Implementation of good practices for administering vasoactive amines: a quasi-experimental study / Implementación de buenas prácticas para la administración de aminas vasoactivas: un estudio cuasi-experimental / Implementação de boas práticas para administração de aminas vasoativas: um estudo quase-experiemental

ABSTRACT Objective to analyze the implementation of training on good practices for administering vasoactive amines when facing undesirable clinical events in patients of a cardiointensive unit. Method this is a quasi-experimental study (before and after), carried out in three stages at a university hospital located in Rio de Janeiro, Brazil. An observation was performed in the first stage about the team's adherence to good practices in administering vasoactive amines. Training was conducted with the nursing team in the second stage to implement the actions, and adherence to good practices in administering vasoactive amines was evaluated in the third stage. Data collection was performed from October 2019 to July 2021. The McNemar test and the Wilcoxon non-parametric test were used to compare the differences in the pre- and post-intervention groups. Results a total of 280 patients were infused with vasoactive amines, 97 in the first stage (pre-intervention) and 183 after the intervention. The variables related to the administration in an exclusive way and the identification of the infusion pump obtained 100% assertiveness. A total of 37 (13.2%) undesirable clinical events related to the use of vasoactive amines were identified, 27 (27.8%) in the control group (pre-intervention) and 10 (5.5%) after the intervention, evidencing a significant reduction (p-value = 0.0001). Conclusion the implementation of the intervention significantly contributed to reducing the occurrence of undesirable clinical events related to administering vasoactive amines, contributing to safer drug therapy.

RESUMEN Objetivo analizar la implementación de capacitaciones sobre buenas prácticas para la administración de aminas vasoactivas ante la ocurrencia de eventos clínicos indeseables en pacientes de una unidad cardiointensiva. Método se trata de un estudio cuasi-experimental (antes y después), realizado en tres etapas en un hospital universitario ubicado en Río de Janeiro, Brasil. En la primera etapa, se realizó una observación sobre la adherencia del equipo a las buenas prácticas en la administración de aminas vasoactivas. En la segunda etapa, se realizó capacitación con el equipo de enfermería para la implementación de las acciones y, en la tercera etapa, se evaluó la adherencia a las buenas prácticas en la administración de aminas vasoactivas. La recolección de datos fue de octubre de 2019 a julio de 2021. Para comparar las diferencias en los grupos pre y post intervención se utilizó la prueba de McNemar y la prueba no paramétrica de Wilcoxon. Resultados 280 pacientes fueron infundidos con aminas vasoactivas, 97 en la primera etapa (preintervención) y 183 después de la intervención. Las variables relacionadas con la administración de forma exclusiva y la identificación de la bomba de infusión obtuvieron 100% de asertividad. Se identificaron un total de 37 (13,2%) eventos clínicos indeseables relacionados con el uso de aminas vasoactivas, 27 (27,8%) en el grupo control (preintervención) y 10 (5,5%) después de la intervención, evidenciándose una reducción significativa (valor p = 0,0001). Conclusión la implementación de la intervención contribuyó significativamente para la reducción de la ocurrencia de eventos clínicos indeseables relacionados con la administración de aminas vasoactivas, contribuyendo para una terapia farmacológica más segura.

RESUMO Objetivo analisar a implementação de um treinamento sobre boas práticas para administração de aminas vasoativas frente à ocorrência de eventos clínicos indesejáveis em pacientes de uma unidade cardiointensiva. Método trata-se de um estudo quase-experimental (antes e depois), realizado em três etapas em um hospital universitário localizado no Rio de Janeiro, Brasil. Na primeira etapa, fez-se uma observação sobre adesão da equipe às boas práticas na administração de aminas vasoativas. Na segunda etapa, realizou-se um treinamento com a equipe de enfermagem para implementação das ações e, na terceira etapa, avaliou-se a adesão às boas práticas na administração de aminas vasoativas. A coleta de dados foi de outubro de 2019 a julho de 2021. Para comparar as diferenças nos grupos pré e pós-intervenção, utilizou-se o teste de McNemar e o teste não paramétrico de Wilcoxon. Resultados observaram-se 280 pacientes em infusão de aminas vasoativas, sendo 97 na primeira etapa (pré-intervenção) e 183 após a intervenção. As variáveis relacionadas à administração em via exclusiva e a identificação da bomba infusora obtiveram 100% de assertividade. Identificaram-se ao todo 37 (13,2%) eventos clínicos indesejáveis relacionados ao uso das aminas vasoativas, sendo 27 (27,8%) no grupo controle (pré- intervenção) e 10 (5,5%) após a intervenção, evidenciando uma redução significativa (p valor =0,0001). Conclusão a implementação da intervenção corroborou de forma significativa para redução da ocorrência de eventos clínicos indesejáveis relacionados à administração de aminas vasoativas, contribuindo para uma terapia medicamentosa mais segura.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

