scholarly journals Improving Safety of Intravenous Prostacyclin Administration to Pediatric Patients With Pulmonary Hypertension

2019 ◽  
Vol 39 (4) ◽  
pp. e1-e7 ◽  
Author(s):  
Julia McSweeney ◽  
Emily Rosenholm ◽  
Katherine Penny ◽  
Mary P. Mullen ◽  
Thomas J. Kulik
Keyword(s):  
Pulmonary Hypertension ◽  
Medication Errors ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Therapeutic Index ◽  
Quality Improvement Initiative ◽  
Chi Square ◽  
Safety Reporting ◽  
Life Threatening ◽  
Chi Square Analysis

Background Pulmonary hypertension is a rare, life-threatening disease with limited therapeutic options and no definitive cure. Continuous intravenous prostacyclin therapy is indicated for treatment of severe disease. These medications have a narrow therapeutic index and a brief half-life; therefore, administration errors can be lethal. Objective To reduce medication errors through an inpatient program to improve, standardize, and disseminate continuous intravenous prostacyclin therapy practice guidelines. Methods Data were collected from the electronic safety reporting system of a single hospital to determine the number and types of continuous intravenous prostacyclin therapy errors that were reported over an 8-year period. A clinical database and hospital pharmacy records were used to determine the number of days on which hospitalized pediatric patients received the therapy. Interventions A nursing-directed quality improvement initiative to enhance the safety of continuous intravenous prostacyclin therapy for pediatric patients was begun in January 2009. Efforts to improve safety fell into 4 domains: policy, process, education, and hospital-wide safety initiatives. Results The number of therapy errors per 1000 patient days fell from 19.28 in 2009 to 5.95 in 2016. Chi-square analysis was used to compare the result for 2009 with that for each subsequent year, with P values of .66, .35, .16, .09, .03, .12, and .25 found for 2010 through 2016, respectively. Conclusions The trend in reduction of continuous intravenous prostacyclin therapy errors suggests that proactive processes to standardize its administration, emphasizing both policy and education, reduce medication errors and increase patient safety.

scholarly journals RECOGNITION AND PREVENTION OF MEDICATION ERRORS IN PEDIATRIC INPATIENTS: THE ROLE OF CLINICAL PHARMACISTS

2021 ◽  
Vol 3 (2) ◽  
pp. 438-446
Keyword(s):  
Medication Errors ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Dose Calculation ◽  
Medical Setting ◽  
Chi Square ◽  
Proper Action ◽  
Clinical Pharmacists ◽  
Chi Square Analysis

Introduction: Medication errors (MEs) are considered preventable errors that may occur frequently during the treatment process with or without patient harm in addition to their economic consequence. MEs occur during prescribing, dose calculation, dispensing, or administration of medicine which could be made by any healthcare professional as a physician, pharmacist or nurse, or by the patient himself. Objective: To detect and report MEs in pediatric inpatients’ medical records and potentially preventing these MEs by making recommendations/suggestions for healthcare professionals about the proper action needed to be taken. Methods: This was a prospective observational study, in which the medical records of admitted pediatric patients to Ibn Al-Atheer Teaching Hospital, Nineveh were reviewed to detect, report, and prevent MEs between the 1st of January and the 30th of June 2019. Results: Out of 6964 medical records reviewed by clinical pharmacists during the study period, 119 MEs were reported to healthcare professionals and prevented. 83% of detected MEs were dosing errors. The results of the Chi-square analysis showed that the highest percentage of dosing errors were associated with antibiotics (p=0.0493). Furthermore, the results of Chi-square analysis showed that the highest percentage of dosing errors were seen in infants and toddlers (p=0.011). Conclusion: This study highlighted the role of clinical pharmacists in recognizing, reporting and preventing MEs which are still occurring in every medical setting. Dosing errors were the most commonly occurring errors and antibiotics were the most frequent group of medicines involved in MEs.

