[Benchmarking in patient identification: An opportunity to learn]. / Benchmarking en la identificación de pacientes: una oportunidad para aprender.

OBJECTIVE: To perform a benchmarking on the safe identification of hospital patients involved in "Club de las tres C" (Calidez, Calidad y Cuidados) in order to prepare a common procedure for this process. MATERIAL AND METHODS: A descriptive study was conducted on the patient identification process in palliative care and stroke units in 5medium-stay hospitals. The following steps were carried out: Data collection from each hospital; organisation and data analysis, and preparation of a common procedure for this process. RESULTS: The data obtained for the safe identification of all stroke patients were: hospital 1 (93%), hospital 2 (93.1%), hospital 3 (100%), and hospital 5 (93.4%), and for the palliative care process: hospital 1 (93%), hospital 2 (92.3%), hospital 3 (92%), hospital 4 (98.3%), and hospital 5 (85.2%). CONCLUSIONS: The aim of the study has been accomplished successfully. Benchmarking activities have been developed and knowledge on the patient identification process has been shared. All hospitals had good results. The hospital 3 was best in the ictus identification process. The benchmarking identification is difficult, but, a useful common procedure that collects the best practices has been identified among the 5 hospitals.

Una aproximación al benchmarking de indicadores de cuidados. Aprendiendo para mejorar la seguridad del paciente / An approach to care indicators benchmarking. Learning to improve patient safety

La mejora de la seguridad clínica puede alcanzarse mediante la promoción de una cultura de seguridad, formación y aprendizaje a través del benchmarking. El objetivo fue identificar áreas de mejora tras analizar indicadores relacionados con la seguridad de 2 hospitales públicos del área noroeste de la Comunidad de Madrid. Material y métodos. Estudio descriptivo realizado en 2011 en el Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) y en el Hospital de Guadarrama (HG). Las variables fueron 40 indicadores sobre cuidados de enfermería relacionados con la seguridad; 19 habían sido definidos en el Proyecto SENECA como estándares de calidad de cuidados para mejorar la seguridad en los hospitales. Para la recogida de datos se utilizó la historia clínica, los informes de evaluación del Servicio Madrileño de Salud, los procedimientos de cuidados y la observación directa. Resultados. De 40 indicadores 22 eran de estructura (procedimientos), el HUPHM disponía del 86% y el HG del 95%. Hubo 14 indicadores de proceso (formación y cumplimiento de protocolos) con resultados similares en los 2 hospitales, excepto en los informes de continuidad de cuidados y formación en higiene de manos. Los 4 indicadores de resultado (incidencia, y prevalencia de úlceras por presión, caídas y dolor) mostraron resultados dispares. Conclusiones. Analizar indicadores permitió identificar acciones de mejora en cada hospital, elaborar conjuntamente un decálogo de seguridad en los cuidados y un protocolo de prevención y tratamiento de heridas crónicas, instaurar la evaluación sistemática del dolor y la realización de informes de continuidad de cuidados a los pacientes derivados del HUPHM al HG (AU)

Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. Material and methods. Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation. Results. Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. Conclusions. The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG (AU)

[An approach to care indicators benchmarking. Learning to improve patient safety]. / Una aproximación al benchmarking de indicadores de cuidados. Aprendiendo para mejorar la seguridad del paciente.

UNLABELLED: Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. MATERIAL AND METHODS: Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation RESULTS: Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. CONCLUSIONS: The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG.

Effect of CYP3A51/3 polymorphism on blood pressure in renal transplant recipients.

