Estudi comparatiu: errors de les infermeres en la preparació i l'administració de la medicació segons dos sistemes de distribució

Introducció: Els errors de medicació són definits com qualsevol incident prevenible que pot causar dany al pacient o donar lloc a una utilització inapropiada dels medicaments, quan aquests estan sota el control dels professionals sanitaris o del pacient. Els errors en la preparació i l’administració de medicació són els més comuns de l’àrea hospitalària i, tot i la llarga cadena per la qual passa el fàrmac, el professional d’infermeria és el últim responsable de l’acció, tenint així, un paper molt important en la seguretat del pacient. Les infermeres dediquen el 40% del temps de la seva jornada laboral en tasques relacionades amb la medicació. Objectiu: Determinar si les infermeres produeixen més errors si treballen amb sistemes de distribució de medicació de stock o en sistemes de distribució unidosis de medicació. Metodologia: Estudi quantitatiu, observacional i descriptiu, on la notificació d’errors (o oportunitats d’error) realitzats per la infermera, en les fases de preparació i administració de medicació, es farà mitjançant un qüestionari autoelaborat. Els elements a identificar seran: el tipus d’error, les causes que poden haver--‐lo produït, la seva potencial gravetat i qui l’ha pogut evitar; així com el tipus de professional que l’ha produït. Altres dades rellevants són: el medicament implicat junt amb la dosis i la via d’administració i el sistema de distribució utilitzat. Mostreig i mostra: El mostreig serà no probabilístic i per conveniència. S’escolliran aquelles infermeres que l’investigador consideri amb les característiques necessàries per participar en l’estudi, així que la mostra estarà formada per les infermeres les quals treballen a la unitat 40 de l’Hospital del Mar i utilitzen un sistema de distribució de medicació de dosis unitàries i les infermeres que treballen a urgències (concretament a l’àrea de nivell dos) de l’Hospital del Mar les quals treballen amb un sistema de distribució de medicació de stock.

Mortality rates in by-caught loggerhead turtle Caretta caretta in the Mediterranean Sea and implications for the Atlantic populations

Reliable estimates of the post-release mortality probability of marine turtles after incidental by-catch are essential for assessing the impact of longline fishing on these species.Large numbers of loggerhead turtles Caretta caretta from rookeries in the northwestern Atlantic Ocean have been by-caught annually in the southwestern Mediterranean Sea since the 1980s, but nothing is known about their post-release mortality probability under natural conditions. Pop-up archival transmitting tags were attached to 26 loggerhead turtles following incidental capture by Spanish longliners. Hooks were not removed, and 40 cm of line was left in place. The post-release mortality probability during the 90 d following release ranged from 0.308 to 0.365, and was independent of hook location. When the post-release mortality probability was combined with previously reported estimates of the mortality probability before hauling, the aggregated by-catch mortality probability ranged from 0.321 to 0.378. Assuming a total annual by-catch of 10656 loggerhead turtles by the Spanish longline fleet operating in the southwestern Mediterranean, by-catch results in 3421 to 4028 turtle deaths annually. This range is equivalent to 8.5−10.1% of the approximately 40000 turtles inhabiting the fishing grounds used by Spanish longliners, most of them from rookeries in the northwestern Atlantic. As a consequence, the accumulated mortality during the oceanic stage is expected to be larger for those loggerhead turtles of Atlantic origin that spend several years in the Mediterranean Sea than for turtles of the same cohort that remain in the Atlantic. For this reason, the Mediterranean can be considered a dead end for loggerhead turtle populations nesting in the Atlantic, although the actual demographic relevance of by-catch mortality of loggerhead turtles in the Mediterranean remains unknown.

Safety and Mobility Impacts of Winter Weather --Phase 3, SPR RB01-012, 2014

Highway agencies spend millions of dollars to ensure safe and efficient winter travel. However, the effectiveness of winter-weather maintenance practices on safety and mobility are somewhat difficult to quantify. Safety and Mobility Impacts of Winter Weather - Phase 1 investigated opportunities for improving traffic safety on state-maintained roads in Iowa during winter-weather conditions. In Phase 2, three Iowa Department of Transportation (DOT) high-priority sites were evaluated and realistic maintenance and operations mitigation strategies were also identified. In this project, site prioritization techniques for identifying roadway segments with the potential for safety improvements related to winter-weather crashes, were developed through traditional naïve statistical methods by using raw crash data for seven winter seasons and previously developed metrics. Additionally, crash frequency models were developed using integrated crash data for four winter seasons, with the objective of identifying factors that affect crash frequency during winter seasons and screening roadway segments using the empirical Bayes technique. Based on these prioritization techniques, 11 sites were identified and analyzed in conjunction with input from Iowa DOT district maintenance managers and snowplow operators and the Iowa DOT Road Weather Information System (RWIS) coordinator.