@#Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

Recomendaciones para la atención fonoaudiológica en motricidad orofacial en contexto Covid-19 / Recommendations for speech therapy in myofunctional orofacial in COVID-19 context

Buscamos otorgar recomendaciones de resguardo para el ejercicio de la profesión en el área de la motricidad orofacial de manera segura, tanto para el fonoaudiólogo, como para sus usuarios, documentadas en publicaciones científicas relevantes. El método usado en la busqueda constituye una revisión integradora. La búsqueda se realizó a través de las bases de datos Lilacs, PubMed y SciELO. Se consultaron diversas páginas web, bajo los términos COVID-19; SARS-CoV; protocolo de seguridad; sugerencias COVID-19 y guías de acción COVID-19. Los resultados encontrados se proponen recomendaciones para los fonoaudiólogos vinculados a la motricidad orofacial en diversos contextos. la identificación correcta de estas recomendaciones representa una de las acciones de absoluta prioridad, para que los profesionales puedan direccionar las conductas relacionadas con la seguridad del paciente y continuar las atenciones en contexto de COVID-19, aumentando las protecciones, con el fin de cuidar y evitar contagios en este proceso.

Provide recommendations for safeguarding the practice of the profession in the myofunctional area in a safe way, both for the speech therapist and for its users, documented in relevant scientific publications. Methods: it constitutes an integrating review. The search was performed through the Lilacs, Pubmed, SciELO databases, and various web pages were consulted, under the terms COVID-19; SARS-CoV 2; security protocol; COVID-19 suggestions and COVID 19 action guides. Results: Recommendations are proposed for speech pathologist linked to myofunctional therapy in various contexts. Discussion: the correct identification of these recommendations represents an absolute top-priority action so that professionals can instruct the behaviors related to patient safety and continue the treatments in COVID-19 context, increasing the protection, with the purpose of preventing infections in the process.

Central venous catheter insertion and maintenance: Evidence-based clinical recommendations / Inserción y mantenimiento del catéter venoso central: recomendaciones clínicas basadas en la evidencia

RESUMEN Objetivo: presentar a los clínicos la evidencia que soporta los procesos más seguros y efectivos en la inserción y el mantenimiento del catéter venoso central (CVC), como estrategia en la prevención de las infecciones del torrente sanguíneo asociadas a catéter. Materiales y métodos: a partir de preguntas clínicas dirigidas a mejorar la seguridad y efectividad de los procesos de inserción y mantenimiento de catéter venoso, en los momentos clave, se hicieron búsquedas de literatura en las bases de datos Medline vía PubMed, Embase, Central y Lilacs. Se utilizó la metodología de revisión sistemática rápida de la literatura. Los estudios identificados fueron evaluados desde el punto de vista de la calidad con las herramientas para estudios cualitativos, cuantitativos y revisiones sistemáticas del Joanna Briggs Institute (JBI). Las guías de práctica clínicas fueron evaluadas con el instrumento AGREE II. La evidencia se presenta como recomendaciones clínicas basadas en la evidencia, a las cuales se les dio gradación, según la metodología del JBI. Resultados: se presentan 12 resúmenes clínicos que contienen la evidencia relacionada con el uso seguro y efectivo del catéter venoso central en cuanto a: las indicaciones, la inserción del catéter en venas centrales y en inserción periférica (PICC), la valoración prequirúrgica, el uso de analgesia, la preparación del campo, la selección entre CVC o PICC, el cuidado y mantenimiento de CVC, la prevención de complicaciones y consideraciones generales en el uso de catéter venoso central (CVC) en el paciente oncológico y en nutrición parenteral. Conclusiones: se presentan las recomendaciones para el uso seguro y efectivo de los catéteres de acceso venoso central con relación a los procesos de inserción y mantenimiento de CVC en el modelo de resúmenes basados en la evidencia. Es necesario hacer evaluación de la implementación de los mismos en resultados en salud en las instituciones donde se desarrollen.

