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Speth J. Guidelines in Practice: Medication Safety. AORN J 2023; 118:380-389. [PMID: 38011062 DOI: 10.1002/aorn.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 11/29/2023]
Abstract
Medication errors are preventable events that health care professionals, consumers, and medication manufacturers report to the US Food and Drug Administration. The agency receives more than 100,000 medication-related reports each year, and some reports involve patient death. A variety of sources provide perioperative nurses with information on interventions and practices to prevent medication errors, including the US Pharmacopeia, The Joint Commission, medication manufacturers' instructions for use, safety data sheets, and the updated AORN "Guideline for medication safety." This article provides an overview of the guideline and discusses recommendations for organizational oversight, procurement and storage, retrieval and preparation, labeling, and hazardous medications. It also includes a scenario that illustrates perioperative nursing practices for administering an antineoplastic medication intraoperatively. Perioperative nurses should review the guideline in its entirety and implement recommendations in operative or procedural settings.
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Bhirich N, Chefchaouni AC, Medkouri SE, Shytry O, Belahcen MJ, Rahali Y. Risk assessment of personnel exposure in a central cytotoxic preparation unit using the FMECA method. J Oncol Pharm Pract 2023; 29:1884-1892. [PMID: 36718981 DOI: 10.1177/10781552231153625] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Personnel involved in the preparation of cytotoxics are exposed to them and the resulting risks. To protect themselves, many means of protection are currently implemented. Nevertheless, the exposure of these manipulators remains a possibility to be considered. MATERIALS AND METHODS The study was conducted during the period (October-November 2022) in the pharmacy of the National Institute of Oncology (INO), a hospital structure specializing in cancer care. The Failure Mode, Effects and Criticality Analysis method was used to assess the risks of exposure of personnel in a central cytotoxic preparation unit and then calculate the criticality index (CI = severity × frequency × detectability). The risks were classified into toxic, traumatic, chemical, and environmental risks. We have cited 12 failure modes of which nine are minor and three are major. The three major modes cited are essentially related to the particulate environment, direct contact and daily passive inhalation of handling. CONCLUSION Our study shows that in our institution, the analysis of the risk of exposure of personnel to cytotoxics remains important, hence the interest of automaton in charge of preparations and which will gradually take charge of all the preparations. The existing procedures and the pharmacotechnical equipment used also contribute to protection and risk reduction.
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Affiliation(s)
- Nihal Bhirich
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Ali Cherif Chefchaouni
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Safaa El Medkouri
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Oumaima Shytry
- Pharmacy Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Mohammed Jaouad Belahcen
- Pharmacy Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Younes Rahali
- Pharmacy Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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3
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Jiang Z, Chen J, Feng L, Jin M, Liu S, Wang L, Wang J, Yu C, Zhou J, Ye Y, Mei L, Yu W, Zhang X, Lou J. Associations between maternal occupational exposures and pregnancy outcomes among Chinese nurses: a nationwide study. Reprod Health 2023; 20:161. [PMID: 37907929 PMCID: PMC10617240 DOI: 10.1186/s12978-023-01704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Several studies have provided evidence about adverse pregnancy outcomes of nurses involved in occupational exposure. However, the pregnancy outcomes among nurses in middle-income countries are not well demonstrated. The main aim of this study is to present the prevalence and influencing factors of pregnancy outcomes among female nurses in China. METHODS We included 2243 non-nurse health care workers, and 4230 nurses in this national cross-sectional study in China. Information on occupational exposures and pregnancy outcomes was collected using a face-to-face investigation. Odds ratios (ORs) were estimated through logistic regression. RESULTS The proportion of threatened abortion, spontaneous abortion, and stillbirth of female nurses was 2.6%, 7%, and 2.1%, respectively. We found an increased risk of threatened abortion among nurses with overtime work (OR = 1.719, 95% CI 1.158-2.550). The risk of threatened abortion and spontaneous abortion was elevated among nurses handling disinfectant (OR = 2.293 and 1.63, respectively). We found a nearly twofold increased risk of premature birth (OR = 2.169, 95% CI 1.36-3.459) among nurses handling anti-cancer drugs. CONCLUSIONS Our findings suggested that maternal occupational exposures might be associated with the risk of adverse pregnancy outcomes among female nurses in China. We recommend that policy-markers and hospital managers work together to reduce exposure to occupational hazards and improve pregnancy outcomes among female nurses.
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Affiliation(s)
- Zhaoqiang Jiang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Junfei Chen
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Lingfang Feng
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Mingying Jin
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Shuang Liu
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Lina Wang
- School of Medicine, The First Affiliated Hospital, Huzhou University, Huzhou, Zhejiang Province, China
| | - Jing Wang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Changyan Yu
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road, Hangzhou, 310006, China.
| | - Yan Ye
- Department of Occupational Health, Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Liangying Mei
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Wenlan Yu
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Xing Zhang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Jianlin Lou
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China.
- School of Medicine, The First Affiliated Hospital, Huzhou University, Huzhou, Zhejiang Province, China.
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Liu S, Huang Y, Huang H, Hu S, Zhong X, Peng J, Zhang X, Huang X. Influence of occupational exposure to antineoplastic agents on adverse pregnancy outcomes among nurses: A meta-analysis. Nurs Open 2023; 10:5827-5837. [PMID: 37219069 PMCID: PMC10416046 DOI: 10.1002/nop2.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/14/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
AIM This study aimed to explore the relationship between nurses' occupational exposure to antineoplastic agents and adverse pregnancy outcomes. DESIGN Meta-analysis. METHODS Data were retrieved from studies published before April 2022 in PubMed, the Cochrane Library, the Web of Science, Embase databases, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), China Science and Technology Journal databases (VIP) and Wan Fang databases (WF). Stata MP (Version 17.0) was used to conduct this meta-analysis. RESULTS The current evidence shows that occupational exposure to antineoplastic agents increases nurses' risk of spontaneous abortions, stillbirths, and congenital abnormalities. It is necessary to pay attention to occupational exposures caused by antineoplastic agents, especially for female nurses of reproductive age. Managers should take timely and effective countermeasures to ensure their occupational safety and reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Shuhan Liu
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
| | - Yanshan Huang
- Longgang District Central Hospital of ShenzhenShenzhenChina
- Shantou University Medical CollegeShantouChina
| | - Hong Huang
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
| | - Song Hu
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Xiao Zhong
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Ji Peng
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Xiaoming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences‐Peking Union Medical CollegePeking Union Medical College Hospital (Dongdan Campus)BeijingChina
| | - Xiaohong Huang
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
- Longgang District Central Hospital of ShenzhenShenzhenChina
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Villa A, Geshkovska A, Bellagamba G, Baldi I, Molimard M, Verdun-Esquer C, Lehucher-Michel MP, Canal-Raffin M. Factors associated with internal contamination of nurses by antineoplastic drugs based on biomonitoring data from a previous study. Int J Hyg Environ Health 2023; 254:114264. [PMID: 37776759 DOI: 10.1016/j.ijheh.2023.114264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
Internal contamination of healthcare professionals by antineoplastic drugs (ADs) remains a current occupational health issue, particularly because these compounds are classified as dangerous to handle by the NIOSH. In order to improve preventive actions, a study of the factors associated with this internal contamination was conducted among nursing staff in health care institutions. This study is a statistical analysis of metadata from a cross-sectional observational study conducted among nurses in two French hospitals. The internal contamination of each nurse was assessed in a previous study and was defined by whether or not at least one studied AD was detected in at least one urine sample. Three urine samples and a self-questionnaire were collected for each participant. Analysis of five ADs (cyclophosphamide, ifosfamide, metabolite of 5-fluorouracil, methotrexate, doxorubicin) were performed by liquid chromatography coupled to tandem mass spectrometry. A multivariate stepwise descending regression model was used to determine factors associated with internal contamination by coupling data from a self-questionnaire with internal contamination data. A total of 74 nurses participated to the study and 68 were included for this work: 39 nurses with and 29 without detectable internal ADs contamination. Two protective factors of internal contamination could be identified: a high "glove wearing score" (OR: 0.957; 95%CI: 0.93-0.98; p < 0.01) and a high "total number of years handling ADs and/or caring for patients treated with ADs" (OR: 0.797; 95%CI: 0.67-0.91; p < 0.01). In addition, three factors contributing to internal contamination were identified, namely "feeling sufficiently informed about tasks exposing to ADs" (OR: 9.585; 95%CI: 2.23-57.05; p < 0.01), "disposal of a waste bin containing equipment used for administration of the ADs studied" (OR: 8.04; 95%CI: 1.87-46.08; p < 0.01) and "changing sheets and/or making bed of a patient treated by one of the ADs studied" (OR: 10.479; 95%CI: 1.43-133.30; p < 0.05). Thus, the use of gloves when handling ADs directly or indirectly and the contaminating nature of certain tasks should be taken into account when (1) implementing preventive actions in health care services and (2) training and informing exposed staff. Further studies would be desirable to confirm these results and extend them to other professional categories.
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Affiliation(s)
- Antoine Villa
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France; Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Arna Geshkovska
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France
| | - Gauthier Bellagamba
- Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Isabelle Baldi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France; Service Santé Travail Environnement, CHU de Bordeaux, 33076, Bordeaux, France
| | - Mathieu Molimard
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, AHEAD Team, UMR 1219, F-33000, Bordeaux, France
| | | | - Marie-Pascale Lehucher-Michel
- Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Mireille Canal-Raffin
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France.
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Speranza ED, Jeronimo M, Colombo M. Initial assessment of multi-compound antineoplastic drug surface contamination in Argentinean healthcare centers: Insights into occupational exposures in South America. J Oncol Pharm Pract 2023:10781552231188320. [PMID: 37470481 DOI: 10.1177/10781552231188320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Antineoplastic drug contamination can result in severe health effects for healthcare workers exposed to them. Despite the worldwide growing concern regarding these drugs and sustained monitoring efforts in developed countries, there is almost no data about surface contamination levels in Argentina, in particular, and South America, in general. METHODS Antineoplastic drug contamination was measured in three Argentinean public hospitals (pharmacy and daycare center areas) by surface wiping and liquid chromatography coupled with tandem mass spectrometry. RESULTS AND DISCUSSION Eleven drugs were detected, in 51 of 58 sampled surfaces, in variable concentrations from 0.00064 to 7.3 ng cm-2, with cyclophosphamide, gemcitabine, and paclitaxel as the most prevalent drugs. This highly variable antineoplastic distribution reflects differences in facility layout, number of patients, antineoplastic drug use, etc., at each hospital. Values exceeding the 1 ng cm-2 threshold were detected in 13 surfaces of the two hospitals handling the largest amounts of antineoplastic drugs. The cyclophosphamide 75th percentile averaged 0.030 ng cm-2 comparable to the high values reported more than 10 years ago for developed countries, emphasizing the potential of reducing antineoplastic contamination by implementing routine monitoring and improved cleaning and handling procedures. CONCLUSION This study is the first survey of multi-compound surface antineoplastic contamination in Argentinean (and South American) hospitals, providing a baseline against which future studies can be compared. Widespread antineoplastic contamination has been detected on numerous surfaces, with concentrations surpassing suggested threshold exposure levels (1 ng cm-1) for some surfaces in two of the sampled hospitals.
