Title: ??? ????? ????? (Adjuvant) ????? ???? ???????.
1 ????? ???? ??????? ????????????
2?? ??????
- ????? ??????? ???????????? ??? ?? ?? ????? ??
?????? ????????. (??????, ???? ?????,
???????,...) - ?????? ???????? ????? ???? ??? ????? ??? 20 ???
- ????? ????, ??????? ???????? ?? ????????
?????????? ????? ????? ??????? ??????, ?? ??????
??????? ???????.
3??????? ??????? ????? ??????
??????? ?????? ??????????? ?????? ??????
?????. ??????? ?????? ????? ????? ?????? ??????
?????? ?????? ?? ?????? ???, ????? ??? ???????
?????? ??????? ??????. ??? ????? ?????
(Adjuvant) ????? ???? ???????. ?????? ???????
???????, ?????? ??????????? ?????? ??? ????? ???
?????? ????.
4??? ??????? ?????? ????? ?? ?? ?????. ???
?????? ??? ?????? ????? ??????, ??????? ???????
????? ??????????, ??????, ?????????) ???? ???????
?????? ?????? ??????? ??????. ????? ??????
??????? ??? ?? ?????? ?? ??????? ??????? ??????
?????????? ????? ???????.
5??????? ???????????? ?????? ?
- ??????????? - ????? ????? ???? ??????? ???
- ???????? - ????? ????? ????? ?????? ???? ??? ????
????? ????? ???. - ????????? - ????? ????? ????? ??? ???? ????,
????? ??????.
6Known Human Carcinogens(IARC Group 1)
- Azothiaprine
- Cyclophosphamide
- Melphalan
- Chlorambucil
- Busulfan
- Thiotepa
- Tamoxifen
- MOPP
International Agency for Research on Cancer
(IARC) http//www.iarc.fr/
7Possible Carcinogens(IARC Group 2B)
- Streptozocin
- Dacarbazine
- Daunorubicin
- Bleomycin
- Mitomycin
- Mitoxantrone
- Amsacrine
International Agency for Research on Cancer
(IARC) http//www.iarc.fr/
8Cancer 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
9Reproductive 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)
16Vaporization
- ????? ?????? ??????? ?????? ??? ?????? ?????? ???
???? ????? ?- 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?? ????? ?????? ??? ?? ?? ?? ????? ?? ?????
????? ?????, ??? ?? ?? ????? !!! ???? ????
????? ?????? ?????? ?????? ??????.
42THE WAY TO BE SAFE IS NEVER TO BE SECURE