Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial.

OBJECTIVE: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. METHODS: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. RESULTS: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. CONCLUSIONS: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it.

Fraude y plagio en la carrera y en la profesión / Fraud and plagiarisim in school and career

Entre el 0 y el 94% de los estudiantes reconocen haber cometido fraude durante su carrera. Sus formas son diversas: engaños en los exámenes, suplantación en exámenes y trabajos, plagios, citas falsas o inventadas, presentación de resultados ficticios en experimentos, historias clínicas o exploraciones físicas, conducta desleal hacia los compañeros y muchos otros. Entre las consecuencias del fraude en los estudios se encuentran el aprendizaje de la corrupción, los esfuerzos baldíos de alumnos y profesores, la evaluación incorrecta y la selección injusta para puestos de trabajo. Dado que las trampas en la universidad pueden ser el preludio de la corrupción de los futuros médicos o investigadores, revisamos la prevalencia, factores de riesgo, motivaciones, formas clínicas, detección y prevención de la enfermedad del fraude académico (AU)

Between 0% and 94% of university students acknowledge having committed academic fraud. Its forms are varied: cheating on examinations, submitting someone else's work, plagiarism, false citations, false reporting on experiments, tests or findings in the medical history and physical examination, unfair behavior toward fellow students, and many others. The consequences of academic fraud include learning corruption, useless efforts by students and faculty, incorrect performance evaluations and unfair selection for jobs. Since this can be a prelude to future fraud as doctors or researches, the prevalence, risk factors, motivations, clinical appearances, detection and prevention of the disease of academic fraud are here reviewed (AU)

Fraud and plagiarisim in school and career. / Fraude y plagio en la carrera y en la profesión.

Between 0% and 94% of university students acknowledge having committed academic fraud. Its forms are varied: cheating on examinations, submitting someone else's work, plagiarism, false citations, false reporting on experiments, tests or findings in the medical history and physical examination, unfair behavior toward fellow students, and many others. The consequences of academic fraud include learning corruption, useless efforts by students and faculty, incorrect performance evaluations and unfair selection for jobs. Since this can be a prelude to future fraud as doctors or researches, the prevalence, risk factors, motivations, clinical appearances, detection and prevention of the disease of academic fraud are here reviewed.

Higher vitamin D levels in HIV-infected out-patients on treatment with boosted protease inhibitor monotherapy.

OBJECTIVES: We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. METHODS: For this cross-sectional study, out of 450 HIV-infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured (January 2009 to December 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load (VL), CD4 cell count, and concentrations of 25(OH)-vitamin D [25(OH)-D], parathyroid hormone (PTH), albumin and calcium. Vitamin D status cut-off points were: (1) deficiency (vitDd): 25(OH)-D < 20 ng/mL; (2) insufficiency (vitDi): 25(OH)-D from 20 to 29.99 ng/mL; and (3) optimal (vitDo): 25(OH)-D ≥ 30 ng/mL. RESULTS: The percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty-nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV-1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs. Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2-94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13-4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25-8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10-7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01-0.6; P = 0.018). CONCLUSIONS: Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.

Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients.

BACKGROUND: Researchers have previously found that persistent subthreshold symptoms increase the risk and shorten the time until an affective relapse in bipolar disorder (BD) patients. Research has mainly focused on patients from tertiary Care Centers in USA. We tested the hypothesis that even in a different setting, BD outpatients with subsyndromal affective symptoms would re.turn to a subsequent major affective episode significantly faster than completely asymptomatic at baseline. Secondarily, we analysed other variables related to time and risk to relapse. METHODS: A community cohort of BD outpatients from Madrid (Spain) followed-up in a systematic prospective follow-up protocol for up to five years were evaluated. Patients in clinical euthymia at baseline were included and evaluated quarterly. RESULTS: Initially, 225 patients were included in the survival analysis. Of them, according to predefined psychometric criteria, 163 were in euthymia (72.4%) and 62 (27.6%) suffered subsyndromal symptoms. Median follow-up was 157.6 weeks (95% CI, 78.14 to 111); 57.3% of patients experienced at least one affective episode during their follow-up. Median survival time to first affective episode was 109 weeks for patients in euthymia at baseline, versus 35 weeks for those with subsyndromal symptoms (p<0.0001). Psychosocial stress (p=0.003; HR 2.20; 95% CI 1.31-3.68) and the affective mood baseline state, subsyndromal vs. euthymic (p=0.046; HR 1.74; 95%CI 1.009-3.020), were related to time to first affective episode. LIMITATIONS: Naturalistic study, some of the data collected were necessarily retrospective. CONCLUSIONS: In Spanish non-tertiary psychiatric outpatients, subsyndromal BD symptoms and psychosocial stress at baseline predict earlier episode relapse/recurrence.

Syndromal and subsyndromal illness status and five-year morbidity using criteria of the International Society for Bipolar Disorders compared to alternative criteria.

