Application of a mindfulness program among healthcare professionals in an intensive care unit: Effect on burnout, empathy and self-compassion. / Aplicación de un programa de mindfulness en profesionales de un servicio de medicina intensiva. Efecto sobre el burnout, la empatía y la autocompasión.

OBJECTIVE: To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. DESIGN: A longitudinal study with an intrasubject pre-post intervention design was carried out. SETTING: Intensive Care Unit of a tertiary hospital. PARTICIPANTS: A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. INTERVENTION: A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. MAIN MEASUREMENTS: Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. RESULTS: Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high. CONCLUSIONS: In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.

Parametric bootstrap for testing model fitting of threshold and grouped data models: an application to the analysis of calving ease of Bruna dels Pirineus beef cattle.

The aim of this study was to compare the goodness of fit of the threshold models with homoscedasticity or heteroscedasticity and the grouped data model for the analysis of calving ease in beef cattle by using a parametric bootstrap procedure. Field data included 8,205 records of the Bruna dels Pirineus beef cattle breed in the Pyrenean mountain areas of Catalonia (Spain). The actual distribution was 81.81% of calvings without assistance, 11.02% slightly assisted by the farmer, 5.12% strongly assisted by the farmer, 0.89% assisted by the veterinarian, and 1.16% cesarean, but these percentages were very different in the different herds. This can be explained partially by the different subjective way of scoring of each farmer. Primiparous cows had a greater (P < 0.001) difficulty calving than cows with 5 or more parities (11.74 vs. 4.49% of calvings strongly assisted by the farmer or the veterinarian and 2.8 vs. 0.65% cesarean). Male calves caused greater (P < 0.001) calving difficulty than females (7.71% of male calvings strongly assisted by the farmer or the veterinarian vs. 4.25% of females and 1.83% cesarean in males vs. 0.47% in females). The month and year of calving also had a strong influence on calving ease. These data were analyzed using 3 different models: the threshold models with homoscedasticity or heteroscedasticity and the grouped data model. The bootstrap comparison among models suggested that the threshold models, even allowing for heteroscedasticity, did not fit the herd effects well. In contrast, fitting deficiencies were not observed for the grouped data model in any factor. The variance of direct effect of the calf was estimated using the 3 models, and the heritability estimate ranged from 0.165 for the grouped data model to 0.185 for the hereroscedastic threshold model. This heritability was moderate, but it would justify the inclusion of direct effects of the calf on calving ease in the breeding objective. Overall, results highlighted the flexibility of the grouped data model for the analysis of discrete traits, like calving ease of beef calves.

Binational evaluation of type traits from Germany and France with a single-trait MACE animal model.

Binational genetic evaluation between Germany and France were performed for each type trait using a single-trait MACE (multiple across-country evaluation) model. Daughter yield deviations (DYD) of bulls having 30 equivalent daughter contributions or more were the data for parameter estimation. Full pedigree information of bulls was used via sire and dam relationships. In general, across-country genetic correlation estimates were in agreement with what is observed by Interbull. The estimated correlations were over 0.93 for stature, rump angle, udder depth, front teat placement, teat length and rear teat placement. These traits have been classified in both countries for a long period of time. However, some other type traits were included later in the French type classification system (most of them since 2000): chest width, body depth, angularity, rump width, rear leg rear view, fore udder and rear udder height. The estimated correlations for these traits were relatively low. In order to check changes in genetic correlations over time, data from bulls born until the end of 1995 were discarded. Higher genetic correlation estimates between both countries were obtained by using more recent data especially for traits having lower genetic correlation, e.g. body depth correlation increased from 0.55 to 0.83. Once genetic correlations were estimated, binational genetic evaluation between Germany and France were performed for each type trait using DYD of bulls. The rankings of bulls obtained from this evaluation had some differences with Interbull rankings but a similar proportion of bulls from each country was found. Finally, more computationally demanding binational evaluations were performed using yield deviations of cows for binational cow comparison. The rankings obtained were influenced by the number of daughters per bull and heritabilities used in each country.

[Unique patient identification in hospitals in the National Health Service]. / Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud.

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs.

Validation of an approximate REML algorithm for parameter estimation in a multitrait, multiple across-country evaluation model: a simulation study.

A multitrait, multiple across-country evaluation (MT-MACE) model permitting a variable number of correlated traits per country allows international genetic evaluation models to more closely match national models. Before the MT-MACE evaluation can be applied, genetic (co)variance components within and across country must be estimated. An approximate REML algorithm for parameter estimation was developed and was validated via simulation. This method is based on the expectation maximization REML (EM-REML) algorithm. Because obtaining the inverse of co-efficient matrix is not usually feasible for large amounts of data, an algorithm using the multiple-trait effective daughter contribution (EDC) is proposed to provide approximate diagonal elements of the inverse matrix. The accuracy of the approximate EM-REML was tested with simulated data and compared with an average information REML (AI-REML) from available software. Two simulation studies were performed. First, data of 2 countries were simulated using a single-trait model. Estimates of across-country genetic correlations with the developed algorithm were unbiased and very precise. The precision, however, depended on the percentage of bulls with data in both countries. The results obtained with the approximate EM-REML software were very close to those obtained with the AI-REML software regarding estimated genetic correlations and bulls' estimated breeding values. The second simulation assumed a multiple trait model and the same number of traits, pedigree structure, EDC, and pattern of missing records as for actual observations for milk yield obtained from French and German national Holstein evaluations. As with the single-trait scenarios, the approximate EM-REML gave nearly unbiased and very precise estimates of within- and across-country genetic correlations. The results obtained in both simulation studies confirmed the suitability of the MT-MACE model and approximate EM-REML software in a wide range of situations. Even when the genetic trend was incorrectly estimated by the national evaluations, a joint analysis including a time effect in the MT-MACE model adequately corrected for this bias.

[Comorbidity and related costs as a burden in the treatment of outpatients with depressive disorders in a primary care setting]. / Comorbilidad y coste ambulatorio asociado a los pacientes con trastornos depresivos en un ámbito poblacional.

OBJECTIVE: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. METHOD: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. RESULTS: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%-75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean +/- SD; 7.4 +/- 4.3 vs. 4.7 +/- 3.3, p < 0.0001) and global medical visits/patient/year (12.0 +/- 9.3 vs. 7.4 +/- 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; 1,083.8 euro (SEM; 8.4 euro) vs. 684.1 euro (3.4 euro), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. CONCLUSIONS: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age.

Comorbilidad y coste ambulatorio asociado a los pacientes con trastornos depresivos en un ámbito poblacional / No disponible

Objetivo: Medir el impacto económico de los trastornos depresivos (TD) y la comorbilidad asociada en en población atendida por equipos de atención primaria (EAP) en condiciones de práctica clínica habitual. Método: Estudio de cohortes retrospectivo. Se incluyeron pacientes mayores de 14 años, con diagnóstico de TD (CIAP; P76) atendidos por EAP durante el año 2004. Se formó una cohorte comparativa con el resto de pacientes sin TD. Las variables fueron: edad, sexo, historial/comorbilidad, utilización de recursos sanitarios y costes correspondientes (medicamentos, procedimientos diagnósticos, visistas a especialistas y a EAP). Se efectuó un análisis de regresión logística múltiple y modelos ANCOVA para comparar los costes, totales y desagregados, y las comorbilidades. Resultados: Se incluyeron 64.072 pacientes; 6.592 con TD [10,3% (CI: 8,2-12,4%); 7,5% (CI: 73,4-756%) mujeres]. Los pacientes con TD presentaron un mayor número de episodios de comorbilidades/año (media ± DE; 7,4 ± 4,3 vs. 4,7 ± 3,3; p < 0,0001) y de todo tipo de visitas médicas/paciente/año (12,0 ± 9,3 vs. 7,4 ± 7,6; < 0,0001). Las principales episodios de comorbilidad asociados con los TD fueron los trastornos neurológicos [Odd ratio (IC 95%); 2,1 (1,5-2,6); p < 0,0001], alcoholismo [1,6 (1,3-1,9), p < 0,0001] y neoplasias malignas [1,3 (1,1-1,5); p < 0,0001]. Los TD se asociaron con unos costes totales ajustados significativamente mayores; 1.083,8 (EEM; 8,4 ) vs. 684,1 (3,4 ); p < 0,0001. Las personas mayores mostraron mayores costes. El 62% de los costes totales se derivó de los medicamentos. Conclusiones: La prevalencia de los TD es elevada, particularmente en mujeres. Después del ajuste por comorbilidad, edad y sexo, los pacientes con TD utilizaron más recursos sanitarios y ocasionaron unos costes más altos. Los costes más elevados se asociaron con la edad

Objective: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. Method: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. Results: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%- 75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean ± SD; 7.4 ± 4.3 vs. 4.7 ± 3.3, p < 0.0001) and global medical visits/patient/year (12.0 ± 9.3 vs. 7.4 ± 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; € 1,083.8 (SEM; € 8.4) vs. € 684.1 (€ 3.4), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. Conclusions: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age

Analysis of longevity and exterior traits on Large White sows in Switzerland.

Records of length of productive life, from first farrowing to culling, of 16,464 Large White purebred sows from SUISAG were studied using survival analysis. The major aims of the study were to model the risk of culling within parity and to assess the influence of exterior traits, such as the number of teats or feet and leg scores, on culling. Culling was concentrated at the first day after each farrowing or at the first day after weaning. Weaning itself was mostly between 21 and 49 d after farrowing, with an average weaning age of 35 d. Because of the definition of culling date used, there was practically no risk of culling from these periods. The culling rates at different periods suggested a modeling of the baseline hazard function within parity instead of over the entire productive life of the animals. A piecewise Weibull function and a simple graphical method to validate its adequacy were proposed for sow longevity analysis. The risk of culling increased with older parities (P < 0.001) and with decreasing litter size at weaning (P < 0.001). The exterior traits analyzed (number of teats, and feet and leg scores, on a scale from 1 to 7) had a moderate effect on the risk of culling compared with other factors but were still influential on survival, productive life expectancy, and annual replacement rate. Sows with less than 13 good teats had 1.35 times greater risk of being culled than sows with more good teats (P < 0.05). Sows with an X-O rear leg score of 2 had 1.4 times greater risk of being culled than sows with an intermediate score of 4 (P < 0.05). Sows at the optimum score of 4 for the size of inner claws of the rear leg had 0.83 times less risk of being culled (P < 0.01) than sows with scores of 2 and 3. Furthermore, when a phenotypic index for feet and legs was used to group these variables, the effect was highly significant (P < 0.001). Therefore, a means to improve longevity is through phenotypic selection of replacement gilts based on exterior traits: gilts with 13 or less good teats or with extreme feet and leg scores should be culled. From a genetic point of view, sows with the best value in the current index for exterior traits had a lower risk of culling (P < 0.01), and therefore, it is possible to obtain a response for sow longevity via indirect selection for exterior traits. From 1999 to 2003, the trend has been to eliminate extreme animals on exterior traits. This may partly explain the improvement of sow length of productive life longevity from 560 d in 2000 to nearly 710 d in 2003 observed in the data set.

Parametric bootstrap for testing model fitting in the proportional hazards framework: an application to the survival analysis of Bruna dels Pirineus beef calves.

Given that correct assumptions on the baseline survival function are determinant for the validity of further inferences, specific tools to test the fit of a model to real data become essential in proportional hazards models. In this sense, we have proposed a parametric bootstrap to test the fit of survival models. Monte Carlo simulations are used to generate new data sets from the estimates obtained through the assumed models, and then bootstrap intervals can be established for the survival function along the time space studied. Significant fitting deficiencies are revealed when the real survival function is not included within the bootstrap interval. We tested this procedure in a survival data set of Bruna dels Pirineus beef calves, assuming 4 parametric models (exponential, Weibull, exponential time-dependent, Weibull time-dependent) and the Cox's semiparametric model. Fitting deficiencies were not observed for the Cox's model and the exponential time-dependent model, whereas the Weibull time-dependent model suffered from moderate overestimation at different ages. Thus, the exponential time-dependent model appears to be preferable because of its correct fit for survival data of beef calves and its smaller computational and time requirements. Exponential and Weibull models were completely rejected due to the continuous over- and underestimation of the survival probability reported. Results here highlighted the flexibility of parametric models with time-dependent effects, achieving a fit comparable to nonparametric models.

