Cultura de seguridad y eventos adversos en una clínica de primer nivel / Culture of safety and adverse events in a first level clinic / Cultura de segurança e eventos adversos em uma clínica de primeiro nível

Objetivo: Identificar la percepción sobre clima y cultura de seguridad, y determinar la prevalencia de eventos adversos en el personal de enfermería de una clínica de primer nivel. Métodos: Estudio descriptivo, transversal y prospectivo, desarrollado en una clínica de medicina familiar del sur de la ciudad de México. Se aplicó el cuestionario Hospital survey on patient safety culture. Se utilizó estadística descriptiva. Los datos se capturaron y analizaron en el programa estadístico SPSS versión 22. Resultados: Aceptaron participar en el estudio 27 profesionales de enfermería. El promedio de edad fue de 44.7 años. Cerca del 15% refirió percibir un clima de seguridad del paciente entre excelente y muy bueno. El 66.7% del personal de enfermería describió no haber notificado ningún evento adverso. La dimensión retroalimentación y comunicación sobre errores con 75.3% aparece globalmente como fortaleza. En las debilidades percibidas, destacan 2 dimensiones: respuesta no punitiva a los errores con 61.7% y dotación de personal con 62%, ambas corresponden al área o rubro de cultura de seguridad en el nivel servicio. Conclusiones: Cerca de la tercera parte de los entrevistados no habían reportado ningún evento adverso en los últimos años, además de que solo un poco más de la mitad refirió percibir un clima de seguridad del paciente entre aceptable y superior.

Objective: To identify the perception on climate and culture of safety and prevalence of adverse events among nurses in a first level clinic. Methods: This is a descriptive, transversal and prospective study conducted in a family medicine clinic located at the south of Mexico City. The questionnaire hospital survey on patient safety culture was used. Descriptive statistics were obtained and analyzed with spss v22. Results: A total of 27 nurses agreed to participate in the study. The average age of the participants was 44.7 years old. Close to 15% said they perceive a patient safety climate between excellent and very good. The 66.7% describe having not noticed any adverse event. The dimension of feedback and communication about errors with 75.3% appears globally as a strength. In the perceived weaknesses, 2 dimensions stand out: non-punitive response to errors with 61.7% and staffing with 62% both correspond to the area or culture of service-level safety culture. Conclusions: Approximately one third of the interviewed had not reported any adverse event during the previous years, while a little more than half perceive a patient safety climate between acceptable and superior.

Objetivo: Identificar a percepção sobre clínica e cultura de segurança, e determinar a prevalência de eventos adversos em enfermeiras/os de uma clínica de primeiro nível. Métodos: Estudo descritivo, transversal e prospetivo, desenvolvido em uma clínica de medicina familiar do sul da Cidade do México. Aplicou-se o questionário hospital survey on patient safety culture: utilizou-se estatística descritiva, os dados capturaram-se e analisaram no programa estatístico spss versão 22. Resultados: Aceitaram participar no estudo vinte e sete enfermeiras/os. A média de idade foi de 44.7 anos. Cerca do 15 % refere perceber um clima de segurança do paciente entre excelente e muito bom. O 66.7% das enfermeiras/os descrevem não ter notificado nenhum evento adverso. A dimensão dos erros de feedback e comunicação com 75,3% aparece globalmente como uma fortaleza. Em debilidades percebidas, existem duas dimensões: nenhuma resposta punitiva a erros com 61,7% e de pessoal com 62%, tanto para a área ou categoria de cultura de segurança no nível de serviço. Conclusões: Cerca da terceira parte 2 entrevistados não tinham reportado algum evento adverso nos últimos anos, além disso que um pouco mais da metade refere perceber um clima de segurança do paciente entre aceitável e superior.

[Factors of risk of bacterial vaginosis]. / Factores de riesgo asociados a vaginosis bacteriana.

