By M. Silas. University of Indianapolis.

Despite their differing perspectives and needs buy cheap caverta 100 mg on-line, the stakeholders share a common goal: patient focused care discount 50 mg caverta otc; and correct purchase caverta 100 mg free shipping, safe and appropriate use of procedures. Increased caseload increases the probability of human error in the performance of procedures and interpretation, thus lowering diagnostic accuracy. Technological advances and an ageing population increase the demand for diagnostic imaging services. Inappropriate use, self-referral and defensive medicine contribute to unnecessary exposure and waste. Reports showing an increased cancer risk from medical radiation highlight the need for action to ensure a more appropriate use of procedures [2]. Inappropriate use could be due to ineffective justification, poor optimization or human error. Poor awareness of stakeholders’ roles, responsibilities and the reasons for inappropriate use contribute to this challenge. Some fluoroscopic equipment users have not received proper training in radiation safety and protection. Inadequate user training prior to the implementation of new equipment, for example, digital radiography or digital mammography, hinders the optimization of dose, image quality and radiation protection. In many undergraduate courses, medical imaging, radiation protection and safety are poorly covered. Practitioners are too busy with clinical and administrative work; ongoing professional development and teaching methodology may not be optimal for adult education. Some referrers do not appreciate the difference in the use of medical imaging between community and tertiary settings. The challenges for guidance tools to facilitate the lowering of exposure in radiography, fluoroscopy and mammography are access to them, and the ways they are presented. The workforce shortage is global and is compounded by inequitable distribution, migration and changing practice models, e. In others, while magnetic resonance imaging is available and more appropriate, its use is limited by criteria to contain cost. The resources available to accurately monitor and record patient dose in radiography, fluoroscopy and mammography vary greatly. It is becoming challenging for some authorities to implement timely policy updates. For the end users, teleradiology threatens communication and disrupts team efforts in justification, optimization, error reduction, quality assurance, the control of repeats, the audits of doses and image quality, and the use of diagnostic reference levels, etc. For actions involving many stakeholders, there is a risk of poor coordination or fragmentation. Without good communication and collaboration, duplication and unintended complication are possibilities. Personnel and leadership changes could lead to discontinuity of long term actions. Ineffective advocacy, poor awareness and inadequate peer support are threats to volunteering. Radiation protection actions compete with other projects for funding, thus joint resource mobilization is more effective. Many system based actions have a long lead-time and it is important to persevere, stay focused and maintain motivation with these long term plans. The first is a framework of measures, strategies and process improvements for health care systems and end users [3]. The three measures are justification, optimization and error minimization, which are used along the patient journey. For the realization of any action, it is important to narrow the gaps between knowledge and practice. Each step of an action requires the contribution from different stakeholders who play unique roles. Effective advocacy improves the probability of policy adoption and use by practitioners. Under this radiation protection framework, a range of implementation strategies is used. Research includes conducting population exposure surveys and procedure exposure in facilities. The strengthening of advocacy, awareness, training, workforce capacity, physical infrastructure, policies, evaluation and ongoing improvement apply to health care systems and end users. There is synergy between these strategies and collectively they add value to each other. The common vehicles supporting these actions are evidence based recommendations and tools. Keeping these tools current; matching the contents to the setting; improving their user friendliness, format, media and search function; and securing end user support will lead to better acceptance and use. All actions are interrelated and synergy should be sought to maximize the outcome. Based on the findings of population and procedure exposure surveys, improvement actions should follow. Similarly laboratory developed quality control measures should be integrated into daily practice when appropriate. One of the issues limiting the development and implementation of these actions is the availability of human and financial resources. To maximize resources and synergy, and to minimize duplication, collaboration under an integrated framework is useful. A global platform such as this forum, the International Action Plan for the Radiological Protection of Patients [4], the International Basic Safety Standards [5], the World Health Organization’s Global Initiative on Radiation Safety in Healthcare Settings [6] and the global referral guidelines project [7] facilitate leader and stakeholder engagement across disciplines and sectors, communication, collaboration, team building, innovation, development of a safety culture and resource mobilization. Using a framework such as the one discussed, together with good teamwork, will overcome many of the emerging challenges and narrow the gaps between evidence and practice. These actions will improve patient care through doing the right procedure (justified) and doing the procedure right (optimized and without error), each time. Most principles for dose reduction in screen-film radiography, including justification, are relevant to digital systems. However, digital systems have the potential to significantly increase patient dose, possibly due to lack of awareness among imaging personnel. Examination parameters, such as tube voltage, tube current and filtration, have been adopted from screen-film technology without further adjustments. The imaging parameters must be optimized according to the best performance of a particular system. Current safety issues with clinical digital radiography are discussed; these are technology factors, such as automatic exposure factors and exposure index; and human factors, such as inappropriate exposure, no collimation and overexposure. Therefore, implementation of dose indicators and dose monitoring is mandatory for digital radiography in practice. Finally, the advantages and challenges of radiographer performed fluoroscopy will also be discussed. Most principles for dose reduction in screen-film radiography, including justification, are still relevant to digital systems. However, in digital systems, different scenarios apply for dose reduction and optimization compared with screen-film radiography [1–3].

