Incidentes en oftalmología: estudio nacional en Argentina / Incidents in ophthalmology: A National Survey in Argentina

Resumen Objetivo: Realizar un análisis descriptivo de los incidentes en oftalmología reportados por médicos oftalmólogos de Argentina. Métodos: Se realizó un estudio basado en una encuesta desarrollada mediante un sistema electrónico, en agosto de 2021, dirigido a médicos oftalmólogos de Argentina. Se solicitó la descripción de incidentes oftalmológicos, clasificándolos en cuatro grupos, acorde a lo descrito por Organización Mundial de la Salud, en A: "Incidentes, casi-accidentes (no alcanzaron a los pacientes)"; B: "Incidentes (que alcanzaron al paciente, pero sin daño)"; C: "Incidentes prevenibles con daño" y D: "Incidentes no prevenibles con daño". El instructivo de la encuesta explicó la terminología y ofreció ejemplos de cada tipo de incidentes, que fueron evaluados mediante un proceso estadístico descriptivo. Resultados: Participaron 264 médicos oftalmólo gos quienes informaron 434 incidentes. A- Incidentes sin alcance al paciente: 125 casos (28.8%). B- Incidentes que alcanzaron al paciente sin daño: 117 casos. (27%). C- Incidentes prevenibles, con daño: 96 casos (22.1%). D- Incidentes no prevenibles con daño: 96 casos (22.1%). Los incidentes vinculados al uso de gotas fueron los más frecuentes en los 4 grupos (68, 75, 13 y 29 incidentes respectivamente). Conclusión: El 77.9% de los incidentes comunicados en este estudio se podrían haber evitado con adecuadas medidas de seguridad, siendo los más frecuentes los asociados a la utilización de gotas oftálmicas.

Abstract Objective: To perform a descriptive analysis of incidents in ophthalmology reported by ophthal mologists of Argentina. Methods: A questionnaire-based study was performed by an electronic survey during August 2021, including ophthalmologists of Argentina, requesting the description of ophthalmological incidents, which were classified in four groups, in accordance with World Health Organization Definition, as follow: A- "Inci dents, almost-accidents (patient no affected)"; B: "Incidents (patient affected without damage)"; C: "Preventable incidents, with damage", and D: "Not Preventable incidents, with damage". An instructive was supported in the survey explaining these definitions with examples of each kind of incidents. Data was processed for descriptive statistics. Results: The survey was performed by 264 ophthalmologists, reporting 434 incidents: A- Incidents, almost-accidents (patient not affected): 125 cases (28.8%). B- Incidents (patient affected without damage): 117 cases (27%). C- Preventable incidents, with damage: 96 cases (22.1%). D- "Not Preventable incidents, with damage: 96 cases (22.1%). In four groups the most frequent incidents were those associated with the use of ophthalmic drops (68, 75, 13, and 29 incidents respectively). Conclusion: Most of the incidents (77.9%) reported in this study could be avoided if appropriate safety measures were taken. Ophthalmic drops related incidents were the most frequent.

Media surveillance of occupational chemical incidents in 2021 / 公共卫生与预防医学

Objective To understand the occurrence characteristics of occupational chemical incidents in China by media surveillance, to provide scientific evidences for formulating effective prevention and control strategies, and to provide new ideas for public surveillance and early warning of chemical incidents. Methods Occupational chemical incidents were collected and sorted through the Internet every day. The statistical analysis was conducted from time, region, industry, and causes of the collected incidents. Results A total of 99 occupational chemical incidents were collected in 2021, involving 356 peoples and 186 deaths. April to July was the high incidence period of events, mainly limited space poisoning and asphyxiation events. Majority of the incidents were general grade events, mainly occurring in small and medium enterprises. Guangdong Province had the most incident reporting areas. Incidents mainly occurred in chemical raw material and chemical product manufacturing industry as well as in water production and supply industry, mainly in manufacturing, cleaning and maintenance positions. The main types of poisons were asphyxiating gases and organic solvents, mainly involving hydrogen sulfide and benzene. The incidents could have been caused by lack of safety awareness, leakage of equipment, and lack of protective measures. Conclusion Occupational chemical incidents still occur frequently and cause serious harm. It is suggested that the relevant departments and employers should strengthen supervision and management, effectively manage and control operational risks, and increase supervision of key industries and positions, to ensure the health and safety of workers.

Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

Preparação do enfermeiro para o atendimento í múltiplas ví­timas no resgate aéreo / Preparation of nurses to meet multiple victims in air recue

Objetivo: Caracterizar a atuação do enfermeiro de bordo, com ênfase no atendimento à múltiplas vítimas. Metodologia: Estudo exploratório e qualitativo. Os dados foram obtidos por meio de questionários semiestruturados, aplicados nosenfermeiros debordo em Belo Horizonte/MG. Utilizada a técnica metodológica de Bola de Neve (Snowball Sampling) e analisesob o conteúdo de Laurence Bardin. Resultado: Dos enfermeiros atuantes no resgate aéreo, que aceitaram participar, a maioria são do sexo masculino, possuem a renda familiar média de nove salários mínimos, mais de um vínculo empregatício, experiência média de seis anos. A partir da análise dos dados, as categorias elencadas foram: Atendimento Sistematizado e Capacitação Aeromédica. Conclusão: É preciso reconhecer o papel do enfermeiro no atendimento as vítimas no resgate aeromédico. Vale ressaltar a importância da capacitação para alcançar a excelência, no ambiente hostil confinado.(AU)

Objective: To characterize the role of the nurse on board, with an emphasis on attending to multiple wounds. Methodology: Exploratory and qualitative study. Data were obtained through semi-structured, scientific questionnaires on board nurses in Belo Horizonte / MG. The Snowball methodological technique was used and analyzed under the content of Laurence Bardin. Result: Of the nurses working in the air rescue, who agreed to participate: the majority are male, have an average family income of nine relative, more than one job, average experience of six years. From the analysis of the data, according to the categories listed were: Systematized Service and Aeromedical Training. Conclusion: It is necessary to recognize the role of the nurse in the care aswounds in the aeromedical rescue. It is worth emphasizing the importance of training to achieve excellence in a confined hostile environment.(AU)

Objetivo: Caracterizar a atuação do enfermeiro de bordo, com ênfase no atendimento à múltiplas vítimas. Metodologia: Estudo exploratório e qualitativo. Os dados foram obtidos por meio de questionários semiestruturados, aplicados nosenfermeiros debordo em Belo Horizonte/MG. Utilizada a técnica metodológica de Bola de Neve (Snowball Sampling) e analisesob o conteúdo de Laurence Bardin. Resultado: Dos enfermeiros atuantes no resgate aéreo, que aceitaram participar, a maioria são do sexo masculino, possuem a renda familiar média de nove salários mínimos, mais de um vínculo empregatício, experiência média de seis anos. A partir da análise dos dados, as categorias elencadas foram: Atendimento Sistematizado e Capacitação Aeromédica. Conclusão: É preciso reconhecer o papel do enfermeiro no atendimento as vítimas no resgate aeromédico. Vale ressaltar a importância da capacitação para alcançar a excelência, no ambiente hostil confinado.(AU)

Medical Safety Committee Report :Medical Accident Information and Minor Incidents from Medical Institutions Related to Kampo Products / 日本東洋医学雑誌

The Medical Safety Committee analyzed the case reports of minor incidents from the pharmacies last time as part of an activity to promote patient safety in Japanese traditional Kampo medicine. This time, we analyzed the case reports of medical accidents and minor incidents from the medical institutions. We extracted 626 reports related to Kampo products from the public database, which the Japan Council for Quality Health Care has established based on the collected information related to the medical accidents and minor incidents. The medical accident information includes case reports related to drug-induced liver injury. The minor incident reports include prescribing error due to misinterpretation related to the quantity of one sachet of Kampo extract product, dispensing error due to similarity of product appearance, number or name, and administration error due to judging the medicine only by Kanji characters or product company names without checking the Kampo formula name. Additionally, the minor incidents were often discovered by people belonging to different professions or patients themselves. In order to promote patient safety, knowledge about these incidents should be shared among the people involved in the same or different professions.

A Prospective Observational Study to Find the Incidence of Position Related Injuries in Patients Undergoing Urological Procedures under Anaesthesia.

The entire operating team shares the responsibility of patient positioning before a surgical procedure. It is of prime importance to maintain a balance between optimal surgical positioning and the safety of the patient as many of these positions can induce adverse physiological consequences which can affect the haemodynamics of the patient. This study was conducted with the primary objective of determining the incidence of position related injuries and incidents and to analyse the risk factors associated in patients undergoing urological procedures under anaesthesia. The secondary objective was to study the time taken for the injury to resolve and their management.METHODSThis is a prospective observational study carried out in adult subjects undergoing urological procedures over a period of 6 months. A thorough preoperative evaluation was carried out which included history taking, examination, preoperative neurological and vascular examination, and pertinent investigations. After the patient was anaesthetized and operative position decided, the nature of position, time taken to position, number of people involved, and the positioning aids used were noted. Any adverse hemodynamic changes occurring during or after the positioning were noted. At the end of the surgery the patient was re-examined for any injuries or incidents related to positioning. Factors contributing to positional injury were categorized and the management of these injuries and the progress was followed up. An analysis sheet was attached. Statistical analysis was done with the help of SPSS Software ver. 10.RESULTSOnly one patient sustained nerve injury. The incidence of position related injuries was about 2.1 % with more injuries in patients with general anaesthesia, longer duration of surgery, in those with low BMI. The incidence of position related incidents was seen to be 3.4% with most common event being hypotension requiring vasopressors and was more prevalent in those undergoing surgery under general anaesthesia.CONCLUSIONSIn conclusion, it must be stressed that utmost care must be taken to avoid the occurrence but also to counsel patients undergoing surgeries about the rare possibility of positioning related injuries and incidents under anaesthesia. Every effort should be taken to analyse the underlying precipitating factors and correct them. Symptomatic incidents leading to unstable haemodynamic condition should be treated promptly.

