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Sample records for unit dose medication

  1. 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.

  2. Measurement of irradiation doses secondary to bedside radiographs in a medical intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Boles, J M; Boussert, F; Manens, J P; Le Cam, B; Bellet, M; Garre, M

    1987-01-01

    The authors prospectively studied the radiation doses to radio-sensitive organs secondary to bedside radiographs in intensive care patients and in a control phantom. Dosimeters were taped on different organs during each bedside X-ray. The mean radiation doses, expressed in 10(-5) Gy (m-rad), for an ''average patient'' who was hospitalized 9 days and had 6 chest X-rays were respectively: 292 to the sternal bone marrow; 239 to the thyroid gland; 3 to the testes; 1 to the ovaries; 605 to the eye for 2 maxillary sinus X-rays. No diffused irradiation was measured during a 2-month period in the intensive care unit nor on dosimeters worn by four nurses.

  3. Doses from Medical Radiation Sources

    Science.gov (United States)

    ... Medical Radiation Sources Michael G. Stabin, PhD, CHP Introduction Radiation exposures from diagnostic medical examinations are generally ... of exposure annually to natural background radiation. Plain Film X Rays Single Radiographs Effective Dose, mSv Skull ( ...

  4. Dose imprecision and resistance: free-choice medicated feeds in industrial food animal production in the United States.

    Science.gov (United States)

    Love, David C; Davis, Meghan F; Bassett, Anna; Gunther, Andrew; Nachman, Keeve E

    2011-03-01

    Industrial food animal production employs many of the same antibiotics or classes of antibiotics that are used in human medicine. These drugs can be administered to food animals in the form of free-choice medicated feeds (FCMF), where animals choose how much feed to consume. Routine administration of these drugs to livestock selects for microorganisms that are resistant to medications critical to the treatment of clinical infections in humans. In this commentary, we discuss the history of medicated feeds, the nature of FCMF use with regard to dose delivery, and U.S. policies that address antimicrobial drug use in food animals. FCMF makes delivering a predictable, accurate, and intended dose difficult. Overdosing can lead to animal toxicity; underdosing or inconsistent dosing can result in a failure to resolve animal diseases and in the development of antimicrobial-resistant microorganisms. The delivery of antibiotics to food animals for reasons other than the treatment of clinically diagnosed disease, especially via free-choice feeding methods, should be reconsidered.

  5. Patient dose in neonatal units

    International Nuclear Information System (INIS)

    Smans, K.; Struelens, L.; Smet, M.; Bosmans, H.; Vanhavere, F.

    2008-01-01

    Lung disease represents one of the most life-threatening conditions in prematurely born children. In the evaluation of the neonatal chest, the primary and most important diagnostic study is therefore the chest radiograph. Since prematurely born children are very sensitive to radiation, those radiographs may lead to a significant radiation detriment. Hence, knowledge of the patient dose is necessary to justify the exposures. A study to assess the patient doses was started at the neonatal intensive care unit (NICU) of the Univ. Hospital in Leuven. Between September 2004 and September 2005, prematurely born babies underwent on average 10 X-ray examinations in the NICU. In this sample, the maximum was 78 X-ray examinations. For chest radiographs, the median entrance skin dose was 34 μGy and the median dose area product was 7.1 mGy.cm 2 . By means of conversion coefficients, the measured values were converted to organ doses. Organ doses were calculated for three different weight classes: extremely low birth weight infants ( 2500 g). The doses to the lungs for a single chest radiograph for infants with extremely low birth weights, low birth weights and normal birth weights were 24, 25 and 32 μGy, respectively. (authors)

  6. Attempt to establish the ionizing radiation dose to be used in the sterilization of one-use medical equipment units

    International Nuclear Information System (INIS)

    Czerniawski, E.; Stolarczyk, L.

    1974-01-01

    The radioresistance of 8576 microbiological clones was examined. 8314 bacterial clones were isolated in the injection needle factory halls, from the surface exposed to strong ionizing irradiation sources. Those 649 clones which proved resistant to 2-4 Mrad radiation doses were used in further research work. The sterilizing value was based upon a detailed analysis of the bacteria according to their radioresistance groups and D 10 values. The 3 Mrad doses have to be used in order to achieve the sterility degree of a 10 6 product series with an initial 100-microorganisms infection. In case of a 1000/one product bacteria infection limit, the dose should be raised to 3.5 Mrad. (author)

  7. Dose reconstruction modeling for medical radiation workers

    International Nuclear Information System (INIS)

    Choi, Yeong Chull; Cha, Eun Shil; Lee, Won Jin

    2017-01-01

    Exposure information is a crucial element for the assessment of health risk due to radiation. Radiation doses received by medical radiation workers have been collected and maintained by public registry since 1996. Since exposure levels in the remote past are greater concern, it is essential to reconstruct unmeasured doses in the past using known information. We developed retrodiction models for different groups of medical radiation workers and estimate individual past doses before 1996. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure.

  8. Dose reconstruction modeling for medical radiation workers

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yeong Chull; Cha, Eun Shil; Lee, Won Jin [Dept. of Preventive Medicine, Korea University, Seoul (Korea, Republic of)

    2017-04-15

    Exposure information is a crucial element for the assessment of health risk due to radiation. Radiation doses received by medical radiation workers have been collected and maintained by public registry since 1996. Since exposure levels in the remote past are greater concern, it is essential to reconstruct unmeasured doses in the past using known information. We developed retrodiction models for different groups of medical radiation workers and estimate individual past doses before 1996. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure.

  9. [Developments in medical units. 1915].

    Science.gov (United States)

    Fajardo-Ortiz, Guillermo

    2016-01-01

    In 1915 the political, economic, and social instability initiated the destruction of medical units; they had no administrative bases and they lacked the resources. However, needs encouraged that structures arose to meet the wounded, fractured, and traumatized, called “blood” hospitals and so-called crosses and sanitary trains.

  10. Establishment Of Dose Correlation During Dose Mapping On Medical Devices

    International Nuclear Information System (INIS)

    Ruzalina Baharin; Hasan Sham; Ahsanulkhaliqin Abdul Wahab

    2014-01-01

    This paper explains the work done during product dose mapping in order to get the correlation between doses at MINTec-Sinagama plant. Product used was medical devices in aluminium tubes packaged in cardboard kegs packaging with average weight of 12 kg per carton. 12 cartons were loaded in every one tote to give 0.2 g/ cm 3 of density. Ceric cerous dosimeters were placed at specific locations as indicated in SP14: Product Dose Mapping, QMS of MINTec-Sinagama around three planes. Three processes were made at different days as a three replicates to show the reproducibility of measurements. (author)

  11. Charpak, Garwin, propose unit for radiation dose

    CERN Multimedia

    Feder, Toni

    2002-01-01

    Becquerels, curries, grays, rads, rems, roentgens, sieverts - even for specialists the units of radiation can get confusing. That's why two eminent physicists, Georges Charpak of France, and Richard Garwin, are proposing the DARI as a unit of radiation dose they hope will help the public evaluate the risks associated with low-level radiation exposure (1 page)

  12. Topology optimization of inertia driven dosing units

    DEFF Research Database (Denmark)

    Andreasen, Casper Schousboe

    2017-01-01

    This paper presents a methodology for optimizing inertia driven dosing units, sometimes referred to as eductors, for use in small scale flow applications. The unit is assumed to operate at low to moderate Reynolds numbers and under steady state conditions. By applying topology optimization...

  13. Use of dose constraints in medical exposure

    International Nuclear Information System (INIS)

    Mutanga, N. V. T.

    2013-04-01

    Medical-related radiation is the largest source of controllable radiation exposure to humans and it accounts for more than 95% of radiation exposure from man-made sources. Medical exposure to radiation is exposure incurred by patients as part of their own medical or dental diagnosis or treatment; by persons, other than those occupationally exposed, knowingly, while voluntarily helping in the support and comfort of patients; and by volunteers in a programme of biomedical research involving their exposure. Because it is planned exposure, medical exposure has to conform to a set of principles of protection that apply equally to all controllable exposure situations: the principle of justification, the principle of optimisation of protection, and the principle of application of limits on maximum doses in planned situations. In this study the concept of dose constraints is being scrutinized to see if it can be applied in medical exposures and the benefits of such restrictions. Dose constraints can only be applied to exposure to persons voluntary helping in the support and comfort of patients as well as volunteers in the programme of biomedical research. There are no dose constraints for patients but the concept of reference levels applies. (au)

  14. Work on optimum medical radiation doses

    International Nuclear Information System (INIS)

    Vanhavere, F.

    2010-01-01

    Every day the medical world makes use of X-rays and radioisotopes. Radiology allows organs to be visualised, nuclear medicine diagnoses and treats cancer by injecting radioisotopes, and radiotherapy uses ionising radiation for cancer therapy. The medical world is increasingly mindful of the risks of ionising radiation that patients are exposed to during these examinations and treatments. In 2009 SCK-CEN completed two research projects that should help optimise the radiation doses of patients.

  15. X-rays, radiometers and skin unit dose. The development of measuring methods and measuring units for X radiation in medical physics from the beginning until the international standardization

    International Nuclear Information System (INIS)

    Glessmer-Junike, Simone

    2015-01-01

    X-rays, a special form of ionizing radiation, have been utilized in medicine and technology ever since their discovery at the end of 1895. However, the usage of X-rays made the development of measuring techniques necessary. Newly-developed measuring devices were at first called radiometers', but later the term dosimeter' has gained universal acceptance. The development of numerous dosimeters used in radiotherapy was accompanied by new units of measurement, each corresponding to its individual newly constructed dosimeter or method of measurement. While at first conversions between old and new units were performed, it later became clear that both within Germany and Europe units with similar names were used with different meanings, which was both incompatible and confusing. The first serious attempts of a standardization of units in Germany were made after the First World War, when the when the ionizing properties of X-rays was focused on for both measurements and unit definitions. Efforts towards an international standardization of units became successful in the mid-1920s when the Roentgen was defined as the universal unit. From the development described above, four stages of the evolution of radiation measurement and units in radiotherapy could be identified by means of comprehensive systematic research in printed publications. The first stage was the period of diagnostic application of X-rays, when tools for the determination of X-ray quality were designed. This stage progressed into that of therapeutic administration of X-rays shortly after, when instruments and units for the measurement of X-ray quantities (dose') were implemented. Due to the variety and diversity of measurement apparatus and units a third stage emerged, closely interconnected with the second. During the third stage, a nation-wide standardization was attempted in Germany. With the conclusion of this stage - the resolution of a unit for dose measurement in Germany - the stage of

  16. Radiation absorbed dose from medically administered radiopharmaceuticals

    International Nuclear Information System (INIS)

    Roedler, H.D.; Kaul, A.

    1975-01-01

    The use of radiopharmaceuticals for medical examinations is increasing. Surveys carried out in West Berlin show a 20% average yearly increase in such examinations. This implies an increased genetic and somatic radiation exposure of the population in general. Determination of radiation exposure of the population as well as of individual patients examined requires a knowledge of the radiation dose absorbed by each organ affected by each examination. An extensive survey of the literature revealed that different authors reported widely different dose values for the same defined examination methods and radiopharmaceuticals. The reason for this can be found in the uncertainty of the available biokinetic data for dose calculations and in the application of various mathematical models to describe the kinetics and calculation of organ doses. Therefore, the authors recalculated some of the dose values published for radiopharmaceuticals used in patients by applying biokinetic data obtained from exponential models of usable metabolism data reported in the literature. The calculation of organ dose values was done according to the concept of absorbed fractions in its extended form. For all radiopharmaceuticals used in nuclear medicine the energy dose values for the most important organs (ovaries, testicles, liver, lungs, spleen, kidneys, skeleton, total body or residual body) were recalculated and tabulated for the gonads, skeleton and critical or examined organs respectively. These dose values are compared with those reported in the literature and the reasons for the observed deviations are discussed. On the basis of recalculated dose values for the gonads and bone-marrow as well as on the basis of results of statistical surveys in West Berlin, the genetically significant dose and the somatically (leukemia) significant dose were calculated for 1970 and estimated for 1975. For 1970 the GSD was 0.2 mrad and the LSD was 0.7 mrad. For 1975 the GSD is estimated at < 0.5 mrad and the

  17. Radiation doses from medical diagnostic procedures in Canada

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, J E; Lentle, B C; Vo, C [British Columbia Univ., Vancouver, BC (Canada). Dept. of Radiology

    1997-03-01

    This document sets out to record and analyze the doses incurred in Canada from medical procedures involving the use of ionizing radiation in a typical year. Excluded are those doses incurred during therapeutic irradiation, since they differ in scale to such a large degree and because they are used almost exclusively in treating cancer. In this we are following a precedent set by the United Nations Scientific Committee on the Effects of Ionizing Radiation. Although the International Commission on Radiological Protection (ICRP) notes that dose limits should not be applied to medical exposures, it also observes that doses in different settings for the same procedure may vary by as much as two orders of magnitude, and that there are considerable opportunities for dose reductions in diagnostic radiology. Because these data do not stand in isolation the report also encompasses a review of the relevant literature and some background comment on the evolving technology of the radiological sciences. Because there is a somewhat incomplete perception of the changes taking place in diagnostic methods we have also provided some introductory explanations of the relevant technologies. In addition, there is an analysis of at least some of the limitations on the completeness of the data which are reported here. (author).

  18. Radiation doses from medical diagnostic procedures in Canada

    International Nuclear Information System (INIS)

    Aldrich, J.E.; Lentle, B.C.; Vo, C.

    1997-03-01

    This document sets out to record and analyze the doses incurred in Canada from medical procedures involving the use of ionizing radiation in a typical year. Excluded are those doses incurred during therapeutic irradiation, since they differ in scale to such a large degree and because they are used almost exclusively in treating cancer. In this we are following a precedent set by the United Nations Scientific Committee on the Effects of Ionizing Radiation. Although the International Commission on Radiological Protection (ICRP) notes that dose limits should not be applied to medical exposures, it also observes that doses in different settings for the same procedure may vary by as much as two orders of magnitude, and that there are considerable opportunities for dose reductions in diagnostic radiology. Because these data do not stand in isolation the report also encompasses a review of the relevant literature and some background comment on the evolving technology of the radiological sciences. Because there is a somewhat incomplete perception of the changes taking place in diagnostic methods we have also provided some introductory explanations of the relevant technologies. In addition, there is an analysis of at least some of the limitations on the completeness of the data which are reported here. (author)

  19. Dosimetric systems of high dose, dose rate and dose uniformity in food and medical products

    International Nuclear Information System (INIS)

    Vargas, J.; Vivanco, M.; Castro, E.

    2014-08-01

    In the Instituto Peruano de Energia Nuclear (IPEN) we use the chemical dosimetry Astm-E-1026 Fricke as a standard dosimetric system of reference and different routine dosimetric systems of high doses, according to the applied doses to obtain the desired effects in the treated products and the doses range determined for each type of dosimeter. Fricke dosimetry is a chemical dosimeter in aqueous solution indicating the absorbed dose by means an increase in absorbance at a specific wavelength. A calibrated spectrophotometer with controlled temperature is used to measure absorbance. The adsorbed dose range should cover from 20 to 400 Gy, the Fricke solution is extremely sensitive to organic impurities, to traces of metal ions, in preparing chemical products of reactive grade must be used and the water purity is very important. Using the referential standard dosimetric system Fricke, was determined to March 5, 2013, using the referential standard dosimetric system Astm-1026 Fricke, were irradiated in triplicate Fricke dosimeters, to 5 irradiation times (20; 30; 40; 50 and 60 seconds) and by linear regression, the dose rate of 5.400648 kGy /h was determined in the central point of the irradiation chamber (irradiator Gamma cell 220 Excel), applying the decay formula, was compared with the obtained results by manufacturers by means the same dosimetric system in the year of its manufacture, being this to the date 5.44691 kGy /h, with an error rate of 0.85. After considering that the dosimetric solution responds to the results, we proceeded to the irradiation of a sample of 200 g of cereal instant food, 2 dosimeters were placed at the lateral ends of the central position to maximum dose and 2 dosimeters in upper and lower ends as minimum dose, they were applied same irradiation times; for statistical analysis, the maximum dose rate was 6.1006 kGy /h and the minimum dose rate of 5.2185 kGy /h; with a dose uniformity of 1.16. In medical material of micro pulverized bone for

  20. INTERPERSONAL COMMUNICATION IN MEDICAL UNITS

    Directory of Open Access Journals (Sweden)

    Irina Ionela ROTARIU

    2015-12-01

    Full Text Available Over the last few years there has been noticed an increase of the general interest in proper communication between medical specialists, on one hand, and the patients and their families, on the other. The benefits of properly performed communication certainly lead to an increase of public confidence in the medical system and therefore to the patients' improved satisfaction and contentment.

  1. 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.

  2. Patient doses from CT examinations in the United Arab Emirates

    International Nuclear Information System (INIS)

    Janeczek, J.

    2006-01-01

    Full text of publication follows: The main goal of the study was to estimate effective patient doses from the 6 most common CT examinations for different types of CT scanners within the United Arab Emirates. The results were used to assess future trends in patient CT doses following rapid replacement of axial and single-slice spiral scanners by multi-slice scanners. At present all three types of scanner technology exist: axial, spiral and multi-slice with axial scanners being gradually replaced by multi-slice scanners as the medical infrastructure of the country is modernized. Altogether there are more than 30 CT scanners in the country with a population of 4 million. Out of these 11 scanners are 16-slice models with tube-current modulation system. The majority of larger United Arab Emirates hospitals have at least two CT scanners: a single slice and 4 or 16-slice scanner. The survey was carried out with data collection forms distributed to the majority of CT scanner users in the United Arab Emirates hospitals, both private and government. Effective doses for different examinations were calculated from T.L.D. measurements using an Alderson Rando phantom simulating an average size patient. Our results show that effective doses to patients initially increased with the introduction of 4-slice scanners. Multi-slice scanners with 16 and more slices have tube-current modulation system as a standard. It is routinely used by radiographers in almost all examinations resulting in patient dose reduction up to 40 % in certain examinations. Another factor affecting population dose is the increased number of patients examined using multi-slice scanners. In the United Arab Emirates there was an increase of more than 30 % in the annual number of patients examined using multi-slice scanners in comparison to single-slice scanners. This fact is attributed to the ease and speed of operation of multi-slice scanners. Rapid increase in number of CT examinations is of concern. Medical

  3. Pharmacy collected medication histories in an observation unit

    Directory of Open Access Journals (Sweden)

    Gabrielle L Procopio

    2015-08-01

    Full Text Available Background: Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical. Objectives: The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients. Methods: Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies. Results: A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37% matched medication records and 1467 discrepancies identified, including 808 (55% omissions, 296 (20.2% wrong frequency, 278 (19% wrong dose, 51 (3.5% discontinued, and 34 (2.3% wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15% of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1–48 min. Conclusion: Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.

  4. [Medication errors in Spanish intensive care units].

    Science.gov (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

    2013-01-01

    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  5. Radiation Dose to Newborns in Neonatal Intensive Care Units

    International Nuclear Information System (INIS)

    Bahreyni Toossi, M. T.; Malekzadeh, M.

    2012-01-01

    With the increase of X-ray use for medical diagnostic purposes, knowing the given doses is necessary in patients for comparison with reference levels. The concept of reference doses or diagnostic reference levels has been developed as a practical aid in the optimization of patient protection in diagnostic radiology. To assess the radiation doses to neonates from diagnostic radiography (chest and abdomen). This study has been carried out in the neonatal intensive care unit of a province in Iran. Entrance surface dose was measured directly with thermoluminescent dosimeters. The population included 195 neonates admitted for a diagnostic radiography, in eight NICUs of different hospital types. The mean entrance surface dose for chest and abdomen examinations were 76.3 μGy and 61.5 μGy, respectively. Diagnostic reference levels for neonate in NICUs of the province were 88 μGy for chest and 98 μGy for abdomen examinations that were slightly higher than other studies. Risk of death due to radiation cancer incidence of abdomens examination was equal to 1.88 × 10 -6 for male and 4.43 × 10 -6 for female. For chest X-ray, it was equal to 2.54 × 10 -6 for male and 1.17 × 10 -5 for female patients. Diagnostic reference levels for neonates in our province were slightly higher than values reported by other studies such as European national diagnostic reference levels and the NRPB reference dose. The main reason was related to using a high mAs and a low kVp applied in most departments and also a low focus film distance. Probably lack of collimation also affected some exams in the NICUs.

  6. Evaluation of the sterility of single-dose medications used in a multiple-dose fashion.

    Science.gov (United States)

    Martin, Elizabeth P; Mukherjee, Jean; Sharp, Claire R; Sinnott-Stutzman, Virginia B

    2017-11-01

    Bacterial proliferation was evaluated in single-dose medications used in a multi-dose fashion and when medications were intentionally inoculated with bacteria. Of 5 experimentally punctured medications, 1 of 75 vials (50% dextrose) became contaminated. When intentionally inoculated, hydroxyethyl starch and heparinized saline supported microbial growth. Based on these findings, it is recommended that hydroxyethyl starch and heparinized saline not be used in a multi-dose fashion.

  7. Howard Hughes Medical Institute dose assessment survey

    International Nuclear Information System (INIS)

    O'Brien, S.L.; McDougall, M.M.; Barkley, W.E.

    1996-01-01

    Biomedical science researchers often express frustration that health physics practices vary widely between individual institutions. A survey examining both internal and external dose assessment practices was devised and mailed to fifty institutions supporting biomedical science research. The results indicate that health physics dose assessment practices and policies are highly variable. Factors which may contribute to the degree of variation are discussed. 2 tabs

  8. Effective dose from direct and indirect digital panoramic units

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Gun Sun; Kim, Jin Soo; Seo, Yo Seob; Kim, Jae Duk [School of Dentistry, Oral Biology Research Institute, Chosun University, Gwangju (Korea, Republic of)

    2013-06-15

    This study aimed to provide comparative measurements of the effective dose from direct and indirect digital panoramic units according to phantoms and exposure parameters. Dose measurements were carried out using a head phantom representing an average man (175 cm tall, 73.5 kg male) and a limbless whole body phantom representing an average woman (155 cm tall, 50 kg female). Lithium fluoride thermoluminescent dosimeter (TLD) chips were used for the dosimeter. Two direct and 2 indirect digital panoramic units were evaluated in this study. Effective doses were derived using 2007 International Commission on Radiological Protection (ICRP) recommendations. The effective doses of the 4 digital panoramic units ranged between 8.9 {mu}Sv and 37.8 {mu}Sv. By using the head phantom, the effective doses from the direct digital panoramic units (37.8 {mu}Sv, 27.6 {mu}Sv) were higher than those from the indirect units (8.9 {mu}Sv, 15.9 {mu}Sv). The same panoramic unit showed the difference in effective doses according to the gender of the phantom, numbers and locations of TLDs, and kVp. To reasonably assess the radiation risk from various dental radiographic units, the effective doses should be obtained with the same numbers and locations of TLDs, and with standard hospital exposure. After that, it is necessary to survey the effective doses from various dental radiographic units according to the gender with the corresponding phantom.

  9. Occupational doses in medical staff during hemodynamic procedures

    International Nuclear Information System (INIS)

    Alonso, Thessa C.; Silva, Teogenes A. da

    2008-01-01

    The main objective of an occupational radiation program for workers is to keep radiation exposures under control and to assure that radiation protection principles are followed. Due to different types of interventionist medical exams, usually the medical staffs are highly exposed to radiation, which it emphasizes that it is required safety procedures for dose reduction. In this work, studies were concerned with individual doses of medical staff that are directly engaged to interventionist procedures at hemodynamic services. Dose values from a data bank of the CDTN Individual Monitoring Service (IMS) were analyzed and measurements with film type and thermoluminescent (TL) dosimeters were performed for comparison purposes. Additionally, the influence of the use of a lead apron on the individual dose was investigated. Results suggested that the medical staff does not care about wearing the routine personal dosimeter and that the registered doses may not be representative to the actual annual effective doses. They also showed that effective doses are highly dependent on the characteristics and conditions of the lead apron that is worn by the medical staff. It is concluded that it is important to have personal dosimetric system up-graded for reliable measurements, to define an adequate algorithm for determining the effective dose and to train the medical staff to follow the basic radiation protection principle of optimization. (author)

  10. Statistical behavior of high doses in medical radiodiagnosis

    International Nuclear Information System (INIS)

    Barboza, Adriana Elisa

    2014-01-01

    This work has as main purpose statistically estimating occupational exposure in medical diagnostic radiology in cases of high doses recorded in 2011 at national level. For statistical survey of this study, doses of 372 IOE's diagnostic radiology in different Brazilian states were evaluated. Data were extracted from the work of monograph (Research Methodology Of High Doses In Medical Radiodiagnostic) that contains the database's information Sector Management doses of IRD/CNEN-RJ, Brazil. The identification of these states allows the Sanitary Surveillance (VISA) responsible, becomes aware of events and work with programs to reduce these events. (author)

  11. Overview of the use of dose constraints in medical exposures

    International Nuclear Information System (INIS)

    Tuyisenge, J. D.

    2014-01-01

    The project overviewed the use of dose constraints in medical exposure in literature. Different documents on the establishment, the development and the application of this concept are reviewed with regard to the use of medical exposure of patients, including their comforters and carers or helpers, and volunteers in biomedical research. It has been showed that the concept of Dose Constraints along with many other concepts of radiation protection is widely applied in the optimisation of exposure to radiation. These concepts include Dose Limits, Dose References levels and Guidance levels among others. With regard to medical exposure of patients, it is not appropriate to apply dose limits or dose constraints, because such limits would often do more harm than good as far as benefits from such an exposure is concerned. Dose constraints do not apply with regard to any exposure of patient for his/her diagnostic or therapeutic purposes. With regard to patient comforters, carers or helpers, and volunteers in biomedical research, the benefits of such an exposure are not direct to the exposed individuals; therefore dose constraints will be appropriately applied. From the beginning of the establishment of Dose Constraints as a concept in radiation protection, the International Commission of Radiological Protection (ICRP) has published a number of documents that provide detailed application related to radiological protection and safety in the medical applications of ionising radiation. Each of these publications addresses a specific topic defined by the type of radiation source and the medical discipline in which the source is applied. This is done in the intention of communicating directly to the relevant medical radiation users, competent radiation authorities and health related institutions concerns with radiation protection and safe use of radiation sources in medical applications. This project provides an overview of such publications and related documents. (author)

  12. Habitat Demonstration Unit Medical Operations Workstation Upgrades

    Science.gov (United States)

    Trageser, Katherine H.

    2011-01-01

    This paper provides an overview of the design and fabrication associated with upgrades for the Medical Operations Workstation in the Habitat Demonstration Unit. The work spanned a ten week period. The upgrades will be used during the 2011 Desert Research and Technology Studies (Desert RATS) field campaign. Upgrades include a deployable privacy curtain system, a deployable tray table, an easily accessible biological waste container, reorganization and labeling of the medical supplies, and installation of a retractable camera. All of the items were completed within the ten week period.

  13. Medication administration errors in an intensive care unit in Ethiopia

    Directory of Open Access Journals (Sweden)

    Agalu Asrat

    2012-05-01

    Full Text Available Abstract Background Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU. In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. Objective To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH, Southwest Ethiopia. Methods Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study. Results Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%. Common administration errors were attributed to wrong timing (30.3%, omission due to unavailability (29.0% and missed doses (18.3% among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%. Conclusion Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don’t occur as frequently as observed in this study.

  14. Statistical behavior of high doses in medical radiodiagnosis; Comportamento estatistico das altas doses em radiodiagnostico medico

    Energy Technology Data Exchange (ETDEWEB)

    Barboza, Adriana Elisa, E-mail: adrianaebarboza@gmail.com, E-mail: elisa@bolsista.ird.gov.br [Instituto de Radioprotecao e Dosimetria, (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2014-07-01

    This work has as main purpose statistically estimating occupational exposure in medical diagnostic radiology in cases of high doses recorded in 2011 at national level. For statistical survey of this study, doses of 372 IOE's diagnostic radiology in different Brazilian states were evaluated. Data were extracted from the work of monograph (Research Methodology Of High Doses In Medical Radiodiagnostic) that contains the database's information Sector Management doses of IRD/CNEN-RJ, Brazil. The identification of these states allows the Sanitary Surveillance (VISA) responsible, becomes aware of events and work with programs to reduce these events. (author)

  15. Recent trend of radiation doses of medical workers

    Energy Technology Data Exchange (ETDEWEB)

    Anzai, I [Tokyo Univ. (Japan). Faculty of Medicine; Tanaka, M; Nakamura, S; Nawa, H; Nukazawa, A

    1981-10-01

    Radiation doses of medical workers in Japan between 1976 and 1979 were analysed based on the data provided by a film badge servicing company. Average annual radiation doses between April, 1978 and March, 1979 were 129 mrems for 2556 doctors, 108 mrems for 2074 radiographers, and 60 mrems for 1915 nurses. It was also suggested that the log-normal distribution could provide a good fit to the frequency distribution of radiation doses of these medical staffs. Time series data of monthly average doses during the period between April, 1976 and March, 1979 were analysed using a computer code named EPA that had been developed by the Japanese Economic Planning Agency. The EPA code separated the original time series data into three components, i.e., the trend and cycle factor, the seasonal factor and the irregular factor based on a multiplicative model. The results of analyses strongly suggested that there existed a significant common pattern among the trend factors of doctors, radiographers and nurses. The similar phenomenon was also observed about the seasonal factors. Some specific cases of medical workers who received considerably high radiation doses were studied, and it was pointed out that, in order to lower the doses of medical workers, the factors which are peculiar to each medical facility must be precisely examined in addition to the strengthening of general radiological protective measures.

  16. Methodology of high dose research in medical radiodiagnostic

    International Nuclear Information System (INIS)

    Barboza, Adriana E.; Martins, Cintia P. de S.

    2013-01-01

    This work has as main purpose to study occupational exposure in diagnostic radiology in medical cases of high doses recorded in 2011 at the national level . These doses were recorded by monitoring individual of the occupationally exposed individuals (OEI's). This monitoring of the doses received by ionizing radiation has as main objective to ensure that the principle of dose limitation is respected. In this study it were evaluated doses of 372 OEI's radiology in different Brazilian states. Doses were extracted from the database of Sector Management Doses of the Institute for Radioprotection and Dosimetry - IRD/CNEN-RJ, Brazil. The information from the database provide reports of doses from several states, which allows to quantify statistically, showing those with the highest doses in four areas: dose greater than or equal to 20 mSv apron and chest and dose greater than or equal to 100 mSv apron and chest. The identification of these states allows the respective Sanitary Surveillance (VISA), be aware of the events and make plans to reduce them. This study clarified the required procedures when there is a record of high dose emphasizing the importance of using protective radiological equipment, dosimeter and provide a safety environment work by maintaining work equipment. Proposes the ongoing training of professionals, emphasizing the relevance of the concepts of radiation protection and the use of the questionnaire with their investigative systematic sequence, which will allow quickly and efficiently the success the investigations

  17. Research on dose setting for radiation sterilization of medical device

    International Nuclear Information System (INIS)

    Zhang Tongcheng; Liu Qingfang; Zhong Hongliang; Mi Zhisu; Wang Chunlei; Jiang Jianping

    2002-01-01

    Objective: To establish the radiation sterilization dose for medical devices using data of bioburden on the medical device. Methods: Firstly determination of recovery ratio and correction coefficient of the microbiological test method was used according to ISO11737 standard, then determination of bioburden on the products, finally the dose setting was completed based on the Method 1 in ISO11137 standard. Results: Fifteen kinds of medical devices were tested. Bioburden range was from 8.6-97271.2 CFU/device, recovery ration range 54.6%-100%, correction co-efficiency range 1.00-1.83, D 10 distribution from 1.40 to 2.82 kGy, verification dose (dose at SAL = 10 -2 ) range 5.1-17.6 kGy and sterilization dose (dose at SAL 10 -6 ) range 17.5-32.5 kGy. Conclusion: One hundred samples of each kind of product were exposed to the pre-determined verification dose and then the sterility test was performed. Each sterility test showed positive number was not greater than two. This indicated that the sterilization dose established for each kind of product was statistically acceptable

  18. Occupational Radiation Dose for Medical Workers at a University Hospital

    Directory of Open Access Journals (Sweden)

    M.H. Nassef

    2017-11-01

    Full Text Available Occupational radiation doses for medical workers from the departments of diagnostic radiology, nuclear medicine, and radiotherapy at the university hospital of King Abdul-Aziz University (KAU were measured and analysed. A total of 100 medical radiation workers were monitored to determine the status of their average annual effective dose. The analysis and the calibration procedures of this study were carried out at the Center for Radiation Protection and Training-KAU. The monitored workers were classified into subgroups, namely, medical staff/supervisors, technicians, and nurses, according to their responsibilities and specialties. The doses were measured using thermo luminescence dosimeters (TLD-100 (LiF:Mg,Ti placed over the lead apron at the chest level in all types of workers except for those in the cath lab, for whom the TLD was placed at the thyroid protective collar. For nuclear medicine, a hand dosimeter was used to measure the hand dose distribution. The annual average effective doses for diagnostic radiology, nuclear medicine, and radiotherapy workers were found to be 0.66, 1.56, and 0.28 mSv, respectively. The results of the measured annual dose were well below the international recommended dose limit of 20 mSv. Keywords: Occupational radiation dose, radiation workers, TLD, radiation protection

  19. Optimal medication dosing from suboptimal clinical examples: a deep reinforcement learning approach.

    Science.gov (United States)

    Nemati, Shamim; Ghassemi, Mohammad M; Clifford, Gari D

    2016-08-01

    Misdosing medications with sensitive therapeutic windows, such as heparin, can place patients at unnecessary risk, increase length of hospital stay, and lead to wasted hospital resources. In this work, we present a clinician-in-the-loop sequential decision making framework, which provides an individualized dosing policy adapted to each patient's evolving clinical phenotype. We employed retrospective data from the publicly available MIMIC II intensive care unit database, and developed a deep reinforcement learning algorithm that learns an optimal heparin dosing policy from sample dosing trails and their associated outcomes in large electronic medical records. Using separate training and testing datasets, our model was observed to be effective in proposing heparin doses that resulted in better expected outcomes than the clinical guidelines. Our results demonstrate that a sequential modeling approach, learned from retrospective data, could potentially be used at the bedside to derive individualized patient dosing policies.

  20. Sample Based Unit Liter Dose Estimates

    International Nuclear Information System (INIS)

    JENSEN, L.

    2000-01-01

    The Tank Waste Characterization Program has taken many core samples, grab samples, and auger samples from the single-shell and double-shell tanks during the past 10 years. Consequently, the amount of sample data available has increased, both in terms of quantity of sample results and the number of tanks characterized. More and better data is available than when the current radiological and toxicological source terms used in the Basis for Interim Operation (BIO) (FDH 1999a) and the Final Safety Analysis Report (FSAR) (FDH 1999b) were developed. The Nuclear Safety and Licensing (NS and L) organization wants to use the new data to upgrade the radiological and toxicological source terms used in the BIO and FSAR. The NS and L organization requested assistance in producing a statistically based process for developing the source terms. This report describes the statistical techniques used and the assumptions made to support the development of a new radiological source term for liquid and solid wastes stored in single-shell and double-shell tanks. The results given in this report are a revision to similar results given in an earlier version of the document (Jensen and Wilmarth 1999). The main difference between the results in this document and the earlier version is that the dose conversion factors (DCF) for converting μCi/g or μCi/L to Sv/L (sieverts per liter) have changed. There are now two DCFs, one based on ICRP-68 and one based on ICW-71 (Brevick 2000)

  1. Analysis of occupational doses of radiation workers in medical institutions

    International Nuclear Information System (INIS)

    Sanaye, S.S.; Baburajan, Sujatha; Joshi, V.D.; Pawar, S.G.; Nalawade, S.K.; Raman, N.V.; Kher, R.K.

    2007-01-01

    Routine monitoring of occupational radiation workers is done for controlling the doses to the individuals and to demonstrate the compliance with occupational dose limits. One of the objective of personnel monitoring program is the assessment of the radiation safety of working area and trends of exposure histories of individuals or group of workers. Computerised dose registry of all monitored radiation workers along with their personnel data helps in analyzing these trends. This in turn helps the institutions in management of their radiation safety programs. In India, annual and life time occupational dose records are maintained as National Dose Registry in the Radiological Physics and Advisory Division, Bhabha Atomic Research Centre. This paper presents analysis of occupational dose data of monitored radiation workers in medical institutions in India during last five years (i.e. 2002-2006)

  2. Knowledge of medical imaging radiation dose and risk among doctors

    International Nuclear Information System (INIS)

    Brown, Nicholas; Jones, Lee

    2013-01-01

    The growth of computed tomography (CT) and nuclear medicine (NM) scans has revolutionised healthcare but also greatly increased population radiation doses. Overuse of diagnostic radiation is becoming a feature of medical practice, leading to possible unnecessary radiation exposures and lifetime-risks of developing cancer. Doctors across all medical specialties and experience levels were surveyed to determine their knowledge of radiation doses and potential risks associated with some diagnostic imaging. A survey relating to knowledge and understanding of medical imaging radiation was distributed to doctors at 14 major Queensland public hospitals, as well as fellows and trainees in radiology, emergency medicine and general practice. From 608 valid responses, only 17.3% correctly estimated the radiation dose from CT scans and almost 1 in 10 incorrectly believed that CT radiation is not associated with any increased lifetime risk of developing cancer. There is a strong inverse relationship between a clinician's experience and their knowledge of CT radiation dose and risks, even among radiologists. More than a third (35.7%) of doctors incorrectly believed that typical NM imaging either does not use ionising radiation or emits doses equal to or less than a standard chest radiograph. Knowledge of CT and NM radiation doses is poor across all specialties, and there is a significant inverse relationship between experience and awareness of CT dose and risk. Despite having a poor understanding of these concepts, most doctors claim to consider them prior to requesting scans and when discussing potential risks with patients.

  3. Occupational dose due to neutrons in medical linear accelerators

    International Nuclear Information System (INIS)

    Larcher, Ana M.; Bonet Duran, Stella M.; Lerner, Ana M.

    2000-01-01

    This paper describes a semi-empirical method to calculate the occupational dose due to neutrons and capture gamma rays in medical linear accelerators. It compares theoretical dose values with measurements performed in several 15 MeV medical accelerators installed in the country. Good agreement has been found between calculations made using the model and dose measurements, except for those accelerator rooms in which the maze length was shorter than the postulated tenth value distance. For those cases the model seems to overestimate neutron dose. The results demonstrate that the semi-empirical model is a good tool for quick and conservative shielding calculations for radiation protection purposes. Nevertheless, it is necessary to continue with the measurements in order to perform a more accurate validation of the model. (author)

  4. Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

    Science.gov (United States)

    Kelm, Matthew; Campbell, Udobi

    2016-05-01

    Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

  5. Comparative study of radiation dose between digital panoramic X-ray unit and general panoramic X-ray unit

    International Nuclear Information System (INIS)

    Li Qingshan; Duan Tao; Wang Xiaoyun; Zhao Li; Dong Jian; Wei Lei

    2010-01-01

    Objective: To compare the actual dose of patients who receive the same medical practice by either digital panoramic X-ray unit and general panoramic X-ray unit and give evidence for better selection of oral X-ray examination method. Methods: Round sheet lithium fluoride (LiF) thermoluminescent dosimeters (TLD) were used. The experiment was divided into natural background contrast group, general panoramic X-ray children group, general panoramic X-ray adults group, digital panoramic X-ray children group and digital panoramic X-ray adults group. The dosimeter of natural background radiation was placed at the office of the doctor, the dosimeters of general panoramic X-ray children group and general panoramic X-ray adults group were irradiated by different conditions according to the clinical application of panoramic X-ray to children and adults, the dosimeters of digital panoramic X-ray children group and digital panoramic X-ray adults group were irradiated by different conditions according to the clinical application of digital panoramic X-ray to children and adults. The thermoluminescent dosimeter was used to count and calculate the exposure doses in various groups. Results: The dose of children exposed in general panoramic X-ray unit was 1.28 times of that in digital panoramic X-ray unit, there was significant difference (t=6.904, P<0.01). The dose of adults exposed in general panoramic X-ray unit was 1.55 times of that in the digital panoramic X-ray unit, there also was significant difference (t=-11.514. P< 0.01). Conclusion: The digital panoramic X-ray unit can reduce the dose of patients, so the digital panoramic X-ray unit should be used as far as possible. (authors)

  6. Knowledge of medical imaging radiation dose and risk among doctors.

    Science.gov (United States)

    Brown, Nicholas; Jones, Lee

    2013-02-01

    The growth of computed tomography (CT) and nuclear medicine (NM) scans has revolutionised healthcare but also greatly increased population radiation doses. Overuse of diagnostic radiation is becoming a feature of medical practice, leading to possible unnecessary radiation exposures and lifetime-risks of developing cancer. Doctors across all medical specialties and experience levels were surveyed to determine their knowledge of radiation doses and potential risks associated with some diagnostic imaging. A survey relating to knowledge and understanding of medical imaging radiation was distributed to doctors at 14 major Queensland public hospitals, as well as fellows and trainees in radiology, emergency medicine and general practice. From 608 valid responses, only 17.3% correctly estimated the radiation dose from CT scans and almost 1 in 10 incorrectly believed that CT radiation is not associated with any increased lifetime risk of developing cancer. There is a strong inverse relationship between a clinician's experience and their knowledge of CT radiation dose and risks, even among radiologists. More than a third (35.7%) of doctors incorrectly believed that typical NM imaging either does not use ionising radiation or emits doses equal to or less than a standard chest radiograph. Knowledge of CT and NM radiation doses is poor across all specialties, and there is a significant inverse relationship between experience and awareness of CT dose and risk. Despite having a poor understanding of these concepts, most doctors claim to consider them prior to requesting scans and when discussing potential risks with patients. © 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.

  7. Organ-specific external dose coefficients and protective apron transmission factors for historical dose reconstruction for medical personnel.

    Science.gov (United States)

    Simon, Steven L

    2011-07-01

    While radiation absorbed dose (Gy) to the skin or other organs is sometimes estimated for patients from diagnostic radiologic examinations or therapeutic procedures, rarely is occupationally-received radiation absorbed dose to individual organs/tissues estimated for medical personnel; e.g., radiologic technologists or radiologists. Generally, for medical personnel, equivalent or effective radiation doses are estimated for compliance purposes. In the very few cases when organ doses to medical personnel are reconstructed, the data is usually for the purpose of epidemiologic studies; e.g., a study of historical doses and risks to a cohort of about 110,000 radiologic technologists presently underway at the U.S. National Cancer Institute. While ICRP and ICRU have published organ-specific external dose conversion coefficients (DCCs) (i.e., absorbed dose to organs and tissues per unit air kerma and dose equivalent per unit air kerma), those factors have been published primarily for mono-energetic photons at selected energies. This presents two related problems for historical dose reconstruction, both of which are addressed here. It is necessary to derive conversion factor values for (1) continuous distributions of energy typical of diagnostic medical x-rays (bremsstrahlung radiation), and (2) energies of particular radioisotopes used in medical procedures, neither of which are presented in published tables. For derivation of DCCs for bremsstrahlung radiation, combinations of x-ray tube potentials and filtrations were derived for different time periods based on a review of relevant literature. Three peak tube potentials (70 kV, 80 kV, and 90 kV) with four different amounts of beam filtration were determined to be applicable for historic dose reconstruction. The probabilities of these machine settings were assigned to each of the four time periods (earlier than 1949, 1949-1954, 1955-1968, and after 1968). Continuous functions were fit to each set of discrete values of the

  8. Medical and occupational dose reduction in pediatric barium meal procedures

    Science.gov (United States)

    Filipov, D.; Schelin, H. R.; Denyak, V.; Paschuk, S. A.; Ledesma, J. A.; Legnani, A.; Bunick, A. P.; Sauzen, J.; Yagui, A.; Vosiak, P.

    2017-11-01

    Doses received in pediatric Barium Meal procedure can be rather high. It is possible to reduce dose values following the recommendations of the European Communities (EC) and the International Commission on Radiological Protection (ICRP). In the present work, the modifications of radiographic techniques made in a Brazilian hospital according to the EC and the ICRP recommendations and their influence on medical and occupational exposure are reported. The procedures of 49 patients before and 44 after the optimization were studied and air kerma-area product (PK,A) values and the effective doses were evaluated. The occupational equivalent doses were measured next to the eyes, under the thyroid shield and on each hand of both professionals who remained inside the examination room. The implemented modifications reduced by 70% and 60% the PK,A and the patient effective dose, respectively. The obtained dose values are lower than approximately 75% of the results from similar studies. The occupational annual equivalent doses for all studied organs became lower than the limits set by the ICRP. The equivalent doses in one examination were on average below than 75% of similar studies.

  9. Introduction to the new version of the standard DIN 6814, part 3 'dose magnitudes and dose units'

    Energy Technology Data Exchange (ETDEWEB)

    Harder, D

    1985-02-01

    The recent draft of the DIN standard on dose quantities and dose units is presented on original version and explained by the chairman of the Working Comittee Dosimetry. There are important modifications by the introduction of SI units, the new definitions of site dose and individual dose characteristic dose rate and dose rate constant, as well as by corrections of the notions ''secondary electron equilibrium'' and ''free in air''.

  10. Introduction: Issues Related to Dose Units and Damage Correlation

    International Nuclear Information System (INIS)

    Stoller, Roger E.

    2012-01-01

    The observable effects of irradiation on material properties are complex and each such property changed depends sensitively on a range of irradiation and material parameters. This works against development of a universal exposure parameter. The irradiation dose to the material (both ionizing and displacement dose) can be calculated with good accuracy as long as the relevant reaction cross sections are known and implemented in the codes used. This suggests that a focus on dose calculations is warranted. When assessing damage correlation parameters, it is important to determine the appropriate dose parameter first. Then a clear distinction between damage formation and damage accumulation needs to be kept in mind. The dose unit is most helpful for estimating the primary damage generation, e.g. how damage energy is used to estimate atomic displacements. However, damage accumulation requires longer times and involves kinetic and thermodynamic processes that cannot be accounted for in a dose or primary damage unit. The adequacy of the primary damage formulations can be assessed through their use in mean field reaction rate theory or kinetic Monte Carlo microstructural evolution models to predict damage accumulation. The results of these models can be directly compared with experimental observations. (author)

  11. Radiation dose to neonates on a Special Care Baby Unit

    International Nuclear Information System (INIS)

    Faulkner, K.; Barry, J.L.; Smalley, P.

    1989-01-01

    The skin entrance dose to neonates on a special care baby unit was estimated from a knowledge of the technique factors, X-ray tube output and backscatter factors. Normalized organ dose data were employed to estimate radiation dose to a number of critical organs. Methods of reducing radiation dose to neonates were investigated. Initially, this involved changing the radiographic technique factors and introducing a lead rubber adjustable collimator, placed on top of the incubator, in addition to light beam diaphragms on the X-ray tube. These modifications to the examination technique appeared to reduce average entrance dose per radiograph from 92 μGy, to 58 μGy, a reduction of 37%. Later, a rare-earth film-screen combination was introduced to replace existing fast calcium tungstate screens. This enabled average entrance dose per radiograph to be reduced to 39 μGy, a further reduction of 33%. The mean radiation dose to a neonate is mainly determined by the number of radiographs. (author)

  12. Radiation dose to neonates on a Special Care Baby Unit

    Energy Technology Data Exchange (ETDEWEB)

    Faulkner, K.; Barry, J.L.; Smalley, P.

    1989-03-01

    The skin entrance dose to neonates on a special care baby unit was estimated from a knowledge of the technique factors, X-ray tube output and backscatter factors. Normalized organ dose data were employed to estimate radiation dose to a number of critical organs. Methods of reducing radiation dose to neonates were investigated. Initially, this involved changing the radiographic technique factors and introducing a lead rubber adjustable collimator, placed on top of the incubator, in addition to light beam diaphragms on the X-ray tube. These modifications to the examination technique appeared to reduce average entrance dose per radiograph from 92 ..mu..Gy, to 58 ..mu..Gy, a reduction of 37%. Later, a rare-earth film-screen combination was introduced to replace existing fast calcium tungstate screens. This enabled average entrance dose per radiograph to be reduced to 39 ..mu..Gy, a further reduction of 33%. The mean radiation dose to a neonate is mainly determined by the number of radiographs.

  13. Representation and preservation of the water-energy dose unit

    International Nuclear Information System (INIS)

    Roos, M.

    1992-01-01

    To represent the water-energy dose unit for high-energy photon and electron radiation, the chemical procedure was expanded into a fundamental measuring technique, and established as a primary normal measuring device of the Federal Republic of Germany. In addition, the water-energy calorimetric dosemeter, a definition measuring method, is being developed which seems to be destined for making a contribution, over the longer term, to reducing measuring uncertainties in dosimetry. (orig./DG) [de

  14. Dose surveys in two digital mammography units using DICOM headers

    International Nuclear Information System (INIS)

    Tsalafoutas, I.; Michalaki, C.; Papagiannopoulou, C.; Efstathopoulos, E.

    2012-01-01

    Background and objective: Digital mammography units store images in DICOM format. Thus, data regarding the acquisition parameters are available within DICOM headers, including among others, the anode/filter combination, tube potential and tube current exposure time product, compressed breast thickness, entrance surface air kerma (ESAK) and mean glandular dose (MGD). However, manual extraction of these data for the verification of the displayed values' accuracy and for dose survey purposes is time consuming. Our objective was to develop a method that enables the automation of such procedures. Materials and methods: Two hundred mammographic examinations (800 mammograms) performed in two digital units (GE, Essential) were recorded on CD-roms. Using appropriate software (DICOM Info Extractor) all dose related DICOM headers were extracted into a Microsoft Excel based spreadsheet, containing embedded algorithms for the calculation of ESAK and MGD according to Dance et al (Phys. Med. Biol. 45, 2000) methodology. Results: The ESAK and MGD values stored in the DICOM headers were compared with those calculated and in most cases were within ±10%. The basic difference among the two mammographic units is that, the older one calculates MGD assuming a breast composition 50% glandular-50% adipose tissue, while the newer one calculates the actual breast glandularity and stores this value in a DICOM header. The average MGD values were 1.21 mGy and 1.38 mGy, respectively. Conclusion: For the units studied, the ESAK and MGD values stored in DICOM headers are reliable. Utilizing tools for their automatic extraction provides an easy way to perform dose surveys. (authors)

  15. Dose variation in the practice of medical examination

    International Nuclear Information System (INIS)

    Huyskens, C.

    1989-01-01

    A discussion is presented on dose variation in the practice of the x-ray examination and on the desirability of checks in the framework of quality care. It is shown that, roughly speaking, for all examination types the dose distribution per action shows the same character. About 20% of the actions cause about half of the collective dose and the individual radiation burden in this is a factor 3 up to 10 larger than average, the remaining 80%. Insight in the distribution of the use of radiation per action is characterized as a necessary step in the control of patient doses. Radiation protection of patients is of avail mostly when the attention is aimed in first instance at examination categories with an average high dose and at the 2-% group of actions with the relatively highest radiation use. Regularly measuring of the 'actual practice' in relation to the 'good practice' is a logical test which makes part of the general quality assurance of medical action. It is recommended to take in hand the care for radiation protection of the patient in this way, within the own department or institute as well as by means of inter collegial checks on a national level. (author). 2 refs.; 3 figs

  16. A survey of chest medical X-ray doses

    International Nuclear Information System (INIS)

    Lomba, M.; Conha, P.G. da; Almeida, C.E. de

    1996-01-01

    The medical X-ray exposures due to radiological examinations are responsible for the largest contribution to the population collective dose as result of the normal use of artificial sources of radiation. The relative impact of the medical exposures to the total dose received by the population from all kinds of radiation sources varies from country to country and in some cases within the same country. The dose variations observed for a specific type of examination are in general associated to several factors i.e. the type of film-ecran combination, the choice of the appropriate physical parameters of the X-ray generator (Kvp, filament current, exposure time) and finally to the film processing conditions. At the present moment the data available in Brazil are scarce and scanty to allow a complete analyzis of this question so needed by the health authorities to justify the implementation of a quality assurance and dose reduction programs. In addition, it is desirable to establish a cost effective operation based on simple administrative concepts in order to reduce the number of films retake, then increasing the life expectancy of the equipment and the number of radiological procedures. The aim of this work was to assess the typical doses of an PA and LAT chest wall X-ray examinations in five different public hospitals (a University Hospital, a Cancer Hospital, a Navy Hospital, an Emergency Hospital and a State General Hospital), as representative of the city of Rio de Janeiro, and compare the results with the international data and recommendations available. (author)

  17. Occupational doses due to photoneutrons in medical linear accelerators rooms

    International Nuclear Information System (INIS)

    Soares, Alessandro Facure Neves de Salles

    2006-04-01

    Medical linear accelerators, with maximum photon energies above 10 MeV, are becoming of common use in Brazil. Although desirable in the therapeutic point of view, the increase in photon energies causes the generation of undesired neutrons, which are produced through nuclear reactions between photons and the high Z target nuclei of the materials that constitute the accelerator head. In this work, MCNP simulation was undertaken to examine the neutron equivalent doses around the accelerators head and at the entrance of medical linear accelerators treatment rooms, some of them licensed in Brazil by the National Regulatory Agency (CNEN). The simulated neutron dose equivalents varied between 2 e 26 μ Sv/Gy RX , and the results were compared with calculations performed with the use of some semi-empirical equations found in literature. It was found that the semi-empirical equations underestimate the simulated neutron doses in the majority of the cases, if compared to the simulated values, suggesting that these equations must be revised, due to the increasing number of high energy machines in the country. (author)

  18. Comprehensive analysis of a medication dosing error related to CPOE.

    Science.gov (United States)

    Horsky, Jan; Kuperman, Gilad J; Patel, Vimla L

    2005-01-01

    This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

  19. Assessment of medical occupational radiation doses in Costa Rica

    International Nuclear Information System (INIS)

    Mora, P.; Acuna, M.

    2011-01-01

    Participation of the Univ. of Costa Rica (UCR) in activities in an IAEA Regional Project RLA/9/066 through training, equipment and expert missions, has enabled to setting up of a national personal monitoring laboratory. Since 2007, the UCR has been in charge of monitoring around 1800 medical radiation workers of the Social Security System. Individual external doses are measured with thermoluminescent dosemeter using a Harshaw 6600 Plus reader. The service has accreditation with ISO/IEC 17025:2005. Distribution of monitored medical personnel is as follows: 83 % in diagnostic radiology, 6 % in nuclear medicine and 6 % in radiotherapy. Preliminary values for the 75 percentile of annual H p (10) in mSv are: radiology 0.37; interventional radiology 0.41; radiotherapy 0.53 and nuclear medicine 1.55. The service provided by the UCR in a steady and reliable way can help to implement actions to limit the doses received by the medical workers and optimise their radiation protection programs. (authors)

  20. Assessment of medical occupational radiation doses in Costa Rica.

    Science.gov (United States)

    Mora, P; Acuña, M

    2011-09-01

    Participation of the University of Costa Rica (UCR) in activities in an IAEA Regional Project RLA/9/066 through training, equipment and expert missions, has enabled to setting up of a national personal monitoring laboratory. Since 2007, the UCR has been in charge of monitoring around 1800 medical radiation workers of the Social Security System. Individual external doses are measured with thermoluminescent dosemeter using a Harshaw 6600 Plus reader. The service has accreditation with ISO/IEC 17025:2005. Distribution of monitored medical personnel is as follows: 83 % in diagnostic radiology, 6 % in nuclear medicine and 6 % in radiotherapy. Preliminary values for the 75 percentile of annual H(p)(10) in mSv are: radiology 0.37; interventional radiology 0.41; radiotherapy 0.53 and nuclear medicine 1.55. The service provided by the UCR in a steady and reliable way can help to implement actions to limit the doses received by the medical workers and optimise their radiation protection programs.

