RESUMO
OBJECTIVE: To evaluate the accuracy with which veterinary anaesthetists and nurses of different experience draw up small volumes of liquid. STUDY DESIGN: Prospective blinded randomized study. METHODS: A group of seven European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates, six ECVAA residents and six anaesthesia nurses participated in the study. For each participant, five target volumes between 0.01 and 1.0 mL were randomly allocated. They were drawn up 20 times in random order using a 1 mL syringe attached to a 23 gauge needle. A total of 1900 measurements were analysed. An investigator filled the syringe and needle dead space with water for injection before each experiment. The change in mass of the syringe once filled to the target volume was used to calculate the actual volume of liquid drawn up. RESULTS: Large errors were made with measurements < 0.04 mL, so they were excluded from the statistical analysis. There was a significant effect of the target volume (p < 0.001) and of the order (p < 0.01). For each mL increase in the target volume, the absolute error decreased by 4% and from the first to the hundredth withdrawal each participant's absolute error decreased by 1%. The target volume was underestimated in 52.3% of measurements, 42% were overestimated and 5.7% were on target. None of the between-subject predictor variables approached significance. CONCLUSIONS AND CLINICAL RELEVANCE: Accuracy of veterinary anaesthetists and nurses in drawing up medications decreases as the target volume becomes smaller. Small veterinary patients receive small volumes of anaesthetic drugs with higher risks of overdosing compared with larger dogs. Years of experience and staff grade are not associated with greater accuracy. Large percentage errors may be seen with target volumes less than 0.04 mL. Dilutions are recommended for volumes > 0.19 mL in 1 mL syringe.
Assuntos
Anestesia , Anestésicos , Animais , Cães , Humanos , Anestésicos/administração & dosagem , Anestesistas/estatística & dados numéricos , Injeções/estatística & dados numéricos , Injeções/veterinária , Estudos Prospectivos , Enfermeiros Anestesistas/estatística & dados numéricos , Anestesia/métodos , Anestesia/estatística & dados numéricos , Anestesia/veterináriaRESUMO
BACKGROUND: Counterfeit medical devices and injectables have recently garnered interest in the field of aesthetics. Unlike their original counterparts, these counterfeit products have neither been tested nor verified using certified quality control measures. OBJECTIVE: Our study investigated the pervasiveness of counterfeit products in the field as well as the experiences and attitudes of practitioners. MATERIALS AND METHODS: An online survey was distributed to current members of the American Society for Dermatologic Surgery (ASDS) and the American Society for Laser Medicine and Surgery (ASLMS). RESULTS: For medical devices, 37.4% have encountered counterfeits and 20.1% have experienced patients with adverse events from them. For injectables, 41.1% have encountered counterfeits and 39.7% have experienced patients with adverse events from them. Compared with their original, most respondents believe that counterfeits are worse in terms of reliability, safety, and effectiveness. The majority also believe that counterfeits are either very or extremely endangering to patient safety. CONCLUSION: Counterfeit medical devices and injectables are not uncommonly encountered. Overall, practitioners believe counterfeits are endangering patient safety and result in adverse events and think that either stricter rules and regulations or better enforcement of existing regulations is necessary.
Assuntos
Técnicas Cosméticas/estatística & dados numéricos , Medicamentos Falsificados/efeitos adversos , Fraude/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Controle de Qualidade , Técnicas Cosméticas/efeitos adversos , Técnicas Cosméticas/instrumentação , Técnicas Cosméticas/normas , Fraude/prevenção & controle , Humanos , Injeções/efeitos adversos , Injeções/normas , Injeções/estatística & dados numéricos , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Padrões de Prática Médica/normas , Reprodutibilidade dos Testes , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Food and Drug Administration/normasRESUMO
OBJECTIVES: We describe compliance with the 'IOC Needle Policy' at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro. METHOD: All needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively. RESULTS: In total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD. CONCLUSION: A limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.