OBJECTIVES: To recognise factors in the host that might condition the appearance of the bacterial vaginosis (BV) syndrome, whether gynae-obstetrical factors, habits of sexual conduct, hygiene, or other factors. DESIGN: Cross-sectional, observational study. SETTING: The study was conducted from January 2002 to June 2003 in the Primary Care Dr. Jose Castro Villagrana Community Health Centre at Tlalpan, Mexico City. PARTICIPANTS: 968 patients with an active sexual life who had not taken antibiotics for at least 15 days before the study and who were not menstruating at the moment of taking a swab, 859 of whom had a diagnosis of cervico-vaginitis and 109 had no symptoms. MAIN MEASUREMENTS: Confidential questionnaire and a cervical-vaginal culture. The Amsel criteria were used to make the diagnosis of bacterial vaginosis. RESULTS: There was 32.9% prevalence of BV. There was a statistically significant association with factors such as age, start of active sexual life, the number of sexual relations per week, the number of sexual partners, and pregnancy. CONCLUSIONS: Bacterial vaginosis is the main cause of infectious processes in the vagina. Its appearance appears to be linked to factors involving sexual transmission. Interventions to reduce its prevalence and complications are recommended.

[Is the Papanicolaou smear useful as aid for diagnosing some sexually transmitted infections?]. / ¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual?

OBJECTIVE: We undertook this study to assess the validity of cytologic diagnosis of sexually transmitted infections like: bacterial vaginosis (BV), tricomoniasis and candidiasis using the Papanicolaou (Pap) smear. DESIGN: Prospective, descriptive transverse study. SETTING: The present study was carried out in the Health Center Dr. José Castro Villagrana in Tlalpan, México, D.F. from January 1997, to February 2000. PARTICIPANTS: Routine Pap smears and vaginal secretion smears were collected from two hundred and seventy one patients ranged from age 16-66 years, with cervicovaginitis diagnosis. MEASUREMENTS AND MAIN RESULTS: Of the 271 patients, 92 (33.9%) had bacterial vaginosis diagnosed by Amsel criteria, 47 (17.3%) had candidiasis by culture and 5 (1.8%) had tricomoniasis by wet smear. The Bethesda system for diagnosing BV on Pap smear had 66% sensitivity and a specificity of 86%. The respective positive predictive and negative predictive value were 79% and 84%. Therefore, compared to the Candida culture, cervical cytologic test results had a sensitivity of 21% and specificity of 99%. The predictive positive predictive and negative predictive values were 90% and 85%. CONCLUSIONS: Specificity tended to be higher than sensitivity, in other words cytology tended to be more efficient in identifying women without sexually transmitted infection than in identifying those with infection. In summary, the Pap smear should not be used in lieu of more effective diagnostic test for sexually transmitted disease, and treatment should not be based on cytologic findings alone.

¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual? / Is the Papanicolaou smear useful for diagnosing some sexually transmitted infections?

Objetivo. Validar si la tinción de Papanicolaou es útil para el diagnóstico de tres de las patologías mayormente asociadas a infecciones de transmisión sexual (ITS): vaginosis bacteriana (VB), candidiasis y tricomoniasis. Diseño. Estudio prospectivo, descriptivo y transversal. Emplazamiento. El estudio se realizó en la Unidad de Atención Primaria Dr. José Castro Villagrana, Tlalpan, México, DF, entre enero de 1997 y febrero de 2000.Participantes. A 271 pacientes de 16-66 años (media, 32,2) con diagnóstico de cervicovaginitis se les realizó toma de muestra cervical para tinción de Papanicolaou (Pap) y toma de muestra vaginal para pruebas de laboratorio de rutina. Mediciones y resultados principales. La prevalencia de VB diagnosticada por criterios de Amsel fue de 33,9 por ciento, de candidiasis por cultivo de 17,3 por ciento y de tricomoniasis por fresco del 1,8 por ciento. Para VB utilizando el sistema Bethesda para interpretar el Pap se obtuvo 66 por ciento de sensibilidad y 86 por ciento de especificidad y valores predictivos positivo y negativo (VPP y VPN) del 79 por ciento y 84 por ciento, respectivamente. Para candidiasis se obtuvo 21 por ciento de sensibilidad, 99 por ciento de especificidad, VPP y VPN de 90 por ciento y 85 por ciento, respectivamente. Conclusiones. El Pap tiene baja sensibilidad y elevada especificidad para detectar ITS, por lo tanto parece más adecuado para excluir que para diagnosticar dichas infecciones. Tanto los métodos de laboratorio, como los criterios para diagnosticar ITS no son uniformes, por lo que el Pap no debe usarse en lugar de una prueba diagnóstica más efectiva y el tratamiento no debe basarse en los hallazgos citológicos (AU)

[Streptococcus pyogenes: in vitro susceptibility and role of beta-lactamase producing bacteria in the persistence of streptococcal pharyngotonsillitis]. / Streptococcus pyogenes: susceptibilidad in vitro y papel de las bacterias productoras de betalactamasa en la persistencia de la faringoamigdalitis estreptocócica.

