Treatment with bisphosphonates in severe hypercalcemia due to subcutaneous fat necrosis in an infant with hypoxic-ischemic encephalopathy.

Subcutaneous fat necrosis (SCFN) is a rare entity that occurs generally in term or post-term newborns exposed to perinatal stressing factors. These cutaneous lesions appear during the first weeks of life and their potential complications, such as hypercalcemia, determine the prognosis. We present a full-term newborn with SCFN lesions that appeared at the age of 12 days and who, 1 week later, developed moderate hypercalcemia. In our patient, the standard treatment was not enough to normalize calcemia and, in order to prevent secondary effects, etidronate therapy was initiated and it successfully normalized calcium levels. When SCFN is diagnosed, it is important to detect early hypercalcemia and treat it aggressively. This case provides further evidence of etidronate as an alternative and effective treatment for moderate-severe hypercalcemia.

Conductas de riesgo: entrevista al adolescente en el Servicio de Urgencias / Risk behaviours: interview of the adolescent in the Emergency Service

Objetivos. Determinar los hábitos tóxicos y sexuales de los adolescentes que acuden a Urgencias. Métodos. Estudio prospectivo realizado del 1/1/2010 al 31/12/2011, basado en encuestas a adolescentes y que incluye preguntas dirigidas a conocer su hábitos tóxicos y sexuales. Resultados. Se realizan 279 encuestas (2,8% de adolescentes atendidos). El 51,3% son mujeres. La edad media es 14,5 años (DE: 1,5). El 22,2% son inmigrantes. La distribución de los adolescentes según edad, sexo y origen no presenta diferencias significativas entre grupos. El 51,6% (IC95%: 45,8-57,4%) de los adolescentes refiere contacto con alguna sustancia psicoactiva; el 47% alcohol, 24% tabaco, y 12,5% cannabis. La proporción de consumidores de las 3 sustancias aumenta progresivamente con la edad (de 4,9%, 4,9% y 0% a los 12 años a 95,8%, 58,3% y 45,8%, respectivamente, a los 17 años: p<0,001). No se hallan diferencias significativas ene l consumo de las tres sustancias según el origen del paciente. El 20,4% (IC95%: 15,8-25,1%9 manifiesta tener relaciones sexuales, el 17,6% de ellos sin método anticonceptivo. Conclusiones. Los hábitos tóxico y sexuales hallados en los adolescentes atendidos en Urgencias son superponibles a los referidos en encuestas realizadas a este grupo de edad en otros ámbitos, pudiendo ser Urgencias un buen sitio para la promoción de hábitos saludables (AU)

Objectives. To describe the toxic and sexual behavior of adolescents who are seen in the Emergency Department (ED). Methods. Prospective study from 1/1/2009 to 31/12/2011, based on surveys of adolescents. The study includes questions to know their toxic habits and sexual behavior. Results. We perform 279 surveys (2.8% of adolescents seen), 51,3% are women. The mean age is 14.5 years (SD 1.5). 22,2% are immigrants. The distribution of adolescents according to age, gender and origin do not present significant differences between groups. The 51,6% (CI95%: 45.8-57.4%) of adolescents refer contact which any psychoactive substance, 47% alcohol, 24% tobacco and 12,5% cannabis. The proportion of consumers of the 3 substances increases progressively with age (since 4.9%, 4.9% and 0% at 12 years, to 95,8% , 58,3% and 45,8% at 17 years, p<0.001). No significant differences were found in the consumption of the three substances according to the origin of the patient. The 20.4% (CI95%: 15.8-25.1%) manifested having sexual intercourse, 17.6% without contraceptive method. Conclusions. The toxic habits and sexual behavior found in adolescents seen at the ED are similar to those reported in surveys of this age group in other fields. ED may be a good place to promote healthy habits (AU)

Impacto de un cambio de programa informático en los errores de prescripción farmacológica en urgencias / Impact of a change of computer software on prescription drug errors in an emergency department

