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1.
J Pediatr ; 222: 264, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32362408
2.
Account Res ; : 1-20, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32223327

RESUMO

In the United States, through nation-wide discussions, the procedures for handling allegations of research misconduct are now well established. Procedures are geared toward carefully treating both complainants and respondents fairly in accordance with the US framework. Other countries, which have their own cultural and legal framework, also need fair and legally compatible procedures for conducting investigations of allegations of research misconduct. Given the rapid growth of international collaboration in research, it is desirable to have a global standard, or common ground, for misconduct investigations. Institutions need clear guidance on important subjects such as what information should be included in the investigation reports, how the investigation committee should be organized once research misconduct allegation has been received, how to conduct the investigation, how the data and information obtained should be taken as evidence for vs. against misconduct, and what policies the investigation committee should follow. We explore these issues from the viewpoint of members of committees investigating accusations of research misconduct (hereafter referred to as "investigation committees") as well as persons overseeing the committees in Japan. We hope to engender productive discussions among experts in misconduct investigations, leading to a formulation of international standards for such investigation.

3.
Curr Probl Pediatr Adolesc Health Care ; 50(2): 100758, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32151591

RESUMO

Three siblings with inhalational elemental mercury toxicity presented with fever, rash, and upper respiratory tract symptoms. The patients were heavily exposed to elemental mercury that was spilled in their home and then vacuumed. Initial whole blood mercury levels were elevated at >200 µg/L, 153 µg/L and 130 µg/L (Mayo Clinic Laboratories lab reference range <9 µg/L) for Cases 1, 2, and 3, respectively. All three required chelation with succimer. Clinically significant elemental mercury toxicity can resemble an infectious illness. Severe morbidity and mortality can be prevented if heavy metal poisoning is considered early, through a detailed history including an environmental exposure history. For elemental mercury spills in the home, safe and effective clean-up steps are needed. Improved public health education is needed to prevent similar household exposures.

4.
J Pediatr ; 219: 188-195.e6, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32005542

RESUMO

OBJECTIVE: To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention. STUDY DESIGN: From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children ≤5 years. Study participants answered contextually directed questions about exposure circumstances. RESULTS: Sixty-two percent of eligible callers participated. Among 4496 participants, 71.6% of SDM exposures involved children aged ≤2 years; 33.8% involved only prescription medications, 32.8% involved only over-the-counter (OTC) products that require child-resistant packaging, and 29.9% involved ≥1 OTC product that does not require child-resistant packaging. More than one-half of exposures (51.5%) involving prescription medications involved children accessing medications that had previously been removed from original packaging, compared with 20.8% of exposures involving OTC products (aOR, 3.39; 95% CI, 2.87-4.00). Attention deficit hyperactivity disorder medications (49.3%) and opioids (42.6%) were often not in any container when accessed; anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic agents (30.8%) were often transferred to alternate containers. Grandparents' medications were involved in 30.7% of prescription medication exposures, but only 7.8% of OTC product exposures (aOR, 3.99; 95% CI, 3.26-4.87). CONCLUSIONS: Efforts to reduce pediatric SDM exposures should also address exposures in which adults, rather than children, remove medications from child-resistant packaging. Packaging/storage innovations designed to encourage adults to keep products within child-resistant packaging and specific educational messages could be targeted based on common exposure circumstances, medication classes, and medication intended recipients.

