rays. When a conventional clam-shell shielding device was used, the dose to the testis from the photons scattered by the patient and collimator jaws was found to be about 1.6% of the prescribed midplane dose. A more substantial gonadal shield made of low melting point Ostalloy, that reduced further the dose from internal scattered X rays, was therefore designed. A 10 cm thick lead scrotal block above the scrotum immediately outside the field is shown to reduce the external scattering radiation to negligible levels. Using the shield and the block, it is possible to reduce the dose to the testicle to one-tenth of one percent of the prescribed midplane dose

Antibiotic prescribing in women during and after delivery in a non-teaching, tertiary care hospital in Ujjain, India: a prospective cross-sectional study.

Science.gov (United States)

Sharma, Megha; Sanneving, Linda; Mahadik, Kalpana; Santacatterina, Michele; Dhaneria, Suryaprakash; Stålsby Lundborg, Cecilia

2013-01-01

Antibacterial drugs (hereafter referred to as antibiotics) are crucial to treat infections during delivery and postpartum period to reduce maternal mortality. Institutional deliveries have the potential to save lives of many women but extensive use of antibiotics, add to the development and spread of antibiotic resistance. The aim of this study was to present antibiotic prescribing among inpatients during and after delivery in a non-teaching, tertiary care hospital in the city of Ujjain, Madhya Pradesh, India. A prospective cross-sectional study was conducted including women having had either a vaginal delivery or a cesarean section in the hospital. Trained nursing staff collected the data on daily bases, using a specific form attached to each patient file. Statistical analysis, including bivariate and multivariable logistic regression was conducted. Of the total 1077 women, 566 (53%) had a vaginal delivery and 511 (47%) had a cesarean section. Eighty-seven percent of the women that had a vaginal delivery and 98% of the women having a cesarean section were prescribed antibiotics. The mean number of days on antibiotics in hospital for the women with a vaginal delivery was 3.1 (±1.7) and for the women with cesarean section was 6.0 (±2.5). Twenty-eight percent of both the women with vaginal deliveries and the women with cesarean sections were prescribed antibiotics at discharge. The most commonly prescribed antibiotic group in the hospital for both the women that had a vaginal delivery and the women that had a cesarean section were third-generation cephalosporins (J01DD). The total number of defined daily doses (DDD) per100 bed days for women that had a vaginal delivery was 101, and 127 for women that had a cesarean section. The high percentage of women having had a vaginal delivery that received antibiotics and the deviation from recommendation for cesarean section in the hospital is a cause of concern. Improved maternal health and rational use of antibiotics are

Prescribed computer games in addition to occlusion versus standard occlusion treatment for childhood amblyopia: a pilot randomised controlled trial.

Science.gov (United States)

Tailor, Vijay K; Glaze, Selina; Khandelwal, Payal; Davis, Alison; Adams, Gillian G W; Xing, Wen; Bunce, Catey; Dahlmann-Noor, Annegret

2015-01-01

Amblyopia ("lazy eye") is the commonest vision deficit in children. If not fully corrected by glasses, amblyopia is treated by patching or blurring the better-seeing eye. Compliance with patching is often poor. Computer-based activities are increasingly topical, both as an adjunct to standard treatment and as a platform for novel treatments. Acceptability by families has not been explored, and feasibility of a randomised controlled trial (RCT) using computer games in terms of recruitment and treatment acceptability is uncertain. We carried out a pilot RCT to test whether computer-based activities are acceptable and accessible to families and to test trial methods such as recruitment and retention rates, randomisation, trial-specific data collection tools and analysis. The trial had three arms: standard near activity advice, Eye Five, a package developed for children with amblyopia, and an off-the-shelf handheld games console with pre-installed games. We enrolled 60 children age 3-8 years with moderate or severe amblyopia after completion of optical treatment. This trial was registered as UKCRN-ID 11074. Pre-screening of 3600 medical notes identified 189 potentially eligible children, of whom 60 remained eligible after optical treatment, and were enrolled between April 2012 and March 2013. One participant was randomised twice and withdrawn from the study. Of the 58 remaining, 37 were boys. The mean (SD) age was 4.6 (1.7) years. Thirty-seven had moderate and 21 severe amblyopia. Three participants were withdrawn at week 6, and in total, four were lost to follow-up at week 12. Most children and parents/carers found the study procedures, i.e. occlusion treatment, usage of the allocated near activity and completion of a study diary, easy. The prescribed cumulative dose of near activity was 84 h at 12 weeks. Reported near activity usage numbers were close to prescribed numbers in moderate amblyopes (94 % of prescribed) but markedly less in severe amblyopes (64

Emerging and encouraging trends in e-prescribing adoption among providers and pharmacies.

Science.gov (United States)

Gabriel, Meghan E; Furukawa, Michael F; Vaidya, Varun

2013-09-01

The objective of this study is to describe the growth in provider (physician, nurse practitioner, and physician assistant) adoption of e-prescribing and the growth in pharmacies actively accepting e-prescriptions using nationally representative data from December 2008 to December 2012. Additionally, this study explored e-prescribing adoption variation by urban and rural counties. Descriptive analysis of nationally representative, transactional e-prescribing data. Data for this analysis were from Surescripts. Surescripts is a leading e-prescription network utilized by a majority of all chain, franchise, or independently owned pharmacies in the United States routing prescriptions for more than 240 million patients through their network. The total number of prescribers, including physicians, nurse practitioners, and physician assistants e-prescribing via an electronic health record (EHR) on the Surescripts network has increased from 7% to 54%. Additionally, the number of pharmacies actively accepting e-prescriptions is 94%. These increases in pharmacies actively accepting e-prescriptions and the provider's eprescribing mirror the increase in the volume of e-prescriptions sent on the Surescripts network. This analysis shows that the vast majority of pharmacies in the United States are able to accept e-prescriptions and over half of providers are e-prescribing via an EHR.

Validation and dosimetric evaluation employing the techniques of TL and OSL of thermoluminescent materials for application in the dosimetry of clinical beams of electrons used in total irradiation of the skin - TSI; Validação e avaliação dosimétrica empregando as técnicas de TL e OSL de materiais termoluminescentes para aplicação na dosimetria de feixes clínicos de elétrons utilizados na irradiação total da pele

Energy Technology Data Exchange (ETDEWEB)

Almeida, Shirlane Barbosa de

2017-07-01

In vivo dosimetry has become an important role for the treatment of total skin irradiation within a rigorous quality assurance program that should be an integral part of the radiotherapy departments. TSI dosimetry is difficult because of the complexity of the treatment in assessing dose uniformity and measuring the dose absorbed at shallow depths throughout the skin surface extent, resulting in a wide variation in dose distribution. The TLDs have proven to be very useful for the distribution and verification of the dose prescribed for the patient as the dose may differ from place to place due to patient body geometry, overlapping of structures and asymmetries of the radiation field. The use of TLDs in vivo can identify variations in the prescribed dose because its measurement accuracy and great precision. Several types of dosimeters have been used in the radiotherapy sectors, the most commonly used are Lithium Fluride (TLD-100), where it obtains a long history in this type of application. New dosimetric materials have gained great importance in the dosimetry of clinical electron beams, such as Dysprosium-doped Calcium Sulphate (TL) and Carbon doped (OSL) based Aluminum Oxide, This work evaluates the performance of the respective thermoluminescent dosimeters and the optically stimulated luminescence in the dosimetry of clinical electron beams used in total irradiation of the skin. (author)

Protocol: mixed-methods study to evaluate implementation, enforcement, and outcomes of U.S. state laws intended to curb high-risk opioid prescribing.

