scholarly journals Chemotherapy Order Entry by a Clinical Support Pharmacy Technician in an Outpatient Medical Day Unit

2016 ◽  
Vol 69 (3) ◽  
Author(s):  
Heather Neville ◽  
Larry Broadfield ◽  
Claudia Harding ◽  
Shelley Heukshorst ◽  
Jennifer Sweetapple ◽  
...  
Keyword(s):  
Patient Care ◽  
Medication Errors ◽  
Phase 1 ◽  
Scope Of Practice ◽  
Phase 2 ◽  
Order Entry ◽  
Pharmacy Technician ◽  
Clinical Support ◽  
Before And After ◽  
Pharmacy Technicians

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Pharmacy technicians are expanding their scope of practice, often in partnership with pharmacists. In oncology, such a shift in responsibilities may lead to workflow efficiencies, but may also cause concerns about patient risk and medication errors.</p><p><strong>Objectives: </strong>The primary objective was to compare the time spent on order entry and order-entry checking before and after training of a clinical support pharmacy technician (CSPT) to perform chemotherapy order entry. The secondary objectives were to document workflow interruptions and to assess medication errors.</p><p><strong>Methods: </strong>This before-and-after observational study investigated chemotherapy order entry for ambulatory oncology patients. Order entry was performed by pharmacists before the process change (phase 1) and by 1 CSPT after the change (phase 2); order-entry checking was performed by a pharmacist during both phases. The tasks were timed by an independent observer using a personal digital assistant. A convenience sample of 125 orders was targeted for each phase. Data were exported to Microsoft Excel software, and timing differences for each task were tested with an unpaired <em>t </em>test.</p><p><strong>Results: </strong>Totals of 143 and 128 individual orders were timed for order entry during phase 1 (pharmacist) and phase 2 (CSPT), respectively. The mean total time to perform order entry was greater during phase 1 (1:37 min versus 1:20 min; <em>p </em>= 0.044). Totals of 144 and 122 individual orders were timed for order-entry checking (by a pharmacist) in phases 1 and 2, respectively, and there was no difference in mean total time for order-entry checking (1:21 min versus 1:20 min; <em>p </em>= 0.69). There were 33 interruptions not related to order entry (totalling 39:38 min) during phase 1 and 25 interruptions (totalling 30:08 min) during phase 2. Three errors were observed during order entry in phase 1 and one error during order-entry checking in phase 2; the errors were rated as having no effect on patient care.</p><p><strong>Conclusions: </strong>Chemotherapy order entry by a trained CSPT appeared to be just as safe and efficient as order entry by a pharmacist. Changes in pharmacy technicians’ scope of practice could increase the amount of time available for pharmacists to provide direct patient care in the oncology setting.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Les techniciens en pharmacie élargissent leur champ de pratique, souvent en partenariat avec les pharmaciens. En oncologie, un tel changement dans les responsabilités pourrait conduire à une optimisation de l’organisation du travail, mais il peut aussi soulever des inquiétudes au sujet des risques pour le patient et des erreurs de médicaments.</p><p><strong>Objectifs : </strong>L’objectif principal était de comparer le temps passé à la saisie d’ordonnances et à la vérification de cette saisie avant et après avoir formé un technicien en pharmacie dédié au soutien clinique (TPDSC) à la saisie d’ordonnances de chimiothérapie. Les objectifs secondaires étaient de répertorier les interruptions de travail et d’évaluer les erreurs de médicaments.</p><p><strong>Méthodes : </strong>La présente étude observationnelle avant-après s’est intéressée à la saisie d’ordonnances de  chimiothérapie pour les patients ambulatoires en oncologie. La saisie d’ordonnances était réalisée par des pharmaciens avant le changement de procédé (phase 1), puis, après le changement (phase 2), un TPDSC en avait la responsabilité. Un pharmacien vérifiait la saisie d’ordonnances au cours des deux phases. Les tâches étaient chronométrées par un observateur indépendant à l’aide d’un assistant numérique personnel. Un échantillon de  commodité de 125 ordonnances était souhaité pour chaque phase. Les données ont été consignées dans un tableur Excel de Microsoft et les écarts de temps pour chaque tâche ont été évalués à l’aide d’un test <em>t </em>pour échantillons indépendants.</p><p><strong>Résultats : </strong>Au total, on a chronométré le temps de saisie pour 143 ordonnances à la phase 1 (pharmacien), puis de 128 ordonnances pour la phase 2 (TPDSC). Le temps total moyen nécessaire pour saisir une ordonnance était plus long au cours de la phase 1 (1 min 37 s contre 1 min 20 s; <em>p </em>= 0,044). Au total, on a chronométré la vérification (réalisée par un pharmacien) de saisie pour 144 ordonnances à la phase 1 et 122 ordonnances à la phase 2. Aucune différence notable n’a été relevée dans le temps total moyen de vérification (1 min 21 s contre 1 min 20 s; <em>p </em>= 0,69). On a dénombré 33 interruptions sans lien à la saisie d’ordonnances (totalisant 39 min 38 s) au cours de la phase 1 et 25 interruptions (totalisant 30 min et 8 s) durant la phase 2. Trois erreurs à la saisie d’ordonnances ont été observées pendant la phase 1 et une erreur à la vérification de la saisie d’ordonnances pendant la phase 2; ces erreurs ont été jugées sans effet sur les soins aux patients.</p><p><strong>Conclusions : </strong>La saisie d’ordonnances de chimiothérapie par un TPDSC formé semblait être tout aussi sûre et efficiente que si elle était réalisée par un pharmacien. Les changements apportés au champ de pratique des techniciens en pharmacie pourraient accroître le temps dont disposent les pharmaciens pour prodiguer des soins directs aux patients en oncologie.</p>

