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Introduction: Anticoagulants are associated with significant harm when used in error, but there are limited data on potential harm of inappropriate treatment with direct oral anticoagulants (DOACs). We conducted a matched case-control study among atrial fibrillation (AF) patients admitting the hospital with a chronic treatment with DOACs, in order to assess factors associated with the risk of major bleeding. Methods: Patient data were documented using hospital’s computerized provider order entry system. Patients identified with major bleeding were defined as cases and were matched with controls based on the duration of treatment with DOACs and number of chronic medications. Appropriateness of prescribing was assessed based on the relevant clinical guidelines. Conditional logistic regression was used to evaluate the potential impact of safety-relevant prescribing errors with DOACs on major bleeding. Results: A total number of 509 eligible admissions were detected during the study period, including 64 cases of major bleeding and 445 controls. The prevalence of prescribing errors with DOACs was 33%. Most prevalent prescribing errors with DOACs were “drug dose too low” (16%) and “non-recommended combination of drugs” (11%). Safety-relevant prescribing errors with DOACs were associated with major bleeding [adjusted odds ratio (aOR) 2.17, 95% confidence interval (CI) 1.14-4.12]. Conclusion: Prescribers should be aware of the potential negative impact of prescribing errors with DOACs and understand the importance of proper prescribing and regular follow-up.

Stress ulcer prophylaxis is commonly prescribed in the intensive care unit but can be inappropriately commenced or continued on discharge, exposing patients to potential harm. We aimed to evaluate whether a prescribing guideline, education program and pharmacist oversight would reduce inappropriate continuation of stress ulcer prophylaxis. This was a multicentre pre- (2014) and post- (2016) quality improvement study across five Australian intensive care units. Cost data were estimated using local information about prescribing patterns, and the relationship between long-term use and adverse events. A total of 531 patients were included in the pre- and 393 in the post-implementation periods. The proportion of hospital survivors inappropriately continued on stress ulcer prophylaxis reduced from 78/184 (42.4%) to 11/143 (7.7%) in the post-implementation period (odds ratio = 8.83; 95% confidence interval 4.47–17.45; P

Radiologists typically spend long hours staring at the computer monitor. This unavoidable nature of our work can lead to detrimental effects on the eyes. Moreover, there is little awareness among radiologists with regards to such potential harm. Ocular hazards, such as computer vision syndrome, are increasingly becoming more relevant to the radiology community. In this article, we discuss the ocular occupational hazards faced by radiologists and suggestions that may help in minimizing such hazards.

Among many in the research, policy, and practice communities, the application of sex offender registration and notification (SORN) to juveniles who sexually offend (JSO) has raised ongoing concerns regarding the potential collateral impacts on youths’ social, mental health, and academic adjustment. To date, however, no published research has systematically examined these types of collateral consequences of juvenile SORN. Based on a survey of a national sample of treatment providers in the United States, this study investigates the perceived impact of registration and notification on JSO across five key domains: mental health, harassment and unfair treatment, school problems, living instability, and risk of reoffending. Results indicate that treatment providers overwhelmingly perceive negative consequences associated with registration with an incremental effect of notification indicating even greater concern across all five domains. Providers’ demographics, treatment modalities, and client profile did not influence their perceptions of the collateral consequences suggesting that provider concern about the potential harm of SORN applied to juveniles is robust. Policy implications are discussed.