  1. X-rays, radiometers and skin unit dose. The development of measuring methods and measuring units for X radiation in medical physics from the beginning until the international standardization; X-Strahlen, Radiometer und Hauteinheitsdosis. Die Entwicklung der Messverfahren und Masseinheiten fuer Roentgenstrahlung in der medizinischen Physik von den Anfaengen bis zur internationalen Standardisierung

    Energy Technology Data Exchange (ETDEWEB)

    Glessmer-Junike, Simone

    2015-01-22

    X-rays, a special form of ionizing radiation, have been utilized in medicine and technology ever since their discovery at the end of 1895. However, the usage of X-rays made the development of measuring techniques necessary. Newly-developed measuring devices were at first called radiometers', but later the term dosimeter' has gained universal acceptance. The development of numerous dosimeters used in radiotherapy was accompanied by new units of measurement, each corresponding to its individual newly constructed dosimeter or method of measurement. While at first conversions between old and new units were performed, it later became clear that both within Germany and Europe units with similar names were used with different meanings, which was both incompatible and confusing. The first serious attempts of a standardization of units in Germany were made after the First World War, when the when the ionizing properties of X-rays was focused on for both measurements and unit definitions. Efforts towards an international standardization of units became successful in the mid-1920s when the Roentgen was defined as the universal unit. From the development described above, four stages of the evolution of radiation measurement and units in radiotherapy could be identified by means of comprehensive systematic research in printed publications. The first stage was the period of diagnostic application of X-rays, when tools for the determination of X-ray quality were designed. This stage progressed into that of therapeutic administration of X-rays shortly after, when instruments and units for the measurement of X-ray quantities (dose') were implemented. Due to the variety and diversity of measurement apparatus and units a third stage emerged, closely interconnected with the second. During the third stage, a nation-wide standardization was attempted in Germany. With the conclusion of this stage - the resolution of a unit for dose measurement in Germany - the stage of

  2. Dose-dependent analysis of acute medical effects of mixed neutron-gamma radiation from selected severe 235U or 239Pu criticality accidents in USSR, United States, and Argentina.

    Science.gov (United States)

    Barabanova, Tatyana; Wiley, Albert L; Bushmanov, Andrey

    2012-04-01

    Eight of the most severe cases of acute radiation disease (ARS) known to have occurred in humans (as the result of criticality accidents) had survival times less than 120 h (herein defined as "early death"). These accidents were analyzed and are discussed with respect to the specific accident scenarios and the resulting accident-specific, mixed neutron-gamma radiation clinical dose distributions. This analysis concludes that the cardiovascular system appears to be the most critical organ system failure for causing "early death" following approximate total body, mixed gamma-neutron radiation doses greater than 40-50 Gy. The clinical data also suggest that there was definite chest dose dependence in the resulting survival times for these eight workers, who unfortunately suffered profound radiation injury and unusual clinical effects from such high dose radiation exposures. In addition, "toxemic syndrome" is correlated with the irradiation of large volumes of soft tissues. Doses to the hands or legs greater than 80-100 Gy or radiation lung injury also play significant but secondary roles in causing "early death" in accidents delivering chest doses greater than 50 Gy.

  3. Medical effects of low doses of ionising radiation

    International Nuclear Information System (INIS)

    Coggle, J.E.

    1990-01-01

    Ionising radiation is genotoxic and causes biological effects via a chain of events involving DNA strand breaks and 'multiply damaged sites' as critical lesions that lead to cell death. The acute health effects of radiation after doses of a few gray, are due to such cell death and consequent disturbance of cell population kinetics. Because of cellular repair and repopulation there is generally a threshold dose of about 1-2 Gy below which such severe effects are not inducible. However, more subtle, sub-lethal mutational DNA damage in somatic cells of the body and the germ cells of the ovary and testis cause the two major low dose health risks -cancer induction and genetic (heritable) effects. This paper discusses some of the epidemiological and experimental evidence regarding radiation genetic effects, carcinogenesis and CNS teratogenesis. It concludes that current risk estimates imply that about 3% of all cancers; 1% of genetic disorders and between 0% and 0.3% of severe mental subnormality in the UK is attributable to the ubiquitous background radiation. The health risks associated with the medical uses of radiation are smaller, whilst the nuclear industry causes perhaps 1% of the health detriment attributable to background doses. (author)

  4. Evaluation of dose to tooth enamel from medical diagnostic X-ray examinations at Mayak PA

    Energy Technology Data Exchange (ETDEWEB)

    Wieser, A., E-mail: wieser@helmholtz-muenchen.de [Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Institute of Radiation Protection, D-85764 Neuherberg (Germany); Vasilenko, E. [Mayak Production Association, 456780 Ozyorsk (Russian Federation); Zankl, M.; Greiter, M.; Ulanovsky, A. [Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Institute of Radiation Protection, D-85764 Neuherberg (Germany); Sabayev, A.; Knyazev, V.; Zahrov, P. [Mayak Production Association, 456780 Ozyorsk (Russian Federation)

    2011-09-15

    The nuclear workers of the Mayak Production Association had regular check-ups including medical diagnostic X-ray examinations since start of the production lines in 1948. Doses from diagnostic examinations need to be considered in reconstruction of occupational doses of the workers with electron paramagnetic resonance (EPR) of tooth enamel. The numbers and types of examinations of an individual worker can be assessed from the Mayak PA archives but no information was available on doses delivered to teeth by a single specific examination. Of the twenty one applied examination procedures only three affected the teeth, these being X-ray examinations of teeth, skull and cervical spine. For these three kinds of examinations operational procedures and operating modes of X-ray units were compiled from the archive and photon spectra were obtained from a catalog of spectral data for diagnostic X-rays. Entrance doses in air kerma were calculated using the fluence of photon spectra and absorbed dose in tooth enamel for various tooth positions and exposure geometry was then calculated using dose conversion coefficients obtained from Monte Carlo simulations. Doses were calculated for examinations in 1948-2000. Except for examination of the skull, absorbed doses in enamel of incisors were found to be about twice as large as in enamel of molars. In the period before 1970 the largest mean absorbed doses in tooth enamel were due to X-ray examination of teeth, with 64 mGy and 34 mGy calculated for incisors and molars, respectively. In the same period the lowest mean doses were due to X-ray examination of the skull, with 11 mGy and 12 mGy calculated for incisors and molars, respectively. In the period from 1970 to 2000, largest mean doses in enamel were due to X-ray examination of cervical spine, with 23 mGy and 12 mGy calculated for incisors and molars, respectively.

  5. The United States Army Medical Department Journal, April - June 2008

    Science.gov (United States)

    2008-06-01

    Amazon community at Iquitos, Stancil42 (Naval Medical Research Center Detachment, Peru ) received a grant to optimize strategies for preventing the breeding...Detachment, Lima, Peru ; Naval Medical Research Unit-2, Jakarta, Indonesia; and the Naval Medical Research Unit 3, Cairo, Egypt. These resources...the soil beneath tents and camps. In an effort to prevent sand flies breeding in rodent burrows, the Genesis Company (Wellington, Colorado) won an

  6. The neutron dose equivalent around high energy medical electron linear accelerators

    Directory of Open Access Journals (Sweden)

    Poje Marina

    2014-01-01

    Full Text Available The measurement of neutron dose equivalent was made in four dual energy linear accelerator rooms. Two of the rooms were reconstructed after decommissioning of 60Co units, so the main limitation was the space. The measurements were performed by a nuclear track etched detectors LR-115 associated with the converter (radiator that consist of 10B and with the active neutron detector Thermo BIOREM FHT 742. The detectors were set at several locations to evaluate the neutron ambient dose equivalent and/or neutron dose rate to which medical personnel could be exposed. Also, the neutron dose dependence on collimator aperture was analyzed. The obtained neutron dose rates outside the accelerator rooms were several times smaller than the neutron dose rates inside the accelerator rooms. Nevertheless, the measured neutron dose equivalent was not negligible from the aspect of the personal dosimetry with almost 2 mSv a year per person in the areas occupied by staff (conservative estimation. In rooms with 15 MV accelerators, the neutron exposure to the personnel was significantly lower than in the rooms having 18 MV accelerators installed. It was even more pronounced in the room reconstructed after the 60Co decommissioning. This study confirms that shielding from the neutron radiation should be considered when building vaults for high energy linear accelerators, especially when the space constraints exist.

  7. Individual radiation doses from unit releases of long lived radionuclides

    International Nuclear Information System (INIS)

    Bergstroem, U.; Nordlinder, S.

    1990-04-01

    The turn-over in a standard biosphere of radionuclides, disposed in a repository for high level waste was studied from a dose point of view. A multi-compartment model with unit releases to the biosphere was designed and solved by the BIOPATH-code. The uncertainty in the results due to the uncertainty in input parameter values were examined for all nuclides with the PRISM-system. Adults and five year old children were exposed from 10 different exposure pathways originating from activity in well and lake water. The results given as total doses per year and Bq release (conversion factors) can be used in combination with leakage rates from the geosphere for safety analysis of a repository. The conversion factors obtained (arithmetic mean values), are given. (65 refs.) (authors)

  8. Radiation monitoring and dose distribution of medical workers in A.P. state 1999-2000

    International Nuclear Information System (INIS)

    Singh, D.R.; Reddy, K.S.; Kamble, M.K.; Roy, Madhumita

    2001-01-01

    Individual monitoring for external ionizing radiation is being conducted for all radiation workers in Andhra Pradesh State by TLD Unit located in Nuclear Fuel Complex, Hyderabad.The Unit comes under Personnel Monitoring Section of Bhabha Atomic Research Center, Mumbai. The aim of monitoring is to confirm that the radiation safety standards are strictly adhered in the institutions and also to investigate excessive exposures, if any. Personnel monitoring also provides data for epidemiological studies. In view of ICRP/AERB recommendations of 100 mSv dose limit for the five years block of 1994-98, the dose distribution among radiation workers in Andhra Pradesh State is analyzed for the period 1994-98. In continuation of above work, we have analyzed the data for the year 1999-2000 for various medical diagnostic procedures and these are presented

  9. Design of shared unit-dose drug distribution network using multi-level particle swarm optimization.

    Science.gov (United States)

    Chen, Linjie; Monteiro, Thibaud; Wang, Tao; Marcon, Eric

    2018-03-01

    Unit-dose drug distribution systems provide optimal choices in terms of medication security and efficiency for organizing the drug-use process in large hospitals. As small hospitals have to share such automatic systems for economic reasons, the structure of their logistic organization becomes a very sensitive issue. In the research reported here, we develop a generalized multi-level optimization method - multi-level particle swarm optimization (MLPSO) - to design a shared unit-dose drug distribution network. Structurally, the problem studied can be considered as a type of capacitated location-routing problem (CLRP) with new constraints related to specific production planning. This kind of problem implies that a multi-level optimization should be performed in order to minimize logistic operating costs. Our results show that with the proposed algorithm, a more suitable modeling framework, as well as computational time savings and better optimization performance are obtained than that reported in the literature on this subject.

  10. Development of radiological concentrations and unit liter doses for TWRS FSAR radiological consequence calculations

    International Nuclear Information System (INIS)

    Cowley, W.L.

    1996-01-01

    The analysis described in this report develops the Unit Liter Doses for use in the TWRS FSAR. The Unit Liter Doses provide a practical way to calculate conservative radiological consequences for a variety of potential accidents for the tank farms

  11. [Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

    Science.gov (United States)

    Yamamoto, Hideo; Yoneda, Tarou; Satou, Shuji; Ishikawa, Toru; Hara, Misako

    2009-12-20

    By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

  12. USE OF ELECTRONIC CASE HISTORIES IN OPERATION OF MEDICAL UNITS

    Directory of Open Access Journals (Sweden)

    I. B. Boltenkova

    2016-01-01

    Full Text Available Introduction of electronic case histories to medical units including TB units is one of the factors allowing enhancing quality of medical care provision. Use of the electronic case histories provides conditions for information transparency improvement in a medical unit: financial, statistic and medico-technological. Information contained in the electronic case history is important and required both for internal and external use. Use of electronic case histories contributes to reduction of labor costs of workers in medical units, provides fast access of medical personnel to information, formalizes data, provides preservation, invariance and reliability of the information entered into electronic case history during the whole period of storage, regulates the access rights and confidentiality, personifies data and allows unifying health data of all Russian population into one pool.

  13. Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control.

    Science.gov (United States)

    Rasmussen, Keith G

    2014-08-01

    To assess the psychiatric side effects of ketamine when administered in subanesthetic doses to hospitalized patients. It is hypothesized that such effects occur frequently. In this retrospective study, the medical records of 50 patients hospitalized on medical and surgical units at our facility who had continuous intravenous infusions of ketamine for pain or mild sedation were reviewed. Patient progress in the days following the start of ketamine infusion was reviewed and response to ketamine was noted. Twenty-two percent of the patients were noted to have some type of psychiatric reaction to ketamine, including agitation, confusion, and hallucinations. These reactions were relatively short lived, namely, occurring during or shortly after the infusions. No association was found between patient response to ketamine and gender, age, or infusion rate. Awareness of the psychiatric side effects of ketamine is an important consideration for clinicians administering this medication either for pain control or for depressive illness.

  14. Iatrogenic medication errors in a paediatric intensive care unit in ...

    African Journals Online (AJOL)

    This unit has guided the development of various types of adverse event reporting, ... iatrogenic medi cation errors in children at healthcare facilities in industrialised .... A pharmacist dispenses electronically submitted medication orders but ..... Hand-held devices such as smartphones with medication dosage applications.

  15. Training programs in medical physics in the United States

    International Nuclear Information System (INIS)

    Lanzl, L.H.

    1977-01-01

    The history of the field of medical physics in the United States is reviewed; the importance of the development of the nuclear reactor and particle accelerators to medical physics is pointed out. Conclusions and recommendations of an IAEA/WHO seminar on the training of medical physicists (in 1972) are given and compared with existing programs in the US. It is concluded that the recommendations of the IAEA are, for the most part, followed. 1 table

  16. 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.

  17. Analysis of female radiation workers dose records in the DAE Units of Andhra Pradesh

    International Nuclear Information System (INIS)

    Padma Savitri, P.; Kamble, M.K.; Reddy, K.S.

    2010-01-01

    Basis for control of occupational exposures of women is same as that of men except for pregnant women. Percentage of women working in radiation areas of DAE has marginally increased in the last three decades. This paper analysed the data on the externally received personal dose equivalent for female radiation workers who have been exposed ti ionizing radiation in different occupations of DAE units in Andhra Pradesh. From this study we can say confidently that it is equally safe for women to work in radiation areas as long as they follow radiation protection principles. Hence, women in India should be made aware that it is safe to work in radiation areas and DAE is taking their care by periodical medical checkups, maintaining dose records, etc

  18. Pharmacist-led medication review in an acute admissions unit

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel

    2015-01-01

    of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units......) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication review. We do so...

  19. Quality control of radiopharmaceutical dose calibrators in nuclear medicine unit

    International Nuclear Information System (INIS)

    Oliveira, C.F.M.; Lucindo Junior, C.R.; Lopes Filho, F.J.

    2015-01-01

    As part of the program to ensure quality in nuclear medicine unit, in addition to diagnostic procedures, are evaluated activity meters, which is intended to measure the aliquot of radiation of radionuclides and / or radiopharmaceuticals that are administered to patients undergoing diagnostic investigation and / or therapeutic treatment. The good operating condition of dose calibrators is essential to ensure efficiency, safety and reliability of the measurements, once the lack of accuracy in the responses of these equipments can cause significant errors in the activity administered to the patient and may result in poor quality images resulting in the repetition of examis and interference in the successful treatment of the patient. This study aims to, considering the need for constant evaluation of the functioning of the activity meters and the fact that this issue be part the responsibilities of the professional of radiology, perform quality control testing of these instruments in relation to the most recent norm of National Commission of nuclear Energy (CNEN-NN 3:05) in Brazil, that is also in according to the international standards and reference values established during acceptance testing of these instruments in a nuclear medicine service. For this, was made a review of specific literature and the use of barium, cobalt and cesium to the tests in a nuclear medicine service of the state of Pernambuco in Brazil. The obtained results of the specific tests utilized to verify the correct working of the dose calibrators show coherency with the resolutions of the CNEN-NN 3:05 and are also in agreement with the international standards to that the measurement of activities be made with accurate results and thereby contribute to the proper functioning of nuclear medicine service. (authors)

  20. 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.

  1. Identification of Units and Other Terms in Czech Medical Records

    Czech Academy of Sciences Publication Activity Database

    Zvára Jr., Karel; Kašpar, Václav

    2010-01-01

    Roč. 6, č. 1 (2010), s. 78-82 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural language processing * healthcare documentation * medical reports * EHR * finite-state machine * regular expression Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/61-en-identification-of-units-and-other-terms-in-czech-medical-records.html

  2. Methodology of high dose research in medical radiodiagnostic; Metodologia de investigacao de doses elevadas em radiodiagnostico medico

    Energy Technology Data Exchange (ETDEWEB)

    Barboza, Adriana E.; Martins, Cintia P. de S., E-mail: ird@ird.gov.br [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2013-11-01

    This work has as main purpose to study occupational exposure in diagnostic radiology in medical cases of high doses recorded in 2011 at the national level . These doses were recorded by monitoring individual of the occupationally exposed individuals (OEI's). This monitoring of the doses received by ionizing radiation has as main objective to ensure that the principle of dose limitation is respected. In this study it were evaluated doses of 372 OEI's radiology in different Brazilian states. Doses were extracted from the database of Sector Management Doses of the Institute for Radioprotection and Dosimetry - IRD/CNEN-RJ, Brazil. The information from the database provide reports of doses from several states, which allows to quantify statistically, showing those with the highest doses in four areas: dose greater than or equal to 20 mSv apron and chest and dose greater than or equal to 100 mSv apron and chest. The identification of these states allows the respective Sanitary Surveillance (VISA), be aware of the events and make plans to reduce them. This study clarified the required procedures when there is a record of high dose emphasizing the importance of using protective radiological equipment, dosimeter and provide a safety environment work by maintaining work equipment. Proposes the ongoing training of professionals, emphasizing the relevance of the concepts of radiation protection and the use of the questionnaire with their investigative systematic sequence, which will allow quickly and efficiently the success the investigations.

  3. Trend of patient radiation doses in medical examination in Japan

    International Nuclear Information System (INIS)

    Suzuki, Shoichi

    2013-01-01

    We have investigated radiation doses to patients in selected types of examinations in Japan since 1974 and have analyzed the trend of patient radiation doses during a period of 37 years. This study covered regular plain X-ray scanning (including mammography) and computed tomography (CT) scanning. Dose evaluation was performed in terms of entrance skin dose (ESD) for regular plain X-ray scanning, average glandular dose (AGD) for mammography, and volume CT dose index (CTDIvol) for CT scanning. Evaluation was performed in 26 orientations at 21 sites for regular plain X-rays, and for cranial, thoracic, and abdominal scans of children and adults for CT scanning. With the exception of chest X-rays, the dose during regular plain X-ray scanning had decreased by approximately 50% compared with scans performed in 1974. The dose during mammography had decreased to less than 10% of its former level. In scans performed in 2011, dose at all sites were within International Atomic Energy Authority (IAEA) guidance levels. The increasing use of multiple detectors in CT scanning devices was evident in CT scanning. A comparison of doses from cranial non-helical scans performed in 2007 and 2011 found that the latter were higher. An examination of changes in doses between 1997 and 2011 revealed that doses had tended to increase in cranial scans of adults, but had hardly changed at all in abdominal scans. Doses during CT scanning of children were around half those for adults in cranial, thoracic, and abdominal scans. We have ascertained changes in the doses to which patients have been exposed during X-ray scanning in Japan. (author)

  4. Determination of Entrance Skin Doses and Organ Doses for Medical X Ray Examinations

    International Nuclear Information System (INIS)

    Tung, C.J.; Cheng, C.Y.; Chao, T.C.; Tsai, H.Y.

    1999-01-01

    A national survey of patient doses for diagnostic X ray radiographs is planned in Taiwan. Entrance skin doses and organ doses for all installed X ray machines will be investigated. A pilot study has been carried out for the national survey to develop a protocol for the dose assessment. Entrance skin doses and organ doses were measured by thermoluminescence dosemeters and calculated by Monte Carlo simulations for several X ray examinations. The conversion factor from free air entrance absorbed dose to entrance skin dose was derived. A formula for the computation of entrance skin doses from inputs of kV p , mA.s, source to skin distance, aluminium filtration, and generator rectifying was constructed. Organ doses were measured using a RANDO phantom and calculated using a mathematical phantom. All data will be passed to the Atomic Energy Council for developing a programme of national survey and regulatory controls for diagnostic X ray examinations. (author)

  5. Terms and definitions in the field of radiological technique. Dose quantities and units

    International Nuclear Information System (INIS)

    1985-12-01

    The standard gives the terms and definitions of concepts, dose quantities and units. The radiation field condition 'secondary electron equilibrium', which forms part of the definition of standard ion dose, is given more precisely. The term 'free in air' is used in its original meaning, i.e. characterization of measuring conditions excluding avoidable stray radiation, which deviates from DIN 6814, part 3/06.72. Dosemeters for measurement of standard ion dose of air kerma are calibrated 'free in air', but this calibration condition is not part of the quantity definition. The quantities standard ion dose or air kerma therefore can also be measured in any other material. The qunatitative relationships between standard ion dose and the quantities 'exposure' and air kerma, as given in the ICRU publication 33 'Quantities and Units' (1980), are explained. The standard introduces the SI units Gray (for energy dose), Sievert (for dose equivalent), and Becquerel (for the activity of a radioactive substance). As the change to the SI units conceals the approximated equality of the numerical values of the standrd ion dose of photon radiation in roentgen, of the energy dose for soft tissue in rad, and of the dose equivalent in rem, new definitions are given in accordance with ICRU 33 for the quantities specified dose rate, dose rate constant, and area exposure product. These definitions use the terms 'energy dose' and 'kerma'. The dose concepts applied in the field of radiation protection, especially ambient dose and individual dose, are defined as dose equivalents in compliance with the Radiation Protection Ordinance. The relevant sections present information on the conversion of standard ion dose values to the corresponding values of kerma, energy dose, or dose equivalent. (orig./HP) [de

  6. Medical tourism services available to residents of the United States.

    Science.gov (United States)

    Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

    2011-05-01

    There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical

  7. [The nurse within emergency medical-psychological units].

    Science.gov (United States)

    Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric

    2017-04-01

    The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. A mobility program for an inpatient acute care medical unit.

    Science.gov (United States)

    Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

    2014-10-01

    For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

  9. Identification of factors which affect the tendency towards and attitudes of emergency unit nurses to make medical errors.

    Science.gov (United States)

    Kiymaz, Dilek; Koç, Zeliha

    2018-03-01

    To determine individual and professional factors affecting the tendency of emergency unit nurses to make medical errors and their attitudes towards these errors in Turkey. Compared with other units, the emergency unit is an environment where there is an increased tendency for making medical errors due to its intensive and rapid pace, noise and complex and dynamic structure. A descriptive cross-sectional study. The study was carried out from 25 July 2014-16 September 2015 with the participation of 284 nurses who volunteered to take part in the study. Data were gathered using the data collection survey for nurses, the Medical Error Tendency Scale and the Medical Error Attitude Scale. It was determined that 40.1% of the nurses previously witnessed medical errors, 19.4% made a medical error in the last year, 17.6% of medical errors were caused by medication errors where the wrong medication was administered in the wrong dose, and none of the nurses filled out a case report form about the medical errors they made. Regarding the factors that caused medical errors in the emergency unit, 91.2% of the nurses stated excessive workload as a cause; 85.1% stated an insufficient number of nurses; and 75.4% stated fatigue, exhaustion and burnout. The study showed that nurses who loved their job were satisfied with their unit and who always worked during day shifts had a lower medical error tendency. It is suggested to consider the following actions: increase awareness about medical errors, organise training to reduce errors in medication administration, develop procedures and protocols specific to the emergency unit health care and create an environment which is not punitive wherein nurses can safely report medical errors. © 2017 John Wiley & Sons Ltd.

  10. Radiation dose in the neonatal intensive care unit of Antoine Beclere Hospital

    International Nuclear Information System (INIS)

    Lebreton, C.; Rehel, J. L.; Aubert, B.; Musset, D.

    2006-01-01

    As part of a program aiming a better knowledge of the medical exposure of the french population and in the frame of the principle of optimisation, a study of radiation doses to neonates was carried out in neonatal intensive care unit of Antoine Beclere hospital. From March to August 2005, entrance surface dose (ESD) received by 63 neonates classified according the their weight (184 X-ray examinations) was measured with thermoluminescent dosimeters (TLD) during examination. The mean ESD ESD per exposure was found between 20 and 37 μGy according to the weight of neonates. The newborn of less than 1000 g at birth have a mean of 20 X-ray examinations. Above 1000 g the number of X-ray examinations was between 5 and 8.5. During their stay in neonatal intensive care unit, the total ESD of neonates was from 500 μGy for the smallest Neonates (<1000 g) and the other respectively. Results indicate that neonate exposition, is very small compared with french and international data. ESD was significantly lower than the french reference level of 80 μGy. (Author)

  11. The monetary value of the collective dose equivalent unit (person-rem)

    International Nuclear Information System (INIS)

    Rodgers, Reginald C.

    1978-01-01

    In the design and operation of nuclear power reactor facilities, it is recommended that radiation exposures to the workers and the general public be kept as 'low as reasonably achievable' (ALARA). In the process of implementing this principle cost-benefit evaluations are part of the decision making process. For this reason a monetary value has to be assigned to the collective dose equivalent unit (person-rem). The various factors such as medical health care, societal penalty and manpower replacement/saving are essential ingredients to determine a monetary value for the person-rem. These factors and their dependence on the level of risk (or exposure level) are evaluated. Monetary values of well under $100 are determined for the public dose equivalent unit. The occupational worker person-rem value is determined to be in the range of $500 to about $5000 depending on the exposure level and the type of worker and his affiliation, i.e., temporary or permanent. A discussion of the variability and the range of the monetary values will be presented. (author)

  12. Eye lens exposure to medical staff performing electrophysiology procedures: dose assessment and correlation to patient dose

    International Nuclear Information System (INIS)

    Ciraj-Bjelac, Olivera; Bozovic, Predrag; Arandjic, Danijela; Antic, Vojislav; Selakovic, Jovana; Pavlovic, Sinisa

    2016-01-01

    The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 μSv for the first operator, 8.7 μSv for the second operator/nurse and 0.50 μSv for radiographer. Corresponding values for cardiac re-synchronisation therapy procedures were 30, 26 and 2.0 μSv, respectively. Significant (p < 0.01) correlation between the eye dose and the kerma-area product was found for the first operator and radiographers, but not for other staff categories. The study revealed eye dose per procedure and eye dose normalised to patient dose indices for different staff categories and provided an input for radiation protection in electrophysiology procedures. (authors)

  13. Effect of the European directive on medical exposure on patients doses

    Energy Technology Data Exchange (ETDEWEB)

    Wade, P.; Heaton, B. [Aberdeen Royal Infirmary, Aberdeen (United Kingdom)

    2006-07-01

    Full text of publication follows: In 2000 the European Directive on medical exposures was incorporated into United Kingdom law. Whilst the primary aim was to ensure that all uses of ionising radiation in medical practice were justified and a benefit to the patient or volunteer was identified, there was an understanding that patient doses would be controlled and collective doses reduced. The Ionising Radiation (Medical Exposure) Regulations 2000 made a lot of new demands on radiology and Nuclear Medicine departments. No department is too small or specialized to ignore these regulations and the impact can be major. The Aberdeen Radiation Protection Service advises a number of users of ionising radiation on the implementation of these regulations ranging from single person dental practices to large radiology departments in busy regional hospitals. The particular problems and issues affecting different departments will be discussed. The regulations identified new key roles with Employers, Referrers, Practitioners and Operators all having specific responsibilities. Each of these groups needs to be identified, informed of their responsibilities and trained as necessary. The problems this has raised for the various staff groups will be discussed. A large number of procedures had to be written from how a patient is uniquely identified to how incidents are reported and investigated. There is much emphasis on optimising the use of equipment and techniques used, paying particular attention to women of child bearing age and children. Again there are problems in implementing this in practice and these issues will be discussed. A formal procedure for reporting 'near misses' and actual incidents of overexposure, were introduced. Each reported event is reviewed to identify issues and lessons which can be learnt by others. There is often a lateral thinking exercise involved to reduce the probability of an incident happening again and some novel solutions have been

  14. Effect of the European directive on medical exposure on patients doses

    International Nuclear Information System (INIS)

    Wade, P.; Heaton, B.

    2006-01-01

    Full text of publication follows: In 2000 the European Directive on medical exposures was incorporated into United Kingdom law. Whilst the primary aim was to ensure that all uses of ionising radiation in medical practice were justified and a benefit to the patient or volunteer was identified, there was an understanding that patient doses would be controlled and collective doses reduced. The Ionising Radiation (Medical Exposure) Regulations 2000 made a lot of new demands on radiology and Nuclear Medicine departments. No department is too small or specialized to ignore these regulations and the impact can be major. The Aberdeen Radiation Protection Service advises a number of users of ionising radiation on the implementation of these regulations ranging from single person dental practices to large radiology departments in busy regional hospitals. The particular problems and issues affecting different departments will be discussed. The regulations identified new key roles with Employers, Referrers, Practitioners and Operators all having specific responsibilities. Each of these groups needs to be identified, informed of their responsibilities and trained as necessary. The problems this has raised for the various staff groups will be discussed. A large number of procedures had to be written from how a patient is uniquely identified to how incidents are reported and investigated. There is much emphasis on optimising the use of equipment and techniques used, paying particular attention to women of child bearing age and children. Again there are problems in implementing this in practice and these issues will be discussed. A formal procedure for reporting 'near misses' and actual incidents of overexposure, were introduced. Each reported event is reviewed to identify issues and lessons which can be learnt by others. There is often a lateral thinking exercise involved to reduce the probability of an incident happening again and some novel solutions have been implemented

  15. Towards more reliable automated multi-dose dispensing: retrospective follow-up study on medication dose errors and product defects.

    Science.gov (United States)

    Palttala, Iida; Heinämäki, Jyrki; Honkanen, Outi; Suominen, Risto; Antikainen, Osmo; Hirvonen, Jouni; Yliruusi, Jouko

    2013-03-01

    To date, little is known on applicability of different types of pharmaceutical dosage forms in an automated high-speed multi-dose dispensing process. The purpose of the present study was to identify and further investigate various process-induced and/or product-related limitations associated with multi-dose dispensing process. The rates of product defects and dose dispensing errors in automated multi-dose dispensing were retrospectively investigated during a 6-months follow-up period. The study was based on the analysis of process data of totally nine automated high-speed multi-dose dispensing systems. Special attention was paid to the dependence of multi-dose dispensing errors/product defects and pharmaceutical tablet properties (such as shape, dimensions, weight, scored lines, coatings, etc.) to profile the most suitable forms of tablets for automated dose dispensing systems. The relationship between the risk of errors in dose dispensing and tablet characteristics were visualized by creating a principal component analysis (PCA) model for the outcome of dispensed tablets. The two most common process-induced failures identified in the multi-dose dispensing are predisposal of tablet defects and unexpected product transitions in the medication cassette (dose dispensing error). The tablet defects are product-dependent failures, while the tablet transitions are dependent on automated multi-dose dispensing systems used. The occurrence of tablet defects is approximately twice as common as tablet transitions. Optimal tablet preparation for the high-speed multi-dose dispensing would be a round-shaped, relatively small/middle-sized, film-coated tablet without any scored line. Commercial tablet products can be profiled and classified based on their suitability to a high-speed multi-dose dispensing process.

  16. Control of absorbed dose in radiotherapy with 60 Co units

    International Nuclear Information System (INIS)

    Penchev, V.; Constantinov, B.; Buchakliev, Z.

    2000-01-01

    A Network for External Quality Audit has been developed and established in Bulgaria by the Secondary Standard Dosimetry Laboratory (SSDL) - Sofia. The results prove the usefulness of the TL Postal Dose programme in helping Bulgarian radiotherapy departments improve and maintain the consistency of patient doses in clinically acceptable level. The participation of the SSDL-Sofia in the IAEA Quality Audit Programme confirms the quite satisfactory accuracy of the therapy level dose measurements and determination achieved. The role of the SSDL is critical in providing traceable calibration to hospitals

  17. Medical Terminology of the Circulatory System. Medical Records. Instructional Unit for the Medical Transcriber.

    Science.gov (United States)

    Gosman, Minna L.

    Developed as a result of an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis…

  18. Medical Terminology of the Respiratory System. Medical Records. Instructional Unit for the Medical Transcriptionist.

    Science.gov (United States)

    Gosman, Minna L.

    Following an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for…

  19. Medical Terminology of the Musculoskeletal System. Medical Records. Instructional Unit for the Medical Transcriber.

    Science.gov (United States)

    Gosman, Minna L.

    Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for a…

  20. Method of estimating patient skin dose from dose displayed on medical X-ray equipment with flat panel detector

    International Nuclear Information System (INIS)

    Fukuda, Atsushi; Koshida, Kichiro; Togashi, Atsuhiko; Matsubara, Kousuke

    2004-01-01

    The International Electrotechnical Commission (IEC) has stipulated that medical X-ray equipment for interventional procedures must display radiation doses such as air kerma in free air at the interventional reference point and dose area product to establish radiation safety for patients (IEC 60601-2-43). However, it is necessary to estimate entrance skin dose for the patient from air kerma for an accurate risk assessment of radiation skin injury. To estimate entrance skin dose from displayed air kerma in free air at the interventional reference point, it is necessary to consider effective energy, the ratio of the mass-energy absorption coefficient for skin and air, and the backscatter factor. In addition, since automatic exposure control is installed in medical X-ray equipment with flat panel detectors, it is necessary to know the characteristics of control to estimate exposure dose. In order to calculate entrance skin dose under various conditions, we investigated clinical parameters such as tube voltage, tube current, pulse width, additional filter, and focal spot size, as functions of patient body size. We also measured the effective energy of X-ray exposure for the patient as a function of clinical parameter settings. We found that the conversion factor from air kerma in free air to entrance skin dose is about 1.4 for protection. (author)

  1. Dosimetric accuracy at low monitor unit setting in electron beams at different dose rates

    International Nuclear Information System (INIS)

    Ravikumar, M.; Ravichandran, R.; Supe, Sanjay S.; Sharma, Anil K.

    1999-01-01

    As electron beam with low monitor unit (LMU) settings are used in some dosimetric studies, better understanding of accuracy in dose delivery at LMU setting is necessary. The dose measurements were carried out with 0.6 cm 3 farmer type ion chamber at d max in a polystyrene phantom. Measurements at different MUs show that the dose linearity ratio (DLR) increases as the MU setting decreases below 20 MU and DLRs are found to increase when the incident electron beams have higher energies. The increase in DLR is minimum for low dose rate setting for all five electron beam energies (6, 9, 12, 16 and 20 MeV). As the variation in dose delivery is machine-specific, a detailed study should be conducted before the low MU setting is implemented. Since errors in dose delivery are high at higher dose rates, low dose rate may be better at low MU unit setting. (author)

  2. Can medical students calculate drug doses? | Harries | Southern ...

    African Journals Online (AJOL)

    ... with calculations when the drug concentration was expressed either as a ratio or a percentage. Conclusion: Our findings support calls for the standardised labelling of drugs in solution and for dosage calculation training in the medical curriculum. Keywords: drug dosage calculations, clinical competence, medication errors

  3. The ethics of medical tourism: from the United Kingdom to India seeking medical care.

    Science.gov (United States)

    Meghani, Zahra

    2013-01-01

    Is the practice of UK patients traveling to India as medical tourists morally justified? This article addresses that question by examining three ethically relevant issues. First, the key factor motivating citizens of the United Kingdom to seek medical treatment in India is identified and analyzed. Second, the life prospects of the majority of the citizens of the two nations are compared to determine whether the United Kingdom is morally warranted in relying on India to meet the medical needs of its citizens. Third, as neoliberal reforms are justified on the grounds that they will help the indigent populations affected by them, the impact of medical tourism--a neoliberal initiative--on India's socially and economically marginalized groups is scrutinized.

  4. Home iv antibiotic therapy through a medical day care unit

    OpenAIRE

    Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

    1993-01-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-pa...

  5. An introduction to medical malpractice in the United States.

    Science.gov (United States)

    Bal, B Sonny

    2009-02-01

    Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering.

  6. Annual dose equivalents estimation received by Cienfuegos population due medical practice

    International Nuclear Information System (INIS)

    Usagaua R, Z.; Santander I, E.

    1996-01-01

    This study represents the first evaluation of the effective equivalent dose that receives the population of the Cienfuegos province in Cuba because of medical practice. The evaluation is based on the tables of doses depending on several parameters that influence over these ones, and also based on large diagnostic examinations statistics of all medical institutions over a 9 years period. Values of examinations frequency, contribution to total dose from radiography, fluoroscopy, dental radiography and nuclear medicine, and other characteristics of the last ones are offered. A comparative reflection dealing with received doses by radiography and fluoroscopy techniques is also included. (authors). 4 refs

  7. Medical leadership and management in the United Kingdom.

    Science.gov (United States)

    Kyratsis, Yiannis; Armit, Kirsten; Zyada, Azra; Lees, Peter

    2016-06-01

    This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, and discuss professional development and future prospects. With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research informed medical leadership training. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  8. Assessment of Clinical Practices for Crushing Medication in Geriatric Units.

    Science.gov (United States)

    Fodil, M; Nghiem, D; Colas, M; Bourry, S; Poisson-Salomon, A-S; Rezigue, H; Trivalle, C

    2017-01-01

    To assess the modification of the form of medication and evaluate staff observance of good clinical practices. One-day assessment of clinical practices. 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. Elderly in-patients with difficulties swallowing capsules and tablets. Assessment of target-patient prescriptions and direct observation of nurses' medical rounds. 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.

  9. [Helicopters and medical first aid units. Role of Medical First Aid Unit 94].

    Science.gov (United States)

    Huguenard, P; Hanote, P; Metrot, J

    1975-10-01

    For the transport of injured and sick patients, the helicopter (even the mono-turbine type) offers greater advantages when compared to land vehicles: - more comfort (less vibrations, accelerations and decelerations); - a greater speed, that is to say a 61 p. 100 gain of time upon the distance and a gain from 29 up to 44 p. 100 upon the total amount of time taken up by each transport. This gain in time enables valuable specialised medical teams to be more available: - more precise time-tables than by land which namely makes it easier to receive the patients. The drawbacks are linked with the risks which are not nonexistent but rather less serious than by land. The drawbacks also depend upon the weather-conditions (although this factor does not matter much in our area), upon nuisances such as the noise (which is more important but far more transitory than by ambulance) and chiefly upon the cost of air-transport. In fact, the mean cost of a medical land transport amounts roughly to one thousand Francs, a quarter of which only does represent the actual cost of medical aid. For a similar transport, the helicopter comes to a 47 mns flight. There are several ways of making good use of a helicopter. Practical problems have been solved. The "SAMU 94" experience goes back to 1973 and includes over 500 transports by helicopter essentially with the help of the teams and the helicopters belonging to the Paris Base (Civil Protection and the Fire-Brigade). For flights over urban areas, it is to be desired in the future that only twin-turbine helicopters should be used.

  10. Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Liao TV

    2017-05-01

    Full Text Available T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU are at an increased risk for medication errors (MEs and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU. Studies with the implementation of electronic health records (EHR have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I, January–February 2011 (2 months postimplementation; period II, August–September 2012 (21 months postimplementation; period III, and January–February 2013 (25 months postimplementation; period IV. All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase

  11. Medical staffing in Ontario neonatal intensive care units.

    Science.gov (United States)

    Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D

    1989-06-01

    Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

  12. Assessment of teamwork during structured interdisciplinary rounds on medical units.

    Science.gov (United States)

    O'Leary, Kevin J; Boudreau, Yvonne N; Creden, Amanda J; Slade, Maureen E; Williams, Mark V

    2012-01-01

    Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR. To evaluate and characterize teamwork during IDR. Cross-sectional observational study. Six medical units which had implemented structured interdisciplinary rounds (SIDR). We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool. We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Copyright © 2012 Society of Hospital Medicine.

  13. [Knowledge of nurses about medication doses at pediatric urgency departament].

    Science.gov (United States)

    Guerrero-Márquez, Gloria; Martínez-Serrano, Ana; Míguez-Navarro, Concepción; López-Mirón, Juan Antonio; Espartosa-Larrayad, Marta

    2016-01-01

    Errors in drug administration are the second cause of errors in hospitalized patients. Children are a high risk group. Besides, pressure in care interventions at emergency department leads to increase incidence errors. Determining nurses' knowledge about the most common drug doses at pediatric urgency department. Descriptive transversal study. We collected data from nurses of 14 pediatric emergency departments of Madrid. With an "ad hoc" questionnaire we collected the following data during five days in January of 2014: demographic, knowledge of responsibility in administration and doses of drugs. Global descriptive analysis was made and it was stratified by hospital and work experience. The answer rate was 114 (34.9%). Only 80 (70.8%) of nurses confirm doses before their administration; 20 (18.6%) think that a wrong prescription that they administer is not their responsibility. There is a high knowledge in the group with more than five years of work experience, except for sedative-analgesic drugs (p<0.05). The average score obtained was 3.8 of 10 (1.99). Nurses' knowledge about drug doses is low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. Dental radiographic units - radiation safety and patient doses

    International Nuclear Information System (INIS)

    Nagpal, J.S.; Varadharajan, Geetha

    2001-01-01

    Three models of dental radiographic machines have been examined for radiation safety. Using TL dosemeters, doses received by the patients at chest level and the gonads have been estimated. Care should be taken to shield gonads during dental radiographic examinations. (author)

  15. An overview of measuring and modelling dose and risk from ionising radiation for medical exposures

    International Nuclear Information System (INIS)

    Tootell, Andrew; Szczepura, Katy; Hogg, Peter

    2014-01-01

    Purpose: This paper gives an overview of the methods that are used to calculate dose and risk from exposure to ionizing radiation as a support to other papers in this special issue. Background: The optimization of radiation dose is a legal requirement in medical exposures. This review paper aims to provide the reader with knowledge of dose by providing definitions and concepts of absorbed, effective and equivalent dose. Criticisms of the use of effective dose to infer the risk of an exposure to an individual will be discussed and an alternative approach considering the lifetime risks of cancer incidence will be considered. Prior to any dose or risk calculation, data concerning the dose absorbed by the patient needs to be collected. This paper will describe and discuss the main concepts and methods that can be utilised by a researcher in dose assessments. Concepts behind figures generated by imaging equipment such as dose-area-product, computed tomography dose index, dose length product and their use in effective dose calculations will be discussed. Processes, advantages and disadvantages in the simulation of exposures using the Monte Carlo method and direct measurement using digital dosimeters or thermoluminescent dosimeters will be considered. Beyond this special issue, it is proposed that this paper could serve as a teaching or CPD tool for personnel working or studying medical imaging

  16. 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

  17. Practical considerations in medical cannabis administration and dosing.

    Science.gov (United States)

    MacCallum, Caroline A; Russo, Ethan B

    2018-03-01

    Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable. In this article, the authors endeavour to present concise data on cannabis pharmacology related to tetrahydrocannabinol (THC), cannabidiol (CBD) et al., methods of administration (smoking, vaporisation, oral), and dosing recommendations. Adverse events of cannabis medicine pertain primarily to THC, whose total daily dose-equivalent should generally be limited to 30mg/day or less, preferably in conjunction with CBD, to avoid psychoactive sequelae and development of tolerance. CBD, in contrast to THC, is less potent, and may require much higher doses for its adjunctive benefits on pain, inflammation, and attenuation of THC-associated anxiety and tachycardia. Dose initiation should commence at modest levels, and titration of any cannabis preparation should be undertaken slowly over a period of as much as two weeks. Suggestions are offered on cannabis-drug interactions, patient monitoring, and standards of care, while special cases for cannabis therapeutics are addressed: epilepsy, cancer palliation and primary treatment, chronic pain, use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and in relation to driving and hazardous activities. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  18. Dose setting for radiation sterilization of disposable medical device, (3)

    International Nuclear Information System (INIS)

    Iwasaki, Yoshio; Hosobuchi, Kazunari.

    1985-01-01

    The microbial burden and dose setting for radiation sterilization of tampon for menstrual hygiene were examined, and the following results were obtained. 1. The maximum and minimum contaminants per a tampon were 100 and 0, and the average was 46.1. 2. The 91.2 % of the 125 strains isolated from the tampon was identified as bacilli by the microbiological and biochemical activities, and Bacillus pumilus compried 35.2 % of the strains. B. pumilus and B. megaterium spores indicated the highest radioresistance among those contaminants and both D-values were 0.22 Mrad. 3. The difference in the D-value was not found for the radioresistance of standard strain carried on a tampon and a glass fiber filter. 4. The sterilization dose (SD) was calculated to be 1.10 Mrad by the formula SD = D x log (No/N), while the SD was 0.90 and 0.76 Mrad, respectively, for the microbial burden informations and steility tests. From above ressults, it is supposed that the sterility assurance level in 10 -3 can be achieved by irradiating the dose less than 1 Mrad. (author)

  19. An overview of the United States dose reassessment program

    International Nuclear Information System (INIS)

    Christy, R.F.

    1983-01-01

    The US Dose Reassessment Program consists of a number of separate efforts to reexamine all the stages from the initial assembly of the fissionable material, through the transport of neutrons and gamma rays, to the final deposition of the dose of ionizing radiation. Where possible, experimental measurements will be used to normalize the calculations. This program is summarized as follows: (1) calculations on the output of prompt neutrons and gamma rays from the detonating bomb, by Los Alamos National Laboratory (LANL), including calculation of the output of various test bombs where measurements have been made and of a critical assembly of a Hiroshima type bomb, (2) transport calculations for prompt neutrons and gamma rays in air by Oak Ridge National Laboratory (ORNL) and Lawrence Livermore National Laboratory (LLNL) including transport in air of gamma rays secondary to prompt neutrons and calculation of various test devices, (3) calculation of the emission and transport in air of delayed gamma rays from the cloud of fission products by Science Applications, Inc. (SAI) which can also include delayed neutron calculations, (4) calculations of the shielding effects of buildings, etc., on the neutron and gamma ray flux by SAI and ORNL, (5) calculation of organ doses and transport in the body by ORNL and SAI, (6) calibration of in situ measurements by LLNL and ORNL, (7) thermoluminescent (TL) dosimetry to determine gamma ray flux by the Japanese National Institute of Radiological Sciences and the University of Utah, and (8) review of information on bomb yield by LANL and ORNL. (author)

  20. Estimation of population doses from diagnostic medical examinations in Japan, 1974. II. Estimation of genetically significant dose

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-03-01

    The genetically significant dose from radiographic and fluoroscopic examination in Japan has been estimated based on a 1974 nation wide survey of randomly sampled hospitals and clinics. The gonad dose during x-ray diagnosis was determined with an ionization chamber placed at the positions of ovary and testis in a Rando phantom. The instrumented phantom was irradiated with medical diagnostic x-rays on the basis of the exposure data on the patients selected in the nation wide survey. In the calculation of the genetically significant dose, the child expectancy of the patients that undergo each particular type of examination was assumed to be same as that of the general population. The resultant genetically significant dose was 11.1 and 5.43 mrad per person per year for radiography and fluoroscopy, respectively. These values were compared with those of 1960 and 1969. Though the number of examinations per year shows a yearly increase, the genetically significant dose is gradually on the decrease. This may be due to technical improvements in medical radiological practices.

  1. Medical irradiation and the use of the ''effective dose equivalent'' concept

    International Nuclear Information System (INIS)

    Persson, B.R.R.

    1980-01-01

    The aim of this paper is to demonstrate the use of the effective dose for all kinds of medical irradiation. In order to estimate the 'somatic effective dose' the weighting factors recommended by ICRP 26 have been separated into those for somatic effects and for genetic effects. Calculation of the effective dose in diagnostic radiology procedures must consider the various technical parameters which determine the absorbed dose in the various organs, i.e. beam quality, typical entrance dose and the number of films of each view. Knowledge about these parameters is not always well established and therefore the effective dose estimates are very uncertain. The average dose absorbed by various organs in the case of administration of radionuclides to the body depends to a much higher degree on biological parameters than in the case of external irradiation. In contrast to the variability and lack of reliability of biological data, the physical methods for internal dose calculation are quite elaborate. However, these methods have to be extended to involve the target dose from the radioactivity distributed within the remaining parts of the body. An attempt was made to estimate the somatic effective dose for the most common diagnostic X-ray and nuclear medicine procedures. This would make it possible to compare the risk of X-ray and nuclear medicine techniques on a more equitable basis. The collective effective dose from medical irradiation is estimated for various countries on the basis of reported statistical data. (H.K.)

  2. International students in United States’ medical schools: does the medical community know they exist?

    Directory of Open Access Journals (Sweden)

    Jashodeep Datta

    2012-06-01

    Full Text Available Background: Matriculation of international students to United States’ (US medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education. Methods: While these students’ numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. Results: These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools – both public and private – to support international students’ education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME. However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement. Conclusion: By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to

  3. Radiological emergency response in a medical waste treatment unit

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L. [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil)

    2000-07-01

    Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

  4. Radiological emergency response in a medical waste treatment unit

    International Nuclear Information System (INIS)

    Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L.

    2000-01-01

    Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

  5. Establishment of exposure dose assessment laboratory in National Radiation Emergency Medical Center (NREMC)

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Jae Ryong; Ha, Wi Ho; Yoon, Seok Won; Han, Eun Ae; Lee, Seung Sook [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2011-10-15

    As unclear industry grown, 432 of the nuclear power plants are operating and 52 of NPPs are under construction currently. Increasing use of radiation or radioisotopes in the field of industry, medical purpose and research such as non-destructive examination, computed tomography and x-ray, etc. constantly. With use of nuclear or radiation has incidence possibility for example the Fukushima NPP incident, the Goiania accident and the Chernobyl Nuclear accident. Also the risk of terror by radioactive material such as Radiological Dispersal Device(RDD) etc. In Korea, since the 'Law on protection of nuclear facilities and countermeasure for radioactive preparedness was enacted in 2003, the Korean institute of Radiological and Medical Sciences(KIRAMS) was established for the radiation emergency medical response in radiological disaster due to nuclear accident, radioactive terror and so on. Especially National Radiation Emergency Medical Center(NREMC) has the duty that is protect citizens from nuclear, radiological accidents or radiological terrors through the emergency medical preparedness. The NREMC was established by the 39-article law on physical protection of nuclear material and facilities and measures for radiological emergencies. Dose assessment or contamination survey should be performed which provide the radiological information for medical response. For this reason, the NREMC establish and re-organized dose assessment system based on the existing dose assessment system of the NREMC recently. The exposure dose could be measured by physical and biological method. With these two methods, we can have conservative dose assessment result. Therefore the NREMC established the exposure dose assessment laboratory which was re-organized laboratory space and introduced specialized equipment for dose assessment. This paper will report the establishment and operation of exposure dose assessment laboratory for radiological emergency response and discuss how to enhance

  6. Doses in sensitive organs during prostate treatment with a 60Co unit

    International Nuclear Information System (INIS)

    Vega-Carrillo, H.R.; Navarro Becerra, J.A.; Pérez Arrieta, M.L.; Pérez-Landeros, L.H.

    2014-01-01

    Using thermoluminiscent dosimeters the absorbed dose in the bladder, rectum and thyroid have been evaluated when 200 cGy was applied to the prostate. The treatment was applied with a 60 Co unit. A water phantom was built and thermoluminiscent dosimeters were located in the position where the prostate, bladder, rectum and thyroid are located. The therapeutic beam was applied in 4 irradiations at 0, 90, 180 and 270° with the prostate at the isocenter. The TLDs readouts were used to evaluate the absorbed dose in each organ. The absorbed doses were used to estimate the effective doses and the probability of developing secondary malignacies in thyroid, rectum and bladder. - Highlights: • The absorbed doses in the bladder, rectum and thyroid were measured. • Measurements were done during prostate treatment with a 60 Co unit. • TLD100s in a water phantom were used. • The effective doses were also estimated

  7. Modernization of the accident localisation system and relevant dose exposure on unit four of KNPP

    International Nuclear Information System (INIS)

    Valtchev, G.; Neshkova, M.; Nikilov, A.

    2005-01-01

    In 2001 a modernization of the accident localisation system (ALS) on Unit 4 was accomplished. The outage duration was longer then usually and special dose budget was elaborated. All ALS work was performed by external organisation. An ALARA implementation was recognised priority. The really accumulated collective doses were analysed and conclusions drawn. A short film on CD was prepared. (authors)

  8. Bioeffect modeling and equieffective dose concepts in radiation oncology – Terminology, quantities and units

    International Nuclear Information System (INIS)

    Bentzen, Søren M.; Dörr, Wolfgang; Gahbauer, Reinhard; Howell, Roger W.; Joiner, Michael C.; Jones, Bleddyn; Jones, Dan T.L.; Kogel, Albert J. van der; Wambersie, André; Whitmore, Gordon

    2012-01-01

    The International Commission on Radiation Units and Measurements (ICRU) Report Committee on “Bioeffect Modeling and Biologically Equivalent Dose Concepts in Radiation Therapy” is currently developing a comprehensive and consistent framework for radiobiological effect modeling based on the equieffective dose, EQDX α/β , a concept encompassing BED and EQD2 as special cases.

  9. Chernobyl: response of medical physics departments in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Haywood, J K

    1986-01-01

    This conference drew attention to gaps in United Kingdom arrangements for dealing with the effects (both supposed and real) of accidents at civil nuclear installations on the populations which surround them; it showed how, in the case of the Chernobyl accident, Medical Physicists in the National Health Service responded to plug these gaps in spite of the organisational difficulties which the crisis presented; and it suggested a method of incorporating this hitherto underestimated resource into national planning for civil nuclear accidents. Reports are included from Newcastle, Charing Cross Hospital, The London Hospital, Cambridge, Westminster Hospital, Leeds, Liverpool, Cardiff, Canterbury, Swansea (environmental measurements) and Mount Vernon.

  10. Decommissioning of a 60Co unit and estimation of personal doses

    International Nuclear Information System (INIS)

    Lin, H.; Lin, P.; Liu, T.; Chu, C.

    2003-01-01

    Chang-hua Christian hospital needs to uninstall the 60 Co unit. The mode of this 60 Co teletherapy unit is SHIMADZU RTGS-10. The original lead head was taken as the source container of this 60 Co unit. The source head was dismantled and put into the prepared wooden box, after the source was sealed. This study describes the planning and dismantling of the retirement and transport of the 60 Co unit, and personal doses measured during the procedure. This work estimates the doses of radiation received by exposed workers during the dismantling of the machine. The workers received doses of approximately 53 μSv. This study shows that the original lead head can be used as the source container of this 60 Co unit. The 60 Co machine was smoothly dismantled and transported by conscientious and careful workers, using planned and controlled radiation protection, following the ALARA (as low as reasonably achievable) rule. (author)

  11. Low-dose quantitative phase contrast medical CT

    Science.gov (United States)

    Mittone, A.; Bravin, A.; Coan, P.

