Development and influential factor analysis of pharmacy outpatient departments in 714 Chinese tertiary healthcare institutions / 中国药房

OBJECTIVE To investigate the basic situation of developing pharmacy outpatient departments in Chinese tertiary medical institutions and analyze the influencing factors. METHODS The research targeted the pharmacy outpatient department managers of hospitals and conducted a survey through Sojump in March 2023. Various independent variables were selected from the hospital’s own characteristics， the management of the pharmacy outpatient departments， and the construction of the pharmacist team for Logistic and linear regression analysis， with the aim of separately analyzing the factors influencing the establishment of pharmacy outpatient departments and the factors affecting the total number of patients served by these departments throughout the year 2022. RESULTS & CONCLUSIONS A total of 1 304 medical institutions of different levels nationwide participated in this survey， with 714 tertiary hospitals. Among the tertiary hospitals， 377 （52.80%） had established pharmacy outpatient departments， including 321 grade-A tertiary hospitals， 48 grade-B tertiary hospitals and 8 other tertiary hospitals. The 377 tertiary hospitals collectively operated 1 739 pharmacy outpatient departments， covering 19 specialized fields， with the highest proportion found in the cardiovascular field （including anticoagulation） at 16.45%. Tertiary hospitals in North China， Central China， East China and South China regions had more pharmacy outpatient departments. The establishment of pharmacy outpatient departments was found to be influenced by tertiary grade-B status （P＝0.010） and the annual outpatient volume of the hospital （P＝0.008）， although the impact was relatively small. The factors influencing the number of patients served by pharmacy outpatient departments were the annual outpatient volume of the hospital （P＝0.042） and the number of pharmacists engaged in clinical pharmacy work （P＝0.004）. The proportion of tertiary hospitals in China that have established pharmacy outpatient departments is insufficient. It is necessary to further accelerate the construction of pharmacy outpatient departments and appropriately expand the talent pool of hospital pharmacy teams based on the needs of pharmacy outpatient departments and patients， in order to meet the requirements of medical practice and patient care.

Detección molecular de patógenos en deposiciones en niños consultantes por diarrea aguda en Servicios de Urgencia

Introducción: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. Objetivo: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. Métodos: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. Resultados: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. Discusión: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

Background: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. Aim: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. Material and Methods: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. Results: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. Discussion: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

Automatic transfer of diversion pouches among Blood Transfusion Departments: a multicenter observation and study / 中国输血杂志

【Objective】 To explore the significance of automatic transfer of diversion pouches in blood transfusion departments on improving the standardization of quality management. 【Methods】 A total of 16 548 diversion pouches of suspended red blood cells (sRBC) were collected from Blood Transfusion Departments of ten tertiary hospitals in China. The sRBC was supplied by local blood centers from January to March 2021. The diversion pouches were randomly divided into experimental group (n=8 274, using DS-6800A automatic for transferring) and control group (n=8 274, manual transfer). The transfer duration of diversion pouches labels, whole process operation time of diversion pouches, label accuracy after transferring, table cleanliness and accurate transfer rate of diversion pouches of the two groups were recorded and compared. 【Results】 The results of experimental group and control group were as follows: transfer duration(s) of diversion pouch labels was 0.67±0.3 vs 3.67±0.6(P<0.05); whole process operation time was 16.93±0.5 vs 19.85±1 (P<0.05); label accuracy after transferring was 100% (8 274/8 274) vs 97.91% (8 101/8 274); table cleanliness was 99.19% (8 207/8 274) vs 94.39% (7 810/8 274); transfer accuracy was 100%(8 274/8 274) vs 95.85% (7 931/8 274). 【Conclusion】 Automatic transfer of diversion pouches of blood samples can improve the efficiency and quality of the sample transfer, and is conductive to the standardization of internal quality evaluation and control of blood transfusion departments.

