Medication Errors in Pediatrics: Proposals to Improve the Quality and Safety of Care Through Clinical Risk Management

Medication errors represent one of the most common causes of adverse events in pediatrics and are widely reported in the literature. Despite the awareness that children are at increased risk for medication errors, little is known about the real incidence of the phenomenon. Most studies have focused on prescription, although medication errors also include transcription, dispensing, dosage, administration, and certification errors. Known risk factors for therapeutic errors include parenteral infusions, oral fluid administration, and tablet splitting, as well as the off-label use of drugs with dosages taken from adult literature. Emergency Departments and Intensive Care Units constitute the care areas mainly affected by the phenomenon in the hospital setting. The present paper aims to identify the risk profiles in pediatric therapy to outline adequate preventive strategies. Precisely, through the analysis of the available evidence, solutions such as standardization of recommended doses for children, electronic prescribing, targeted training of healthcare professionals, and implementation of reporting systems will be indicated for the prevention of medication errors.

SARS Antibody Testing in Children: Development of Oral Fluid Assays for IgG Measurements

We report on the first large-scale assessment of the suitability of oral fluids for detection of SARS-CoV-2 antibody obtained from healthy children attending school. The sample type (gingiva-crevicular fluid, which is a transudate of blood but is not saliva) can be self collected.

Blood groups and secretory state in COVID-19

INTRODUCTION: Despite the achievements of modern medicine, healthcare system is lacking in knowledge about the new coronavirus infection caused by the SARS-CoV-2 virus. AIM: To establish the relationship of the new coronavirus infection with the blood group according to the AB0 blood system in the Samara region and assess the secretory status of the oral fluid in patients with COVID-19. MATERIALS AND METHODS: This study was conducted from June 2019 to December 2020, and included 89 healthy individuals (38% males, 62% females, average age 24 ± 2.5 years) and 92 patients with COVID-19 (24% males and 76% females, average age 55.68 ± 1.83 years). The material for the study was oral fluid and venous blood. Determination of the blood group according to the AB0 system was carried out by a cross method, the secretory status of saliva according to the I. Vidas method. Descriptive methods were used for statistical data processing (arithmetic mean, error of the mean), calculation of the percentage of a whole number using computer programs IBM SPSS Statistics 23 and Microsoft Office Excel 2010. RESULTS: The distribution by blood group in patients with COVID-19 was as follows: A (II) blood group was found in 43.5%, O (I) in 36.9%, B (III) in 17.4%, AB (IV) in 2.2%. Rh-positive status was determined for 92.4%. Among secretory representatives, antigen A was secreted in 92.1%, and antigen B was secreted in 7.9% of cases. Antigens A and B were absent in the oral fluid of patients with AB (IV) blood group. CONCLUSIONS: This study confirmed the prevalence of A(II) blood group carriers among patients with COVID-19. In this case, the secretion of antigen A into the oral fluid is 92.1%. Group A antigen, being a glycoprotein, can act as a factor facilitating the mechanism of penetration of the SARS-CoV-2 into the human body. The results of the study indicate the need for a personalized approach at the stage of diagnosis and monitoring of the treatment of new coronavirus infection, as well as taking into consideration the blood group to develop preventive measures for COVID-19.

Features of local etiological factors of periodontal disease in residents of high latitudes

Aim. The purpose of the article is to determine specific regional risk factors for periodontal diseases in residents of the North-East of Russia on a complex clinical and physiological research.Materials and methods. A clinical study of the biophysical properties and composition of oral fluid (salivation rate, pH, viscosity, microcrystallization type, lysozyme activity) in the adult population with inflammatory periodontal diseases were done at dental clinic of the Medical Institute of M.K.Ammosov North-Eastern Federal University, dental clinic "Valeon" and clinical and diagnostic laboratory "Scientific and Practical Center of Phthisiatry" (Yakutsk). A total of 1012 individuals aged 15-19 years old (n = 248) and 35-44 years old (n = 764) were examined. Oral hygiene in the age groups was assessed by the Oral Hygiene Index according to J.C. Green and J.R. Vermillion (1964). In addition, social and hygienic status was assessed according Yu. V.Chizhov's method (2005). Statistical processing was carried out using the SPSS software package, version 22. The research was performed in accordance with the principles and rules of evidence-based medicine.Results. The obtained results determine quantitative and qualitative changes in oral fluid properties. The presence of biological risk factors associated with changes in the composition and properties of the oral fluid, as well as a low sanitary level, which are associated with viscosity increase, salivation rate decrease, a predominance of II and III types of microcrystallization, acidic pH level, a decrease in the level of lysozyme activity, were revealed. The identified risk factors have an impact on the prevalence of periodontal disease in the people of the North and mostly determine their clinical course.Conclusion. The revealed biophysical features of oral fluid in the examined adolescents and adult population of the North-East of Russia are specific regional local risk factors for the development of periodontitis, which must be taken into account when improving the therapeutic and preventive measures of pathological processes of periodontal tissues.

