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Dose Error Reduction System

John A Todd, Marina Evangelou, Antony J Cutler, Marcin L Pekalski, Neil M Walker, Helen E Stevens, Linsey Porter, Deborah J Smyth, Daniel B Rainbow, Ricardo C Ferreira, Laura Esposito, Kara M D Hunter, Kevin Loudon, Kathryn Irons, Jennie H Yang, Charles J M Bell, Helen Schuilenburg, James Heywood, Ben Challis, Sankalpa Neupane, Pamela Clarke, Gillian Coleman, Sarah Dawson, Donna Goymer, Katerina Anselmiova, Jane Kennet, Judy Brown, Sarah L Caddy, Jia Lu, Jane Greatorex, Ian Goodfellow, Chris Wallace, Tim I Tree, Mark Evans, Adrian P Mander, Simon Bond, Linda S Wicker, Frank Waldron-Lynch
BACKGROUND: Interleukin-2 (IL-2) has an essential role in the expansion and function of CD4+ regulatory T cells (Tregs). Tregs reduce tissue damage by limiting the immune response following infection and regulate autoreactive CD4+ effector T cells (Teffs) to prevent autoimmune diseases, such as type 1 diabetes (T1D). Genetic susceptibility to T1D causes alterations in the IL-2 pathway, a finding that supports Tregs as a cellular therapeutic target. Aldesleukin (Proleukin; recombinant human IL-2), which is administered at high doses to activate the immune system in cancer immunotherapy, is now being repositioned to treat inflammatory and autoimmune disorders at lower doses by targeting Tregs...
October 2016: PLoS Medicine
Khadijeh Aghajani, Habib-Allah Tayebi
In this study, the Mesoporous material SBA-15 were synthesized and then, the surface was modified by the surfactant Cetyltrimethylammoniumbromide (CTAB). Finally, the obtained adsorbent was used in order to remove Reactive Red 198 (RR 198) from aqueous solution. Transmission electron microscope (TEM), Fourier transform infra-red spectroscopy (FTIR), Thermogravimetric analysis (TGA), X-ray diffraction (XRD), and BET were utilized for the purpose of examining the structural characteristics of obtained adsorbent...
January 15, 2017: Spectrochimica Acta. Part A, Molecular and Biomolecular Spectroscopy
Steven van Welie, Linda Wijma, Tim Beerden, Jasperien van Doormaal, Katja Taxis
OBJECTIVES: Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes. SETTING: This was a prospective uncontrolled intervention study with a preintervention and postintervention measurement...
2016: BMJ Open
G Hyun, J Li, A R Bass, A Mohapatra, S C Woller, H Lin, C Eby, G A McMillin, B F Gage
Warfarin-dosing algorithms combine clinical factors and dosing history with the current international normalized ratio (INR) to estimate the therapeutic warfarin dose. Unfortunately, these approaches can result in an overdose if the INR is spuriously low. Our goal was to develop an alert mechanism based on prior INRs in addition to the current INR. Using data from the Genetics InFormatics Trial (GIFT) of Warfarin to Prevent DVT, we analyzed warfarin dose estimates for days 3 through 11 that were ≥10 % higher than an average of the previous two dose estimates...
November 2016: Journal of Thrombosis and Thrombolysis
David Niedrig, Regina Krattinger, Annika Jödicke, Carmen Gött, Guido Bucklar, Stefan Russmann
PURPOSE: Overdosing of the oral antidiabetic metformin in impaired renal function is an important contributory cause to life-threatening lactic acidosis. The presented project aimed to quantify and prevent this avoidable medication error in clinical practice. METHODS: We developed and implemented an algorithm into a hospital's clinical information system that prospectively identifies metformin prescriptions if the estimated glomerular filtration rate is below 60 mL/min...
July 14, 2016: Pharmacoepidemiology and Drug Safety
Andrew O Paulus, Jeffrey A Colburn, Mark W True, Darrick J Beckman, Richard P Davis, Jana L Wardian, Sky D Graybill, Irene Folaron, Jack E Lewi
OBJECTIVE: Patients using U-500 regular insulin are severely insulin resistant requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systemically investigate this phenomenon. METHODS: We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a five-year period...
