What Ibero-American hospitals do when things go wrong? A cross-sectional international study.

OBJECTIVE: To know what hospital managers and safety leaders in Ibero-American countries are doing to respond effectively to the occurrence of adverse events (AEs) with serious consequences for patients. DESIGN: Cross-sectional international study. SETTING: Public and private hospitals in Ibero-American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Portugal and Spain). PARTICIPANTS: A convenience sample of hospital managers and safety leaders from eight Ibero-American countries. A minimum of 25 managers/leaders from each country were surveyed. INTERVENTIONS: A selection of 37 actions for the effective management of AEs was explored. These were related to the safety culture, existence of a crisis plan, communication and transparency processes with the patients and their families, attention to second victims and institutional communication. MAIN OUTCOME MEASURE: Degree of implementation of the actions studied. RESULTS: A total of 190 managers/leaders from 126 (66.3%) public hospitals and 64 (33.7%) private hospitals participated. Reporting systems, in-depth analysis of incidents and non-punitive approaches were the most implemented interventions, while patient information and care for second victims after an AE were the least frequent interventions. CONCLUSIONS: The majority of these hospitals have not protocolized how to act after an AE. For this reason, it is urgent to develop and apply a strategic action plan to respond to this imperative safety challenge. This is the first study to identify areas of work and future research questions in Ibero-American countries.

The 2019 Pan American games: Communicable disease risks and travel medicine advice for visitors to Peru - Recommendations from the Latin American Society for Travel Medicine (SLAMVI).

The next Pan American Games will be held in Peru in the period July-August 2019. Around 6680 participants from 41 countries are expected to take part in the event. There will be a total of 62 sport disciplines. This event poses specific challenges, given its size and the diversity of attendees. Such gatherings also have potential for the transmission of imported or endemic communicable diseases, including measles in view of the global outbreak situation, but also tropical endemic diseases. In anticipation of increased travel, a panel of experts from the Latin American Society for Travel Medicine (SLAMVI) developed the current recommendations taking into consideration the epidemiology and risks of the main communicable diseases at potential destinations in Peru, recommended immunizations and other preventives measures. These recommendations can be used as a basis for advice for travelers and travel medicine practitioners. Mosquito-borne infections also pose a challenge. Although Lima is malaria free, travelers visiting Peruvian high-risk areas for malaria should be assessed regarding the need for chemoprophylaxis. Advice on the correct timing and use of repellents and other personal protection measures is key to preventing vector-borne infections. Other important recommendations for travelers should focus on preventing water- and food-borne diseases including travelers' diarrhea. This paper addresses pre-travel, preventive strategies to reduce the risk of acquiring communicable diseases during the Pan American Games and also reviews the spectrum of endemic infections in Lima and Peru to facilitate the recognition and management of infectious diseases in travelers returning to their countries of origin.

Propofol en combinación con meperidina y midazolam en colonoscopia y endoscopia: primer estudio prospectivo en prácticas privadas en el Perú / Propofol in combination with midazolam and meperidine in colonoscopy and endoscopy: first prospective study in private practices in Peru

Introducción: Existe amplia experiencia reportada en la literatura mundial con respecto al uso de Propofol como agente único y en combinación con narcóticos y/o benzodiazepinas en procedimientos endoscópicos, sin la presencia de un anestesiólogo en la sala de endoscopía. Más de 200 mil procedimientos reportados han demostrado seguridad y excelente aceptación por parte de los pacientes. Objetivos: Reportar la experiencia de una práctica privada endoscópica en Lima Metropolitana utilizando Propofol en combinación con Meperidina y Midazolam en colonoscopías y endoscopías altas, administrado por una enfermera supervisada por un gastroenterólogo entrenado sin la presencia de un anestesiólogo. Pacientes y métodos: Se incluyó a pacientes adultos de bajo o moderado riesgo para recibir sedación, que fueron sometidos a colonoscopía y/o endoscopía alta entre Noviembre 2006 y Setiembre 2007 en el Servicio de Gastroenterología de la Clínica Anglo Americana en Lima. Se administró Meperidina 25 mg para colonoscopías y 50 mg para endoscopías altas y Midazolam 1.5 mg endovenoso para ambos procedimientos como premedicación. Todos los pacientes recibieron oxígeno 2 L/min por cánula nasal durante el procedimiento. Luego de la mencionada premedicación se administró un bolo inicial de Propofol 10-30 mg según la condición general del paciente y el nivel de sedación alcanzado con la premedicación, a juicio del gastroenterólogo y la enfermera. Se registraron las variables de sexo, edad, dosis promedio de propofol por sexo, edad y por procedimiento. Se registraron efectos adversos como de saturación de oxígeno (< 90 por ciento), hipotensión, bradicardia, necesidad de ventilación asistida u hospitalización. Resultados: Se realizaron 400 procedimientos, 315 colonoscopías (78.8 por ciento) y 85 por ciento endoscopías altas (21.3 por ciento). 171 procedimientos (42.8 por ciento) fueron realizados en varones y 229 (57.3 por ciento) en mujeres. La edad promedio fue 60 años (22-91)...

