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© AORN, Inc, 2020.Surgical gowns help protect patients from exposure to microorganisms and serve as personal protective equipment for perioperative staff members. Medical textiles, including surgical gowns, are available as reusable and disposable products. Health care facility administrators and leaders who endeavor to use environmentally sustainable practices require current data for decision making. This study analyzed all activities from the extraction of fossil materials from the earth to the end-of-life disposal of reusable and disposable surgical gowns. The researchers included calculations for laundry and wastewater treatment operations and compared the environmental effects of the two surgical gown systems. The study results showed that selection of reusable gowns rather than disposable gowns reduced natural resource energy consumption (64%), greenhouse gas emissions (66%), blue water consumption (83%), and solid waste generation (84%). Perioperative nurses can use this information to assist facility leaders as they make informed decisions related to gown system selection. © AORN, Inc, 2020.Four decades ago, perioperative nursing transitioned from a task-oriented and problem-focused specialty to a patient-centered discipline. This transition involved the incorporation of research and implementation of evidence-based practice to improve patient care. This article discusses the theory of planned behavior (TPB) and its possible application in the perioperative practice area. There is a lack of published literature on the direct use of the TPB to describe and explain perioperative practice behaviors. Perioperative leaders and educators can use this theory to help them understand their staff members' behaviors (eg, lack of adherence to policies for patient care activities [eg, surgical counting]). Using the model may help leaders and educators determine the intentions behind staff members' behaviors and identify participants' attitudes, subjective beliefs, and perceived control over their behaviors. This information should help leaders and educators implement effective strategies to improve patient safety and clinical outcomes. © AORN, Inc, 2020.Thermal comfort is an important component of any work setting and can be difficult to achieve in the complex OR environment. This comparative descriptive study sought to identify factors affecting the thermal comfort of perioperative personnel in the OR (N = 68). Researchers used the American Society of Heating, Refrigerating and Air-Conditioning Engineers Thermal Sensation Scale and researcher-developed surveys to collect data. The mean reported thermal comfort level was -0.44 (standard deviation 1.3), which is within acceptable parameters. Factors affecting thermal comfort were gender, professional role, and wearing additional clothing. Additionally, participants who complained about temperature or ventilation were less likely to report thermal comfort levels in the normal range. Health care facility leaders should consider the comfort needs of perioperative personnel when making purchasing decisions about ventilation systems and surgical clothing; however, they also should consider other factors (eg, surgeon comfort, permeability of protective clothing to blood and other body fluids). © AORN, Inc, 2020.Hazardous drug (HD) use in the perioperative environment poses unique challenges and risks for exposure that can have adverse consequences for perioperative personnel. The United States Pharmacopeial Convention has implemented new standards to address the safe handling and administration of HDs by health care workers. β-Glycerophosphate To comply with these standards and minimize perioperative personnel's occupational exposure to HDs, a multidisciplinary team at an academic medical center in Boston that was performing an increased number and variety of operative and other invasive procedures using antineoplastic agents updated their protocol for the safe use of HDs in the OR. This article discusses HDs and the risks they pose to health care workers and outlines the new HD safety protocol for the OR that was part of a performance improvement plan to ensure compliance with new standards and staff member safety in the perioperative setting. © AORN, Inc, 2020.BACKGROUND Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains equivocal. OBJECTIVES To determine the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcification, and to establish its usefulness in the context of other available treatment options. SEARCH METHODS We searched Ovid MEDLINE, Ovid Embase, CENTRAL, ClinicalTrials.gov and the WHO ICTRP up to November 2019, with no restrictions on language. We reviewed the reference lists of retrieved trials to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that used quasi-randomised methods to allocate participants, investigating participants with rotator cuff disease with or without calcific deposits. We included trials of comparisons of extracorporeal or radial shock wave therapy versus any other intervention. Major tator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review. A standard dose and treatment protocol should be decided upon before further research is conducted. Development of a core set of outcomes for trials of rotator cuff disease and other shoulder disorders would also facilitate our ability to synthesise the evidence. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Atorvastatin (ATV) is frequently prescribed and generally well tolerated, but can lead to myotoxicity, especially at higher doses. A genome-wide association study of circulating levels of ATV, 2-hydroxy (2-OH) ATV, ATV lactone (ATV L) and 2-OH ATV L was performed in 590 patients that had been hospitalised with a non-ST elevation acute coronary syndrome one month earlier and were on high dose ATV (80mg or 40mg daily). The UGT1A locus (lead SNP, rs887829) was strongly associated with both increased 2-OH ATV/ATV (p=7.25x10-16 ) and 2-OH ATV L/ATV L (p=3.95x10-15 ) metabolic ratios. Moreover, rs45446698, which tags CYP3A7*1C, was nominally associated with increased 2-OH ATV/ATV (p=6.18x10-7 ), and SLCO1B1 rs4149056 with increased ATV (p=2.21x10-6 ) and 2-OH ATV (p=1.09x10-6 ) levels. In a subset of these patients whose levels of ATV and metabolites had also been measured at 12 months after hospitalisation (n=149), all of these associations remained, except for 2-OH ATV and rs4149056 (p=0.057). Clinically, rs4149056 was associated with increased muscular symptoms (OR 3.
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