scholarly journals Evaluation of Factors Influencing Thigh Circumference Measurement in Dogs

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Felix Michael Duerr ◽  
Ana Luisa Bascuñán ◽  
Nina Kieves ◽  
Clara Goh ◽  
Juliette Hart ◽  
...  
Keyword(s):  
Outcome Measurement ◽  
Phase 1 ◽  
Alternative Methods ◽  
Observer Variability ◽  
Phase 2 ◽  
Laser Guidance ◽  
Thigh Circumference ◽  
Inter Observer Variability ◽  
Before And After ◽  
The Impact

<p class="AbstractSummary"><strong>Objective: </strong>To evaluate inter- and intra-observer variability, influence of hair clipping and laser guidance on canine thigh circumference (TC) measurements amongst observers.<strong></strong></p><p class="AbstractSummary"><strong>Background:</strong> It was our goal to further study the reliability of canine TC measurements as currently performed. For this purpose we designed a cadaveric model that allows for controlled inflation of the thigh resembling increase of muscle mass. We also investigated the impact of novel technologies (laser guidance) and hair clipping on TC measurements in this model. </p><p class="AbstractSummary"><strong>Evidentiary value:</strong> Phase 1 cadaveric study - five long-haired, large breed canine cadavers; Phase 2 clinical study - eight clinically healthy Golden Retrievers. This study should impact clinical research and practice.</p><p class="AbstractSummary"><strong>Methods: </strong>Phase 1 - Canine cadaveric thigh girth was manually expanded to three different levels using a custom, submuscular inflation system before and after hair clipping; Phase 2 - TC of Golden Retrievers was measured with and without laser guidance. TC measurements for both phases were performed by four observers in triplicate resulting in a total of 552 measurements. </p><p class="AbstractSummary"><strong>Results:</strong> Phase 1 - TC measurements before and after hair clipping were significantly different (3.44cm difference, p&lt;0.001). Overall inter-observer and intra-observer variability were 2.26±1.18cm and 0.90±0.61cm, respectively. Phase 2 - Laser guidance nominally improved inter-observer variability (3.34 ±1.09cm versus 4.78 ±2.60cm) but did not affect intra-observer variability (1.14 ±0.66cm versus 1.13 ±0.77cm).</p><p class="AbstractSummary"><strong>Conclusion: </strong>TC measurement is a low fidelity outcome measure with a large inter- and intra-observer variability even under controlled conditions in a cadaveric setting. Current methods of canine TC measurement may not produce a valid outcome measurement. If utilised, hair coat clipping status should be considered and an intra-observer variability of at least 1cm should be assumed when comparing repeated TC measurements. Laser guidance may be helpful to nominally reduce inter-observer variability in settings with multiple observers. Further investigation of alternative methods for canine TC measurement should be pursued.<strong></strong></p><p class="AbstractSummary"><strong>Application:</strong> This information should be considered by everyone utilizing TC measurements as an outcome assessment for clinical or research purposes. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

