Estudio de percepción de seguridad en pacientes aislados y no aislados en un hospital de agudos y análisis de concordancia con su identificación por los profesionales / Study of perception of security in isolated and non-isolated patients in an acute hospital and concordance analysis with their identification by the professionals

Objetivo: Evaluar la percepción del paciente sobre la ocurrencia de incidentes relacionados con la seguridad (IRS) y eventosadversos (EA) en pacientes sometidos a precauciones de transmisión (pacientes aislados) y pacientes no aislados durante suingreso hospitalario y compararlo con los identificados por los profesionales sanitarios en la revisión de las historias clínicas en unhospital público universitario de agudos de la provincia de Alicante.Metodología: Estudio transversal mediante encuesta telefónica a pacientes aislados y no aislados con cuestionario validado depercepción de seguridad sobre la ocurrencia de IRS y EA y posterior análisis de concordancia mediante coeficiente Kappa con losidentificados por el personal sanitario en la revisión de historias clínicas.Resultados: Los pacientes aislados respecto a los no aislados, manifestaron haber tenido menos complicaciones médicas poralguna medicación y estas eran poco graves. Por el contrario, manifestaron tener algo más de complicaciones médicas porintervenciones quirúrgicas y ser poco graves. Finalmente, opinaron haber padecido más eventos adversos, respecto a los noaislados. Las diferencias no fueron estadísticamente significativas. En los resultados del índice de concordancia (índice Kappa),de identificación de EA de los pacientes durante su ingreso, y los identificados por los profesionales sanitarios en la revisión de lashistorias clínicas, se observó una fuerza de concordancia leve (Kappa= 0,061).Discusión: Los resultados de nuestro estudio pueden estar influenciados por una escasa información a los pacientes sobre suproceso clínico (diagnóstico, tratamientos y efectos adversos, etc...), esto podría ser la causa del bajo nivel de detección porlos pacientes de los incidentes relacionados con la seguridad que hayan podido suceder durante su ingreso hospitalario...(AU)

Objective: To evaluate the perception of the patient about the occurrences of IRS and AE in patients subjected to transmissionprecautions (isolated patients) and non-isolated patients during their hospital admission and compare it with those identified bythe health professionals in the review of the medical records in a public university hospital for acute care in the province of Alicante.Methodology: Cross-sectional study using a telephone survey in isolated and non-isolated patients with a validated questionnaire in the perception of safety on the occurrence of IRS and AEs and subsequent concordance analysis using the Kappa coefficient withthe identifiers by the health personnel in the review of medical records.Results: The isolated patients compared to the non-isolated ones, stated that they had fewer medical complications due to anymedication and these were not serious. On the contrary, they stated that they had slightly more medical complications fromsurgical interventions and that they were not very serious. Finally, they thought they had suffered more adverse events, comparedto those not isolated. The differences were not statistically significant. In the results of the concordance index (Kappa index), forthe identification of AEs of the patients during their admission, and those identified by the health professionals in the review of themedical records, a slight strength of concordance was discovered (Kappa= 0.061).Discussion: The results of our study may be influenced by insufficient information given to patients about their clinical process(diagnosis, treatments and adverse effects, etc...), this could be the cause of the low level of detection by patients of incidentsrelated to the security that may have happened during their hospital admission...(AU)

An overview of patterns and dynamics of suspended sediment transport in an agroforest headwater system in humid climate: Results from a long-term monitoring.

Small headwater catchments deliver large quantities of suspended sediment (SS) to the ocean. However, there are relatively few studies focused on the study of patterns and dynamics of suspended sediment in headwater catchments over the long-term (10 year or more). In this study, the dynamics of suspended sediment transport were examined at different time scales in a small headwater catchment in NW Spain, based on a 12-year dataset from high-resolution monitoring. The results revealed that, similar to other humid catchments, the hydrological response was highly dependent on initial conditions, especially in autumn and summer. However, in winter and spring the hydrology was more influenced by rainfall amount. The annual suspended sediment was 117 Mg, which equates to a suspended sediment yield of 10 Mg km-2 y-1. The SS yield in the Corbeira catchment is related to runoff generation and flooding, which play a key role in sediment yield from the catchment. About 80% of the annual SS was transported over 12% of the study period. Rainfall and discharge at the beginning of the events were the most important factors in explaining the hydrological response at event scale. Suspended sediment transport in this catchment is determined by event magnitude, while the SS is mainly influenced by variables related to runoff erosivity.

