A modified animal-free serum technique for efficient isolation and proliferation of mesenchymal stem cells from Hoffa fat pad.

We focus on this study in designing an alternative technique for obtaining mesenchymal stem cells (MSCs) from residual tissue, Hoffa fat, in arthroscopic procedures. Two males and two females were included, and underwent knee arthroscopy; a sample of infrapatellar adipose tissue was obtained with basket forceps. The primary culture was made using the explant method and the culture media: DMEM-high glucose, supplemented with 10% of inactivated human allogeneic serum. All the cellular cultures remained under culture conditions for three weeks, after that by flow cytometry the cells were characterized by MSCs antibody panel: CD105, CD73 and CD90. Subsequently, in the first pass, the MSCs were cultured in commercial human chondrogenic, osteogenic and adipogenic mediums, respectively. After primary culture, we obtained on average 95,600.00 ± 7,233.26 cells/cm2, and the duplication time of MSCs isolate from Hoffa fat pad was established in 39 hours. By flow cytometry, we found that surface markers percentage for expanded MSCs (CD105, CD73, CD90) in primary culture significantly increased and its morphology was fibroblastic-like. After differentiation culture which was made in the first pass, by immunofluorescence, we obtained positive cell markers for three lineages of differentiation, adipocytes: LPL protein, osteocytes: RUNX2, Osteopontin, chondrocytes: SOX9, Aggrecan and COL2A1. We managed to isolate a significant number of MSCs from this source using an easy method to implement and minimal nutrient supplementation, with high potential for differentiation to mature mesenchymal tissues and potential use in basic experimental, preclinical and even clinical research.

Synovial membrane mesenchymal stem cells for cartilaginous tissues repair.

BACKGROUND: The present review is focused on general aspects of the synovial membrane as well as specialized aspects of its cellular constituents, particularly the composition and location of synovial membrane mesenchymal stem cells (S-MSCs). S-MSC multipotency properties are currently at the center of translational medicine for the repair of multiple joint tissues, such as articular cartilage and meniscus lesions. METHODS AND RESULTS: We reviewed the results of in vitro and in vivo research on the current clinical applications of S-MSCs, surface markers, cell culture techniques, regenerative properties, and immunomodulatory mechanisms of S-MSCs as well as the practical limitations of the last twenty-five years (1996 to 2021). CONCLUSIONS: Despite the poor interest in the development of new clinical trials for the application of S-MSCs in joint tissue repair, we found evidence to support the clinical use of S-MSCs for cartilage repair. S-MSCs can be considered a valuable therapy for the treatment of repairing joint lesions.

Validation and clinical application of a targeted next-generation sequencing gene panel for solid and hematologic malignancies.

BACKGROUND: Next-generation sequencing (NGS) is a high-throughput technology that has become widely integrated in molecular diagnostics laboratories. Among the large diversity of NGS-based panels, the Trusight Tumor 26 (TsT26) enables the detection of low-frequency variants across 26 genes using the MiSeq platform. METHODS: We describe the inter-laboratory validation and subsequent clinical application of the panel in 399 patients presenting a range of tumor types, including gastrointestinal (GI, 29%), hematologic (18%), lung (13%), gynecological and breast (8% each), among others. RESULTS: The panel is highly accurate with a test sensitivity of 92%, and demonstrated high specificity and positive predictive values (95% and 96%, respectively). Sequencing testing was successful in two-thirds of patients, while the remaining third failed due to unsuccessful quality-control filtering. Most detected variants were observed in the TP53 (28%), KRAS (16%), APC (10%) and PIK3CA (8%) genes. Overall, 372 variants were identified, primarily distributed as missense (81%), stop gain (9%) and frameshift (7%) altered sequences and mostly reported as pathogenic (78%) and variants of uncertain significance (19%). Only 14% of patients received targeted treatment based on the variant determined by the panel. The variants most frequently observed in GI and lung tumors were: KRAS c.35G > A (p.G12D), c.35G > T (p.G12V) and c.34G > T (p.G12C). CONCLUSIONS: Prior panel validation allowed its use in the laboratory daily practice by providing several relevant and potentially targetable variants across multiple tumors. However, this study is limited by high sample inadequacy rate, raising doubts as to continuity in the clinical setting.