scholarly journals Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241804
Author(s):  
Dong Eun Lee ◽  
Hyun Wook Ryoo ◽  
Sungbae Moon ◽  
Jeong Ho Park ◽  
Sang Do Shin
Keyword(s):  
Phase 1 ◽  
Cerebral Performance Category ◽  
Integrated Approach ◽  
Phase 2 ◽  
Phase 3 ◽  
Neurologic Outcomes ◽  
Shockable Rhythm ◽  
Before And After ◽  
Care Systems ◽  
Chain Of Survival

Improving outcomes after out-of-hospital cardiac arrests (OHCAs) requires an integrated approach by strengthening the chain of survival and emergency care systems. This study aimed to identify the change in outcomes over a decade and effect of citywide intervention on good neurologic outcomes after OHCAs in Daegu. This is a before- and after-intervention study to examine the association between the citywide intervention to improve the chain of survival and outcomes after OHCA. The primary outcome was a good neurologic outcome, defined as a cerebral performance category score of 1 or 2. After dividing into 3 phases according to the citywide intervention, the trends in outcomes after OHCA by primary electrocardiogram rhythm were assessed. Logistic regression analysis was used to analyze the association between the phases and outcomes. Overall, 6203 patients with OHCA were eligible. For 10 years (2008–2017), the rate of survival to discharge and the good neurologic outcomes increased from 2.6% to 8.7% and from 1.5% to 6.6%, respectively. Especially for patients with an initial shockable rhythm, these changes in outcomes were more pronounced (survival to discharge: 23.3% in 2008 to 55.0% in 2017, good neurologic outcomes: 13.3% to 46.0%). Compared with phase 1, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for good neurologic outcomes was 1.20 (95% CI: 0.78–1.85) for phase 2 and 1.64 (1.09–2.46) for phase 3. For patients with an initial shockable rhythm, the AOR for good neurologic outcomes was 3.76 (1.88–7.52) for phase 2 and 5.51 (2.77–10.98) for phase 3. Citywide improvement was observed in the good neurologic outcomes after OHCAs of medical origin, and the citywide intervention was significantly associated with better outcomes, particularly in those with initial shockable rhythm.

scholarly journals Implementation of a Multifactorial Fall Intervention Model in Hospital: a Longitudinal Before-and-after Controlled Study From 2015 to 2018

2020 ◽  
Author(s):  
Changju Liao ◽  
Linghong Guo ◽  
Han Wang ◽  
Tengyong Wang ◽  
Yuyang Zhang ◽  
...  
Keyword(s):  
Phase 1 ◽  
Hospitalized Patients ◽  
Favorable Effect ◽  
Controlled Study ◽  
Fall Rate ◽  
Phase 2 ◽  
Intervention Model ◽  
Phase 3 ◽  
Fall Injuries ◽  
Before And After