[Critically ill patient isolation: risk or protection?] / Aislamiento del paciente crítico: ¿riesgo o protección?

INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

Aluminum fractionation in acidic soils and river sediments in the Upper Mero basin (Galicia, NW Spain).

This study aims to determine aluminum fractions in the fine earth of acidic soils under different land uses (forest, pasture and cultivation) and in the river bed sediments of the headwater of the Mero River in order to identify and quantify Al-bearing phases to assess Al mobility and potential bioavailability (environmental availability) in the monitoring area. Sequential extraction is used to evaluate the Al partitioning into six fractions operationally defined: soluble/exchangeable/specifically adsorbed, bound to manganese oxides, associated with amorphous compounds, aluminum bound to oxidizable organic matter, associated with crystalline iron oxides, and residual fraction (aluminum within the crystal lattices of minerals). The mean concentration of total aluminum (24.01 g kg-1) was similar for the three considered uses. The mean percentage of the aluminum fractions, both in soils and sediments, showed the following order: residual fraction â‰« amorphous compounds ≈ crystalline iron oxides > water-soluble/exchangeable/specifically adsorbed > bound to oxidizable organic matter ≈ Mn oxides. However, in the soils, the amorphous compounds and water-soluble/exchangeable/specifically adsorbed fraction showed considerable differences between some types of uses, the percentage of aluminum linked to amorphous compounds being higher in forest soils (16% of total Al) compared to other uses (mean about 8% of total Al). The highest values of water-soluble/exchangeable/specifically adsorbed Al were also found in forest soils (mean 8.6% of the total Al versus about 4% of pasture and cultivation), which is consistent with the lower pH and higher organic matter content in forest soils. Nevertheless, the potentially bioavailable fraction (sum of the first three fractions) is low, suggesting very low geoavailability of this element in both soils and sediments; hence, the possibility to affect the crops and water quality is minimal.

Short-term nitrogen losses by overland flow in a recently burnt forest area in north-central Portugal: A study at micro-plot scale.

Over the past decades, wildfires have affected extensive areas of the Mediterranean region with negative impacts on the environment. Most of the studies on fire-affected areas have focused on sediment losses by overland flow, whereas few have addressed post-fire nutrient export. The present study aimed to address this research gap by assessing nitrogen (nitrate and total nitrogen) losses by overland flow in a recently burnt area in north-central Portugal. To this end, three burnt slopes were selected for their contrasting forest types (eucalypt vs. pine) and parent materials (granite vs. schist). The selected study sites were a eucalypt site on granite (BEG), a eucalypt site on schist (BES) and a maritime pine site on schist (BPS). Overland flow samples were collected during the first six months after the wildfire on a 1- to 2-weekly basis, after which this study had to be cancelled due to bench terracing of some of the sites. A peak in total nitrogen concentrations was observed in burnt areas immediately after the first post-fire rainfall event as a response to the erosion of the N-enriched ash layer. After this initial peak, smaller peaks were observed throughout the study period, mainly as a response to overland flow and/or erosion events. Nitrogen export differed strikingly between the two types of forests on schist, being higher at the eucalypt than at the pine site, due to the lack of a protective soil layer. Parent material did not play an important role on nitrogen export by overland flow since no significant differences were found between the eucalypt sites on granite and schist. The present study provides some insight into the differences in post-fire soil fertility losses between forest types and parent materials in the Mediterranean region, which is crucial information for defining post-fire land management measures to reduce soil degradation.

[Identification of adverse events in hospitalised influenza patients]. / Identificación de eventos adversos en pacientes hospitalizados por gripe.

OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

Phosphorus loss from a mixed land use catchment in northwest Spain.