    2018-02-01

    X-ray computed tomography (CT) is a powerful and routinely used clinical diagnostic technique, which is well tolerated by patients, and which provides high-resolution images and volumetric information about the body. However, two important limitations still affect this examination procedure: (1) its low sensitivity with respect to soft tissues, and (2) the hazards associated with x-ray exposure. Conventional radiology is based on the detection of the different photon absorption properties that characterize biological tissues, and thus the obtainable image contrast from soft and/or similar tissues is intrinsically limited. In this scenario, x-ray phase contrast imaging (XPCI) has been extensively tested and proven to overcome some of the main issues surrounding standard x-ray imaging. In addition to the absorption signal, XPCI relies on detecting the phase shifts induced by an object. Interestingly, as the order of magnitude of the phase contrast is higher than that of absorption, XPCI can, in principle, offer higher sensitivity at lower radiation doses. However, other technical aspects may counterbalance this gain, and an optimized setup and image processing solutions need to be implemented. The work presented here describes the strategies and developments we have realized, with the aim of controlling the radiation dose for the highly sensitive and quantitative XPCI-CT. Different algorithms for the phase retrieval and CT reconstruction of the XPCI data are presented. The CT algorithms we have implemented, namely the equally sloped tomography and the dictionary learning method, allow the image quality to be preserved while reducing the number of angular projections required by a factor of five. The results applied to breast imaging report accurate reconstructions at clinically compatible doses of the 3D distribution of the refractive properties of full human organs obtained by using three different phase retrieval methods. The described methodologies and the

  12. Analysis of liquid medication dose errors made by patients and caregivers using alternative measuring devices.

    Science.gov (United States)

    Ryu, Gyeong Suk; Lee, Yu Jeung

    2012-01-01

    Patients use several types of devices to measure liquid medication. Using a criterion ranging from a 10% to 40% variation from a target 5 mL for a teaspoon dose, previous studies have found that a considerable proportion of patients or caregivers make errors when dosing liquid medication with measuring devices. To determine the rate and magnitude of liquid medication dose errors that occur with patient/caregiver use of various measuring devices in a community pharmacy. Liquid medication measurements by patients or caregivers were observed in a convenience sample of community pharmacy patrons in Korea during a 2-week period in March 2011. Participants included all patients or caregivers (N = 300) who came to the pharmacy to buy over-the-counter liquid medication or to have a liquid medication prescription filled during the study period. The participants were instructed by an investigator who was also a pharmacist to select their preferred measuring devices from 6 alternatives (etched-calibration dosing cup, printed-calibration dosing cup, dosing spoon, syringe, dispensing bottle, or spoon with a bottle adapter) and measure a 5 mL dose of Coben (chlorpheniramine maleate/phenylephrine HCl, Daewoo Pharm. Co., Ltd) syrup using the device of their choice. The investigator used an ISOLAB graduated cylinder (Germany, blue grad, 10 mL) to measure the amount of syrup dispensed by the study participants. Participant characteristics were recorded including gender, age, education level, and relationship to the person for whom the medication was intended. Of the 300 participants, 257 (85.7%) were female; 286 (95.3%) had at least a high school education; and 282 (94.0%) were caregivers (parent or grandparent) for the patient. The mean (SD) measured dose was 4.949 (0.378) mL for the 300 participants. In analysis of variance of the 6 measuring devices, the greatest difference from the 5 mL target was a mean 5.552 mL for 17 subjects who used the regular (etched) dosing cup and 4

  13. Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangio-pancreatography procedures

    International Nuclear Information System (INIS)

    Seo, Deoknam; Kim, Kie Hwan; Park, Kyung; Kim, Jung-Su; Han, Seonggyu; Kim, Jungmin

    2016-01-01

    The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm 2 , 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated. (authors)

  14. Extremity doses of medical staff involved in interventional radiology and cardiology: Correlations and annual doses (hands and legs)

    International Nuclear Information System (INIS)

    Krim, S.; Brodecki, M.; Carinou, E.; Donadille, L.; Jankowski, J.; Koukorava, C.; Dominiek, J.; Nikodemova, D.; Ruiz-Lopez, N.; Sans-Merce, M.; Struelens, L.; Vanhavere, F.

    2011-01-01

    An intensive measurement campaign was launched in different hospitals in Europe within work package 1 of the ORAMED project (Optimization of RAdiation protection for MEDical staff). Its main objective was to obtain a set of standardized data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimize staff protection. The monitored procedures were divided in three main categories: cardiac, general angiography and endoscopic retrograde cholangio-pancreatography(ERCP) procedures. Using a common measurement protocol, information such as the protective equipment used (lead table curtain, transparent lead glass ceiling screen, patient shielding, whole body shielding or special cabin etc.) as well as Kerma Area Product (KAP) values and access of the catheter were recorded. This study was performed with a final database of more than 1300 procedures performed in 34 European hospitals. Its objectives were firstly to determine if the measured extremity doses could be correlated to the KAP values; secondly to check if the doses to the eyes could be linked to the doses to the hands (finger or wrist positions) and finally if the doses to the fingers could be estimated based on the doses to the wrists. General correlations were very difficult to find and their strength was mostly influenced by three main parameters: the X-ray tube configuration, the room collective radioprotective equipment and the access of the catheter. The KAP value can provide a simple mean to estimate the extremity doses of the operator given that it is assessed correctly for the operator when he is actually using the X-ray tube. Moreover, this study showed that the doses to the left finger are strongly correlated to the doses to the left wrist when no ceiling shield is used. It is also possible to estimate the doses to the eyes given the doses to the left finger or left wrist but the X-ray tube configuration and the access have to be considered. The annual

  15. Variations of Patient Doses in Interventional Examinations at Different Angiographic Units

    International Nuclear Information System (INIS)

    Bor, Dogan; Toklu, Tuerkay; Olgar, Turan; Sancak, Tanzer; Cekirge, Saruhan; Onal, Baran; Bilgic, Sadik

    2006-01-01

    Purpose. We analyzed doses for various angiographic procedures using different X-ray systems in order to assess dose variations. Methods. Dose-area product (DAP), skin doses from thermoluminescent dosimeters and air kerma measurements of 308 patients (239 diagnostic and 69 interventional) were assessed for five different angiographic units. All fluoroscopic and radiographic exposure parameters were recorded online for single and multiprojection studies. Radiation outputs of each X-ray system were also measured for all the modes of exposure using standard protocols for such measurements. Results. In general, the complexity of the angiographic procedure was found to be the most important reason for high radiation doses. Skill of the radiologist, management of the exposure parameters and calibration of the system are the other factors to be considered. Lateral cerebral interventional studies carry the highest risk for deterministic effects on the lens of the eye. Effective doses were calculated from DAP measurements and maximum fatal cancer risk factors were found for carotid studies. Conclusions. Interventional radiologists should measure patient doses for their examinations. If there is a lack of necessary instrumentation for this purpose, then published dose reports should be used in order to predict the dose levels from some of the exposure parameters. Patient dose information should include not only the measured quantity but also the measured radiation output of the X-ray unit and exposure parameters used during radiographic and fluoroscopic exposures

  16. The estimation of radiation effective dose from diagnostic medical procedures in general population of northern Iran

    International Nuclear Information System (INIS)

    Shabestani Monfared, A.; Abdi, R.

    2006-01-01

    The risks of low-dose Ionizing radiation from radiology and nuclear medicine are not clearly determined. Effective dose to population is a very important factor in risk estimation. The study aimed to determine the effective dose from diagnostic radiation medicine in a northern province of Iran. Materials and Methods: Data about various radiologic and nuclear medicine procedures were collected from all radiology and nuclear medicine departments In Mazandaran Province (population = 2,898,031); and using the standard dosimetry tables, the total dose, dose per examination, and annual effective dose per capita as well as the annual gonadal dose per capita were estimated. Results: 655,730 radiologic examinations in a year's period, lead to 1.45 mSv, 0.33 mSv and 0.31 mGy as average effective dose per examination, annual average effective dose to member of the public, and annual average gonadal dose per capita, respectively. The frequency of medical radiologic examinations was 2,262 examinations annually per 10,000 members of population. However, the total number of nuclear medicine examinations in the same period was 7074, with 4.37 mSv, 9.6 μSv and 9.8 μGy, as average effective dose per examination, annual average effective dose to member of the public and annual average gonadal dose per caput, respectively. The frequency of nuclear medicine examination was 24 examinations annually per 10,000 members of population. Conclusion: The average effective dose per examination was nearly similar to other studies. However, the average annual effective dose and annual average gonadal dose per capita were less than the similar values in other reports, which could be due to lesser number of radiation medicine examinations in the present study

  17. Incremental cost of PACS in a medical intensive care unit

    Science.gov (United States)

    Langlotz, Curtis P.; Cleff, Bridget; Even-Shoshan, Orit; Bozzo, Mary T.; Redfern, Regina O.; Brikman, Inna; Seshadri, Sridhar B.; Horii, Steven C.; Kundel, Harold L.

    1995-05-01

    Our purpose is to determine the incremental costs (or savings) due to the introduction of picture archiving and communication systems (PACS) and computed radiology (CR) in a medical intensive care unit (MICU). Our economic analysis consists of three measurement methods. The first method is an assessment of the direct costs to the radiology department, implemented in a spreadsheet model. The second method consists of a series of brief observational studies to measure potential changes in personnel costs that might not be reflected in administrative claims. The third method (results not reported here) is a multivariate modeling technique which estimates the independent effect of PACS/CR on the cost of care (estimated from administrative claims data), while controlling for clinical case- mix variables. Our direct cost model shows no cost savings to the radiology department after the introduction of PACS in the medical intensive care unit. Savings in film supplies and film library personnel are offset by increases in capital equipment costs and PACS operation personnel. The results of observational studies to date demonstrate significant savings in clinician film-search time, but no significant change in technologist time or lost films. Our model suggests that direct radiology costs will increase after the limited introduction of PACS/CR in the MICU. Our observational studies show a small but significant effect on clinician film search time by the introduction of PACS/CR in the MICU, but no significant effect on other variables. The projected costs of a hospital-wide PACS are currently under study.

  18. Optimal medication dosing in patients with diabetes mellitus and chronic kidney disease.

    Science.gov (United States)

    MacCallum, Lori

    2014-10-01

    Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in Canada. As rates of diabetes rise, so does the prevalence of CKD. Diabetes and CKD are chronic diseases that require multiple medications for their management. Many of the anticipated effects of these medications are altered by the physiologic changes that occur in CKD. Failure to individualize drug dosing in this population may lead to toxicity or decreased therapeutic response, leading to treatment failure. At times this can be challenging for a multitude of reasons, including the limitations of available calculations for estimating renal function, inconsistent dosing recommendations and the lack of dosing recommendations for some medications. Clinicians caring for these patients need to consider an approach of individualized drug therapy that will ensure optimal outcomes. The better understanding that clinicians have of these challenges, the more effective they will be at using the available information as a guide together with their own professional judgement to make appropriate dosing changes. This article discusses the following: 1) physiologic changes that occur in CKD and its impact on drug dosing; 2) advantages and disadvantages of various calculations used for estimating renal function; 3) pharmacokinetic and pharmacodynamic changes of some commonly used medications in diabetes, and finally, 4) an approach to individualized drug dosing for this patient population. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  19. Home iv Antibiotic Therapy through a Medical Day Care Unit

    Directory of Open Access Journals (Sweden)

    Marie Gourdeau

    1993-01-01

    Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

  20. The high dose and low dose food irradiation programmes in the United States of America

    International Nuclear Information System (INIS)

    Brynjolfsson, A.

    1978-01-01

    Many highly acceptable shelf-stable irradiated food items have been developed in the United States of America. The most extensive wholesomeness studies ever carried out on any food-processing method continue to indicate that irradiated foods are wholesome. (author)

  1. Detection unit for measuring dose rate and/or dose of gamma radiation

    International Nuclear Information System (INIS)

    Viererbl, L.

    1987-01-01

    A detection unit is designed consisting of a scintillation detector of the NaI(Tl) type on which there is a correction filter. The filter is an aluminium case in which are placed alternately side by side lead and iron absorption layers. The sensitivity of the detector with this filter is constant for gamma energy within the range 50 to 1300 keV. (M.D.). 2 figs

  2. Benefits of the effective dose equivalent concept at a medical center

    International Nuclear Information System (INIS)

    Vetter, R.J.; Classic, K.L.

    1991-01-01

    A primary objective of the recommendations of the International Committee on Radiological Protection Publication 26 is to insure that no source of radiation exposure is unjustified in relation to its benefits. This objective is consistent with goals of the Radiation Safety Committee and Institutional Review Board at medical centers where research may involve radiation exposure of human subjects. The effective dose equivalent concept facilitates evaluation of risk by those who have little or no knowledge of quantities or biological effects of radiation. This paper presents effective dose equivalent data used by radiation workers and those who evaluate human research protocols as these data relate to personal dosimeter reading, entrance skin exposure, and target organ dose. The benefits of using effective dose equivalent to evaluate risk of medical radiation environments and research protocols are also described

  3. Monitor units are not predictive of neutron dose for high-energy IMRT

    Directory of Open Access Journals (Sweden)

    Hälg Roger A

    2012-08-01

    Full Text Available Abstract Background Due to the substantial increase in beam-on time of high energy intensity-modulated radiotherapy (>10 MV techniques to deliver the same target dose compared to conventional treatment techniques, an increased dose of scatter radiation, including neutrons, is delivered to the patient. As a consequence, an increase in second malignancies may be expected in the future with the application of intensity-modulated radiotherapy. It is commonly assumed that the neutron dose equivalent scales with the number of monitor units. Methods Measurements of neutron dose equivalent were performed for an open and an intensity-modulated field at four positions: inside and outside of the treatment field at 0.2 cm and 15 cm depth, respectively. Results It was shown that the neutron dose equivalent, which a patient receives during an intensity-modulated radiotherapy treatment, does not scale with the ratio of applied monitor units relative to an open field irradiation. Outside the treatment volume at larger depth 35% less neutron dose equivalent is delivered than expected. Conclusions The predicted increase of second cancer induction rates from intensity-modulated treatment techniques can be overestimated when the neutron dose is simply scaled with monitor units.

  4. Automation of PCXMC and ImPACT for NASA Astronaut Medical Imaging Dose and Risk Tracking

    Science.gov (United States)

    Bahadori, Amir; Picco, Charles; Flores-McLaughlin, John; Shavers, Mark; Semones, Edward

    2011-01-01

    To automate astronaut organ and effective dose calculations from occupational X-ray and computed tomography (CT) examinations incorporating PCXMC and ImPACT tools and to estimate the associated lifetime cancer risk per the National Council on Radiation Protection & Measurements (NCRP) using MATLAB(R). Methods: NASA follows guidance from the NCRP on its operational radiation safety program for astronauts. NCRP Report 142 recommends that astronauts be informed of the cancer risks from reported exposures to ionizing radiation from medical imaging. MATLAB(R) code was written to retrieve exam parameters for medical imaging procedures from a NASA database, calculate associated dose and risk, and return results to the database, using the Microsoft .NET Framework. This code interfaces with the PCXMC executable and emulates the ImPACT Excel spreadsheet to calculate organ doses from X-rays and CTs, respectively, eliminating the need to utilize the PCXMC graphical user interface (except for a few special cases) and the ImPACT spreadsheet. Results: Using MATLAB(R) code to interface with PCXMC and replicate ImPACT dose calculation allowed for rapid evaluation of multiple medical imaging exams. The user inputs the exam parameter data into the database and runs the code. Based on the imaging modality and input parameters, the organ doses are calculated. Output files are created for record, and organ doses, effective dose, and cancer risks associated with each exam are written to the database. Annual and post-flight exposure reports, which are used by the flight surgeon to brief the astronaut, are generated from the database. Conclusions: Automating PCXMC and ImPACT for evaluation of NASA astronaut medical imaging radiation procedures allowed for a traceable and rapid method for tracking projected cancer risks associated with over 12,000 exposures. This code will be used to evaluate future medical radiation exposures, and can easily be modified to accommodate changes to the risk

  5. Radiation doses in head CT examinations in Serbia: comparison among different CT units

    International Nuclear Information System (INIS)

    Arandjic, D.; Ciraj-Bjelac, O.; Bozovic, P.; Stankovic, J.; Hadnadjev, D.; Stojanovic, S.

    2012-01-01

    A rapid increase in number of Computed Tomography (CT) examinations has been observed world wide. As haed CT is the most frequent CT examination, the purpose of this study was to collect and analyse patient doses in children and adults in different CT units for this procedure. The study included 8 CT units from three manufacturers (Siemens, Toshiba and General Electric). Data for adults and pediatric patients were collected in terms of CTDIvol and DLP values. The doses were estimated as a mean value of 10 patients on each CT unit. For pediatrics, doses were collected for four age groups (0-1year, >1-5years, >5-10years and >10-15years). Comparing different manufacturers and the same number of detector rows it was observed that, in case of 16 slices units, doses were very similar on Siemens and General Electric scanner. CTDIvol and DLP on Siemens scanner were 60 mGy and 1066 mGy·cm, respectively, while on General Electric those values were 66 mGy and 1050 mGy·cm. However, this trend was not observed in case of 64 slices units. CTDIvol and DLP values collected on Toshiba were much higher (177 mGy and 2109 mGy·cm) than in case of Siemens scanner (59 mGy and 1060 mGy·cm). Doses on 16 and 64 slices Siemens scanners were very similar, while on 4 slices were higher. Except in two units, doses were were in line with DRLs. In case of pediatrics, doses increase with patient age and again Siemens scanner showed the lowest values while the highest were observed on Toshiba. (authors)

  6. Effect on moisture permeability of typewriting on unit dose package surfaces.

    Science.gov (United States)

    Rackson, J T; Zellhofer, M J; Birmingham, P H

    1984-10-01

    The effects of typewriting on labels of two unit dose packages with respect to moisture permeability were examined. Using an electric typewriter, a standard label format was imprinted on two different types of class A unit dose packages: (1) a heat-sealed paper-backed foil and cellofilm strip pouch, and (2) a copolyester and polyethylene multiple-cup blister with a heat-sealed paper-backed foil and cellofilm cover. The labels were typed at various typing-element impact settings. The official USP test for water permeation was then performed on typed packages and untyped control packages. The original untyped packages were confirmed to be USP class A quality. The packages for which successively harder impact settings were used showed a corresponding increase in moisture permeability. This resulted in a lowering of USP package ratings from class A to class B and D, some of which would be unsuitable for use in any unit dose system under current FDA repackaging standards. Typing directly onto the label of a unit dose package before it is sealed will most likely damage the package and possibly make it unfit for use. Pharmacists who must type labels for the unit dose packages studied should use the lowest possible typewriter impact setting and test for damage using the USP moisture-permeation test.

  7. Scale and scope economies in Mexican private medical units.

    Science.gov (United States)

    Keith, Jorge; Prior, Diego

    2014-01-01

    To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

  8. Scale and scope economies in Mexican private medical units

    Directory of Open Access Journals (Sweden)

    Jorge Keith

    2014-07-01

    Full Text Available Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the “Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A” questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

  9. Internal dose evaluation of workers involved in radioisotopes and radiopharmaceuticals handling for medical use

    International Nuclear Information System (INIS)

    Cesar, R.B.P.; Mesquita, C.H. de

    1987-01-01

    The internal dose levels of IPEN workers, involved in the production of radioisotopes and radiopharmaceuticals for medical use are surveyed. In this production, the workers were splited in six group: research and development, routine production, quality control, packaging, radiological protection and maintenance. The internal dose was evaluated according to the models described by ICRP-30, from the results obtained in the whole body counters monitoring. (C.G.C.) [pt

  10. Investigation of initial contamination for disposal medical infusion items and determination of sterilization dose

    International Nuclear Information System (INIS)

    Hu Jinhui; Xu Ziyan; Sun Naifeng; Yan Aoshuang; Gao Wei; Wang Binglin

    1993-01-01

    Statistical analyses on initial contamination of 624 disposal medical infusion items are made. The normal distribution of the initial contamination, the relation of initial contamination of inner and outer walls of disposal medical infusion items and the changes of initial contamination before irradiation are shown. The sterilized dose for disposal infusion is determined as 17.2 kGy using bioburden information. The SAL (sterility assurance level) dose is 10 6 . The SIP (device sample item proportion) is 1 and the average initial contamination is 7 CFU/item

  11. Average glandular dose in routine mammography screening using a Sectra Microdose Mammography unit

    International Nuclear Information System (INIS)

    Hemdal, B.; Herrnsdorf, L.; Andersson, I.; Bengtsson, G.; Heddson, B.; Olsson, M.

    2005-01-01

    The Sectra MicroDose Mammography system is based on direct photon counting (with a solid-state detector), and a substantially lower dose to the breast than when using conventional system can be expected. In this work absorbed dose measurements have been performed for the first unit used in routine mammography screening (at the Hospitals of Helsingborg (Sweden)). Two European protocols on dosimetry in mammography have been followed. Measurement of half value layer (HVL) cannot be performed as prescribed, but this study has demonstrated than non-invasive measurements of HVL can be performed accurately with a sensitive and well collimated solid-state detector with simultaneous correction for the energy dependence. The average glandular dose for a 50 mm standard breast with 50% glandularity, simulated by 45 mm polymethylmethacrylate, was found to be 0.21 and 0.28 mGy in March and December 2004, respectively. These values are much lower than for any other mammography system on the market today. It has to be stressed that the measurement were made using the current clinical settings and that no systematic optimisation of the relationship between absorbed dose and diagnostic image quality has been performed within the present study. In order to further increase the accuracy of absorbed dose measurements for this unit, the existing dose protocols should be revised to account also for the tungsten/aluminium anode/filter combination, the multi-slit pre-collimator device and the occurrence of a dose profile in the scanning direction. (authors)

  12. Ethical issues in advertising and promotion of medical units.

    Science.gov (United States)

    Solomon, Maria; Radu, Gabriel; Hostiuc, Marinela; Margan, M Madalin; Bulescu, I Alexandru; Purcarea, Victor Lorin

    2016-01-01

    Bioethics tries to define the medical activity and any other related activity needed to maintain the function of a health institution, through the development of principles and moral values. Bioethics is quite broad and has a background that combines various disciplines such as medicine, philosophy, law, sociology, and theology. Advertising and promotion are part of the strategy aimed at developing and maintaining relationships with the targeted audience (patients). To regulate this activity, it was necessary to develop ethical rules of healthcare marketing. The content of promotional messages must be truthful and should not create unjustified expectations. The doctor or the healthcare unit must be able to provide the services claimed in the advertisement. From an ethical point of view, marketing communication should be more consistent with reality, even if its purpose is to shed light on more attractive issues. In this context, the categories and groups vulnerable to certain content of the advertising message should be mentioned. A patient with a serious suffering will be easily influenced and will tend to trust any promise easily, with the desire to heal. Ethically, the information presented must not alter the reality and should not give false hopes to patients. Those responsible for marketing in the healthcare field must keep in mind the ethics code of the medical profession, must maintain an honest marketing communication, which does not create inaccurate expectations, must not denigrate other colleagues, and must use a message whose content should respect the dignity of the profession.

  13. Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital

    Directory of Open Access Journals (Sweden)

    Jiang SP

    2014-10-01

    Full Text Available Sai-Ping Jiang,1,* Jian Chen,2,* Xing-Guo Zhang,1 Xiao-Yang Lu,1 Qing-Wei Zhao1 1Department of Pharmacy, 2Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China *These authors contributed equally to this work Background: Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU in a tertiary hospital in People’s Republic of China.Method: A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed.Results: During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2% pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%, drug omission (n=83, 20.4%, and potential or actual occurrence of adverse drug reaction (n=54, 13.3% were the three most commonly committed medication errors. Approximately 339 (83.4% medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0% were the most frequent type of medication associated with errors.Conclusion: Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors. Keywords: pharmacist, medication error, preva­lence rate, type, severity, intensive care

  14. Genetic and mean bone-marrow doses from medical use of unsealed radioisotopes

    International Nuclear Information System (INIS)

    Keam, D.W.

    1980-06-01

    Annual genetically significant and mean bone-marrow doses to the Australian population arising from the medical use of unsealed radioisotopes are derived for the year 1970 using the results of a survey carried out at that time and published data on doses to individuals resulting from such use. Values of 3.9 and 38 microgray for the annual (per capita) genetic and mean bone-marrow doses respectively are reported, which are similar to those reported for other countries at about that time

  15. Exposure doses of the patient and the medical staff during urological X-ray examens

    International Nuclear Information System (INIS)

    Vogel, H.; Loehr, H.; Haug, P.; Schuett, B.

    1977-01-01

    During 32 intravenous urografies and 48 angiografies of the kidney and the suprarenal glands the X-ray doses at the patient's skin and gonades were determined. During the angiografies the doses were mesured at the hands. the gonades and the front (eyes) of the medical staff. The results are discussed. Because the X-ray doses are relatively high, the number of the pictures and the exposure time is to be reduced to the minimum. Clinical experience and special knowledge is the best X-ray protection. (orig.) [de

  16. Trends in Radiation Doses to Patients from Medical X-ray Examinations in Romania

    Energy Technology Data Exchange (ETDEWEB)

    Olga Iacob; Irina Anca Popescu [Institute of Public Health, Iassy (Romania); Mihai Radu Iacob [University ' Al. I. Cuza' Iassy (Romania)

    2006-07-01

    Even if the doses received by patients during 2005 survey are lower than those estimated in the 2000 national survey on diagnostic medical radiation exposure by 27 percent, on average, their values still indicate an urgent need to develop radiation protection and optimization activities for X ray examinations, especially in pediatrics radiology. The increasing attention given in last years to radiation protection for conventional examinations, with development of national patient dosimetry protocols and reference doses, new radiation protection legislation and norms have played a significant part in this substantial reduction in effective doses. (N.C.)

  17. Neutron dose to patients treated with high-energy medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.

    2001-01-01

    The neutron dose equivalent received by patients treated with high energy x-ray beams was measured in this research. A total of 13 different medical accelerators were evaluated in terms of the neutron dose equivalent in the patient plane and at the beam center. The neutron dose equivalent at the beam center was found to ranged from 0.02 to 9.4 mSv per Sv of x-ray dose and values from 0.029 to 2.58 mSv per Sv of x-ray were measured in the patient plane. It was concluded that the neutron levels meet the International Electrotechnical Commission standard for the patient plane. It was also concluded that when intensity modulated radiation treatment is conducted the neutron dose equivalent received by the patient will increase by a factor of 2 to 10. (author)

  18. Determination of Absorbed Dose to Water for Leksell Gamma Knife Unit

    International Nuclear Information System (INIS)

    Hrsak, H.

    2013-01-01

    Because of geometry of photon beams in Leksell Gamma Knife Unit (LGK), there are several technical problems in applying standard protocols for determination of absorbed dose to water (Dw). Currently, Dw in LGK unit, measured at the center of spherical plastic phantom, is used for dose calculation in LGK radiosurgery. Treatment planning software (LGP TPS) accepts this value as a measurement in water and since plastic phantom has higher electron density than water, this leads to systematic errors in dose calculation. To reduce these errors, a photon attenuation correction (PAC) method was applied. For that purpose, measurements of absorbed dose in a center of three different plastic phantoms with 16 cm diameter (ABS - acrylonitrile butadiene styrene, PMMA - polymethyl metacrylate, PMMA + teflon - polytetrafluoroethylene 5 mm shell) were made with ionization chamber (Semiflex, PTW Freiburg). For measured dose values, PAC to water was applied based on electron density (ED) and equivalent water depths (EWD) of the plastic phantoms. The relation between CT number and ED was determined by measuring CT number of standard CT to ED phantom (CIRS Model 062 Phantom). Absorbed dose in plastic phantoms was 2.5 % lower than calculated dose in water for ABS phantom and more than 5.5 % lower for PMMA and PMMA+teflon phantom. Calculated dose in water showed more consistent values for all three phantoms (max. difference 2.6 %). EWD for human cranial bones and brain has value close to the EWD of ABS phantom, which makes this phantom most suitable for dose measurements in clinical application. In LGK radiosurgery determination of errors related to the difference of phantom materials should not be neglected and measured dose should be corrected before usage for patient treatment dose calculation.(author)

  19. Factors associated with self-medication among expatriate high school students: a cross-sectional survey in United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Syed Ilyas Shehnaz

    2013-09-01

    Full Text Available The study aimed to assess factors associated with self-medication (SM among expatriate high school students of United Arab Emirates using a validated questionnaire. Most common reasons for self-medication in 324 participating students were: presence of mild illness and previous experiences. High risk practices like altering the dose, discontinuation of medication and self-medication without adult guidance were observed. The likelihood of SM was 4.9 times (95%C.I.: 2.0-12.2 in students not utilizing private healthcare services than those who were utilizing these services. Increased efforts are needed to prevent the risks of self-medication in adolescents through healthcare education for both parents and adolescents.

  20. Format of medical order sheet improves security of antibiotics prescription: The experience of an intensive care unit.

    Science.gov (United States)

    Wasserfallen, Jean-Blaise; Bütschi, Anne-Joëlle; Muff, Patrik; Biollaz, Jérôme; Schaller, Marie-Denise; Pannatier, André; Revelly, Jean-Pierre; Chiolero, René

    2004-03-01

    To assess whether formatting the medical order sheet has an effect on the accuracy and security of antibiotics prescription. Prospective assessment of antibiotics prescription over time, before and after the intervention, in comparison with a control ward. The medical and surgical intensive care unit (ICU) of a university hospital. All patients hospitalized in the medical or surgical ICU between February 1 and April 30, 1997, and July 1 and August 31, 2000, for whom antibiotics were prescribed. Formatting of the medical order sheet in the surgical ICU in 1998. Compliance with the American Society of Hospital Pharmacists' criteria for prescription safety was measured. The proportion of safe orders increased in both units, but the increase was 4.6 times greater in the surgical ICU (66% vs. 74% in the medical ICU and 48% vs. 74% in the surgical ICU). For unsafe orders, the proportion of ambiguous orders decreased by half in the medical ICU (9% vs. 17%) and nearly disappeared in the surgical ICU (1% vs. 30%). The only missing criterion remaining in the surgical ICU was the drug dose unit, which could not be preformatted. The aim of antibiotics prescription (either prophylactic or therapeutic) was indicated only in 51% of the order sheets. Formatting of the order sheet markedly increased security of antibiotics prescription. These findings must be confirmed in other settings and with different drug classes. Formatting the medical order sheet decreases the potential for prescribing errors before full computerized prescription is available.

  1. Answers to questions about updated estimates of occupational radiation doses at Three Mile Island, Unit 2

    International Nuclear Information System (INIS)

    1983-12-01

    The purpose of this question and answer report is to provide a clear, easy-to-understand explanation of revised radiation dose estimates which workers are likely to receive over the course of the cleanup at Three Mile Island, Unit 2, and of the possible health consequences to workers of these new estimates. We will focus primarily on occupational dose, although pertinent questions about public health and safety will also be answered

  2. Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit.

    Science.gov (United States)

    Sohrevardi, Seyed Mojtaba; Jarahzadeh, Mohammad Hossein; Mirzaei, Ehsan; Mirjalili, Mahtabalsadat; Tafti, Arefeh Dehghani; Heydari, Behrooz

    2017-01-01

    Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue.

  3. Estimation of the collective dose in the Portuguese population due to medical procedures in 2010

    International Nuclear Information System (INIS)

    Teles, Pedro; Vaz, Pedro; Sousa, M. Carmen de; Paulo, Graciano; Santos, Joana; Pascoal, Ana; Cardoso, Gabriela; Santos, Ana Isabel; Lanca, Isabel; Matela, Nuno; Janeiro, Luis; Sousa, Patrick; Carvoeiras, Pedro; Parafita, Rui; Simaozinho, Paula

    2013-01-01

    In a wide range of medical fields, technological advancements have led to an increase in the average collective dose in national populations worldwide. Periodic estimations of the average collective population dose due to medical exposure is, therefore of utmost importance, and is now mandatory in countries within the European Union (article 12 of EURATOM directive 97/ 43). Presented in this work is a report on the estimation of the collective dose in the Portuguese population due to nuclear medicine diagnostic procedures and the Top 20 diagnostic radiology examinations, which represent the 20 exams that contribute the most to the total collective dose in diagnostic radiology and interventional procedures in Europe. This work involved the collaboration of a multidisciplinary taskforce comprising representatives of all major Portuguese stakeholders (universities, research institutions, public and private health care providers, administrative services of the National Healthcare System, scientific and professional associations and private service providers). This allowed us to gather a comprehensive amount of data necessary for a robust estimation of the collective effective dose to the Portuguese population. The methodology used for data collection and dose estimation was based on European Commission recommendations, as this work was performed in the framework of the European wide Dose Datamed II project. This is the first study estimating the collective dose for the population in Portugal, considering such a wide national coverage and range of procedures and consisting of important baseline reference data. The taskforce intends to continue developing periodic collective dose estimations in the future. The estimated annual average effective dose for the Portuguese population was of 0.080±0.017 mSv caput -1 for nuclear medicine exams and of 0.96±0.68 mSv caput -1 for the Top 20 diagnostic radiology exams. (authors)

  4. A population-based study of dosing and persistence with anti-dementia medications.

    LENUS (Irish Health Repository)

    Brewer, Linda

    2013-02-27

    PURPOSE: Cholinesterase inhibitors and memantine are the mainstay of pharmacological intervention for the cognitive symptoms of Alzheimer\\'s disease (AD). This study assessed the adequacy of dosing and persistence with AD medications and the predictors of these variables in the \\'real world\\' (outside the clinical trial setting). METHODS: The Health Service Executive-Primary Care Reimbursement Services prescription claims database in the Republic of Ireland contains prescription information for 1.6 million people. Patients aged >70 years who received at least two prescriptions for donepezil, rivastigmine, galantamine and memantine between January 2006 and December 2010 were included in the study. Rates of dose-maximisation were recorded by examining the initiation dose of each AD drug commenced during the study period and any subsequent dose titrations. Non-persistence was defined by a gap in prescribing of more than 63 consecutive days. Predictors of dose-maximisation and non-persistence were also analysed. RESULTS: Between January 2006 and December 2010, 20,729 patients aged >70 years received a prescription for an AD medication. Despite most patients on donepezil and memantine receiving a prescription for the maximum drug dose, this dose was maintained for 2 consecutive months in only two-thirds of patients. Patients were significantly more likely to have their doses of donepezil and memantine maximised if prescribed in more recent years (2010 vs. 2007). Rates of non-persistence were 30.1 % at 6 months and 43.8 % at 12 months. Older age [75+ vs. <75 years; hazards ratio (HR) 1.16, 95 % confidence interval (CI) 1.06-1.27] and drug type (rivastigmine vs. donepezil; HR 1.15, 95 % CI 1.03-1.27) increased the risk of non-persistence. Non-persistence was lower for those commencing therapy in more recent years (2010 vs. 2007; HR 0.81, 95 % CI 0.73-0.89, p < 0.001) and for those on multiple anti-dementia medications (HR 0.59, 95 % CI 0

  5. FZUImageReg: A toolbox for medical image registration and dose fusion in cervical cancer radiotherapy.

    Directory of Open Access Journals (Sweden)

    Qinquan Gao

    Full Text Available The combination external-beam radiotherapy and high-dose-rate brachytherapy is a standard form of treatment for patients with locally advanced uterine cervical cancer. Personalized radiotherapy in cervical cancer requires efficient and accurate dose planning and assessment across these types of treatment. To achieve radiation dose assessment, accurate mapping of the dose distribution from HDR-BT onto EBRT is extremely important. However, few systems can achieve robust dose fusion and determine the accumulated dose distribution during the entire course of treatment. We have therefore developed a toolbox (FZUImageReg, which is a user-friendly dose fusion system based on hybrid image registration for radiation dose assessment in cervical cancer radiotherapy. The main part of the software consists of a collection of medical image registration algorithms and a modular design with a user-friendly interface, which allows users to quickly configure, test, monitor, and compare different registration methods for a specific application. Owing to the large deformation, the direct application of conventional state-of-the-art image registration methods is not sufficient for the accurate alignment of EBRT and HDR-BT images. To solve this problem, a multi-phase non-rigid registration method using local landmark-based free-form deformation is proposed for locally large deformation between EBRT and HDR-BT images, followed by intensity-based free-form deformation. With the transformation, the software also provides a dose mapping function according to the deformation field. The total dose distribution during the entire course of treatment can then be presented. Experimental results clearly show that the proposed system can achieve accurate registration between EBRT and HDR-BT images and provide radiation dose warping and fusion results for dose assessment in cervical cancer radiotherapy in terms of high accuracy and efficiency.

  6. TMI-2 [Three Mile Island Unit 2] reactor building dose reduction task force

    International Nuclear Information System (INIS)

    Daniels, R.S.

    1988-01-01

    In late October 1982, the director of Three Mile Island Unit 2 (TMI-2) created the dose reduction task force with the objective of identifying the principal radiological sources in the reactor building and recommending actions to minimize the dose to workers on labor-intensive projects. Members of the task force were drawn form various groups at TMI. Findings and recommendations were presented to the US Nuclear Regulatory Commission in a briefing on November 18, 1982. The task force developed a three-step approach toward dose reduction. Step 1 identified the radiological sources. Step 2 modeled the source and estimated its contribution to the general area dose rates. Step 3 recommended actions to achieve dose reductions consistent with general exposure rate goals

  7. Canadian and United States regulatory models compared: doses from atmospheric pathways

    International Nuclear Information System (INIS)

    Peterson, S-R.

    1997-01-01

    CANDU reactors sold offshore are licensed primarily to satisfy Canadian Regulations. For radioactive emissions during normal operation, the Canadian Standards Association's CAN/CSA-N288.1-M87 is used. This standard provides guidelines and methodologies for calculating a rate of radionuclide release that exposes a member of the public to the annual dose limit. To calculate doses from air concentrations, either CSA-N288.1 or the Regulatory Guide 1.109 of the United States Nuclear Regulatory Commission, which has already been used to license light-water reactors in these countries, may be used. When dose predictions from CSA-N288.1 are compared with those from the U.S. Regulatory Guides, the differences in projected doses raise questions about the predictions. This report explains differences between the two models for ingestion, inhalation, external and immersion doses

  8. Modernization of the accident localization system and relevant dose exposure on Unit 4 of KNPP

    Energy Technology Data Exchange (ETDEWEB)

    Valtchev, G.; Neshkova, A.; Nikolov, M. [Nuclear Power Plant Kozloduy, 3321 Kozloduy (Bulgaria)

    2004-07-01

    In 2001 a modernization of the Accident Localization System (ALS) on unit 4 was accomplished. The outage duration was longer then usually and special dose budget was elaborated. All ALS work was performed by external organization. An ALARA implementation was recognized priority. The really accumulated collective doses were analyzed and conclusions drawn. A short film on CD was prepared. Two conclusions are drawn: 1. Good work management and a first attempt of effective empowerment of the workers gave satisfactory results; 2. Although the work was not typical, and performed for a first time, the ALARA implementation reduced the projected collective dose with 19%.

  9. Dose rate evaluation of workers on the operation floor in Fukushima-Daiichi Unit 3

    Science.gov (United States)

    Matsushita, Kaoru; Kurosawa, Masahiko; Shirai, Keisuke; Matsuoka, Ippei; Mukaida, Naoki

    2017-09-01

    At Fukushima Daiichi Nuclear Power Plant Unit 3, installation of a fuel handling machine is planned to support the removal of spent fuel. The dose rates at the workplace were calculated based on the source distribution measured using a collimator in order to confirm that the dose rates on the operation floor were within a manageable range. It was confirmed that the accuracy of the source distribution was C/M = 1.0-2.4. These dose rates were then used to plan the work on the operation floor.

  10. Radiation doses received by premature babies in the neonatal intensive care unit

    International Nuclear Information System (INIS)

    Thierry-Chef, I.; Maccia, C.; Thierry-Chef, I.; Laurier, D.; Tirmarche, M.; Costil, J.

    2005-01-01

    Purpose. Because of frequent radiological investigations performed in 1 neonatal intensive care unit, a dosimetry study was carried out to assess the level of doses received by premature babies. Materials and methods. In vivo measurements were performed and effective doses were evaluated for single radiographs. Individual cumulative doses received over the period of stay were then estimated, for each premature baby entering the intensive care unit in 2002, taking into account the number of radiographs they underwent. Results. On average, babies stayed for a week and more than one radio-graph was taken per day. Results showed that, even if average doses per radiograph were relatively low (25μSv), cumulative doses strongly depended on the length of stay, and can reach a few mSv. Conclusion. Even if doses per radiograph are in agreement with European recommendations, optimisation of doses is particularly important because premature babies are more sensitive to radiation than adults and because they usually undergo further radiological examinations in other services. On the basis of the results of this dosimetry study, the implementation of a larger study is being discussed. (author)

  11. Medical and social consequences of low doses of radiation for the population of Latvia

    International Nuclear Information System (INIS)

    Tsoi, V.

    1997-01-01

    About 6000 people involved in the elimination of the consequences of the Chernobyl accident and family members evacuated from Pripyat settled in Latvia. Although exposed to doses not exceeding 25cGy, an increasing number of diseases leading to invalidity and mortality of liquidators is noted. The symptoms of the various medical disorders being observed are described. (author)

  12. Professional exposure of medical workers: radiation levels, radiation risk and personal dose monitoring

    International Nuclear Information System (INIS)

    Bai Guang

    2005-01-01

    The application of radiation in the field of medicine is the most active area. Due to the rapid and strong development of intervention radiology at present near 20 years, particularly, the medical workers become a popularize group which most rapid increasing and also receiving the must high of professional exposure dose. Because, inter alias, radiation protection management nag training have not fully follow up, the aware of radioactive protection and appropriate approach have tot fully meet the development and need, the professional exposure dose received by medical workers, especially those being engaged in intervention radiology, are more higher, as well as have not yet fully receiving the complete personal dose monitoring, the medical workers become the population group which should be paid the most attention to. The writer would advice in this paper that all medical workers who being received a professional radiation exposure should pay more attention to the safety and healthy they by is strengthening radiation protection and receiving complete personal dose monitoring. (authors)

  13. Collective dose estimation in Portuguese population due to medical exams of diagnostic radiology and nuclear medicine

    International Nuclear Information System (INIS)

    Teles, Pedro; Vaz, Pedro; Paulo, Graciano; Santos, Joana; Pascoal, Ana; Lanca, Isabel; Matela, Nuno; Sousa, Patrick; Carvoeiras, Pedro; Parafita, Rui; Simaozinho, Paula

    2013-01-01

    In order to assess the exposure of the Portuguese population to ionizing radiation due to medical examinations of diagnostic radiology and nuclear medicine, a working group, consisting of 40 institutions, public and private, was created to evaluation the coletive dose in the Portuguese population in 2010. This work was conducted in collaboration with the Dose Datamed European consortium, which aims to assess the exposure of the European population to ionizing radiation due to 20 diagnostic radiology examinations most frequent in Europe (the 'TOP 20') and nuclear medicine examinations. We obtained an average value of collective dose of ≈ 1 mSv/caput, which puts Portugal in the category of countries medium to high exposure to Europe. We hope that this work can be a starting point to bridge the persistent lack of studies in the areas referred to in Portugal, and to enable the characterization periodic exposure of the Portuguese population to ionizing radiation in the context of medical applications

  14. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  15. Medical aspects of quality assurance in the United States

    International Nuclear Information System (INIS)

    Hanks, G.E.

    1997-01-01

    Three powerful national programs have been developed, and their acceptance and utilization in the United States have been accelerated by the recent development of managed competition. The first program was a model quality assurance program for day to day use in an individual radiation oncology facility. In addition to maintaining the physical aspects of the department, the medical side includes indicator items in patient evaluation and treatment and other measures that are periodically monitored. The entire process is comprehensive and is accepted by the Joint Commission on Hospital Accreditation as being satisfactory evidence of ongoing quality assurance and quality improvement. The second program was the development of a set of standards for radiation oncology in the United States. These standards were developed in the past and have recently been expanded into a more comprehensive document that describes the appropriate performance by this specialty. The third program was a Practice Accreditation program. The Practice Accreditation program is an on-site review of structure and processes of patient care by a radiation oncologist and data manager. This intense on-site review generated data that is then compared to similar facilities and to national averages to judge the adequacy of patient management in the facility. We have observed recently that various managed care programs require this practice accreditation before their patients can be treated in contracting facilities. Lastly, the Council of the American College of Radiology has made some extremely positive statements in support of improving radiation oncology practice, and the positive effects of these council resolutions can be clearly shown on the practice

  16. Unit Cost of Medical Services at Different Hospitals in India

    Science.gov (United States)

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  17. Medical review practices for driver licensing volume 3: guidelines and processes in the United States.

    Science.gov (United States)

    2017-04-01

    This is the third of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically or : functionally at-risk drivers. ...

  18. Medical complications and outcomes at an onsite rehabilitation unit for older people.

    LENUS (Irish Health Repository)

    Mulroy, M

    2013-09-01

    The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

  19. Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

    NARCIS (Netherlands)

    Verhoef, T. I.; Redekop, W. K.; Langenskiold, S.; Kamali, F.; Wadelius, M.; Burnside, G.; Maitland-van der Zee, A.-H.; Hughes, D. A.; Pirmohamed, M.

    2016-01-01

    We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per

  20. Radiation dose distribution monitoring at neutron radiography facility area, Nuclear Energy Unit, Malaysia

    International Nuclear Information System (INIS)

    Abdul Razak Daud

    1995-01-01

    One experiment was carried out to get the distribution of radiation doses at the neutron radiography facilities, Nuclear Energy Unit, Malaysia. The analysis was done to evaluate the safety level of the area. The analysis was used in neutron radiography work

  1. Comparison of 2-Dose and 3-Dose 9-Valent Human Papillomavirus Vaccine Schedules in the United States: A Cost-effectiveness Analysis.

    Science.gov (United States)

    Laprise, Jean-François; Markowitz, Lauri E; Chesson, Harrell W; Drolet, Mélanie; Brisson, Marc

    2016-09-01

    A recent clinical trial using the 9-valent human papillomavirus virus (HPV) vaccine has shown that antibody responses after 2 doses are noninferior to those after 3 doses, suggesting that 2 and 3 doses may have comparable vaccine efficacy. We used an individual-based transmission-dynamic model to compare the population-level effectiveness and cost-effectiveness of 2- and 3-dose schedules of 9-valent HPV vaccine in the United States. Our model predicts that if 2 doses of 9-valent vaccine protect for ≥20 years, the additional benefits of a 3-dose schedule are small as compared to those of 2-dose schedules, and 2-dose schedules are likely much more cost-efficient than 3-dose schedules. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  2. Dose per unit area - a study of elicitation of nickel allergy

    DEFF Research Database (Denmark)

    Fischer, Louise Arup; Menné, Torkil; Johansen, Jeanne Duus

    2007-01-01

    BACKGROUND: Experimental sensitization depends upon the amount of allergen per unit skin area and is largely independent of the area size. OBJECTIVES: This study aimed at testing if this also applies for elicitation of nickel allergy. PATIENTS/METHODS: 20 nickel allergic individuals were tested...... with a patch test and a repeated open application test (ROAT). Nickel was applied on small and large areas. The varying parameters were area, total dose and dose per unit area. RESULTS: In the patch test, at a low concentration [15 microg nickel (microg Ni)/cm(2)], there were significantly higher scores...... on the large area with the same dose per area as the small area. At higher concentrations of nickel, no significant differences were found. In the ROAT at low concentration (6.64 microg Ni/cm(2)), it was found that the latency period until a reaction appeared was significantly shorter on the large area...

  3. PWR design for low doses in the United Kingdom: The present and the future

    Energy Technology Data Exchange (ETDEWEB)

    Zodiates, A.M.; Willcock, A. [PWR Project Group, Knutsford, England (United Kingdom)

    1995-03-01

    The Pressurizer Water Reactor (PWR) design chosen for adoption by Nuclear Electric plc was based on the Westinghouse Standard Nuclear Unit Power Plant System (SNUPPS). This design was developed to meet the United Kingdom (UK) requirements and those improvements are embodied in the Sizewell B plant. Nuclear Electric plc is now looking to the design of the future PWRs to be built in the UK. These PWRs will be based as replicas of the Sizewell B design, but attention will be given to reducing operator doses further. This paper details the approach in operator protection improvements incorporated at Sizewall B, presents the estimated annual collective dose, and identifies the approach being adopted to reduce further operator doses in future plants.

  4. Missed doses of oral antihyperglycemic medications in US adults with type 2 diabetes mellitus: prevalence and self-reported reasons.

    Science.gov (United States)

    Vietri, Jeffrey T; Wlodarczyk, Catherine S; Lorenzo, Rose; Rajpathak, Swapnil

    2016-09-01

    Adherence to antihyperglycemic medication is thought to be suboptimal, but the proportion of patients missing doses, the number of doses missed, and reasons for missing are not well described. This survey was conducted to estimate the prevalence of and reasons for missed doses of oral antihyperglycemic medications among US adults with type 2 diabetes mellitus, and to explore associations between missed doses and health outcomes. The study was a cross-sectional patient survey. Respondents were contacted via a commercial survey panel and completed an on-line questionnaire via the Internet. Respondents provided information about their use of oral antihyperglycemic medications including doses missed in the prior 4 weeks, personal characteristics, and health outcomes. Weights were calculated to project the prevalence to the US adult population with type 2 diabetes mellitus. Outcomes were compared according to number of doses missed in the past 4 weeks using bivariate statistics and generalized linear models. Approximately 30% of adult patients with type 2 diabetes mellitus reported missing or reducing ≥1 dose of oral antihyperglycemic medication in the prior 4 weeks. Accidental missing was more commonly reported than purposeful skipping, with forgetting the most commonly reported reason. The timing of missed doses suggested respondents had also forgotten about doses missed, so the prevalence of missed doses is likely higher than reported. Outcomes were poorer among those who reported missing three or more doses in the prior 4 weeks. A substantial number of US adults with type 2 diabetes mellitus miss doses of their oral antihyperglycemic medications.

  5. Development and characterization of an interferometer for calorimeter-based absorbed dose to water measurements in a medical linear accelerator.

    Science.gov (United States)

    Flores-Martinez, Everardo; Malin, Martha J; DeWerd, Larry A

    2016-11-01

    The quantity of relevance for external beam radiotherapy is absorbed dose to water (ADW). An interferometer was built, characterized, and tested to measure ADW within the dose range of interest for external beam radiotherapy using the temperature dependence of the refractive index of water. The interferometer was used to measure radiation-induced phase shifts of a laser beam passing through a (10 × 10 × 10) cm 3 water-filled glass phantom, irradiated with a 6 MV photon beam from a medical linear accelerator. The field size was (7 × 7) cm 2 and the dose was measured at a depth of 5 cm in the water phantom. The intensity of the interference pattern was measured with a photodiode and was used to calculate the time-dependent phase shift curve. The system was thermally insulated to achieve temperature drifts of less than 1.5 mK/min. Data were acquired 60 s before and after the irradiation. The radiation-induced phase shifts were calculated by taking the difference in the pre- and post-irradiation drifts extrapolated to the midpoint of the irradiation. For 200, 300, and 400 monitor units, the measured doses were 1.6 ± 0.3, 2.6 ± 0.3, and 3.1 ± 0.3 Gy, respectively. Measurements agreed within the uncertainty with dose calculations performed with a treatment planning system. The estimated type-A, k = 1 uncertainty in the measured doses was 0.3 Gy which is an order of magnitude lower than previously published interferometer-based ADW measurements.

  6. Association of cumulative dose of haloperidol with next-day delirium in older medical ICU patients.

    Science.gov (United States)

    Pisani, Margaret A; Araujo, Katy L B; Murphy, Terrence E

    2015-05-01

    To evaluate the association between cumulative dose of haloperidol and next-day diagnosis of delirium in a cohort of older medical ICU patients, with adjustment for its time-dependent confounding with fentanyl and intubation. Prospective, observational study. Medical ICU at an urban, academic medical center. Age 60 years and older admitted to the medical ICU who received at least one dose of haloperidol (n = 93). Of these, 72 patients were intubated at some point in their medical ICU stay, whereas 21 were never intubated. None. Detailed data were collected concerning time, dosage, route of administration of all medications, as well as for important clinical covariates, and daily status of intubation and delirium using the confusion assessment method for the ICU and a chart-based algorithm. Among nonintubated patients, and after adjustment for time-dependent confounding and important covariates, each additional cumulative milligram of haloperidol was associated with 5% higher odds of next-day delirium with odds ratio of 1.05 (credible interval [CI], 1.02-1.09). After adjustment for time-dependent confounding and covariates, intubation was associated with a five-fold increase in odds of next-day delirium with odds ratio of 5.66 (CI, 2.70-12.02). Cumulative dose of haloperidol among intubated patients did not change their already high likelihood of next-day delirium. After adjustment for time-dependent confounding, the positive associations between indicators of intubation and of cognitive impairment and next-day delirium became stronger. These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients.

  7. Investigation of organ dose difference of age phantoms for medical X-ray examinations

    International Nuclear Information System (INIS)

    Park, Sang Hyun; Kim, Woo Ran; Lee, Jai Ki; Lee, Choon Sik

    2003-01-01

    Methodology for calculating the organ equivalent doses and the effective doses of pediatric and adult patients undergoing medical X-ray examinations were established. The MIRD-type mathematical phantoms of 4 age groups were constructed with addition of the esophagus to the same phantoms. Two typical examination procedures, chest PA and abdomen AP, were simulated for the pediatric patients as well as the adult as illustrative examples. The results confirmed that patients pick up approximate 0.03 mSv of effective dose from a single chest PA examination, and 0.4 to 1.7 mSv from an abdomen AP examination depending on the ages. For dose calculations where irradiation is made with a limited field, the details of the position, size and shape of the organs and the organ depth from the entrance surface considerably affect the resulting doses. Therefore, it is important to optimize radiation protection by control of X-ray properties and beam examination field. The calculation result, provided in this study, can be used to implement optimization for medical radiation protection

  8. Survey of radiation doses and health effects in medical diagnostic X-ray workers in China

    International Nuclear Information System (INIS)

    Wang Jixian; Zhang Liangan; Liu Jinzhong; Zhang Jingyuan

    1984-01-01

    The results of a nationwide survey of radiation doses and health effects in 26983 medical diagnostic X-ray workers in 28 provinces of China were reported. The control group was composed of 25785 non-X-ray medical workers in the same hospitals where the investigated X-ray workers worked. Of the radiological workers surveyed 75.3% received cumulative radiation doses below 50 mGy, only 2.7% received doses greater than 500 mGy, the average cumulative dose being 45.0 mGy. The average length of service was 11 years. The main radiation effects relating to radiation doses were the increase of frequencies of both chromosomal aberrations and micronuclei in peripheral blood lymphocytes, which were 0.362% and 0.0358% in the irradiated group, and 0.122% and 0.0138% in the control group, respectively. The incidence and mortality rate of leukemias increased significantly in the irradiated group. The incidence and standardized incidence of leukemias were 9.61 . 10 -5 and 9.67 . 10 -5 in the irradiated group and 2.74 . 10 -5 and 2.77 . 10 -5 in the control group. The leukemia mortality rates in the two groups were 8.60 . 10 -5 and 1.24 . 10 -5 respectively, and the standardized mortality rates were 8.60 . 10 -5 and 1.27 . 10 -5 respectively. (Author)

  9. Dose linearity and monitor unit stability of a G4 type cyberknife robotic stereotactic radiosurgery system

    International Nuclear Information System (INIS)

    Sudahar, H.; Kurup, P.G.G.; Murali, V.; Velmurugan, J.

