[Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. / Comparaison en France, en Italie et en Espagne des modalités de prise en charge de la maladie thromboembolique veineuse.

BACKGROUND: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION: Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.

Evaluación de la calidad en el laboratorio en la fase preanalítica: un estudio multicéntrico / Quality assessment for preanalytical phase in clinical laboratory: a multicentric study

Introducción. El objetivo del trabajo es mostrar y analizar los resultados de errores preanalíticos en las muestras de laboratorio remitidas desde atención primaria a 7 laboratorios de la Comunidad Valenciana que atienden a 7 departamentos de salud. Material y métodos. Se realizó un estudio transversal mediante la evaluación y el análisis de los errores preanalíticos de 7 laboratorios. El error preanalítico se definió como muestra que no puede ser analizada por no cumplir los criterios de aceptabilidad o que no se recibe en el laboratorio. Se diseñaron indicadores de proporción que cuantifican cada incidencia respecto al total de cada muestra (hematología, coagulación, bioquímica y orina). Los errores preanalíticos y las muestras se recogieron automáticamente del Sistema de Información del Laboratorio, y también se calcularon los indicadores a tiempo real mediante un software basado en data warehouse y cubos OLAP. Resultados. La variabilidad de los resultados entre los diferentes centros fue elevada, evidenciándose que el mayor porcentaje de incidencias se debió a la falta de disponibilidad de las muestras, en especial de coagulación y de orina. Conclusiones. Existe una gran variabilidad de errores preanalíticos dependiendo del Departamento de Salud. Existe una necesidad de homogeneizar la práctica de la extracción de muestras(AU)

Purpose. To show the number of preanalytical sample errors in seven laboratories attending seven health departments of Valencian Community (Spain). Methods. Cross-sectional study of the number of preanlytical errors in samples obtained in primary care centers. An error is defined as a rejected specimen: any blood or urine sample, which cannot be successfully tested as it does not meet the acceptability criteria of the laboratory or if the sample is not received. We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples. Registers were collected and indicators calculated automatically through a data warehouse and OLAP cubes software. Results. Larges differences in the results of preanalytical errors were observed between health departments. The highest percentage of errors occurred in coagulation samples, followed by urine, hematology and biochemistry. With regard to the type of error, the largest proportion of errors was due to failures of process. Conclusions. The high incidence of preanalytical errors and variability between health departments suggests that there is a need to standardize the drawing practice(AU)

[Quality assessment for preanalytical phase in clinical laboratory: a multicentric study]. / Evaluación de la calidad en el laboratorio en la fase preanalítica: un estudio multicéntrico.

PURPOSE: To show the number of preanalytical sample errors in seven laboratories attending seven health departments of Valencian Community (Spain). METHODS: Cross-sectional study of the number of preanlytical errors in samples obtained in primary care centers. An error is defined as a rejected specimen: any blood or urine sample, which cannot be successfully tested as it does not meet the acceptability criteria of the laboratory or if the sample is not received. We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples. Registers were collected and indicators calculated automatically through a data warehouse and OLAP cubes software. RESULTS: Large differences in the results of preanalytical errors were observed between health departments. The highest percentage of errors occurred in coagulation samples, followed by urine, hematology and biochemistry. With regard to the type of error, the largest proportion of errors was due to failures of process. CONCLUSIONS: The high incidence of preanalytical errors and variability between health departments suggests that there is a need to standardize the drawing practice.

Estudio piloto regional de evaluación del tiempo de respuesta de laboratorio según el tipo de cliente / Regional pilot study to evaluate the laboratory turnaround time according to the client source

Objetivo. Presentar los resultados del tiempo de respuesta relacionado con el tipo de cliente en ocho laboratorios clínicos de la Comunidad Valenciana que atienden a ocho departamentos de salud (2.014.475 habitantes). Material y métodos. Se utilizaron registros internos (fecha/hora de registro y validación de la prueba) y registros diarios (tipo de paciente) del Sistema Informático del Laboratorio para construir los indicadores. Estos indicadores muestran el porcentaje de pruebas clave (hemograma y glucosa y tirotropina séricas) solicitadas que son validadas en el mismo día de la extracción de muestra (pacientes ingresados o de atención primaria) y/o antes de las 12.00 a.m. (pacientes ingresados). El tiempo de respuesta de pruebas urgentes se refirió a pruebas clave (troponina y potasio séricos) y se expresó en minutos. La recogida de registros y el cálculo de indicadores se realizó de forma automática mediante una aplicación informática basada en data warehouse y cubos OLAP. Resultados. Se observaron grandes diferencias en los porcentajes de validación antes de las 12.00 a.m. para pacientes ingresados y en el día de la extracción para pacientes de atención primaria. La variabilidad observada en los tiempos de respuesta de pruebas urgentes se relacionó con el tamaño del hospital, actividad y validación por el facultativo del laboratorio. Conclusiones. El estudio de benchmarking ha servido para mostrar la gran disparidad de tiempos de respuesta en ocho departamentos de salud de la Comunidad Valenciana. La atención en el laboratorio a distintos tipos de clientes crea la necesidad de la continua adaptación de los procesos para conseguir su satisfacción(AU)