Science.gov (United States)

McGinty, Emma E; Stuart, Elizabeth A; Caleb Alexander, G; Barry, Colleen L; Bicket, Mark C; Rutkow, Lainie

2018-02-26

The U.S. opioid epidemic has been driven by the high volume of opioids prescribed by healthcare providers. U.S. states have recently enacted four types of laws designed to curb high-risk prescribing practices, such as high-dose and long-term opioid prescribing, associated with opioid-related mortality: (1) mandatory Prescription Drug Monitoring Program (PDMP) enrollment laws, which require prescribers to enroll in their state's PDMP, an electronic database of patients' controlled substance prescriptions, (2) mandatory PDMP query laws, which require prescribers to query the PDMP prior to prescribing an opioid, (3) opioid prescribing cap laws, which limit the dose and/or duration of opioid prescriptions, and (4) pill mill laws, which strictly regulate pain clinics to prevent nonmedical opioid prescribing. Some pain experts have expressed concern that these laws could negatively affect pain management among patients with chronic non-cancer pain. This paper describes the protocol for a mixed-methods study analyzing the independent effects of these four types of laws on opioid prescribing patterns and chronic non-cancer pain treatment, accounting for variation in implementation and enforcement of laws across states. Many states have enacted multiple opioid prescribing laws at or around the same time. To overcome this issue, our study focuses on 18 treatment states that each enacted a single law of interest, and no other potentially confounding laws, over a 4-year period (2 years pre-/post-law). Qualitative interviews with key leaders in each of the 18 treatment states will characterize the timing, scope, and strength of each state law's implementation and enforcement. This information will inform the design and interpretation of synthetic control models analyzing the effects of each of the two types of laws on two sets of outcomes: measures of (1) high-risk opioid prescribing and (2) non-opioid treatments for chronic non-cancer pain. Study of mandatory PDMP enrollment

Statistical analysis of dose heterogeneity in circulating blood: Implications for sequential methods of total body irradiation

International Nuclear Information System (INIS)

Molloy, Janelle A.

2010-01-01

Purpose: Improvements in delivery techniques for total body irradiation (TBI) using Tomotherapy and intensity modulated radiation therapy have been proven feasible. Despite the promise of improved dose conformality, the application of these ''sequential'' techniques has been hampered by concerns over dose heterogeneity to circulating blood. The present study was conducted to provide quantitative evidence regarding the potential clinical impact of this heterogeneity. Methods: Blood perfusion was modeled analytically as possessing linear, sinusoidal motion in the craniocaudal dimension. The average perfusion period for human circulation was estimated to be approximately 78 s. Sequential treatment delivery was modeled as a Gaussian-shaped dose cloud with a 10 cm length that traversed a 183 cm patient length at a uniform speed. Total dose to circulating blood voxels was calculated via numerical integration and normalized to 2 Gy per fraction. Dose statistics and equivalent uniform dose (EUD) were calculated for relevant treatment times, radiobiological parameters, blood perfusion rates, and fractionation schemes. The model was then refined to account for random dispersion superimposed onto the underlying periodic blood flow. Finally, a fully stochastic model was developed using binomial and trinomial probability distributions. These models allowed for the analysis of nonlinear sequential treatment modalities and treatment designs that incorporate deliberate organ sparing. Results: The dose received by individual blood voxels exhibited asymmetric behavior that depended on the coherence among the blood velocity, circulation phase, and the spatiotemporal characteristics of the irradiation beam. Heterogeneity increased with the perfusion period and decreased with the treatment time. Notwithstanding, heterogeneity was less than ±10% for perfusion periods less than 150 s. The EUD was compromised for radiosensitive cells, long perfusion periods, and short treatment times

Statistical analysis of dose heterogeneity in circulating blood: implications for sequential methods of total body irradiation.

Science.gov (United States)

Molloy, Janelle A

2010-11-01

Improvements in delivery techniques for total body irradiation (TBI) using Tomotherapy and intensity modulated radiation therapy have been proven feasible. Despite the promise of improved dose conformality, the application of these "sequential" techniques has been hampered by concerns over dose heterogeneity to circulating blood. The present study was conducted to provide quantitative evidence regarding the potential clinical impact of this heterogeneity. Blood perfusion was modeled analytically as possessing linear, sinusoidal motion in the craniocaudal dimension. The average perfusion period for human circulation was estimated to be approximately 78 s. Sequential treatment delivery was modeled as a Gaussian-shaped dose cloud with a 10 cm length that traversed a 183 cm patient length at a uniform speed. Total dose to circulating blood voxels was calculated via numerical integration and normalized to 2 Gy per fraction. Dose statistics and equivalent uniform dose (EUD) were calculated for relevant treatment times, radiobiological parameters, blood perfusion rates, and fractionation schemes. The model was then refined to account for random dispersion superimposed onto the underlying periodic blood flow. Finally, a fully stochastic model was developed using binomial and trinomial probability distributions. These models allowed for the analysis of nonlinear sequential treatment modalities and treatment designs that incorporate deliberate organ sparing. The dose received by individual blood voxels exhibited asymmetric behavior that depended on the coherence among the blood velocity, circulation phase, and the spatiotemporal characteristics of the irradiation beam. Heterogeneity increased with the perfusion period and decreased with the treatment time. Notwithstanding, heterogeneity was less than +/- 10% for perfusion periods less than 150 s. The EUD was compromised for radiosensitive cells, long perfusion periods, and short treatment times. However, the EUD was

Recent Total Ionizing Dose Results and Displacement Damage Results for Candidate Spacecraft Electronics for NASA

Science.gov (United States)

Cochran, Donna J.; Buchner, Stephen P.; Irwin, Tim L.; LaBel, Kenneth A.; Marshall, Cheryl J.; Reed, Robert A.; Sanders, Anthony B.; Hawkins, Donald K.; Flanigan, Ryan J.; Cox, Stephen R.

2005-01-01

We present data on the vulnerability of a variety of candidate spacecraft electronics to total ionizing dose and displacement damage. Devices tested include optoelectronics, digital, analog, linear bipolar devices, hybrid devices, Analog-to- Digital Converters (ADCs), and Digital-to-Analog Converters (DACs), among others. T

Prescribed fire research in Pennsylvania

Science.gov (United States)

Patrick Brose

2009-01-01

Prescribed fire in Pennsylvania is a relatively new forestry practice because of the State's adverse experience with highly destructive wildfires in the early 1900s. The recent introduction of prescribed fire raises a myriad of questions regarding its correct and safe use. This poster briefly describes the prescribed fire research projects of the Forestry Sciences...

Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Retrospective analysis of 29 medulloblastoma patients

Energy Technology Data Exchange (ETDEWEB)

Scobioala, Sergiu; Kittel, Christopher; Ebrahimi, Fatemeh; Wolters, Heidi; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiotherapy and Radiooncology, Muenster (Germany); Parfitt, Ross; Matulat, Peter; Am Zehnhoff-Dinnesen, Antoinette [University Hospital of Muenster, Department of Phoniatrics and Pediatric Audiology, Muenster (Germany)

2017-11-15

To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (D{sub mean}), and total cisplatin dose. In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though D{sub mean} was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m{sup 2}, with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when D{sub mean} exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies. (orig.) [German] Analyse von Inzidenz und Schweregrad einer sensorineuralen Schwerhoerigkeit (''sensorineural hearing loss'', SNHL) infolge der Wirkung unterschiedlicher Bestrahlungstechniken, Fraktionierungen, mittlerer

Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

Science.gov (United States)

Meeker, Daniella; Knight, Tara K; Friedberg, Mark W; Linder, Jeffrey A; Goldstein, Noah J; Fox, Craig R; Rothfeld, Alan; Diaz, Guillermo; Doctor, Jason N

2014-03-01

"Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. To investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more

Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment

Directory of Open Access Journals (Sweden)

Sittig Dean F

2010-11-01

Full Text Available Abstract Background The United States (US Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system in the ambulatory setting. Methods Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17 and staff (n = 53 perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory. Two coders independently coded to theoretical saturation and resolved discrepancies through discussions. Results Ten themes emerged that describe perceptions of e-prescribing implementation: 1 improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2 improved documentation resulted in safer care; 3 efficiencies were gained by using fewer paper charts; 4 organizational support facilitated adoption; 5 transition required time; resulted in workload shift to staff; 6 hardware configurations and network stability were important in facilitating workflow; 7 e-prescribing was time-neutral or time-saving; 8 changes in patient interactions enhanced patient care but required education; 9 pharmacy

Safe prescribing: a titanic challenge

Science.gov (United States)

Routledge, Philip A

2012-01-01

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Neuropharmacology and mental health nurse prescribers.

Science.gov (United States)

Skingsley, David; Bradley, Eleanor J; Nolan, Peter

2006-08-01

To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they

Forest fires in Mediterranean countries: CO2 emissions and mitigation possibilities through prescribed burning.

Science.gov (United States)

Vilén, Terhi; Fernandes, Paulo M

2011-09-01

Forest fires are an integral part of the ecology of the Mediterranean Basin; however, fire incidence has increased dramatically during the past decades and fire is expected to become more prevalent in the future due to climate change. Fuel modification by prescribed burning reduces the spread and intensity potential of subsequent wildfires. We used the most recently published data to calculate the average annual wildfire CO(2) emissions in France, Greece, Italy, Portugal and Spain following the IPCC guidelines. The effect of prescribed burning on emissions was calculated for four scenarios of prescribed burning effectiveness based on data from Portugal. Results show that prescribed burning could have a considerable effect on the carbon balance of the land use, land-use change and forestry (LULUCF) sector in Mediterranean countries. However, uncertainty in emission estimates remains large, and more accurate data is needed, especially regarding fuel load and fuel consumption in different vegetation types and fuel layers and the total area protected from wildfire per unit area treated by prescribed burning, i.e. the leverage of prescribed burning.

Airborne characterization of smoke marker ratios from prescribed burning

Science.gov (United States)

A. P. Sullivan; A. A. May; T. Lee; G. R. McMeeking; S. M. Kreidenweis; S. K. Akagi; R. J. Yokelson; S. P. Urbanski; J. L. Collett

2014-01-01

A Particle-Into-Liquid Sampler - Total Organic Carbon (PILS-TOC) and fraction collector system was flown aboard a Twin Otter aircraft sampling prescribed burning emissions in South Carolina in November 2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated offline samples for carbohydrate (i.e., smoke markers levoglucosan,...

Effect of physiological factors on dose due to organically bound tritium

International Nuclear Information System (INIS)

Trivedi, A.

1998-01-01

The International Commission on Radiological Protection (ICRP) recommends the understanding of the effect of age, anatomical and physiological data on the doses in order to prescribe dose coefficient for radionuclides. The published data on OBT dose fraction after acute or chronic intakes of HTO are evaluated to examine the variation of OBT dose with the age and physiology of occupational workers. (author)

Prescribing antibiotics in general practice:

DEFF Research Database (Denmark)

Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

Supporting biodiversity by prescribed burning in grasslands - A multi-taxa approach.

Science.gov (United States)

Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid D; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

2016-12-01

There are contrasting opinions on the use of prescribed burning management in European grasslands. On the one hand, prescribed burning can be effectively used for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. On the other hand burning can have a detrimental impact on grassland biodiversity by supporting competitor grasses and by threatening several rare and endangered species, especially arthropods. We studied the effects of prescribed burning in alkaline grasslands of high conservation interest. Our aim was to test whether dormant-season prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in East-Hungary: in three sites, a prescribed fire was applied in November 2011, while three sites remained unburnt. We studied the effects of burning on soil characteristics, plant biomass and on the composition of vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soil pH, organic matter, potassium and phosphorous did not change, but soluble salt content increased significantly in the burnt sites. Prescribed burning had several positive effects from the nature conservation viewpoint. Shannon diversity and the number of flowering shoots were higher, and the cover of the dominant grass Festuca pseudovina was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control. The key finding of our study was that prescribed burning did not decrease the abundance and diversity of arthropod taxa. Species-level analyses showed that out of the most abundant invertebrate species, 10 were not affected, 1 was negatively and 1 was positively affected by burning. Moreover, our results suggest that prescribed burning leaving unburnt patches can be a viable management tool in open landscapes, because it supports plant diversity and does not threaten

Influence of radioprotectors on total body weight evolution and on oxygen consumption in lethal dose irradiated animals. (Preliminary study)

International Nuclear Information System (INIS)

Fatome, M.; Martine, G.; Bargy, E.; Andrieu, L.

Comparison of total body weight evolution and oxygen consumption in lethal dose irradiated animals, protected by various well known radioprotective substances, isolated or in mixture, with evolution and consumption of non protected animals irradiated at the same dose and with these of check animals [fr

Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators

International Nuclear Information System (INIS)

Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.

2008-01-01

Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)

Improving dose homogeneity in head and neck radiotherapy with custom 3-D compensation

International Nuclear Information System (INIS)

Brock, Linda K.; Harari, Paul M.; Sharda, Navneet N.; Paliwal, Bhudatt R.; Kinsella, Timothy J.

1996-01-01

Purpose/Objective: Anatomic contour irregularities and tissue inhomogeneities can lead to significant radiation dose variation across complex treatment volumes. Such dose non-uniformity occurs routinely in radiation of the head and neck (H and N) despite beam shaping with blocks or beam modification with wedges. Small dose variations are amplified by the high total doses delivered (often >70 Gy) which can thereby influence late normal tissue complications as well as tumor control. We have therefore implemented the routine use of 3-D custom tissue compensators for our H and N cancer patients fabricated directly from CT scan contour data obtained in the treatment position. The capacity of such compensators to improve dose uniformity in patients with tumors of the H and N is herein reported. Materials and Methods: Between July 1992 and March 1995, 80 patients receiving H and N radiotherapy had 3-D custom compensators fabricated for their treatment course. Detailed dosimetric records have been reviewed for thirty cases to date (60 custom compensators). Dose uniformity across the treatment volume, peak dose delivery and maximum doses to selected, clinically relevant, anatomic subsites were analyzed and compared with uncompensated and wedged plans. Dose-volume histograms were generated and volumes receiving greater than 5% and 10% of the prescribed dose noted. Phantom dose measurements were performed for compensated fields using a water chamber and were compared to calculated doses in order to evaluate the accuracy of isodoses generated by the Theraplan treatment planning system. Accuracy of the fabrication and positioning of the custom compensators was verified by direct measurement. Results: Custom compensators resulted in an average reduction of dose variance across the treatment volume from 13.8% (7-20%) for the uncompensated plans to 4.5% (2-7%) with the compensators. Wedged plans were variable but on average an 8% (3-15%) dose variance was noted. Maximum doses

Northern Marshall Islands radiological survey: terrestrial food chain and total doses

International Nuclear Information System (INIS)

Robison, W.L.; Mount, M.E.; Phillips, W.A.; Conrado, C.A.; Stuart, M.L.; Stoker, C.E.