June 30, 2016: Endocrine Practice
Muhammad Fawad Rasool, Feras Khalil, Stephanie Läer
BACKGROUND AND OBJECTIVE: Liver cirrhosis is a complex pathophysiological condition that can affect the pharmacokinetics (PK) and hereby dosing of administered drugs. The physiologically based pharmacokinetic (PBPK) models are a valuable tool to explore PK of drugs in cirrhosis patients. The objective of this study was to develop and evaluate a PBPK-carvedilol-cirrhosis model with the available clinical data in liver cirrhosis patients and to recommend model-based drug dosing after exploring the underlying differences in unbound and total (bound and unbound) systemic carvedilol concentrations with the different disease stages...
June 16, 2016: European Journal of Drug Metabolism and Pharmacokinetics
P H Richter, J Steinbrener, A Schicho, F Gebhard
INTRODUCTION: Mobile C-arm imaging is commonly used in operating rooms worldwide. Especially in orthopaedic surgery, intraoperative C-arms are used on a daily basis. Because of new minimally-invasive surgical procedures a development in intraoperative imaging is required. The purpose of this article is investigate if the choice of mobile C-arms with flat panel detector technology (Siemens Cios Alpha and Ziehm Vision RFD) influences image quality and dose using standard, commercially available test devices...
August 2016: Injury
Yuanshui Zheng, Randall Johnson, Gary Larson
PURPOSE: Failure mode and effects analysis (FMEA) is a widely used tool to evaluate safety or reliability in conventional photon radiation therapy. However, reports about FMEA application in proton therapy are scarce. The purpose of this study is to apply FMEA in safety improvement of proton treatment planning at their center. METHODS: The authors performed an FMEA analysis of their proton therapy treatment planning process using uniform scanning proton beams. The authors identified possible failure modes in various planning processes, including image fusion, contouring, beam arrangement, dose calculation, plan export, documents, billing, and so on...
June 2016: Medical Physics
Lucas R Borges, Helder C R de Oliveira, Polyana F Nunes, Predrag R Bakic, Andrew D A Maidment, Marcelo A C Vieira
PURPOSE: This work proposes an accurate method for simulating dose reduction in digital mammography starting from a clinical image acquired with a standard dose. METHODS: The method developed in this work consists of scaling a mammogram acquired at the standard radiation dose and adding signal-dependent noise. The algorithm accounts for specific issues relevant in digital mammography images, such as anisotropic noise, spatial variations in pixel gain, and the effect of dose reduction on the detective quantum efficiency...
June 2016: Medical Physics
Shun-Wang Huang, Wei Wang, Meng-Yu Zhang, Qing-Bo Liu, Sheng-Yong Luo, Ying Peng, Bei Sun, De-Ling Wu, Shao-Jiang Song
BACKGROUND: Alzheimer's disease (AD) is one of the most prevalent neurodegenerative disorders characterized by neuronal loss in the brain and cognitive impairment. AD is now considered to be the third major cause of death in developed countries, after cardiovascular disease and cancer. Persimmon leaves are used as a popular folk medicine to treat hypertension, angina and internal haemorrhage in Cyangbhina, and it has been reported that ethyl acetate extract of persimmon leaves (EAPL) displays a potential therapeutic effect on neurodegenerative diseases...
June 15, 2016: Phytomedicine: International Journal of Phytotherapy and Phytopharmacology
Hanna M Seidling, David W Bates
Health IT is becoming an increasingly powerful tool for improving medication safety. While errors may happen at all stages of the medication process, different tools have been developed to support the prescribing process (e.g. computerized prescribing with decision support), the dispensing process (e.g. barcoding or automated dispensing and unit-dose systems), or the administration process (e.g. electronic medication administration records and smart pumps). Health IT can reduce medication error and preventable adverse drug event rates by increasing documentation quality and transparency, enhancing accuracy and correctness of the medication process, and supporting information exchange and interlinking different stages of the medication process...
2016: Studies in Health Technology and Informatics
Sofia Celi, Emilie Costa, Claas Wessels, Alejandro Mazal, Alain Fourquet, Pascal Francois
Mandatory in several countries, in vivo dosimetry has been recognized as one of the next milestones in radiation oncology. Our department has implemented clinically an EPID based in vivo dosimetry system, EPIgray, by DOSISOFT S.A., since 2006. An analysis of the measurements per linac and energy over a two-year period was performed, which included a more detailed examination per technique and treat-ment site over a six-month period. A comparison of the treatment planning system doses and the doses estimated by EPIgray shows a mean of the differences of 1...
