Safety considerations for dietary supplement manufacturers in the United States.

Due to significant dietary supplement use in the US, product manufacturers must understand the importance of implementing a robust approach to establishing safety for all ingredients, including dietary ingredients, components, and finished dietary supplement products. Different regulatory pathways exist by which the safety of dietary ingredients can be established, and thus allowed to be marketed in a dietary supplement. For individual dietary ingredients, safety information may come from a variety of sources including history of safe use, presence of the ingredient in foods, and/or non-clinical and clinical data. On occasion safety data gaps are identified for a specific ingredient, particularly those of botanical origin. Modern toxicological methods and models can prove helpful in satisfying data gaps and are presented in this review. For finished dietary supplement products, issues potentially impacting safety to consider include claims, product labeling, overages, contaminants, residual solvents, heavy metals, packaging, and product stability. In addition, a safety assessment does not end once a product is marketed. It is important that manufacturers actively monitor and record the occurrence of adverse events reported in association with the use of their products, in accordance with the law. Herein, we provide a comprehensive overview of considerations for assessing dietary supplement safety.

Factors influencing evidence-based nursing utilization intention in Korean practice nurses.

The purpose of this study was to describe Korean nurses' perceptions, attitudes and utilization intention for evidence-based nursing (EBN), and to explore what factors influence utilization intention. We conducted a cross-sectional survey in 2012. Registered nurses directly involved in clinical practice were recruited at a medical centre in Korea. A total of 420 nurses completed a self-report questionnaire. Results showed that participants reported moderate scores regarding their perceptions and attitudes towards EBN, and rated themselves as higher than the median for utilization intention. Furthermore, this study revealed that perceptions of and attitudes towards EBN, occupational view and previous EBN education were significant factors affecting utilization intention. Nurse educators and managers should encourage nurses to have better attitudes towards EBN, help them be more satisfied with their work and provide them with appropriate education for EBN to establish evidence-based practice as a part of daily nursing care.

Parotid stone removal.

Salivary stones, or sialolithiasis, are calcifications found in the salivary ducts, less commonly in the parotid ducts and more frequently in the submandibular system. Parotid stones cause obstructions that result in parotid swellings, a decrease in salivary flow and secondary infection. The limited options for treatment of a parotid stone are varied, but include its surgical removal via dissection into the duct. The authors present a case of parotid sialolithiasis that was treated with surgical removal of the stone via an intraoral surgical approach.

Diagnosing bulimia nervosa with parotid swelling. Case report.

Patients with bulimia nervosa (BN) may show dental erosion, resulting from the effect of acid regurgitation. Asymptomatic bilateral parotid swellings may also be present. Other signs include serum electrolyte imbalance and Russell's sign. The authors describe the case of a 26-year-old woman with BN, whose only clinical manifestation of BN was her bilateral parotid swellings. Because patients with BN tend to be secretive about their purging, it is important that the clinician consider BN as part of a differential diagnosis when faced with such painless parotid gland swellings.