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Affiliation(s)
- Eric D Speranza
- Laboratorio de Química Ambiental y Biogeoquímica, Universidad Nacional de La Plata-Universidad Nacional Arturo Jauretche, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, C.A.B.A., Argentina
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manuel Colombo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Takahashi Y, Nagamine A, Kaneta A, Yashima H, Obayashi K, Araki T, Yamamoto K. Risk of exposure of patients' family members to lenalidomide at home. Eur J Hosp Pharm 2023:ejhpharm-2022-003632. [PMID: 37339864 DOI: 10.1136/ejhpharm-2022-003632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES Lenalidomide, a hazardous drug, has strict distribution controls. However, the risk of contamination with lenalidomide when patients take the drug has not been studied and the risk of drug exposure to people in the patient's living environment is unknown. Thus, we investigated the amount of lenalidomide that could be dispersed during the period between removal of the capsule and returning the used blister packages, and we considered the conditions under which lenalidomide could be dispersed and countermeasures. METHODS The amount of lenalidomide contamination was measured on the outside of the unused blister packages returned by the patients, on the surface of the capsule, and on the inside of the package immediately after removal of the capsule. In addition, the amount of contamination was measured on the blister packages used by the patients and on the gloves worn by the pharmacists on receipt of the packages. Lenalidomide was analysed by liquid chromatography-tandem mass spectrometry. RESULTS Lenalidomide amounts on the outside of the unused blister packages returned by the three patients were <10, <10, and 26.8 ng/pack, those on the capsule surface immediately after removal from the packages were 297, 388, and 297 ng/capsule, and those on the inside of packages immediately after removal of all capsules were 143, 184, and 554 ng/pack, respectively. A median of 15.6 ng/pack lenalidomide was detected on the surface of packages used by the patients (n=18). The lenalidomide remaining in the packages immediately after capsule removal (~200 ng/pack), except for the 15.6 ng/pack detected in the packages used by the patients, may have been dispersed in the patient's living environment (~90% or more). The maximum amount of lenalidomide on the surface of the packages used by the patients was over 2500 ng/pack. CONCLUSIONS The amount of lenalidomide contamination per package was found to be at least 100 ng less after collection by the pharmacist than immediately after removal of the capsules. Therefore, it is recommended to clean the surrounding area and wash one's hands after taking the capsules.
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Affiliation(s)
- Yuta Takahashi
- Education Center for Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
- Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ayumu Nagamine
- Education Center for Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
- Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akiko Kaneta
- Department of Pharmacy, Gunma University Hospital, Meabashi, Gunma, Japan
| | - Hideaki Yashima
- Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Pharmacy, Gunma University Hospital, Meabashi, Gunma, Japan
| | - Kyoko Obayashi
- Education Center for Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
- Laboratory of Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
| | - Takuya Araki
- Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Pharmacy, Gunma University Hospital, Meabashi, Gunma, Japan
| | - Koujirou Yamamoto
- Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Pharmacy, Gunma University Hospital, Meabashi, Gunma, Japan
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8
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Clark C. Taking steps to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S8. [PMID: 37219988 DOI: 10.12968/bjon.2023.32.10.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in March 2023 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.
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Brechtelsbauer E. Identification and reduction of hazardous drug surface contamination through the use of a novel closed-system transfer device coupled with a point-of-care hazardous drug detection system. Am J Health Syst Pharm 2023; 80:435-444. [PMID: 36370411 DOI: 10.1093/ajhp/zxac336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Minimizing hazardous drug (HD) contamination is critical for protecting the health of healthcare workers (HCWs) and patients. Alarmingly, widespread HD contamination has been documented across a variety of clinical settings. Quantitative wipe sampling presents significant time and cost barriers, resulting in routine monitoring adherence rates around 25%. Closed-system drug transfer devices (CSTDs) and qualitative point-of-care tests can be implemented to overcome these barriers. METHODS In this study, we tested the effects of the BD PhaSeal Optima (Becton, Dickinson and Company), a recently introduced CSTD, on HD contamination at 2 chemotherapy infusion centers. Wipe samples were taken at 29 workstations at each location prior to and a year following CSTD implementation. Additionally, traditional liquid chromatography with mass spectrometry (LCMS/MS) analyses were compared against a novel lateral flow immunoassay HD testing device (BD HD Check; Becton, Dickinson and Company) to determine the validity of the qualitative assay. RESULTS We found a 46% reduction in HD contamination after incorporating the CSTD into clinical workflows. Across time points and sites, HD contamination reported by the BD HD Check device was 91% accurate against LCMS/MS and 98% accurate within its limits of detection. CONCLUSION Collectively, the evaluated CSTD and lateral flow immunoassay device may help to reduce HD contamination and provide real-time measures of contamination, respectively. As part of a multifaceted approach, these devices may help minimize barriers to routine monitoring, ultimately improving the safety of HCWs and patients.
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Occupational Exposure to Inhalational Anesthetics and Teratogenic Effects: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11060883. [PMID: 36981540 PMCID: PMC10048231 DOI: 10.3390/healthcare11060883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to analyze the teratogenic effects of inhalational anesthetics in conditions of actual use, determining any association with spontaneous abortion or congenital malformations. (2) Methods: A systematic review was carried out according to the PRISMA statement based on PICO (problem of interest–intervention to be considered–intervention compared–outcome) (Do inhalational anesthetics have teratogenic effects in current clinical practice?). The level of evidence of the selected articles was evaluated using the SIGN scale. The databases used were PubMed, Embase, Scopus, Web of Science, Google academic and Opengrey. Primary studies conducted in professionals exposed to inhalational anesthetics that evaluate spontaneous abortions or congenital malformations, conducted in any country and language and published within the last ten years were selected. (3) Results: Of the 541 studies identified, 6 met all inclusion criteria in answering the research question. Since many methodological differences were found in estimating exposure to inhalational anesthetics, a qualitative systematic review was performed. The selected studies have a retrospective cohort design and mostly present a low level of evidence and a low grade of recommendation. Studies with the highest level of evidence do not find an association between the use of inhalational anesthetics and the occurrence of miscarriage or congenital malformations. (4) Conclusions: The administration of inhalational anesthetics, especially with gas extraction systems (scavenging systems) and the adequate ventilation of operating rooms, is not associated with the occurrence of spontaneous abortions or congenital malformations.
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11
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Kennedy K, Vu K, Coakley N, Daley-Morris J, Forbes L, Hartzell R, Lessels D. Safe handling of hazardous drugs. J Oncol Pharm Pract 2023; 29:401-412. [PMID: 36373754 PMCID: PMC9900183 DOI: 10.1177/10781552221135121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.
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Affiliation(s)
- Kardi Kennedy
- Cancer Services, Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Kathy Vu
- Safety Initiatives Systemic Treatment Program, Ontario Health,
Cancer Care Ontario, Toronto, Ontario, Canada,Teaching Stream, Leslie Dan Faculty of Pharmacy, University of
Toronto, Toronto, Ontario, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
| | - Nadia Coakley
- Department of Oncology, McMaster University, Hamilton, Ontario,
Canada,Ontario Health's Cancer Care Ontario's Program in Evidence-Based
Care, McMaster University, Hamilton, Ontario, Canada,Nadia Coakley, Department of Oncology,
McMaster University, Hamilton, ON, Canada; Ontario Health's Cancer Care
Ontario's Program in Evidence-based care, McMaster University, Juravinski Site
G-227, 1280 Main St W, Hamilton, Ontario, Canada L8N 3Z5.
| | - Jennifer Daley-Morris
- Oncology Pharmacy & Systemic Therapy Suite, Southlake Regional Health
Centre, Newmarket, Ontario Canada
| | - Leta Forbes
- Systemic Treatment Program Ontario Health, Cancer Care Ontario,
Durham Regional Cancer Center, Oshawa, Ontario, Canada
| | - Renee Hartzell
- Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Darrilyn Lessels
- Lakeridge Health, Durham Regional Cancer Center, Oshawa, Ontario,
Canada
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12
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Low-dose ionizing radiation and adverse birth outcomes: a systematic review and meta-analysis. Int Arch Occup Environ Health 2023; 96:77-92. [PMID: 35913560 PMCID: PMC9823032 DOI: 10.1007/s00420-022-01911-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Ionizing radiation is a human carcinogen, and there is evidence that exposure to low-dose ionizing radiation increases the risk of adverse birth outcomes. METHODS We undertook a systematic review and meta-analysis to synthesize the research of maternal and paternal exposure to low-dose radiation on low birth weight, miscarriage, pre-term delivery, and stillbirth. Our literature search used four databases (PubMed, Environmental Index, GeoBASE, and the Cumulative Index to Nursing and Allied Health Literature). We included study populations exposed to occupational and medical sources of radiation, nuclear disasters, and those living near nuclear power plants. We considered papers published between January 1st, 1990, and June 30th, 2021. The quality of the studies was assessed, and we performed meta-analysis using random effects models to generate summary measures of association. Forest plots were created to assess the heterogeneity in these measures, and funnel plots were used to assess publication bias. RESULTS Overall, 26 studies were identified, and these yielded measures of association from 10, 11, and 8 studies for low birth weight, miscarriage, and stillbirth outcomes, respectively. It was not possible to perform meta-analyses for pre-term delivery due to a small number of studies. The meta-analysis summary relative risk (RR) of having a low-birth-weight infant among those ever exposed to radiation relative to those unexposed, after adjusting for publication bias, was 1.29 (95% CI 0.97-1.73). The corresponding risk estimates for miscarriage and stillbirth were 1.15 (95% CI 1.02-1.30), and 1.19 (95% CI 0.98-1.45), respectively. CONCLUSIONS Our findings suggest that ionizing radiation increases the risk of adverse birth outcomes. Future work should strive to provide data needed to better understand the shape of the exposure-response curve.
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Kim C, Choe S, Kim T, Kim M, Ryu J, Oh J, Yoon J. Risk of adverse pregnancy outcomes by maternal occupational status: A national population-based study in South Korea. J Occup Health 2023; 65:e12380. [PMID: 36694993 PMCID: PMC9874245 DOI: 10.1002/1348-9585.12380] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study examined the association between maternal occupational status and adverse pregnancy outcomes in the general South Korean population. METHODS We analyzed 1 825 845 employed and non-employed women with a diagnostic code for pregnancy in the National Health Insurance Service (NHIS) database (2010-2019) of South Korea. Based on their employment status and type of occupation, we calculated risk ratios for three adverse outcomes: early abortive outcomes (miscarriage, ectopic pregnancy, and molar pregnancy), stillbirth, and no live birth (diagnosis of pregnancy with no record of live birth thereafter, which include early abortive outcomes and stillbirth) with adjusting for covariates. RESULTS Overall, 18.0%, 0.7%, and 39.8% ended in early abortive outcomes, stillbirths, and no live births, respectively. The risk of early abortive outcomes and stillbirths was higher in non-employed women than in employed women, while no live births were more frequent in employed women. Those in the health and social work industry showed the highest risk of no live births. Manufacturing jobs (1.030, 95% CI: 1.013, 1.047) and health/social work (1.029, 95% CI: 1.012, 1.046) were associated with an increased risk of early abortive outcomes compared with financial and insurance jobs. Consistently higher risks of no live births were observed in the manufacturing, wholesale/retail trade, education, health/social work, and public/social/personal service occupation. CONCLUSION Employment during pregnancy and several occupation types were associated with a higher risk of pregnancy loss. Additional research using detailed job activity data is needed to determine specific occupational causes of adverse pregnancy outcomes.
