??? ????? ????? (Adjuvant) ????? ???? ???????. - PowerPoint PPT Presentation

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??? ????? ????? (Adjuvant) ????? ???? ???????.

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Title: ??? ????? ????? (Adjuvant) ????? ???? ???????.


1
????? ???? ??????? ????????????

2
?? ??????
  • ????? ??????? ???????????? ??? ?? ?? ????? ??
    ?????? ????????. (??????, ???? ?????,
    ???????,...)
  • ?????? ???????? ????? ???? ??? ????? ??? 20 ???
  • ????? ????, ??????? ???????? ?? ????????
    ?????????? ????? ????? ??????? ??????, ?? ??????
    ??????? ???????.

3
??????? ??????? ????? ??????
??????? ?????? ??????????? ?????? ??????
?????. ??????? ?????? ????? ????? ?????? ??????
?????? ?????? ?? ?????? ???, ????? ??? ???????
?????? ??????? ??????. ??? ????? ?????
(Adjuvant) ????? ???? ???????. ?????? ???????
???????, ?????? ??????????? ?????? ??? ????? ???
?????? ????.
4
??? ??????? ?????? ????? ?? ?? ?????. ???
?????? ??? ?????? ????? ??????, ??????? ???????
????? ??????????, ??????, ?????????) ???? ???????
?????? ?????? ??????? ??????. ????? ??????
??????? ??? ?? ?????? ?? ??????? ??????? ??????
?????????? ????? ???????.
5
??????? ???????????? ?????? ?
  • ??????????? - ????? ????? ???? ??????? ???
  • ???????? - ????? ????? ????? ?????? ???? ??? ????
    ????? ????? ???.
  • ????????? - ????? ????? ????? ??? ???? ????,
    ????? ??????.

6
Known Human Carcinogens(IARC Group 1)
  • Azothiaprine
  • Cyclophosphamide
  • Melphalan
  • Chlorambucil
  • Busulfan
  • Thiotepa
  • Tamoxifen
  • MOPP

International Agency for Research on Cancer
(IARC) http//www.iarc.fr/
7
Possible Carcinogens(IARC Group 2B)
  • Streptozocin
  • Dacarbazine
  • Daunorubicin
  • Bleomycin
  • Mitomycin
  • Mitoxantrone
  • Amsacrine

International Agency for Research on Cancer
(IARC) http//www.iarc.fr/
8
Cancer Risk in Workers
  • Leukemia in nurses- Skov et al, 1992
  • Cyclophosphamide risk assessment-Sessink et al,
    1993
  • NHL and skin cancer in pharmacists- Hansen
    Olsen, 1994

9
Reproductive Risks in Workers
  • Fetal Loss - Selevan et al, 1985
  • Spontaneous Abortions - Stucker, 1990
  • Infertility - Valanis et al, 1997
  • Abnormalities - Peelen et al, 1999
  • Miscarriages - Valanis et al, 1999

10
?????? ?????? ???? ????? ??
  • OSHA - The Occupational Safety Health .
    Administration
  • ONS - Oncology Nursing Society
  • ASHP - The American Society of Hospital
    Pharmacists.

11
???? ????? ?????? ???? ??????? ?????? ????
  • (HBM (Health Belief Model
  • (PMT (Protection Motivation Theory
  • ????? ????? ???? ???? ???????? ?????????
  • ???? ??? ???? ?? ?? ?????? ??? ?? ?????? ????? ??
    ????????
  • ??? ??????? ????? ?????? ??????? ?????? ?????
    ?????
  • ????? ??? ???? ???? ????? ???? ?? ??????
    ?????????? ?????? ?? ??? ????? ??????.

12
?????? ?????
  • ????? ?????? ?????
  • ????? ?????? ?? ????? ?????????
  • ????? ?????? ?????? ??????, ??????? ???????
    ???????.
  • ????? ???????? ?????? ?????? (???, ???? ?????,
    ????, ?? ??????, ????? ??????)
  • ??????? ????? - ???? ?? ??????? ??????????

13
????? ??????? ???? ??????
  • 4.2
  • 4.5
  • 4.6
  • 5.3
  • 5.7
  • 5.8
  • 6.0
  • 6.0
  • 6.3
  • ????? ???????
  • ????? ??????
  • ????? ??????
  • ????? ??????
  • ????? ??????
  • ??? ????
  • ????? ????
  • ????? ?????
  • ???? ????

14
????? ??????
  • ????? - ?? ???? ??????? ?????? ???? ?????, ????,
    ????? ??????, ????? ?????, ???? ????? ??????
    ?????.
  • ????? - ??? ????, ???? ???? ?? ?????? ???????,
    ??????? ?????.
  • ????? ?????? - ??????? ????, ?????, ????? ??
    ????? ????????? ????? ??????.
  • VAPOR - ?????? ??????? ?? ???? ?????? ????