ABSTRACT Objective: To share with clinicians supporting evidence of the safest and the most effective processes for central venous catheter insertion and maintenance as a strategy to prevent catheter-associated bloodstream infections. Materials and Methods: A literature search was conducted in the Medline via PubMed, Embase Central and Lilacs databases based on a set of clinical questions aimed at improving safety and effectiveness at key moments in the process of central venous catheter insertion and maintenance. The rapid literature review methodology was used. The studies identified were assessed from the quality point of view, using the Joanna Briggs Institute (JBI) tools for qualitative and quantitative studies and for systematic reviews. Clinical practice guidelines were assessed using the AGREE II tool. The evidence is presented in the form of evidence-based clinical recommendations, which were graded in accordance with the JBI methodology. Results: Twelve clinical evidence summaries containing evidence related to the safe and effective use of central venous catheters are presented, including the following topics: central venous catheter insertion (CVC), peripherally inserted central catheters (PICC), preoperative assessment, the use of analgesia, field preparation, choice between CVC or PICC, CVC care and maintenance, prevention of complications, and general considerations pertaining to the use of central venous catheters in oncologic patients and in parenteral nutrition. Conclusions: Recommendations on the safe and effective use of central venous access catheters in relation to CVC insertion and maintenance processes are presented in the evidence-based summary model. It is necessary to evaluate their implementation in health outcomes in the institutions where they are developed.

Awareness and behavior patterns regarding road safety measures among undergraduate medical students of western Uttar Pradesh: a cross-sectional study

Background: More than 1.2 million deaths occur each year on the world's roads. In India, the number of motor vehicles on the road is increasing with the population and economic growth. It has been estimated that if effective and immediate action is not taken, deaths due to road traffic accidents will become the fifth leading cause of deaths by 2020. Objectives was to assess the level of awareness and behavior regarding road safety rules among undergraduate medical students.Methods: The present cross-sectional study was conducted in a Medical College of western Uttar Pradesh. In the present study 200 final and pre-final year, undergraduate medical students were selected with the help of simple random selection, who drive/use vehicles either of their own or others. The study period was from June 2019 to August 2019.Results: About 29 percent of participants responded that they do not follow lane rules while driving. Study showed that 72.1% and 42.0% were aware that what documents to be carried with them while driving among those who attend and did not attend any program on road safety measures respectively. About 58.1 % and 38.2% were aware that penalty for driving without a helmet can be imposed among those who attend and did not attend any program on road safety measures.Conclusions: Awareness of road safety measures among participants was satisfactory, but the gap was also seen between awareness and behavior patterns regarding road safety measures.

A rare form of domestic accident: blast abdominal injury with evisceration of abdominal viscus

Evisceration of abdominal viscus following 'Flowerpot firecracker' (tubri) blast injury to the abdomen is a rare but dangerous form of domestic accident. Lack of knowledge and non-compliance of safety measures is the major reason for firecracker eventualities. A 10-year male child presented three hours post-injury with a wound over the upper abdomen. On examination there was evisceration of part of stomach along with colon through supraumbilical abdominal wound. Resuscitation and repair following exploratory laparotomy performed. Patient recovered well postoperatively. Public awareness and safety measures need to be taken to prevent the fatal outcomes of firecracker misuse.

Perception and practice of occupational safety measures against HIV infection among health care personnel in a tertiary health care facility of Ganjam district, Southern Odisha, India

