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SIGNpost 00694

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00694 Logistics Course + Tools + Abstracts + News 17 April 2013

CONTENTS
1. PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services
2. New Guide and Dashboard Can Help Improve Procurement Performance
3. Abstract: Staff’s attitude regarding hospital waste management in the
dental college hospitals of Bangalore city, India
4. Abstract: Investigation of medical waste management in Gansu province,
China
5. Abstract: Awareness of biomedical waste management among dental
professionals and auxiliary staff in Amritsar, India
6. Abstract: Post-traumatic stress disorder in trainee doctors with
previous needlestick injuries
7. Abstract: Gender differences in HIV risk behaviours among intravenous
drug users in Catalonia, Spain
8. Abstract: Injecting behaviour and service use among young injectors in
Albania, Moldova, Romania and Serbia
9. Abstract: Hand hygiene: a way out of the deadlock
10. Abstract: Randomized trial using ultrasound to assess intramuscular
vaccination at a 60° or 90° needle angle
11. Abstract: A safety assessment of residual formaldehyde in infant
vaccines
12. Abstract: Fatal adverse effects of injected ceftriaxone sodium in China
13. Abstract: Results of peri-articular steroid injection in the treatment
of chronic extra-articular pain after total knee arthroplasty
14. Abstract: Evaluation of an antimicrobial surgical glove to inactivate
live human immunodeficiency virus following simulated glove puncture
15. Abstract: Comparison of injection dose force, accuracy and precision
among three growth hormone injection devices
16. No Abstract: Endophthalmitis and antibiotic prophylaxis after
intravitreal injections
17. No Abstract: Endophthalmitis after intravitreal injections administered
in office
18. No Abstract: FDA, NIOSH, and OSHA recommend blunt-tip suture needles to
reduce needlesticks
19. Nosocomial outbreak of hepatitis C in Gdansk Poland
20. Call for Papers: Human Resources for Health is pleased to announce a
new thematic series “Right Time, Right Place
22. News
– Alert: Potential Contamination in ApotheCure, NuVision Products Monthly
– USA: FDA staff concerned about safety of Endo’s testosterone injection
– Global: 400 Scientists From 80 Countries Sign Scientific Declaration On
Polio Eradication
– U.S. funds multiple vaccine device
– USA: Hepatitis C Spikes on Cape Cod

The web edition of SIGNpost is online at:
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__________________________________________________________________
________________________________*_________________________________

1. PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services
__________________________________________________________________
PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services

The Pan American Health Organization/World Health Organization (PAHO/WHO)
is sponsoring the 3rd Virtual Course on Primary Health Care–based
Pharmaceutical Services for Managers, aimed at developing the capacities of
pharmaceutical services leaders and managers through a client- and
community-centered approach.

The course will be offered from June 6th through October 17, 2013.
Registration is open through April 30, 2013.

The 190-hour, 19-week course is designed for professionals involved in
management, administration and technical activities in public sector
pharmaceutical services as well academics in public health and pharmacy
education, professionals involved in pharmacy service delivery, and those
involved in pharmaceutical delivery research.

The overarching goal of the course is to shift the focus of pharmaceutical
service management from “medicines as products” to “medicines for people”
in the community and their health-care needs.

Specific subjects will include:

* The role of pharmaceutical services in primary health care and health-
care delivery
* The influence of social determinants on the health of individuals and
communities
* Knowledge to help improve pharmaceutical services in individual countries
* Components and management structure of existing pharmaceutical services
* Formulation of plans for shifting pharmaceutical services from being
medicines-oriented to client/people-oriented
* Competencies required for implementing client-oriented strategies
* Designing interventional proposals for introducing renewed primary health
care.

The 3rd Virtual Course on Primary Health Care-based Pharmaceutical Services
for Managers – Version 2013 will be offered through the Virtual Campus for
Public Health in English and Portuguese.

PAHO/WHO is promoting access to medicines and technologies as one of the
six elements needed to strengthen health-care delivery systems and
universal health coverage.

Registration: http://www.virtualcampus.org/
For more information visit: http://www.campusvirtualsp.org/?q=en/welcome
__________________________________________________________________
________________________________*_________________________________

2. New Guide and Dashboard Can Help Improve Procurement Performance
__________________________________________________________________
From: Anne Marie Hvid, Knowledge Management Advisor at JSI, Washington D.C.
USA via Linkedin

New Guide and Dashboard Can Help Improve Procurement Performance

The USAID | DELIVER PROJECT has published three new documents that can help
health supply chain program managers understand and track key performance
indicators for the procurement process.The Procurement Performance
Indicators Guide—Using Procurement Performance Indicators to Strengthen the
Procurement Process for Public Health Commodities describes suggested key
indicators that can be helpful in tracking various aspects of a procurement
system.

The guide is intended for procurement managers at ministries of health and
central medical stores who are responsible for procuring public health
commodities. It is complemented by the Procurement Performance Indicators
Dashboard, a Microsoft Excel spreadsheet that captures performance data and
graphically summarizes results for each indicator in a dashboard format.

In addition, a brief entitled, Key Performance Indicators Strengthen
Procurement in Latin America, describes the evolution of contraceptive
procurement in the Latin America and Caribbean (LAC) region, highlighting
how LAC countries monitored and evaluated key data when making performance
improvements. By introducing and monitoring key indicators, they were able
to smooth the procurement process and improve procurement performance.

Download the three publications at http://j.mp/ZR4O6V

Anne Marie Hvid, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
John Snow, Inc.

1616 Fort Myer Drive, 15th floor
Arlington, VA 22209 USA
Phone: +1.703.310.5256

email: ahvid@jsi.com
http://deliver.jsi.com/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Staff’s attitude regarding hospital waste management in the
dental college hospitals of Bangalore city, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23580838

Indian J Occup Environ Med. 2012 May;16(2):75-8.