Assuntos
Injeções/estatística & dados numéricos , Notificação de Abuso , Esportes/legislação & jurisprudência , Anestésicos Locais/administração & dosagem , Aniversários e Eventos Especiais , Anti-Inflamatórios não Esteroides/administração & dosagem , China , Dopagem Esportivo/prevenção & controle , Glucocorticoides/administração & dosagem , Humanos , Agulhas/estatística & dados numéricosRESUMO
OBJECTIVES: In England, notifications of invasive group A streptococcal (iGAS) infections have increased since 2015. We describe time trends, risk factors, as well as clinical and infection characteristics amongst iGAS cases in North West England, focussing on people who inject drugs (PWIDs), prisoners and homeless populations (referred to as risk groups), and analyse factors for fatal infection. STUDY DESIGN: The study design used was a cross-sectional study. METHODS: Data for all iGAS cases notified to Public Health England North West between January 2016 and May 2019 were used. Analysis consisted of time trend analysis, descriptive statistics, hypothesis testing to investigate differences in clinical and infection characteristics between risk and non-risk groups and binary logistic regression to identify factors associated with fatal infection. RESULTS: There were 1353 cases. Two hundred and two were amongst risk groups, who were predominantly PWIDs in Greater Manchester. Soft tissue risk factors were widespread. There were differences in strain-type between risk and non-risk groups. Female gender, cancer, emm1.0 and emm5.23 were associated with increased odds of death, whilst cellulitis was associated with reduced odds. The relationship between age and death was U-shaped. CONCLUSIONS: iGAS has increased in North West England since 2016, including amongst PWIDs. This may be due to emm-type replacement, barriers to good hygiene and increasing colonisation.
Assuntos
Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Adulto , Idoso , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Pessoas Mal Alojadas/estatística & dados numéricos , Humanos , Incidência , Injeções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prisioneiros/estatística & dados numéricos , Fatores de Risco , Infecções Estreptocócicas/mortalidadeRESUMO
PURPOSE/BACKGROUND: Despite proven benefits of long-acting injectables (LAIs), these are frequently underused by the psychiatrists. Accordingly, this study aimed to explore the perceptions of psychiatrists toward the use of LAI antipsychotics in their routine clinical practice. METHODS/PROCEDURE: An online e-mail survey was conducted by using Survey Monkey platform. RESULTS: A total of 622 psychiatrists with a mean age of 41 years who were in psychiatric practice for approximately 14 years participated in the survey. Participants reported using LAI, mainly for patients with schizophrenia, with LAI prescribed to approximately one-tenth (9.30%) of their patients in acute phase of illness and in one-fifth (18.42%) of patients in stabilization/stable phase. Fluphenazine decanoate (32.7%) was the most commonly used LAI followed by flupenthixol decanoate (19.5%), haloperidol decanoate (17.8%), and olanzapine pamoate (11.1%). The most common reasons for starting LAI were history of medication (100%) and treatment (80.5%) nonadherence, followed by having frequent relapses/exacerbations of symptoms (54.8%). Overall, more than half of the participants felt the level of acceptance of LAI among patients offered to be quite reasonable (54.3%), and mostly, LAIs were used as combination therapy with oral antipsychotics (73.6%). Despite all these, approximately three-fifths (59%) of the participants reported that they underuse LAI to a certain extent, with most common reasons that deter them from using LAI being the cost (55.45%), lack of interest of patients in receiving LAI (42.9%), lack of regular availability (41.3%), and patients being scared of receiving injectables (41.2%). CONCLUSIONS/IMPLICATIONS: The LAI antipsychotics despite having several benefits are still underused by a substantial proportion of practicing psychiatrists.
Assuntos
Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Preparações de Ação Retardada/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Índia , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Reuse of injection devices to give healthcare injections decreased from 39.8 to 5.5% between 2000 and 2010, but trends since 2011 have not been described. We reviewed results of Demographic and Health Surveys (DHS) to describe injection practices worldwide from 2011 to 2015. METHODS: We searched the DHS Internet site for data published on injection practices conducted in countries from 2011 to 2015, extracted information on frequency (number of healthcare injections per person in the last 12 months) and safety (proportion of syringes and needles taken from a new, unopened package). We compared gender groups and WHO regions in terms of frequency and safety. For countries with data available, we compared injection practices 2004-2010 and 2011-2015. RESULTS: Since 2011, 40 of 92 countries (43%) that conducted DHS surveys reported on injection practices. On average, the frequency of injection was 1.64 per person per year (from 3.84 in WHO Eastern Mediterranean region to 1.18 in WHO African region). Among those, 96.1% of injections reportedly used new injection devices (from 90.2% in the WHO Eastern Mediterranean region to 98.8% in the WHO Western Pacific region). On average, women received more injections per year (1.85) than men (1.41). Among 16 (40%) countries with data in 2004-2010 and 2011-2015, 69% improved in terms of safety. The annual number of unsafe injections reduced in 81% of countries. In Pakistan, the number of unsafe injections was the highest and did not decrease between 2006 and 2012. CONCLUSIONS: Injection practices have continued to improve in most countries worldwide, although the Eastern Mediterranean region in particular still faces unsafe practices that are not improving. Further efforts are needed to eliminate unsafe injection practices in health care settings, including through the use of reuse-prevention devices. Despite some limitations, DHS is an easily available method to measure progress over time.
