Abstract Background The new building of the Hospital in Lichtenfels (Germany) was put into operation in mid-July 2018. Neither the medical personnel nor medical departments have been changed. We want ...to evaluate how “safe” or “insecure” the new hospital or department in the beginning might have been. Our objective is to investigate if safety decreases at the beginning in a new hospital, despite modern environments and conditions. Methods Adverse events associated with treatment were included to evaluate the total number of adverse events resulting from medical care and medications. Patients records had to be closed and completed, the length of stay had to be at least 24 hours, the patient had to have been formally admitted to the hospital (Institute for Healthcare Improvement IHI GTT “Global Trigger Tool” recommendation). The identified adverse events were grouped into 27 categories of the Institute for Healthcare Improvement “Global Trigger Tool.” We randomly reviewed 40 patient records per month 6 months before and 6 months after moving to the new hospital. Results Statistical analysis showed that there was no significant difference in individual adverse events. The sum of adverse events was statistically higher after moving into a new hospital. Complete number of harms did reach statistical significance (χ2=6.62; df=1; p<.05; Cramer’s V=0.12), indicating that new environments “triggers” significantly more potential errors (50%) in comparison to the old environments (38.33%). Conclusion According to our results, the new hospital is slightly insecure in the first period (6 months) after its founding.
During a pandemic, protective measures to prevent bio-aerosol based infections, such as Corona Virus Infection Disease 19 (COVID 19), are very important. Everyday face masks can only partially block ...aerosols, and their effectiveness also depend on how well the person is wearing it. They are recommended for classroom situations during high pandemic activity. However, 'unprotected' communication with and among children is fundamental from the pedagogical and psychological point of view for normal psychosocial development and teaching. Partition walls around the persons can theoretically provide substantial standardized mechanical protection against the spread of droplets and aerosols, either as additional protection to face masks or as an alternative.
In the present research, the protection effectiveness of partition walls was investigated. With mannequin heads, fog generators, line lasers and a classroom-like setup with protective walls, flow visualization and aerosol concentration measurements were performed. Additionally, an active fan-suction system was tested to remove the channelled aerosols on top of the partition walls before they reach other persons in the room.
It was found that partition walls protect neighbours from bio-aerosol contact regardless of whether they wear masks or not. The combination with standardized room ventilation enforces this effect. Moreover, the experiments performed here clearly showed that partition walls may protect neighbours from bio-aerosols better than suboptimally fitting everyday face masks only.
Partition walls are the most effective protection against infectious bio-aerosols in classroom settings and should be combined with standardized ventilation as the preferred method for classrooms during the current COVID 19 pandemic.
•EEG data from a randomized controlled trial in children with BECTS.•No significant differences between Sulthiame or Levetiracetam.•Persistent EEG pathologies associated with an increased risk for ...recurrent seizures.
BECTS (benign childhood epilepsy with centrotemporal spikes) is associated with characteristic EEG findings. This study examines the influence of anti-convulsive treatment on the EEG.
In a randomized controlled trial including 43 children with BECTS, EEGs were performed prior to treatment with either Sulthiame or Levetiracetam as well as three times under treatment. Using the spike-wave-index, the degree of EEG pathology was quantified. The EEG before and after initiation of treatment was analyzed. Both treatment arms were compared and the EEG of the children that were to develop recurrent seizures was compared with those that were successfully treated.
Regardless of the treatment agent, the spike-wave-index was reduced significantly under treatment. There were no differences between the two treatment groups. In an additional analysis, the EEG characteristics of the children with recurrent seizures differed statistically significant from those that did not have any further seizures.
Both Sulthiame and Levetiracetam influence the EEG of children with BECTS. Persistent EEG pathologies are associated with treatment failures.
Children are often treated off-label and are at a disadvantage in pharmacotherapy. The aim of this study was to implement and evaluate a quality assurance measure (PaedPharm) for pediatric ...pharmacotherapy whose purpose is to reduce medication-related hospitalizations among children and adolescents.
PaedPharm consisted of the digital pediatric drug information system PaedAMIS, pediatric pharmaceutical quality circles (PaedZirk), and an adverse drug event (ADE) reporting system (PaedReport). The intervention was implemented in a cluster-randomized trial (DRKS 00013924) in 12 regions, with a pediatric and adolescent medicine clinic in each and a total of 152 surrounding private practitioners, in 6 sequences over 8 quarters. In addition to the proportion of ADE-related hospital admissions (primary endpoint), comprehensive process evaluation included other endpoints such as coverage, user acceptance, and relevance to practice.
41 829 inpatient admissions were recorded, of which 5101 were patients of physicians who participated in our study. 4.1% of admissions were ADE-related under control conditions, and 3.1% under intervention conditions (95% CI: 2.3; 5.9 and 1.8; 4.5, respectively). A model-based comparison yielded an intervention effect of 0.73 (population-based odds ratio; 0.39; 1.37; p = 0.33). PaedAMIS achieved moderate user acceptance and PaedZirk achieved high user acceptance.
