Efectividad de una intervención para mejorar la cultura de seguridad. ¿Menos es más? / Effectiveness of an intervention to improve safety culture. Less is more?

Objetivo. Evaluar el impacto de una iniciativa a largo plazo para contribuir a la mejora en cultura de seguridad entre profesionales de un área de salud, y conocer su utilidad percibida. Material y métodos. Estudio de intervención no controlado en una organización de la red pública asistencial incluyendo hospital de tercer nivel y 5.000 profesionales. Para medir impacto se realizó la encuesta de la Agency for Healthcare Research and Quality (AHRQ) por vía telefónica. Se midieron 7 dimensiones de cultura antes del proyecto (2012, n=100) y a los 3 años (2015, n=207). Se compararon variaciones entre 2012 y los conocedores del proyecto en 2015, y entre estos y no conocedores. Se valoró la utilidad (escala Likert de 5 ítems, alta utilidad medianas de 4 o superior). Resultados. Tasas de respuesta homogéneas superiores al 80%. El 41,5% conocían el proyecto (IC95%: 34,8-48,3), percibido de alta utilidad. En ambas comparaciones, variación negativa en «percepción de seguridad» (−9,9%, p<0,01, frente a 2012 y −4,2% entre grupos 2015) y «retroalimentación y comunicación sobre errores» (−10,0% frente a 2012 y −8,9% entre grupos 2015, p<0,05); y positiva no significativa en «franqueza en comunicación» (1,3% frente a 2012 y 6,9% entre grupos 2015). El «apoyo de gerencia» mejora no significativamente en 2015 (37,0%, IC95%: 30,9-43,1 en conocedores, y 38,3%, IC95%: 33,1-43,4 en no conocedores) frente a 2012 (31,4%, IC95%: 28,4-39,7. Conclusiones. Se detecta empeoramiento paradójico en varias dimensiones, probablemente por inmadurez de la organización y el instrumento utilizado. Herramientas que contemplen el grado de madurez pudieran ser más adecuadas en medición de cambios culturales, siendo necesarios más estudios (AU)

Objective. To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness. Material and methods. An uncontrolled intervention study was designed in a public health care organization including a 3rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n=100) and 3 years later (2015, n=207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher. Results. The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95%CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in "sense of security" (−9.9%, P<.01, vs. 2012, and −4.2% between 2015 groups) and "feedback and communication errors" (−10.0% vs. 2012, and −8.9% between 2015 groups, P<.05). There was a not-significant positive variation in "openness in communication" (1.3% vs. 2012, and 6.9% between 2015 groups). The "management support" showed a not-significant improve in 2015 (37.0%, 95%CI: 30.9-43.1, in RAP; and 38.3%, 95%CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95%CI: 28.4-39.7). Conclusions. A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed (AU)

[Effectiveness of an intervention to improve safety culture. Less is more?] / Efectividad de una intervención para mejorar la cultura de seguridad. ¿Menos es más?

OBJECTIVE: To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness. MATERIAL AND METHODS: An uncontrolled intervention study was designed in a public health care organization including a 3rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n=100) and 3 years later (2015, n=207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher. RESULTS: The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95%CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in "sense of security" (-9.9%, P<.01, vs. 2012, and -4.2% between 2015 groups) and "feedback and communication errors" (-10.0% vs. 2012, and -8.9% between 2015 groups, P<.05). There was a not-significant positive variation in "openness in communication" (1.3% vs. 2012, and 6.9% between 2015 groups). The "management support" showed a not-significant improve in 2015 (37.0%, 95%CI: 30.9-43.1, in RAP; and 38.3%, 95%CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95%CI: 28.4-39.7). CONCLUSIONS: A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed.

Simultaneous determination of propacetamol and paracetamol by derivative spectrophotometry.

A first-derivative spectrophotometric method for the simultaneous determination of propacetamol hydrochloride (PRO) and paracetamol (PA) is described. Measurements are made at the zero-crossing wavelengths at 242.0 for PRO and 239.0 nm for PA. The calibration graphs were linear up to 20.0 and 15.0 mg l(-1) of PRO and PA, respectively, the limits of quantification were 0.75 and 0.46 mg l(-1). The possible interfering effects of other substances were studied. The method was applied to determining the stability of PRO in ethanolic solutions and in glucose and saline parenteral solutions.

