"El dia de l'antibiòtic": una eina per sensibilitzar sobre l'ús correcte d'antimicrobians / "El día del antibiótico": una herramienta para sensibilizar sobre el uso correcto de los antimicrobianos / "Antibiotic day": a tool for the correct use of antimicrobials

FONAMENT: El Pla de Salut de Catalunya 2016-2020 promou la implantació de projectes que disminueixin les resistències antibiòtiques. OBJECTIU: Valorar «El dia de l'antibiòtic» com una eina per fer control de qualitat I seguiment de l'ús dels antibiòtics. MÈTODE: Recollida de dades de pacients hospitalitzats en un centre pediàtric de segon nivell, per un membre del comitè d'infeccioses sense intervenció en la pràctica assistencial I amb desconeixement dels facultatius del centre. La recollida es fa aleatòriament dos dies a l'any durant 2016, 2017 I gener de 2018. S'obtenen: edat, pes, motiu I dies d'ingrés, antibiòtic, dosi, via, durada, cultius, tractament a l'ingrés I durant l'hospitalització, I compliment dels protocols interns. Es comuniquen els resultats als responsables dels pacients. S'avalua el cost que va representar la despesa d'antibiòtics durant els dos anys. RESULTATS: Al 2016, tres pacients ingressen amb una dosi incorrecta, dos amb una durada allargada I tres amb un espectre massa ample. Al 2017, dos pacients no segueixen el protocol, dos reben una dosi incorrecta I dos un antibiòtic d'espectre massa ample. Al 2018, un pacient rep antibiòtic amb un espectre massa ample. Tot això comporta un canvi en el protocol de la pneumònia adquirida a la comunitat (PAC). Es calcula una disminució de la despesa del 13,2%. CONCLUSIONS: La revisió anònima de la prescripció antibiòtica ha provocat un canvi en la mentalitat del pediatre per tal de emprar l'antibiòtic adient. El seguiment acurat de protocols interns ha fet que es modifiqui el protocol de PAC minvant l'espectre antibiòtic empíric. La despesa econòmica ha millorat un 13%

FUNDAMENTO: El Plan de Salud de Catalunya 2016-2020 promueve la implantación de proyectos que disminuyan las resistencias antibióticas. OBJETIVO: Valorar «El día del antibiótico» como herramienta para el control de la calidad y el seguimiento de la utilización de los antibióticos. MÉTODO: Recogida de datos de pacientes hospitalizados en un centro pediátrico de segundo nivel, por un miembro del comité de infecciones sin intervención asistencial y con desconocimiento de los facultativos asistenciales. La recogida se hace aleatoriamente dos días al año durante 2016, 2017 y enero de 2018. Se recoge: edad, peso, motivo y días de ingreso, antibiótico, dosis, vía, duración, cultivos, tratamiento al ingreso y durante la hospitalización, y cumplimiento de los protocolos internos. Se comunican los resultados a los responsables de los pacientes. Se evalúa el coste del gasto de antibióticos durante los dos años. RESULTADOS: En 2016, tres pacientes ingresan con dosis incorrectas, dos con duración alargada y tres con espectro demasiado amplio. En 2017, dos pacientes no siguen el protocolo, dos reciben dosis incorrectas y dos un antibiótico de espectro demasiado amplio. En 2017 se cambia el protocolo de neumonía adquirida en la comunidad (NAC). En 2018, un paciente recibe antibiótico con un espectro demasiado amplio. Se calcula una disminución de gastos del 13,2%. CONCLUSIONES: La revisión anónima de la prescripción antibiótica ha producido un cambio en la mentalidad del pediatra con el fin de utilizar el antibiótico adecuado. El seguimiento estricto de protocolos internos facilitó la modificación del protocolo de NAC disminuyendo el espectro antibiótico empírico. El gasto económico mejoró un 13%

BACKGROUND: The Catalonia Health Plan 2016-2020 promotes the implementation of projects that reduce antibiotic resistance in health centers. OBJECTIVE: To evaluate «Antibiotic Day» as a tool for quality control and monitoring of the use of antibiotics. METHOD: Collection of data from a second level pediatric hospital by a member of the infectious disease committee without intervention in clinical practice and without the prior knowledge of the hospital staff. Twice a year, with randomly selected dates for 2016, 2017 and January 2018, the following data were collected for patients receiving antibiotics: age, weight, cause and days of admission, antibiotic dose, route, days of treatment, cultures, treatment during hospitalization and upon discharge, and compliance with internal protocols. The results were communicated to the primary care providers. The antibiotic-associated cost for the two-year period was calculated. RESULTS: In 2016, three patients were admitted with an incorrect dose, two with prolonged duration and three received antibiotics of wider spectrum than indicated. In 2017, two patients did not follow the protocol, two received incorrect doses, and two received antibiotics of wider spectrum than required. In 2017, the Community Acquired Pneumonia Protocol (CAP) was modified. In 2018, one patient received an antibiotic of wider spectrum that indicated. Hospital expenses decreased by 13.2% during the study period. CONCLUSIONS: The implementation of "Antibiotic Day" resulted in a change in the antibiotic prescription practices with the use of antibiotics with narrower spectrum. The careful monitoring of internal protocols has led to the modification of the CAP protocol, which is used to reduce the empirical antibiotic spectrum. Economic waste has improved by 13%

Converging Medial Frontal Resting State and Diffusion-Based Abnormalities in Borderline Personality Disorder.

