RESUMEN
AIM To prototype a system for identifying and monitoring those organisational processes that give rise to latent conditions that can contribute to failures in a dispensary environment. METHODS A proactive risk-monitoring system was prototyped during a 9-month period within the dispensary at Hereford Hospital. The system is used to identify empirically a preliminary set of Basic Problem Factors through qualitative analysis of narratives submitted by pharmacy staff about problems they encountered during their daily work. These factors are monitored and rated based on staff perceptions elicited through a questionnaire. At the concept stage, the system idea was discussed at two stakeholder workshops to ensure plausibility. A Plan-Do-Study-Act approach was used to prototype the system and to evaluate the perceived usability and perceived completeness of the system. RESULTS After four Plan-Do-Study-Act cycles, staff were satisfied with the usability of the questionnaire and the choice of factors being monitored. In total, 11 Basic Problem Factors were identified from the narratives, 10 of which have been monitored over a period of 6 months using a questionnaire. The differences in staff perceptions were statistically not significant. The qualitative and quantitative results led to improvements that included a review of all IT equipment in the department and the clean-up of the work environment. CONCLUSION A system for identifying and monitoring organisational processes that give rise to latent conditions that may contribute to failures was prototyped at the dispensary at Hereford Hospital. This contributes to the organisation's efforts towards creating a proactive safety culture.
Asunto(s)
Actitud del Personal de Salud , Hospitales Públicos/organización & administración , Farmacéuticos , Servicio de Farmacia en Hospital/organización & administración , Técnicos de Farmacia , Administración de la Seguridad/métodos , Inglaterra , Humanos , Narración , Cultura Organizacional , Percepción , Proyectos Piloto , Investigación Cualitativa , Medición de Riesgo/métodos , Encuestas y CuestionariosRESUMEN
A deficiency of most current drug products for treatment of acute conditions is slow onset of action. A promising means of accelerating drug action is through rapid systemic drug administration via deep lung inhalation. The speed of pulmonary drug absorption depends on the site of aerosol deposition within the lung and the dissolution rate and drug content of the deposited particles. Alveolar delivery of fast-dissolving, pure drug particles should in theory enable very rapid absorption. We have previously shown that heating of thin drug films generates vapor-phase drug that subsequently cools and condenses into pure drug particles of optimal size for alveolar delivery. Here we present a hand held, disposable, breath-actuated device incorporating this thermal aerosol technology, and its application to the delivery of alprazolam, an anti-panic agent, and prochlorperazine, an anti-emetic with recently discovered anti-migraine properties. Thermal aerosol particles of these drugs exist in an amorphous state, which results in remarkably rapid drug absorption from the lung into the systemic circulation, with peak left ventricular concentrations achieved within 20 s, even quicker than following rapid (5 s) intravenous infusion. Absorption of the thermal aerosol is nearly complete, with >80% absolute bioavailability found in both dogs and human normal volunteers.
Asunto(s)
Pulmón/metabolismo , Preparaciones Farmacéuticas/administración & dosificación , Absorción , Administración por Inhalación , Adulto , Aerosoles , Alprazolam/administración & dosificación , Alprazolam/farmacocinética , Animales , Área Bajo la Curva , Rastreo Diferencial de Calorimetría , Cromatografía Líquida de Alta Presión , Perros , Antagonistas de Dopamina/administración & dosificación , Antagonistas de Dopamina/farmacocinética , Método Doble Ciego , Femenino , Moduladores del GABA/administración & dosificación , Moduladores del GABA/farmacocinética , Ventrículos Cardíacos/metabolismo , Humanos , Pulmón/fisiología , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Miocardio/metabolismo , Tamaño de la Partícula , Preparaciones Farmacéuticas/química , Proclorperazina/administración & dosificación , Proclorperazina/farmacocinética , Difracción de Rayos XRESUMEN
Atrial septal defect is one of the most common forms of congenital heart malformation. We identified a new locus linked with atrial septal defect on chromosome 14q12 in a large family with dominantly inherited atrial septal defect. The underlying mutation is a missense substitution, I820N, in alpha-myosin heavy chain (MYH6), a structural protein expressed at high levels in the developing atria, which affects the binding of the heavy chain to its regulatory light chain. The cardiac transcription factor TBX5 strongly regulates expression of MYH6, but mutant forms of TBX5, which cause Holt-Oram syndrome, do not. Morpholino knock-down of expression of the chick MYH6 homolog eliminates the formation of the atrial septum without overtly affecting atrial chamber formation. These data provide evidence for a link between a transcription factor, a structural protein and congenital heart disease.