Estratègies per optimitzar el temps de pràctica motriu en les sessions d'educació física

L'alumne necessita practicar per aprendre. En les classes d'educació física, però, aquesta pràctica es veu limitada per molts factors que, per petits que siguin, quan s'ajunten provoquen que el temps de pràctica motriu d'una sessió sigui excessivament reduït. Aquest treball que presento, doncs, tracta de cercar i analitzar els factors més rellevants que generen aquesta manca de minuts amb què compten els alumnes per tal d'assolir els objectius establerts. Així, es podrà reflexionar sobre les possibles estratègies a utilitzar per tal de poder optimitzar al màxim el temps de pràctica motriu en les sessions d'educació física

Comparació del servei en curt i en llarg del porter dins de la fase ofensiva del joc

En el procés ofensiu de la majoria d’equips de futbol, es pot distingir una tendència a jugar en base a dos estils de joc. Un estil basat en un joc en curt, per tal de poder mantenir la possessió de la pilota, i estar durant més temps atacant la porteria contraria. I un altre estil que prefereix buscar la profunditat en les seves accions, anant d’una forma més directe cap a la porteria rival. En aquest treball es pretén analitzar quin dels dos estils és millor perquè un equip encadeni un total de 6 accions, tenint com a referència en l’inici de la jugada al porter. Per tal d’aconseguir-ho s’analitzaran els 24 partits de la fase de grups de l’Eurocopa 2012 a través d’una metodologia pròpia, que ens permetrà saber a través de quines situacions rep la pilota el porter abans de posar la pilota en joc, i a través de quines accions, l’equip no és capaç d’assolir el nombre d’encadenaments marcat.

Road Profile Adjustment Computer Program, HR-143, 1969

A computer program to adjust roadway profiles has been developed to serve as an aid to the county engineers of the State of Iowa. Many hours are spent reducing field notes and calculating adjusted roadway profiles to prepare an existing roadway for paving that will produce a high quality ride and be as maintenance free as possible. Since the computer is very well adapted to performing long tedious tasks; programming this work for a computer would result in freeing the engineer of these tasks. Freed from manual calculations, the engineer is able to spend more time in solving engineering problems. The type of roadway that this computer program is designed to adjust is a road that at sometime. in its history was graded to a finished subgrade. After a period of time, this road is to receive a finished paved surface. The problem then arises whether to bring the existing roadway up to the de signed grade or to make profile adjustments and comprise between the existing and the design profiles. In order to achieve the latter condition using this program, the engineer needs to give the computer only a minimum amount of information.

Acquisitions thérapeutiques en médecine ambulatoire en 2013 [2013 literature findings in internal general medicine].

The prescribing of antibiotics for uncomplicated skin abscesses and diverticulitis has no benefit. Some antibiotics are more at risk of causing a Clostridium difficile infection. The tests used to exclude a history of a penicillin allergy are safe. A threshold of D-dimer adjusted for the age significantly improves the specificity of the test without affecting the sensitivity. The prescription of paraclinics tests is not an effective "treatment" for the patient's anxiety. In the sleep apnea syndrome, treatment with CPAP (Continuous positive airway pressure) appears to have more benefits compared to the mandibular advancement prosthesis. The work of primary care physicians can be supported by the work of advanced practice nurses. The limitation placed on the working hours of doctors in hospitals seems to affect their ability to spend time with their patients.

