A new technique in the treatment of intestinal malrotation. / Una nueva técnica en el tratamiento de la malrotación intestinal.

INTRODUCTION: Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd's procedure). Dr. Abu-Elmagd recently described a new technique that was applied in one of our patients. CLINICAL CASE: 12-year-old boy who had undergone Ladd's procedure as a result of intestinal volvulus secondary to malrotation when he was 2 days old. He had subocclusion and eventually obstruction, with intestinal volvulus compatible imaging. Intraoperative findings: duodenal subocclusion, volvulus and lymphangiectasias. Kareem's procedure: bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixation of the cecum, the ascending colon, and the mesenteric root. The patient was discharged on postoperative day 6 and remains asymptomatic after 1 year of follow-up. DISCUSSION: Kareem's procedure is a safe and effective malrotation repair technique. It can replace Ladd's procedure as it reduces the risk of re-volvulation and improves digestive symptoms.

INTRODUCCION: La malrotación intestinal es una patología congénita con complicaciones potencialmente catastróficas, destacando el vólvulo, cuyo tratamiento no ha variado significativamente en casi 100 años (procedimiento de Ladd). Recientemente el Dr. Abu-Elmagd describió una técnica que hemos aplicado en un paciente. CASO CLINICO: Varón de 12 años, intervenido con 2 días de vida por vólvulo intestinal secundario a malrotación realizándose procedimiento de Ladd. Presenta cuadros suboclusivos y finalmente obstructivo con imágenes compatibles con vólvulo intestinal. Hallazgos intraoperatorios: suboclusión duodenal, vólvulo y linfangiectasias. Procedimiento de Kareem: posicionando intestino en normorotación, duodenopexia (C duodenal posterior a vasos mesentéricos), formación de neoTreitz, fijación de ciego, colon ascendente y raíz mesentérica. Alta hospitalaria al 6º día postoperatorio, asintomático en 1 año de seguimiento. COMENTARIOS: El procedimiento de Kareem es una técnica segura y efectiva que corrige la malrotación, pudiendo reemplazar al procedimiento de Ladd al disminuir el riesgo de revolvulación y mejorar síntomas digestivos.

Una nueva técnica en el tratamiento de la malrotación intestinal / A new technique in the treatment of intestinal malrotation

Introducción: La malrotación intestinal es una patología congénitacon complicaciones potencialmente catastróficas, destacando el vólvulo,cuyo tratamiento no ha variado significativamente en casi 100 años(procedimiento de Ladd). Recientemente el Dr Abu-Elmagd describióuna técnica que hemos aplicado en un paciente.Caso clínico: Varón de 12 años, intervenido con 2 días de vidapor vólvulo intestinal secundario a malrotación realizándose procedimiento de Ladd. Presenta cuadros suboclusivos y finalmente obstructivo con imágenes compatibles con vólvulo intestinal. Hallazgosintraoperatorios: suboclusión duodenal, vólvulo y linfangiectasias.Procedimiento de Kareem: posicionando intestino en normorotación,duodenopexia (C duodenal posterior a vasos mesentéricos), formaciónde neoTreitz, fijación de ciego, colon ascendente y raíz mesentérica.Alta hospitalaria al 6º día postoperatorio, asintomático en 1 año deseguimiento. Comentarios: El procedimiento de Kareem es una técnica seguray efectiva que corrige la malrotación, pudiendo reemplazar al procedimiento de Ladd al disminuir el riesgo de revolvulación y mejorarsíntomas digestivos.(AU)

Introduction: Intestinal malrotation is a congenital pathology withpotentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd’s procedure). Dr. Abu-Elmagd recently described a new technique that was appliedin one of our patients. Clinical case. 12-year-old boy who had undergone Ladd’s procedure as a result of intestinal volvulus secondary to malrotation when hewas 2 days old. He had subocclusion and eventually obstruction, withintestinal volvulus compatible imaging. Intraoperative findings: duodenalsubocclusion, volvulus and lymphangiectasias. Kareem’s procedure:bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixationof the cecum, the ascending colon, and the mesenteric root. The patientwas discharged on postoperative day 6 and remains asymptomatic after1 year of follow-up. Discussion: Kareem’s procedure is a safe and effective malrotationrepair technique. It can replace Ladd’s procedure as it reduces the riskof re-volvulation and improves digestive symptoms.(AU)

Assessing main process mechanism and rates of sulfate reduction by granular biomass fed with glycerol under sulfidogenic conditions.