OBJECTIVE: To assess the frequency of association between Streptococcus pyogenes and beta-lactamase-producing-bacteria in the pharyngotonsillitis and the evaluate the in vitro susceptibility. DESIGN: Prospective, descriptive, transverse study. SETTING: The present study was carried out in the Health Center Dr. José Castro Villagrana, in Tlalpan, México, D.F., from Juanary, 1996 to February 1999. PARTICIPANTS: In three hundred and ninety four patients with pharyngotonsillitis diagnosis we isolated the same number of Streptococcus pyogenes, and possible beta-lactamase-producing-bacteria. RESULTS: In 180 patients (45.7%) we isolated at least one possible beta-lactamase-producing-bacteria. Of these, in 138 patients (35%) were confirmed the enzyme presence. In total, we isolated 218 possible beta-lactamase-producing bacteria, and 152 (69.7%) were beta-lactamase positive. We found no significant change in the in vitro susceptibility of group A Streptococcus to penicillin, but erythromycin resistance is relatively common, approximately 10% in this study. CONCLUSIONS: Streptococcus pyogenes was uniformly susceptible to all penicillins and cephalosporins in vitro. Erythromycin treatment should not be promoted as first-line therapy because the consequent increase of bacterial resistance could create difficulty in treating penicillin-allergic patients. Because of the poor activity of trimetoprimsulfametoxazol, this drug no longer can be considered the drug of choice for the management of group A Streptococcal infections.

Streptococcus pyogenes: susceptibilidad in vitro y papel de las bacterias productoras de betalactamasa en la persistencia de la faringoamigdalitis estreptocócica / Streptococcus pyogenes:in vitro susceptibility and the role of beta-lactamase producing bacteria in the persistence of streptococcal pharyngoamygdalitis

Objetivo. Determinar la frecuencia de asociación entre Streptococcus pyogenes y bacterias productoras de betalactamasa en la faringoamigdalitis y evaluar su sensibilidad antimicrobiana in vitro. Diseño. Estudio prospectivo, descriptivo y transversal. Emplazamiento. El estudio de realizó en el Centro de Salud Dr. José Castro Villagrana, en Tlalpan, México, D.F., de enero de 1996 a febrero de 1999. Pacientes. A 394 pacientes con diagnóstico de faringoamigdalitis se les aisló igual número de Streptococcus pyogenes, así como posibles bacterias productoras de betalactamasa. Resultados. En 180 pacientes (45,7 por ciento), se aisló cuando menos una bacteria posible productora de betalactamasa. De éstos, en 138 pacientes (35 por ciento del total) se confirmó la presencia de al menos una bacteria productora de la enzima. En total se aislaron 218 bacterias reconocidas como productoras, y de éstas 152 (69,7 por ciento) resultaron betalactamasa positivas. No se encontraron cepas resistentes a antibióticos betalactámicos, mientras que un 9,6 por ciento fue resistente a eritromicina y el 45 por ciento a trimetoprimsulfametoxazol. Conclusiones. Más de la tercera parte de los pacientes presentaron al menos una bacteria productora de betalactamasa. Streptococcus pyogenes continúa siendo 100 por ciento sensible in vitro a las penicilinas. El uso de la eritromicina no debe ser promovido como primera alternativa de terapia debido al notable incremento de cepas resistentes, lo que podría llegar a provocar dificultades en el tratamiento de pacientes alérgicos. Debido a su pobre actividad in vitro, el trimetoprim-sulfametoxazol no debe considerarse antibiótico de elección (AU)

Bacterial vaginosis a "broad overview".

