Impact of pharmaceutical validation on prescribing errors in a neonatal intensive care unit. Randomised and controlled study.

Purpose: To compare the frequency of electronic prescription errors when the prescription was validated by the clinical pharmacist vs. when it was not. Methods: This prospective randomised controlled study was conducted in three phases. A randomised phase, in which patients were divided into control and intervention groups, and a pre- and post-intervention phase were consecutively performed to analyse the impact of pharmaceutical validation of prescriptions in a neonatal intensive care unit (NICU). This study was performed at a highly complex NICU at a tertiary hospital. All patients born during the study period who were admitted to the NICU, with a stay lasting ≥24 h, and received active pharmacological treatment were included in the study. Pharmaceutical validation was performed according to the paediatric pharmaceutical care model. A high level of validation was selected for this study. In the intervention group, discrepancies found during the review process were communicated to the medical team responsible for the patients and resolved on the same day. Results: In total, 240 patients were included in this study. Sixty-two patients were allocated to the pre-intervention (n = 38) or post-intervention (n = 24) groups, and 178 patients were randomly sorted into two groups, control (n = 82 newborns) and intervention (n = 96 newborns). During the randomisation phase, the number of prescription errors detected was significantly lower in the intervention group than that in the control group (129 vs. 270; p < 0.001). Similarly, prescription errors reaching the patient were significantly reduced from 40% (n = 108) in the control group to 1.6% (n = 2) in the intervention group. In the pre- and post-intervention periods, the prescription lines containing prescription errors decreased from 3.4% to 1.5% (p = 0.005). Conclusions: This study showed that the pharmaceutical validation process decreased both the number of errors in the electronic prescribing tools and the number of prescription errors reaching the patient.

[Pulmonary reperfusion syndrome after pulmonary stent implants in a patient with vascular tortuosity syndrome]. / Síndrome de reperfusión pulmonar tras implante de stents pulmonares en un paciente con síndrome de tortuosidad vascular.

Vascular tortuosity syndrome is a rare genetic disorder that causes tortuosity and stenosis of the pulmonary, systemic and / or coronary circulations. As a result of treatment of pulmonary stenosis, symptoms of pulmonary edema, known as lung reperfusion syndrome, may occur. The case is presented of an adolescent patient with vascular tortuosity syndrome who presented with a pulmonary reperfusion syndrome after multiple stent implants in the left pulmonary artery. After the procedure, the patient immediately developed an acute pulmonary edema with severe clinical deterioration, which required assistance with extracorporeal membrane oxygenation for recovery.

La expresión clínica y epidemiológica actual por tos ferina en un hospital terciario / The clinical expression and current epidemiology of whooping cough in a tertiary hospital

Objetivo: Describir el patrón clínico y epidemiológico de la expresión de tos ferina. Material y métodos: Estudio retrospectivo observacional de pacientes entre 0 y 15 años de edad diagnosticados de infección por Bordetella pertussis entre enero de 2009 y diciembre de 2011 en un hospital terciario de Madrid. Resultados: Se confirmaron microbiológicamente 65 casos, un 46,1% de ellos en menores de 1 año; un 20% de los niños no había recibido ninguna vacuna de B. pertussis, un 77% de ellos debido a que eran menores de 2 meses. El síntoma principal fue la tos paroxística (61,5%), con una media de 11 días de evolución. La radiografía de tórax y el hemograma no ayudaron a esclarecer el diagnóstico. Conclusión: La tos ferina es una enfermedad que cabe considerar en lactantes y adolescentes. Es necesario adoptar determinadas medidas preventivas para disminuir la incidencia de esta patología (AU)