Sulfate-reducing bioreactors for sulfide production are the initial stage of processes targeting elemental sulfur recovery from sulfate-rich effluents. In this work, the principal reactions involved in glycerol fermentation and sulfate reduction using glycerol and its fermentation products as electron donors were assessed together with their specific consumption/production rates. A battery of batch activity tests with and without sulfate were performed with glycerol and with each fermentation product using a non-methanogenic but sulfidogenic granular sludge from an up-flow anaerobic sludge blanket (UASB) reactor operated under long-term while fed with crude glycerol. As a result, a mechanistic approach based on the experimental observations is proposed in this work. Glycerol was mainly fermented to 1,3-propanediol, ethanol, formate, propionate and acetate by fermentative bacteria. All organic intermediates were found to be further used by sulfate reducing bacteria (SRB) for sulfate reduction except for acetate. The most abundant genus detected under sulfidogenic conditions were Propionispora (15.2%), Dysgonomonas (13.2%), Desulfobulbus (11.6%) and Desulfovibrio (10.8%). The last two SRB genera accounted for 22.4% of the total amount of retrieved sequences, which were probably performing an incomplete oxidation of the carbon source in the sulfidogenic UASB reactor. As single substrates, specific sulfate reduction rates (SRRs) using low molecular weight (MW) carbon sources (formate and ethanol) were 39% higher than those using high-MW ones (propionate, 1,3-propanediol and butanol). However, SRRs in glycerol-fed tests showed that 1,3-propanediol played a major role in sulfate reduction in addition to formate and ethanol.

Diagnosis of multiple sclerosis using multifocal ERG data feature fusion.

The purpose of this paper is to implement a computer-aided diagnosis (CAD) system for multiple sclerosis (MS) based on analysing the outer retina as assessed by multifocal electroretinograms (mfERGs). MfERG recordings taken with the RETI-port/scan 21 (Roland Consult) device from 15 eyes of patients diagnosed with incipient relapsing-remitting MS and without prior optic neuritis, and from 6 eyes of control subjects, are selected. The mfERG recordings are grouped (whole macular visual field, five rings, and four quadrants). For each group, the correlation with a normative database of adaptively filtered signals, based on empirical model decomposition (EMD) and three features from the continuous wavelet transform (CWT) domain, are obtained. Of the initial 40 features, the 4 most relevant are selected in two stages: a) using a filter method and b) using a wrapper-feature selection method. The Support Vector Machine (SVM) is used as a classifier. With the optimal CAD configuration, a Matthews correlation coefficient value of 0.89 (accuracy = 0.95, specificity = 1.0 and sensitivity = 0.93) is obtained. This study identified an outer retina dysfunction in patients with recent MS by analysing the outer retina responses in the mfERG and employing an SVM as a classifier. In conclusion, a promising new electrophysiological-biomarker method based on feature fusion for MS diagnosis was identified.

[DISCREPA study: treatment of advanced Parkinson's disease and use of second-line treatments in Catalonia]. / Estudio DISCREPA: tratamiento de la enfermedad de Parkinson avanzada y utilización de terapias de segunda línea en Cataluña.

INTRODUCTION: The treatment of Parkinson's disease (PD) is complex, and the establishment of second-line therapies in advanced PD remains controversial. AIM: To analyze the assistance of patients with PD in Catalonia, with special attention to the use of second-line therapies in advanced PD. SUBJECTS AND METHODS: Online self-administered survey to neurologists in Catalonia who treated patients with PD, through the Catalan Society of Neurology. RESULTS: 72 neurologists who visited a monthly average of 38 PD patients (37.3% motor complications) participated. 86% routinely asked about motor. The main reasons for indicating second-line therapies were disability in off (83.1%), impact of dyskinesias (76.9%), impact of time in off (75.4%) and time in off (73.8%). 70% of neurologists declared limitations to establish second-line therapies: lack of resources in their hospital, lack of time to visit the patient or to perform administrative tasks and lack nursing support. Second-line therapies is not used in 72% of patients who could potentially be candidates, especially due to patient rejection (37.9%). CONCLUSIONS: The majority of neurologists in Catalonia who visit patients with PD routinely ask about motor complications without using specific tools. Although neurologists are well aware of the indications for the establishment of second-line therapies, the refusal of the patient, the lack of time and the lack of defined care protocols to refer patients, they can contribute to a lower use of second-line therapies in advanced PD.

TITLE: Estudio DISCREPA: tratamiento de la enfermedad de Parkinson avanzada y utilización de terapias de segunda línea en Cataluña.Introducción. El tratamiento de la enfermedad de Parkinson (EP) es complejo y la instauración de terapias de segunda línea en la EP avanzada sigue siendo controvertida. Objetivo. Analizar la asistencia de pacientes con EP en Cataluña, con especial atención a la utilización de las terapias de segunda línea en la EP avanzada. Sujetos y métodos. Encuesta en línea autoadministrada a través de la Societat Catalana de Neurologia a neurólogos de Cataluña que atendían a pacientes con EP. Resultados. Participaron 72 neurólogos que visitaban una media mensual de 38 pacientes con EP (el 37,3% con complicaciones motoras). El 86% preguntaba rutinariamente por complicaciones motoras. Los principales motivos para indicar terapias de segunda línea fueron la discapacidad en off (83,1%), el impacto de las discinesias (76,9%), el impacto del tiempo en off (75,4%) y el tiempo en off (73,8%). El 70% de los neurólogos declaró limitaciones para instaurar terapias de segunda línea: escasez de recursos en su hospital, falta de tiempo para visitar al paciente o para realizar tareas administrativas y falta de soporte de enfermería (33,3%). No se utilizan terapias de segunda línea en el 72% de los pacientes que podrían ser potencialmente candidatos, sobre todo por rechazo del paciente (37,9%). Conclusiones. La mayoría de los neurólogos en Cataluña que visitan pacientes con EP pregunta rutinariamente por complicaciones motoras sin utilizar herramientas específicas. Aunque los neurólogos conocen bien las indicaciones de instauración de terapias de segunda línea, la negativa del paciente, la falta de tiempo y la falta de protocolos asistenciales definidos para derivar a pacientes pueden contribuir a una menor utilización de terapias de segunda línea en la EP avanzada.

Diagnostic ability of multifocal electroretinogram in early multiple sclerosis using a new signal analysis method.

PURPOSE: To determine if a novel analysis method will increase the diagnostic value of the multifocal electroretinogram (mfERG) in diagnosing early-stage multiple sclerosis (MS). METHODS: We studied the mfERG signals of OD (Oculus Dexter) eyes of fifteen patients diagnosed with early-stage MS (in all cases < 12 months) and without a history of optic neuritis (ON) (F:M = 11:4), and those of six controls (F:M = 3:3). We obtained values of amplitude and latency of N1 and P1 waves, and a method to assess normalized root-mean-square error (FNRMSE) between model signals and mfERG recordings was used. Responses of each eye were analysed at a global level, and by rings, quadrants and hemispheres. AUC (area under the ROC curve) is used as discriminant factor. RESULTS: The standard method of analysis obtains further discrimination between controls and MS in ring R3 (AUC = 0.82), analysing N1 waves amplitudes. In all of the retina analysis regions, FNRMSE value shows a greater discriminating power than the standard method. The highest AUC value (AUC = 0.91) was in the superior temporal quadrant. CONCLUSION: By analysing mfERG recordings and contrasting them with those of healthy controls it is possible to detect early-stage MS in patients without a previous history of ON.

Efecto de la rehabilitación respiratoria asociada a suplementación nutricional sobre la actividad física en pacientes con bronquiectasias: estudio aleatorizado / The effect of pulmonary rehabilitation associated with nutritional supplementation on physical activity in patients with bronchiectasis: randomized trial

Introducción: la actividad física está fuertemente relacionada con la mortalidad y la situación respiratoria en patologías respiratorias como la enfermedad pulmonar obstructiva crónica (EPOC) y la fibrosis quística (FQ). Los programas de rehabilitación respiratoria (RR) han demostrado mejorar el grado de actividad física en pacientes con EPOC. No existen trabajos específicos en pacientes con bronquiectasias (BQ). Objetivos: comparar el efecto sobre la actividad física de la RR durante 12 semanas, comparado con RR más un suplemento hiperproteico enriquecido en beta-hidroxi-beta-metilbutirato (HMB) en pacientes con BQ no debidas a FQ. Material y métodos: estudio prospectivo aleatorizado, en el que se aplica un programa de RR estructurado a pacientes con BQ durante tres meses. A uno de los grupos, además, se le asoció un suplemento hiperproteico con HMB. Se valoró el grado de actividad física en situación basal, a los tres y seis meses mediante acelerómetro wGT3X (ActiGraph) y cuestionario IPAQ. Se analizaron los datos mediante una Anova de medidas repetidas (intención de tratar). Resultados: se incluyeron 30 pacientes con BQ no debidas a FQ (15 en cada rama) sin diferencias en variables clínicas entre los grupos. Después de la intervención, un porcentaje significativo de pacientes incrementaron la actividad física medida mediante el cuestionario IPAQ en el grupo suplementado a los 3 y 6 meses. No se observaron diferencias significativas en función del tipo de intervención. En ambos grupos se observó un discreto aumento de la actividad física de intensidad moderada medida por acelerómetro, a los 3 y 6 meses, pero no alcanzó significación estadística. Conclusiones: la RR, unida a suplementación nutricional en pacientes con BQ no debidas a FQ, aumentó el nivel de actividad física medida mediante el cuestionario IPAQ (a los 3 y 6 meses). Sin embargo, no alcanzó la significación estadística mediante acelerómetro. Son necesarios más estudios que evalúen la validez de los diferentes instrumentos de medida

Introduction: physical activity is closely related to mortality and respiratory status for respiratory diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF).Pulmonary rehabilitation (PR) programs have been shown to improve the level of physical activity in COPD patients. There are no specific studies on patients with bronchiectasis. Objectives: study the effect of PR on physical activity over 12 weeks, in comparison with PR plus a hyperproteic supplement enriched in beta-hydroxy-beta-methylbutyrate (HMB) in patients with non CF bronchiectasis. Material and methods: prospective, randomized study in which a structured PR program is applied in bronchiectasis patients for three months. Additionally, one of the groups received a hyperproteic supplement with HMB. The degree of physical activity was evaluated at baseline and after three and six months using the wGT3X (ActiGraph) accelerometer and the IPAQ (International Physical Activity Questionnaire).Data was analyzed using a repeated measures ANOVA (intention to treat). Results: 30 patients with non-CF bronchiectasis (15 in each group)were included, without differences in clinical variables between groups. After intervention, a significant percentage of patients in the supplement group increased their average physical activity according to the IPAQ after 3 and 6 months. Significant differences depending on type of intervention were not observed. A slight increase in average moderate intensity physical activity measured by accelerometer was observed at 3 and 6 months, but it did not reach statistical significance. Conclusions: PR, along with nutritional supplements, in non-CF bronchiectasis patients increased the level of physical activity measured by the IPAQ (at 3 and 6 months).However, it did not reach statistical significance according to accelerometer measurements. Further studies are needed to evaluate the validity of the different measurement instruments

