The results of this observational study support the notion that acarbose is effective, safe and well tolerated in a large cohort of Asian patients with type 2 diabetes.
A bstract Background Medication error in developed countries is of primary concern when there is a question of adversity to a patient's health, but in developing countries like India, it is just a term and its significance is undervalued. The incidence of medication error is essential to estimate the proper medical care provided in the healthcare system. Objective The main objective of the study is to determine the incidences of medication error in critical care unit and to evaluate its risk outcomes. Materials and methods This is a prospective observational study conducted over a period of 6 months in a critical care unit of a tertiary care hospital. Medication chart review method was opted for data collection. The medication errors were mainly classified as prescription, transcription, indenting, dispensing, and administration error. A total of 6,705 charts were reviewed. The NCCMERP risk index was used to evaluate the outcome of errors. Results Of the total 6,705 charts, 410 medication errors were found, i.e., 6.11%. The most common error is transcription error that constitutes 44.1% of the total errors, followed by prescription error 40%, and administration error 14%. The frequency of indenting and dispensing errors is negligible with 1.5% and 0.5%, respectively. The main causes of medication errors are due to incomplete prescription 50.2% and wrong doses 22.9%. In drug class, antibiotics and antihypertensive agents are most prone to medication error. About 87.1% errors belonged to the Category B of National Coordinating Council for Medication Error Reporting and Prevention risk index. Conclusion Majority of the errors are transcription errors followed by prescription and administration errors. Consultant doctors have to be more vigilant during prescribing and verifying the medication charts. Clinical pharmacists should act as a checkpoint at each step of medication process to identify and prevent medication errors. How to cite this article Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, et al. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med 2020;24(9):799–803.
The purpose of this study was to investigate the ultrastructure of the local nerve supply of ovine gallbladders as well as the functional characteristics of inhibitory nerves. We used electron microscopy of thin sections of ovine gallbladders and in vitro isometric tension recording using gallbladder strips. Specifically, we measured contractile and inhibitory responses induced by transmural electrical field stimulation (EFS). We found a ganglionated plexus with intramural nerve cells and interconnecting axons. Clear and large dense-core vesicles colocalized in axons close to smooth muscle cells. EFS elicited gallbladder contractions which were converted to relaxation after atropine. EFS-induced relaxation was reduced by the nitric oxide (NO) synthase inhibitor, L-NOARG and blocked by propranolol and/or tetrodotoxin. In conclusion, enteric ganglia and neurones with synaptic vesicles (clear and dense core) were detected close to smooth muscle bundles. Neural inhibition of gallbladder contraction was mediated by β-adrenoceptors coupled to NO generation.
Objective: It is known that the macrolide antibiotic erythromycin stimulates gastrointestinal and gallbladder motility by an as yet unidentified mechanism. It was the objective of this study to investigate the mechanism of the gallbladder motility-stimulating effect of erythromycin. Methods: In our experiments we used strips of sheep gallbladders measuring isometric tension in organ baths. Since erythromycin itself did not induce contraction we examined the prokinetic effects of sheep duodenal extract, incubated with (DEX) or without (blank) erythromycin (10–5 M). Results: Both DEX and blank elicited gallbladder contraction associated with heat-stable, water-soluble but not with lipid-soluble duodenal prokinetic factor. The factor is unrelated to motilin or cholecystokinin and is only partially (<20%) blocked by atropine (10–6 M) and not affected by the pretreatment with dexamethasone or somatostatin. Conclusion: It was concluded that erythromycin indirectly stimulates contraction of ovine gallbladders through the endogenous release of a duodenal prokinetic factor.
and chronic kidney disease were 46%, 43% and 13% respectively, and 14 (8%) patients had previous coronary artery bypass surgery. Exercise SE was performed in 84 (46%) patients and Dobutamine SE in 100 (54%) patients. Contrast was used in 158 patients (86%). In 108 patients (59%), the SE was positive for inducible ischaemia. From 217 vessels analysed, the Left Anterior Descending Artery, Right Coronary Artery, Left Circumflex Artery and Left Main Coronary artery were involved in 120 (55%), 47 (22%), 30 (14%), 18 (8%) respectively, with 2 vessels being grafts. 46 FFR measurements were positive (21%) and 171 were negative (79%), using a cut off of£ 0.80. At the vessel level, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SE for identifying significant disease as assessed by FFR was 70%, 77%, 45% and 90% respectively. In 73 patients, there was single vessel disease on angiography. At the vessel level, the sensitivity, specificity, PPV and NPV were 85%, 68%, 37% and 95%. Conclusion To date this is the largest study comparing SE and FFR for the assessment of the physiological significance of a coronary lesion, and reflects real world experience. SE demonstrates good diagnostic accuracy and excellent NPV for excluding flow-limiting disease. The low PPV is likely to represent the commencement of medical therapy following a positive SE, as well as referral bias (since only patients with positive SE underwent angiography) as well as the low prevalence of positive FFR measurements in this population. The presence of a haemodynamically significant stenosis can be accurately ruled out with SE. Background NICE guidelines recommend CT coronary angiography (CTCA) as a first line investigation for patients with chest pain and an estimated likelihood of coronary artery disease (CAD) of 10-29%. These guidelines do not recommend exercise testing in this patient group. The recently published PROMISE and SCOT-HEART studies extended the use of CTCA to moderate and high risk patients. Neither study has shown clear clinical benefit for patient randomised to CTCA and there remains a divergence of opinion regarding the appropriateness of CTCA in these patient groups. In particular, there is a concern that CTCA may increase the number of future invasive coronary angiograms. We studied patients referred to the CTCA service in our centre and compared their predicted risk, prior stress testing and subsequent investigations to the NICE guidance and with data from the PROM-ISE and SCOT-Heart studies. Methods Data was collected prospectively for consecutive patients undergoing CTCA over a 3 month period. CTCA reports were retrospectively reviewed with details recorded of the scan protocol, scan quality and severity of coronary disease. Our cardiac catheterisation database was retrospectively ALTHOUGH CT CORONARY ANGIOGRAPHY IN THE WEST OF SCOTLAND IS USED IN A HIGHER RISK POPULATION THAN RECOMMENDED BY NICE, THE RATE OF SUBSEQUENT INVASIVE CORONARY ANGIOGRAPHY IS LOWER THAN IN THE PROMISE AND...
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