Medicamentos potencialmente perigosos: a expertise dos enfermeiros que atuam em unidade de urgência e emergência / High-alert medications: the expertise of nurses who work in an emergency and emergency unit / Medicamentos potencialmente peligrosos: la experiencia de las enfermeras que trabajan en una unidad de emergencia y emergencia

Objetivo: Identificar o conhecimento dos enfermeiros de um setor de urgência e emergência sobre os medicamentos potencialmente perigosos. Métodos: Estudo descritivo quantitativo desenvolvido com 23 enfermeiros em hospital de nível terciário municipal. Foi aplicado o Questionário de Medicamentos Potencialmente Perigosos. Para a análise dos dados, foi utilizado o software SPSS e foram utilizadas as medidas de tendência central e as medidas de dispersão. Resultados: A média±(DP) do tempo de formação foi 9,7 ± 3,0 anos e o tempo de serviço na instituição obteve média±(DP) 3,9 ± 3,8 anos. A média±(DP) de acertos no domínio 1 foi de 7 ± 1,74 e no domínio 2 foi 6,9 ± 1,55. Muitos profissionais referiram ter alguma dúvida relacionada ao uso de Medicamentos Potencialmente Perigosos. O domínio 2 obteve menor número de acertos quando comparado ao domínio 1. Conclusão: Os enfermeiros possuem conhecimento sobre a temática, pois a média de acertos nos dois domínios foram satisfatórias, mas apresentaram o menor número de acertos quanto ao uso de alguns fármacos, como prometazina e amiodarona. Com isso, reforça-se a importância de capacitar esses profissionais visando a segurança do paciente. (AU)

Objective: To identify the knowledge of nurses in an urgency and emergency sector about potentially dangerous drugs. Methods: Quantitative descriptive study developed with 23 nurses in a municipal tertiary level hospital. The Questionnaire of High-Alert Medicationswas applied. For data analysis, the SPSS software was used and measures of central tendency and dispersion measures were used. Results: The mean ± (SD) time since graduation was 9.7 ± 3.0 years and the length of service at the institution had a mean ± (SD) 3.9 ± 3.8 years. The mean ± (SD) of correct answers in domain 1 was 7 ± 1.74 and in domain 2 its was 6.9 ± 1.55. Many professionals reported having some doubt related to the use of Potentially Dangerous Medicines. Domain 2 had a lower number of correct answers when compared to domain 1. Conclusion: Nurses have knowledge on the subject, as the average of correct answers in the two domains were satisfactory, but they had the lowest number of correct answers regarding the use of some drugs, such as promethazine and amiodarone. With this, the importance of training these professionals is reinforced with a view to patient safety. (AU)

Objetivo: Identificar el conocimiento de los enfermeros en un sector de urgencia y emergencia sobre medicamentos potencialmente peligrosos. Métodos: Estudio descriptivo cuantitativo desarrollado con 23 enfermeras de un hospital municipal de nivel terciario. Se aplicó el Cuestionario de medicamentos potencialmente peligrosos. Para el análisis de los datos se utilizó el software SPSS y se utilizaron medidas de tendencia central y medidas de dispersión. Resultados: El tiempo medio ± (DE) desde la graduación fue de 9,7 ± 3,0 años y el tiempo de servicio en la institución tuvo una media ± (DE) 3,9 ± 3,8 años. La media ± (DE) de respuestas correctas en el dominio 1 fue de 7 ± 1,74 y en el dominio 2 fue de 6,9 ± 1,55. Muchos profesionales informaron tener alguna duda relacionada con el uso de medicamentos potencialmente peligrosos. El dominio 2 tuvo un número menor de respuestas correctas en comparación con el dominio 1. Conclusión: Los enfermeros tienen conocimiento sobre el tema, ya que el promedio de aciertos en los dos dominios fue satisfactorio, pero tuvieron el menor número de aciertos en cuanto al uso de algunos fármacos, como prometazina y amiodarona. Con ello, se refuerza la importancia de formar a estos profesionales con miras a la seguridad del paciente. (AU)

Effectiveness of Teaching Standardized Protocol on Safe Medication Administration Process Upon the Level of Knowledge among Nurses at a Tertiary Care Hospital, Chennai

Strategies to improve medication safety focused on acute care settings. Twenty-six studies and descriptions of quality improvement projects were identified. Strategies used to focus on recommendations to prevent medication errors at various stages, from a nationwide voluntary organization to improve safety of patients and empower education system of nurses and other health care providers in safe practices in health care system and vast growing technology.

