885 resultados para Medication Errors
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We provide a comprehensive study of out-of-sample forecasts for the EUR/USD exchange rate based on multivariate macroeconomic models and forecast combinations. We use profit maximization measures based on directional accuracy and trading strategies in addition to standard loss minimization measures. When comparing predictive accuracy and profit measures, data snooping bias free tests are used. The results indicate that forecast combinations, in particular those based on principal components of forecasts, help to improve over benchmark trading strategies, although the excess return per unit of deviation is limited.
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[Sin resumen]
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Introduction: Since 2005, the workload of community pharmacists in England has increased with a concomitant increase in stress and work pressure. However, it is unclear how these factors are impacting on the ability of community pharmacists to ensure accuracy during the dispensing process. This research seeks to extend our understanding of the nature, outcome, and predictors of dispensing errors. Methodology: A retrospective analysis of a purposive sample of incident report forms (IRFs) from the database of a pharmacist indemnity insurance provider was conducted. Data collected included; type of error, degree of harm caused, pharmacy and pharmacist demographics, and possible contributory factors. Results: In total, 339 files from UK community pharmacies were retrieved from the database. The files dated from June 2006 to November 2011. Incorrect item (45.1%, n = 153/339) followed by incorrect strength (24.5%, n = 83/339) were the most common forms of error. Almost half (41.6%, n = 147/339) of the patients suffered some form of harm ranging from minor harm (26.7%, n = 87/339) to death (0.3%, n = 1/339). Insufficient staff (51.6%, n = 175/339), similar packaging (40.7%, n = 138/339) and the pharmacy being busier than normal (39.5%, n = 134/339) were identified as key contributory factors. Cross-tabular analysis against the final accuracy check variable revealed significant association between the pharmacy location (P < 0.024), dispensary layout (P < 0.025), insufficient staff (P < 0.019), and busier than normal (P < 0.005) variables. Conclusion: The results provide an overview of some of the individual, organisational and technical factors at play at the time of a dispensing error and highlight the need to examine further the relationships between these factors and dispensing error occurrence.
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Abstract Health institutions have an increased risk of occurrence of errors due to their diversity, specificity and volume of services, representing a great concern for health professionals whose main function is to protect the health and lives of their patients. We intend to identify a body of evidence, that shows what the most common adverse events are and what adverse events potentially arise from clinical miscommunications. An integrative literature review using the keywords "Adverse Events", "Patient Safety", "Communication". An inquiry was made on databases PubMed, Web of Science, Scielo and CINAHL, in articles published between January 2010 and March 2016, available in Portuguese and English. Of the 216 articles that emerged were selected eight articles that answered the research questions: what are the most common adverse events that have their origin in communication errors? Analyzing the selected studies, it appears that the most common adverse events arise in the context of obstetrics and pediatrics, in surgical contexts, in the continuity of care and related medication. Patient safety should be seen as a key component of quality in health care, with good management of the risk of fundamental error for the promotion of this security. The knowledge and understanding that communication failures are one of the main factors contributing to the occurrence of errors in the context of health care, allows the subsequent development of strategies to improve this process and thus ensure safer healthcare.
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The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.
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Human radiosensitivity is a quantitative trait that is generally subject to binomial distribution. Individual radiosensitivity, however, may deviate significantly from the mean (by 2-3 standard deviations). Thus, the same dose of radiation may result in different levels of genotoxic damage (commonly measured as chromosome aberration rates) in different individuals. There is significant genetic component in individual radiosensitivity. It is related to carriership of variant alleles of various single-nucleotide polymorphisms (most of these in genes coding for proteins functioning in DNA damage identification and repair); carriership of different number of alleles producing cumulative effects; amplification of gene copies coding for proteins responsible for radioresistance, mobile genetic elements, and others. Among the other factors influencing individual radioresistance are: radioadaptive response; bystander effect; levels of endogenous substances with radioprotective and antimutagenic properties and environmental factors such as lifestyle and diet, physical activity, psychoemotional state, hormonal state, certain drugs, infections and others. These factors may have radioprotective or sensibilising effects. Apparently, there are too many factors that may significantly modulate the biological effects of ionising radiation. Thus, conventional methodologies for biodosimetry (specifically, cytogenetic methods) may produce significant errors if personal traits that may affect radioresistance are not accounted for.
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Improve the effectiveness, coordination, and safety of medication use in Iowa.
