incidences of oxidative-stress occurrence following two metabolic support measures in critically ill patients

A high percentage of patients admitted to the Intensive Care Unit [ICU] have Systemic Inflammatory Response Syndrome [SIRS] criteria. Free radicals play an important role in initiation and development of SIRS. The purpose of this study was to assess and compare the molecular changes of cellular antioxidant power in patients with SIRS who received enteral nutrition [EN] or EN combined with parenteral nutrition [PN]. Two groups of 10 patients were enrolled in this randomized, controlled clinical trial. Those in the treatment group received EN+PN and the control group received only EN. Venous blood samples were taken just prior to initiation of nutritional support and then 24, 48 and 72 hours following entry into the study for examination of antioxidant parameters including total thiol, total antioxidant capacity and lipid peroxidation. The two supportive regimens had different affects on total antioxidant capacity [P=0.005]. In the EN group the amount of total antioxidant capacity was not significantly different in different days [P>0.05], but in the EN+PN group it was significantly different on third and forth days as compared to the first day. The two other parameters had no significant differences between the two groups. These results are suggesting that an increase in oxidative stress bio-markers are not necessarily related to the route of pharmaconutrition and may occur independently during metabolic support measures.

Transcription errors observed in a teaching hospital

Medication errors are among the most common medical errors in the hospitals. Transcription error is a specific type of medication errors and is due to data entry error that is commonly made by the human operators. This study was designed to detect transcription errors in a teaching hospital in Tehran. Direct observational method was used in this study. Error was defined as any deviation in transcribing medication order from the previous step [order on the order sheet, administration nursing note and/or cardex, documentation of the order in the pharmacy database]. A total of 287 charts with 558 opportunities for error were reviewed. Of those opportunities for error 167 [29.9%] resulted in an error. Omission [the patient did not receive the medication that was ordered] was the highest [52%] transcription error type seen in this study. The evaluation clearly showed that errors at transcription stage were not infrequent. To cut these errors down we suggest implementation of surveillance systems, which might help to decrease medication errors