Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative oral administration of fast-release morphine sulfate reduces postoperative piritramide consumption.
The aim of this prospective randomized placebo-controlled double-blind study was to investigate the effect of premedication with morphine sulfate on postoperative pain. Ninety-eight ASA I-III patients undergoing total replacement of the knee or hip joint were randomly assigned to one of two groups. Group 1 received 20 mg morphine sulfate p.o. approximately one hour before the start of surgery; group 2 received placebo. ⋯ The duration of surgery (mean +/- SD) was comparable in the two groups (group 1: 145 +/- 42 min, group 2: 131 +/- 35 min). In group 1 the cumulative piritramide consumption during 24 hours postoperation was significantly less than in the placebo group (37.5 +/- 12.5 mg versus 46.8 +/- 22.1, t-test, p < 0.05), although similar pain scores were recorded (group 1: 4.8 +/- 1.8 and 3.6 +/- 1.7, group 2: 4.8 +/- 1.6 and 3.4 +/- 2.0, at 1 and 24 hours, respectively). These data show that the preoperative oral administration of morphine sulfate, regardless of its short half-life, can reduce postoperative consumption of opioids at similar pain levels.
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Wien. Klin. Wochenschr. · Jul 2003
Review Comparative StudyThe epidemiology of preventable adverse drug events: a review of the literature.
A growing amount of data suggests that adverse drug events (ADEs) in hospital settings are frequent and result in substantial harm. Even though prevention is where efforts must be directed, only a few studies have reported on the preventability of these events. The objective of this article is to review the literature of ADEs and their preventability, and to report on their incidences, characteristics, risk factors, costs and prevention strategies. ⋯ The detection of errors having only the potential for harm by means of computerized surveillance has shown to be a useful technique in order to understand and prevent ADEs. Apart from the use of sophisticated computer techniques the participation of pharmacists in the drug prescribing process results in a tremendous error reduction. The greatest task in changing the health care system into a system with safety as its first priority is to create a culture of constant learning from mistakes among health care professionals. The appreciation of the health care teams' ideas and perceptions for improvement, and their implementation through small improvement cycles, may represent the leading strength in error reduction and health care improvement.