Identificación de eventos centinela en atención primaria / Identification of sentinel events in primary care

Objetivo. Identificar y describir un listado de eventos centinela (EC) en atención primaria (AP). Metodología. Consenso de expertos estructurado mediante 2 cuestionarios online. Los expertos fueron elegidos por su experiencia en AP y conocimientos en seguridad del paciente. El primer cuestionario valoró la adaptación de los EC hospitalarios del National Quality Forum 2006 al ámbito de AP a través de las respuestas: sí, no, sí con adaptación; en este último caso se permitió una nueva redacción de los mismos y además el cuestionario permitía la incorporación de nuevos EC. El segundo cuestionario incluyó los EC con respuesta positiva (sí, sí con adaptación>55%) para que los expertos eligieran entre redacción original y alternativa y los nuevos EC descritos. Resultados. De los 47 expertos convocados 44 respondieron a ambos cuestionarios. Se identificaron en total 17 EC para AP. Primer cuestionario: de 28 EC hospitalarios 12 se consideraron adaptables para AP; 11 de ellos con redacción alternativa. Treinta y ocho expertos propusieron algún EC nuevo referidos principalmente a: problemas con la medicación/vacunas, retrasos/ausencia en la atención, retraso diagnóstico y problemas con pruebas diagnósticas, resumidos en 5 EC. Segundo formulario: los expertos escogieron en más del 65% la redacción alternativa de los 11 EC adaptados a AP. Los 5 nuevos EC fueron considerados adecuados con respuesta positiva entre 70-85%. Conclusión. Se identificaron 17 EC para AP, lo que disponer de un listado de EC permitirá llevar a cabo una mejor gestión del riesgo sanitario (AU)

Objective. To identify and describe a list of sentinel events (SEs) for Primary Care (PC). Methododology. A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. Results. The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. Conclusion. Having a list of SEs available in PC will help to improve the management of health care risks (AU)

[Identification of sentinel events in primary care]. / Identificación de eventos centinela en atención primaria.

OBJECTIVE: To identify and describe a list of sentinel events (SEs) for Primary Care (PC). METHODODOLOGY: A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. RESULTS: The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. CONCLUSION: Having a list of SEs available in PC will help to improve the management of health care risks.

Probabilistic cardiac and respiratory based classification of sleep and apneic events in subjects with sleep apnea.

Current clinical standards to assess sleep and its disorders lack either accuracy or user-friendliness. They are therefore difficult to use in cost-effective population-wide screening or long-term objective follow-up after diagnosis. In order to fill this gap, the use of cardiac and respiratory information was evaluated for discrimination between different sleep stages, and for detection of apneic breathing. Alternative probabilistic visual representations were also presented, referred to as the hypnocorrogram and apneacorrogram. Analysis was performed on the UCD sleep apnea database, available on Physionet. The presence of apneic events proved to have a significant impact on the performance of a cardiac and respiratory based algorithm for sleep stage classification. WAKE versus SLEEP discrimination resulted in a kappa value of κ = 0.0439, while REM versus NREM resulted in κ = 0.298 and light sleep (N1N2) versus deep sleep (N3) in κ = 0.339. The high proportion of hypopneic events led to poor detection of apneic breathing, resulting in a kappa value of κ = 0.272. While the probabilistic representations allow to put classifier output in perspective, further improvements would be necessary to make the classifier reliable for use on patients with sleep apnea.

[Implementation of a patient safety strategy in primary care of the Community of Madrid]. / Despliegue de la estrategia de seguridad del paciente en atención primaria de la Comunidad de Madrid.

This paper describes the implementation of a patient safety strategy in primary care within the new organizational and functional structure that was created in October 2010 to cover the single primary health care area of the Community of Madrid. The results obtained in Patient Safety after the implementation of this new model over the first two years of its development are also presented.

