[Assessment of outcomes of implementing the Sepsis Code in the emergency department of a tertiary hospital]. / Evaluación de los resultados de la implantación del Código Sepsis en el servicio de urgencias de un hospital terciario.

INTRODUCTION: A Sepsis Code (CS) is a comprehensive multidisciplinary system which has the aim of optimising the identification and intervention times of patients with sepsis, as well as improving their monitoring and treatment adjustments in order to reduce their mortality. OBJECTIVES: To present the outcomes of the first year of introducing the CS in the emergency department of a tertiary hospital. MATERIAL AND METHODS: A single-centre retrospective descriptive observational study was conducted on all patients in whom the CS was activated in the emergency department of a tertiary hospital during the first year of implementation. The variables included: demographics, CS activation, comorbidities, focus of infection, microbiology, antibiotic treatment, and mortality. RESULTS: CS was activated in 555 patients, of which 302 (54.4%) had a definitive diagnosis of sepsis or septic shock on discharge from the emergency department. The degree of completion of the protocol variables was variable (41.8-95%).The large majority (86.1%) of the patients received antibiotics in the first hour, and in 76.2% blood cultures were collected prior to the antibiotic. Of the blood cultures performed, 13.3% of the isolated germs were multi-resistant and the level of contamination of blood cultures was 9.1%. All patients received empirical treatment and recommendations were followed in patients with septic shock in 28.3%. During follow-up, 64.4% the antibiotic treatment was targeted, and 39.5% received sequential therapy. In-hospital mortality was 32.2%. CONCLUSIONS: Areas of improvement in the completion of the variables, contamination of blood cultures, and empirical treatment received were detected, with the strong points being the early administration of the antibiotic and the collection of blood cultures.

[A version of DSM-IV criteria adapted for adolescents and applied to young smokers]. / Aplicación en jóvenes fumadores de una versión de los criterios nosológicos DSM-IV adaptada para adolescentes.

OBJECTIVES: To evaluate nicotine dependence in adolescent smokers using a version of DSM-IV criteria for nicotine dependence adapted for adolescents (DSM-IVa). To establish its usefulness and the most relevant items for diagnosing adolescent smokers. POPULATION AND METHODS: Two thousand six hundred forty-seven schoolchildren between 10 and 17 years old were surveyed. A sample size was calculated for each year of age, using the finite population equation with the addition of 10% so that the absolute error would not increase at the end of the study if questionnaires were withdrawn. The sample was stratified by sex and type of school for each age group, with allocation to each stratum proportional to the number of individuals. Schools and students were selected using random number tables. The questionnaire collected the most significant personal data and information related to DSM-IVa criteria. RESULTS: Smokers made up 23.1% of the sample, and 63.5% of them smoked daily. According to the DSM-IVa criteria, 70.7% of the smokers were nicotine dependent. The DSM-IVa had a kappa value of 1 and internal consistency was good (Cronbach's alpha: 0.5598). CONCLUSIONS: The DSM-IVa is useful in the studied population, although not perfect. According to the criteria, 70.7% of those interviewed were already nicotine dependent. The key questions were those that referred to the presence of nicotine withdrawal syndrome symptoms and the need to spend a large amount of free time obtaining or smoking cigarettes.

Aplicación en jóvenes fumadores de una versiónde los criterios nosológicos DSM-IV adaptadapara adolescentes / A version of DSM-IV criteria adapted for adolescents and applied to young smokers

OBJETIVOS: Valorar la dependencia nicotínica en jóvenes fumadores a través de una versión adaptada para adolescentes de los criterios nosológicos DSM-IV para la dependencia a la nicotina (DSM-IVa). Determinar su utilidad y los ítems más importantes del mismo en adolescentes fumadores. POBLACIÓN Y MÉTODOS: Se entrevistó a 2.647 escolares de entre 10 y 17 años. Se calculó un tamaño muestral para cada edad, en años, mediante la ecuación de poblaciones finitas, añadiendo un 10 por ciento para que en el caso de existir mermas no aumentasen el error absoluto final. Para cada edad el muestreo fue estratificado por sexo y tipo de centro, con afijación en cada estrato proporcional al número de individuos. La elección de centros y alumnos se hizo mediante tabla de números aleatorios. La encuesta, además de recoger los principales datos personales, comprendía una versión adaptada a adolescentes de los criterios nosológicos DSM-IV para la dependencia a la nicotina. RESULTADOS: El 23,1 por ciento eran fumadores, y de ellos el 63,5 por ciento eran fumadores diarios. Según el DSM-IVa, el 70,7 por ciento de los fumadores eran dependientes de la nicotina. El DSMIVa obtuvo un índice kappa de 1 y una buena consistencia interna (coeficiente alfa de Cronbach = 0,5598). CONCLUSIONES: El DSM-IVa es útil en dicha población, aunque no perfecto. Según sus criterios, el 70,7 por ciento de los entrevistados ya se habían vuelto dependientes de la nicotina, siendo las preguntas clave las referentes a la presencia de síntomas del síndrome de abstinencia nicotínica y a la necesidad de emplear gran parte del tiempo libre en conseguir o consumir tabaco (AU)