Factores asociados a malestar psicológico durante la pandemia de COVID-19 en personal de salud de un hospital público de Ecuador / Related factors to psychological distress during the COVID-19 pandemic in the health staff of a public hospital in Ecuador

Fundamento: La pandemia por el coronavirus SARS-CoV-2, genera afectaciones en las esferas social, económica y sanitaria de un país, y de manera particular, consecuencias psicológicas negativas en el personal sanitario de hospitales públicos, considerados como la primera línea de atención a pacientes con esta enfermedad. Objetivo: Describir factores asociados a la presencia de malestar psicológico en el personal sanitario de un hospital general público en Ecuador, durante la pandemia de COVID-19. Metodología: Estudio no experimental, de corte transversal, con alcance descriptivo-correlacional. Los datos correspondieron a 276 funcionarios de la salud que respondieron un instrumento online, con un módulo de datos sociodemográficos y una escala de tamizaje de malestar psicológico, estos se aplicaron después de una intervención en salud dirigida al personal de salud realizada al inicio de la pandemia, en mayo del año 2020. Se realizaron análisis descriptivos y de asociación, mediante el software SPSS 25.0. Resultados: La muestra estuvo compuesta por 76.1 % de mujeres, 23.9 % de hombres, con una media de edad de 36 años, en mayor cantidad con profesionales de Enfermería (33.7 %), seguido de Medicina (24.3 %). El 70.7 % del personal de salud presentó malestar psicológico, de estos, el 26.1 % con indicativo de trastorno mental. Se encontraron tres variables asociadas a la presencia de malestar psicológico: clima laboral, teletrabajo y convivir con grupos de riesgo. Conclusiones: El personal de Salud ha presentado afectación en su salud mental asociado a las condiciones sociolaborales durante la pandemia.

Background: The SARS-CoV-2 coronavirus pandemic affects the social, economic and health spheres of a country, especially negative psychological consequences to the health staff of public hospitals, considered as the first line of care for patients with this disease. Objective: To describe factors related to the presence of psychological distress in the health personnel of a public general hospital in Ecuador, during the COVID-19 pandemic. Methodology: Non-experimental, cross-sectional study with a descriptive-correlational scope. The data corresponded to 276 health officials who answered to an online instrument, with a sociodemographic data module and a psychological distress screening scale, these were applied after a health intervention aimed at health personnel conducted at the beginning of the pandemic, in May 2020. Descriptive and association analyzes were performed using SPSS 25.0 software. Results: The sample was made up of 76.1 % women, 23.9 % men, mean age of 36 years, with a greater number of Nursing professionals (33.7 %), followed by Medicine (24.3 %). 70.7 % of the health personnel presented psychological distress, out of these, 26.1 % showed mental disorder. Three variables related to the presence of psychological distress were found: work environment, teleworking and living with risk groups. Conclusions: Health staff has presented mental health distress related to socio-labor conditions during the pandemic.

Assessment of appropriateness of prescribing among Indian geriatric outpatients using STOPP and START Criteria Version 2 at a tertiary care teaching hospital

Background: Inappropriate prescribing is more prevalent in geriatric patients. A popular tool for screening appropriateness of prescribing is the screening tool of older person’s prescriptions (STOPP) and screening tool to alert doctors to right treatment (START) criteria. In this study, our aim was to estimate the incidence of potentially inappropriate prescribing (PIP) utilizing these criteria among patients attending outpatient departments. In addition, we aimed to identify potential factors that are associated with PIP. Aims and Objectives: The objectives of the study are as follows: (1) To estimate incidence of potentially inappropriate medications (PIMs) using STOPP criteria; (2) To estimate incidence of potential prescribing omissions (PPOs) using START criteria; and (3) To identify potential factors that are associated with PIP. Materials and Methods: A prospective and cross-sectional study that was observational in nature was performed in patients with age 65 years and above. Prescriptions of these patients were analyzed by collecting relevant data that were subsequently entered in specially designed case record forms. The modified version 2.0 of STOPP/START criteria was utilized to assess PIP in the form of PIMs and PPOs. Data were entered in Microsoft Excel 2013 and analyzed. Categorical variables were described as frequency and percentage whereas continuous variables were described as mean with standard deviation. Results: Prescriptions of a total 306 patients were evaluated (mean age: 69.4, 60% male, average number of medications per prescription: 5.04 ± 2.44), PIMs were detected in 88 (28.75%) and PPOs in 30 (9.8%) patients. Ninety-six patients had either a PIM or a PPO. PIMs mainly involved were duplication of drug class (26.5%), use of first generation antihistaminic for >1 week (20.4%) and use of glimepiride (18.6%). Major PPOs identified were non-use of angiotensin converting enzyme inhibitors following acute myocardial infarction (26%), non-use of statin therapy (26%), and antiplatelet therapy (21.7%) in patients with diabetes mellitus along with cardiovascular risk factor. Polypharmacy (OR 6.011, P < 0.0001) and comorbidity (OR 3.097, P = 0.015) significantly increase the risk of PIM encounter. Conclusion: PIP in the form of PIMs and PPOs was prevalent in the studied patients. Polypharmacy and comorbidity were associated with an increased likelihood of PIM.

