La seguridad del paciente en urgencias y emergencias: balance de cuatro años del Programa SEMES-Seguridad Paciente / Patient safety in emergency medicine: report on 4 years’ implementation of a program designed for the Spanish Society of Emergency Medicine (SEMES)

Los servicios de urgencias y emergencias (SUE) son áreas asistenciales donde existe un alto riesgo de incidentes y eventos adversos, que afectan, por tanto, a la seguridad del paciente (SP). El Programa SEMES-Seguridad Paciente inició una estrategia hace cuatro años (2008) en los SUE enfocada a la difusión de la cultura de seguridad, la formación en SP de los profesionales, el análisis de los incidentes con o sin daño en los SUE y el desarrollo de herramientas proactivas para la detección de riesgos durante la atención urgente. Como fruto de ello se ha generado una red de instructores de SP para SUE, compuesta actualmente por 176 profesionales; se ha desarrollado el estudio EVADUR y CULTURA, que han permitido conocer tanto la incidencia de sucesos adversos en dichos servicios, sus causas y evitabilidad, como el grado de seguridad y cultura de las organizaciones; y finalmente se ha elaborado un mapa de riesgos de la atención urgente. Todo ello ha permitido, no sólo conocer la situación en SP de los SUE, sino recomendar y desarrollar estrategias específicas enfocadas a la reducción de riesgos para el paciente derivados de la asistencia en los SUE (AU)

Emergency departments (ED) and Emergency Medical Systems (EMS) are areas where there is high risk of adverse events and incidents that affect patient safety. In 2008 the Spanish Society of Emergency Medicine (SEMES) initiated a program to promote a patient safety culture in ED and EMS. The program included training in patient safety, the analysis of incidents with and without patient harm, and the development of proactive tools to detect risk during emergency interventions. Outcomes of this program include the establishment of a network of 176 instructors in emergency patient safety and the EVADUR and CULTURA studies to determine the types of incidents and adverse events in our ED and EMS, their causes and preventability, and the level of safety and safety culture within organizations. The results make it possible to draw an emergency service risk map. After 4 years the program has provided information on patient safety in Spanish ED and EMS and allows us to develop guidelines for devising risk reduction strategies for this setting (AU)

Células dendríticas en la sepsis: una aproximación a la inmunosupresión postinfecciosa / Dendritic cells in sepsis: An approach to post-infectious immunosuppression

Las células dendríticas (CD) desempeñan un papel decisivo en la puesta en marcha del sistema inmunitario, especialmente en los episodios iniciales que determinan la coordinación entre la respuesta innata y la respuesta adaptativa. Además, son células presentadoras de antígenos que, a través del contacto con los linfocitos T, decantan la respuesta inmunitaria hacia una vertiente inflamatoria o antiinflamatoria. En la actualidad, se está consolidando la hipótesis que atribuye al desarrollo de un estado de inmunosupresión postinfecciosa relevancia en el pronóstico del paciente séptico. El papel que desempeñan estas células en este tipo de inmunosupresión se ha podido comprobar por el descenso significativo en el número de CD y por las disfunciones en la capacidad funcional que incluyen, por un lado, la producción anómala de citocinas y, por otro lado, la alteración de la comunicación entre las CD y los linfocitos T que constituye un hecho inmunológico esencial. La profundización del conocimiento de las CD en el contexto de la infección grave podría ayudar a consolidar algunos datos esperanzadores que señalan a estas células como: 1) una herramienta eficaz para la monitorización de la infección grave; 2) una variable discriminatoria que podría ayudar a determinar el riesgo de infección nosocomial, y 3) más a largo plazo, una diana del tratamiento que pudiera restaurar las alteraciones inmunológicas que acontecen en la sepsis (AU)

Dendritic cells (DCs) play a decisive role in the immune system, especially in the initial events that determine coordination between the innate and adaptive response. Moreover, they are antigen-presenting cells which, through contact with T cells, determine the type of immune responses towards inflammatory or anti-inflammatory. Currently, the hypothesis that attributes importance to the development of a post-infectious immunosuppression in the prognosis of the septic patient is growing stronger. It has been possible to verify the role played by these cells in this type of immunosuppression by the significant decrease in the number of DCs and by the dysfunctions in the functional capacity that include, on the one hand, the abnormal cytokine production and, on the other hand, the alterations in communication between the DCs and T cells that constitute an essential immunological fact. Further research into the knowledge regarding the DCs, in the context of severe infection, may help to consolidate some encouraging data that indicate these cells as: 1) an effective tool for monitoring the acute infection, 2) a discriminatory variable that may help determine the risk of nosocomial infection and 3) in a longer term, a treatment target that would restore the immunological abnormalities that occur in sepsis (AU)

Usefulness of simulated cases for assessing pandemic influenza preparedness plans.

To evaluate compliance with preparedness plans, actors simulating avian influenza attended various hospital emergency departments and public health centres during the last quarter of 2007. Most centres (89%) did not respond correctly. The useful information obtained was sent to the medical and administrative staff who were responsible for the preparedness plans. Awareness of these errors and their rectification can lead to improvements in the response to any case of influenza with pandemic potential and in the capacity to combat any other emergent or re-emergent community infection.

[Dendritic cells in sepsis: an approach to post-infectious immunosuppression]. / Células dendríticas en la sepsis: una aproximación a la inmunosupresión postinfecciosa.

Dendritic cells (DCs) play a decisive role in the immune system, especially in the initial events that determine coordination between the innate and adaptive response. Moreover, they are antigen-presenting cells which, through contact with T cells, determine the type of immune responses towards inflammatory or anti-inflammatory. Currently, the hypothesis that attributes importance to the development of a post-infectious immunosuppression in the prognosis of the septic patient is growing stronger. It has been possible to verify the role played by these cells in this type of immunosuppression by the significant decrease in the number of DCs and by the dysfunctions in the functional capacity that include, on the one hand, the abnormal cytokine production and, on the other hand, the alterations in communication between the DCs and T cells that constitute an essential immunological fact. Further research into the knowledge regarding the DCs, in the context of severe infection, may help to consolidate some encouraging data that indicate these cells as: 1) an effective tool for monitoring the acute infection, 2) a discriminatory variable that may help determine the risk of nosocomial infection and 3) in a longer term, a treatment target that would restore the immunological abnormalities that occur in sepsis.