Total Cost of Transportation Analysis of Road and Highway Issues, HR-388, 2002

In the administration, planning, design, and maintenance of road systems, transportation professionals often need to choose between alternatives, justify decisions, evaluate tradeoffs, determine how much to spend, set priorities, assess how well the network meets traveler needs, and communicate the basis for their actions to others. A variety of technical guidelines, tools, and methods have been developed to help with these activities. Such work aids include design criteria guidelines, design exception analysis methods, needs studies, revenue allocation schemes, regional planning guides, designation of minimum standards, sufficiency ratings, management systems, point based systems to determine eligibility for paving, functional classification, and bridge ratings. While such tools play valuable roles, they also manifest a number of deficiencies and are poorly integrated. Design guides tell what solutions MAY be used, they aren't oriented towards helping find which one SHOULD be used. Design exception methods help justify deviation from design guide requirements but omit consideration of important factors. Resource distribution is too often based on dividing up what's available rather than helping determine how much should be spent. Point systems serve well as procedural tools but are employed primarily to justify decisions that have already been made. In addition, the tools aren't very scalable: a system level method of analysis seldom works at the project level and vice versa. In conjunction with the issues cited above, the operation and financing of the road and highway system is often the subject of criticisms that raise fundamental questions: What is the best way to determine how much money should be spent on a city or a county's road network? Is the size and quality of the rural road system appropriate? Is too much or too little money spent on road work? What parts of the system should be upgraded and in what sequence? Do truckers receive a hidden subsidy from other motorists? Do transportation professions evaluate road situations from too narrow of a perspective? In considering the issues and questions the author concluded that it would be of value if one could identify and develop a new method that would overcome the shortcomings of existing methods, be scalable, be capable of being understood by the general public, and utilize a broad viewpoint. After trying out a number of concepts, it appeared that a good approach would be to view the road network as a sub-component of a much larger system that also includes vehicles, people, goods-in-transit, and all the ancillary items needed to make the system function. Highway investment decisions could then be made on the basis of how they affect the total cost of operating the total system. A concept, named the "Total Cost of Transportation" method, was then developed and tested. The concept rests on four key principles: 1) that roads are but one sub-system of a much larger 'Road Based Transportation System', 2) that the size and activity level of the overall system are determined by market forces, 3) that the sum of everything expended, consumed, given up, or permanently reserved in building the system and generating the activity that results from the market forces represents the total cost of transportation, and 4) that the economic purpose of making road improvements is to minimize that total cost. To test the practical value of the theory, a special database and spreadsheet model of Iowa's county road network was developed. This involved creating a physical model to represent the size, characteristics, activity levels, and the rates at which the activities take place, developing a companion economic cost model, then using the two in tandem to explore a variety of issues. Ultimately, the theory and model proved capable of being used in full system, partial system, single segment, project, and general design guide levels of analysis. The method appeared to be capable of remedying many of the existing work method defects and to answer society's transportation questions from a new perspective.

Effect of an ectoparasite on reproduction in great tits.

1. The effect of a haematophageous ectoparasite, the hen flea, on quality an number of offspring was experimentally investigated in the great tit. The experiment consisted of a controlled infestation of a random sample of nests with the parasitic flea and of a regular treatment of control nests with Microwaves in order to eliminate the naturally occurring fleas. 2. To assess the effects of fleas on variables related to offspring number, we considered the number of hatchlings and fledglings, the mortality between hatching and fledging, and the hatching and fledging success. For assessment of offspring quality, we measured body mass, tarsus and wing length, and calculated the nutritional condition of, nestlings as the ratio of body mass to tarsus length. A physiological variable, the haematocrit level, was also measured. 3. Hatching success and hatchling numbers did not differ between the two experimental groups. Offspring mortality between hatching and fledging was significantly higher in the infested broods (xBAR = 0.22 chicks dead per day) than in the parasite-free broods (xBAR = 0.07 dead per day). Fledging success was 83% in the parasite-free broods, but only 53% in the infested ones. The number of fledglings in infested broods (xBAR = 3.7 fledglings +/-2.1 SD) was significantly lower than in the parasite-free (xBAR = 4.9 +/- 1.1 SD) broods. 4. Body mass of chicks in the infested broods was significantly smaller than in the parasite-free broods both 14 days and 17 days after hatching. The chicks in the infested broods reached a significantly smaller tarsus length than the ones in the parasite-free broods. Close to fledging, the nutritional condition of chicks was significantly lower in infested broods. Haematocrit levels were significantly lower in the infested broods. 5. Brood size correlated differently with body mass and condition of chicks in infested and parasite-free nests. In parasite-free broods both body mass and condition of chicks at age 17 days, i.e. close to fledging, were significantly higher in small broods than in large ones. However, in the infested broods chicks were of the same body mass and condition in large as in small broods. Therefore, in parasite-free broods fitness can potentially be gained through offspring quality or number or both, whereas in infested broods it can be gained through offspring quantity only. In other words, a trade-off between quality and number of offspring is feasible only in the absence of the parasitic hen flea. 6. These results emphasize the need to study the effects of ectoparasites on ecological, behavioural and evolutionary traits of their bird hosts. A knowledge of these effects is essential for the understanding of population dynamics, behaviour and life-history traits of the hosts.