Staff’s attitude regarding hospital waste management in the dental college
hospitals of Bangalore city, India.

Rudraswamy S, Sampath N, Doggalli N.

Department of Public Health Dentistry, J.S.S Dental College and Hospital,
J.S.S University, Mysore, India.

BACKGROUND: Growing urbanization has led to several changes in the
healthcare sector. While on one hand, access to healthcare services are
being provided to the community, thereby resulting in better health for
all, improper management of biomedical waste emanating from these
healthcare establishments has also given rise to many environmental and
health problems (Acharya 2003). Although awareness in this issue has
increased considerably over the last few years, sensitivity to this problem
has been limited. Most hospitals are not actively involved in addressing
this problem.

MATERIALS AND METHODS: The present study was conducted to assess the
attitude of waste management among staff of dental hospitals in Bangalore
city, by issuing a pre-tested structured questionnaire.

RESULTS: While 82.6% of attenders said that it is necessary to segregate
waste into different categories at the point of origin, 61.5% of
auxiliaries strongly disagreed that segregation of waste at source
increases the risk of injury to waste handlers.

As many as 33.5% of dentists strongly disagreed that segregation of waste
at source increases the risk of injury to waste handlers and 53.6% agreed
that segregation of waste at source does not increase the risk of injury to
waste handlers.

CONCLUSION: The findings of this study suggest that the staff had good
attitude towards waste management among.

KEYWORDS: Attitude, biomedical waste, dental hospitals, health care staff,
health care waste, hospital waste management
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Investigation of medical waste management in Gansu province,
China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23567844

Waste Manag Res. 2013 Apr 8.

Investigation of medical waste management in Gansu province, China.

Zhang HJ, Zhang YH, Wang Y, Yang YH, Zhang J, Wang YL, Wang JL.

People’s Hospital of Gansu Province, Lanzhou, People’s Republic of China.

Medical waste is a special category of waste with potential health and
environment risks. The present study aimed to explore the current status of
medical waste management in western China.

Seventy-four healthcare facilities were selected to assess the general
status of medical waste management based upon a designed questionnaire
survey.

The surveyed results showed that the quantities of average medical waste
generation were 0.79, 0.59 and 0.61 kg bed-1 day-1 in tertiary, secondary
and primary hospitals, respectively. The incomplete segregation of domestic
and medical waste generated a higher quantity of medical waste in primary
hospitals (0.61 kg bed-1 day-1) than that in secondary hospitals.

Furthermore, the effective implementation of the medical waste management
system depended on national regulations, occupational safety, internal
policies and administration and the qualifications and competence of the
directors of the waste management department in the healthcare facilities.

Therefore, sufficient training programmes and protective measures should be
provided by healthcare facilities to all relevant personnel and adequate
financial support and effective administrative monitoring should be
performed by local authorities.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Awareness of biomedical waste management among dental
professionals and auxiliary staff in Amritsar, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23208592

Oral Health Dent Manag. 2012 Dec;11(4):162-8.

Awareness of biomedical waste management among dental professionals and
auxiliary staff in Amritsar, India.

Narang RS, Manchanda A, Singh S, Verma N, Padda S.

Department of Oral Pathology and Microbiology, Sri Guru Ram Das Institute
of Dental Sciences and Research, Amritsar, Punjab, India.

AIM: The aim of this study was to determine awareness of biomedical waste
(BMW) management policies and practices among dental professionals and
auxiliary staff in a dental hospital/clinics in Amritsar, India, to inform
the development of future policies for effective implementation of BMW
rules.

METHOD: The study involved 160 staff members at the Amritsar
hospital/clinics (80 dentists and 80 auxiliary staff) to whom a
questionnaire was distributed regarding policies, practices and awareness
relating to BMW. The questionnaire was first piloted. Completed
questionnaires were returned anonymously. The resulting data were
statistically tested using the chi- square test for differences between the
dentists and auxiliary staff.

RESULTS: In respect of BMW management policies, there was a highly
significant difference in the responses of the dentists, whose answers
suggested far greater knowledge than that of the auxiliaries (P<0.001).
Regarding BMW management practices, the dentists were significantly more
aware (P<0.001) of the method of waste collection in the hospital and the
disposal of various items into different colour-coded bags. As for employee
education/awareness, there was a significant difference (P<0.05) between
the dentists and the auxiliaries on the question regarding records of BMW
maintained in the hospital and the other responses to questions on these
topics had a highly significant (P<0.001) difference between the two groups
in favour of the dentists.

CONCLUSION: The results of this study have demonstrated a lack of awareness
of most aspects of BMW management among dental auxiliary staff in the
dental hospital/clinics in Amritsar and a lack of awareness of some aspects
among dentists who work in the hospital/clinics. The results provide the
hospital authorities with data upon which they can develop a strategy for
improving BMW management.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Post-traumatic stress disorder in trainee doctors with
previous needlestick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23580567

Occup Med (Lond). 2013 Apr 10.

Post-traumatic stress disorder in trainee doctors with previous needlestick
injuries.

Naghavi SH, Shabestari O, Alcolado J.

Occupational Health Department, Barking, Havering and Redbridge University
Hospitals NHS Trust, Romford, UK.

Background: Doctors are at particular risk of occupational needlestick
injuries (NSI), and these may result in considerable acute anxiety and fear
of disease transmission.AimsTo measure the prevalence of post-traumatic
stress disorder (PTSD) among trainee doctors who had experienced an NSI.

Methods: A questionnaire was distributed to trainee doctors starting work
in a large university hospital in the UK. The survey gathered demographic
information and experience of previous NSI and included questions designed
to assess the presence of PTSD via the Impact of Event Scale (IES), a
widely used screening tool for PTSD. The six-item version of this tool
(IES-6) was used in this study.