Genetic and environmental factors influencing mortality up to weaning of Bruna dels Pirineus beef calves in mountain areas. A survival analysis.

Survival analysis techniques were used to analyze survival up to weaning of beef calves in the Pyrenean mountains areas of Catalonia, Spain. The Kaplan-Meier curve showed that the survival experience was not constant throughout the lactation period, as the mortality rate was more pronounced during the first month of life. The proportional hazards model analysis showed that several factors influenced the instantaneous mortality rate, with the herd-year effect having the strongest influence. Calves born in the first part of the breeding season, from September to February, had the lowest mortality risk (P < 0.001), showing that mortality risk increases as births accumulate. Calves from cows younger than 1,300 d of productive life had a higher risk of mortality (P < 0.05). Unassisted calvings presented the smallest risk of mortality, and mortality risk increased up to five times as birth became more difficult (P < 0.001). This risk also tended to increase slightly when calf birth weight was small (P < 0.10); for bigger calves, no increase of risk was detected, probably because calving difficulty was included in the model. These results suggest the need for improving the environment in the second part of the breeding period and paying more attention to births from younger cows. The survival curve fitted a parametric piecewise exponential function very well, with cut points at 16 and 32 d. The lower risk corresponded to the period of 33 to 180 d, the risk for the periods 17 to 32 d and 1 to 16 d being multiplied by 7 and 26, respectively. Confirming the robustness of the Cox model, the relative risks estimated for the different factors under this piecewise exponential model or a Weibull time-dependent model were similar to those reported above, as well as to those estimated under a frailty model, including the sire as a random effect. The modal estimates of sire variance under different baseline functions were close to 0.3, although the standard errors were very large. At weaning, the heritability estimate in the binary scale reached a value of only 0.037 because the survival at weaning was very high (96.9%) in this population. Nevertheless, in populations with a higher mortality, the inclusion of survival to weaning in the breeding objective might be justified. Overall, these results show that survival analysis is a powerful tool to analyze the mortality curve until weaning of beef calves.

A propósito de la adecuación de los ingresos hospitalarios no quirúrgicos desde un servicio de urgencias / One the adequacy of non-surgical hospital admission referrals from an emergency service

No disponible

Análisis de la prescripción farmacológica según el modelo de gestión de Atención Primaria en un sector sanitario

Objetivo. Analizar la prescripción farmacológica en función del modelo de gestión a partir de una serie de indicadores cuantitativos y cualitativos.Diseño. Estudio descriptivo retrospectivo del período enero-junio de 2000.Emplazamiento. Atención primaria del Sector Sanitario Badalona-Sant Adrià del Besòs (Badalona).Mediciones y resultados principales. Se han agrupado los centros de atención primaria del sector (13) según su entidad proveedora y modelo de gestión en 3 grupos: a) red empresarial (RE), que incluye una entidad con financiación pública, provisión empresarial de servicios y un sistema organizativo reformado; b) red reformada (REF), es decir, centros con financiación y provisión de servicios públicas y un sistema organizativo reformado, y c) red no reformada (SNR), formada por centros con financiación y provisión públicas y un modelo organizativo no reformado.El número de envases prescritos en los 13 centros ha sido de 1.774.565, que han generado un gasto de 3.209.225.749 ptas. Los resultados obtenidos presentan diferencias estadísticamente significativas en el importe por habitante asignado, que ha sido de 10.707,2 ñ 2.365 (RE), 11.053,8 ñ 2.859 (REF) y 14.191,6 ñ 3.857 ptas. (SNR) (p = 0,033). El número de envases consumidos, tanto en activos (p = 0,000), pensionistas (p = 0,003) como en cifras globales ha sido de 1.664,6 ñ 362,5 (RE), 1.751,8 ñ 355,6 (REF) y 1.925,6 ñ 357,5 (SNR) (p = 0,006). El porcentaje de VIFE ha sido de un 90,9 por ciento en RE, un 88,5 por ciento en REF y un 83,9 por ciento en SNR (p = 0,000). El porcentaje de medicamentos genéricos utilizado en los tres modelos ha sido del 10,2, 5,7 y 1,1 por ciento, respectivamente (p = 0,000).Se incluye una serie de indicadores de selección o uso relativo medidos en dosis diaria definida por 1.000 habitantes y día (DHD). Conclusiones. Los resultados obtenidos demuestran un potencial ahorro siguiendo el modelo más eficiente entre un 3-5 por ciento y un 13-24 por ciento en la contención del gasto en el sector, si no se modifican las circunstancias del entorno. Este efecto está directamente relacionado con una mayor utilización de medicamentos genéricos (AU)