    2012-01-01

    Dose linearity studies on conventional linear accelerators show a linearity error at low monitor units (MUs). The purpose of this study was to establish the dose linearity and MU stability characteristics of a cyberknife (Accuracy Inc., USA) stereotactic radiosurgery system. Measurements were done at a depth of 5 cm in a stereotactic dose verification phantom with a source to surface distance of 75 cm in a Generation 4 (G4) type cyberknife system. All the 12 fixed-type collimators starting from 5 to 60 mm were used for the dose linearity study. The dose linearity was examined in small (1-10), medium (15-100) and large (125-1000) MU ranges. The MU stability test was performed with 60 mm collimator for 10 MU and 20 MU with different combinations. The maximum dose linearity error of -38.8% was observed for 1 MU with 5 mm collimator. Dose linearity error in the small MU range was considerably higher than in the medium and large MU ranges. The maximum error in the medium range was -2.4%. In the large MU range, the linearity error varied between -0.7% and 1.2%. The maximum deviation in the MU stability was -3.03%. (author)

  10. Dose in sensitive organs during the prostate treatment with a 60Co unit

    International Nuclear Information System (INIS)

    Vega C, H. R.; Navarro B, J. A.; Perez A, M. L.; Perez L, L. H.

    2012-10-01

    The absorbed dose by the bladder, the rectum and the gland thyroid was measured during a treatment applied for prostate cancer by means of a Cobalt 60 unit. The dose was measured using thermoluminescent dosimeters of the type TLD 100, with the values of the absorbed the values of the effective dose were calculated and was determined the probability of the development of a secondary cancer. Because these measurements cannot be made -in vivo- a phantom or mannequin was built with water that represents the hip and part of the torso of the human body and to represent the neck was used polyethylene. The study was carried out in the Instituto Zacatecano del Tumor that has a -cobalt bomb- which is used to treat oncology patients, during the phantom irradiation a dose of 200 c Gy was applied of this dose the bladder received 96.7%, the rectum 100.8% and the gland thyroid 0.3%. The dose received by the rectum and the bladder is due to the therapeutic beam while the dose received by the thyroid is due to the dispersed radiation by the phantom. The probability that in these organs a new neoplasm is developed is of 0.033% for the bladder, 0.157% for the rectum and 7.8 x 10 -5 % for the thyroid case. (Author)

  11. Identifying medication errors in the neonatal intensive care unit and ...

    African Journals Online (AJOL)

    Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied. Objectives. To determine the incidence of medication errors in neonatal ...

  12. The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments.

    Science.gov (United States)

    Austin, Jodie A; Smith, Ian R; Tariq, Amina

    2018-01-22

    Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment. To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration. Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy. Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8-57 min versus 120 min, 30-180 min, P medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities. The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time. © 2018 Royal Pharmaceutical Society.

  13. Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system.

    Science.gov (United States)

    Bledsoe, Sarah; Van Buskirk, Alex; Falconer, R James; Hollon, Andrew; Hoebing, Wendy; Jokic, Sladan

    2018-02-01

    The effectiveness of barcode-assisted medication preparation (BCMP) technology on detecting oral liquid dose preparation errors. From June 1, 2013, through May 31, 2014, a total of 178,344 oral doses were processed at Children's Mercy, a 301-bed pediatric hospital, through an automated workflow management system. Doses containing errors detected by the system's barcode scanning system or classified as rejected by the pharmacist were further reviewed. Errors intercepted by the barcode-scanning system were classified as (1) expired product, (2) incorrect drug, (3) incorrect concentration, and (4) technological error. Pharmacist-rejected doses were categorized into 6 categories based on the root cause of the preparation error: (1) expired product, (2) incorrect concentration, (3) incorrect drug, (4) incorrect volume, (5) preparation error, and (6) other. Of the 178,344 doses examined, 3,812 (2.1%) errors were detected by either the barcode-assisted scanning system (1.8%, n = 3,291) or a pharmacist (0.3%, n = 521). The 3,291 errors prevented by the barcode-assisted system were classified most commonly as technological error and incorrect drug, followed by incorrect concentration and expired product. Errors detected by pharmacists were also analyzed. These 521 errors were most often classified as incorrect volume, preparation error, expired product, other, incorrect drug, and incorrect concentration. BCMP technology detected errors in 1.8% of pediatric oral liquid medication doses prepared in an automated workflow management system, with errors being most commonly attributed to technological problems or incorrect drugs. Pharmacists rejected an additional 0.3% of studied doses. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Estimation of population doses from diagnostic medical examinations in Japan, 1974, (4)

    International Nuclear Information System (INIS)

    Hashizume, Tadashi; Maruyama, Takashi; Kumamoto, Yoshikazu

    1976-01-01

    In fetus exposed in utero to diagnostic x-rays for the medical examinations of the mother, the absorbed dose has been estimated on the basis of a 1974 nation wide radiological survey. The results of the survey showed that the number of radiographs per year connected with pregnant women was 0.32 million for chest examination excluding mass surveys. 0.29 million for obstetrical examinations including pelvimetry, and 0.21 million for abdominal and pelvic examinations with a total of 0.82 million. The dose absorbed in the fetus was measured with an ionization chamber placed at the hypothetical center of the fetus in an ''average woman'' Rando phantom in which a maternal body was simulated by adding MixDp materials. ''The collective dose'' to the fetus in the pregnant women receiving a given type of examination was calculated from the number of radiographs per year connected with the pregnant women and the fetal doses. The percapita mean marrow dose (CMD), the leukemia significant dose (LSD) and the genetically significant dose (GSD) for the fetus were determined from the collective dose, taking into account the birth expectancy, the child expectancy, life expectancy and significant factor for the fetus. The collective dose to the fetus was estimated to be 9.3 x 10 4 man rad per year. The resultant values of CMD, LSD and GSD were 0.81 mrad per year, 0.79 mrad per person per year and 1.44 mrad per person per year, respectively. (Evans, J.)

  15. Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

    LENUS (Irish Health Repository)

    Watts, M

    2011-02-01

    Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

  16. Independent dose per monitor unit review of eight U.S.A. proton treatment facilities

    International Nuclear Information System (INIS)

    Moyers, M. F.; Ibbott, G. S.; Grant, R. L.; Summers, P. A.; Followill, D. S.

    2014-01-01

    Purpose: Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods. Methods: Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values. Results: Agreement between the measured and reported doses was similar using any of the three dosimetry methods. Use of the ICRU 59 N D,w based method gave results approximately 3% higher than both the ICRU 59 N X and ICRU 78 (TRS-398) N D,w based methods. Conclusions: Any single dosimetry method could be used for multi-institution trials with similar conformity between facilities. A multi-institutional trial could support facilities using both the ICRU 59 N X based and ICRU 78 (TRS-398) N D,w based methods but use of the ICRU 59 N D,w based method should not be allowed simultaneously with the other two until the difference is resolved

  17. Annual dose at the exclusion area boundary of a multi-unit CANDU site

    International Nuclear Information System (INIS)

    Gagnon, N.; Bobb, C.R.; Tsang, K.T.

    1997-01-01

    The annual dose to members of the public from CANDU nuclear power stations is dominated by the contribution from airborne effluents. The principal radionuclides contributing to the annual dose are tritium, carbon-14 and noble gases. The tritium is released as tritiated heavy-water vapour; the carbon-14 is released principally as carbon dioxide. To demonstrate compliance with the public dose limit, AECL has calculated the annual dose from airborne emissions from 10 CANDU units at an extended Wolsong site. The analysis has used the treatment of atmospheric dispersion described in the US Regulatory Guide 1.111 and programmed in the code XOQDOQ. The analysis has then modelled the transport of these airborne emissions through the environment as they expose the critical group using the US Regulatory Guide 1.109. the study takes account of the different annual emissions from each unit to reflect the different design features of the units. This study also includes a treatment of topography and makes allowances for building wake effects

  18. Residency training in the United States: What foreign medical ...

    African Journals Online (AJOL)

    FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past ...

  19. Applying graphics processor units to Monte Carlo dose calculation in radiation therapy

    Directory of Open Access Journals (Sweden)

    Bakhtiari M

    2010-01-01

    Full Text Available We investigate the potential in using of using a graphics processor unit (GPU for Monte-Carlo (MC-based radiation dose calculations. The percent depth dose (PDD of photons in a medium with known absorption and scattering coefficients is computed using a MC simulation running on both a standard CPU and a GPU. We demonstrate that the GPU′s capability for massive parallel processing provides a significant acceleration in the MC calculation, and offers a significant advantage for distributed stochastic simulations on a single computer. Harnessing this potential of GPUs will help in the early adoption of MC for routine planning in a clinical environment.

  20. Evaluation of secondary exposure doses to transportation and medical personnel in the radiation emergency medicine

    International Nuclear Information System (INIS)

    Kato, Hideki; Suzuki, Shoichi; Koga, Sukehiko; Mukoyama, Takashi; Tomatsu, Hirotaka; Suzuki, Yusuke

    2009-01-01

    Radionuclide contamination is one of the accidents that might occur while carrying out a periodical inspection of nuclear power stations during normal reactor operation. When such an accident occurs, rescue and medical personnel, involved in transporting and treating affected workers run the risk of exposure to secondary radiation. In this study, the ambient dose equivalent rate at a certain distance from the surface of the human body contaminated with typical radioactive corrosion products was calculated. Further, the relationships among the adhesion area, contamination density, and secondary exposure dose were clarified. The secondary exposure dose and permissible working hours in a radiation emergency medicine were estimated by presenting these relationships in the form of a chart and by specifying the contamination levels. (author)

  1. Dose levels due to neutrons in the vicinity of high energy medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.; Wood, M.; Sohrabi, M.; Mills, M.; Rodriguez, R.

    1976-01-01

    High energy photons are generated for use in radiation therapy by the decelleration of electrons in metal targets. Fast neutrons are also generated as a result of (γ, n) and (e, e'n) interactions in the target, beam compensator filter, and collimator material. In this work the adsorbed dose to neutrons was measured at the center of a 10 x 10 cm photon beam and 5 cm outside of the beam edge for a number of treatment units. Dose levels due to slow and fast neutrons were also established outside of the treatment rooms and a Bonner sphere neutron spectrometer system was employed to determine the neutron energy spectrum due to stray neutron radiation at each accelerator. For the linac it was found that the neutron dose at the beam center was 0.0039% of the photon dose and values of 0.049% and 0.053% were observed for the Allis Chalmers betatron and the Brown Boveri Betatron. Dose equivalent rates in the range of 0.3 to 22.5 mrem/hr were measured for points outside the treatment rooms when the accelerators were operated at a photon dose rate of 100 rad/min at the treatment position

  2. Radiation doses to neonates and issues of radiation protection in a special care baby unit

    International Nuclear Information System (INIS)

    Armpilia, C.I.; Fife, I.A.J.; Croasdale, P.L.

    2001-01-01

    Radiographs are most commonly taken in the neonatal period to assist in the diagnosis and management of respiratory difficulties. Frequent accurate radiographic assessment is required and a knowledge of the radiation dose is necessary to make the justification of such exposures. A survey of radiation doses to neonates from diagnostic X-ray examinations (chest and abdomen) has been carried out in the special care baby unit (SCBU) of the Royal Free Hospital. Entrance surface dose (ESD) was calculated from Quality Control measurements on the X-ray set itself. Direct measurement of radiation doses was also performed using highly sensitive thermoluminescence dosimeters (LiF:Mg,Cu,P), calibrated and tested for consistency in sensitivity. The mean ESD per radiograph was calculated to be 36μGy (with a standard deviation of 6μGy), averaged over 95 X-ray examinations. The ESD's as derived from the TLD crystals, ranged from 18μGy to 60μGy. The mean energy imparted (EI) and the mean whole body dose per radiograph were estimated to be 14μJ and 10μGy respectively. Assuming that neonates and foetuses are equally susceptible to carcinogenic effects of radiation (it involves an overestimation of risk), the radiation risk of childhood cancer from a single radiograph was estimated to be of the order (0.3-1.3)x10 -6 . Radiation doses compared favourably with the reference value of 80μGy ESD published by CEC in 1996. (author)

  3. 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)

  4. Choice of the irradiation dose for the sterilization of medical products

    International Nuclear Information System (INIS)

    Bochkarev, V.V.; Pavlov, E.P.; Sedov, V.V.; Khrushchev, V.G.; Tushov, Eh.G.; Konyaev, G.A.

    1975-01-01

    The principles for selecting the appropriate dose for the radiation sterilization of medical products are set forth, taking into account the initial contamination of the product, the radiation senstivity of contaminants and the required level of reliability of sterilization. The initial contamination level of certain preparations (glucose and radiopharmaceuticals) is established and the radiation sensitivity of the isolated contaminants is determined in terms of Dio indices. Of the microorganisms isolated the most common were staphylococci, streptococci, Gram-negative bacteria, Aspergilli, Penicillia and yeast fungi. Spore-forming types of microorganisms were isolated with a frequency of the order of 10 -2 . The radiation sensitivity in terms of D 10 was established for more than 3000 strains of microorganisms. For 75-85% of the strains the D 10 indices gave 10-40 krad and for 0.2-1% more than 100 krad. The experimental data were subjected to computer analysis which confirmed the adequacy of the techniques used to determine radiosensitivity. The authors then calculated by computer the radiation sterilizing doses for different degrees of initial contamination of the products with reliability coefficients of 10 6 and 10 8 . For sterilizing radiopharmaceuticals and glucose solutions these doses are 0.8-1 Mrad. Verification experiments show that these doses give reliable sterilization of the medical products concerned. (author)

  5. The role of the medical physic on radiologic, hemodynamic and surgery unit at Hospital das Clinicas de Porto Alegre, Rio Grande do Sul State, Brazil

    International Nuclear Information System (INIS)

    Bacelar, A.; Furtado, A.P.A.; Krebs, E.M.; Oliveira, S.S.; Lima, A.A.; Jacques, L.C.; Silveira, C.S.

    1996-01-01

    The activities executed by the medical physic in the radiologic, hemodynamic and surgery unit are presented. Topics such as organization of a radiologic protection project and a quality assurance program, monthly information of the individual doses, sanitary inspection and training of the professionals involved are emphasized. The methodology and results are briefly presented

  6. Assessment of medical staff radiation doses received in some interventional examination

    International Nuclear Information System (INIS)

    Oenal, E.

    2006-03-01

    The aim of this work is to suggest a simple method for the estimation of cardiologist extremity doses. The extremity and effective doses The extremity and effective doses of nine cardiologists working at five different angiographic units were measured for 157 interventional examinations. Simultaneous measurement of patient doses were also carried out using a DAP meter separately for each projection. Fluoroscopy time (T f l), number of radiographic frames (N) were recorded on-line during these measurements. A Rando phantom was exposed at similar projections with patient studies and one minute of fluoroscopic exposure (D 1 50 n T f l n ) and one frame of radiographic exposure (D 1 50 n N n ) were determined for each projection. Scatter radiations from these exposures were also measured at 50, 100 and 150 cm above the floor level at the cardiologist positions for the estimation of legs, wrists and thyroid (or eye) doses. Weighting of projections were determined for the patient group of each cardiologist using the recorded values of T f l and N r f. Extremity doses, D x were calculated with the following formula: D 1 50=Σ n D 1 50 n T f l n (T f l n )+Σ n D 1 50 n N n (N n ), n=4, 5, 6, 7, 10. n gives the projection numbert and x is the distance from the floor level. Measured and calculated extremity doses for each cardiologist were in good agreement. The calculated doses for 50cm and 100cm were found within the measured values of left and right legs and wrists. The use of dominant projection data alone still provided comparable results

  7. Estimation of North American population doses resulting from radon-222 release in western United States: methodology

    International Nuclear Information System (INIS)

    Fields, D.E.; Travis, C.C.; Watson, A.P.; McDowell-Boyer, L.M.

    1979-12-01

    The report represents a compilation of computer codes used to estimate potential human exposures and inhalation doses due to unit releases of 222 Rn from uranium milling sites in western United States. The populations considered for potential exposure to risk from 222 Rn and associated daughters are the inhabitants of North America between 20 0 and 60 0 North latitude. The primary function of these codes is to integrate spatially atmospheric radionuclide concentrations with current population data for the geographic area under consideration. It is expected that these codes will be of assistance to anyone interested in assessing nuclear or nonnuclear population exposures over large geographic areas

  8. X/Qs and unit dose calculations for Central Waste Complex interim safety basis effort

    International Nuclear Information System (INIS)

    Huang, C.H.

    1996-01-01

    The objective for this problem is to calculate the ground-level release dispersion factors (X/Q) and unit doses for onsite facility and offsite receptors at the site boundary and at Highway 240 for plume meander, building wake effect, plume rise, and the combined effect. The release location is at Central Waste Complex Building P4 in the 200 West Area. The onsite facility is located at Building P7. Acute ground level release 99.5 percentile dispersion factors (X/Q) were generated using the GXQ. The unit doses were calculated using the GENII code. The dimensions of Building P4 are 15 m in W x 24 m in L x 6 m in H

  9. A method for calculation of dose per unit concentration values for aquatic biota

    International Nuclear Information System (INIS)

    Batlle, J Vives i; Jones, S R; Gomez-Ros, J M

    2004-01-01

    A dose per unit concentration database has been generated for application to ecosystem assessments within the FASSET framework. Organisms are represented by ellipsoids of appropriate dimensions, and the proportion of radiation absorbed within the organisms is calculated using a numerical method implemented in a series of spreadsheet-based programs. Energy-dependent absorbed fraction functions have been derived for calculating the total dose per unit concentration of radionuclides present in biota or in the media they inhabit. All radionuclides and reference organism dimensions defined within FASSET for marine and freshwater ecosystems are included. The methodology has been validated against more complex dosimetric models and compared with human dosimetry based on ICRP 72. Ecosystem assessments for aquatic biota within the FASSET framework can now be performed simply, once radionuclide concentrations in target organisms are known, either directly or indirectly by deduction from radionuclide concentrations in the surrounding medium

  10. The Current Status of Medical Marijuana in the United States

    OpenAIRE

    McKenna, Gerald J

    2014-01-01

    Medical marijuana is currently a controversial issue in medicine. There are strong pro and con opinions but relatively little scientific data on which to base medical decisions. The unfortunate scheduling of marijuana in class I has limited research and only serves to fuel the controversy.

  11. Iatrogenic medication errors in a paediatric intensive care unit in ...

    African Journals Online (AJOL)

    Errors most frequently encountered included failure to calculate rates of infusion and the conversion of mL to mEq or mL to mg for potassium, phenobarbitone and digoxin. Of the 117 children admitted, 111 (94.9%) were exposed to at least one medication error. Two or more medication errors occurred in 34.1% of cases.

  12. QUANTITIES AND UNITS IN MEDICAL SCIENCE - A PLEA FOR STANDARDIZATION

    NARCIS (Netherlands)

    ZIJLSTRA, WG

    1993-01-01

    The paper puts forward the idea that a relative lack of interest in the quantitative aspects of pathophysiological processes has made medical practice as well as medical research vulnerable to misconceptions carried into the field by technical innovations. More attention to these matters may not

  13. Radiation doses and risks to neonates undergoing common radiographic examinations in the neonatal intensive care unit

    International Nuclear Information System (INIS)

    McParland, B.J.; Lee, R.

    1996-01-01

    Neonates in the-Neonatal Intensive Care Unit (NICU) can receive large numbers of radiographs owing to the clinical conditions they may present. More neonatal radiation dosimetry data are required for three fundamental reasons: (1.) to aid in the establishment of reference dose levels for interinstitutional comparisons; (2.) to improve childhood cancer risk estimates following neonatal exposure; and (3.) to indicate appropriate directions for dose reduction. This paper describes an investigation of two different NICU radiological techniques with significantly different neonate doses. While patient-matched images taken with both techniques were assessed in a blind review, this component of the study is beyond the scope of this paper and is not discussed here. (author)

  14. Radiation Dose to Patients and Medical Staff in Different Procedures of Nuclear Medicine

    International Nuclear Information System (INIS)

    Dimcheva, M.; Sergieva, S.

    2015-01-01

    The aim of this study is to provide information on developing technologies and clinical techniques for Hybrid SPECT/CT imaging using ionizing radiation and their associated radiation dose to patients and medical staff. A thermoluminescent dosimeters (TLD) was used in this study to analyze the historic records of the external radiation doses to staff members working in our nuclear medicine department in 7 procedures, including elution of 99mTc from "9"9"mMo/"9"9"mTc generators, syringe preparation, radiopharmacy kit preparation, injection, accompanying patients, SPECT/CT scan, oral "1"3"1I preparation. These dosimeters was worn by the staff members at the level of the chest on the front part of the body. A retrospective review of 110 clinical studies of various nuclear medicine procedures ("9"9"mTc–MIBI–Tetrofosmin, "9"9"mTc–MDP bone scan, "9"9"mTc–Tektrotyd, "9"9"mTc–Thyroid imaging, "9"9"mTc–Nanocoll, "1"3"1I–Nal (diagnostic application 185 MBq) obtained on hybrid SPECT/CT systems was performed to calculate the effective radiation dose to patients. The results from this study showed that annual effective radiation doses to nuclear medicine department staff members were within permissible levels. The contribution of total effective radiation dose from SPECT component were calculated using the activity of the injected radiopharmaceutical and dose tables published by the conversion factors listed in ICRP 53 and ICRP 80. The radiation dose for CT was calculated by Dose Length Product method. According to the results of this study the dose in each procedure depends on different factors such as the education and experience of the staff members, usage of shielding and taking the radiation protection requirements into consideration. When SPECT–CT is being performed, all measures should be taken to reduce both the radiopharmaceutical dose and the CT effective dose following the ALARA principle. (author)

  15. Extremity dosimetry in medical applications within Europe: an overview of doses and monitoring practices

    International Nuclear Information System (INIS)

    Donadille, Laurent; Carinou, E.; Ginjaume, M.; Jankowski, J.; Rimpler, A.; Sans Merce, M.; Vanhavere, F.

    2008-01-01

    Full text: Some activities of the EURADOS Working Group 9 (WG9) related to the radiation protection dosimetry of medical staff were funded by the European Commission in the framework of the CONRAD project, Work Package 7. The objective of WG9 was to promote and co-ordinate research activities for the assessment of occupational exposure to staff at workplaces in therapeutic and diagnostic radiology and nuclear medicine. At these workplaces, from the point of view of the individual monitoring for external radiation, the skin of the fingers is generally the limiting organ. Subgroup 1 of WG9 had as main objective the study of the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in medicine together with the difficulties of measuring a local dose which should be representative for the maximum skin dose using one single detector, makes it difficult to perform extremity dosimetry with an accuracy similar to that of whole-body one. A recent intercomparison organised by WG9 showed that some types of dosemeters significantly underestimate or overestimate skin doses. Subgroup 1 carried out a thorough literature review on extremity dosimetry issues. It covered diagnostic and therapeutic nuclear medicine and PET, interventional radiology and cardiology, and brachytherapy. It has notably pointed out the consensus about the requirement of regular extremity dose monitoring for nuclear medicine and PET, and the great difficulty of measuring extremity doses for procedures in interventional radiology and cardiology, activities for which routine extremity dose monitoring has been found to be poor. Furthermore, information on the status of extremity dosimetry in medical applications and associated monitoring practices was gathered from 7 European countries: France, Germany, Greece, Ireland, Poland, Spain and Switzerland. Interpretation of the data was not easy because of the wide range of procedures involved and also

  16. Neonatal doses from X ray examinations by birth weight in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Ono, K.; Akahane, K.; Aota, T.; Hada, M.; Takano, Y.; Kai, M.; Kusama, T

    2003-07-01

    The aim of this study was to investigate the frequency and type of X ray examinations performed on neonates classified according to their birth weight in a neonatal intensive care unit (NICU). In this study, the radiology records of 2408 neonates who were admitted to the NICU of Oita Prefectural Hospital between January 1994 and September 1999 were investigated. This study revealed that the neonates with earlier gestational ages and lower birth weights required longer NICU stays and more frequent X ray examinations made using a mobile X ray unit. The average number of X ray examinations performed on neonates of less than 750 g birth weight was 26 films per neonate. In regard to computed tomography and fluoroscopy, no significant relationship was found between the birth weight and number of X rays. This study revealed that the entrance-surface dose per neonate was dependent upon the birth weight, while the maximum dose was not dependent upon the birth weight. The average neonatal dose in the NICU was predominantly from computed tomography and fluoroscopy. The individual dose varied widely among neonates. (author)

  17. Neonatal doses from X ray examinations by birth weight in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    Ono, K.; Akahane, K.; Aota, T.; Hada, M.; Takano, Y.; Kai, M.; Kusama, T.

    2003-01-01

    The aim of this study was to investigate the frequency and type of X ray examinations performed on neonates classified according to their birth weight in a neonatal intensive care unit (NICU). In this study, the radiology records of 2408 neonates who were admitted to the NICU of Oita Prefectural Hospital between January 1994 and September 1999 were investigated. This study revealed that the neonates with earlier gestational ages and lower birth weights required longer NICU stays and more frequent X ray examinations made using a mobile X ray unit. The average number of X ray examinations performed on neonates of less than 750 g birth weight was 26 films per neonate. In regard to computed tomography and fluoroscopy, no significant relationship was found between the birth weight and number of X rays. This study revealed that the entrance-surface dose per neonate was dependent upon the birth weight, while the maximum dose was not dependent upon the birth weight. The average neonatal dose in the NICU was predominantly from computed tomography and fluoroscopy. The individual dose varied widely among neonates. (author)

  18. Dose-current discharge correlation analysis in a Mather type Plasma Focus device for medical applications

    Science.gov (United States)

    Sumini, M.; Mostacci, D.; Tartari, A.; Mazza, A.; Cucchi, G.; Isolan, L.; Buontempo, F.; Zironi, I.; Castellani, G.

    2017-11-01

    In a Plasma Focus device the plasma collapses into the pinch where it reaches thermonuclear conditions for a few tens of nanoseconds, becoming a multi-radiation source. The nature of the radiation generated depends on the gas filling the chamber and the device working parameters. The self-collimated electron beam generated in the backward direction with respect to the plasma motion is one of the main radiation sources of interest also for medical applications. The electron beam may be guided against a high Z material target to produce an X-ray beam. This technique offers an ultra-high dose rate source of X-rays, able to deliver during the pinch a massive dose (up to 1 Gy per discharge for the PFMA-3 test device), as measured with EBT3 GafchromicⒸfilm tissue equivalent dosimeters. Given the stochastic behavior of the discharge process, a reliable on-line estimate of the dose-delivered is a very challenging task, in some way preventing a systematic application as a potentially interesting therapy device. This work presents an approach to linking the dose registered by the EBT3 GafchromicⒸfilms with the information contained in the signal recorded during the current discharge process. Processing the signal with the Wigner-Ville distribution, a spectrogram was obtained, displaying the information on intensity at various frequency scales, identifying the band of frequencies representative of the pinch events and define some patterns correlated with the dose.

  19. AAPM medical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems.

    Science.gov (United States)

    Gress, Dustin A; Dickinson, Renee L; Erwin, William D; Jordan, David W; Kobistek, Robert J; Stevens, Donna M; Supanich, Mark P; Wang, Jia; Fairobent, Lynne A

    2017-07-01

    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: •Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. •Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  20. Medical researchers unite for study on cancer intervention

    Directory of Open Access Journals (Sweden)

    Editorial Office

    2016-08-01

    Full Text Available We introduce Drs. Antoine Snijders and Jian-Hua Mao, whose article is published in this issue of AMOR and discuss their views on cancer genetics, targeted therapy, and personalized medicine.Having worked together in numerous joint investigations that have yielded significant results, Dr. Snijders and Dr. Mao would most definitely agree that two heads are better than one. “Researchers these days need to have the ability to collaborate across many different disciplines,” said the duo in an exclusive interview with AMOR. Dr. Snijders and Dr. Mao, both with PhDs in cancer genetics and genomics, are currently based at the Biological Systems and Engineering Division of Lawrence Berkeley National Laboratory, California, which is a member of the national laboratory system supported by the U.S Department of Energy through its Office of Science. The Berkeley Lab is well known for producing excellent scholars, as thirteen Nobel Prize winners are affiliated with the Lab and seventy of its scientists are members of the National Academy of Sciences (NAS, one of the highest honors for a scientist in the United States. Dr. Snijders, a Dutch who has conducted his research at Berkeley Lab for the past eight years, did his Masters in Science (Medical Biology at the Vrije Universiteit Amsterdam, Netherlands – an institute with a strong focus on scientific research and is home to five Spinoza Prize (a.k.a. the “Dutch Nobel” winners. Dr. Snijders’s PhD (cum laude in cancer and molecular biology was awarded by University Utrecht in Netherlands, but his research work was carried out at the University of California San Francisco. Subsequently, he continued his postdoctoral research in molecular cytogenetics at the same institution. A prolific author of 114 publications (with 3,851 citations according to ResearchGate, Dr. Snijders – who also volunteers with California’s Contra Costa County Search and Rescue team for missing persons – has interests in

  1. Variability in United States Allopathic Medical School Tuition.

    Science.gov (United States)

    Gil, Joseph A; Park, Sarah H; Daniels, Alan H

    2015-11-01

    Over the course of the last generation, the cost of medical school attendance and medical student debt has increased drastically. Medical student debt has been reported as high as $350,000, and the Association of American Medical Colleges (AAMC) reports that medical school tuition continues to increase annually. The increasing cost of medical education and associated financial burden is now beginning to deter potential applicants from pursuing a career in medicine. In this study we aimed to assess medical school tuition across the US. We hypothesized that the cost of medical school attendance is variable across all regions of the US, and as a result, the financial burden on medical students is inconsistent. All 123 allopathic medical schools accredited by the AAMC were assessed in this investigation. In-state and out-of-state tuitions for the year 2016 were obtained from U.S. News and World Report. Additionally, medical school size was collected. Regions were defined according to the US Census Bureau definition, with the US being divided into 4 regions: Northeast, Midwest, South, and West. There was no difference in average medical school size among the 4 regions (P > .05). Average in-state tuition was $38,291.56 ± $9801.38 (95% confidence interval [CI], $34,658.07-$41,513.46) in the Midwest, $45,923.04 ± $9178.87 (95% CI, $42,566.28-$49,216.78) in the Northeast, $32,287.78 ± $12,277.53 (95% CI, $28,581.90-$35,378.68) in the South, and $37,745.40 ± $11,414.37 (95% CI, $30,063.28-$40,458.99) in the West. In-state tuition in the South was significantly lower than in the Northeast, West, and Midwest (P tuition in the Northeast was significantly higher than in the South, West, and Midwest (P tuition is $54,104.04 ± $8227.65 (95% CI, $51,207.6-$57,000.39) in the Midwest, $53,180.10 ± $3963.71 (95% CI, $51,761.71-$54,598.50) in the Northeast, $48,191.86 ± $12,578.13 (95% CI, $44,595.84-$51,787.89) in the South, and $52,920.47 ± $7400.83 (95% CI, $49

  2. Assessment of medical radiation exposure to patients and ambient doses in several diagnostic radiology departments

    Science.gov (United States)

    Sulieman, A.; Elhadi, T.; Babikir, E.; Alkhorayef, M.; Alnaaimi, M.; Alduaij, M.; Bradley, D. A.

    2017-11-01

    In many countries diagnostic medical exposures typically account for a very large fraction of the collective effective dose that can be assigned to anthropological sources and activities. This in part flags up the question of whether sufficient steps are being taken in regard to potential dose saving from such medical services. As a first step, one needs to survey doses to compare against those of best practice. The present study has sought evaluation of the radiation protection status and patient doses for certain key radiological procedures in four film-based radiology departments within Sudan. The radiation exposure survey, carried out using a survey meter and quality control test tools, involved a total of 299 patients their examinations being carried out at one or other of these four departments. The entrance surface air kerma (ESAK) was determined from exposure settings using DosCal software and an Unfors -Xi-meter. The mean ESAK for x-ray examination of the chest was 0.30±0.1 mGy, for the skull it was 0.96±0.7 mGy, for the abdomen 0.85±0.01 mGy, for spinal procedures 1.30±0.6 mGy and for procedures involving the limbs it was 0.43±0.3 mGy. Ambient dose-rates in the reception area, at the closed door of the x-ray room, recorded instantaneous values of up to 100 μSv/h. In regard to protection, the associated levels were found to be acceptable in three of the four departments, corrective action being required for one department, regular quality control also being recommended.

  3. Estimated Visualization of Dose Calculation with GEANT4 in Medical Linac

    International Nuclear Information System (INIS)

    Kim, Jhin Kee; Kim, Bu Gil; Lee, Jeong Ok; Kang, Jeong Ku; Oh, Young Kee; Jeong, Dong Hyeok; Kim, Jeong Kee

    2011-01-01

    Geant4 is a toolkit used to simulate the pass age of particles through matter. Recently, it has been used in many medical physics applications. In radiotherapy, positron emission tomography, and magnetic resonance tomography, Geant4 has been applied to accurately simulate the propagation of particles and the interaction of particles, not only with medical devices, but also with patient's phantoms.1,2 Many researchers try to use patient's image data to calculate the dose. The use of DICOM images files to simulate is desired. We construct detector with parameterized volume for Geant4 simulations, which can be applied to simulations using DICOM data as the input.We try to apply this code to the patient's DICOM images to simulate the propagation and interaction of the particles. So we can calculate the absorbed dose of the patient. In this study, the used visualization tool is called gMocren. The purpose of the present paper is to verify a volume visualization tool that simultaneously displays both the complex patient data and the simulated dose distribution with real patient's DICOM data. We applied a volume visualization tool for GEANT4 simulation. We developed to create the each voxel's dose tables of the every slices and review the distribution with DICOM file, gMocren is very convenience tool but provide only qualitative analysis. We need more enhanced functions to display contour like RTP and utility program to create dose table in every points.

  4. Identifying medication errors in the neonatal intensive care unit and ...

    African Journals Online (AJOL)

    of the health care professional, patient, or consumer. ... Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, ..... patient safety. ... Clifton-Koeppel R. What nurses can do right now to reduce medication errors.

  5. Iatrogenic medication errors in a paediatric intensive care unit in ...

    African Journals Online (AJOL)

    trigger tool method rather than a real-time reporting tool in both ... Therapeutic skills of healthcare professionals working in the PICU need to be improved to decrease ..... devices such as smartphones with medication dosage applications.

  6. Radiation dose to neonates undergoing X-ray imaging in special care baby units in Iran

    International Nuclear Information System (INIS)

    Faghihi, R.; Mehdizadeh, S.; Sina, S.; Alizadeh, F. N.; Zeinali, B.; Kamyab, G. R.; Aghevlian, S.; Khorramdel, H.; Namazi, I.; Heirani, M.; Moshkriz, M.; Mahani, H.; Sharifzadeh, M.

    2012-01-01

    Radiographic imaging has a significant role in the timely diagnosis of the diseases of neonates in intensive care units. The estimation of the dose received by the infants undergoing radiographic examination is of great importance, due to greater more radiosensitivity and longer life expectancy of the neonates and premature babies. In this study, the values of entrance skin dose (ESD), dose area products (DAPs), energy imparted (EI), whole-body dose, effective dose and risk of childhood cancer were estimated using three methods including direct method [using thermoluminescence dosimetry (TLD) chips], indirect method (using tube output) and Monte Carlo (MC) method (using MCNP4C code). In the first step, the ESD of the neonates was directly measured using TLD-100 chips. Fifty neonates, mostly premature, with different weights and gestational ages in five hospitals mostly suffering from respiratory distress syndrome and pneumonia were involved in this study. In the second step, the values of ESD to neonates were indirectly obtained from the tube output in different imaging techniques. The imaging room, incubator, neonates and other components were then simulated in order to obtain the ESD values using the MCNP4C code. Finally, the values of ESD assessed by the three methods were used for calculation of DAP, EI, whole-body dose, effective dose and risk of childhood cancer. The results indicate that the mean ESD per radiograph estimated by the direct, indirect and MC methods are 56.6±4.1, 50.1±3.1 and 54.5±3.3 μGy, respectively. The mean risk of childhood cancer estimated in this study varied between 4.21x10 -7 and 2.72x10 -6 . (authors)

  7. Radiation doses and risks to neonates undergoing radiographic examinations in intensive care units in Tunisia

    Directory of Open Access Journals (Sweden)

    Abir Bouaoun

    2015-12-01

    Full Text Available Purpose: To assess the radiation doses to neonates from diagnostic radiography in order to derive the local diagnostic reference levels (LDRLs for optimisation purposes.Methods: This study was carried out in the neonatal intensive care units (NICU of  two hospitals in Tunis. 134 babies, with weights ranging from 635 g to 6680 g, performed chest-abdomen X-ray examinations. Neonates were categorized into groups of birth weight. For each X-ray examination, patient data and exposure parameters were recorded. Dose area product (DAP was measured and entrance surface dose (ESD was estimated. Effective dose was calculated from the Monte Carlo simulation software PCXMC.Results: DAP values increased with neonatal weight and demonstrated a wide variation (5.0 - 43.0 mGy.cm2, mean 23.4 mGy.cm2 for patient weight from 600 g to 4000 g. A wide variation was also observed for ESD (14 - 93 μGy, mean 55.2 μGy. The LDRLs expressed in term of DAP were estimated to be 17.6 mGy.cm2 and 29.1 mGy.cm2 for the first and the second NICU, respectively. In terms of effective dose, the average value was about 31.6 μSv per single radiological examination. The results show the necessity to use a standardized protocol with high voltage technique combined to lower current time product (mAs values and an adapted collimation which could lead to further reductions in the neonatal doses. Conclusion: This study presents the LDRLs and the effective doses for neonates in two NICUs and demonstrates the necessity to optimize patient protection for this category of patient.

  8. Predicting Pulmonary O2 Toxicity: A New Look at the Unit Pulmonary Toxicity Dose

    Science.gov (United States)

    1985-05-01

    beatl loeged# aNy ahepes in Vo was considered error. The assumptieo was shoe eapeova to a 10 below the "safe’! I02 should have produced se daeromeat...Naval Medical Research Institute SethesdolMO 20814-505b NMRI 86-52 December 1986 PREDICTING4 PULMONARY 0 2 TOXICITY: j k,, NEW LOOK AT THE UNIT...distribution is unlimited °Q0- C(-" Naval Medical Research LLj and Development Command ,, J Bethesda, Maryland 20814-5044 -4 • Department of the Navy Naval

  9. Professionalism among multicultural medical students in the United Arab Emirates.

    Science.gov (United States)

    Abdulrahman, Mahera; Alsalehi, Shahd; Husain, Zahra S M; Nair, Satish C; Carrick, Frederick Robert

    2017-01-01

    Moral competencies and ethical practices of medical professionals are among the desired outcomes of academic training. Unfortunately, academic dishonesty and misconduct are reported from medical colleges across the world. This study investigates the level of academic dishonesty/misconduct among multicultural medical students. The aim of this study is to investigate the level of academic dishonesty/misconduct among multicultural medical students. Validated and customized version of Dundee Polyprofessionalism Inventory-1 detailing lapses of professionalism in undergraduate health professions education was used to determine the perceived prevalence and self-reported lapses of academic integrity in this study. This study shows that the majority (458/554, 83%) of medical students have admitted to acts of academic dishonesty mentioned in the questionnaire. Approximately 42% (231/554) of the students have given proxy for attendance and 71% of them considered this as an offense. Similarly, 12% (66/554) have copied from the record books of others, and 86% (477/554) have considered it unethical. In addition, 5% (28/554) of the students revealed forging a teacher's signature in their record or logbooks, with 16% (91/554) of them reporting that they have seen others forge signatures. This is the first multi-center, multi-cultural and multi-ethnic study involving a large number of participants that addresses academic professionalism among medical students in the Middle East. Certainly, the paucity of data limits definitive conclusions about the best approach to prevent academic misconduct in the UAE medical schools. Yet, the results of our study are anticipated not only to benefit the UAE but also to find application in the Arab world, with similar medical school programs, values, culture and tradition.

  10. Profesional medical library education in the United States in relation to the qualifications of medical library manpower in Ohio.

    Science.gov (United States)

    Rees, A M; Rothenberg, L; Denison, B

    1968-10-01

    THE PRESENT SYSTEM OF EDUCATION FOR MEDICAL LIBRARY PRACTICE IN THE UNITED STATES CONSISTS OF FOUR MAJOR COMPONENTS: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice.The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel.

  11. Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States.

    Science.gov (United States)

    Mizuno, Yuko; Frazier, Emma L; Huang, Ping; Skarbinski, Jacek

    2015-09-01

    Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.

  12. Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

    Science.gov (United States)

    Farag, Amany; Tullai-McGuinness, Susan; Anthony, Mary K; Burant, Christopher

    2017-01-01

    This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

  13. Occupational exposure to radiation in the United Kingdom and its contribution to the genetically effective dose

    Energy Technology Data Exchange (ETDEWEB)

    Binks, W; Marley, W G

    1960-12-01

    It is now the common practice in the United Kingdom for persons who are exposed occupationally to ionizing radiations to be subjected to continuous individual monitoring in order to ensure that the doses that they receive from sources external to the body do not exceed the levels which are regarded as acceptable. In the operation of large-scale monitoring services such as are provided by the Radiological Protection Service (R.P.S.) and by the establishments of the United Kingdom Atomic Energy Authority (U.K.A.E.A.) there is no satisfactory alternative to the use of photographic film, bearing in mind such aspects as simplicity, reliability, accuracy, cheapness, ease of postal transmission of the films in the special holders, and availability of a durable record of the dose received. The Radiological Protection Service provides a film badge service which is widely used by industry. This organization also provides film badges for about one-third of the occupationally exposed persons in National Health Service hospitals; for the remaining hospital workers the majority of establishments undertake their own monitoring arrangements. The United Kingdom Atomic Energy Authority provides its own film badge services for all exposed workers. It is the purpose of this report to summarize the information obtained by the R.P.S. and the U.K.A.E.A. regarding the doses received by occupationally exposed persons. The total genetically effective dose received by the population from occupational exposure is also compared with that received from natural background radiation. This report also summarizes the measurements made by the R.P.S. and the U.K.A.E.A. to check the internal contamination of the body in cases where radioactivity has been ingested or inhaled.

  14. Occupational exposure to radiation in the United Kingdom and its contribution to the genetically effective dose

    International Nuclear Information System (INIS)

    Binks, W.; Marley, W.G.

    1960-01-01

    It is now the common practice in the United Kingdom for persons who are exposed occupationally to ionizing radiations to be subjected to continuous individual monitoring in order to ensure that the doses that they receive from sources external to the body do not exceed the levels which are regarded as acceptable. In the operation of large-scale monitoring services such as are provided by the Radiological Protection Service (R.P.S.) and by the establishments of the United Kingdom Atomic Energy Authority (U.K.A.E.A.) there is no satisfactory alternative to the use of photographic film, bearing in mind such aspects as simplicity, reliability, accuracy, cheapness, ease of postal transmission of the films in the special holders, and availability of a durable record of the dose received. The Radiological Protection Service provides a film badge service which is widely used by industry. This organization also provides film badges for about one-third of the occupationally exposed persons in National Health Service hospitals; for the remaining hospital workers the majority of establishments undertake their own monitoring arrangements. The United Kingdom Atomic Energy Authority provides its own film badge services for all exposed workers. It is the purpose of this report to summarize the information obtained by the R.P.S. and the U.K.A.E.A. regarding the doses received by occupationally exposed persons. The total genetically effective dose received by the population from occupational exposure is also compared with that received from natural background radiation. This report also summarizes the measurements made by the R.P.S. and the U.K.A.E.A. to check the internal contamination of the body in cases where radioactivity has been ingested or inhaled

  15. Psychotropic Medication Use among Adolescents: United States, 2005-2010

    Science.gov (United States)

    ... no. 12–3929. 2010. Pratt LA, Brody DJ. Depression in the United States household population, 2005–2006. NCHS data brief, no 7. Hyattsville, MD: National Center for Health Statistics. 2008. Akinbami LJ, Liu X, Pastor PN, Reuben ...

  16. Retrospective Dose Reconstruction for Medical Diagnostic X Ray Workers in China using Stable Chromosome Aberrations

    International Nuclear Information System (INIS)

    Wang, Q.; Liu, P.; Li, J.; Wang, Q.; Tang, S.; Sun, M.; Wang, L.; Aoyama, T.; Sugahara, T.

    1998-01-01

    The chromosome rearrangements in medical diagnostic X ray workers were analysed using the G-banding technique and evaluated collectively in accumulated doses. A total of 9102 metaphase spreads from 84 medical diagnostic X ray workers and 17 controls were scored. The results showed that: (1) the frequencies of translocation, stable chromosome aberration and total aberration in X ray workers were significantly higher than those of controls (P < 0.05 γ 0.005), unstable chromosome aberrations (including dicentric and acentric aberration) tended upwards; (2) the main aberration in stable aberrations was reciprocal translocation; (3) the stable aberration predominated strikingly in total aberrations. The medical diagnostic X ray workers were divided into three groups according to calendar year of entry. The data showed that the frequencies of translocation, stable aberration and total aberration increased with earlier year of entry, especially in two groups who started working before 1970. According to the equation recommended by Straume et al, linear coefficient (α) in the linear quadratic model provided by Fernandez's experiment, their collective accumulation doses calculated were 0.53, 0.26 and 0.06 Gy for calendar year of entry before 1960, 1960-1969, and after 1970, in X ray workers, respectively. (author)

  17. Valuation of medical resource units collected in health economic studies.

    Science.gov (United States)

    Copley-Merriman, C; Lair, T J

    1994-01-01

    This paper reviews the issues that are critical for the valuation of medical resources in the context of health economic studies. There are several points to consider when undertaking the valuation of medical resources. The perspective of the analysis should be established before determining the valuation process. Future costs should be discounted to present values, and time and effort spent in assigning a monetary value to a medical resource should be proportional to its importance in the analysis. Prices vary considerably based on location of the service and the severity of the illness episode. Because of the wide variability in pricing data, sensitivity analysis is an important component of validation of study results. A variety of data sources have been applied to the valuation of medical resources. Several types of data are reviewed in this paper, including claims data, national survey data, administrative data, and marketing research data. Valuation of medical resources collected in clinical trials is complex because of the lack of standardization of the data sources. A national pricing data source for health economic valuation would greatly facilitate study analysis and make comparisons between results more meaningful.

  18. Enhanced Engraftment of a Very Low-Dose Cord Blood Unit in an Adult Haemopoietic Transplant by Addition of Six Mismatched Viable Cord Units

    Directory of Open Access Journals (Sweden)

    Stephen J. Proctor

    2010-01-01

    , supported by six mismatched cord blood units (one unit per 10 kg recipient weight. No adverse reaction occurred following the infusion of mismatched units and engraftment of the suboptimal-dose matched unit occurred rapidly, with no molecular evidence of engraftment of mismatched cords. Early molecular remission of ALL was demonstrated using a novel PCR for a mitochondrial DNA mutation in the leukaemic clone. The cell dose of the matched cord was well below that recommended to engraft a 70 kg recipient. We suggest that a factor or factors in the mismatched cords enhanced/supported engraftment of the matched cord.

  19. Mean glandular dose measurement on various breast phantom using mammography machine in MINT Medical Physics Laboratory

    International Nuclear Information System (INIS)

    Wan Hazlinda Ismail; Asmaliza Hashim; Abd Aziz Mhd Ramli

    2005-01-01

    Until recently, mammography have been the primary means of detecting early breast cancer. Although there is a risk of radiation- induced carcinogenesis associated with the x-ray examination of the female breast, but this risk is small compared to its benefits with modern equipment and technique. Therefore, it is important to determine the dose of the tissue at risk from radiation exposure by measuring the mean glandular dose (MGD). This can help minimize the risk to the patient. This paper describe the MGD measurement done on various types and thickness of breast phantom using a Bennett mammography machine model DMF-150 in the Medical Physics laboratory at the Malaysian Institute for Nuclear Technology Research (MINT). Results of this study are discussed in this paper. (Author)

  20. Brachytherapy. High dose rate brachytherapy - Radiation protection: medical sheet ED 4287

    International Nuclear Information System (INIS)

    Celier, D.; Aubert, B.; Vidal, J.P.; Biau, A.; Lahaye, T.; Gauron, C.; Barret, C.; Boisserie, G.; Branchet, E.; Gambini, D.; Gondran, C.; Le Guen, B.; Guerin, C.; Nguyen, S.; Pierrat, N.; Sarrazin, T.; Donnarieix, D.

    2010-02-01

    After having indicated the required authorization to implement brachytherapy techniques, this document presents the various aspects and measures related to radiation protection when performing high-dose-rate brachytherapy treatments. It presents the concerned personnel, describes the operational process, indicates the associated hazards and the risk related to ionizing radiation, and describes how the risk is to be assessed and how exposure levels are to be determined (elements of risk assessment, delimitation of controlled and monitored areas, personnel classification, and choice of the dose monitoring method). It describes the various components of a risk management strategy (risk reduction, technical measures regarding the installation and the personnel, training and information, prevention and medical monitoring). It briefly presents how risk management is to be assessed, and mentions other related risks (biological risk, handling and posture, handling of heavy loads, mental workload, chemical risk)

  1. Brachytherapy. Pulsed dose rate brachytherapy - Radiation protection: medical sheet ED 4250

    International Nuclear Information System (INIS)

    Celier, D.; Aubert, B.; Vidal, J.P.; Biau, A.; Lahaye, T.; Gauron, C.; Barret, C.; Boisserie, G.; Branchet, E.; Gambini, D.; Gondran, C.; Le Guen, B.; Guerin, C.; Nguyen, S.; Pierrat, N.; Sarrazin, T.; Donnarieix, D.

    2009-06-01

    After having indicated the required authorization to implement brachytherapy techniques, this document presents the various aspects and measures related to radiation protection when performing pulsed-dose-rate brachytherapy treatments. It presents the concerned personnel, describes the operational process, indicates the associated hazards and the risk related to ionizing radiation, and describes how the risk is to be assessed and how exposure levels are to be determined (elements of risk assessment, delimitation of controlled and monitored areas, personnel classification, and choice of the dose monitoring method). It describes the various components of a risk management strategy (risk reduction, technical measures regarding the installation and the personnel, training and information, prevention and medical monitoring). It briefly presents how risk management is to be assessed, and mentions other related risks (biological risk, handling and posture, handling of heavy loads, mental workload, chemical risk)

  2. Radiation dose reduction in a neonatal intensive care unit in computed radiography

    International Nuclear Information System (INIS)

    Frayre, A.S.; Torres, P.; Gaona, E.; Rivera, T.; Franco, J.; Molina, N.

    2012-01-01

    The purpose of this study was to evaluate the dose received by chest x-rays in neonatal care with thermoluminescent dosimetry and to determine the level of exposure where the quantum noise level does not affect the diagnostic image quality in order to reduce the dose to neonates. In pediatric radiology, especially the prematurely born children are highly sensitive to the radiation because of the highly mitotic state of their cells; in general, the sensitivity of a tissue to radiation is directly proportional to its rate of proliferation. The sample consisted of 208 neonatal chest x-rays of 12 neonates admitted and treated in a Neonatal Intensive Care Unit (NICU). All the neonates were preterm in the range of 28–34 weeks, with a mean of 30.8 weeks. Entrance Surface Doses (ESD) values for chest x-rays are higher than the DRL of 50 μGy proposed by the National Radiological Protection Board (NRPB). In order to reduce the dose to neonates, the optimum image quality was achieved by determining the level of ESD where level noise does not affect the diagnostic image quality. The optimum ESD was estimated for additional 20 chest x-rays increasing kVp and reducing mAs until quantum noise affects image quality. - Highlights: ► Entrance surface doses (ESD) in neonates were measured. ► Doses measured in neonates examinations were higher than those reported by literature. ► Reference levels in neonatal studies are required. ► Radiation protection optimization was proposed.

  3. Impact of one-dose package dispensing with patient counseling on medication adherence in geriatrics suffering from chronic disorders

    Directory of Open Access Journals (Sweden)

    Narayana Goruntla

    2018-01-01

    Full Text Available Introduction: Medication nonadherence in elderly patients could result in a waste of medical expenses in a long-time span as well as deterioration of the patient's medical condition. Aim: The aim of this study is to evaluate the impact of one-dose package dispensing with patient counseling on medication adherence among elderly patients suffering from chronic disorders. Settings and Design: This is prospective, open-labeled, randomized trial carried out at dispensing pharmacy of the secondary care referral hospital, located in resource-limited settings of Anantapur District, Andhra Pradesh, India. Subjects and Methods: A total of 330 (aged ≥60 years patients were randomly assigned to one of three study groups: Group A (n = 110, no change in dosing and packing; Group B (n = 110, one-dose package dispensing; Group C (n = 110, One-dose package dispensing with patient counseling. Medication adherence levels were measured using a pill count and visual analog scale (VAS method at baseline and follow-up (after 1 month. Statistical Analysis: Descriptive statistics were used to represent the sociodemographic, clinical, and medication adherence profile of study participants. One-way ANOVA test is used to assess significant differences between three groups with a P 60 years who are on multiple medications can benefit from one-dose package dispensing and appropriate counseling. This will improve medication adherence hence better outcomes.

  4. Comparison of intensive care unit medication errors reported to the United States' MedMarx and the United Kingdom's National Reporting and Learning System: a cross-sectional study.

    Science.gov (United States)

    Wahr, Joyce A; Shore, Andrew D; Harris, Lindsay H; Rogers, Philippa; Panesar, Sukhmeet; Matthew, Linda; Pronovost, Peter J; Cleary, Kevin; Pham, Julius C

    2014-01-01

    The objective was to compare the characteristics of medication errors reported to 2 national error reporting systems by conducting a cross-sectional analysis of errors reported from adult intensive care units to the UK National Reporting and Learning System and the US MedMarx system. Outcome measures were error types, severity of patient harm, stage of medication process, and involved medications. The authors analyzed 2837 UK error reports and 56 368 US reports. Differences were observed between UK and US errors for wrong dose (44% vs 29%), omitted dose (8.6% vs 27%), and stage of medication process (prescribing: 14% vs 49%; administration: 71% vs 42%). Moderate/severe harm or death was reported in 4.9% of UK versus 3.4% of US errors. Gentamicin was cited in 7.4% of the UK versus 0.7% of the US reports (odds ratio = 9.25). There were differences in the types of errors reported and the medications most often involved. These differences warrant further examination.

  5. CAN INITIAL βHCG VALUES PREDICT THE NEED FOR SECOND DOSE OF METHOTREXATE IN MEDICAL MANAGEMENT OF ECTOPIC PREGNANCY?

    Directory of Open Access Journals (Sweden)

    Priya Narayanan

    2016-09-01

    Full Text Available INTRODUCTION Prediction of requirement of second dose of methotrexate in patients treated with single dose would help in guiding treatment and counseling. The aim of this study is to determine whether pretreatment beta HCG values can predict the need for second dose of methotrexate in medically managed ectopic pregnancy. MATERIALS AND METHODS 46 women with ectopic pregnancies who were managed medically were included. The median of beta HCG titres on day 1, day 4 and day 7 was assessed in patients who responded to single dose methotrexate and those who required a second dose. RESULTS Out of the 46 patients studied, 41 responded to medical treatment (success 91%. 14 out of 41 required second dose of methotrexate (34%. Two patients required third dose of methotrexate. Five patients required surgery. DISCUSSION The median of day 1 and day 4 beta HCG values were not statistically different between those who responded to single dose methotrexate and those who required a second dose. Only day 7 values were found to be different. CONCLUSION The beta-hCG titre on day 1 and day 4 is not a predictor of requirement of second dose of methotrexate.