Simultaneous determination of piroxicam and its major metabolite 5'-hydroxypiroxicam in human plasma by derivative spectrophotometry.

A first-derivative spectrophotometric method for the simultaneous determination of piroxicam (PX) and its major metabolite 5'-hydroxypiroxicam (OH PX) in human plasma is described. The method consists of direct extraction of the two drugs from the plasma samples with hydrochloric and trichloroacetic acid prior to their determination by measuring the first-derivative signals at 337.0 nm for PX and at 327.0 nm for OHPX (zero-crossing wavelength). The calibration graphs were linear up to 10.0 and 8.0 mg l-1 of PX and OH PX, respectively, and the limits of quantification were 0.27 and 0.56 mg l-1. The possible interfering effects of other substances were studied.

Spectrophotometric methods for the determination of cephradine or ceftazidine in human urine using batch and flow-injection procedures.

Sensitive and fast spectrophotometric methods for the determination of cephradine or ceftazidine in human urine, based on the formation of compounds between these drugs and Pd(II), are described. In the batch procedures the calibration graphs resulting from the measurement of the absorbance at 330 nm is linear over the range 5.0-60.0 micrograms. ml-1 for cephradine and 3.0-60.0 micrograms ml-1 for ceftazidine. The methods were successfully adapted to FI-systems, the peak heights being proportional to cephalosporin concentration over the range 5.0-60.0 micrograms ml-1 for cephradine and 3.0-60.0 micrograms ml-1 for ceftazidine. The sampling frequency was 60 h-1 with a sample injection of 72 microliters.

Flow-injection spectrophotometric determination of frusemide or sulphathiazole in pharmaceuticals.

Two sensitive and fast flow-injection spectrophotometric methods are proposed for the determination of frusemide or sulphathiazole based on the formation of coloured complexes between these compounds and Pd(II) at pH 5.0 and 55 degrees C. Using the peak height as a quantitative parameter, frusemide or sulphathiazole was determined at 410 nm over the range 2.0 x 10(-5)-4.0 x 10(-4) M or 5.0 x 10(-5)-3 x 10(-4) M, respectively. The methods were applied to the determination of these sulphonamides in pharmaceuticals.

Simultaneous determination of cefepime and L-arginine in injections by second-derivative spectrophotometry.

A simple spectrophotometric assay for the determination of cefepime and L-arginine in injections is described. Since zero-order spectra showed considerable overlap, second-derivative spectrophotometry was used to enhance the spectral details. A linear relationship between second-derivative amplitude and concentration of each compound was found. Beer's law was obeyed up to 50 and 22 micrograms ml-1 of cefepime and arginine, respectively, in the second-derivative mode. Detection limits were 0.31 and 0.58 micrograms ml-1 for cefepime and arginine, respectively. The method, which is rapid, simple and does not require any separation step, has been successfully applied to the assay of commercial injections containing cefepime and arginine.

First and second derivative spectrophotometric determination of cefoperazone and sulbactam in injections.

A simple, spectrophotometric assay to measure the concentrations of cefoperazone and sulbactam in injectable formulations is described. Since zero-order spectra are subject to interference, derivative spectrophotometry was used to enhance the spectral details. A linear relationship between derivative amplitudes and the concentrations of the compounds was found. Beer's law is obeyed up to 75 and 80 micrograms ml-1 of cefoperazone in the first and second derivative modes, respectively, and up to 75 micrograms ml-1 of sulbactam in the second derivative mode. Detection limits were 0.64 and 0.88 microgram ml-1, respectively for cefoperazone in the first and second derivative modes and 0.30 micrograms ml-1 for sulbactam in the second derivative mode. The method is rapid, simple, does not require a separation step and has successfully been applied to the assay of commercial injections containing cefoperazone and sulbactam.

[Microbiological study via occluded telescopic catheter in patients under mechanical ventilation and suspected of pneumonia. Clinico-bacteriological follow up of the cases]. / Estudio microbiológico mediante catéter telescópico ocluido en pacientes bajo ventilación mecánica y sospecha de neumonía. Seguimiento clínico-bacteriológico de los casos.

