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Cancer Nursing 2014The central nervous system is a unique sanctuary site for malignant disease. To ensure optimal disease control, intrathecal (IT) chemotherapy is commonly given in... (Review)
Review
BACKGROUND
The central nervous system is a unique sanctuary site for malignant disease. To ensure optimal disease control, intrathecal (IT) chemotherapy is commonly given in conjunction with standard chemotherapy protocols, thus providing the opportunity for medication errors.
OBJECTIVE
A systematic review of the current literature on medication errors associated with the administration of IT chemotherapy was conducted.
METHODS
English-language literature published from January 1960 through June 2013 was accessed. Case reports, clinical studies, and review articles pertaining to IT medication errors were included in the review. References of all relevant articles were searched for additional citations.
RESULTS
Twenty-two cases of accidental IT overdoses have been reported with methotrexate and 1 with cytarabine. There have been numerous cases of antineoplastic agents intended for administration by the parenteral route being inadvertently given intrathecally. Vincristine has been implicated 31 times (25 deaths), as well as vindesine, asparaginase, bortezomib, daunorubicin, and dactinomycin. This has led to profound toxicity and, commonly, death. Unfortunately, many cases go unrecognized or unreported.
CONCLUSIONS
The best method for eliminating the risk of IT medication errors is to develop effective methods of prevention and incorporate them into oncology and hematology practice internationally. Strategies include abolishing the syringe as a method of vinca alkaloid administration and substituting small-volume intravenous bags, and developing novel methods for intraspinal drug administration.
IMPLICATIONS FOR PRACTICE
The nursing profession is in a unique position to influence change and lead the way in establishing preventative strategies into current practice.
Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Cytarabine; Evidence-Based Medicine; Humans; Injections, Spinal; Medication Errors; Methotrexate; Vincristine
PubMed: 24201315
DOI: 10.1097/NCC.0000000000000108 -
Environmental Pollution (Barking, Essex... May 2017Large and growing literature has explored whether temperature modified the effect of particular matter (PM) on mortality, but results of the modification effect are... (Meta-Analysis)
Meta-Analysis Review
Large and growing literature has explored whether temperature modified the effect of particular matter (PM) on mortality, but results of the modification effect are inconsistent. In this study, we reviewed information from 29 studies to get the qualitative evidence of the modification effects of temperature on PM to mortality, and the data from 16 of the 29 studies were extracted to conduct a meta-analysis. Temperatures were grouped into three level: "low", "middle" and "high" according to the original studies. The random effect model was used in the meta-analysis with the relative risk (RR) as the measure indicator. The RRs (95% confidence intervals, CIs) for non-accidental death, cardiovascular death and respiratory death per 10 μg/m increase in PM were 1.004 (1.003, 1.006), 1.005 (1.003,1.007), and 1.005 (1.000,1.010) in the low temperature level, 1.005 (1.004,1.006), 1.005 (1.004,1.007), and 1.008 (1.006, 1.010) in the middle temperature level, and 1.012 (1.010, 1.015), 1.016 (1.010, 1.022) and 1.019 (1.010,1.028) in the high temperature level, respectively. In conclusion, moderate evidence exists that temperature modifies the effect of PM on mortality. The effect of PM on respiratory death was the greatest, while the effect on non-accidental death was the smallest in the same temperature level. In addition, the effects of PM on all the three kinds of mortality were the biggest in the high-temperature level, and the smallest in the low-temperature level.
Topics: Air Pollutants; Cardiovascular Diseases; Humans; Models, Theoretical; Particulate Matter; Respiration Disorders; Temperature
PubMed: 28215581
DOI: 10.1016/j.envpol.2017.02.012 -
Journal of Pain Research 2021Mortalities due to fentanyl derivatives are on the rise with novel fentanyl analogues and still emerging on the global illicit drug market. They are highly potent and... (Review)
Review
OBJECTIVE
Mortalities due to fentanyl derivatives are on the rise with novel fentanyl analogues and still emerging on the global illicit drug market. They are highly potent and very fatal in low doses, yet there has been a lack of systematic research surrounding this subject. This review aims to assess the causes, nature, and toxicology of fatalities associated with fentanyl analogues.
