Seguridad del paciente

La seguridad del paciente es un factor esencial de la calidad asistencial y desde la publicación del informe \"Errar es humano\" es objeto de atención general. Las estrategias de mejora han estimulado el desarrollo de modelos que permiten un mejor conocimiento de los efectos adversos ligados a la asistencia sanitaria. Los sistemas de comunicación de efectos adversos generan información que permitirá adoptar medidas que incrementen la calidad asistencial. Los efectos adversos más comunes son los relacionados con el uso de medicamentos y con frecuencia son evitables. Para disminuirlos, detectarlos y mitigarlos cuando se producen, se pueden emplear estrategias dirigidas a reducir la complejidad, optimizar la información y la automatización de procesos. Aunque el progreso sea lento los cambios se están acelerando especialmente en la implantación de sistemas de prescripción electrónica y difusión de prácticas seguras.

Osteopetrosis del adulto. Conceptos actuales / Osteopetrosis of the adult. Current concepts

Se presentan cuatro casos de osteopetrosis del adulto, entidad poco frecuente, recogidos en nuestro hospital desde 1985 hasta 2005. Se revisa la patogenia y se actualizan conceptos y clasificación. Las manifestaciones clínicas se corresponden con otras publicaciones en las que la edad al diagnóstico es muy variable y el primer síntoma oscila desde dolor óseo a un hallazgo tras una fractura. Se revisan las mutaciones genéticas clásicas de todos los tipos, actualizando conceptos. Se introduce la propuesta de retirada de la osteopetrosis tipo I del adulto, ya que su patogenia parece un defecto intrínseco osteoblástico(AU)

We presents four cases of adult osteopetrosis, a very rare disease, compiled from our hospital from 1985 to 2005. Revising the pathogenesis and updating the current concept and classification. The clinical manifestations correspond with other publications where the age at diagnosis is highly variable and the first symptom oscillate from bone pain to a fracture. Presents the classic genetic mutations of all types updating concepts. Introducing the propose withdrawal of adult osteoporosis type I, because the pathogenesis seemed a intrinsic osteoblastic defect(AU)

[Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006]. / Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006.

Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006 / Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006

Experiencias recientes en nuestro país tratan deintroducir los portafolios profesionales comoherramientas de evaluación-aprendizaje, tanto anivel de pregrado como en la formaciónespecializada de posgrado. La aprobación del nuevoprograma de la especialidad de Medicina Interna, enun esfuerzo de adaptación a las necesidades de laatención sanitaria actual, ofrece la oportunidad parala aplicación de estas metodologías docentes y deevaluación formativa del proceso de aprendizaje delos futuros internistas. Durante el curso 2005-2006,el Grupo de Formación de la Sociedad Española deMedicina Interna (SEMI) se propuso desarrollar unaexperiencia piloto demostrativa de la aplicación delportafolio como instrumento para la evaluaciónformativa y la tutorización. Este artículo describedicha experiencia de diseño, desarrollo,implantación y evaluación de un portafolio ensoporte electrónico para residentes de MedicinaInterna de primer año de la especialidad, realiza unanálisis de las fortalezas y las debilidades delPortafolio SEMI y, por último, proponerecomendaciones para su futuro desarrollo

Recent educational projects in our country havebeen trying to introduce professional portfolios asassessment/learning tools on the undergraduate andspecialized post-graduate education levels. Theapproval of a new formative program for theInternal Medicine specialty in an effort to adapt tothe present health care needs offers an opportunityto apply these formative and evaluativemethodologies in the learning process of futureinternists. During the 2005-2006 academic year, theFormative Work Group of the Spanish InternalMedicine Society (SEMI) developed a pilot study onportfolio application as a tool for formativeassessment and mentoring. This article describes theproject of designing, developing, applying andassessing an electronic portfolio for first yearInternal Medicine residents. It presents an analysisof the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development (AU)

[Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service]. / Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna.

BACKGROUND AND OBJECTIVE: To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. MATERIAL AND METHOD: A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. RESULTS: Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. CONCLUSIONS: The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection.

Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna / Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service

Fundamento y objetivos. Conocer la percepción que los profesionales sanitarios tienen sobre los riesgos derivados de la práctica asistencial, estimar los efectos adversos (EA) más frecuentes, y establecer las diferencias y similitudes entre la percepción de riesgos y los EA producidos. Material y método. Se realizó una encuesta autoadministrada sobre percepción de riesgos y seguridad del paciente a todo el personal de un servicio de medicina interna de un hospital general universitario. Posteriormente, y a través de la guía de cribado del proyecto IDEA 1ª edición, se analizaron las historias clínicas de los pacientes seleccionados por médicos residentes de medicina preventiva y de medicina interna. Resultados. Encuesta. Se enviaron 50 cuestionarios y se obtuvo una tasa de respuesta del 42%. Los riesgos priorizados por obtener una puntuación media más baja fueron la no existencia de plan de actuación frente a catástrofes (2,79 sobre 10) y la falta de espacios para informar (3 sobre 10.); y por mayor porcentaje en las preguntas abiertas, el mantenimiento prolongado de sondajes urinarios, con un 47.61% y la prescripción inadecuada de antibióticos (33,33%). Estudio sobre efectos adversos. Incidencia acumulada (IA) de pacientes con EA: 25% (intervalo de confianza [IC] 95% 11,06-38,9); IA de EA: 26,6% (IC 95% 12,6-40,6). El 41,6% de los EA estuvieron relacionados con la medicación, un 25% con la infección nosocomial, y con problemas técnicos de procedimientos y con fallos en los cuidados del paciente un 16,66% cada uno. Conclusiones. La percepción de los profesionales sanitarios sobre los riesgos derivados de la práctica asistencial es diferente a los sucesos adversos que realmente se terminan materializando. Los profesionales están más preocupados por la información a los pacientes y por la calidad científico-técnica. Los sucesos adversos más frecuentes que se producen son los relacionados con la medicación. El único punto común es la preocupación por la infección nosocomial (AU)