Results: Among the 147 doctors who participated, 80 (54%) had sustained at
least one NSI during their training and 77 of these completed the IES-6
survey. Of note, 38% of injuries (30/80) were not reported to the
occupational health or emergency departments. Using a cut-off level of 10
in the IES-6, 12% (9/77) of the doctors who suffered NSI during their
training showed evidence of PTSD. Since the prevalence of PTSD in the
general population is estimated at 3%, the odds ratio of PTSD in doctors
who had NSI was 4.28 (95% confidence interval: 2.16-8.47).

Conclusions: NSI injury is common among doctors in training. As 12% of
doctors with experience of NSI had post-traumatic stress reactions, special
attention should be paid to psychological impacts of NSIs. We would
recommend further prospective studies.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Gender differences in HIV risk behaviours among intravenous
drug users in Catalonia, Spain
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23393852

G Ital Med Lav Ergon. 2011 Jul-Sep;33(3 Suppl):266-8.

[Injuries with biological risk within Salerno ASL hospitals: descriptive
epidemiologic analyses in the period 2006-2008].

[Article in Italian]

Crescenzi F, Scarpati F, Cannavacciuolo L.

Direttore UOC Medico Competente ASL Salerno. medicocompetente@aslsa1.it

The performed study assesses the exposure to biological liquids among
health operators of Hospitals belonging to the ASL Salerno/1 in the period
2006/2008.

In the following case all work injuries announced in the mentioned period
were considered.

Overall, 633 injuries have been analysed. Of these, 323 had significant
biological risk.

Collected data highlighted that professional categories mostly affected are
hospital nurses and doctors, and that most injuries happened during
injecting therapy and also that the most frequent injury has been caused by
the noodle injection.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Gender differences in HIV risk behaviours among intravenous
drug users in Catalonia, Spain
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23578527

Gac Sanit. 2013 Apr 8. pii: S0213-9111(13)00048-4.

Gender differences in HIV risk behaviours among intravenous drug users in
Catalonia, Spain.

Folch C, Casabona J, Espelt A, Majó X, Meroño M, Gonzalez V, Brugal MT;
REDAN Study Group.

Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual
i Sida de Catalunya (CEEISCAT), Institut català d’Oncologia (ICO), Agència
de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona,
Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain;
Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina
Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma
de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
Electronic address: cfolch@iconcologia.net.

OBJECTIVE: To describe gender differences in injection and sexual risks
behaviours, and human immunodeficiency virus (HIV) and hepatitis C (HCV)
prevalence among injecting drug users (IDU) in Catalonia, Spain.

METHODS: Cross-sectional studies in 2008-2009 (n=748) and 2010-2011 (n=597)
in the network of harm reduction centres. Face to face interviews were
conducted and oral fluid samples were collected to estimate HIV/HCV
prevalence.

RESULTS: Female were more likely than male IDU to have had a steady sexual
partner (68.2% versus 44.9%), to have had an IDU steady sexual partner
(46.6% versus 15.1%) and to have exchanged sex for money or drugs in the
last 6 months (25.5% versus 2.3%). There were no gender differences in
injecting risk behaviours. HIV prevalence was 38.7% (91/235) in women and
31.5% (347/1103) in men (p=0.031). HIV prevalence among female IDU who
reported having exchange sex for money or drugs was 53.3% (32/60). The
prevalence of HCV was 67.4% (159/236) and 73.6% (810/1101) in female and
male IDU, respectively (p=0.053). After adjustment by immigrant status, age
and years of injection, differences among HIV/HCV prevalence by gender were
not significant.

CONCLUSIONS: This study demonstrated differences in sexual risk behaviours
between male and female IDU, but failed to find gender differences in
injecting risk behaviours. Apart from that, the higher prevalence of HIV
among women than among men, together with a lower prevalence of HCV,
provides evidence that sexual transmission of HIV is important among female
IDU. Additional studies are needed to analyze in-depth these specific risk
factors for women in order to develop appropriate prevention and health
education programs.

Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.
Free full text link out from: http://www.ncbi.nlm.nih.gov/pubmed/23578527
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Injecting behaviour and service use among young injectors in
Albania, Moldova, Romania and Serbia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23567098

Int J Drug Policy. 2013 Apr 5. pii: S0955-3959(13)00033-9.

Injecting behaviour and service use among young injectors in Albania,
Moldova, Romania and Serbia.

Busza J, Douthwaite M, Bani R, Scutelniciuc O, Preda M, Simic D.

London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E
7HT, UK. Electronic address: Joanna.Busza@lshtm.ac.uk.

BACKGROUND: This study examines socio-demographic profiles, injecting risk
and use of health services among young injectors (15-24) in Albania,
Moldova, Romania and Serbia. The objective was to provide age-disaggregated
data to identify differences between adolescents (<18) and youth (18-24),
and help fill the gap in knowledge on the youngest injectors in this
region.

METHODS: Cross sectional surveys were conducted in each country using
chain-referral sampling to reach diverse networks of people who use drugs
(PWID). In Albania and Romania, surveys were conducted in the capitals,
respectively, Bucharest and Tirana. Respondents were recruited from 3
cities in Moldova (Chisinau, Balti and Tiraspol) and Serbia (Belgrade, Novi
Sad and Nis). Data were collected on risk behaviours, service use and
contact with police and other authorities. Analysis focused on associations
between unsafe injecting behaviour and key determinants including
demographic background, source of needles/syringes, use of harm reduction
services and interactions with law enforcement.

RESULTS: Although drug use and health-seeking varied across settings,
sources of injecting equipment were significantly associated with sharing
needles and syringes in Moldova, Romania and Serbia. Obtaining equipment
from formal sources (pharmacies, needle-exchange programmes) reduced
likelihood of sharing significantly, while being stopped by the police or
incarcerated increased it. Adolescents relied on pharmacies more than
public sector services to obtain equipment.

