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- [Show abstract] [Hide abstract] ABSTRACT: This study was designed to assess the importance of communication between surgeons and radiographers in the operation of image intensifiers during orthopaedic surgery. This study was designed and conducted as single-centre, observational study. Fifteen medical officers and 15 radiographers were involved in this study. Each of the 15 radiographers was assigned to a medical officer. The 15 pairs were then each given a task to simulate achieving 'perfect circles' on fluoroscopy for distal locking of an intramedullary nail. The time taken for the surgeon to verbally instruct the radiographer how to position the image intensifier in order to achieve 'perfect circles' was recorded. The overall time taken to perform the task, and total number of images taken was recorded before and after a terminology system to manoeuvre image intensifier was introduced to the pairs. The mean time taken for the pairs to achieve perfect circles after the introduction of the manoeuvre terminology showed statistically significant reduction from 212 to 97 s (t = 4.212, df = 88, P < 0.05) after the introduction of the terminology. The mean number of fluoroscopy exposures taken also showed a statistically significant reduction from 12 to 6 (t = 6.791, df = 88, P < 0.05). The implementation of a clear and unambiguous set of commands to control the image intensifier, which are common to both surgeon and radiographer, can reduce the time to acquire the desired images, and requires less radiation exposure in the process.
- [Show abstract] [Hide abstract] ABSTRACT: 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. A systematic review of the current literature on medication errors associated with the administration of IT chemotherapy was conducted. 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. 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. 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. The nursing profession is in a unique position to influence change and lead the way in establishing preventative strategies into current practice.
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