Assuntos
Reutilização de Equipamento , Injeções/tendências , Seringas , Adulto , Demografia , Reutilização de Equipamento/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Injeções/estatística & dados numéricos , Internacionalidade , MasculinoRESUMO
BACKGROUND: Malaria is a leading cause of paediatric morbidity and mortality in Uganda. More than half of febrile children in rural areas initially seek care at private clinics and drug shops. These shops are generally unregulated and the quality of clinical care is variable, with the potential for misdiagnosis and the development of drug resistance. There is thus an urgent need to identify rural drug shops and coordinate their malaria treatment efforts with those of the public sector. The objective of the study was to identify all drug shops in the Bugoye sub-county of Western Uganda and assess their anti-malarial dispensing practices. METHODS: This study is a cross-sectional survey of drug shops in a rural sub-county of Western Uganda. In the first phase, shop locations, licensing and shopkeeper's qualifications, and supply and pricing of anti-malarials were characterized. In the second phase, the proportion of anti-malarials dispensed by private drug shops was compared to public health facilities. RESULTS: A total of 48 drug shops were identified. Only one drug shop (1 of 48, 2%) was licensed with the sub-county's records office. The drug shops stocked a variety of anti-malarials, including first-line therapies and less effective agents (e.g., sulfadoxine/pyrimethamine). Almost all drug shops (45 of 48, 94%) provided parenteral anti-malarials. Of the 3900 individuals who received anti-malarials during the study, 2080 (53.3%) purchased anti-malarials through the private sector compared to 1820 (46.7%) who obtained anti-malarials through the public sector. Drug shops were the primary source of parenteral anti-malarials. Inadequate dosing of anti-malarials was more common in drug shops. CONCLUSIONS: Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria. Strengthening malaria case management and incorporating drug shops in future interventions is necessary to optimize malaria control efforts in the sub-county, and in similarly endemic regions.
Assuntos
Antimaláricos/uso terapêutico , Injeções/estatística & dados numéricos , Farmácia , Setor Privado , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , População Rural , Uganda , Adulto JovemRESUMO
OBJECTIVE: To investigate the prevalence and transmission risks of hepatitis B virus and hepatitis C virus infections among internally displaced persons. METHODS: This study was conducted in district Bannu, Khyber Pakhtunkhwa, Pakistan, from August 2014 to April 2015, and comprised internally displaced people from North Waziristan Agency residing in camps or settled in towns. Potential subjects were initially screened through immunochromatographic test devices. Samples detected positive were confirmed through enzyme-linked immunosorbent assay. Confirmation of the presence of viral nucleic acids and genotyping was done via real-time polymerase chain reaction. SPSS 21 was used for data analysis. RESULTS: Of the 1,000 participants, 570(57%) were males and 430(43%) females. Seroprevalence of hepatitis B virus among the participants was 45(4.5%) and hepatitis C virus was 52(5.2%). Viral nucleic acids were present in 41(4.1%) participants in case of hepatitis B virus and 39(3.9%) in case of hepatitis C virus. No co-infection with both of these viruses was found. Dominant hepatitis B virus and hepatitis C virus genotypes were genotype-D 19(46.3%) and 3a with 20(51.2%), respectively. CONCLUSIONS: High prevalence of hepatitis B and C virus infections was found among internally displaced people.