Life-threatening complications of pulmonary hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2497-2500
Author(s):  
Marion Delcroix ◽  
Catharina Belge
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Coronary Artery ◽  
Pulmonary Arterial Hypertension ◽  
Severe Disease ◽  
Right Heart Failure ◽  
Artery Dissection ◽  
Life Threatening ◽  
Pulmonary Arterial ◽  
Arterial Dilation

Pulmonary arterial hypertension is a severe disease with a 1-year mortality of over 10%. Since it is a rare disease, it is usually managed in expert centres. However, life-threatening complications can occur at any moment and place and should be adequately taken care of to prevent avoidable deaths. Therefore, based on an analysis of the causes of death, this chapter describes the most important complications and their management: right heart failure, arrhythmias, haemoptysis, pericardial effusion, pulmonary arterial dilation with as a consequence left main coronary artery compression, and pulmonary artery dissection, as well as treatment-related adverse events.

scholarly journals Injured Workers Perspectives on Recovery following Non-Life-Threatening Acute Orthopaedic Trauma: A Descriptive Study

2014 ◽  
Vol 2014 ◽  
pp. 1-12
Author(s):  
Fiona J. Clay ◽  
Swati Shourie ◽  
Priscilla Robinson ◽  
Donna McKenzie ◽  
Emily Kerr
Keyword(s):  
Recovery Process ◽  
Descriptive Study ◽  
Current Status ◽  
Orthopaedic Trauma ◽  
Chi Square ◽  
Recovery Expectations ◽  
Successful Recovery ◽  
Injury Event ◽  
Life Threatening ◽  
Chi Square Analysis

Background. Little is known about the recovery process following non-life-threatening acute orthopaedic trauma from the viewpoint of the injured person. A better understanding could facilitate optimal rehabilitative planning. Objective. To explore patients’ views on factors important to them in recovery following non-life threatening acute orthopaedic trauma. Methods. Descriptive study utilizing content analysis and chi-square analysis. To better understand recovery expectations, 168 adults who had sustained non-life threatening acute orthopaedic trauma were surveyed at 2, 12, and 26 weeks after injury and invited to respond to the following question “what are the most important things necessary for you to best recover?” Results. According to participant’s responses, major themes on recovery involved a return to health and a return to health but with an ongoing plan, and for a minority (12%) recovery involved a focus on their current status. The study found that some recovery expectations changed over time. Conclusion. The journey to recovery is complex, often prolonged, and highly individual. Responses suggest that some injured persons need more assistance for a successful recovery than others. Those who appeared “caught in the moment” of the injury may benefit from clinical and rehabilitative management focusing on long-term recovery and acceptance of the injury event.

scholarly journals HUBUNGAN LAMANYA MENJALANI HEMODIALISIS DENGAN TINGKAT KECEMASAN PADA PASANGAN HIDUP PASIEN YANG MENDERITA PENYAKIT GINJAL KRONIK DI RSUP PROF. Dr. R. D. KANDOU MANADO

e-CliniC ◽  
2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Ainivi F. Tangian ◽  
L. F. J. Kandou ◽  
Herdy Munayang
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Severe Disease ◽  
Anxiety Level ◽  
Chi Square ◽  
Cognitive Changes ◽  
Cross Sectional ◽  
Probability Sampling ◽  
Purposive Sampling ◽  
Life Threatening