Purpose. To show turnaround time to client source in eight laboratories covering eight Health Areas (2,014,475 inhabitants) of the Valencian Community (Spain). Material and methods. Internal Laboratory Information System (LIS) registers (test register and verification date and time), and daily LIS registers were used to design the indicators, These indicators showed the percentage of key tests requested (full blood count and serum glucose and thyrotropin) that were validated on the same day the blood was taken (inpatients and Primary Care and/or at 12 a.m. (inpatients). Urgent (stat) tests were also registered as key tests (serum troponin and potassium) and were recorded in minutes. Registers were collected and indicators calculated automatically through a Data Warehouse application and OLAP cube software. Results. Long turnaround time differences were observed at 12 a.m. in inpatients, and in the day of sample extraction in primary care patients. The variability in turnaround of stat tests is related to hospital size, activity and validation by the laboratory physician. Conclusions. The study results show the large turnaround time disparity in eight Health Care Areas of Valencian Community. The various requesting sources covered by the laboratories create the need for continuous mapping processes redesign and benchmarking studies to achieve customer satisfaction(AU)

[Regional pilot study to evaluate the laboratory turnaround time according to the client source]. / Estudio piloto regional de evaluación del tiempo de respuesta de laboratorio según el tipo de cliente.

PURPOSE: To show turnaround time to client source in eight laboratories covering eight Health Areas (2,014,475 inhabitants) of the Valencian Community (Spain). MATERIAL AND METHODS: Internal Laboratory Information System (LIS) registers (test register and verification date and time), and daily LIS registers were used to design the indicators, These indicators showed the percentage of key tests requested (full blood count and serum glucose and thyrotropin) that were validated on the same day the blood was taken (inpatients and Primary Care and/or at 12 a.m. (inpatients). Urgent (stat) tests were also registered as key tests (serum troponin and potassium) and were recorded in minutes. Registers were collected and indicators calculated automatically through a Data Warehouse application and OLAP cube software. RESULTS: Long turnaround time differences were observed at 12 a.m. in inpatients, and in the day of sample extraction in primary care patients. The variability in turnaround of stat tests is related to hospital size, activity and validation by the laboratory physician. CONCLUSIONS: The study results show the large turnaround time disparity in eight Health Care Areas of Valencian Community. The various requesting sources covered by the laboratories create the need for continuous mapping processes redesign and benchmarking studies to achieve customer satisfaction.

Interpretación de la radiografía de tórax en los pacientes que ingresan en una Unidad de Corta Estancia. Relación con la estancia media / Chest X-ray interpretation on patients admitted in a short-stay unit. Relation with the mean length of stay

Introducción: Determinar la concordancia entre los médicos de un Servicio de Urgencias y un radiólogo en la interpretación de la radiografía de tórax (RxT) de pacientes ingresados en una unidad de estancia corta (UEC) y evaluar si ello influye en la estancia media. Material y método: Se revisaron las historias clínicas de los pacientes ingresados en una UEC durante 4 meses. Se comparó la interpretación de la RxT realizada por el médico responsable del paciente en urgencias con la interpretación realizada por un radiólogo. Se determinó la estancia media y se analizó si la lectura de la RxT previa al ingreso por el radiólogo hubiera mejorado la estancia media. Resultados: Se revisaron 260 historias clínicas. La concordancia total fue del 74,2%, siendo mayor cuando el médico de urgencias era un residente mayor o un adjunto que cuando era un residente menor (82% vs 66,4%; p < 0,003). No se observaron diferencias según el horario en el que se realizó la lectura. Solo en 9 casos (3,5%) se hubiera producido un cambio de diagnóstico y/o tratamiento. No se produjeron cambios en la estancia media de los pacientes según existiera concordancia o no, aunque en los casos en que se hubiera producido un cambio de diagnóstico y/o tratamiento se observó una tendencia a su aumento.Conclusiones: La lectura de la RxT por un radiólogo previa al ingreso en una UEC no está justificada en todos los casos. Podría realizarse cuando el residente mayor o el adjunto de guardia tuvieran dudas en su interpretación. Una mayor supervisión de los residentes menores podría mejorar el rendimiento diagnóstico de la RxT

