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INTRODUCTION: Medication errors are multifactorial and multidisciplinary, and may originate in processes such as drug prescription, transcription, dispensation, preparation and administration. The goal of this work was to measure the incidence of detectable medication errors that arise within a unit dose drug distribution and control system, from drug prescription to drug administration, by means of an observational method confined to the Pharmacy Department, as well as a voluntary, anonymous report system. The acceptance of this voluntary report system's implementation was also assessed. MATERIAL AND METHODS: A prospective descriptive study was conducted. Data collection was performed at the Pharmacy Department from a review of prescribed medical orders, a review of pharmaceutical transcriptions, a review of dispensed medication and a review of medication returned in unit dose medication carts. A voluntary, anonymous report system centralized in the Pharmacy Department was also set up to detect medication errors. RESULTS: Prescription errors were the most frequent (1.12%), closely followed by dispensation errors (1.04%). Transcription errors (0.42%) and administration errors (0.69%) had the lowest overall incidence. Voluntary report involved only 4.25% of all detected errors, whereas unit dose medication cart review contributed the most to error detection. CONCLUSIONS: Recognizing the incidence and types of medication errors that occur in a health-care setting allows us to analyze their causes and effect changes in different stages of the process in order to ensure maximal patient safety.

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Following a brief introduction on the history and generic codification of the different cardiac stimulation methods available, the implantation techniques are described and the requisites, such as human resources, their qualifications and the materials required, which are essential in the organization of a Pacemaker Unit are discussed. The current indications for permanent cardiac stimulation are reported and are classified by sections in tales following the 1998 norms of the ACC/AHA. In another section, the indications in special situations such as hypertrophic or dilated cardiomyopathy are described. Stimulation frequency modulation with the incorporation of biodetectors in modern pacemakers or in the probes are commented upon as is atriosynchronic ventricular stimulation with a single electrode (VDD). The recent automatisms which have been implemented in the current pacemakers are discussed and the most adequate selection of the stimulation mode for each patient is analyzed and demonstrated in a table which may be easily interpreted. On establishing the recommendable protocol for undertaking the follow up of the patient with a pacemaker, the criteria accepted as replacement indicators are discussed. In a brief section some legal aspects (drivers license, informed consent) are commented upon and the possible sources of interference with the function of the system implanted, whether medical or environmental or laboral, have been analyzed more in depth. The chapter ends with a brief discussion on the survival of patients with pacemakers.

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The pericardium is a serous membrane consisting of two layers (parietal and visceral), which may be involved by different infectious, physical, traumatic, or inflammatory agents as well as in metabolic or systemic diseases. The reactions of the pericardium to these insults result in rather nonspecific clinical features, such as the characteristic inflammatory findings in acute pericarditis, the development of pericardial effusion with the possible complication of cardiac tamponade, and a fibrous retractile reaction that may lead to constrictive pericarditis. These phenomena are not mutually exclusive and can be simultaneous or consecutive in the same patient; however, for the sake of clarity they are independently discussed. The aim of the present guidelines is to provide orientation about the management of patients with pericardial disease. Such management should basically rest on the knowledge of the clinical and epidemiological features (such as disease frequency) of the different types of pericardial disease that determine the diagnostic and therapeutic yield of the different invasive pericardial procedures (pericardiocentesis, pericardial biopsy and pericardiectomy), and, therefore, their respective indications. In addition, the indication of the different types of medical therapy are discussed. On the other hand, emphasis is made on the possible limitation of the validity of these guidelines for patients belonging to geographical areas or socioeconomic contexts with different etiologic spectra.

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Exercise testing is considered to play a major role in risk stratification after myocardial infarction. With the aim of improving prognosis, an exercise test should be able to identify patients at higher risk of coronary events. In this sense, its major limitation is a low positive predictive value, especially in patients who have been treated with thrombolytic agents. This fact limits its clinical value in the decision making process in individual patients. Finally, the decision to revascularize with angioplasty or surgery when only a positive exercise test result is taken into account, has not been proven to prolong life in these patients. All these considerations should make us think about some clinical attitudes that are taken for granted.

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Nuclear cardiology has progressed in the past few years to the point of obtaining a consolidated position in the management of chronic ischemic heart disease. In the first part of our, methodology and interpretation criteria of the fundamental nuclear techniques (myocardial perfusion imaging and radionuclide angiography) are reviewed. In the second part, clinical indications in diagnostic and prognostic evaluations of patients with chronic ischemic heart disease are discussed, while remembering its usefulness in myocardial viability assessment.

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