Background: Globally, 36.7 million people were living with HIV. The prevalence in India is estimated to be 0.26% and it is in the range of 0.21-0.25% in Odisha. The objectives were to assess the perception on HIV and the preventive practices among the health personnel in a tertiary level health facility of South Odisha.Methods: This study was hospital based cross-sectional study. Place of study was OPDs, indoor wards, emergency Department of MKCG Medical College, Berhampur, Ganjam, Odisha, India. Study period was from December 2017 to February 2018. Study participants were all the health care workers present during the visit were interviewed using semi structured questionnaire. Sample size were 174 health personnel. Those who didn’t give consent for the study were excluded from the study. Statistical tests used were percentage and proportion. Statistical software used-SPSS 16 version.Results: Out of 174 respondents 67.8% were doctors, 14.9% staff nurses and 17.3% other professionals. Among safety measures, gloves, mask, apron and cap were used by 69%, 11.5%, 13.8% and 5.7% respectively. The patient’s HIV status was enquired by 78.9% male health personnel during treatment. 90% female health personnel had come across HIV positive patients during treatment procedure. The knowledge about basic PEP regimen was present in 54.4% male and 80% female health personnel.Conclusions: The study participants were not aware about all the mode of transmission. There is gap in knowledge and practices of safety gears. Perceptions and practice of doctors were no way better than other health personnel. Knowledge and practice of safety gear should be enforced by the hospital authority to keep its work force safe and healthy.

Awareness Of Driving Safety Measures In General Population Visiting Tertiary Care Hospital

BACKGROUND:Road traffic accident is a preventable global disaster. In developing countries, the existing road safety policies are ineffective in preventing casualties, mainly because of lack of knowledge regarding the same in the general population. The early assessment of awareness of driving safety measures in general population will thus go a long way to help in reducing existing high fatalities. MATERIALAND METHODS: Aclose ended questionnaire based, cross-sectional study was conducted among 200 participants of age 16 years and above with a valid driving license to assess the awareness regarding driving safety measures. The data was collected and analyzed for number, percentage, mean, standard deviation, t test and Chi-square test. RESULTS: 80.8% of the urban population and 60.5% of the rural population were aware of the legal age for driving vehicles. Majority of the participants were aware regarding wearing helmets while driving. Use of seatbelt and prohibition of alcohol intake while driving was comparatively less in rural population. Awareness of prohibition of use of mobile phone while driving and sign of speed limit was observed in 2/3rd of the population. Less than half of the rural population was unaware of the basic traffic signs like stop, no parking, no horn, school ahead, and one way. CONCLUSION:Awareness regarding driving safety measures in general population was comparatively less among rural population than urban. Traffic awareness campaigns in hospitals in association with Regional Transport Office would be one of the beneficial measures to minimize fatalities arising due to lack of knowledge of safe driving measures.

1．Evaluation of the Effectiveness of Risk Minimization Activities / 薬剤疫学

Various measures have been taken to minimize risk for individual drug products in the past. It is noteworthy that these measures are now documented and made public as a　“risk minimization plan” with the implementation of the scheme of Risk Management Plan （RMP). Risk minimization activities are conducted with the aim of securing and enhancing patients' safety, and at the same time, it places additional burdens on patients, healthcare practitioners and manufacturers/distributors. In this context, it should be assessed whether the original purpose is achieved. It is the key　for RMP to revise the plan effectively based on the assessment result. Measures to evaluate the effectiveness of risk minimization activities include analysis using medical information databases, questionnaire survey/interview to healthcare practitioner and patients. We may need to conduct prospective/retrospective surveys for some cases. There is no single method to be universally applied to different situations and we have no other way than putting our heads together and moving into action.

<b>1．Evaluation of the Effectiveness of Risk Minimization Activities </b> / 薬剤疫学

<p>Various measures have been taken to minimize risk for individual drug products in the past. It is noteworthy that these measures are now documented and made public as a　“risk minimization plan” with the implementation of the scheme of Risk Management Plan （RMP). Risk minimization activities are conducted with the aim of securing and enhancing patients' safety, and at the same time, it places additional burdens on patients, healthcare practitioners and manufacturers/distributors. In this context, it should be assessed whether the original purpose is achieved. It is the key　for RMP to revise the plan effectively based on the assessment result. Measures to evaluate the effectiveness of risk minimization activities include analysis using medical information databases, questionnaire survey/interview to healthcare practitioner and patients. We may need to conduct prospective/retrospective surveys for some cases. There is no single method to be universally applied to different situations and we have no other way than putting our heads together and moving into action.</p>

Prevención del abuso sexual en una comunidad maya de Yucatán, México: relevancia de las características socioculturales (2014) / Prevention of sexual abuse within a Maya community in Yucatan, Mexico: Relevance of their sociocultural features (2014) / Prevenção do abuso sexual em uma comunidade maia de Yucatan, México: relevância das características socioculturais (2014)