Introduction: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. Material and method: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. Results: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. Conclusions: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films

[Chest X-ray interpretation on patients admitted in a short-stay unit. Relation with the mean length of stay]. / Interpretación de la radiografía de tórax en los pacientes que ingresan en una unidad de estancia corta. Relación con la estancia media.

INTRODUCTION: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. MATERIAL AND METHOD: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. RESULTS: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. CONCLUSIONS: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films.

Tira reactiva de orina como test determinante en el manejo del síndrome miccional en los servicios de urgencias / Urine reactive strip as the determinant test in the management of the mictional syndrome in the emergency services

No disponible

Neuritis óptica bilateral y síndrome de hipertensión endocraneal en una paciente afecta de linfoma no Hodgkin / Bilateral optic neuritis and endocranial hypertension syndrome in a woman with no-Hodgkin lymphoma

La afectación orbitaria es una complicación poco frecuente en los linfomas no Hodgkin, pudiendo manifestarse como pérdida de agudeza visual a consecuencia de una neuritis óptica. En aquellos casos en que se acompaña de deterioro del nivel de consciencia y clínica progresiva de hipertensión endocraneal debe descartarse la presencia de una carcinomatosis meníngea. El diagnóstico precoz en urgencias del cuadro de hipertensión endocraneal, y de la causa del mismo, permitirá instaurar un tratamiento precoz y de esa forma evitar las posibles secuelas que pudieran producirse. Presentamos el caso de una paciente afecta de un linfoma no Hodgkin en fase de remisión, que acudió a nuestro Servicio de Urgencias por un cuadro de pérdida de agudeza visual y en la que se diagnosticó un síndrome de hipertensión endocraneal. El rápido diagnóstico de una carcinomatosis meníngea fue fundamental para la evolución posterior de la paciente (AU)

Comparative study of the physical properties of a polyacid-modified composite resin and a resin-modified glass ionomer cement.

OBJECTIVES: The physical properties of the resin-modified composite resin Dyract (Detrey Dentsply) and the resin-modified glass ionomer cement Fuji II LC (GC) were compared, and the effect of water sorption on these properties was studied. METHODS: Compressive, diametral compressive and flexural strengths were measured using specimens aged up to three months. The Vickers hardness and the water erosion were also determined. The specimens were stored at 37 degrees C under five different conditions, chosen to vary the water sorption of the samples. The results were analyzed using a multi-factor analysis of variance. RESULTS: Dry specimens of Dyract and Fuji II LC showed similar properties. However, the two materials behaved differently when stored in presence of water. In contrast to Fuji II LC, Dyract showed very little expansion for the first 24 h (1.5 +/- 0.3 and 0.03 +/- 0.01%, respectively), leached small quantities of ions and retained its mechanical strength. Those differences are related to their chemical composition. Fuji II LC is hydrophilic, as it contains polyHEMA. In the presence of water, Fuji II LC behaves like a hydrogel, but the network resulting from the copolymerization of acidic and UDMA monomers is less hydrophilic, and the effect of water on Dyract is retarded. SIGNIFICANCE: The significant properties of Dyract are determined by its composite character. This certainly represents some advantages, for instance, a higher mechanical strength, a better protection against initial dehydration and subsequent water effects. However, Dyract shows some disadvantages over Fuji II LC, like a lower amount of fluoride release or the interference of oxygen during polymerization.

Effect of water on the physical properties of resin-modified glass ionomer cements.