Committee for Medical Safety Report : Example of Minor Incidents in the Preparation of Kampo Products in Pharmacy / 日本東洋医学雑誌

We collected and analyzed the case reports of minor incidents in the preparation of Kampo products in Japanese pharmacies in order to manage the medical safety control in Japanese traditional Kampo medicine. We extracted 2,166 reports that are related to Kampo products from the database of minor incidents in pharmacies supplied from The Japan Council for Quality Health Care from 2009 to 2019. Among the reports, we found the cases that pharmacists could find the mistakes about the name, dosage and administration of Kampo products or could prevent the appearance of adverse reaction when pharmacists check the prescription and ask prescription question for doctors. It is suggested that the system of separation of dispensing and prescribing functions would be well working in medical safety control. At the same time, we also found many cases that pharmacists have actually made mistakes by confusing the name of Kampo products and dosage. In this report, we summarized the cases of these minor incidents and frequently appearing confusions about the names of Kampo products.

Aplicabilidade da simulação realística na graduação de enfermagem: experiência em incidentes com múltiplas vítimas / Aplicabilidad de la simulación realista en el pregrado en enfermería: experiencia en incidentes con múltiples víctimas / Applicability of realistic simulation in nursing graduation: experience in incidents involving multiple victims

Objetivo descrever a aplicabilidade de uma simulação realística de incidentes com múltiplas vítimas no processo de ensino-aprendizagem na enfermagem. Método estudo descritivo, com abordagem quantitativa que envolveu uma simulação realística. Participaram da simulação 250 pessoas, sendo incluídos no estudo 30 acadêmicos de enfermagem. Para a coleta de dados, aplicou-se um questionário para analisar a experiência acadêmica com simulação e paciente simulado. Resultados a maioria (80%) dos alunos não vivenciou experiência anterior com simulação e 53,3% concordaram que houve integração entre medicina e enfermagem durante a simulação. Para 66,7% dos graduandos foi possível colocar seu conhecimento em prática, havendo contribuição para melhora do raciocínio clínico e sobre as condutas realizadas. Conclusão a utilização da simulação realística na graduação de enfermagem é uma estratégia metodológica que contribui para o aprendizado e possibilita aos acadêmicos vivenciarem situações do seu futuro ambiente profissional.

Objetivo describir la aplicabilidad de una simulación realista de incidentes con múltiples víctimas en el proceso de enseñanza-aprendizaje en enfermería. Método estudio descriptivo con abordaje cuantitativo, utilizándose una simulación realista. Participaron 250 personas en la simulación, siendo incluidos en el estudio, 30 estudiantes de enfermería. Para la recolección de datos, se aplicó un cuestionario para analizar la experiencia académica con la simulación y el paciente simulado. Resultados la mayoría (80%) de los estudiantes tenía experiencia anterior con la simulación y el 53,3% estuvo de acuerdo en que hay integración entre medicina y enfermería durante la simulación. Para el 66,7% de los estudiantes, fue posible poner sus conocimientos en práctica, contribuyendo a la mejora del razonamiento clínico y comportamientos. Conclusión el uso de la simulación realista en la graduación en enfermería es una estrategia metodológica que contribuye al aprendizaje y permite a los estudiantes experimentar situaciones de su futuro entorno profesional.

Objective to describe the applicability of a realistic simulation of incidents involving multiple victims in the nursing teaching-learning process. Method descriptive study with quantitative approach involving a realistic simulation. The participants were 250 persons, including 30 nursing students. For data collection, a questionnaire was applied to analyze the academic experience with simulation and simulated patient. Results most (80%) students had previous experience with simulation and 53.3% agreed that there is integration between medicine and nursing during the simulation. For 66.7% of the students, it allowed putting their knowledge into practice, contributing to improvement of clinical reasoning and behaviors. Conclusion the use of realistic simulation in undergraduate nursing is a methodological strategy that contributes to the learning and allows students experience situations of their future professional environment.

Incidentes relacionados con resbalos, tropiezos y caídas en una fábrica pulverizadora de leche en el municipio de Valledupar, Cesar / Incidents related to slips, trips and falls in a Milkpulverizer factory in the municipality of Valledupar, Cesar

