ABSTRACT
Resumen El número de personas en tratamiento con fármacos anticoagulantes o antiplaquetarios está en crecimiento constante debido al aumento de la supervivencia de los pacientes con fibrilación auricular, válvulas cardiacas mecánicas o que han sufrido un evento isquémico o trombótico agudo. Cuando estos pacientes necesitan un procedimiento radiológico intervencionista que acarrea riesgo de sangrado, es necesario analizar el riesgo trombótico del paciente al interrumpir la medicación frente al riesgo hemorrágico del procedimiento para tomar la decisión más adecuada en cada caso. Por tanto, es una decisión individualizada y supone un desafío para los/as radiólogos/as que realicen estas técnicas. Nuestro objetivo en esta revisión es mostrar las recomendaciones actuales sobre el manejo perioperatorio de la medicación anticoagulante y antiplaquetaria, adaptada al intervencionismo radiológico.
Abstract The number of people treated with anticoagulant or antiplatelet agents is constantly growing due to the increased survival of patients with atrial fibrillation, mechanical cardiac valves or who have suffered an acute thrombotic or ischemic event. When these patients need an interventional radiological procedure that carries a risk of bleeding, it is necessary to analyze the thrombotic risk of the patient when interrupting the medication against the hemorrhagic risk of the procedure, to make the most appropriate decision in each case. Therefore, it is an individualized decision, and it is a challenge for radiologists who perform these techniques. Our goal in this review is to update the current recommendations on the perioperative management of anticoagulant and antiplatelet agents, adapted to the radiological interventionism.
ABSTRACT
INTRODUCTION: Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS: A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended () and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS: The number of notifications from P1 (4.1; 95%CI 3.2-5.0) increased in P2 (10.9; 95%CI 9.8-10.2, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION: It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.
Subject(s)
Emergency Service, Hospital/standards , Pediatrics , Quality Assurance, Health Care/standards , Quality Improvement , Risk Management/standards , Child , Humans , Retrospective StudiesABSTRACT
Abstract The water resources mismanagement is a common concern in the agriculture, and this issue is boosting salinity processes in the Colombian lands. Thus, this paper aimed to assess the soil salinity risk in the RUT irrigation district for sugarcane, grape, and passion fruit by coupling SOSALRIEGO-GIS. First, sources of surface water and their influence areas were identified in the RUT irrigation district. Afterwards, inputs (water ionic constituents, electrical conductivity of rainwater, annual rainfall, crop salt tolerance, soil texture, and leaching fraction) fed in the SOSALRIEGO model, and then, the leaching requirement (LR) of each zone was computed (output) for each crop. Finally, employing GIS, LR values were arranged in categories in order to map the soil salinity risk in the RUT irrigation district for each crop and zone. The soil salinity risk fell into a medium rank for sugarcane, medium to high ranks for grape, and high to very high ranks for passion fruit. Furthermore, the soil salinity risk was higher in zones with poor irrigation water quality. Zones II and III, which canals convey domestic wastewater and drained water fell in greater salinity risk category than zone I, which bears water withdrawal from the Cauca River.
Resumen La inadecuada gestión de los recursos hídricos es una preocupación común en la agricultura, y este hecho está impulsando procesos de salinización en los suelos de Colombia. Por lo tanto, este trabajo tuvo como objetivo evaluar el riesgo de salinización del suelo en el distrito de riego RUT para cultivos de caña de azúcar, uva, maracuyá integrando el modelo SOSALRIEGO con SIG. En primer lugar, se identificaron las fuentes hídricas y sus áreas de influencia. Posteriormente, los parámetros de entrada (composición iónica del agua, conductividad eléctrica del agua de lluvia, precipitación anual, tolerancia de cultivos a la salinidad, cultivos, textura del suelo y la eficiencia de lavado) alimentaron el modelo SOSALRIEGO y, a continuación, el Requerimiento de Lavado de sales (RL) fue calculado para cada cultivo. Por último, utilizando SIG, los valores RL se organizaron en categorías con el fin de mapear el riesgo de salinización del suelo en el distrito de riego RUT para cada cultivo en cada zona. El riesgo de salinización se clasificó como medio para caña de azúcar, medio a Alto para la uva, y alto a muy alto para maracuyá. Además, el riesgo salinización del suelo encontrado fue mayor en zonas con baja calidad del agua de riego. Las Zonas II y III, en las cuales los canales conducen aguas residuales domésticas y el agua drenada fueron calificados en categorías superiores de riesgo de salinización que la Zona I, la cual recibe agua extraída directamente del río Cauca.
Resumo A inadequada gestão dos recursos hídricos é uma preocupação comum na agricultura, este fato está impulsando processos de salinização nos solos da Colômbia. Portanto, esta pesquisa objetivou avaliar o risco da salinização dos solos no distrito de irrigação RUT às culturas de cana-de-açúcar, uva e maracujá; integrando o modelo SOSALRIEGO com os Sistemas de Informações Geográficas (SIG). Em primeiro lugar, os parâmetros de entrada (composição iônica da água de irrigação, condutividade elétrica da água de precipitação, precipitação anual, tolerância das culturas à salinidade, culturas, textura do solo e eficiência de lavado de sais) alimentaram o modelo SOSALRIEGO e, seguidamente o requerimento de lavado de sais (RL) foi calculado. Finalmente, usando os SIG, os valores de RL foram categorizados com o objetivo de mapear o risco de salinização dos solos na área de estudo para cada cultura em cada zona. O risco de salinização foi classificado como Médio para a cultura da cana-de-açúcar, Médio a Elevado para a cultura da uva, e Elevado a Muito Elevado para o maracujá. Além disso, o risco de salinização foi maior nas zonas com menor qualidade da água de irrigação. As zonas II e III, cujos canais conduzem águas residuais e de drenagem foram qualificados em categorias maiores de risco do que a zona I, a qual extrai a água diretamente do Rio Cauca.