Keene purchase 100mg caverta with visa, Chapman and Hall cheap caverta 50 mg without prescription, London purchase caverta with paypal, 1997 y Drug Education: A Social and Evaluative Study E. King, The Liffey Press, Dublin, 2003 y Drug Use Prevention – Overview of Research Dr. Murphy, Cork University Press, Cork, 1996 y Excessive Appetites, A Psychological View of Addictions J. Orford, Wiley, Chichester, 2001 y Illegal Leisure, the normalisation of adolescent recreational drug use H. Measham, Routledge, London, 2000 Websites One of the greatest strengths of the web is that it allows anyone with access to what is now fairly basic technology to put their thoughts, views, prejudices and work up there for everyone to see but, just because it is on the web, it does not automatically mean that it is true and/or accurate. If you or your students are using the web in relation to drugs education it is important to ask: y How reliable is the information? Most of the sites listed here are either run by governments or academic institutions and, whilst that fact in itself is no guarantee of their truth or accuracy, what it does mean is that the information posted on their sites should have been developed, researched and written within an academic framework with transparency and accountability. This means that the work should contain references and bibliographies, be research and evidence based and subject to peer review. Ireland’s first interactive website providing continually updated drug information and live online support for three target groups: young people, parents and professionals. It includes a Live-Helper Messaging system whereby a visitor to the site can type in an enquiry which a trained counsellor replies to, there and then, in complete confidentiality www. Drink Awareness for Youth – An Alcohol Education Resource Pack’National Youth Council of Ireland, Health Promotion Unit, Department of Health and Youth Affairs Section Department of Education, Booklet 2 Information on Alcohol p. Drink Awareness for Youth – An Alcohol Education Resource Pack’Booklet 2 Information on Alcohol p. Nuke’s Guide to the Science of Cannabis and the Sociology of Getting Stoned, Lifeline Publications, Manchester, pp. You can 8 use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. It provides recommendations on how you, the applicant, can submit analytical 4 5 20 procedures and methods validation data to support the documentation of the identity, strength, 6 21 quality, purity, and potency of drug substances and drug products. It will help you assemble 22 information and present data to support your analytical methodologies. The amount of information on analytical procedures 7 36 and methods suitability will vary with the phase of the investigation. For example, some bioassays are based on animal challenge models, and 50 immunogenicity assessments or other immunoassays have unique features that should be 51 considered during development and validation. The use of 69 the word should in Agency guidances means that something is suggested or recommended, but 70 not required. To apply an analytical method to a 92 different drug product, appropriate validation or verification studies for compendial procedures 93 with the matrix of the new product should be considered. Early in the 100 development of a new analytical procedure, the choice of analytical instrumentation and 101 methodology should be selected based on the intended purpose and scope of the analytical 102 method. You should 110 submit development data within the method validation section if they support the validation of 111 the method. You should begin with an initial risk assessment and follow with 116 multivariate experiments. Such approaches allow you to understand factorial parameter effects 117 on method performance. Evaluation of a method’s performance may include analyses of 118 samples obtained from various stages of the manufacturing process from in-process to the 119 finished product. Knowledge gained during these studies on the sources of method variation can 120 help you assess the method performance. The following is a list of essential 132 information you should include for an analytical procedure: 133 134 A. Principle/Scope 135 136 A description of the basic principles of the analytical test/technology (i. Operating Parameters 146 147 Qualified optimal settings and ranges (include allowed adjustments supported by compendial 148 sources or development and/or validation studies) critical to the analysis (e. A drawing 150 with experimental configuration and integration parameters may be used, as applicable. Reagents/Standards 153 154 The following should be listed where applicable: 155 156 • Description of reagent or standard 157 • Grade of chemical (e. A 175 single preparation for qualitative and replicate preparations for quantitative tests with appropriate 176 units of concentrations for working solutions (e. Standards Control Solution Preparation 180 181 Procedures for the preparation and use of all standard and control solutions with appropriate 182 units of concentration and information on stability of standards and storage conditions, 183 including calibration standards, internal standards, system suitability standards, etc. System Suitability 193 194 Confirmatory test(s) procedures and parameters to ensure that the system (equipment, 195 electronics, and analytical operations and controls to be analyzed) will function correctly as an 196 integrated system at the time of use. The system suitability acceptance criteria applied to 197 standards controls and samples, such as peak tailing, precision and resolution acceptance criteria, 198 may be required as applicable. Calculations 203 204 The integration method and representative calculation formulas for data analysis (standards, 205 controls, samples) for tests based on label claim and specification (e. This includes a description of any 207 mathematical transformations or formulas used in data analysis, along with a scientific 208 justification for any correction factors used. Data Reporting 211 212 A presentation of numeric data that is consistent with instrumental capabilities and acceptance 213 criteria. You should include information supporting any reference standards and 231 materials that you intend to use in the application. Information supporting reference standards 232 and materials should include qualification test reports and certificates of analysis (including 233 stability protocols, reports, and relevant known impurity profile information) as applicable. You should consider orthogonal 244 methods for reference material characterization. Additional testing could include attributes to 245 determine the suitability of the reference material not necessarily captured by the drug substance 246 or product release tests (e. For biological reference standards and materials, we 251 recommend that you follow a two-tiered approach when qualifying new reference standards to 252 prevent drift in the quality attributes. Noncompendial Analytical Procedures 260 261 Analytical method validation is the process of demonstrating that an analytical procedure is 262 suitable for its intended purpose. The methodology and objective of the analytical procedures 263 should be clearly defined and understood before initiating validation studies. This understanding 264 is obtained from scientifically-based method development and optimization studies. Validation 265 data must be generated under a protocol approved by the sponsor following current good 266 manufacturing practices with the description of methodology of each validation characteristic 14 267 and predetermined and justified acceptance criteria, using qualified instrumentation. Protocols 268 for both drug substance and product analytes or mixture of analytes in respective matrices should 269 be developed and executed. You should include details of the validation studies and results with 270 your application. To demonstrate specificity of a stability-indicating test, a combination of 292 challenges should be performed. Some challenges include the use of samples spiked with target 293 analytes and all known interferences; samples that have undergone various laboratory stress 294 conditions; and actual product samples (produced by the final manufacturing process) that are 295 either aged or have been stored under accelerated temperature and humidity conditions. Compendial Analytical Procedures 308 309 The suitability of an analytical procedure (e.