2016: Journal of Applied Clinical Medical Physics
M Mücke, R Conrad, M Marinova, H Cuhls, F Elsner, R Rolke, L Radbruch
To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken...
April 12, 2016: Der Schmerz
Hidemi Kamezawa, Hidetaka Arimura, Katsutoshi Shirieda, Noboru Kameda, Masafumi Ohki
We investigated the feasibility of patient dose reduction based on six noise suppression filters for cone-beam computed tomography (CBCT) in an image-guided patient positioning (IGPP) system. A midpoint dose was employed as a patient dose index. First, a reference dose (RD) and low-dose (LD)-CBCT images were acquired with a reference dose and various low doses. Second, an automated rigid registration was performed for three axis translations to estimate patient setup errors between a planning CT image and the LD-CBCT images processed by six noise suppression filters (averaging filter, median filter, Gaussian filter, edge-preserving smoothing filter, bilateral filter, and adaptive partial median filter (AMF))...
May 7, 2016: Physics in Medicine and Biology
Jon E Grant, Samuel R Chamberlain, Sarah A Redden, Eric W Leppink, Brian L Odlaug, Suck Won Kim
IMPORTANCE: Excoriation (skin-picking) disorder (SPD) is a disabling, underrecognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. To date, there has been no clearly effective pharmacologic or psychological treatment for SPD. OBJECTIVE: To determine whether N-acetylcysteine, an amino acid that appears to restore extracellular glutamate concentration in the nucleus accumbens, will be more effective than placebo in reducing compulsive picking behavior...
May 1, 2016: JAMA Psychiatry
Paul Rostykus, Jamie Kennel, Kristian Adair, Micah Fillinger, Ryan Palmberg, Amy Quinn, Jonathan Ripley, Mohamud Daya
BACKGROUND: In many industries, limiting variability in process has been associated with a reduction in errors. Hypoglycemia is a common prehospital diabetic emergency for which most EMS systems have a treatment protocol. OBJECTIVE: To examine the treatment variability for prehospital hypoglycemia within EMS protocols in the U.S. METHODS: EMS protocols were reviewed in a structured fashion from 2 sources: the website and through manual identification from the 50 largest populated cities in the U...
July 2016: Prehospital Emergency Care
A Saha, I Mallick, P Das, R K Shrimali, R Achari, S Chatterjee
AIMS: Clinical implementation of image-guided intensity-modulated radiotherapy is rapidly evolving. Helical tomotherapy treatment delivery involves daily imaging before intensity-modulated radiotherapy delivery. This can be a time consuming resource-intensive process, which may not be essential in head and neck radiotherapy, where effective immobilisation is possible. This study aimed to evaluate whether an offline protocol implementing the shifts derived from the first few fractions can be an acceptable alternative to daily imaging for helical tomotherapy...
March 2016: Clinical Oncology: a Journal of the Royal College of Radiologists
Janid P Blanco Kiely, Benjamin M White, Daniel A Low, Sharon X Qi
Our goal was to geometrically validate the use of mega-voltage orthogonal scout images (MV topograms) as a fast and low-dose alternative to mega-voltage computed tomography (MVCT) for daily patient localization on the TomoTherapy system. To achieve this, anthropomorphic head and pelvis phantoms were imaged on a 16-slice kilo-voltage computed tomography (kVCT) scanner to synthesize kilo-voltage digitally reconstructed topograms (kV-DRT) in the Tomotherapy detector geometry. MV topograms were generated for couch speeds of 1-4 cm s(-1) in 1 cm s(-1) increments with static gantry angles in the anterior-posterior and left-lateral directions...
January 21, 2016: Physics in Medicine and Biology
Daan Martens, Mark Luesink, Henk Huizenga, Kasper L Pasma
Cone-beam CTs (CBCTs) installed on a linear accelerator can be used to provide fast and accurate automatic six degrees of freedom (6DoF) vector displacement information of the patient position just prior to radiotherapy. These displacement corrections can be made with 6DoF couches, which are primarily used for patient setup correction during stereotactic treatments. When position corrections are performed daily prior to treatment, the correction is deemed "online". However, the interface between the first generation 6DoF couches and the imaging software is suboptimal...
2015: Journal of Applied Clinical Medical Physics
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