A study of cases reported as incidents in a public hospital from 2011 to 2014

OBJETIVO Analizar los incidentes notificados en un hospital público del Distrito Federal, según las características y los resultados cuando involucraron a pacientes. MÉTODO Estudio descriptivo y retrospectivo de los incidentes notificados entre enero de 2011 y septiembre de 2014. RESULTADOS Notificados 209 incidentes categorizados en consecuencia comunicable (n = 22, 10,5%), casi evento (n = 16, 7,7%), incidente sin daño (n = 4, 1,9%) e incidente con daño (eventos adversos) (n = 167, 79,9%). La edad media de los pacientes fue de 44 años y el tiempo de la estancia hospitalaria hasta el momento del incidente tuvo promedio de 38,5 días. Los enfermeros fueron los que más notificaron (n = 55, 67%). Ningún resultado causó muerte. CONCLUSIÓN Los incidentes relacionados con sangre/hemoderivados, dispositivos/equipo médico, accidentes del enfermo y medicación/fluidos endovenosos fueron los más frecuentes. Se recomienda estandarizar los procesos de notificación y potenciar la participación de los profesionales en el manejo de los incidentes.OBJECTIVE Analyzing incidents reported in a public hospital in the Federal District, Brasilia, according to the characteristics and outcomes involving patients. METHOD A descriptive and retrospective study of incidents reported between January 2011 and September 2014. RESULTS 209 reported incidents were categorized as reportable occurrences (n = 22, 10.5%), near misses (n = 16, 7.7%); incident without injury (n = 4, 1.9%) and incident with injury (adverse events) (n = 167, 79.9%). The average age of patients was 44 years and the hospitalization time until the moment of the incident was on average 38.5 days. Nurses were the healthcare professionals who most reported the incidents (n = 55, 67%). No outcomes resulted in death. CONCLUSION Incidents related to blood/hemoderivatives, medical devices/equipment, patient injuries and intravenous medication/fluids were the most frequent. Standardizing the reporting processes and enhancing participation by professionals in managing incidents is recommended.OBJETIVO Analisar os incidentes notificados em um hospital público do Distrito Federal, segundo as características e os desfechos quando envolveram pacientes. MÉTODO Estudo descritivo e retrospectivo dos incidentes notificados entre janeiro de 2011 e setembro de 2014. RESULTADOS Notificados 209 incidentes categorizados em ocorrência comunicável (n = 22, 10,5%), quase evento (n = 16, 7,7%), incidente sem dano (n = 4, 1,9%) e incidente com dano (eventos adversos) (n = 167, 79,9%). A idade média dos pacientes foi de 44 anos e o tempo da internação até o momento do incidente teve média de 38,5 dias. Os enfermeiros foram os que mais notificaram (n = 55, 67%). Nenhum desfecho resultou em morte. CONCLUSÃO Os incidentes relacionados a sangue/hemoderivados, dispositivos/equipamento médico, acidentes do doente e medicação/fluidos endovenosos foram os mais frequentes. Recomenda-se padronizar os processos de notificação e potencializar a participação dos profissionais no manejo dos incidentes

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background: Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods: AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings: Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation: Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke. Funding: National Health and Medical Research Council of Australia

Microbial Cytochromes P450

The microbial P450s perform an array of oxidative and other chemical reactions that are both crucial for the viability of the bacterial, archaeal, and fungal hosts, and which have numerous important applications. The soluble nature of the bacterial and archaeal P450s has facilitated their expression and purification in high yields, and has enabled the determination of the crystal structures of several important members of the P450 superfamily. Many of the major breakthroughs in our knowledge of the catalytic mechanisms of the P450s have been made through spectroscopic and transient kinetic studies on the microbial P450s, including recent research that has definitively identified the highly reactive P450iron–oxo species compound I and has demonstrated its catalytic potency. This chapter describes our current knowledge on the structural and functional properties of the microbial P450s, including their involvement in pathways for production of industrially important molecules such as antibiotics. Aspects such as engineering of these P450s for novel reaction chemistry are also detailed, along with emerging data for novel P450 enzymes fused to both redox and nonredox partner proteins, and novel systems that bypass the requirement for redox partner proteins altogether. The microbial P450s provide a rich source of catalysts that continue to provide new information on the versatility of the P450s as well as novel activitieswith applications in the biomedical, biofuels, and bioremediation fields. This chapter highlights recent breakthroughs and developments that will ensure that microbial P450s remain center stage for biotechnology applications in the coming years