Hospital Oxygen Supply Overwhelmed Due to COVID-19: When Demand Exceeds Supply.

BACKGROUND: During the first wave of COVID-19, we experienced problems with our hospital oxygen supply system. This study aimed to analyze factors that stressed this system and rethink the design criteria of the gas pipeline system considering the varying oxygen demand. METHODS: A retrospective study was conducted to describe problems that occurred at different stages in the oxygen supply system at our hospital due to increases in oxygen use in general, and the creation of an intermediate respiratory care unit (IRCU) and use of high-flow nasal cannula (HFNC) in particular. Herein, the characteristics and design criteria of the medical gas pipeline system are analyzed, and the steps taken to avoid future problems are outlined. RESULTS: Increases in oxygen use were observed at times of maximum occupancy, and these created vulnerabilities in the oxygen supply due to insufficient capacity in terms of cryogenic tanks, evaporators, and the piping network. The peak consumption was 3 times higher than the peak in the preceding 4 years. The use of HFNC therapy aggravated the problem; IRCU use accounting for as much as two-fifths of the total across the hospital. Steps taken subsequently prevented the recurrence of vulnerabilities. CONCLUSIONS: The design criteria for storage and distribution networks of medical gases in hospitals need to be revised considering new parameters for their implementation and the use of HFNC therapy in an IRCU. In particular, the cryogenic tanks, evaporators, and piping network for hospital wards are critical.

The importance of prevalence and pre-test probability on the microbiological diagnosis of SARS-CoV-2: the case of Spain in 2020 / La importancia de la prevalencia y de la probabilidad pre-test en el diagnóstico microbiológico de SARS-CoV-2: el caso de España en 2020

Objectives. The aim of this work was to estimate the con ditioned probability for the diagnosis of SARS-CoV-2 infection with reverse transcription polymerase chain reaction (RT-PCR), viral antigen rapid diagnostic tests (Ag-RDT), and antibody detection tests depending on the prevalence in the specific healthcare settings in Spain in 2020, and on the pre-test prob ability (PTP) according to the clinical situation, age and un known or close contacts of the patient. Material and methods. Performance parameters of tests were obtained from literature. Prevalence data and PTP were obtained from Spanish sources and a survey, respectively. The post-test probability is the positive predictive value (PPV) when test is positive. For negative result, we also calculated the probability of having the infection (false negatives). Results. For both RT-PCR and viral Ag-RDT, the lowest PPV values were for the population screenings. This strategy proved to be useful in ruling out infection but generates a high number of false positives. At individual level, both tools provided high PPV (≥ 97%) when the PTP values are over 35%. In seroprevalence studies, though the specificity of IgG alone tests is high, under low seroprevalence, false positives cannot be avoided. Total antibodies tests are useful for diagnosis of COVID-19 in those doubtful cases with RT-PCR or Ag-RDT tests being repeatedly negative. Conclusions. The interpretating of results depends not only on the accuracy of the test, but also on the prevalence of the infection in different settings, and the PTP associated to the patient before performing the test (AU)

bjetivos. En este trabajo estimamos la probabilidad con dicionada del diagnóstico de infección por SARS-CoV-2 con RT PCR, pruebas de antígenos virales (Ag-RDT) y pruebas de detec ción de anticuerpos, en función de la prevalencia en España en diferentes ámbitos durante 2020, y de la probabilidad pre-test (PPT) según la situación clínica, edad y contactos del paciente. Material y métodos. Los parámetros de rendimiento de las pruebas se obtuvieron de bibliografía. Los datos de preva lencia y PPT se obtuvieron de fuentes españolas y de una en cuesta, respectivamente. La probabilidad post-test es el valor predictivo positivo (VPP) cuando la prueba es positiva. Para el resultado negativo, también calculamos la probabilidad de te ner la infección (falsos negativos). Resultados. Tanto con RT-PCR como con Ag-RDT, los va lores más bajos de VPP se detectaron en los cribados poblacio nales, que demostraron ser útiles para descartar la infección, pero generan muchos falsos positivos. A nivel individual, am bas pruebas proporcionaron un VPP ≥ 97% cuando los valores de PPT son superiores al 35%. En estudios de seroprevalencia, aunque la especificidad de las pruebas de IgG sola es alta, si la seroprevalencia es baja, no se pueden evitar falsos positivos. Además, las pruebas de anticuerpos totales pueden ayudar al diagnóstico de COVID-19 en aquellos casos dudosos con prue bas de RT-PCR o Ag-RDT repetidamente negativas. Conclusiones. La interpretación de los resultados depen de no sólo del rendimiento de las pruebas, sino también de la prevalencia de la infección en diferentes ámbitos, y de la PPT asociada al paciente antes de realizar la prueba (AU)