  6. Automating and estimating glomerular filtration rate for dosing medications and staging chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Trinkley KE

    2014-05-01

    Full Text Available Katy E Trinkley,1 S Michelle Nikels,2 Robert L Page II,1 Melanie S Joy11Skaggs School of Pharmacy and Pharmaceutical Sciences, 2School of Medicine, University of Colorado, Aurora, CO, USA Objective: The purpose of this paper is to serve as a review for primary care providers on the bedside methods for estimating glomerular filtration rate (GFR for dosing and chronic kidney disease (CKD staging and to discuss how automated health information technologies (HIT can enhance clinical documentation of staging and reduce medication errors in patients with CKD.Methods: A nonsystematic search of PubMed (through March 2013 was conducted to determine the optimal approach to estimate GFR for dosing and CKD staging and to identify examples of how automated HITs can improve health outcomes in patients with CKD. Papers known to the authors were included, as were scientific statements. Articles were chosen based on the judgment of the authors.Results: Drug-dosing decisions should be based on the method used in the published studies and package labeling that have been determined to be safe, which is most often the Cockcroft–Gault formula unadjusted for body weight. Although Modification of Diet in Renal Disease is more commonly used in practice for staging, the CKD–Epidemiology Collaboration (CKD–EPI equation is the most accurate formula for estimating the CKD staging, especially at higher GFR values. Automated HITs offer a solution to the complexity of determining which equation to use for a given clinical scenario. HITs can educate providers on which formula to use and how to apply the formula in a given clinical situation, ultimately improving appropriate medication and medical management in CKD patients.Conclusion: Appropriate estimation of GFR is key to optimal health outcomes. HITs assist clinicians in both choosing the most appropriate GFR estimation formula and in applying the results of the GFR estimation in practice. Key limitations of the

  7. Report of the Nuclear Energy Agency expert group on gut transfer factors: implications for dose per unit intake

    International Nuclear Information System (INIS)

    1988-01-01

    This note describes the gut transfer factors recommended by an Expert Group of the Nuclear Energy Agency for intakes of certain important elements in food and drinking water. The evidence behind the recommendations is discussed and their implications for dose per unit intake is investigated. It is found that in many cases the dose per unit intake calculated using the gut uptake factor recommended by the Expert Group is similar to that calculated using the recommendations of ICRP Publication 30. However, in some cases there are substantial increases in dose per unit intake. The largest increases are by a factor of fifty for intakes of certain thorium isotopes by infants. (author)

  8. Radiation dose reduction in a neonatal intensive care unit in computed radiography.

    Science.gov (United States)

    Frayre, A S; Torres, P; Gaona, E; Rivera, T; Franco, J; Molina, N

    2012-12-01

    The purpose of this study was to evaluate the dose received by chest x-rays in neonatal care with thermoluminescent dosimetry and to determine the level of exposure where the quantum noise level does not affect the diagnostic image quality in order to reduce the dose to neonates. In pediatric radiology, especially the prematurely born children are highly sensitive to the radiation because of the highly mitotic state of their cells; in general, the sensitivity of a tissue to radiation is directly proportional to its rate of proliferation. The sample consisted of 208 neonatal chest x-rays of 12 neonates admitted and treated in a Neonatal Intensive Care Unit (NICU). All the neonates were preterm in the range of 28-34 weeks, with a mean of 30.8 weeks. Entrance Surface Doses (ESD) values for chest x-rays are higher than the DRL of 50 μGy proposed by the National Radiological Protection Board (NRPB). In order to reduce the dose to neonates, the optimum image quality was achieved by determining the level of ESD where level noise does not affect the diagnostic image quality. The optimum ESD was estimated for additional 20 chest x-rays increasing kVp and reducing mAs until quantum noise affects image quality. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Dose mapping in working space of KORI unit 1 using MCNPX code

    Energy Technology Data Exchange (ETDEWEB)

    Lee, C. W.; Shin, C. H.; Kim, J. G. [Hanyang University, Seoul (Korea, Republic of); Kim, S. Y. [Innovative Techonology Center for Radiation Safety, Seoul (Korea, Republic of)

    2004-07-01

    Radiation field analysis in nuclear power plant mainly depends on actual measurements. In this study, the analysis using computational calculation is performed to overcome the limits of measurement and provide the initial information for unfolding. The radiation field mapping is performed, which makes it possible to analyze the trends of the radiation filed for whole space. By using MCNPX code, containment building inside is modeled for KORI unit 1 cycle 21 under operation. Applying the neutron spectrum from the operating reactor as a radiation source, the ambient doses are calculated in the whole space, containment building inside, for neutron and photon fields. Dose mapping is performed for three spaces, 6{approx}20, 20{approx}44, 44{approx}70 ft from bottom of the containment building. The radiation distribution in dose maps shows the effects from structures and materials of components. With this dose maps, radiation field analysis contained the region near the detect position. The analysis and prediction are possible for radiation field from other radiation source or operating cycle.

  10. Pre-sterilization contamination of disposable medical products and the choice of minimum sterilization dose

    International Nuclear Information System (INIS)

    Horakova, V.; Buriankova, E.

    1975-01-01

    The bacterial contamination was assessed on randomly taken samples of blood-transfusion devices, donor sets, intra-uterine contraceptive devices and inserters, surgical gloves and dressing material prior to sterilization. The quantitative and qualitative efficiency of six nutrient media was compared. The best results were obtained with the enriched ''Universal'' medium. It was confirmed that the contamination of plastic products was low compared with dressing material. Most frequently, Gram-positive aerobic spore-forming rods and Gram-positive cocci were found on non-sterile medical disposable products. A method was tested to obtain a general informative picture of the resistance of bacteria on products. The methods used for choosing the dose for radiation sterilization of medical products are discussed. (author)

  11. Cytogenetic analysis for radiation dose assessment in the medical nuclear workers

    International Nuclear Information System (INIS)

    Milacic, S.; Jovicic, D.; Rakic, B.; Djokovic, J.

    2009-01-01

    Radionuclide is used in medicine for laboratory research, laboratory testing for enzymes, hormones, medicines in vitro and in vivo in nuclear medicine (NM) for the diagnosis and treatment of diseases. Commissioners, who performed the application radionuclide (RN), are nuclear medicine specialists, senior medical and radiological technicians, nurses and laboratory technicians. They are daily exposed to ionizing irradiations, from outside sources, as well as inside if they were to contamination. Medical nuclear workers (MNW) are exposed to ionizing irradiation, working with radio nuclides. MNW are periodically reviewed for contamination verified. Cytogenetic analysis of peripheral-blood lymphocytes (Ly) is the most sensitive tests for detecting a clinical biologic response to ionizing radiation. The frequency of chromosomal aberrations (f ca) in peripheral circulating lymphocytes (Ly) correlates with the dose received. (author) [sr

  12. A program on quality assurance and dose calibration for radiation therapy units in Venezuela

    International Nuclear Information System (INIS)

    Padilla, M.C. de; Carrizales, L.; Diaz, J.; Gutt, F.; Cozman, A.

    1996-01-01

    The results of a five year program (1988-90-91-92-93) on quality assurance and dose calibration for 12 Cobalt-60 units from public hospitals, which represents 30% of total radiation therapy units in Venezuela, are presented. The remarkable improvement in the general performance of these units can be seen in the IAEA/WHO Postal TLD Intercomparison results which gave 100% within ± 5% in 1990 and 1992, while 63% in 1990 and 44% in 1992, with errors up to 37% were obtained for the participants not included in the program. The difference between the two groups lead the government to decrete through the Gaceta Oficial de la Republica de Venezuela, Resolution G-1397 on March 3, 1993, the quality assurance and dose calibration programs shall be established for all radiation therapy installations in Venezuela. The project for the standards was developed by the SSDL physicists and it was already approbated by the Health Ministry. It is expected that the Norms will enter into effect by the end of 1994. (author). 14 refs, 1 fig., 3 tabs

  13. A program on quality assurance and dose calibration for radiation therapy units in Venezuela

    Energy Technology Data Exchange (ETDEWEB)

    Padilla, M.C. de; Carrizales, L; Diaz, J; Gutt, F; Cozman, A [Instituto Venezolano de Investigaciones Cientificas, Caracas (Venezuela). Lab. de Calibracion Dosimetrica

    1996-08-01

    The results of a five year program (1988-90-91-92-93) on quality assurance and dose calibration for 12 Cobalt-60 units from public hospitals, which represents 30% of total radiation therapy units in Venezuela, are presented. The remarkable improvement in the general performance of these units can be seen in the IAEA/WHO Postal TLD Intercomparison results which gave 100% within {+-} 5% in 1990 and 1992, while 63% in 1990 and 44% in 1992, with errors up to 37% were obtained for the participants not included in the program. The difference between the two groups lead the government to decrete through the Gaceta Oficial de la Republica de Venezuela, Resolution G-1397 on March 3, 1993, the quality assurance and dose calibration programs shall be established for all radiation therapy installations in Venezuela. The project for the standards was developed by the SSDL physicists and it was already approbated by the Health Ministry. It is expected that the Norms will enter into effect by the end of 1994. (author). 14 refs, 1 fig., 3 tabs.

  14. Individualized Dosing of Children’s Liquid Medications in the Community Pharmacy Setting: A Survey of Parents and Guardians

    Directory of Open Access Journals (Sweden)

    Lingxiao Zhai, MS

    2013-01-01

    Full Text Available Objectives: 1 To determine parents’ and/or guardians’ interest in having pharmacists provide children’s liquid medications in a pre-measured, individualized dosing device 2 To assess parents’ and/or guardians’ perception of dosing liquid medications for a child. Design: Observational survey Setting: Regional chain pharmacy in North Carolina Participants: > 18 years old, parent/guardian of a child <13 who had prescription filled for liquid medication within the pharmacy chain, responsible for administering child’s liquid medication Intervention: 14 item questionnaire Main Outcome Measure: Interest in pharmacists providing children’s liquid medications in pre-measured, individualized dosing devices Results: 250 questionnaires were mailed; 42 were marked “return to sender” (16.8%, 22 were returned completed (10.6%, and 20 of the 22 met inclusion criteria (9.6%. 95% of study participants reported being interested in having pharmacists provide children’s liquid medications in the proposed dosing device, and 40% were willing to pay for such a service. 90% of respondents reported it is “not at all difficult” to understand the amount of dose a child is to receive, while 55% reported it is “not at all difficult” to measure doses. 25% of respondents reported sometimes using a kitchen spoon to measure a child’s medication. Conclusion: Community pharmacists should explore providing children’s liquid medications in an individualized dosing device, as study results determined parents are interested in and willing to pay for the theoretical device. Further large-scale studies would be beneficial in determining interest in and willingness to pay for the dosing device in various pharmacy settings nationwide.

  15. Morbidity rate of nervous system among medical personnel occupationally exposed to chronic low dose irradiation

    International Nuclear Information System (INIS)

    Jonkova, A.

    1987-01-01

    The morbidity rate of the nervous system among 1190 subjects, medical personnel, working with sources and environment of ionizing radiation was studied by the personal analysis of the diseases, written down in the personal out-patient department cards as well as of a control group of 870 medical workers of various other specialities. The morbidity rate of the nervous system among the medical personnel, exposed to chronic occupational radiation effect, was established not to be higher than that of the other medical workers - 38.0 and 40.3% respectively. Neuroses and peripheral nervous diseases have the greatest relative share in the structure of morbidity rate of the nervous system in both groups examined, with no statistical significance in the differences of the indices. The significantly higher incidence of autonome dystonias, established among the personnel from the X-ray departments and consulting rooms could be discussed in connection with the great relative share of the subjects from that group with a length of service over 15 years and had received the possible maximum cumulative equivalent doses. 3 tabs., 21 refs

  16. Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

    2014-01-01

    Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

  17. [Diagnosis and the technology for optimizing the medical support of a troop unit].

    Science.gov (United States)

    Korshever, N G; Polkovov, S V; Lavrinenko, O V; Krupnov, P A; Anastasov, K N

    2000-05-01

    The work is devoted to investigation of the system of military unit medical support with the use of principles and states of organizational diagnosis; development of the method allowing to assess its functional activity; and determination of optimization trends. Basing on the conducted organizational diagnosis and expert inquiry the informative criteria were determined which characterize the stages of functioning of the military unit medical support system. To evaluate the success of military unit medical support the complex multi-criteria pattern was developed and algorithm of this process optimization was substantiated. Using the results obtained, particularly realization of principles and states of decision taking theory in machine program it is possible to solve more complex problem of comparison between any number of military units: to dispose them according to priority decrease; to select the programmed number of the best and worst; to determine the trends of activity optimization in corresponding medical service personnel.

  18. Survey of radiation doses received by atomic-bomb survivors residing in the United States

    International Nuclear Information System (INIS)

    Kerr, G.D.; Yamada, H.; Marks, S.

    1976-01-01

    A survey has been completed of 300 of an estimated 500 to 750 survivors of the atomic bombings in Hiroshima and Nagasaki who reside in the United States. Distributions with respect to age, sex, citizenship status, distance from the hypocenter at the time of bombing, and dose from immediate weapon radiation have been tabulated from the results and are presented for this group of 300 survivors. Also presented are survey results concerning exposures to residual radiation from fallout and neutron-induced radioactivity in the areas adjacent to the hypocenter

  19. Evaluation of mean glandular dose in a full-field digital mammography unit in Tabriz (IR)

    International Nuclear Information System (INIS)

    Riabi, H. A.; Mehnati, P.; Mesbahi, A.

    2010-01-01

    This study was aimed at evaluating the mean glandular dose (MGD) and affecting factors during mammography examinations by a full-field digital mammography unit. An extensive quality control program was performed to assure that the unit is properly working. Required information including compressed breast thickness (CBT), breast parenchymal pattern and technical factors used for imaging were recorded. An entrance skin exposure measurement was also performed using slabs of polymethylmethacrylate with 2-8 cm thickness. On the basis of recorded information and measured data, the MGD was estimated for 1145 mammography examinations obtained from 298 patients. Mean CBTs of 4.9 and 5.8 cm and MGDs of 2 and 2.4 mGy were observed for cranio-caudal and medio-lateral oblique views, respectively. Significant correlation was seen between MGD and CBT, breast parenchymal pattern and applied kVp and mAs. (authors)

  20. Public Health England survey of eye lens doses in the UK medical sector

    International Nuclear Information System (INIS)

    Ainsbury, E A; Bouffler, S; Gilvin, P; Peters, S; Slack, K; Cocker, M; Holt, E; Williamson, A

    2014-01-01

    The ICRP has recently recommended that the occupational exposure limit for the lens of the eye be reduced to 20 mSv in a year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv. There has been concern amongst some groups of individuals, particularly interventional cardiologists and radiologists as well as relevant professional bodies, that implementation of these recommendations into UK law will adversely affect working patterns. However, despite a number of informative European studies, there is currently little UK dosimetry data available upon which judgements can effectively be based. In order to address this knowledge gap, Public Health England has carried out a small, targeted survey of UK lens doses to medical staff undertaking procedures likely to involve the highest levels of radiation exposure. Two out of a total of 61 individuals surveyed had projected annual doses which could be close to 20 mSv, measured outside lead glasses. Use of protective equipment was generally good; however, lead glasses were only used by 9 participants. The results of this survey suggest that compliance with the ICRP recommendations is likely to be possible for most individuals in the UK medical sector. (paper)

  1. Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts' Recommendations

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available The objective of this article was to determine the current practice on amikacin dosing and monitoring in spinal cord injury patients from spinal cord physicians and experts. Physicians from spinal units and clinical pharmacologists were asked to provide protocol for dosing and monitoring of amikacin therapy in spinal cord injury patients. In a spinal unit in Poland, amikacin is administered usually 0.5 g twice daily. A once-daily regimen of amikacin is never used and amikacin concentrations are not determined. In Belgium, Southport (U.K., Spain, and the VA McGuire Medical Center (Richmond, Virginia, amikacin is given once daily. Whereas peak and trough concentrations are determined in Belgium, only trough concentration is measured in Southport. In both these spinal units, modification of the dose is not routinely done with a nomogram. In Spain and the VA McGuire Medical Center, monitoring of serum amikacin concentration is not done unless a patient has renal impairment. In contrast, the dose/interval of amikacin is adjusted according to pharmacokinetic parameters at the Edward Hines VA Hospital (Hines, Illinois, where amikacin is administered q24h or q48h, depending on creatinine clearance. Spinal cord physicians from Denmark, Germany, and the Kessler Institute for Rehabilitation (West Orange, New Jersey state that they do not use amikacin in spinal injury patients. An expert from Canada does not recommend determining serum concentrations of amikacin, but emphasizes the value of monitoring ototoxicity and nephrotoxicity. Experts from New Zealand recommend amikacin in conventional twice- or thrice-daily dosing because of the theoretical increased risk of neuromuscular blockade and apnea with larger daily doses in spinal cord injury patients. On the contrary, experts from Greece, Israel, and the U.S. recommend once-daily dosing and determining amikacin pharmacokinetic parameters for each patient. As there is considerable variation in clinical

  2. Individualized Dosing of Children's Liquid Medications in the Community Pharmacy Setting: A Survey of Parents and Guardians

    Directory of Open Access Journals (Sweden)

    Jamie Shelly

    2013-01-01

    Full Text Available Objectives: 1 To determine parents' and/or guardians' interest in having pharmacists provide children's liquid medications in a pre-measured, individualized dosing device 2 To assess parents' and/or guardians' perception of dosing liquid medications for a child. Design: Observational survey Setting: Regional chain pharmacy in North Carolina Participants: > 18 years old, parent/guardian of a childchain, responsible for administering child's liquid medication Intervention: 14 item questionnaire Main Outcome Measure: Interest in pharmacists providing children's liquid medications in pre-measured, individualized dosing devices Results: 250 questionnaires were mailed; 42 were marked "return to sender" (16.8%, 22 were returned completed (10.6%, and 20 of the 22 met inclusion criteria (9.6%. 95% of study participants reported being interested in having pharmacists provide children's liquid medications in the proposed dosing device, and 40% were willing to pay for such a service. 90% of respondents reported it is "not at all difficult" to understand the amount of dose a child is to receive, while 55% reported it is "not at all difficult" to measure doses. 25% of respondents reported sometimes using a kitchen spoon to measure a child's medication. Conclusion: Community pharmacists should explore providing children's liquid medications in an individualized dosing device, as study results determined parents are interested in and willing to pay for the theoretical device. Further large-scale studies would be beneficial in determining interest in and willingness to pay for the dosing device in various pharmacy settings nationwide.   Type: Original Research

  3. Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD.

    Science.gov (United States)

    Surana, Sikander; Kumar, Neeru; Vasudeva, Amita; Shaikh, Gulvahid; Jhaveri, Kenar D; Shah, Hitesh; Malieckal, Deepa; Fogel, Joshua; Sidhu, Gurwinder; Rubinstein, Sofia

    2017-01-17

    Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted. The overall pattern for all post-graduate year (PGY) groups in all medication classes was a lack of awareness and knowledge. For awareness, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, endocrine, gastrointestinal, and rheumatologic medication classes but not for analgesic, cardiovascular, and neuropsychotropic medication classes. For knowledge, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, cardiovascular, endocrine, and gastrointestinal, medication classes but not for analgesic, neuropsychotropic, and rheumatologic medication classes. Internal Medicine house-staff across all levels of training demonstrated poor awareness and knowledge for many medication classes in CKD patients. Internal Medicine house-staff should receive more nephrology exposure and formal didactic educational training during residency to better manage complex treatment regimens and prevent medication dosing errors.

  4. Concentrations of amoxicillin and clindamycin in teeth following a single dose of oral medication.

    Science.gov (United States)

    Schüssl, Yvonne; Pelz, Klaus; Kempf, Jürgen; Otten, Jörg-Elard

    2014-01-01

    The main purpose of this study is the detection of amoxicillin and clindamycin concentrations in teeth. Eleven patients received 2 g of amoxicillin, and 11 patients received 600 mg of clindamycin in a single dose of oral medication at least 60 min prior to tooth extraction due to systemic diseases. The concentrations were determined in crowns and roots separately using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Amoxicillin (13 samples) and clindamycin (12 samples) were detected in the samples of the root and crown preparations of the extracted teeth. The mean concentration of amoxicillin was 0.502 μg/g in the roots and 0.171 μg/g in the crowns. The mean concentration of clindamycin was 0.270 μg/g in the roots and 0.064 μg/g in the crowns. A single dose of oral amoxicillin and clindamycin leads to concentrations of both antibiotics in teeth which exceed the minimal inhibition concentration of some oral bacteria. The proof of antibacterial activity in dental hard tissue after oral single-dose application is new. The antimicrobial effect of amoxicillin and clindamycin concentrations in roots of teeth may be of clinical relevance to bacterial reinfection from dentinal tubules.

  5. Medical abortion practices : a survey of National Abortion Federation members in the United States

    NARCIS (Netherlands)

    Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

    2008-01-01

    Background: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation

  6. Medical abortion practices: a survey of National Abortion Federation members in the United States

    NARCIS (Netherlands)

    Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

    2008-01-01

    Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members

  7. Aspects of medical migration with particular reference to the United Kingdom and the Netherlands

    NARCIS (Netherlands)

    Herfs, Paulus

    2014-01-01

    Background In most countries of the European Economic Area (EEA), there is no large-scale migration of medical graduates with diplomas obtained outside the EEA, which are international medical graduates (IMGs). In the United Kingdom however, health care is in part dependent on the influx of IMGs. In

  8. Using evidence to improve satisfaction with medication side-effects education on a neuro-medical surgical unit.

    Science.gov (United States)

    Ahrens, Susan L; Wirges, Ashley M

    2013-10-01

    Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.

  9. Increase of doses delivered to patients during medical imagery examinations. Conclusions of 16 September 2010 seminar organized by the ASN

    International Nuclear Information System (INIS)

    2011-01-01

    This document reports the contributions of the participants to the seminar which aimed at discussing the increase of doses delivered in medical imagery, and the actions to undertake to limit this increase. The authors recall the regulatory and legal context regarding the optimization of medical procedures and the organisation of radiation protection for medical exposures, comment the assessment of exposures by medical imagery in 2007, comment the CE marking of medical devices, the recent evolutions in dose optimization of radiology and scanography devices. Other sets of interventions address the application of the justification and optimization principle by professionals (in new scanography practices, in radio-paediatrics), the professional training issue (radiologist continuous training, electro-radiology operator training), the comparison between scanner and RMI (new fields for RMI, imagery benchmark), the assessment of professional practices (tools for continuous professional development of health professionals, medical imagery initiatives in Belgium), and international recommendations (by the IAEA, the WHO, the European Union)

  10. Evaluation of the population dose due to the gaseous emission of a radioisotopes production unit

    International Nuclear Information System (INIS)

    Gordon, A.M.P.L.; Jacomino, V.M.F.; Sordi, G.-M.A.A.

    1990-05-01

    In order to control the emission of gaseous radioactive iodine from the unit responsible for the production of radioisotopes of IPEN-CNEN/SP, a discharge monitoring is carried out. In 1988 an activity of 65 GBq of I-131 was discharged to the environment. Based upon this value and the site analysis, the effective equivalent dose in the general public was evaluated for normal operation and for an incidental discharge. The evaluation was carried out by using a diffusion atmospheric model, 500 to 7000 m away from the discharge point and using 8 different wind direction sectors. The critical group was identified as being the people who lives 3000 m far from the discharge point, in the diffusion sector NW. The dose evaluated at this point is 10 9 times lower than the annual dose limit for individual of the public, according to Radiological Protection Standards. The derived limit for discharge of iodine was also evaluated and it was concluded that the IPEN-CNEN/SP can increase their production up to a level which results in an annual discharge of 1,5 x 10 12 of I-131. (author) [pt

  11. 'Dose per unit content' functions: A robust tool for the interpretation of bioassay data

    International Nuclear Information System (INIS)

    Berkovski, V.; Bonchuk, Y.; Ratia, G.

    2003-01-01

    The purposes of this study were to investigate the influence of the consequences of the lack of primary bioassay information and to elaborate approaches which could improve the reliability of dose assessments. The aggregated time-dependent functions 'dose per unit organ (excretion) content' z(t) have been proposed in this study as a convenient and reliable tool for bioassay. The analysis of the variation of z with changes of AMAD has demonstrated the existence of areas of the relative invariance of z, which permits the selection of one (reference) function z for the whole area of stability. Within the framework of such an approach an arbitrary set of bioassay data can be approximated by the linear combination F(t) S i E/ i z(t-t i ), whereI> F(t) function of time t, which approximates the observed bioassay time trend; t i = time shift of the acute intake i; E i effective dose, associated with the acute intake i (the two last parameters are results of the approximation procedure). (author)

  12. Measuring instruments of the Physikalisch-Technische Bundesanstalt for realization of the units of the dosimetric quantities standard ion dose, photon-equivalent dose and air-kerma

    International Nuclear Information System (INIS)

    Engelke, B.A.; Oetzmann, W.; Struppek, G.

    1988-08-01

    The realization of the units of the dosimetric quantities exposure, air-kerma and photon-equivalent dose is an important task of the Physikalisch-Technische Bundesanstalt. The report describes the measuring instruments and other technical equipment as well as the determination of the numerous corrections needed. All data and correction factors required for the realization of the units mentioned above are given in many diagrams and tables. (orig.) [de

  13. Equivalent doses of ionizing radiation received by medical staff at a nuclear medicine department

    International Nuclear Information System (INIS)

    Dziuk, E.; Kowalczyk, A.; Siekierzynski, M.; Jazwinski, J.; Chas, J.; Janiak, M.K.; Palijczuk, D.

    2002-01-01

    Aim: Total annual activity of I-131 used for the treatment of thyroid disorders at the Dept.of Nuclear Medicine, Central Clinical Hospital, Military University School of Medicine, in Warsaw, Poland, equal to 190 GBq; at the same time, total activity of Tc-99m utilized at the same Department for diagnostic purposes reached 1 TBq. As estimated from the radiometer readings, in extreme cases the equivalent at a couple of measurement points at this Department may exceed 200 mSv per year. Thus, in the present study we aimed to assess the potential risk of the exposure of medical personnel of the Department to ionizing radiation. Material and Methods: Polymethacrylate cases each housing four thermoluminescent dosimeters were continuously worn for one year by the nurses and doctors with the dosimeters being replaced by the new ones every three months. In addition, cases containing thermoluminescent dosimeters (three dosimeters per case) were placed in 20 different measurement points across the Department and the monitoring of the doses was carried out continuously for more than six years (from May 1995 to March 2002). Based on the quarterly readings of the dosimeters, equivalent doses were calculated for both the members of the personnel and the measurement space points. Results: The doses registered in the patient rooms ranged 5 to 90 mSv x y -1 , in the application room 10 to 15 mSv x y -1 , in the laboratory rooms 1.5 to 30 mSv x y -1 , and in the waiting room 2 to 6 mSv x y -1 ; no increment above the background level was detected in the nurses' station. Accordingly, the annual doses calculated from the dosimeters worn by the staff ranged 0.2 to 1.1 mSv x y -1 ; these latter findings were confirmed by direct readings from individual film dosimeters additionally worn by the staff members. Conclusion: The obtained results indicate that it is unlikely for the personnel of the monitored Nuclear Medicine Department to receive doses of radiation exceeding 40% of the annual

  14. Radiation doses to patients in medical diagnostic x-ray examinations in New Zealand: a 1983-84 survey

    International Nuclear Information System (INIS)

    Williamson, B.D.P.; Poletti, J.L.; Cartwright, P.H.; Le Heron, J.C.

    1993-06-01

    A survey of doses to patients undergoing diagnostic x-ray examinations was performed in 1983-84. Developments since 1983-84 were reviewed and estimates made of the frequency of x-ray examinations, and doses to patients, as at 1992. The collective effective dose from general medical diagnostic radiology in 1983-84 was estimated to have been about 443 μSv per capita per annum. The figure excluded computed tomography which was estimated to have contributed about 5.6 μSv per capita per annum and mammography gave 0.3 μSv per annum. The total per capital effective dose from all medical diag over the whole period from 1983-84 to 1992. The highest dose examinations in 1983-84 were the fluoroscopic procedures barium enema and meal. Over the whole period 1983-84 to 1992 the genetically significant dose (GSD) to the population of New Zealand from medical diagnostic radiology was estimated to have been in the range 200-250 μSv per capita per annum. The two opposing tendencies noted for effective dose, viz, the fall in frequency of some examination types and the rise of Computed tomography, acted also upon this dose index. 43 refs., tabs., figs., ills

  15. High dose rate brachytherapy for medically inoperable stage I endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Petereit, Daniel G; Sarkaria, Jann N; Schink, Julian; Springman, Scott R; Kinsella, Timothy J; Buchler, Dolores A

    1995-07-01

    Purpose/Objective: To determine the efficacy of high dose rate (HDR) brachytherapy in patients with medically inoperable endometrial cancer clinically confined to the corpus. Materials and Methods: Forty-two patients with endometrial cancer and an intact uterus have been treated since 1989 with HDR brachytherapy. Twenty-six patients with medically inoperable Stage I disease were treated with radiation alone and form the basis of this study. Obesity was assessed using the body mass index (BMI kg/m{sup 2}) scale. Patients with a BMI above 28 were considered obese and those above 35 morbidly obese, per standard anesthesia guidelines. Brachytherapy was delivered in 5 HDR insertions, 1 week apart, without any external beam radiation. The following doses were delivered per insertion: 5.7 Gy to point S, 7.0 Gy to point W, 8.2 Gy to the vaginal surface and 9.2 Gy to point M. Point M represents the conventional point A dose, while points S and W are myometrial points. A single tandem with either ovoids or cylinders was placed, unless the uterine cavity would accommodate 2 tandems. All treatments were outpatient using intravenous fentanyl and midazolam for sedation. Pelvic ultrasound was commonly used at the time of brachytherapy to verify tandem placement. Three year clinical endpoints were calculated using the Kaplan Meier method. Results: The median follow-up for the study cohort was 21 months with follow-up greater than 36 months in 11 patients. Seventeen of the 26 patients were inoperable due to morbid obesity (median weight and BMI; 316 lbs and 55 kg/m{sup 2}, respectively); the other patients had poor cardiopulmonary reserve {+-} obesity. The median age, KPS (Karnofsky Performance Status), weight, ASA (American Society of Anesthesiologists' Physical Class System) and BMI were 63 yrs, 80%, 285 lbs, 3 and 49 kg/m{sup 2}, respectively. Two patients with an ASA of 3 and 4 died from acute cardio-pulmonary events within 30 days of the last insertion, emphasizing the need

  16. High dose rate brachytherapy for medically inoperable stage I endometrial cancer

    International Nuclear Information System (INIS)

    Petereit, Daniel G.; Sarkaria, Jann N.; Schink, Julian; Springman, Scott R.; Kinsella, Timothy J.; Buchler, Dolores A.

    1995-01-01

    Purpose/Objective: To determine the efficacy of high dose rate (HDR) brachytherapy in patients with medically inoperable endometrial cancer clinically confined to the corpus. Materials and Methods: Forty-two patients with endometrial cancer and an intact uterus have been treated since 1989 with HDR brachytherapy. Twenty-six patients with medically inoperable Stage I disease were treated with radiation alone and form the basis of this study. Obesity was assessed using the body mass index (BMI kg/m 2 ) scale. Patients with a BMI above 28 were considered obese and those above 35 morbidly obese, per standard anesthesia guidelines. Brachytherapy was delivered in 5 HDR insertions, 1 week apart, without any external beam radiation. The following doses were delivered per insertion: 5.7 Gy to point S, 7.0 Gy to point W, 8.2 Gy to the vaginal surface and 9.2 Gy to point M. Point M represents the conventional point A dose, while points S and W are myometrial points. A single tandem with either ovoids or cylinders was placed, unless the uterine cavity would accommodate 2 tandems. All treatments were outpatient using intravenous fentanyl and midazolam for sedation. Pelvic ultrasound was commonly used at the time of brachytherapy to verify tandem placement. Three year clinical endpoints were calculated using the Kaplan Meier method. Results: The median follow-up for the study cohort was 21 months with follow-up greater than 36 months in 11 patients. Seventeen of the 26 patients were inoperable due to morbid obesity (median weight and BMI; 316 lbs and 55 kg/m 2 , respectively); the other patients had poor cardiopulmonary reserve ± obesity. The median age, KPS (Karnofsky Performance Status), weight, ASA (American Society of Anesthesiologists' Physical Class System) and BMI were 63 yrs, 80%, 285 lbs, 3 and 49 kg/m 2 , respectively. Two patients with an ASA of 3 and 4 died from acute cardio-pulmonary events within 30 days of the last insertion, emphasizing the need for accurate pre

  17. Assessing Interprofessional Teamwork in Inpatient Medical Oncology Units.

    Science.gov (United States)

    Weaver, A Charlotta; Callaghan, Mary; Cooper, Abby L; Brandman, James; O'Leary, Kevin J

    2015-01-01

    Teamwork is important to providing safe and effective care for hospitalized patients with cancer; however, few studies have evaluated teamwork in this setting. We surveyed all nurses, residents, hospitalists, and oncology physicians in oncology units at a large urban teaching hospital from September to November 2012. Respondents rated teamwork using a validated instrument (Safety Attitudes Questionnaire; scale, 0 to 100) and rated the quality of collaboration they had experienced with other professionals using a 5-point ordinal response scale (1, very low quality; 5, very high quality). Respondents also rated potential barriers to collaboration using a 4-point ordinal response scale (1, not at all a barrier; 4, major barrier). We compared ratings by professionals using analysis of variance (ANOVA). Overall, 129 (67%) of 193 eligible participants completed the survey. Teamwork scores differed across professional types, with nurses providing the lowest ratings (69.7) and residents providing the highest (81.9; ANOVA P = .01). Ratings of collaboration with nurses were high across all types of professionals. Ratings of collaboration with physicians varied significantly by professional type (P ≤ .02), with nurses giving lower ratings of collaboration with all physician types. Similarly, perceived barriers to collaboration differed by professional type, with nurses perceiving the biggest barrier to be negative attitudes regarding the importance of communication. Oncologists did not perceive any of the listed options as major barriers to collaboration. In inpatient oncology units, discrepancies exist between nurses' and physicians' ratings of teamwork and collaboration. Oncologists seem to be unaware that teamwork is suboptimal in this setting. Copyright © 2015 by American Society of Clinical Oncology.

  18. Clinical neuro-oncology formal education opportunities for medical students in the United States and Canada.

    Science.gov (United States)

    Dixit, Karan S; Nicholas, Martin Kelly; Lukas, Rimas V

    2014-12-01

    To develop an understanding of the availability of the formal clinical neuro-oncology educational opportunities for medical students. The curriculum websites of all medical schools accredited by the Liaison Committee on Medical Education were reviewed for the presence of clinical neuro-oncology electives as well as other relevant data. Ten (6.8%) of medical schools accredited by the Liaison Committee on Medical Education offer formal neuro-oncology electives. Half are clustered in the Midwest. Forty percent are at institutions with neuro-oncology fellowships. All are at institutions with neurosurgery and neurology residency programs. Formal clinical neuro-oncology elective opportunities for medical students in the United States and Canada are limited. Additional such opportunities may be of value in the education of medical students. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization

    Directory of Open Access Journals (Sweden)

    Agnus M. Kim

    2016-07-01

    Full Text Available Objectives: We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts and new areal units organized based on the actual health care use of the population in Korea. Methods: To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. Results: Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. Conclusions: Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

  20. [Medication reconciliation: an innovative experience in an internal medicine unit to decrease errors due to inacurrate medication histories].

    Science.gov (United States)

    Pérennes, Maud; Carde, Axel; Nicolas, Xavier; Dolz, Manuel; Bihannic, René; Grimont, Pauline; Chapot, Thierry; Granier, Hervé

    2012-03-01

    An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation. We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance. Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant. The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  1. [Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

    Science.gov (United States)

    Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

    2009-01-01

    To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

  2. Diversity of United States medical students by region compared to US census data

    Directory of Open Access Journals (Sweden)

    Smith MM

    2015-05-01

    Full Text Available Mark M Smith,1 Steven H Rose,1 Darrell R Schroeder,2 Timothy R Long1 1Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA; 2Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA Purpose: Increasing the diversity of the United States (US physician workforce to better represent the general population has received considerable attention. The purpose of this study was to compare medical student race data to that of the US general population. We hypothesized that race demographics of medical school matriculants would reflect that of the general population. Patients and methods: Published race data from the United States Census Bureau (USCB 2010 census and the 2011 Association of American Medical Colleges (AAMC allopathic medical school application and enrollment by race and ethnicity survey were analyzed and compared. Race data of enrolled medical students was compared to race data of the general population within geographic regions and subregions. Additionally, race data of medical school applicants and matriculants were compared to race data of the overall general population. Results: Race distribution within US medical schools was significantly different than race distribution for the overall, regional, and subregional populations of the US (P<0.001. Additionally, the overall race distribution of medical school applicants differed significantly to the race distribution of the general population (P<0.001. Conclusion: This study demonstrated that race demographics of US medical school applicants and matriculants are significantly different from that of the general population, and may be resultant of societal quandaries present early in formal education. Initiatives targeting underrepresented minorities at an early stage to enhance health care career interest and provide academic support and mentorship will be required to address the racial disparity that exists in US

  3. Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series

    Directory of Open Access Journals (Sweden)

    Fligou Fotini

    2010-03-01

    Full Text Available Abstract Introduction Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. Case presentations Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. Conclusion In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.

  4. Key considerations for the success of Medical Education Research and Innovation units in Canada: unit director perceptions.

    Science.gov (United States)

    Varpio, Lara; Bidlake, Erin; Humphrey-Murto, Sue; Sutherland, Stephanie; Hamstra, Stanley J

    2014-08-01

    Growth in the field of medical education is evidenced by the proliferation of units dedicated to advancing Medical Education Research and Innovation (MERI). While a review of the literature discovered narrative accounts of MERI unit development, we found no systematic examinations of the dimensions of and structures that facilitate the success of these units. We conducted qualitative interviews with the directors of 12 MERI units across Canada. Data were analyzed using qualitative description (Sandelowski in Res Nurs Health 23:334-340, 2000). Final analysis drew on Bourdieu's (Outline of a theory of practice. Cambridge University Press, Cambridge, 1977; Media, culture and society: a critical reader. Sage, London, 1986; Language and symbolic power. Harvard University Press, Cambridge, 1991) concepts of field, habitus, and capital, and more recent research investigating the field of MERI (Albert in Acad Med 79:948-954, 2004; Albert et al. in Adv Health Sci Educ 12:103-115, 2007). When asked about the metrics by which they define their success, directors cited: teaching, faculty mentoring, building collaborations, delivering conference presentations, winning grant funding, and disseminating publications. Analyzed using Bourdieu's concepts, these metrics are discussed as forms of capital that have been legitimized in the MERI field. All directors, with the exception of one, described success as being comprised of elements (capital) at both ends of the service-research spectrum (i.e., Albert's PP-PU structure). Our analysis highlights the forms of habitus (i.e., behaviors, attitudes, demeanors) directors use to negotiate, strategize and position the unit within their local context. These findings may assist institutions in developing a new-or reorganizing an existing-MERI unit. We posit that a better understanding of these complex social structures can help units become savvy participants in the MERI field. With such insight, units can improve their academic output and

  5. Doses for various pathways to man based on unit concentrations of radionuclides pertinent to decontamination and decommissioning of properties

    International Nuclear Information System (INIS)

    Hill, G.S.

    1979-03-01

    This report gives dose tabulations for unit concentrations of radionuclides likely to be encountered in the decommissioning of real estate contaminated with uranium and thorium ores and residues. The reported doses may be ratioed to known air, soil, and water concentrations, exposure times, and intakes to estimate the total radiation dose for individuals exposed to the facilities. These dose estimates may be used in developing criteria to determine appropriate remedial actions for returning the properties to useful purposes and for establishing restrictions for such use

  6. Patient dose evaluations from medical X-ray exposure in Italy: an analysis of next data

    International Nuclear Information System (INIS)

    Marchetti, A.; Paganini, F.M.; Susanna, A.

    1980-01-01

    NEXT (Nationwide Evaluation of X-ray Trends) is a program for the evaluation of patient exposure in X-ray diagnostic tests. The program is aimed at reducing patient exposure by pin-pointing poor radiological techniques and improving them. CNEN (Comitato Nazionale per l'Energia Nucleare) and ISS (Istituto Superiore di Sanita) have been developing such a program in Italy since 1976. Up to now two regional administrations applied the method and regional operators collected the needed data in all the medical institutions in their areas. The results show a wide spread of values for all the parameters studied in the 12 X-ray projections selected. Gonad dose and skin entrance exposure were found to be spread over a range up to about two orders of magnitude. (H.K.)

  7. Bayesian Classifier for Medical Data from Doppler Unit

    Directory of Open Access Journals (Sweden)

    J. Málek

    2006-01-01

    Full Text Available Nowadays, hand-held ultrasonic Doppler units (probes are often used for noninvasive screening of atherosclerosis in the arteries of the lower limbs. The mean velocity of blood flow in time and blood pressures are measured on several positions on each lower limb. By listening to the acoustic signal generated by the device or by reading the signal displayed on screen, a specialist can detect peripheral arterial disease (PAD.This project aims to design software that will be able to analyze data from such a device and classify it into several diagnostic classes. At the Department of Functional Diagnostics at the Regional Hospital in Liberec a database of several hundreds signals was collected. In cooperation with the specialist, the signals were manually classified into four classes. For each class, selected signal features were extracted and then used for training a Bayesian classifier. Another set of signals was used for evaluating and optimizing the parameters of the classifier. Slightly above 84 % of successfully recognized diagnostic states, was recently achieved on the test data. 

  8. Staff eye doses in a large medical centre in Saudi Arabia: are they meeting the new ICRP recommendations?

    International Nuclear Information System (INIS)

    Al-Haj, Abdalla N.; Al-Gain, Ibrahim; Lobriguito, Aida M.

    2015-01-01

    A 5-y retrospective analysis of the cardiology staff eye doses was performed on 34 staff from different categories (cardiologists, nurses and technologists) at King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh, Saudi Arabia. KFSHRC is a tertiary medical centre with 800-bed capacity having more than 5000 cardiac catheterisation procedures performed annually. The aim of the study is to derive staff doses to the lens of the eyes using the personal dose equivalent Hp(0.07) values from the annual TLD dose report for the years 2008-2012 and determine the category of staff with high estimated eye doses. The study also aims to investigate the causes for high doses and recommend dose-reduction techniques. The dose to the lens of the eye was estimated by using the ratio Hp(0.07) slab /H lens of 1.1 where Hp(0.07) values are the reported doses read from TLD badge worn at the collar level. The average annual eye dose of each category for the 5-y monitoring period was determined. Cardiologists tend to receive higher doses than the nurses by a factor of 2-4 and can exceed 5 mSv y -1 . No correlation exists between the eye doses of nurses and the cardiologists. There is a need to use a conversion coefficient in terms of eye lens dose per dose-area product for faster estimation of eye lens doses. However, there is a limitation on the use of the conversion coefficient because it will depend on the clinical procedure and the X-ray tube angulation. Further investigation on this limitation is needed. (authors)

  9. On the risk to low doses (<100 mSv) of ionizing radiation during medical imaging procedures - IOMP policy statement

    International Nuclear Information System (INIS)

    Pradhan, A.S.

    2013-01-01

    The science committee of International Organization for Medical Physics (IOMP) developed a policy statement on the predictions of radiation-induced cancers and cancer deaths in patients exposed to low doses (<100 mSv) of ionizing radiation during medical imaging; this statement has been approved by the IOMP council. In order to attract the attention of medical physicists, an editorial (1) titled 'Risk of Medical Imaging' that includes the said statement has recently been published in Medical Physics journal of American Association of Physicists in Medicine (AAPM). As stated, IOMP represents 80 national and 6 regional medical physics organizations and 18,000 medical physicists worldwide. The IOMP affiliated bodies/organizations in different countries (such as Association of Medical Physicists of India, AMPI) have been encouraged to reproduce the IOMP statement in their journals/newsletters for the benefit of larger community of medical physicists. The IOMP statement is reproduced below (readers may also go through the supportive literature listed in references). It is hoped that this policy statement will have some deterrent influence on the continued propagation of unproven risk related to medical imaging procedures conducted with small doses.

  10. Evaluating secondary neutron doses of a refined shielded design for a medical cyclotron using the TLD approach

    International Nuclear Information System (INIS)

    Lin, Jye-Bin; Tseng, Hsien-Chun; Liu, Wen-Shan; Lin, Ding-Bang; Hsieh, Teng-San; Chen, Chien-Yi

    2013-01-01

    An increasing number of cyclotrons at medical centers in Taiwan have been installed to generate radiopharmaceutical products. An operating cyclotron generates immense amounts of secondary neutrons from reactions such the 18 O(p, n) 18 F, used in the production of FDG. This intense radiation can be hazardous to public health, particularly to medical personnel. To increase the yield of 18 F-FDG from 4200 GBq in 2005 to 48,600 GBq in 2011, Chung Shan Medical University Hospital (CSMUH) has prolonged irradiation time without changing the target or target current to meet requirements regarding the production 18 F. The CSMUH has redesigned the CTI Radioisotope Delivery System shield. The lack of data for a possible secondary neutron doses has increased due to newly designed cyclotron rooms. This work aims to evaluate secondary neutron doses at a CTI cyclotron center using a thermoluminescent dosimeter (TLD-600). Two-dimensional neutron doses were mapped and indicated that neutron doses were high as neutrons leaked through self-shielded blocks and through the L-shaped concrete shield in vault rooms. These neutron doses varied markedly among locations close to the H 2 18 O target. The Monte Carlo simulation and minimum detectable dose are also discussed and demonstrated the reliability of using the TLD-600 approach. Findings can be adopted by medical centers to identify radioactive hot spots and develop radiation protection. - Highlights: • Neutron doses were verified using TLD approach. • Neutron doses were increased at cyclotron centers. • Revised L-shaped shield suppresses effectively the neutrons. • Neutron dose can be attenuated to 1.13×10 6 %

  11. Medical imaging using ionizing radiation: Optimization of dose and image quality in fluoroscopy

    International Nuclear Information System (INIS)

    Jones, A. Kyle; Balter, Stephen; Rauch, Phillip; Wagner, Louis K.

    2014-01-01

    The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic

  12. Dose evaluation in medical staff during diagnostics procedures in interventional radiology; Avaliacao da dose na equipe medica durante procedimentos diagnoticos de radiologia intervencionista

    Energy Technology Data Exchange (ETDEWEB)

    Bacchim Neto, Fernando A.; Alves, Allan F.F.; Rosa, Maria E.D.; Miranda, Jose R.A. [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Instituto de Biociencias. Departamento de Fisica e Biofisica; Moura, Regina [Faculdade de Medicina de Botucatu, SP (Brazil). Departamento de Cirurgia e Ortopedia; Pina, Diana R., E-mail: bacchim@ibb.unesp.br [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina. Departamento de Doencas Tropicais e Diagnostico por Imagem

    2014-08-15

    Studies show that personal dosimeters may underestimate the dose values in interventional physicians, especially in extremities and crystalline. The objective of this work was to study the radiation exposure levels of medical staff in diagnostic interventional radiology procedures. For this purpose LiF:Mg,Ti (TLD-100) dosimeters were placed in different regions of the physician body. When comparing with reference dose levels, the maximum numbers of annual procedures were found. This information is essential to ensure the radiological protection of those professionals. (author)

  13. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    Science.gov (United States)

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  14. Accuracy assessment of pharmacogenetically predictive warfarin dosing algorithms in patients of an academic medical center anticoagulation clinic.

    Science.gov (United States)

    Shaw, Paul B; Donovan, Jennifer L; Tran, Maichi T; Lemon, Stephenie C; Burgwinkle, Pamela; Gore, Joel

    2010-08-01

    The objectives of this retrospective cohort study are to evaluate the accuracy of pharmacogenetic warfarin dosing algorithms in predicting therapeutic dose and to determine if this degree of accuracy warrants the routine use of genotyping to prospectively dose patients newly started on warfarin. Seventy-one patients of an outpatient anticoagulation clinic at an academic medical center who were age 18 years or older on a stable, therapeutic warfarin dose with international normalized ratio (INR) goal between 2.0 and 3.0, and cytochrome P450 isoenzyme 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) genotypes available between January 1, 2007 and September 30, 2008 were included. Six pharmacogenetic warfarin dosing algorithms were identified from the medical literature. Additionally, a 5 mg fixed dose approach was evaluated. Three algorithms, Zhu et al. (Clin Chem 53:1199-1205, 2007), Gage et al. (J Clin Ther 84:326-331, 2008), and International Warfarin Pharmacogenetic Consortium (IWPC) (N Engl J Med 360:753-764, 2009) were similar in the primary accuracy endpoints with mean absolute error (MAE) ranging from 1.7 to 1.8 mg/day and coefficient of determination R (2) from 0.61 to 0.66. However, the Zhu et al. algorithm severely over-predicted dose (defined as >or=2x or >or=2 mg/day more than actual dose) in twice as many (14 vs. 7%) patients as Gage et al. 2008 and IWPC 2009. In conclusion, the algorithms published by Gage et al. 2008 and the IWPC 2009 were the two most accurate pharmacogenetically based equations available in the medical literature in predicting therapeutic warfarin dose in our study population. However, the degree of accuracy demonstrated does not support the routine use of genotyping to prospectively dose all patients newly started on warfarin.

  15. Estimation of population doses from diagnostic medical examinations in Japan, 1974. III. Per caput mean marrow dose and leukemia significant dose

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-03-01

    The mean per capita marrow dose and leukemia-significant dose from radiographic and fluoroscopic examinations in Japan have been estimated based on a 1974 nation wide survey of randomly sampled hospitals and clinics. To determine the mean marrow dose to an individual from a certain exposure of a given type of examination, the active marrow in the whole body was divided into 119 parts for an adult and 103 for a child. Dosimetric points on which the individual marrow doses were determined were set up in the center of each marrow part. The individual marrow doses at the dosimetric points in the beams of practical diagnostic x-rays were calculated on the basis of the exposure data on the patients selected in the nation wide survey, using depth dose curves experimentally determined for diagnostic x-rays. The mean individual marrow dose was averaged over the active marrow by summing, for each dosimetric point, the product of the fraction of active marrow exposed and the individual marrow dose at the dosimetric point. The leukemia significant dose was calculated by adopting a weighting factor that is, a leukemia significant factor. The factor was determined from the shape of the time-incidence curve for radiation-induced leukemia from the Hiroshima A-bomb and from the survival statistics for the average population. The resultant mean per capita marrow dose from radiographic and fluoroscopic examination was 37.0 and 70.0 mrad/person/year, respectively, with a total of 107.05 mrad/person/year. The leukemia significant dose was 32.1 mrad/person/year for radiographic examination and 61.2 mrad/person/year, with a total of 93.3. These values were compared with those of 1960 and 1969.

  16. Trends of the effective dose distribution of occupational exposures in medical and research departments for KIRAMS in Republic of Korea

    International Nuclear Information System (INIS)

    Park, M.; Kim, G. S.; Ji, Y. H.; Jung, M. S.; Kim, K. B.; Jung, H.

    2014-01-01

    This work proposes the basic reference data of occupational dose management and statistical dose distribution with the classification of radiation work groups though analysis of occupational dose distribution. Data on occupational radiation exposure from medical and scientific usage of radiation in Korea Institute of Radiological and Medical Sciences for the years 2002-11 are presented and evaluated with the characteristic tendency of radiation working groups. The results of occupational radiation exposure were measured by personal dosemeters. The monitored occupational exposure dose data were evaluated according to the average effective dose and collective dose. The most annual average effective dose for all occupational radiation workers was under 1 mSv. Considering the dose distribution of each department, most overexposure workers worked in radiopharmaceutical product facilities, nuclear medicine department and radiation oncology department. In addition, no monitored workers were found to have received an occupational exposure over 50 mSv in single year or 100 mSv in this period. Although the trend of occupational exposure was controlled <1 mSv after 2007 and the radiation protection status was sufficient, it was consistently necessary to optimise and reduce the occupational radiation exposure. (authors)

  17. Estimation of population doses from diagnostic medical examinations in Japan, 1974. IV. Dose estimation of fetus exposed in utero to diagnostic x rays

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-07-01

    In fetus exposed in utero to diagnostic x rays for the medical examinations of the mother, the absorbed dose has been estimated on the basis of a 1974 nation wide radiological survey. The results of the survey showed that the number of radiographs per year connected with pregnant women was 0.32 million for chest examination excluding mass surveys. 0.29 million for obstetrical examinations including pelvimetry, and 0.21 million for abdominal and pelvic examinations with a total of 0.82 million. The dose absorbed in the fetus was measured with an ionization chamber placed at the hypothetical center of the fetus in an ''average woman'' Rando phantom in which a maternal body was simulated by adding MixDp materials. ''The collective dose'' to the fetus in the pregnant women receiving a given type of examination was calculated from the number of radiographs per year connected with the pregnant women and the fetal doses. The percapita mean marrow dose (CMD), the leukemia significant dose (LSD) and the genetically significant dose (GSD) for the fetus were determined from the collective dose, taking into account the birth expectancy, the child expectancy, life expectancy and significant factor for the fetus. The collective dose to the fetus was estimated to be 9.3 x 10/sup 4/ man rad per year. The resultant values of CMD, LSD and GSD were 0.81 mrad per year, 0.79 mrad per person per year and 1.44 mrad per person per year, respectively.

  18. United States Department of Health and Human Services Biodosimetry and radiological/nuclear medical countermeasure programs

    International Nuclear Information System (INIS)

    Homer, Mary J.; Raulli, Robert; Esker, John; Moyer, Brian; Wathen, Lynne; DiCarlo-Cohen, Andrea L.; Maidment, Bert W.; Rios, Carmen; Macchiarini, Francesca; Hrdina, Chad; Prasanna, Pataje G.

    2016-01-01

    The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats. (authors)

  19. TU-F-CAMPUS-T-01: Dose and Energy Spectra From Neutron Induced Radioactivity in Medical Linear Accelerators Following High Energy Total Body Irradiation

    International Nuclear Information System (INIS)

    Keehan, S; Taylor, M; Franich, R; Smith, R; Dunn, L; Kron, T

    2015-01-01

    Purpose: To assess the risk posed by neutron induced activation of components in medical linear accelerators (linacs) following the delivery of high monitor unit 18 MV photon beams such as used in TBI. Methods: Gamma spectroscopy was used to identify radioisotopes produced in components of a Varian 21EX and an Elekta Synergy following delivery of photon beams. Dose and risk estimates for TBI were assessed using dose deliveries from an actual patient treatment. A 1 litre spherical ion chamber (PTW, Germany) has been used to measure the dose at the beam exit window and at the total body irradiation (TBI) treatment couch following large and small field beams with long beam-on times. Measurements were also made outside of the closed jaws to quantify the benefit of the attenuation provided by the jaws. Results: The radioisotopes produced in the linac head have been identified as 187 W, 56 Mn, 24 Na and 28 Al, which have half-lives from between 2.3 min to 24 hours. The dose at the beam exit window following an 18 MV 2197 MU TBI beam delivery was 12.6 µSv in ten minutes. The dose rate at the TBI treatment couch 4.8 m away is a factor of ten lower. For a typical TBI delivered in six fractions each consisting of four beams and an annual patient load of 24, the annual dose estimate for a staff member at the treatment couch for ten minutes is 750 µSv. This can be further reduced by a factor of about twelve if the jaws are closed before entering the room, resulting in a dose estimate of 65 µSv. Conclusion: The dose resulting from the activation products for a representative TBI workload at our clinic of 24 patients per year is 750 µSv, which can be further reduced to 65 µSv by closing the jaws

  20. A description of medication errors reported by pharmacists in a neonatal intensive care unit.

    Science.gov (United States)

    Pawluk, Shane; Jaam, Myriam; Hazi, Fatima; Al Hail, Moza Sulaiman; El Kassem, Wessam; Khalifa, Hanan; Thomas, Binny; Abdul Rouf, Pallivalappila

    2017-02-01

    Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

  1. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK: a regional survey

    Directory of Open Access Journals (Sweden)

    Payne Karl Frederick

    2012-10-01

    Full Text Available Abstract Background Smartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors. Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations. Methods An online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful. Results 257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257 of medical students and 74.8% (n=98/131 of junior doctors owned a smartphone, with 56.6% (n=115/203 of students and 68.4% (n=67/98 of doctors owning an iPhone. The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p Conclusions This study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.