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Affiliation(s)
- Chae‐Bong Kim
- Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
| | - Seung‐Ah Choe
- Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
- Division of Life ScienceKorea UniversitySeoulRepublic of Korea
| | - Taemi Kim
- Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
| | - Myoung‐Hee Kim
- Center for Public Health Data Analytics, National Medical CenterSeoulRepublic of Korea
| | - Jia Ryu
- Department of Occupational and Environmental MedicineInternational St. Mary's Hospital, Catholic Kwandong UniversityIncheonRepublic of Korea
| | - Jeong‐Won Oh
- Department of Obstetrics and GynecologySoonchunhyang University Seoul HospitalSeoulRepublic of Korea
| | - Jung‐won Yoon
- Department of Obstetrics and GynecologyNational Medical CenterSeoulRepublic of Korea
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Delva F, Carcasset P, Mouton P, Auguste-Virginie R, Lairez F, Sentilhes L, Brochard P, Joseph JP. Greater Risk of Pregnancy Complications for Female Surgeons: A Cross-Sectional Electronic Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:125. [PMID: 36612447 PMCID: PMC9819732 DOI: 10.3390/ijerph20010125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. METHODS We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. RESULTS Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84]. CONCLUSION Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy.
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Affiliation(s)
- Fleur Delva
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
- Centre d’Investigation Clinique 1401 Épidémiologie Clinique, Institut National de la Santé et de la Recherche, University of Bordeaux, 33076 Bordeaux, France
| | - Pierre Carcasset
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Pauline Mouton
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
| | | | - Fanny Lairez
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
| | - Loïc Sentilhes
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Patrick Brochard
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
| | - Jean-Philippe Joseph
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
- Centre d’Investigation Clinique 1401 Épidémiologie Clinique, Institut National de la Santé et de la Recherche, University of Bordeaux, 33076 Bordeaux, France
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
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MacVane CZ, Puissant M, Fix M, Strout TD, Bonney C, Welsh L, Mittelman A, Ricker J, Agarwal I. Scheduling practices for pregnant emergency medicine residents. AEM EDUCATION AND TRAINING 2022; 6:e10813. [PMID: 36425789 PMCID: PMC9677363 DOI: 10.1002/aet2.10813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/22/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Background Night shift work is associated with adverse pathophysiologic effects on maternal and fetal well-being. Although emergency medicine (EM) residents work frequent night shifts, there is no existing guidance for residency program directors (PDs) regarding scheduling pregnant residents. Our study assessed scheduling practices for pregnant EM residents, differences based on program and PD characteristics, barriers and attitudes toward implementing a formal scheduling policy, and PDs' awareness of literature describing adverse effects of night shifts on maternal-fetal outcomes. Methods We conducted an anonymous, web-based survey of U.S. EM residencies (N = 276). Quantitative data were summarized; chi-square analysis and logistic regression were used to assess relationships between program and PD characteristics and schedule accommodations. Qualitative description was used to analyze an open-ended question, organizing findings into major and minor themes. Results Of the 167 completed surveys (response rate 61%), 67% of programs reported no formal policy for scheduling pregnant residents but made adjustments on an individual basis including block changes (85%), decreased (46%) or no night shifts (34%), and working shifts earlier in pregnancy to cover later shifts (20%). Barriers to adjustments included staffing constraints (60%), equity concerns (45%), or impact on wellness (41%) among all residents and privacy (28%). PDs endorsed scheduling adjustments as important (mean 8.1, 0-10 scale) and reported guidance from graduate medical education governance would be useful (60%). Larger program size, but not PD gender or proportion of female residents, was associated with an increased likelihood of scheduling modifications. Twenty-five percent of PDs reported little knowledge of literature regarding night shift work and pregnancy. Qualitative themes supported quantitative findings. Conclusions Most EM residency programs do not have formal scheduling policies for pregnant residents, but most PDs support making adjustments and do so informally. More education and guidance for PDs are needed to promote the development of formal policies.
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Affiliation(s)
- Casey Z. MacVane
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | | | - Megan Fix
- Department of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Tania D. Strout
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | - Caitlin Bonney
- Department of Emergency MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - Laura Welsh
- Department of Emergency Medicine, Boston Medical CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew Mittelman
- Department of Emergency Medicine, Boston Medical CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Jana Ricker
- Department of Emergency MedicineMaine Medical CenterPortlandMaineUSA
| | - Isha Agarwal
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
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16
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Clark C. The need to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S10. [PMID: 36149419 DOI: 10.12968/bjon.2022.31.17.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in May 2022 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.
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Kevric J, Suter K, Hodgson R, Chew G. A survey of Australian and New Zealand medical parents' experiences of infertility, pregnancy, and parenthood. Front Med (Lausanne) 2022; 9:943112. [PMID: 35966836 PMCID: PMC9363658 DOI: 10.3389/fmed.2022.943112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To describe the incidence of infertility, pregnancy complications, and breastfeeding practices among Australian and New Zealand doctors and identify factors associated with increased pregnancy complication rates. Methods A survey of ANZ doctors using an online questionnaire during November 2021. Results One thousand ninety-nine completed responses were received. The median age of female doctors at the time of their first child was 32.4. Fertility testing was undertaken by 37%, with 27% having in vitro fertilization. More than 60% of respondents delayed family planning due to work. Pregnancy loss occurred in 36% of respondents, and 50% suffered a pregnancy complication. There were significant differences between specialists, with surgeons working longer hours before and after pregnancy, but having greater access to maternity leave than general practitioners. Conclusion Female doctors delay starting and completing their family due to work-related demands and structural biases in career progression, which may result in higher infertility and pregnancy complication rates.
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Affiliation(s)
- Jasmina Kevric
- Division of Surgery, Northern Health, Epping, VIC, Australia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
- *Correspondence: Jasmina Kevric
| | - Katherine Suter
- Department of Surgery, Western Health, Melbourne, VIC, Australia
| | - Russell Hodgson
- Division of Surgery, Northern Health, Epping, VIC, Australia
- Department of Surgery, University of Melbourne, Epping, VIC, Australia
| | - Grace Chew
- Division of Surgery, Northern Health, Epping, VIC, Australia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
- Breast Screen Victoria, St Vincent's Hospital, Melbourne, VIC, Australia
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18
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Chen Y, Liu H, Zheng Q, Li H, You H, Feng Y, Feng W. Promotion of tumor progression induced by continuous low-dose administration of antineoplastic agent gemcitabine or gemcitabine combined with cisplatin. Life Sci 2022; 306:120826. [PMID: 35870618 DOI: 10.1016/j.lfs.2022.120826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES There are indications that certain antineoplastic agents at low dosages may exhibit abnormal pharmacological actions, such as promoting tumor growth. However, the phenomenon still needs to be further confirmed, and its underlying mechanisms have not yet been fully elucidated. METHODS Gemcitabine (GEM) and cisplatin (CDDP) were employed as representative antineoplastic agents to observe effects of continuous low-dose chemotherapy with GEM or GEM combined with CDDP (GEM+CDDP) on tumor formation and growthin xenograft tumor models in vivo. Tumor and endothelial cell functions, apoptosis, cell cycle analysis, as well as bone marrow derived cells (BMDCs) mobilization, were evaluated with transwell, MTT or flow cytometry analysis in vitro, respectively. Histological methods were employed to assess angiogenesis in tumor tissues. RESULTS The results showed that tumor formation and growth were both significantly promoted by GEM or GEM+CDDP at as low as half of the metronomic dosages, which were accompanied by enhancements of angiogenesis in tumor tissues and the release of proangiogenic BMDCs in the circulating blood. Additionally, GEM or GEM+CDDP at low concentrations dramatically facilitated the proliferation, migration, and invasion of tumor cells in vitro. Cell-cycle arrest, activation of associated apoptotic proteins, and inhibition of apoptosis were also observed in tumor cells. CONCLUSIONS These findings indicate that, the continuous low-dose administration of GEM and GEM+CDDP can promote tumorigenesis and tumor progression in vivo by inhibiting apoptosis, mobilizing BMDCs, and promoting angiogenesis in certain dose ranges. These findings urge further investigations to avoid the potential risks in current empiric continuous low-dose chemotherapy regimens with antineoplastic agents. MAJOR FINDING This study observes a previously neglected pharmacological phenomenon and investigates its mechanism of that the continuous low-dose administration of some antineoplastic agents in certain dose ranges can promote tumorigenesis and tumor progression in vitro and in vivo, through stimulation of tumor cell functions directly as well as enhancement of tumor angiogenesis by BMDCs recruitment indirectly. The results alert to a potential risk in current empirically based continuous low-dose chemotherapy regimens such as metronomic chemotherapy.
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Affiliation(s)
- Yanshen Chen
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China; Department of Pharmacy, Jiangsu Vocational College of Medicine, Jiefang South Road 283 th, Yancheng 224005, Jiangsu, PR China
| | - Hua Liu
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China
| | - Qiaowei Zheng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China
| | - Houli Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China
| | - Huining You
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China
| | - Yan Feng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China
| | - Weiyi Feng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, PR China.
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Ogbaghebriel A, Alshamrani M, Ibrahim A, Al-Masaary W, Hakami S, Alrasheed S, Al-Sayed N. Pharmacy practitioners' adherence to safe-handling practices of chemotherapeutic drugs: A cross-sectional study in Saudi Arabia. J Oncol Pharm Pract 2022:10781552221105584. [PMID: 35642271 DOI: 10.1177/10781552221105584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy drug handling and occupational exposure are topics of concern for a variety of oncology health care professionals. Inappropriate handling can pose health risks to practitioners particularly, those who handle them on a daily basis. Therefore, this study aimed to assess chemotherapy handling practices among oncology pharmacists and pharmacy technicians in Saudi Arabia. METHODS A cross-sectional study was conducted using an online survey with a structured pre-validated questionnaire. Data was collected from pharmacists and pharmacy technicians who handle chemotherapeutic agents in Saudi Arabia, and analyzed using descriptive and inferential statistics. RESULTS A total of 79 oncology pharmacy practitioners responded to the survey. The majority (92.4%) had written chemotherapy guidelines at their workplaces. Almost all participants (98.7%) reported the availability of protective gloves and gowns, however, the availability of eye protection was only 57%. Most used chemotherapy-designated gloves (83.6%), and gowns (86.1%). However, 54.4% have reused disposable gowns. The extent of utilization of most protective equipment ranged from 70% (always using closed system transfer device) to 98% (always using shoe cover); while the practice of always using eye protection and face shield was only 30.4% and 38%, respectively. With regard to cleaning practice, the work area was cleaned at least once a day by 35%; monthly decontamination (77%); certification by the biomedical department every 6 months (67%) and at least yearly (95%). Accidental exposure was reported by 28%, and the most common adverse effect was skin irritation (82%). There was no workplace medical surveillance available for 50%. The majority (88.6%) received relevant training, but not periodic updates on their training (38%). The main barriers against the use of personal protective equipment were: that some personal protective equipments were not always available (38%), and personal protective equipments were too uncomfortable to use (30.4%). The demographic variables did not have a statistically significant effect (p > 0.05) on the responses except for type of institution (workplace) on some of the cleaning practices that showed significant differences namely, the monthly decontamination and certification by the biomedical department. CONCLUSIONS Most protective equipment and chemotherapy guidelines were available, and the majority of pharmacy practitioners adhered to many aspects of chemotherapy safe-handling practices. Nevertheless, some areas such as medical surveillance programs, use of eye protection and face shields, the practice of re-using disposable gowns, some of the barriers against personal protective equipment use, and the provision of periodic training need improvement for better protection of the health care professionals.