5.
Clin Toxicol (Phila) ; : 1-8, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856616

RESUMO

Introduction: Previous studies using administrative data have demonstrated that the United States opioid epidemic is harming both adults and children, and is straining health care systems. Our objective is to describe the outcomes and trends in resource use among children with acute opioid ingestions using patient-level case report data.Materials and Methods: This study was a retrospective analysis of prospectively collected data from the 55 poison control centers in the United States which comprise the National Poison Data System (NPDS). Children under 19 years of age with a primary opioid ingestion between 1 January 2005 and 31 December 2018 were included in the analysis. Trends over three eras (2005-2009, 2010-2014, 2015-2018) were assessed using a Cochran-Armitage Trend Test. Yearly trends in the proportion of cases were calculated using generalized linear models. Multi-variable logistic regression analysis was used to calculate the adjusted odds of variables associated with having at least one Pediatric Intensive Care Unit (PICU) level intervention.Results: Children were involved in 207,543 (27.54%) of a total of 1,002,947 primary exposure-related opioid poisoning cases reported to US poison centers. The percentage of patients admitted to a critical care unit from these exposures increased in each era (6.6%, 8.5%, 9.6%). Suicidal intent increased in each era (14.0%, 15.3%, 21.2%), and was associated with increased adjusted odds of receiving a PICU procedure (OR 9.68, CI 7.97-11.76). Fentanyl (OR 12, CI 9.2-15.7), heroin (OR 11.1, CI 9.4-13.1), and methadone (OR 15, CI 13-17.3) were the opioids most associated with having a PICU procedure.Discussion and Conclusions: The severity of admissions for acute opioid ingestions, especially following attempted suicide, has increased over the studied time frame. Efforts focused on reducing access, especially to synthetic and illicit opioids, and addressing adolescent suicidality are needed to reduce these serious consequences of the opioid epidemic on children in the United States.

6.
Clin Toxicol (Phila) ; 57(12): 1137-1141, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30900467

RESUMO

Aim: To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care unit (PICU) admissions.Methods: Calls received by the Georgia Poison Center about children for acute ingestions between May 25, 2017 and May 17, 2018 were scored in real time using the full, age-stratified, and simplified clinical scoring tool to reduce childhood admissions to PICUs for poisoning (RECAP2). Clinically significant ingestions with a poison center recommendation of PICU admission are defined in the simple RECAP2 model as ingestion of clonidine, ethanol, an oral anti-hyperglycemic agent, or exposure to carbon monoxide, as well as the presence of symptoms occurring within 2 h for an immediate release, or 4 h for an extended release, medication exposure. Model statistics and percent reduction in PICU admissions were computed.Results: There were 886 children admitted after ingestions, of which 454 (51.2%) children were admitted to intensive care. At the time of the initial poison center call to report the ingestion, 44 cases (5%) were incomplete using the full, age-stratified model compared to the complete scoring using the simple scoring model. Seventy-two children (8.1%) required monitoring or interventions performed only in a PICU. Real-time application of the full model compared with the simple model would have reduced PICU admissions by 33.3 and 31.7%, respectively.Conclusions: The simple RECAP2 clinical scoring model is a sensitive prediction tool to identify children at very low risk for clinically significant ingestions for whom PICU admission can be avoided. Clinical implementation of the simple RECAP2 model and recommendation for admission to an inpatient unit versus PICU should be further evaluated, to reduce unnecessary PICU admissions following acute ingestions.

7.
Clin Toxicol (Phila) ; 57(1): 56-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29929405

RESUMO

CONTEXT: Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50-500 mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age. METHODS: Cases with acute trazodone ingestions in children ≤6 years of age between 2000 and 2015 were retrospectively reviewed. Data were analyzed for dose (mg/kg), clinical effects, management site, treatment, and outcome. Cases with coingestions, unknown outcome, or unknown dose were excluded. RESULTS: A total of 84 patients (mean age 26.7 months, 35 females, 49 males) were included. Of those, 52 (61.9%) had no clinical effects; 29 (34.5%) had minor effects (vomiting, dizziness, headache); and three (3.6%) had moderate effects (ataxia, slurred speech, priapism). No major effects or deaths were observed. Moderate effects were manifested at doses ≥6.9 mg/kg. Priapism occurred in a 2-year-old child at a dose of 6.9 mg/kg. Sixteen (19%) patients were managed at home and 68 (81%) patients were referred to a HCF. Among those referred to a HCF, three (4.4%) patients had moderate effects with ingested dose ≥6.9 mg/kg. However, 27 (39.7%) patients of those referred to a HCF had an ingested dose <6 mg/kg and none of them manifested symptoms beyond minor effects. All referred patients had uneventful recovery and no sequela. CONCLUSIONS: Children should be referred for further evaluation in acute unintentional trazodone ingestions with doses ≥6 mg/kg.