[Assessment of the appropriate utilization of an emergency department observation unit with the Appropriateness Evaluation Protocol: analysis of 4,700 cases]. / Evaluación del uso apropiado de un área de observación de urgencias mediante el Appropriateness Evaluation Protocol: un análisis de 4.700 casos.

BACKGROUND: The Emergency Department Observation Units (EDO) constitutes an alternative of conventional hospitalization. The admissions and stays' appropriateness may influence the efficient use of bed resource in an acute care hospital. METHOD: Prospective evaluation of EDO admissions in a 18 month period, using the original criteria of Appropriateness Evaluation Protocol (A.E.P.), which were adapted to the area characteristics. RESULTS: We evaluate 4,700 admissions (55.1% male, 44.9% female; mean age: 64.9 +/- 14.9 years old). Average length of stay was 23.8 (+/- 18.3) hours. 35.5% patients were discharged at home and 62.0% were admitted in hospital. In 98.1% patients we obtained clinical stabilization in 48 hours. 85.0% of admissions were explained by 35 DRG categories, the most prevalent being chronic obstructive pulmonary disease (COPD) (411 admissions, 9.0%). A total of 258 (5.5%) admissions were qualified as inappropriate, primary due to diagnostic and therapeutical services that could have been provided in an outpatient basis (3.4%). A total of 797 (17.0%) stays were considered inappropriate, mainly due to hospital bed occupancy (13.0%) and discharge delays because of conservative medical management of patients (3.4%), social problems representing only 0.6%. A daily average of 4.2 beds (total of 19) were inappropriate used as assessed by modified AEP criteria. DISCUSSION: EDO represents an alternative for conventional hospitalization, obtaining patient clinical stabilization in 48 hours and saving unnecessary hospital admissions. AEP application lets know the impact of the efficient use of this area in the emergency department and the hospital.

Evaluación del uso apropiado de un área de observación de urgencias mediante el Appropriateness Evaluation Protocol: un análisis de 4.700 casos / Evaluation in emergency department observation unit with the appropiateness evaluation protocol: an analysis of 700 cases

Fundamento: El Área de Observación de los Servicios de Urgencias (AOSU) es una alternativa a la hospitalización convencional. La adecuación de sus ingresos y estancias puede repercutir en la eficiente utilización del recurso cama en el hospital. Métodos: Evaluación prospectiva de los ingresos en el AOSU durante 18 meses, según criterios del Appropriateness Evaluation Protocol (AEP) original adaptados al área. Resultados: Se evaluaron 4.700 ingresos (55,1 por ciento varones, 44,9 por ciento mujeres; edad media: 64,9 ± 14,9 años). La estancia media fue 23,8 (± 18,3) horas. El 35,5 por ciento fueron alta domiciliaria y 62,0 por ciento ingresaron en el hospital. En 98,1 por ciento de pacientes se consigue estabilización clínica en 48 horas. El 85,0 por ciento de ingresos correspondieron a 35 categorías GRD, siendo la patología más prevalente la enfermedad pulmonar obstructiva crónica (EPOC) (411 ingresos, 9,0 por ciento). Cumplieron criterios de admisión inadecuada 258 (5,5 por ciento) ingresos, predominando las necesidades diagnósticas y terapéuticas que podían realizarse como paciente externo (3,4 por ciento). Se consideraron inapropiadas 797 (17,0 por ciento) estancias, fundamentalmente debido a problemas hospitalarios por falta de camas (13,0 por ciento) y actitud médica conservadora retrasando el alta (3,4 por ciento), mientras que la problemática social únicamente representó 0,6 por ciento. Un promedio diario de 4,2 camas (del total de 19) se utilizaron inadecuadamente según el AEP modificado. Conclusiones: La AOSU representa una alternativa de la hospitalización convencional, consiguiendo la estabilización clínica de los pacientes en 48 horas y evitando ingresos innecesarios en el hospital. La aplicación del AEP permite conocer el impacto de la utilización inadecuada de esta área sobre el servicio de Urgencias y el propio hospital (AU)

Chronic rhinitis associated with herpesviral infection in captive spur-thighed tortoises from Spain.

