Purpose-The goal of this study is to summarize trends in rates of adverse events attributable to acetaminophen use, including hepatotoxicity and mortality.Methods-A comprehensive analysis of data from three national surveillance systems estimated rates of acetaminophen-related events identified in different settings, including calls to poison centers (2008-2012), emergency department visits (2004-2012), and inpatient hospitalizations (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). Rates of acetaminophen-related events were calculated per setting, census population, and distributed drug units. Conclusions-Acetaminophen-related adverse events continue to be a public health burden. Future studies with additional time points are necessary to confirm trends and determine whether recent risk mitigation efforts had a beneficial impact on acetaminophen-related adverse events. Results-Rates

Purpose To estimate the rate of hypersensitivity reactions per 100,000 prescription dispensings of fluoroquinolones based on care rendered in a nationally-representative sample of US hospital emergency departments (ED). Methods We analyzed the frequency of fluoroquinolone-associated hypersensitivity reactions using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system (2004–2010) in conjunction with US retail outpatient prescription data from IMS Health (2004–2010). We further categorized reaction severity into three subgroups (mild, moderate, severe). Results Based on 1,422 cases of fluoroquinolone-associated hypersensitivity reactions and national drug utilization projections, we estimated risk of hypersensitivity reactions for moxifloxacin, ciprofloxacin, and levofloxacin. The absolute risk of a fluoroquinolone-related hypersensitivity reaction of any severity was low (44.0 (95% CI 34.8–53.3) ED visits/100,000 prescriptions; however, we identified a statistically significant difference in the relative risk (rate ratios) of seeking care in an ED attributed to moxifloxacin hypersensitivity compared to either levofloxacin or ciprofloxacin. For all reaction severities, the estimated ED visits/100,000 prescriptions were 141.3 (95% CI 99.9–182.7) for moxifloxacin, 40.8 (95% CI 31.5–50.0) for levofloxacin, and 26.3 (95% CI 20.8–31.9) for ciprofloxacin. When the rates were stratified by reaction severity category (mild or moderate-severe), moxifloxacin continued to be implicated in more ED visits per 100,000 prescriptions dispensed than either levofloxacin or ciprofloxacin. Conclusion Fluoroquinolones may cause hypersensitivity reactions requiring care in an ED, and relative to use, the rate of moxifloxacin-related hypersensitivity reactions is higher than comparator fluoroquinolones.

Purpose We used data from two public health surveillance systems for national estimates and detailed descriptions of insulin mix‐up errors resulting in emergency department (ED) visits and other serious adverse events to help inform prevention efforts. Methods ED visits involving patients seeking care for insulin medication errors collected by the NEISS‐CADES project in 2012–2017 and voluntary reports of serious insulin medication errors submitted to the US Food and Drug Administration (FDA) in 2016–2017 were analyzed. National estimates of insulin product prescriptions dispensed from retail pharmacies were obtained from IQVIA National Prescription Audit. Results Between 2012 and 2017, based on 514 NEISS‐CADES cases, there were an estimated 5636 (95% CI, 4143‐7128) ED visits annually for insulin mix‐up errors; overall, over three‐quarters (77.5%; 95% CI, 71.6%–83.3%) involved taking rapid‐acting instead of long‐acting insulin. Between 2012 and 2017, the proportion of mix‐up errors among all estimated ED visits for all insulin errors decreased by 60%; concurrently, the proportion of pens among all insulin package types dispensed increased by 50%. Among 58 voluntary reports submitted to FAERS, over one‐half (56.9%) of cases involved taking rapid‐ instead of long‐acting insulin. Among 27 cases with documented contributing factors, approximately one‐half involved patients having difficulty differentiating products. Conclusions Among all ED visits for insulin errors collected by NEISS‐CADES in 2012–2017, the proportion involving mix‐up errors has declined. Continued reductions may require additional prevention strategies, including improving insulin distinctiveness, particularly for rapid‐ vs long‐acting insulins. Ongoing national surveillance is important for identifying the impact of interventions.

Purpose The combination of effective hearing health education and hearing protection establishes a strong foundation of hearing loss prevention efforts in the military; however, it is not clear which elements of the educational materials used in hearing loss prevention programs are the most effective in preventing noise-induced hearing loss. To explore this question, a cohort of Excellence in Government Fellowship participants and the Army Hearing Program conducted a preliminary study examining two hearing health education materials. Method A convenience sample of active duty personnel reviewed a hearing health education Technical Guide and video, developed by the military for hearing conservation programs. A “pre- and posteducation” questionnaire was administered to assess the participants' knowledge regarding hearing protection, causes of noise-induced hearing loss, effects of noise on hearing, noise exposure both on and off duty, and satisfaction with educational materials provided during the session. Results Short-term learning effects from the educational materials was achieved for some knowledge-based items (> 10% change from pre-education to posteducation), particularly for questions related to the effect of noise-induced hearing loss on ability to hear speech or hear at a distance. Thirty five percent of study participants reported using hearing protection in hazardous noise 75%–100% of the time. Primary reason for not using hearing protection was comfort. Conclusions Despite hearing loss prevention efforts in the military, hearing loss and tinnitus (ringing in the ears) continue to be prevalent service-connected disabilities among veterans. This study offers some insights regarding current hearing loss prevention understanding and practices for a group of active duty U.S. military personnel. Results from this study can inform future improvements in military hearing loss prevention education.

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