Assuntos
Overdose de Drogas/etiologia , Centros de Controle de Intoxicações , Trazodona/envenenamento , Triagem , Pré-Escolar , Relação Dose-Resposta a Droga , Overdose de Drogas/epidemiologia , Feminino , Georgia , Humanos , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Trazodona/administração & dosagem
8.
J Spec Oper Med ; 18(4): 24-26, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566719

RESUMO

Smoke grenades are used during drills, police and military exercises, and crowd control. We report on a 25-year-old man who was exposed to a Superior 3C smoke bomb. He was initially stable but developed respiratory distress after 3 days and ultimately developed pulmonary fibrosis with marked loss in pulmonary function. The Superior 3C smoke bomb is similar in composition to the British Military's L83A1/2 and L132A1 and the US M18 smoke grenades, all commonly used as multipurpose smoke-producing devices for combat and training. They are primarily composed of zinc oxide and hexachlorethane, the combustion of which produces zinc chloride. These devices are safe when used properly in open air but can cause significant morbidity in an enclosed space. This case emphasizes the potential hazards of using smoke bombs even in semienclosed spaces and the potential delay in the development of significant pulmonary complications.


Assuntos
Bombas (Dispositivos Explosivos) , Pneumonia/diagnóstico , Insuficiência Respiratória/diagnóstico , Lesão por Inalação de Fumaça/complicações , Adulto , Humanos , Masculino , Pneumonia/etiologia , Insuficiência Respiratória/etiologia
9.
Pediatr Crit Care Med ; 19(2): e120-e129, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29227437

RESUMO

OBJECTIVE: To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary. DESIGN: Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016. SETTING: United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016. PATIENTS: Children 18 years and younger admitted to a United States PICU following an acute intoxication. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary study outcome was the occurrence of clinically significant intoxications defined a priori as organ system-based clinical effects that require intensive care monitoring and interventions. We analyzed 70,364 cases. Derivation (n = 42,240; 60%) and validation cohorts (n = 28,124; 40%) were randomly selected from the eligible population and had similar distributions of clinical effects and PICU interventions. PICU interventions were performed in 1,835 children (14.1%) younger than 6 years, in 374 children (15.4%) 6-12 years, and in 4,446 children (16.5%) 13 years and older. We developed highly predictive models with an area under the receiver operating characteristic curve of 0.834 (< 6 yr), 0.771 (6-12 yr), and 0.786 (≥13 yr), respectively. For predicted probabilities of less than or equal to 0.10 in the validation cohorts, the negative predictive values were 95.4% (< 6 yr), 94.9% (6-12 yr), and 95.1% (≥ 13 yr). An additional 700 patients from the Georgia Poison Center were used to validate the model and would have reduced PICU admission by 31.4% (n = 110). CONCLUSIONS: These validated models identified children at very low risk of clinically significant intoxications for whom pediatric intensive care admission can be avoided. Application of this model using Georgia Poison Center data could have resulted in a 30% reduction in PICU admissions following intoxication.


Assuntos
Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Envenenamento/diagnóstico , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Técnicas de Apoio para a Decisão , Feminino , Georgia/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/epidemiologia , Envenenamento/mortalidade , Curva ROC , Estudos Retrospectivos
10.
Sci Adv ; 3(11): e1602700, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29209659

RESUMO

D″ (Dee double prime), the lowermost layer of the Earth's mantle, is the thermal boundary layer (TBL) of mantle convection immediately above the Earth's liquid outer core. As the origin of upwelling of hot material and the destination of paleoslabs (downwelling cold slab remnants), D″ plays a major role in the Earth's evolution. D″ beneath Central America and the Caribbean is of particular geodynamical interest, because the paleo- and present Pacific plates have been subducting beneath the western margin of Pangaea since ~250 million years ago, which implies that paleoslabs could have reached the lowermost mantle. We conduct waveform inversion using a data set of ~7700 transverse component records to infer the detailed three-dimensional S-velocity structure in the lowermost 400 km of the mantle in the study region so that we can investigate how cold paleoslabs interact with the hot TBL above the core-mantle boundary (CMB). We can obtain high-resolution images because the lowermost mantle here is densely sampled by seismic waves due to the full deployment of the USArray broadband seismic stations during 2004-2015. We find two distinct strong high-velocity anomalies, which we interpret as paleoslabs, just above the CMB beneath Central America and Venezuela, respectively, surrounded by low-velocity regions. Strong low-velocity anomalies concentrated in the lowermost 100 km of the mantle suggest the existence of chemically distinct denser material connected to low-velocity anomalies in the lower mantle inferred by previous studies, suggesting that plate tectonics on the Earth's surface might control the modality of convection in the lower mantle.