BACKGROUND: The cytochrome P450 3A5 (CYP3A5) enzyme has been implicated to determine blood pressure (BP) in humans. Different results have been reported concerning CYP3A5 gene polymorphisms and posttransplantation hypertension in kidney recipients. Our objective was to investigate whether CYP3A5 1/3 polymorphism was associated with ambulatory BP among a population of renal transplant recipients receiving the calcineurin inhibitor tacrolimus for immunosuppression. METHODS: Sixty primary kidney transplant recipients undergoing treatment with tacrolimus were genotyped for the CYP3A5 1/3 polymorphism. We analysed the association of the CYP3A5 alleles with ambulatory systolic and diastolic BP measured at 6 and 24 months posttransplantation. RESULTS: We observed that 23.3% of the patients were CYP3A5 1 carriers and 76.7% were homozygous for CYP3A5 3. CYP3A5 1 carriers showed higher adjusted systolic BP and diastolic BP at 6 and 24 months posttransplantation, and they were prescribed more antihypertensive drugs compared with non CYP3A5 1 carrier patients, albeit not significant. No significant differences were found comparing the distribution of the hypertension classes. CONCLUSION: We did not observe a significant association of CYP3A5 1/3 polymorphism with posttransplantation hypertension, although there were some differences in BP associated with the presence of the CYP3A5 1 allele.

Lack of association of immune cell function test with rejection in kidney transplantation.

BACKGROUND: The Cylex Immuknow assay provides a rapid assessment of global immune function in immunocompromised patients by measuring the global immune responses of CD4 T cells from a whole-blood sample. It may help to monitor the immune status of immunosuppressed transplant patients. However, earlier studies have shown that there is no consensus on the utility of the Immuknow assay in renal transplant rejection. METHODS: T-cell activation was determined by measuring an increase of intracellular adenosine triphosphate (iATP) from CD4 cells in 227 samples from 116 kidney transplant patients. The results were analyzed regarding patient clinical status, namely, rejection, infection, or stability. In addition, we measured the immunologic response of 108 healthy control subjects. RESULTS: There were 24 infectious and 36 rejection episodes. iATP concentrations differed significantly between stable and infected patients (180.5 ± 55.2 vs 375.3 ± 140.1 ng/mL; P < .001) and between infected patients and control subjects (180.5 ± 55.2 vs 436.5 ± 112 ng/mL; P < .001). No correlation was observed between patients suffering an acute rejection episode with this response. CONCLUSIONS: Our results confirmed that the Immuknow assay identified transplant patients at risk for infection. It may provide information to guide immunosuppressive therapy, but the assay did not seem to have the potential to differentiate subjects experiencing rejection.

Abordaje multidisciplinar de las caídas en un hospital de media estancia / A multidisciplinary approach to falls in a medium-stay hospital

ObjetivoAbordar el problema de las caídas en un hospital de media estancia, identificando a los pacientes de mayor riesgo y las circunstancias más habituales en las que se producen.Pacientes y métodosEstudio descriptivo de todos los pacientes ingresados en el Hospital Guadarrama durante el año 2007 (n=920). Se recogieron en una base de datos incluida en la historia informatizada del paciente: el STRATIFY al ingreso, la situación cognitiva y funcional, Unidad de Hospitalización, registro de las caídas y circunstancias en las que se produjeron. Se realizó el estudio descriptivo y análisis multivariante con el programa SPSS 16.ResultadosDurante el periodo de estudio se produjeron 144 caídas. La incidencia de caídas/ingreso fue de 14,3%, siendo la Unidad de Recuperación funcional la que mas caídas registra con un 22,01%, siendo los pacientes con ictus, con un 31%, el grupo de pacientes que más caídas sufrieron. El turno de la mañana ha sido el que mas caídas ha registrado, el 51%. El mayor número de caídas se produjeron desde la silla (44%). Un 34% de los pacientes habían sufrido caídas anteriores. Cuando se realizó el análisis de regresión logística, las variables que permanecieron con asociación estadísticamente significativa con caídas fueron: el índice de Barthel al ingreso (Exp β 2,5, IC del 95%: 1,5–4,2; p<0,01) y la escala de STRATIFY al ingreso (Exp β 1,67, IC del 95%: 1,05–2,66; p=0,02).ConclusionesLos pacientes crónicos con mayor deterioro funcional son más propensos a sufrir caídas. En cuanto a la actividad en el momento de la caída, podemos observar que el mayor porcentaje de pacientes sufren la caída al tratar de levantarse(AU)