Explored the Function of Electromagnetic Compatibility (EMC) of Medical Devices from the Perspective of Test / 中国医疗器械杂志

OBJECTIVE@#To improve the electromagnetic compatibility (EMC) quality of medical devices, improve the efficiency of EMC testing, and promote the speed of market approval.@*METHODS@#The unqualified cases of EMC test items of medical devices in recent years were statistically analyzed, and the reasons of low EMC quality of medical devices were analyzed from the perspective of test.@*RESULTS@#Based on the analysis of the reasons, the suggestions were given from the perspectives of medical device manufacturers and testing organizations.@*CONCLUSIONS@#In order to ensure the quality of EMC of medical devices, medical device manufacturers, regulatory authorities and inspection and testing institutions should strengthen the monitoring and evaluation of medical device electromagnetic compatibility, to ensure the safety of products work together to promote the development of the medical device industry healthily and orderly.

Principles & Functions Of Conventional & Digital X-Rays Imaging Systems In Diagnosis

Digital radiography (DR) is an advanced form of x-ray inspection which produces a digital radiographic image instantly on a computer. This technique uses x-ray sensitive plates to capture data during object examination, which is immediately transferred to a computer without the use of an intermediate cassette. The incident x-ray radiation is converted into an equivalent electric charge and then to a digital image through a detector sensor. Compared to other imaging devices, flat panel detectors, also known as digital detector arrays (DDAs) provide high quality digital images. They can have better signal-to-noise ratio and improved dynamic range, which, in turn, provides high sensitivity for radiographic applications. Flat panel detectors work on two different approaches, namely, indirect conversion and direct conversion. Indirect conversion flat panel detectors have a scintillator layer which converts x-ray photons to photons of visible light and utilise a photo diode matrix of amorphous silicon to subsequently convert the light photons into an electrical charge. This charge is proportional to the number and energy of x-ray photons interacting with the detector pixel and therefore the amount and density of material that has absorbed the x-rays. Direct conversion flat panel detectors use a photo conductor like amorphous selenium (a-Se) or Cadmium telluride (Cd-Te) on a multi-micro electrode plate, providing the greatest sharpness and resolution. The information on both types of detectors is read by thin film transistors. In the direct conversion process, when x-ray photons impact over the photo conductor, like amorphous Selenium, they are directly converted to electronic signals which are amplified and digitised. As there is no scintillator, lateral spread of light photons is absent here, ensuring a sharper image. This differentiates it from indirect construction.

PRINCIPLES OF X-RAY TECHNOLOGY IN MEDICAL IMAGING AND IMPROVEMENT OF RADIOLOGICAL IMAGES (2nd Part)

Radioisotopes are unstable nuclei of elements (eg Molybdenum 99), which are transformed into stable nuclei while emitting radiation (particles, photons). This phenomenon is characterized as radioactivity. Radioactivity can be natural or artificial. Artificial radioactivity is that observed in isotopes produced artificially in a laboratory. The study of radioactive isotopes in combination with the development of systems for the detection of emitted radiation, was the trigger for the investigation of possible applications of radioisotopes in medicine. This research resulted in the creation of a new science, Nuclear Medicine, whose main purpose is to apply the properties of radioisotopes in the diagnosis and treatment of human diseases.

PRINCIPLES OF X-RAY TECHNOLOGY IN MEDICAL IMAGING AND IMPROVEMENT OF RADIOLOGICAL IMAGES (1st Part)

The X-ray tube is one of the most important components in any X-ray system. In the beginning, physicists and physicians used gas ion tubes. The so-called Coolidge tube applied a high vacuum and is still used today. Medical examinations have required continuously improved designs of X-ray tubes (smaller focal spots at a higher output). The principle of the Goetze line focus is still applied in any diagnostic X-ray tube. Different anode materials and the rotating anode contributed to an increased output and reduced exposure time. Bearings needed special attention. Spiral groove bearings are the most advanced design today. The heat storage capacity of the anode and the tube housing assembly influences examination time and patient throughput. Cardiac imaging required less motion blurring in cine film images and increasing radiation exposure in interventional procedures calling for measures to reduce dose. Protection against radiation and electric shock has always been a concern of design engineers. Focal spot sizes dedicated to specific applications and heat management within the total tube housing assembly will be future issues. Even in the event of ultrasound and MR technology, X-ray procedures will still be applied for diagnostic and interventional purposes.