Impacto de la dispensación automatizada de medicamentos en la seguridad del paciente. Evidencia de una Unidad de Cuidado Crítico en Colombia

Objetivo: Determinar el impacto de la dispensación automatizada en la seguridad del paciente en una unidad de cuidado crítico y medir el tiempo de dispensación para conocer los efectos en la atención del paciente y los trabajadores de la salud. Metodología: Estudio retrospectivo observacional. La técnica fue documentar la dispensación tomando las bases de datos en el sistema tradicional y automatizado procesados en Microsoft Excel y medición del tiempo. Resultados: Con el sistema automatizado el uso de controles para el acceso en la dispensación de los medicamentos e insumos fue del 100 %. Y, el porcentaje de casos de problemas con el uso de medicamentos en el sistema tradicional fue de 0,38 y en el automatizado descendió a 0,007. Discusión: Pasar de manual a automatizado en la dispensación representa reducción del tiempo de un día a 22 segundos, el uso del 100 % de las alertas tecnológicas y la eficiencia en los procesos de dispensación reflejado por el 15,2 % de transacciones en el cargue de los dispositivos médicos y medicamentos. Conclusiones: La dispensación automatizada impacta en el paciente acortando el tiempo para que el medicamento sea administrado oportunamente, en los trabajadores este tiempo es una ventaja para invertir en los cuidados, el equipo de sistema automatizado adiciona controles que ayudan al doble chequeo en el alistamiento y cargue y la reducción de eventos adversos. Y, en la organización disminuye los eventos relacionados con roturas de envases, daño de empaques por la menor manipulación y disposición de medicamentos en gabinetes cerrados.

SUMMARY Objective: To determine the impact of automated dispensing on patient safety in a Critical Care Unit and measure the dispensing time to know the effects on patient care and health workers. Methodology: Retrospective observational study. The technique was to document the dispensing taking the databases in the traditional and automated system processed in Microsoft Excel and measuring time. Results: With the automated system, the use of controls for access in the dispensing of medicines and supplies was 100 %. And, the percentage of cases of problems with the use of medicines in the traditional system was 0.38 and in the automated system it fell to 0.007. Discussion: Going from manual to automated in the dispensing represents a reduction in time from one day to 22 seconds, the use of 100 % of technological alerts and the efficiency in the dispensing processes reflected by 15.2 % of transactions in the load of medical devices and drugs. Conclusions: Automated dispensing impacts on the patient by shortening the time for the medication to be administered in a timely manner, in workers this time is an advantage to invest in care, the automated system equipment adds controls that help the double check in the readiness and burden and reducing adverse events. And, in the organization it reduces the events related to container breakage, packaging damage due to less manipulation and disposal of medicines in closed cabinets.

Objetivo: Determinar o impacto da dispensação automatizada na segurança do paciente em um unidade de terapia intensiva e medir o tempo de dispensação para conhecer os efeitos no paciente cuidadores e trabalhadores da saúde. Metodologia: Estudo observacional retrospectivo. O técnica foi documentar a dispensação tomando os bancos de dados na forma tradicional e sistema automatizado processado em Microsoft Excel e medição de tempo. Resultados: Com o sistema automatizado, o uso de controles para acesso na dispensação de medicamentos e suprimentos foi de 100%. E, a porcentagem de casos de problemas com o uso de medicamentos no sistema tradicional foi de 0,38 e no sistema automatizado caiu para 0,007. Discussão : Passar de manual para automatizado na dispensação representa redução do tempo de um dia para 22 segundos, o uso de 100% de tecnologia alertas e a eficiência nos processos de dispensação refletida em 15,2% das transações na carga de dispositivos médicos e medicamentos. Conclusões: dispensação automatizada impactos no paciente, diminuindo o tempo para a medicação ser administrada em tempo hábil, nos trabalhadores este tempo é uma vantagem para investir no atendimento, a automatização equipamentos do sistema adicionam controles que auxiliam na dupla verificação da prontidão e sobrecarga e redução de eventos adversos. E, na organização, reduz o eventos relacionados à quebra de contêineres, danos à embalagem devido à menor manipulação e descarte de medicamentos em armários fechados.

Knowledge of teachers about suicidal behavior in adolescents / Conocimiento de los profesores sobre el comportamiento suicida en los adolescentes / Conhecimento de professores sobre comportamento suicida em adolescentes

Objective. To identify the knowledge of teachers about suicidal behavior in adolescents. Methods. Qualitative exploratory-descriptive study conducted in a state school in the municipality of Porto Alegre, RS, Brazil. Twelve teachers participated in the study. Data were collected through semi-structured interviews analyzed using Bardin's Content Analysis. Results. Three categories were built: "Warning signs of suicide", related to the signs identified by the professionals; "Risk factors for suicide", which indicate the reasons that may lead adolescents to present this type of behavior; and "Difficulties in dealing with the behaviors", referring to the behaviors adopted by adolescents and the difficulties of teachers before the theme. Conclusion. It was possible to identify that teachers recognize some signs of suicidal behavior, as well as some risk factors. Nonetheless, it is necessary to qualify them to approach the subject, since they feel insecure to act in more critical moments, thus generating mainly feelings of sadness, guilt and powerlessness.