Despliegue de la estrategia de seguridad del paciente en atención primaria de la Comunidad de Madrid / Implementation of a patient safety strategy in primary care of the Community of Madrid

En este trabajo se describe el despliegue de la estrategia de seguridad del paciente (SP) en atención primaria (AP) dentro de la nueva estructura organizativa y funcional que se crea en octubre de 2010, para dar cobertura al área única de salud de AP de la Comunidad de Madrid (CM). Así mismo, se detallan cuáles han sido los resultados obtenidos en SP tras la implantación de este nuevo modelo a lo largo de los 2 primeros años de su desarrollo (AU)

This paper describes the implementation of a patient safety strategy in primary care within the new organizational and functional structure that was created in October 2010 to cover the single primary health care area of the Community of Madrid. The results obtained in Patient Safety after the implementation of this new model over the first two years of its development are also presented (AU)

On the genetic parameter determining the efficiency of purging: an estimate for Drosophila egg-to-pupae viability.

The consequences of inbreeding on fitness can be crucial in evolutionary and conservation grounds and depend upon the efficiency of purging against deleterious recessive alleles. Recently, analytical expressions have been derived to predict the evolution of mean fitness, taking into account both inbreeding and purging, which depend on an 'effective purging coefficient (d(e) )'. Here, we explore the validity of that predictive approach and assay the strength of purging by estimating d(e) for egg-to-pupae viability (EPV) after a drastic reduction in population size in a recently captured base population of Drosophila melanogaster. For this purpose, we first obtained estimates of the inbreeding depression rate (δ) for EPV in the base population, and we found that about 40% was due to segregating recessive lethals. Then, two sets of lines were founded from this base population and were maintained with different effective size throughout the rest of the experiment (N = 6; N = 12), their mean EPV being assayed at different generations. Due to purging, the reductions in mean EPV experienced by these lines were considerably smaller than the corresponding neutral predictions. For the 60% of δ attributable to nonlethal deleterious alleles, our results suggest an effective purging coefficient d(e) > 0.02. Similarly, we obtain that d(e) > 0.09 is required to roughly account for purging against the pooled inbreeding depression from lethal and nonlethal deleterious alleles. This implies that purging should be efficient for population sizes of the order of a few tens and larger, but might be inefficient against nonlethal deleterious alleles in smaller populations.

Interaction between sorption and biodegradation in a biofilter packed with activated carbon.

The main objective of this study is to evaluate qualitatively and quantitatively the effect of starvation periods in the biodegradation capacity of microorganisms when the support media is a material with high sorption capacity. Pollutant sorption and biodegradation, which occur simultaneously in the biofilter, describe the overall behavior of the air treatment system during normal operation and during starvation periods. Results obtained in the present study demonstrate that sorption capacity of the material not only plays an important role during the start-up of operation, but it is also important during steady operation. Simultaneously, as biomass grows on the support, biodegradation becomes more decisive in the performance. It was found that zones of packing material with low moisture content are controlled by the sorption mechanism, at the expense of biodegradation, and they are essential as a pollutant reservoir during starvation periods. In the present study a significant decrease in the biodegradation capacity of microorganisms immobilized on activated carbon was not observed as a consequence of continuous load interruptions.

Manejo minimamente invasivo de la acalasia: la cirugía como la opción más efectiva / Surgery as the most effective option for minimally invasive treatente of achalasia

El tratamiento de la acalasia es controversial. Diferentes opciones se han propuesto: desde el manejo médico, los procedimientos endoscópicos, hasta, finalmente, el manejo quirúrgico. Con el advenimiento de la laparoscopia y todas las ventajas que trajo consigo la mínima invasión, Cushieri, en los años 90, fue el primero en realizar una miotomía de Heller por mínima invasión. Son numerosos los artículos y metaanálisis que han comparado las técnicas disponibles en cuanto a la mejoría de los síntomas y la calidad de vida, y la opción quirúrgica ha sido superior en todos los casos. En el servicio de mínima invasión del Hospital San Ignacio se llevó a cabo una cardiomiotomía por vía laparoscópica y endoscopia intraoperatoria para evaluar y determinar si hay perforaciones en la mucosa esofágica. Por ultimo con calibración de 50F se realizó una fundoplicatura parcial posterior tipo Toupet.