DEVELOPMENT OF PROGNOSTIC MODELS FOR CALCULATION OF ASYMMETRY COEFFICIENT OF CHEWING MUSCLE TONE AT VARIOUS STAGES OF ORTHODONTIC CORRECTION

Цель работы: Разработка прогностических моделей для оценки зависимости коэффициента асимметрии тонуса собственно жевательных мышц от функциональных параметров жевательных мышц и иммуноферментного состава ротовой жидкости на различных этапах ортодонтической коррекции. Материал и методы исследования: В исследовании приняли участие 82 пациента Детской клинической стоматологической поликлиники №2 г. Воронежа в возрасте от 6 до 12 лет с дистальной окклюзией зубных рядов, которым было рекомендовано лечение пластиночным аппаратом в модификации Шварца. Проводилась оценка функциональных параметров жевательных мышц: средней амплитуды биоэлектрической активности височных и подъязычных мышц, тонуса покоя и коэффициента асимметрии собственно жевательных мышц; количественное определение общих иммуноглобулинов G, А, M и секреторного иммуноглобулина A ротовой жидкости до начала лечения, через 3 и через 6 месяцев. Статистический анализ осуществлялся с использованием программ IBM SPSS Statistics 20, StatTech v. 1.2.0. Прогностическая модель, характеризующая зависимость количественной переменной от факторов, разрабатывалась с помощью метода множественной линейной регрессии. Результаты: Разработаны 2 прогностические модели. Полученные данные связаны с перестройкой функциональных параметров жевательной мускулатуры в результате ортодонтической коррекции. Вывод: Разработаны 2 прогностические модели для оценки зависимости коэффициента асимметрии тонуса собственно жевательных мышц от функциональных параметров жевательных мышц и иммуноферментного состава ротовой жидкости через 3 и 6 месяцев ортодонтической коррекции, которые позволят врачу грамотно выстроить план лечения, спрогнозировать его срок, повысить качество и эффективность диагностики The purpose of the work: Development of prognostic models for assessing the dependence of the asymmetry coefficient of the tone of the chewing muscles proper on the functional parameters of the chewing muscles and the immunoenzyme composition of the oral fluid at various stages of orthodontic correction. Material and methods of research: The study was attended by 82 patients of the Children's Clinical Dental Clinic No. 2 of Voronezh, aged 6 to 12 years, with distal occlusion of the dentition, who were recommended for treatment with a plate machine in the Schwartz modification. The functional parameters of chewing muscles were evaluated: the average amplitude of the bioelectric activity of temporal and sublingual muscles, the resting tone and the asymmetry coefficient of the chewing muscles themselves; quantification of total immunoglobulins G, A, M and oral fluid secretory immunoglobulin A before treatment, at 3 and 6 months. Statistical analysis was carried out using IBM SPSS Statistics 20, StatTech v. 1.2.0 (developer - Stattech LLC, Russia). A predictive model characterizing the dependence of a quantitative variable on factors was developed using the multiple linear regression method. Results: 2 prognostic models developed. The obtained data are related to reconfiguration of functional parameters of chewing muscles as a result of orthodontic correction. Conclusion: 2 prognostic models have been developed to assess the dependence of the asymmetry coefficient of the tone of the chewing muscles proper on the functional parameters of the chewing muscles and the immunoenzyme composition of the oral fluid after 3 and 6 months of orthodontic correction, which will allow the doctor to competently build a treatment plan, predict its duration, increase the quality and effectiveness of diagnosis

Usability and Acceptability of Oral Fluid Hepatitis C Self-testing Among People Who Inject Drugs in Coastal Kenya: a Cross-sectional Pilot Study

Background: People who inject drugs (PWID) are disproportionally affected by hepatitis C virus (HCV) infection and many remain undiagnosed. HCV self-testing (HCVST) may be an effective approach to increase testing uptake, but has rarely been used among PWID. We assessed the usability and acceptability of HCVST among PWID in Kenya. Methods: We conducted a cross-sectional study nested within a cohort study between August and December 2020 on Kenya’s North Coast region. Participants were handed a prototype oral fluid HCVST kit and asked to conduct the test relying on the instructions for use. Usability was assessed by documenting errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. Results: Among 150 participants, 19% were female and 65.3% had primary level education or lower. 71.3% made at least one error, 56.7% experienced some difficulty during at least one step, and the majority of participants (78%) required assistance during at least one step of the procedure. Most common errors occurred when placing the tube into the stand (18%), collecting the oral fluid sample (24%) and timing of reading results (53%). There was a strong association between presence of symptoms of opiate withdrawals and observed errors (94% vs 62%; p=0.016) in a sub-group of 74 participants assessed. Inter-reader and inter-operator concordance were 97.7% (kappa: 0.92) and 99.2% (kappa: 0.95), respectively. Acceptability assessed by asking whether participants would choose to use HCVST prior to and after conducting HCVST was 98% and 95%, respectively. Conclusions: We found a high acceptability of oral fluid HCVST among PWID. User errors were common and were associated with the presence of withdrawal symptoms among users. Despite errors, most participants were able to obtain and interpret results correctly. These findings suggest that this group of users may benefit from greater messaging and education including options to receive direct assistance when self-testing for HCV.

INFLUENCE OF THE TREATMENT AND PREVENTIVE MEASURES ON THE PHYSICAL INDICATORS OF ORAL LIQUID IN CHILDREN WITH CHRONIC CATARRHIC GINGIVITIS AND DIABETES MELLITUS

The aim of our study was to find out the effect of our proposed treatment and prevention complex, which included oral administration of «Kvertulin» complex drug, «Imupret» drops, «Pikovit» multivitamin drug and «Exodent» local irrigation of the oral cavity with a solution of tooth elixir that influence on the rate of salivation and viscosity of oral fluid in children with chronic catarrhal gingivitis and diabetes mellitus.The treatment and prophylactic measures had positive effect on the homeostasis of the oral cavity, which assisted to reduce the viscosity of the oral fluid, increase the rate of salivation, as evidenced by observation of patients for 6 months. The treatment and prevention complex are recommended to use 2 times a year, as the studied indicators deteriorate over time.