Introducción: Los incidentes relacionados con resbalos, tropiezos y caídas requieren un enfoque de prevención integral y constante para un desempeño sostenible a largo plazo, enfocado hacia la identificación, evaluación y control, para generar una mejora continua. Objetivo: Determinar las causas de incidentesrelacionados con resbalos, tropiezos y caídas en una fábrica pulverizadora de leche en Valledupar, Cesar. Materiales y métodos: Estudio descriptivo transversal; se utilizaron como instrumentos, la matriz de riesgos de la Guía Técnica Colombiana 45/2012 y lista de chequeo Anexo1 de Instrucción Técnica Gu-18.007,06/2016. Resultados: Los mayores reportes estuvieron relacionados con desnivel, hueco, rejillas, tapas de registro en piso, escaleras, objeto prominente en rutas peatonales, sustancias derramadas y rampa/Plataforma. El área con mayor número de hallazgos asociados fue condensación con 19%, con 34% Riesgos Altos y 39% Riesgos Medios. Los agentes causales: Suelo arrojó: riesgo Alto 87.4% y riesgo medio 10.3%; Escaleras: riesgo Alto 85.7%, riesgo bajo 14.3%; Rampas/plataformas: riesgo Alto 60% y riesgo medio 33.3% y para Limpieza y señalización: riesgo Alto 52% yriesgomedio48%.Siendo598RiesgosAltos,145RiesgosMediosy28Riesgos Bajos evaluados en la lista de chequeo del Anexo1 de la Guía Técnica Gu-18.007,06/2016. Para valoración y priorización según Guía Técnica Colombiana 45/2012 fue de 16 Riesgos Muy Altos, 116 Riesgos Altos, 122 Riesgos Medios y 57 Riesgos Bajos. Conclusiones: Se concluye que las principales causas de resbalos, tropiezos y caídas están relacionada con Suelo, Escalera, Limpieza y señalización.

Introduction: The incidents related to slips, trips and falls require acomprehensive and constant preventionapproach for long-term sustainable performance, with an effortfocusedonidentifying,evaluatingandcontrollingthemtogenerateasignificant improvement. Objective: Determine the causes of incidents related to slips, trips and falls in a milk pulverizer factory in Valledupar, Cesar. Design: Descriptive type and cross section. Methodology: Instruments: Risk matrix of the Colombian TechnicalGuide45/2012andChecklistAnnex1ofTechnicalInstructionGu-18.007, 06 / 2016. Results: The biggest reports were related to unevenness, gaps, grids, floor registration caps, stairs, prominent object in pedestrian routes, spilled substances and ramp / Platform. The area with the highest number of associated findings was 19% condensation, with 34% High Risksand 39% Average Risks.The causal agents: Soil showed: High risk 87.4% and medium risk 10.3%, Stairs: High risk85.7%,lowrisk14.3%,Ramps/platforms:Highrisk60%andmediumrisk33.3% and for Cleaning and signaling: High risk 52% and medium risk 48%. For a total of 598 High Risks, 145 Medium Risks and 28 Low Risks evaluated in the checklist of Annex 1 of Technical Guide Gu-18.007,06 / 2016. For valuation and prioritization according to the Colombian Technical Guide 45/2012, it was 16 Very High Risks, 116 High Risks, 122 Medium Risks and 57 Low Risks. Conclusions:Conclusions: It is concluded that the main cause of slips, trips and falls is related to Soil, Ladder, Cleaning andsignaling

Simulação de incidente com múltiplas vítimas: treinando profissionais e ensinando universitários / Multiple victims incident simulation: training professionals and university teaching

RESUMO Objetivo: descrever estratégia de ensino a partir da simulação de Incidente de Múltiplas Vítimas (IMV), discutindo e avaliando a atuação dos discentes envolvidos no atendimento inicial às vítimas de trauma. Métodos: estudo transversal com abordagem quantitativa que contemplou a execução de uma simulação realística de IMV, envolvendo discentes, docentes dos Cursos de Medicina e de Enfermagem, além de profissionais do atendimento pré-hospitalar. Resultados: a partir da análise de 17 checklists, foi possível perceber que a classificação segundo o método START (Simple Triage And Rapid Treatment) aconteceu de forma correta em 94,1% dos atendimentos. Seguindo a avaliação primária com o mnemônico ABCDE, todas as etapas foram realizadas de forma correta em 70%. Contudo, só houve oferta de oxigênio em alto fluxo em 64,7% dos atendimentos. A pesquisa por fontes de sangramento visíveis e ocultas foi realizada em 70,6% dos atendimentos. A avaliação neurológica com a escala de coma de Glasgow e avaliação pupilar ocorreu em 70,6% das vítimas. A exposição da vítima foi realizada em 70,6% dos atendimentos. Conclusão: ambientes simulados permitem a consolidação e o aperfeiçoamento de competências e habilidades profissionais, principalmente quando se trata de uma área pouco treinada na graduação, como o IMV. O treinamento precoce e o atendimento em equipe estimulam o raciocínio clínico, a integração e a comunicação, aspectos essenciais diante de situações caóticas.

ABSTRACT Objective: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. Methods: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. Results: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. Conclusion: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.

Análise dos potenciais eventos adversos e reações adversas a medicamentos em Hospital de Minas Gerais: estudo exploratório sobre os fatores contribuintes / Analysis of potential adverse events and adverse drug reactions at Hospital de Minas Gerais: exploratory study on contributing factors

