Pseudoephedrine for ejaculatory dysfunction after retroperitoneal lymph node dissection in testicular cancer.

OBJECTIVE: To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health-related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment. PATIENTS AND METHODS: In a single arm, phase II trial, patients at ≥6 months after RPLND were invited to complete patient-reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]-30-item core, EORTC QLQ-testicular cancer-26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow-up (ACTRN12622000537752/12622000542796). If EjD was reported, post-ejaculatory urine ± semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts. RESULTS: Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29-41) years, with a median (IQR) of 37 (18-60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow-up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose. CONCLUSION: Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis.

Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy.

PURPOSE: It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD: Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS: By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS: De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Examination of a Modified Incremental Rehearsal Approach to Explore Causal Mechanisms.

Incremental rehearsal (IR) has consistently been shown to improve students' math fact retention and fluency (Maki et al., Journal of Behavioral Education 30:534-558, 2021). However, less is known about how intervention modifications may support longer-term skill maintenance. The purpose of this study was to compare traditional IR with a modified IR (shuffle IR; ShIR) in which known multiplication facts were shuffled between sequences using a cumulative acquisition design with six fourth- and fifth-grade students. All participants retained and maintained more facts in IR and ShIR compared to a control condition. However, IR or ShIR did not consistently result in greater retention than the other, with three students demonstrating greater retention in the IR condition and three students demonstrating greater retention in the ShIR condition. Most participants demonstrated greater fact maintenance in the ShIR condition than in the IR condition. All participants made fewer intervention session errors in the condition in which they retained more multiplication facts.

Dual discrepancy/consistency pattern of strengths and weaknesses method of specific learning disability identification: Classification accuracy when combining clinical judgment with assessment data.

The Dual Discrepancy/Consistency (DD/C) pattern of strengths and weaknesses (PSW) method is the most prominent "other alternative research-based procedure" used to identify a specific learning disability (SLD). The DD/C method is intended to be used with multiple data sources, but no research has examined identification decision making using the DD/C PSW analysis of cognitive and academic achievement test scores with other assessment data (e.g., pre-referral intervention data, parent/teacher reports, observations, evaluation of exclusionary factors). This study used an experimental vignette methodology to investigate school psychologists' (N = 343) identification decision making using the DD/C method with multiple data sources. Results showed that school psychologist participants made highly accurate (97.50%) identification decisions when both cognitive and achievement test score patterns and other assessment data were clearly indicative of SLD, but that overall identification accuracy was only 65.60%. Participants made less accurate identification decisions when examining test score data that did not meet DD/C PSW criteria for SLD than when examining test score data that did. Participants made less accurate decisions when other assessment data (interpreted in conjunction with test scores) did not meet DD/C PSW criteria for SLD or were ambiguous than when they did. In addition, male school psychologists were less likely to make accurate identification decisions than female school psychologists, and participants who were Nationally Certified School Psychologists were less likely to make accurate identification decisions than those who were not. Last, more experience with DD/C resulted in less accurate identification decisions, and participants who made accurate decisions reported higher levels of confidence, although the effect size was negligible. Implications for research and practice are discussed.

Report on 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination.

PURPOSE: The 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination was convened in order to gather subject matter experts in the field of hazardous drug (HD) handling to develop consensus statements regarding surface contamination monitoring for adoption by stakeholders in the drug supply chain, policy, and healthcare arenas. SUMMARY: The Safe to Touch conference convened virtually on September 22, 24, and 26, 2020. An expert panel of healthcare providers with experience in HD handling, monitoring, and research; pharmacy and nursing operations; and medication safety led the conference. An experienced audience of approximately 25 reaction panel members provided feedback to the panel via a preconference survey, during the conference, and at a postconference virtual town hall. Additionally, expert speakers presented on a range of issues, including the impact of HD surface contamination on health, current regulations and standards, surface contamination monitoring technologies, and variables impacting surface contamination testing. CONCLUSION: At the end of the conference, the expert panel developed 11 consensus statements and corresponding recommendations that should be widely disseminated in order to educate individuals regarding the impact of HD surface contamination and increase the scope of HD surface contamination monitoring. Institutions involved in the handling of HDs should set short- and long-term goals for implementation of applicable consensus statements.

Third Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems-2018.

PURPOSE: The Third Consensus Conference on the Safety of Intravenous Drug Delivery Systems was convened to evaluate the benefits and risks of available systems and assess ongoing threats to the safety of intravenous drug delivery. SUMMARY: The Third Consensus Conference on the Safety of Intravenous Drug Delivery Systems convened in Chicago, Illinois in November 2018. An expert panel of healthcare providers with experience in medication quality and safety, pharmacy and nursing operations, information technology, and/or sterile compounding led the conference. An experienced audience of approximately 30 healthcare leaders provided feedback to the panel via preconference survey and during the conference. Additionally, expert speakers presented on a range of issues, including the effects of drug shortages, the impact of standards and guidelines, and patient and administrator perspectives on the importance of intravenous drug delivery safety. CONCLUSION: At the end of the conference, the expert panel concluded that manufacturer ready-to-use products remain the safest intravenous drug delivery system due to their many benefits and low overall risk profile. The panel identified various ongoing threats to the safety of intravenous drug delivery, with major concerns including the impact of drug shortages and lack of intravenous product standardization. Finally, the panel agreed upon a series of statements designed to advance the safety of intravenous drug delivery in healthcare institutions.