ObjectiveTo approach the problem of the falls in an average stay hospital; identifying the patients of greater risk; and find out the circumstances in which the falls occurred.Patients and methodsA descriptive study of all the patients who entered the Guadarrama Hospital (Madrid) during year 2007 (n=920). On admission, all patients were assessed using the Stratify falls risk scale, their cognitive and functional situation, unit of hospitalisation, record of falls and circumstances under which the falls occurred. The descriptive study and multivariate analysis was performed using the SPSS 16 statistics program.ResultsDuring the period of study 144 falls took place. There was a falls/admission incidence of 14.30%. The highest number of falls (22.1%) occurred in the Functional Recovery Unit (FRU) and patients with stroke being the group that suffered most falls (31%). Most falls were registered during the morning shift, with 51%. The greatest number of falls occurred from a chair (44%) and 66% of the patients had mobility limitations. A total of 34% of the patients had fallen previously. When the logistic regression analysis was made, the variables that remained with statistically significant association with falls, were: the Barthel index on admission (Exp β 2.5, 95%CI; 1.5–4.2; P<0,01) and the STRATIFY scale on admission (Exp β 1.67, 95%CI; 1.05–2.66; P=0.02)ConclusionsThe chronic patients with greater functional deterioration are more prone to suffer falls. With respect to patient activity at the time of the fall, we can observe that most of them were seated and tried to stand up(AU)

[A multidisciplinary approach to falls in a medium-stay hospital]. / Abordaje multidisciplinar de las caídas en un hospital de media estancia.

OBJECTIVE: To approach the problem of the falls in an average stay hospital; identifying the patients of greater risk; and find out the circumstances in which the falls occurred. PATIENTS AND METHODS: A descriptive study of all the patients who entered the Guadarrama Hospital (Madrid) during year 2007 (n = 920). On admission, all patients were assessed using the Stratify falls risk scale, their cognitive and functional situation, unit of hospitalisation, record of falls and circumstances under which the falls occurred. The descriptive study and multivariate analysis was performed using the SPSS 16 statistics program. RESULTS: During the period of study 144 falls took place. There was a falls/admission incidence of 14.30%. The highest number of falls (22.1%) occurred in the Functional Recovery Unit (FRU) and patients with stroke being the group that suffered most falls (31%). Most falls were registered during the morning shift, with 51%. The greatest number of falls occurred from a chair (44%) and 66% of the patients had mobility limitations. A total of 34% of the patients had fallen previously. When the logistic regression analysis was made, the variables that remained with statistically significant association with falls, were: the Barthel index on admission (Exp beta 2.5, 95%CI; 1.5-4.2; P < 0,01) and the STRATIFY scale on admission (Exp beta 1.67, 95%CI; 1.05-2.66; P = 0.02) CONCLUSIONS: The chronic patients with greater functional deterioration are more prone to suffer falls. With respect to patient activity at the time of the fall, we can observe that most of them were seated and tried to stand up.

Canine visceral leishmaniasis in São José de Ribamar, Maranhão State, Brazil.