Abstract: Anxiety is defined as a prolonged response to unexpected threats, which include physiological responses, affective, and cognitive changes. Anxiety will appear in families where one member of the family is ill and requires hospitalization. Severe disease especially life threatening can cause anxiety, rejection and anger. The purpose of this research is to know the relationship between the duration of having hemodialysis and the anxiety level of partners ofpatients who suffer from chronic kidney disease at the Prof. dr. R.D. Kandou Manado Hospital. This research has descriptive analytic type with cross-sectional approach. Samples in this study were 34 spouses. This study used Non Probability Sampling with Purposive Sampling. The results showed that anxiety did not occur at 19 respondents (55%). The result of Chi-square correlation test was a value of Sig. 0.064 (P > 0.05) which meant there was no siginificant relationship. Therefore, H0 was approved and H1 was rejected. Conclusion: There was no relationship between the duration of having hemodialysis and the anxiety level of partners of the patients who suffered from chronic kidney disease at the Prof. dr. R.D. Kandou Manado Hospital.Keywords: anxiety, partners of hemodialysis patients, chronic kidney disease, hemodialysisAbstrak: Kecemasan didefinisikan sebagai respon yang berkepanjangan terhadap ancaman yang tak terduga, responyang meliputi fisiologis, afektif, dan perubahan kognitif. Kecemasan akan muncul pada keluarga yang salah satu anggota keluarganya sedang sakit dan memerlukan perawatan di rumah sakit. Penyakit yang berat terutama yang mengancam kehidupan, dapat menimbulkan kecemasan, penolakan, dan marah.Penelitian ini bertujuan untuk mengetahui hubungan lamanya menjalani hemodialisis dengan tingkat kecemasan pada pasangan hidup pasien yang menderita penyakit ginjal kronik di RSUP Prof dr. R. D. Kandou Manado. Penelitian ini bersifat deskriptif analitik dengan pendekatan potong lintang.Jumlah sampel dalam penelitian ini sebanyak 34 pasangan hidup.Sampling yang digunakan adalah Non Probability Sampling dengan metode purposive sampling. Hasil penelitian sebagian besar yaitu 19 responden (55,9%) tidak mengalami kecemasan. Hasil uji korelasi Chi-square adalah nilai Sig. sebesar 0,064. Penggunaan signifikansi α = 5% (0,05), maka nilai p = 0,064 > 0,05 yang berarti tidak ada hubungan yang bermakna. Dapat disimpulkan H0 diterima dan H1 ditolak yang berarti tidak ada hubungan lamanya menjalani hemodialisis dengan tingkat kecemasan pada pasangan hidup pasien yang menderita penyakit ginjal kronik di RSUP Prof dr. R. D. Kandou Manado.Kata kunci: kecemasan, pasangan hidup, penyakit ginjal kronik, hemodialisis

Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies

2016 ◽  
Vol 73 (15) ◽  
pp. 1167-1173 ◽  
Author(s):  
Gary L. Cochran ◽  
Ryan S. Barrett ◽  
Susan D. Horn
Keyword(s):  
Medication Errors ◽  
Medication Safety ◽  
Medication Administration ◽  
Error Rates ◽  
Critical Access Hospitals ◽  
Chi Square ◽  
Exact Test ◽  
Transcription Error ◽  
Chi Square Analysis ◽  
Dispensing Errors

Abstract Purpose The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse–nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Methods Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician’s order. Chi-square analysis and Fisher’s exact test were used to measure differences between groups of medication-dispensing procedures. Results Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Conclusion Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.

scholarly journals LO006: Interarm blood pressure differential as a clinical marker for acute aortic dissection in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S32
Author(s):  
S.W. Um ◽  
R. Ohle ◽  
J.J. Perry
Keyword(s):  
Back Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Tertiary Care ◽  
Mean Difference ◽  
Healthy Population ◽  
Chi Square ◽  
Significant Difference ◽  
Life Threatening ◽  
Chi Square Analysis

Introduction: Acute Aortic Dissection (AAD) is life threatening, requiring early diagnosis. Although previous literature suggest interarm BP differential is an independent predictor of AAD, up to 20% of a healthy population can have a significant differential. Our objectives were to assess the rate of bilateral BP measurement in acute non-traumatic truncal pain patients, and the association of BP differential with non-traumatic AAD. Methods: This is a historical matched case control study: participants were adults >18 years old presenting to two tertiary care EDs with a triage diagnosis of truncal (i.e. chest, abdominal, flank, back) pain. Cases were selected based on an ED or in-hospital diagnosis of non-traumatic AAD confirmed by CT or Echo. Controls were from a single calendar year matched in a 1:1.5 ratio by sex and age within 5 years. ED and referral consult BP measurements were used. Exclusion criteria: clear diagnosis on basic investigation (i.e. UTI, pneumonia, pneumothorax, acute fracture) or pain >14 days/no pain. Sample size of 126 cases and 183 controls was calculated based on 20% exposure in controls (80% power and alpha of 5%), to detect an OR >2. P-values were calculated using chi square analysis. Results: A total of 294 (119 cases, 175 controls) patients were included (mean 66+/-14.5yrs, 59.5% male). Cases (199 potential: 119 included; 80 excluded). Controls (8239 potential: 305 reviewed; 175 included; 130 excluded). Bilateral BP was measured in 70.6% of cases (n=84, mean difference=15.5mmHg) versus 31.3% of controls (n=55, mean difference=10.9mmHg). Among included controls, most common diagnoses were: Unspecified Chest (36.0%) or Abdominal (9.7%) Pain, ACS (12.6%), Muscular Back Pain (5.1%), and Renal Colic (4.0%). BP differential >10mmHg was found in 58.8% of cases and 40.7% of controls (P=0.10). A BP differential >20mmHg was found in 31.3% of cases and 22.2% of controls (P=0.37). BP differential >20mmHg did not significantly increase the odds of AAD (OR 2.0 (95%CI 0.82-4.90), p<0.129). Conclusion: Interarm BP differential is not routinely measured in ED patients with acute non-traumatic truncal pain, and there is no significant difference in the presence or magnitude of differentials in patients with or without AAD. Therefore, physicians should not rely on BP differentials to aid in their diagnosis or exclusion of AAD.