Evaluating the Training, Responsibilities, and Practices of P&T Committee Members and Nonmember Contributors.

BACKGROUND: Pharmacy and therapeutics (P&T) committees are responsible for managing drug formularies in numerous health care settings. Although pharmacy practice and health care organizations provide general recommendations of responsibilities and skills for members and nonmember contributors of P&T committees, the study investigators hypothesized that there is diversity in the training, responsibilities, and practices of these members and contributors. OBJECTIVE: To describe the training, responsibilities, and practices of members and nonmember contributors of P&T committees in a variety of health care settings, using an online survey. METHODS: In December 2015, an online survey was delivered to clinicians who were considered likely to be involved in P&T committee service from hospitals ranked by U.S. News & World Report and a convenience sample of clinicians practicing in managed care settings. The survey instrument was designed to assess various domains and perceptions of P&T committee processes. RESULTS: Sixty-nine respondents representing various health care delivery settings in the United States were eligible for and completed the survey. The majority of the respondents were pharmacists (94.2%), and 72.5% of the respondents were P&T committee members. The remainder of the respondents were nonmember P&T committee contributors. Approximately 60% of the respondents had served in P&T committee roles for ≥ 10 years. Specialized postgraduate training incorporating literature evaluation and formulary management was possessed by 21.7% and 17.4% of the respondents, respectively; however, most of the respondents received on-the-job training. Approximately half of the respondents were responsible for preparation of P&T committee documents, and 58% reported that nonmember contributors typically write and prepare these documents. Skill in literature evaluation was the most important criterion in selecting authors of P&T committee documents, while 10.1% of the respondents indicated that their committees did not use any criteria for author selection. When authoring documents, primary literature was routinely consulted by 89.5% of the respondents. Most of the respondents (84.1%) used an organization-specific document template, while 5.8% of the respondents indicated that they prepared documents with no defined process. The most highly ranked factor that could have a perceived beneficial effect on P&T committee functions were guidelines on the authoring and reviewing of P&T committee documents. CONCLUSIONS: The survey of P&T committee members and nonmember contributors used in this study identified current training, responsibilities, and practices that can inform recommendations for standards in these domains. Findings suggest opportunities for improvement in achieving best practice recommendations to ensure evidence-based decision making by P&T committees. DISCLOSURES: No outside funding supported this study. At the time of this study, Kelly was employed by Global Account Management Group (GAMG), which provides consulting services to the hospital and health services industry. As an employee of GAMG, Kelly has served on various advisory boards. All fees for consulting work were paid to GAMG and were primarily related to training or the federal market (e.g., Department of Defense or the Department of Veterans Affairs) and have no association with this study. Rodriguez and Moody report no conflicts of interest. All authors contributed to study concept and design. Rodriguez took the lead in data collection, assisted by the other authors. Data interpretation was performed by Rodriguez, along with Kelly and Moody. The manuscript was written and revised primarily by Rodriguez, along with the other authors.

Evaluation of a new battery of toxicity tests for boreal forest soils: assessment of the impact of hydrocarbons and salts.

The ability to assess the toxic potential of soil contamination within boreal regions is currently limited to test species representative of arable lands. This study evaluated the use of six boreal plant species (Pinus banksiana, Picea glauca, Picea mariana, Populus tremuloides, Calamagrostis Canadensis, and Solidago canadensis) and four invertebrate species (Dendrodrilus rubidus, Folsomia nivalis, Proisotoma minuta, and Oppia nitens) and compared their performance to a suite of standard agronomic soil test species using site soils impacted by petroleum hydrocarbon (PHC) and salt contamination. To maintain horizon-specific differences, individual soil horizons were collected from impacted sites and relayered within the test vessels. Use of the boreal species was directly applicable to the assessment of the contaminated forest soils and, in the case of the hydrocarbon-impacted soil, demonstrated greater overall sensitivity (25th percentile of estimated species sensitivity distribution [ESSD25] = 5.6% contamination: 10,600 mg/kg fraction 3 [F3; equivalent hydrocarbon range of >C16 to C34] Of/Oh horizon, and 270 mg/kg F3 Ahg horizon) relative to the standard test species (ESSD25 = 23% contamination: 44,000 mg/kg F3 Of/Oh horizon, and 1,100 mg/kg F3 Ahg horizon). For salinity, there was no difference between boreal and standard species with a combined ESSD25 = 2.3%, equating to 0.24 and 0.25 dS/m for the Ah and Ck horizons. The unequal distribution of soil invertebrates within the layered test vessels can confound test results and the interpretation of the toxic potential of a site. The use of test species relevant to boreal eco-zones strengthens the applicability of the data in support of realistic ecological risk assessments applicable to the boreal regions.

Consensus conference on prevention of central line-associated bloodstream infections: 2009.

Health care-acquired infections are a significant cause of morbidity and mortality in all patient care settings. In 2009, a consensus conference was held to evaluate practices and recommendations for the prevention and control of one specific type of health care-acquired infections, those associated with central catheter use. The conference had 2 purposes--to provide a tool for quality changes within health care institutions regarding central catheter infections and to empower those who are responsible for implementing policies needed to reduce the risk of these infections. The findings of the expert panel assembled for the conference are presented in this article.