11.
Pediatr Crit Care Med ; 18(7): e281-e289, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28481828

RESUMO

OBJECTIVES: Acute intoxications in children account for 4.6% of annual admissions to the PICU. We aimed to describe the interventions and monitoring required for children admitted to the PICU following intoxications with the ultimate goal of determining patient and intoxication characteristics associated with the need for PICU interventions. DESIGN: Retrospective review of prospectively collected data from Virtual Pediatric Systems, LLC. SETTING: United States PICUs participating in the Virtual Pediatric Systems database from 2011 to 2014. PATIENTS: Less than or equal to 18 years old admitted to a PICU with a diagnostic code for poisoning, ingestion, intoxication, or overdose. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In total, 12,021 patients were included with a median PICU length of stay of 0.97 days (interquartile range, 0.67-1.60). Seventy-eight percent of the intoxications were intentional. The top five classes of medications ingested were unknown substances (21.6%), antidepressants (11.5%), other chemicals (10.7%), analgesics (7.3%), and antihypertensives (6.2%). Seventy-six (0.61%) patients died. Any of the interventions reported in the Virtual Pediatric Systems database were performed in only 29.1% of the total cases. CONCLUSIONS: The majority of cases (70.9%) admitted to the PICU following an intoxication did not undergo any significant intervention. Future studies should focus on distinguishing patient and intoxication characteristics associated with need for PICU intervention to optimize patient safety and minimize resource burden.


Assuntos
Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Overdose de Drogas/terapia , Unidades de Terapia Intensiva Pediátrica , Envenenamento/terapia , Adolescente , Criança , Pré-Escolar , Overdose de Drogas/diagnóstico , Overdose de Drogas/epidemiologia , Overdose de Drogas/etiologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Determinação de Necessidades de Cuidados de Saúde , Razão de Chances , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Envenenamento/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
12.
Nature ; 545(7654): 289, 2017 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-28516930
13.
Am J Emerg Med ; 35(5): 802.e7-802.e8, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27884585

RESUMO

According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived. This is the first published case report of survival after 5-FU overdose who also was immunocompromised from HIV/AIDs. A 52year old male with history of HIV/AIDS (CD4 70), CNS toxoplasmosis and anal cancer presented to the emergency department after realizing he had received an entire course of 5-FU in 24 instead of 96h. Treatment with uridine triacetate was arranged in the emergency department. After receiving treatment the patient was asymptomatic and had an uncomplicated hospital course. 5-FU poisoning must be recognized early as uridine triacetate is approved by the FDA for use within 96h following the end of 5-FU administration. Emergency medicine physicians should promptly recognize and treat 5-FU poisoning. However, this may be challenging as patients may not seek medical attention until many hours or several days after last administration since symptoms are often delayed with 5-FU poisoning.


Assuntos
Acetatos/uso terapêutico , Antimetabólitos Antineoplásicos/envenenamento , Neoplasias do Ânus/tratamento farmacológico , Depressão/tratamento farmacológico , Medicina de Emergência , Fluoruracila/envenenamento , Infecções por HIV/tratamento farmacológico , Toxoplasmose Cerebral/tratamento farmacológico , Uridina/análogos & derivados , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/farmacocinética , Overdose de Drogas , Fluoruracila/administração & dosagem , Fluoruracila/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uridina/uso terapêutico
14.
J Anal Toxicol ; 40(9): 744-748, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27624696

