Involving stakeholders in radiological protection decision making: recovery history and lessons from the people of Fukushima.

Between September 2011 and August 2015, the International Commission on Radiological Protection (ICRP) organised a series of 12 stakeholder dialogue workshops with residents of Fukushima Prefecture. Discussions focused on recovery, addressing topics such as protection of children, management of contaminated food, monitoring, and self-help measures. The OECD Nuclear Energy Agency (NEA) supported, and the Committee on Radiation Protection and Public Health (CRPPH) Secretariat attended, all 12 meetings to listen directly to the concerns of affected individuals and draw lessons for CRPPH. To summarise the dialogue results, ICRP organised a final meeting in Date, Japan with the support of NEA and other organisations. The lessons from and utility of the dialogue meetings were praised by dialogue participants and sponsors, and ICRP agreed that some form of dialogue would continue, although with ICRP participation and support rather than leadership. This paper summarises the internationally relevant lessons learned by CRPPH from this important process.

Scheduled acetaminophen with as-needed opioids compared to as-needed acetaminophen plus opioids for post-cesarean pain management.

BACKGROUND: Combination opioid-acetaminophen drugs are commonly used for pain management after cesarean delivery. The aim of this study was to determine if scheduled acetaminophen decreases opioid use compared to as-needed combination acetaminophen-opioid administration. METHODS: We performed a retrospective chart review of women who underwent cesarean delivery before and after a clinical practice change. All patients received spinal anesthesia containing intrathecal morphine 200µg and scheduled non-steroidal anti-inflammatory drugs for 48h postoperatively. The first group (As-Needed Group, n=120) received combination oral opioid-acetaminophen analgesics as needed for breakthrough pain. The second group (Scheduled Group, n=120) received oral acetaminophen 650mg every 6h for 48h postoperatively with oral oxycodone administered as needed for breakthrough pain. The primary outcome was opioid use, measured in intravenous morphine mg equivalents, in the first 48h postoperatively. RESULTS: The Scheduled Group used 9.1±2.1mg (95% CI 5.0-13.2) fewer intravenous morphine equivalents than the As-Needed Group (P <0.0001) over the study period. Fewer patients in the Scheduled Group exceeded acetaminophen 3g daily compared to the As-Needed Group (P=0.008). Pain scores were similar between study groups. CONCLUSIONS: After cesarean delivery, scheduled acetaminophen results in decreased opioid use and more consistent acetaminophen intake compared to acetaminophen administered as needed via combination acetaminophen-opioid analgesics, without compromising analgesia.

Non-cancer effects: science and values aspects of protection decisions.

The Nuclear Energy Agency organised its third workshop on 'Science and values in radiological protection' in November 2012 in Tokyo. One of the issues addressed, non-cancer effects, had also been addressed in the first two science and values workshops (Helsinki, Finland, 2008; Vaux-de-Cernay, France, 2009), but presented several new elements of relevance to International Commission on Radiological Protection discussions of the evolution of the system of radiological protection. Radiological protection science, both epidemiological and biological, now suggests that stroke and heart disease may well be caused by radiation exposure at doses of the order of 0.5 Gy or less. Further, it is possible that such detriments may be caused by either chronic or acute exposures. While significant uncertainties remain, the need to consider non-cancer detriment in risk assessment and in the development of protection strategies is now a significant scientific and ethical question. This paper will present the results of the Nuclear Energy Agency science and values workshop discussion of non-cancer risks, and of the questions and possible future directions raised during the workshop.

ICRP Publication 111 - Application of the Commission's recommendations to the protection of people living in long-term contaminated areas after a nuclear accident or a radiation emergency.

In this report, the Commission provides guidance for the protection of people living in long-term contaminated areas resulting from either a nuclear accident or a radiation emergency. The report considers the effects of such events on the affected population. This includes the pathways of human exposure, the types of exposed populations, and the characteristics of exposures. Although the focus is on radiation protection considerations, the report also recognises the complexity of post-accident situations, which cannot be managed without addressing all the affected domains of daily life, i.e. environmental, health, economic, social, psychological, cultural, ethical, political, etc. The report explains how the 2007 Recommendations apply to this type of existing exposure situation, including consideration of the justification and optimisation of protection strategies, and the introduction and application of a reference level to drive the optimisation process. The report also considers practical aspects of the implementation of protection strategies, both by authorities and the affected population. It emphasises the effectiveness of directly involving the affected population and local professionals in the management of the situation, and the responsibility of authorities at both national and local levels to create the conditions and provide the means favouring the involvement and empowerment of the population. The role of radiation monitoring, health surveillance, and the management of contaminated foodstuffs and other commodities is described in this perspective. The Annex summarises past experience of longterm contaminated areas resulting from radiation emergencies and nuclear accidents, including radiological criteria followed in carrying out remediation measures.