Errores médicos/Medical errors

Encuesta voluntaria para pacientes de los eventos médicos adversos: perspectiva de 696 pacientes y familiares lesionados. A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families. Southwick FS, Cranley NM, Hallisy JA. BMJ Qual Saf. 2015 Oct;24(10):620-9. doi: 10.1136/bmjqs-2015-003980. Epub 2015 Jun 19. Abstract BACKGROUND: Preventable medical errors continue to be a major cause of death in the USA and throughout the world. Many patients have written about their experiences on websites and in published books.METHODS:As patients and family members who have experienced medical harm, we have created a nationwide voluntary survey in order to more broadly and systematically capture the perspective of patients and patient families experiencing adverse medical events and have used quantitative and qualitative analysis to summarise the responses of 696 patients and their families.RESULTS:Harm was most commonly associated with diagnostic and therapeutic errors, followed by surgical or procedural complications, hospital-associated infections and medication errors, and our quantitative results match those of previous provider-initiated patient surveys. Qualitative analysis of 450 narratives revealed a lack of perceived provider and system accountability, deficient and disrespectful communication and a failure of providers to listen as major themes. The consequences of adverse events included death, post-traumatic stress, financial hardship and permanent disability. These conditions and consequences led to a loss of patients' trust in both the health system and providers. Patients and family members offered suggestions for preventing future adverse events and emphasised the importance of shared decision-making.CONCLUSIONS:This large voluntary survey of medical harm highlights the potential efficacy of patient-initiated surveys for providing meaningful feedback and for guiding improvements in patient care. KEYWORDS: Communication; Medical error, measurement/epidemiology; Patient safety; Qualitative research; Surveys PDF Evaluación de la confiabilidad de la revisión de historia clínica para la detección del eventos adversos hospitalarios. Assessing Reliability of Medical Record Reviews for the Detection of Hospital Adverse Events. Ock M, Lee SI, Jo MW, Lee JY, Kim SH. J Prev Med Public Health. 2015 Sep;48(5):239-48. doi: 10.3961/jpmph.14.049. Epub 2015 Sep 11. Abstract OBJECTIVES: The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events. METHODS: We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later. RESULTS: In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89). CONCLUSIONS: In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study. KEYWORDS: Adverse event; Inter-rater reliability; Intra-rater reliability; Medical record review; Patient safety PDF Comprobación cruzada para reducir los eventos adversos derivados de los errores médicos en elservicio de urgencias: protocolo de estudio del estudio aleatorizado clúster CHARMED. Cross-checking to reduce adverse events resulting from medical errors in the emergency department: study protocol of the CHARMED cluster randomized study. Freund Y, Rousseau A, Berard L, Goulet H, Ray P, Bloom B, Simon T, Riou B. BMC Emerg Med. 2015 Sep 4;15:21. doi: 10.1186/s12873-015-0046-1. Abstract BACKGROUND: Medical errors and preventable adverse events are a major cause of concern, especially in the emergency department (ED) where its prevalence has been reported to be roughly of 5-10% of visits. Due to a short length of stay, emergency patients are often managed by a sole physician - in contrast with other specialties where they can benefit from multiples handover, ward rounds and staff meetings. As some studies report that the rate and severity of errors may decrease when there is more than one physician involved in the management in different settings, we sought to assess the impact of regular systematic cross-checkings between physicians in the ED.DESIGN: The CHARMED (Cross-checking to reduce adverse events resulting from medical errors in the emergency department) study is a multicenter cluster randomized study that aim to evaluate the reduction of the rate of severe medical errors with implementation of systematic cross checkings between emergency physician, compared to a control period with usual care. This study will evaluate the effect of this intervention on the rate of severe medical errors (i.e. preventable adverse events or near miss) using a previously described two-level chart abstraction. We made the hypothesis that implementing frequent and systematic cross checking will reduce the rate of severe medical errors from 10 to 6% - 1584 patients will be included, 140 for each period in each center. DISCUSSION: The CHARMED study will be the largest study that analyse unselected ED charts for medical errors. This could provide evidence that frequent systematic cross-checking will reduce the incidence of severe medical errors. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Más sobre reacción a drogas / More on drugs reaction