BACKGROUND: The psychological profile of patients with borderline personality disorder (BPD), with impulsivity and emotional dysregulation as core symptoms, has guided the search for abnormalities in specific brain areas such as the hippocampal-amygdala complex and the frontomedial cortex. However, whole-brain imaging studies so far have delivered highly heterogeneous results involving different brain locations. METHODS: Functional resting-state and diffusion magnetic resonance imaging data were acquired in patients with BPD and in an equal number of matched control subjects (n = 60 for resting and n = 43 for diffusion). While mean diffusivity and fractional anisotropy brain images were generated from diffusion data, amplitude of low-frequency fluctuations and global brain connectivity images were used for the first time to evaluate BPD-related brain abnormalities from resting functional acquisitions. RESULTS: Whole-brain analyses using a p = .05 corrected threshold showed a convergence of alterations in BPD patients in genual and perigenual structures, with frontal white matter fractional anisotropy abnormalities partially encircling areas of increased mean diffusivity and global brain connectivity. Additionally, a cluster of enlarged amplitude of low-frequency fluctuations (high resting activity) was found involving part of the left hippocampus and amygdala. In turn, this cluster showed increased resting functional connectivity with the anterior cingulate. CONCLUSIONS: With a multimodal approach and without using a priori selected regions, we prove that structural and functional abnormality in BPD involves both temporolimbic and frontomedial structures as well as their connectivity. These structures have been previously related to behavioral and clinical symptoms in patients with BPD.

[Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups]. / Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud.

OBJECTIVE: To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). DESIGN: Retrospective, observational study. SETTING: Four PC teams. PARTICIPANTS: All patients attended during 2003. MEASUREMENTS: Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62,311 patients seen, with an average of 4.8+/-3.2 episodes/patient/year. MAIN RESULTS: The total health care cost reached 24,135,236.62 euro, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was 387.34 euro+/-145.87 euro (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P < .0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P = .005). CONCLUSIONS: The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres.

Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud / Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups

Objetivo. Medir la eficiencia en el uso de recursos entre los cupos asistenciales de 4 centros de atención primaria de salud (APS), a partir de la utilización de los Ambulatory Care Groups (ACG). Diseño. Estudio observacional retrospectivo. Emplazamiento. Cuatro equipos de atención primaria. Participantes. Todos los pacientes atendidos durante el año 2003. Mediciones. Variables dependientes (costes por paciente, entre cupos médicos [medicina de familia, pediatría] y centros asistenciales) y de casuística. El modelo de costes para cada paciente se estableció diferenciando los costes semifijos y los variables. El índice de eficiencia (IE) se estableció entre el cociente entre el coste real observado y el coste esperado en función de la distribución ACG, por estandarización indirecta. Resultados principales. La población de estudio fue de 62.311 pacientes atendidos, con una media de 4,8 ± 3,2 episodios/paciente/año. El coste total de la atención sanitaria ascendió a 24.135.236,62 €, de los cuales el 65,2% correspondió a la prescripción de farmacia, el 28,9% a los costes semifijos y el 2,9% al coste de las derivaciones a especialistas. El promedio de coste total por paciente/año fue de 387,34 ± 145,87 € (peso relativo medio). El IE por centro fue de 0,93 (intervalo de confianza [IC] del 95% 0,85-1,01), 0,97 (IC del 95% del 95% 0,89-1,05), 1,04 (IC del 95% 0,96-1,12) y 1,05 (IC del 95%, 0,97-1,13), respectivamente (p < 0,0001). Además, se observan diferencias entre los cupos médicos (rango, 0,63-1,56) y entre los cupos pediátricos (rango, 0,73-1,26) (p = 0,005). Conclusiones. Los ACG permiten realizar una aproximación a la medida de la eficiencia de centros y cupos asistenciales de APS de nuestro entorno. La eficiencia no puede ser considerada de manera aislada de otras dimensiones de la calidad asistencial. El estudio del IE permite profundizar en el conocimiento del perfil de los profesionales y de los centros de salud

Objective. To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). Design. Retrospective, observational study. Setting. Four PC teams. Participants. All patients attended during 2003. Measurements. Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62 311 patients seen, with an average of 4.8±3.2 episodes/patient/year. Main results. The total health care cost reached €24 135 236.62, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was €387.34±€145.87 (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P<.0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P=.005). Conclusions. The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres

Auditory sensory gating deficit in abstinent chronic alcoholics.

P50 event-related potential was studied in abstinent chronic alcoholics to determine whether they had normal sensory gating. Repeated tones were presented to 17 recently detoxified chronic alcoholic patients and 17 healthy subjects while EEG was recorded. Low-resolution tomography (LORETA) was performed to obtain cerebral sources of P50. Abstinent chronic alcoholics showed reduced P50 sensory gating. Present results suggest an inhibitory deficit in early pre-attentive auditory sensory processing in chronic alcoholism.