[Determination of nicotine dependence in school-aged smokers through a modified Fagerström Test]. / Determinación de la dependencia nicotínica en escolares fumadores a través de un test de Fagerström modificado.

BACKGROUND: Approximately 65 % of young smokers have failed to give up smoking because of their addiction to nicotine. The Fagerström Test for Nicotine Dependence is used to quantify nicotine dependence in adults but studies in teenagers are scarce. OBJECTIVES: To determine whether young smokers are nicotine-dependent, and if so, to what extent, as well as the factors linked to nicotine dependence. METHODS: A total of 2647 schoolchildren, aged 10 to 17 years old, from 41 different schools were interviewed. A sample size was calculated for each age, in years, by using the equation of finite population, but adding an extra 10 % so that if the numbers decreased, the final absolute error would not be increased. For each age the sample was stratified by sex and type of school, with proportional affixation to the number of individuals within each stratum. Schools and students were chosen by using the random numbers table. In addition to eliciting personal data, the questionnaire also included a version of the FTND adapted for use in teenagers. RESULTS: The mean age was 13.77 years and 51.5 % were male. A total of 23.1 % reported they were smokers (54.5 % of them were girls and 45.5 % were boys). Most (86.6 %) of these teenager smokers showed low-moderate nicotine dependence and 3.3 % showed high dependence. No differences were found according to sex or age. CONCLUSIONS: Most teenagers who smoke show low nicotine dependence. Campaigns to prevent smoking should be aimed at children aged less than 10 years old to delay smoking the first cigarette and the subsequent next step of becoming a daily smoker for as long as possible since both factors have proved decisive in nicotine dependence.

Determinación de la dependencia nicotínica en escolares fumadores a través de un test de Fagerström modificado / Determination of nicotine dependence in school-aged smokersthrough a modified Fagerströmtest

Antecedentes. Alrededor del 65 por ciento de los jóvenes fumadores ha intentado dejar de fumar sin conseguirlo debido a su dependencia nicotínica. El método para cuantificar dicha dependencia en adultos es el test de Fagerström, y son escasos los estudios realizados en adolescentes. Objetivos. Establecer la posible existencia de dependencia nicotínica en los jóvenes fumadores, el grado de ésta y los factores asociados a su aparición. Métodos. Se entrevistaron 2.647 escolares, de 10 a 17 años, de 41 centros escolares. Se calculó un tamaño muestral para cada edad, en años, mediante la ecuación de poblaciones finitas, añadiendo el 10 por ciento para en el caso de existir mermas no aumentasen el error absoluto final. Para cada edad el muestreo fue estratificado por sexo y tipo de centro, con afijación en cada estrato proporcional al número de individuos. La elección de los centros y alumnos se llevó a cabo mediante tabla de números aleatorios. La encuesta, además de recoger los principales datos personales, comprendía una versión adaptada a adolescentes del Test de Fagerström para la Dependencia de Nicotina. Resultados. Edad media de 13,77 años (varones, 51,5 por ciento). El 23,1 por ciento se declararon fumadores (54,5 por ciento mujeres y 45,5 por ciento varones). El 86,6 por ciento de los adolescentes fumadores tienen dependencia nicotínica baja-moderada y el 3,3 por ciento alta, sin que se observen diferencias en función del sexo ni edad. Conclusiones. La mayor parte de los adolescentes fumadores presentan dependencia nicotínica baja. Las campañas de prevención del consumo de tabaco se deben realizar antes de los 10 años, retrasando en lo posible, el consumo del primer cigarrillo y el paso a fumador diario, pues ambos factores se han mostrado determinantes en la presencia de dependencia nicotínica (AU)