Enero 3, 2016. No. 2195

Identificación de los factores de riesgo para reacciones severas de hipersensibilidad en anestesia general Identification of risk factors of severe hypersensitivity reactions in general anaesthesia. Mirone C, Preziosi D, Mascheri A, Micarelli G, Farioli L, Balossi LG, Scibilia J, Schroeder J, Losappio LM, Aversano MG, Stafylaraki C, Nichelatti M,Pastorello EA. Clin Mol Allergy. 2015 Jun 22;13(1):11. doi: 10.1186/s12948-015-0017-9. eCollection 2015. CONCLUSIONS: We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk. KEYWORDS: Age; Anaphylaxis; Angiotensin-converting enzyme inhibitor; General anaesthesia; Hypersensitivity; Hypertension; Neuromuscular blocking agents; Risk factors; Serum tryptase; Severity PDF Reacciones de hipersensibilidad durante anestesia. Resultados de una encuesta en Francia (2005-2007) Hypersensitivity reactions during anesthesia. Results from the ninth French survey (2005-2007). Dong SW, Mertes PM, Petitpain N, Hasdenteufel F, Malinovsky JM; GERAP. Minerva Anestesiol. 2012 Aug;78(8):868-78. Epub 2012 Mar 22. Abstract BACKGROUND: Hypersensitivity reactions occurring during anesthesia remain a major cause of concern for anesthesiologists. We report the results of the ninth consecutive survey of hypersensitivity reactions observed during anesthesia in France. This report will be used as an epidemiologic reference prior to this intervention.METHODS: Between January 1, 2005 to December 31, 2007, 1253 patients who experienced an immune-mediated (IgE-mediated) or non-immune-mediated (non-IgE-mediated) hypersensitivity reaction were referred to one of the 40 participating centers. Diagnosis was established on the basis of clinical history, skin tests and/or specific IgE assay. RESULTS: An IgE-mediated or non-IgE-mediated reaction was diagnosed in 786 cases (63%) and 467 cases (37%), respectively. The most common causes of anaphylaxis were neuromuscular blocking agents (NMBA) (N.=373, 47.4%), latex (N.=158, 20%), and antibiotics (N.=141, 18.1%). Succinylcholine (N.=226, 60.6%) was the most frequently incriminated NMBA, whereas the low frequency of reactions involving cis-atracurium was confirmed (N.=22, 5.9%) when market shares of each NMBA were taken into account. An increased number of reactions involving vital dyes was recorded (N.=34, 4.4%). CONCLUSION: These changes in the epidemiology of allergic reactions confirm the need for regular epidemiologic surveys of anaphylaxis in the perioperative period. PDF Reacción anafilactoidea al midazolam durante cirugía maxilofacial Anaphylactoid-like Reaction to Midazolam During Oral and Maxillofacial Surgery. Ayuse T, Kurata S, Ayuse T. Anesth Prog. 2015 Summer;62(2):64-5. doi: 10.2344/0003-3006-62.1.64.  Abstract We experienced a case of life-threatening hypotension and bronchoconstriction associated with edema in a patient undergoing resection of a tumor of the right mandible following intravenous midazolam for induction of general anesthesia. We decided to postpone surgery for further examination of a possible drug-induced allergic reaction, and we rescheduled surgery for 1 week later. After administering H1 and H2 histamine antagonists, we administered a slow induction with sevoflurane in nitrous oxide and oxygen plus intravenous atropine sulfate after performing a test dose injection. We safely induced and maintained anesthesia with nitrous oxide, oxygen, and sevoflurane. KEYWORDS: Anaphylactoid reaction; Midazolam PDF

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Lactancia Prolongada

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 6 Enero 2016 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Lactancia Prolongada” por la “Dra. Roxana García López”, Gastrenterologo Pediatra, de la Cd. De México DF La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/lactancia_prolongada/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López Webmaster: CONAPEME Coordinador Nacional: Seminario Ciberpeds-Conapeme Av La clinica 2520-310 Colonia Sertoma ,Mty N.L. México CP 64710 Tel-Fax 52 81 83482940 y 52 81 81146053 Celular 8183094806 www.conapeme.org www.pediatramendoza.com enrique@pediatramendoza.com emendozal@yahoo.com.mx