The introduction of PaedPharm was associated with a decrease in medicationrelated hospitalizations that did not reach statistical significance. The process evaluation revealed broad acceptance of the intervention in outpatient pediatrics and adolescent medicine.
BACKGROUNDChildren are often treated off-label and are at a disadvantage in pharmacotherapy. The aim of this study was to implement and evaluate a quality assurance measure (PaedPharm) for pediatric ...pharmacotherapy whose purpose is to reduce medication-related hospitalizations among children and adolescents.METHODSPaedPharm consisted of the digital pediatric drug information system PaedAMIS, pediatric pharmaceutical quality circles (PaedZirk), and an adverse drug event (ADE) reporting system (PaedReport). The intervention was implemented in a cluster-randomized trial (DRKS 00013924) in 12 regions, with a pediatric and adolescent medicine clinic in each and a total of 152 surrounding private practitioners, in 6 sequences over 8 quarters. In addition to the proportion of ADE-related hospital admissions (primary endpoint), comprehensive process evaluation included other endpoints such as coverage, user acceptance, and relevance to practice.RESULTS41 829 inpatient admissions were recorded, of which 5101 were patients of physicians who participated in our study. 4.1% of admissions were ADE-related under control conditions, and 3.1% under intervention conditions (95% CI: 2.3; 5.9 and 1.8; 4.5, respectively). A model-based comparison yielded an intervention effect of 0.73 (population-based odds ratio; 0.39; 1.37; p = 0.33). PaedAMIS achieved moderate user acceptance and PaedZirk achieved high user acceptance.CONCLUSIONThe introduction of PaedPharm was associated with a decrease in medication-related hospitalizations that did not reach statistical significance. The process evaluation revealed broad acceptance of the intervention in outpatient pediatrics and adolescent medicine.
OBJECTIVESTo investigate whether aerosolized prostacyclin improves oxygenation in children with acute lung injury.
DESIGNDouble-blind, randomized, and placebo-controlled trial.
SETTINGPediatric ...intensive care unit at a university hospital.
PATIENTSFourteen children with acute lung injury defined by the criteria of an American-European Consensus Conference.
INTERVENTIONSAerosolized prostacyclin (epoprostenol sodium) by stepwise increments of different doses (10, 20, 30, 40, and 50 ng·kg·min) vs. aerosolized normal saline (placebo).
MEASUREMENTS AND MAIN RESULTSBefore the start of the study, and before and after each dose of prostacyclin/placebo, the following variables were measuredarterial blood gases, heart rate, mean arterial blood pressure, and ventilator settings required. Changes in oxygenation were measured by calculation of the oxygenation index (mean airway pressure × 100 × Pao2/Fio2). After treatment with aerosolized prostacyclin, there was a significant 26% (interquartile range, 3%, 35%) improvement in oxygenation index at 30 ng·kg·min compared with placebo (p = .001). The response to prostacyclin was not the same in all children. We saw an improvement of ≥20% in eight of 14 children (i.e., responders), and the number needed to treat was 1.8 (95% confidence interval, 1.2–3.2). No adverse effects were observed.
CONCLUSIONSAerosolized prostacyclin improves oxygenation in children with acute lung injury. Future trials should investigate whether this treatment will positively affect outcome.
To investigate the effect of mechanical ventilation on alveolar fibrinolytic capacity.
Randomized controlled animal study in 66 Sprague-Dawley rats.
Test animals received intratracheal fibrinogen and ...thrombin instillations; six were killed immediately (fibrin controls), and the others were allocated to three ventilation groups (ventilation period: 225 min) differing in positive inspiratory pressure and positive end-expiratory pressure, respectively: group 1, 16 cmH2O and 5 cmH2O (n=17); group 2, 26 cmH2O and 5 cmH2O (n=16); group 3, 35 cmH2O and of 5 cmH2O (n=17). Ten animals that had not been ventilated served as healthy controls.
After animals were killed, we measured D-dimers, plasminogen activator inhibitor (PAI) 1, and tumor necrosis factor alpha in the bronchoalveolar lavage fluid and calculated lung weight and pressure/volume (P/V) plots. The median D-dimer concentration (mg/l) decreased with increasing pressure amplitude (192 in group 1, IQR 119; 66 in group 2, IQR 107; 29 in group 3, IQR 30) while median PAI-1 (U/ml) increased (undetectable in group 1; 0.55 in group 2, IQR 4.55; 3.05 in group 3, IQR 4.85). PAI-1 level was correlated with increased lung weight per bodyweight (Spearman's rank correlation 0.708). Tumor necrosis factor alpha concentration was not correlated with PAI-1 level.
Alveolar fibrinolytic capacity is suppressed during mechanical ventilation with high pressure amplitudes due to local production of PAI-1.
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