This work examined P loss from a mixed land use catchment in northwest Spain and how it was related to hydrological factors. A stream draining a mixed land use catchment of 16 km in northwest Spain was monitored for 5 yr. Water samples were taken more frequently with increased stream flows. A total of 132 runoff events of different magnitudes were analyzed in this study. Mean annual P loss from the catchment was 11.5 kg km, about 68% being transported during runoff events, which only contributed to 29% of the flow. The contribution of runoff events to particulate P and dissolved P losses was 76 and 46% of total losses during the study period, respectively. A high interannual variability in P loss was observed, the differences being related to rainfall amount and distribution. At a seasonal scale, the highest P loads and concentrations were observed during rainy seasons; the lowest P loads occurred in summer because they occurred with stream flow. Particulate P accounted for the greatest proportion (74%) of transported P. There was a high variability in P transported between runoff events, with maximum discharge and discharge increase being the most important variables explaining total P concentration in these events through their effect on suspended sediment concentration.

Evaluación del estudio de contactos de tuberculosis en el Departamento de Salud 17 de Alicante / Assessment of tuberculosis contact tracing in the 17th health area in Alicante

Objetivo: Evaluar el estudio de contactos (EC) de tuberculosis realizado en nuestro servicio y analizar la demora en el diagnóstico y en la notificación de los casos de tuberculosis y el retraso en el inicio del EC. Material y métodos: Se realizó un estudio observacional retrospectivo de los casos índices de tuberculosis y sus contactos declarados, además de la adecuación del manejo de los contactos estudiados, y se calculó la demora en el diagnóstico y la notificación de los casos de tuberculosis y la demora en el inicio del estudio de contactos. Resultados: La tasa global de tuberculosis encontrada fue de 10,91 por 100.000 habitantes durante el total de años de estudio. Se identificaron 128 casos de tuberculosis y 635 contactos. Para todos los casos de tuberculosis, la mediana de la demora diagnóstica total fue de 45 días, de la demora en la declaración de tres días y de la demora en el inicio del estudio de contactos de 9,5 días. Entre los contactos evaluados se diagnosticaron ocho nuevos casos de tuberculosis. En el 94,5% de los contactos estudiados el manejo fue adecuado. Conclusión: El manejo de los contactos de tuberculosis fue en su mayor parte adecuado. La demora diagnóstica para los casos de tuberculosis fue elevada, mientras que el retraso en la notificación de los casos de tuberculosis y en el inicio del estudio de contactos, estuvieron en límites normales (AU)

Objective: To assess the tuberculosis (TB) contact investigations conducted in our Department and to analyze the delay in diagnosis and reporting of TB cases and the delay in starting the contacts investigations. Methods: We carried out a retrospective observational study of the reported tuberculosis index cases and their contacts. We analyzed the adequacy of management of contacts investigations and calculated the delay in diagnosis and reporting of TB cases in addition to the delay in the onset of contacts study. Results: The overall rate of tuberculosis found was 10.91 per 100,000 inhabitants during the total years of study. We identified 635 contacts of 128 tuberculosis cases. The median from total diagnostic delay was 45 days, from delay in the notification three days and from delay in the start of contact investigations 9,5 days for all TB cases. Among the assessed contacts were diagnosed eight new TB cases during contact investigations. In the 94.5% of studied contacts the management was adequate. Conclusion: The management of TB contacts was mostly adequate. The delay in diagnosis for tuberculosis cases was elevated. The delay in the notification of tuberculosis cases and the delay in the start of contacts investigations were found within normal limits (AU)

Plan de seguridad clínica del Complejo Hospitalario Universitario de Albacete (CHUA). Diagnóstico inicial: estudio de eventos adversos / Clinical safety plan in a university hospital complex. Initial diagnosis: Study of adverse events