Here, we describe the situation of canine visceral leishmaniasis in two villages of São José de Ribamar in Maranhão State/Brazil, where human cases have been registered. Blood samples of 36 household crossbred dogs from Sergio Tamer village and 43 dogs from Quinta village were collected and the serum used for serological diagnosis. An Indirect Fluorescent Antibody Test (IFAT) and enzyme-linked immunosorbent assay (ELISA) were used to detect antibodies against Leishmania. The clinical examination showed that 25% of the canine population of Quinta presented a poor body condition and in 39%, ectoparasites (ticks and fleas) were detected. In both tests, serology revealed that 21% (9 out of 43) of the dogs presented antibodies against Leishmania (55% were asymptomatic and 45% were symptomatic). In the Vila Sérgio Tamer, 25% (9 out of 36) of the dogs were seropositive for Leishmania (66.67% were asymptomatic and 33.33% were symptomatic), 33% presented poor body condition, and 22% have ectoparasites. The clinical signs more frequent were skin lesions. The statistical analysis showed that there was no statistical difference (p>0.05) between the seropositivity of the dogs from the two villages. The same was observed when the clinical signs were compared (p>0.05). Both villages have favorable conditions to maintain the cycle of leishmaniasis.

Single-blind and comparative clinical study of the efficacy and safety of benzoyl peroxide 4% gel (BID) and adapalene 0.1% Gel (QD) in the treatment of acne vulgaris for 11 weeks.

objectives: To compare the efficacy and tolerability of a gel containing benzoyl peroxide 4%, used twice daily, with a gel containing adapalene 0.1% used once daily, in the treatment of acne vulgaris for 11 weeks. methods: 178 patients bearing acne vulgaris, aged between 13 and 30 years, were studied in a comparative and single-blind clinical study. The 178 patients were divided into two groups: 89 patients treated with benzoyl peroxide 4% and 89 patients treated with adapalene 0.1%. The treatment duration was 11 weeks. The efficacy assessment was conducted through an accounting of both the inflammatory and non-inflammatory lesions in all visits. The safety assessment was conducted through reports regarding adverse reactions and local tolerance in all visits and an overall tolerance at the end of the study. conclusions: The results showed that both treatments were efficient in the reduction of acne lesions after 11 weeks treatment and were well tolerated, without any serious adverse event report. The benzoyl peroxide 4% was superior in the reduction of the number of inflammatory and non-inflammatory lesions at weeks 2 and 5, when compared to adapalene 0.1%.

Analysis of citrates and benzoates used in poly(vinyl chloride) by supercritical fluid extraction and gas chromatography.

Supercritical fluid extraction (SFE) has been demonstrated to be a useful tool in the determination of additives in polymeric materials. This paper describes the determination of some citrates and benzoates in poly(vinyl chloride) blended with 33-34% of plasticizer using off-line SFE followed by gas chromatography. Experimental factors affecting SFE have been studied by gravimetric analysis, followed by analysis of the extracts using a gas chromatograph equipped with a flame ionization detector. The extraction process is governed by the solubility of the plasticizers in the supercritical fluid or by their diffusion through the polymer matrix, which depend on the pressure and temperature used. Maximum extraction (>99%) is obtained at pressures and temperatures higher than 40 MPa and 80 degrees C, respectively. Due to purge losses, the collection efficiency of plasticizers into a liquid solvent ranges from 85 to 90%. The applicability of the SFE method is demonstrated using real samples and comparing the results with those obtained by conventional Soxhlet extraction.

Bromocriptine-induced dissociation of hyperglycemia and prolactin response to restraint.

The present study investigated the effects of immobilization (restraint stress) on rat chronically treated with a D(2) receptor agonist (bromocriptine, 0.4 mg/100 g body weight, injected daily intraperitoneally (ip) for 2 weeks) on plasma glucose, prolactin, and insulin levels. During restraint, the plasma prolactin of vehicle-treated (VEH) rats increased rapidly, reaching a peak at 10 min (57.9 +/- 8.1 ng/ml, P < .01). In contrast, restraint failed to induce any significant change in the plasma prolactin levels of bromocriptine-treated (BR) rats. The hyperglycemic response to immobilization was 97% higher (P < .05) in BR rats than in VEH rats. Our data demonstrate that prolactin secretion and hyperglycemia in response to restraint can be dissociated by chronic treatment with BR, which also increased the hyperglycemic response to immobilization probably due to central D(2) dopaminergic activity.

