How to avoid paediatric medication errors: a user's guide to the literature.

The National Health Service, in its report An organisation with memory, has called for a fundamental rethinking of the way the healthcare system learns from error. The NHS further details its goal to reduce serious medication errors by 40% in a second report entitled Building a safer NHS: improving medication safety. This report calls for a review of paediatric medication delivery systems to assess safety for children.

Radical-mediated synthesis of alpha-C-glycosides based on N-acyl galactosamine.

[structure] C-Glycosides of N-acyl 2-amino-2-deoxygalactose (acyl = MeCO, CF(3)CO, t-BuOCO) are available in a stereoselective manner by trapping of an anomeric radical with an activated alkene. Using anomeric selenides, radical generation and trapping is carried out under conditions that avoid competitive reduction, and this chemistry has been applied to the synthesis of the novel C-glycoside analogue of O-benzyl alpha-D-GalNAc.

Feasibility and accuracy of a postcard diary system for tracking healthcare utilization of community-dwelling older persons.

OBJECTIVE: To test the feasibility of and to validate a self-report weekly postcard diary of health care utilization. DESIGN: Case-series and validation study. SETTING: Community-based sample of fee-for-service and health maintenance organization (HMO) patients. PARTICIPANTS: A convenience sample of 24 community-dwelling older persons who had failed a self-administered screen and were eligible for a study of outpatient comprehensive geriatric assessment consultation. MEASUREMENTS: Subjects completed and mailed in a weekly postcard diary documenting medical, counseling, or rehabilitation therapy visits. If a subject did not respond within 10 days after the end of the week, a telephone call was placed to gather the information. For a subset of 10 subjects who were HMO enrollees, all records were reviewed to determine accuracy of the postcard diaries. RESULTS: Of the 24 subjects enrolled, one HMO enrollee dropped out following hip surgery after 4 weeks of completing diaries. The remaining 23 subjects (96% of total entered) provided complete information for 12 weeks. Telephone follow-up to either obtain or clarify utilization information was required for 22% of subjects. For the subset of 10 HMO subjects, seven underreporting, two overreporting, and one incorrect day errors were detected-a total of 10 errors representing 9% of diaries and 1.3% of patient-days. Kappa as a measure of agreement between the two methods (self-report and chart review) was 0.82 (P < .0001). Compared with chart review, the diary report was 75.0% sensitive and 99.8% specific. Positive and negative predictive values were 91.3% and 99.2%, respectively. CONCLUSION: These findings suggest that a postcard diary system with telephone follow-up is both a feasible and reasonably accurate method of tracking health care utilization by community-dwelling older persons, although a small percentage will be unable to adhere to this method.

Functional analysis of hypothalamic control of the cardiovascular responses accompanying emotional behavior.

The cardiovascular (CV) responses to an acute emotional situation in unanesthetized, chair-restrained baboons include elevations in heart rate, blood pressure, and terminal aortic flow and a complex biphasic reduction in renal flow. The same CV responses can be produced by stimulating an area in the hypothalamus. Furthermore, bilateral ablation of the hypothalamic area eliminates CV responses to the emotional behavior while responses to exercise, free feed, and lever press remain unaltered. This effect is not due to memory loss, loss of emotionality, or a general loss of CV regulatory capacity. Efferent projections of the hypothalamic site were traced by means of autoradiography and afferent sources were traced by horseradish peroxidase injections. Efferents include projections to amygdala, central gray, zona incerta, midline thalamic nuclei, dorsal midbrain tegmentum, the parabrachial region. Afferents were widely distributed and included inputs from the subiculum, amygdala, septal area, central gray, locus ceruleus, interpeduncular nucleus, and bilateral labeling in and around the dorsal motor nucleus of X and the nucleus ambiguus.

A horseradish peroxidase study of afferent connections of the globus pallidus in Macaca mulatta.

The high tonic discharge rates of globus pallidus neurons in awake monkeys suggest that these neurons may receive some potent excitatory input. Because most current electrophysiological evidence suggests that the major described pallidal afferent systems from the neostriatum are primarily inhibitory, we used retrograde transport of horseradish peroxidase (HRP) to identify possible additional sources of pallidal afferent fibers. The appropriate location was determined before HRP injection by mapping the characteristic high frequency discharge of single pallidal units in awake animals. In animals with injections confined to the internal pallidal segment, retrograde label was seen in neurons of the pedunculopontine nucleus, dorsal raphe nucleus, substantia nigra, caudate, putamen, subthalamic nucleus, parafascicular nucleus, zona incerta, medial and lateral subthalamic tegmentum, parabrachial nuclei, and locus coeruleus. An injection involving the external pallidal segment and the putamen as well resulted in additional labeling of cells in centromedian nucleus, pulvinar, and the ventromedial thalamus.