Objetivo. Identificar el conocimiento de los profesores sobre el comportamiento suicida en adolescentes. Métodos. Estudio exploratorio-descriptivo y cualitativo realizado en una escuela pública del municipio de Porto Alegre, RS, Brasil. Doce profesores participaron en el estudio. Los datos se recogieron mediante entrevistas semiestructuradas, que fueron analizadas utilizando el Análisis de Contenido de Bardin. Resultados. Se construyeron tres categorías: "Señales de alerta de suicidio", relacionada con las señales identificadas por los profesionales; "Factores de riesgo de suicidio", que indican las razones que pueden llevar a los adolescentes a presentar este tipo de comportamiento; y "Dificultades para lidiar con los comportamientos", relativa a las conductas adoptadas por los adolescentes y a las dificultades de los profesionales frente al tema. Conclusión. Se pudo identificar que los profesores reconocen algunas señales de comportamiento suicida, así como algunos factores de riesgo. Sin embargo, es necesario cualificarlas para el abordaje del problema, pues se sienten inseguros para actuar en los momentos más críticos, generando principalmente sentimientos de tristeza, culpa e impotencia.

Objetivo. Identificar o conhecimento de professores sobre comportamento suicida em adolescentes. Métodos. Estudo exploratório-descritivo, qualitativo, realizado em uma escola estadual no município de Porto Alegre, RS, Brasil. Participaram no estudo 12 professores. Os dados foram coletados mediante entrevistas semiestruturadas analisadas por meio da Análise de Conteúdo de Bardin. Resultados. Foram construídas três categorias: "Sinais de alerta para o suicídio", relacionada com os sinais identificados pelos profissionais; "Fatores de risco para o suicídio", que apontam os motivos que podem levar os adolescentes a apresentarem este tipo de comportamento; e, "Dificuldades em lidar com os comportamentos" referentes às condutas adotadas pelos adolescentes e as dificuldades dos professores frente ao tema. Conclusão. Foi possível identificar que os professores reconhecem alguns sinais de comportamento suicida assim como alguns fatores de risco. Porém, é preciso qualificá-los para a abordagem ao assunto, visto que se sentem inseguros para agir em momentos mais críticos, gerando principalmente sentimentos de tristeza, culpa e impotência.

A Prospective Observational Study Of Evaluation Of Progress Of Labour With Partograph In Primigravida And Multigravida

Background:Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour.Material And Methods:This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in thisstudy. Individual partograph was studied to know the various aspect of course of labour.Result:208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group inpresent study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as c ompared to Zone A (2%) and Zone B (1.6%).Conclusion:This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity.

Discussion on the reference range and alert level of amisulpride in the treatment of schizophrenia / 四川精神卫生

ObjectiveTo study a therapeutic reference range and laboratory alert level of amisulpride in the clinical treatment of schizophrenia. MethodsPatients who met the diagnostic criteria for schizophrenia in the International Classification of Diseases， tenth edition （ICD-10） were enrolled， and all patients received amisulpride treatment. Data including age， gender， duration of treatment， single daily dose， clinical diagnosis， amisulpride concentration， the scores of the Scale for the Assessment of Positive Symptoms （SAPS）， Scale for the Assessment of Negative Symptoms （SANS） and Positive and Negative Syndrome Scale （PANSS）， the adverse reaction rate and multitherapy were collected. The concentration of amisulpride was compared within different efficacy groups and different dosage groups， meantime， the incidence rate of adverse reactions was compared within different amisulpride concentration groups， and between monotherapy and multitherapy groups. Thereafter， the therapeutic reference range and laboratory alert level of amisulpride in the clinical treatment of schizophrenia were explored via estimating the negative and positive predictive values. ResultsThe amisulpride concentration yielded no statistical difference within different dosage groups and different efficacy groups （F=0.745， 1.343， P>0.05）. The single daily dose among patients in different efficacy groups demonstrated no significant difference （F=0.902， P>0.05）. The correlation between amisulpride treatment efficacy and its concentration denoted no statistical significance （r=0.023， P=0.744）. The clinical efficacy and adverse reaction rate showed no significant difference between monotherapy group and multitherapy group （F=2.198， 0.095， P>0.05）. The concentration of amisulpride was not linearly correlated with the adverse reaction rates ［y=100x/（78.13+x）， r=0.960］. When amisulpride concentrations ranged from 100 to 600 ng/mL， the mean reduction rate was equal to or above 42%， the effective detection rate of the reference cut-off value was equal to or above 1.485， and the incidence of adverse reactions was equal to or below 85%. When amisulpride concentrations ranged from 1400 to 1800 ng/mL， there was a decreasing trend in reduction rate （all<42%） and an increasing trend in adverse reaction rate （all>85%） as the concentration of amisulpride increased. ConclusionA reference range of 100~600 ng/mL and an alert level of 1400 ng/mL are recommended for the clinical safety of amisulpride.