PRINCIPLES OF MAGNETIC RESONANCE TECHNOLOGY IN MEDICAL IMAGING OF NON IONIZATION IMAGES

The X-ray tube is one of the most important components in any X-ray system. In the beginning, physicists and physicians used gas ion tubes. The so-called Coolidge tube applied a high vacuum and is still used today. Medical examinations have required continuously improved designs of X-ray tubes (smaller focal spots at a higher output). The principle of the Goetze line focus is still applied in any diagnostic X-ray tube. Different anode materials and the rotating anode contributed to an increased output and reduced exposure time. Bearings needed special attention. Spiral groove bearings are the most advanced design today. The heat storage capacity of the anode and the tube housing assembly influences examination time and patient throughput. Cardiac imaging required less motion blurring in cine film images and increasing radiation exposure in interventional procedures called for measures to reduce dose. Protection against radiation and electric shock has always been a concern of design engineers. Focal spot sizes dedicated to specific applications and heat management within the total tube housing assembly will be future issues. Even with the event of ultrasound and MR technology, X-ray procedures will still be applied for diagnostic and interventional purposes.

Safety and efficacy of video DLT (VDLT) for lung isolation during the COVID?19 pandemic

One lung ventilation (OLV) with collapse of the ipsilateral lung is a prerequisite for most thoracic surgical procedures. Double?lumen tube (DLT) is still the preferred method to isolate the lungs and fiberoptic bronchoscopy (FOB) is the gold standard for the confirmation of correct placement of the DLT. However, both these procedures are considered as a high?aerosol?generating procedures and are hazardous to the health workers, particularly at this time of the COVID?19 pandemic. We did nine thoracic surgery cases categorized as essential, requiring OLV during the ongoing period of the COVID?19 between April 2020 and May 2020 where we used Full view DLT for lung isolation. We present our case series which shows that the Full view VDLT can minimize or circumvent the use of FOB during OLV, and reduce the time taken to isolate the lungs thus reducing aerosol in the theater. None of the nine patients required FOB for confirmation of initial positioning nor for diagnosis of intraoperative malposition. The time taken to isolate the lungs was significantly less and the surgical positioning was done under real?time monitoring by visualizing the blue cuff distal to carina at all times. The real?time monitoring by the Full view VDLT offers the additional advantage of detecting any malposition even before it results in loss of isolation or desaturation. We conclude that the Full view VDLT is an efficient and safe alternative for lung isolation at this time of the COVID?19 pandemic.

Analysis on the department distribution and workload of physicians in China / 中华医院管理杂志

Objective:To analyze the department distribution and workload of China′s physician team, and promote the establishment of a well-structured physician team.Methods:Based on the relevant data of Health Statistics Yearbook, the distribution of departments and workload of diagnosis and treatment of physicians during the 13th Five-Year Plan period were analyzed. Results:During the " 13th Five-Year Plan" period, the number of physicians increased by an average of 6.11% per year, of which the average annual growth rate in medical cosmetology and rehabilitation medicine exceeded 10%, and the number of infectious disease physicians declined. The daily visits per physician decreased by an average of 4.67% per year, and the daily inpatients per physician decreased by 4.14%. Among them, the daily visits per physician in infectious diseases, preventive health care, oncology had increased overall, and the daily inpatients per physician in medical cosmetology, dental had decreased the most.Conclusions:It is suggested to optimize the professional structure and department distribution in accordance with the principle of " matching medical service needs with a certain workload" , and promote the establishment of a physician team with reasonable distribution to better meet medical service needs.

Discussion on the performance reform of administrative and logistics personnel in a large public hospital / 中华医院管理杂志

Because the work of administrative and logistics personnel in public hospitals is difficult to quantify and evaluate, its performance reform is difficult. A large public hospital in Wuhan has explored and established a distribution incentive mechanism that combines department performance appraisal, individual classification and grading, and secondary distribution within the department. Taking into account the completion of performance appraisal indicators of the national tertiary public hospital in the department, the results of the institutional " Excellent Management Team Ranking" , personal job grades, working years and other factors, a relatively mature and operable system has been formed, which could provide reference for the performance reform of other hospitals.