Bacterial vaginosis (BV) was first reported in 1995 by Gardner and Dukes, who described the unique clinical signs and symptoms and the distinctive nature of the vaginal discharge associated with it. They also described a "new" causative organism, which they named "Haemophilus vaginalis", subsequently renamed Gardnerella vaginalis. BV is currently the most prevalent cause of infectious vaginitis among women attending for genitourinary diseases. BV has a complex microbiology. Lactobacillus populations, which are usually dominant in healthy women, are replaced by a polymicrobial group of organisms that includes G. vaginalis, anaerobic Gram-negative rods such as Prevotella species, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and often Mobiluncus species. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue cell". Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge if untreated. Results from epidemiologic studies have associated BV with serious upper genital tract infections and adverse pregnancy outcome. In particular, the presence of BV in pregnant women increases the risk of preterm delivery, and evidence is now compelling that BV is a cause of preterm delivery. The interest in potential invasiveness of G. vaginalis has increased. However, virulence determinants have not been studied enough. The most important therapy includes clindamycin and metronidazole.

[Vaginal candidiasis: diagnosis and treatment in a primary care clinic]. / Candidiasis vaginal: diagnóstico y tratamiento en el primer nivel de atención médica.

OBJECTIVE: To assess the frequency of Candida species others than Candida albicans isolation, in patients with chronic as well as relapsing vaginitis. To analyze the clinical pictures and the treatments routinely employed in patients with Candida albicans infection, compared to those with other Candida species infection, in a Primary Care Clinic. DESIGN: Prospective, comparative, transverse study. SETTING: Primary health center from January, 1995 to May, 1997. MATERIAL: Two hundred and thirty four women (234) in ages between 16 and 55 years, with cervicovaginitis and a positive culture to any species of Candida, were the subject of the present study. RESULTS: From the total of 234 patients studied, 142 (60.5%) were infected by Candida albicans and 92 (39.5%) by other Candida species; no difference in symptomatology was recorded in both groups. Nistatine alone or combined with imidazole derivatives were the antimycotics more commonly employed, with Candida albicans resistance of 9.6% in the first case and 11.2% in the second one. CONCLUSIONS: It is stressed the importance that has the identification of Candida species causing vaginitis. It is also acknowledged the well handled treatment, despite of the species to be treated.

[A comparison of 2 clinical laboratory methods in the diagnosis of bacterial vaginosis]. / Comparación de 2 métodos de laboratorio clínico en el diagnóstico de la vaginosis bacteriana.

OBJECTIVE: To determine the sensitivity, the specificity, and positive and negative predictive values of two laboratory methods used to diagnose bacterial vaginosis; Gram stain and the Gardnerella vaginalis culture, in comparison with the clinical sings of vaginal discharge; homogeneous secretion, pH > 4.7, positive amine test and the presence of clue cells. DESIGN: A prospective, comparative and crossover type. SETTING: This study was carried out in the Health Center "Dr. José Castro Villagrana" SSA, situated in Tlalpan, México City. From January, 1992 to July, 1996. PARTICIPANTS: 3,142 women, from 16 to 55 years old with cervicovaginitis diagnosis, without previous treatment and sexual active life history. RESULTS: By means of clinical criterion (33.1%), it was diagnosed 1,041 women with bacterial vaginosis. Statistical differences were not found between the culture and Gram stain in the presence or no-presence of bacterial vaginosis diagnosed by clinical criterion (p = 0.33) The clue cells were the best predictor of bacterial vaginosis. CONCLUSIONS: The differences between both methods analysed were minimal and they didn't have statistical value so that, it is proposed the Gram stain as diagnostic method of bacterial vaginosis based on factors like speed, reproductiveness and low cost.

Biotypes of Gardnerella vaginalis isolated from urinary tract.

A modified scheme is proposed for biotyping Gardnerella vaginalis isolated from urinary tract of symptomatic and asymptomatic women based on detection of hippurate hydrolysis, beta-galactosidase (ONPG) and lipase, and fermentation of arabinose, galactose and xylose. Thirty biotypes were found among 73 strains. The distribution of biotypes was similar in both populations but the biotypes 1H, 5G and 7G were found more frequently in women without symptoms of urinary tract infection.