Preservation of hearing in partial deafness patients who received two different regimes of corticosteroid therapy following cochlear implantation: one-year observations

Abstract The objective of this study was to assess how different modes of steroid therapy affect hearing preservation in Partial Deafness Treatment group of patients. In this study, the group consisted of 46 (24 women, 22 men; aged 18-78 years) cochlear implant patients divided into 3 subgroups. In the first subgroup (N = 13), patients underwent standard intravenous (IV) steroid therapy following implantation. In the second (N = 16), patients underwent prolonged treatment with a combination of oral and IV corticosteroids. Third subgroup (N = 17) was a control group who received no steroids therapy. The mean hearing preservation rate was 52.1% (SD = 36.7) in patients receiving standard steroid therapy, 71.4% (SD = 22.7) in patients with prolonged steroid therapy, and 22.1% (SD = 33.9) in control patients. The smallest variation of hearing preservation rate was observed in patients with prolonged steroid therapy and was 9.9 dB. In comparison, the mean change in patients with standard steroid therapy was 11.7 dB and for control patients the figure was 18.0 dB. A combination of intravenous and oral steroid therapy seems to be optimal and stabilizes hearing thresholds and preserves hearing.

Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Evaluación del método de Petroff modificado con solución salina para el diagnóstico de micobacterias en el sistema Bact/Alert 3D / Assessment of Petroff method modified with saline solution for the diagnosis of mycobacteria in Bact/Alert 3D system

Introducción: Existen diferentes métodos de descontaminación de muestras pulmonares para el diagnóstico de micobacterias. El Programa Nacional de Control de Tuberculosis recomienda el método de Petroff modificado con solución salina, pero no existen evidencias documentadas que avalen este método. Objetivo: Evaluar el método de Petroff modificado con solución salina para el diagnóstico de micobacterias en el sistema Bact/Alert 3D. Métodos: Se realizó un estudio observacional analítico de pruebas diagnósticas utilizando 100 muestras pulmonares recibidas en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias del Instituto Pedro Kourí, abril 2016 enero 2017. La muestra se dividió en 3 alícuotas y se descontaminaron mediante 3 métodos; luego se inocularon en los medios de cultivo sólido y líquido. Se compararon los resultados del cultivo en cuanto: tiempo de detección de crecimiento, tasa de contaminación, por ciento de positividad, además se calcularon indicadores de desempeño. Resultados: Al comparar el método Petroff modificado con solución salina con el Petroff modificado con solución fosfato en Löwenstein Jensen, el tiempo de detección de crecimiento, por ciento de positividad y la tasa de contaminación se comportaron de forma similar y la sensibilidad (93,75 por ciento), concordancia (96,47 por ciento) e índice de Youden (0,91) fueron elevadas. Al compararlo el Petroff modificado con solución salina con el N-Acetil-L-Cisteína, las variables no mostraron diferencias significativas y los Indicadores de Desempeño se comportaron por encima del 93 por ciento, para el medio sólido y líquido. Conclusiones: Los resultados avalan la continuidad del uso del Petroff modificado con solución salina como método de descontaminación de las muestras pulmonares en la red de laboratorios de Cuba y como alternativa en el pretratamiento de las muestras para el medio líquido (Bact/Alert 3D), además constituye un soporte para el Programa Nacional de Control de Tuberculosis(AU)

Introduction: There are different decontamination methods of pulmonary samples for the diagnosis of mycobacteria. The National Program for the Control of Tuberculosis recommends Petroff method modified with saline solution; but there are not documented evidences that endorse it. Objective: Assess Petroff method modified with saline solution for the diagnosis of mycobacteria in Bact / Alert 3D system. Methods: An observational analytic study of diagnostic tests was conducted; there were used 100 pulmonary samples received in the National Laboratory of References and Researches of Tuberculosis, Leprosy and Mycobacteria of Pedro Kourí Institute, from April 2016 to January 2017. The sample was divided in 3 aliquots and those were decontaminated using 3 methods; then, they were inoculated in the solid and liquid culture means. Cultures´ results were compared according to: growth's detection time, contamination rate, percent of positivity; in addition, performance indicators were calculated. Results: When comparing Petroff method modified with saline solution with Petroff method modified with phosphate solution in Löwenstein Jensen, the growth's detection time, the percent of positivity and the rate of contamination behaved similarly, and sensitivity (93,75percent), concordance (96,47percent) and Youden´s index (0,91) were high. When the Petroff method modified with saline solution was compared with N-Acetil-L- Cisteina, the variables did not show significative differences and the behaviour indicators were over 93percent for the solid and liquid mean. Conclusions: The results endorse the continuity of the use of Petroff method modified with saline solution as a decontamination method of pulmonary samples in the network of Cuban laboratories and as alternative to the pre-treatment of the samples for the liquid mean (Bact/Alert 3D); it also constitutes a support for the National Program for the Control of Tuberculosis(AU)

EWMA control chart based on its first hitting time and coronavirus alert levels for monitoring symmetric COVID-19 cases

