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1.
Curr Drug Saf ; 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33902416

RESUMO

Medication errors are amongst the most frequently occurring health care related incidents and have the potential to lead to life-threatening harm to patients. An incident reporting system is a traditional approach to improvement of patient safety and entails the retrieval of information from incident reports. This not only provides a better understanding of causes and contributing factors but also enables the collection of data on the severity of incidents, system deficiencies and the role of human factors in safety incidents. Medication error reporting systems are often developed as a part of larger incident reporting systems which deal with other types of incidents. Although a rise in the prevalence of medication errors has led to an increased demand for medication error reporting, little is known about characteristics and limitations of medication error reporting systems. The authors broach the subject of medication error reporting systems and propose a more robust and standardized approach.

2.
Stud Health Technol Inform ; 265: 113-118, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431586

RESUMO

This study aimed to develop a classification scheme for retrieving information from incident reports of medication errors. This 15-category classification scheme captures minimal medication-incident related information from incident reports and thus serves as an information model for automatic information retrieval solution. The automatic solution uses recent advances in artificial intelligence methods to learn from incident report resources and is promising to the prevention of adverse drug events and promotion of safety in medical care.


Assuntos
Erros Médicos , Inteligência Artificial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Erros de Medicação , Gestão de Riscos
3.
Pediatr Int ; 61(9): 859-864, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247125

RESUMO

BACKGROUND: End-of-life (EOL) care is an important topic in critical care medicine, but EOL discussions with families can be difficult and stressful for intensivists. The aim of this study was to clarify the current practices and barriers facing pediatric intensive care unit (PICU) EOL care and to identify the requisites for excellent PICU EOL care in Japan. METHODS: A survey was conducted in 29 facilities across Japan in 2016. The questionnaire consisted of 19 multiple-choice questions and one open-ended question. RESULTS: Twenty-seven facilities responded to the survey. Only 19% had educational programs on EOL care for fellows or residents. Although 21 hospitals (78%) had a multidisciplinary palliative care team, only eight of these teams were involved in EOL care in PICUs. Mental health care for health-care providers provided by a psychiatrist was rare (4%). The free comments were categorized as individual, team, environment, legal/ethics, or culture. Commonly raised individual issues included "lack of experience and knowledge about EOL care", "fear of making the decision to end care", and "reluctance to be involved in EOL care because of its complex process". Team issues included "insufficient frequency of conferences" and "non-multidisciplinary approach". Legal and ethics issues were "lack of legal support" and "fear of lawsuits". CONCLUSIONS: This study is the first to investigate the current conditions and barriers in PICU EOL care in Japan. Most of the facilities involved were not satisfied with current practices. A need was identified for relevant educational programs, as well as the importance of multidisciplinary and legal support.


Assuntos
Atitude do Pessoal de Saúde , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Tomada de Decisão Clínica/métodos , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/normas , Japão , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Padrões de Prática Médica/normas , Assistência Terminal/métodos , Assistência Terminal/normas
4.
Pediatr Crit Care Med ; 19(3): e136-e144, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29504951

RESUMO

OBJECTIVES: To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. DESIGN: Prospective observational study. SETTING: Emergency department resuscitation bay in single tertiary pediatric center. PATIENTS: Children undergoing emergent tracheal intubation under videorecorded conditions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24-47 s). A significant subset of tracheal intubation attempts were made with the patient's bed at a height below the level of intubator's umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator's right hand prior to laryngoscopy (46%), and with the intubator's face less than 12 inches away from the patient's mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient's mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient's mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success. CONCLUSIONS: Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.


Assuntos
Intubação Intratraqueal/estatística & dados numéricos , Laringoscopia/estatística & dados numéricos , Gravação em Vídeo/métodos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos
5.
Pediatr Emerg Care ; 33(8): 564-569, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27261952

RESUMO

OBJECTIVES: To assess the effectiveness of pediatric simulation by remote facilitation. We hypothesized that simulation by remote facilitation is more effective compared to simulation by an on-site facilitator. We defined remote facilitation as a facilitator remotely (1) introduces simulation-based learning and simulation environment, (2) runs scenarios, and (3) performs debriefing with an on-site facilitator. METHODS: A remote simulation program for medical students during pediatric rotation was implemented. Groups were allocated to either remote or on-site facilitation depending on the availability of telemedicine technology. Both groups had identical 1-hour simulation sessions with 2 scenarios and debriefing. Their team performance was assessed with behavioral assessment tool by a trained rater. Perception by students was evaluated with Likert scale (1-7). RESULTS: Fifteen groups with 89 students participated in a simulation by remote facilitation, and 8 groups with 47 students participated in a simulation by on-site facilitation. Participant demographics and previous simulation experience were similar. Both groups improved their performance from first to second scenario: groups by remote simulation (first [8.5 ± 4.2] vs second [13.2 ± 6.2], P = 0.003), and groups by on-site simulation (first [6.9 ± 4.1] vs second [12.4 ± 6.4], P = 0.056). The performance improvement was not significantly different between the 2 groups (P = 0.94). Faculty evaluation by students was equally high in both groups (7 vs 7; P = 0.65). CONCLUSIONS: A pediatric acute care simulation by remote facilitation significantly improved students' performance. In this pilot study, remote facilitation seems as effective as a traditional, locally facilitated simulation. The remote simulation can be a strong alternative method, especially where experienced facilitators are limited.