Continuous monitoring and quantification of multiple parameters of daily physical activity in ambulatory Duchenne muscular dystrophy patients.

Multiple motor function and strength assessment tools exist for the evaluation of neuromuscular diseases, but most do not directly assess functional ability in the patients' daily physical activity in their home environment. In this study our aim was to assess: 1) the feasibility and accuracy of physical activity monitoring during two days in a home environment of five DMD patients using a non-commercialized monitor containing a 3D accelerometer and a gyroscope, 2) if a difference in the physical activity parameters could be measured before and one month after starting prednisolone. We reliably quantified the time spend sitting, standing, lying, walking, the number of steps taken, the cadence, the number of walking episodes and their duration as well as how these were distributed over the day. Parameters possibly reflecting endurance, such as the duration of the walking episodes or the succession of two or three walking episodes lasting more than 30 s were the most improved after prednisolone treatment. This degree of detailed determination of physical activity in a home environment has not been previously reported in neuromuscular disorders to our knowledge and some of the reported parameters are potential new outcome measures in clinical trials.

Is Internet use unhealthy? A cross-sectional study of adolescent Internet overuse.

OBJECTIVE: To assess whether problematic internet use is associated with somatic complaints and whether this association remains when checking for internet activity among a random sample of adolescents living in the canton of Vaud, Switzerland. METHODS: Cross-sectional survey of 3,067 8th graders (50.3% females) divided into average (n = 2,708) and problematic (n = 359) Internet users and compared for somatic complaints (backache, overweight, headaches, musculoskeletal pain, sleep problems and sight problems) controlling for sociodemographic and internet-related variables. Logistic regressions were performed for each complaint and for all of them simultaneously controlling variables significant at the bivariate level. RESULTS: At the multivariate level, when taken separately, problematic internet users were more likely to have a chronic condition (adjusted odds ratio [aOR] with 95% CI: 1.58 [1.11:2.23]) and to report back pain (aOR: 1.46 [1.04:2.05]), overweight (aOR: 1.74 [1.03:2.93]), musculoskeletal pain (aOR: 1.36 [1.00:1.84]) and sleep problems (aOR: 2.16 [1.62:2.88]). When considered in the full model, only sleep problems remained significant (aOR: 2.03 [1.50:2.74]). CONCLUSIONS: Our results confirm that problematic internet users report health problems more frequently, with lack of sleep being the most strongly associated and seeming to act as mediator regarding the other ones. Clinicians should remember to screen for excessive internet use their patients complaining of sleep-related problems, back or musculoskeletal pain or overweight. Clinicians should advise parents to limit the amount of time their adolescent children can spend online for leisure activities. Furthermore, limiting the number of devices used to connect to the internet could help warrant enough sleeping time.

1208-005 North Raccoon Watershed Final Report

The Buena Vista SWCD is submitting this WIRB request on behalf of both Buena Vista and Pocahontas SWCDs. The two SWCDs are working jointly on a project that includes three existing Mississippi River Basin Imitative (MRBI) project areas in the North Raccoon River Watershed. The total project area is 280,654 crop acres. The MRBI project involves installing conservation practices through the EQIP program. Funding from MRBI will support costs of practice design, layout and checkout, however, there is no funding to market and sell the program and practices to landowners and producers in the project area. Both soil and water districts are financially supporting work currently being done to encourage signup for the approved practices. To effectively implement the MRBI project it is imperative that marketing and promotion through group meetings and one-on­ one contacts is completed. Funding from WIRB will allow the existing employee to spend the needed time on these promotional activities in both Buena Vista and Pocahontas County. Through this WIRB request these two SWCDs districts plan to apply over $800,000 worth of conservation practices that is funded through the MRBI program. The return from this investment of WIRB dollars is large. This is an opportunity to support a large amount of conservation work in the North Raccoon River Watershed, which, is also an important water source for the city Des Moines and provides recreational activities from Des Moines up to BY and Pocahontas Counties.