Investigating Emergency Department Healthcare Professionals’ Intention to Use the Poison Information System

@#Introduction: The objective of this paper is to investigate the behavioural intention to use the Poison Information System (PIS) among healthcare professionals based on the extension of the Technology Acceptance Model. Methods: A quantitative approach used a five-point Likert scale questionnaire adapted from previous research. Data were obtained from 136 health professionals working in the Emergency Department of public hospitals in Malaysia. Results: A multiple linear regression model showed that approximately 40% of the variation in intention to use was related to positive attitude, staff category, and inversely to computer anxiety. Perceived usefulness, perceived ease of use, and computer usage were related to intention to use, but their correlation was accounted for by positive attitude, staff category, and computer anxiety. A factor analysis grouped positive attitude, intention to use, and perceived usefulness on Factor I and perceived ease of use, inverse computer anxiety, and computer habit on Factor II. Cluster analysis indicated three clusters. Gender, age, experience, and staff category were strongly inter-related; intention to use clustered with perceived ease of use and perceived usefulness; positive attitude clustered with computer habit; and the latter two clustered together. Conclusion: These findings show that positive attitude, staff category, and computer anxiety of healthcare professionals, working in emergency departments, may have the greatest effect on PIS usage.

A study on the application of Hay and IPE in the position evaluation of functional departments directors at public hospitals / 中华医院管理杂志

Objective:To conduct a position evaluation of functional departments directors by means of Hay guide-chart profile (Hay) and international position evaluation (IPE) for heads of public hospital departments, and a comparative analysis of the results, for reference in reforming the performance-related pay system of the functional departments.Methods:From July to August of 2021, positions of ten functional department directors of a public tertiary general hospital were selected, and expert groups within and out of the hospital were invited for a position evaluation using both Hay and IPE. Cronbach α and intraclass correlation coefficient were used in the reliability and consistency evaluation. Technique for order preference by similarity to ideal solution (TOPSIS) was conducted to compare the differences between results of both methods, with the position value ranked by quartiles. Results:22 position evaluation forms were issued and 20 were recovered (12 for in-hospital experts and 8 for extramural experts). In Hay evaluation, the scores of medical affairs department and hospital head office were higher, averaging 757.30 and 727.21 respectively, and those of logistics management department were the lowest, being 279.94. In-hospital experts scored lower than those extramural experts on the posts of directors of scientific research management department, Party committee office and medical insurance department, while the scores of the directors of the hospital head office were higher than those extramural experts. In IPE evaluation, the position values of hospital head office and medical affairs department were the highest, averaging 680.25 and 621.00 respectively, and the score of the logistics management department was the lowest, being 365.05. In-hospital experts scored lower than those extramural experts on the posts of directors of Party committee office, scientific research management department and logistics management department, while the scores of the directors of the hospital head office were higher than those of extramural experts. The Cronbach α coefficients of position value scoring of functional department heads evaluated by two evaluation methods were 0.943 (Hay) and 0.800 (IPE) respectively. The hospital head office and medical affairs department ranked the first quartile, the Party committee office and nursing department ranked the second, while the medical insurance department and logistics department ranked the third and fourth respectively. In addition, the ranking differences of the information technology department, human resource department, financial department and scientific research management department were within one quartile. Conclusions:The position evaluation results of Hay and IPE are consistent, but the former is more sensitive. Ranking of position values by quartiles via TOPSIS can support the reform of performance-related pay system of functional departments of public hospitals.

Pediatric emergency preparedness in Canadian family physician offices: A national survey / 世界急诊医学杂志（英文）

@#Family physicians often serve as the primary resource for parents seeking medical treatment for their children, and it is not uncommon for children with medical emergencies to be brought into primary care offices instead of local emergency departments (EDs). Although estimated incidence rates of pediatric emergencies in primary care offices vary based on the definition used, the number of patients seen, and clinic location,[1,2,3] any healthcare provider who sees pediatric patients should be ready for immediate medical intervention to minimize adverse outcomes.