BACKGROUND: Subsyndromal symptoms have been recognized as relevant in the course and outcome of bipolar disorder (BD) patients. Nevertheless, their definition and cutoff points on current depression and mania scales are uncertain. The recently defined International Society for Bipolar Disorders (ISBD) operational criteria for the assessment of the course and outcome of bipolar illness have never been tested until now. METHODS: A naturalistic longitudinal follow-up study of up to 5 years included a cohort of 317 DSM-IV-TR BD outpatients. For the first time, we assessed the proportion of visits in different affective states using the ISBD criteria. Secondarily, we compared the results with those obtained applying other cutoff points. RESULTS: Patients were symptomatic in 39.1% (95% CI 35.3-42.9) of the visits. Subsyndromal symptoms, primarily subsyndromal depression, were present in 15.9% of patients (95% CI 13.4-18.4). No significant differences were found between bipolar I patients and bipolar II patients. There were differences in the total percentage of visits in euthymia depending on the cutoff points (p < 0.05). CONCLUSIONS: Applying ISBD criteria, bipolar patients have significant clinical morbidity and are often symptomatic, both with threshold symptoms and with subthreshold symptoms, especially with depression. The chosen cutoff points modify the apparent results. LIMITATIONS: The cutoff points used have not been validated. Psychopharmacologic treatments were naturalistic.

Factores familiares y sociales asociados al bienestar emocional en adolescentes diabéticos

Hemos realizado un estudio transversal en el que han participado 55 adolescentes diabéticos y sus familias. Se analizan las relaciones existentes entre factores sociodemográficos, características generales de la familia, apoyo específico a la enfermedad, bienestar del adolescente y control metabólico. El sexo y la cohesión familiar son los factores que con más fuerza predicen el bienestar del adolescente diabético. El apoyo específico a la enfermedad tanto por parte de la familia como de los amigos es también un importante factor asociado al bienestar. No se encuentra ninguna asociación entre las variables estudiadas y el control metabólico. Los resultados nos llevan a la conclusión de que, en los adolescentes estudiados, el bienestar emocional depende de factores personales y de su entorno, y es independiente del buen control de su glucemia (AU)

Isquemia intestinal intermitente en relación con tumor / Intermittentintestinal ischemia caused by ileal carcinoid tumor

No disponible

Kaposi's sarcoma with an intense parasitization by Leishmania.

Visceral leishmaniasis has been reported as a complication in patients infected with human immunodeficiency virus (HIV) who live in areas where leishmaniasis is endemic or in patients who have traveled to these areas. Kaposi's sarcoma has been found frequently in patients with acquired immunodeficiency syndrome (AIDS). We report a HIV-infected patient having visceral leishmaniasis associated with Kaposi's sarcoma in which a biopsy specimen obtained from a pigmented cutaneous lesion revealed the coexistence of a Kaposi's sarcoma pattern with Leishmania parasitic colonization.

Systemic anaphylaxis following parenteral orgotein administration.

We present a patient displaying a systemic anaphylactic reaction after local infiltration of orgotein. An IgE-mediated mechanism was demonstrated with skin tests and specific IgE measurement. It is concluded that orgotein can rarely cause IgE-mediated anaphylaxis.

[Hepatic fascioliasis. Resistance to praziquantel treatment and the radiological findings]. / Fasciolasis hepática. Resistencia al tratamiento con praziquantel y hallazgos radiológicos.

We report a case of hepatic fascioliasis. Fever and epigastric pain was the clinical presentation. We describe the features of the ultrasound and computed tomography examination. Symptoms were persistent after praziquantel treatment. Bithionol was effective and cured the patient.

Growth hormone response to acute growth hormone releasing hormone administration in uraemic patients on haemodialysis.

To examine the response of growth hormone (GH) to growth hormone releasing factor (GHRF) in patients on haemodialysis, we performed the acute GHRF test (50 micrograms administered intravenously as a bolus) in 10 uraemic male patients on haemodialysis and eight normal controls. Each patient was tested before and after a haemodialysis session (at 08.30 and 12.30). Controls were tested on the same time schedule. At 08.30, patients had significantly greater basal and peak GH values (2.5 +/- 0.6 and 27.8 +/- 5.5 micrograms/l) than controls (0.68 +/- and 11.5 +/- 4 micrograms/l). After the haemodialysis session, basal and peak values declined significantly (P less than 0.01) in the uraemic group (0.5 +/- 0.03 and 3.1 +/- 1.1 micrograms/l), whereas the controls did not show such a change in the 12.30 test. Basal and intratest glycaemic values were comparable both before and after haemodialysis. After dialysis test results did not change either with the use of glucose-free dialysate or with bicarbonate buffer. Uraemic patients display a greater GH response to GHRF injection than normal subjects, and this response decreases after haemodialysis. The degree of reduction has no relationship with either glycaemia or the dialysate buffer. We suggest that other GH secretion regulating factors are altered by the haemodialysis procedure.