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Affiliation(s)
- Azieb Ogbaghebriel
- Department of Pharmaceutical Sciences, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alnada Ibrahim
- Department of Pharmacy Practice, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Wed Al-Masaary
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Sarah Hakami
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Shahad Alrasheed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Nada Al-Sayed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
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20
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Eisenberg S. Closed safety system for administration (CSSA): proposal for a new cytotoxic chemotherapy acronym. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S32. [PMID: 35648666 DOI: 10.12968/bjon.2022.31.10.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exposure to cytotoxic chemotherapy can result in acute and chronic conditions including nausea, headaches, rashes, miscarriages, infertility and genetic aberrations. Surface contamination can occur during drug administration, and can subsequently spread throughout the healthcare environment. Dermal contact with contaminated surfaces can lead to drug absorption. Closed system drug-transfer devices (CSTDs) were initially developed to protect pharmacists during compounding. Components include a vial adapter to prevent pressurisation leakage and a syringe connector for transferring the drug to the intravenous infusion bag. Membrane-based CSTDs require a Luer adapter for drug administration whereas Luer system-based products do not. Most European nurses are familiar with needleless connectors. Unfortunately, these devices do not provide protection from chemotherapy exposure. To decrease confusion, CytoPrevent, a multi-national, primarily European organisation has proposed the term 'closed safety system for administration' (CSSA) for Luer based CSTDs. Along with education, the new term can help promote safety for nurses administering cytotoxic chemotherapy.
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Affiliation(s)
- Seth Eisenberg
- Professional Practice Coordinator, Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington USA
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21
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Plante I, Winn LM, Vaillancourt C, Grigorova P, Parent L. Killing two birds with one stone: Pregnancy is a sensitive window for endocrine effects on both the mother and the fetus. ENVIRONMENTAL RESEARCH 2022; 205:112435. [PMID: 34843719 DOI: 10.1016/j.envres.2021.112435] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
Pregnancy is a complex process requiring tremendous physiological changes in the mother in order to fulfill the needs of the growing fetus, and to give birth, expel the placenta and nurse the newborn. These physiological modifications are accompanied with psychological changes, as well as with variations in habits and behaviors. As a result, this period of life is considered as a sensitive window as impaired functional and physiological changes in the mother can have short- and long-term impacts on her health. In addition, dysregulation of the placenta and of mechanisms governing placentation have been linked to chronic diseases later-on in life for the fetus, in a concept known as the Developmental Origin of Health and Diseases (DOHaD). This concept stipulates that any change in the environment during the pre-conception and perinatal (in utero life and neonatal) period to puberty, can be "imprinted" in the organism, thereby impacting the health and risk of chronic diseases later in life. Pregnancy is a succession of events that is regulated, in large part, by hormones and growth factors. Therefore, small changes in hormonal balance can have important effects on both the mother and the developing fetus. An increasing number of studies demonstrate that exposure to endocrine disrupting compounds (EDCs) affect both the mother and the fetus giving rise to growing concerns surrounding these exposures. This review will give an overview of changes that happen during pregnancy with respect to the mother, the placenta, and the fetus, and of the current literature regarding the effects of EDCs during this specific sensitive window of exposure.
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Affiliation(s)
- Isabelle Plante
- INRS-Centre Armand-Frappier Santé Biotechnologie, Laval, QC, Canada.
| | - Louise M Winn
- Queen's University, School of Environmental Studies, Department of Biomedical and Molecular Sciences, Kingston, ON, Canada
| | | | - Petya Grigorova
- Département Science et Technologie, Université TELUQ, Montreal, QC, Canada
| | - Lise Parent
- Département Science et Technologie, Université TELUQ, Montreal, QC, Canada
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22
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O’Brien LM. Sleep in Pregnancy. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Geese F, Zwakhalen S, Lucien B, Hahn S. Job satisfaction of advanced practice nurses in cancer care: A systematic review. Eur J Oncol Nurs 2021; 56:102089. [PMID: 35033880 DOI: 10.1016/j.ejon.2021.102089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/18/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To identify, evaluate, and summarise evidence about advanced practice nurses' (APNs') job satisfaction in cancer care and its related factors. METHODS A systematic review was performed including a narrative synthesis. Relevant evidence was identified from searches of three databases: Medline (PubMed), EBSCO (CINAHL), and PsychInfo. This systematic review searched for relevant articles published in English between 2000 and 2020. A structured process according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. The articles critical appraisal was based on the Mixed-Methods Appraisal Tool. Narrative data synthesis was based on the extracted data (study characteristics, type of questionnaire, level of job satisfaction, related factors, and risk of bias). RESULTS Just four articles met the inclusion criteria and were included in the systematic review. Job satisfaction of APNs providing cancer care in different care settings varied from low to high. Satisfying factors were personal, role, work, and institutional factors, whereas dissatisfies included the work setting and stress factors. Different measurement tools of the job satisfaction level were used, which might lead to non-comparable results. CONCLUSION The number of included studies and the findings from this systematic review present underinvestigated content according to the influence of patient group demands on APNs' job satisfaction. Evidence of patient group-specific factors relevant to APNs' job satisfaction could not be found. Further research is needed to address the influence of advanced nursing practice and patient group-related factors on job satisfaction.
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Affiliation(s)
- F Geese
- Academic-Practice-Partnership, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - S Zwakhalen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands and Living Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - B Lucien
- Centre of Interprofessional Simulation, Haute école de Santé, Geneva, Switzerland
| | - S Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Nakaoka H, Hisada A, Matsuzawa D, Yamamoto M, Mori C, Kamijima M, Yamazaki S, Ohya Y, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Nakayama T, Iso H, Shima M, Kurozawa Y, Suganuma N, Kusuhara K, Katoh T. Associations between prenatal exposure to volatile organic compounds and neurodevelopment in 12-month-old children: The Japan Environment and Children's Study (JECS). THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 794:148643. [PMID: 34198080 DOI: 10.1016/j.scitotenv.2021.148643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/01/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
In recent years, there has been an increase in the number of problems associated with neurodevelopmental disorders in children, and there has been a growing interest in the relationship between environmental chemicals and children's health. The objective of this study was to examine whether an association exists between occupational or environmental prenatal maternal exposure to volatile organic compounds and the risk of neurodevelopmental disorders in children using Japanese translations of the Ages & Stages Questionnaires, Third Edition (J-ASQ-3). An increase in the risk of neurodevelopmental delay in 12-month-old children associated with maternal exposure to formalin or formaldehyde was identified in terms of problem-solving (odds ratio (OR): 1.76, 95% confidence interval (CI): 0.99-3.12) and personal-social skills (OR: 3.32, 95% CI: 1.46-7.55). It is not clear whether or not this tendency is reversible, and whether it is observed past 12 months of age. Further research and a preventive approach are needed.
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Affiliation(s)
- Hiroko Nakaoka
- Centre for Preventive Medical Sciences, Chiba University, Japan; Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Japan.
| | - Aya Hisada
- Centre for Preventive Medical Sciences, Chiba University, Japan
| | - Daisuke Matsuzawa
- Research Center for Child Mental Development, Chiba University, Japan
| | - Midori Yamamoto
- Centre for Preventive Medical Sciences, Chiba University, Japan
| | - Chisato Mori
- Centre for Preventive Medical Sciences, Chiba University, Japan; Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Japan
| | | | - Shin Yamazaki
- National Institute for Environmental Studies, Tsukuba, Japan
| | - Yukihiro Ohya
- National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Koichi Kusuhara
- University of Occupational and Environmental Health, Kitakyushu, Japan
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Jung AM, Jahnke SA, Dennis LK, Bell ML, Burgess JL, Jitnarin N, Kaipust CM, Farland LV. Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters. Environ Health 2021; 20:116. [PMID: 34749749 PMCID: PMC8573857 DOI: 10.1186/s12940-021-00800-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence from previous studies suggests that women firefighters have greater risk of some adverse reproductive outcomes. The purpose of this study was to investigate whether women firefighters had greater risk of miscarriage compared to non-firefighters and whether there were occupational factors associated with risk of miscarriage among firefighters. METHODS We studied pregnancies in the United States fire service using data from the Health and Wellness of Women Firefighters Study (n = 3181). We compared the prevalence of miscarriage among firefighters to published rates among non-firefighters using age-standardized prevalence ratios. We used generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs) between occupational factors (employment (career/volunteer), wildland firefighter status (wildland or wildland-urban-interface/structural), shift schedule, fire/rescue calls at pregnancy start) and risk of miscarriage, adjusted for age at pregnancy, education, gravidity, BMI, and smoking. We evaluated if associations varied by age at pregnancy or employment. RESULTS Among 1074 firefighters and 1864 total pregnancies, 404 pregnancies resulted in miscarriages (22%). Among most recent pregnancies, 138 resulted in miscarriage (13%). Compared to a study of US nurses, firefighters had 2.33 times greater age-standardized prevalence of miscarriage (95% CI 1.96-2.75). Overall, we observed that volunteer firefighters had an increased risk of miscarriage which varied by wildland status (interaction p-value< 0.01). Among structural firefighters, volunteer firefighters had 1.42 times the risk of miscarriage (95% CI 1.11-1.80) compared to career firefighters. Among wildland/wildland-urban-interface firefighters, volunteer firefighters had 2.53 times the risk of miscarriage (95% CI 1.35-4.78) compared to career firefighters. CONCLUSIONS Age-standardized miscarriage prevalence among firefighters may be greater than non-firefighters and there may be variation in risk of miscarriage by fire service role. Further research is needed to clarify these associations to inform policy and decision-making.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Sara A Jahnke
- Center for Fire, Rescue, & EMS Health Research, NDRI-USA, Leawood, KS, USA
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nattinee Jitnarin
- Center for Fire, Rescue, & EMS Health Research, NDRI-USA, Leawood, KS, USA
| | | | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA
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Nurses' experiences of working while pregnant: A qualitative descriptive study. Int J Nurs Stud 2021; 124:104092. [PMID: 34689012 DOI: 10.1016/j.ijnurstu.2021.104092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum. OBJECTIVE To describe registered nurses' (RNs') experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards. DESIGN A qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy. PARTICIPANTS AND SETTING A convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews. METHOD Participants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis. RESULTS Deductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be 'supernurses' and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures. CONCLUSIONS Occupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses. TWEETABLE ABSTRACT RNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.
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Gagaille MP, Pieragostini R, Girault E, Touil Y, Chalopin M, Besse M, Pons-Kerjean N. Risk management in an anticancer drug preparation unit: use of Preliminary Risk Analysis method and application to the preparation process. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2021. [DOI: 10.1515/pthp-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Preparation of injectable anticancer drugs in hospital pharmacies, in particular of cytotoxics, is a high-risk activity. We used Preliminary Risk Analysis (PRA) to analyse the risks in the different steps of our anticancer drug circuit, including the preparation step (PRA1). Then, to prepare an important change in management of the circuit with the software Chimio® (pooling of three databases for subcontracting), we repeated the analysis of preparation step (PRA2). PRA is known to be time and resource consuming. To overcome this, we developed a strict organisational framework to perform the analysis within a reasonable amount of time. We present the PRA method including its practical implementation, and its application to the anticancer drug preparation process, before and after pooling of Chimio® databases.