Pneumonias related to mechanical ventilation pose a serious diagnostic challenge and are responsible for elevated mortality. Conventional diagnostic methods are of little help. The introduction of invasive techniques such as bronchial catling via an occluded telescopic catheter (OTC) has proven to be an important advance in diagnosis and therapy. We have compared the bacteriological results obtained using OTC with those using conventional diagnostic methods such as tracheobronchial pumps (TBP) and hemocultures, and we have undertaken a bacteriological, clinical follow-up of the cases. Seventy-four patients under mechanical ventilation and suspected of pneumonia were under study. The study consisted to two consecutive phases of collecting bacteriological samples throughout the patient's evolution. A total of 121 fibrobronchoscopies were performed. The sensitivity obtained with OTC was 76%, and the specificity was 100%. The two techniques, OTC and TBP, coincided in 38% of the cases. According to the bacteriological results obtained with OTC, the antibiotic treatment was modified in 44.5% of the patients. The sensitivity of the OTC was significantly less in those patients were the last doses of antibiotic was administered within two hours of performing the procedure. The procedure of gathering secretions from the inferior respiratory tract with OTC possesses greater sensitivity and diagnostic specificity in patients with mechanical ventilation and pulmonary infiltrates and improves the diagnosis performed by other conventional and routine techniques such as TBA and hemocultures.

Determination of captopril in pharmaceutical samples by flow injection analysis.

A flow injection spectrophotometric method for the determination of captopril involving measurement of the absorbance of the captopril complex with palladium(II) in a 0.12 M HCl medium at 400 nm is presented. The calibration graph was linear over the range 2 x 10(-5)-6 x 10(-4) M. The sampling frequency was 90 h-1 with sample injections of 70 microliters. The proposed method was applied to the determination of captopril in pharmaceutical samples.

Determination of penicillamine or tiopronin in pharmaceutical preparations by flow injection analysis.

Two flow injection analysis (FIA) methods, using spectrophotometric detection, are proposed for the determination of penicillamine or tiopronin [N-(2-mercaptopropionylglycine)]. The procedures are based on the formation of yellow complexes between these thiol-containing drugs and Pd(II), in a 1 M or 0.25 M HCl medium, respectively. With peak height as a quantitative parameter, penicillamine is determined over the range 1.0 x 10(-5)-7.0 x 10(-4) M; for tiopronin the range is 1.0 x 10(-5)-6.0 x 10(-4) M. The methods have been applied to the routine determination of the drugs in pharmaceutical preparations.

First- and second-derivative spectrophotometric determination of imipenem and cilastatin in injections.

First- and second-derivative spectrophotometry has been used for the quantitation of mixtures of imipenem and cilastatin sodium, compounds that have closely overlapping spectral bands. Beer's law was obeyed at concentrations up to 100 micrograms ml-1 of imipenem in both the first- and second-derivative modes and up to 75 micrograms ml-1 of cilastatin in the first-derivative mode. Detection limits at the P = 0.05 level of significance were calculated to be 0.40 and 0.52 micrograms ml-1 of imipenem and cilastatin sodium, respectively, in the first-derivative mode, and in a range from 0.45 to 0.68 micrograms ml-1 for imipenem in the second-derivative mode. The method, which is rapid, simple and does not require a separation step, has been successfully applied to the assay of commercial injections.

[The prediction of the severity of acute pancreatitis by C-reactive protein]. / Predicción de la severidad de una pancreatitis aguda por la proteína C reactiva.

Reactive C Protein (RCP) has been determined in fifty-one patients with acute pancreatitis. RCP has been compared with Ranson's criteria which include several clinical and biochemical parameters. The value of 20 mg/dl is the one which discriminates serious acute pancreatitis from the mild forms in a 84.3% of patients. Sensitivity and specificity of RCP and Ranson's criteria are compared, the results obtained are similar (88.9% vs. 81.8% and 94.4% vs. 97%). In summary, the determination of RCP is very useful for its simplicity and accuracy in the prognosis of acute pancreatitis.