Who is afraid of the big bad ban? An evaluation of the effects of the Spanish clean air law on expenditure at hospitality venues

Background:In January 2011 Spain modified clean air legislation in force since 2006, removing all existing exceptions applicable to hospitality venues. Although this legal reform was backed by all political parties with parliamentary representation, the government's initiative was contested by the tobacco industry and its allies in the hospitality industry. One of the most voiced arguments against the reform was its potentially disruptive effect on the revenue of hospitality venues. This paper evaluates the impact of this reform on household expenditure at restaurants and bars and cafeterias. Methods and empirical strategy:We use micro-data from the Encuesta de Presupuestos Familiares (EPF) for years 2006 to 2012 to estimate "two part" models where the probability of observing a positive expenditure and, for those who spend, the expected level of expenditure are functions of an array of explanatory variables. We apply a before-after analysis with a wide range of controls for confounding factors and a flexible modeling of time effects.Results:In line with the majority of studies that analyze the effects of smoking bans using objective data, our results suggest that the reform did not cause reductions in households' expenditures on restaurant services or on bars and cafeteria services.

Of great tits and fleas: sleep baby sleep

Many bird parasites reduce their hosts' fitness and, as a consequence, anti-parasite behaviour such as preening and nest sanitation has evolved. These activities are time consuming and, during the day, compete directly with time devoted to foraging and food provisioning to nestlings. Moreover, infested hosts may have to allocate extra time to foraging in order to compensate for the energy loss that ectoparasites impose on the nestlings and parents. Alternatively, brooding females could, at the expense of sleeping, allocate more time to preening and nest sanitation at night. If sleeping has a short-term restoring function, one may then expect a reduction in feeding efficiency of sleep-deprived females. In this study, the effect of a haematophagous ectoparasite, the hen flea, on the activity budgets of breeding female great tits during the day and at night was investigated experimentally. Time allocated to nest sanitation increased only slightly from 0.6 % of daytime in ectoparasite-free nests to 2.8% of daytime in infested nests, thus demonstrating the higher priority given to food provisioning than parasite control. Females in infested nests reduced their sleeping time significantly (73.5% of night-time in parasite-free nests versus 48.1% in infested nests). The time freed from the reduction of sleeping time was mainly used for nest sanitation (8.3% of night-time in parasite-free nests versus 27.1% in infested nests). Despite this strong decrease in sleeping time, there was no effect of ectoparasites on the females' rate of food provisioning to nestlings.

Mothers' experience of their contact with their stillborn infant: an interpretative phenomenological analysis.

BACKGROUND: Guidelines surrounding maternal contact with the stillborn infant have been contradictory over the past thirty years. Most studies have reported that seeing and holding the stillborn baby is associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so. In contrast, others studies suggest that contact with the stillborn infant can lead to poorer maternal mental health outcomes. There is a lack of research focusing on the maternal experience of this contact. The present study aimed to investigate how mothers describe their experience of spending time with their stillborn baby and how they felt retrospectively about the decision they made to see and hold their baby or not. METHOD: In depth interviews were conducted with twenty-one mothers three months after stillbirth. All mothers had decided to see and the majority to hold their baby. Qualitative analysis of the interview data was performed using Interpretive Phenomenological Analysis. RESULTS: Six superordinate themes were identified: Characteristics of Contact, Physicality; Emotional Experience; Surreal Experience; Finality; and Decision. Having contact with their stillborn infant provided mothers with time to process what had happened, to build memories, and to 'say goodbye', often sharing the experience with partners and other family members. The majority of mothers felt satisfied with their decision to spend time with their stillborn baby. Several mothers talked about their fear of seeing a damaged or dead body. Some mothers experienced strong disbelief and dissociation during the contact. CONCLUSIONS: Results indicate that preparation before contact with the baby, professional support during the contact, and professional follow-up are crucial in order to prevent the development of maternal mental health problems. Fears of seeing a damaged or dead body should be sensitively explored and ways of coping discussed. Even in cases where mothers experienced intense distress during the contact with their stillborn baby, they still described that having had this contact was important and that they had taken the right decision. This indicates a need for giving parents an informed choice by engaging in discussions about the possible benefits and risks of seeing their stillborn baby.