Penetration of sodium hypochlorite into root canal dentine: effect of surfactants, gel form and passive ultrasonic irrigation.

AIM: To assess the penetration of sodium hypochlorite (NaOCl) gel or NaOCl solutions with surfactants, and the effect of passive ultrasonic irrigation (PUI) on penetration into dentinal tubules. METHODOLOGY: Bovine incisor root canals were instrumented, the roots sectioned and the dentine blocks obtained were stained with crystal violet. Dentine blocks (n = 10 per group) were exposed to 3% NaOCl gel or 3% NaOCl solution for 10 and 20 min. Other dentine blocks (n = 10 per group) were exposed to Chlor-Extra (6% NaOCl + surfactant), 6% NaOCl, 2.5% NaOCl with 0.2% cetrimide and 2.5% NaOCl for 10 and 20 min. The penetration depth of irrigants into dentinal tubules was measured in micrometres by viewing the bleached crystal violet under a stereomicroscope. Additionally, bovine incisor root canals, instrumented and stained with crystal violet, were distributed into two groups (n = 10) and irrigated with 2.5% NaOCl with PUI or conventional syringe irrigation (CSI). The penetration depth of irrigants into dentinal tubules was assessed 3 and 7 mm from the apex. Statistical analysis was performed by ANOVA and Tukey tests (α = 0.05). RESULTS: There was significantly greater penetration of 3% NaOCl solution into dentinal tubules compared with the gel form (P < 0.05). There was no difference (P > 0.05) between 6% NaOCl and Chlor-Extra, and between 2.5% NaOCl and 2.5% NaOCl + cetrimide. PUI significantly increased the penetration depth of NaOCl into dentinal tubules when compared with CSI (P < 0.05). CONCLUSIONS: In extracted bovine incisors, NaOCl gel penetrated less into dentinal tubules than NaOCl solution. The addition of surfactants did not increase the penetration depth. The use of PUI significantly increased NaOCl penetration into dentinal tubules.

Adaptación española de los criterios Beers / Spanish adaptation of Beers criteria

Fundamento: Los Criterios de Beers, de procedencia estadounidense y actualizados en 2012, son una herramienta asesora en la prescripción en pacientes ancianos. Dadas las diferencias entre nuestro catálogo de medicamentos y el norteamericano, el objetivo del estudio fue obtener una adaptación española de dichos criterios. Material y método: La comparación de los Criterios de Beers con el catálogo español de medicamentos de 2012 permitió detectar los principios activos, presentes en los criterios, no comercializados en España. Además se buscaron medicamentos comercializados en España similares a los presentes en los criterios. Se asume que los medicamentos comercializados en Estados Unidos ya fueron evaluados en la elaboración de los Beers. Así, sobre los medicamentos similares, disponibles en España y no en Estados Unidos, se realizó una evaluación de acuerdo a 3 tipos de fuentes: los artículos presentados por la American Geriatrics Society para avalar la evidencia de los Beers; las fichas técnicas y prospectos; y los criterios europeos STOPP/START, NORGEP y PRISCUS. Resultados: De los 199 principios activos presentes en los criterios Beers, se detectaron 54 (27,0%) no comercializados en España. Además se incorporaron 50 principios activos. Entre el grupo de los "Criterios Directos" se detectaron 47 (34,3%) no disponibles y 40 posibles inclusiones, y en el grupo de los "Criterios Dependientes de Enfermedad" 33 (21,3%) y 48 respectivamente. Conclusiones: Se ha detectado una importante presencia de medicamentos no comercializados en España, así como un elevado número de principios activos no incluidos en la versión original. Este trabajo facilita una adaptación de los Criterios de Beers a los profesionales de nuestro entorno (AU)

Background: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. Patients and methods: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. Results: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. Conclusions: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario (AU)

[Spanish adaptation of Beers criteria]. / Adaptación española de los criterios Beers.

BACKGROUND: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. PATIENTS AND METHODS: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. RESULTS: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. CONCLUSIONS: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario.

Effectiveness of several solutions to prevent the formation of precipitate due to the interaction between sodium hypochlorite and chlorhexidine and its effect on bond strength of an epoxy-based sealer.

AIM: To evaluate the effectiveness of isopropyl alcohol, saline or distilled water to prevent the precipitate formed between sodium hypochlorite (NaOCl) and chlorhexidine (CHX) and its effect on the bond strength of an epoxy-based sealer in radicular dentine. METHODOLOGY: The root canals of 50 extracted human canines (n = 10) were instrumented. In G1, root canals were irrigated with 17% EDTA and 2.5% NaOCl; G2, as G1, except that 2% CHX was used as the final irrigant. In the other groups, intermediate flushes with isopropyl alcohol (G3), saline (G4) or distilled water (G5) were used between NaOCl and CHX. The specimens were submitted to SEM analysis to evaluate the presence of debris and smear layer, in the apical and cervical segments. In sequence, fifty extracted human canines were distributed into five groups (n = 10), similar to the SEM study. After root filling, the roots were sectioned transversally to obtain dentine slices, in the cervical, middle and apical thirds. The root filling was submitted to a push-out bond strength test using an electromechanical testing machine. Statistical analysis was performed using Kruskal-Wallis and Dunn's tests (α = 5%). RESULTS: All groups had similar amounts of residue precipitated on the canal walls (P > 0.05). The push-out bond strength values were similar for all groups, independently of the root third evaluated (P > 0.05). CONCLUSIONS: Isopropyl alcohol, saline and distilled water failed to prevent the precipitation of residues on canal walls following the use of NaOCl and CHX. The residues did not interfere with the push-out bond strength of the root filling.