scholarly journals 05. EMS and the Pediatric Arrest: Are EMTs Getting the Whole Story?

1996 ◽  
Vol 11 (S2) ◽  
pp. S38-S38
Author(s):  
Susan Graham ◽  
Lenora Olson ◽  
Robert Sapien ◽  
Dan Tandberg ◽  
David Sklar
Keyword(s):  
Pediatric Patients ◽  
Kappa Statistic ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
Chi Square ◽  
Exact Test ◽  
One Year ◽  
Chi Square Analysis ◽  
Good Agreement ◽  
Overall Mortality

Purpose: Among pediatric patients, cardiopulmonary arrests account for a small, but important, percentage of responses by emergency medical services (EMS). EMS prehospital assessment of medical and traumatic arrests in the pediatric patient were compared with that of the Office of Medical Investigator (OMI) autopsy reports to assess differences and implications for EMS training and prevention in pediatric arrests.Methods: Retrospective review of ambulance run forms from an urban EMS system with OMI autopsy correlation. Patients less than fifteen years of age and younger who were treated by prehospital personnel from November 1, 1990, to October 31, 1991, for a medical or traumatic arrest. Proportions were analyzed using chi-square analysis or Fisher's exact test and agreement was assessed using the Kappa statistic.Results: Ambulance runs were reported for 2,586 pediatric patients. Of these, forty-two (1.6%) suffered arrests, with thirty-two (76%) medical arrests and ten (24%) traumatic arrests. Children one year of age or less accounted for 75% of the medical arrests while children greater that one year of age accounted for 80% of the traumatic arrests (p = 0.003). Overall mortality was 81%. When EMS prehospital assessment of medical and traumatic arrests were compared with OMI reports, there was good agreement (kappa = 0.70) for Sudden Infant Death Syndrome (SIDS), but poor agreement (kappa = 0.37) for child abuse.

scholarly journals Correlation between potassium administration and resolution in patients with diabetic ketoacidosis

2021 ◽  
Vol 17 (2) ◽  
pp. 127-136
Author(s):  
Rina Oktaviani ◽  
Zullies Ikawati ◽  
Nanang Munif Yasin
Keyword(s):  
Diabetic Ketoacidosis ◽  
Early Administration ◽  
Chi Square ◽  
Factors Affecting ◽  
Cohort Design ◽  
Acute Diabetes ◽  
Chi Square Test ◽  
Life Threatening ◽  
History Of ◽  
Chi Square Analysis

