Estudo prospectivo comparativo de sistema especialista de prescrição médica na redução de erro e sobrecarga de trabalho médico

Erros médicos preveníveis(EMP) em hospitais excedem às mortes causadas por acidentes \ud automobilísticos, câncer de mama e AIDS. O Institute of Medicine estima até 98.000 mortes \ud causadas por EMP. O risco é aumentado quando os EMPs ocorrem em pacientes criticamente \ud enfermos ou com medicações que variam com o peso do paciente. A demora da primeira \ud prescrição é uma preocupação em UTI. Fadiga e sobrecarga podem comprometer a segurança \ud numa UTI pediátrica. Objetivos: Comparar a funcionalidade de um Sistema Especialista(SE) \ud experimental com a prescrição médica convencional Materiais/Métodos: Após termo de \ud consentimento, pediatras de um hospital universitário são convidados a fazer a prescrição de 10 \ud itens medicamentosos completos(soro de manutenção, adenosina, adrenalina, atropina, \ud difenilhidantoína, vancomicina , ceftadizima, anfotericina_B, dobutamina, fentanil) para uma \ud criança hipotética. Comparou-se a prescrição convencional com a prescrição feita no SE, após \ud um treinamento prévio de 2 minutos. Uma equipe(médicos, enfermeiras e farmacêuticas) \ud avaliaram os EMPs. Comparações feitas pelo X2, teste exato de fisher, teste t-student pareado ou \ud Wilconson, quando aplicáveis. Significância considerada: p<0.05. Resultados:13 médicos \ud residentes e 7 assistentes participaram do estudo com tempo médio de formação de 10,1+/-9 anos \ud . Constatados 57 casos de EMP (9 ilegibilidades, 23 omissões, 6 erros de dose, 14 erros de \ud diluição e 5 erros de velocidade de infusão) pela prescrição convencional comparado com 1 \ud duplicação de medicação na prescrição por SE(p<0,001). O tempo médio de prescrição dos 10 \ud medicamentos utilizando a abordagem ONE TOUCH do SE foi de 22,4 +/- 5,6 segundos_[13-36 \ud segundos] e estava significantemente abaixo do tempo de prescrição convencional (média:557 +/- \ud 164 segundos; p=0,00088). O tempo médio de prescrição com SE foi 27 vezes(IC95% 21,5-\ud 32,5)) mais rápido que a convencional com economia de 89,1 minutos em uma UTI de 10 leitos. \ud Conclusão:Embora não infalível, o uso de SE requer pouco tempo de treinamento e resulta em \ud significante diminuição de erros e sobrecarga de trabalho

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Septic Shock, Necrotizing Pneumonitis, and Meningoencephalitis Caused by Mycoplasma pneumoniae in a Child: A Case Report

Mycoplasma pneumoniae is an important causative agent of respiratory infection in childhood. Although the infection caused by M. pneumoniae is classically described as benign, severe and life-threatening pulmonary and extrapulmonary complications can occur. This study describes the first case of septic shock related to M. pneumoniae in a child with necrotizing pneumonitis, severe encephalitis, and multiple organs involvement, with a favorable outcome after lobectomy and systemic corticosteroid

Prenatal and pubertal testosterone exposure imprint permanent modifications in the prostate that predispose to the development of lesions in old Mongolian gerbils

The prostate is an accessory sex gland that develops under precise androgenic control. It is known that hormonal imbalance may disrupt its development predisposing this gland to develop diseases during aging. Although the hypothesis regarding earlier origins of prostate diseases was proposed many years ago, the mechanisms underlying this complex phenomenon are poorly understood. Therefore, the aim of this study was to evaluate the prostates of old male gerbils exposed to testosterone during intrauterine and postnatal life using morphological, biometrical, stereological, Kariometric, immunohistochemical, and immunofluorescence analyses. Our findings demonstrate that prenatal and pubertal exposure to testosterone increases the susceptibility to the development of prostate diseases during aging. The presence of a more proliferative gland associated with foci of adenomatous hyperplasia in animals exposed to testosterone during the prenatal and pubertal phase show that the utero life and the pubertal period are important phases for prostatic morphophysiology establishment, which is a determinant for the health of the gland during aging. Therefore, these findings reinforce the idea that prostate disease may result from hormonal disruptions in early events during prostate development, which imprint permanently on the gland predisposing it to develop lesions in later stages of life192160167CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP301596/2011-52009/16789-7; 2009/53990-

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data