Gli errori di terapia. Interventi di prevenzione in Terapia Intensiva Neonatale

I danni da errori terapeutici rappresentano un grave problema per la sanità. La Terapia Intensiva Neonatale (TIN) è un area peculiare e gli studi prodotti in letteratura dimostrano come il neonato critico sia maggiormente esposto al rischio di errore. Si è avviato un percorso di revisione del processo terapeutico in collaborazione fra medici, infermieri della TIN e il farmacista per individuare lacune e proporre interventi idonei. Le aree maggiormente esposte a rischio di errore si sono dimostrate: • Prescrizione medica e trascrizione della prescrizione sul foglio terapia. • Calcolo della dose di farmaco da infondere e modalità di diluizione del farmaco. • Principio dell’unitarietà (non sempre chi prepara è colui che somministra il farmaco). Il percorso ha permesso alle varie figure sanitarie di prendere coscienza del rischio e come sia importante adottare comportamenti standardizzati e protocollati in tutte le fasi del processo terapeutico, onde prevenire tutte le possibili cause di errore. " Introducendo il calcolo computerizzato della dose di farmaco da infondere si è ovviato difficoltà matematiche e alla prescrizione standardizzata. Infine, l’introduzione delle schede di denuncia volontaria dell’errore dovrebbe permettere non tanto la quantificazione del problema, quanto un’analisi degli sbagli per l’individuazione, in futuro, dei correttivi più appropriati

How Hybridization of Energy Storage Technologies Can Provide Additional Flexibility and Competitiveness to Microgrids in the Context of Developing Countries

Hybrid microgrids, integrating renewable energy sources and energy storage, are key in extending energy access in the remote areas of developing countries, in a sustainably way and in providing a good quality of service. Their extensive development faces a financing gap, having a high capital expenditure (CAPEX) also due to high storage costs. In the present work, a case study of a Ugandan microgrid was used to compare various battery technologies employed on their own and in a combination with a flywheel, in terms of their durability and the overall levelized cost of energy (LCOE) of the plant. Simulations show how hybrid storage configurations result in a lower LCOE for the current load profile of the microgrid and even more so for two reference residential and industrial load scenarios, suggesting this would remain the best solution even accounting for future socio-economic development. The resulting LCOE for hybrid storage configurations is lower than the average values reported for microgrid projects and represents a promising solution to speed up the development of such electrification initiatives

Quantitative cerebral blood flow and metabolism determination in the first 48 hours after severe head injury with a new dynamic SPECT device

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Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged 6565 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels

Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged 6565 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels