Pharmacoepidemiological study of potential drug interactions in heart and neurological outpatients.

Background: Drug-drug interaction (DDI) is a potential cause of adverse drug reactions. This study estimates the rate and factors associated with potential DDI in cardiac and neurological prescriptions from the out-patient department of various hospitals. Methods: A cross-sectional study was conducted from February to April, 2014 in various outpatients department of different hospitals in Indore. Total 60 prescriptions of cardiac and 60 prescriptions of neuro patients were collected from different hospitals. All the prescriptions were analyzes by various pharmaceutical and medical books, drug interaction checker software, and journals, etc. Results: Prescriptions having moderate drug interactions are more than that of severe and minor interactions and severity of the interaction found moderate in both type of prescriptions. Among cardiac patients 75% are male and 25% are females including all age groups, and in neuro patients, 58.33% are male, and 41.66% are females including all age groups. Types of drug interaction found in prescriptions are as follow, severe interaction (13% in cardiac, 8% in neuro), and moderate interaction (45% in cardiac, 37% in neuro), minor interaction (17% in cardiac, 25% in neuro), interaction not found (25% in cardiac, 30% in neuro patients). Conclusion: The hazards of prescribing many drugs, including side-effects, DDI and difficulties of compliance have long been recognized as particular problems when prescribing. Proper emphasis should be given to drug information center and training of clinical pharmacy across the country, which can play an important role in minimizing DDIs.

Consideraciones prácticas sobre la cirugía oftalmológica en el paciente cardiópata / Practical considerations on eye surgery in the cardiac patient

La responsabilidad de la evaluación preoperatoria integral en las intervenciones oftalmológicas, con frecuencia recae en el cirujano, quien debe identificar a los afectados con riesgo cardiovascular incrementado y tomar a tiempo las medidas para evitar complicaciones de esta índole. El presente artículo se enfoca en tales aspectos, definiendo las acciones que corresponden directamente al oftalmólogo, aquellas en que funge como gestor, y las que rigurosamente no le competen. También se exponen las estrategias farmacológicas más modernas, con énfasis en el consumo de antiagregantes plaquetarios o anticoagulantes y en la necesidad de la profilaxis antimicrobiana; se refieren las entidades cardíacas inestables que, salvo escasas excepciones, exigen postergar la intervención, y los principios del tratamiento en las enfermedades cardiovasculares más comunes.

Responsibility for comprehensive preoperative evaluation in ophthalmologic interventions often falls on the surgeon, who should identify those patients with increased cardiovascular risk and take timely measures to prevent these complications. This article focuses on such aspects, defining the actions that correspond directly to the ophthalmologist, those in which he serves as manager, and those which do not concern him rigorously. The most modern pharmacological strategies are also described, with emphasis on the use of antiplatelet drugs or anticoagulants and on the need of antimicrobial prophylaxis; unstable heart entities, which, with few exceptions, require postponing the intervention and treatment principles in the most common cardiovascular diseases are referred.

Training in physical examination using a cardiac patient simulator for medical students during bedside learning / 医学教育

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.<br>1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.<br>2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.<br>3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.<br>4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.<br>Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

Cirurgia torácica geral em pacientes cardiopatas / Non-Cardiac Thoracic Surgery in Cardiac Patients

PURPOSE: To analyse the main cardiac risk factors responsible for immediate and late outcomes in patients undergoing thoracic surgeries. METHODS: We performed a retrospective analysis of 90 cases of cardiac patients submitted to non-cardiac thoracic surgeries. Surgeries were divided into greater ones and others and the heart diseases into severe and mild disease. We analysed immediate and late complications, and the mortality inside these groups. RESULTS: We found a greater morbi-mortality in the greater surgeries group and a greater late mortality in the severe heart disease group. There were evidences that the degree of the heart disease does not influence immediate outcome. CONCLUSION: The heart disease was not a limiting immediate risk for surgery.