Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. / Sobreutilización innecesaria. Estudio de los «no hacer¼ en pacientes con fibrilación auricular.

OBJECTIVE: To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD: The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS: We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION: The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.

[How do primary care patients perceive information for involving themselves in self-care?]. / ¿Cómo perciben los pacientes de las consultas de Atención Primaria la información para implicarse en su autocuidado?

BACKGROUND: Analyze if patients receive information from their GPs to engage in self-management (medication,physical exercise or diet). METHODS: A descriptive study in which 2,401 randomly selected, primary care patients were interviewed by telephone. A short scale of 6 questions was used to analyze if they received information for self-care. Statistics included analyzing differences according to age,sex, occurrence of security incidents, whether they regularly attended the physician's surgery and length of consultation time. RESULTS: A total of 2,350 patients responded (97.9%response rate). A total of 1,253 (34.6%) of respondents obtained 5 or more points on the scale (percentile 50).Receiving information about foreseeable prognosis increased satisfaction (OR 11.2 (95% 8.3-15.3). Consultation time length (p<0.01), regularly visiting physicians(p<0.01), and not suffering an adverse event (p<0.01)were associated with higher scores on the scale. CONCLUSIONS: Patients report they receive directions for the proper management of medication at home, but claim that they receive less information to engage in healthy behaviors.

[The reputation of Spanish hospitals. Basis for developing a reputation index of hospitals]. / La reputación de los hospitales españoles. Bases para el desarrollo de un índice de reputación de los hospitales.

BACKGROUND: The reputation of the health centers is associated with: greater user preference in obtaining their services, better clinical outcomes and higher care quality and potential for attracting talented professionals. Reputation was evaluated using indexes and scales. The aim of this study is to analyze the attributes that should be gathered in a reputation index for Spanish hospitals. MATERIAL AND METHODS: Study based on qualitative techniques of consensus (nominal group technique + Delphi technique). RESULTS: Four dimensions were identified that form the reputation index: care quality, ethical behavior, credibility/confidence and biomedical innovation and research, which in turn are subdivided into 12 components in total. CONCLUSIONS: In building a reputation index consideration must be given to the combination of objective data (e.g. quality and safety outcomes) with other data that are subjective in nature (e.g., patient satisfaction). Future studies should go online to validate the reference standards in building a reputation index for hospitals.

La acrilamida, contaminante químico de procesado: revisión / Acrylamide formation in foods: a review Acrylamide

La acrilamida, 'probable carcinógeno para los humanos',mutágeno de categoría 2 y tóxico para la reproducción de categoría 3según la UE, se comporta como neurotóxico tras exposiciones agudas. A pesar de que se recomienda disminuir los niveles de exposición, el tabaquismo, la exposición ocupacional y la exposición dietética son fuentes de acrilamida para el hombre. De entre todos los alimentos, son los ricos en carbohidratos y los elaborados a altas temperaturas, los que mayores niveles de este tóxico presentan. En la presente revisión se explica la formación de acrilamida en los alimentos, se describen sus efectos tóxicos, se citan los métodos analíticos usados en su determinación, se recopilan datos sobre los niveles detectados en distintos alimentos y se enumeran los datos más recientes sobre la ingesta en distintas poblaciones (AU)

Acrylamide formation in foods: A review Acrylamide,'probable carcinogenic for humans', mutagenic type 2 and toxic for reproduction type 3 for the European Union, produces neurotoxicity after acute expositions. Although recommendations are given to minimize the exposition levels to this compound, smoking and occupational and dietary exposures are important acrylamide sources. Among foods, those rich in carbohydrates and those cooked at high temperatures present the highest acrylamide concentrations. The present revision points out the acrylamide formation in foods, its toxic effects and the analytical methods used in its determination. Moreover, data are given about acrylamide levels in foods and dietary intakes in different populations (AU)

Ecology of Vibrio cholerae non-O1 and Salmonella spp. and role of zooplankton in their seasonal distribution in Fukuyama coastal waters, Japan.

Seasonal variation of human pathogens such as Vibrio Cholerae non-01 and Salmonella spp. in Fukuyama coastal waters and the role of zooplankton in their distribution were studies for a period of 1 year. Comparison of two established methods, viz., the elevated temperature method and the two-step enrichment method of enumerating V. cholerae, showed that the former is superior in the recoveries of V. cholerae non-01. Isolation of this pathogen on a wider range of salinities (0.4 to 32.5%) revealed that these organisms are apparently an autochthonous component of the aquatic environment. Temperature appears to be the most crucial element in governing the distribution of V. cholerae non-01. Among the 69 isolates serotyped, 22 different serovars were identified, while one isolate failed to react with any of the known Louisiana State University antisera tested. Zooplankton samples did not harbor more V. Cholerae non-01 than the water column did. Better isolation of an allochthonous pathogen, viz., Salmonella spp., was noticed from the water samples when swabs were employed. Of the 251 isolates serotyped, 18 serotypes with three variants of Salmonella spp. were identified. A high amount of nutrients in the water column increased the survival rate of these pathogens in saline waters as evidenced by a higher incidence of various serotypes in polluted Fukuyama port than in clean marine waters. Salmonella spp. association between V. cholerae non-01 of Salmonella spp. with zooplankton could be noticed as influencing their seasonal distribution.