Eventos adversos (EA) são definidos como lesão ou dano não intencional que resulta em incapacidade ou disfunção, temporária ou permanente, e/ou prolongamento do tempo de permanência hospitalar ou morte em decorrência do cuidado em saúde prestado. Dentre eles estão os incidentes relacionados a medicamentos. Diante da escassez de conhecimento epidemiológico sobre os EA no país, este estudo propôs analisar os incidentes relacionados a medicamentose os potenciais eventos adversos (pEA) registrados em prontuários de internação de adultos em hospital geral do Estado de Minas Gerais, no ano de 2015. Metodologicamente foram utilizados instrumentos de coleta para verificar a ocorrência de pEA e reação advesa medicamentosa (RAM) baseados no Canadian Adverse Events Study:Tracking Form. Foram realizadas análises descritivas considerando grupos de variáveis: características do paciente, dados da admissão, fatores intrínsecos e extrínsecos e critérios de rastreamento de pEA. As análises consistiram em avaliar as frequências absoluta e relativa dos fatores indicados pelo instrumento de coleta. Para a análise das possíveis correlações e associações com pEA e RAM, foram realizados testes de correlação de Spearman, Qui-quadrado e Teste Exato de Fisher, respectivamente. Para a identificação de possíveis preditores de pEA foram realizados Testes de Regressão Logística. Em todos os testes foram adotados nível de significância de e α=0,05 e intervalo de confiança de 95%.Os fatores: orientação do farmacêutico, reconciliação medicamentosa e ordem fonada fornecida pelos médicos foram analisadas descritivamente. Os resultados mostraram correlação positiva entre idade e dias de internação e associação entre pEA e o atendimento via SUS e o tipo de internação eletiva. Houve evidência de associação entre pEA e os fatores intrínsecos: diabetes, insuficiência cardíaca, hipertensão arterial e história de alcoolismo e os extrínsecos:sonda urinária fechada, cateter arterial, cateter venoso central, nutrição enteral, sonda nasogástrica, ventilação mecânica e bomba de infusão.Os resultados mostraram, ainda, associação significativa entre pEA e RAM.A regressão logística apontou que os preditores: atendimento (SUS), caráter eletivo, idade, tempo de internação, hipertensão arterial, diabetes, uso de nutrição enteral, sonda nasogátrica e ventilação mecânica aumentam a chance de pEA. Concluiu-se que as RAM estão associadas ao pEA e que as características dos pacientes (idade) associadas a fatores intrínsecos e extrínsecos, tipo de convênio e caráter de internação podem potencializar a ocorrência de EA em ambiente hospitalar

Adverse events (AE) are defined as unintentional injury or damage not wonted that results in incapacity or dysfunction temporary or permanent disability, and / or extendimy temp of hospital story or death as a result of health care provided. Among them, are the incidents related to medicines, facing the lock of epidemiological. Epidemiological knowledge about AE in the country, this study got proposed to analyze the incidents related to the medicines and potencial adverse events scored in adults and potential adverse events (pAE) recorded in adult hospitalization records in a general hospital in the state of Minas Gerais in the year of 2015, in 2015.It was used Methodologically, instruments to verify the occurrence of Potencial adverse event (pEA) and adverse drug reaction (ADR) by the the Canadian Adverse Events Study: Tracking Form. Descriptive analyzes were accomplished considering groups of variables: features of patient, admission data, intrinsic and extrinsic factors, and pEA screening criteria. The analyzes consisted of evaluating the absolute and relative frequencies of the factors indicated by the collects instrument. For the analysis of possible correlations and associations with pEA and RAM, were accomplisheb tests of Spearman's correlation tests, Chi-square and Fisher's exact tests were performed, respectively. To identify possible predictors of pEA, Logistic Regression Tests were accomplished tests of logistic regression. All over the tests, were adapted level of meaning of α= 0.05 and a confidence interval of 95%. The results have shown positive correlation between age and hospitalization doy and between association between pEA and the treatment by SUS, elective type. were adopted. The factors: pharmacist guidance, drug reconciliation, and phoned order provided by physicians were analyzed descriptively. The results showed a positive correlation between age and days of hospitalization and association between ASD and SUS care and the type of elective hospitalization. There was evidence of an association between pEA and intrinsic factors: diabetes, heart failure, hypertension and history of alcoholism and extrinsic factors: closed urinary tube, arterial catheter, central venous catheter, enteral nutrition, nasogastric tube, mechanical ventilation and infusion pump. The results also showed a significant association between pEA and RAM. The logistic regression indicated that the predictors: attendance (SUS), elective character, age, length of stay, hypertension, diabetes, use of enteral nutrition, nasogastric tube and mechanical ventilation increase the chance of pEA. It was concluded that ADRs are associated with ASP and that patient characteristics (age) associated with intrinsic and extrinsic factors, type of agreement and hospitalization character may potentiate the occurrence of AE in a hospital environment

Differences in Perspectives of Medical Device Adverse Events: Observational Results in Training Program Using Virtual Cases

BACKGROUND: Medical device adverse event reporting is an essential activity for mitigating device-related risks. Reporting of adverse events can be done by anyone like healthcare workers, patients, and others. However, for an individual to determine the reporting, he or she should recognize the current situation as an adverse event. The objective of this report is to share observed individual differences in the perception of a medical device adverse event, which may affect the judgment and the reporting of adverse events. METHODS: We trained twenty-three participants from twelve Asia-Pacific Economic Cooperation (APEC) member economies about international guidelines for medical device vigilance. We developed and used six virtual cases and six questions. We divided participants into six groups and compared their opinions. We also surveyed the country's opinion to investigate the beginning point of ‘patient use’. The phases of ‘patient use’ are divided into: 1) inspecting, 2) preparing, and 3) applying medical device. RESULTS: As for the question on the beginning point of ‘patient use,’ 28.6%, 35.7%, and 35.7% of participants provided answers regarding the first, second, and third phases, respectively. In training for applying international guidelines to virtual cases, only one of the six questions reached a consensus between the two groups in all six virtual cases. For the other five questions, different judgments were given in at least two groups. CONCLUSION: From training courses using virtual cases, we found that there was no consensus on ‘patient use’ point of view of medical devices. There was a significant difference in applying definitions of adverse events written in guidelines regarding the medical device associated incidents. Our results point out that international harmonization effort is needed not only to harmonize differences in regulations between countries but also to overcome diversity in perspectives existing at the site of medical device use.

Guía para la enseñanza del apoyo vital avanzado ante múltiples víctimas. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching advanced life support in the presence of mass casualty. Consensus for the project of training and research in life support. Cienfuegos, 2018

Fundamento: en situaciones de desastres, cuando el número de enfermos o lesionados es alto y los recursos limitados, la atención médica precisa de cambios de estructura y procesos si se quiere salvar un número elevado de personas. El personal de salud debe estar entrenado para enfrentar esta situación cada vez más frecuente. El "Proyecto para la formación e investigación en apoyo vital en emergencias y desastres" puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante víctimas múltiples. Métodos: taller nacional realizado el 10-11 de julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del apoyo vital en situaciones de desastres, tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso "Apoyo vital avanzado ante víctimas múltiples" permiten la preparación de los profesionales de la salud para brindar asistencia médica en situaciones de desastres, con escasos recursos y en ambientes complejos.

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course "Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments.

Sucesos adversos relacionados con el acto quirúrgico en una institución de salud de tercer nivel / Adverse events related to the surgical act in a third level of health care's institution

Introducción: Los eventos adversos constituyen actualmente un problema de salud pública a nivel mundial y un gran reto para los programas de control y prevención. Objetivo: Determinar las causas que ocasionan la presencia de sucesos adversos relacionados con el acto quirúrgico en una institución de salud de tercer nivel. Métodos: Estudio descriptivo con temporalidad retrospectiva realizado en Cali, Colombia en 2015. Se revisaron 164 registros de reporte de evento adverso. Se diseñó un formato de recolección de datos y se tomó como referente el instrumento de reporte de evento adverso del Instituto Nacional de Vigilancia de Medicamentos y Alimentos. Resultados: Los sucesos adversos registrados se clasificaron en eventos adversos prevenibles 58,44 por ciento, eventos adversos no prevenibles 13,64 por ciento, acciones inseguras 22,73 por cinto e incidentes 5,19 por ciento. Conclusiones: Los sucesos adversos obedecen a cancelaciones inoportunas de los procedimientos quirúrgicos, descuido en la administración de medicamentos, identificación incorrecta de pacientes, no lavado de manos por parte del equipo quirúrgico y falta de aseo en el quirófano durante los recambios(AU)

Introduction: The Adverse Event is the result of health care that unintentionally caused harm. Currently, adverse events are a global public health problem and a major challenge for prevention and control programs. Objective: To determine the causes that occasioned the occurrence of adverse events related to the surgical act in a third level of health care's institution. Methods: A descriptive study with retrospective temporality was carried out in Cali, Colombia in 2015. A documentary review was carried out on 164 records of adverse events reporting. A data collection format was designed taking as reference the adverse event reporting instrument of the National Institute for Drug and Food Surveillance. Results: Registered adverse events were classified in preventable adverse events (58.44 percent), non-preventable adverse events (13.64 percent), unsafe actions (22.73 percent), and incidents (5.19 percent). Conclusions: Adverse events are due to untimely cancellations of surgical procedures, neglect in medication management, wrong identification of patients, non-hand washing by the surgical team; and lack of cleanliness in the operating room during refills(AU)

Autoeficacia académica y ansiedad, como incidente crítico, en mujeres y hombres universitarios / Academic Self-efficacy and Anxiety, as a Critical Incident in Female and Male University Students

Resumen Con el objetivo de explorar las relaciones entre la autoeficacia académica y la ansiedad, como inciden te crítico, el presente estudio descriptivo-correlacional incluyó una muestra de 310 estudiantes (183 mujeres y 127 hombres), quienes respondieron a la Escala de Autoeficacia en Conductas Académicas (EACA), la Escala de Ansiedad ZUNG y el Inventario de Ansiedad Estado-Rasgo (IDARE). La prueba de Pearson indicó una correlación positiva significativa entre las puntuaciones de autoeficacia percibida, deseable y alcanzable en EACA, pero una correlación negativa con el índice de mejora de la misma prueba; es decir, los puntajes de autoeficacia percibida, deseable y alcanzable se com portan de manera similar; pero, a medida en que los puntajes de estos tres indicadores disminuyen, la puntuación del índice de mejora es mayor. Por lo tanto, la autoeficacia percibida se tomó como el principal indicador de EACA, la cual se correlacionó inversamente con los puntajes de las escalas de ZUNG e IDARE; es decir, cuanto menor es la autoeficacia percibida mayor es el nivel de ansie dad. En un segundo análisis, un criterio arbitrario permitió definir tres rangos de puntuaciones en autoeficacia percibida: baja (puntuación 1-7.4), intermedia (puntuación 7.5-8.9) y alta (puntuación 9.0-10.0). Un ANOVA de dos vías indicó que los estudiantes, con niveles de autoeficacia percibida baja, obtuvieron los niveles de ansiedad más altos con la conocida tendencia del género femenino a desarrollar mayores puntajes de ansiedad. En conclusión, los estudiantes con baja autoeficacia perci bida manifiestan ansiedad en el momento de la prueba. Permanece pendiente la exploración de una relación causa-efecto.