Abstract Background: Falls are serious public health problems associated with irreversible health consequences and substantial economic burden. To effectively reduce the incidence of falls and mitigate fall-related injuries, we designed and verified a multifactorial fall intervention model.Methods: The current study was a longitudinal before-and-after controlled investigation including 3 phases with clinical characteristics of fall patients retrospectively identified in phase 1, a multifactorial fall intervention model designed in phase 2 and prospectively evaluated in phase 3. Phase 1 and 2 were conducted based on 153,601 hospitalized patients between January 2015 and December 2016. Phase 3 was carried out based on 171,776 hospitalized patients between January 2017 and December 2018. The Pearson Chi-squared test was used to compare categorical variables and the Mann-Whitney non-parametric test was utilized for one-way ordered data.Results: In phase 1, baseline characteristics of 491 fall patients revealed that inpatients falls were highly associated with the age, medication and disease. In phase 2, a new multifactorial fall intervention model covering measures for fall prevention, fall-onset management and continuous improvement was developed. Phase 3 recorded a total of 396 falls and demonstrated a remarkably declined fall rate (Reduction in falls by 0.09%, p<0.001) and fall rate per 1000 patient-days (Reduction in falls/1000 patient-days by 0.07‰, p<0.001) as compared with phase 1. The adjusted incident rate ratio of fall was 1.443 (95%CI: 1.263-1.647) (Phase 1 vs. Phase 3). Furthermore, the occurrence and the severity of fall injuries in phase 3 were significantly lower than that in phase 1 (Z=-4.426, p<0.001). More specifically, the number of uninjured falls accounted for 42.42% in phase 3 in comparison of 32.99% in phase 1.Conclusions: This multifactorial fall intervention model exhibited favorable effect on reducing the occurrence of fall and fall injuries.

Impact of order entry alerts and modifications on doses of intravenous opioids dispensed during a national drug shortage

2020 ◽  
Vol 77 (Supplement_2) ◽  
pp. S41-S45
Author(s):  
Laura A Bowers ◽  
Alex P Raymond ◽  
Caity B Guest ◽  
Mary Bennett ◽  
Sara Shields ◽  
...  
Keyword(s):  
Phase 1 ◽  
Final Analysis ◽  
Historical Control ◽  
Phase 2 ◽  
Order Entry ◽  
Drug Shortage ◽  
National Drug ◽  
Secondary Endpoints ◽  
Computer Based ◽  
The Impact

Abstract Purpose To address the intravenous (i.v.) opioid shortage, computer-based alerts and modifications were implemented over 2 phases beginning in August 2017 and February 2018, respectively. A study was conducted to assess the impact of these interventions on dispenses of intermittent doses of i.v. opioids during a national shortage. Methods A retrospective, single-center, pre- and postimplementation study was conducted to compare opioid dispenses from September 2017 through December 2017 (phase 1) and March 2018 through May 2018 (phase 2) with dispenses during the same time periods of the previous year (historical control periods). Dispense data for intermittent doses of i.v. fentanyl, hydromorphone, and morphine and select oral opioids were collected from automated dispensing cabinets (ADCs) located in nonprocedural areas. The primary endpoint was the percentage of total intermittent doses of i.v. and oral opioids that were dispensed for i.v. administration. A subanalysis accounting for unit type was conducted. Key secondary endpoints were the numbers of oral and i.v. opioid dispenses by month. Results The final analysis included data from 92 ADCs. The percentage of i.v. opioid dispenses significantly decreased, by 9.8% during phase 1 (P &lt; 0.0001) and by 16.8% during phase 2 (P &lt; 0.0001) compared to dispenses during the historical control periods. These decreases were significant across all unit types except pediatric units during phase 1. Average monthly dispenses of i.v. opioids were 49.9% and 74.2% fewer than dispenses during the historical control periods after the phase 1 and phase 2 implementations, respectively. Conclusion Order entry alerts and modifications significantly decreased dispenses of intermittent doses of i.v. opioids during a national shortage, with demonstrated sustainability of decreases over 7 months.