Se presenta parte de un proyecto que consistió en realizar estrategias de prevención de abuso sexual con niños y niñas, a través de medios psicoeducativos acordes con el contexto sociocultural en el que se desenvuelven, con la finalidad de fortalecer sus recursos y mecanismos de autoprotección. El grupo participante estuvo compuesto por 623 niños y niñas entre seis y nueve años, residentes de una comunidad maya. Se realizaron estrategias de acuerdo con ejes de acción pertinentes en materia de prevención y las particularidades de la comunidad, tomando en cuenta la etapa de desarrollo de los participantes. Se encontró que los niños y niñas reconocen factores de riesgo y protección, y de igual forma, las personas a quienes ellos acuden para pedir ayuda se encuentran en su núcleo familiar; también se evidenció la influencia del contexto sociocultural en las respuestas ante las actividades llevadas a cabo. Se concluye que es importante involucrar en las estrategias preventivas a figuras presentes en la cotidianidad de los niños y niñas; se constata la importancia de la educación sexual, así como trabajar con estrategias específicas y acordes con la etapa de desarrollo de los participantes y las características socioculturales de cada comunidad en donde se lleve a cabo un proyecto social.

Part of a project consisting of implementing sexual abuse prevention strategies with boys and girls is presented through psycho-educational means in harmony with the socio-cultural context in which they grow and develop themselves, with an aim to strengthening their self-protection resources and mechanisms. The participant group consisted of 623 children of both genders between the ages of six and nine years residing in a Maya community. Strategies according to relevant main lines of activity ('axes of action') in the field of prevention and the community's peculiarities, taking into account the development stage of the participants. It was found that both. boys and girls are aware of the risk and protection factors and, likewise, they recognize those family unit individuals in their so-called 'nuclear family' they usually turn to for help. Also the influence of the socio-cultural context was evidenced in their responses to the activities carried out. It has been concluded that involving figures present in the everydayness of boys and girls is worth, as well as the importance of sexual education and working with specific strategies according to the children's developmental stage and the sociocultural features of each one of the communities where a social project is taking place.

Apresenta-se parte de um projeto que consistiu em fazer estratégias da prevenção do abuso sexual com meninas e meninos, através dos meios psicoeducativos acordes com o contexto sociocultural em que se desenvolvem, a fim de fortalecer seus recursos e mecanismos da autoproteção. O grupo participante foi composto por 623 meninos e meninas entre seis e nove anos, residentes de uma comunidade maia. Realizaram-se estratégias de acordo com os eixos de ação em matéria da prevenção e os particularidades da comunidade, levando em conta a etapa do desenvolvimento dos participantes. Descobrimos que os meninos e as meninas reconhecem fatores de risco e da proteção e, do mesmo modo, eles acudem as pessoas da sua família nuclear para pedir ajuda; também evidenciou-se a influência do contexto sociocultural nas respostas perante as atividades realizadas. Conclui-se que é importante envolver nas estratégias preventivas as figuras presentes na cotidianidade dos meninos e as meninas; a importância da educação sexual é constatada, assim como trabalhar com estratégias específicas e acordes com a etapa do desenvolvimento dos participantes e das características socioculturais de cada comunidade onde um projeto social é realizado.

Knowledge, attitude and practice on safety measures against occupational hazards among constructional workers at Bayint Naung Bridge construction site in Yangon Region.

A cross sectional analytic study was carried out to assess the knowledge, attitude and practice on safety measures against occupational hazards and their inter-relationships, among Bayint Naung New Bridge Construction workers during 2014. Altogether 184 workers were selected by simple random sampling. Face to face interview method was used to collect the necessary data. Among respondents, only 4.3% (95% CI = 2%, 8.1%) had good knowledge, but all respondents had favorable attitude and 77.7% (95% CI = 71.3%, 83.3%) had good practice. There were statistically significant associations between age (P = 0.040), educational status (P = 0.001), type of work (P = 0.013), type of worker (P = 0.016), attending skill training (P = 0.002) and knowledge. However, no statistically significant associations were found between knowledge and attitude, knowledge and practice, attitude and practice of respondents on safety measures against occupational hazards. Although attitude and practice among workers are satisfactory, knowledge of respondents needs to be improved. The information gained from this study may be helpful in prevention against occupational hazards.