Assuntos
Reanimação Cardiopulmonar/educação , Pediatria/educação , Treinamento por Simulação/métodos , Estudantes de Medicina , Adulto , Criança , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Projetos Piloto , Adulto Jovem
6.
Pediatr Surg Int ; 33(1): 91-95, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27803953

RESUMO

PURPOSE: For Wilms tumor, intraoperative tumor rupture with wide tumor spillage during surgical manipulation raises the classification to stage 3. Then, postoperative chemotherapy must be more intensive, and abdominal radiotherapy is added. Therefore, intraoperative tumor rupture should be avoided if possible. However, predictive factors for intraoperative tumor rupture have not been sufficiently described. Here we examined the risk factors for intraoperative tumor rupture. METHODS: Patients with Wilms tumor who underwent treatment according to the National Wilms Tumor Study or the Japanese Wilms Tumor Study protocol at our institution were reviewed retrospectively. Collected cases were categorized into two groups: the ruptured group and the non-ruptured group. Risk factors for intraoperative tumor rupture, including the ratio of the tumor area to the abdominal area in a preoperative single horizontal computed tomography slice (T/A ratio), were investigated in both groups. RESULTS: The two groups were not different in age, body weight, tumor laterality, sex, or histological distribution. The T/A ratio in the ruptured group was significantly higher than that in the non-ruptured group. Receiver operating characteristic curve analysis identified a discriminative value for a T/A ratio >0.5. CONCLUSION: The T/A ratio can be a predictive factor for intraoperative tumor rupture of Wilms tumor.


Assuntos
Complicações Intraoperatórias , Neoplasias Renais/cirurgia , Tumor de Wilms/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Neoplasias Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Tumor de Wilms/diagnóstico , Adulto Jovem
7.
Crit Care Med ; 44(9): 1675-82, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27071070

RESUMO

OBJECTIVES: To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs. DESIGN: Retrospective cohort study of prospectively collected data. SETTING: Twenty-five diverse PICUs. PATIENTS: Critically ill children requiring tracheal intubation in PICUs. INTERVENTIONS: Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubations in 25 PICUs from July 2010 to March 2014 using National Emergency Airway Registry for Children registry. MEASUREMENTS AND MAIN RESULTS: Tracheal intubation-associated cardiac arrest was defined as chest compressions more than 1 minute occurring during tracheal intubation or within 20 minutes after tracheal intubation. A total of 5,232 pediatric tracheal intubations were evaluated. Tracheal intubation-associated cardiac arrest was reported in 87 (1.7%). Patient factors (demographics and indications for tracheal intubation), provider factors (discipline and training level), and practice factors (tracheal intubation method and use of neuromuscular blockade) were recorded. Hemodynamic instability and oxygenation failure as tracheal intubation indications were associated with cardiac arrests (adjusted odds ratio, 6.3; 95% CI, 3.9-10.3; and adjusted odds ratio, 4.3; 95% CI, 2.6-6.9, respectively). History of difficult airway and cardiac disease were also associated with cardiac arrests (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5; and adjusted odds ratio, 2.1; 95% CI, 1.2-3.9, respectively). Provider and practice factors were not associated with cardiac arrests, and provider factors did not modify the effect of patient factors on cardiac arrests. CONCLUSIONS: Tracheal intubation-associated cardiac arrests occurred during 1.7% of PICU tracheal intubations. Tracheal intubation-associated cardiac arrests were much more common with tracheal intubations when the child had acute hemodynamic instability or oxygen failure and when the child had a history of difficult airway or cardiac disease.


Assuntos
Parada Cardíaca/epidemiologia , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/efeitos adversos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Parada Cardíaca/prevenção & controle , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco
8.
Ann Thorac Surg ; 91(5): 1611-3, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21524476

RESUMO

A sharp rise in intracranial pressure (ICP) was noted in a 6-year-old girl with Fontan circulation after surgical removal of a hematoma associated with intracranial hemorrhage. Inhalation of nitric oxide resulted in reduction of central venous pressure (CVP) and precipitous fall in ICP, which was otherwise resistant to conventional therapy. Specifically, the rate of fall of ICP (9 mm Hg) exceeded that of the CVP (3 mm Hg), indicating disproportionate CVP-ICP coupling. The present case provides not only a novel insight into cardio-cerebral interaction in Fontan physiology but also useful information regarding the treatment of Fontan patients in the setting of increased ICP.


Assuntos
Técnica de Fontan/efeitos adversos , Hemorragias Intracranianas/cirurgia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/terapia , Óxido Nítrico/uso terapêutico , Administração por Inalação , Pressão Venosa Central/fisiologia , Circulação Cerebrovascular/fisiologia , Criança , Feminino , Seguimentos , Técnica de Fontan/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hipertensão Intracraniana/fisiopatologia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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