Effects of chronic bromocriptine (CB-154) treatment on the plasma glucose and insulin secretion response to neurocytoglucopenia in rats.

Neurocytoglucopenia has been reported to increase both parasympathetic and sympathetic tone with a predominant effect on the latter, which accounts for the major effect of plasma hyperglycemia and the inhibition of insulin secretion. The aim of this study was to determine the effects of chronic treatment with bromocriptine (0.4 mg/100 g body wt per day), a potent sympatholytic D(2)-dopaminergic agonist, on hyperglycemia and insulin secretion in response to neurocytoglucopenia induced by 2-deoxy-d-glucose (2DG). After 2 weeks of bromocriptine treatment the animals, freely moving in their cages, were submitted to 2DG administration (50 mg/100 g body wt) via atrial catheter infusion. After 2DG infusion, the plasma prolactin of vehicle-treated (VEH) rats increased rapidly, reaching a peak at 10 min (34.3+/-7.6 ng/ml; P<0.01). In contrast, 2DG infusion failed to induce any significant change in the plasma prolactin levels of bromocriptine-treated (BR) rats. BR rats showed higher resting glucose levels than control rats (8.2+/-0.28 mM (BR) vs 6.0+/-0.18 mM (VEH); P<0.01). However, the hyperglycemic response of BR rats to 2DG injection was 30% lower than that of VEH rats (P<0.05). BR rats also showed a rapid rise in plasma insulin levels reaching a peak at 30 min after 2DG injection (243% higher than basal values; P<0.01). This increased rise in the insulin response to neurocytoglucopenia of BR rats was blocked by previous intravenous injection of atropine methyl nitrate (0.2 mg/100 g body wt). The present results suggest that chronic treatment with bromocriptine determines a strong increase in the parasympathetic tone response to neurocytoglucopenia, which is responsible for the higher stimulation of insulin secretion observed in BR rats. The data also provide further evidence that D(2)-dopaminergic agonist can block neurocytoglucopenia-induced prolactin release.

FTIR monomer conversion analysis of UDMA-based dental resins.

The utility of the amide II absorption band at 1537 cm-1 as internal reference for calculation of monomer conversion in urethane dimethacrylates (UDMA)-based dental restorative materials and sealants by means of Fourier transform infrared spectroscopy (FTIR) is demonstrated in this paper.

Blood glucose and prolactin in hyperprolactinemic rats exposed to restraint and surgical stress.

The effects of chronic hyperprolactinemia on plasma prolactin (PRL) and glucose were investigated in male rats submitted to two different types of stress: restraint (60 min in a plastic tube) or surgery (laparotomy under ether anesthesia). Hyperprolactinemia was induced by grafting one homologous pituitary gland under the kidney capsule. Restraint stress induced a marked increase of plasma PRL of control rats with a peak at 15 min (increase of 403%), but did not change the PRL levels of hyperprolactinemic rats. Plasma glucose levels of both groups were elevated by restraint stress at 5 min (control, 26%; grafted, 63%), and remained above basal levels during the whole experimental period. However, at 15 min the hyperglycemic response of the grafted rats was higher than that of control rats (p<0.05). Surgical stress induced a 204% increase of plasma PRL at 5 min in the control group, but failed to induce alterations of PRL in the hyperprolactinemic group. Plasma glucose was remarkably elevated at 15 min both in control (138%) and grafted (124%) rats after surgery, producing a hyperglycemic response much more intense than that induced by restraint. Grafted rats presented hyperglycemia during all the experimental period, whereas control rats showed glycemia similar to basal levels by the end of the experiment. In conclusion, different responses are induced depending on the type of stress: more intense PRL secretion is induced by restraint and higher hyperglycemia by surgery. Chronic hyperprolactinemia induced a higher (restraint) or longer lasting (surgery) hyperglycemic response in the rat, adding new evidence for a diabetogenic effect of PRL.