Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey.

BACKGROUND: Patient safety (PS) is a key factor in reducing or even eradicating adverse incidents and events. Many health organizations promote strategies to improve PS, while also pointing out the importance of measuring it. For more than eight years, our institution has developed strategies focused on improving PS-culture among our personnel. The goal of this paper is to analyze the PS-culture between the years 2009 and 2017. METHODS: A cross-sectional survey focused on PS, and developed by the American Agency for Healthcare Research and Quality (AHRQ), was conducted in 2009 and in 2017 among all healthcare workers at Mutualia, anonymously and voluntarily. RESULTS: The overall response rate was similar in both 2009 and 2017 (37.2% and 38.5%, respectively). The average rating obtained showed a significant improvement over the period (7.7 vs. 8.1; p < 0.05). Itemizing by question, the main strengths were found in management support, organizational learning and continuous improvement, and, especially, in teamwork. Regarding weaknesses, the two lowest scores were those which refer to the balance between clinical safety and workload and the freedom to question the decisions made by superiors. CONCLUSIONS: The results obtained from the PS-surveys show that the overall PS-culture in our institution has increased, suggesting that the strategies focused on the improvement of PS-culture were well adopted among our personnel. The overall score places Mutualia at similar levels to those reached by the AHRQ and Spanish National Health System.

Bases y fundamentos del tratamiento de la carcinomatosis peritoneal por cáncer colorrectal. Revisión actual y puesta al día / Principles of the treatment of peritoneal carcinomatosis due to colorectal cancer. Current review and update

El cáncer de origen colorrectal es el tumor digestivo más frecuente. La alta incidencia de su diseminación abdominal, el mal pronóstico de estos pacientes, con una media de supervivencia de 5-9 meses demostrada en todos los estudios sobre la historia natural de la carcinomatosis colorrectal, y el fracaso del tratamiento adyuvante sistémico, con supervivencias máximas de 18 meses, han obligado al estudio y desarrollo de otras estrategias de tratamiento. Se presenta una revisión de los principios que fundamentan el Protocolo de Tratamiento de Sugarbaker, que comprende la máxima cirugía (..) (AU)

Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum (..) (AU)

[Principles of the treatment of peritoneal carcinomatosis due to colorectal cancer. Current review and update]. / Bases y fundamentos del tratamiento de la carcinomatosis peritoneal por cáncer colorrectal. Revisión actual y puesta al día.

Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum survival of 18 months. Consequently, other treatment strategies need to be studied and developed. We present a review of the principles that underlie Sugarbakers treatment protocol, which includes maximal cytoreductive surgery for the treatment of macroscopic disease through peritonectomy together with perioperative intraperitoneal intensification chemotherapy for residual microscopic disease. We present all the phase II studies with more than 10 treated patients published in the medical literature by the main groups working in this line of treatment, together with the only phase III study published to date. With this new therapeutic alternative, the mean overall survival at 2 and 5 years is 40% and 20% respectively. Based on these results, this new therapeutic approach is recommended as the treatment of choice in these unfortunate patients. The limits of the treatment of advanced colorectal cancer are also discussed.

Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit.

OBJECTIVES: To assess the influence of nosocomial infection on length of stay in the intensive care unit (ICU) and to determine the relative effect of other factors on extra length of hospitalization associated with nosocomial infection. DESIGN: Prospective cohort multicenter study in the context of the ENVIN-UCI project. SETTING: Medical or surgical ICUs of 49 different hospitals in Spain. METHODS: All consecutive patients (N = 6,593) admitted to ICUs of the participating hospitals who stayed for more than 24 hours during a 3-month period (from January 15 to April 15, 1996) were included. Length of ICU stay was compared between patients with and without nosocomial infections. RESULTS Uninfected patients (N = 5,868) had a median stay in the ICU of 3 days, whereas the median for infected patients (N = 725) was 17 days (P < .001). The median for infected patients with one episode of nosocomial infection was 13 days. The greatest length of stay (40 days) was among patients admitted to the ICU because of medical diseases, with an infection acquired before admission to the ICU, and with the largest number of nosocomial infection episodes. In extended stays, nosocomial infection was significantly associated with length of hospitalization (day 21; odds ratio, 22.38; 95% confidence interval 16.6 to 30.4), whereas an effect of variables related to severity of illness on admission (Acute Physiology and Chronic Health Evaluation II score, urgent surgery, and infection prior to ICU admission) was not found. CONCLUSIONS: The presence of nosocomial infection and the number of infection episodes were the variables with the strongest association with prolonged hospital stay among ICU patients.