METHODS
Five databases: Scopus, Embase, Medline, PubMed and Google Scholar were searched from inception to October 2020 to identify case studies and case series reporting fentanyl analogue-related fatalities. Two independent reviewers screened and selected the articles followed by the data extraction from each article, which included demography, route of administration, causes and nature of death, and the fentanyl analogue implicated. All articles were then subject to quality assessment tools developed by the Joanna Briggs Institute (JBI). A narrative synthesis was undertaken.
RESULTS
The initial data search yielded 834 articles, only 14 of which met the inclusion criteria - this included nine case reports and five case series. Of the 1079 fentanyl-analogue related deaths reported, the majority of them occurred in the US (n=1044, 96.8%). The majority of fatalities were male (n=766, 71%), white (n=884, 87%) and in the age ranges 25-34 and 35-44 years (30.5% and 29.6%, respectively). The most common route of administration was intravenous (n=319, 66%) and the manner of death was almost exclusively accidental (99.7%). The predominant cause of death was fentanyl-analogue toxicity (n=292, 85.4%) and involved mixed drug toxicity (n=47, 13.7%). The mean post-mortem fentanyl analogue concentration was 31.6 ng/mL.
CONCLUSION
Most fatalities were reported in the US involving young white males. Overdose through intravenous administration and by mixed drug toxicities with other opioids were the major causes of death. Deaths reported in peer-reviewed literature were relatively less than those reported by real-world data.
PubMed: 34466028
DOI: 10.2147/JPR.S312227 -
Preventive Medicine Dec 2014Efforts to promote environmental designs that facilitate opportunities for physical activity should consider the fact that injuries are the leading cause of death for... (Review)
Review
OBJECTIVE
Efforts to promote environmental designs that facilitate opportunities for physical activity should consider the fact that injuries are the leading cause of death for Americans ages 1 to 44, with transportation-related injuries the most common cause. Drawing on the latest research and best practices in the field of injury prevention, the purpose of this article is to provide those working to promote physical activity with evidence-based recommendations on building in safety while designing active environments.
METHOD
A systematic review of the peer-reviewed and grey literature published from 1995 to 2012 was conducted to identify injury prevention strategies applicable to objectives in the Active Design Guidelines (ADG), which present design strategies for active living. Injury prevention strategies were rated according to the strength of the research evidence.
RESULTS
We identified 18 urban design strategies and 9 building design strategies that promote safety. Evidence was strong or emerging for 14/18 urban design strategies and 7/9 building design strategies.
CONCLUSION
ADG strategies are often wholly compatible with well-accepted injury prevention principles. By partnering with architects and planners, injury prevention and public health professionals can help ensure that new and renovated spaces maximize both active living and safety.
Topics: Accidents, Traffic; Cooperative Behavior; Environment Design; Evidence-Based Practice; Humans; Interinstitutional Relations; Motor Activity; New York City; Residence Characteristics; Safety; Urban Population; Wounds and Injuries
PubMed: 25117526
DOI: 10.1016/j.ypmed.2014.08.010 -
BMJ Quality & Safety Jul 2016Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of... (Review)
Review
IMPORTANCE
Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.
OBJECTIVE
We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.
EVIDENCE REVIEW
We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.
FINDINGS
Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.
CONCLUSIONS AND RELEVANCE
Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.
SYSTEMATIC REVIEW REGISTRATION
This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304).
Topics: Humans; Medical Errors; Patient Safety; Primary Health Care
PubMed: 26715764
DOI: 10.1136/bmjqs-2015-004178 -
Resuscitation Jul 2016To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles.
STUDY SELECTION
Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated.
RESULTS
Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings.
CONCLUSIONS
Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.
Topics: Case-Control Studies; Cohort Studies; Drowning; Emergency Medical Services; Humans; Time Factors
PubMed: 27154004
DOI: 10.1016/j.resuscitation.2016.04.006 -
Journal of Vascular Surgery Apr 2012Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and... (Review)
Review
BACKGROUND
Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular management of proximal vertebral artery disease and perform an analysis of the published outcomes.