CONCLUSION: Adolescents comprise a small proportion of PWID in this region,
but have poorer access to harm reduction services than older peers.
Engaging young PWID through private and public sector outlets might reduce
unsafe practices, while use of the justice system to address drug use
complicates efforts to reach this population.

Copyright © 2013 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Hand hygiene: a way out of the deadlock
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22958350

Aust Health Rev. 2012 Nov;36(4):363-4.

Hand hygiene: a way out of the deadlock.

Stevens SC, Scott CL.

School of Medicine, University of Tasmania, Bag 96, Clinical School,
Hobart, TAS 7000, Australia. stella.stevens@utas.edu.au

Hospital-acquired infection costs money and lives. Improving compliance
with hand hygiene is proving an intractable problem as initial gains often
lack sustainability.

A growing field of research suggests that health service managers may have
a critical role in dealing with this issue, which crosses all professional
boundaries.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Randomized trial using ultrasound to assess intramuscular
vaccination at a 60° or 90° needle angle
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23566948

Vaccine. 2013 Apr 5. pii: S0264-410X(13)00372-1.

Randomized trial using ultrasound to assess intramuscular vaccination at a
60° or 90° needle angle.

Marshall HS, Clarke MF, Evans S, Piotto L, Gent RJ.

Vaccinology and Immunology Research Trials Unit, Women’s and Children’s
Hospital (72 King William Road, North Adelaide) and University of Adelaide,
South Australia, Australia. Electronic address:
Helen.marshall@adelaide.edu.au.

OBJECTIVE: Globally, recommendations differ on the ideal angle of needle
insertion to ensure vaccinate deposition in muscle for optimal safety and
immunogenicity. This study aimed to compare the level of vaccinate
deposition during vaccination, using two different needle angles (60° and
90°), in young children, adolescents and adults.

METHODS: In this randomized cross-over study, two doses of a licensed
hepatitis vaccine, were administered to study participants, at a 60° or 90°
angle using a fixed template. Ultrasonography was performed with a Philips
iu22 ultrasound system. Real time clips and hard copies of images were
recorded showing the injection and level of deposition of the vaccinate.
Reactogenicity at the site of administration was assessed by
participants/parents.

RESULTS: Nineteen participants were enrolled including children,
adolescents and adults. Of the total 38 injections performed, 29 (76%) were
confirmed by ultrasound as intramuscular (IM), 3 (8%) as not IM, and 6
(16%) unknown. For vaccinations visualised and administered at 60°, 87%
(13/15) were intramuscular vs 94.1% (16/17) for those administered at 90°.
A body mass index (BMI)=25 was associated with a higher likelihood of IM
injection compared to BMI>25 (p=0.038). There were no differences in
reactogenicity for either 60° or 90° angle of administration.

CONCLUSION: For the majority of vaccinees, a 60-90° angle of vaccine
administration is appropriate for IM deposition of vaccinate. The
likelihood of intramuscular deposition is reduced for individuals with a
BMI>25. The increasing rates of obesity globally highlight the importance
of tailoring vaccination procedures accordingly.

Copyright © 2013. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: A safety assessment of residual formaldehyde in infant
vaccines
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23583892

Vaccine. 2013 Apr 10. pii: S0264-410X(13)00417-9.

A safety assessment of residual formaldehyde in infant vaccines.

Mitkus RJ, Hess MA, Schwartz SL.

Office of Biostatistics and Epidemiology, USFDA Center for Biologics
Evaluation and Research, 1401 Rockville Pike, HFM-210, Rockville, MD 20852,
United States. Electronic address: Robert.Mitkus@fda.hhs.gov.

Formaldehyde is a one-carbon, highly water-soluble aldehyde that is used in
certain vaccines to inactivate viruses and to detoxify bacterial toxins. As
part of the manufacturing process, some residual formaldehyde can remain
behind in vaccines at levels less than or equal to 0.02%.

Environmental and occupational exposure, principally by inhalation, is a
continuing risk assessment focus for formaldehyde. However, exposure to
formaldehyde via vaccine administration is qualitatively and quantitatively
different from environmental or occupational settings and calls for a
different perspective and approach to risk assessment.

As part of a rigorous and ongoing process of evaluating the safety of
biological products throughout their lifecycle at the FDA, we performed an
assessment of formaldehyde in infant vaccines, in which estimates of the
concentrations of formaldehyde in blood and total body water following
exposure to formaldehyde-containing vaccines at a single medical visit were
compared with endogenous background levels of formaldehyde in a model 2-
month-old infant. Formaldehyde levels were estimated using a
physiologically based pharmacokinetic (PBPK) model of formaldehyde
disposition following intramuscular (IM) injection.

Model results indicated that following a single dose of 200µg, formaldehyde
is essentially completely removed from the site of injection within 30min.
Assuming metabolism at the site of injection only, peak concentrations of
formaldehyde in blood/total body water were estimated to be 22µg/L, which
is equivalent to a body burden of 66µg or <1% of the endogenous level of
formaldehyde. Predicted levels in the lymphatics were even lower.

Assuming no adverse effects from endogenous formaldehyde, which exists in
blood and extravascular water at background concentrations of 0.1mM, we
conclude that residual, exogenously applied formaldehyde continues to be
safe following incidental exposures from infant vaccines.

Copyright © 2013. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Fatal adverse effects of injected ceftriaxone sodium in China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22761158

Pharmacoepidemiol Drug Saf. 2012 Nov;21(11):1197-201.

Fatal adverse effects of injected ceftriaxone sodium in China.

Yao Y, Zhou R, Wang Y.