  2. PCXMC. A PC-based Monte Carlo program for calculating patient doses in medical x-ray examinations

    International Nuclear Information System (INIS)

    Tapiovaara, M.; Lakkisto, M.; Servomaa, A.

    1997-02-01

    The report describes PCXMC, a Monte Carlo program for calculating patients' organ doses and the effective dose in medical x-ray examinations. The organs considered are: the active bone marrow, adrenals, brain, breasts, colon (upper and lower large intestine), gall bladder, heats, kidneys, liver, lungs, muscle, oesophagus, ovaries, pancreas, skeleton, skin, small intestine, spleen, stomach, testes, thymes, thyroid, urinary bladder, and uterus. (42 refs.)

  3. [Phenylephrine dosing error in Intensive Care Unit. Case of the trimester].

    Science.gov (United States)

    2013-01-01

    A real clinical case reported to SENSAR is presented. A patient admitted to the surgical intensive care unit following a lung resection, suffered arterial hypotension. The nurse was asked to give the patient 1 mL of phenylephrine. A few seconds afterwards, the patient experienced a hypertensive crisis, which resolved spontaneously without damage. Thereafter, the nurse was interviewed and a dosing error was identified: she had mistakenly given the patient 1 mg of phenylephrine (1 mL) instead of 100 mcg (1 mL of the standard dilution, 1mg in 10 mL). The incident analysis revealed latent factors (event triggers) due to the lack of protocols and standard operating procedures, communication errors among team members (physician-nurse), suboptimal training, and underdeveloped safety culture. In order to preempt similar incidents in the future, the following actions were implemented in the surgical intensive care unit: a protocol for bolus and short lived infusions (del Dolor. Published by Elsevier España. All rights reserved.

  4. Dosimetric systems of high dose, dose rate and dose uniformity in food and medical products; Sistemas dosimetricos de altas dosis, tasa de dosis y uniformidad de dosis en alimentos y producto medico

    Energy Technology Data Exchange (ETDEWEB)

    Vargas, J.; Vivanco, M.; Castro, E., E-mail: jvargas@ipen.gob.pe [Instituto Peruano de Energia Nuclear, Av. Canada 1470, San Borja, Lima (Peru)

    2014-08-15

    In the Instituto Peruano de Energia Nuclear (IPEN) we use the chemical dosimetry Astm-E-1026 Fricke as a standard dosimetric system of reference and different routine dosimetric systems of high doses, according to the applied doses to obtain the desired effects in the treated products and the doses range determined for each type of dosimeter. Fricke dosimetry is a chemical dosimeter in aqueous solution indicating the absorbed dose by means an increase in absorbance at a specific wavelength. A calibrated spectrophotometer with controlled temperature is used to measure absorbance. The adsorbed dose range should cover from 20 to 400 Gy, the Fricke solution is extremely sensitive to organic impurities, to traces of metal ions, in preparing chemical products of reactive grade must be used and the water purity is very important. Using the referential standard dosimetric system Fricke, was determined to March 5, 2013, using the referential standard dosimetric system Astm-1026 Fricke, were irradiated in triplicate Fricke dosimeters, to 5 irradiation times (20; 30; 40; 50 and 60 seconds) and by linear regression, the dose rate of 5.400648 kGy /h was determined in the central point of the irradiation chamber (irradiator Gamma cell 220 Excel), applying the decay formula, was compared with the obtained results by manufacturers by means the same dosimetric system in the year of its manufacture, being this to the date 5.44691 kGy /h, with an error rate of 0.85. After considering that the dosimetric solution responds to the results, we proceeded to the irradiation of a sample of 200 g of cereal instant food, 2 dosimeters were placed at the lateral ends of the central position to maximum dose and 2 dosimeters in upper and lower ends as minimum dose, they were applied same irradiation times; for statistical analysis, the maximum dose rate was 6.1006 kGy /h and the minimum dose rate of 5.2185 kGy /h; with a dose uniformity of 1.16. In medical material of micro pulverized bone for

  5. Estimation of effective collective doses to population of Balti city with health risk assessment by means of medical radiodiagnostic irradiation

    International Nuclear Information System (INIS)

    Chislari, V.

    2009-01-01

    In this work the equivalent of effective collective dose, average annual of radio diagnostic researches in medicine for one habitant Belti city during 2006-2008 and a tendency was exposed to multiplying a dose due to multiplying the number of radiological researches was calculated. As compared to indexes for Republic of Moldova annual equivalent of effective dose is increased in 3 times. A potential risk of a medical radiation makes in 2006 - 7 cases of cancer, in 2007 - 8 cases and in 2009 - 9 cases. (author)

  6. The effect of aluminium added filter on mean glandular dose using mammography machine in MINT Medical Physics Laboratory

    International Nuclear Information System (INIS)

    Asmaliza Hashim; Wan Hazlinda Ismail; Abd Aziz Mhd Ramli

    2005-01-01

    The effect of various thickness of aluminium added filter on mean glandular dose in mammography is investigated for a standard breast phantom, 4.2 cm Perspex. A mammography machine in Medical Physics Laboratory MINT, Bennett Model DMF-150 is used to provide radiation in various kV range under clinical condition. The mean glandular dose on the phantom were measured based on technique recommended by AAPM protocol (1990) report no 29. The mean glandular dose was found reducing with increasing thickness of added filter. A more detail results of this study is presented in this paper. (Author)

  7. A medical admission unit reduces duration of hospital stay and number of readmissions

    DEFF Research Database (Denmark)

    Vork, Jan C; Brabrand, Mikkel; Folkestad, Lars

    2011-01-01

    Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. ...... present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure....

  8. Impact of digitalization of mammographic units on average glandular doses in the Flemish Breast Cancer Screening Program

    OpenAIRE

    De Hauwere, An; Thierens, Hubert

    2012-01-01

    The impact of digitalization on the average glandular doses in 49 mammographic units participating in the Flemish Breast Cancer Screening Program was studied. Screen-film was changed to direct digital radiography and computed radiography in 25 and 24 departments respectively. Average glandular doses were calculated before and after digitalization for different PMMA-phantom thicknesses and for groups of 50 successive patients. For the transition from screen-film to computed radiography both ph...

  9. Measurements of X ray absorbed doses to dental patients in two dental X ray units in Nigeria

    International Nuclear Information System (INIS)

    Ogundare, F.O.; Oni, O.M.; Balogun, F.A.

    2002-01-01

    Measurements of absorbed doses from radiographic examinations to various anatomical sites in the head and neck of patients with an average age of 45 years using intra-oral dental radiography have been carried out. LiF (TLD-100) dosemeters were used for the measurements of the absorbed dose. The measured absorbed doses to the various anatomical sites in the two units are reported, discussed and compared with results from the literature. Quality control measurements were also performed using a Victoreen quality control test device on the X ray units. The tube voltage accuracies for the two units were found to be within acceptable limits (less than ±10%). On the other hand the exposure time accuracies for these units have large deviations (>20%). These results and those that have been reported in the literature may be an indication that high patient doses are common in most dental X ray centres and countries. As a result of this, regular compliance and performance checks of dental diagnostic X ray equipment are essential in order to ensure proper performance and to minimise unnecessary patient and operator doses. (author)

  10. Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

    Directory of Open Access Journals (Sweden)

    T B Singh

    2013-01-01

    Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

  11. Heel Effect: Dose Mapping And Profiling For Mobile C-Arm Fluoroscopy Unit Toshiba SXT-1000A

    International Nuclear Information System (INIS)

    Husaini Salleh; Mohd Khalid Matori; Muhammad Jamal Md Isa; Mohd Ramli Arshad; Shahrul Azlan Azizan; Mohd Firdaus Abdul Rahman; Md Khairusalih Md Zin

    2014-01-01

    Heel Effect is the well known phenomena in x-ray production. It contributes the effect to image formation and as well as scattered radiation. But there is paucity in the study related to heel effect. This study is for mapping and profiling the dose on the surface of water phantom by using mobile C-arm unit Toshiba SXT-1000A. Based on the result the dose profile is increasing up to about 57 % from anode to cathode bound of the irradiated area. This result and information can be used as a guide to manipulate these phenomena for better image quality and radiation safety for this specific and dedicated fluoroscopy unit. (author)

  12. Perceptions of Continuing Medical Education, Professional Development, and Organizational Support in the United Arab Emirates

    Science.gov (United States)

    Younies, Hassan; Berham, Belal; Smith, Pamela C.

    2010-01-01

    Introduction: This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). Methods: A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training…

  13. Medication errors in the adult emergency unit of a tertiary care teaching hospital in Addis Ababa

    Directory of Open Access Journals (Sweden)

    Gediwon Negash

    2013-01-01

    Conclusion: Incidence and types of medication errors committed in Tikur Anbesa Specialized Hospital Adult Emergency Unit were substantiated; moreover, necessary information on factors within the healthcare delivery system that predispose healthcare professionals to commit errors have been pointed, which should be addressed by healthcare professionals through multidisciplinary efforts and involvement of decision makers at national level.

  14. An Update on the Status of Anatomical Sciences Education in United States Medical Schools

    Science.gov (United States)

    Drake, Richard L.; McBride, Jennifer M.; Pawlina, Wojciech

    2014-01-01

    Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to…

  15. A Study of the Impact of Cannabis on Doses of Discharge Antipsychotic Medication in Individuals with Schizophrenia or Schizoaffective Disorder.

    Science.gov (United States)

    Babatope, Taiwo; Chotalia, Jigar; Elkhatib, Rania; Mohite, Satyajit; Shah, Joel; Goddu, Sumana; Patel, Ruchir Arvind; Aimienwanu, Osarhiemen Ruth; Patel, Devanshu; Makanjuola, Titilayo; Okusaga, Olaoluwa O

    2016-12-01

    Patients with schizophrenia or schizoaffective disorder have a high prevalence of comorbid cannabis use disorder (CUD). CUD has been associated with poorer outcomes in patients. We compared doses of antipsychotic medications at the time of discharge from hospital among inpatients with schizophrenia or schizoaffective disorder with or without concurrent cannabis use. We reviewed the medical records of patients (N = 8157) with schizophrenia or schizoaffective disorder discharged from the hospital between 2008 and 2012. The patients were divided into two groups; those with urine drug tests positive for cannabis and those negative for cannabis. Doses of antipsychotic medications were converted to chlorpromazine equivalents. Bivariate analyses were done with Student's t test for continuous variables and χ 2 test for categorical variables. Linear regression was carried out to adjust for potential confounders. Unadjusted analysis revealed that the cannabis positive group was discharged on lower doses of antipsychotic medication compared with the cannabis negative group (geometric mean chlorpromazine equivalent doses 431.22 ± 2.20 vs 485.18 ± 2.21; P schizoaffective disorder.

  16. On the calibration of photon dosemeters in the equivalent dose units

    International Nuclear Information System (INIS)

    Bregadze, Yu.I.; Isaev, B.M.; Maslyaev, P.F.

    1980-01-01

    General aspects of transition from exposure dose of photo radiation to equivalent one are considered. By determination the equivalent dose is a function of point location in an irradiated object, that is why it is necessary to know equivalent dose distribution in the human body for uniform description of the risk degree. The international electrotechnical comission recommends to measure equivalent doses at 7 and 800 mg/cm 2 depths in a tissue-equivalent ball with 30 cm diameter, calling them skin equivalent dose and depth equivalent dose, respectively, and to compare them with the permissible 500 mZ and 50 mZ a year, respectively. Practical transition to using equivalent dose for evaluation of radiation danger of being in photon radiation field of low energy should include measures on regraduating already produced dose meters, graduating the dose meters under production and developing the system of their metrologic supply [ru

  17. The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Porhomayon Jahan

    2015-06-01

    Full Text Available Background: The practice of low vs. high sedation dosing strategy may impact the cognitive and mental health function in the intensive care unit (ICU. We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients. Methods: We performed a systemic search and meta-analysis of medical databases in MEDLINE(from 1966 to March 2013 and EMBASE (from 1980 to March 2013, as well as the Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental Health, for assessing the impact of sedation on posttraumatic stress disorder (PTSD or anxiety/depression and deliriumin the mix ICU setting including cardiac surgery patients. A total of 1216 patients were includedin the final analysis.Results: We included 11 studies in the final analysis and concluded that high dose sedationstrategy resulted in higher incidence of cognitive dysfunction with P value of 0.009. Theresult for subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P = 0.001,Heterogeneity I2 was 64%. Overall analysis was statistically significant with a P value of 0.002.Conclusion: High sedation dosing strategy will negatively affect cognitive function in criticallyill patients. Large randomized trials are needed to address cognitive dysfunction in subgroup of patients with delirium.

  18. 3D web based learning of medical equipment employed in intensive care units.

    Science.gov (United States)

    Cetin, Aydın

    2012-02-01

    In this paper, both synchronous and asynchronous web based learning of 3D medical equipment models used in hospital intensive care unit have been described over the moodle course management system. 3D medical equipment models were designed with 3ds Max 2008, then converted to ASE format and added interactivity displayed with Viewpoint-Enliven. 3D models embedded in a web page in html format with dynamic interactivity-rotating, panning and zooming by dragging a mouse over images-and descriptive information is embedded to 3D model by using xml format. A pilot test course having 15 h was applied to technicians who is responsible for intensive care unit at Medical Devices Repairing and Maintenance Center (TABOM) of Turkish High Specialized Hospital.

  19. Genetically significant dose assessments of occupationally exposed individuals involved in industrial and medical radiographic procedures in certain establishments in Nigeria

    International Nuclear Information System (INIS)

    Jibiri, N.N.; Oguntade, G. T.

    2007-01-01

    The main source of radiation doses received by humans from man-made sources of ionizing radiation in medicine and industry comes from X-rays. The genetic risks of ionizing radiation effects on an individual who is occupationally exposed largely depend on the magnitude of the radiation dose received, period of practice, work load and radio logical procedures involved. In this work, using the linear non-thresh old model, we have attempted to assess the level of genetic risk of occupationally exposed individuals in two medical and industrial establishments in Nigeria by estimating their genetically significant dose values. The estimation was based on continuous personnel radiation dose monitoring data for the individuals in each of the establishments over a three year period (1998-2001). The estimated genetically significant dose values in the years considered were 12 mSv for the medical, and 29 mSv for the industrial personnel. Appropriate radiation protection precautions should be taken by the personnel to adhere to standard operational practices in order to minimize the genetically significant dose resulting from radio logical practices

  20. Medical and Nonmedical Use of Prescription Opioids among High School Seniors in the United States

    Science.gov (United States)

    McCabe, Sean Esteban; West, Brady T.; Teter, Christian J.; Boyd, Carol J.

    2012-01-01

    Objective To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States, and to assess substance use behaviors based on medical and nonmedical use of prescription opioids. Design Nationally representative samples of high school seniors (modal age 18) were surveyed during the spring of their senior year via self-administered questionnaires. Setting Data were collected in public and private high schools. Participants The sample consisted of 7,374 students from three independent cohorts (2007-09). Main Outcome Measures Self-reports of medical and nonmedical use of prescription opioids and other substance use. Results An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Gender differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. Over 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. Conclusions Nearly one in every four high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication. PMID:22566521

  1. Upgrading of Alum Preparation and Dosing Unit for Sharq Dijla Water Treatment Plant by Using Programmable Logic Controller System

    Directory of Open Access Journals (Sweden)

    Aumar Al-Nakeeb

    2018-02-01

    Full Text Available One of the important units in Sharq Dijla Water Treatment Plant (WTP first and second extensions are the alum solution preparation and dosing unit. The existing operation of this unit accomplished manually starting from unloading the powder alum in the preparation basin and ending by controlling the alum dosage addition through the dosing pumps to the flash mix chambers. Because of the modern trend of monitoring and control the automatic operation of WTPs due to the great benefits that could be gain from optimum equipment operation, reducing the operating costs and human errors. This study deals with how to transform the conventional operation to an automatic monitoring and controlling system depending on a Programmable Logic Controller (PLC and online sensors for alum preparation and dosing unit in Sharq Dijla WTP. PLC system will receive, analyze transmitting data, compare them with preset points then automatically orders the operational equipment (such as pumps, valves, and mixers in a way that guarantees the safe and appropriate operation of the unit. As a result of Process and Instrumentation Diagrams (PID that were prepared in this study, these units can be fully operating and manage by using Supervisory Control and Data Acquisition (SCADA system.

  2. Educational gradients in psychotropic medication use among older adults in Costa Rica and the United States.

    Science.gov (United States)

    Domino, Marisa Elena; Dow, William H; Coto-Yglesias, Fernando

    2014-10-01

    The relationship of education, psychiatric diagnoses, and use of psychotropic medication has been explored in the United States, but little is known about this relationship in poorer countries, despite the high burden of mental illness in these countries. This study estimated educational gradients in diagnosis and psychotropic drug use in the United States and Costa Rica, a middle-income country with universal health insurance. Analyses were conducted by using data of older adults (≥60) from the 2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the effect of education level (low, medium, or high) and urban residence on the rates of self-reported mental health diagnoses, screening diagnosis, and psychotropic medication use with and without an associated psychiatric diagnosis. Rates of self-reported diagnoses were lower in the United States (12%) than in Costa Rica (20%), possibly reflecting differences in survey wording. In both countries, the odds of having depression were significantly lower among persons with high education. In Costa Rica, use of psychotropic medication among persons with self-reported diagnoses increased by education level. The educational gradients in medication use were different in the United States and Costa Rica, and stigma and access to care in these countries may play an important role in these differences, although type of insurance did not affect educational gradients in the United States. These analyses increase the evidence of the role of education in use of the health care system.

  3. Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania.

    Science.gov (United States)

    Aziz, Riaz; Peck, Robert N; Kalluvya, Samuel; Kenemo, Bernard; Chandika, Alphonce; Downs, Jennifer A

    2017-11-01

    In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported. We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016. Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women. From our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme - e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital - all of overwhelming sepsis. Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.

  4. The current format and ongoing advances of medical education in the United States.

    Science.gov (United States)

    Gishen, Kriya; Ovadia, Steven; Arzillo, Samantha; Avashia, Yash; Thaller, Seth R

    2014-01-01

    The objective of this study was to examine the current system of medical education along with the advances that are being made to support the demands of a changing health care system. American medical education must reform to anticipate the future needs of a changing health care system. Since the dramatic transformations to medical education that followed the publication of the Flexner report in 1910, medical education in the United States has largely remained unaltered. Today, the education of future physicians is undergoing modifications at all levels: premedical education, medical school, and residency training. Advances are being made with respect to curriculum design and content, standardized testing, and accreditation milestones. Fields such as plastic surgery are taking strides toward improving resident training as the next accreditation system is established. To promote more efficacious medical education, the American Medical Association has provided grants for innovations in education. Likewise, the Accreditation Council for Graduate Medical Education outlined 6 core competencies to standardize the educational goals of residency training. Such efforts are likely to improve the education of future physicians so that they are able to meet the future needs of American health care.

  5. Otolaryngology in the medical school curriculum: Current trends in the United States.

    Science.gov (United States)

    Boscoe, Elizabeth F; Cabrera-Muffly, Cristina

    2017-02-01

    To identify trends in medical school otolaryngology curriculum requirements. Survey of United States allopathic medical schools. A survey was sent to deans of curriculum at allopathic medical schools. We identified opportunities for medical students to learn basic concepts in otolaryngology during their undergraduate medical training. The opportunities were classified into preclinical and clinical as well as elective and mandatory rotations. Of the schools surveyed, 60% responded. Mean class size was 149 students. Sixty-eight percent of surveyed schools noted that 75% to 100% of their students participated in preclinical otolaryngology experiences, with 59% reporting a mandatory preclinical otolaryngology module for all students. Eighty-nine percent of schools offered otolaryngology as a clinical elective rotation, with a mean of 12 students participating yearly. Only 7% of schools required a mandatory otolaryngology clinical rotation. Our data suggest that medical students do not receive sufficient exposure to otolaryngology during medical school. Increased requirements for otolaryngology curriculum may be beneficial to all medical students, regardless of their specialty choice. NA. Laryngoscope, 00:000-000, 2016 127:346-348, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Patterns of Daily Costs Differ for Medical and Surgical Intensive Care Unit Patients.

    Science.gov (United States)

    Gershengorn, Hayley B; Garland, Allan; Gong, Michelle N

    2015-12-01

    Published studies suggest hospital costs on Day 1 in the intensive care unit (ICU) far exceed those of subsequent days, when costs are relatively stable. Yet, no study stratified patients by ICU type. To determine whether daily cost patterns differ by ICU type. We performed a retrospective study of adults admitted to five ICUs (two surgical: quaternary surgical ICU [SICU quat] and quaternary cardiac surgical ICU [CSICU quat]; two medical: tertiary medical ICU [MICU tertiary] and quaternary medical ICU [MICU quat]; one general: community medical surgical ICU [MSICU comm]) at Montefiore Medical Center in the Bronx, New York during 2013. After excluding costs clearly accrued outside the ICU, daily hospital costs were merged with clinical data. Patterns of daily unadjusted costs were evaluated in each ICU using median regression. Generalized estimating equations with first-order autocorrelation were used to identify factors independently associated with daily costs. Unadjusted daily costs were higher on Day 1 than on subsequent days only for surgical ICUs-SICU quat (median [interquartile range], $2,636 [$1,834-$4,282] on Day 1 vs. $1,840 [$1,501-$2,332] on Day 2; P cost from Days 1 to 2. After multivariate adjustment, there remained a significant decrease in cost from ICU Day 1 to 2 in surgical units with statistically similar Day 1 and 2 costs for other ICUs. Higher Day 1 costs are not seen in patients admitted to medical/nonsurgical ICUs.

  7. Occupational doses due to photoneutrons in medical linear accelerators rooms; Doses ocupacionais devido a neutrons em salas de aceleradores lineares de uso medico

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Alessandro Facure Neves de Salles

    2006-04-15

    Medical linear accelerators, with maximum photon energies above 10 MeV, are becoming of common use in Brazil. Although desirable in the therapeutic point of view, the increase in photon energies causes the generation of undesired neutrons, which are produced through nuclear reactions between photons and the high Z target nuclei of the materials that constitute the accelerator head. In this work, MCNP simulation was undertaken to examine the neutron equivalent doses around the accelerators head and at the entrance of medical linear accelerators treatment rooms, some of them licensed in Brazil by the National Regulatory Agency (CNEN). The simulated neutron dose equivalents varied between 2 e 26 {mu} Sv/Gy{sub RX}, and the results were compared with calculations performed with the use of some semi-empirical equations found in literature. It was found that the semi-empirical equations underestimate the simulated neutron doses in the majority of the cases, if compared to the simulated values, suggesting that these equations must be revised, due to the increasing number of high energy machines in the country. (author)

  8. The distribution of committed dose equivalents to workers exposed to tritium in the luminising industry in the United Kingdom

    International Nuclear Information System (INIS)

    Hipkin, J.

    1977-01-01

    In the United Kingdom tritium has become almost the only radionuclide that is used in luminising. Two distinct methods of luminising are used, one involving the use of tritium gas and the other involving the use of tritium activated luminous paint. All major luminisers have voluntarily taken part in urine monitoring programmes. The analyses have been carried out by the National Radiological Protection Board and estimates of committed dose equivalent have been made from the results. The work presented is an analysis of the committed dose equivalents received by all the individuals monitored in the years 1974, 1975 and 1976. It is shown that doses follow, in general, a lognormal distribution modified only at the high dose end by what must be described as dose management. Further evidence for dose management is seen when the pattern of dose versus time are analysed for selected individuals. It is shown that the maximum permissible dose as recommended by the International Commission on Radiological Protection, is only rarely exceeded. It is also shown that there is a substantial difference in the degree of exposure between workers involved in gaseous tritium luminising and workers using paint luminising. A comparison is made between exposure in gaseous tritium luminising and exposure in another common use of gaseous tritium, ie. the filling of electronic devices with tritium gas. It is shown that exposure is very much less in the electronic device work

  9. Evaluation of radiation dose to neonate on special care baby unit

    International Nuclear Information System (INIS)

    Adam, A. Y. I.

    2012-08-01

    A total of 132 patients in One-armed Maternity Hospital in Khartoum State. ESDs from patient exposure parameters using DosCal software. Effective doses (E) were calculated using published conversion factor and methods recommended by the national Radiological Protection Board (NRPB). The mean patient dose was 80 μGy per procedures. The mean organ doses per procedures were ranged between 0.04 to 0.0002 mGy per procedure. The mean effective dose was 0.02 mSv. Patients' doses showed wide variations. This variation in patient dose could be attributed to the variation in patient weight, tube voltage and tube current time product.The radiation risk per procedures was very low. However, due to their sensitive tissues, additional dose reduction is justifiable. A dedicated x-ray machine with additional filtration is recommended for patient dose reductions. (Author)

  10. Estimation of the collective effective dose to the population from medical X-ray examinations in Finland

    International Nuclear Information System (INIS)

    Tenkanen-Rautakoskia, Petra; Jaervinen, Hannu; Bly, Ritva

    2008-01-01

    The collective effective dose to the population from all X-ray examinations in Finland in 2005 was estimated. The numbers of X-ray examinations were collected by a questionnaire to the health care units (response rate 100 %). The effective doses in plain radiography were calculated using a Monte Carlo based program (PCXMC), as average values for selected health care units. For computed tomography (CT), weighted dose length product (DLP w ) in a standard phantom was measured for routine CT protocols of four body regions, for 80 % of CT scanners including all types. The effective doses were calculated from DPL w values using published conversion factors. For contrast-enhanced radiology and interventional radiology, the effective dose was estimated mainly by using published DAP values and conversion factors for given body regions. About 733 examinations per 1000 inhabitants (excluding dental) were made in 2005, slightly less than in 2000. The proportions of plain radiography, computed tomography, contrast-enhanced radiography and interventional procedures were about 92, 7, 1 and 1 %, respectively. From 2000, the frequencies (number of examinations per 1000 inhabitants) of plain radiography and contrast-enhanced radiography have decreased about 8 and 33 %, respectively, while the frequencies of CT and interventional radiology have increased about 28 and 38 %, respectively. The population dose from all X-ray examinations is about 0.43 mSv per person (in 1997 0.5 mSv). About half of this is caused by CT (in 1997 only 20 %) although the relative number of CT examinations is only 7 %. The contribution by plain radiography is 19 %, interventional radiology 17 %, and contrast-enhanced radiology 14 %. It is concluded that CT examinations are the major source of the population dose, while interventional radiology gives about the same population dose as plain radiography. For plain radiography, body examinations cause the highest effective dose. (author)

  11. Ability of Saudi mothers to appropriately and accurately use dosing devices to administer oral liquid medications to their children

    Directory of Open Access Journals (Sweden)

    Almazrou S

    2014-12-01

    Full Text Available Saja Almazrou, Hind Alsahly, Huda Alwattar, Lamya Alturki, Mona Alamri Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia Background: Most liquid medications are packaged with administration devices, which may be used inappropriately or inaccurately, and sometimes are not used at all. Because of the importance of their proper use for children's health, this study was designed to assess Saudi mothers' experiences with measuring cups, syringes, and droppers for oral liquid medications; to compare accuracy of dosing across these devices; and to determine the effects of mothers' education statuses and pharmacist counseling on dosing accuracy. Methods: This was a cross-sectional study in which mothers were observed as they used a set of commonly available dosing devices which are a dosing cup, syringe, and dropper. Interviews were conducted in the outpatient pharmacy waiting area in several tertiary hospitals and primary clinics in Riyadh, Saudi Arabia between March and April 2013. Saudi women who were mothers of children aged 12 years old or younger and who gave their consent were eligible. Caregivers other than mothers and subjects with vision problems or cognitive/physical disabilities were excluded. We gathered demographic information such as age, number of children, and education status. Subjects were asked if they had had counseling on how to use measuring devices and which device they preferred. Then, the mothers were required to demonstrate how to measure 5 mL of paracetamol (acetaminophen syrup using a cup and a syringe and 1 mL of paracetamol syrup using a dropper. Dosing errors were evaluated visually as overdosing, underdosing, or no error (if the dose was accurate. The data were entered into Microsoft Excel and evaluated using Stata 11.1. Logistic regression was employed to determine relationships. Results: The results revealed that 58% of participants measured an accurate dose of paracetamol

  12. Psychotropic Medication Use Among Adults With Schizophrenia and Schizoaffective Disorder in the United States.

    Science.gov (United States)

    Stroup, T Scott; Gerhard, Tobias; Crystal, Stephen; Huang, Cecilia; Tan, Zhiqiang; Wall, Melanie M; Mathai, Chacku M; Olfson, Mark

    2018-05-01

    The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010. The cohort of Medicaid recipients who filled one or more prescriptions for a psychotropic medication in 2010 included 116,249 patients classified as having schizophrenia and 84,537 classified as having schizoaffective disorder. During 2010, 86.1% of patients with schizoaffective disorder and 70.1% with schizophrenia were treated with two or more different classes of psychotropic. Psychotropic medications other than antipsychotics were commonly prescribed for individuals with a diagnosis of schizophrenia or schizoaffective disorder. Their widespread use and uncertainty about their net benefits signal a need for research on their efficacy, safety, and appropriate use in these conditions.

  13. A Comparative Analysis of Patient Access Modes at Wilford Hall United States Air Force Medical Center and Selected Civilian Medical Centers

    Science.gov (United States)

    1983-12-01

    In A COMPARATIVE ANALYSIS OF PATIENT ACCESS MODES AT WILFORD HALL UNITED STATES AIR FORCE MEDICAL CENTER N AND SELECTED CIVILIAN MEDICAL CENTERS0 N...current patient access modes at WHMC and several civilian medical centers of comparable size. This project has pursued the subject of patient access in...selected civilian medical centers which are comparable to WHMC in size, specialty mix, workload, and mission, providing responsive and efficient patient

  14. Medical reference dosimetry using EPR measurements of alanine: Development of an improved method for clinical dose levels

    International Nuclear Information System (INIS)

    Helt-Hansen, Jakob; Andersen, Claus Erik; Rosendal, Flemming; Kofoed, Inger Matilde

    2009-01-01

    Electron spin resonance (EPR) is used to determine the absorbed dose of alanine dosimeters exposed to clinical photon beams in a solid-water phantom. Alanine is potentially suitable for medical reference dosimetry, because of its near water equivalence over a wide energy spectrum, low signal fading, non-destructive measurement and small dosimeter size. Material and Methods. A Bruker EMX-micro EPR spectrometer with a rectangular cavity and a measurement time of two minutes per dosimeter was used for reading of irradiated alanine dosimeters. Under these conditions a new algorithm based on scaling of known spectra was developed to extract the alanine signal. Results. The dose accuracy, including calibration uncertainty, is less than 2% (k=1) above 4 Gy (n=4). The measurement uncertainty is fairly constant in absolute terms (∼30 mGy) and the relative uncertainty therefore rises for dose measurements below 4 Gy. Typical reproducibility is <1% (k=1) above 10 Gy and <2% between 4 and 10 Gy. Below 4 Gy the uncertainty is higher. A depth dose curve measurement was performed in a solid-water phantom irradiated to a dose of 20 Gy at the maximum dose point (dmax) in 6 and 18 MV photon beams. The typical difference between the dose measured with alanine in solid water and the dose measured with an ion chamber in a water tank was about 1%. A difference of 2% between 6 and 18 MV was found, possibly due to non-water equivalence of the applied phantom. Discussion. Compared to previously published methods the proposed algorithm can be applied without normalisation of phase shifts caused by changes in the g-value of the cavity. The study shows that alanine dosimetry is a suitable candidate for medical reference dosimetry especially for quality control applications

  15. Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.

    Science.gov (United States)

    Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee

    2016-09-01

    The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to

  16. The biological effects of low doses of radiation: medical, biological and ecological aspects

    International Nuclear Information System (INIS)

    Gun-Aajav, T.; Ajnai, L.; Manlaijav, G.

    2007-01-01

    Full text: The results of recent studies show that low doses of radiation make many different structural and functional changes in a cell and these changes are preserved for a long time. This phenomenon is called as effects of low doses of radiation in biophysics, radiation biology and radiation medicine. The structural and functional changes depend on doses and this dependence has non-linear and bimodal behaviour. More detail, the radiation effect goes up and reaches its maximum (Low doses maximum) in low doses region, then it goes down and takes its stationary means (there is a negative effect in a few cases). With increases in doses and with further increases it goes up. It is established that low dose's maximum depends on physiological state of a biological object, radiation quality and dose rate. During the experiments another special date was established. This specialty is that many different physical and chemical factors are mutually connected and have synergetic behaviour. At present, researches are concentrating their attention on the following three directions: 1. Direct and indirect interaction of radiation's low doses: 2. Interpretation of its molecular mechanism, regulation of the positive effects and elaboration of ways o removing negative effects: 3. Application of the objective research results into practice. In conclusion the authors mention the current concepts on interpretation of low doses effect mechanism, forward their own views and emphasize the importance of considering low doses effects in researches of environmental radiation pollution, radiation medicine and radiation protection. (author)

  17. Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related?

    Science.gov (United States)

    Muroi, Maki; Shen, Jay J; Angosta, Alona

    2017-02-01

    Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. United States academic medical centers: priorities and challenges amid market transformation.

    Science.gov (United States)

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

  19. Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009-2014.

    Science.gov (United States)

    Lemons, Ansley; Beer, Linda; Finlayson, Teresa; McCree, Donna Hubbard; Lentine, Daniel; Shouse, R Luke

    2018-01-01

    To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States. This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology. Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months. Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons.

  20. Library instruction in medical education: a survey of current practices in the United States and Canada.

    Science.gov (United States)

    Nevius, Amanda M; Ettien, A'Llyn; Link, Alissa P; Sobel, Laura Y

    2018-01-01

    The most recent survey on instruction practices in libraries affiliated with accredited medical institutions in the United States was conducted in 1996. The present study sought to update these data, while expanding to include Canadian libraries. Additional analysis was undertaken to test for statistically significant differences between library instruction in the United States and Canada and between libraries affiliated with highly ranked and unranked institutions. A twenty-eight-question survey was distributed to libraries affiliated with accredited US and Canadian medical schools to assess what and how often librarians teach, as well as how librarians are involved in the curriculum committee and if they are satisfied with their contact with students and faculty. Quantitative data were analyzed with SAS, R, and MedCalc. Most of the seventy-three responding libraries provided instruction, both asynchronously and synchronously. Library instruction was most likely to be offered in two years of medical school, with year one seeing the most activity. Database use was the most frequently taught topic, and libraries reported a median of five librarians providing instruction, with larger staffs offering slightly more education sessions per year. Libraries associated with highly ranked schools were slightly more likely to offer sessions that were integrated into the medical school curriculum in year four and to offer sessions in more years overall. In US and Canadian libraries, regardless of the rank of the affiliated medical school, librarians' provision of instruction in multiple formats on multiple topics is increasingly common.

  1. Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

    Science.gov (United States)

    Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

    2015-12-01

    Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

  2. Relationship between mutation frequency of GPA locus and cumulative dose among medical diagnostic X-ray workers

    International Nuclear Information System (INIS)

    Wang Jixian; Yu Wenru; Li Benxiao; Fan Tiqiang; Li Zhen; Gao Zhiwei; Chen Zhenjun; Zhao Yongcheng

    2000-01-01

    Objective: To explore the feasibility of using GPA locus mutation assay as a bio-dosimeter for occupational exposure to ionizing radiation. Methods: An improved technique of GPA locus mutation assay was used in th study. The frequencies of mutant RBC in peripheral blood of 55 medical X-ray workers and 50 controls employed in different calendar-year periods were detected. The relationship between mutation frequencies (MFs) and period of entry, working years and cumulative doses were analyzed. Results: The MFs were significantly elevated among X-ray workers employed before 1970. This finding is similar to the result of cancer epidemiological study among medical X-ray workers , in which the cancer risk was significantly increased only X-ray workers employed before 1970. The MFs of GPA increased with increasing cumulative dose. The dose-effect relationship of Nφ MF with cumulative dose was closer than that of NN MF. Conclusion: There are many problems to be solved for using GPA MF assay as a bio-dosimeter such as individual variation, specificity and calibration curve of dose-effect relationship

  3. Relationship between radiation dose and changes of blood cells in medical diagnostic X-ray workers in China

    International Nuclear Information System (INIS)

    Zhao Wenzheng

    1984-01-01

    The hematological changes of 2867 cases of medical X-ray workers and 1152 cases of non-X-ray medical workers were compared. It was shown that the total number of leukocytes, the numbers of neutrophils, lymphocytes and platelets were significantly lower in X-ray workers than those in controls. However, the percentages of monocytes, eosinophils, basophils and the concentration of hemoglobin were higher in the irradiated group. the difference between the two groups was statistically significant. The degree of changes in the number of blood cells was dose-dependent. A negative correlation could be found between the changes of leukocyte and neutrophil counts and cumulative dose (<250 mGy), annual dose (<15 mGy/a) and length of service of the X-ray workers; and a positive correlation existed between the percentages of basophils, eosinophils and monocytes, and the radiation dose. The abnormality rate of blood picture in the irradiated group was higher than that in the control group. Most X-ray workers with abnormal blood picture were distributed in low-dose group. The data also showed that radiation effect on male X-ray workers was greater than that on female workers. (Author)

  4. Study on radiation dose in the medical image data display method-focus on the DICOM standard

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Su [Dept. of Radio-technology, Health Welfare, Wonkwang Health Science University, Iksan (Korea, Republic of)

    2015-12-15

    DICOM (Digital Imaging and Communications in Medicine) standards are generally introduced as de facto and de jure standards in modern medical imaging devices to store and to transmit medical image information. DICOM Dose Structured Report (DICOM dose SR) is implemented to report radiation exposure information in image acquiring process. and DIOCM Modality Performed Procedure Step (DICOM MPPS) is also partly used to report this exposure with the information in its DICOM tag. This article is focused on three type of radiation exposure information of DICOM standards, 1) DICOM dose SR, 2) DICOM MPPS and 3) Radiation Exposure Monitoring(REM) profile by Integrating the Healthcare Enterprise(IHE), to study on radiation exposure reporting. Healthcare facility and its staff of medical imaging related to radiation exposure should have a deep understanding of radiation exposure, and it required a standards to enhance the quality control of medical imaging and the safety of patients and staffs. Staff member have to pay attention on radiation exposures and controlling processes from the purchasing stage of X-ray devices.

  5. Study on radiation dose in the medical image data display method-focus on the DICOM standard

    International Nuclear Information System (INIS)

    Kim, Jung Su

    2015-01-01

    DICOM (Digital Imaging and Communications in Medicine) standards are generally introduced as de facto and de jure standards in modern medical imaging devices to store and to transmit medical image information. DICOM Dose Structured Report (DICOM dose SR) is implemented to report radiation exposure information in image acquiring process. and DIOCM Modality Performed Procedure Step (DICOM MPPS) is also partly used to report this exposure with the information in its DICOM tag. This article is focused on three type of radiation exposure information of DICOM standards, 1) DICOM dose SR, 2) DICOM MPPS and 3) Radiation Exposure Monitoring(REM) profile by Integrating the Healthcare Enterprise(IHE), to study on radiation exposure reporting. Healthcare facility and its staff of medical imaging related to radiation exposure should have a deep understanding of radiation exposure, and it required a standards to enhance the quality control of medical imaging and the safety of patients and staffs. Staff member have to pay attention on radiation exposures and controlling processes from the purchasing stage of X-ray devices

  6. ALARA review of the maintenance and repair jobs of repetitive high radiation dose at Kori Unit 3 and 4

    International Nuclear Information System (INIS)

    Cho, Y.H.; Moon, J.H.; Kang, C.S.; Lee, J.S.; Lee, D.H.

    2003-01-01

    The policy of maintaining occupational radiation dose (ORD) as low as reasonably achievable (ALARA) requires the effective reduction of ORD in the phases of design as well as operation of nuclear power plants. It has been identified that a predominant portion of ORD arises during maintenance and repair operations at nuclear power plants. The cost-effective reduction of ORD cannot be achieved without a comprehensive analysis of accumulated ORD data of existing nuclear power plants. To identify the jobs of repetitive high ORD, the ORD data of Kori Units 3 and 4 over 10-year period from 1986 to 1995 were compiled into the PC-based ORD database program. As the radiation job classification structure, 26 main jobs are considered, most of which are further subdivided into detailed jobs. According to the order of the collective dose values for 26 main jobs, 10 jobs of high collective dose are identified. As an ALARA review, then, top 10 jobs of high collective dose are statistically analyzed with regard to 1) dose rate, 2) crew number and 3) job frequency that are the factors determining the collective dose for the radiation job of interest. Through the ALARA review, main reasons causing to high collective dose values are identified as follows. The high collective dose of RCP maintenance job is mainly due to the large crew number and the high job frequency. The characteristics of refueling job are similar to those of RCP maintenance job. However, the high collective doses of SG-related jobs such as S/G nozzle dam job, S/G man-way job and S/G tube maintenance job are mainly due to high radiation dose rate. (author)

  7. Terms and definitions in the field of radiological technique. Dose quantities and units. Begriffe und Benennungen in der radiologischen Technik. Dosisgroessen und Dosiseinheiten

    Energy Technology Data Exchange (ETDEWEB)

    1985-01-01

    The standard gives the terms and definitions of concepts, dose quantities and units. The radiation field condition 'secondary electron equilibrium', which forms part of the definition of standard ion dose, is given more precisely. The term 'free in air' is used in its original meaning, i.e. characterization of measuring conditions excluding avoidable stray radiation, which deviates from DIN 6814, part 3/06.72. Dosemeters for measurement of standard ion dose of air kerma are calibrated 'free in air', but this calibration condition is not part of the quantity definition. The quantities standard ion dose or air kerma therefore can also be measured in any other material. The qunatitative relationships between standard ion dose and the quantities 'exposure' and air kerma, as given in the ICRU publication 33 'Quantities and Units' (1980), are explained. The standard introduces the SI units Gray (for energy dose), Sievert (for dose equivalent), and Becquerel (for the activity of a radioactive substance). As the change to the SI units conceals the approximated equality of the numerical values of the standrd ion dose of photon radiation in roentgen, of the energy dose for soft tissue in rad, and of the dose equivalent in rem, new definitions are given in accordance with ICRU 33 for the quantities specified dose rate, dose rate constant, and area exposure product. These definitions use the terms 'energy dose' and 'kerma'. The dose concepts applied in the field of radiation protection, especially ambient dose and individual dose, are defined as dose equivalents in compliance with the Radiation Protection Ordinance. The relevant sections present information on the conversion of standard ion dose values to the corresponding values of kerma, energy dose, or dose equivalent.

  8. Radioactive waste evacuation of the sources of a low dose rate brachytherapy unit

    International Nuclear Information System (INIS)

    Serrada, A.; Huerga, C.; Santa Olalla, I.; Vicedo, A.; Corredoira, E.; Plaza, R.; Vidal, J.; Tellez, M.

    2006-01-01

    Introduction The second class Radioactive Installation start -up authorization makes responsible for its security to the installation exploiter and supervisor. The specifications established in the authorization, which are mandatory, point out several actions, some of these actions are the hermeticity tests of radioactive sources an radiologic controls of environment dosimetry. It is necessary to optimize the time spent in each activity, managing them as reasonably as possible. An important matter to take into account is to keep and control only those radioactive or radiological equipment which, even if are in work, have an appropriate performance for the patient treatment Material And Method a Paz hospital has an intracavity brachytherapy (L.D.R.), Curietron model. The Radioprotection Department proposed to remove from service the unit due to its age, this was carried out by the Commission of Guarantee and Quality Control. There were different solutions taken into account to decommission the unit, finally the option chosen as the most convenient for the installation was to manage directly the withdrawal of the radioactive material which consisted of seven Cs-137 probes model CsM1 and total nominal certificated activity of 7770 MBq ( 210 mCi ) dated in May 2005. It also has to be considered as a radioactive waste the inner storage elements of the Curietron and the transport and storage curie stock, built with depleted uranium. To accomplish this aim an evacuation container was designed consisting of an alloy of low-melting point (M.C.P.96), which fulfills the transport conditions imposed by E.N.R.E.S.A. ( Empresa Nacional de Residuos Radiactivos, S.A). A theoretical calculation was performed to estimate the thickness of the shield which adequate to the rate of dose in contact demanded. Accuracy of these calculations has been verified using T.L. dosimetry. Results The radiation levels during the extraction intervention of the radioactive probes and its transfer to

  9. Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

    Science.gov (United States)

    Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

    2009-02-01

    The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

  10. Association between number of doses per day, number of medications and patient's non-compliance, and frequency of readmissions in a multi-ethnic Asian population

    Directory of Open Access Journals (Sweden)

    Ming Ren Toh

    2014-01-01

    Conclusion: Complex medication regimen (i.e. multiple medications and multiple doses per day is a statistically significant predictor of number of readmissions. Simplifying therapeutic regimens with alternatives such as longer-acting or fixed-dose combination drugs may facilitate better patient adherence and reduce costly readmissions.

  11. Patients' family satisfaction with needs met at the medical intensive care unit.

    Science.gov (United States)

    Khalaila, Rabia

    2013-05-01

    The current study investigated the perceived importance and the perceived met needs of family members in the medical intensive care unit and assessed family members' satisfaction with needs met. Studies conducted throughout the world over the past 30 years indicate that family needs are still neglected. Unmet needs of family members of patients in the intensive care unit lead to dissatisfaction with care. A cross-sectional study. A total of 70 family members of critically ill patients were included in this study conducted in a medical intensive care unit in Israel between October 2007-September 2008, using a structured interview. Three outcomes measured by the Family Satisfaction in the Intensive Care Unit Inventory were regressed separately for baseline variables and family needs met subscales as measured by the Critical Care Family Needs Inventory. Multivariate linear regression analysis was used to detect factors that could have predicted each outcome. The results showed differences between the perceived importance and the perceived met needs of family members. Satisfaction with care was positively related to meeting all needs domains except the information need. However, satisfaction with information and decision-making was related only to meeting information and emotional support needs. Continued unmet needs of family members of intensive care unit patients have a negative impact on family satisfaction. Only sweeping changes in clinical practice will succeed in meeting the unmet needs of patients' families. © 2012 Blackwell Publishing Ltd.

  12. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010

    Science.gov (United States)

    Bachhuber, Marcus A.; Saloner, Brendan; Cunningham, Chinazo O.; Barry, Colleen L.

    2015-01-01

    IMPORTANCE Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. OBJECTIVE To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. DESIGN, SETTING, AND PARTICIPANTS A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. EXPOSURES Presence of a law establishing a medical cannabis program in the state. MAIN OUTCOMES AND MEASURES Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. RESULTS Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4

  13. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.

    Science.gov (United States)

    Bachhuber, Marcus A; Saloner, Brendan; Cunningham, Chinazo O; Barry, Colleen L

    2014-10-01

    Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. Presence of a law establishing a medical cannabis program in the state. Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, -37.5% to -9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (-19.9%; 95% CI, -30.6% to -7.7%; P = .002), year 2 (-25.2%; 95% CI, -40.6% to -5.9%; P = .01), year 3 (-23.6%; 95% CI, -41.1% to -1.0%; P = .04), year 4 (-20.2%; 95% CI, -33.6% to -4.0%; P = .02), year 5 (-33.7%; 95% CI, -50.9% to -10.4%; P = .008), and year 6 (-33.3%; 95% CI, -44.7% to

  14. AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams.

    Science.gov (United States)

    Smilowitz, Jennifer B; Das, Indra J; Feygelman, Vladimir; Fraass, Benedick A; Kry, Stephen F; Marshall, Ingrid R; Mihailidis, Dimitris N; Ouhib, Zoubir; Ritter, Timothy; Snyder, Michael G; Fairobent, Lynne

    2015-09-08

    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:• Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.• Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

  15. Research on the radiation doses to adults receiving from main types of medical X-ray CT examinations

    International Nuclear Information System (INIS)

    Gao Linfeng; Wang Bin; Yao Jie; Qian Aijun; Zheng Junzheng; Zhuo Weihai; Qu Liangyong

    2013-01-01

    To study and master the doses to examinees receiving from the wide spread X-CT examinations, is a key issue for strengthening the medical radiation protection. In the studies of the medical exposure levels during the Eleventh Five-Year Plan period in Shanghai, based on the brands of X-CT scanners and their distributions in different levels of hospitals, a total of 45 sets (about 30% of all) of scanners were selected for the field study. Among the 8 commonly performed examinations, the scan parameters and their relevant dosimetry information for 500 adults were collected, and their typical effective doses were estimated with the dose conversion factors. The results showed that the averages of weighted CT dose index (CTDI w ) were 55.4, 12.5 and 18.4 mGy, and the dose length products (DLP) were averaged to be 603, 294 and 415 mGy·cm, for the skull, chest and abdomen X-CT scans, respectively. The typical effective doses were estimated to be 1.4, 5.3, and 7.5 mSv for adults in the head, chest and abdomen X-CT scans, respectively. The values of CTDI w for skull scans were generally higher than those for the ear canal, eye, or sinus examinations. It is clear that the optimization between the image quality and the radiation dose should be further strengthened. Particular attentions should be paid in selecting the scanning parameters for various types of X-CT scans, and the diagnostic reference levels for X-CT examinations should be continuously improved. (authors)

  16. Exchange sex among people receiving medical care for HIV in the United States - medical monitoring project 2009-2013.

    Science.gov (United States)

    Olaiya, Oluwatosin; Nerlander, Lina; Mattson, Christine L; Beer, Linda

    2018-04-20

    Many studies of persons who exchange sex for money or drugs have focused on their HIV acquisition risk, and are often limited to select populations and/or geographical locations. National estimates of exchange sex among people living with HIV (PLWH) who are in medical care, and its correlates, are lacking. To address these gaps, we analyzed data from the Medical Monitoring Project, a surveillance system that produces nationally representative estimates of behavioral and clinical characteristics of PLWH receiving medical care in the United States, to estimate the weighted prevalence of exchange sex overall, and by selected socio-demographic, behavioral and clinical characteristics. We found 3.6% of sexually active adults reported exchange sex in the past 12 months. We found a higher prevalence of exchange sex among transgender persons, those who experienced homelessness, and those with unmet needs for social and medical services. Persons who exchanged sex were more likely to report depression and substance use than those who did not exchange sex. We found a higher prevalence of sexual behaviors that increase the risk of HIV transmission and lower viral suppression among persons who exchanged sex. PLWH who exchanged sex had a higher prevalence of not being prescribed ART, and not being ART adherent than those who did not exchange sex. We identify several areas for intervention, including: provision of or referral to services for unmet needs (such as housing or shelter), enhanced delivery of mental health and substance abuse screening and treatment, risk-reduction counseling, and ART prescription and adherence support services.

  17. Estimation of the population dose from medical X-ray diagnostic examination in Shandong province, China

    International Nuclear Information System (INIS)

    Su Xieming

    1985-01-01

    The exposure doses on the examinated body surface for verious types of X-ray diagnostic examanition in Shandong Province were surveyed. The collective effective dose equivalent in per million population were calculated with the measured results, the ratios of orga absorbed doses to irradiated surface exposure doses and the frequencies of X-ray examination in Shandong Province. The result was 326 man.Sv per million total population in 1980, of which chest fluoroscopies. lumbar spine radiographies and G.I. examination were estimated to be about 78, 9 and 5 precent, respectively

  18. Measurement of {sup 131}I activity in thyroid of nuclear medical staff and internal dose assessment in a Polish nuclear medical hospital

    Energy Technology Data Exchange (ETDEWEB)

    Brudecki, K.; Mietelski, J.W. [Polish Academy of Sciences, Institute of Nuclear Physics, Krakow (Poland); Kowalska, A.; Szczodry, A. [Holy Cross Cancer Center, Department of Endocrinology and Nuclear Medicine, Kielce (Poland); Zagrodzki, P. [Polish Academy of Sciences, Institute of Nuclear Physics, Krakow (Poland); Jagiellonian University, Department of Food Chemistry and Nutrition, Medical College, Krakow (Poland); Mroz, T. [Pedagogical University in Cracow, Krakow (Poland); Janowski, P. [AGH University of Science and Technology, Krakow (Poland)

    2017-03-15

    This paper presents results of {sup 131}I thyroid activity measurements in 30 members of the nuclear medicine personnel of the Department of Endocrinology and Nuclear Medicine Holy Cross Cancer Centre in Kielce, Poland. A whole-body spectrometer equipped with two semiconductor gamma radiation detectors served as the basic research instrument. In ten out of 30 examined staff members, the determined {sup 131}I activity was found to be above the detection limit (DL = 5 Bq of {sup 131}I in the thyroid). The measured activities ranged from (5 ± 2) Bq to (217 ± 56) Bq. The highest activities in thyroids were detected for technical and cleaning personnel, whereas the lowest values were recorded for medical doctors. Having measured the activities, an attempt has been made to estimate the corresponding annual effective doses, which were found to range from 0.02 to 0.8 mSv. The highest annual equivalent doses have been found for thyroid, ranging from 0.4 to 15.4 mSv, detected for a cleaner and a technician, respectively. The maximum estimated effective dose corresponds to 32% of the annual background dose in Poland, and to circa 4% of the annual limit for the effective dose due to occupational exposure of 20 mSv per year, which is in compliance with the value recommended by the International Commission on Radiological Protection. (orig.)

  19. Measurement of 131I activity in thyroid of nuclear medical staff and internal dose assessment in a Polish nuclear medical hospital

    International Nuclear Information System (INIS)

    Brudecki, K.; Mietelski, J.W.; Kowalska, A.; Szczodry, A.; Zagrodzki, P.; Mroz, T.; Janowski, P.

    2017-01-01

    This paper presents results of 131 I thyroid activity measurements in 30 members of the nuclear medicine personnel of the Department of Endocrinology and Nuclear Medicine Holy Cross Cancer Centre in Kielce, Poland. A whole-body spectrometer equipped with two semiconductor gamma radiation detectors served as the basic research instrument. In ten out of 30 examined staff members, the determined 131 I activity was found to be above the detection limit (DL = 5 Bq of 131 I in the thyroid). The measured activities ranged from (5 ± 2) Bq to (217 ± 56) Bq. The highest activities in thyroids were detected for technical and cleaning personnel, whereas the lowest values were recorded for medical doctors. Having measured the activities, an attempt has been made to estimate the corresponding annual effective doses, which were found to range from 0.02 to 0.8 mSv. The highest annual equivalent doses have been found for thyroid, ranging from 0.4 to 15.4 mSv, detected for a cleaner and a technician, respectively. The maximum estimated effective dose corresponds to 32% of the annual background dose in Poland, and to circa 4% of the annual limit for the effective dose due to occupational exposure of 20 mSv per year, which is in compliance with the value recommended by the International Commission on Radiological Protection. (orig.)