Antibacterial effectiveness of several irrigating solutions and the Endox Plus system - an ex vivo study.

AIM: To compare the ex vivo antibacterial effectiveness of the Endox Plus system and sodium hypochlorite (NaOCl) in combination with BioPure MTAD (Tulsa Dental, Tulsa, OK, USA) or with EDTA in Enterococcus faecalis-contaminated root canals. METHODOLOGY: After initial preparation, the root canals of 70 single-rooted human teeth were inoculated with E. faecalis (ATCC 29212) and incubated for 21 days. Specimens were divided into five groups: Endox Plus/saline; 2.5% NaOCl/MTAD; 2.5% NaOCl/EDTA; saline (positive control); negative control (root canals not prepared, nor irrigated). Samples were collected using paper points. Microbiological analysis evaluated the number of CFUs. Data were analysed by anova and Tukey tests at 0.05 significance. RESULTS: All specimens had bacterial growth after the incubation period, with similar CFU per mL counts (P > 0.05). After chemo-mechanical preparation, the number of bacteria in all groups reduced, except for the negative control. No significant differences were observed between 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA, but these groups had lower CFU counts than the other groups (P < 0.05). In the final samples, an increase in the bacterial counts was observed for Endox Plus/saline, 2.5% NaOCl/MTAD, 2.5% NaOCl/EDTA and saline (P < 0.05) with no significant differences between these groups. CONCLUSIONS: This ex vivo study revealed that the Endox Plus system was associated with a reduced antibacterial effectiveness compared with conventional irrigation using 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA. All irrigation procedures allowed recovery of bacteria 7 days after treatment, demonstrating persistence of contamination within the root canal system.

[Analysis of the errors associated with the prescription, preparation and administration of cytostatic drugs]. / Errores asociados con la prescripción, validación, preparación y administración de medicamentos citostáticos.

OBJECTIVE: To analyse errors relating to the process of prescription, validation, preparation, dispensing and administration of cytostatic drugs, set out in the risk management programme regarding cytostatic drugs at our hospital. METHODS: Prospective, descriptive and cross-sectional study, of three-year duration (2003-2005) on the total number of errors reported in the chemotherapy risk management programme.The dosing of cytostatic drugs is centralised in the Pharmacy Department, which prepared an average of 12,966 cytostatic preparations per annum during the study period. The prescription validation procedure for chemotherapy is therefore centralised at the Pharmacy Department and is the responsibility of the area pharmacist who detects the majority of prescription errors and keeps a record of all the errors detected in the circuit. Most chemotherapy dosing errors are detected when the preparations are checked prior to dispensing. Pharmaceutical validation errors are detected in the clinical units after the checking of the prescription by the nursing staff and administration errors are gathered through voluntary communication by nursing staff or, occasionally, by the patients themselves. The classification used for errors "by error type" is in accordance with the Spanish adaptation of the National Coordinating Causal for Medication Error Reporting and Prevention prepared by Otero. The qualitative variables analysed were measured as rates and/or percentages. RESULTS: During the study period (between 2003-2005), 268 errors were reported, 87.91% of which were detected in the medical day hospital. An increase in errors was seen in 2005, affecting 13.91% of the patients as opposed to 6.69% and 4.81% in the years 2003 and 2004. The largest number of errors was reported by the nursing staff (54.08%) followed by the pharmacist with 39.55% and the doctor 4.47%. Prescription errors (45.14%) were the most frequent, followed by validation (33.58%) and preparation (16.41%) errors. Among the prescription errors, the greatest percentages correspond to underdosing (32.32%), overdosing (16.16%) and dose reversal (11.11%). A total of 11.94% (32) of these reached the patient and 88.06% were prevented. CONCLUSIONS: The assessment of care practices and the critical, constructive analysis of the errors detected therein can be used as a tool that will enable the continuous improvement of procedures and the increased clinical safety of the patients. The collaboration of all the personnel involved in the circuits with known and shared objectives can enable a more exact dimension to be obtained of our current care situation in aspects for the clinical safety of patients.