Background. Annual lung cancer screening using low-dose computed tomography (LDCT) scans is associated with a survival benefit, but it is also associated with potential harm. Unlike descriptive probability formats, experienced tasks have been shown to decrease perceptions of rare events. The objective of this study was to compare descriptive versus experienced probability formats on patients’ knowledge, beliefs, endorsement of screening for heavy smokers, and preference (choice predisposition) to undergo screening. Methods. A total of 276 patients attending an outpatient pulmonary practice were randomized to learn about screening using 1 of 3 formats: numbers only, numbers + icon arrays, numbers + a set of slides illustrating LDCT scans of 250 people in random order that displayed the number of normal scans, false-positive lung nodules, cancers found leading to a life saved, and cancers found leading to death despite treatment. Results. Knowledge differed between the 3 formats ( P = 0.001), with participants randomized to the numbers + icon array format having the highest knowledge score. Beliefs were more favorable among participants randomized to the numbers + experienced format compared with the numbers + icon array format (difference between means [95% confidence interval]= 1.6 [0.4–2.8]). Differences in participants’ endorsement of screening ( P = 0.4) and choice predisposition ( P = 0.6) across probability format mirrored those of beliefs but were not statistically significant. Discussion. Contrary to what we expected, the experienced format increased propensity toward screening compared with the numbers + icon array format, as indicated by more favorable beliefs and nonsignificant trends toward stronger choice predisposition and endorsement. Experienced risk formats may not be a practical approach to improve risk communication for patients deciding whether or not to undergo annual lung cancer screening.

Remotely operated vehicles (ROVs) present a potential risk for the transmission of invasive species. This is particularly the case for small, low-cost microROVs that can be easily transported among ecosystems and, if not properly cleaned and treated, may introduce novel species into new regions. Here we present a set of 5 best-practice guidelines to reduce the risk of marine invasive species introduction for microROV operators. These guidelines include: educating ROV users about the causes and potential harm of species invasion; visually inspecting ROVs prior to and at the conclusion of each dive; rinsing ROVs in sterile freshwater following each dive; washing ROVs in a mild bleach (or other sanitizing agent) solution before moving between discrete geographic regions or ecosystems; and minimizing transport between ecosystems. We also provide a checklist that microROV users can incorporate into their pre- and post-dive maintenance routine.

In Base of the Pyramid (BoP) and subsistence marketplaces literature, a general consensus prevails that the process of creating solutions for the poor is most successful when marketers gain a local perspective. This paper highlights that, as companies seek this local perspective within impoverished communities, they can appropriate community knowledge. Drawing on research in the area of community knowledge, an area of growing importance that is all but missing from the marketing literature, this paper explicates key features of community knowledge. Appropriation of community knowledge can have potential benefits to communities, but also can cause social harm, including undermining financial, economic, and cultural safety, in the BoP community. The papers proposes a framework, bridging ethical and legal approaches, that guides marketers to consider consent, cognitive justice, capacity, and community impact in order to mitigate harm and generate social benefits.

In India, rural medical practitioners (RMPs) practice allopathic, homeopathic, and other modern systems of medicine without formal medical training. However, the quality of treatment offered remains questionable. The present study systematically examines the knowledge, practices, and competencies of the RMPs. While about 80% of RMPs can diagnose common diseases and treat them, 25% are involved in inappropriate practices like unsafe abortion and unsafe childbirth. Hence, there is an urgent need for appropriate intervention to reduce potential harm and improve care provided.

In this rejoinder, we address three responses to our major contribution in this issue, “Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses.” These responses support our contention that not only are the potentially harmful therapy and multicultural counseling and psychotherapy literatures quite disparate, but that this compartmentalization is a symptom of broad and serious problems in the discipline. We explore further some of the underlying complexities the responding authors have raised, including (a) systemic ways that the current landscape of psychotherapy research maintains the status quo, thereby limiting a desirable integration of the two literatures; (b) complexities associated with multiple aspects of diversity, including the inadequacy of current professional ethical codes and practitioner training for addressing potential harm for disparate and vulnerable populations; and (c) the need for the discipline to articulate collective “goods” (against which conceptions of harm are at least implicitly formulated).

Perceptions, attitudes, and ethical concerns related to conducting research with adults with intellectual disability hinder scientific innovation to promote health. Yet we lack an understanding of community views on effective research policy and practice. To address this knowledge void, we qualitatively studied the views of adults with intellectual disability and those who provide them support regarding research participation of adults with intellectual disability. We found substantial support for their inclusion, particularly given the possibility of benefits to adults with intellectual disability, researchers, and society. We also found concerns for potential harm and differing ideas on how to promote safety. Our findings emphasize the importance of their inclusion in research, and the need for policies and practices that promote respect and safety.