Methods
PRA has two main stages, PRA “system” and PRA “scenario”. A multidisciplinary working group is created for the entire PRA process. PRA “system” is an exploratory and qualitative stage. PRA “scenario” requires the creation of risk assessment tools and decision tools before actually developing, analysing and treating scenarios, with risk reduction actions structured in an action plan. For PRA2 we used the same working group, assessment and decision tools as for PRA1 and we only analysed dangerous situations (DS) that appeared or changed towards more risk, requiring a new action plan. The different PRA only required four 2 h meetings thanks to the investment of a coordinator who is expert in the method.
Results
In PRA1, the riskiest phase was production while it was the verification and delivery of the finished product in PRA2. The risks were mainly related to management, human and technical dangers in PRA1. Human danger was found to be the main danger in PRA2, followed by organisational danger. Among the 264 scenarios described in PRA1, six of criticality 3 and 69 of criticality 2 have been associated with risk reduction actions. These actions mainly involved managing the risk of human error, with the control system Drugcam® and the standardisation of the pharmaceutical assistants’ training program. In PRA2, 11 scenarios were analysed, including three of criticality 3 and 4 of criticality 2 for which risk reduction measures were taken.
Conclusions
PRA allowed us to perform an in depth analysis of the highly specific and technical process of anticancer drug preparation. Human danger was one of the most important dangers identified, and it should always be taken into consideration, whatever the measures taken to prevent it. PRA2 was extremely useful to plan the organisation that would result from the new Chimio® database, while involving the team and winning its commitment. It allowed an exhaustive and structured anticipation of this major change. Practical aspects of PRA method implementation we have adopted facilitate its application and can help to deploy it on many areas in our hospitals. Indeed, besides an exhaustive analysis of the risks, this approach promotes collaboration, develops a quality culture and is an excellent tool for team and project management, as well as communication.
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Affiliation(s)
| | | | | | | | | | - Michael Besse
- Quality and Risk Management Direction , Hôpital Bichat , Paris , France
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Momeni M, Askarian M, Azad H, Danaei M. Exposure To Cytotoxic Drugs Threatens The Health Of Staff In Oncology Wards. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background — Cancer is one of the leading causes of death worldwide. Using cytotoxic drugs for cancer treatment is increased. The hazardous effects of occupational exposure to cytotoxic drugs are challenging. Objective — This study aimed to compare the frequency of adverse effects and using personal protective equipment (PPE) between the staff of oncology wards and other hospital wards staff in Iran. Methods — A cross-sectional study with a control group was conducted on female staff members in educational hospitals, selected through convenience sampling. A data collection form was designed for this study. It includes demographic data, acute complications (allergic and neurologic reactions), chronic complications (infertility, menstrual disorders, malignancy, and congenital malformations), and use of PPE. Data analysis was performed using SPSS software through Chi-square and Mann-Whitney tests. Results — The frequencies of chronic complications were not statistically different between the two groups. The frequency of itching (P=0.001), hair loss (P=0.003), itchy eyes (P=0.001), watery eyes (P=0.001), runny nose (P=0.003), headache (P=0.001), vertigo (P=0.007), and nausea (P=0.008) were significantly higher in oncology wards nurses. Among different PPE, only the frequency of using the mask (P= 0.001), and glasses (P=0.027) were significantly higher in the staff of oncology wards. Conclusion — Despite the frequency of acute complications of exposure to cytotoxic drugs, oncology staff does not fully adhere to the standard precautions. Providing effective training and emphasis on implementing accreditation laws can improve the existing situation.
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Affiliation(s)
| | | | - Hossein Azad
- Kerman University of Medical Sciences, Kerman, Iran
| | - Mina Danaei
- Kerman University of Medical Sciences, Kerman, Iran
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Abstract
Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be performed immediately and elective surgery should be deferred during pregnancy.
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Koga Y, Sanefuji M, Toya S, Oba U, Nakashima K, Ono H, Yamamoto S, Suzuki M, Sonoda Y, Ogawa M, Yamamoto H, Kusuhara K, Ohga S. Infantile neuroblastoma and maternal occupational exposure to medical agents. Pediatr Res 2021:10.1038/s41390-021-01634-z. [PMID: 34244617 DOI: 10.1038/s41390-021-01634-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/07/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Healthcare workers are often exposed to hazardous agents and are at risk for adverse health consequences that affect not only themselves but also their infants. This study aimed to examine whether such occupational exposure increased the risk of childhood cancer in offspring. METHODS We used the dataset of the Japan Environment and Children's Study, a nationwide birth cohort involving over 100,000 mother-child pairs. Information was obtained via successive questionnaires that were completed until the child turned 1 year of age. The parents were asked whether they occupationally handled medical agents during pregnancy. RESULTS A total of 26 infants developed neoplasms: neuroblastoma, leukemia, and brain tumor. The incidence of neuroblastoma was significantly higher in infants whose mothers were exposed to radiation (3/2142: 140.1 per 100,000 population) than in those who were not (12/90,384: 13.3 per 100,000 population). Multivariable regression analyses revealed a close association between maternal irradiation and the development of neuroblastoma (adjusted incident rate ratio: 10.68 [95% confidence interval: 2.98‒38.27]). CONCLUSIONS The present study demonstrated, for the first time, a potential association between maternal occupational exposure and the occurrence of neuroblastoma in offspring. Further studies involving the large pediatric cancer registries are needed to confirm these preliminary results. IMPACT Healthcare workers are often exposed to hazardous agents and are at risk for adverse health consequences that affect not only themselves but also their infants. This study examined the association between such occupational exposure and offspring's cancers that developed until the age of 1 year. Maternal exposure to ionizing radiation was associated with infantile neuroblastoma in offspring. Further studies involving the large pediatric cancer registries are needed to confirm these preliminary results.
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Affiliation(s)
- Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Syunichiro Toya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Utako Oba
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Ono
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamamoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Maya Suzuki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanobu Ogawa
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
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Bajpai J, Mailankody S, Nair R, T Surappa S, Gupta S, Prabhash K, Banavali SS, Malhotra H, Bhattacharyya GS, Bk S, Babu G. Gender climate in Indian oncology: national survey report. ESMO Open 2021; 5:S2059-7029(20)30066-1. [PMID: 32354723 PMCID: PMC7213870 DOI: 10.1136/esmoopen-2020-000671] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction There is evidence of under-representation of women in leadership roles and publications in oncology. However, there is little knowledge about their perceptions of professional environment, unique challenges and opportunities compared with male counterparts. The problem is more prominent in lower-income and middle-income countries like India and merits exploration. Materials and methods A survey, ‘Exploratory Study on the Challenges of Female Oncologists in India’, was conducted among oncology professionals. We included questions on demography, working team details, role at work, perceived challenges for advancement of career, gender-related values brought into the team and the measures for improvement of gender disparity. Lead authorship data were collected from two Indian oncology journals. Results Of the 324 respondents, 198 (61.1%) were women. Majority of the respondents were medical oncologists (46.3%), ≤45 years old (69.4%) and working in universities and corporate hospitals (71.6%). One hundred eighty-nine (58.3%) respondents worked in teams with male majority, 50 (15.4%) in women-majority teams, while 85 (26.2%) worked in teams with gender equality. Of the 324 respondents, 218 (67.3%) had men managers, while 106 (32.7%) had women managers. Men led 160 (84.7%) male-majority teams; 45 (52.9%) gender-equal teams; and 13 (26%) female-majority teams (p<0.00001). Age >45 years was found to be associated with a leadership role (43% vs 25%, p=0.0012). The most significant barrier perceived for advancement of career for women was finding a work–life balance. Most respondents suggested provision of flexible training programmes to improve the disparity. Of the 558 journal publications inspected, 145 (26%) articles had a female first or corresponding author. Conclusions The study brought out the current figures regarding gender climate in oncology practice and academia across India. We identified lead thrust areas and schemes to improve the gender bias. There needs to be action at international, national and personal levels to bring about an efficient gender-neutral workforce.
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Affiliation(s)
- Jyoti Bajpai
- Medical Oncology, Tata Memorial Centre, Mumbai, India .,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sharada Mailankody
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Reena Nair
- Clinical Hematology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sudeep Gupta
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad S Banavali
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Hemant Malhotra
- Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | | | - Smruti Bk
- Medical Oncology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Govind Babu
- Medical Oncology, HCG Cancer Centre, Bengaluru, India
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Zhou G, Duong TV, Kasten EP, Hoffmann HM. Low CLOCK and CRY2 in 2nd trimester human maternal blood and risk of preterm birth: A nested case-control study. Biol Reprod 2021; 105:827-836. [PMID: 34142702 DOI: 10.1093/biolre/ioab119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Previous studies have observed an association between maternal circadian rhythm disruption and preterm birth (PTB). However, the underlying molecular mechanisms and the potential of circadian clock genes to serve as predictors of PTB remain unexplored. We examined the association of 10 core circadian transcripts in maternal blood with spontaneous PTB (sPTB) vs term births using a nested case-control study design. We used a public gene expression dataset (GSE59491), which was nested within the All Our Babies (AOB) study cohort in Canada. Maternal blood was sampled in trimesters 2-3 from women with sPTB (n = 51) and term births (n = 106), matched for 5 demographic variables. In 2nd trimester maternal blood, only CLOCK and CRY2 transcripts were significantly lower in sPTB vs term (p = 0.02 ~ 0.03, FDR < 0.20). A change of PER3 mRNA from trimesters 2 to 3 was significantly associated with sPTB (decline in sPTB, p = 0.02, FDR < 0.20). When CLOCK and CRY2 were modeled together in 2nd trimester blood, the odds ratio of being in the low level of both circadian gene transcripts was greater in sPTB vs term (OR = 4.86, 95%CI = (1.75,13.51), p < 0.01). Using GSVA and Pearson correlation, we identified 98 common pathways that were negatively or positively correlated with CLOCK and CRY2 expression (all p < 0.05, FDR < 0.10). The top three identified pathways were amyotrophic lateral sclerosis, degradation of extracellular matrix, and inwardly rectifying potassium channels. These three processes have previously been shown to be involved in neuron death, parturition, and uterine excitability during pregnancy, respectively.
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Affiliation(s)
- Guoli Zhou
- Clinical & Translational Sciences Institute, Michigan State University, USA
| | - Thu V Duong
- Department of Animal Science, The Reproductive and Developmental Sciences Program, College of Agriculture and Natural Resources, Michigan State University, USA
| | - Eric P Kasten
- Clinical & Translational Sciences Institute, Michigan State University, USA.,Department of Radiology, Michigan State University, USA
| | - Hanne M Hoffmann
- Department of Animal Science, The Reproductive and Developmental Sciences Program, College of Agriculture and Natural Resources, Michigan State University, USA
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Eisenberg S, Klein C. Safe Handling of Hazardous Drugs in Home Infusion. JOURNAL OF INFUSION NURSING 2021; 44:137-146. [PMID: 33935248 DOI: 10.1097/nan.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemotherapy agents used for cancer treatment are considered hazardous drugs (HDs). Guidelines and standards for handling HDs have been in place for several decades to protect oncology nurses working in hospitals and outpatient infusion areas. However, chemotherapy is frequently being administered in home settings, often by infusion nurses who do not necessarily have the requisite knowledge and training. Providing appropriate education for home infusion nurses is key to ensuring they are practicing in a manner that minimizes potential exposure to HDs.