Abstract: With the aim of exploring relationships between academic self-efficacy and anxiety, as critical incidents, this des criptive study included a sample of 310 students (183 women and 127 men). Volunteers responded to the Self-efficacy in Academic Behavior Scale (EACA), ZUNG anxiety scale and State-Trait Anxiety Inventory (STAI). A correlation analysis was performed between the different levels of perceived, desirable, achievable self-efficacy and an improvement index with anxiety indicators. A Pearson analysis indicated a moderate but significant positive correlation among perceived, desirable, and attainable self-efficacy scores in the EACA test, but a negative corre lation among these three indicators and the same test's improvement index. In other words, perceived, desirable, and attainable self-efficacy scores tabulated similarly, but as the scores of these three indicators rose, the score of the improvement index declined. Therefore, the perceived self-efficacy was taken as main indicator of EACA. The perceived self-efficacy correlated inversely with the scores obtained on ZUNG and STAI scales, i.e., as lower the perceived self-efficacy, the higher the level of anxiety. In second analyses, an arbitrary criterion allowed the esta blishment of three ranges of perceived self-efficacy scores into low (score 1-7.4), intermediate (score 7.5-8.9) and high (score 9.0-10.0). A two-way ANOVA indicated that students in the low range of perceived self-efficacy also scored the highest anxiety levels, with the well-known trend of feminine gender to express high levels of anxiety. In conclusion, students with low perceived self-efficacy are also anxious at the moment of the test, leaving for the future an exploration of a cause and effect relationship.

Reflection on rescue and treatment of mass burn casualties in 21st century / 中华烧伤杂志

The rescue and treatment of mass burn casualties is a test for both the burn treatment level and the disaster emergency response ability of a country or a region. In recent years, burn disasters happened occasionally around the world despite of the improvement of safety level in production and the awareness of fire prevention. On one hand, mass burn casualty events caused catastrophic damages to human health. On the other hand, they also promoted the development of burn treatment and disaster medicine. This paper may provide some references for further improving the management of mass burn casualties in the future by reviewing several typical cases of burn disaster rescue and treatment in the world since the 21st century.

Characteristics of mass casualty chemical incidents: a case series

OBJECTIVE: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. METHODS: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. RESULTS: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. CONCLUSION: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.

Indicadores de Atención Pre Hospitalaria para incidentes viales en Colombia / Prehospital care indicators for road incidents in Colombia / Indicadores de Assistência Pré-Hospitalar para incidentes viários na Colômbia

Resumen La Atención Pre Hospitalaria (APH) reduce la letalidad, minimiza la morbilidad y sus secuelas en situaciones de urgencia y emergencia. Evaluar su grado de desarrollo es relevante. Metodología: Revisión sistemática de literatura, consulta a expertos y prueba piloto de un sistema de indicadores de APH para incidentes viales en Colombia implementado en 6 ciudades, un departamento y una concesión vial. Resultados: Según lineamientos políticos, normativos, conceptuales y metodológicos, internacionales y nacionales, se propuso un sistema de indicadores para ser aplicado según el desarrollo territorial de la APH; hubo diversas dificultades para implementarlo. Conclusión: Es necesario fortalecer los servicios de APH y estandarizar un sistema de información para su monitoreo en el país.

Abstract Prehospital care (PHC) reduces lethality and minimizes morbidity and its effects in urgency and emergency situations. Assessing its degree of development is thus relevant. Methodology: the authors used a systematic review of the literature, inquiries to experts and a pilot test with a system of PHC indicators for road incidents in Colombia which was implemented in 6 cities, one department and one highway concession. Results: according to political, regulatory, conceptual, methodological, international and national guidelines, a system of indicators was proposed to be applied in accordance with the territorial development of PHC. However, there were a number of difficulties to implement it. Conclusion: it is necessary to strengthen PHC and standardize an information system for monitoring it in Colombia.