OBJECTIVES: Resin-modified glass ionomer cements (GIC) are available for clinical use as restorative materials or as liners and bases. This work was conducted to study the effect of water sorption on the physical properties of several resin-modified GIC, by changing the samples' storage conditions. METHODS: The water sorption, the flexural strength, the flexural elastic modulus, the Vickers hardness and the dimensional changes of five resin-modified GICs were measured using specimens aged for 24 h to 3 mon. The specimens were stored at 37 degrees C, either in a dry environment (A), immersed in water (B), stored in a humid environment (C), stored in a humid environment for 1 h and then immersed in water (D), or immersed in water and subsequently dried (B + A). An analysis of variance was used to compare the results. RESULTS: The resin-modified GIC absorb during the first 24 h large amounts of water (114-172 mg/cm3) compared to the conventional GIC (30-63 mg/cm3). Water alters the physical properties of resin-modified GICs: With regard to dry specimens, a decrease in the flexural strength of 20 to 80% was observed for samples immersed in water. Decreases in their flexural elastic modulus (50 to 80%) and in their hardness (approximately 50%) were also observed. Water sorption also provoked an expansion in volume of the immersed specimens, ranging from 3.4 to 11.3% after 24 h. SIGNIFICANCE: The flexural strength and Vickers hardness of the resin-modified GICs are sensitive to the water contained in the tested specimens. A correlation was established between the decrease in their physical properties and the water uptake. However, it should not be concluded that these materials are not adequate for use in applications in direct contact with oral fluids. Probably, resin-modified GIC placed in oral cavities would not be affected to the same extent as in in vitro tests. In an oral environment, the constituents of saliva will certainly decrease the rate of water sorption and will hence delay its effects.

Compomers: between glass-ionomer cements and composites.

The term 'compomer' was crafted by the producers of the first commercial material of this kind: a polyacid-modified composite resin, sold as a filling material for some specific applications. This term should recall the composite resins and glass-ionomer cements, since some features of these two generic materials are found in the compomers. Compomers contain a bifunctional monomer, which should be able to react with the pendant methacrylate groups of other monomers, as well as with the cations liberated by the glass particles. Several products of this kind are now available, and the purpose of this paper is to describe some of their specificities and to compare their influence on the mechanical properties, water uptake and fluoride release.

[Mitral endocarditis secondary to Streptococcus mitis bacteremic pneumonia]. / Endocarditis mitral secundaria a neumonía bacteriémica por Streptococcus mitis.

Streptococcus viridans usually are an etiologic agent in odontogenic infection and endocarditis and only in some cases have been acknowledged as a respiratory pathogens. We present two cases of Streptococcus mitis bacteremic pneumonia with secondary mitral endocarditis in two patients that were been admitted by a respiratory infection (pneumonia), and later diagnosticated of mitral endocarditis. We dismiss the fisiopathogenic possibility of pneumonia with secondary pulmonary septic embolisms. With this description we help to prove the S. mitis respiratory system pathogenicity and show the known risk of endocarditis in any case of Streptococcus viridans bacteremic infection.

Mechanical behavior of glass ionomer cements affected by long-term storage in water.

OBJECTIVES: The early strength of glass ionomer cements was investigated previously (Cattani et al., 1993). Using the same set of glass ionomer cements, this study was designed to determine if mechanical property degradation occurred after an extended period of storage in water. METHODS: In the present study, the effect of aging in water on the compressive, tensile and flexural strengths of twelve commercial glass ionomer cements was evaluated at different time intervals after the beginning of the setting reaction. The aging periods varied from 24 h to 12 mon. RESULTS: The results show that the mechanical properties of the tested materials are in some cases affected by long-term aging in water. The evolution of strength follows distinct patterns of change. It has been established that the glass ionomer cements are neither characterized by a continuous increase nor a continuous decrease in strength. Most of the materials tested maintained a constant strength. However, several of them first display an improvement of the mechanical strength followed by a reduction. In this case, the 24h and the 12 mon strengths are usually similar. SIGNIFICANCE: The aging mechanisms of glass ionomers are complex. Strengthening probably results from additional crosslinking and build-up of a silica gel phase, whereas weakening may result from erosion and plasticizing effect of water.

Early strength of glass ionomer cements.

The present study compared the compressive, tensile and flexural strengths of 26 commercial glass ionomer cements, which were evaluated 24 h after the beginning of the setting reaction. In order to give a global estimation of their overall strength, a coefficient was attributed to each glass ionomer cement. This strength coefficient provided a ranking of the tested materials. The highest scores were obtained by the restorative glass ionomers; however, these materials exhibited lower mechanical properties than the more classic restorative materials such as amalgams or composites. The results also showed a large scattering of the mechanical properties among the luting and lining glass ionomer cements. The creep behavior of the glass ionomer cements was also investigated.