Research on the construction of the evaluation index system of scientific research performance of departments in a tertiary hospital in Xinjiang / 中华医学科研管理杂志

Objective:Constructing a scientific research performance evaluation index system based on the departments of a tertiary hospital in Xinjiang.Methods:Delphi method and the boundary value method are used to establish the scientific research performance evaluation indicators of the hospital clinical departments, then the analytic hierarchy process is used to determine the weights of indicators at all levels.Results:A scientific research performance evaluation index system of a tertiary hospital in Xinjiang was set up, which including 3 first-level indicators, 14 second-level indicators, and 49 third-level indicators.Conclusions:The departmental scientific research performance evaluation index system established has reasonable scientificity, objectivity and feasibility, and it can be used as a reference for the evaluation of scientific research performance of departments in the tertiary hospitals.

Analysis of inpatients proportion of the first five major departments in Dongfang Hospital of Beijing University of Traditional Chinese Medicine from 2015 to 2019 / 国际中医中药杂志

The analysis of inpatients proportion of the first five major department in Dongfang Hospital of Beijing University of Traditional Chinese Medicine from 2015 -2019 helped to determine the future development direction of the hospital and the center of hospital construction. According to the number of patients, the top five key specialties of the hospital are encephalopathy, oncology, cardiovascular medicine, gynecology and respiratory fever. The encephalopathy showed an increasing trend in five years, while the oncology department was relatively stable. The proportion of >65 years old in the department of encephalopathy, oncology, cardiovascular medicine and respiratory fever was 64.59%, 53.25%, 54.79% and 77.37%, respectively. The high proportion of stroke was in brain disease department, high proportion of cancer maintenance and support treatment in the oncology department, and high proportion of unstable angina in cardiovascular department.

Evaluación del tratamiento de la fibrilación auricular valvular y no valvular y su relación con eventos adversos en pacientes hospitalizados en el servicio de urgencias de un hospital de tercer nivel / Evaluation of the treatment of valvular and non-valvular atrial fibrillation and its relationship with adverse events in patients admitted to the Emergency Department of a third level hospital

Resumen Introducción: La fibrilación auricular es la arritmia más frecuente, y a pesar de importantes avances en su tratamiento, sigue siendo una de las principales causas de accidente cerebrovascular, insuficiencia cardíaca, muerte súbita y morbimortalidad cardiovascular en el mundo (1,2). En Colombia se cuenta con muy pocos registros que determinen su prevalencia y patrón epidemiológico. Objetivo: Describir el tratamiento de los pacientes que ingresan al servicio de urgencias con diagnóstico de fibrilación auricular, así como establecer la prevalencia, epidemiología y eventos adversos asociados con el tratamiento. Materiales y método: Se utilizaron los programas EXCEL, para la organización de los datos, y SPSS versión 23, para el análisis. Resultados: Durante el periodo del estudio 105 pacientes fueron admitidos en el servicio de Urgencias con diagnóstico de fibrilación auricular. 58% eran hombres, con promedio de edad de 67.8 años. Las comorbilidades más asociadas a la fibrilación auricular fueron hipertensión arterial y falla cardiaca. El 35% de los pacientes habían tenido alguna complicación cardioembólica, principalmente ataque cerebrovascular, y 12% ingresaron por complicaciones derivadas de la anticoagulación. En la mayoría de los casos se prefirió una estrategia de control de frecuencia cardíaca y anticoagulación. En cuanto al manejo anticoagulante, el 45% fueron tratados con warfarina y el 37% con anticoagulantes orales directos. Se documentaron tres casos de sangrados mayores en pacientes tratados con warfarina y ninguno en pacientes tratados con anticoagulantes orales directos. Conclusión: La fibrilación auricular continúa siendo una de las principales causas de atención en el servicio de urgencias, así como una importante causa de accidente cerebrovascular. Las comorbilidades asociadas son hipertensión arterial y falla cardiaca. La estrategia terapéutica más utilizada es el control de la frecuencia cardiaca y la anticoagulación; adicionalmente, hay un porcentaje creciente de pacientes en tratamiento con anticoagulantes directos.

