Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers.

BACKGROUND: Occupational exposure to carcinogens contributes greatly to the etiology of sinonasal cancer (SNC), but the role of different risk factors in determining different histological subtypes is disputed. METHODOLOGY: All consecutive surgical epithelial SNC cases (case-series study) underwent a systematic occupational medicine examination to determine previous exposure to a wide range of work-related chemical hazards. RESULTS: We investigated 65 SNC cases including intestinal-type adenocarcinoma [ITAC] squamous-cell carcinoma [SCC], and others. Occupational exposure was recognized for 39 cases. Occupational exposures were sensibly more frequent among ITAC than among SCC or other histotypes. Occupational exposure in ITAC cases was to leather or wood dust only, while among non-ITAC cases, we recognised exposure to formaldehyde, solvents and metal fumes. A high proportion of SNC with occupational exposure originated in the ethmoidal epithelium. CONCLUSION: In our case-series of SNC, a very high frequency of previous occupational exposure to carcinogens was detected, suggesting that occupational hazards may be associated to the aetiopathogenesis, primarily for ITAC, but also for other histotypes. Besides leather or wood, other chemical agents must be recognized as occupational risk factors.

[Prospectic evaluation of the Italian Workers' Compensation Authority in a large case series of Occupational sino-nasal cancers]. / Studio prospettico sulla valutazione in sede INAIL di un'ampia sistica di TuNS professionali.

Sino-nasal cancer (SNC) are rare tumours with an elevated occupational etiological fraction, due both to well-established risk factors (wood and leather) and to more rare carcinogens. We evaluated the assessment for workers' compensation performed by the Italian Authority (INAL) in a case-series of occupational SNC (N = 45). We observed an elevated proportion of cases that were recognised as occupational, overall (36 on 39) and for any histotype. INAIL tended to recognize as professional not only patients with exposure to wood and leather but also cases with a documented exposure to formaldehyde, metal, polycyclic hydrocarbons. Significant differences across Italian macro-regions appeared, when the amount of worker compensation was investigated.

Evaluating dispensing error detection rates in a hospital pharmacy.

OBJECTIVES: The filling of unit dose orders and checking for filling errors are two essential distributive responsibilities of a hospital pharmacy. Previous studies have shown that nonpharmacists, usually technicians, are capable of assuming these distributive tasks traditionally performed by hospital pharmacists. The study tested whether nonpharmacists, in this case licensed practical nurses/medication nurses, were as competent as pharmacists in checking for errors in unit dose cassettes prepared for hospital patients. METHODS: A university teaching hospital was used for the study. Artificial errors (n = 812) were introduced into the drug distribution system during a 4-month period in 1995. Included in the study were seven staff pharmacists and nine medication nurses (licensed practical nurses) involved in the decentralized drug distribution system. The primary measure was the ratio of errors detected to the number of artificial errors introduced into the system. This primary measure is different from those used in prior studies that do not separate dispensing errors and checking errors. RESULTS: Overall, pharmacists were significantly more accurate in detecting errors (87.7% vs. 82.1%). In one category of serious errors, that of wrong strength, the difference between pharmacists and licensed practical nurses was even greater (93.3% vs. 83.3%). CONCLUSIONS: This study's results do not support conclusions of prior studies that nonpharmacists can match the error detection accuracy of pharmacists. It demonstrates the importance of considering the types of errors under examination and of using appropriate measures of error checkers when drawing conclusions on relative competence.

Clinical clerkships in professional education: a study in pharmacy and other ancillary professions.

An empirical study of the dynamics of clinical clerkships in professional education is offered, with particular attention to ancillary professions. For students to eventually establish innovative practices within professional organizations, they need skills in the technical aspects of their fields, as well as in role-making and interprofessional negotiation. In examining a clinical clerkship in pharmacy, it was found that faculty overwhelmingly focus on technical matters, and assume that technical competence alone is enough to attain role expansion. The experiences of students, simulating participation in a complex organization as members of clinical teams, give good reason to question this and other assumptions constituting the structure of clerkships. Several recommendations issue from the analysis for strengthening the objectives of professional training.

Observational study of job satisfaction in hospital pharmacy technicians.

Intrinsic and extrinsic factors contributing to job satisfaction of pharmacy technicians in two community hospitals were studied. A pharmacy student employed part-time as a pharmacy technician by one of the hospitals observed fellow technicians in a wide range of job activities for 22 months. In a second hospital, the same student conducted similar observations during one summer while posing as a social researcher. Both hospitals had technician training programs providing classroom instruction and on-the-job training. Data were gathered primarily from informal conversations with technicians and pharmacists and by recording activities through notetaking. Formal training programs, praise from pharmacists, opportunities to train other technicians, diversity of job activities, and autonomy in coordinating work with time demands were identified as factors contributing to job satisfaction of technicians. Negative aspects of the job that employers attempted to circumvent or clarify were the unchallenging nature of the work and the limited opportunities for advancement. Technicians' and pharmacists' attitudes toward job enrichment for technicians are discussed, and suggestions for improving technicians' intrinsic and extrinsic job satisfaction are provided. A reliable cadre of pharmacy technicians is necessary for further expansion of clinical pharmacy services under current hospital budgetary restraints. In addition to modifying job activities to promote technicians' intrinsic job satisfaction, pharmacy managers can improve extrinsic satisfaction by providing adequate salaries, job security, and flexible work schedules.

Access to generic drugs in the 1950s: the politics of a social problem.

From the published literature of the 1950s, the social history of anti-substitution law is analyzed in terms of sociological theory on the construction of social problems. The analysis reveals how the substitution of generic drugs for prescribed brands came to be recognized as a social problem in need of remedial legislation. The most influential party in the process was the brand-drug industry which centered the debate on matters of public health and professionalism instead of industrial profitability. The industry was able to form a coalition of interests and establish the saliency and legitimacy of the problem, even though there was no objective evidence to establish brand substitution as a hazard to health. The case fits well into the theory of social problem construction. Other issues in health care, particularly drug issues can be studied from this same perspective.