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Affiliation(s)
- Seth Eisenberg
- Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington (Mr Eisenberg); Cancer Treatment Centers of America, Philadelphia, and Community College of Philadelphia, Philadelphia, Pennsylvania (Ms Klein)
- Seth Eisenberg, ASN, RN, OCN®, BMTCN®, has been practicing in the field of oncology since 1983. His experience includes 35 years in blood and marrow transplantation and 21 years in ambulatory oncology infusion. He has published numerous articles on chemotherapy and biotherapy, as well as 6 book chapters (including a chapter for the Joint Commission Resources), and was a contributing author to the Oncology Nursing Society's (ONS') Safe Handling of Hazardous Drugs. He has also coedited the ONS Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice. Mr Eisenberg has presented nationally and internationally at nursing and pharmacy conferences. He has been the recipient of numerous awards, including the 2017 March of Dimes Research Advancement Award, the 2018 ONS Susan Baird Excellence in Clinical Writing Award, the 2020 Ruth McCorkle Lectureship Award, and, most recently, the 2021 Distinguished Award for Consistent Contribution to Nursing Literature
- Christina Klein, MSN, RN, CRNI®, OCN®, has 31 years' experience across the care continuum working in inpatient medical/surgical and critical care, outpatient infusion, home care infusion, vascular access, clinical education, and adjunct faculty nursing education. She is currently an oncology clinical educator at Cancer Treatment Center of America and adjunct faculty at Community College of Philadelphia. Her roles include educating clinical staff and onboarding new-to-practice and experienced nurses, direct patient care in the oncology outpatient infusion suite, and working with first-year nursing students in the clinical arena. Ms Klein is a member of the Infusion Nurses Certification Corporation RN Examination Council and an editorial reviewer for the Journal of Infusion Nursing
| | - Christina Klein
- Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington (Mr Eisenberg); Cancer Treatment Centers of America, Philadelphia, and Community College of Philadelphia, Philadelphia, Pennsylvania (Ms Klein)
- Seth Eisenberg, ASN, RN, OCN®, BMTCN®, has been practicing in the field of oncology since 1983. His experience includes 35 years in blood and marrow transplantation and 21 years in ambulatory oncology infusion. He has published numerous articles on chemotherapy and biotherapy, as well as 6 book chapters (including a chapter for the Joint Commission Resources), and was a contributing author to the Oncology Nursing Society's (ONS') Safe Handling of Hazardous Drugs. He has also coedited the ONS Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice. Mr Eisenberg has presented nationally and internationally at nursing and pharmacy conferences. He has been the recipient of numerous awards, including the 2017 March of Dimes Research Advancement Award, the 2018 ONS Susan Baird Excellence in Clinical Writing Award, the 2020 Ruth McCorkle Lectureship Award, and, most recently, the 2021 Distinguished Award for Consistent Contribution to Nursing Literature
- Christina Klein, MSN, RN, CRNI®, OCN®, has 31 years' experience across the care continuum working in inpatient medical/surgical and critical care, outpatient infusion, home care infusion, vascular access, clinical education, and adjunct faculty nursing education. She is currently an oncology clinical educator at Cancer Treatment Center of America and adjunct faculty at Community College of Philadelphia. Her roles include educating clinical staff and onboarding new-to-practice and experienced nurses, direct patient care in the oncology outpatient infusion suite, and working with first-year nursing students in the clinical arena. Ms Klein is a member of the Infusion Nurses Certification Corporation RN Examination Council and an editorial reviewer for the Journal of Infusion Nursing
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Francis F, Johnsunderraj SE, Divya KY, Raghavan D, Al-Furgani A, Bera LP, Abraham A. Ergonomic Stressors Among Pregnant Healthcare Workers: Impact on pregnancy outcomes and recommended safety practices. Sultan Qaboos Univ Med J 2021; 21:e172-e181. [PMID: 34221463 PMCID: PMC8219330 DOI: 10.18295/squmj.2021.21.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/01/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
Workplace environment can have a considerable impact on the physical, psychological and maternal health of pregnant healthcare workers. This article aimed to summarise the impact of work-related ergonomic stressors on pregnancy outcomes for healthcare workers, along with potential interventions to resolve these stressors. A narrative review analysis using the Pearl Growing Strategy was conducted between February 2019 and June 2020 to identify English-language articles published between 2000 and 2020. A total of 89 studies were identified from the SCOPUS (Elsevier, Amsterdam, Netherlands), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) databases and Google Scholar (Google LLC, Menlo Park, California, USA). The results indicated that poor work-related ergonomics had detrimental effects on pregnancy outcomes, resulting in spontaneous abortions, preterm delivery, low birth weight babies and infertility. Policymakers and employers should conduct ergonomic assessments and implement appropriate practices to ensure the safety of pregnant healthcare workers.
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Affiliation(s)
- Frincy Francis
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | | | - K. Y. Divya
- Department of Community & Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Divya Raghavan
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | - Atiya Al-Furgani
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | - Lily P. Bera
- Department of Maternal & Child Health, College of Nursing, All India Institute of Medical Sciences, Bhopal, India
| | - Aniamma Abraham
- Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
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5-Fluorouracil Management of Oculofacial Scars: A Systematic Literature Review. Ophthalmic Plast Reconstr Surg 2021; 36:222-230. [PMID: 31923097 DOI: 10.1097/iop.0000000000001532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To review the literature for the safety and efficacy of intralesional 5-fluorouracil (5-FU) in the management of oculofacial scars. METHODS A literature search was performed in July 2019 in the PubMed database to identify reports of the use of 5-FU injections for modulating oculofacial cutaneous scars. The search yielded 152 articles, of which 15 met criteria outlined for assessment. Data were abstracted from these 15 relevant articles. RESULTS While there were no high-level prospective randomized controlled trials, 8 were lower-quality randomized controlled trial, 3 were retrospective cohort studies, and 4 were case series. Most studies pooled results of facial and nonfacial cutaneous applications. Three studies focused solely on oculofacial applications, and these were all lower-level evidence studies. The study outcomes included scar dimension reduction, erythema, patient satisfaction score, observer assessment of scar improvement, and recurrence rates. 5-Fluorouracil was administered as monotherapy or as part of multimodality treatment with other agents (usually corticosteroids) or with CO2 laser, radiotherapy, or pulsed dye laser. 5-Fluorouracil was usually given as an intralesional injection, but in some studies, it was applied topically after micropuncture of the skin. The number and timing of treatments varied between studies. Overall, the level of safety of 5-FU was high. Pain with injection was the most common reported side effect. Other common adverse side effects included pruritus, telangiectasias, changes in pigmentation, and purpura, and 2 studies noted more serious events, such as ulceration, superficial necrosis, and local infection. There were no severe side effects such as anaphylaxis, immune suppression, secondary malignancy, systemic infection, blindness, or death. In all studies, 5-FU was associated with prophylaxis of oculofacial scars or improvement of keloids or hypertrophic scars in terms of reducing size, erythema, and pruritus. 5-Fluorouracil application was associated with favorable patient satisfaction and observer assessment scores especially compared with corticosteroid injections alone. CONCLUSIONS High-quality randomized controlled trials are currently lacking, and the existing literature is predominately not specific to use of 5-FU on the face. These studies, however, suggest that intralesional 5-FU is safe and probably more effective than other options in the management of cutaneous scars in the oculofacial region. The delivery methods, timing, dosing, and concomitant therapies were highly variable. Further high-quality controlled studies specific to oculofacial scars may be indicated to assess the efficacy of 5-FU and to establish the best protocols for administering this medication.
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Ishimaru H, Tsuda Y, Kage H, Kawano T, Takayama S, Morimoto Y, Goto K, Watanabe K. [Pressure Compatibility Test of Closed System Drug Transfer Devices for 71 Anticancer Drugs]. YAKUGAKU ZASSHI 2021; 141:143-150. [PMID: 33390441 DOI: 10.1248/yakushi.20-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Occupational exposure to anticancer drugs may increase the risk of cancer and the risk of miscarriage and stillbirth, and cause other adverse events such as hypersensitivity reactions, skin/mucous reactions, and digestive symptoms. Several studies have investigated the use of closed-system drug-transfer devices (CSTDs) to reduce the environmental pollution by hazardous drugs. However, few reports have verified whether CSTDs contain the hazardous drugs within the vials. The BD PhaSealTM System is a CSTD that is frequently used in Japan. However, the fit of each anti-cancer drug vial has not been investigated. We investigated the fit of 71 major anti-cancer drug vials and protectors released and frequently used in Japan by means of a pressure compatibility test that we developed. The pressure compatibility test involved attaching a three-way stopcock to a Luer lock syringe and attaching an injector in line with the syringe. The pressure tubing was connected to the other side of the three-way stopcock and connected to the pressure inlet of the pressure gauge. The pressure in the anti-cancer drug vial was raised to 100 kPa and connected/disconnected repeatedly. If the pressure fluctuation during the 10th connection was within 6%, it was defined as "no change", and the compatibility of the protector and the vial was evaluated. The median pressure reduction rates at the 10th connection ranged from -1.98% to -4.95%. All drugs surveyed had an error rate within 6%. The BD PhaSealTM Protector was shown to be compatible with the 71 anti-cancer drugs we surveyed.
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Affiliation(s)
- Hiromasa Ishimaru
- Department of Pharmacy, St. Luke's International Hospital.,Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
| | - Yasumasa Tsuda
- Department of Pharmacy, St. Luke's International Hospital
| | - Hidenori Kage
- Department of Pharmacy, St. Luke's International Hospital
| | - Tomoaki Kawano
- Department of Pharmacy, St. Luke's International Hospital
| | | | - Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
| | - Kazumi Goto
- Department of Pharmacy, St. Luke's International Hospital
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
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Nassan FL, Chavarro JE, Johnson CY, Boiano JM, Rocheleau CM, Rich-Edwards JW, Lawson CC. Prepregnancy handling of antineoplastic drugs and risk of miscarriage in female nurses. Ann Epidemiol 2021; 53:95-102.e2. [PMID: 32920100 PMCID: PMC7736108 DOI: 10.1016/j.annepidem.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/22/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the association betweenantineoplastic drug (AD) handling and risk of miscarriage. METHODS Nurses' Health Study-3 participants self-reported AD administration and engineering controls (ECs) and personal protective equipment (PPE) use at baseline. We estimated the hazard ratio (HR) of miscarriage in relation to baseline AD handling using multivariable Cox proportional regression. RESULTS Overall, 2440 nurses reported 3327 pregnancies, with 550 (17%) ended in miscarriages. Twelve percent of nurses self-reported currently handling AD and 28% previously handling AD. Compared with nurses who never handled AD, nurses who handled AD at baseline had an adjusted HR of miscarriage of 1.26 (95% confidence interval [CI], 0.97-1.64). This association was stronger after 12-weeks gestation (HR=2.39 [95% CI, 1.13-5.07]). Nurses who did not always use gloves had HR of 1.51 (95% CI, 0.91-2.51) compared with 1.19 (95% CI, 0.89-1.60) for those always using gloves; nurses who did not always use gowns had HR of 1.32 (95% CI, 0.95-1.83) compared with 1.19 (95% CI, 0.81-1.75) for nurses always using gowns. CONCLUSIONS We observed a suggestive association between AD handling and miscarriage, particularly among nurses who did not consistently use PPE and EC with stronger associations for second trimester losses.