1982-01-01

A radiological survey was conducted from September through November of 1978 to assess the concentrations of persistent manmade radionuclides in the terrestrial and marine environments of 11 atolls and 2 islands in the Northern Marshall Islands. The survey consisted mainly of an aerial radiological reconnaissance to map the external gamma-ray exposure rates over the islands of each atoll. The logistical support for the entire survey was designed to accommodate this operation. As a secondary phase of the survey, shore parties collected appropriate terrestrial and marine samples to assess the radiological dose from pertinent food chains to those individuals residing on the atolls, who may in the future reside on some of the presently uninhabited atolls, or who collect food from these atolls. Over 5000 terrestrial and marine samples were collected for radionuclide analysis from 76 different islands. Soils, vegetation, indigenous animals, and cistern water and groundwater were collected from the islands. Reef and pelagic fish, clams, lagoon water, and sediments were obtained from the lagoons. The concentration data for 90 Sr, 137 Cs, 238 Pu, 239 240 Pu, and 241 Am in terrestrial food crops, fowl, and animals collected at the atolls or islands are summarized. An assessment of the total dose from the major exposure pathways including external gamma, terrestrial food chain including food products and drinking water, marine food chain, and inhalation is provided. Radiological doses at each atoll or island are calculated from the average radionuclide concentrations in the terrestrial foods, marine foods, etc. assuming the average daily intake for each food item

Nurse practitioner prescribing: an international perspective

Directory of Open Access Journals (Sweden)

Fong J

2015-10-01

Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

Safe prescribing: a titanic challenge.

Science.gov (United States)

Routledge, Philip A

2012-10-01

The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

Science.gov (United States)

Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-08-01

Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

Total body irradiation: current indications; L`irradiation corporelle totale: les indications actuelles

Energy Technology Data Exchange (ETDEWEB)

Giraud, P.; Danhier, S.; Dubray, B.; Cosset, J.M. [Institut Curie, 75 - Paris (France)

1998-05-01

The choice of dose and fractionation for total body irradiation is made difficult by the large number of considerations to be taken into account. The outcome of bone marrow transplantation after total body irradiation can be understood in terms of tumor cell killing, engraftment, and normal tissue damage, each of these endpoints being influenced by irradiation-, disease-, transplant-, and patient- related factors. Interpretation of clinical data is further hampered by the overwhelming influence of logistic constraints, the small numbers of randomized studies, and the concomitant variations in total dose and fraction size or dose rate. So far, three cautious conclusions can be drawn in order to tentatively adapt the total body irradiation schedule to clinically-relevant situations. Firstly, the organs at risk for normal tissue damage (lung, liver, lens, kidney) are protected by delivering small doses per fraction at low dose rate. This suggests that, when toxicity is at stake (e.g. in children), fractionated irradiation should be preferred, provided that inter-fraction intervals are long enough. Secondly, fractionated irradiation should be avoided in case of T-cell depleted transplant, given the high risk of graft rejection in this setting. An alternative would be to increase total (or fractional) dose of fractionated total body irradiation, but this approach is likely to induce more normal tissue toxicity. Thirdly, clinical data have shown higher relapse rates in chronic myeloid leukemia after fractionated or low dose rate total body irradiation, suggesting that fractionated irradiation should not be recommended, unless total (or fractional) dose is increased. Total body irradiation-containing regimens, primarily cyclophosphamide / total body irradiation, are either equivalent to or better than the chemotherapy-only regimens, primarily busulfan / cyclophosphamide. Busulfan / cyclophosphamide certainly represents a reasonable alternative, especially in patients who

High daily doses of benzodiazepines among Quebec seniors: prevalence and correlates

Directory of Open Access Journals (Sweden)

Moride Yola

2001-11-01

Full Text Available Abstract Background Use of high daily doses of benzodiazepines is generally contraindicated for seniors. While both patient and physician factors may influence the use of high daily doses, previous research on the effect of patient factors has been extremely limited. The objectives of this study were to determine the one year prevalence of use of high daily doses of benzodiazepines, and examine physician and patient correlates of such use among Quebec community-dwelling seniors. Methods Patient information for 1423 community-dwelling Quebec seniors who participated in the Canadian Study of Health and Aging was linked to provincial health insurance administrative data bases containing detailed information on prescriptions received and prescribers. Results The standardized one year period prevalence of use of high daily doses of benzodiazepines was 7.9%. Use of high daily doses was more frequent among younger seniors and those who had reported anxiety during the previous year. Patients without cognitive impairment were more likely to receive high dose prescriptions from general practitioners, while those with cognitive impairment were more likely to receive high dose prescriptions from specialists. Conclusion High dose prescribing appears to be related to both patient and physician factors.

Measurement with total scatter calibrate factor at different depths in the calculation of prescription dose

International Nuclear Information System (INIS)

Li Lijun; Zhu Haijun; Zhang Xinzhong; Li Feizhou; Song Hongyu

2004-01-01

Objective: To evaluate the method of measurement of total scatter calibrate factor (Sc, p). Methods: To measure the Sc, p at different depths on central axis of 6MV, 15MV photon beams through different ways. Results: It was found that the measured data of Sc, p changed with the different depths to a range of 1% - 7%. Using the direct method, the Sc, p measured depth should be the same as the depth in dose normalization point of the prescription dose. If the Sc, p (fsz, d) was measured at the other depths, it could be obtained indirectly by the calculation formula. Conclusions: The Sc, p in the prescription dose can be obtained either by the direct measure method or the indirect calculation formula. But emphasis should be laid on the proper measure depth. (authors)

Patterns of Antimicrobial Prescribing in a Tertiary Care Hospital in Oman

Directory of Open Access Journals (Sweden)

Abdulrahman Al-Yamani

2016-01-01

Full Text Available Objectives: Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman. Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four-week period (1 November to 28 November 2012. The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant. Results: There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5±1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed. Conclusions: National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted.

Total Ionizing Dose Effects on Threshold Switching in 1T-Tantalum Disulfide Charge-Density-Wave Devices

OpenAIRE

Liu, G.; Zhang, E. X.; Liang, C. D.; Bloodgood, M. A.; Salguero, T. T.; Fleetwood, D. M.; Balandin, A. A.

2017-01-01

The 1T polytype of TaS2 exhibits voltage-triggered threshold switching as a result of a phase transition from nearly commensurate to incommensurate charge density wave states. Threshold switching, persistent above room temperature, can be utilized in a variety of electronic devices, e.g., voltage controlled oscillators. We evaluated the total-ionizing-dose response of thin film 1T-TaS2 at doses up to 1 Mrad(SiO2). The threshold voltage changed by less than 2% after irradiation, with persisten...

Prescription Dose Guideline Based on Physical Criterion for Multiple Metastatic Brain Tumors Treated With Stereotactic Radiosurgery

International Nuclear Information System (INIS)

Sahgal, Arjun; Barani, Igor J.; Novotny, Josef; Zhang Beibei; Petti, Paula; Larson, David A.; Ma Lijun

2010-01-01

Purpose: Existing dose guidelines for intracranial stereotactic radiosurgery (SRS) are primarily based on single-target treatment data. This study investigated dose guidelines for multiple targets treated with SRS. Methods and Materials: A physical model was developed to relate the peripheral isodose volume dependence on an increasing number of targets and prescription dose per target. The model was derived from simulated and clinical multiple brain metastatic cases treated with the Leksell Gamma Knife Perfexion at several institutions, where the total number of targets ranged from 2 to 60. The relative increase in peripheral isodose volumes, such as the 12-Gy volume, was studied in the multitarget treatment setting based on Radiation Therapy Oncology Group 90-05 study dose levels. Results: A significant increase in the 12-Gy peripheral isodose volumes was found in comparing multiple target SRS to single-target SRS. This increase strongly correlated (R 2 = 0.92) with the total number of targets but not the total target volumes (R 2 = 0.06). On the basis of the correlated curve, the 12-Gy volume for multiple target treatment was found to increase by approximately 1% per target when a low target dose such as 15 Gy was used, but approximately 4% per target when a high dose such as 20-24 Gy was used. Reduction in the prescription dose was quantified for each prescription level in maintaining the 12-Gy volume. Conclusion: Normal brain dose increases predictably with increasing number of targets for multitarget SRS. A reduction of approximately 1-2 Gy in the prescribed dose is needed compared with single target radiosurgery.

Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision.

Science.gov (United States)

Haffey, Faye; Brady, Richard R W; Maxwell, Simon

2014-01-01

Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. Three hundred and six apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest apps found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of £14.25 per app and a range of £0.62-101.90. A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalized app stores may help universities/healthcare organizations offer high quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers. This will enable them to make informed choices about the use of such apps in their clinical practice. © 2013 The British Pharmacological Society.

SU-F-T-35: Optimization of Bladder and Rectal Doses Using a Multi-Lumen Intracavitary Applicator for Gynecological Brachytherapy

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Laoui, S; Dietrich, S; Sehgal, V; Al-Ghazi, M [University of California, Irvine, Orange, CA (United States)

2016-06-15

Purpose: Radiation dose delivery for endometrial cancer using HDR techniques is limited by dose to bladder and rectum. A dosimetric study was performed using Varian Capri vaginal brachytherapy applicator to determine the optimal channel configuration which minimizes dose to bladder and rectum, while providing good target coverage. Methods: A total of 17 patients, 63 plans clinically delivered, and 252 simulated plans using Varian BrachyVision planning system were generated to investigate optimal channel configuration which results in minimum dose to bladder and rectum while providing adequate target coverage. The Capri applicator consists of 13 lumens arranged in two concentric rings, one central lumen and six lumens per ring. Manual dose shaping is invariably required to lower the dose to critical organs. Three-dimensional plans were simulated for 4 channel arrangements, all 13 channels, channel 12 o’clock (close to bladder) and 6 o’clock (close to rectum) deactivated, central channel deactivated, and central channel in addition to 12 o’clock and 6 o’clock deactivated. A relationship between V100, the volume that receives the prescribed dose, and the amount of curie-seconds required to deliver it, was established. Results: Using all 13 channels results in maximum dose to bladder and rectum. Deactivating central channel in addition to 12 o’clock and 6 o’clock resulted in minimizing bladder and rectum doses but compromised target coverage. The relationship between V100, the volume that receives the prescribed dose, and the curie seconds was found to be linear. Conclusion: Deactivating channels 12 o’clock and 6 o’clock was shown to be the optimal configuration leading to minimum dose to bladder and rectum without compromising target coverage. The linear relationship between V100 and the curie- seconds can be used as a verification parameter.

Total-dose radiation effects data for semiconductor devices. 1985 supplement. Volume 2, part A

International Nuclear Information System (INIS)

Martin, K.E.; Gauthier, M.K.; Coss, J.R.; Dantas, A.R.V.; Price, W.E.

1986-05-01

Steady-state, total-dose radiation test data, are provided in graphic format for use by electronic designers and other personnel using semiconductor devices in a radiation environment. The data were generated by JPL for various NASA space programs. This volume provides data on integrated circuits. The data are presented in graphic, tabular, and/or narrative format, depending on the complexity of the integrated circuit. Most tests were done using the JPL or Boeing electron accelerator (Dynamitron) which provides a steady-state 2.5 MeV electron beam. However, some radiation exposures were made with a cobalt-60 gamma ray source, the results of which should be regarded as only an approximate measure of the radiation damage that would be incurred by an equivalent electron dose

Antibiotic prescribing practices for catheter urine culture results.

Science.gov (United States)

Chiu, Jonathan; Thompson, G William; Austin, Thomas W; Hussain, Zafar; John, Michael; Bombassaro, Anne Marie; Connelly, Sarah E; Elsayed, Sameer

2013-01-01

The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship. To assess the appropriateness of antibiotic prescribing in response to the results of urine cultures from patients with indwelling urinary catheters. This retrospective study was conducted at a tertiary care centre and involved adults with indwelling urinary catheters from whom urine specimens were obtained for culture. Patients with positive or negative culture results were identified from microbiology laboratory reports. The medical records of consecutive patients were screened to select a sample of 80 inpatients (40 per group). Abstracted patient histories were independently evaluated by an expert panel of 3 infectious diseases consultants blinded to the decisions of prescribers and of fellow panelists. The primary end point was concordance of each patient's treatment decision (with respect to the indication) between the expert panel (based on majority agreement, i.e., at least 2 of the 3 expert panelists) and the prescriber. The secondary end points were unnecessary days of therapy and selected outcomes over a predefined period after urine was obtained for culture. A total of 591 charts were screened to generate the targeted number of patients. Baseline demographic characteristics were comparable for the 2 groups, except antibiotic exposure before urine collection was significantly more frequent for the group with negative culture results. The treatment decision was concordant in 40% (16/40) of the patients with a positive culture result and 85% (34/40) of those with a negative culture result (p < 0.001). The most common reason for discordance was administration of antibiotics when not indicated (23 of 24 patients with a positive result and 5 of 6 patients with a negative result), which accounted for 165 and 32 unnecessary days of therapy per 1000 inpatient

Antibiotic Prescribing Patterns in Outpatient Emergency Clinics at Queen Rania Al Abdullah II Children's Hospital, Jordan, 2013.

Science.gov (United States)

Al-Niemat, Sahar I; Aljbouri, Tareq M; Goussous, Lana S; Efaishat, Rania A; Salah, Rehab K

2014-07-01

To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children's Hospital at Royal Medical Services in Amman, Jordan. The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs) were also measured. Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85%) when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60%) of the total prescribed antibiotics and (83%) of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin) were the leading class among them. Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.

ASSET (Age/Sex Standardised Estimates of Treatment): a research model to improve the governance of prescribing funds in Italy.

Science.gov (United States)

Favato, Giampiero; Mariani, Paolo; Mills, Roger W; Capone, Alessandro; Pelagatti, Matteo; Pieri, Vasco; Marcobelli, Alberico; Trotta, Maria G; Zucchi, Alberto; Catapano, Alberico L

2007-07-04

The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment). Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro) and females (195.12 euro). After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources to regional authorities and general practices.

Total-ionizing-dose effects on isolation oxides in modern CMOS technologies

International Nuclear Information System (INIS)

Barnaby, Hugh J.; Mclain, Michael; Esqueda, Ivan Sanchez

2007-01-01

This paper presents experimental data on the total dose response of deep sub-micron bulk CMOS devices and integrated circuits. Ionizing radiation experiments on shallow trench isolation (STI) field oxide MOS capacitors (FOXCAP) indicate a characteristic build-up of radiation-induced defects in the dielectric. In this paper, capacitors fabricated with STI, thermal, SIMOX and bipolar base oxides of similar thickness are compared and show the STI oxide to be most susceptible to radiation effects. Experimental data on irradiated shift registers and n-channel MOSFETs are also presented. These data indicate that radiation damage to the STI can increase the off-state current of n-channel devices and the standby current of CMOS integrated circuits

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: A study from rural centre of Maharashatra, India

Directory of Open Access Journals (Sweden)

Jain Vandana

2007-01-01

Full Text Available Aim : To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR intracavitary brachytherapy (ICBT. Materials and Methods : Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C. The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups- less then 80% (< 80%, 80-100% and above 100% (>100%. A total of 180 applications for 60 patients were calculated for the above analyses. Results : There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by ′A′ radiotherapist were within the limits in the self as well as in the shared groups more number of times, by ′B′ radiotherapist was more times exceeding the limit and by ′C′ radiotherapist doses were in between the A and B. Discussion and Conclusion : For the rectal and bladder doses most important factors are patient′s age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

Prescribing practices amid the OxyContin crisis: examining the effect of print media coverage on opioid prescribing among physicians.

