Impact of an intervention to reduce prescribing errors in a pediatric intensive care unit.

PURPOSE: To identify and reduce medication prescribing errors in a pediatric intensive care unit (PICU) by means of an educational program designed to improve medical prescriptions. METHODS: Before-after interventional study in a tertiary-level PICU. Handwritten prescriptions were prospectively collected: 2,228 during period 1 and 1,791 during period 2. In both periods elements of good prescribing practice including error indicators and quality indicators were studied. The interventional program included four measures: standardization of prescription sources, pocket tables with dosing guidelines, an updated prescription protocol, and an educational program on correct prescribing. RESULTS: The prescribing error (PE) rate decreased from 34.2 to 21.7 % after the intervention. Lack of administration route was considered separately for its high prevalence, 30 and 20.8 % of prescriptions, respectively. The most frequent error was presence of some illegible element (59 %). Legibility was the element of prescription experiencing the greatest reduction in error rate, from 4.1 % of prescriptions with one or more illegible elements in period 1 to 0.2 % in period 2. Tenfold overdosage decreased from two cases in period 1 to one case in period 2. The attending physician and on-call physician were associated with more PEs in both periods. The number of prescriptions with two or more errors decreased from 3.1 to 0.7 %. Errors reaching the patient were scarce, 14 (0.63 %) in period 1 and 6 (0.34 %) in period 2, without adverse events. CONCLUSIONS: Implementation of an educational program for physicians may significantly reduce the prescribing error rate in a PICU.

Structure of the high-molecular weight exopolysaccharide isolated from Lactobacillus pentosus LPS26.

The strain Lactobacillus pentosus LPS26 produces a capsular polymer composed of a high- (2.0x10(6)Da) (EPS A) and a low-molecular mass (2.4x10(4)Da) (EPS B) polysaccharide when grown on semi-defined medium containing glucose as the carbon source. The structure of EPS A and its deacetylated form has been determined by monosaccharide and methylation analysis as well as by 1D/2D NMR studies ((1)H and (13)C). We conclude that EPS A is a charged heteropolymer, with a composition of D-glucose, D-glucuronic acid and L-rhamnose in a molar ratio 1:2:2. The repeating unit is a pentasaccharide with two O-acetyl groups at O-4 of the 3-substituted alpha-D-glucuronic acid and at O-2 of the 3-substituted beta-L-rhamnose, respectively. -->4)-alpha-D-Glcp-(1-->3)-alpha-D-GlcpA4Ac-(1-->3)-alpha-L-Rhap-(1-->4)-alpha-D-GlcpA-(1-->3)-beta-L-Rhap2Ac-(1--> This unbranched structure is not common in EPSs produced by Lactobacilli. Moreover, the presence of acetyl groups in the structure is an unusual feature which has only been reported in L. sake 0-1 [Robijn et al. Carbohydr. Res., 1995, 276, 117-136].

Tumor de células de Leydig de ovario: una causa infrecuente de virilización en la mujer posmenopáusica / Leydig cell tumor of the ovary: an uncommon cause of virilization in postmenopausal women

El tumor de células de Leydig de ovario es un tipo de neoplasia muy raro que suele presentarse en mujeres posmenopáusicas. Presentamos el caso de una mujer de 72 años que consultó por virilización. Las determinaciones hormonales mostraron una elevación muy marcada de la testosterona (12.038 pg/ml), con valores normales del resto de hormonas sexuales. En la ecografía se observó una tumoración de 10 mm en el ovario izquierdo. Se realizó histerectomía y doble anexectomía. El estudio histológico demostró la existencia de un tumor de células de Leydig en el ovario izquierdo. Tras la intervención, los valores plasmáticos de testosterona se normalizaron, y la paciente mostró una lenta regresión de los síntomas clínicos

Leydig cell tumor of the ovary is a very rare neoplasm that usually occurs in postmenopausal women. We report the case of a 72-year-old woman with symptoms of virilization. Hormonal evaluation showed marked elevation of serum testosterone (12038 pg/ml) and no evidence of increased production of other sexual hormones. Ultrasound examination revealed a 10-mm tumor within the left ovary. Subsequently, total hysterectomy with bilateral oophorectomy was performed. Histopathological examination showed a Leydig cell tumor within the left ovary. Postoperative plasma testosterone levels returned to normal and the patient showed slow regression of clinical symptoms

[The environment and its impact on health: old risks, new risks]. / El medio ambiente y su impacto en la salud: riesgos tradicionales, nuevos riesgos.

The objective of this article is to investigate three representative elements of environmental health from a geographical perspective taking the Autonomous Community as the unit of analysis: legionnaire's disease, chemical safety and food safety. Legionnaire's disease is a pathology with a specific epidemiological profile; males, adults, and with previous chronic pathologies and habits. The official response, with regard to recent outbreaks and the increase in the incidence of legionnaire's disease, has differed between autonomous communities due to peculiarities and different organizational cultures. Both the sinking of the ship Prestige and the accident at the oil refinery at Puertollano (Ciudad Real) have increased concern in the population about chemical substances, so familiar in our environment. However it is not only the big accidents which are relevant: it is surprising to learn that most of the registered poisonings are due to domestic cleaning goods. The pending challenge from the Public Health point of view is to elaborate the Report on Human Exposure to Environmental Chemical Agents which, undoubtedly, will help to establish differences between type and class. Finally, the number of outbreaks of food poisoning continues to be of concern; this should lead us to think about the effectiveness of food safety programmes and to focus on the home, being place where most of the outbreaks occur. The General Sanitary Inspection of Food ought to be a good tool to help improve food safety.