15
(No Transcript)
16
Vaporization
  • ????? ?????? ??????? ?????? ??? ?????? ?????? ???
    ???? ????? ?- HEPA ?? ?????.
  • ??????? ??? ??????? ????? ????? ?????? ??? ??
    ???? ??? ??? ???? ??? ????? ????.
  • ????? ?????? ?? ????? ??????? ????? ?????? ?????,
    ?? ?????, ?? ???? ??????, ??????????, ?? ?????
    ????? ????.
  • - Opiolka 1999, Connor 2000, ASHP 2000

17
?????? ???? ???? ?????? ?????
  • ??? ???
  • ??? ???
  • ?????, ????
  • ????? ????
  • ????? ???
  • ?????? ???????
  • ????????
  • ??? ?????? ?????? ???? ????????

18
????? ???????
  • ?????? ??????? ?? ??????? ???????????? ?????
    ?-75 ???????? ????? ????? ??????? ??-65 ?????
    ??? ?????? ???.
  • ????? ??? ??????? ?????? ???? ?- ?? ?????? ???
    ?????, ????, ????? ??????, ????? ?????? ????.

19
??? ????? ???????
  • ??? ????? ??? ??????
  • ??? ????? ?????? ??? ?? ????? ?????
  • ??? ????? ???? ?????? ?????
  • ???? ????? ????? ?????? ?????
  • ??? ????? ?????
  • ??? ????? ?????? ????? ?????.

20
(No Transcript)
21
????? ???? ???
22
????? ???? PUSH
23
???? ?? ?????
24
????? ??????
?????
25
?????? ??????
  • ?? ????? ?????? ??????? ?? ????? ????? ????? ????
    ??????? ????????????.
  • ????? ????? ??? ?? ???????? ??????????
    ???????????? ??????. ???? ????? ??????? ????????
    ???????.
  • ?????? ??????? ???? ????? ?????, ????? ????? ???,
    ??? ?????? ?????? ?????, ??????,????? ??? ?????
    ???????? ???????.
  • ?????? ????? ???????? ???????.

26
????? ??? ??????? ????? ?????
  • ???? ????? ???? ????? ????? ?????, ??? ?????
    ?????? ??????? ????????????.
  • ????? ?????? ?? ?????? ???? latex ??? ??? ??? ???
    ?? ??????? ????? ????, ???, ????? ????? ??????
    ??????? ?????. ????? ??? ?????? ?? ???, ?? ????
    ????? ??? ???.
  • ????? ???? ?? ???? ?? ??????? ??????, ??? ??????
    ????? ?? ????? ?????? ??????? ??????? ??????.
    ????? ????? ??? ??? ?? ????,??? ???????, ?????
    ??????? ??????.

27
(No Transcript)
28
????
  • ????? ????? ??? ??? ????? ??
  • ??? ?? ???? ????? ?????? ??????
    ??????? ??????.
  • ?? ?? ??????? ?? ????? ????? ???????, ???????
    ????? ????? ???? Biological Safety Cabinet Class
    II or III Type A ??????? ?? ????? ??? ?????.

29
????? ??????
??? ??!!!
  • ??????? ???????????? ??????? ????? ????
    ????/????.
  • ?? ?????? ???????? ?? ??? ????? (????) ???? ?????
    ?????.
  • ?? ????? ???? ????? ????? ????? ???? ??? ???????.
  • ??? ????? ????? ??????? ??????????, ???????
    ??????? ????? ????? ?? ????? ??? ?? ????? ?????
    ???????? ???.

30
???? ?????? ?-ONF ?-1999
  • ????? 13 ????? ?? ????? ???????? ?????? ??
    ??????? ???????????? ??? ??? ???????.
  • ??? ??? ????? 10 ??????
  • ??????? ?????? Taxol, Vp16, Bcnu
  • ??????? ????? ????? ????? ?????? ??????.
  • ???? ?????? ???? ????? ???? ????? ?????/?????
    ???????.
  • ??????? Bcnu ?? ??? ?? ????? ????? ???.
  • - Taxol ?? ??? ?? ????? ????? ?-13 ???? 14
  • - Vp16??? ?? ????? ????? ?-12 ???? 14
  • ???? ?????? ?????? 11 - Nitril - 3 , Latex

31
???? ????? ??????
  • ????? ?????? ??????
  • ??????? ??????? ????? ?? ????? ?????
  • ??????? ?????? ???????
  • ?????? ??? ?? ??????? ???????
  • ?????? ????? ?????
  • - Sessink 1992 5fu, MTX, If
  • Mc Devitt 1993 C.P
  • Rubino 1999 5fu, MTX
  • Micoli 2001 5fu

32
????? ???? ????? ?????? ??????? ??"?
  • ????? 4 ??????
  • ???? ?????? ?????? ????????
  • ????? ???? ?????? ???
  • ????? ??? ??????? ?????? ???
  • ??????? ???????????
  • ??????
  • 2 ???? 44 ????????? ?????? ?????
  • 9 ???? 36 ?????? ??????, ???? ????? ????
  • ?- 17 ???? 24 ?????? ???? ???? 5fu
  • 5 ???? 76 ?????? ?????? ????? ??????
  • (Sessink, Boer et al 1992)


