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Maa T, Scherzer DJ, Harwayne-Gidansky I, Capua T, Kessler DO, Trainor JL, Jani P, Damazo B, Abulebda K, Diaz MCG, Sharara-Chami R, Srinivasan S, Zurca AD, Deutsch ES, Hunt EA, Auerbach M. Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1239-1246.e3. [PMID: 31770652 DOI: 10.1016/j.jaip.2019.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. OBJECTIVE To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. METHODS A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. RESULTS Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. CONCLUSIONS A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites.
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Affiliation(s)
- Tensing Maa
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio.
| | - Daniel J Scherzer
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Ilana Harwayne-Gidansky
- Division of Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, NY
| | - Tali Capua
- Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David O Kessler
- Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jennifer L Trainor
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Priti Jani
- Department of Pediatrics, Section of Critical Care Medicine, Comer Children's Hospital, University of Chicago, Chicago, Ill
| | | | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Ind
| | - Maria Carmen G Diaz
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Sushant Srinivasan
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Adrian D Zurca
- Division of Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pa
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Elizabeth A Hunt
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Health Informatics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Marc Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale University, New Haven, Conn
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Shokri M, Moradpour R, Shafaroudi MM, Rezaei N, Tabary SZ. Comparing the Effects of Krebs Plus Verapamil Solution on Endothelial Function of Harvested Human Greater Saphenous Vein with Heparinized Blood, an Invitro Study. Med Arch 2017; 71:188-192. [PMID: 28974831 PMCID: PMC5585787 DOI: 10.5455/medarh.2017.71.188-192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Integrity of the great saphenous vein (GSV) endothelium is the most important key element for long-term patency rate of grafts in coronary artery bypass graft (CABG). Storage solutions play an important role in maintaining viability of vein endothelium. Diminished nitric oxide (NO) because of endothelial dysfunction may facilitate vascular inflammation and formation of atherosclerotic plaque. AIM So, we decided to find a reasonable alternative preservative solution instead of heparinized blood (HB) by measuring NO concentration with Griess assay. MATERIAL AND METHOD SVG samples were obtained from 54 patients undergoing elective CABG. 3 mm rings were stored in solutions: heparinized blood (HB), Krebs (K), Krebs + Propranolol (K+P) 6.66 g/l, Krebs + Adrenaline (K+A) 200 µl/l, and Krebs + Verapamil (K+V) 200 µl/l for 30, 45, 60 and 90 min. Nitrite concentration was measured by Griess assay at 540 nm. H&E staining was performed for histologic test. Statistical analysis was performed using SPSS (V16). Results were expressed as (Means ± SE) followed by One-Way ANOVA for finding best preservative solution. Repeated measurement test was used to investigate best time. In all analysis, (P<0.05) was considered significant. RESULTS Average concentration of NO in (K+V) compare with HB (1st control), K (2nd control), (K+A) and (K+P) showed higher rate in all times from 30 to 90 min (16.55±1.85:) and in (K+A, K+P) compare with (HB) and (K) there was no statistically significant difference in the same times. Comparing the average concentration of (NO) between (HB) and (K) showed no significant difference (K+V>HB=K=K+A=K+P). Also, our investigations showed that NO concentration in (K+V) has the highest rate in time 90 min (10.07±0.56, p=0.002):. More than 50 percent of endothelial cells stay normal in (K+V) compare with other solutions. CONCLUSION It seems that (K+V) is the best solution for the maintenance of normal physiology of SVGs endothelial cells. The most appropriate SVGs endothelial function is within 90 minutes after harvesting.
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Affiliation(s)
- Mitra Shokri
- Department of Anatomy and Cell Biology, Cell and Molecoular Research Center (CMRC), Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Majid Malekzade Shafaroudi
- Department of Anatomy and Cell Biology, Cell and Molecoular Research Center (CMRC), Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nourollah Rezaei
- Department of Anatomy and Cell Biology, Cell and Molecoular Research Center (CMRC), Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shervin Ziabakhsh Tabary
- Department of Cardiac Surgery, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
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