Science.gov (United States)

Borwein, Alexandra; Kephart, George; Whelan, Emma; Asbridge, Mark

2013-12-01

The pain medication OxyContin (hereafter referred to as oxycodone extended release) has been the subject of sustained, and largely negative, media attention in recent years. We sought to determine whether media coverage of oxycodone extended release in North American newspapers has led to changes in prescribing of the drug in Nova Scotia, Canada. An interrupted time-series design examined the effect of media attention on physicians' monthly prescribing of opioids. The outcome measures were, for each physician, the monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone extended release. The exposure of interest was media attention defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in the prescribing of oxycodone extended release in Nova Scotia were observed, and they followed changes in media coverage. Oxycodone extended release prescribing rose steadily prior to receiving media attention. Following peak media attention in the United States, the prescribing of oxycodone extended release slowed. Likewise, following peak coverage in Canadian newspapers, the prescribing of oxycodone extended release declined. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied. This study demonstrates that print media reporting of oxycodone extended release in North American newspapers, and its continued portrayal as a social problem, coincided with reductions in the prescribing of oxycodone extended release by physicians in Nova Scotia. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

Breast internal dose measurements in a physical thoracic phantom

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Silva, S.D.; Oliveira, M.A.; Castro, A.L.S.; Dias, H.G.; Nogueira, L.B.; Campos, T.P.R., E-mail: sadonatosilva@hotmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear; Hospital das Clinicas de Uberlandia, MG (Brazil). Departamento de Oncologia; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Anatomia e Departamento de Imagem

2017-10-01

Radiotherapy is a cancer treatment intended to deposit the entire prescribed dose homogeneously into a target volume in order to eliminate the tumor and to spare the surrounding healthy tissues. This paper aimed to provide a dosimetric comparison between the treatment planning system (TPS) ECLIPSE from Varian Medical Systems and the internal dosimetric measurements in a breast phantom. The methodology consisted in performing a 3D conformal radiotherapy planning with two tangential opposite parallel fields applied to the synthetic breast in a thoracic phantom. The irradiation was reproduced in the Varian Linear accelerator, model SL - 20 Precise, 6 MV energy. EBT2 Radiochromic films, placed into the glandular equivalent tissue of the breast, were used to measure the spatial dose distribution. The absorbed dose was compared to those values predicted by the treatment planning system; besides, the dosimetric uncertainties were analyzed. The modal absorbed dose was in agreement with the prescribed value of 180 cGy, although few high dose points between 180 and 220 cGy were detected. The findings suggested a non-uniform dose distribution in the glandular tissue of the synthetic breast, similar to those found in the TPS, associated with the irregular anatomic breast shape and presence of inhomogeneities next to the thoracic wall generated by the low lung density. (author)

Compendium of Current Total Ionizing Dose and Displacement Damage Results from NASA Goddard Space Flight Center and NASA Electronic Parts and Packaging Program

Science.gov (United States)

Topper, Alyson D.; Campola, Michael J.; Chen, Dakai; Casey, Megan C.; Yau, Ka-Yen; Cochran, Donna J.; Label, Kenneth A.; Ladbury, Raymond L.; Mondy, Timothy K.; O'Bryan, Martha V.;

Total Dose Effects on Bipolar Integrated Circuits at Low Temperature

Science.gov (United States)

Johnston, A. H.; Swimm, R. T.; Thorbourn, D. O.

2012-01-01

Total dose damage in bipolar integrated circuits is investigated at low temperature, along with the temperature dependence of the electrical parameters of internal transistors. Bandgap narrowing causes the gain of npn transistors to decrease far more at low temperature compared to pnp transistors, due to the large difference in emitter doping concentration. When irradiations are done at temperatures of -140 deg C, no damage occurs until devices are warmed to temperatures above -50 deg C. After warm-up, subsequent cooling shows that damage is then present at low temperature. This can be explained by the very strong temperature dependence of dispersive transport in the continuous-time-random-walk model for hole transport. For linear integrated circuits, low temperature operation is affected by the strong temperature dependence of npn transistors along with the higher sensitivity of lateral and substrate pnp transistors to radiation damage.

Direct measurement of dose at depth in breast cancer using lithium fluoride

Energy Technology Data Exchange (ETDEWEB)

Dawes, P J.D.K.; Aird, E G; Crawshaw, I P

1988-05-01

In 23 cases of breast cancer treated conservatively using external beam and interstitial radiotherapy, lithium fluoride thermoluminescent dosimetry has been used to measure the radiation dose received by the breast tissue at depth. Thirty-six investigations were made using a number of lithium fluoride micro-rods for each investigation. Three results could not be analysed because of measurement problems in two and insufficient information in one. Twenty-eight results were obtained at a depth in tissue greater than the build-up zone, 23 of the 28 falling within +- 5% and 27 of the 28 falling within +- 10% of the computer-calculated prescribed dose. Of five results obtained within the build-up zone, two fell within +- 5% and four within +- 10% of the prescribed dose.

Organ doses and effective doses in some medical and industrial applications

International Nuclear Information System (INIS)

Keshavkumar, Biju

2000-01-01

The ICRP recommends radiation protection standards for the safe use of radiation and also prescribes the radiation protection quantities and periodically reviews them. In this context, the quantities like organ doses and effective doses are defined by ICRP. In this work we calculate these quantities and hence the conversion functions for the industrial radiation sources and those for CT and diagnostic X-ray exposures. Workers who are occupationally exposed to radiation are regularly monitored to evaluate the radiation dose received by them. It is quite possible that in an accident situation, the worker involved in the accident might not have worn a personal monitor, popularly known as the monitoring badge. In addition, even some non radiation workers (who are obviously not monitored) may also have received exposure. Under these circumstances, the persons involved are interviewed, the accident site inspected, and on the basis of realistic assumptions, the likely doses received by the exposed persons are estimated

Total Ambient Dose Equivalent Buildup Factor Determination for Nbs04 Concrete.

Science.gov (United States)

Duckic, Paulina; Hayes, Robert B

2018-06-01

Buildup factors are dimensionless multiplicative factors required by the point kernel method to account for scattered radiation through a shielding material. The accuracy of the point kernel method is strongly affected by the correspondence of analyzed parameters to experimental configurations, which is attempted to be simplified here. The point kernel method has not been found to have widespread practical use for neutron shielding calculations due to the complex neutron transport behavior through shielding materials (i.e. the variety of interaction mechanisms that neutrons may undergo while traversing the shield) as well as non-linear neutron total cross section energy dependence. In this work, total ambient dose buildup factors for NBS04 concrete are calculated in terms of neutron and secondary gamma ray transmission factors. The neutron and secondary gamma ray transmission factors are calculated using MCNP6™ code with updated cross sections. Both transmission factors and buildup factors are given in a tabulated form. Practical use of neutron transmission and buildup factors warrants rigorously calculated results with all associated uncertainties. In this work, sensitivity analysis of neutron transmission factors and total buildup factors with varying water content has been conducted. The analysis showed significant impact of varying water content in concrete on both neutron transmission factors and total buildup factors. Finally, support vector regression, a machine learning technique, has been engaged to make a model based on the calculated data for calculation of the buildup factors. The developed model can predict most of the data with 20% relative error.