A questionnaire survey for orthopedists on the clinical experience of patients who suffered adverse events associated with acupuncture and moxibustion / 全日本鍼灸学会雑誌

[Objective]The purpose of this study was to gain a clear understanding of adverse events associated with acupuncture (Acp) and moxibustion (Mox) therapies. Thus, we administered questionnaires to orthopedists in order to understand the clinical experience of patients who suffered adverse events.<BR>[Materials and Methods]For this study, 6,000 orthopedic hospitals and clinics were randomly selected from 13,225 hospitals and clinics listed in the telephone directory iTown Page (http://itp.ne.jp). In October 2011 and July 2012, 3,500 and 2,500 questionnaires, respectively, were sent by mail. The questions addressed the following:(1) the respondent's profile (e.g., years of experience as a licensed orthopedist);(2) adverse events associated with Acp, including electroacupuncture;(3) adverse events associated with Mox;(4) use of Acp and Mox therapies in the orthopedist's hospital or clinic;(5) comments on the safety of Acp and Mox therapies. The identity of respondents remained secret.<BR>[Results]The questionnaire response rate was 10.7%. The respondents were licensed orthopedists for 30 ± 11 years (mean ±standard deviation). Adverse events associated with Acp included retained needles and needle breakage (n ≥148), hemorrhages (n ≥ 64), infections (n ≥ 40), organ injuries (n = 28), and so on. Retained needles (≥ 145 out of 148), subcutaneous hemorrhages (63out of 64), arthritis (17 out of 40), and pneumothorax injuries (27 out of 28) occurred most frequently. The adverse events associated with Mox were burn injuries (n ≥ 121), infections (n ≥ 16), and other adverse events (n = 2). Second-degree burn injuries (n ≥ 48 out of 121) and suppuration infections (11 out of 16) occurred most frequently. These were the most common adverse events associated with Acp and Mox. The usage rate of Acp and Mox therapies in the orthopaedist's hospital or clinic was 18.6%. There were many comments on infection control by acupuncturists (n = 27), education and technical levels of Acp and Mox (n = 13), and retained needles and needle breakages (n = 13). <BR>[Conclusion]These survey results reveal that the occurrence of severe adverse events associated with Acp and Mox was higher than our expectation. In order to improve the safety of Acp and Mox therapies, various educational activities to disseminate information about existing safety measures to acupuncturists are needed. Further studies on new preventive measures, continuous surveys, and feedback to acupuncturists are also required.

Investigação da técnica de preparo de medicamentos para administração por cateteres pela enfermagem na terapia intensiva / Research on preparation techniques for drugs administered through catheters by intensive care nursing / Investigación de técnicas de preparación de medicamentos administrados vía catéteres por enfermeros en terapia intensiva

Esta pesquisa teve como objetivo identificar a forma farmacêutica dos medicamentos preparados para serem administrados por cateteres e o perfil dos erros cometidos durante o preparo. Trata-se de estudo epidemiológico transversal, de natureza observacional, conduzido em uma unidade de terapia intensiva com amostra de 350 doses de medicamentos preparados por 56 técnicos de enfermagem. A coleta de dados ocorreu no mês de março de 2010. Os resultados mostram que 92% dos medicamentos eram sólidos. Os erros foram agrupados nas categorias diluição e mistura para formas líquidas, acrescidos de trituração para sólidos. As taxas de erro foram superiores a 40% em todas as categorias. Concluiu-se que: a trituração indevida pode ter comprometido o resultado terapêutico em comprimidos revestidos e de liberação controlada; não diluir xaropes pode ter contribuído para a obstrução de cateteres; misturar medicações ao triturá-las pode aumentar o risco de interações farmacêuticas.

The goals of the research were to assess the pharmaceutical form of medicinal preparations administered through catheters and identify the profile of errors that occur during their preparation. This is a cross-sectional study of an observational nature, conducted in an intensive care unit with a sample of 350 doses of medication prepared by 56 nursing technicians. Data collection occurred in March 2010. The results showed that 92% of the drugs were in the solid form. The errors were divided into two categories for liquid forms: dilution and mixing, and grinding was added as an error possibility for a solid form. The error rates were greater than 40% in all categories. The conclusions are that grinding can compromise the therapeutic effect of coated controlled-release tablets, not diluting syrups may contribute to the obstruction of catheters, and mixing medication during grinding may increase the risk of drug interactions.