scholarly journals 8 Positive Distraction Entertainment System (PDES) in Paediatric Population Undergoing Day Surgery

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e3-e3
Author(s):  
Michael Chang ◽  
Alicia Fernandes ◽  
Alexandra Frankel
Keyword(s):  
Virtual Reality ◽  
Separation Anxiety ◽  
Pediatric Population ◽  
Phase 1 ◽  
Paediatric Population ◽  
Day Surgery ◽  
Control Group ◽  
Phase 2 ◽  
Before And After ◽  
Experience Survey

Abstract Background Patients undergoing procedures at hospitals may experience anxiety and such anxiety can be heightened in pediatric populations. Anxiety can invoke a physical and mental stress response leading to poorer health outcomes and in children these outcomes include: resistance to treatment, nightmares, longer recovery periods, lowered pain thresholds and separation anxiety (Biddis, 2014; Manyande 2015; Aydın 2017). Objectives This study aimed to test whether a virtual reality intervention is feasible, beneficial and effective in reducing anxiety prior to surgery in the pediatric population of Scarborough Health Network. Design/Methods Virtual Reality (VR) is a computer technology that simulates a user’s physical presence in a virtual or imaginary environment. ‘Bubble Bloom’, an underwater fishing game where participants launch bubbles to catch colourful fish, is the VR game that the children are administered in a two phased research design to explore whether the VR intervention was a beneficial tool in reducing anxiety in our pediatric population. Phase 1 was a trial phase in which participants (n=20) were administered the condensed version of the State Trait Anxiety Scale before and after the intervention to determine if anxiety levels had been reduced. Participants were also administered an experience survey to explore patient satisfaction, headset comfort, and virtual reality satisfaction. Phase 2, randomized control trial, is currently ongoing with the same measures and VR intervention being administered. In Phase 2, participants are randomized to the control group (regular play activities) or intervention (virtual reality game). Results In Phase 1, all participants indicated they enjoyed the experience of the virtual reality intervention. Sixteen of the 20 participants had pre scores that were in the mild to moderate anxiety range (80%). Of these 16 participants, 10 participants’ post scores decreased to the normal or no anxiety range (63%). Additionally, 80% of participants demonstrated a reduction in anxiety post-virtual reality intervention. Conclusion Phase 1 results were encouraging with 80% of participants experiencing a reduction in anxiety and all participants enjoying the virtual reality experience.

Implementation of Computerized Provider Order Entry (CPOE) Does Not Impact Provider Work Time in An Inpatient Malignant Hematology Service

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4704-4704
Author(s):  
David A Hanauer ◽  
Sung W Choi ◽  
Robert W Beasley ◽  
Ronald B Hirschl ◽  
Douglas W Blayney
Keyword(s):  
Patient Care ◽  
Training Session ◽  
Direct Patient Care ◽  
Order Entry ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
Order Sets ◽  
Before And After ◽  
The Impact