This paper introduces Task Excursion Analysis (TEA), a new approach for assessing medical device usability that is under development at the Veterans Health Administration’s National Center for Patient Safety. This approach will aid in identifying vulnerabilities that exist in the design of a device and, eventually, it will allow purchasers and users to select a device that will minimize the potential harm to patients.

Holding therapy, an intervention often used in the treatment of foster and adopted children, has been rejected by professional groups on grounds of lack of evidentiary support and of potential harmfulness. Nevertheless, some British proponents have continued to advocate its use. Is this support brought about by the familiarity of concepts used in this treatment? This article reviews the history of related concepts and methods in Britain. It is concluded that a long history of British involvement with related ideas may have encouraged approval of holding therapy, but that ethical concerns argue against its use.

When patients are brought to the operating theatre a series of checks are performed to reduce harm or potential harm to our patients. One harm that can cause significant morbidity and mortality to our patients is surgical site infection (SSI). Reducing SSIs requires a multi-faceted approach prior to the incision. Prophylactic antibiotics are given, if indicated, along with glucose and temperature control as part of an SSI bundle. Meticulous attention is paid by the team to ensure that the surgical field is prepared with antiseptic solutions such as chlorhexidine or betadine. The airflow changes in theatres also help minimise the risk of infection. The surgeon and scrub team are trained to undertake strict asepsis when ‘scrubbing up’. The rest of the team are careful to ensure hand hygiene and appropriate glove use at all times.

High levels of exposure to phthalates have been associated with an increased risk for adverse male fetal reproductive development. Although animal studies have consistently demonstrated reproductive health effects, additional human epidemiological studies are needed to fully understand the potential harm to humans. Recent findings reported for humans have demonstrated endocrine-disrupting action similar to that associated with phthalate exposures in animals. As a result, phthalate exposure is an emerging public health concern that warrants further review. This article explores the state of the science on phthalate exposure, reviews the literature, and provides recommendations occupational health nurses can use to optimize the health of susceptible populations.

Currently in the popular and academic press, a debate exists as to the usefulness and the potential harm of praising young children. On one side of this debate, there are professionals who are involved in research and education of children with disabilities, and on the other side, those involved in research and education of children without special needs. Because early childhood education has increasingly become inclusive, it is important to understand each side of this debate, and its related issues. This article reviews the literature related to use of praise in education of children with special needs. Clarifications are made regarding the cultural roots of praise and research developments regarding the arguments for and against praise. Finally, recommendations for the best practices for use of praise with all young children are made for parents and early childhood special and general education professionals.

The second in a series of three articles. This article describes the management of cancer by surgery, radiotherapy and drugs. The beneficial and harmful effects of radiation are described, and the planning and delivery of radiotherapy are outlined. Potential errors such as incorrect or delayed diagnosis, failure to obtain informed consent, errors in planning, identification, or dose of radiation given are discussed. Chemotherapy and its side effects are explained and the potential harm from error in prescription or delivery is described.

The thesis of this article is that the individual should be regarded as the locus of media literacy—not schools, parents, or the media industries. Furthermore, the article argues that it is not sufficient to educate individuals about the nature of the media and the potential harm of various messages. There is an issue more fundamental than education and that is the building of greater understanding about how the human mind works. Therefore, we need a cognitive theory that will focus on the special characteristics of media exposure and will explain how people filter messages and construct meaning from those messages.