METHODS
A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms "vertebral artery," "angioplasty," and "stents" in all possible combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause ≤30 days of treatment were defined as the primary outcome end points.
RESULTS
One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%). Reintervention for recurrent disease during follow-up occurred in 86 patients (9%; range, 0%-35%).
CONCLUSIONS
There is limited comparative evidence on the efficacy of medical, surgical, and endovascular treatment of proximal vertebral artery disease. Percutaneous transluminal angioplasty and stenting has low periprocedural neurologic adverse events and mortality.
Topics: Angiography; Angioplasty; Case-Control Studies; Female; Follow-Up Studies; Hospital Mortality; Humans; Male; Randomized Controlled Trials as Topic; Recurrence; Risk Assessment; Safety Management; Severity of Illness Index; Stents; Survival Analysis; Treatment Outcome; United Kingdom; Vertebrobasilar Insufficiency
PubMed: 22206680
DOI: 10.1016/j.jvs.2011.09.084 -
Drug and Alcohol Dependence Sep 2014Both cocaine use and strokes impact public health. Cocaine is a putative cause of strokes, but no systematic review of the scientific evidence has been published. (Review)
Review
BACKGROUND
Both cocaine use and strokes impact public health. Cocaine is a putative cause of strokes, but no systematic review of the scientific evidence has been published.
METHODS
All relevant bibliographic-databases were searched until January 2014 for articles on the epidemiological association between cocaine use and strokes. Search strings were supervised by expert librarians. Three researchers independently reviewed studies for inclusion and data extraction following STROBE recommendations. Quality appraisal included study validity and bias. Both ischemic and hemorrhagic strokes were considered.
RESULTS
Of 996 articles, 9 were selected: 7 case-control studies (CCS) and 2 cross-sectional (CSS) studies. One CCS (aOR=6.1; 95% CI: 3.3-11.8) and one CSS (aOR=2.33; 95% CI: 1.74-3.11) showed an association between cocaine and hemorrhagic strokes. The latter study also found a positive relationship with ischemic stroke (aOR=2.03; 95% CI: 1.48-2.79). Another CCS found the exposure to be associated with stroke without distinguishing between types (aOR=13.9; 95% CI: 2.8-69.4). One forensic CCS found that deaths with cocaine-positive toxicology presented a 14.3-fold (95% CI: 5.6-37) and 4.6-fold (95% CI: 2.5-8.5) increased risk of atherosclerosis compared to opioid-related deaths and hanging-deaths respectively. One CCS did not provide an aOR but found a statistically significant association between cocaine and hemorrhagic stroke. Three CCS and one CSS did not find any relationship between cocaine and strokes. Inadequate control for confounding was not uncommon.
CONCLUSIONS
Epidemiological evidence suggests that cocaine use increases the risk of stroke. Larger, more rigorous observational studies, including cohort approaches, are needed to better quantify this risk, and should consider stroke type, hypertension variation, frequency/length of cocaine use, amphetamines co-use, and other factors.
Topics: Cocaine; Cocaine-Related Disorders; Humans; Risk; Stroke
PubMed: 25066468
DOI: 10.1016/j.drugalcdep.2014.06.041 -
World Journal of Emergency Surgery :... May 2022Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting... (Review)
Review
BACKGROUND
Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs.
METHODS
The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM).
RESULTS
Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries.
CONCLUSION
Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes. PROSPERO registration number CRD42020170245.
Topics: Accidents, Traffic; Head Protective Devices; Humans; Incidence; Off-Road Motor Vehicles; Risk Factors
PubMed: 35619139
DOI: 10.1186/s13017-022-00430-2 -
American Journal of Preventive Medicine Aug 2022The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use.
METHODS
Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models.
RESULTS
In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27.
DISCUSSION
Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.
Topics: Accidents, Traffic; Alcohol Drinking; Blood Alcohol Content; Cause of Death; Child; Ethanol; Firearms; Humans; Wounds and Injuries; Wounds, Gunshot
PubMed: 35581102
DOI: 10.1016/j.amepre.2022.03.025