Identificación de las prácticas seguras simples en un área de atención primaria / Identification of simple safe practices in a primary care area

Objetivos. Valorar las prácticas seguras (PS) elaboradas por la Unidad Funcional de Gestión de Riesgos Sanitarios (UFGRS), según su complejidad de implantación y el impacto en la seguridad del paciente (SP) e identificar PS simples (PSS). Material y métodos. Desde la UFGRS del Área 4 de Atención Primaria (AP) de Madrid, se han elaborado un número importante de PS, posteriormente se valoraron según su complejidad de implantación e impacto potencial en la SP, identificándose las PSS: contra eventos adversos (EA), de baja complejidad de implantación y de alto impacto en la SP. Por último, se identificaron las barreras para su implantación efectiva y se diseñaron acciones para superar dichas barreras. Resultados. Se han elaborado 50 PS, de ellas 42 se han generalizado a todo el área. Se han identificado como PSS: 7 de nivel 1, que cumplen las condiciones ideales. Las principales barreras tienen que ver con la falta de formación, cultura, liderazgo de los equipos directivos y profesionales de los centros y escasa difusión de las PS. Conclusiones. Desde la UFGRS se ha elaborado un número importante de PS, identificándose PSS para AP. La mayoría de estas tienen que ver con el uso seguro de medicamentos y con las vacunas(AU)

Objectives. To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. Material and methods. A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. Results. Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. Conclusions. A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines(AU)

[Identification of simple safe practices in a primary care area]. / Identificación de las prácticas seguras simples en un área de atención primaria.

OBJECTIVES: To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. MATERIAL AND METHODS: A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. RESULTS: Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. CONCLUSIONS: A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines.

Proyecto de mejora del Proceso de Atención Continuada domiciliaria en Atención Primaria: rediseño y AMFE / Improving the continuous care process in primary care during weekends and holidays. Redesigning and FMEA

Objetivo. Describir el proyecto de mejora aplicado al proceso de atención continuada (ATC) de sábados y festivos en el Área 4 de Atención Primaria (AP) de Madrid, para garantizar una atención segura y libre de fallos en los cuidados domiciliarios de los fines de semana. Material y método. El proceso de ATC se identificó como de riesgo por la Unidad Funcional de Gestión de Riesgos (UFGR) del Área, además presentaba quejas: de las enfermeras que realizan la atención y de pacientes. En 2009 se realiza un DAFO (debilidades, amenazas, fortalezas y oportunidades) que evidenció problemas. Posteriormente se diseña un proyecto de mejora que se desarrolla en las fases: 1. Rediseño y mejora del proceso. 2. Aplicación AMFE al nuevo proceso. 3. Pilotaje. 4. Formación a las enfermeras. 5. Implantación en todo el Área. 6. Encuesta de satisfacción a las enfermeras de ATC. Resultados. El rediseño del proceso, proporcionó mejoras como la automatización y aumento de la eficiencia. Posteriormente a la implantación de las medidas de mejora, no se han producido nuevas reclamaciones de pacientes y ha mejorado la satisfacción de las enfermeras de ATC medida a través de encuesta. Al aplicar el AMFE se priorizaron fallos y se pusieron en marcha acciones de mejora. Conclusiones. La mejora del proceso y sobre todo su automatización, ha sido un gran avance para mejorar la seguridad. El AMFE nos ha resultado una herramienta útil y práctica que ha permitido implantar importantes acciones, igualmente se ha conseguido mejorar la satisfacción de las enfermeras que realizan la ATC(AU)

Objective. To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. Materials and method. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. Results. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. Results. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. Conclusion. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved(AU)