Evaluation of reflux in intravenous hazardous drugs (HDs) delivery systems. Exposure of nursing staff to hazardous drugs / Evaluación del reflujo en los sistemas de administración intravenosa de MP. Exposición del personal de enfermería

For the intravenous administration of hazardous drugs, infusion kits are used to administer various drugs using the same system. The system acts as a protection measure for the health workers who are administering the drugs, and reduces the amount of handling required when using the perfusion system, thus minimising exposure to HDs. These systems have been sampled and analysed using ultraviolet (UV) and fluorescence spectrophotometric techniques. It has been observed that they do not prevent contamination of the washing solution that cleans the system prior to disconnection and removal. The system should therefore not be regarded as safe

Para la administración intravenosa de medicamentos peligrosos (MP), se utilizan equipos de infusión que permiten administrar varios fármacos en el mismo sistema y sirven como medida de protección para los trabajadores que los administran, pues reducen las manipulaciones del sistema de perfusión y minimizan la exposición. Se han realizado tomas de muestras de estos sistemas, y se han analizado mediante técnicas de espectrofotometría ultravioleta (UV) y espectrofotometría de fluorescencia. Se ha observado, que no evitan la contaminación de la solución de lavado que limpia el sistema antes de su desconexión y retirada. Por tanto, el sistema no debe considerarse seguro

Personality traits and sick leave in workers diagnosed with nonorganic neck pain.

Previous research has suggested that personality can influence the perception and reporting of physical symptoms, such as pain. To assess the relationship between the course of nonorganic neck pain and the individual's personality, we studied the association between two indicators of neck pain prognosis, such as the duration of sick leave associated with neck pain and sick leave recurrence, and 15 personality traits in a sample of 64 workers suffering from disabling neck pain without any signs of physical abnormalities in the neck area. The TEA Personality Test (TPT), a self-report instrument designed to evaluate personality traits related to organizational behaviors, was used. Compared to the normative data, the study sample obtained high scores in the Depression, Anxiety and Emotional Instability scales, thus suggesting a personality profile primarily characterized by high neuroticism-related scores. Controlling for age, gender, and any rehabilitation undergone, we found a positive relationship between Depression and the duration of sick leave (in weeks). Moreover, lower scores on the TPT personality trait Dynamism and activeness were associated with higher likelihood of sick leave recurrence. These findings highlight the need for further research into the role played by personality at the onset and in the maintenance of nonorganic neck pain. Furthermore, they suggest that a complementary psychological approach may be useful to nonorganic neck pain management.

Reorientación de la actividad asistencial en un servicio de Medicina Física y Rehabilitación: análisis de costes. Evidencia y medicina coste-efectiva / Assistance activity reorientation in a physical medicine and rehabilitation service: costs analyses. Evidence and cost-efectiveness medicine

Introducción: El continuo aumento del gasto sanitario, en un medio con recursos limitados, obliga a potenciar la función gestora de los servicios utilizando criterios de efectividad y eficiencia. Material y métodos: Realizamos una revisión de todas las patologías atendidas en fisioterapia en el hospital durante el año 2007, analizando las prescripciones de tratamiento más habituales. Solicitamos a Control de Gestión información de los costes del área terapéutica del mismo año, realizando un cálculo aproximado del coste que supuso la patología dolorosa osteoarticular y el programa de rehabilitación cardiaca. Revisamos información de medicina basada en la evidencia (MBE) en rehabilitación y consultamos la base de datos Centre for Reviews and Dissemination, buscando información coste-efectividad de las patologías revisadas. Resultados: Del total de patologías atendidas en el área terapéutica del hospital el 42% correspondieron a algias de origen osteoarticular, que fueron tratadas de forma individual, con prescripciones terapéuticas de dudosa eficacia, según la revisión de la MBE y con un coste similar, en el caso de la cervicalgias y lumbalgias al coste por paciente del grupo de rehabilitación cardiaca, siendo este programa, en nuestro departamento, de desarrollo hospitalario y avalado por la MBE y la medicina coste-efectiva. Conclusiones: El desarrollo de la función gestora del servicio precisa reorientar nuestra actividad asistencial: descentralizar la patología dolorosa osteoarticular, modificar nuestras prescripciones terapéuticas con pautas más acordes a la MBE, teniendo en cuenta los costes de los procedimientos empleados y mejorar la atención de la patología más compleja a nivel hospitalario (AU)

Introduction: The continuous increase of health expense in an enviroment of scant resources makes necessary the reinforcement of the services management function using efficiency and effectiveness criteria. Material and methods: We carried out a revision of each pathology attended in physiotherapy at our hospital in 2007, analyzing the most habitual treatment prescriptions. We asked Management Control for information about therapeutic area costs during the same year in order to make an estimate calculation of the cost of osteoarticular painful pathology and the cardiac rehabilitation programme. Information about medicine based on evidence (MBE) in rehabilitation is revised and the Centre for Reviews and Dissemination data base is consulted looking for information on cost-effectiveness in the pathologies revised. Results: From the total of the pathologies attended in the hospital therapeutic area, 42% correspond to pain with an osteoarticular origin. These were treated in an individual way, with therapeutic prescriptions of questionable effectiveness, according to the MBE revision and with a similar cost, in the case of neck and back pain, to the cost per patient in the heart rehabilitation group, this programme being, in our department, developed in hospital and guaranteed by the MBE and the cost-effective medicine. Conclusion: The development of the services management function needs to reorientate assistance activity by decentralizing osteoarticular painful pathology, by modifying our therapeutic prescriptions with patterns more in agreement with the MBE, taking into account the cost of the procedures used, and finally by improving the treatment of more complex pathologies at hospital level (AU)

Biochemical and immunologic features of an outbreak of Legionnaires disease: comparative study between community-acquired pneumonias.

Legionella pneumophila has been recognized as an important cause of community- and hospital-acquired pneumonia. This study evaluates the interrelationship between that patients group with Legionnaires disease (LD) and the possible factors that may predispose hosts to acquire this infection. Likewise, we search for preliminary biochemical and immunologic evidences that could help physicians to differentiate between LD and other pneumonias. We analyzed biochemical parameters and immunoglobulin levels in 61 LD patients and a control group (n = 30) who were non-Legionella pneumonia diagnosed. We observed statistically significant differences in LD patients versus control group in serum sodium, albumin, gamma-band, IgG levels, (P < .01) and for total proteins, aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (P < .05). Our study shows a trend between the presence of LD and immunoglobulin deficiencies in the group studied. Deficit in IgG or IgG plus IgM, during the exposure period, may predispose individuals to suffer legionellosis (P < .05). Overall, hypoalbuminemia, hyponatremia, and high AST and LDH levels can represent a useful prognostic marker in patients with severe pulmonary infection suspected to be legionellosis.