Biologically effective dose in total-body irradiation and hematopoietic stem cell transplantation

International Nuclear Information System (INIS)

Kal, H.B.; Kempen-Harteveld, M.L. van; Heijenbrok-Kal, M.H.; Struikmans, H.

2006-01-01

Background and Purpose: Total-body irradiation (TBI) is an important part of the conditioning regimen for hematopoietic stem cell transplantation (HSCT) in patients with hematologic malignancies. The results after treatment with various TBI regimes were compared, and dose-effect relationships for the endpoints relapse incidence, disease-free survival, treatment-related mortality, and overall survival were derived. The aim was to define requirements for an optimal treatment schedule with respect to leukemic cell kill and late normal-tissue morbidity. Material and Methods: A literature search was performed. Three randomized studies, four studies comparing results of two or three TBI regimens, and nine reports with results of one specific TBI regimen were identified. Biologically effective doses (BEDs) were calculated. The results of the randomized studies and the studies comparing results of two or three TBI regimens were pooled, and the pooled relative risk (RR) was calculated for the treatments with high BED values versus treatments with a low BED. BED-effect relationships were obtained. Results: RRs for the high BED treatments were significantly lower for relapse incidence, not significantly different for disease-free survival and treatment-related mortality, and significantly higher for overall survival. BED-effect relationships indicate a decrease in relapse incidence and treatment-related mortality and an increase in disease-free and overall survival with higher BED values. Conclusion: 'More dose is better', provided that a TBI setting is used limiting the BEDs of lungs, kidneys, and eye lenses. (orig.)

Effectiveness of an educational feedback intervention on drug prescribing in dental practice.

Science.gov (United States)

Rauniar, G P; Das, B P; Manandhar, T R; Bhattacharya, S K

2012-01-01

Irrational use of drugs as well as inappropriate and over drug prescribing leads to unnecessary expenditures and emergence of resistant bacterial strains. Feedback intervention on drug prescribing habits and face to face educational intervention of prescription audit would be effective in rationalizing prescribing practices. To measure the impact of educational feedback intervention on the prescribing behavior of dental surgeons. Prospective audit of twelve hundred outpatients prescriptions in dental OPD at BPKIHS of those dental surgeon who attended the educational intervention session was collected randomly by trained persons on customized data collection sheet before and after educational intervention. A total 1200 prescription were collected, 300 before and 300 after intervention period at the internal of one month, three months and six months. Majority of the prescriptions (39.33%) contained four drugs but after intervention, prescriptions contained mostly one drug, 73% in first month, 78.67% in third month and 65.34% in six month. Mean number of drugs per prescription after intervention were decreased. There was increased number of generic names of drugs after intervention. Amoxicillin, Metronidazole, Chlorhexidine, Povidone iodine gargle, Nimesulide, Ibuprofen, Ibuprofen + paracetamol, and Paracetamol were most commonly prescribed by dental prescribers before and after intervention. Selection of antimicrobial was done on empirical basis which was correct because Amoxicillin concentration reaches effectively in gingival crevicular fluid and Metronidazole covered effectively against anaerobic bacteria were found in orodental infection. The uses of topical anti-infective preparation as irrigants of choice that can kill majority of micro-organisms found is root canal and dental tubules and minimize systemic use of antimicrobials. Nimesulide prescribing needs to be rationalized. Feedback educational intervention of prescription audit is effective to improve their

Prescribed Burning and Erosion Potential in Mixed Hardwood Forests of Southern Illinois

Directory of Open Access Journals (Sweden)

Gurbir Singh

2017-04-01

Full Text Available Prescribed fire has several benefits for managing forest ecosystems including reduction of fuel loading and invasive species and enhanced regeneration of desirable tree species. Along with these benefits there are some limitations like nutrient and sediment loss which have not been studied extensively in mixed hardwood forests. The objective of our research was to quantify the amount of sediment movement occurring on a watershed scale due to prescribed fire in a southern Illinois mixed hardwood ecosystem. The research site was located at Trail of Tears State Forest in western Union county, IL, USA and included five watershed pairs. One watershed in each pair was randomly assigned the prescribed burn treatment and the other remained as control (i.e., unburned. The prescribed burn treatment significantly reduced the litter depth with 12.6%–31.5% litter remaining in the prescribed burn treatment watersheds. When data were combined across all watersheds, no significant differences were obtained between burn treatment and control watershed for total suspended solids and sediment concentrations or loads. The annual sediment losses varied from 1.41 to 90.54 kg·ha−1·year−1 in the four prescribed burn watersheds and 0.81 to 2.54 kg·ha−1·year−1 in the four control watersheds. Prescribed burn watershed 7 showed an average soil sediment loss of 4.2 mm, whereas control watershed 8 showed an average accumulation of sediments (9.9 mm, possibly due to steeper slopes. Prescribed burning did not cause a significant increase in soil erosion and sediment loss and can be considered acceptable in managing mixed hardwood forests of Ozark uplands and the Shawnee Hills physiographic regions of southern Illinois.

A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.

LENUS (Irish Health Repository)

Naughton, Corina

2009-10-01

The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.

Optimizing Collimator Margins for Isotoxically Dose-Escalated Conformal Radiation Therapy of Non-Small Cell Lung Cancer

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Warren, Samantha, E-mail: Samantha.warren@oncology.ox.ac.uk [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Panettieri, Vanessa [William Buckland Radiotherapy Centre, Alfred Hospital, Commercial Road, Melbourne (Australia); Panakis, Niki; Bates, Nicholas [Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Lester, Jason F. [Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff (United Kingdom); Jain, Pooja [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Landau, David B. [Department of Radiotherapy, Guy' s and St. Thomas' NHS Foundation Trust, London (United Kingdom); Nahum, Alan E.; Mayles, W. Philip M. [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Fenwick, John D. [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom)

2014-04-01

Purpose: Isotoxic dose escalation schedules such as IDEAL-CRT [isotoxic dose escalation and acceleration in lung cancer chemoradiation therapy] (ISRCTN12155469) individualize doses prescribed to lung tumors, generating a fixed modeled risk of radiation pneumonitis. Because the beam penumbra is broadened in lung, the choice of collimator margin is an important element of the optimization of isotoxic conformal radiation therapy for lung cancer. Methods and Materials: Twelve patients with stage I-III non-small cell lung cancer (NSCLC) were replanned retrospectively using a range of collimator margins. For each plan, the prescribed dose was calculated according to the IDEAL-CRT isotoxic prescription method, and the absolute dose (D{sub 99}) delivered to 99% of the planning target volume (PTV) was determined. Results: Reducing the multileaf collimator margin from the widely used 7 mm to a value of 2 mm produced gains of 2.1 to 15.6 Gy in absolute PTV D{sub 99}, with a mean gain ± 1 standard error of the mean of 6.2 ± 1.1 Gy (2-sided P<.001). Conclusions: For NSCLC patients treated with conformal radiation therapy and an isotoxic dose prescription, absolute doses in the PTV may be increased by using smaller collimator margins, reductions in relative coverage being offset by increases in prescribed dose.

Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013.