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Affiliation(s)
- Feiby L Nassan
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Candice Y Johnson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - James M Boiano
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Carissa M Rocheleau
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA; Connors Center for Women's Health and Gender Biology and Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christina C Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
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Yaw AM, McLane-Svoboda AK, Hoffmann HM. Shiftwork and Light at Night Negatively Impact Molecular and Endocrine Timekeeping in the Female Reproductive Axis in Humans and Rodents. Int J Mol Sci 2020; 22:E324. [PMID: 33396885 PMCID: PMC7795361 DOI: 10.3390/ijms22010324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 01/17/2023] Open
Abstract
Shiftwork, including work that takes place at night (nightshift) and/or rotates between day and nightshifts, plays an important role in our society, but is associated with decreased health, including reproductive dysfunction. One key factor in shiftwork, exposure to light at night, has been identified as a likely contributor to the underlying health risks associated with shiftwork. Light at night disrupts the behavioral and molecular circadian timekeeping system, which is important for coordinated timing of physiological processes, causing mistimed hormone release and impaired physiological functions. This review focuses on the impact of shiftwork on reproductive function and pregnancy in women and laboratory rodents and potential underlying molecular mechanisms. We summarize the negative impact of shiftwork on female fertility and compare these findings to studies in rodent models of light shifts. Light-shift rodent models recapitulate several aspects of reproductive dysfunction found in shift workers, and their comparison with human studies can enable a deeper understanding of physiological and hormonal responses to light shifts and the underlying molecular mechanisms that may lead to reproductive disruption in human shift workers. The contributions of human and rodent studies are essential to identify the origins of impaired fertility in women employed in shiftwork.
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Affiliation(s)
| | | | - Hanne M. Hoffmann
- Department of Animal Science and the Reproductive and Developmental Science Program, Michigan State University, East Lansing, MI 48824, USA
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39
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Nurses' Clinical Work Experience during Pregnancy. Healthcare (Basel) 2020; 9:healthcare9010016. [PMID: 33374472 PMCID: PMC7823590 DOI: 10.3390/healthcare9010016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
The working environment of nurses contains numerous hazards that can be particularly harmful to pregnant women. In addition, pregnancy-induced changes can themselves cause discomfort. Therefore, it is necessary to analyze pregnant nurses' experiences of clinical work. This qualitative study analyzed data collected through in-depth interviews. From January to June in 2020, 12 shift-work nurses who had experienced pregnancy within three years were interviewed. The main question was "Could you describe your clinical work experience during pregnancy?" Qualitative data from field notes and transcriptions of the interviews were analyzed using Colaizzi's method. Six categories were extracted that described the nurses' clinical work experience during pregnancy, as follows: "enduring alone," "organizational characteristics of nursing," "risky work environment," "strengths that sustain work during pregnancy," "growth as a nurse," and "methods to protect pregnant nurses." Pregnant nurses experienced various difficulties due to physical and mental changes during pregnancy, and the clinical working environment did not provide them with adequate support. The findings of this study will be helpful for developing and implementing practical maternity protection policies and work guidelines.
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40
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Al Alawi L, Soteriades ES, Paulo MS, Östlundh L, Grivna M, Al Maskari F, Al-Rifai RH. Environmental assessment of cytotoxic drugs in healthcare settings: protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:242. [PMID: 33076972 PMCID: PMC7574301 DOI: 10.1186/s13643-020-01494-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/23/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Occupational exposure to cytotoxic drugs is associated with various unfavorable health outcomes. This protocol reports a methodology for a systematic review and meta-analysis that aims to systematically review the published literature and quantify the level of environmental contamination of healthcare settings with cytotoxic drugs. METHODS This protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol-2015 (PRISMA-P) guidelines. Six electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, and EMBASE) will be searched with no restrictions on publication period. Eligible studies will be identified and data will be extracted using a predefined data extraction form by at least two independent reviewers following best practice. Eligible studies should report calculated or calculable estimates on the proportion of positive samples tested for cytotoxic drugs and/or estimates on the concentration of the cytotoxic drug(s) in the tested samples. Risk of bias (RoB) will be assessed by using the RoB in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool, which developed by the World Health Organization (WHO) and International Labour Organization (ILO) for environmental and occupational health systematic reviews. The random-effects model will be used to perform meta-analyses. DISCUSSION Occupational exposure to cytotoxic drugs is associated with short- and long-term adverse health outcomes. Following this protocol, the review to be carried out will be the first to fill an evidence gap on the environmental contamination of healthcare settings with cytotoxic drugs. The findings of this review will help in the understanding of the risk of occupational exposure of healthcare workers to cytotoxic drugs and facilitate the identification of priority areas for specific interventions. ETHICS AND DISSEMINATION The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020162780 , dated July 14, 2020.
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Affiliation(s)
- Laila Al Alawi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Elpidoforos S Soteriades
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
- Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Harvard School of Public Health, Boston, MA, USA
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Fatima Al Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Hori A, Shimura M, Iida Y, Yamada K, Nohara K, Ichinose T, Yamashita A, Shirataki J, Hagiwara S. Occupational exposure of platinum-based anti-cancer drugs: five-year monitoring of hair and environmental samples in a single hospital. J Occup Med Toxicol 2020; 15:29. [PMID: 33005211 PMCID: PMC7523399 DOI: 10.1186/s12995-020-00280-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Occupational exposure to chemotherapeutic agents in hospitals is a critical issue. Here, we focused on occupational exposure to platinum-based anti-cancer drugs (PDs) by evaluating platinum concentrations in hair and environmental workplace samples to monitor the risk among workers. Methods Hospital workers who dealt with or without PDs, patients treated with PDs, and non-medical office workers outside the hospital donated hair samples and completed a questionnaire regarding their history of handling PDs, including any incidents. Hair samples were collected and surface wipe sampling was performed in July 2010 and April 2015, before and after moving to a new building and introducing a revised safety program in August 2010. Samples were analyzed by inductively coupled plasma-mass spectrometry. Results Platinum concentrations in hair from PDs-handling workers was significantly higher than in non-PDs-handling workers (P = 0.045), although 50 times lower than that from PDs-treated patients. Platinum concentrations in the hospital environment had decreased at the second survey 5 years later but had not changed significantly in the hair samples from hospital workers. Conclusion Platinum concentrations in hair are likely dependent on the frequency of handling PDs. Reduced environmental contamination from PDs did not influence platinum levels in hospital workers’ hair. Continuous monitoring by measuring platinum concentrations in the environment and in hair would provide information regarding these issues.
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Affiliation(s)
- Ai Hori
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.,Department of Global Public Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Mari Shimura
- Department of Intractable Diseases, NCGM, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Yutaka Iida
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Japan
| | | | - Kyoko Nohara
- Department of Surgery, Hospital, NCGM, Tokyo, Japan
| | - Takayuki Ichinose
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Japan
| | - Ai Yamashita
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Japan
| | - Junko Shirataki
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Japan
| | - Shotaro Hagiwara
- Division of Hematology, Internal Medicine, Hospital, NCGM, Tokyo, Japan.,Present address: Department of Hematology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Astrakianakis G, Jeronimo M, Griffiths A, Colombo M, Kramer D, Demers PA, Hon CY. The application of novel field measurement and field evaluation protocols for assessing health care workers' exposure risk to antineoplastic drugs. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2020; 17:373-382. [PMID: 32615872 DOI: 10.1080/15459624.2020.1777296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contamination of multiple antineoplastic drugs (ADs) on work surfaces presents an exposure concern for health care workers. Surface wipe sampling is a recognized method to evaluate the degree of contamination present. Our research team has previously reported on wipe sampling and analytical methods to simultaneously detect 10 commonly used ADs from a single wipe. Our objectives here were: to field test a protocol consisting of the wipe sampling method and an accompanying wipe sample collection tool kit and confirm this protocol can be effectively used by health care workers to assess drug contamination levels in their facilities; and, to confirm the potential for simultaneous exposure to multiple antineoplastic drugs. Three facilities within one health authority in British Columbia, Canada participated in this field study. In collaboration with the site health and safety advisors, up to 25 surfaces within each facility were considered for sampling. Collected wipe samples were analyzed using HPLC-MS/MS to quantify the 10 analyte, resulting in 750 potential analyses. Following the sampling, each of the three facilities' safety advisors provided feedback regarding the usability of the protocols. Among the 72 wipe samples actually collected (or 720 analyses conducted), detectable levels and simultaneous contamination of work surfaces of five of the 10 analytes were found at all three participating sites: 5-fluorouracil, cyclophosphamide, vincristine, paclitaxel, and methotrexate; (range < LoD to 33.0 ng/cm2) with 5-fluorouracil having the highest concentration in every instance. Drug contamination was found on a variety of different work surfaces in pharmacies and patient care areas among all three sites. Users of the sampling protocols were generally satisfied with the wipe sample collection toolkit with some minor suggestions for improvement. Our findings support the hypothesis that health care workers may be simultaneously at risk of exposure to several ADs. Our toolkit was found to be user-friendly and manageable by those who were not experienced in collecting wipe samples to monitor contamination of ADs on the work surfaces in their facilities.
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Affiliation(s)
- George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Griffiths
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Manuel Colombo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Desré Kramer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Demers
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Chun-Yip Hon
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Jang MY, Lee WJ, Chun BC, Cha ES. OCCUPATIONAL RADIATION PROCEDURES AND DOSES AMONG NURSES IN SOUTH KOREA. RADIATION PROTECTION DOSIMETRY 2020; 188:493-502. [PMID: 31950171 DOI: 10.1093/rpd/ncz309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/06/2019] [Accepted: 12/26/2019] [Indexed: 06/10/2023]
Abstract
This study investigated occupational radiation procedures and radiation exposures among nurses in South Korea. A total of 530 nurses were surveyed from 2012 to 2013, and the survey data were linked with the dosimetry data. Multiple regression analysis was used to identify the factors associated with radiation dose. The most frequent procedure performed by the nurses was interventional radiology, followed by fluoroscopy and routine X-ray. The average annual effective dose and the cumulative dose were 0.91 mSv and 4.66 mSv, respectively. Characteristics of nurses exposed to high radiation doses were male, completed graduate school or higher, first worked before 2000 and performing interventional procedures, nuclear medicine test and fluoroscopy. Performing nuclear medicine tests and interventional procedures had a significant positive association with high radiation exposure.
