[Evolution of patient safety culture in a medium-stay hospital: monitoring indicators]. / Evolución de la cultura de seguridad del paciente en un hospital de media-larga estancia: indicadores de seguimiento.

BACKGROUND: Patient safety is a challenge for health care. The aim of this study is to identify the dimensions with the greatest impact on patient safety culture of healthcare staff in a medium-stay hospital; to asses its evolution over time and to check the sensitivity of monitoring indicators. METHODS: Two cross-sectional studies (2013 to 2015) were conducted. The safety culture assessment tool used was the Spanish version of the "Hospital Survey on Patient Safety" (AHRQ). Outcome variable is high perception of safety (score = 75th percentile). INDEPENDENT VARIABLES: socio-demographic characteristics and perceptions of the evaluated dimensions. The association between variables was quantified by Odds Ratio. RESULTS: The mean of perceived safety was similar in both studies: (7.81 and 7.48, N2013= 66; N2015=92). The best aspects evaluated were: "Supervisor actions" and "Teamwork within unit"; the worst evaluated were: "Staffing", "Management support" and "Teamwork across units". Socio-demographic variables had little significance, while a positive perception in some of the considered dimensions was associated with high perceived safety. The most strongly associated aspects were: "Supervisor actions", "Communication openness" and "Problems in transitions". In the comparative study, indicators based on individual dimensions detected changes better than the assessment of the degree of perceived safety. CONCLUSION: The regular assessment of Patient Safety Culture makes it possible to know the status and evolution of professionals' perceptions. The choice of appropriate indicators optimises the information obtained through these surveys.

Evolución de la cultura de seguridad del paciente en un hospital de media-larga estancia: indicadores de seguimiento / Evolution of patient safety culture in a medium-stay hospital: monitoring indicators

Fundamento: La seguridad del paciente es un reto para la asistencia sanitaria. El objetivo de este estudio es identificar las dimensiones con mayor impacto sobre la cultura de seguridad en un hospital de media-larga estancia, monitorizar su evolución y comprobar la sensibilidad de los indicadores de seguimiento. Material y métodos: Se realizaron 2 estudios transversales (2013-2015), utilizando la versión española del cuestionario «Hospital Survey on Patient Safety» (AHRQ). Variable resultado: alto grado de seguridad percibida (puntuación ≥ al percentil 75). Variables predictoras: características socio-demográficas y percepciones de las dimensiones evaluadas. La asociación entre variables se cuantificó mediante OddsRatio. Resultados: El grado de seguridad percibida fue similar en ambos estudios: (7,81-7,48; N2013=66; N2015=92). Los aspectos mejor evaluados fueron: «Acciones de los supervisores» y «Trabajo en equipo en la unidad»; los peor evaluados fueron: «Dotación de personal», «Apoyo de la dirección» y «Trabajo en equipo entre unidades». Las variables socio-demográficas presentaron escasa significación, mientras que una percepción positiva de algunas dimensiones consideradas, sí que se asociaba a un alto grado de seguridad percibida. Los aspectos más fuertemente asociados fueron: «Acciones de los supervisores», «Franqueza en la comunicación» y «Problemas en los cambios de turno». En el estudio comparativo de los resultados, los indicadores basados en las dimensiones individuales detectaron mejor los cambios que el grado de seguridad percibida. Conclusiones: La evaluación periódica de la cultura de seguridad permite conocer el estado y la evolución de las percepciones de los profesionales. La elección de indicadores apropiados optimiza la información obtenida a través de estas encuestas (AU)

Background: Patient safety is a challenge for health care. The aim of this study is to identify the dimensions with the greatest impact on patient safety culture of healthcare staff in a medium-stay hospital; to asses its evolution over time and to check the sensitivity of monitoring indicators. Methods: Two cross-sectional studies (2013 to 2015) were conducted. The safety culture assessment tool used was the Spanish version of the «Hospital Survey on Patient Safety» (AHRQ). Outcome variable is high perception of safety (score ≥ 75th percentile). Independent variables: socio-demographic characteristics and perceptions of the evaluated dimensions. The association between variables was quantified by Odds Ratio. Results: The mean of perceived safety was similar in both studies: (7.81 and 7.48, N2013= 66; N2015=92). The best aspects evaluated were: «Supervisor actions» and «Teamwork within unit»; the worst evaluated were: «Staffing», «Management support» and «Teamwork across units». Socio-demographic variables had little significance, while a positive perception in some of the considered dimensions was associated with high perceived safety. The most strongly associated aspects were: «Supervisor actions», «Communication openness» and «Problems in transitions». In the comparative study, indicators based on individual dimensions detected changes better than the assessment of the degree of perceived safety. Conclusion: The regular assessment of Patient Safety Culture makes it possible to know the status and evolution of professionals' perceptions. The choice of appropriate indicators optimises the information obtained through these surveys (AU)

Decisiones ético-clínicas sobre la alimentación e hidratación artificial mediante sonda en la enfermedad terminal / Ethical and clinical decisions on artificial hydration and feeding via tube in the terminally ill

El soporte nutricional artificial mediante sondas de acceso digestivo es un tratamiento médico ampliamente utilizado. La indicación de soporte nutricional prolongado en pacientes terminales y en pacientes con deterioro neurológico irreversible crea conflictos éticos y legales de difícil solución. En este trabajo, además de aportar nuestra casuística en enfermos con deterioro psicorgánico avanzado, se revisan las bases culturales y ético-legales, así como se sugieren líneas de actuación sencillas que puedan servir de orientación clínica, si bien la toma de decisiones clínicas debe ser siempre individualizada y pormenorizada en cada caso, incluyendo, en el proceso de decisión clínica, las preferencias del paciente y de sus familiares (AU)

Tube feeding is a widely used medical treatment for providing nutrition to terminally ill patients. Long term nutritional support in these patients or patients with irreversible neurological deterioration create a host of ethical and legal conflicts with difficult solutions. This work looks at the cultural and ethical-legal basis of these decisions and gives simple suggestions that might help the health care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the rights and desires of each patient and their families (AU)

[Ethical and clinical decisions on artificial hydration and feeding via tube in the terminally ill]. / Decisiones ético-clínicas sobre la alimentación e hidratación artificial mediante sonda en la enfermedad terminal.

Tube feeding is a widely used medical treatment for providing nutrition to terminally ill patients. Long term nutritional support in these patients or patients with irreversible neurological deterioration create a host of ethical and legal conflicts with difficult solutions. This work looks at the cultural and ethical-legal basis of these decisions and gives simple suggestions that might help the health care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the rights and desires of each patient and their families.

[Miliary tuberculosis and cerebral tuberculomas. Apropos a case]. / Tuberculosis miliar y tuberculomas cerebrales. A propósito de un caso.

We present a case of a 45-year-old patient with miliary tuberculosis (MI), whose initial clinical symptomatology was uncertain. A few weeks after the beginning of chemotherapy, and in the face a Jacksonian crisis, cerebral tuberculomas were detected with CAT. The interesting thing in this case is to highlight that the diagnosis of MT anatomopathologic after pulmonary biopsy with mini-thoracotomy and that the cerebral complication could be classified within the so-called "paradoxical worsening" as it has been documented in the literature.