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Although errors might foster learning, they can also be perceived as something to avoid if they are associated with negative consequences (e.g., receiving a bad grade or being mocked by classmates). Such adverse perceptions may trigger negative emotions and error-avoidance attitudes, limiting the possibility to use errors for learning. These students’ reactions may be influenced by relational and cultural aspects of errors that characterise the learning environment. Accordingly, the main aim of this research was to investigate whether relational and cultural characteristics associated with errors affect psychological mechanisms triggered by making mistakes. In the theoretical part, we described the role of errors in learning using an integrated multilevel (i.e., psychological, relational, and cultural levels of analysis) approach. Then, we presented three studies that analysed how cultural and relational error-related variables affect psychological aspects. The studies adopted a specific empirical methodology (i.e., qualitative, experimental, and correlational) and investigated different samples (i.e., teachers, primary school pupils and middle school students). Findings of study one (cultural level) highlighted errors acquire different meanings that are associated with different teachers’ error-handling strategies (e.g., supporting or penalising errors). Study two (relational level) demonstrated that teachers’ supportive error-handling strategies promote students’ perceptions of being in a positive error climate. Findings of study three (relational and psychological level) showed that positive error climate foster students’ adaptive reactions towards errors and learning outcomes. Overall, our findings indicated that different variables influence students’ learning from errors process and teachers play an important role in conveying specific meanings of errors during learning activities, dealing with students’ mistakes supportively, and establishing an error-friendly classroom environment.
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Il progetto di tesi è stato sviluppato durante il periodo di tirocinio svolto all’interno del “Laboratorio di Radio Scienza ed Esplorazione Planetaria” da un'esperienza da cui prende il nome lo stesso elaborato: ”Numerical integration errors in deep space orbit determination”. Lo scopo del sopraccitato laboratorio è stato quello di studiare in modo approfondito il problema kepleriano dei due corpi, per poi passare ad un’analisi del problema dei tre corpi e successivamente a n corpi (con particolare attenzione alle orbite dei satelliti medicei di Giove). Lo studio è stato affiancato ad un costante utilizzo della piattaforma di programmazione Matlab per l’elaborazione e la stesura di codici per il calcolo di traiettorie orbitali ed errori numerici. Infatti, il fulcro del lavoro è stato proprio il confronto di vari integratori e degli errori numerici derivanti dall’integrazione. Nella tesi, dapprima, viene introdotto il sistema Gioviano, vengono presentati i satelliti medicei, delineate le caratteristiche fisiche fondamentali e i principali motivi che portano ad avere particolare interesse nel conoscere lo sviluppo orbitale di tale sistema. In seguito, l'elaborato, dopo una dettagliata descrizione teorica del problema dei due corpi, presenta un codice per la rappresentazione di orbite kepleriane e il calcolo dei relativi errori commessi dal metodo numerico rispetto a quello analitico. Nell'ultimo capitolo, invece, il problema è esteso a più corpi dotati di massa e a tal proposito viene proposto un codice per la rappresentazione delle orbite descritte nel tempo da n corpi, date le condizioni iniziali, e il calcolo dei rispettivi errori nel sistema di riferimento (r,t,n). In merito a ciò, vengono infine testati diversi integratori per cercare quello con le migliori performance e sono poi analizzati alcuni parametri in input al problema per verificare sotto quali condizioni l’integratore lavora meglio.
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The reproductive capacity between Triatoma lenti and Triatoma sherlocki was observed in order to verify the fertility and viability of the offspring. Cytogenetic, morphological and morphometric approaches were used to analyze the differences that were inherited. Experimental crosses were performed in both directions. The fertility rate of the eggs in crosses involving T. sherlocki females was 65% and 90% in F1 and F2 offspring, respectively. In reciprocal crosses, it was 7% and 25% in F1 and F2 offspring, respectively. The cytogenetic analyses of the male meiotic process of the hybrids were performed using lacto-acetic orcein, C-banding and Feulgen techniques. The male F1 offspring presented normal chromosome behavior, a finding that was similar to those reported in parental species. However, cytogenetic analysis of F2 offspring showed errors in chromosome pairing. This post-zygotic isolation, which prevents hybrids in nature, may represent the collapse of the hybrid. This phenomenon is due to a genetic dysregulation that occurs in the chromosomes of F1. The results were similar in the hybrids from both crosses. Morphological features, such as color and size of connexive and the presence of red-orange rings on the femora, were similar to T. sherlocki, while wins size was similar to T. lenti in F1 offspring. The eggshells showed characteristics that were similar to species of origin, whereas the median process of the pygophore resulted in intermediate characteristics in the F1 and a segregating pattern in F2 offspring. Geometric morphometric techniques used on the wings showed that both F1 and F2 offspring were similar to T. lenti. These studies on the reproductive capacity between T. lenti and T. sherlocki confirm that both species are evolutionarily closed; hence, they are included in the brasiliensis subcomplex. The extremely reduced fertility observed in the F2 hybrids confirmed the specific status of the species that were analyzed.