Objetivos. Determinar la incidencia de eventos adversos (EA) y de pacientes con EA en el Complejo Hospitalario Universitario de Albacete (CHUA). Identificar y definir los EA ligados a la asistencia; analizar los EA evitables y conocer su impacto; planificar las acciones de mejora. Método. Diseño. Estudio retrospectivo de cohortes. Ámbito de estudio. Pacientes dados de alta del 5 al 19 de noviembre de 2007. Definición de caso Todo accidente o incidente recogido en la historia clínica que ha causado daño al paciente o lo ha podido causar. Instrumentalización. Guía de cribado de efectos adversos, adaptada del estudio de Harvard. Versión española del formulario modular para revisión retrospectiva de casos, MRF2. Análisis estadístico. Análisis univariante, bivariante y modelo de regresión logística. Resultados. La incidencia de pacientes con EA relacionados con la asistencia hospitalaria fue de 6,8%. La incidencia fue diferente significativamente según: edad, presencia de factores de riesgo intrínseco y extrínseco (excluyendo el catéter venoso periférico). El 8,2% de los EA se relacionaron con cuidados, el 14,3% con medicación, el 26,5% con infecciones nosocomiales, el 35,7% con problemas técnicos en procedimientos, el 11,2% con diagnóstico y el 4,1% restante con otros tipos de EA. El 12,2% se consideraron leves, 78,6% moderados y 8,2% graves. El 50% de EA aumentaron la estancia, y en un 34,7% condicionó el ingreso. El 63,3% de los EA se consideraron evitables. Conclusiones. El estudio de EA en el CHUA constituye un aspecto de mejora dentro del programa de calidad del hospital. Las incidencias de pacientes con EA y con la asistencia sanitaria se encuentran entre las alcanzadas en el conjunto de estudios cuyo objetivo es la mejora de la calidad(AU)

Objectives. To establish the incidence of adverse events (AEs) and incidence of patients with AEs in the University Hospital Complex of Albacete (CHUA); to identify and define the AEs which are linked to health care; to analyse avoidable AE and determine their impact; to plan improvement actions. Method. Design. Retrospective cohort study. Sample. Patients registered from 5 November to 19 November, 2007. Case definition. Any accident or incident reported in the medical record which injured or may have injured the patient. Material. Adverse Events Screening Guide, adapted from the Harvard study. Spanish version of the Modular Review Form (MRF2) for retrospective case record review. Statistical Analysis. Univariate and bivariate analysis and logistic regression model. Results. The incidence of patients with AEs linked to hospital care was 6.8%. The incidence was significantly different depending on: age, presence of intrinsic or extrinsic risk factors (excluding peripheral venous catheter); 8.2% of AE was linked to care; 14.3% to medication; 26.5% to nosocomial infections; 35.7% to technical problems in procedures; 11.2% to diagnosis, and the remaining 4.1% to other types of AEs. In these incidences, 12.2% were considered mild, 78.6% moderate and 8.2% serious. Half (50%) of AEs caused an increase in hospital stay, and in 34.7% cases determined hospitalisation. A total of 63.3% of AEs were considered avoidable. Conclusions. The study of AEs in the CHUA represents an improvement within the hospital quality program. Incidences of patients with AEs and those related to health care fall within the range of those found in the studies where the objective was quality improvement(AU)

[Clinical safety plan in a university hospital complex. Initial diagnosis: study of adverse events]. / Plan de seguridad clínica del Complejo Hospitalario Universitario de Albacete (CHUA). Diagnóstico inicial: estudio de eventos adversos.

OBJECTIVES: To establish the incidence of adverse events (AEs) and incidence of patients with AEs in the University Hospital Complex of Albacete (CHUA); to identify and define the AEs which are linked to health care; to analyse avoidable AE and determine their impact; to plan improvement actions. METHOD: . DESIGN: Retrospective cohort study. SAMPLE: Patients registered from 5 November to 19 November, 2007. CASE DEFINITION: Any accident or incident reported in the medical record which injured or may have injured the patient. MATERIAL: Adverse Events Screening Guide, adapted from the Harvard study. Spanish version of the Modular Review Form (MRF2) for retrospective case record review. STATISTICAL ANALYSIS: Univariate and bivariate analysis and logistic regression model. RESULTS: The incidence of patients with AEs linked to hospital care was 6.8%. The incidence was significantly different depending on: age, presence of intrinsic or extrinsic risk factors (excluding peripheral venous catheter); 8.2% of AE was linked to care; 14.3% to medication; 26.5% to nosocomial infections; 35.7% to technical problems in procedures; 11.2% to diagnosis, and the remaining 4.1% to other types of AEs. In these incidences, 12.2% were considered mild, 78.6% moderate and 8.2% serious. Half (50%) of AEs caused an increase in hospital stay, and in 34.7% cases determined hospitalisation. A total of 63.3% of AEs were considered avoidable. CONCLUSIONS: The study of AEs in the CHUA represents an improvement within the hospital quality program. Incidences of patients with AEs and those related to health care fall within the range of those found in the studies where the objective was quality improvement.

Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos / Factors that contribute to health care associated infections: how to prevent them

Objetivo. Identificar las características de los pacientes y de la asistencia asociadas con la infección relacionada con la atención sanitaria (IRAS) y determinar si existen diferencias entre las evitables (IRASE) y las que no lo son. Método. Estudio de cohortes retrospectivo basado en tres estudios españoles de eventos adversos ligados a la hospitalización. Se revisaron las historias clínicas valorando si la asistencia era la causante de IRAS e IRASE. Resultados. El 2,3% de los pacientes del estudio presentó una o más IRAS. El 60,2% fueron IRASE. Los que presentaron IRAS eran mayores que el resto, y presentaron mayor número de factores de riesgo intrínseco y extrínseco. Se observaron diferencias entre los pacientes que presentaron IRAS o IRASE en la presencia de algún factor de riesgo intrínseco. Los factores que mejor explicaron IRAS fueron distintos para cada una de las localizaciones más frecuentes. En el caso de las IRAS: catéter urinario (OR=2,4), catéter venoso central (OR=1,8) y sonda nasogástrica (OR=1,9); servicio de ingreso quirúrgico (OR=1,6) y estancia hospitalaria >1 semana (OR=7,5). Las estrategias identificadas para evitar IRAS fueron: técnica aséptica adecuada (25,5%), correcto seguimiento de los protocolos de sondaje vesical (20%) y de los cuidados y la valoración de vulnerabilidad de los pacientes (16,5%). Conclusiones. Entre los pacientes que presentaron IRAS y los que no presentaron se encontraron características diferenciadas. La evitabilidad es un juicio de valor independiente del de causalidad y se relaciona con si se han aplicado de forma correcta o no los protocolos. Identificar estos puntos en la asistencia permite establecer estrategias de mejora de la asistencia(AU)

Objective. To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. Method. A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. Results. A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). Conclusion. Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care(AU)

[Factors that contribute to health care associated infections: how to prevent them]. / Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos.

OBJECTIVE: To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. METHOD: A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. RESULTS: A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). CONCLUSION: Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care.

Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS).

OBJECTIVE: To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. DESIGN: Retrospective cohort study. SETTING: Twenty-four Spanish hospitals. PARTICIPANTS: Patients of any age with a clinical record indicating an inpatient stay of >24 h and a discharge between 4 and 10 June 2005 (n = 5908). INTERVENTION: None. MAIN OUTCOME MEASURES: Percentage of AEs considered preventable. RESULTS: We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8-6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). CONCLUSIONS: In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.

Realidad de la prescripción y grado de cumplimiento de los suplementos de calcio + vitamina D en el tratamiento de la osteoporosis en la Atención Primaria de Andalucía. Estudio SOL-D8 / Reality of the prescription and degree of compliance regarding calcium + vitamin D supplements in the treatment of osteoporosis in Primary Care of Andalusia. SOL-D8 Study

INTRODUCCIÓN. La osteoporosis es una enfermedad crónica que afecta en España a más de dos millones de mujeres. En su abordaje terapéutico, además de un tratamiento antirresortivo, se debe garantizar un adecuado aporte de calcio y vitamina D, y cuando la paciente no alcanza un mínimo diario de estos elementos se debe proceder a su administración de forma exógena mediante la recomendación de suplementos. En nuestro entorno no se conoce cuál es la realidad de la prescripción y grado de cumplimiento desde la práctica clínica en Atención Primaria de los suplementos de calcio y vitamina D para el tratamiento concomitante de la osteoporosis, por lo que nos hemos planteado realizar un estudio de índole pragmática que permita aclarar estos interrogantes. MATERIAL Y MÉTODOS. Estudio transversal utilizando un cuestionario ad hoc a partir del objetivo del estudio, que fue administrado durante los meses de marzo y abril de 2006, por 49 médicos de Atención Primaria de los 32 distritos sanitarios de Andalucía, elegidos mediante muestreo no probabilístico a criterio, siendo el criterio de selección la condición de experto en osteoporosis. Cada uno de estos investigadores se responsabilizó de contactar con al menos 10 médicos que debían ejercer su actividad profesional en el ámbito de la asistencia primaria, de cara a poder administrarles el cuestionario. RESULTADOS. Respondieron el cuestionario un total de 749 médicos de Atención Primaria correspondientes a todos los distritos sanitarios de Andalucía. Se ha recogido información de 3.745 pacientes ya que cada médico debía revisar 5 historias de pacientes en tratamiento para la osteoporosis. El 31% de los encuestados reconocía que no asocia calcio y vitamina D junto al tratamiento antirresortivo, o lo hacía en menos del 50% de las veces. El 52% de los encuestados reconoció que la tolerancia a los suplementos de calcio y vitamina D era regular, mala o muy mala, y hasta un 62% de los médicos encuestados afirmaron que la mitad de sus pacientes abandonaba los suplementos a los tres meses por intolerancia o efectos secundarios. La mitad de los médicos reconocía no estar preocupado por el aporte de vitamina D en estos pacientes, dado que consideraban que en España, por su clima soleado, el déficit de vitamina D era una situación infrecuente. CONCLUSIONES. La mayoría de los médicos de Atención Primaria de Andalucía opinan que el cumplimiento de los suplementos de calcio y vitamina D para el tratamiento concomitante de la osteoporosis es bastante deficiente, por lo que el abordaje terapéutico integral de la osteoporosis es inadecuado, debiéndose insistir en la importancia de garantizar una adecuada ingesta de calcio y vitamina D. Existe un alto porcentaje de abandono de los suplementos por efectos secundarios e intolerancia. Hay una falsa asociación entre clima soleado y niveles adecuados de vitamina D