Introducción: Un cambio de programa informático es un factor de riesgo de errores de prescripción farmacológica. Nuestro objetivo fue evaluar la eficacia de medidas preventivas para evitar estos errores en nuestro centro. Material y métodos: En el año 2007 (período 1), ante un futuro cambio de programa informático, se realizó un estudio de los errores de tratamiento y se diseñó un plan de prevención. Se clasificaron los errores según el tipo (indicación, dosis, vía de administración), la gravedad y los factores asociados a errores (nivel de urgencia, edad del paciente, experiencia del facultativo, día de la semana y hora del día). Tras la implantación del nuevo programa (año 2009) (período 2) se reevaluaron los mismos parámetros y se compararon con el período previo. Se realizó una revisión retrospectiva de todos los informes donde constaba algún tratamiento administrado en urgencias la misma semana y mes de ambos períodos. Resultados: En el período 1 se realizaron 615 prescripciones con errores en 92 (15%) y en el período 2, 445 con 51 (11,5%) errores, sin diferencias significativas entre ambos. Se observó una disminución significativa de errores de indicación inapropiada (8,1% período 1 vs 3,6% período 2; p=0,04) sin diferencias en los de dosis, vía de administración y gravedad del error. Se redujeron de forma significativa los errores en los facultativos de mayor experiencia y aumentaron en los rotantes externos (que no recibieron formación en el funcionamiento del nuevo programa). Conclusiones: El conocimiento de la situación previa y la aplicación de medidas preventivas permitieron que no aumentaran los errores con un nuevo programa informático(AU)

Introduction: Changing the computer software is a known risk factor of increased prescription drug errors. The aim of this study was to evaluate the effectiveness of preventive measures to prevent these errors at our centre. Material and methods: In 2007 (period 1), knowing that a change of computer software was coming, a study to determine the prescription drug errors was performed and an improvement plan was designed. Errors were classified as: type of error (indication, dosage, route of administration), severity and associated risk factors (emergency level, patient age, physician experience, day of week, time of day). Following the introduction of the new computer software (year 2009) (period 2), the same parameters were re-evaluated and compared with the previous period. All Paediatric Emergency Department (PED) reports, where some treatment was administered in the Emergency room in the same week and month for both periods, were reviewed. Results: A total of 615 prescriptions were written during period 1, of which 92 (15%) were classified as errors, and in period 2, 445 were written and 51 (11.5%) had errors, with no significant differences between both periods. There was a significant decrease in inappropriate indication errors (8.1% in period 1 vs 3.6% in period 2; P=.04), with no differences in dosage, route of administration and severity of errors. There was a significant error reduction in more experienced physicians, and an increase in errors by external rotation physicians (who were not skilled in the use of the new program). Conclusions: The knowledge of the previous situation and the use of preventive measures ensured that errors did not increase after a change of computer software(AU)

[Impact of a change of computer software on prescription drug errors in an emergency department]. / Impacto de un cambio de programa informático en los errores de prescripción farmacológica en urgencias.

INTRODUCTION: Changing the computer software is a known risk factor of increased prescription drug errors. The aim of this study was to evaluate the effectiveness of preventive measures to prevent these errors at our centre. MATERIAL AND METHODS: In 2007 (period 1), knowing that a change of computer software was coming, a study to determine the prescription drug errors was performed and an improvement plan was designed. Errors were classified as: type of error (indication, dosage, route of administration), severity and associated risk factors (emergency level, patient age, physician experience, day of week, time of day). Following the introduction of the new computer software (year 2009) (period 2), the same parameters were re-evaluated and compared with the previous period. All Paediatric Emergency Department (PED) reports, where some treatment was administered in the Emergency room in the same week and month for both periods, were reviewed. RESULTS: A total of 615 prescriptions were written during period 1, of which 92 (15%) were classified as errors, and in period 2, 445 were written and 51 (11.5%) had errors, with no significant differences between both periods. There was a significant decrease in inappropriate indication errors (8.1% in period 1 vs 3.6% in period 2; P=.04), with no differences in dosage, route of administration and severity of errors. There was a significant error reduction in more experienced physicians, and an increase in errors by external rotation physicians (who were not skilled in the use of the new program). CONCLUSIONS: The knowledge of the previous situation and the use of preventive measures ensured that errors did not increase after a change of computer software.