Abstract No data are available concerning the impact of CPOE on inpatient leukemia and lymphoma care. CPOE may improve patient safety, reduce time between order entry and medication administration, and reduce medication and transcription errors. However, concerns have arisen about potential increased time required to enter electronic orders compared to handwritten orders. Our hypothesis was that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. We studied the work patterns of three Physician Assistants (PAs) who worked under the supervision of faculty physicians, and were the exclusive inpatient care providers. The PA-staffed hematology service was chosen to minimize the impact of rotating house staff on our results. Faculty, who were not studied, entered the few chemotherapy orders necessary, while PAs entered orders for hydration, antibiotics, supportive care and other medications, and for consultations and diagnostic tests. The UMHS Institutional Review Board reviewed the study protocol and waived the requirement for patient informed consent. We performed a direct observation time and motion study pre- and post-implementation of a commercial CPOE system (Sunrise Clinical Manager™ 4.5, Eclipsys, Boca Raton, Florida) on one inpatient hematology service at the UMHS University Hospital. The same three PAs were shadowed pre- and post-implementation. We also closely matched morning and afternoon observation times in order to reduce variability in activities taking place at different times of the day. Prior to CPOE implementation the PAs had a 4 hour general training session and a 1 hour chemotherapy training session. Pre-built order sets were routinely used by the PAs. A portable tablet computer was used by an independent observer to record data, using a data entry interface containing 63 individual activity categories modified from the Time and Motion database under “IT Tools” at http://www.ahrq.gov. Data were grouped into subcategories for analysis. We grouped 12 activities as ordering-related (e.g. writing orders, writing forms, clarifying orders, etc.) We observed the same three PAs for 85.4 hours (over 2 weeks) pre, and for 75.8 hours (over 4 weeks) starting 3 months post-CPOE. Mean patient census was 11.3 per day pre- and 9.2 per day post implementation observation periods. Overall time for order-related activities was unchanged, requiring 7.7% of total time pre- and 8.1% of total time post-CPOE even though actual order writing took longer with CPOE compared to written (4.9% pre vs. 7.0% post). CPOE had almost no impact on direct patient care time (Figure), with PAs spending 38.2% total time on direct patient care pre-CPOE compared to 38.4% post. A minimal difference was also found with the overall total for indirect patient care activities (37.1% pre vs. 38.7% post). Our results suggest that using CPOE on a busy hematology inpatient service has minimal impact on time spent by trained PAs using standard order sets 3 months after implementation. The decision to adopt CPOE for a busy hematology service should not be based on the hypothesis that there will be a change in workflow or task organization. More study is needed to determine if CPOE for hematology patients results in a change in the quality of patient care or safety. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals.

scholarly journals Electronic prescription: frequency and severity of medication errors

2019 ◽  
Vol 65 (11) ◽  
pp. 1349-1355
Author(s):  
Mário Borges Rosa ◽  
Mariana Martins Gonzaga do Nascimento ◽  
Priscilla Benfica Cirilio ◽  
Rosângela de Almeida Santos ◽  
Lucas Flores Batista ◽  
...  
Keyword(s):  
Potassium Chloride ◽  
Medication Errors ◽  
High Complexity ◽  
Order Entry ◽  
Electronic Prescription ◽  
Computerized Provider Order Entry ◽  
Error Frequency ◽  
Before And After ◽  
Belo Horizonte ◽  
Stage 1

SUMMARY OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.

scholarly journals The pontine respiratory group, particularly the Kölliker-Fuse nucleus, mediates phases of the hypoxic ventilatory response in unanesthetized goats

2010 ◽  
Vol 108 (5) ◽  
pp. 1321-1335 ◽  
Author(s):  
J. M. Bonis ◽  
S. E. Neumueller ◽  
K. L. Krause ◽  
T. Kiner ◽  
A. Smith ◽  
...  
Keyword(s):  
Metabolic Rate ◽  
Phase 1 ◽  
Pulmonary Ventilation ◽  
Ibotenic Acid ◽  
Phase 2 ◽  
Phase 3 ◽  
Before And After ◽  
Parabrachial Nuclei ◽  
Pontine Respiratory Group