Introduction: There is currently a vast experience reported in the literature with respect to Propofol utilization as a single agent and in combination with narcotics and/orbenzodiazepines in endoscopic procedures, without the presence of an anesthesiologist in the endoscopy suite. Over 200 thousand reported procedures have demonstrated safety and excellent acceptance by patients. OBJECTIVES: To report the experience in a private endoscopy center in Lima utilizingpropofol in combination with Meperidine and Midazolam in colonoscopies and upper endoscopies, administered by a nurse supervised by a trained gastroenterologist without the presence of an anesthesiologist. PATIENTS AND METHODS: We included adult patients with low or moderate risk for sedation, subjected to colonoscopy and / or upper endoscopy between November 2006and September 2007 in the Gastroenterology Service at the Clinica Anglo Americana in Lima. Meperidine 25 mg IV was administered for colonoscopy and 50 mg IV for upper endoscopy and Midazolam 1.5 mg for both procedures as premedication. All the patientsreceived Oxygen 2 L/min per nasal cannula throughout the procedure. After the above mentioned premedication, an initial bolus of propofol (10 – 30 mg) was administered, according to the general condition of the patient and the level of sedation achieved by thepremedication, according to the judgement made by the gastroenterologist and the nurse. We registered the following variables: sex, age, average dose of propofol according to sex, age and procedure. We also registered adverse events such as desaturation < 90 per cent, hypotension, bradycardia, need for assisted ventilation or hospitalization. RESULTS: Four hundred procedures were performed, 315 colonoscopies (78.8 per cent) and 85 upper endoscopies (21.3 per cent). One hundred sixty one procedures (42.8 per cent) were done inmales and 229 (57.3 per cent) in females. The average age was 60 years (22-91)...

[Propofol in combination with meperidine and midazolam in colonoscopy and upper endoscopy: first prospective study in private practice in Peru]. / Propofol en combinación con Meperidina y Midazolam en colonoscopía y endoscopia: primer estudio prospectivo en práctica privada en el Perú.

INTRODUCTION: There is currently a vast experience reported in the literature with respect to Propofol utilization as a single agent and in combination with narcotics and/or benzodiazepines in endoscopic procedures, without the presence of an anesthesiologist in the endoscopy suite. Over 200 thousand reported procedures have demonstrated safety and excellent acceptance by patients. OBJECTIVES: To report the experience in a private endoscopy center in Lima utilizing propofol in combination with Meperidine and Midazolam in colonoscopies and upper endoscopies, administered by a nurse supervised by a trained gastroenterologist without the presence of an anesthesiologist. PATIENTS AND METHODS: We included adult patients with low or moderate risk for sedation, subjected to colonoscopy and / or upper endoscopy between November 2006 and September 2007 in the Gastroenterology Service at the Clinica Anglo Americana in Lima. Meperidine 25 mg IV was administered for colonoscopy and 50 mg IV for upper endoscopy and Midazolam 1.5 mg for both procedures as premedication. All the patients received Oxygen 2 L/min per nasal cannula throughout the procedure. After the above mentioned premedication, an initial bolus of propofol (10 - 30 mg) was administered, according to the general condition of the patient and the level of sedation achieved by the premedication, according to the judgement made by the gastroenterologist and the nurse. We registered the following variables: sex, age, average dose of propofol according to sex, age and procedure. We also registered adverse events such as desaturation < 90%, hypotension, bradycardia, need for assisted ventilation or hospitalization. RESULTS: Four hundred procedures were performed, 315 colonoscopies (78.8%) and 85 upper endoscopies (21.3%). One hundred sixty one procedures (42.8%) were done in males and 229 (57.3%) in females. The average age was 60 years (22-91). The average propofol dose in general was 85.6 mg (10-330), 85.6, 87.7 mg in average for colonoscopies and 41.05 mg for upper endoscopies (p< 0.05). The average propofol dose for males was 78.4 mg and 91 mg for females (p<0.05). For patients younger than 70 years old (307) the average propofol dose was 91.6 mg and for patients older than 70 years old (93) it was 65.6 mg (p<0.05). We only registered one episode of oxygen desaturation to less than 90% (86%) responding to increase in the oxygen flow per nasal cannula and repositioning of the neck and chin. No patient required assisted ventilation or intubation, nor hospitalization for observation after the procedure. One hundred percent of the patients stated non having any discomfort whatsoever and expressed their satisfaction with the procedure. CONCLUSIONS: Propofol combined with Meperine and Midazolam in endoscopic procedures is a safe agent administered by a trained gastroenterologist and nurse. Pacientes undergoing upper endoscopy, males and patients younger than 70 years old, required less doses of propofol compared with those subjected to colonoscopy, females and patients older than 70 years old respectively. We did not report complications or hospitalizations. Tolerance to endoscopic procedures with the above mentioned combination.