Science.gov (United States)

Paulozzi, Leonard J; Strickler, Gail K; Kreiner, Peter W; Koris, Caitlin M

2015-10-16

Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of >100 morphine milligram equivalents (MMEs) per day. 2013. The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines

Patterns of drug prescribing in a hospital in Dubai, United Arab Emirates

Directory of Open Access Journals (Sweden)

Wess L

2008-01-01

Full Text Available To determine the pattern of drug prescription by consultants in a private hospital in Dubai, UnitedArab Emirates, 1190 prescriptions were collected from the hospital’s pharmacy over 30 days. In total,2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of alldrugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters.Information about the prescribing physician and the patient was invariably deficient. Name of patient,age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, noneof the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician,signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principaldrug in each class were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenacsodium being 51.6%, 21.4% antibiotics (amoxicillin-clavulanate 13.5%, and 11.5% gastrointestinaldrugs (GI, Hyoscine-N-butylbromide 28.1%. Other therapeutic classes included endocrine drugs(6.1%, vitamin supplements (5.9%, nasal decongestants (4%, antihistaminics (3.8% andcardiovascular drugs (2.6%. Antibiotic injections accounted for 7.4% of all antibiotics prescribed,which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions ofencounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicatespossible areas of improvement in prescription practice.

Radiation-induced rib fracture after stereotactic body radiotherapy with a total dose of 54-56 Gy given in 9-7 fractions for patients with peripheral lung tumor: impact of maximum dose and fraction size.

Science.gov (United States)

Aoki, Masahiko; Sato, Mariko; Hirose, Katsumi; Akimoto, Hiroyoshi; Kawaguchi, Hideo; Hatayama, Yoshiomi; Ono, Shuichi; Takai, Yoshihiro

2015-04-22

Radiation-induced rib fracture after stereotactic body radiotherapy (SBRT) for lung cancer has been recently reported. However, incidence of radiation-induced rib fracture after SBRT using moderate fraction sizes with a long-term follow-up time are not clarified. We examined incidence and risk factors of radiation-induced rib fracture after SBRT using moderate fraction sizes for the patients with peripherally located lung tumor. During 2003-2008, 41 patients with 42 lung tumors were treated with SBRT to 54-56 Gy in 9-7 fractions. The endpoint in the study was radiation-induced rib fracture detected by CT scan after the treatment. All ribs where the irradiated doses were more than 80% of prescribed dose were selected and contoured to build the dose-volume histograms (DVHs). Comparisons of the several factors obtained from the DVHs and the probabilities of rib fracture calculated by Kaplan-Meier method were performed in the study. Median follow-up time was 68 months. Among 75 contoured ribs, 23 rib fractures were observed in 34% of the patients during 16-48 months after SBRT, however, no patients complained of chest wall pain. The 4-year probabilities of rib fracture for maximum dose of ribs (Dmax) more than and less than 54 Gy were 47.7% and 12.9% (p = 0.0184), and for fraction size of 6, 7 and 8 Gy were 19.5%, 31.2% and 55.7% (p = 0.0458), respectively. Other factors, such as D2cc, mean dose of ribs, V10-55, age, sex, and planning target volume were not significantly different. The doses and fractionations used in this study resulted in no clinically significant rib fractures for this population, but that higher Dmax and dose per fraction treatments resulted in an increase in asymptomatic grade 1 rib fractures.

In pediatric leukemia, dose evaluation according to the type of compensators in total body irradiation

Energy Technology Data Exchange (ETDEWEB)

Lee, Dong Yeon [Dongnam Inst. of Radiological and Medical science, Busan (Korea, Republic of); Kim, Chang Soo; Kim, Jung Hoon [Dept. of Radiological Science, College of Health Science, Catholic University of Busan, Busan (Korea, Republic of)

2015-04-15

Total body irradiation (TBI) and chemotherapy are the pre-treatment method of a stem cell transplantations of the childhood leukemia. in this study, we evaluate the Quantitative human body dose prior to the treatment. The MCNPX simulation program evaluated by changing the material of the tissue compensators with imitation material of pediatric exposure in a virtual space. As a result, first, the average skin dose with the material of the tissue compensators of Plexiglass tissue compensators is 74.60 mGy/min, Al is 73.96 mGy/min, Cu is 72.26 mGy/min and Pb 67.90 mGy/min respectively. Second, regardless of the tissue compensators material that organ dose were thyroid, gentile, digestive system, brain, lungs, kidneys higher in order. Finally, the ideal distance between body compensator and the patient were 50 cm aparting each other. In conclusion, tissue compensators Al, Cu, Pb are able to replace of the currently used in Plexiglass materials.

Antibiotic Prescribing Patterns in Outpatient Emergency Clinics at Queen Rania Al Abdullah II Children's Hospital, Jordan, 2013

Directory of Open Access Journals (Sweden)

Sahar I. Al-Niemat

2014-07-01

Full Text Available Objective: To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children’s Hospital at Royal Medical Services in Amman, Jordan. Methods: The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs were also measured. Results: Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85% when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60% of the total prescribed antibiotics and (83% of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin were the leading class among them. Conclusion: Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.

High Total Ionizing Dose and Temperature Effects on Micro- and Nano-electronic Devices

International Nuclear Information System (INIS)

Gaillardin, M.; Martinez, M.; Paillet, P.; Leray, J.L.; Marcandella, C.; Duhamel, O.; Raine, M.; Richard, N.; Girard, S.; Ouerdane, Y.; Boukenter, A.; Goiffon, V.; Magnan, P.; Andrieu, F.; Barraud, S.; Faynot, O.

2013-06-01

This paper investigates the vulnerability of several micro- and nano-electronic technologies to a mixed harsh environment including high total ionizing dose at MGy levels and high temperature. Such operating conditions have been revealed recently for several applications like new security systems in existing or future nuclear power plants, fusion experiments, or deep space missions. In this work, the competing effects already reported in literature of ionizing radiations and temperature are characterized in elementary devices made of MOS transistors from several technologies. First, devices are irradiated using a radiation laboratory X-ray source up to MGy dose levels at room temperature. Devices are grounded during irradiation to simulate a circuit which waits for a wake up signal, representing most of the lifetime of an integrated circuit operating in a harsh environment. Devices are then annealed at several temperatures to discuss the post-irradiation behavior and to determine whether an elevated temperature is an issue or not for circuit function in mixed harsh environments. (authors)

Retrospective analysis of dose delivery in intra-operative high dose rate brachytherapy

International Nuclear Information System (INIS)

Oh, M.; Avadhani, J.S.; Malhotra, H.K.; Cunningham, B.; Tripp, P.; Jaggernauth, W.; Podgorsak, M.B.

2007-01-01

Background. This study was performed to quantify the inaccuracy in clinical dose delivery due to the incomplete scatter conditions inherent in intra-operative high dose rate (IOHDR) brachytherapy. Methods. Treatment plans of 10 patients previously treated in our facility, which had irregular shapes of treated areas, were used. Treatment geometries reflecting each clinical case were simulated using a phantom assembly with no added build-up on top of the applicator. The treatment planning geometry (full scatter surrounding the applicator) was subsequently simulated for each case by adding bolus on top of the applicator. Results. For geometries representing the clinical IOHDR incomplete scatter environment, measured doses at the 5 mm and 10 mm prescription depths were lower than the corresponding prescribed doses by about 7.7% and 11.1%, respectively. Also, for the two prescription methods, an analysis of the measured dose distributions and their corresponding treatment plans showed average decreases of 1.2 mm and 2.2 mm in depth of prescription dose, respectively. Conclusions. Dosimetric calculations with the assumption of an infinite scatter environment around the applicator and target volume have shown to result in dose delivery errors that significantly decrease the prescription depth for IOHDR treatment.(author)