Abstract Introduction: Atrial fibrillation is the most common arrhythmia, and despite the significant advances in its treatment, it continues to be one of the main causes of cerebrovascular accident, heart failure, sudden death, and cardiovascular morbidity and mortality in the world. In Colombia, there are very few registers that help to determine its prevalence and epidemiological pattern. Objective: To describe the treatment of the patients admitted to the Emergency Department with a diagnosis of atrial fibrillation, as well as to establish the prevalence, epidemiology, and adverse events associated with the treatment. Materials and method: Excel programs were used for the organisation of the data, SPSS version 23, for the analysis. Results: During the study period, a total of 105 patients were admitted into the Emergency Department with a diagnosis of atrial defibrillation. The mean age was 67.8 years and the majority (58%) were males. Arterial hypertension and heart failure were comorbidities most associated with the atrial fibrillation. More than one-third (35%) of the patients had suffered some cardio-embolic complication, mainly a stroke, and 12% were admitted due to complications arising from anticoagulation. Monitoring heart rate and anticoagulation was the preferred strategy in the majority of patients. As regards anticoagulant management, 45% were treated with warfarin, and 37% with direct oral anticoagulants. Three cases of major bleeding were documented in patients on warfarin, and none in patients treated with direct oral anticoagulants. Conclusion: Atrial fibrillation continues to be one of the main causes in the Emergency Department, as well as a significant cause of cerebrovascular accident. Arterial hypertension and heart failure were the most associated comorbidities. The most used therapeutic strategy was monitoring of heart rate and the anticoagulation. Furthermore, there was an increasing percentage of patients on treatment with direct oral anticoagulants.

Triage hospitalario. La clasificación de la atención según el nivel de urgencia, en los servicios de urgencias / Hospital triage. Classification of care according to level of urgency, at emergency departments

El triage hospitalario en los servicios de urgencias es un proceso de valoración clínica preliminar. Permite clasificar a los pacientes según su nivel de urgencia y no por orden de llegada. Prioriza la asistencia de los pacientes graves. Organiza la atención de acuerdo a la demanda, los recursos físicos y humanos disponibles. Debe incluir protocolos que definan la clasificación del nivel de urgencia, los tiempos de asistencia y reevaluación, las intervenciones que se pueden ejecutar en el sector y el registro de las actuaciones. La clasificación del nivel de urgencia se define mediante el triángulo de evaluación pediátrica, el problema principal, las constantes vitales y la consideración de modificadores o alertas. Aunque resulta imprescindible, su uso no está uinversalmente difundido(AU)

At emergency departments, triage is the process of initial clinical assessment. It allows for the classification of patients based on their level of emergency regardless of order of arrival. It prioritizes care for severe patients and organizes care according to the demand and available physical and human resources. The triage should include protocols that define classification of the level of urgency, necessary times for care and reassessment, interventions that may be performed in the area, and recording of the activities. The level of emergency is classified based on the triad of pediatric assessment, consisting of the main complaint, vital signs, and consideration of modifiers or alerts. Although essential, it is not universally used (AU).

Diversidad y distribución de los mamíferos del Perú I: Didelphimorphia, Paucituberculata, Sirenia, Cingulata, Pilosa, Primates, Lagomorpha, Eulipotyphla, Carnivora, Perissodactyla y Artiodactyla / Diversity and distribution of mammals from Peru I: Didelphimorphia, Paucituberculata, Sirenia, Cingulata, Pilosa, Primates, Lagomorpha, Eulipotyphla, Carnivora, Perissodactyla, and Artiodactyla