Resumo A Assistência Pré-Hospitalar (APH) reduz a letalidade, minimiza a morbidade e as suas sequelas em situações de urgência e emergência. Avaliar seu grau de desenvolvimento é relevante. Metodologia: Revisão sistemática de literatura, consulta a especialistas e teste piloto de um sistema de indicadores de APH para incidentes viários na Colômbia implantado em 6 cidades, um estado do país e uma concessão viária. Resultados: De acordo com diretrizes políticas, normativas, conceituais e metodológicas, internacionais e nacionais, propôs-se um sistema de indicadores para ser aplicado segundo o desenvolvimento territorial da APH; houve diferentes dificuldades para a sua implantação. Conclusão: É preciso fortalecer os serviços de APH e padronizar um sistema de informação para seu monitoramento no país.

A hemovigilância no processo de administração de transfusão de hemocomponente para qualidade e segurança do paciente / Hemovigilance in the blood component transfusion administration process for patient quality and safety

O estudo partiu da premissa que a inserção de uma tecnologia irá auxiliar na produção de informações para conhecimento e educação nos processos que necessitam de acompanhamento, monitoramento e avaliação contínua das ações contribuindo com a implementação da política de formação direcionada. Objetivo geral Desenvolver um instrumento de acompanhamento do processo de administração de transfusão de hemocomponente para mitigação e rastreabilidade de incidentes transfusionais. Metodologia estudo descritivo realizado através de observação sistemática do processo de administração de transfusão de hemocomponente em uma instituição pública federal, localizada no Rio de Janeiro com foco no tratamento e cirurgia das doenças cardiovasculares. O estudo foi realizado conforme resolução n°466 de 2012 do Conselho Nacional de Saúde, submetido à Plataforma Brasil e aprovado pelo Comitê de Ética em Pesquisa (CEP) da UNIRIO sob n° CAAE: 51244015.9.0000.5285 e CEP da instituição em que foi realizada a pesquisa sob o n° CAAE: 51244015.9.3001.5272. Foram observadas, 30 transfusões sanguíneas durante os meses de Junho e Julho de 2016. Resultados o estudo evidenciou que conforme o grau de risco, considerando a probabilidade e a severidade dos itens avaliados, todas as etapas do processo avaliado, apresentou Percentual de Conformidades (PC) baixo, ou seja, menor que 60% classificando-as quanto ao potencial grau de risco em alto risco. Conclusão os resultados apontam que mediante a avaliação das conformidades do processo de administração de transfusão sanguínea, há necessidade de uma gestão de ações de vigilância considerando os riscos inerentes identificados, de maneira proativa a fim de prevenir incidentes e minimizar danos associados à terapia, através da implantação de capacitação e educação permanente relacionada à temática. O instrumento irá auxiliar na rastreabilidade, monitorização e mitigação dos riscos de incidentes transfusionais de forma a garantir a qualidade e segurança de todo o processo

The study started from the premise that the insertion of a technology will help in the production of information for knowledge and education in the processes that need monitoring, monitoring and continuous assessment of the actions contributing to the implementation of the targeted training policy. General Objective To develop an instrument to monitor the blood transfusion administration process for the mitigation and traceability of transfusion incidents. Methodology A descriptive study was carried out through a systematic observation of the process of blood transfusion administration at a federal public institution, located in Rio de Janeiro, focused on the treatment and surgery of cardiovascular diseases. The study was carried out according to resolution n ° 466 of 2012 of the National Health Council, submitted to the Brazil Platform and approved by the Research Ethics Committee (CEP) of UNIRIO under n ° CAAE: 51244015.9.0000.5285 and CEP of the institution in which it was performed the research under CAAE: 51244015.9.3001.5272. Thirty blood transfusions were observed during the months of June and July 2016. Results The study showed that according to the degree of risk, considering the probability and severity of the evaluated items, all stages of the evaluated process presented Percentage of Conformities (PC), that is, less than 60%, classifying them for the potential high-risk degree. Conclusion, the results indicate that by evaluating the conformity of the process of blood transfusion administration, there is a need for a management of surveillance actions considering the inherent risks identified, in a proactive way in order to prevent incidents and minimize damage associated with therapy, through implementation of training and permanent education related to the theme. The instrument will assist in the traceability, monitoring and mitigation of the risks of transfusion incidents in order to guarantee the quality and safety of the entire process

Analysis of acute occupational poisoning events in China during 2006-2016 / 中华劳动卫生职业病杂志

Objective@#To analyze the epidemic characteristics of acute occupational poisoning events in order to state the regularity of outbreak and provide scientific evidences of prevention and control measure in China.@*Methods@#According to the report information from the Management Information System of Public Health Emergency, we analyzed acute occupational poisoning events time distribution, regional distribution, toxicant variety, route of exposure and events detection from 2006 to 2016.@*Results@#The total number of acute occupational poisoning events reported in 26 provinces of China from 2006 to 2016 was 337, causing 2 399 people poisoned, and the fatality rate was 18.09%. Majority of them were higher grade events and the top three provinces of acute occupational poisoning events were Shanghai, Anhui, Shandong. Inhalation is the main cause of poisoning. The acute occupational poisoning events for carrying out poison dectection were accounted for 56.68%.@*Conclusion@#Acute occupational poisoning events in China is reducing year by year, But fatality rate is not decrease. So the country should increase the supervision and management of safety in production, strengthen the safety education of employees and coordination mechanism among different departments.