Se apuntó a identificar la forma farmacéutica de los medicamentos preparados para ser administrados vía catéter y el perfil de errores cometidos durante la preparación. Estudio epidemiológico transversal, de tipo observacional, desarrollado en unidad de terapia intensiva sobre muestra de 350 dosis de medicamentos preparados por 56 técnicos de enfermería. Datos recolectados en marzo de 2010. Los resultados expresan que 92% de los medicamentos eran sólidos. Los errores se agruparon en las categorías: dilución y mezcla para formas líquidas, agregados de trituración para sólidos. Las tasas de errores superaron el 40% en todas las categorías. Se concluye en que: la trituración inapropiada pudo comprometer el resultado terapéutico con comprimidos revestidos y de liberación controlada; no diluir jarabes pudo haber ayudado a obstruir catéteres, y mezclar medicamentos al triturarlos puede aumentar el riesgo de interacciones medicamentosas.

The Efforts to Utilize Electronic Medical Information for Safety Measures / 薬剤疫学

One of the target points in the PMDA 2nd midterm plan (FY2009-2013) is reinforcement and enhancement of the system for safety evaluation for pharmaceuticals using expanded data sources beyond spontaneous reports of adverse drug reactions (ADRs). To achieve this goal, PMDA started investigation in FY2009 to develop methodology to utilize electronic medical information for secondary purpose of safety evaluation of pharmaceuticals. (MIHARI project- Medical Information for Risk Assessment Initiative)<br>Data sources targeted in MIHARI project are claims data, diagnosis procedure combination (DPC) data, hospital information system (HIS) data, etc.<br>Secondary use of electronic medical information for safety evaluation is expected to enable safety evaluation based on quantitative analysis, which has been difficult so far. It will also provide faster and easier way of evaluation compared to collecting primary data from study planned and conducted just for the purpose.<br>PMDA intends to establish the system to utilize electronic medical information (eg. claim data, DPC data, HIS data) practically for safety evaluation by the end of FY2013. Aiming for this, PMDA is conducting various pilot studies using currently available data in the MIHARI project. Here we report on recent developments of this project.

Uso de la dexmedetomidina (DXM) en implantación de resincronizador cardiaco: ¿es realmente seguro? / The use of dexmedetomidine (DXM) for implanting a cardiac resynchronization device: is it really safe?

La dexmedetomidina (DXM) es un agonista selectivo de los receptores alfa 2 preganglionares, que actúa tanto en el sistema nervioso central como en el periférico. Desde su incursión en la práctica médica, ha sido utilizada satisfactoriamente en un amplio espectro de procedimientos anestésicos, que van desde sedación hasta intervenciones bajo anestesia general. Dentro de sus principales ventajas se encuentran la estabilidad hemodinámica y la mínima depresión respiratoria. Este artículo describe una terapia de resincronización cardiaca exitosa a través de la implantación deun marcapasos biventricular en un paciente hemodinámicamenteinestable, bajo sedación con DXM y midazolam a bajas dosis.

Dexmedetomidine (DXM) is a selective 2-adrenoreceptor agonist acting over both the central and peripheral nervous system. Since it became available for medical application, DXM has been satisfactorily used for a broad spectrum of anesthetic procedures, ranging from sedation to interventions under general anesthesia. Its key advantages include its hemodynamic stability and minimal respiratory depression. This articleprovides a description of a successful cardiac resynchronization therapy implanting a biventricular pacemaker in a hemodynamically unstable patient under DXM and low-dose midazolamsedation.

Anesthetic Management of Cesarean Section in Human Immunodeficiency Virus (HIV)Positive Pregnant Woman : A case report

Anesthesiologists are encountering an increasing number of human immunodeficiency virus (HIV) infections in pregnant women. In HIV infected patients, the history should include an evaluation of opportunistic infections, malignancies and treatments with antiretroviral drugs. The anesthesiologist should be aware of the possible toxic side effects or interactions between the antiretroviral drugs and anesthetics. In addition, a HIV infection passing from patient to physician can occur. Therefore, safety measures must be taken when handling body fluid or blood. We report the anesthetic management of an elective cesarean section in a HIV positive pregnant woman who was treated with antiretroviral drugs to decrease the possibility of vertical transmission.