Assuntos
Transfusão de Sangue/estatística & dados numéricos , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Higiene , Refugiados/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Feminino , Genótipo , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus/genética , Hepatite B/virologia , Vírus da Hepatite B/genética , Hepatite C/virologia , Humanos , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Paquistão/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Adulto JovemRESUMO
This cross-sectional study was carried out to assess drug prescribing pattern at a tertiary care teaching medical institute. One thousand prescriptions were randomly collected and analyzed using the world health organization prescribing indicators. The average number of drugs per prescription was 2.91. The percentage of drugs prescribed by generic name, from the essential drug list (National) and as fixed dose combinations (FDCs) was 10.05%, 22.57%, and 49.22%, respectively. The total percentage of encounters with antibiotics, injectables, and FDCs was 19.70%, 2.20%, and 73.60%, respectively. The most common group of drug prescribed was gastrointestinal tract drugs (26.38%) followed by Vitamins and Minerals (23.12%), cardiovascular system drugs (11.56%) and antimicrobials (9.63%). The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, and overprescription of FDCs. There is a need for improvement in the standards of prescribing patterns in many aspects.
Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Antibacterianos/provisão & distribuição , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/provisão & distribuição , Medicamentos Genéricos/provisão & distribuição , Hospitais de Ensino/estatística & dados numéricos , Humanos , Índia , Injeções/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Organização Mundial da SaúdeRESUMO
BACKGROUND: People who inject drugs (PWID) are at increased risk for bacterial skin and soft tissue infections (SSTIs). Although SSTIs pose significant health risks, little is known about their prevalence and characteristics in the population of PWID in the United States. This study investigates whether behavioral factors related to skin and equipment hygiene and tissue-damaging injection practices are associated with recent SSTIs among PWID. METHODS: Active PWID were recruited using targeted sampling in San Francisco in 2011-2013. Interviewers collected information on behavioral risk factors of past-month self-reported SSTIs. Inferential analyses used multivariate logistic regression methods (i.e., generalized linear model) to characterize risk factors for past-month SSTIs. RESULTS: The self-reported prevalence of lifetime, past-year, and past-month SSTI was 70%, 29%, and 11%, respectively. Several factors were significantly associated with past-month SSTIs in bivariate analysis, including injecting nonpowder drugs (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.23, 10.35; P = .01), needle-licking before injection (OR = 3.36; 95% CI = 1.28, 8.81; P = .01), injecting with someone else's preused syringe/needle (OR = 7.97; 95% CI = 2.46, 25.83; P < .001), being injected by another person (OR = 2.63; 95% CI = 1.02, 6.78; P = .04), infrequent skin cleaning before injection (OR = 2.47; 95% CI = 1.00, 6.10; P = .04), and frequent injections (P = .02). In multivariate analysis, only syringe/needle sharing (adjusted OR = 6.38; 95% CI = 1.90, 21.46) remained statistically significant. CONCLUSION: SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment.
Assuntos
Injeções/psicologia , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Feminino , Humanos , Injeções/efeitos adversos , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , São Francisco/epidemiologiaRESUMO
BACKGROUND: Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. OBJECTIVE: To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. METHODS: This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. RESULTS: Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). CONCLUSIONS: Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
Assuntos
Glicemia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Injeções/estatística & dados numéricos , Sistemas de Infusão de Insulina/estatística & dados numéricos , Sistema de Registros , Adolescente , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Lactente , MasculinoRESUMO
The study aimsed at surveying and analysing the prevailing risks for medical students due to so-called needlestick injuries, I. e., injuries to the skin by handling sharp objects by which blood of patients can be transmitted to the health professional. After introducing preventive measures in a typical German university hospital, a total of 1 903 students of human medicine in their clinical period from 2009 to 2012 (from a total of 2 024 subjects - a rate of 94.0%) were questioned in detail about potential needlestick or other injuries related to their work. The results show that such injuries happen particularly during the clinical period of the medical studies: While only 20.6% of the students indicated a needlestick injury at the beginning of this period, half of the students (50.9%) had experienced at least one injury at the end of the clinical period. The activities mentioned most frequently were taking of blood samples and injections. Needlestick injuries happened most frequently in surgical units, in internal medicine, and in gynaecology. Accidents happened mostly during secondary employment, medical traineeship, or in the context of practical nursing. In consequence, measures for improvement of the primary prevention should start with training on the one hand: Only briefing seems to be insufficient - intensive exercises in using stick-proof instruments seems to be more promising. On the other hand, the comprehensive introduction of stick-proof instruments has to be supported.
Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/estatística & dados numéricos , Acidentes de Trabalho/prevenção & controle , Adulto , Feminino , Alemanha/epidemiologia , Luvas Protetoras/estatística & dados numéricos , Humanos , Injeções/estatística & dados numéricos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Doenças Profissionais/prevenção & controle , Prevalência , Fatores de Risco , Estudantes de Medicina , Adulto JovemRESUMO
Animal studies have shown that injection pressures > 75 kPa indicate probable intrafascicular needle tip position. This study describes the flow/pressure characteristics of seven common needle systems. A syringe pump delivered flow rates of 5, 6.67, 10, 13.3, 15 and 20 ml.min(-1) through these needle systems, while keeping the needle tips open to atmosphere. A pressure transducer connected between the syringe and needle provided a real-time graphical display for analysis. Mean plateau pressures increased linearly with flow and with decreasing needle diameter (2.7-92 kPa). Flow rates > 17 ml.min(-1) and needle sizes 22 G and smaller produced mean plateau pressures > 75 kPa. Pressure monitors upstream from the needle may produce false-positive alarms at high flow rates due to needle resistance, and unreliable readings due to non-laminar flow. We recommend injection rates ≤ 15 ml.min(-1) (0.25 ml.s(-1) ) to reduce the effect of factors upstream from the needle tip as a cause of high pressure readings.
Assuntos
Anestesia por Condução/instrumentação , Agulhas/classificação , Agulhas/estatística & dados numéricos , Pressão , Desenho de Equipamento , Bombas de Infusão/estatística & dados numéricos , Injeções/instrumentação , Injeções/estatística & dados numéricos , Reologia/métodos , Reologia/estatística & dados numéricos , Seringas/estatística & dados numéricosRESUMO
BACKGROUND: Previous studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people's knowledge and perception about injections between the urban and rural areas of Kaski district. METHODS: A descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held. RESULTS: In 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people. CONCLUSIONS: Less preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Injeções/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gestão da Segurança/métodos , Seringas/estatística & dados numéricos , Adulto , Estudos Transversais , Humanos , Injeções/efeitos adversos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Nepal , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Seringas/efeitos adversos , População Urbana/estatística & dados numéricosRESUMO
UNLABELLED: Reports of hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission associated with unsafe medical practices have been increasing in the United States. However, the contribution of healthcare exposures to the burden of new infections is poorly understood outside of recognized outbreaks. We conducted a case-control study at three health departments that perform enhanced viral hepatitis surveillance in New York and Oregon. Reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons≥55 years of age from 2006 to 2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59, 60-69, and ≥70 years) and residential postal code. Data collection covered exposures within 6 months before symptom onset (cases) or date of interview (controls). Forty-eight (37 hepatitis B and 11 hepatitis C) case and 159 control patients were enrolled. Case patients were more likely than controls to report one or more behavioral risk exposures, including sexual or household contact with an HBV or HCV patient, >1 sex partner, illicit drug use, or incarceration (21% of cases versus 4% of controls exposed; matched odds ratio [mOR]=7.1; 95% confidence interval [CI]: 2.1, 24.1). Case patients were more likely than controls to report hemodialysis (8% of cases; mOR=13.0; 95% CI: 1.5, 115), injections in a healthcare setting (58%; mOR=2.7; 95% CI: 1.3, 5.3), and surgery (33%; mOR=2.3; 95% CI: 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR]=5.4; 95% CI: 1.5, 19.0; 17% attributable risk), injections (aOR=2.7; 95% CI: 1.3, 5.8; 37% attributable risk), and hemodialysis (aOR=11.5; 95% CI: 1.2, 107; 8% attributable risk) were associated with case status. CONCLUSION: Healthcare exposures may represent an important source of new HBV and HCV infections among older adults.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Hepatite B/epidemiologia , Hepatite B/transmissão , Hepatite C/epidemiologia , Hepatite C/transmissão , Doença Aguda , Distribuição por Idade , Idoso , Estudos de Casos e Controles , Contaminação de Equipamentos/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Injeções/efeitos adversos , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Vigilância da População , Fatores de Risco , Distribuição por Sexo , Vacinação/efeitos adversos , Vacinação/estatística & dados numéricosRESUMO
Two live rotavirus oral vaccines, RotaTeq (RV5) (Merck & Co., Inc.) and Rotarix (RV1) (GlaxoSmithKline Biologicals), are approved for prevention of rotavirus gastroenteritis and recommended at ages 2, 4 (RV5/RV1), and 6 (RV5) months by the Advisory Committee on Immunization Practices. Because most childhood vaccines are injectable, vaccination providers might have less experience administering oral vaccines. To assess that hypothesis, CDC searched for reports to the Vaccine Adverse Event Reporting System (VAERS) of rotavirus vaccine administration errors involving injection and eye splashes in the United States during the period January 1, 2006-August 1, 2013. A total of 66 reports were found.
