Mujeres médicas e investigación en salud / Women physicians and health research

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Acquisition of multidrug-resistant Serratia marcescens by critically ill patients who consumed tap water during receipt of oral medication.

We describe an outbreak of multidrug-resistant Serratia marcescens infection and colonization involving adults admitted to a surgical intensive care unit. Examination of the outbreak revealed epidemiological evidence that consumption of tap water from a contaminated faucet during receipt of oral medication was the mechanism of S. marcescens acquisition.

[Distribution of anesthesia practice, types of anesthesia, and human resources in Catalonia, Spain, in 2003]. / Distribución de la actividad, tipos de anestesia y recursos humanos en Cataluña en 2003.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe the temporal distribution and types of anesthesia used in Catalonia, Spain, in 2003, along with the associated human resources used. PATIENTS AND METHOD: Data were used from a survey of 23,136 anesthetic procedures collected on 14 randomly selected days in 2003 and an individual questionnaire was completed by 765 anesthesiologists working in Catalonia. RESULTS: Anesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other nonsurgical procedures (10.4%). Of all anesthetic procedures performed, 84.3% took place in operating theaters and 7.0% in obstetric areas. Emergency procedures accounted for 20.3% of the total. Most procedures (71.2%) were undertaken within 08:00 and 16:00 h, and the lowest number of procedures performed on workdays took place on Fridays. The median duration of anesthesia was 60 minutes. The most common technique was regional anesthesia (41.4%), with spinal block being the most widely used. There were an estimated 12.5 anesthesiologists per 100,000 inhabitants, with a median (10th-90th percentile) age of 45 (34-57) years; women made up 47.2% of that group. The mean number of standard working hours was 46 hours per week and 65% of anesthesiologists also undertook on duty shifts. Anesthesiologists spent 77% of their time performing anesthesia and the remainder in postoperative recovery and critical care units and pain clinics. CONCLUSIONS: Emergency anesthesia represents 20% of the total workload and obstetrics and nonsurgical procedures another 20%. The use of regional anesthesia was very widespread. The population density of anesthesiologists is comparable to that of other European countries, but with a higher proportion of women.

[Anesthesia for surgical emergencies in Catalonia, Spain, in 2003]. / Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. PATIENTS AND METHOD: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. RESULTS: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. CONCLUSIONS: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred.

Distribución de la actividad, tipos de anestesia y recursos humanos en Cataluña en 2003 / Distribution of anesthesia practice, types of anesthesia, and human resources in Catalonia, Spain, in 2003

Fundamento y objetivo: Describir la distribución temporal y los tipos de anestesia administrada en Cataluña en el año 2003, así como los recursos humanos para su realización. Pacientes y método: Para ello se utilizaron datos del estudio epidemiológico ANESCAT sobre 23.136 anestesias recogidas en 14 días aleatorios del año 2003 y de un cuestionario individual contestado por 765 anestesiólogos que trabajaban en Cataluña (España). Resultado: La actividad anestésica se repartió en un 78,4% para procedimientos quirúrgicos, en un 11,3% para obstetricia y en un 10,4% para técnicas y exploraciones. El 84,3% de todas las anestesias se realizó en quirófano y el 7,0%, en las salas de partos. El 20,3% de toda la actividad fue urgente. El 71,2% de la actividad se realizó de las 8 a las 16 h y entre los días laborables fue menor los viernes. La duración mediana de la anestesia fue de 60 min. El tipo de anestesia más frecuente fue la regional (41,4%), y el bloqueo subaracnoideo fue el más utilizado. La densidad de anestesiólogos se estimó en 12,5 por 100.000 habitantes, con edad mediana (percentiles 10-90) de 45 (34-57) años; el 47,2% eran mujeres. El promedio de horas de trabajo en horario regular fue de 46 h semanales y además el 65% hacía guardias. El 77% del tiempo global de los anestesiólogos estuvo dedicado a la anestesia y el resto, a reanimación y dolor. Conclusiones: La actividad anestésica urgente supone el 20% de toda la actividad y también el 20% de toda ésta se realiza para procedimientos no quirúrgicos. El uso de anestesia regional es muy elevado. La densidad de anestesiólogos es comparable con la del entorno europeo, con un porcentaje mayor de mujeres