  20. Integration testing through reusing representative unit test cases for high-confidence medical software.

    Science.gov (United States)

    Shin, Youngsul; Choi, Yunja; Lee, Woo Jin

    2013-06-01

    As medical software is getting larger-sized, complex, and connected with other devices, finding faults in integrated software modules gets more difficult and time consuming. Existing integration testing typically takes a black-box approach, which treats the target software as a black box and selects test cases without considering internal behavior of each software module. Though it could be cost-effective, this black-box approach cannot thoroughly test interaction behavior among integrated modules and might leave critical faults undetected, which should not happen in safety-critical systems such as medical software. This work anticipates that information on internal behavior is necessary even for integration testing to define thorough test cases for critical software and proposes a new integration testing method by reusing test cases used for unit testing. The goal is to provide a cost-effective method to detect subtle interaction faults at the integration testing phase by reusing the knowledge obtained from unit testing phase. The suggested approach notes that the test cases for the unit testing include knowledge on internal behavior of each unit and extracts test cases for the integration testing from the test cases for the unit testing for a given test criteria. The extracted representative test cases are connected with functions under test using the state domain and a single test sequence to cover the test cases is produced. By means of reusing unit test cases, the tester has effective test cases to examine diverse execution paths and find interaction faults without analyzing complex modules. The produced test sequence can have test coverage as high as the unit testing coverage and its length is close to the length of optimal test sequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Doses to medical workers operating in a PET/CT department after the use of new dynamic techniques

    International Nuclear Information System (INIS)

    Dalianis, K; Kollias, G; Malamitsi, J; Euthimiadou, R; Andreou, J; Georgiou, E; Prassopoulos, V

    2015-01-01

    Since new radiopharmaceuticals are used like [18F]-fluoro-3'-deoxy-3'-L- fluorothymidine and 18F fluoromethylcholine, also new dynamic techniques of imaging are used, measurements concerning the doses to medical staff are needed. The aim of this study was to measure the effective whole body dose of the personnel and compare them with the oldest. Estimation of equivalent dose for all members of the staff was monitored with the use of TLDs badges and electronic dosimeters. The duration of the study was year 2011 (983 patients).Concerning the nurses, we measured 10% increase in the wholebody doses and that is due to the longer time they spent near the patient (dynamic protocol). For technologist we measure 15-21% increase for they come near the patient immediately after administration. We can observe that there is an increase of the doses for technologists and nurses the numbers are significantly lower than the recommended annual dose limit by Euratrom 97/43. (paper)

  2. Doses to medical workers operating in a PET/CT department after the use of new dynamic techniques.

    Science.gov (United States)

    Dalianis, K.; Kollias, G.; Malamitsi, J.; Euthimiadou, R.; Andreou, J.; Georgiou, E.; Prassopoulos, V.

    2015-09-01

    Since new radiopharmaceuticals are used like [18F]-fluoro-3'-deoxy-3'-L- fluorothymidine and 18F fluoromethylcholine, also new dynamic techniques of imaging are used, measurements concerning the doses to medical staff are needed. The aim of this study was to measure the effective whole body dose of the personnel and compare them with the oldest. Estimation of equivalent dose for all members of the staff was monitored with the use of TLDs badges and electronic dosimeters. The duration of the study was year 2011 (983 patients).Concerning the nurses, we measured 10% increase in the wholebody doses and that is due to the longer time they spent near the patient (dynamic protocol). For technologist we measure 15-21% increase for they come near the patient immediately after administration. We can observe that there is an increase of the doses for technologists and nurses the numbers are significantly lower than the recommended annual dose limit by Euratrom 97/43.

  3. Return of TRIGA fuel from the Medical University of Hanover (MHH) to the United States

    International Nuclear Information System (INIS)

    Hampel, Gabriele; Klaus, Uwe; Schmidt, Thomas

    1999-01-01

    The Medical University of Hanover (MHH) returned its TRIGA fuel to the United States in the summer of 1999. This paper deals with the procedure for handling the fuel elements within and outside the reactor facility. It describes the dry loading technology, taking into account the special conditions relevant to the MHH. It also includes the time scale for both the various steps of the procedure and the entire process, as well as the main results of the radiological surveys. (author)

  4. Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

    OpenAIRE

    Wen-Ping Zeng; Han Su; Chein-Wen Chen; Shu-Meng Cheng; Li-Fang Chang; Wen-Chii Tzeng; Bing-Hsiean Tzeng

    2015-01-01

    Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this stud...

  5. Ultralow dose dentomaxillofacial CT imaging and iterative reconstruction techniques: variability of Hounsfield units and contrast-to-noise ratio

    Science.gov (United States)

    Bischel, Alexander; Stratis, Andreas; Kakar, Apoorv; Bosmans, Hilde; Jacobs, Reinhilde; Gassner, Eva-Maria; Puelacher, Wolfgang; Pauwels, Ruben

    2016-01-01

    Objective: The aim of this study was to evaluate whether application of ultralow dose protocols and iterative reconstruction technology (IRT) influence quantitative Hounsfield units (HUs) and contrast-to-noise ratio (CNR) in dentomaxillofacial CT imaging. Methods: A phantom with inserts of five types of materials was scanned using protocols for (a) a clinical reference for navigated surgery (CT dose index volume 36.58 mGy), (b) low-dose sinus imaging (18.28 mGy) and (c) four ultralow dose imaging (4.14, 2.63, 0.99 and 0.53 mGy). All images were reconstructed using: (i) filtered back projection (FBP); (ii) IRT: adaptive statistical iterative reconstruction-50 (ASIR-50), ASIR-100 and model-based iterative reconstruction (MBIR); and (iii) standard (std) and bone kernel. Mean HU, CNR and average HU error after recalibration were determined. Each combination of protocols was compared using Friedman analysis of variance, followed by Dunn's multiple comparison test. Results: Pearson's sample correlation coefficients were all >0.99. Ultralow dose protocols using FBP showed errors of up to 273 HU. Std kernels had less HU variability than bone kernels. MBIR reduced the error value for the lowest dose protocol to 138 HU and retained the highest relative CNR. ASIR could not demonstrate significant advantages over FBP. Conclusions: Considering a potential dose reduction as low as 1.5% of a std protocol, ultralow dose protocols and IRT should be further tested for clinical dentomaxillofacial CT imaging. Advances in knowledge: HU as a surrogate for bone density may vary significantly in CT ultralow dose imaging. However, use of std kernels and MBIR technology reduce HU error values and may retain the highest CNR. PMID:26859336

  6. Relationship medical exposure in X-ray diagnosis and loading factor and film/screen system for reduction exposure dose in Aomori. An analysis based on the results of questionnaire

    International Nuclear Information System (INIS)

    Kon, Masanori; Fukushi, Shouji; Oota, Fumio; Kawamura, Kouji; Shinohe, Tetsuo; Suwa, Kouki; Fujii, Kiyosuke; Yamagami, Hirofumi

    2000-01-01

    A fact-finding questionnaire survey on medical exposure in Aomori Prefecture was conducted in September 1998. Of the 23 exposed sites in the body investigated, exposure at 17 sites in adults was investigated in terms of the type of high-voltage generator, imaging conditions (X-ray tube voltage, electric current, exposure time, etc.), photosensitive materials and relative photosensitivity, and entrance surface doses. At 6 of the 17 exposed sites, the relationships between these technical conditions and entrance surface doses were analyzed to consider further reduction of medical exposure. The most frequently used high-voltage generators were inverter generators (about 52%). In many institutions, additional filters were utilized for high-voltage imaging of the chest. Highly sensitive green-emission materials were the most frequently used photosensitive materials (73%). These findings indicate that many institutions are attempting to reduce exposure. Entrance surface doses varied greatly among institutions: and a 100-fold difference was observed in exposure to the chest, Martius, and the pelvis. Further efforts to lower entrance surface doses are therefore necessary to reduce medical exposure. Negative correlations were observed between electric voltage, electric current, and exposure time. Examination of the relationships between entrance surface doses, electric current, and exposure time yielded positive correlations. However, the entrance surface doses may not have been properly calculated in some institutions, and examination of the relationship between the relative sensitivity of the sensitive material and entrance surface doses showed great variability in entrance surface doses between institutions. Based on the above results, it is concluded that further reduction of medical exposure is possible, not only by improving the accuracy of X-ray units/devices, but by choosing a more appropriate of conditions to perform radiography. (K.H.)

  7. Medication reconciliation by a pharmacy technician in a mental health assessment unit.

    Science.gov (United States)

    Brownlie, Kay; Schneider, Carl; Culliford, Roger; Fox, Chris; Boukouvalas, Alexis; Willan, Cathy; Maidment, Ian D

    2014-04-01

    Medication discrepancies are common when patients cross organisational boundaries. However, little is known about the frequency of discrepancies within mental health and the efficacy of interventions to reduce discrepancies. To evaluate the impact of a pharmacy-led reconciliation service on medication discrepancies on admissions to a secondary care mental health trust. In-patient mental health services. Prospective evaluation of pharmacy technician led medication reconciliation for admissions to a UK Mental Health NHS Trust. From March to June 2012 information on any unintentional discrepancies (dose, frequency and name of medication); patient demographics;and type and cause of the discrepancy was collected. The potential for harm was assessed based on two scenarios; the discrepancy was continued into primary care, and the discrepancy was corrected during admission. Logistic regression identified factors associated with discrepancies. Mean number of discrepancies per admission corrected by the pharmacy technician. Unintentional medication discrepancies occurred in 212 of 377 admissions (56.2 %). Discrepancies involving 569 medicines (mean 1.5 medicines per admission) were corrected.The most common discrepancy was omission(n = 464). Severity was assessed for 114 discrepancies. If the discrepancy was corrected within 16 days the potential harm was minor in 71 (62.3 %) cases and moderate in 43(37.7 %) cases whereas if the discrepancy was not corrected the potential harm was minor in 27 (23.7 %) cases and moderate in 87 (76.3 %) cases. Discrepancies were associated with both age and number of medications; the stronger association was age. Medication discrepancies are common within mental health services with potentially significant consequences for patients.Trained pharmacy technicians are able to reduce the frequency of discrepancies, improving safety.

  8. Hounsfield units variations: impact on CT-density based conversion tables and their effects on dose distribution.

    Science.gov (United States)

    Zurl, B; Tiefling, R; Winkler, P; Kindl, P; Kapp, K S

    2014-01-01

    Determination of dose error margins in radiation therapy planning due to variations in Hounsfield Units (HU) values dependent on the use of different CT scanning protocols. Based on a series of different CT scanning protocols used in clinical practice, conversion tables for radiation dose calculations were generated and subsequently tested on a phantom. These tables were then used to recalculate the radiation therapy plans of 28 real patients after an incorrect scanning protocol had inadvertently been used for these patients. Different CT parameter settings resulted in errors of HU values of up to 2.6% for densities of 1.1 g/cm(3). The largest errors were associated with changes in the tube voltage. Tests on a virtual water phantom with layers of variable thickness and density revealed a sawtooth-shaped curve for the increase of dose differences from 0.3 to 0.6% and 1.5% at layer thicknesses of 1, 3, and 7 cm, respectively. Use of a beam hardening filter resulted in a reference dose difference of 0.6% in response to a density change of 5%. The recalculation of data from 28 patients who received radiation therapy to the head revealed an overdose of 1.3 ± 0.4% to the bone and 0.7 ± 0.1% to brain tissue. On average, therefore, one monitor unit (range 0-3 MU) per 100 MU more than the correct dose had been given. Use of different CT scanning protocols leads to variations of up to 20% in the HU values. This can result in a mean systematic dose error of 1.5%. Specific conversion tables and automatic CT scanning protocol recognition could reduce dose errors of these types.

  9. Management of encopresis in early adolescence in a medical-psychiatric unit.

    Science.gov (United States)

    Fennig, S; Fennig, S

    1999-01-01

    The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.

  10. Maternal high-dose folic acid during pregnancy and asthma medication in the offspring

    NARCIS (Netherlands)

    Zetstra-van der Woude, Priscilla A.; De Walle, Hermien E. K.; Hoek, Annemieke; Bos, H. Jens; Boezen, H. Marike; Koppelman, Gerhard H.; de Jong-van den Berg, Lolkje T. W.; Scholtens, Salome

    2014-01-01

    Purpose Low-dose folic acid supplementation (0.5 mg) taken during pregnancy has been associated with an increased risk for childhood asthma. The effect of high-dose folic acid (5 mg) advised to women at risk for having a child with neural tube defect has not been assessed so far. Our aim was to

  11. A snapshot of patients' awareness of radiation dose and risks associated with medical imaging examinations at an Australian radiology clinic.

    Science.gov (United States)

    Singh, N; Mohacsy, A; Connell, D A; Schneider, M E

    2017-05-01

    Cumulative radiation exposure is linked to increasing the lifetime attributable risk of cancer. To avoid unnecessary radiation exposure and facilitate shared decision making, patients should be aware of these issues. This paper examines patients' awareness of radiation dose and risks associated with medical imaging examinations. Consecutive patients attending a private radiology clinic over a nine week period in 2014 in Metropolitan Melbourne were surveyed while waiting to undergo an imaging examination. Patients who were under 18 years of age, did not speak English and/or were referred for interventional imaging procedures were excluded from participation. Survey questions addressed patients' awareness of radiation dose associated with various imaging modalities' and patients' experience and preferences regarding communication of information about radiation. Data was analysed using SPSS (Ver 20.1). A total of 242 surveys were completed. Most participants were male (143/239, 59.8%) and aged between 33 and 52 years (109/242, 45%). Over half of participants were not concerned about radiation from medical imaging (130/238, 54.6%). Only a third of participants (80/234, 34.2%) correctly reported that CT has a higher radiation dose than X-ray. Very few participants correctly identified mammography, DEXA, PET and PET/CT as radiation emitting examinations. The majority of participants (202/236, 85.6%) indicated that they were not informed about radiation dose and risks by their referring doctor in advance. This paper provides information relevant to a single private radiology clinic in Australia. Nevertheless, our results have shown that patients presenting for medical imaging have little awareness of radiation dose and risks associated with these examinations and received little information by their referring physicians or staff at the radiology clinic. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  12. Radiation Dose Effects into LCO in Technical Specification by Iodine in Hanul units 1,2

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Min; Lee, Seung Chan [KHNP Central Research Institute, Daejeon (Korea, Republic of)

    2015-05-15

    This study estimates the impact of the 1-th coolant system in NPP to the LCO (Limiting Condition of Operation) limits which is in the site boundary. Dose limit is merged into the effective dose from whole body and thyroid dose limits, that is possible to combine the two LCOs to a unified LCO. To estimate the limits, the radiation dose of one of the designed accidents should be chosen to check the radiation dose response. The selected accident is based on Seung Chan Lee's study at KHNP in 2011. Using the selected accident, Iodine dose effect is reviewed depending on the LCO limiting responsibility and the specific behavior. In order to evaluate the radiation dose effect in Technical Specification of Hanul 1,2, SGTR is selected for some sensitivity analysis. From the results, in Hanul site, the case of LOOP plus ADV plus GIS is the most severe case and the dose limit margin is about 110% in LCO.

  13. Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

    Science.gov (United States)

    Abdulrahman, Mahera; Qayed, Khalil I; AlHammadi, Hisham H; Julfar, Adnan; Griffiths, Jane L; Carrick, Frederick R

    2015-01-01

    PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward

  14. Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit.

    Science.gov (United States)

    Lazaryan, Moran; Abu-Kishk, Ibrahim; Rosenfeld-Yehoshua, Noa; Berkovitch, Sofia; Toledano, Michal; Reshef, Iris; Kanari, Tal; Ziv-Baran, Tomer; Berkovitch, Matitiahu

    2016-01-01

    One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available. To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU). A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded. The review time for one medical record was 8.9 (95% CI, 6.9-10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8) and 12 (9-15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations. Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

  15. Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moran Lazaryan

    2016-08-01

    Full Text Available Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU. Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9-10.9 minutes. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11 minutes. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8 and 12 (9-15 minutes, respectively, for patients with psychiatric-neurologic disorders compared to those without (p=0.032. Usually, a daily workload of 240 minutes was needed for the pharmacist accompanying the round in contrast to 108 minutes per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9% and made no comment on 36.9% of the recommendations. Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

  16. Cross-cultural medical education in the United States: key principles and experiences.

    Science.gov (United States)

    Betancourt, Joseph R; Cervantes, Marina C

    2009-09-01

    The field of cross-cultural care focuses on the ability to communicate effectively and provide quality health care to patients from diverse sociocultural backgrounds. In recent years, medical schools in the United States have increasingly recognized the growing importance of incorporating cross-cultural curricula into medical education. Cross-cultural medical education in the United States has emerged for four reasons: (1) the need for providers to have the skills to care for a diverse patient population; (2) the link between effective communication and health outcomes; (3) the presence of racial/ethnic disparities that are, in part, due to poor communication across cultures; and (4) medical school accreditation requirements. There are three major approaches to cross-cultural education: (1) the cultural sensitivity/awareness approach that focuses on attitudes; (2) the multicultural/categorical approach that focuses on knowledge; and (3) the cross-cultural approach that focuses on skills. The patient-based approach to cross-cultural care combines these three concepts into a framework that can be used to care for any patient, anytime, anywhere. Ultimately, if cross-cultural medical education is to evolve, students must believe it is important and understand that the categorical approach can lead to stereotyping; it should be taught using patient cases and highlighting clinical applications; it should be embedded in a longitudinal, developmentally appropriate fashion; and it should be integrated into the larger curriculum whenever possible. At the Harvard Medical School, we have tried to apply all of these lessons to our work, and we have started to develop a strategic integration process where we try to raise awareness, impart knowledge, and teach cross-cultural skills over the 4 years of schooling.

  17. The mean active bone marrow dose to the adult population of the United States from diagnostic radiology

    International Nuclear Information System (INIS)

    Shleien, B.; Tucker, T.T.; Johnson, D.W.

    1977-01-01

    Estimates, based on an empirical model and computer program, have been calculated and are presented on the mean active bone marrow dose to adults from diagnostic radiography, fluoroscopy, and dental radiography as practiced in the United States in 1970. The annual per capita mean active bone marrow dose in 1970 to adults from the above practices is estimated to be 103 mrad; 77 percent, 20 percent, and 3 percent from radiographic, fluoroscopic and dental examinations respectively. Examinations of the upper and lower abdomen contribute approximately 39 percent each to the total mean active bone marrow dose for adults; those of the pelvis 4 percent; the thorax 12 percent; and head and neck examinations (including dental) contribute about 6 percent. The per capita mean active bone marrow dose for various age groups is discussed. Contributions to the dose within a given age group from different examinations indicate that in the 15-34 year old age group Lumbar and Lumbosacral Spine examinations contribute most to the mean active bone marrow dose. Thereafter Upper G I Series and Barium Enemas are the highest contributors. Comparisons are made with results of the 1964 U.S. X-ray survey and similar surveys from other nations

  18. Radiation dose measurements of an on-board imager X-ray unit using optically-stimulated luminescence dosimeters

    International Nuclear Information System (INIS)

    Smith, Leon; Haque, Mamoon; Hill, Robin; Morales, Johnny

    2015-01-01

    Cone beam computed tomography (CBCT) is now widely used to image radiotherapy patients prior to treatment for the purpose of accurate patient setup. However each CBCT image delivered to a patient increases the total radiation dose that they receive. The measurement of the dose delivered from the CBCT images is not readily performed in the clinic. In this study, we have used commercially available optically stimulated luminescence (OSLD) dosimeters to measure the dose delivered by the Varian OBI on a radiotherapy linear accelerator. Calibration of the OSLDs was achieved by using a therapeutic X-ray unit. The dose delivered by a head CBCT scan was found to be 3.2 ± 0.3 mGy which is similar in magnitude to the dose of a head computed tomography (CT) scan. The results of this study suggest that the radiation hazard associated with CBCT is of a similar nature to that of conventional CT scans. We have also demonstrated that the OSLDs are suitable for these low X-ray dose measurements.

  19. Effective dose per unit kerma-area product conversion factors in adults undergoing modified barium swallow studies

    International Nuclear Information System (INIS)

    Shaw Bonilha, Heather; Wilmskoetter, Janina; Tipnis, Sameer V.; Martin-Harris, Bonnie; Huda, Walter

    2017-01-01

    This study presents an investigation of adult effective dose (E) per unit Kerma-Area Product (KAP) in Modified Barium Swallow Study (MBSS) examinations. PC program for X-ray Monte Carlo (version 2.0.1) was used to calculate patient organ doses during MBSS examinations, which used combined to generate effective dose. Normalized patient doses were obtained by dividing the effective dose (mSv) by the incident KAP (Gy.cm 2 ). Five standard projections were studied and the importance of X-ray beam size and in patient size (body mass index) were investigated. Lateral projections had an average E/ KAP conversion factor of 0.19 ± 0.04 mSv/Gy.cm 2 . The average E/KAP was highest for upper gastrointestinal (GI) anterior- posterior projections (0.27 ± 0.04 mSv/Gy.cm 2 ) and lowest for upper GI posterior-anterior projections (0.09 ± 0.03 mSv/ Gy.cm 2 ). E/KAP always increased with increasing filtration and/or X-ray tube voltage. Reducing the X-ray beam cross-sectional area increased the E/KAP conversion factors. Small patients have the E/KAP conversion factors that are twice those of a standard adult. Conversion factors for effective dose of adult patients undergoing MBSS examinations must account for X-ray beam projection, beam quality (kV and filtration), image size and patient size. (authors)

  20. [Cases of acute poisoning admitted to a medical intensive care unit].

    Science.gov (United States)

    Viertel, A; Weidmann, E; Brodt, H R

    2001-10-19

    Because of the paucity of information on the epidemiology of acute poisoning requiring intensive medical care, all such patients treated on the medical intensive care unit of the university hospital in Frankfurt am Main, Germany, between January 1993 and December 1999, were retrospectively evaluated. Of the total of 6211 patients, 147 (80 women, 67 men, mean age 41 years, 2,3 %) were treated for acute intoxication in the intensive care unit. Reasons for admission to the intensive care unit were the need for ventilator treatment or intensive monitoring of vital functions. 52 % of the patients (n = 76) had attempted suicide, most of them using anti-depressive drugs (n = 19), paracetamol (n = 16), or benzodiazepines (n = 9). Two patients (2,6 %) died. 48 % of the patients (n = 71) were admitted because of accidental poisoning. Leading toxic agents in this group were heroin (n = 19), alcohol (n = 18) and digitalis (n = 12). 11 patients had taken herbicides, animal poisons or chemicals used at work or for house cleaning. In this cohort, three i. v. drug abusers (4,2 %) had died. Depending on the agents used, a variety of treatments (charcoal, antidots, extracorporal therapy) were undertaken. Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.

  1. Organizational effects on patient satisfaction in hospital medical-surgical units.

    Science.gov (United States)

    Bacon, Cynthia Thornton; Mark, Barbara

    2009-05-01

    The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals. Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes. The sample for this study was 2,720 patients and 3,718 RNs in 286 medical-surgical units in 146 hospitals. Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status, and better symptom management were also associated with higher levels of patient satisfaction. Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses' work engagement and effective symptom management, are important influences on patient satisfaction.

  2. An overview of equivalent doses in eye lens of occupational radiation workers in medical, industrial and nuclear areas

    International Nuclear Information System (INIS)

    Lima, A.R.; Silva, F.C.A. da; Hunt, J.G.

    2013-01-01

    Some epidemiological evidences were recently reviewed by the ICRP and it was suggested that, for the eye lens, the absorbed dose threshold for induction of late detriments is about 0.5 Gy. On this basis, on 2011, the ICRP has recommended changes to the occupational dose limit in planned exposure situations, reducing the eye lens dose equivalent limit of 150 mSv to 20 mSv per year, on average, during the period of 5 years, with exposure not exceeding 50 mSv in a single year. Following the ICRP recommendation, the Brazilian Commission of Nuclear Energy (CNEN) adopted immediately the new limit to the eyes lens. This study aimed to show an overview about the doses in eye lens of occupational radiation workers in situations of planned exposures in the medical, industrial and nuclear areas, emphasizing the greatest radiological risks applications. It was observed that there are some limitations, such as example, to use individual monitor calibrated on Hp(3), to assess the equivalent dose in the eye lens. This limitation obstructs some experimental studies and monitoring of the levels of radiation received in the eye lens of radiation workers. Recent studies have showed that the lenses of eyes monitoring of workers, mainly in the planned exposure, must be follow-up. However, such researches were obtained only in medical exposures, mainly in interventional medicine procedures. Studies with planned exposure on nuclear and industrial areas are really needed and will be very important due to the new recommended by ICRP dose limits. (author)

  3. Medical Device Regulation: A Comparison of the United States and the European Union.

    Science.gov (United States)

    Maak, Travis G; Wylie, James D

    2016-08-01

    Medical device regulation is a controversial topic in both the United States and the European Union. Many physicians and innovators in the United States cite a restrictive US FDA regulatory process as the reason for earlier and more rapid clinical advances in Europe. The FDA approval process mandates that a device be proved efficacious compared with a control or be substantially equivalent to a predicate device, whereas the European Union approval process mandates that the device perform its intended function. Stringent, peer-reviewed safety data have not been reported. However, after recent high-profile device failures, political pressure in both the United States and the European Union has favored more restrictive approval processes. Substantial reforms of the European Union process within the next 5 to 10 years will result in a more stringent approach to device regulation, similar to that of the FDA. Changes in the FDA regulatory process have been suggested but are not imminent.

  4. [Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000].

    Science.gov (United States)

    Vincent-Boulétreau, A; Caillat-Vallet, E; Dumas, A M; Ayzac, L; Chapuis, C; Emery, M N; Girard, R; Haond, C; Lafarge-Leboucher, J; Tissot-Guerraz, F; Fabry, J

    2005-04-01

    In this study we describe the changes in medical practices and nosocomial infection rates in obstetrics observed through a surveillance network in the South East of France. The maternity units which belong to this network participated in voluntary surveillance using the network's methodology. The criteria for the diagnosis of nosocomial infections were in accordance with the methods described by the Centers for Disease Control and Prevention. 101240 pregnancies including 18503 caesareans (18.3%) were included in the network from 1997 to 2000. During the study period, nosocomial infection rates following caesarean section and vaginal delivery decreased respectively from 7.8% to 4.3% (p infection control programs in maternity units has been confirmed by the results of this surveillance network. During the study period, both obstetrics-related risk factors for nosocomial infection and observed hospital-acquired infection rates were dramatically reduced, what prove an improvement of quality of care in maternity units.

  5. Current disparities in the prices of medical materials between Japan and the United States: further investigation of cardiovascular medical devices.

    Science.gov (United States)

    Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki

    2007-02-01

    Prices of medical devices in Japan were previously reported to be 2 to 4 times higher than those in the United States in 1996 and 1997. However, such data are out of date. We previously compared the market prices in early 2005 between Japan and the US for 16 items in 10 categories of medical materials, and showed that price differences still existed for all these items. However, the number of items investigated was small for each category, and generalization of the results might have been limited. The present study conducted a further investigation into price information for multiple items for each category, focusing on 5 cardiovascular devices. The US market price information was obtained from interviews of a healthcare provider network and 2 different group-purchasing organizations. We could obtain price information on 19 items in 5 categories. We substituted the Japanese reimbursement prices for the Japanese market prices. The price ratio (Japanese reimbursement price / US market price)was 2.0-3.5 for coronary stents, 5.9-6.8 for percutaneous transluminal coronary angioplasty catheters, 2.2-3.5 for pacemakers, 1.6-2.5 for mechanical valves, and 3.4-4.7 for oxygenators. The price disparities for cardiovascular devices between Japan and the US were reconfirmed. Japan's healthcare system should establish group-purchasing organizations, promote centers of clinical excellence, and abolish regulation of parallel imports and protectionism under the Japanese Pharmaceutical Affairs Law.

  6. The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication stockpiles

    DEFF Research Database (Denmark)

    Larsen, Anna Bira; Haugbølle, Lotte Stig

    2007-01-01

    the assumed user benefits. Neither Danish nor international studies dealt with users' perspective on ADD in general or with respect to the pinpointed benefits, and thus exploration was needed. OBJECTIVES: The objective of this article is to respond to the following research question: How does ADD affect users......' handling and consumption of medication in terms of compliance behavior, and how does the assumption of user benefits made by health professionals and legislators measure up to users' experiences with ADD? METHODS: The results built on a secondary analysis of 9 qualitative interviews with a varied selection...... understanding, nor does it automatically eliminate stockpiles of old medication in users' homes. The gap between the perspectives of users and health professionals makes a compelling case for considering users' voices in the development and implementation of future health technologies....

  7. Neutron dose rate for {sup 252} Cf AT source in medical applications

    Energy Technology Data Exchange (ETDEWEB)

    Paredes, L.; Balcazar, M. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico); Azorin, J. [UAM-I, 09340 Mexico D.F. (Mexico); Francois, J.L. [FI-UNAM, 04510 Mexico D.F. (Mexico)

    2006-07-01

    The AAPM TG-43 modified protocol was used for the calculation of the neutron dose rate of {sup 252}Cf sources for two tissue substitute materials, five normal tissues and six tumours. The {sup 252}Cf AT source model was simulated using the Monte Carlo MCNPX code in spherical geometry for the following factors: a) neutron air kerma strength conversion factor, b) dose rate constant, c) radial dose function, d) geometry factor, e) anisotropy function and f) neutron dose rate. The calculated dose rate in water at 1 cm and 90 degrees from the source long axis, using the Watt fission spectrum, was D{sub n}(r{sub 0}, {theta}{sub 0})= 1.9160 cGy/h-{mu}g. When this value is compared with Rivard et al. calculation using MCNP4B code, 1.8730 cGy/h-{mu}g, a difference of 2.30% is obtained. The results for the reference neutron dose rate in other media show how small variations in the elemental composition between the tissues and malignant tumours, produce variations in the neutron dose rate up to 12.25%. (Author)

  8. Evaluation of the distribution of absorbed dose in child phantoms exposed to diagnostic medical x rays

    Energy Technology Data Exchange (ETDEWEB)

    Chen, W. L.; Poston, J. W.; Warner, G. G.

    1978-04-01

    The purpose of this study was to determine, by theoretical calculation and experimental measurement, the absorbed dose distributions in two heterogeneous phantoms representing one-year- and five-year-old children from typical radiographic examinations for those ages. Theoretical work included the modification of an existing internal dose code which uses Monte Carlo methods to determine doses within the Snyder-Fisher mathematical phantom. A Ge(Li) detector and a pinhole collimator were used to measure x-ray spectra which served as input to the modified Monte Carlo codes which were used to calculate organ doses in children. The calculated and measured tissue-air values were compared for a number of organs. For most organs, the results of the calculated absorbed doses agreed with the measured absorbed doses within twice the coefficient of variation of the calculated value. The absorbed dose to specific organs for several selected radiological examinations are given for one-year-old, five-year-old, and adult phantoms.

  9. Doses to patients from medical X-ray examinations in the UK. 2000 review

    CERN Document Server

    Hart, D; Wall, B F

    2002-01-01

    In 1992 NRPB established a National Collation Centre for measurements of doses to patients made by x-ray departments throughout the UK. This report is the second in a series of five-yearly reviews of the national patient dose database and analyses the information collected during the period January 1996 to December 2000. It includes the results of 28,000 entrance surface dose (ESD) measurements and 13,000 dose-area product (DAP) measurements for single radiographs, and 140,000 DAP measurements and 128,000 records of the fluoroscopy time for complete examinations, collected from 371 hospitals throughout the UK. Information on the patient dose distributions and exposure conditions for over 30 types of examination and radiograph is presented. National reference doses based on the rounded third quartile values of these dose distributions are recommended and are seen to be about 20% lower than corresponding values in the previous (1995) review. They have approximately halved since the original UK national referenc...

  10. Evaluation of the distribution of absorbed dose in child phantoms exposed to diagnostic medical x rays

    International Nuclear Information System (INIS)

    Chen, W.L.; Poston, J.W.; Warner, G.G.

    1978-04-01

    The purpose of this study was to determine, by theoretical calculation and experimental measurement, the absorbed dose distributions in two heterogeneous phantoms representing one-year- and five-year-old children from typical radiographic examinations for those ages. Theoretical work included the modification of an existing internal dose code which uses Monte Carlo methods to determine doses within the Snyder-Fisher mathematical phantom. A Ge(Li) detector and a pinhole collimator were used to measure x-ray spectra which served as input to the modified Monte Carlo codes which were used to calculate organ doses in children. The calculated and measured tissue-air values were compared for a number of organs. For most organs, the results of the calculated absorbed doses agreed with the measured absorbed doses within twice the coefficient of variation of the calculated value. The absorbed dose to specific organs for several selected radiological examinations are given for one-year-old, five-year-old, and adult phantoms

  11. Terms and definitions in the field of radiological technique. Dose quantities and units. Draft. Begriffe und Benennungen in der radiologischen Technik. Dosisgroessen und Dosiseinheiten. Entwurf

    Energy Technology Data Exchange (ETDEWEB)

    1977-11-01

    This draft standard contains the definitions of the terms, quantities, and units important in dosimetry, while the methods of measurement and calculation are dealt with in other standards. Other than the standard of June 1972, this revised draft standard introduces the SI units of the energy dose, the Gray, and of the activity of a radioactive substance, the Becquerel. Important new measuring quantities are the standard energy dose and the dose equivalent index. The terms local dose and personnel dose are redefined in agreement with the Radiation Protection Ordinance of October 13, 1976.

  12. Terms and definitions in the field of radiological technique. Dose quantities and units. Draft. Begriffe und Benennungen in der radiologischen Technik. Dosisgroessen und Dosiseinheiten. Entwurf

    Energy Technology Data Exchange (ETDEWEB)

    1977-11-01

    The standard contains the definitions of terms, quantities and units important in dosimetry, while other standards deal with the measurement and calculation methods. As against the June 1972 edition, this amended standard introduces the SI units of the energy dose, the Gray (Gy), and of the activity of a radioactive substance, the Becquerel (Bq). Important new measuring quantities are the standard energy dose and the equivalent dose index. The terms local dose and personnel dose are redefined in accordance with the Radiation Protection Ordinance of Oct. 13th, 1976.

  13. Measurement of MV CT dose index for Hi-ART helical tomotherapy unit

    International Nuclear Information System (INIS)

    Wang Yunlai; Liao Xiongfei

    2010-01-01

    Objective: To evaluate the patient dose from Hi-ART MV helical CT imaging in image-guided radiotherapy. Methods: Weighted CT dose index (CTDI W ) was measured with PTW TM30009 CT ion chamber in head and body phantoms, respectively,for slice thicknesses of 2, 4, 6 mm with scanned range of 5 cm and 15 cm. Dose length products (DLP) were subsequently calculated. The CTDI W and DLP were compared with XVI kV CBCT and ACQSim simulator CT for routine clinical protocols. Results: An inverse relationship between CTDI and the slice thickness was found. The dose distribution was inhomogeneous owing to the attenuation of the couch. CTDI and DLP had close relationship with the slice thickness and the scanned range. Patient dose from MVCT was lower than XVI CBCT for head, but larger for body scan. Conclusions: CTDI W can be used to assess the patient dose in MV helical CT due to its simplicity for measurement and reproducibility. Regular measurement should be performed in QA and QC program. Appropriate slice thickness and scan range should be chosen to reduce the patient dose. (authors)

  14. Prescription medication by physiotherapists: a Brazilian view of the United Kingdom, Canada, Australia and New Zealand

    Directory of Open Access Journals (Sweden)

    Valton da Silva Costa

    Full Text Available Abstract Many health systems (HS have adopted novel models of care which have included non-medical prescription (NMP by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.

  15. Doctors qualifying from United Kingdom medical schools during the calendar years 1977 and 1983.

    Science.gov (United States)

    Parkhouse, J; Parkhouse, H F

    1989-01-01

    At the conclusion of undergraduate medical education in the United Kingdom most students pass a university qualifying examination and obtain a degree in medicine and surgery. Some students pass an external non-university qualifying examination in medicine as an alternative to obtaining a degree, and some do both. The degree may be obtained in the same year as the non-university qualifying examination, or in a different year. Some students from a medical school intake qualify in a later year than expected, for various reasons. Data from university, Health Department and other sources may relate to the academic year, the calendar year, or a fixed date such as 30 September. It is not a simple exercise, therefore, to define the exact number of people who qualify to practise medicine, for the first time, in any given 'year'. In counting qualifiers from individual medical schools, the problems are further compounded by the movement of students between the preclinical and clinical stages of the course, particularly from Oxford and Cambridge to London teaching hospitals. This paper analyses the situation for the calendar years 1977 and 1983, showing a decline in the number of students obtaining double (i.e. both university and non-university) qualifications. The number of UK graduates not registering with the General Medical Council to practise, at least for a time, in the UK was small, and the population base compiled for Medical Career Research Group studies was reasonably accurate in each of the 2 years examined.

  16. New medical schools in the United States: forces of change past and present.

    Science.gov (United States)

    Smith, Lawrence

    2009-01-01

    The new millennium has ushered in a growth phase in the number of American medical schools. Historically the United States has built schools during bursts of activity with relative quiescence in between these periods. We had a twenty-two year period with no growth in medical school size or number. During that time there were significant changes in patient characteristics, student culture, financial reimbursement, quality, and manpower needs that have put stress on medical schools, hospitals, clinical practice and healthcare systems. In addition, there have been remarkable new opportunities in the way we teach, including changes in teaching methodology, educational technology, and a better understanding of how students actually learn. All of these advances have taken place during a period of enormous pressure to change residency programs, reorganize medical and clinical science, and question the very need for traditional departmental structures. It is likely that the new medical schools will emerge looking different from the older schools and they are likely to catalyze a period of curricular change.

  17. Intercoder Reliability of Mapping Between Pharmaceutical Dose Forms in the German Medication Plan and EDQM Standard Terms.

    Science.gov (United States)

    Sass, Julian; Becker, Kim; Ludmann, Dominik; Pantazoglou, Elisabeth; Dewenter, Heike; Thun, Sylvia

    2018-01-01

    A nationally uniform medication plan has recently been part of German legislation. The specification for the German medication plan was developed in cooperation between various stakeholders of the healthcare system. Its' goal is to enhance usability and interoperability while also providing patients and physicians with the necessary information they require for a safe and high-quality therapy. Within the research and development project named Medication Plan PLUS, the specification of the medication plan was tested and reviewed for semantic interoperability in particular. In this study, the list of pharmaceutical dose forms provided in the specification was mapped to the standard terms of the European Directorate for the Quality of Medicines & HealthCare by different coders. The level of agreement between coders was calculated using Cohen's Kappa (κ). Results show that less than half of the dose forms could be coded with EDQM standard terms. In addition to that Kappa was found to be moderate, which means rather unconvincing agreement among coders. In conclusion, there is still vast room for improvement in utilization of standardized international vocabulary and unused potential considering cross-border eHealth implementations in the future.

  18. A study to determine the differences between the displayed dose values for two full-field digital mammography units and values calculated using a range of Monte-Carlo-based techniques: A phantom study

    International Nuclear Information System (INIS)

    Borg, M.; Badr, I.; Royle, G. J.

    2013-01-01

    Modern full-field digital mammography (FFDM) units display the mean glandular dose (MGD) and the entrance or incident air kerma (K) to the breast following each exposure. Information on how these values are calculated is limited and knowing how displayed MGD values compare and correlate to conventional Monte-Carlo-based methods is useful. From measurements done on polymethyl methacrylate (PMMA) phantoms, it has been shown that displayed and calculated MGD values are similar for thin to medium thicknesses and appear to differ with larger PMMA thicknesses. As a result, a multiple linear regression analysis on the data was performed to generate models by which displayed MGD values on the two FFDM units included in the study may be converted to the Monte-Carlo values calculated by conventional methods. These models should be a useful tool for medical physicists requiring MGD data from FFDM units included in this paper and should reduce the survey time spent on dose calculations. (authors)

  19. An MCNP-based model for the evaluation of the photoneutron dose in high energy medical electron accelerators.

    Science.gov (United States)

    Carinou, Eleutheria; Stamatelatos, Ion Evangelos; Kamenopoulou, Vassiliki; Georgolopoulou, Paraskevi; Sandilos, Panayotis

    The development of a computational model for the treatment head of a medical electron accelerator (Elekta/Philips SL-18) by the Monte Carlo code mcnp-4C2 is discussed. The model includes the major components of the accelerator head and a pmma phantom representing the patient body. Calculations were performed for a 14 MeV electron beam impinging on the accelerator target and a 10 cmx10 cm beam area at the isocentre. The model was used in order to predict the neutron ambient dose equivalent at the isocentre level and moreover the neutron absorbed dose distribution within the phantom. Calculations were validated against experimental measurements performed by gold foil activation detectors. The results of this study indicated that the equivalent dose at tissues or organs adjacent to the treatment field due to photoneutrons could be up to 10% of the total peripheral dose, for the specific accelerator characteristics examined. Therefore, photoneutrons should be taken into account when accurate dose calculations are required to sensitive tissues that are adjacent to the therapeutic X-ray beam. The method described can be extended to other accelerators and collimation configurations as well, upon specification of treatment head component dimensions, composition and nominal accelerating potential.

  20. Exposure Scenarios and Unit Dose Factors for the Hanford Immobilized Low Activity Tank Waste Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    RITTMANN, P.D.

    1999-12-29

    Exposure scenarios are defined to identify potential pathways and combinations of pathways that could lead to radiation exposure from immobilized tank waste. Appropriate data and models are selected to permit calculation of dose factors for each exposure

  1. Evaluation of the distribution of absorbed dose in child phantoms exposed to diagnostic medical x rays

    International Nuclear Information System (INIS)

    Chen, W.L.

    1977-01-01

    The purpose of the study was to determine, by theoretical calculation and experimental measurement, the absorbed dose distributions in two heterogeneous phantoms representing one-year- and five-year-old children from typical radiographic examinations for those ages. Theoretical work included the modification of an existing internal dose code which used Monte Carlo methods to determine doses within the Snyder-Fisher mathematical phantom. A Ge(Li) detector and a pinhole collimator were used to measure x-ray spectra which served as input (i.e., the source routine) to the modified Monte Carlo codes which were used to calculate organ doses in children. Experimental work included the fabrication of child phantoms to match the existing mathematical models. These phantoms were constructed of molded lucite shells filled with differing materials to simulate lung, skeletal, and soft-tissue regions. The skeleton regions of phantoms offered the opportunity to perform meaningful measurements of absorbed dose to bone marrow and bone. Thirteen to fourteen sites in various bones of the skeleton were chosen for placement of TLDs. These sites represented important regions in which active bone marrow is located. Sixteen typical radiographic examinations were performed representing common pediatric diagnostic procedures. The calculated and measured tissue-air values were compared for a number of organs. For most organs, the results of the calculated absorbed doses agreed with the measured absorbed doses within twice the coefficient of variation of the calculated value. The absorbed dose to specific organs for several selected radiological examinations are given for one-year-old, five-year-old, and adult phantoms. For selected radiological exposures, the risk factors of leukemia, thyroid cancer, and genetic death are estimated for one-year- and five-year-old children

  2. An observational study evaluating tacrolimus dose, exposure, and medication adherence after conversion from twice- to once-daily tacrolimus in liver and kidney transplant recipients.

    Science.gov (United States)

    Bäckman, Lars; Persson, Carl-Axel

    2014-03-17

    Immunosuppression regimens in transplantation medicine are complex. Drugs with extended release action have simplified medication dosing without affecting efficacy. This prospective, observational, multicenter study, conducted in a routine medical practice setting, evaluated changes in tacrolimus daily dose and trough levels and patient-reported medication adherence at day 90 after 1:1 (mg: mg) conversion to once-daily tacrolimus in adult liver and kidney transplant recipients. Data from 224 recipients of a liver (n=19) or kidney (n=205) transplant, average age 51±14.5 years, were evaluated. The mean change in tacrolimus daily dose was +0.04 mg/day. Dose remained stable after conversion in 62.5%, was lower in 15.6%, and higher in 22% of patients. Trough level after conversion was lower in 62.6% and higher in 36.5%; generally, levels were 12.8% lower than pre-conversion levels. No acute rejection, graft loss, or serious safety events were observed. Two deaths occurred due to myocardial infarction. Conversion helped 19% to less frequently forget medications and 55% reported no difference in remembering to take the once-daily dose after conversion. The change in dosing frequency was identified as "better" for 55%. Tacrolimus daily dose remained stable while trough levels were significantly lower after conversion to once-daily dosing. Safety and efficacy were maintained; reduced dosing frequency had no apparent influence on patient-reported medication adherence.

  3. [Evaluation of an Experimental Production Wireless Dose Monitoring System for Radiation Exposure Management of Medical Staff].

    Science.gov (United States)

    Fujibuchi, Toshioh; Murazaki, Hiroo; Kuramoto, Taku; Umedzu, Yoshiyuki; Ishigaki, Yung

    2015-08-01

    Because of the more advanced and more complex procedures in interventional radiology, longer treatment times have become necessary. Therefore, it is important to determine the exposure doses received by operators and patients. The aim of our study was to evaluate an experimental production wireless dose monitoring system for pulse radiation in diagnostic X-ray. The energy, dose rate, and pulse fluoroscopy dependence were evaluated as the basic characteristics of this system for diagnostic X-ray using a fully digital fluoroscopy system. The error of 1 cm dose equivalent rate was less than 15% from 35.1 keV to 43.2 keV with energy correction using metal filter. It was possible to accurately measure the dose rate dependence of this system, which was highly linear until 100 μSv/h. This system showed a constant response to the pulse fluoroscopy. This system will become useful wireless dosimeter for the individual exposure management by improving the high dose rate and the energy characteristics.

  4. Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States

    International Nuclear Information System (INIS)

    Hopkins, Katharine L.; Vajtai, Petra L.; Pettersson, David R.; Spinning, Kristopher; Beckett, Brooke R.; Koudelka, Caroline W.; Bardo, Dianna M.E.

    2013-01-01

    During the last decade, there has been a movement in the United States toward utilizing size-appropriate radiation doses for pediatric body CT, with smaller doses given to smaller patients. This study assesses community adoption of size-appropriate pediatric CT techniques. Size-specific dose estimates (SSDE) in pediatric body scans are compared between community facilities and a university children's hospital that tailors CT protocols to patient size as advocated by Image Gently. We compared 164 pediatric body scans done at community facilities (group X) with 466 children's hospital scans. Children's hospital scans were divided into two groups: A, 250 performed with established pediatric weight-based protocols and filtered back projection; B, 216 performed with addition of iterative reconstruction technique and a 60% reduction in volume CT dose index (CTDI vol ). SSDE was calculated and differences among groups were compared by regression analysis. Mean SSDE was 1.6 and 3.9 times higher in group X than in groups A and B and 2.5 times higher for group A than group B. A model adjusting for confounders confirmed significant differences between group pairs. Regional community hospitals and imaging centers have not universally adopted child-sized pediatric CT practices. More education and accountability may be necessary to achieve widespread implementation. Since even lower radiation doses are possible with iterative reconstruction technique than with filtered back projection alone, further exploration of the former is encouraged. (orig.)

  5. Pharyngeal and cervical cancer incidences significantly correlate with personal UV doses among whites in the United States.

    Science.gov (United States)

    Godar, Dianne E; Tang, Rong; Merrill, Stephen J

    2014-09-01

    Because we found UV-exposed oral tissue cells have reduced DNA repair and apoptotic cell death compared with skin tissue cells, we asked if a correlation existed between personal UV dose and the incidences of oral and pharyngeal cancer in the United States. We analyzed the International Agency for Research on Cancer's incidence data for oral and pharyngeal cancers by race (white and black) and sex using each state's average annual personal UV dose. We refer to our data as 'white' rather than 'Caucasian,' which is a specific subgroup of whites, and 'black' rather than African-American because blacks from other countries around the world reside in the U.S. Most oropharyngeal carcinomas harboured human papilloma virus (HPV), so we included cervical cancer as a control for direct UV activation. We found significant correlations between increasing UV dose and pharyngeal cancer in white males (p=0.000808) and females (p=0.0031) but not in blacks. Shockingly, we also found cervical cancer in whites to significantly correlate with increasing UV dose (p=0.0154). Thus, because pharyngeal and cervical cancer correlate significantly with increasing personal UV dose in only the white population, both direct (DNA damage) and indirect (soluble factors) effects may increase the risk of HPV-associated cancer. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  6. Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Hopkins, Katharine L.; Vajtai, Petra L. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States); Pettersson, David R.; Spinning, Kristopher; Beckett, Brooke R. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Koudelka, Caroline W. [Oregon Health and Science University, Division of Biostatistics, Department of Public Health and Preventive Medicine, Portland, OR (United States); Bardo, Dianna M.E. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Oregon Health and Science University, Department of Cardiovascular Medicine, Portland, OR (United States)

    2013-09-15

    During the last decade, there has been a movement in the United States toward utilizing size-appropriate radiation doses for pediatric body CT, with smaller doses given to smaller patients. This study assesses community adoption of size-appropriate pediatric CT techniques. Size-specific dose estimates (SSDE) in pediatric body scans are compared between community facilities and a university children's hospital that tailors CT protocols to patient size as advocated by Image Gently. We compared 164 pediatric body scans done at community facilities (group X) with 466 children's hospital scans. Children's hospital scans were divided into two groups: A, 250 performed with established pediatric weight-based protocols and filtered back projection; B, 216 performed with addition of iterative reconstruction technique and a 60% reduction in volume CT dose index (CTDI{sub vol}). SSDE was calculated and differences among groups were compared by regression analysis. Mean SSDE was 1.6 and 3.9 times higher in group X than in groups A and B and 2.5 times higher for group A than group B. A model adjusting for confounders confirmed significant differences between group pairs. Regional community hospitals and imaging centers have not universally adopted child-sized pediatric CT practices. More education and accountability may be necessary to achieve widespread implementation. Since even lower radiation doses are possible with iterative reconstruction technique than with filtered back projection alone, further exploration of the former is encouraged. (orig.)

  7. Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

    Science.gov (United States)

    Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

    2011-08-01

    Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

  8. Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.

    Science.gov (United States)

    Al Saleem, Nouf; Al Harthy, Abdulrahman

    2015-01-01

    The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.

  9. Accommodating the medical use of marijuana: surveying the differing legal approaches in Australia, the United States and Canada.

    Science.gov (United States)

    Bogdanoski, Tony

    2010-02-01

    While the scientific and medical communities continue to be divided on the therapeutic benefits and risks of cannabis use, anecdotal evidence from medical users themselves suggests that using cannabis is indeed improving their quality of life by alleviating their pain and discomfort. Notwithstanding the benefits anecdotally claimed by these medical users and the existence of some scientific studies confirming their claims, criminal drug laws in all Australian and most United States jurisdictions continue to prohibit the possession, cultivation and supply of cannabis even for medical purposes. However, in contrast to Australia and most parts of the United States, the medical use of cannabis has been legal in Canada for about a decade. This article reviews these differing legal and regulatory approaches to accommodating the medical use of cannabis (namely, marijuana) as well as some of the challenges involved in legalising it for medical purposes.

  10. Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol.

    Science.gov (United States)

    El-Hadidy, Mohmed Adel; Helaly, Ahmed Mohamed Nabil

    2015-04-01

    Tramadol dependence has been studied recently after large-scale exposure. Although tramadol dependence has increased rapidly in Egypt since 2004, no studies have evaluated the effect of high dose long-term tramadol dependence. To address the chronic sequel of tramadol dependence over at least 5 years duration with a large dose (more than 675 mg/day, three tablets or more, each tablet of 225 mg). The study was aimed to check the physical and psychiatric status during tramadol dependence and 3 months after complete treatment. The present study was applied on 79 patients with single tramadol-dependence dose of 675 mg or more for 5 years or more. We examined the physical and psychological impact of tramadol abuse before and after 3 months of stoppage of the drug. The blood chemistry was nearly within normal parameters, although slight nonsignificant rise in liver enzymes was reported in some cases. Patients during tramadol dependence period were angry, hostile, and aggressive. On the other hand, after treatment the main problem observed was the significant increase in comorbid anxiety, depressive, and obsessive-compulsive symptoms, but no increase was found in psychotic symptoms. Tramadol-dependence dose was more important than duration of use in psychiatric illness. Tramadol dependence on high dose could be physically safe to some limit, but psychiatrically it has many side effects.

  11. Observations of the role of science in the United States medical cannabis state policies: Lessons learnt.

    Science.gov (United States)

    Grbic, Jelica; Goddard, Perilou; Ryder, David

    2017-04-01

    Clinical trials have shown cannabis to be effective in the treatment of some medical conditions and there is mounting public and political pressure to enact laws enabling the use of cannabis for medicinal purposes. To date, 28 United States (U.S.) states and the District of Columbia have enacted medical cannabis laws. This study sought to identify the main issues pertaining to the development of medical cannabis laws in the U.S, including the role of scientific evidence. Data were collected from three groups of participants: government officials, lobbyists and medical professionals involved in the medical cannabis debate in five selected states in the U.S.; researchers from the same five states conducting funded research in the alcohol and other drugs field; and members of the International Society for the Study of Drug Policy. The data were analysed using thematic analysis. Six major themes emerged in relation to the factors influencing policy: scientific evidence plays a limited role in the development of policy; the available research is limited and mixed; there is a need for clearer communication and active dissemination of evidence to policy makers; researchers need to consider what research is likely to impact on policy; scientific evidence is not a major factor in policy development; and there is a need to consider evidence within a political context. Researchers need to be aware of the political context in which medical cannabis laws are or are not enacted and consider ways in which research findings can achieve a higher profile within this context. Copyright © 2016. Published by Elsevier B.V.

  12. Enterococcal bacteremia is associated with prolonged stay in the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Viju Moses

    2012-01-01

    Full Text Available Background: Although enterococci are relatively common nosocomial pathogens in surgical intensive care units (ICUs, their significance in blood cultures from patients in the medical ICU is unclear. Materials and Methods: In this retrospective study spanning 2 years, the clinical and microbiological characteristics of enterococcal bacteremia among medical ICU patients were evaluated. Results: Of 1325 admissions, 35 with enterococcal bacteremia accounted for 14.8% of positive blood cultures. They were significantly older (P=0.03 and had various co-morbidities. Most had vascular (96.9% and urinary (85.3% catheters, and 67.7% were mechanically ventilated. In addition to blood, enterococci were isolated from vascular catheters (8.6% and other sites (20%, while no focus was identified in 77% of patients. Prior use of broad-spectrum antimicrobials was nearly universal. All isolates tested were sensitive to vancomycin and linezolid. Resistance to ampicillin and gentamicin were 44.7% and 52.6%, respectively. Compared with other medical ICU patients, patients with enterococcal bacteremia had a longer ICU stay (P<0.0001 and a trend toward higher ICU mortality (P=0.08. Conclusions: Enterococcal bacteremia is an important nosocomial infection in the medical ICU, with a predilection for older patients with multiple comorbidities. Its occurrence is associated with a significantly longer ICU stay and a trend to a higher mortality. The choice of antibiotics should be dictated by local susceptibility data.

  13. Interprofessional intensive care unit team interactions and medical crises: a qualitative study.

    Science.gov (United States)

    Piquette, Dominique; Reeves, Scott; Leblanc, Vicki R

    2009-05-01

    Research has suggested that interprofessional collaboration could improve patient outcomes in the intensive care unit (ICU). Maintaining optimal interprofessional interactions in a setting where unpredictable medical crises occur periodically is however challenging. Our study aimed to investigate the perceptions of ICU health care professionals regarding how acute medical crises affect their team interactions. We conducted 25 semi-structured interviews of ICU nurses, staff physicians, and respiratory therapists. All interviews were audio-taped and transcribed, and the analysis was undertaken using an inductive thematic approach. Our data indicated that the nature of interprofessional interactions changed as teams passed through three key temporal periods around medical crises. During the "pre-crisis period", interactions were based on the mutual respect of each other's expertise. During the "crisis period", hierarchical interactions were expected and a certain lack of civility was tolerated. During the "post-crisis period", divergent perceptions emerged amongst health professionals. Post-crisis team dispersion left the nurses with questions and emotions not expressed by other team members. Nurses believed that systematic interprofessional feedback sessions held immediately after a crisis could address some of their needs. Further research is needed to establish the possible benefits of strategies addressing ICU health care professionals' specific needs for interprofessional feedback after a medical crisis.

  14. A dose-per-pulse monitor for a dual-mode medical accelerator

    International Nuclear Information System (INIS)

    Galbraith, D.M.; Martell, E.S.; Fueurstake, T.; Norrlinger, B.; Schwendener, H.; Rawlinson, J.A.

