Errores en la preparación de fármacos intravenosos en una Unidad de Cuidados Intensivos Neonatal. Una potencial fuente de eventos adversos / Intravenous drug preparation errors in a Neonatal Intensive Care Unit. A potential source of adverse events

Introducción: El objetivo del estudio fue determinar la tasa de errores en la preparación de fármacos de administración intravenosa en una Unidad de Cuidados Intensivos Neonatal (UCIN). Pacientes y métodos: Se realizó un estudio prospectivo observacional, durante 24 días elegidos al azar. Se determinaron las concentraciones de vancomicina y tobramicina preparadas para uso intravenoso. Se definieron 2 tipos de errores: 1) error de cálculo, cuando la desviación entre la dosis prescrita por el médico y la dosis teórica administrada, según los cálculos realizados por la enfermera, era superior a un ±10%, y 2) error de precisión, cuando la desviación entre la concentración teórica y la determinada por el laboratorio era superior a un ±10%. Resultados: Se recogieron un total de 91 muestras, 52 de vancomicina y 39 de tobramicina. En un 4,6% de las muestras se detectaron errores de cálculo. La tasa de errores de precisión fue del 37,9%. Conclusiones: Aunque los errores registrados no produjeron consecuencias clínicas negativas evidentes, nuestros resultados señalan una fuente potencial de complicaciones severas. Por ello, deben mejorarse los métodos usados para la preparación de medicamentos de uso intravenoso a pie de cama (AU)

Introduction: To determine the rate of errors during preparation of intravenous drugs in a regional Neonatal Intensive Care Unit (NICU). Methods: A prospective observational study was performed on 24 non-consecutive working days. The vancomycin and tobramycin solutions administered were analysed to determine drug concentrations. We defined 2 types of error: 1) calculation error, when the deviation between the dose prescribed by the physician and theoretical dose administered, according to calculations performed by the nurse, was greater than ±10%, and 2) precision error, when the deviation between the theoretical concentration and that determined by the laboratory was greater than ±10%. Results: A total of 91 samples were collected, 52 of vancomycin and 39 of tobramycin. Calculation errors were detected in 4.6% of samples. Precision errors were identified in 37.9% of the total sample. Conclusions: Although the errors reported did not produce adverse clinical consequences, our findings point out a potential source of severe complications. Better methods in the preparation of intravenous medications in NICU are needed (AU)

[Intravenous drug preparation errors in a Neonatal Intensive Care Unit. A potential source of adverse events]. / Errores en la preparación de fármacos intravenosos en una Unidad de Cuidados Intensivos Neonatal. Una potencial fuente de eventos adversos.

INTRODUCTION: To determine the rate of errors during preparation of intravenous drugs in a regional Neonatal Intensive Care Unit (NICU). METHODS: A prospective observational study was performed on 24 non-consecutive working days. The vancomycin and tobramycin solutions administered were analysed to determine drug concentrations. We defined 2 types of error: 1) calculation error, when the deviation between the dose prescribed by the physician and theoretical dose administered, according to calculations performed by the nurse, was greater than ±10%, and 2) precision error, when the deviation between the theoretical concentration and that determined by the laboratory was greater than ±10%. RESULTS: A total of 91 samples were collected, 52 of vancomycin and 39 of tobramycin. Calculation errors were detected in 4.6% of samples. Precision errors were identified in 37.9% of the total sample. CONCLUSIONS: Although the errors reported did not produce adverse clinical consequences, our findings point out a potential source of severe complications. Better methods in the preparation of intravenous medications in NICU are needed.

Gancyclovir prophylaxis in high risk patients.

The aim of this study was to compare the incidence of cytomegalovirus (CMV) disease between seronegative recipients who received a CMV seropositive kidney (D+/R-) and seropositive recipients who received a CMV seropositive kidney (D+/R+). Among 42 patients included in the study, 26 were D+/R-, and the other 16 were D+/R+. Immunosuppression was based on cyclosporine (n = 12), tacrolimus (n = 28), or other agents (n = 2). Twenty-four seronegative patients were treated with gancyclovir for 3 months. The 16 D+/R+ patients did not receive CMV prophylaxis. Two D+/R- patients did not receive gancyclovir prophylaxis because of various health problems just after the surgery. Over the year post-renal transplant, there were 10 (23.8%) episodes of CMV disease. The two D+/R- patients who were not treated with gancyclovir developed CMV disease. The incidence of disease was higher in patients who were given cyclosporine (41.7% vs 17.9%). In conclusion, sero negative patients who received a kidney from a seropositive donor had greater risk of developing CMV disease. Despite gancyclovir treatment, the incidence was higher than in D+/R+ cases without treatment.

Family-based association study of serotonin transporter promoter in suicidal adolescents: no association with suicidality but possible role in violence traits.

The serotonin transporter-linked promoter region polymorphism (5-HTTLPR) is thought to be associated with some serotonin dysfunction-related psychopathologies such as depression and anxiety disorders. Suicide and suicide-related behaviors such as violence, aggression, and impulsivity have been reproducibly associated with serotonin dysfunction and are partially genetic. This study examined the association of 5-HTTLPR with suicidal behavior and related traits in Israeli suicidal adolescent inpatients using the haplotype relative risk (HRR) method that controls for artifacts caused by population stratification. Forty-eight inpatient adolescents who recently attempted suicide were assessed by structured interviews for detailed clinical history, diagnoses, suicide intent, suicide risk, impulsivity, violence, and depression. Blood samples were collected and DNA extracted from patients and their biological parents. The 5-HTTLPR allele frequencies were tested for association with suicidality by the HRR method. In addition, the relationship between genotypes and phenotypic severity of several clinical parameters was analyzed. No significant allelic association of the 5-HTTLPR polymorphism with suicidal behavior was found (chi square = 0.023; P = 0.88). Analysis of variance of the suicide-related trait measures for the three genotypes demonstrated a significant difference in violence measures between patients carrying the LL and LS genotypes (9.50+/-4.04 vs. 5.36+/-4.03; P = 0.029). This study suggests that the 5-HTTLPR polymorphism is unlikely to have major relevance to the pathogenesis of suicidal behavior in adolescence but may contribute to violent behavior in this population.

[Alternatives for the financing of health care in Latin America and the Caribbean]. / Alternatives de financiamiento de la atención médica en América Latina y el Caribe.

Latin America and the Caribbean (LAC) countries are experiencing both an economic crisis and a crisis in the public sector. As a result it is impossible to increase the amount of resources available to the health sector, unless there is a drastic restructuring of the way in which financing occurs. The measures so far referred to in the economic debate - user fees, cost recovery, privatization - at best represent partial solutions. Given the magnitude of health problem in LAC countries, they are unable to generate the amount of money needed to cover the deficit of financial resources for medical treatment. The central idea behind this article is that in order to cover the deficit of resources for medical it is necessary to utilize fiscal resources. It is shown that it is possible to increase the amount of financial resources available for medical treatment either through increases in taxes and/or through an increase in the proportion of the government budget dedicated to medical treatment. Increases in taxes collected provide a feasible alternative. In some of the poor countries of Latin America and the Caribbean, the proportion of the Gross National Product that goes for the payment of taxes is well below the figure for that proportion found in developed countries. To increase the proportion of the government budget dedicated to medical treatment is a political decision that depends solely upon the discretion of the governments concerned. The potential of Social Emergency Funds and debt swaps to finance innovations in the production of medical treatment services, thus maintaining the current level to activity in the sector, is discussed.