RESUMO

CONTEXT: Screening for lead poisoning is necessary in young children, but obtaining the needed blood sample is unpleasant and sometimes very difficult. Use of an alternative screening method that is less unpleasant and less difficult would likely help to increase the percent of children receiving screening. OBJECTIVES: To evaluate the correlation of oral fluid and blood lead in a clinical setting, and to ascertain the acceptability and feasibility of obtaining oral fluid from a young child in the clinical setting. METHODS: Oral fluid samples were collected from a convenience sample of 431 children aged 6 months to 5 years already due to receive a blood lead test in a primary care clinic. Blood lead results obtained at the same time were available for 407 children. The results of the two tests were compared with the blood lead test considered to be the "gold standard". Data analysis used Pearson correlations, scatter plots, linear regression, ANOVA and Bland-Altman analysis. RESULTS: 431 patients had oral fluid samples available for analysis, and 407 patients had blood samples available. Patients who had both blood concentrations <5 µg/dL and oral fluid values below the screening cutoff value were 223, while eight had both blood concentrations ≥ 5 µg/dL and oral fluid values above the screening threshold. Elevated oral fluid but blood lead values less than the value recommended for further intervention occurred in 176; no patients had elevated blood lead values with below-intervention oral fluid values. The negative predictive value of an oral fluid lead below the screening cutoff value was 100%. CONCLUSIONS: The use of oral fluid to screen for elevated body burdens of lead instead of the usual blood lead sample is feasible with a negative predictive value of 100%, while eliminating the need for blood for lead screening in more than half of these children.


Assuntos
Intoxicação por Chumbo/sangue , Chumbo/análise , Chumbo/sangue , Saliva/química , Líquidos Corporais/química , Calibragem , Pré-Escolar , Interpretação Estatística de Dados , Humanos , Lactente , Isótopos , Limite de Detecção , Modelos Lineares , Espectrometria de Massas
15.
J Neurosurg Pediatr ; 16(6): 752-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26339960

RESUMO

In environments in which opioids are increasingly abused for recreation, children are becoming more at risk for both accidental and nonaccidental intoxication. In toxic doses, opioids can cause potentially lethal acute leukoencephalopathy, which has a predilection for the cerebellum in young children. The authors present the case of a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status requiring cardiorespiratory support. She required emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle. To the authors' knowledge, this is the first report of surgical decompression used to treat cerebellar edema associated with opioid overdose in a child.


Assuntos
Analgésicos Opioides/efeitos adversos , Cerebelo/cirurgia , Transtornos da Consciência/induzido quimicamente , Descompressão Cirúrgica , Overdose de Drogas , Procedimentos Neurocirúrgicos , Analgésicos Opioides/administração & dosagem , Cerebelo/efeitos dos fármacos , Cerebelo/patologia , Derivações do Líquido Cefalorraquidiano , Pré-Escolar , Fossa Craniana Posterior/cirurgia , Edema/induzido quimicamente , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroimagem/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
J Med Toxicol ; 11(2): 242-4, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25403810

RESUMO

BACKGROUND: Carpet vipers (Echis) are found across the semiarid regions of west, north, and east Africa; west, south, and east Arabia; parts of Iran and Afghanistan north to Uzbekistan; and in Pakistan, India, and Sri Lanka. Recently, a new species belonging to the Echis genus, Echis omanensis has been recognized in Oman. Not much is known about the clinical manifestations of envenomation from its bite. CASE REPORT: A 63-year-old snake keeper presented to the emergency department shortly after being bitten by an Oman carpet viper (E. omanensis). The incident occurred during expression of the venom at a research center. The patient complained of severe pain and swelling of the left index finger, which extended to the mid-forearm within 1 h. His vital signs remained stable, with no evidence of systemic manifestations. He was treated initially with analgesics and tetanus toxoid. Due to rapidly progressive swelling and the potential for a delayed coagulopathy, the Saudi National Guard polyvalent snake antivenom was administered according to the Ministry of Health protocol. The patient was admitted to the intensive care unit, remained hemodynamically stable, and had normal serial coagulation tests, with subsequent resolution of the swelling. CONCLUSION: We report the first case of an E. omanensis bite in which the patient developed rapidly progressive local toxicity, which improved after administration of the Saudi polyvalent antivenom.


Assuntos
Mordeduras de Serpentes/terapia , Venenos de Víboras , Viperidae , Analgésicos Opioides/uso terapêutico , Animais , Antivenenos/uso terapêutico , Coagulação Sanguínea , Cuidados Críticos , Edema/induzido quimicamente , Dedos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Mordeduras de Serpentes/sangue , Toxoide Tetânico/uso terapêutico , Resultado do Tratamento
17.
Emerg Med Clin North Am ; 33(1): 37-49, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25455661

RESUMO

Hospital planning for chemical or radiological events is essential but all too often treated as a low priority. Although some other types of disasters like hurricanes and tornadoes may be more frequent, chemical and radiological emergencies have the potential for major disruptions to clinical care. Thorough planning can mitigate the impact of a chemical or radiological event. Planning needs to include all 4 phases of an event: mitigation (preplanning), preparation, response, and recovery. Mitigation activities should include the performance of a hazards vulnerability analysis and identification of local subject-matter experts and team leaders.