INTRODUCTION. Osteoporosis is a chronic disease that affects more than two million women in Spain. In addition to an antiresorptive agent in its therapeutic approach, adequate intake of calcium and vitamin D should be assured. When the patient cannot achieve these minimum daily requirements, these should be administered exogenously through supplements. The real situation in regard to the prescription and degree of compliance with these elements from the clinical practice of Primary Care is unknown, thus we have considered conducting a pragmatic study to address the unanswered questions. METHODS. Cross-sectional study which includes an ad hoc questionnaire, based on the study objective that was administered by 49 Primary Care physicians from the 32 health districts of Andalusia, during March-April 2006, who were chosen by non-probability sampling criteria, the condition of being an expert in osteoporosis being the selection criteria. Each one of the investigators had to contact at least 10 Primary Care physicians in the Primary Care area providing them with the questionnaire. RESULTS. A total of 749 Primary Care physicians from all of the health districts answered the questionnaire. Information was collected from 3,745 patients since each physician had to review 5 clinical records of patients being treated for osteoporosis. A total of 31% of the physicians admitted that they were not concomitantly associating an antiresorptive agent with calcium-vitamin D supplements for at least 50% of the time. Fifty-two percent of those questioned admitted that tolerance to calcium supplements is either regular, poor or very poor, and up to 62% of the physicians addressed claimed that 50% of their patients discontinued supplement treatment within a three month period due to intolerance or adverse effects. Fifty percent of the physicians admitted they were not concerned about vitamin D intake in these patients, since they believed that due to the sunny climate in Spain, insufficient vitamin D was not a frequent issue. CONCLUSIONS. The majority of Primary Care physicians in Andalusia believe that compliance with calcium and vitamin D supplements for concomitant treatment of osteoporosis is quite poor. Therefore, integral therapeutic management of osteoporosis is inadequate. An effort must be made to increase physicians' awareness regarding adequate intake of calcium and vitamin D. There is a high rate of withdrawal of supplements due to side effects or intolerance as well as a false concept of association between sun exposure and adequate vitamin D levels

[Prostatic benign hyperplasia]. / Hiperplasia benigna da próstata.

After reviewing the clinical, diagnostic and therapeutic attitude related to Benign Prostatic Hyperplasia, the authors present the guidelines for Generalists, in terms of practical handling and when and how to refer their patients to the Urology consultation. Based on the criteria presented, Generalists must refer their patients to the Urology consultation in the presence of mild or severe symptoms, ages below 50 years, diabetes or neurological disturbances, disturbed voiding, palpable bladder, palpable nodule or a diffusely hardened or asymmetric gland revealed by digital rectal examination, hematuria, urinary tract infection, renal impairment or PSA above 4 nglml in patients aged below 70 years.

[Outbreak of Trichinella britovi infection in Granada in the spring of 2000]. / Brote epidémico por Trichinella britovi en Granada durante la primavera del 2000.