Introduction. Products that advertise “prostate health” are readily available at most major supplement and vitamin shops. The SELECT trial, SELenium and vitamin E Cancer prevention Trial, showed that men who were supplemented with vitamin E and selenium faced a higher risk of developing prostate cancer. We opted to look at nationally available products from major retailers that advertised prostate health to determine if they could potentially cause harm by inclusion of selenium and/or vitamin E. Methods. We collected data from national retailers including Vitamin Shoppe, General Nutrition Corporation (GNC), that sell vitamins and supplements. Any product that advertised terms such as “prostate health” or “prostate cancer prevention” or similar were analyzed. In total, 97 products were assessed. The ingredients were analyzed to see if the product contained selenium or vitamin E. The remaining ingredients were also recorded. Results. Of all the products, 17% contained both selenium and vitamin E, 36% had selenium without vitamin E, and 16% had vitamin E without selenium. Overall, more than 50% contained selenium. Of the products containing selenium, 35% had 200 µg daily; the amount used in the SELECT trial. Of the products containing vitamin E, none had the 400 IU used in the SELECT trial. The most common ingredient used in the nationally available supplements advertised for prostate health was saw palmetto, with 85% containing this ingredient. Conclusion. Nearly one fifth of all products advertised for prostate health contained both selenium and vitamin E, although vitamin E was at levels lower than used in the SELECT trial. Selenium was, however, much more common and often at the doses per the SELECT trial. These data do not take into account other supplements and vitamins that people may be taking that also contain these ingredients. According to results from the SELECT trial, products that contain selenium and vitamin E should not be used for prostate health. Patients should exercise caution in selecting nonprescription therapies for prostate health and should receive education from their physicians or pharmacists if seeking these products.

It should be clear that the authors of this article are not enamored of practice guidelines, thinking them of much more potential harm than good. On the other hand, if practice guidelines are deemed essential, then they must be written with the goal of quality patient care advocacy and with an eye toward the possible damage they may do.

The present study examined the underlying dimensions associated with perceived risk for consumer products. Eighty undergraduate students evaluated 40 products using seventeen rating questions. Principal components analysis was then performed on the ratings. Results indicated the presence of three underlying components or dimensions along which the products varied. The first component dealt with qualitative aspects of the risks associated with a product, such as the degree to which potential hazards were known (or knowable) and the immediacy of their onset. The second component concerned subjects' familiarity with the product. The third component was associated with quantitative aspects of the risks and reflected notions about the magnitude of the potential harm (in terms of the number of potential victims) that might be incurred as a result of using the product. Subsequent regression analyses revealed that each dimension was significantly related to subjects' rated intent to act cautiously with a product. Overall, these results suggest that people do not perceive consumer products unidimensionally. Rather, such perceptions are best conceptualized as reflecting multiple underlying facets.

Increasing concern about the impact on-product safety information has on sales of a product has focussed attention on consumer decision making as a new area within which to carry out warnings research. Examples of this new research domain include efforts aimed at exploring the relationships between anticipated purchase decisions and the level of detail with which a warning describes consequences of using a product. The level of detail with which consequences are described in a warning is referred to as the explicitness of the warning. In the research reported here, an attempt was made to examine purchase preferences for explicit warnings in the context of cost-benefit tradeoffs made among fictitious products varying in societal value and potential harm. Seventy-three subjects were presented with brief written descriptions of seven products, each having associated with it a unique injury. Explicit and nonexplicit warnings accompanied each product description. Using a questionnaire, subjects evaluated each product in terms of its value to society and indicated whether it should be made available for sale in the United States. They then assessed the severity of the injury and the degree to which they felt it could be controlled by taking the proper precautions. Finally, subjects indicated which warning (explicit or nonexplicit) they would prefer on the product they were to buy. Overall, it was found that products having more detailed, or explicit, consequence information were overwhelmingly preferred. Other patterns indicated that greater purchase preferences for explicit warnings existed when products were considered high in societal value, ought to be sold in the U.S., and when injuries were construed as being controllable. These findings suggest that explicit warnings do influence anticipated purchases of products about which there exists uncertainty concerning product-related danger. This influence appears to be contingent upon perceptions about the costs and benefits associated with the product.

1. Pesticides account for a small but important number of acute human poisonings. 2. When considering interventions for pesticide poisoning in the workplace, interaction may occur on a continuum from a one-to-one encounter to planning or educating in the context of the aggregate. 3. Occupational health nurses need to be aware of the potential harm inherent in human exposure to pesticides and to be prepared to initiate intervention strategies at all phases of injury--pre-event, event, and post-event.