Objective: To define the alert levels for the total number of COVID-19 cases derived by using quantile functions to monitor COVID-19 outbreaks via an exponentially weighted moving-average (EWMA) control chart based on the first hitting time of the total number of COVID-19 cases following a symmetric logistic growth curve. Methods: The cumulative distribution function of the time for the total number of COVID-19 cases was used to construct a quantile function for classifying COVID-19 alert levels. The EWMA control chart control limits for monitoring a COVID-19 outbreak were formulated by applying the delta method and the sample mean and variance method. Samples were selected from countries and region including Thailand, Singapore, Vietnam, and Hong Kong to generate the total number of COVID-19 cases from February 15, 2020 to December 16, 2020, all of which followed symmetric patterns. A comparison of the two methods was made by applying them to a EWMA control chart based on the first hitting time for monitoring the COVID-19 outbreak in the sampled countries and region. Results: The optimal first hitting times for the EWMA control chart for monitoring COVID-19 outbreaks in Thailand, Singapore, Vietnam, and Hong Kong were approximately 280, 208, 286, and 298 days, respectively. Conclusions: The findings show that the sample mean and variance method can detect the first hitting time better than the delta method. Moreover, the COVID-19 alert levels can be defined into four stages for monitoring COVID-19 situation, which help the authorities to enact policies that monitor, control, and protect the population from a COVID-19 outbreak.

High-alert Drug Management and Risk Control in Our Hospital / 中国药房

OBJECTIVE：To explore high-alert drug management mode of our hospital ，and to provide reference for the management and utilization of this category in medical institutions. METHODS ：According to High-alert Drug Catalog （2019 edition）issued by Hospital Pharmacy Committee of Chinese Pharmaceutical Association ，the high-alert drug catalog of our hospital and their risk points were formulated. Relevant training and assessment were conducted for physicians ，pharmacists and nurses throughout the hospital. Using qualification rate of high-alert drug management and utilization as index ，the effectiveness of high-alert drug management and utilization were compared before and after optimization. RESULTS ：In our hospital ，the risk of high-alert drugs was controlled by establishing inspection and supervision group ，pharmacist education ，information management ， prescription review and individualized administration ，medication guidance ，prescription review and medication error reporting and other measures and with continuous optimization. Compared with before optimization ，qulification rate of high-alert drug management and utilization increased from 37.3％ to 80.1％ in clinical departments （P＜0.01），and that increased from 59.2％ to 85.0％ in pharmacy department （P＜0.01）. There were still some problems ，such as the inconsistency of high-alert drugs accounts and materials ，the failure to report all medication errors in time ，the imperfect establishment of prescription review software rules ， the insufficient medication guidance ，and the lack of individual medication varieties. CONCLUSIONS ：By optimizing the management of high-alert drugs ，the management and utlization of this category is improved effectively in clinical departments and pharmacy departments of our hospital.

Markedly raised haemolysis index with upper limit of normal serum potassium levels

@#Introduction: Haemolytic specimens are a frequent occurrence in clinical laboratories, and they interfere with the analysis of many tests. Case report: We describe here an unusual case of leptospirosis complicated by haemolytic anaemia in a 70-year-old man with established kidney failure. He presented with an abrupt onset of shortness of breath, flushing and erythematous rash after completing haemodialysis. The patient’s biochemistry test samples were however rejected twice as they were grossly haemolysed. The integrated auto-verification alert system implemented in the hospital’s laboratory information system alerted the staff of the possibility of in vivo haemolysis. Discussion: The auto-verification alert system effectively distinguishes between in vitro and in vivo haemolysis and as such can be utilised as a diagnostic aid in patients with suspected intravascular haemolysis. Keywords:

New drugs registered in Brazil from 2003 to 2013: analysis from the perspective of child health

This study aims to analyze the new drugs registered in Brazil from 2003 to 2013 from the perspective of childcare needs, drug safety and considering the disease burden of the country. This is a retrospective cohort study including new drugs registered in Brazil between 2003 and 2013. Drug indications were related to the Disability-Adjusted Life Year (DALY) of the 2015 Global Burden of Disease Study. Association between the number of new drugs and DALY was determined by Spearman's coefficient. Post-marketing safety alerts specific to the pediatric population have been identified in the WHO Drug Information Bulletin and on websites of drug regulatory agencies. A total of 134 new drugs were included in the cohort and 46 (34.3%) had a pediatric indication. There was no evidence of an association between the disease burden in children in Brazil and the number of pediatric drugs. The safety alert data associated with the pediatric population published after registration of the new drugs were scarce. The number of new drugs launched in Brazil with a pediatric indication was small, reflecting the international challenges of developing effective and safe medicines for children. No association was found between the number of new drugs and the disease burden.