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A miniaturised gas analyser is described and evaluated based on the use of a substrate-integrated hollow waveguide (iHWG) coupled to a microsized near-infrared spectrophotometer comprising a linear variable filter and an array of InGaAs detectors. This gas sensing system was applied to analyse surrogate samples of natural fuel gas containing methane, ethane, propane and butane, quantified by using multivariate regression models based on partial least square (PLS) algorithms and Savitzky-Golay 1(st) derivative data preprocessing. The external validation of the obtained models reveals root mean square errors of prediction of 0.37, 0.36, 0.67 and 0.37% (v/v), for methane, ethane, propane and butane, respectively. The developed sensing system provides particularly rapid response times upon composition changes of the gaseous sample (approximately 2 s) due the minute volume of the iHWG-based measurement cell. The sensing system developed in this study is fully portable with a hand-held sized analyser footprint, and thus ideally suited for field analysis. Last but not least, the obtained results corroborate the potential of NIR-iHWG analysers for monitoring the quality of natural gas and petrochemical gaseous products.
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The practice of physical activities contributes to reducing the risk of chronic diseases and improves sleep patterns in the elderly. This research aimed to investigate the association between insomnia symptoms and daytime nap and the participation in physical leisure activities in elderly community residents. Data from the Studies Network of the Fragility in Brazilian Elderly (Campinas site), were used. Information from 689 elderly was analyzed, regarding sociodemographic characterization, physical leisure activity, occurrence of daytime napping and its duration, symptoms of insomnia and use of sleep medication. A significant association was found between the practice of walking and the daytime nap of short duration. Studies indicate that a short nap can benefit the quality of sleep and health of the elderly. Therefore, promoting the practice of walking can be a nursing intervention that favors the sleep patterns of the elderly.
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The Centers for High Cost Medication (Centros de Medicação de Alto Custo, CEDMAC), Health Department, São Paulo were instituted by project in partnership with the Clinical Hospital of the Faculty of Medicine, USP, sponsored by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) aimed at the formation of a statewide network for comprehensive care of patients referred for use of immunobiological agents in rheumatological diseases. The CEDMAC of Hospital de Clínicas, Universidade Estadual de Campinas (HC-Unicamp), implemented by the Division of Rheumatology, Faculty of Medical Sciences, identified the need for standardization of the multidisciplinary team conducts, in face of the specificity of care conducts, verifying the importance of describing, in manual format, their operational and technical processes. The aim of this study is to present the methodology applied to the elaboration of the CEDMAC/HC-Unicamp Manual as an institutional tool, with the aim of offering the best assistance and administrative quality. In the methodology for preparing the manuals at HC-Unicamp since 2008, the premise was to obtain a document that is participatory, multidisciplinary, focused on work processes integrated with institutional rules, with objective and didactic descriptions, in a standardized format and with electronic dissemination. The CEDMAC/HC-Unicamp Manual was elaborated in 10 months, with involvement of the entire multidisciplinary team, with 19 chapters on work processes and techniques, in addition to those concerning the organizational structure and its annexes. Published in the electronic portal of HC Manuals in July 2012 as an e-Book (ISBN 978-85-63274-17-5), the manual has been a valuable instrument in guiding professionals in healthcare, teaching and research activities.
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To identify the adherence rate of a statin treatment and possible related factors in female users from the Unified Health System. Seventy-one women were evaluated (64.2 ± 11.0 years) regarding the socio-economic level, comorbidities, current medications, level of physical activity, self-report of muscular pain, adherence to the medical prescription, body composition and biochemical profile. The data were analyzed as frequencies, Chi-Squared test, and Mann Whitney test (p<0.05). 15.5% of women did not adhere to the medical prescription for the statin treatment, whose had less comorbidities (p=0.01), consumed less quantities of medications (p=0.00), and tended to be younger (p=0.06). Those patients also presented higher values of lipid profile (CT: p=0.01; LDL-c: p=0.02). Musculoskeletal complains were not associated to the adherence rate to the medication. The associated factors to adherence of dyslipidemic women to statin medical prescription were age, quantity of comorbidities and quantity of current medication.