Risk assessment of intravenous dose presentation in secondary care

□ The Breckenridge report highlighted that intravenous drug additions were aseptic procedures and should be conducted under the direct control of a pharmacist □ This study attempts to determine the extent of intravenous drug preparation at ward level and apply a risk assessment model □ Observation and risk assessment of intravenous drug preparation was carried out in two clinical areas within a large hospital □ Two thirds of the intravenous drug administration events were graded as high risk □ In the absence of a centralised intravenous additive service, the use of ready to administer forms or novel reconstitution systems may significantly reduce the risks associated with intravenous administration events     

Shorter AV Delays Provide Improved Echocardiographic Hemodynamics during Exercise in Patients Receiving Cardiac Resynchronization Therapy

Background: Although atrial ventricular (AV) intervals are often optimized at rest in patients receiving cardiac resynchronization therapy (CRT), there are limited data on the impact of exercise on optimal AV interval.
Methods: In 15 patients with CRT, AV intervals were serially programmed while patients were supine and at rest, and during exercise with heart rates that averaged 20 and 40 beats per minute above their resting rates. Echocardiographic Doppler images were acquired at each programmed AV interval and each rate. Three independent echocardiographic criteria were retrospectively used to determine each patient's optimal AV interval as a function of exercise-induced increased heart rates: the duration of left ventricular filling, stroke volume, and a clinical assessment of left ventricular function.
Results: A negative correlation between the optimal AV interval and heart rate was observed across all patients using all three independent criterion: the maximum left ventricular filling time (slope =–0.77, intercept = 151.9, r = 0.55, P < 0.001), maximum stroke volume (slope =–0.93, intercept = 183.3, r = 0.50, P = 0.002), or the subjective clinical assessment (slope =–1.06, intercept = 182.0, r = 0.72, P < 0.001). Consistent trends were observed between all three parameters for 12 out of the 15 patients.
Conclusions: These results suggest that in patients indicated for CRT, rate-adaptive functions may be useful to shorten AV intervals with increased rate, in order to maximize left ventricular filling, stroke volume, and clinical left ventricular function. Further studies are necessary to determine the clinical impact of these rate-adaptive algorithms.     

Children, empowerment and health promotion: some new directions in research and practice

We focus on the goal of health promotion to empower personsto alter the conditions that affect their health. The conceptionof empowerment applied to children implies a fundamental changein the manner in which children are perceived. We propose thatit demands a shift from thinking about children as recipientsof health promotion efforts on their behalf to children as partnersin health promotion whose views and concerns about health areaccepted as valid in their own right and whose competence tomake and implement decisions is recognized. Our intention isto stimulate critical discussion of the place and role of childrenin health promotion and to suggest some new directions in researchand practice.     

Clinical compliance of two resilient denture liners

Although intra-oral-setting resilient denture liners have been used for 30 years to treat the severely resorbed residual ridges of elderly patients, their clinical physical properties are not well understood. The effect of clinical usage on the compliance (compressibility, flexibility) of two intra-oral-setting resilient denture liners was measured in 10 patients, for up to 30 days. The clinical compliance of Material B (Coe-Comfort) was found to be significantly greater than Material A (Veltec) for up to 14 days. At 24 h both materials had significant compliance reductions from the original 1 h measurement. These compliance reductions continued throughout the testing period. For up to 14 days of clinical usage there were no significant differences between the compliance reductions of the two materials. The study suggests that (i) Material B would provide more effective tissue conditioning of abused residual ridge mucosa than Material A; and (ii) a functional impression made with these materials should be left in the mouth for at least 24 h before the cast is poured.     

"Pacecare"-A Computerized Database for Pacemaker Follow-Up

STRATHMORE, N., ET AL.: "Pacecare"-A Computerized Database for Pacemaker Follow-Up. A computerized database for pacemaker follow-up has been designed to run on IBM compatible hardware and to accept pulse generator and lead models of all manufacturers. Stored data includes patient, physician and implant details, indications for pacing, underlying rhythm, complications and management, program settings, and follow-up measurements. Typing is minimized by the use of "pop-up" lists and prepared pulse generator template displays. At each follow-up visit a patient's file is retrieved by surname or number, a visit record created, and measurements documented. As the template of the previous visit is used, recording of the clinic visit takes < 1 minute. Changes in pacing rates (base or magnet), pulse widths, lead thresholds, lead impedance, and battery cell impedance can be displayed graphically for immediate recognition of end-of-life parameters or suspected malfunction. The program will print patient, implantation and clinic visit summary reports, clinic appointment lists, letters to patients, and annual reports. Two Melbourne hospitals have now entered over 3,600 patients into the database. Valuable information has been obtained regarding implantation details and trends with pulse generator and lead usage. Pacecare is a sophisticated, yet user friendly, computerized database for pacemaker follow-up. Recording of clinic visits is fast and changes in testing parameters can be recognized immediately.