BACKGROUND: The magnitude of the epidemic depends upon the scope of the contaminated product distributed. In the spring of 2000, an episode caused by the sale of sausage products which had not undergone health inspection. The purpose of this study is to provide an epidemiological description of the outbreak caused by Trichinella britovi. METHODS: Descriptive study of the control measures and those affected. The food products contaminated with this parasite was investigated by means of an epidemiological survey. RESULTS: Thirty-eight (38) cases were reported throughout weeks 18-22 of the epidemic. The symptoms most often reported were fever, myalgia and palpebral edema. Eighty-seven percent (87%) of those affected tested positive for eosinophilia. Forty percent (40%) required hospitalization. Late diagnosis was curtailed once the alert had been broadcast. T. Britovi was found in the sausage product. CONCLUSIONS: Trichinellosis epidemics can occur despite the current inspection and control systems, placing food safety at risk. Broadcasting a health alert curtails late diagnosis. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs in industries and establishments. A well-tuned, fast-reacting epidemiological monitoring system must be kept in place.

Implicación pronóstica de la sospecha clínica inicial en la disección de aorta torácica. Revisión de los métodos diagnósticos utilizados / Prognostic significance of the initial diagnostic suspicion in cases of thoracic aortic dissection. review of the diagnostic techniques

Objetivo. Analizar la importancia de la sospecha clínica inicial en el diagnóstico de la disección de aorta torácica y la influencia en su pronóstico, revisar los diferentes métodos complementarios utilizados. Material y métodos. Se estudiaron retrospectivamente 33 casos de disección de aorta torácica entre enero de 1993 y junio de 1998, valorándose parámetros clínico-epidemiológicos, diagnósticos de ingreso y pruebas complementarias. Los resultados cualitativos se valoraron mediante 2.Resultados. La sintomatología típica de disección (dolor torácico, abdominal e interescapular) se apreció en 19 (58 por ciento) casos. La sospecha clínica al ingreso se realizó en 9 (27 por ciento) de los pacientes, siendo diagnósticos tardíos/casuales 22 (67 por ciento ) casos. Se realizó el diagnóstico de disección a través de la necropsia en 2 (6 por ciento) ocasiones. Diagnósticos erróneos de ingreso fueron: cardiopatía isquémica en 9 casos; isquemia de miembros inferiores en 3. Se realizó el diagnóstico de cólico hepático, neumonía, gastroenteritis, síncope, cólico nefrítico, aneurisma de aorta abdominal, pancreatitis y dolor osteomuscular respectivamente en un caso. El retraso en el diagnóstico no influyó significativamente en la mortalidad. La prueba diagnóstica que se utiliza en nuestro medio en primer lugar es la tomografía axial computarizada (TAC). La aortografía se utiliza como prueba confirmatoria del diagnóstico. Conclusiones. No se valoran adecuadamente los datos de la clínica inicial. La mortalidad es mayor en el grupo de pacientes en el cual no hay sospecha clínica inicial de disección de aorta (AU)

The bioactive conformation of aminoalkylindoles at the cannabinoid CB1 and CB2 receptors: insights gained from (E)- and (Z)-naphthylidene indenes.