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of acute diabetes mellitus (DM). Insulin is one of the therapies for DKA, which can reduce potassium levels by shifting potassium from extracellular to intracellular. Consequently, early administration of potassium is important in the resolution of DKA. Objective: To determine the correlation between potassium administration and resolution in patients with DKA and the factors affecting such resolution. Methods: An observational study was employed with a retrospective cohort design for inpatients with a diagnosis of DKA during the period of January 2015-August 2020 at Dr. Sardjito Hospital Yogyakarta. Appraisal of the resolution of DKA variable was based on the achievement of blood glucose targets, followed by 2 criteria of serum bicarbonate, pH, and anion gap during 24 hours of therapy. This study involved 55 patients divided into groups with potassium administration and without potassium administration. Data were analyzed using the chi-square test and multivariate logistic regression. Results: The resolution of DKA achieved in less than equal to 24 hours in the group with potassium was 48.5% (16 patients) while it was 18.2% (4 patients) without potassium. Based on the chi-square analysis, there was a relationship between potassium administration and the resolution of DKA (p=0.045; RR=2.667; 95%CI=1.028-6.920). The multivariate analysis showed that the severity and history of DM were positively related to the resolution of DKA (p=0.025; OR: 8.901; 95%CI=1.318-60.123 and p=0.017; OR: 0.090; 95%CI=0.012-0.652). Conclusion: Potassium administration resulted in 48.5% of the DKA patients achieving a resolution in less than equal to 24 hours from the commencement of DKA therapy. The severity and history of DM became the factors that affected the resolution of DKA. Keywords: diabetic ketoacidosis, potassium, resolution

scholarly journals Participation in a Fruit and Vegetable Prescription Program for Pediatric Patients is Positively Associated with Farmers’ Market Shopping

2020 ◽  
Vol 17 (12) ◽  
pp. 4202
Author(s):  
Amy Saxe-Custack ◽  
Richard Sadler ◽  
Jenny LaChance ◽  
Mona Hanna-Attisha ◽  
Tiffany Ceja
Keyword(s):  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Fruit And Vegetable ◽  
Chi Square ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Farmers Market ◽  
Pediatric Clinic ◽  
Chi Square Analysis

Objectives: The primary objective was to investigate the association between participation in a farmers’ market fruit and vegetable prescription program (FVPP) for pediatric patients and farmers’ market shopping. Methods: This survey-based cross-sectional study assessed data from a convenience sample of 157 caregivers at an urban pediatric clinic co-located with a farmers’ market. Prescription redemption was restricted to the farmers’ market. Data were examined using chi-square analysis and independent samples t-tests. Results: Approximately 65% of respondents participated in the FVPP. Those who received one or more prescriptions were significantly more likely to shop at the farmers’ market during the previous month when compared to those who never received a prescription (p = 0.005). Conclusions: This is the first study to demonstrate that participation in a FVPP for pediatric patients is positively associated with farmers’ market shopping.

Do Adult Disease Severity Subclassifications Predict Use of Cyclophosphamide in Children with ANCA-associated Vasculitis? An Analysis of ARChiVe Study Treatment Decisions

2012 ◽  
Vol 39 (10) ◽  
pp. 2012-2020 ◽  
Author(s):  
KIMBERLY MORISHITA ◽  
JAIME GUZMAN ◽  
PETER CHIRA ◽  
EYAL MUSCAL ◽  
ANDREW ZEFT ◽  
...  
Keyword(s):  
Disease Severity ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Rank Correlation ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Chi Square ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Adult Disease ◽  
Choice Of Treatment

Objective.To determine whether adult disease severity subclassification systems for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are concordant with the decision to treat pediatric patients with cyclophosphamide (CYC).Methods.We applied the European Vasculitis Study (EUVAS) and Wegener’s Granulomatosis Etanercept Trial (WGET) disease severity subclassification systems to pediatric patients with AAV in A Registry for Childhood Vasculitis (ARChiVe). Modifications were made to the EUVAS and WGET systems to enable their application to this cohort of children. Treatment was categorized into 2 groups, “cyclophosphamide” and “no cyclophosphamide.” Pearson’s chi-square and Kendall’s rank correlation coefficient statistical analyses were used to determine the relationship between disease severity subgroup and treatment at the time of diagnosis.Results.In total, 125 children with AAV were studied. Severity subgroup was associated with treatment group in both the EUVAS (chi-square 45.14, p < 0.001, Kendall’s tau-b 0.601, p < 0.001) and WGET (chi-square 59.33, p < 0.001, Kendall’s tau-b 0.689, p < 0.001) systems; however, 7 children classified by both systems as having less severe disease received CYC, and 6 children classified as having severe disease by both systems did not receive CYC.Conclusion.In this pediatric AAV cohort, the EUVAS and WGET adult severity subclassification systems had strong correlation with physician choice of treatment. However, a proportion of patients received treatment that was not concordant with their assigned severity subclass.

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