Assuntos
Erros Médicos/estatística & dados numéricos , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Administração Oral , Sistemas de Notificação de Reações Adversas a Medicamentos , Centers for Disease Control and Prevention, U.S. , Traumatismos Oculares/induzido quimicamente , Humanos , Lactente , Injeções/efeitos adversos , Injeções/estatística & dados numéricos , Vacinas contra Rotavirus/efeitos adversos , Estados Unidos , Vacinas Vivas não Atenuadas/administração & dosagem , Vacinas Vivas não Atenuadas/efeitos adversosRESUMO
PURPOSE: This study explored the relationship between sociodemographic factors and injection utilization in South Korea. METHODS: We conducted a retrospective cross-sectional analysis using 2009 prescription claims for Korean National Health Insurance beneficiaries. We analyzed the utilization, costs, and proportion of injections in the insured market for oral-injection dual-dose-form ingredients (DFIs). We included outpatients who were prescribed DFIs with no age limits. Descriptive analysis and multivariate logistic regression were performed to evaluate the predictive factors of injection use. RESULTS: Injections accounted for about 5% of outpatient utilization and costs of the study drugs. The odds of having injections were 1.3-1.6 times higher among those patients who are 70 years and older compared with those in the 20s, in smaller-sized hospitals and clinics than that in larger, and among medical institutions in rural areas than those in the capital area. The odds of having injections were increased stepwise for the age groups of 30-69 years. Injections were more likely to be prescribed for systematic hormonal preparations and drugs for the musculoskeletal system. CONCLUSIONS: The use of injections was higher among older groups, among smaller medical institutions, and among institutions in rural areas in Korean outpatient care. The difference between prescribing defined daily doses and prescribing rate for injections of the audit reports implies that Korean doctors prescribed injections often, but small doses for momentary effects in outpatient settings. Further studies are required to uncover the underlying causes of the high prevalence of injection use in older or rural populations and smaller institutions.
Assuntos
Assistência Ambulatorial/economia , Injeções/economia , Injeções/estatística & dados numéricos , Ambulatório Hospitalar/economia , Adolescente , Adulto , Idoso , Assistência Ambulatorial/tendências , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gastos em Saúde/tendências , Humanos , Recém-Nascido , Injeções/tendências , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto JovemAssuntos
Prescrições de Medicamentos/estatística & dados numéricos , Injeções/estatística & dados numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Assistência Terminal/métodos , Assistência Terminal/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Estudos RetrospectivosRESUMO
BACKGROUND: Community pharmacies in Nepal serve as the first point of contact for the public with the health care system and provide many services, including administering injections. However, there is a general lack of documented information on pharmacy practice and injection use in these pharmacies. This study aims to provide information about pharmacy practice in terms of service and drug information sources, and injection use, including the disposal of used injection equipment. METHODS: A mixed method, cross-sectional study was conducted in 54 community pharmacies in Pokhara city. Data was collected using a pre-tested, semi-structured questionnaire, and also by the direct observation of pharmacy premises. Interviews with pharmacy supervisors (proprietors) were also conducted to obtain additional information about certain points. RESULTS: Interviews were carried out with 54 pharmacy supervisors/proprietors (47 males and 7 females) with a mean age and experience of 35.54 and 11.73 years, respectively. Approximately a half of the studied premises were operated by legally recognized pharmaceutical personnel, while the remainder was run by people who did not have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. The 'Current Index of Medical Specialties' was the most commonly used source for drug information. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste (including sharps) was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste. CONCLUSIONS: Community pharmacies in Pokhara offer a wide range of services including, but not limited to, drug dispensing, counseling, dressing of wounds, and administering injections. However, the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered. Therefore, the health authorities should take the necessary measures to upgrade the qualifications of the personnel and to improve the infrastructure for the sake of good pharmacy practice and the safer use of injections.