The aminoalkylindoles (AAIs) are agonists at both the cannabinoid CB1 and CB2 receptors. To determine whether the s-trans or s-cis form of AAIs is their receptor-appropriate conformation, two pairs of rigid AAI analogues were studied. These rigid analogues are naphthylidene-substituted aminoalkylindenes that lack the carbonyl oxygen of the AAIs. Two pairs of (E)- and (Z)-naphthylidene indenes (C-2 H and C-2 Me) were considered. In each pair, the E geometric isomer is intended to mimic the s-trans form of the AAIs, while the Z geometric isomer is intended to mimic the s-cis form. Complete conformational analyses of two AAIs, pravadoline (2) and WIN-55, 212-2 (1), and of each indene were performed using the semiempirical method AM1. S-trans and s-cis conformations of 1 and 2 were identified. AM1 single-point energy calculations revealed that when 1 and each indene were overlayed at their corresponding indole/indene rings, the (E)- and (Z)-indenes were able to overlay naphthyl rings with the corresponding s-trans or s-cis conformer of 1 with an energy expense of 1.13/0.69 kcal/mol for the C-2 H (E/Z)-indenes and 0.82/0.74 kcal/mol for the C-2 Me (E/Z)-indenes. On the basis of the hypothesis that aromatic stacking is the predominant interaction of AAIs such as 1 at the CB receptors and on the demonstration that the C-2 H (E/Z)- and C-2 Me (E/Z)-indene isomers can mimic the positions of the aromatic systems in the s-trans and s-cis conformers of 1, the modeling results support the previously established use of indenes as rigid analogues of the AAIs. A synthesis of the naphthylidene indenes was developed using Horner-Wittig chemistry that afforded the Z isomer in the C-2 H series, which was not produced in significant amounts from an earlier reported indene/aldehyde condensation reaction. This approach was extended to the C-2 Me series as well. Photochemical interconversions in both the C-2 H and C-2 Me series were also successful in obtaining the less favored isomer. Thus, the photochemical process can be used to provide quantities of the minor isomers C-2 H/Z and C-2 Me/E. The CB1 and CB2 affinities as well as the activity of each compound in the twitch response of the guinea pig ileum (GPI) assay were assessed. The E isomer in each series was found to have the higher affinity for both the CB1 and CB2 receptors. In the rat brain membrane assay versus [3H]CP-55,940, the Ki's for the C-2 H/C-2 Me series were 2.72/2.89 nM (E isomer) and 148/1945 nM (Z isomer). In membrane assays versus [3H]SR141716A, a two-site model was indicated for the C-2 H/C-2 Me (E isomers) with Ki's of 10. 8/9.44 nM for the higher-affinity site and 611/602 nM for the lower-affinity site. For the Z isomers, a one-site model was indicated with Ki's of 928/2178 nM obtained for the C2 H/C-2 Me analogues, respectively. For the C-2 H/C-2 Me series, the CB2 Ki's obtained using a cloned cell line were 2.72/2.05 nM (E isomer) and 132/658 nM (Z isomer). In the GPI assay, the relative order of potency was C-2 H E > C-2 Me E > C-2 H Z > C-2 Me Z. The C-2 H E isomer was found to be equipotent with 1, while the C-2 Me Z isomer was inactive at concentrations up to 3.16 microM. Thus, results indicate that the E geometric isomer in each pair of analogues is the isomer with the higher CB1 and CB2 affinities and the higher pharmacological potency. Taken together, results reported here support the hypothesis that the s-trans conformation of AAIs such as 1 is the preferred conformation for interaction at both the CB1 and CB2 receptors and that aromatic stacking may be an important interaction for AAIs at these receptors.

Sex-related differences in the analgesic response to the rat tail immersion test.

The analgesic response was evaluated by the tail immersion test in adult male (N = 30), female (N = 21) and androgenized female Wistar rats (N = 15). The reaction time for tail withdrawal from the hot water bath was faster for male than for female rats (3.48 +/- 0.12 vs 6.46 +/- 0.42 s). The reaction time of androgenized female rats was similar to that of male rats (3.08 +/- 0.16 s). Blockade of opiate receptors with naloxone (2 mg/kg, ip) decreased the sensitivity to the noxious stimuli in males (4.08 +/- 0.10 s) and in androgenized females (3.69 +/- 0.19 s) but increased it in female rats (5.01 +/- 0.41 s). These data show sex-related differences in the analgesic response evaluated by the tail immersion test and indicate that administration of androgens to newborn female rats affects their pain sensitivity.

Sex-related differences in the analgesic response to the rat tail immersion test

The analgesic response was evaluated by the tail immersion test in adult male (N = 30), female (N = 21) and androgenized female Wistar rats (N = 15). The reaction time for tail withdrawal from the hot water bath was faster for male than for female rats (3.48 +/- 0.12 vs 6.46 +/- 0.42 s). The reaction time of androgenized female rats was similar to that of male rats (3.08 +/- 0.16 s). Blockade of opiate receptors with naloxone (2 mg/kg, ip) decreased the sensitivity to the noxious stimuli in males (4.08 +/- 0.10 s) and in androgenized females (3.69 +/- 0.19 s) but increased it in female rats (5.01 +/- 0.41 s). These data show sex-related differences in the analgesic response evaluated by the tail immersion test and indicate that administration of androgens to newborn female rats affects their pain sensitivity.