    1990-01-01

    On a radiotherapy accelerator, the dose monitoring system is the last level of protection between the patient and the extremely high dose rate which all accelerators are capable of producing. The risk of losing this level of protection is substantially reduced if two or more dose monitoring systems are used which are mechanically and electrically independent in design. This paper describes the installation of an independent radiation monitor in a dual-mode, computer-controlled accelerator with a moveable monitor chamber. The added device is fixed in the beam path, is capable of monitoring each beam pulse, and is capable of terminating irradiation within the pulse repetition period if any measured pulse is unacceptably high

  15. Disposition of the anti-ulcer medications ranitidine, cimetidine, and omeprazole following administration of multiple doses to exercised Thoroughbred horses.

    Science.gov (United States)

    Knych, H K; Stanley, S D; Arthur, R M; McKemie, D S

    2017-01-01

    The use of anti-ulcer medications, such as cimetidine, ranitidine, and omeprazole, is common in performance horses. The use of these drugs is regulated in performance horses, and as such a withdrawal time is necessary prior to competition to avoid a medication violation. To the authors' knowledge, there are no reports in the literature describing repeated oral administrations of these drugs in the horse to determine a regulatory threshold and related withdrawal time recommendations. Therefore, the objective of the current study was to describe the disposition and elimination pharmacokinetics of these anti-ulcer medications following oral administration to provide data upon which appropriate regulatory recommendations can be established. Nine exercised Thoroughbred horses were administered 20 mg/kg BID of cimetidine or 8 mg/kg BID of ranitidine, both for seven doses or 2.28 g of omeprazole SID for four doses. Blood samples were collected, serum drug concentrations were determined, and elimination pharmacokinetic parameters were calculated. The serum elimination half-life was 7.05 ± 1.02, 7.43 ± 0.851 and 3.94 ± 1.04 h for cimetidine, ranitidine, and omeprazole, respectively. Serum cimetidine and ranitidine concentrations were above the LOQ and omeprazole and omeprazole sulfide below the LOQ in all horses studied upon termination of sample collection. © 2016 John Wiley & Sons Ltd.

  16. GATEWAY Report Brief: Evaluating Tunable LED Lighting in the Swedish Medical Behavioral Health Unit

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2017-08-23

    Summary of a GATEWAY report evaluation of a tunable LED lighting system installed in the new Swedish Medical Behavioral Health Unit in Seattle that incorporates color-tunable luminaires in common areas, and uses advanced controls for dimming and color tuning, with the goal of providing a better environment for staff and patients. The report reviews the design of the tunable lighting system, summarizes two sets of measurements, and discusses the circadian, energy, and commissioning implications as well as lessons learned from the project.

  17. A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit.

    Science.gov (United States)

    Skinner, S Rachel; Ng, Cindy; McDonald, Ann; Walters, Tamara

    2005-10-17

    An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

  18. [Health care units image development on the market of medical services].

    Science.gov (United States)

    Kemicer-Chmielewska, Ewa; Karakiewicz, Beata

    2010-01-01

    The cause for this document is to present a deliberation on public health facility image development on the medical services market. Marketization of the health service, growing awareness of Polish citizens and their expectation of high service quality as well as increased competition in the healthcare system market is the reason why health unit managers need to put a lot of strength and effort in sustaining or improving the image of the facility they run. Such action gives a chance for obtaining a competitive advantage.

  19. Latin American dose survey results in mammography studies under IAEA programme: radiological protection of patients in medical exposures (TSA3)

    International Nuclear Information System (INIS)

    Mora, Patricia; Blanco, Susana; Khoury, Helen; Leyton, Fernando; Cardenas, Juan; Defaz, Maria Yolanda; Garay, Fernando; Telon, Flaviano; Garcia Aguilar, Juan; Roas, Norma; Gamarra, Mirtha; Blanco, Daniel; Quintero, Ana Rosa; Nader, Alejandro

    2015-01-01

    Latin American countries (Argentina, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Paraguay, Uruguay and Venezuela) working under the International Atomic Energy Agency (IAEA) Technical Cooperation Programme: TSA3 Radiological Protection of Patients in Medical Exposures have joined efforts in the optimisation of radiation protection in mammography practice. Through surveys of patient doses, the region has a unique database of diagnostic reference levels for analogue and digital equipment that will direct future optimisation activities towards the early detection of breast cancer among asymptomatic women. During RLA9/057 (2007-09) 24 institutions participated with analogue equipment in a dose survey. Regional training on methodology and measurement equipment was addressed in May 2007. The mean glandular dose (DG) was estimated using the incident kerma in air and relevant conversion coefficients for both projections craneo caudal and mediolateral oblique (CC and MLO). For Phase 2, RLA9/067 (2010-11), it was decided to include also digital systems in order to see their impact in future dose optimisation activities. Any new country that joined the project received training in the activities through IAEA expert missions. Twenty-nine new institutions participated (9 analogue and 20 digital equipment). A total of 2262 patient doses were collected during this study and from them D G (mGy) for both projections were estimated for each institution and country. Regional results (75 percentile in mGy) show for CC and MLO views, respectively: RLA9/057 (analogue) 2.63 and 3.17; RLA/067: 2.57 and 3.15 (analogue) and 2.69 and 2.90 (digital). Regarding only digital equipment for CC and MLO, respectively, computed radiography systems showed 2.59 and 2.78 and direct digital radiography (DDR) systems 2.78 and 3.04. Based on the IAEA Basic Safety Standard (BSS) reference dose (3 mGy), it can be observed that there is enough room to start

  20. Latin American dose survey results in mammography studies under IAEA programme: radiological protection of patients in medical exposures (TSA3).

    Science.gov (United States)

    Mora, Patricia; Blanco, Susana; Khoury, Helen; Leyton, Fernando; Cárdenas, Juan; Defaz, María Yolanda; Garay, Fernando; Telón, Flaviano; Aguilar, Juan Garcia; Roas, Norma; Gamarra, Mirtha; Blanco, Daniel; Quintero, Ana Rosa; Nader, Alejandro

    2015-03-01

    Latin American countries (Argentina, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Paraguay, Uruguay and Venezuela) working under the International Atomic Energy Agency (IAEA) Technical Cooperation Programme: TSA3 Radiological Protection of Patients in Medical Exposures have joined efforts in the optimisation of radiation protection in mammography practice. Through surveys of patient doses, the region has a unique database of diagnostic reference levels for analogue and digital equipment that will direct future optimisation activities towards the early detection of breast cancer among asymptomatic women. During RLA9/057 (2007-09) 24 institutions participated with analogue equipment in a dose survey. Regional training on methodology and measurement equipment was addressed in May 2007. The mean glandular dose (DG) was estimated using the incident kerma in air and relevant conversion coefficients for both projections craneo caudal and mediolateral oblique (CC and MLO). For Phase 2, RLA9/067 (2010-11), it was decided to include also digital systems in order to see their impact in future dose optimisation activities. Any new country that joined the project received training in the activities through IAEA expert missions. Twenty-nine new institutions participated (9 analogue and 20 digital equipment). A total of 2262 patient doses were collected during this study and from them D(G) (mGy) for both projections were estimated for each institution and country. Regional results (75 percentile in mGy) show for CC and MLO views, respectively: RLA9/057 (analogue) 2.63 and 3.17; RLA/067: 2.57 and 3.15 (analogue) and 2.69 and 2.90 (digital). Regarding only digital equipment for CC and MLO, respectively, computed radiography systems showed 2.59 and 2.78 and direct digital radiography (DDR) systems 2.78 and 3.04. Based on the IAEA Basic Safety Standard (BSS) reference dose (3 mGy), it can be observed that there is enough room to start

  1. Impact of Medical Tourism on Cosmetic Surgery in the United States

    Science.gov (United States)

    Franzblau, Lauren E.

    2013-01-01

    Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States. PMID:25289258

  2. Impact of Medical Tourism on Cosmetic Surgery in the United States

    Directory of Open Access Journals (Sweden)

    Lauren E. Franzblau, BS

    2013-10-01

    Full Text Available Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

  3. Impact of medical tourism on cosmetic surgery in the United States.

    Science.gov (United States)

    Franzblau, Lauren E; Chung, Kevin C

    2013-10-01

    Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

  4. [Children's medically complex diseases unit. A model required in all our hospitals].

    Science.gov (United States)

    Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

    2018-01-01

    The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team 1

    Science.gov (United States)

    Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia

    2014-01-01

    OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670

  6. United States-assisted studies on dose reconstruction in the former Soviet Union

    International Nuclear Information System (INIS)

    Anspaugh, L.R.; Bouville, A.

    1995-12-01

    Following the Chernobyl accident, the US and the USSR entered into an agreement to work on the safety of civilian nuclear reactors; one aspect of that work was to study the environmental transport and health effects of radionuclides released by the accident. After the break-up of the USSR separate agreements were established between the US and Ukraine, Belarus, and Russia to continue work on dose reconstruction and epidemiologic studies of health effects from exposure to external radiation and the incorporation of radionuclides. Studies in Belarus and Ukraine related to the Chernobyl accident now emphasize epidemiologic: studies of childhood-thyroid cancer and leukemia, and eye-lens-cataract formation in liquidators. Supporting studies on dose reconstruction emphasize a variety of ecological, physical, and biological techniques. Studies being conducted in Russia currently emphasize health effects in the workers and the population around the Mayak Industrial Association. As this production complex is an analogue of the US Hanford Works, advantage is being taken of the US experience in conducting a similar, recently completed dose-reconstruction study. In all cases the primary work on dose reconstruction is being performed by scientists from the former Soviet Union. US assistance is in the form of expert consultation and participation, exchange visits, provision of supplies and equipment, and other forms of local assistance

  7. Multi-dose drug dispensing as a tool to improve medication adherence: A study in patients using vitamin K antagonists.

    Science.gov (United States)

    van Rein, Nienke; de Geus, Kristel S; Cannegieter, Suzanne C; Reitsma, Pieter H; van der Meer, Felix J M; Lijfering, Willem M

    2018-01-01

    Multi-dose drug dispensing (MDD) is a dosing aid that provides patients with disposable bags containing all drugs intended for 1 dosing moment. MDD is believed to increase medication adherence, but studies are based on self-reported data, and results may depend on socially desirable answers. Therefore, our purpose was to determine the effect of MDD on medication adherence in non-adherent patients taking vitamin K antagonists (VKAs), and to compare with instructing patients on medication use. We conducted a before-after study in non-adherent patients where MDD was the exposure and change in adherence after MDD initiation was the outcome (within patient comparison). Time in therapeutic range (TTR) was selected as a measure for adherence, as this reflects stability of VKA treatment. To analyze whether MDD improved adherence as compared with standard care (ie, letters or calls from nurses of the anticoagulation clinic), non-adherent patients without MDD were also followed to estimate their TTR change over time (between patient comparison). Eighty-three non-adherent VKA patients started using MDD. The median TTR was 63% before MDD and 73% 6 months after MDD. The within patient TTR increased on average by 13% (95%CI 6% to 21%) within 1 month after starting MDD and remained stable during the next 5 months. The TTR of MDD-patients increased 10% (95%CI 2% to 19%) higher as compared with non-MDD patients within 1 month but was similar after 4 months (TTR difference 3%, 95%CI -2% to 9%). Adherence improved after initiation of MDD. Compared with instructing patients, MDD was associated with better adherence within 1 month but was associated with similar improvement after 4 months. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Effective doses and standardised risk factors from paediatric diagnostic medical radiation exposures: Information for radiation risk communication

    International Nuclear Information System (INIS)

    Bibbo, Giovanni

    2018-01-01

    In the paediatric medical radiation setting, there is no consistency on the radiation risk information conveyed to the consumer (patient/carer). Each communicator may convey different information about the level of risk for the same radiation procedure, leaving the consumer confused and frustrated. There is a need to standardise risks resulting from medical radiation exposures. In this study, paediatric radiographic, fluoroscopic, CT and nuclear medicine examination data have been analysed to provide (i) effective doses and radiation induced cancer risk factors from common radiological and nuclear medicine diagnostic procedures in standardised formats, (II) awareness of the difficulties that may be encountered in communicating risks to the layperson, and (iii) an overview of the deleterious effects of ionising radiation so that the risk communicator can convey with confidence the risks resulting from medical radiation exposures. Paediatric patient dose data from general radiographic, computed tomography, fluoroscopic and nuclear medicine databases have been analysed in age groups 0 to <5 years, 5 to <10 years, 10 to <15 years and 15 to <18 years to determine standardised risk factors. Mean, minimum and maximum effective doses and the corresponding mean lifetime risks for general radiographic, fluoroscopic, CT and nuclear medicine examinations for different age groups have been calculated. For all examinations, the mean lifetime cancer induction risk is provided in three formats: statistical, fraction and category. Standardised risk factors for different radiological and nuclear medicine examinations and an overview of the deleterious effects of ionising radiation and the difficulties encountered in communicating the risks should facilitate risk communication to the patient/carer.

  9. A "Neurological Emergency Trolley" reduces turnaround time for high-risk medications in a general intensive care unit.

    Science.gov (United States)

    Ajzenberg, Henry; Newman, Paula; Harris, Gail-Anne; Cranston, Marnie; Boyd, J Gordon

    2018-02-01

    To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses. 33-bed general medical-surgical intensive care unit in an academic teaching hospital. Time to medication administration. In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts. The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Image quality evaluation and patient dose assessment of medical fluoroscopic X-ray systems: A national study

    International Nuclear Information System (INIS)

    Economides, S.; Hourdakis, C. J.; Kalivas, N.; Kalathaki, M.; Simantirakis, G.; Tritakis, P.; Manousaridis, G.; Vogiatzi, S.; Kipouros, P.; Boziari, A.; Kamenopoulou, V.

    2008-01-01

    This study presents the results from a survey conducted by the Greek Atomic Energy Commission (GAEC), during the period 1998-2003, in 530 public and private owned fluoroscopic X-ray systems in Greece. Certain operational parameters for conventional and remote control systems were assessed, according to a quality control protocol developed by GAEC on the basis of the current literature. Public (91.5%) and private (81.5%) owned fluoroscopic units exhibit high-contrast resolution values over 1 lp mm -1 . Moreover, 88.5 and 87.1% of the fluoroscopic units installed in the public and private sector, respectively, present Maximum Patient Entrance Kerma Rate values lower than 100 mGy min -1 . Additionally, 68.3% of the units assessed were found to perform within the acceptance limits. Finally, the third quartile of the Entrance Surface Dose Rate distribution was estimated according to the Dose Reference Level definition and found equal to 35 mGy min -1 . (authors)

  11. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach.

    Science.gov (United States)

    Mackie, Jane E; Bruce, Catherine D

    2016-05-01

    Accurate calculation of medication dosages can be challenging for nursing students. Specific interventions related to types of errors made by nursing students may improve the learning of this important skill. The objective of this study was to determine areas of challenge for students in performing medication dosage calculations in order to design interventions to improve this skill. Strengths and weaknesses in the teaching and learning of medication dosage calculations were assessed. These data were used to create online interventions which were then measured for the impact on student ability to perform medication dosage calculations. The setting of the study is one university in Canada. The qualitative research participants were 8 nursing students from years 1-3 and 8 faculty members. Quantitative results are based on test data from the same second year clinical course during the academic years 2012 and 2013. Students and faculty participated in one-to-one interviews; responses were recorded and coded for themes. Tests were implemented and scored, then data were assessed to classify the types and number of errors. Students identified conceptual understanding deficits, anxiety, low self-efficacy, and numeracy skills as primary challenges in medication dosage calculations. Faculty identified long division as a particular content challenge, and a lack of online resources for students to practice calculations. Lessons and online resources designed as an intervention to target mathematical and concepts and skills led to improved results and increases in overall pass rates for second year students for medication dosage calculation tests. This study suggests that with concerted effort and a multi-modal approach to supporting nursing students, their abilities to calculate dosages can be improved. The positive results in this study also point to the promise of cross-discipline collaborations between nursing and education. Copyright © 2016 Elsevier Ltd. All rights

  12. An evaluation of children's metered-dose inhaler technique for asthma medications.

    Science.gov (United States)

    Burkhart, Patricia V; Rayens, Mary Kay; Bowman, Roxanne K

    2005-03-01

    Regardless of the medication delivery system, health care providers need to teach accurate medication administration techniques to their patients, educate them about the particular nuances of the prescribed delivery system (eg, proper storage), and reinforce these issues at each health encounter. A single instruction session is not sufficient to maintain appropriate inhaler techniques for patients who require continued use. Providing written steps for the administration technique is helpful so that the patient can refer to them later when using the medication. The National Heart, Lung, and Blood Institute's "Practical Guide for the Diagnosis and Management of Asthma" recommends that practitioners follow these steps for effective inhaler technique training when first prescribing an inhaler: 1. Teach patients the steps and give written instruction handouts. 2. Demonstrate how to use the inhaler step-by-step. 3. Ask patients to demonstrate how to use the inhaler. Let the patient refer to the handout on the first training. Then use the handout asa checklist to assess the patient's future technique. 4. Provide feedback to patients about what they did right and what they need to improve. Have patients demonstrate their technique again, if necessary. The last two steps should be performed (ie, demonstration and providing feedback on what patients did right and what they need to improve) at every subsequent visit. If the patient makes multiple errors, it is advisable to focus on improving one or two key steps at a time. With improvements in drug delivery come challenges, necessitating that practitioners stay current with new medication administration techniques. Teaching and reinforcing accurate technique at each health care encounter are critical to help ensure medication efficacy for patients with asthma. Since one fifth of children in the study performed incorrect medication technique even after education, checklists of steps for the correct use of inhalation devices

  13. Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay

    NARCIS (Netherlands)

    Brand, Caroline A.; Kennedy, Marcus P.; King-Kallimanis, Bellinda L.; Williams, Ged; Bain, Christopher A.; Russell, David M.

    2010-01-01

    Objective: The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and 'front end loading' approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay. A pre-post study

  14. Web Implementation of Quality Assurance (QA) for X-ray Units in Balkanic Medical Institutions.

    Science.gov (United States)

    Urošević, Vlade; Ristić, Olga; Milošević, Danijela; Košutić, Duško

    2015-08-01

    Diagnostic radiology is the major contributor to the total dose of the population from all artificial sources. In order to reduce radiation exposure and optimize diagnostic x-ray image quality, it is necessary to increase the quality and efficiency of quality assurance (QA) and audit programs. This work presents a web application providing completely new QA solutions for x-ray modalities and facilities. The software gives complete online information (using European standards) with which the corresponding institutions and individuals can evaluate and control a facility's Radiation Safety and QA program. The software enables storage of all data in one place and sharing the same information (data), regardless of whether the measured data is used by an individual user or by an authorized institution. The software overcomes the distance and time separation of institutions and individuals who take part in QA. Upgrading the software will enable assessment of the medical exposure level to ionizing radiation.

  15. Clinical medical sciences for undergraduate dental students in the United Kingdom and Ireland - a curriculum.

    LENUS (Irish Health Repository)

    Mighell, A J

    2011-08-01

    The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term \\'Clinical Medical Sciences in Dentistry\\' was agreed in preference to other names such as \\'Human Disease\\' or \\'Medicine and Surgery\\'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care.

  16. Improving Catheter Associated Urinary Tract Infection Rates in the Medical Units

    Science.gov (United States)

    Taha, Haytham; Raji, Salama J.; Khallaf, Abeer; Abu Hija, Seham; Mathew, Raji; Rashed, Hanan; Du Plessis, Christelle; Allie, Zaytoen; Ellahham, Samer

    2017-01-01

    Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity with a high occupancy rate. SKMC senior management has made a commitment to make quality and patient safety a top priority. Preventing health care associated infections, including Catheter Associated Urinary Tract Infection (CAUTI), is a high priority for our hospital. In order to improve CAUTI rates a multidisciplinary task force team was formed and led this performance improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to reduce CAUTI rates and the outcome of those interventions. We chose to conduct the pilot study in General Medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from March 2015 till April 2016. Our aim was to reduce CAUTI rates per 1000 device days in the medical units. Implemented interventions resulted in a reduction of CAUTI from 6.8 per 1000 device days in March 2015 to zero CAUTI in February through April 2016. PMID:28469893

  17. Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

    2017-06-01

    Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Production of humoral factors that stimulate spleen colony-forming units in mice irradiated with moderate doses of X rays

    International Nuclear Information System (INIS)

    Grande, T.; Gonzalez, J.; Tejero, C.; Maganto, G.; Bueren, J.A.

    1990-01-01

    The production of humoral factors that stimulate spleen colony-forming units (CFU-S) has been studied in irradiated mice using an in vivo diffusion chamber assay. The experiments show that a significant release of factors that stimulate CFU-S takes place in the first few days after irradiation with moderate doses of 1.5 or 5 Gy. In contrast, the release of significant amounts of these humoral factors was not seen in animals irradiated with either low (0.75 Gy) or high (10 Gy) doses of X rays. The correlation observed between the production of factors that stimulate the CFU-S and the hemopoietic regeneration kinetics of the irradiated mice suggests that these factors represent part of the physiological regulators controlling the proliferation of CFU-S

  19. Population characteristics and absorbed dose to the population from nuclear medicine: United States--1982

    International Nuclear Information System (INIS)

    Mettler, F.A. Jr.; Christie, J.H.; Williams, A.G. Jr.; Moseley, R.D. Jr.; Kelsey, C.A.

    1986-01-01

    Those in the U.S. population who receive nuclear medicine examinations have been characterized by age and sex. Males received 42% of examinations while females received 58%. More than one-third of the examinations were done on persons older than 64 y of age and more than two-thirds on patients older than 45 y of age. The per caput effective dose equivalent from nuclear medicine procedures in 1982 was 140 muSv (14 mrem); whereas, the per caput age-specific effective dose equivalent to the U.S. population was 50 muSv (5.9 mrem). These can be compared with 2 mSv (200 mrem) from natural background

  20. Evaluation of internal dose of handlers of radioisotopes and radiopharmaceuticals for medical use

    International Nuclear Information System (INIS)

    Cesar, R.B.P.; Mesquita, C.H. de

    1987-01-01

    The internal dose of workers from IPEN/CNEN-SP (Brazil) is evaluated according to models described by the ICPR-30 (International Comission on Radiological Protection). The workers, monitored by a whole-body counter, are divided into six groups: research and development, routine production, quality control, packaging, radiological protection and maintenance. The results of 970 counting, done in three years, are presented. (M.C.A.) [pt

  1. Physicians' knowledge about radiation dose and possible risks of common medical tests: a survey in Iran

    International Nuclear Information System (INIS)

    Zakeri, Farideh; Mianji, Fereidoun; Shakeri, Mahsa; Rajabpour, Mohammad Reza; Farshidpour, Mohammad Reza

    2016-01-01

    Recent data suggest that knowledge of radiation exposures among physicians is inadequate. This study, therefore, aimed to evaluate their knowledge of the radiation doses their patients received and awareness of associated biological risks of radiation exposure. A questionnaire in multiple-choice format consisted of four sections with a total of 10 questions based on the literature review. A total of 136 questionnaires were returned from 69 general practitioners and 67 physicians in various specialties from 10 different hospitals in the capital city of Tehran, Iran. Fifty-four percent of general practitioners and twenty-five percent of specialties declared that they are not aware of biological risks of radiation exposure. Fifty-six percent of physicians did not know the correct definition of absorbed dose. Only 33% of physicians knew the dose exposure of a chest X-ray and only 31% knew the approximate doses of various procedures relative to a chest X-ray. Forty-seven percent of physicians incorrectly distinguished the stochastic effects of radiation from the deterministic effects, and thirty-eight of physicians did not know the organs of the body that are most sensitive to ionizing radiation. Only 23.5% of physicians were aware of the one in 2000 risk of induction of fatal carcinoma from computed tomography of the abdomen. Seventy-nine percent of physicians incorrectly underestimated the contribution of nuclear and radiological tests in exposure of an average person. The mean score of the specialties trended toward being more accurate than general practitioners (4.18 ± 1.28 vs. 3.89 ± 1.46, respectively, from a potential accurate total score of 9), but these differences were not statistically significant. Among specialists, orthopedics had the highest scores. The present study demonstrated the limited knowledge of radiation exposures among general practitioners and specialists and a need to improve their knowledge by means of targeted training and re

  2. A collimated detection system for assessing leakage dose from medical linear accelerators at the patient plane.

    Science.gov (United States)

    Lonski, P; Taylor, M L; Franich, R D; Kron, T

    2014-03-01

    Leakage radiation from linear accelerators can make a significant contribution to healthy tissue dose in patients undergoing radiotherapy. In this work thermoluminescent dosimeters (LiF:Mg,Cu,P TLD chips) were used in a focused lead cone loaded with TLD chips for the purpose of evaluating leakage dose at the patient plane. By placing the TLDs at one end of a stereotactic cone, a focused measurement device is created; this was tested both in and out of the primary beam of a Varian 21-iX linac using 6 MV photons. Acrylic build up material of 1.2 cm thickness was used inside the cone and measurements made with either one or three TLD chips at a given distance from the target. Comparing the readings of three dosimeters in one plane inside the cone offered information regarding the orientation of the cone relative to a radiation source. Measurements in the patient plane with the linac gantry at various angles demonstrated that leakage dose was approximately 0.01% of the primary beam out of field when the cone was pointed directly towards the target and 0.0025% elsewhere (due to scatter within the gantry). No specific 'hot spots' (e.g., insufficient shielding or gaps at abutments) were observed. Focused cone measurements facilitate leakage dose measurements from the linac head directly at the patient plane and allow one to infer the fraction of leakage due to 'direct' photons (along the ray-path from the bremsstrahlung target) and that due to scattered photons.

  3. A collimated detection system for assessing leakage dose from medical linear accelerators at the patient plane

    International Nuclear Information System (INIS)

    Lonski, P.; Kron, T.; Taylor, M.L.; Franich, R.D.

    2014-01-01

    Leakage radiation from linear accelerators can make a significant contribution to healthy tissue dose in patients undergoing radiotherapy. In this work thermoluminescent dosimeters (LiF:Mg,Cu,P TLD chips) were used in a focused lead cone loaded with TLD chips for the purpose of evaluating leakage dose at the patient plane. By placing the TLDs at one end of a stereotactic cone, a focused measurement device is created; this was tested both in and out of the primary beam of a Varian 21-iX linac using 6 MV photons. Acrylic build up material of 1.2 cm thickness was used inside the cone and measurements made with either one or three TLD chips at a given distance from the target. Comparing the readings of three dosimeters in one plane inside the cone offered information regarding the orientation of the cone relative to a radiation source. Measurements in the patient plane with the linac gantry at various angles demonstrated that leakage dose was approximately 0.01 % of the primary beam out of field when the cone was pointed directly towards the target and 0.0025 % elsewhere (due to scatter within the gantry). No specific ‘hot spots’ (e.g., insufficient shielding or gaps at abutments) were observed. Focused cone measurements facilitate leakage dose measurements from the linac head directly at the patient plane and allow one to infer the fraction of leakage due to ‘direct’ photons (along the ray-path from the bremsstrahlung target) and that due to scattered photons.

  4. [Medication errors in a neonatal unit: One of the main adverse events].

    Science.gov (United States)

    Esqué Ruiz, M T; Moretones Suñol, M G; Rodríguez Miguélez, J M; Sánchez Ortiz, E; Izco Urroz, M; de Lamo Camino, M; Figueras Aloy, J

    2016-04-01

    Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. An analysis was performed on the ME declared in a neonatal unit. A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  5. Lormetazepam addiction: data analysis from an Italian medical unit for addiction

    Directory of Open Access Journals (Sweden)

    Faccini M

    2012-06-01

    Full Text Available Marco Faccini,1 Roberto Leone,2 Benedetta Pajusco,1 Gianluca Quaglio,1 Rebecca Casari,1 Anna Albiero,1 Monia Donati,2 Fabio Lugoboni11Department of Internal Medicine, Addiction Unit, 2Pharmacology Unit, Reference Center for Education and Communication within the World Health Organization Program for International Drug Monitoring, University Hospital of Verona, Verona, ItalyBackground: The purpose of this study was to determine, in the context of a hospital addiction unit, which benzodiazepines were abused and to look for correlations with the characteristics of detoxified patients.Methods: A retrospective study was carried out using the database of hospital admissions to the addiction unit for detoxification from 2003 to 2010.Results: Of 879 admissions to the addiction unit during the seven-year period, 281 were for benzodiazepines. The percentage of patients addicted only to benzodiazepines was higher among females than males. Benzodiazepine consumption had started as a drug addiction behavior in only 10% of cases. The main sources of prescription identified were general practitioners (52% of cases or compliant pharmacists (25%. Overall, 15 different benzodiazepines were abused, with lormetazepam being the most commonly used (by 123 patients, 43.8% of the total.Conclusion: Our data show that, outside the population of multidrug addicts, there is an underestimated group of chronic benzodiazepine consumers who are often not referred to medical institutions for treatment. Even in the group of patients addicted to one substance only, we observed an abnormal number of requests for detoxification from lormetazepam, which appears to be more "popular" than other benzodiazepines. This drug should be prescribed according to stricter criteria and submitted to closer control.Keywords: lormetazepam, benzodiazepines, addiction, inpatient detoxification

  6. Significance of studies of low-dose radiation fallout in the western United States

    International Nuclear Information System (INIS)

    Rothman, K.J.

    1984-01-01

    The sum of evidence from these studies about the effects of nuclear testing is extremely modest. Lack of good dose information precluded any valuable scientific conclusions. The evidence indicating excesses of leukemia incidence beyond what would already be accepted as the leukemogenic effect of ionizing radiation is fragile. Similarly, the evidence presumed to indicate the absence of thyroid effects is unpersuasive, actually showing a weak but positive effect

  7. Study of the impact of artificial articulations on the dose distribution under medical irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Buffard, E. [IRMA/CREST/FEMTO-st, UMR-CNRS 6174, Po-circumflex le Universitaire BP 71427 25211 Montbeliard (France)]. E-mail: edwige.buffard@pu-pm.univ-fcomte.fr; Gschwind, R. [IRMA/CREST/FEMTO-st, UMR-CNRS 6174, Po-circumflex le Universitaire BP 71427 25211 Montbeliard (France)]. E-mail: regine.gschwind@pu-pm.univ-fcomte.fr; Makovicka, L. [IRMA/CREST/FEMTO-st, UMR-CNRS 6174, Po-circumflex le Universitaire BP 71427 25211 Montbeliard (France); Martin, E. [IRMA/CREST/FEMTO-st, UMR-CNRS 6174, Po-circumflex le Universitaire BP 71427 25211 Montbeliard (France); Meunier, C. [IRMA/CREST/FEMTO-st, UMR-CNRS 6174, Po-circumflex le Universitaire BP 71427 25211 Montbeliard (France); David, C. [Departement Oncologie et Radiotherapie, CH A. Boulloche 25200 Montbeliard (France)

    2005-02-01

    Perturbations due to the presence of high density heterogeneities in the body are not correctly taken into account in the Treatment Planning Systems currently available for external radiotherapy. For this reason, the accuracy of the dose distribution calculations has to be improved by using Monte Carlo simulations. In a previous study, we established a theoretical model by using the Monte Carlo code EGSnrc [I. Kawrakow, D.W.O. Rogers, The EGSnrc code system: MC simulation of electron and photon transport. Technical Report PIRS-701, NRCC, Ottawa, Canada, 2000] in order to obtain the dose distributions around simple heterogeneities. These simulations were then validated by experimental results obtained with thermoluminescent dosemeters and an ionisation chamber. The influence of samples composed of hip prostheses materials (titanium alloy and steel) and a substitute of bone were notably studied. A more complex model was then developed with the Monte Carlo code BEAMnrc [D.W.O. Rogers, C.M. MA, G.X. Ding, B. Walters, D. Sheikh-Bagheri, G.G. Zhang, BEAMnrc Users Manual. NRC Report PPIRS 509(a) rev F, 2001] in order to take into account the hip prosthesis geometry. The simulation results were compared to experimental measurements performed in a water phantom, in the case of a standard treatment of a pelvic cancer for one of the beams passing through the implant. These results have shown the great influence of the prostheses on the dose distribution.

  8. A method for estimation of accuracy of dose delivery with dynamic slit windows in medical linear accelerators

    International Nuclear Information System (INIS)

    Ravichandran, R.; Binukumar, J.P.; Sivakumar, S.S.; Krishnamurthy, K.; Davis, C.A.

    2008-01-01

    Intensity-modulated radiotherapy (IMRT) clinical dose delivery is based on computer-controlled multileaf movements at different velocities. To test the accuracy of modulation of the beam periodically, quality assurance (QA) methods are necessary. Using a cylindrical phantom, dose delivery was checked at a constant geometry for sweeping fields. Repeated measurements with an in-house designed methodology over a period of 1 year indicate that the method is very sensitive to check the proper functioning of such dose delivery in medical linacs. A cylindrical perspex phantom with facility to accurately position a 0.6- cc (FC 65) ion chamber at constant depth at isocenter, (SA 24 constancy check tool phantom for MU check, Scanditronix Wellhofer) was used. Dosimeter readings were integrated for 4-mm, 10-mm, 20-mm sweeping fields and for 3 angular positions of the gantry periodically. Consistency of standard sweeping field output (10-mm slit width) and the ratios of outputs against other slit widths over a long period were reported. A 10-mm sweeping field output was found reproducible within an accuracy of 0.03% (n = 25) over 1 year. Four-millimeter, 20-mm outputs expressed as ratio with respect to 10- mm sweep output remained within a mean deviation of 0.2% and 0.03% respectively. Outputs at 3 gantry angles remained within 0.5%, showing that the effect of dynamic movements of multileaf collimator (MLC) on the output is minimal for angular positions of gantry. This method of QA is very simple and is recommended in addition to individual patient QA measurements, which reflect the accuracy of dose planning system. In addition to standard output and energy checks of linacs, the above measurements can be complemented so as to check proper functioning of multileaf collimator for dynamic field dose delivery. (author)

  9. Factors influencing medical students' self-assessment of examination performance accuracy: A United Arab Emirates study.

    Science.gov (United States)

    Shaban, Sami; Aburawi, Elhadi H; Elzubeir, Khalifa; Elango, Sambandam; El-Zubeir, Margaret

    2016-01-01

    Assessment of one's academic capabilities is essential to being an effective, self-directed, life-long learner. The primary objective of this study was to analyze self-assessment accuracy of medical students attending the College of Medicine and Health Sciences, United Arab Emirates University, by examining their ability to assess their own performance on an MCQ examination. 1 st and 2 nd year medical students (n = 235) self-assessed pre and post-examination performance were compared with objectively measured scores (actual examination performance). Associations between accuracy of score prediction (pre and post assessment), and students' gender, year of education, perceived preparation, confidence and anxiety were also determined. Expected mark correlated significantly with objectively assessed marks (r = 0.407; P self-assessment accuracy. Findings reinforce existing evidence indicating that medical students are poor self-assessors. There are potentially multiple explanations for misjudgment of this multidimensional construct that require further investigation and change in learning cultures. The study offers clear targets for change aimed at optimizing self-assessment capabilities.

  10. Moral distress among nurses in medical, surgical and intensive-care units.

    Science.gov (United States)

    Lusignani, Maura; Giannì, Maria Lorella; Re, Luca Giuseppe; Buffon, Maria Luisa

    2017-09-01

    To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. The present study indicates that nurses experience an overall moderate level of moral distress. Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care. © 2016 John Wiley & Sons Ltd.

  11. Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States.

    Science.gov (United States)

    King, Marissa; Bearman, Peter S

    2017-01-01

    The pharmaceutical industry spends roughly 15 billion dollars annually on detailing - providing gifts, information, samples, trips, honoraria and other inducements - to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

    Science.gov (United States)

    Boucher, Bradley A; Hudson, Joanna Q; Hill, David M; Swanson, Joseph M; Wood, G Christopher; Laizure, S Casey; Arnold-Ross, Angela; Hu, Zhe-Yi; Hickerson, William L

    2016-12-01

    High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. Prospective clinical pharmacokinetic study. Ten adult patients with burns receiving I/C for a documented infection and requiring high-dose CVVH were studied. Blood and effluent samples for analysis of I/C concentrations were collected for up to 6 hours after the I/C infusion for calculation of I/C total CL (CL T otal ), CL by CVVH (CL HF ), half-life during CVVH, volume of distribution at steady state (Vd ss ), and the percentage of drug eliminated by CVVH. In this patient sample, the mean age was 50 ± 17 years, total body surface area burns was 23 ± 27%, and 80% were male. Nine patients were treated with high-dose CVVH for acute kidney injury and one patient for sepsis. The mean delivered CVVH dose was 52 ± 14 ml/kg/hour (range 32-74 ml/kg/hr). The imipenem CL HF was 3.27 ± 0.48 L/hour, which accounted for 23 ± 4% of the CL T otal (14.74 ± 4.75 L/hr). Cilastatin CL HF was 1.98 ± 0.56 L/hour, which accounted for 45 ± 19% of the CL T otal (5.16 + 2.44 L/hr). The imipenem and cilastatin half-lives were 1.77 ± 0.38 hours and 4.21 ± 2.31 hours, respectively. Imipenem and cilastatin Vd ss were 35.1 ± 10.3 and 32.8 ± 13.8 L, respectively. Efficient removal of I/C by high-dose CVVH, a high overall clearance, and a high volume of distribution in burn intensive care unit patients undergoing this CRRT method warrant aggressive dosing to treat serious infections effectively depending on the infection site and/or pathogen. © 2016 Pharmacotherapy Publications, Inc.

  13. The comparison of doses and risks from radon, medical and accidental irradiation

    International Nuclear Information System (INIS)

    Zhukovskij, M.V.; Yarmoshenko, I.V.; Bayankin, S.N.

    1998-01-01

    The following radiation hazards to the population of the region of Sverdlovsk are compared: the hazard from the exposure to indoor radon in dwellings; the consequences of the radiation accident at the 'Mayak' nuclear power plant in 1957; radioactive contamination by thorium enrichment tails; medical diagnostic exposure. It is concluded that radon and its daughters constitute the most significant radiation hazard. (A.K.)

  14. Special Needs Dentistry: Interdisciplinary Management of Medically-Complex Patients at Hospital-Based Dental Units in Tasmania, Australia

    Directory of Open Access Journals (Sweden)

    Lim

    2017-06-01

    Full Text Available Background: Increasing awareness of the interactions between oral and general health has led to the establishment of Special Needs Dentistry as a dental specialty in many countries. This specialty assists with the interdisciplinary management of patients between the medical and dental professions particularly those with complex medical problems, intellectual and physical impairments, and psychiatric conditions that may affect their oral health or the manner in which they receive treatment. However, little is known about the utilisation of specialised services provided to facilitate individuals with these needs. Aim: The aim of this study was to understand current utilisation of hospital-based dental services established to provide medically-necessary dental care. Methods: A retrospective review of the demographics and medical status of patients treated at referral hospital-based dental clinics in the state of Tasmania was completed for the month of August 2015. Results: Patients treated at these units had a variety of medical backgrounds. Most (46.4% were referred from medical professionals within the hospital. On average, patients treated at these units had 2.56 medical conditions and were taking 3.59 medications each. Many of these were chronic medical conditions known to have an interaction with oral health. Conclusions: Our results demonstrate the growing recognition of dynamic interactions between oral and general health and the importance of these hospitalbased units and interprofessional relationships in providing timely and holistic health care to these patients.

  15. Evaluating the Frequency of Errors in Preparation and Administration of Intravenous Medications in the Intensive Care Unit of Shahid-Sadoughi Hospital in Yazd

    Directory of Open Access Journals (Sweden)

    SeyedMojtaba Sohrevardi

    2015-10-01

    Full Text Available Background: In most Iranian hospitals, the nurses in the wards prepare intravenous (IV drugs and unfortunately pharmacists are not involved in this process. The severity of the patients in Intensive Care Unit (ICU heightens the risk of errors. More over the frequency of using IV drugs in this unit is high, so we decided to determine the frequency and types of errors, which occur in the preparation and administration of commonly, used IV medications in an ICU.Method: A prospective cross sectional study was performed from November 2013 to August 2014, in the intensive care unit in Shahid-Sadoughi hospital in Yazd. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacy student and were evaluated by direct observation, according to the method established by Barker and McConnell.Results: A total number of 843 intravenous doses were evaluated. The most common type of error (34.26% was the injection of IV doses faster than the recommended rate followed by preparation (15.69%, administration (9.23% and compatibility with doctor’s order (6.24%. Amikacin was the most common drug involved in errors (41.67%. Most of errors were occurred at afternoon (8 p.m, 28.36%.Conclusion: According to our study the rate of errors in preparation and administration of IV drugs was high in this ICU. Employing more nurses, using developed medical instruments and clinical pharmacists can help to decrease these errors and improve the quality of patient care.

  16. [Application of new technologies in the design, manufacture and use of technology deployment of field medical units and establishments].

    Science.gov (United States)

    Iakovlev, S V; Sidorov, V A; Korniushko, I G; Medvedev, V R; Matveev, A G

    2011-11-01

    Presented data is about attendance means of deployment of field medical units and pieces of army-level medical services and disaster medicine Defense Ministry did not ensure compliance with requirements to create optimal conditions for highly effective work of the medical staff, placing the wounded, the use of modern aids and appliances. The prospects of creation of mobile unit for high-availability modular pre-fabricated on the basis of tent structures, pneumoconstructions and removable habitable bodies, containers, tents, pneumocovers till 2020 are analyzed. Livelihood systems provide armor protection against fragments, bullets, flames, damaging factors of chemical and biological weapons.

  17. Changes in the levels of radioactive fall-out and the resulting radiation doses to man in the United Kingdom

    International Nuclear Information System (INIS)

    Loutit, J.F.; Marley, W.G.; Mayneord, W.V.; Russell, R.S.

    1960-01-01

    In the period covered by the Council's 1956 report, that is, up to the spring of 1956, the radioactive debris falling in the United Kingdom had arisen from a large number of small nuclear explosions, chiefly in Nevada, and from a few large nuclear explosions mainly in the Pacific, especially in March, 1954. It was recognized that the doses of radiation to persons from the deposition of debris arising from the smaller nuclear explosions would be far outweighed by those from the larger explosions. The material reaching the U.K. from the latter at that time was found to have an apparent age (determined from the ratio of strontium 89 to strontium 90 which ranged from 7 to 14 months. In these circumstances the dose contributed by the isotopes of relatively short life (say, two months or less) was much less important than the dose from the long-lived isotopes such as caesium 137 and strontium 90. From the autumn of 1956 the pattern of testing changed. A high proportion of the explosions carried out were of megaton size and took place in higher latitudes in the northern hemisphere. As a result the short-lived isotopes became relatively more important and, with the heavy testing of nuclear devices in the Arctic in October, 1958, the contribution of radioactive fall-out to the background dose-rate in air in the open rose in the spring of 1959 so that, for a period of a month or two, it amounted to some 30 per cent of the natural background. This rise in dose-rate can be attributed to two main causes, namely, the increase in the rate of testing and the shorter time during which the fission products from the tests in the autumn in northern latitudes, particularly in the Arctic, have remained airborne

  18. Changes in the levels of radioactive fall-out and the resulting radiation doses to man in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Loutit, J F; Marley, W G; Mayneord, W V; Russell, R S

    1960-12-01

    In the period covered by the Council's 1956 report, that is, up to the spring of 1956, the radioactive debris falling in the United Kingdom had arisen from a large number of small nuclear explosions, chiefly in Nevada, and from a few large nuclear explosions mainly in the Pacific, especially in March, 1954. It was recognized that the doses of radiation to persons from the deposition of debris arising from the smaller nuclear explosions would be far outweighed by those from the larger explosions. The material reaching the U.K. from the latter at that time was found to have an apparent age (determined from the ratio of strontium 89 to strontium 90 which ranged from 7 to 14 months. In these circumstances the dose contributed by the isotopes of relatively short life (say, two months or less) was much less important than the dose from the long-lived isotopes such as caesium 137 and strontium 90. From the autumn of 1956 the pattern of testing changed. A high proportion of the explosions carried out were of megaton size and took place in higher latitudes in the northern hemisphere. As a result the short-lived isotopes became relatively more important and, with the heavy testing of nuclear devices in the Arctic in October, 1958, the contribution of radioactive fall-out to the background dose-rate in air in the open rose in the spring of 1959 so that, for a period of a month or two, it amounted to some 30 per cent of the natural background. This rise in dose-rate can be attributed to two main causes, namely, the increase in the rate of testing and the shorter time during which the fission products from the tests in the autumn in northern latitudes, particularly in the Arctic, have remained airborne.

  19. eDrugCalc: an online self-assessment package to enhance medical students' drug dose calculation skills.

    Science.gov (United States)

    McQueen, Daniel S; Begg, Michael J; Maxwell, Simon R J

    2010-10-01

    Dose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students. We undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer. Final-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n= 173, P variable in all tests with 2.7% of final-year students scoring formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice. © 2010 The Authors. British Journal of Clinical Pharmacology © 2010 The British Pharmacological Society.

  20. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.

    Science.gov (United States)

    Mégarbane, Bruno; Leprince, Pascal; Deye, Nicolas; Résière, Dabor; Guerrier, Gilles; Rettab, Samia; Théodore, Jonathan; Karyo, Souheil; Gandjbakhch, Iradj; Baud, Frédéric J

    2007-05-01

    To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

  1. First trimester medication abortion practice in the United States and Canada.

    Directory of Open Access Journals (Sweden)

    Heidi E Jones

    Full Text Available We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703 and Canada (n = 94 to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5% US and 78 (83.0% Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4% were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US and Canada. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Research is needed on optimal antibiotic and analgesic use.

  2. Pre-Medical Preparation in Microbiology among Applicants and Matriculants in Osteopathic Medical School in the United States.

    Science.gov (United States)

    Ramos, Raddy L; Guercio, Erik; Martinez, Luis R

    2017-01-01

    It is recognized that medical school curricula contain significant microbiology-related content as part of the training of future physicians who will be responsible stewards of antimicrobials. Surprisingly, osteopathic and allopathic medical schools do not require pre-medical microbiology coursework, and the extent to which medical students have completed microbiology coursework remains poorly understood. In this report, we show that fewer than 3% of applicants and matriculants to osteopathic medical school (OMS) have completed an undergraduate major or minor in microbiology, and fewer than 17% of applicants and matriculants to OMS have completed one or more microbiology-related courses. These data demonstrate limited pre-medical microbiology-related knowledge among osteopathic medical students, which may be associated with an increase in perceived stress when learning this content or during clinical rotations as well as a potential lack of interest in pursuing a career in infectious diseases.

  3. Predicting United States Medical Licensure Examination Step 2 clinical knowledge scores from previous academic indicators

    Directory of Open Access Journals (Sweden)

    Monteiro KA

    2017-06-01

    Full Text Available Kristina A Monteiro, Paul George, Richard Dollase, Luba Dumenco Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, RI, USA Abstract: The use of multiple academic indicators to identify students at risk of experiencing difficulty completing licensure requirements provides an opportunity to increase support services prior to high-stakes licensure examinations, including the United States Medical Licensure Examination (USMLE Step 2 clinical knowledge (CK. Step 2 CK is becoming increasingly important in decision-making by residency directors because of increasing undergraduate medical enrollment and limited available residency vacancies. We created and validated a regression equation to predict students’ Step 2 CK scores from previous academic indicators to identify students at risk, with sufficient time to intervene with additional support services as necessary. Data from three cohorts of students (N=218 with preclinical mean course exam score, National Board of Medical Examination subject examinations, and USMLE Step 1 and Step 2 CK between 2011 and 2013 were used in analyses. The authors created models capable of predicting Step 2 CK scores from academic indicators to identify at-risk students. In model 1, preclinical mean course exam score and Step 1 score accounted for 56% of the variance in Step 2 CK score. The second series of models included mean preclinical course exam score, Step 1 score, and scores on three NBME subject exams, and accounted for 67%–69% of the variance in Step 2 CK score. The authors validated the findings on the most recent cohort of graduating students (N=89 and predicted Step 2 CK score within a mean of four points (SD=8. The authors suggest using the first model as a needs assessment to gauge the level of future support required after completion of preclinical course requirements, and rescreening after three of six clerkships to identify students who might benefit from

  4. Methods for decreasing population doses due to medical use of ionizing radiations

    International Nuclear Information System (INIS)

    Marej, A.N.

    1984-01-01

    The problem of radiation safety of population as regard to irradiation of a great contingents of people due to diagnosis procedures, carried out using X-ray and radiological methods of examination, is considered. It is shown, that prevention from excessive irradiation of population due to X-ray radiodiagnostic procedures is possible by realization the complex of activities, including legislative, organizational, technical and other measures. Human exposure doses in diagnosis most not exceed permissible ones, established on the basis of cost-benefit criterion. The necessity of the maximum limitation of exposure of pregnant women and children is emphasized

  5. Individual and work-unit measures of psychological demands and decision latitude and the use of antihypertensive medication

    DEFF Research Database (Denmark)

    Daugaard, S; Andersen, J H; Grynderup, Matias Brødsgaard

    2015-01-01

    were associated with the purchase of prescribed antihypertensive medication among women. This effect was present on both the work-unit and the individual level. Among men there were no associations. The lack of interaction between psychological demands and decision latitude did not support the job......PURPOSE: To analyse whether psychological demands and decision latitude measured on individual and work-unit level were related to prescription of antihypertensive medication. METHODS: A total of 3,421 women and 897 men within 388 small work units completed a questionnaire concerning psychological...... working conditions according to the job strain model. Mean levels of psychological demands and decision latitude were computed for each work unit to obtain exposure measures that were less influenced by reporting bias. Dispensed antihypertensive medication prescriptions were identified in The Danish...

  6. Rapid detection of chromosome rearrangement in medical diagnostic X-ray workers by using fluorescence in situ hybridization and study on dose estimation

    International Nuclear Information System (INIS)

    Wang Zhiquan; Sun Yuanming; Li Jin

    1998-01-01

    Objective: Biological doses were estimated for medical diagnostic X-ray workers. Methods: Chromosome rearrangements in X-ray workers were analysed by fluorescence in situ hybridization (FISH) with composite whole chromosome paintings number 4 and number 7. Results: The frequency of translocation in medical diagnostic X-ray workers was much higher than that in control group (P<0.01). The biological doses to individual X-ray workers were calculated by their translocation frequency. The translocation frequencies of both FISH and G-banding were in good agreement. Conclusion: The biological doses to X-ray workers are estimated by FISH first when their dosimetry records are not documented

  7. Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

    Directory of Open Access Journals (Sweden)

    Wen-Ping Zeng

    2015-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs. Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days was significantly lower than that in the control group (0.495 cases per 1000 ventilator days. We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an

  8. Radiation dose reduction in medical x-ray CT via Fourier-based iterative reconstruction.

    Science.gov (United States)

    Fahimian, Benjamin P; Zhao, Yunzhe; Huang, Zhifeng; Fung, Russell; Mao, Yu; Zhu, Chun; Khatonabadi, Maryam; DeMarco, John J; Osher, Stanley J; McNitt-Gray, Michael F; Miao, Jianwei

    2013-03-01

    A Fourier-based iterative reconstruction technique, termed Equally Sloped Tomography (EST), is developed in conjunction with advanced mathematical regularization to investigate radiation dose reduction in x-ray CT. The method is experimentally implemented on fan-beam CT and evaluated as a function of imaging dose on a series of image quality phantoms and anonymous pediatric patient data sets. Numerical simulation experiments are also performed to explore the extension of EST to helical cone-beam geometry. EST is a Fourier based iterative algorithm, which iterates back and forth between real and Fourier space utilizing the algebraically exact pseudopolar fast Fourier transform (PPFFT). In each iteration, physical constraints and mathematical regularization are applied in real space, while the measured data are enforced in Fourier space. The algorithm is automatically terminated when a proposed termination criterion is met. Experimentally, fan-beam projections were acquired by the Siemens z-flying focal spot technology, and subsequently interleaved and rebinned to a pseudopolar grid. Image quality phantoms were scanned at systematically varied mAs settings, reconstructed by EST and conventional reconstruction methods such as filtered back projection (FBP), and quantified using metrics including resolution, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs). Pediatric data sets were reconstructed at their original acquisition settings and additionally simulated to lower dose settings for comparison and evaluation of the potential for radiation dose reduction. Numerical experiments were conducted to quantify EST and other iterative methods in terms of image quality and computation time. The extension of EST to helical cone-beam CT was implemented by using the advanced single-slice rebinning (ASSR) method. Based on the phantom and pediatric patient fan-beam CT data, it is demonstrated that EST reconstructions with the lowest scanner flux setting of 39 m

  9. Radiation dose reduction in medical x-ray CT via Fourier-based iterative reconstruction

    International Nuclear Information System (INIS)

    Fahimian, Benjamin P.; Zhao Yunzhe; Huang Zhifeng; Fung, Russell; Zhu Chun; Miao Jianwei; Mao Yu; Khatonabadi, Maryam; DeMarco, John J.; McNitt-Gray, Michael F.; Osher, Stanley J.

    2013-01-01

    Purpose: A Fourier-based iterative reconstruction technique, termed Equally Sloped Tomography (EST), is developed in conjunction with advanced mathematical regularization to investigate radiation dose reduction in x-ray CT. The method is experimentally implemented on fan-beam CT and evaluated as a function of imaging dose on a series of image quality phantoms and anonymous pediatric patient data sets. Numerical simulation experiments are also performed to explore the extension of EST to helical cone-beam geometry. Methods: EST is a Fourier based iterative algorithm, which iterates back and forth between real and Fourier space utilizing the algebraically exact pseudopolar fast Fourier transform (PPFFT). In each iteration, physical constraints and mathematical regularization are applied in real space, while the measured data are enforced in Fourier space. The algorithm is automatically terminated when a proposed termination criterion is met. Experimentally, fan-beam projections were acquired by the Siemens z-flying focal spot technology, and subsequently interleaved and rebinned to a pseudopolar grid. Image quality phantoms were scanned at systematically varied mAs settings, reconstructed by EST and conventional reconstruction methods such as filtered back projection (FBP), and quantified using metrics including resolution, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs). Pediatric data sets were reconstructed at their original acquisition settings and additionally simulated to lower dose settings for comparison and evaluation of the potential for radiation dose reduction. Numerical experiments were conducted to quantify EST and other iterative methods in terms of image quality and computation time. The extension of EST to helical cone-beam CT was implemented by using the advanced single-slice rebinning (ASSR) method. Results: Based on the phantom and pediatric patient fan-beam CT data, it is demonstrated that EST reconstructions with the lowest

  10. A dual-energy medical instrument for measurement of x-ray source voltage and dose rate

    Science.gov (United States)

    Ryzhikov, V. D.; Naydenov, S. V.; Volkov, V. G.; Opolonin, O. D.; Makhota, S.; Pochet, T.; Smith, C. F.

    2016-03-01

    An original dual-energy detector and medical instrument have been developed to measure the output voltages and dose rates of X-ray sources. Theoretical and experimental studies were carried out to characterize the parameters of a new scintillator-photodiode sandwich-detector based on specially-prepared zinc selenide crystals in which the low-energy detector (LED) works both as the detector of the low-energy radiation and as an absorption filter allowing the highenergy fraction of the radiation to pass through to the high-energy detector (HED). The use of the LED as a low-energy filter in combination with a separate HED opens broad possibilities for such sandwich structures. In particular, it becomes possible to analyze and process the sum, difference and ratio of signals coming from these detectors, ensuring a broad (up to 106) measurement range of X-ray intensity from the source and a leveling of the energy dependence. We have chosen an optimum design of the detector and the geometry of the component LED and HED parts that allow energy-dependence leveling to within specified limits. The deviation in energy dependence of the detector does not exceed about 5% in the energy range from 30 to 120 keV. The developed detector and instrument allow contactless measurement of the anode voltage of an X-ray emitter from 40 to 140 kV with an error no greater than 3%. The dose rate measur