Department of Ophthalmology, General Hospital of PLA, Beijing, China.
yaoyi301@yahoo.com.cn
PURPOSE: The incidence of adverse reactions to ceftriaxone, which is widely
used in China, has gradually increased, with an associated increase in
patient fatality. An analysis of the reported data from articles published
in China highlights the importance and extent of this growing public health
problem.

METHODS: We identified previously reported cases of adverse effects to
ceftriaxone sodium by searching the Chinese Medical Text Database System
for reports published between January 2002 and December 2009. The
references cited in the articles were examined for additional reports.

RESULTS: A total of 17 articles were identified that cited fatal adverse
reactions in 22 cases. Most patients had been treated for upper respiratory
tract infection and bronchitis and had no reported history of ceftriaxone
allergy. Of the patients, 77% were treated with ceftriaxone without
undergoing intradermal testing, and 36% were not offered any information on
intradermal testing. Concomitant intravenous medications were prescribed in
7 cases, and an overdose of ceftriaxone sodium was prescribed for two
patients. The delay between drug administration and the onset of adverse
drug reactions occurred within 30 min in 72.7% of the patients. Of the
deaths, 73% occurred on the first day of treatment.

CONCLUSIONS: The fatal adverse events associated with ceftriaxone occurred
because of inappropriate drug usage, drug overdoses, careless medical
personnel, poor medical conditions, and possibly poor drug quality.
Although some deaths may be unavoidable, the risks can be minimized by the
appropriate administration of ceftriaxone and further consultation with the
Chinese medical profession and research.

Copyright © 2012 John Wiley & Sons, Ltd.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Results of peri-articular steroid injection in the treatment
of chronic extra-articular pain after total knee arthroplasty
__________________________________________________________________

J Med Assoc Thai. 2012 Oct;95 Suppl 10:S48-52.

Results of peri-articular steroid injection in the treatment of chronic
extra-articular pain after total knee arthroplasty.

Chaiyakit P, Meknavin S, Pakawattana V.

Department of Orthopedic Surgery, Vajira Hospital School of Medicine,
Navamindradhiraj University, Bangkok, Thailand. drpruk@gmail.com

OBJECTIVE: The authors conducted study to analyze results of peri-articular
steroid injection in the treatment of chronic pain from soft tissue
inflammation after total knee arthroplasty (TKA).

MATERIAL AND METHOD: The authors retrieved data from all patients underwent
TKA whom suffered with chronic extra-articular pain and received local
peri-articular steroid injection by 2 senior authors during January 1, 2008
to June 30, 2010. Clinical evaluation such as pain score, knee score and
functional score were recorded pre-injection and three months after
injection.

RESULTS: 554 TKA cases were operated during January 1, 2008 and June 30,
2010. 29 knees from 28 female patients were injected with steroid injection
and included in the present study. Mean age of 64.7 year and mean BMI of
27.7. Three patients in this group were diagnoses as Diabetes. The most
common site of injection was in Tibia, with either Anserinus bursa or
around Gerdy’s tubercle. Mean time to injection after operation was 5
months. Mean VAS was reduced from 56.5 +/- 20.32 to 20.57 +/- 16.1. Mean
knee score and functional score were improved from 74.62 +/- 14.24 to 85.71
+/- 11.85 and from 53.4 +/- 22.57 to 67.04 +/- 21.17 consecutively. All
clinical difference has statistically significant with p-value < 0.05.
There was no incident of superficial or deep infection at mean follow-up
time of 2 years and 5 months.

CONCLUSION: Local steroid injection is a safe and effective choice for
treatment of pain from chronic soft tissue inflammation after TKA.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Evaluation of an antimicrobial surgical glove to inactivate
live human immunodeficiency virus following simulated glove puncture
__________________________________________________________________

Surgery. 2013 Feb;153(2):225-33.

Evaluation of an antimicrobial surgical glove to inactivate live human
immunodeficiency virus following simulated glove puncture.

Edmiston CE Jr, Zhou SS, Hoerner P, Krikorian R, Krepel CJ, Lewis BD, Brown
KR, Rossi PJ, Graham MB, Seabrook GR.

Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI
53226, USA. edmiston@mcw.edu

BACKGROUND: Percutaneous injuries associated with cutting instruments,
needles, and other sharps (eg, metallic meshes, bone fragments, etc) occur
commonly during surgical procedures, exposing members of surgical teams to
the risk for contamination by blood-borne pathogens. This study evaluated
the efficacy of an innovative integrated antimicrobial glove to reduce
transmission of the human immunodeficiency virus (HIV) following a
simulated surgical-glove puncture injury.

METHODS: A pneumatically activated puncturing apparatus was used in a
surgical-glove perforation model to evaluate the passage of live HIV-1
virus transferred via a contaminated blood-laden needle, using a reference
(standard double- layer glove) and an antimicrobial benzalkonium chloride
(BKC) surgical glove. The study used 2 experimental designs. In method A,
10 replicates were used in 2 cycles to compare the mean viral load
following passage through standard and antimicrobial gloves. In method B,
10 replicates were pooled into 3 aliquots and were used to assess viral
passage though standard and antimicrobial test gloves. In both methods,
viral viability was assessed by observing the cytopathic effects in human
lymphocytic C8166 T-cell tissue culture. Concurrent viral and cell culture
viability controls were run in parallel with the experiment’s studies.

RESULTS: All controls involving tissue culture and viral viability were
performed according to study design. Mean HIV viral loads (log(10)TCID(50))
were significantly reduced (P < .01) following passage through the BKC
surgical glove compared to passage through the nonantimicrobial glove. The
reduction (log reduction and percent viral reduction) of the HIV virus
ranged from 1.96 to 2.4 and from 98.9% to 99.6%, respectively, following
simulated surgical-glove perforation.

CONCLUSION: Sharps injuries in the operating room pose a significant
occupational risk for surgical practitioners. The findings of this study
suggest that an innovative antimicrobial glove was effective at
significantly (P < .01) reducing the risk for blood-borne virus transfer in
a model of simulated glove perforation.