Errores asociados con la prescripción, validación, preparación y administración de medicamentos citostáticos / Analysis of the errors associated with the prescription, preparation and administration of cytostatic drugs

Objetivo: Analizar los errores relacionados con el proceso de prescripción,validación, preparación, dispensación y administración demedicamentos citostáticos, recogidos en el programa de gestión deriesgos con medicamentos citostaticos en nuestro hospital.Métodos: Estudio prospectivo, descriptivo y transversal, de 3 años deduración (2003-2005), sobre la totalidad de los errores comunicadosen el programa de gestión de riesgos asociados con quimioterapia.La dosificación de medicamentos citostáticos está centralizada en elservicio de farmacia, que elaboró una media anual de 12.966 mezclascitostáticas en este período de estudio. El procedimiento de validaciónde la prescripción de quimioterapia está, asimismo, centralizadoen el servicio de farmacia y es responsabilidad del farmacéuticodel área, que detecta mayoritariamente errores de prescripción yasume a su vez el registro de todos los errores detectados en el circuito.La detección de errores de dosificación de la quimioterapiaproviene en su mayoría de la revisión de las mezclas elaboradas, previaa la dispensación. Los de validación farmacéutica se detectan enlas unidades clínicas tras la revisión de la prescripción por parte delpersonal de enfermería, y los de administración se recogen a partirde la comunicación voluntaria por parte del personal de enfermeríao, en ocasiones, del propio paciente. La clasificación utilizada para loserrores «por tipo de error» sigue la adaptación española de la clasificaciónNacional Coordinating Causal for Medication Error Reportingand Prevention realizada por Otero. Las variables cualitativas analizadasse midieron como tasas y/o porcentajes.Resultados: En el período de estudio 2003-2005 los errores registradosfueron 268, el 87,91% de los cuales se detectó en hospital de díamédico. Se observa un incremento de los errores en 2005, que afectana un 13,91% de los pacientes atendidos frente a un 6,69 y un 4,81% delos años 2003 y 2004. El mayor número de errores fue comunicadopor el personal de enfermería (54,08%), seguido del farmacéutico conun 39,55% y el médico en un 4,47%. El error de prescripción, con 45casos (14%) fue el más frecuente, seguido de la validación (33,58%) yla elaboración (16,41%). Entre los errores de prescripción, los mayoresporcentajes corresponden a infradosis (32,32%), extradosis (16,16%)e inversión de dosis (11,11%). Un 11,94% (32) de éstos llegaron al pacientey el restante 88,06% se previno.Conclusiones: La evaluación de la práctica asistencial y el análisis críticoy constructivo de los defectos que en ella confluyen pueden seruna herramienta que permita la mejora continua de los procedimientosy el incremento de la seguridad clínica de los pacientes.La colaboración de todo el personal implicado en los circuitos conobjetivos conocidos y compartidos permite obtener una dimensiónmás exacta de nuestra realidad asistencial en los aspectos de la seguridadclínica de los pacientes

Objective: To analyse errors relating to the process of prescription,validation, preparation, dispensing and administration of cytostaticdrugs, set out in the risk management programme regarding cytostaticdrugs at our hospital.Methods: Prospective, descriptive and cross-sectional study, ofthree-year duration (2003-2005) on the total number of errors reportedin the chemotherapy risk management programme.The dosing ofcytostatic drugs is centralised in the Pharmacy Department, whichprepared an average of 12,966 cytostatic preparations per annumduring the study period. The prescription validation procedure forchemotherapy is therefore centralised at the Pharmacy Departmentand is the responsibility of the area pharmacist who detects the majorityof prescription errors and keeps a record of all the errors detectedin the circuit. Most chemotherapy dosing errors are detectedwhen the preparations are checked prior to dispensing. Pharmaceuticalvalidation errors are detected in the clinical units after the checkingof the prescription by the nursing staff and administration errors are gathered through voluntary communication by nursing staff or,occasionally, by the patients themselves. The classification used forerrors «by error type» is in accordance with the Spanish adaptation ofthe National Coordinating Causal for Medication Error Reporting andPrevention prepared by Otero.The qualitative variables analysed were measured as rates and/orpercentages.Results: During the study period (between 2003-2005), 268 errorswere reported, 87.91% of which were detected in the medical dayhospital. An increase in errors was seen in 2005, affecting 13.91% ofthe patients as opposed to 6.69% and 4.81% in the years 2003 and2004. The largest number of errors was reported by the nursing staff(54.08%) followed by the pharmacist with 39.55% and the doctor4.47%. Prescription errors (45.14%) were the most frequent, followedby validation (33.58%) and preparation (16.41%) errors. Amongthe prescription errors, the greatest percentages correspond to underdosing(32.32%), overdosing (16.16%) and dose reversal(11.11%). A total of 11.94% (32) of these reached the patient and88.06% were prevented.Conclusions: The assessment of care practices and the critical, constructiveanalysis of the errors detected therein can be used as a toolthat will enable the continuous improvement of procedures and theincreased clinical safety of the patients. The collaboration of all thepersonnel involved in the circuits with known and shared objectivescan enable a more exact dimension to be obtained of our currentcare situation in aspects for the clinical safety of patients