Resumen Este trabajo presenta una síntesis actualizada del conocimiento de la diversidad y distribución de 11 órdenes de mamíferos del Perú. La información de especies es presentada a nivel de país, ecorregión y por primera vez por departamento. Además, identificamos las especies endémicas para el país y damos los rangos de elevación por especie. Para ello se realizó una revisión exhaustiva tanto de la literatura como de ejemplares en colecciones científicas, además de consultas con especialistas. Aquí, reportamos 191 especies pertenecientes a los órdenes Didelphimorphia (46 spp.), Paucituberculata (2), Sirenia (1), Cingulata (5), Pilosa (8), Primates (42), Lagomorpha (2), Eulipotyphla (3), Carnivora (33), Perissodactyla (2) y Artiodactyla (47, incluyendo 32 cetáceos), de los cuales 22 especies son endémicas para el país. Debido a su alta diversidad y al alto número de cambios taxonómicos los órdenes Chiroptera y Rodentia serán tratados separadamente en futuros artículos. Los registros de especies presentadas en este trabajo, aunado a los reportes recientes de murciélagos (189 especies) y roedores (189 especies) totalizan a una diversidad de 569 especies de mamíferos para el Perú. Finalmente, proporcionamos notas taxonómicas de las especies que presentan cambios con respecto a la anterior lista de mamíferos peruanos. Esperamos que este primer listado de mamíferos por departamentos incentive estudios más detallados de la diversidad peruana a nivel regional.

Abstract This work summarizes recent knowledge regarding the diversity and distribution of 11 Orders of mammals from Peru. Species information is presented for the country, ecoregions and, for the first time, by individual departments. Furthermore, we identified endemic species for the country and provided elevation ranges per species. To compile our information, we conducted an exhaustive review of the scientific literature and specimens in scientific collections, consulting with specialists when needed to verify records. We report 191 species belonging to the orders Didelphimorphia (46 spp.), Paucituberculata (2), Sirenia (1), Cingulata (5), Pilosa (8), Primates (42), Lagomorpha (2), Eulipotyphla (3), Carnivora (33), Perissodactyla (2), and Artiodactyla (47, including 32 cetaceans); 22 of these are endemic to Peru. Due to their high diversity and number of taxonomic changes, the Orders Chiroptera and Rodentia will be treated separately in future articles. The species records presented here, together with previous reports of bats (189 spp.) and rodents (189 spp.) yield a current total 569 species of mammals for Peru. Finally, we provide taxonomic notes for species that exhibit differences with respect to the previously published list of Peruvian mammals. We hope that this first list of mammals by department encourages further studies of Peruvian mammalian diversity at the regional level.

Study Of Potential Drug Interactions Among Eight Major Departments-General Medicine, Orthopedics, Gynecology, Pulmonology, General Surgery, Psychiatry, Otolaryngology And Dermatology Of A Tertiary Care Teaching Hospital In Southern India

Objective: To identify frequency, type, severity and predictors of potential drug-drug interactions(pDDIs), potential drug-food interactions(pDFIs), potential drug-alcohol interactions(pDAIs) and potential drug-tobacco interactions(pDTIs) and most frequently interacting drug combination pairs in hospitalized patients from departments(depts) of General Medicine(GM), Orthopedic(Ortho), Gynecology(OBG), Pulmonology(Pulmo), General Surgery (GS), Psychiatry (Psych), Otolaryngology(ENT) and Dermatology (Derm) of study population. Methods: A Prospective Observational Study was conducted in eight major dept's of a tertiary care teaching hospital for a period of 6 mo. A sample size of 650 prescriptions reflecting admission no's for each department were used. Results: A total of 650 patients were included in the study. Among them, 282(43.4%) were males and 368(56.6%) were females. The mean age of the study population was 39.67±15.23. A total of 487 pDDIs, 734 pDFIs, 586 pDAIs and 159 pDTIs were found out of 650 hospitalized episodes. OBG showed the highest pDDIs and pDAIs. Highest pDFIs and pDTIs were seen in Pulmo. The majority of DDIs were minor, DFIs and DAIs were moderate and DTIs were of major in severity. Pharmacokinetic types of interactions were seen in the majority of the depts. Logistic regression analysis showed that Polypharmacy was associated with the occurrence of DIs. Most of the DIs repeated several times in particular depts and a list of these combinations was prepared. Conclusion: With the high occurrence of overall DIs and characteristic patterns of DIs combination pairs among different departments of the hospital, the presence of clinical pharmacists in hospitals can play a great role, especially in developing nations like India where their role in hospitalized settings is always controversial.