Estudio retrospectivo de la seguridad en el traslado de los pacientes críticos tras aplicación de la metodología para la gestión de riesgo / Retrospective study of security in the transfer of critical patients after application of methodology for risk management

OBJETIVO: El objetivo principal se centra en determinar si la implantación de un protocolo de traslado intrahospitalario (TIH) modifica la tasa anual de incidentes relacionados con la seguridad del paciente. Los objetivos secundarios son, en primer lugar, clasificar los eventos identificados, en segundo lugar, analizar los factores que se asocian a la presencia de dichos eventos adversos y, por último, analizar el grado de seguimiento del protocolo. MATERIAL Y MÉTODOS: Análisis descriptivo retrospectivo que incluyó a pacientes ingresados en la Unidad de Cuidados Intensivos que requirieron TIH entre 2009 y 2018. Se desarrolló un protocolo multidisciplinar y se clasificaron las incidencias según la gravedad y el tipo de eventos. RESULTADOS: Se incluyeron 1.662 traslados. El número total de traslados con incidentes ha sido 153 (9,2%), en los que se han registrado 189 incidentes, de los cuales 17 (9%) fueron descritos como eventos adversos, mientras que 172 (91%) se clasificaron como incidentes sin daño (IsD). Las incidencias clínicas fueron las más frecuentes (70,37%). En el análisis multivariante encontramos como factores asociados las arritmias cardíacas (OR: 2,88 [IQR 2,01-4,12]), antecedentes de accidente cerebrovascular (OR 1,72 [IQR 1,06-2,78]) y anemia (OR 1,55 [IQR 1,02-2,37]). La tasa de incidentes relacionados con la seguridad fue menor a lo largo del tiempo a medida que aumentaba la adhesión a la cumplimentación del protocolo. CONCLUSIONES: La implementación de un protocolo de transporte del paciente crítico y su aplicación mediante listas de verificación permite reducir tanto la incidencia de eventos adversos en estos pacientes como de IsD

OBJECTIVE: The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. MATERIAL AND METHODS: Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. RESULTS: We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]). The rate of safety-related incidents was less over time as adherence to protocol compliance increased. CONCLUSIONS: The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage

Retrospective study of security in the transfer of critical patients after application of methodology for risk management. / Estudio retrospectivo de la seguridad en el traslado de los pacientes críticos tras aplicación de la metodología para la gestión de riesgo.

OBJECTIVE: The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. MATERIAL AND METHODS: Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. RESULTS: We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]) The rate of safety-related incidents was less over time as adherence to protocol compliance increased. CONCLUSIONS: The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage.

Deterioro de la información conceptual en la enfermedad de Alzheimer / Conceptual decline in Alzheimer’s disease

Introducción. Es bien sabido que en la enfermedad de Alzheimer se produce una pérdida gradual y progresiva de la información semántica. Una pregunta de gran interés tanto teórico como práctico es qué conceptos son los primeros que se pierden y cuáles son los más resistentes al deterioro. Algunas teorías sostienen que en el inicio de la enfermedad las pérdidas afectan más a los estímulos pertenecientes a determinadas categorías conceptuales. Método. Un grupo de 22 pacientes con enfermedad de Alzheimer fue contrastado con otro grupo de 22 personas sanas de similares características en cuanto a edad, sexo y escolaridad en la denominación de dibujos de objetos pertenecientes a ocho categorías semánticas, cuatro del dominio de los seres vivos y cuatro del de los objetos inanimados. En cada grupo había 16 mujeres y 6 hombres y en ambos grupos la edad media era de 74 años. Análisis estadístico. Con el fin de comprobar si las diferencias entre pacientes con enfermedad de Alzheimer y sujetos control son mayores en determinadas categorías se realizaron ANOVA tomando como factores el grupo (pacientes/ controles) y la categoría de estímulo. Resultados. Los pacientes con enfermedad de Alzheimer puntúan significativamente menos que los controles en todas las categorías de estímulos, pero las diferencias dependen de las características de cada estímulo (familiaridad, frecuencia, edad de adquisición, etc.) más que de la categoría semántica a la que pertenece. Discusión. Más importante que la pertenencia a una determinada categoría, lo que determina la pérdida conceptual son las características específicas de cada estímulo, fundamentalmente la frecuencia de uso del nombre y la edad en la que se aprende

Introduction. In Alzheimer’s disease a gradual and progressive loss of semantic information takes place. A question of great importance on both the theoretical and practical levels is which concepts are the first to be lost and which are the most resistant to deterioration. Some theories maintain that the beginning of the disease stimuli belonging to certain conceptual categories are most affected by loss. Method. A group of twenty-two patients with mild to moderate Alzheimer’s disease was compared with a group of healthy people of similar age, gender, and educational level, in naming pictures of objects from eight semantic categories: four in the domain of living things and four in the domain of inanimate objects. In each group 16 were women and 6 men. The mean age was 74 in both groups. Statistical analysis. In order to know if differences between Alzheimer patients and control subjects are determined by the semantic categories, ANOVAS were performed taking the group (patients vs control) and the type of stimulus as factors. Results. The scores of the Alzheimer patients are statistically lower than those of the control subjects, but differences are determined by the features of each stimulus (familiarity, frequency, age of acquisition) more than, belonging to a specific category. Discussion. The results indicate that the specific characteristics of each stimulus contribute more to concept loss than does belonging to a certain category, especially the frequency of use and the age of acquisition

[Conceptual decline in Alzheimer's disease]. / Deterioro de la información conceptual en la enfermedad de Alzheimer.

INTRODUCTION: In Alzheimer's disease a gradual and progressive loss of semantic information takes place. A question of great importance on both the theoretical and practical levels is which concepts are the first to be lost and which are the most resistant to deterioration. Some theories maintain that the beginning of the disease stimuli belonging to certain conceptual categories are most affected by loss. METHOD: A group of twenty-two patients with mild to moderate Alzheimer's disease was compared with a group of healthy people of similar age, gender, and educational level, in naming pictures of objects from eight semantic categories: four in the domain of living things and four in the domain of inanimate objects. In each group 16 were women and 6 men. The mean age was 74 in both groups. STATISTICAL ANALYSIS: In order to know if differences between Alzheimer patients and control subjects are determined by the semantic categories, ANOVAS were performed taking the group (patients vs control) and the type of stimulus as factors. RESULTS: The scores of the Alzheimer patients are statistically lower than those of the control subjects, but differences are determined by the features of each stimulus (familiarity, frequency, age of acquisition) more than, belonging to a specific category. DISCUSSION: The results indicate that the specific characteristics of each stimulus contribute more to concept loss than does belonging to a certain category, especially the frequency of use and the age of acquisition.