Theoretical works, introductory texts, and formal legal and ethical standards set forth certain behaviors that psychotherapists are to avoid due to potential harm for the patient or the process of psychotherapy. Yet there are relatively few empirical data concerning whether psychotherapists actually engage in or refrain from engaging in such behaviors. We also lack data concerning a range of behaviors (e.g., whether therapists address clients by their first names, whether therapists ever cry in the presence of their clients), which, while they may not involve ethical issues, are still of potential interest. Initial survey data were obtained from a random sample of 1,000 United States psychologists (return rate = 46%) concerning eighty-three such behaviors [1, 2]. Survey data based on a return rate of 49 percent were also obtained from a random sample of 1,600 psychiatrists, 1,600 psychologists, and 1,600 social workers practicing in the United States concerning a subset of these behaviors constituting dual relationships [3].

Sedation is one of the commonest therapies that we use in intensive care. An international survey of 3,500 patients in 2005 showed that 68% of patients who were ventilated for more than 12 hours received sedation at some time during their stay in intensive care. Although we prescribe sedation on a daily basis, we do not always do so well, or give it the attention it deserves. It is only over the last ten years that we have begun to be aware of the importance of sedation and its impact on the way we care for our patients. We are more aware of the potential harm resulting from the way in which we sedate patients and the drugs that we use. Hopefully we have moved away from the scenario Thomas Petty described in 1998, “I am troubled today when I make rounds in critical care…., but what I see these days are paralysed, sedated patients lying without motion appearing to be dead.” Patients today are more likely to be awake and comfortable on a ventilator. We have begun to investigate the consequences of over sedation, such as delirium and post traumatic stress disorder. There is still a long way to go however, before we can say that we have implemented the current evidence base into our daily clinical practice. The three articles on sedation in this edition of JICS are based on talks given at a one day ICS Symposium in July of this year which was sponsored by GSK who have also supported the publication of these articles. The feedback from the seminar was very positive and shows there is a real interest in the subject. We hope to repeat the seminar next year to coincide with the publication of the ICS guidelines on sedation and analgesia.

1 An adhesive, in general, must be a liquid at the time of application, so that the adherends are wetted out, but must then solidify to enable development of adequate bond strength. The use of volatile solvent is only one way in which the solid ingredients can be converted to a liquid for application. 2 Only those adhesives containing solvents are capable of providing the narcotic effect desired by the 'sniffer'. 3 Solvents used in adhesives include highly volatile hydrocarbons, esters, ketones and chlorinated hydrocarbons. 4 Commonly available domestic materials other than solvent-borne adhesives contain such solvents, and are hence capable of misuse by 'sniffers'. Often such materials are of greater potential harm to the mis-user. 5 Aversive additives in solvent-borne adhesives have been found ineffective and also deter the bona fide user. 6 Aqueous substitutes for existing popular and safely-used solvent-borne adhesives have not found sufficient favour with the domestic adhesive user as to enable the manufacturers to replace the solvent-borne type in the market place. 7 Removal of solvent-borne adhesives from the market would not of itself solve the problem of solvent abuse because of the other solvent sources available. The remedy lies in the removal of the causes of such social misbehaviour, rather than in treatment of the symptoms.

Recent studies of light damage to the retina and studies of the hazards to the eye and skin from laser radiation have permitted the development of occupational exposure limits for optical radiation from lamps and lighting systems. Although concerns for potential hazards from the ultraviolet radiation emitted from some lamps have always existed, few have previously been concerned about potential harm to the eyes from visible radiation. Recent studies show that short wavelength light may in some instances be harmful to the retina. Furthermore, infrared radiation hazards to the eye are probably less than was once believed. Exposure limits for ultraviolet radiation and guidelines for visible and near-infrared radiation have been promulgated in the USA and some other countries. A proper understanding of the changing nature of environmental exposures to sunlight throughout the day permits the development of exposure limits for repeated, chronic exposure. The use of the present limits and guidelines for a given lamp or lighting system requires a careful study of exposure conditions if realistic control measures are to be devised. Misunderstanding of the limits or failure to consider realistic exposure conditions can lead to unwarranted concerns regarding lamp safety.