33
????
  • ?? ?????? ?????? ??????? ?????? ????? ??????
  • ??????? 5FU, MTX, CP
  • ????? ??? ?????? ????? ????? ????? ??? ?????
  • CP ???? ?????? ?????? ??? ?????? ??? 7 ?????
    ?????
  • 8 ?-25 ?????? ?????? ????? ?????? ?? C.P, IF
    ???? ?? 2 ???? 8 ???? ????? ?? ?????? ???.
  • 6 ???? 8 ?? ??? ??????? ????? ???? ????.
  • ????? ??????? ?????? ?? ??????, ????? ??????
    ???? ?????? ?????, ???? ?????? ??????? ?????
    ????? ??????.

34
?????? ?????
  • ????? ???? ???????? ???????????? ?? ???????
  • ????? ????? ?????? ?? ???? ???
  • ????? ?? ???? ??? ??????? ?????????
  • ????? ?? ?????? ??????.

35
?????? ??????
  • ?????? ??????? ?????
  • ???? ?????? ???????? ??????
  • ???? ????? ????? - ???? ???,
    ????? ????? ??????,
  • ???? ??? ?????? ????? ?????? ????
  • ???? ????? ??????
  • ????? ?????

36
?????? ????
  • 83 ????? ??????? ????? ??????? ???? ??? ?????
    (?????????)
  • ???? ????? ???? Adriamycin
  • ??????? 18 ????? ?? ?????? ????? -?? ???
    ???????? ?? ??? ???? ???.
  • 10 ???? ?-18 ??? ?? ???? ??????
  • 3 ????? ??? ???? ??????? ???? ?????
  • 7 ??? ???? ?????? ???? ???
  • ???? ??? ??? ?? ?? ??? ???? ???? ?????.
  • 5 ??? ?? ???? ?? ???? ?-2 ?? ??????.
  • ????? ???? ?? ????? ?????? ???? ?????? ???? ??
    ?????, ??? ???? ????? ???? ??????? ??? ?? ?? ???
    ????.
  • Cancer Nursing (1998)

37
???? ????? ??????????
  • ?????? ???????? ?????? ?? ??????? ????????????
    ?? Latex
  • ??? ???. ?? ????? ?????? ???? ??????? ???? ??????
    ?????? ??
  • ???????.
  • ?? ??????? ??????? ???? ???????.
  • ???? ?????? ???? ????? ????? ????
  • ?????? ?????? ???? ??????.
  • ?????? ?????? ??????? ????.
  • ????? PVC - ?? ??????? ?CDs
  • ????? VYNIL
  • ????? NITRILE
  • ?? ??? ?????? ???? ????
  • ????? ???????? ????? ?? ??????.

38
?????? ???????
  • ?? ??????? ??????? ??? ???? ?-24 ????? ????????
  • ?????? ??????? ??????? ????? ????? ?? ????
  • ?? ????? ?????? ??????? ?? ?????? ????????
    ???????? ????? ?????? ??????? ????? ????? ?? ????
    ??????? ??? ???.
  • ?????? ??????? ???? ????? ????? ?????? ?? ?????
    ?? ???? ????.
  • ?????? ????? ??????? ????? ????? ????? ?????
    ????? ??.
  • ????? ????? ?????? ????? ???? ?????.
  • ??????? ?? ?????? ????? ?? ?????? ????? ?????
    ?????.

39
????? ??????
  • ???? ????? ?????? ??????? ?? ????? ??????? ??
    ????? ????? ????? ????? ??
  • ????? ???????? ????? ?? ??? ?????? ??????
    ????? ?? ??????? ????????????, ???? ????.
  • ??? ???? ?????? ?????? ??????, ???? ??????
    ???? ?????? ??????? ??? ????? ??????? ????????.
  • ?? ????? ??????, ?????? ?????? ?? ??????? ????
    ??? ?????? ???? ?? ??????.

40
?????? ????
  • ???? ??? ????
  • 2 ????? ????? ????, ???? ?? ???? ??? ??????
    ?????
  • ??? ????? ?????? ?? ????, ??? ????? ???,
    ????? ??????? (?? ????????), ???? ???? ?????
    ?????? ???, 2 ?????? ??????,
  • ?????? ?? ??????, 2 ????? ??????? ??? ??????
    ??????.
  • ?????? ???? ????? ?????
  • ?? ???? ?? ???? ??????
  • ?? ????? ?? ????? ?????? ????? ????? ??????
    ???????
  • ?? ?????? ?? ????? ?????? ???????? ???.
  • ?? ???? ?? ???? ?? ????? ??????? ????? ?? ???????

41
?? ????? ?????? ??? ?? ?? ?? ????? ?? ?????
????? ?????, ??? ?? ?? ????? !!! ???? ????
????? ?????? ?????? ?????? ??????.
42
THE WAY TO BE SAFE IS NEVER TO BE SECURE
  • (Thomas Fuller)
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