Background and objective: The aim of this arm of the ANESCAT 2003 study was to describe the temporal distribution and types of anesthesia used in Catalonia, Spain, in 2003, along with the associated human resources used. Patients and method: Data were used from a survey of 23,136 anesthetic procedures collected on 14 randomly selected days in 2003 and an individual questionnaire was completed by 765 anesthesiologists working in Catalonia. Results: Anesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other nonsurgical procedures (10.4%). Of all anesthetic procedures performed, 84.3% took place in operating theaters and 7.0% in obstetric areas. Emergency procedures accounted for 20.3% of the total. Most procedures (71.2%) were undertaken within 08:00 and 16:00 h, and the lowest number of procedures performed on workdays took place on Fridays. The median duration of anesthesia was 60 minutes. The most common technique was regional anesthesia (41.4%), with spinal block being the most widely used. There were an estimated 12.5 anesthesiologists per 100,000 inhabitants, with a median (10th-90th percentile) age of 45 (34-57) years; women made up 47.2% of that group. The mean number of standard working hours was 46 hours per week and 65% of anesthesiologists also undertook on duty shifts. Anesthesiologists spent 77% of their time performing anesthesia and the remainder in postoperative recovery and critical care units and pain clinics. Conclusions: Emergency anesthesia represents 20% of the total workload and obstetrics and nonsurgical procedures another 20%. The use of regional anesthesia was very widespread. The population density of anesthesiologists is comparable to that of other European countries, but with a higher proportion of women

Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003 / Anesthesia for surgical emergencies in Catalonia, Spain, in 2003

Fundamento y objetivo: Conocer la actividad anestésica urgente de las especialidades quirúrgicas en Cataluña (España). Pacientes y método: Estudio prospectivo de las anestesias realizadas en 131 hospitales en 14 días aleatorios de 2003 (ANESCAT 2003), se seleccionaron las anestesias urgentes para cirugía (excluyendo obstetricia y procedimientos no quirúrgicos) y se analizaron: tipo de hospital, características de los pacientes, procedimientos, técnicas anestésicas, tiempos empleados, destino de los pacientes y tipo de urgencia (diferible o no). Los datos se expresan como mediana y percentiles del 10-90%, y se extrapolaron a la población catalana. Resultados: De las 23.136 anestesias, 2.088 (estimación de 54.437 anestesias anuales) fueron urgencias quirúrgicas, lo que supone el 9% del total de anestesias y el 11,5% de las anestesias para procedimientos quirúrgicos. El 51% fueron urgencias diferibles (estimación de 26.906 anestesias anuales). El 81,2% de las urgencias se realizó en centros del Institut Català de la Salut y el 18,8% en centros privados. De lunes a viernes se realizó el 80,6% de las urgencias. El 46,5% de la actividad urgente se efectuó entre las 8 y 16 h y el 8,1% entre las 0 y 8 h. El 60% de la actividad diferible se realizó entre las 8 y 16 h. El 52,4% de los pacientes eran varones, la edad mediana era de 51 años (15-83) y un 15,3% eran pacientes graves (clase 4 de la clasificación de la American Society of Anesthesiologists ­ASA­). La cirugía ortopédica y traumatología y la cirugía general y digestiva sumaban el 74% de la actividad. Se aplicó anestesia general en el 51% de los casos y locorregional en el 38%. La duración de la anestesia fue mayor en las urgencias diferibles (90 min). El 18% de los pacientes ingresaron en unidades de cuidados críticos en el postoperatorio. Conclusiones: Anestesia para urgencias quirúrgicas supuso alrededor del 10% de las anestesias que se realizaron en Cataluña en el año 2003, y más de un 50% de ellas podían haberse diferido

Background and objective: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. Patients and method: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. Results: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. Conclusions: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred

Pathophysiology of pneumonia.

The development of pneumonia requires that a pathogen reach the alveoli and that the host defenses are overwhelmed by microorganism virulence or by the inoculum size. The endogenous sources of microorganisms are nasal carriers, sinusitis, oropharynx, gastric, or tracheal colonization, and hematogenous spread. Other external sources of contamination, such as intensive care unit workers, aerosols, or fibrobronchoscopy, must be considered as accidental.

Hospital-acquired pneumonia: etiologic considerations.

The development of pneumonia requires the pathogen to reach the alveoli and the host defenses to be overwhelmed, either by microorganism virulence or by inoculums size. The endogenous sources of microorganisms are nasal carriers, sinusitis, mouth, oropharynx, gastric, or tracheal colonization, and hematogenous spread. The exogenous sources of microorganisms are biofilm of the tracheal tube, ventilator circuits, nebulizers, and humidifiers. Health care workers may also play a role in this setting. Different microorganisms can be found depending on the onset time of pneumonia and on the local pattern variation encountered between different institutions and countries. Healthy patients may be chronically colonized. A very important, unresolved issue is the definition of early and late-onset pneumonia; it still remains uncertain from the literature whether the given threshold refers to the number of days in hospital or to the number of days following intubation. Noninvasive ventilation is demonstrating that the term "ventilator-associated pneumonia" is perhaps inaccurate and should be referred to as "intubation-associated pneumonia."