Copyright © 2013 Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Comparison of injection dose force, accuracy and precision
among three growth hormone injection devices
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23560872

Expert Rev Med Devices. 2013 Apr 8.

Comparison of injection dose force, accuracy and precision among three
growth hormone injection devices.

Kappelgaard AM, Hansen NA.

Novo Nordisk A/S, Vandtaarnsvej 114 Søborg, DK 2860, Denmark.
amk@novonordisk.com.

Successful growth hormone (GH) therapy requires sustained treatment
adherence, usually over long periods of time. However, adherence rates are
often poor and this can lead to suboptimal clinical outcomes. Developments
in GH injection devices aim to help improve adherence by making daily
injections easier.

Injection force is an important practical aspect for patients receiving
daily GH injections, particularly for patients with small hands or reduced
hand strength due to muscle weakness. Norditropin® FlexPro® (Novo Nordisk
A/S, Bagsværd, Denmark) is an easy-to-use GH injection pen device, shown
here to have reduced injection force, similar dose accuracy and greater
dose precision compared with Norditropin NordiFlex® (Novo Nordisk A/S) and
Genotropin GoQuick® (Pfizer Inc., NY, USA).

Easier injections may enable patients to self-administer GH more readily
and therefore potentially may help improve adherence and clinical outcome.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Endophthalmitis and antibiotic prophylaxis after
intravitreal injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23374578

Ophthalmology. 2013 Feb;120(2):437-8.

Endophthalmitis and antibiotic prophylaxis after intravitreal injections.

da Costa TG, da Rocha BS, Wolff FH.

Comment in [Ophthalmology. 2013]

Incidence of endophthalmitis and use of antibiotic prophylaxis after
intravitreal injections. [Ophthalmology. 2012]
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Endophthalmitis after intravitreal injections administered
in office
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23159446

Br J Ophthalmol. 2013 Mar;97(3):380.

Endophthalmitis after intravitreal injections administered in office.

Shoaib KK.

Intravitreal injections: is there benefit for a theatre setting? [Br J
Ophthalmol. 2012]
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: FDA, NIOSH, and OSHA recommend blunt-tip suture needles to
reduce needlesticks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23444705

Health Devices. 2012 Aug;41(8):267.

FDA, NIOSH, and OSHA recommend blunt-tip suture needles to reduce
needlesticks.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

20. Nosocomial outbreak of hepatitis C in Gdansk Poland

Crossposted from ProMED-mail with thanks http://www.promedmail.org
__________________________________________________________________
A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious
Diseases <http://www.isid.org>

Date: Wed 10 Apr 2013
Source: Dziennik Baltycki [in Polish, trans. submitter MG, edited]
http://tinyurl.com/d5huo2k

A local outbreak of hepatitis C virus infection has occurred in
Gdansk, Poland. The outbreak has been linked to a private medical
clinic performing radiological imaging. In the middle of January 2013,
3 patients were hospitalized in the Regional Hospital of Infectious
Diseases with the diagnosis of acute hepatitis C.

It was revealed that all 3 had undergone CT scans with contrast
administration on 5 Nov 2012, all in the same private medical imaging
facility.

The case was referred to the State Sanitary Inspection for
epidemiological investigation. Altogether, out of 25 patients who had
undergone contrast CT scan on 15 Nov [2012] in the aforementioned
center, 9 have been diagnosed with hepatitis C virus infection. The
medical imaging center is suspected of re-using contrast injector
syringes on multiple patients.

The outbreak is currently being investigated by the local Prosecutor’s
Office.

– —
Michal Gajewski MD
Gdansk
Poland

[ProMED-mail thanks Dr Gajewski for providing this information. An
unwelcome outcome for 9 of the 25 people who received radiological
scanning in a private clinic in Gdansk.

However, hepatitis C does not always require treatment. Depending on
the virus genome therapy with interferon and ribavirin may be
successful in most cases. New therapeutic agents, such as telaprevir
and boceprevir, have become available for treatment of hepatitis
caused by some genotypes of hepatitis c virus. Hopefully appropriate
treatment will be made available for these patients. – Mod.CP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/6gaX>.]
__________________________________________________________________
________________________________*_________________________________

21. Call for Papers: Human Resources for Health is pleased to announce a
new thematic series “Right Time, Right Place

Deadline for submission of the papers is 31st August 2013
http://www.human-resources-health.com/manuscript
__________________________________________________________________
http://blogs.biomedcentral.com/bmcblog/2013/03/21/right-time-right-place/

http://www.human-resources-health.com/

Right Time, Right Place
lizhoffman, blogs.biomedcentral.com (21.03.13)

Health systems around the world are looking to improve access to health
services and health system effectiveness. Two key interlocking components
of a sustainable health workforce solution are to keep scarce skills in the
system by effective retention strategies, and to enable them to be deployed
where they can best make a positive difference to population health.

Many management, education and policy solutions to achieving a “right time,
right place” strategy are being tried and tested in different countries.
Human Resources for Health is pleased to announce a new thematic series
“Right Time, Right Place: Improving access to health service through
effective retention and distribution of health workers.” The aim of this
series is to report on new analysis, strategic intelligence, and evidence
that is pointing to improvements in retention and distribution of health
workers.

Sponsored by Health Workforce Australia (HWA) , the thematic series will
provide new insights for practitioners, policy makers and analysts who have
a responsibility or interest in what can be done to improve access to
health through more effective human resources policies, planning and
management.