An epidemic of chronic rhinitis in a population of 50 captive spur-thighed tortoises (Testudo graeca graeca) from Palafrugell (Girona, Spain) is described, in which eight animals died and 12 were euthanatized to perform necropsies and post-mortem studies. The main clinical sign was a bilateral, seromucous rhinitis often accompanied by stomatitis and glossitis. Hematology and serum biochemistry were performed in 33 of the 50 ill animals and in 29 healthy tortoises from three disease-free populations. Lymphocyte count, aspartate aminotransferase (AST) activity, and alpha-globulin levels were significantly higher in the animals from the sick population. The heterophil count was significantly lower in the sick animals. Some of the diseased tortoises also showed a normocytic-normochromic anemia. Lesions were restricted to the respiratory system and oral cavity. Marked epithelial hyperplasia and presence of a severe mixed inflammatory infiltrate in the epithelium of the oral, nasal, and tracheal mucosae were observed. Electron microscopy demonstrated the presence of intracytoplasmic and intranuclear viral particles of the size, shape, and distribution pattern typical of a herpesvirus.

Immunocytochemical study of the pathogenesis of Pacheco's parrot disease in budgerigars.

Thirty-five budgerigars were infected with the Psittacid herpesvirus 1 (RSL-1 strain, ATCC) to study the pathogenesis of Pacheco's disease. Intramuscular (i.m.) and oral (p.o.) infection routes were used in 21 and 14 animals respectively. Animals were euthanized on days 1, 2, 3, 4, 6 and 8 post-inoculation (p.i.) and complete postmortem examinations and histological studies were performed. The presence of viral antigen in tissues was detected by immunohistochemical techniques using a rabbit polyclonal antibody. In the i.m.-infected birds, lesions were first detected on the third day p.i. and included necrotizing hepatitis and splenitis, both associated to the presence of viral antigen. Necrotic and inflammatory lesions as well as viral antigen were detected in many organs after the fourth day p.i. (oesophagus, crop, pancreas, kidney, adrenal gland, thyroid and parathyroid glands, thymus, ovary and feathers) proving generalization of the disease. Chronology of the infection was similar in the p.o.-infected birds. However, two main differences were observed between the groups: In the p.o. group, viral antigen was first detected in cloacal mucosa (3rd day p.i.), liver and spleen; and viral entry into target cells and dissemination to the rest of the tissues was slower in this group. In addition, detection of viral antigen in feather follicular epithelial cells and in granulosa cells of organ follicles are findings that could be of relevance to the transmission of the virus.

Immunocytochemical diagnosis of Pacheco's disease.

An indirect immunoperoxidase method for the detection of herpesvirus in the liver and digestive tract of two psittacines (Ara macao and Cacatua sulphurea) with Pacheco's disease is described. The anti-Pachecovirus antiserum used was obtained from hyperimmunized specific pathogen-free chickens. It is concluded that this easily executed technique yields reliable results, allows a firm diagnosis of Pacheco's disease to be made and it would be suitable for investigating the pathogenesis of Pacheco's disease.

Tracheobronchopathia osteochondroplastica.

6 cases of tracheobronchopathia osteochondroplastica are discussed. Diagnoses were established ante mortem. Endoscopic examination was performed in 3 patients because of hematic expectoration, in the other 3 cases the induction was given by chronic bronchorhea, slow-resolving pneumonia and suspected neoplasia, respectively. Calcification and cartilaginous areas were restricted to a small portion of the tracheobronchial tree in 1 of the cases; in 3 cases the disease affected the trachea and both main bronchi, whereas it was found markedly spread throughout the trachea in the last 2 patients. Tracheal tomography and bronchoscopic examination are considered the methods of choice for an ante mortem diagnosis of this disease.