The objective of the present study was to test the hypothesis that, in the in vivo awake goat model, perturbation/lesion in the pontine respiratory group (PRG) would decrease the sensitivity to hypercapnia and hypoxia. The study reported herein was part of two larger studies in which cholinergic modulation in the PRG was attenuated by microdialysis of atropine and subsequently ibotenic acid injections neurotoxically lesioned the PRG. In 14 goats, cannula were bilaterally implanted into either the lateral ( n = 4) or medial ( n = 4) parabrachial nuclei or the Kölliker-Fuse nucleus (KFN, n = 6). Before and after cannula implantation, microdialysis of atropine, and injection of ibotenic acid, hypercapnic and hypoxic ventilatory sensitivities were assessed. Hypercapnic sensitivity was assessed by three 5-min periods at 3, 5, and 7% inspired CO2. In all groups of goats, CO2 sensitivity was unaffected ( P > 0.05) by any PRG perturbations/lesions. Hypoxic sensitivity was assessed with a 30-min period at 10.8% inspired O2. The response to hypoxia was typically triphasic, with a phase 1 increase in pulmonary ventilation, a phase 2 roll-off, and a phase 3 prolonged increase associated with shivering and increased metabolic rate and body temperature. In all groups of goats, the phase 1 of the hypoxic ventilatory responses was unaffected by any PRG perturbations/lesions, and there were no consistent effects on the phase 2 responses. However, in the KFN group of goats, the phase 3 ventilatory, shivering, metabolic rate, and temperature responses were markedly attenuated after the atropine dialysis studies, and the attenuation persisted after the ibotenic acid studies. These findings support an integrative or modulatory role for the KFN in the phase 3 responses to hypoxia.

Heart rate control in awake dog after selective SA-nodal parasympathectomy

1992 ◽  
Vol 262 (4) ◽  
pp. H1128-H1135 ◽  
Author(s):  
D. C. Randall ◽  
W. C. Randall ◽  
D. R. Brown ◽  
J. D. Yingling ◽  
R. M. Raisch
Keyword(s):  
Heart Rate ◽  
Phase 1 ◽  
Beta Blockade ◽  
Autonomic Nerves ◽  
Phase 2 ◽  
Behavioral Arousal ◽  
Rate Of Increase ◽  
Before And After ◽  
Multiple Interactions

Selective surgical sinoatrial (SA)-nodal parasympathectomy (PSX) was used to distinguish the role of the cardiac autonomic nerves in heart rate (HR) control in awake dogs (n = 8) during rest and behavioral arousal. Resting HR increased from 85 +/- 9 beats (mean +/- SE) before surgery to 114 +/- 6 beats after denervation (P less than 0.05). Atrioventricular (AV)-nodal block occurred during the first 1-3 wk post-PSX, but subsequently resolved. Dogs were behaviorally conditioned by following a 30-s tone (CS+) by a 0.5-s shock. Before denervation the CS+ evoked an initial, rapidly developing tachycardia (phase 1), which was followed by a more slowly developing, but larger, phase 2 tachycardia. The selective SA-nodal parasympathectomy essentially abolished the phase 1 conditional HR response (magnitude: 23 +/- 5 vs. 5 +/- 2 beats, pre- vs. postdenervation, respectively). The phase 2 HR increase was similar before and after the denervation (magnitude: 44 +/- 6 vs. 33 +/- 6 beats; rate of increase: 5 +/- 1 vs. 6 +/- 1 beats/s, pre- vs. post-PSX). Beta-Blockade (propranolol, 1 mg/kg) after PSX decreased phase 2 (magnitude: 7 +/- 3 beats; rate of increase: 1 +/- 0.3 beats/s). These data reveal a sterotypic pattern of change in cardiac autonomic nervous drive during a sudden arousal from rest. Phases 1 and 2 appear to be selective and specific indexes of changes in SA-nodal parasympathetic and sympathetic tone, respectively. The selective denervation unmasks during stress a component of HR control that occurs in the absence of adrenergic or cholinergic mechanisms. These data suggest that multiple interactions occur within the intrinsic ganglion plexuses of the heart with respect to HR control.

We thought we would be perfect: medication errors before and after the initiation of Computerized Physician Order Entry

2015 ◽  
Vol 198 (1) ◽  
pp. 108-114 ◽  
Author(s):  
David Schwartzberg ◽  
Sasa Ivanovic ◽  
Sheetal Patel ◽  
Sathyaprasad C. Burjonrappa
Keyword(s):  
Medication Errors ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Before And After ◽  
Physician Order Entry
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