Authors can choose to write on any subject matter that covers retention
and/or distribution of health workers, and in any system or country.
Examples could include:

– detailed organisational or system case studies that describe how
barriers
– to improvement of retention or distribution have been identified and
overcome
– reports on regional, state or national HRH policy interventions that
have been tested or evaluated
– studies of how to improve new graduate, “early career” retention
– examination of the impact of new working patterns, new skill mix or new
roles on retention or distribution
– reports on the implementation and effect of incentives to achieve more
effective geographic or sector distribution
– reports on the distribution and retention aspects of achieving health
workforce sustainability
– descriptions of the development and application of new analytical
indicators, tools and techniques to retention and/or distribution.

A selection of papers that meet peer review requirements, are submitted on
time, and meet one of the thematic series requirements will be published in
the thematic series. Author publication fees for these papers will be
waived, as HWA will be covering the costs.

Authors are invited to contact James Buchan with any pre-submission outline
ideas. Submission of papers will be to the normal peer review process at
Human Resources for Health. Please note that the peer review process is
entirely independent of Health Workforce Australia. Papers should meet the
usual Human Resources for Health requirements of size, style and structure.

In order for your author publication fee to be covered by the sponsor
Health Workforce Australia, before submitting please contact James Buchan
(email: James.Buchan@hwa.gov.au) to obtain the details to cover the Article
Processing Charge. When submitting, please indicate “right time, right
place” thematic series in your cover letter.

Deadline for submission of the papers is 31st August 2013
http://www.human-resources-health.com/manuscript

For further information contact the thematic series editor at
James.Buchan@hwa.gov.au
__________________________________________________________________
________________________________*_________________________________

22. News

– Alert: Potential Contamination in ApotheCure, NuVision Products Monthly
– USA: FDA staff concerned about safety of Endo’s testosterone injection
– Global: 400 Scientists From 80 Countries Sign Scientific Declaration On
Polio Eradication
– U.S. funds multiple vaccine device
– USA: Hepatitis C Spikes on Cape Cod

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Alert: Potential Contamination in ApotheCure, NuVision Products Monthly
Prescribing Reference, USA (16.04.13)

The FDA is alerting health care providers, hospital supply managers, and
pharmacists that sterile drug products compounded by ApotheCure, Inc. and
sterile lyophilized drug products from NuVision Pharmacy may have a high
potential for contamination. This warning is a result of an ongoing
inspection of the ApotheCure and NuVision facilities where preliminary
findings raised concerns about a lack of sterility assurance.

Contamination of sterile drug products place patients at risk of serious
infection. All health care providers and hospital staff are to immediately
check and quarantine any sterile products from ApotheCure or sterile
lyophilized products from NuVision Pharmacy.

Both companies have initiated a voluntary recall of all sterile products
made and distributed by ApotheCure and all sterile lyophilized products
made and distributed by NuVision Pharmacy (HcG 5000IU 5mL and
Sermorelin/GHRH6 5mL). Patients who were administered any of the affected
products are to contact their health care providers.

For more information call (888) INFO-FDA or visit
http://tinyurl.com/USFDA-alert01
__________________________________________________________________
__________________________________________________________________
USA: FDA staff concerned about safety of Endo’s testosterone injection

Tue Apr 16, 2013 12:02pm EDT (Reuters) – Reviewers for the U.S. Food and
Drug Administration said safety data on Endo Health Solutions Inc’s twice-
rejected testosterone injection Aveed was “concerning” and showed that the
therapy was associated with severe and immediate post-injection adverse
events.

No deaths were reported from the post-injection reactions, but
resuscitations and hospitalizations were required in some cases, the
reviewers said in documents posted on the FDA’s website on Tuesday.
(link.reuters.com/dem47t)

“There are no known approaches to predict or prevent the occurrence of an
Aveed-related severe post-injection reaction for any patient,” the FDA
reviewers said.

“It is unclear whether a ‘slowly administered’ intramuscular injection or a
30 minute post-injection wait time in the healthcare provider’s office will
entirely mitigate this risk.”

Endo is seeking approval for Aveed as a replacement therapy in adult males
for conditions associated with a deficiency or absence of testosterone
hormone.

The FDA first denied approval to the therapy in 2008, citing safety
concerns, and then again in 2009 as it continued to believe that the drug’s
risks outweighed its benefits.

However, the reviewers said on Tuesday that the drug met the regulatory
requirement for efficacy for a testosterone replacement indication.

The reviewers said that while considering a risk management strategy for
Aveed, the primary benefit of the drug would be to administer fewer
injections in a patient population that has a variety of other treatment
options available.

Endo’s failure to accurately characterize the drug’s use, the consistent
high rate of adverse events, and its “unwillingness to acknowledge or
effectively address possible increased rates is concerning,” the FDA staff
said.

The FDA’s advisory panel will vote on the drug’s safety profile and
approval on Thursday.

“We expect a conservative advisory panel on April 18 due to the poor
risk/benefit profile of Aveed and are not assigning any additional value to
this product in our model,” Cantor Fitzgerald analyst Irina Rivkind said.

The most commonly reported adverse events were acne, fatigue, cough,
injection site pain, insomnia and sinusitis, among others.

Aveed, or testosterone undecanoate, is a long-acting formulation of
testosterone in castor oil and benzyl benzoate, and is intended for
intramuscular injection.

“We think that Aveed, if unexpectedly approved, could conservatively attain
revenues in the $300 million range and add approximately $3 to Endo
valuation,” Rivkind added.

She has a “hold” rating and a $34 price target on Endo shares.

Endo shares were up 1 percent at $34.64 on the Nasdaq in late-morning
trading.

