Biomedical subjects

Kathleen E Walsh

Publications and source records attributed to Kathleen E Walsh.

4 recordsLinked to original sources

PubMed2006

Medication errors related to computerized order entry for children.

OBJECTIVE: The objective of this study was to determine the frequency and types of pediatric medication errors attributable to design features of a computerized order entry system. METHODS: A total of 352 randomly selected, inpatient, pediatric admissions were reviewed retrospectively for identification of medication errors, 3 to 12 months after implementation of computerized order entry. Errors were identified and classified by using an established, comprehensive, active surveillance method. Errors attributable to the computer system were classified according to type. RESULTS: Among 6916 medication orders in 1930 patient-days, there were 104 pediatric medication errors, of which 71 were serious (37 serious medication errors per 1000 patient-days). Of all pediatric medication errors detected, 19% (7 serious and 13 with little potential for harm) were computer related. The rate of computer-related pediatric errors was 10 errors per 1000 patient-days, and the rate of serious computer-related pediatric errors was 3.6 errors per 1000 patient-days. The following 4 types of computer-related errors were identified: duplicate medication orders (same medication ordered twice in different concentrations of syrup, to work around computer constraints; 2 errors), drop-down menu selection errors (wrong selection from a drop-down box; 9 errors), keypad entry error (5 typed instead of 50; 1 error), and order set errors (orders selected from a pediatric order set that were not appropriate for the patient; 8 errors). In addition, 4 preventable adverse drug events in drug ordering occurred that were not considered computer-related but were not prevented by the computerized physician order entry system. CONCLUSIONS: Serious pediatric computer-related errors are uncommon (3.6 errors per 1000 patient-days), but computer systems can introduce some new pediatric medication errors that are not typically seen in a paper ordering system.

Adolescent↗

PubMed2004

Sexual dysfunction in the older woman: an overview of the current understanding and management.

Sexuality is one of the most important quality of life issues for both men and women. Sexual dysfunction is a highly prevalent, age-related and progressive problem. The various physiological and psychological changes that occur with aging can have a significant impact on sexual function. The complexity of female sexual dysfunction remains distinct from that of a man. Thus, we cannot approach female patients or their sexual function problems in a similar fashion to that of male patients. A woman's motivation and ability to find and respond to sexual stimuli is largely influenced by her emotional intimacy with her partner. Frequently, the emotional and relationship well-being a woman experiences contributes more to her sexual enjoyment than does her physiological response. However, it is imperative to assess for possible physiological barriers a woman may have which impede a healthy and satisfying sexual life. Therefore, a comprehensive approach, addressing both the physiological and psychological factors is instrumental to the evaluation of female patients with sexual complaints. After years of ardent research and recent therapeutic advances in male sexual dysfunction, researchers have begun addressing the intricacy of female sexual complaints. Studies involving both pre- and postmenopausal women have reported that most women do experience some type of sexual dysfunction during their lifetime. The sexual complaints women experience in their younger years may follow them into older adulthood, but often times change considerably because of various age-related changes. In an effort to assist researchers and clinicians in designing studies and implementing appropriate evaluation and treatment options for women with sexual complaints, a classification system for female sexual dysfunction has been designed. The four categories of female dysfunction include: hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorders. Evaluation of women with sexual complaints should include a detailed psychological, social and medical history and thorough physical examination including a hormonal profile. Current treatment options are dependent on the diagnosis and include physical therapy, psychological counselling, hormonal supplements, medication changes and sexual devices. There has also been a burgeoning interest in investigational medications for female sexual dysfunction, from centrally acting (e.g. serotonin agonists) to peripheral, localised treatment (e.g. vasodilating creams). The area of female sexuality and sexual dysfunction has been undergoing important critical changes within the last 10 years. Researchers and clinicians are continuing to recognise the need to try and understand both the psychological and physiological aspects of the female sexual experience and how they influence one another.

Aging↗

PubMedDate not supplied

Pediatric resident education about medical errors.

BACKGROUND: National organizations have called for patient safety curricula to help reduce the incidence of errors. Little is known about what trainees are taught about medical errors. OBJECTIVE: 1) To determine the amount and type of training that pediatric residents have about medical errors and 2) to assess pediatric chief resident knowledge about medical errors. METHODS: We surveyed chief residents from a national sample of 51 pediatric training programs by selecting every fourth program from the American Council on Graduate Medical Education list of accredited programs. The 21-item telephone survey was developed with patient safety specialists and piloted on several chief residents. It asked about patient-safety training sessions and awareness and knowledge about medical errors. RESULTS: The 51 chief residents helped teach 2176 residents, approximately one third of all pediatric residents. One third of programs had no lectures about medical errors and 23% did not have morbidity and mortality rounds. Sixty-one percent of respondents stated that outpatient medical errors were rarely discussed. Informal teaching was most often reported as the primary method for educating residents about medical errors. Although 58% of respondents did not know that a systemic change should be made in response to a medical error, 83% felt that residents are adequately trained to deal with a medical error. DISCUSSION: Pediatric resident education about medical errors varies widely. Attention by pediatric residency training programs to this important issue seems limited.

Analysis of Variance↗

PubMedDate not supplied

Safety and efficacy of topical nitroglycerin for treatment of vulvar pain in women with vulvodynia: a pilot study.

OBJECTIVE: To evaluate the safety and efficacy of topical nitroglycerin cream for the treatment of vulvar pain in women with vulvodynia. METHODS: A total of 34 women diagnosed with vulvodynia were included in this study. Patients were treated with 0.2% nitroglycerin cream in the clinic. The cream was applied directly to the skin at the genital/vulvar area where the pain was located. Patients who did not experience any adverse side effects were instructed to use the cream at home at least three times per week, 5-10 minutes prior to sexual relations. Patients completed a pretreatment pain scale at baseline and a posttreatment pain scale questionnaire 4-6 weeks later. RESULTS: Twenty-one patients completed both the pre- and posttreatment pain scale questionnaires, and 13 patients completed only the posttreatment pain questionnaire. Thirty-one patients (91.5%) stated that "overall" their pain had improved. Analysis of the pre- and posttreatment questionnaires revealed a significant decrease in pain intensity on a scale of 0 (no pain) to 5 (excruciating pain; 3.95-2.57; P < .000). There was also a significant decrease in the frequency of overall painful episodes on a scale of 0 (never) to 4 (always; 3.25-2.15, P < .006). All 21 patients reported "improvement" of pain during sexual activity (3.65-2.15; P < .005). CONCLUSION: Topical nitroglycerin is safe and effective in providing temporary relief of introital dyspareunia and vulvar pain in women with vulvodynia. Women who completed this study experienced significant improvement in their overall pain and pain with sexual activity after nitroglycerin use. A larger placebo-controlled study is necessary to establish the optimum dosage level and to minimize the side effects.

Administration, Topical↗