TrackingStorm: Visualization Tool for a Storm Detector Network (SDN) in the LF Spectrum

Abstract During the last year the Group of Atmospheric Electricity Phenomena (FEA/UFPR) developed a short range lightning location network based on a sensor device called Storm Detector Network (SDN), along with a set of algorithms that enables to track storms, determining the Wide Area Probability (WAP) of lightning occurrence, risk level of lightning and Density Extension of the Flashes (DEF), using the geo-located lightning information as input data. These algorithms compose a Dashboard called Tracking Storm Interface (TSI), which is the visualization tool for an experimental short range Storm Detector network prototype in use on the region of Curitiba-Paraná, Brazil. The algorithms make use of Geopandas and clustering algorithms to locate storms, estimate centroids, determine dynamic storm displacement and compute parameters of thunderstorms like velocity, head edge of electrified cloud, Mean Stroke Rate, and tracking information, which are important parameters to improve the alert system which is subject of this research. To validate these algorithms we made use of a simple storm simulation, which enabled to test the system with huge amounts of data. We found that, for long duration storms, the tracking results, velocity and directions of the storms are coherent with the values of simulation and can be used to improve an alert system for the Storm Detector network. WAP can reach at least 75% of prediction efficiency when used 6 past WAP data, but can reach 98.86% efficiency when more data is available. We use storm dynamics to make improved alert predictions, reaching an efficiency of ~87%.

Factors associated with the clinical deterioration recognized by an early warning pediatric score / Factores asociados al deterioro clínico reconocido por una puntuación pediátrica de alerta temprana / Fatores associados à deterioração clínica reconhecida por um escore pediátrico de alerta precoce

ABSTRACT Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.

RESUMEN Objetivo: identificar los factores asociados al deterioro clínico reconocido por una Puntuación Pediátrica de Alerta Temprana. Método: estudio de corte transversal realizado en un hospital público pediátrico terciario con 271 niños de cero a diez años de edad, hospitalizados entre mayo y octubre de 2015. Para identificar a los niños con y sin signos de deterioro clínico, se aplicó la versión traducida, adaptada y validad del Brighton Pediatric Early Warning Score para el contexto brasileño. Se utilizaron el análisis de regresión logística y la relación de prevalencia (RP) para medir la asociación entre las variables estudiadas. Se adoptaron el Intervalo de Confianza (IC) del 95% y el Valor de p como medida de significancia estadística para identificar los potenciales factores asociados. Resultados: los factores asociados al deterioro clínico de los niños estudiados fueron los siguientes: edad ≤ 2 años (p=0,000), internación en la unidad de emergencia (p=0,000), comorbilidad (p=0,020) y diagnóstico clínico de enfermedad respiratoria (p=0,000). Conclusión: los niños con una edad máxima de 2 años, con alguna comorbidad, con diagnóstico de enfermedad respiratoria e internadas en la unidad de emergencia presentaron una mayor probabilidad de deterioro clínico. Identificar factores asociados al deterioro clínico puede servir como alerta y orientar al equipo de salud hacia los niños más susceptibles a este fenómeno.

RESUMO Objetivo: identificar os fatores associados à deterioração clínica reconhecida por um Escore Pediátrico de Alerta Precoce. Método: estudo de corte transversal, realizado num hospital público pediátrico terciário, com 271 crianças de zero a dez anos, hospitalizadas entre maio e outubro de 2015. Para a identificação das crianças com e sem sinais de deterioração clínica, foi aplicada a versão traduzida, adaptada e validada do Brighton Pediatric Early Warning Score para o contexto brasileiro. Foram utilizadas a análise de regressão logística e a razão de prevalência (RP) para medir a associação entre as variáveis estudadas. O Intervalo de Confiança (IC) de 95% e Valor de p foram adotados como medida de significância estatística para a identificação dos potenciais fatores associados. Resultados: os fatores associados à deterioração clínica das crianças estudadas foram idade ≤ 2 anos (p=0,000), internamento na unidade de emergência (p=0,000), comorbidade (p=0,020) e diagnóstico clínico de doença respiratória (p=0,000). Conclusão: crianças ≤ 2 anos, portadoras de comorbidade, com diagnóstico de doença respiratória e internadas na unidade de emergência apresentaram aumento da probabilidade de deterioração clínica. A identificação de fatores associados à deterioração clínica pode alertar e direcionar a equipe de saúde para crianças mais suscetíveis a esse fenômeno.

Entre sirenes, rotas de fuga e exercícios de simulação: vida cotidiana sob os riscos de desastres / Between sirens, escape routes, and emergency drills: everyday life under the risk of disaster

RESUMO Este artigo problematiza a disseminação institucional recente de dispositivos para a redução de riscos de desastres - caracterizados pela tríade sirenes, sinalização de rotas de fuga e exercícios simulados de emergência - desde uma perspectiva sociológica e em interface com o olhar antropológico. Parte-se metodologicamente da identificação de nexos significativos entre as noções de vida cotidiana, ordem social e communitas para, então, considerar as modulações entre tais nexos no que tange à (in)viabilização do bem-estar coletivo. Embora apresentados no sistema de proteção e defesa civil como sendo estratégias eficazes ante perigos consideráveis, essa reflexão sugere que tais dispositivos de redução de riscos de desastres cumpram uma finalidade subsidiária. Tratar-se-ia de retirar da sociedade uma visão mais crítica sobre as origens dos processos socioambientais geradores de tais perigos. Ao se indagar acerca do quão efetivo esse conjunto de estratégias padronizadas poderia ser diante das dinâmicas socioambientais complexas dos diferentes contextos comunitários nos quais têm sido replicadas, conclui-se que o efeito prático mais preocupante é o de, progressivamente, converter o medo coletivo de uma possível ocorrência de desastres em um meio pelo qual se buscaria naturalizar uma ordem social baseada em comportamentos sociais dóceis a uma ordem social antidemocrática.