(Reporting by Esha Dey in Bangalore; Editing by Roshni Menon, Maju Samuel)
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/cnbe7ok

Global: 400 Scientists From 80 Countries Sign Scientific Declaration On
Polio Eradication
The Kaiser Daily Global Health Policy Report (12.04.13)

“Around 400 scientists from 80 countries have come together to declare that
polio could be wiped off the face of the Earth in five years if plans to
eliminate both wild and vaccine-derived polioviruses are implemented,”
SciDev.Net reports (Malhotra, 4/11). “The plan, launched [last week] by the
Global Polio Eradication Initiative — comprising United Nations bodies,
health organizations, Rotary International and governments — is a strategy
for the polio endgame, envisaging a polio-free world in 2018,” The Guardian
notes (Boseley, 4/11). “Launching the Scientific Declaration on Polio
Eradication, they called on governments, international organizations and
philanthropic individuals to fund the $5.5 billion cost of eliminating the
few remaining cases of polio and end transmission of the disease by 2014,
so that the world may be declared polio-free in 2018,” The Independent
writes (Laurance, 4/11).

“The declaration emphasizes that achieving polio eradication requires
efforts interrelated with strengthening routine immunization, a new focus
of the GPEI plan,” a Global Health Strategies press release notes, adding,
“At the same time, resources and learning from polio eradication efforts
can be used to strengthen coverage of other life-saving vaccines, including
for children who have never been reached with any health interventions
before” (4/11). “According to one of the declaration’s signatories,
‘Eradicating polio is no longer a question of technical or scientific
feasibility. Rather, getting the most effective vaccines to children at
risk requires stronger political and societal commitment,'” VOA News writes
(4/11). In a related article, The Lancet examines the new GPEI plan, noting
it “was called for in May last year by the World Health Assembly, which
declared polio eradication ‘an emergency for global public health'” (4/13).
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ct9lype

USA: U.S. funds multiple vaccine device
UPI, USA (10.04.13)

A $3.5 million grant is being given a U.S. public/private partnership for
advancing development of a new device to simultaneously deliver multiple
vaccines.

BLUE BELL, Pa., April 10 (UPI) — A $3.5 million grant is being given a
U.S. public/private partnership for advancing development of a new device
to simultaneously deliver multiple vaccines.

Receiving the grant from the National Institute of Allergy and Infectious
Diseases is Inovio Pharmaceuticals Inc., which is collaborating with the
chief scientist at the U.S. Army Medical Research Institute of Infectious
Diseases.

The device to be developed would administer multiple synthetic vaccines —
via skin surface electroporation, or electrical introduction – to U.S.
troops to protect against diseases and to civilian populations to protect
against pandemic threats.

“This new device would provide a means to rapidly and painlessly deliver
multiple vaccines simultaneously to large groups of people,” said Dr. J.
Joseph Kim, Inovio’s president and chief executive officer. “This
collaboration builds on Inovio’s strong relationship with Dr. Connie
Schmaljohn and her team at USAMRIID in which Inovio is bringing medical
innovation to several biodefense efforts.

“Moreover, the advancements from this project will enable rapid and
efficient delivery of Inovio’s SynCon®vaccines for universal flu, HIV, and
other infectious diseases on a mass scale.”

Inovio said in an earlier joint effort with USAMRIID, an optimized DNA
vaccine for the Lassa virus delivered by surface electroporation
demonstrated complete protection against the virus in animal subjects but
improvements are still needed to make the electroporation technology more
suitable for multiple vaccine administrations and mass vaccinations.

Read more:
http://www.upi.com/Business_News/Security-Industry/2013/04/10/US-funds-
multiple-vaccine-device/UPI-50391365613995/#ixzz2QhVIPRY3
__________________________________________________________________
__________________________________________________________________
USA: Hepatitis C Spikes on Cape Cod
Cynthia Mccormick, Cape Cod Times (08.04.13)

According to surveillance by the Massachusetts Department of Public Health,
chronic hepatitis C among young people is increasing in Barnstable County
and in many other counties in the state, including Suffolk County, which
includes Boston. In 2010, Suffolk County recorded 27 confirmed cases of
hepatitis C virus (HCV) infection in individuals ages 15 to 25 years in
Barnstable County. That corresponds to a rate of 138.75 cases per 100,000
people, the highest incidence rate for that age group in the state. The
other county that came close was Berkshire County, with a rate of 134.29
per 100,000 people. Rates at Cape Cod were very high, but the Department of
Public Health state that the youth rates are climbing across the state.
This increase in HCV among young people is attributed to sharing syringes
for injection drug sue. Preliminary figures for 2011 show 32 probable cases
of HCV among Cape and Islands residents ages 15 to 25 years. Probable cases
are those that tested positive for antibodies. Confirmed results require
further positive tests, which are not yet ready.

On the Cape and Islands, health officials have been tracking down young
people with HCV in treatment centers, shelters, methadone clinics, and a
county correctional facility. Kevin Cranston, director of the state
Department of Public Health’s Bureau of Infections, commented that they
first noticed this disease in this age group in 2002. Public health
officials suspect another epidemic, opiate addiction, as the root cause,
with needle-sharing exposing injecting drug users to the disease.
Approximately 70 percent of young people with HCV have admitted to using an
injectable drug at least once; Cranston suspected the actual percentage was
higher.

Cape Cod Healthcare Infectious Disease Nurse Heidi Smith reported that 10
out of 40 people tested at the Gosnold at Cataumet post-detoxification
center were positive for HCV. Also, at the Barnstable County Correctional
Facility, up to 40 percent of tested inmates were positive for HCV, said
Valerie Al-Hachem, manager of infectious disease clinical services at Cape
Cod Healthcare. Since 2009, the correctional facility has reported 124 new
diagnoses of the virus among inmates in the 17 to 26 age range, almost all
among people with a history of IV drug use, according to Vicki Sherwin,
public health coordinator at the jail.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
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* Visit the WHO injection safety website and the SIGN Alliance Secretariat
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* Download the WHO Best Practices for Injections and Related Procedures
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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

SIGN meets annually to aid collaboration and synergy among SIGN network
participants worldwide.

The 2010 annual Safe Injection Global Network meeting was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

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__________________________________________________________________
________________________________*_________________________________
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