Cambios en el patrón farmacológico de utilización de antihipertensivos en el País Vasco durante el período 1992-2004 / Changes in the Pharmacological Pattern of Antihypertensive Drug Use During the Period 1992-2004 in the autonomous community of the Basque, Spain

No disponible

Estudios de utilización de medicamentos (EUM). Aspectos conceptuales y metodológicos / No disponible

Se puede definir la farmacoepidemiología como un campo del conocimiento relacionado con el impacto de los fármacos en poblaciones humanas, utilizando para ello el método epidemiológico. El objetivo último de la farmacoepidemiología es describir, analizar, predecir y, por lo tanto, planificar los usos y efectos de los diferentes tratamientos farmacológicos referidos a las variables de persona, lugar y tiempo. Resulta esta actividad de la conjunción de la farmacología clínica y de la epidemiología. La primera estudia los efectos de los fármacos en la especie humana, mientras que la epidemiología presta el método que le es propio y permite, así, conocer lo que ocurre con los medicamentos cuando son utilizados por grandes poblaciones. Las contribuciones más características de la farmacoepidemiología se refieren fundamentalmente a la seguridad y al coste de los medicamentos. El conocimiento derivado de los estudios farmacoepidemiológicos influye en una correcta selección de los medicamentos, la cual debe hacerse bajo criterios de eficacia, seguridad, calidad y coste de los mismos para lograr el Uso Racional del Medicamento. El objetivo de este trabajo se centra en comentar y aportar diversas ideas referidas a algunos aspectos conceptuales y metodológicos relevantes en el campo de la Farmacoepidemiología (AU)

Pharmacoepidemiology can be defined as a knowledge camp related with the drugs impact in human populations using for that the epidemiologyc method. Pharmacoepidemiology`s main objective is to describe, to analyse, to predict, and, therefore, to plan the use and effects of the different pharmacologyc treatments to refer to the person, place and time variables. This activity is the result of the conjunction of clinical-pharmacology and epidemiology. The first one studies the drugs effect in human specie, while the epidemiology lends its own method and in this way allow to know what does happen with the drugs when they are used by large populations. The most characteristics contribution of pharmacoepidemiology refers fundamentally to the safety and to the medicaments cost. The knowledge derived from the pharmacoepidemiologyc studies influences in a correct medicines selection, which has to be done with criterion as well as effectiveness, safety, quality and cost of them, in order to reach the drug rational use. The objective of this work is centred in remark and contribute different ideas of some conceptual aspect and relevant methodologies in the camp of pharmacoepidemiology (AU)

Trends in antimicrobial utilization at a Spanish general hospital during a 5-year period.

PURPOSE: Antimicrobials are a major part of hospital pharmacy budgets and must be considered in resource planning and spending projections. This study describes the profile of antibiotic use at a medium-sized hospital (by examining the ICU separately) and analyses its evolution over the period 1996-2000. METHODS: Descriptive and retrospective study. Pharmacy records were reviewed to identify oral and parenteral antimicrobial agents administered to inpatients. Results were expressed in Daily Defined Doses (DDD) per 100 stays and day. RESULTS: During the 5-year study period 176.162 DDD/100 s-d of antibiotics were consumed in the ICU, whereas in the rest of the hospital usage was much lower (54.438 DDD/100 s-d). Aminoglycosides, cephalosporins, penicillins, glycopeptides and carbapenems were the most commonly used groups of antimicrobials in the ICU, and penicillins, cephalosporins, trimethoprim/sulfonamide combinations, aminoglycosides and quinolones in the rest of the hospital. CONCLUSIONS: ICUs have some special features which make them different to the other inpatient areas. Because of that fact we consider it important to study this specific patient-care area separately.