Title: The clinical expression and current epidemiology of whooping cough in a tertiary hospital Objective: To describe the clinical and epidemiological pattern of expression of pertussis. Methods: Retrospective observational study of patients between 0 and 15 years of age diagnosed with infection by Bordetella pertussis between January 2009 and December 2011 in a tertiary hospital in Madrid. Results: 65 cases were confirmed microbiologically, 46.1% of them in children under 1 year; 20% of children had received no vaccine for B. pertussis, 77% of them were under 2 months old. The main symptom was ther paroxistical cough (61.5%), with 11 days of average evolution. Chest X ray and blood test didn’t help to find out the diagnosis. Conclusion: Pertussis is a disease to be considered in infants and adolescents. It is necessary to perform certain preventive attitudes to reduce the incidence of this disease (AU)

Cojera no dolorosa como forma de presentación de una artritis tuberculosa / Painless limp as a presentation of tuberculous arthritis

La coxalgia unilateral puede representar un importante reto diagnóstico en pediatría. Aunque la causa más frecuente es la sinovitis transitoria de cadera, hay otros diagnósticos que deben tenerse en cuenta, como la artritis séptica, las formas de inicio de artritis inflamatoria, en especial las asociadas a entesitis, las enfermedades ortopédicas (Perthes y epifisiolisis de cadera) y las neoplasias (AU)

The unilateral hip pain can be a major diagnostic challenge in pediatrics. Although the most common cause is transient synovitis, there are other diagnoses that should be taken into consideration as septic arthritis, onset forms of inflammatory arthritis, especially those associated with enthesitis, orthopedic disease (Perthes and epiphysiolysis hip) and neoplasms (AU)

Metrorragia persistente en los primeros ciclos menstruales / Persistent metrorrhagia in a teenager’s first menstrual cycles

La metrorragia en adolescentes suele ser consecuencia de ciclos anovulatorios característicos de las primeras menstruaciones, los cuales producen episodios de hemorragia uterina disfuncional. Solo en algunas ocasiones subyace una lesión orgánica. Se presenta el caso de una adolescente de 12 años que consulta por menstruaciones abundantes, que se prolongan en el tiempo con anemia ferropénica secundaria. En una ecografía abdominal se objetiva la presencia de una masa anexial derecha compatible bien con endometrioma ovárico, bien con folículo hemorrágico. La persistencia del sangrado más allá de tres o seis meses, desde el momento de la primera consulta, debe ir acompañada de una analítica y un estudio de imagen, en general, una ecografía. Debe valorarse la derivación a Atención Especializada (AU)

Metrorrhagia in teenagers is often caused by anovulatory cycles, characteristic of the firsts menstruations, that produce episodes of dysfunctional uterine bleeding. Only sometimes there is an underlying organic lesion. We present a 12 years old teenager who consulted for heavy bleeding during menstruation that extended in time, with secondary ferropenic anemia. An abdominal ultrasound showed a right adnexal mass compatible with an ovarian endometrioma or a hemorrhagic follicle. The persistence of bleeding beyond 3 to 6 months from the first consultation makes mandatory an abdominal ultrasound and a blood test. The referral to a specialist should be considered (AU)

Trastorno de la marcha en una niña de dos años: importancia de las revisiones del programa de salud infantil / Walking disturbance in a two years old child: the importance of the well child program

La ataxia es un motivo de consulta relativamente frecuente en Atención Primaria. La mayor parte de las veces se presenta de forma aguda como consecuencia de causas banales. Sin embargo, en ocasiones como en el caso presente, es necesaria una exploración detallada y atenta en las revisiones sistemáticas del niño sano para ponerla de manifiesto, siendo generalmente en estos casos parte de un cuadro clínico más grave y larvado cuya detección y manejo precoz son los factores que más influyen en su mejor pronóstico. Se ofrece a continuación un caso clínico que pone de relieve la importancia de las revisiones sistemáticas y plantea el diagnóstico diferencial de la ataxia infantil(AU)

Ataxia is a relatively common reason for consultation in primary care. Most often it presents acutely as a result of banal causes. However, sometimes, we need a detailed and careful examination in the systematic reviews of healthy children to observe it, being in these cases part of a more severe clinical disease. An early detection and management are the factors that powerfully influence the prognosis. We report a case that highlights the importance of systematic reviews and differential diagnosis of ataxia(AU)