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Affiliation(s)
- Mi Ya Jang
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Won Jin Lee
- Graduate School of Public Health, Korea University, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Chul Chun
- Graduate School of Public Health, Korea University, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Papadopoli R, Nobile CGA, Trovato A, Pileggi C, Pavia M. Chemical risk and safety awareness, perception, and practices among research laboratories workers in Italy. J Occup Med Toxicol 2020; 15:17. [PMID: 32550858 PMCID: PMC7298783 DOI: 10.1186/s12995-020-00268-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Exposure to chemical compounds occurs in numerous occupational settings, among which the research and healthcare laboratories have not been adequately investigated. These settings are characterized by an extreme variability of the used compounds and by the frequent turnover of young researchers. The main objectives of the study were to explore the occupational exposure to hazardous chemical substances among research laboratory workers; to assess their awareness and perceptions regarding chemical hazards; to investigate adherence to guidelines on safe handling of chemical compounds; and to analyze the effects of several factors on these outcomes of interest. Methods The survey was conducted among research laboratories workers who were exposed to chemical substances during their activity. Subjects completed a questionnaire exploring knowledge, attitudes and behaviors related to chemical hazards involved in research activities. Results Enrolled subjects were 237, for an 81.7% response rate. More than 90 hazardous chemical substances were used in the surveyed laboratories. A correct knowledge on hazardous chemicals was significantly more likely in younger researchers, in those manipulating a higher number of hazardous chemicals, and in those with a higher number of years of training in the attended laboratory; 54.4% of the workers said they felt very exposed to chemical risk. Correct practices in the laboratories were significantly more likely in researchers who perceived to have a low exposure to chemicals, but a high exposure to biological risk, who agreed with the statement that colleagues handle chemicals following safety procedures and who perceived to have received an adequate training in the management of accidents and first aid. Conclusions Our results showed significant gaps in knowledge and scarce preparedness in the adherence to safety processes to prevent and contain risks related to use of chemical compounds in research laboratories.
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Affiliation(s)
- Rosa Papadopoli
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Carmelo Giuseppe Angelo Nobile
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Alessandro Trovato
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni, 5, 80138 Naples, Italy.,Department of Health Sciences, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
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Polovich M. USP General Chapter <800>: Considerations for Oncology Nursing Practice. Semin Oncol Nurs 2020; 36:151022. [PMID: 32404243 DOI: 10.1016/j.soncn.2020.151022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the nurse leader's role in implementing the hazardous drug safe-handling standards from USP General Chapter <800> that are most relevant to oncology nursing practice, and to provide strategies for reducing nurses' exposure to hazardous drugs. DATA SOURCES Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION Nurse leaders are essential to promoting a safe environment for nurses handling hazardous cancer drugs. IMPLICATIONS FOR NURSING PRACTICE Several barriers and challenges to handling hazardous drugs exist and must be overcome before oncology nurses' exposure can be reduced.
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Affiliation(s)
- Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA.
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Occupational Exposure in Health Care Personnel to Antineoplastic Drugs and Initiation of Safe Handling in Hong Kong: A Literature Review. JOURNAL OF INFUSION NURSING 2020; 43:121-133. [PMID: 32287167 DOI: 10.1097/nan.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the benefits for patients as cancer treatment, antineoplastic drugs may cause adverse effects not only in patients but also in health care personnel. Apart from minor symptoms, antineoplastic agents can cause serious health problems. However, protection from occupational exposures to antineoplastic drugs varies between pharmacy staff and nurses. While protection used for pharmacy staff are more advanced, personal protective equipment seems to be the only protection for most nurses around the world. Exposure can never be totally prevented, but it should be minimized at all costs. Guidelines and recommendations have been published; however, these guidelines do not have legal enforcement power. This article aims to provide a literature review on the occupational exposure of health care personnel to antineoplastic drugs and to reflect the current status in Hong Kong.
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Suzumori N, Ebara T, Matsuki T, Yamada Y, Kato S, Omori T, Saitoh S, Kamijima M, Sugiura‐Ogasawara M. Effects of long working hours and shift work during pregnancy on obstetric and perinatal outcomes: A large prospective cohort study-Japan Environment and Children's Study. Birth 2020; 47:67-79. [PMID: 31667913 PMCID: PMC7065104 DOI: 10.1111/birt.12463] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The work patterns of pregnant women may be related to adverse obstetric and perinatal outcomes. This study aimed to clarify the effects of weekly working time according to frequencies of night shifts during pregnancy on adverse outcomes in Japan. METHODS The Japan Environment and Children's Study, a prospective cohort study, was conducted in 15 regions nationwide in Japan. The study population included pregnant women with singleton pregnancies (n = 99 744). The mothers' working hours and frequencies of night shifts during the first and the second/third trimesters were assessed using a self-administered questionnaire. Outcome data were collected from medical transcripts. RESULTS Compared with nonworking women, women who worked during pregnancy had significantly increased adjusted odds ratios (aORs) of threatened miscarriage (maximum aOR: 1.47, 95% confidence interval [95% CI]: 1.26-1.73) and of threatened preterm labor (maximum aOR: 1.63, 95% CI: 1.41-1.87). Increased aORs were observed for hypertensive disorders of pregnancy (maximum aOR: 2.02, 95% CI: 1.39-2.93) in women working ≥36 hours per week with night shifts, for vacuum/forceps delivery (maximum aOR: 1.34, 95% CI: 1.22-1.48) at ≥36 hours with or without night shifts, and for small-for-gestational-age babies (aOR: 1.32, 95% CI: 1.10-1.59) at ≥46 hours with night shifts. In contrast, lower aORs were observed for gestational diabetes and meconium-stained amniotic fluid in women working without night shifts. CONCLUSIONS Work during pregnancy slightly increased the risks of threatened miscarriage and threatened preterm labor. Long working hours increased the risks of hypertensive disorders of pregnancy, vacuum/forceps delivery, and small-for-gestational-age babies.
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Affiliation(s)
- Nobuhiro Suzumori
- Department of Obstetrics and GynecologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Takeshi Ebara
- Department of Occupational and Environmental HealthGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Taro Matsuki
- Department of Occupational and Environmental HealthGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Yasuyuki Yamada
- Department of Occupational and Environmental HealthGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
- Graduate School of Health and Sports ScienceJuntendo UniversityChibaJapan
| | - Sayaka Kato
- Department of Occupational and Environmental HealthGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
- Department of Pediatrics and NeonatologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Toyonori Omori
- Department of Health Care Policy and ManagementGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
- National Center for Child Health and DevelopmentTokyoJapan
| | - Shinji Saitoh
- Department of Pediatrics and NeonatologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Michihiro Kamijima
- Department of Occupational and Environmental HealthGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Mayumi Sugiura‐Ogasawara
- Department of Obstetrics and GynecologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
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Ahammer A, Halla M, Schneeweis N. The effect of prenatal maternity leave on short and long-term child outcomes. JOURNAL OF HEALTH ECONOMICS 2020; 70:102250. [PMID: 32062055 DOI: 10.1016/j.jhealeco.2019.102250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
Maternity leave policies are designed to safeguard the health of pregnant workers and their unborn children. We evaluate a maternity leave extension in Austria which increased mandatory prenatal leave from 6 to 8 weeks. We exploit that the assignment to the extended leave was determined by a cutoff date. We find no evidence for significant effects of this extension on children's health at birth or long-term health and labor market outcomes. Subsequent maternal health and fertility are also unaffected. We conclude that employment during the 33rd and 34th week of gestation is not harmful for expecting mothers (without major problems in pregnancy) and their unborn children.
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Affiliation(s)
- Alexander Ahammer
- Johannes Kepler University, Linz, Austria; Christian Doppler Laboratory Aging, Health, and the Labor Market, Linz, Austria.
| | - Martin Halla
- Johannes Kepler University, Linz, Austria; Christian Doppler Laboratory Aging, Health, and the Labor Market, Linz, Austria; IZA, Institute for the Study of Labor, Bonn, Germany; GÖG, Austrian Public Health Institute, Vienna, Austria
| | - Nicole Schneeweis
- Johannes Kepler University, Linz, Austria; Christian Doppler Laboratory Aging, Health, and the Labor Market, Linz, Austria; IZA, Institute for the Study of Labor, Bonn, Germany; CEPR, Centre for Economic Policy Research, London, United Kingdom
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Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:563-576. [PMID: 31276631 DOI: 10.1016/j.ajog.2019.06.051] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUD An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse pregnancy outcomes, but the results remain conflicting and inconclusive. OBJECTIVE To examine the influences of shift work and longer working hours during pregnancy on maternal and fetal health outcomes. DATA SOURCES Five electronic databases and 3 gray literature sources were searched up to March 15, 2019. METHODS OF STUDY SELECTION Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy); exposure (rotating shift work [shifts change according to a set schedule], fixed night shift [typical working period is between 11:00 pm and 11:00 am] or longer working hours [>40 hours per week]);comparator (fixed day shift [typical working period is between 8:00 am and 6:00 pm] or standard working hours [≤40 hours per week]); and outcomes (preterm delivery, low birthweight [birthweight <2500 g], small for gestational age, miscarriage, gestational hypertension, preeclampsia, intrauterine growth restriction, stillbirth, and gestational diabetes mellitus). TABULATION, INTEGRATION, AND RESULTS From 3305 unique citations, 62 observational studies (196,989 women) were included. "Low" to "very low" certainty evidence from these studies revealed that working rotating shifts was associated with an increased odds of preterm delivery (odds ratio, 1.13; 95% confidence interval, 1.00-1.28, I2 = 31%), an infant small for gestational age (odds ratio, 1.18, 95% confidence interval, 1.01-1.38, I2 = 0%), preeclampsia (odds ratio, 1.75, 95% confidence interval, 1.01-3.01, I2 = 75%), and gestational hypertension (odds ratio, 1.19, 95% confidence interval, 1.10-1.29, I2 = 0%), compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased odds of preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; I2 = 36%) and miscarriage (odds ratio, 1.23; 95% confidence interval, 1.03-1.47; I2 = 37%). Compared with standard hours, working longer hours was associated with an increased odds of miscarriage (odds ratio, 1.38; 95% confidence interval, 1.08-1.77; I2 = 73%), preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; I2 = 30%), an infant of low birthweight (odds ratio, 1.43; 95% confidence interval, 1.11-1.84; I2 = 0%), or an infant small for gestational age (odds ratio, 1.16, 95% confidence interval, 1.00-1.36, I2 = 57%). Dose-response analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the odds of having a preterm delivery. CONCLUSION Pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.
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Villa A, Molimard M, Bignon E, Martinez B, Rouyer M, Mathoulin-Pelissier S, Baldi I, Verdun-Esquer C, Canal-Raffin M. Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study. BMJ Open 2019; 9:e033040. [PMID: 31712349 PMCID: PMC6858204 DOI: 10.1136/bmjopen-2019-033040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Antineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination. METHODS AND ANALYSIS This trial will be conducted in two French hospital centres: University Hospital of Bordeaux and IUCT-Oncopole of Toulouse. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The trial will be conducted with the following steps: (1) development of analytical methods to quantify AD urine biomarkers, (2) study of the workplace and organization around AD in each care department (transport and handling, professional practices, personal and collective protection equipments available) (3) development of a self-questionnaire detailing professional activities during the day of inclusion, (4) nurses inclusion (urine samples and self-questionnaire collection), (5) urine assays, (6) data analysis. ETHICS AND DISSEMINATION The study protocol has been approved by the French Advisory Committee on the Treatment of Information in Health Research (CCTIRS) and by the French Data Protection Authority (CNIL). Following the opinion of the Regional Committee for the Protection of Persons, this study is outside the scope of the provisions governing biomedical research and routine care (n°2014/87). The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03137641.
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Affiliation(s)
- Antoine Villa
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Consultation de Pathologie Professionnelle et de I'environnement, CHU Timone, AP-HM, Marseille, France
- Univ. of Bordeaux, Bordeaux, France
| | - Mathieu Molimard
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
| | - Emmanuelle Bignon
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Béatrice Martinez
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Simone Mathoulin-Pelissier
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Isabelle Baldi
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Catherine Verdun-Esquer
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Mireille Canal-Raffin
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
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