Background and objective. To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. Material and method. A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. Results. Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. Conclusions. The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection (AU)

Seguridad del paciente y gestión de riesgos. Réplica / No disponible

No disponible

[Patient safety and quality of care]. / Seguridad del paciente y calidad asistencial.

Adverse effects related to health care are common and partly avoidable. We need to identify how and why adverse events occur and how system defects may contribute to their occurrence. Systems and processes can be designed to help prevent errors and decrease harm that occurs when they are not intercepted. Tactics to reduce errors and mitigate their adverse effects include reducing complexity and optimizing information processing. Implementation of information technology may offer great promise but the most important is to make an effort to promote a culture of safety.

Seguridad del paciente y calidad asistencial / Patient safety and quality of care

Los efectos adversos relacionados con la atención sanitaria son frecuentes y en muchos casos evitables. Es preciso conocer cómo se producen y los defectos del sistema que han contribuido a ello. Los sistemas y procesos deben estar diseñados para prevenir los errores y disminuir el daño que ocasionan si no son evitados. Entre las estrategias para prevenirlos está reducir la complejidad de los procesos y optimizar el manejo de la información. La implementación de las tecnologías de la información puede ofrecer una gran contribución, pero la prioridad es promover una cultura de la seguridad (AU)

Adverse effects related to health care are common and partly avoidable. We need to identify how and why adverse events occur and how system defects may contribute to their occurrence. Systems and processes can be designed to help prevent errors and decrease harm that occurs when they are not intercepted. Tactics to reduce errors and mitigate their adverse effects include reducing complexity and optimizing information processing. Implementation of information technology may offer great promise but the most important is to make an effort to promote a culture of safety (AU)

[Patient safety]. / Seguridad del paciente.

Ensuring patient safety is essential for better heath care. Safety have gripped public attention ever since the release of the report "To Err is Human". To find strategies of promotion of patient safety has stimulated models that improve knowledge of adverse events. Adverse drug events are the most common cause of injury to hospitalized patients and are often preventable. Many tactics are available to make system changes to reduce errors and adverse events; they fall into five categories: Reduce complexity, optimise information processing, automate wisely, use constraints, and mitigate the unwanted side effects of change. These tactics can be deployed to support any of the three strategic components of error prevention, detection, and mitigation. Although progress has been slow, the pace of change is likely to accelerate, particularly in implementation of electronic health records and diffusion of safe practices.

Doble rotura cardiaca post-infarto agudo de miocardio / Double cardiac rupture post myocardial acute infarction

No disponible

Neumonía en los ancianos institucionalizados / Nursing home-acquired pneumonia

No disponible

[Cocaine-induced neurological complications]. / Complicaciones neurológicas por cocaína.

Cocaine intake growth is a well-known fact, and that involves the appearance of unknown or forgotten complications. We have wanted to make a checking of neurologic complications due to the intake of this drug, make a special point of the physiopathological mechanisms and stopping at those related to treatment. We also want to contribute with our experience with regard to these processes.

[Community-acquired pneumonia in the aged: prognostic factors]. / Neumonía comunitaria en el anciano: factores pronósticos.

We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.

[The prognostic factors of mortality in community-acquired pneumonia requiring hospitalization]. / Factores pronósticos de mortalidad en la neumonía comunitaria que requiere hospitalización.

The prognostic influence on mortality of parameters available in an emergency Unit is studied in patients with acquired community pneumonia (ACP) requiring hospitalization. Three hundred and thirty patients admitted consecutively from the emergency unit of a general hospital were evaluated. Radiological, analytical, clinical, and demographic data were recorded. The parameters associated with greater mortality were: age, absence of thoracic pain, obnubilation, hypotension, elevation in urea, GOT, GPT, LDH, decrease in prothrombin activity, pO2, pH, albumin, and the affectation of more than one lobe in a radiography of the thorax. Considering the parameters associated with a higher relative risk (age > 65 years, urea > 50 mg/dl, LDH > 460 U/l and prothrombin < 70%), the presence of three or four of these variables shaved a sensibility of 59 percent and a specificity of 93 percent in predicting mortality. In the multivariant analysis remained as significant: age, obnubilation, elevation in LDH, and decrease in the activity of prothrombin and pH. Appropriate knowledge of the prognostic factors in CAP allows for early determination of patients who require special attention in both diagnosis and in treatment upon hospitalization.