ABSTRACT This article aims to present the problematics of the recent institutional dissemination of a given set of disaster risk reduction strategies, characterized by the triad composed by sirens, escape routes, and emergency drills, using a sociological perspective, in interface with the anthropological view. It begins with the identification of significant links of the notions of everyday life, social order, and communitas. Then, it is analysed the modulations of such links, concerning the (in)practicability of the collective wellbeing. Although these are present in the civil protection and defense system as effective strategies when facing considerable dangers, this reflection suggests that such dispositifs for disaster reduction serve a secondary purpose. That is to hinder from society the critical perspective about the origins of the socioenvironmental processes that generates such dangers. By asking how effective this set of standardized strategies could be, given the complexity of socioenvironmental dynamics in different community contexts in which such strategies have been replicated, one concludes that their primary effect is to convert the collective fear of a possibility of occurrence of disaster into a means by which a new non-democratic social order based on docile collective behaviour is emerging.

Utility of paperless partogram in labor management

Background: Partograph use in labor has revolutionized the obstetric care. WHO recommends universal use of WHO modified partograph, which in clinical setup is less often used. Debdas (2006) proposed the paperless partogram which is designed for use by clinician/nurses/midwives as it is very simple and low skill method. The present study is proposed to evaluate the effectiveness of paperless partogram as a bedside tool and its comparison with WHO modified partograph.Methods: It was a prospective analytical study done in department of obstetrics and gynecology, JNMCH, AMU, Aligarh from September 2017 to July 2019 and included 400 pregnant women at term, divided into 2 groups of 100 each Group A (paperless partogram) and Group B (WHO modified partograph) and their labor events were followed.Results: Out of 200 women that were included in each group, maximum women were multigravida, 58.5% in group A and 61.5% women in Group B. Mean age in Group A was 24.68±3.8years and Group B was 24.93±3.75 years. The mean duration of labor in Group A was 3.57±2.20 hours and Group B was 3.40±2.03 hours. There were 87.5% of women who delivered before alert ETD, likewise in Group B; women who delivered before alert line are 88.5%. These differences were statically not significant. Perinatal outcome was also similar in both groups.Conclusions: In our study, the paperless study was found to be as efficient as WHO modified partograph for management of labor. The mean delivery time was 3.57 hours similar to WHO partograph of difference between alert and action line. Thus, for resource poor setting like India with overburdened population paperless partogram can be used as an alternative to WHO modified partograph which is complex and time consuming.

Dengue y COVID-19: semejanzas y diferencias / Dengue and COVID-19: similarities and differences

Dengue y COVID-19 son dos enfermedades que amenazan a poblaciones enteras en la Región de Las Américas y coexisten en Cuba. Tienen semejanzas y diferencias que obligan a los médicos tratantes a hacer el diagnóstico diferencial entre ambas pues cada una puede ser causa de muerte. El objetivo del presente trabajo es contribuir al diagnóstico correcto de cada enfermo y su mejor atención. Se revisaron los conceptos actuales sobre etiología y patogenia de ambas, así como su cuadro clínico, cuidado y prevención. Tanto dengue como COVID-19 tienen un periodo febril y otro crítico, ambas son infecciones sistémicas y sus síntomas iniciales pueden ser parecidos entre sí y no ser los mismos del cuadro típico o característico posterior, particularmente en la edad pediátrica. El dengue define su curso en una semana y la enfermedad por el nuevo coronavirus tiene al menos tres semanas para su restablecimiento o evolución fatal. Cada semejanza y diferencia entre ambas fue objeto de análisis considerando los criterios nacionales e internacionales más actualizados haciendo énfasis en la mejor manera de tratar cada paciente para evitar complicaciones y muerte(AU)

Dengue and COVID-19 are two diseases that threaten many populations in the region of the Americas and which co-exist in Cuba. They both have similarities and differences which force doctors in charge to do a differential diagnosis among both diseases because each can be a cause of death. The objective of this work is contributing to the correct diagnosis of each patient and their better care. There was a review of the current concepts on etiology and pathogenesis of both diseases, as well as their clinical profile, care and prevention. Dengue as COVID-19 has a fever period and a critical one, both are systemic infections and their initial symptoms can be similar and might not be the same of the subsequent typical clinical picture, particularly in pediatric ages. Dengue defines its evolution in one week and the disease caused by the new coronavirus needs at least three weeks for its recovery or fatal evolution. Each similarity and difference among each disease was analyzed taking into account the most updated national and international criteria higlighting the best way to treat each patient avoiding complications and deads(AU)