Assuntos
Planejamento em Desastres , Serviço Hospitalar de Emergência/organização & administração , Exposição Ambiental/efeitos adversos , Substâncias Perigosas/envenenamento , Lesões por Radiação , Humanos , Preparações Farmacêuticas/provisão & distribução , Medição de Risco , Gestão da Segurança
18.
J Pediatr ; 163(4): 1134-9.e1, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23896185

RESUMO

OBJECTIVE: To assess whether adding flow restrictors (FRs) to liquid medicine bottles can provide additional protection against unsupervised medication ingestions by young children, even when the child-resistant closure is not fully secured. STUDY DESIGN: In April and May 2012, we conducted a block randomized trial with a convenience sample of 110 3- and 4-year-old children from 5 local preschools. Participants attempted to remove test liquid from an uncapped bottle with an FR and a control bottle without an FR (with either no cap or an incompletely closed cap). RESULTS: All but 1 (96%; 25 of 26) of the open control bottles and 82% (68 of 83) of the incompletely closed control bottles were emptied within 2 minutes. Only 6% (7 of 110) of the bottles with FRs were emptied during the 10-minute testing period, none before 6 minutes. Overall, children removed less liquid from the bottles with FRs than from the open or incompletely closed control bottles without FRs (both P < .001). All children assigned open control bottles and 90% of those assigned incompletely closed control bottles removed ≥ 25 mL of liquid. In contrast, 11% of children removed ≥ 25 mL of liquid from uncapped bottles with FRs. Older children (aged 54-59 months) were more successful than younger children at removing ≥ 25 mL of liquid (P = .002) from bottles with FRs. CONCLUSION: Our findings suggest that adding FRs to liquid medicine bottles limits the accessibility of their contents to young children and could complement the safety provided by current child-resistant packaging.


Assuntos
Embalagem de Medicamentos , Segurança do Paciente , Preparações Farmacêuticas/administração & dosagem , Envenenamento/prevenção & controle , Criança , Pré-Escolar , Qualidade de Produtos para o Consumidor , Desenho de Equipamento , Feminino , Humanos , Masculino
20.
West J Emerg Med ; 12(3): 296-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21731785

RESUMO

BACKGROUND: The media can have a profound impact on human behavior. A sensational murder by ethylene glycol (EG) poisoning occurred in our state. The regional media provided extensive coverage of the murder. We undertook this investigation to evaluate our incidence of EG poisoning during the timeframe of before the first report linking a death to ethylene glycol to shortly after the first murder trial. METHODS: Descriptive statistics and linear regression were used to describe and analyze the number of EG cases over time. A search of the leading regional newspaper's archives established the media coverage timeline. RESULT: Between 2000 and 2004, our poison center (PC) handled a steady volume of unintentional exposures to EG [range: 105-123 per year, standard deviation (SD)=7.22]. EG exposures thought to be suicidal in intent increased from 12 cases in 2000 to 121 cases in 2004. In the 19 months prior to the first media report of this story, our PC handled a mean of 1 EG case with suicidal intent per month [range: 0-2, SD=.69]. In the month after the first media report, our PC handled 5 EG cases with suicidal intent. When media coverage was most intense (2004), our PC received a mean of 10 EG suicidal-intent calls per month [range: 5-17, SD=3.55]. Although uncommon, reports of malicious EG poisonings also increased during this same period from 2 in 2000 to 14 in 2004. CONCLUSION: Media coverage of stories involving poisonings may result in copycat events, applicable to both self-poisonings and concern for malicious poisonings. Poison centers should be aware of this phenomenon, pay attention to local media and plan accordingly if a poisoning event receives significant media coverage. The media should be more sensitive to the content of their coverage and avoid providing "how to" poisoning information.

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