Anafilaxia perioperatoria/Perioperative anaphylaxis

Enero 2, 2016. No. 2194

Las reacciones no terapéuticas a los medicamentos pueden carecer de importancia o ser una amenaza para la vida-como las observados en el síndrome de Stevens-Johnson(http://anestesia-dolor.org/proyecto/sindrome-de-stevens-johnson-por-sulfas/ ) Las reacciones perioperatorias a drogas oscilan entre 1 en 20.000 a 1 en 1361. La mayoría de estas reacciones son generalmente clasificadas como IgE o no mediada por IgE. Las sospechas de reacciones adversas pueden subdividirse en función del mecanismo, por ejemploinmunológica (que requiere sensibilización por exposición previa) versus no inmunológica;tiempo (por ejemplo, inmediata o retardada), o si el fenómeno es dependiente de la dosis o no. Se pueden manifestar como una erupción simple, afectar a un solo o múltiples sistemas. El broncoespasmo e hipotensión son siempre sugerentes de tipo 1 o hipersensibilidadgeneralmente mediada por IgE. Es obligatorio registrar las reacciones adversas a drogas y el paciente debe de ser bien informado. Hoy comenzamos un serie de correos electrónicos con artículos sobre este tema.   Drugs non therapeutics consequences can be without importance or life-threatening like those observed in Stevens-Johnson syndrome (http://anestesia-dolor.org/proyecto/sindrome-de-stevens-johnson-por-sulfas/ ) The perioperative drugs reactions ranges from 1 in 20,000 to 1 in 1361. Most of these reactions are usually classified as IgE or non-IgE mediated. Suspected adverse drug reactions may be subdivided on the basis of mechanism e.g. immunological (requiring sensitization by previous exposure) versus nonimmunological; timing (e.g. immediate or delayed), or whether the phenomenon is dose dependent or not. They can manifest as a simple rash, affect a single or multiple systems. Bronchospasm and hypotension are always suggestive of type 1 or typically IgE- mediated hypersensitivity. It is mandatory to record drugs adverse reactions and the patient fully informed. Today we begin to e-mail you several articles on this subject. Anafilaxia perioperatoria Perioperative anaphylaxis. Berrío Valencia MI. Braz J Anesthesiol.2015 Jul-Aug;65(4):292-7. doi: 10.1016/j.bjane.2014.09.002. Epub 2015 Apr 28. Abstract BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes ofperioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed. CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids. CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis. KEYWORDS: Anafilaxia; Anaphylaxis; Anestesia; Anesthesia; Hipersensibilidade;Hypersensitivity; Perioperative period; Período perioperatório; Terapêutica; Treatment PDF La hipersensibilidad de tipo inmediato inducida por antibióticos es un factor de riesgo para pruebas cutáneas positivas de alergia para los bloqueadoresneuromusculares Antibiotic-induced immediate type hypersensitivity is a risk factor for positive allergy skin tests for neuromuscular blocking agents. Hagau N, Gherman N, Cocis M, Petrisor C. Allergol Int. 2015 Aug 29. pii: S1323-8930(15)00156-2. doi: 10.1016/j.alit.2015.07.007. [Epub ahead of print] Abstract BACKGROUND: Skin tests for neuromuscular blocking agents (NMBAs) are not currently recommended for the general population undergoing general anaesthesia. In a previous study we have reported a high incidence of positive allergy tests for NMBAs in patients with a positive history of non-anaesthetic drug allergy, a larger prospective study being needed to confirm those preliminary results. The objective of this study was to compare the skin tests results for patients with a positive history of antibiotic-induced immediate type hypersensitivity reactions to those of controls without drug allergies. METHODS: Ninety eight patients with previous antibiotic hypersensitivity and 72 controls were prospectively included. Skin tests were performed for atracurium, pancuronium, rocuronium, and suxamethonium. RESULTS: We found 65 positive skin tests from the 392 tests performed in patients with a positive history of antibiotic hypersensitivity (1 6.58%) and 23 positive skin tests from the 288 performed in controls (7.98%), the two incidences showing significant statistical difference (p = 0.0011). The relative risk for having a positive skin test for NMBAs for patients versus controls was 1.77 (1.15-2.76). For atracurium, skin tests were more often positive in patients with a positive history of antibiotic hypersensitivity versus controls (p = 0.02). For pancuronium, rocuronium and suxamethonium the statistical difference was not attained (p-values 0.08 for pancuronium, 0.23 for rocuronium, and 0.26 for suxamethonium). CONCLUSIONS: Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population. KEYWORDS: Antibiotic; Drug hypersensitivity; Latent sensitization; Neuromuscular blocking agent; Skin tests PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015