Uso y aplicación de la tecnología de impresión y bioimpresión 3D en medicina / Use and application of 3D printing and bioimpression technology in medicine

RESUMEN En el mundo actual, las llamadas "tecnologías de fabricación por adición" o impresión 3D también llamado prototipado rápido, han trascendido las fronteras de casi todos los campos de la ciencia, y su incursión en la medicina es cada vez mayor. Es justamente en el campo médico que esta tecnología de impresión por adición ha evolucionado a la bioimpresión, que incluye un proceso de cultivo celular en laboratorio haciendo posible la formación de órganos y/o tejidos personalizados. Para la impresión tridimensional de órganos en humanos se toman muestras de un tejido o células madre del paciente, para ser cultivadas y expandidas en laboratorio para su posterior diferenciación a una línea celular específica. Para este proceso se utiliza un material sólido como andamio a temperatura ambiente con un punto de fusión conocido. En la creación de un modelo para la fabricación de un órgano o tejido en impresión 3D, se utilizan los estudios de imágenes médicas de los pacientes intentando preservar al máximo la anatomía de las estructuras que se desean reproducir. En este artículo se abordan las bases y el potencial uso de esta tecnología en el área médica.

ABSTRACT In today's world, so-called "addition manufacturing technologies" or 3D printing also called rapid prototyping have transcended the borders of almost every field of science and medicine is no exception. It is not surprising that its exploration for practical uses is increasing. In medicine, this technology of printing by addition has evolved to bioprinting, which occurs by a special process, from cells grown in a laboratory, which makes possible its transformation into a type of organs tailored to the patient. The three-dimensional impression of human organs requires take samples of tissues or stem cells from the patient, which are grown in the laboratory waiting to multiply or differentiate to other cell lines; then, to create said object, a solid material at room temperature and with a known melting point is applied layer by layer. Currently the use of this technology uses the medical images of patients trying to preserve the anatomy of the structures that they want to reproduce. In this article the bases and the potential use of this technology in the medical area will be addressed.

Optical properties of anatase TiO2: synergy between transition metal doping and oxygen vacancies.

Charge carriers (electrons and holes) are generated on the TiO2 using UV radiation; this excitation energy can be reduced by modifying the material electronic structure, for example, by doping or creating oxygen vacancies. Here, the electronic structure of a transition metal-doped anatase, bulk and surface, and their interaction with oxygen vacancies are studied using density functional theory. The visible light response of metal-doped TiO2 (101) is also determined. Transition metals generate intra-band gap states, which reduce the excitation energy but may also act as charge recombination sites. Dopants Fe, Co, and Ni remarkably enhance the visible light response due to the states in the middle of the gap. However, Co and Ni create heavier charge carriers. Our results show that Pd and Pt-doped TiO2 generate states near the valence and conduction band with a "clean" band gap (without states in the middle of the gap). Moreover, Pt-doped TiO2 maintains the charge mobility because it presents a small charge carriers mass. Hence, Pt-doped TiO2 represents the best alternative to activate TiO2 under visible light. The optical response of transition metal-doped TiO2 follows the order 3d > 4d > 5d. The oxygen vacancies reduce the response of metal-doped TiO2 to visible light because the unpaired electrons generated occupy the empty states of metal-doping. Graphical Abstract Density of states of TiO2 (101) surface doped with transition metals and oxygen vacancies.

Behavior of multipotent stem cells isolated in mobilized peripheral blood from sheep after culture with human chondrogenic medium.

Today, regenerative medicine requires new sources of multipotent stem cells for their differentiation to chondrocytes using the mediums of differentiation available in the market. This study aimed to determine whether the Mesenchymal Stem Cells (MSCs) isolated from Mobilized Peripheral Blood (MPB) in sheep using the Granulocyte Colony-Stimulating Factor (G-CSF), have the ability of first acquire a fibroblast-like morphology after being forced out of the bone marrow niche by G-CSF and second, if the cells have the capacity to express collagen type-II α I in primary culture using a human commercial media of differentiation. Six Suffolk male sheep with age of 2 years were mobilized using G-CSF. One subcutaneous injection of 10 mcg per kilogram of bodyweight were administered every 24 h during three consecutive days. At day four, a sample of 20 mL of peripheral blood was harvested, afterwards, monocytes cells were separated by ficoll gradient. The mobilized MSCs were expanded in primary culture in DMEM medium supplemented with 10% adult sheep serum for three weeks and characterized by an antibody panel for surface markers: CD105, CD90, CD73, CD34, and CD45, before and after primary culture. Subsequently, an aliquot of cells in the first pass were cultured in a commercial human chondrogenic medium for three weeks. As a result, the percentage of surface markers for MSCs (CD105, CD90, CD73) in expanded cells in primary culture significantly increased, at the same time a decrease in the markers for hematopoietic cells (CD34 and CD45) was observed and the cells morphology was fibroblast-like. After three weeks of differentiation culture, the immunofluorescence analysis evidenced the expression of collagen-type-II. It was concluded that Mesenchymal Stem Cells isolated from mobilized peripheral blood in sheep have the ability to pre-differentiate into chondral like cells and express collagen type-II when are stimulated with a human commercial chondrogenic medium in monolayer culture.

[Pneumatosis cystoides intestinalis: a case report and review of the literature]. / Pneumatosis quística intestinalis: presentación de un caso y revisión de la literatura.

Pneumatosis cystoides intestinalis features the presence of subserum or submucous cysts with gas in the intestinal wall. Its prevalence is 0.03%, although it has increased in the past decades due to a greater use of colonoscopy in everyday medical practice. Though there are several theories about its origin and many associated diseases were reported, its pathogenesis still remains uncertain. It is generally diagnosed as a finding in an imaging test. The treatment depends on the severity of the associated disease and symptoms. We report the case of a 59-year-old woman, heavy smoker, with no other clinical conditions who took a medical consultation due to abdominal bloating. She underwent a screening colonoscopy which detected the existence of cysts on the colonic wall. Afterwards, a computed tomography was performed and showed apical lung bullae, gas in a colonic wall segment, and ascitis associated to a big anexial tumor. She underwent a cytoreductive surgery, confirming the presence of advanced ovary neoplasm. The endoscopic biopsy confirmed the diagnosis of penumatosis cystoides intestinalis. We report these case because it is a rare entity which requires uncommon management and treatment guidelines.

Pneumatosis quística intestinalis: presentación de un caso y revisión de la literatura / [Pneumatosis cystoides intestinalis: a case report and review of the literature].

Pneumatosis cystoides intestinalis features the presence of subserum or submucous cysts with gas in the intestinal wall. Its prevalence is 0.03

, although it has increased in the past decades due to a greater use of colonoscopy in everyday medical practice. Though there are several theories about its origin and many associated diseases were reported, its pathogenesis still remains uncertain. It is generally diagnosed as a finding in an imaging test. The treatment depends on the severity of the associated disease and symptoms. We report the case of a 59-year-old woman, heavy smoker, with no other clinical conditions who took a medical consultation due to abdominal bloating. She underwent a screening colonoscopy which detected the existence of cysts on the colonic wall. Afterwards, a computed tomography was performed and showed apical lung bullae, gas in a colonic wall segment, and ascitis associated to a big anexial tumor. She underwent a cytoreductive surgery, confirming the presence of advanced ovary neoplasm. The endoscopic biopsy confirmed the diagnosis of penumatosis cystoides intestinalis. We report these case because it is a rare entity which requires uncommon management and treatment guidelines.

Pneumatosis quística intestinalis: presentación de un caso y revisión de la literatura. / [Pneumatosis cystoides intestinalis: a case report and review of the literature].

Pneumatosis cystoides intestinalis features the presence of subserum or submucous cysts with gas in the intestinal wall. Its prevalence is 0.03

, although it has increased in the past decades due to a greater use of colonoscopy in everyday medical practice. Though there are several theories about its origin and many associated diseases were reported, its pathogenesis still remains uncertain. It is generally diagnosed as a finding in an imaging test. The treatment depends on the severity of the associated disease and symptoms. We report the case of a 59-year-old woman, heavy smoker, with no other clinical conditions who took a medical consultation due to abdominal bloating. She underwent a screening colonoscopy which detected the existence of cysts on the colonic wall. Afterwards, a computed tomography was performed and showed apical lung bullae, gas in a colonic wall segment, and ascitis associated to a big anexial tumor. She underwent a cytoreductive surgery, confirming the presence of advanced ovary neoplasm. The endoscopic biopsy confirmed the diagnosis of penumatosis cystoides intestinalis. We report these case because it is a rare entity which requires uncommon management and treatment guidelines.

Genome sequence of OXA-48 carbapenemase-producing Klebsiella pneumoniae KpO3210.

Klebsiella pneumoniae KpO3210 is a OXA-48 carbapenemase-producing isolate obtained from a blood culture in the context of an outbreak in Hospital Universitario La Paz (Madrid, Spain) in 2010. It belongs to the major clone detected during the outbreak and is resistant to all beta-lactams and to several other antibiotics.

Robust and efficient density fitting.

In this paper we propose an iterative method for solving the inhomogeneous systems of linear equations associated with density fitting. The proposed method is based on a version of the conjugate gradient method that makes use of automatically built quasi-Newton preconditioners. The paper gives a detailed description of a parallel implementation of the new method. The computational performance of the new algorithms is analyzed by benchmark calculations on systems with up to about 35,000 auxiliary functions. Comparisons with the standard, direct approach show no significant differences in the computed solutions.

[Analysis of the patient safety culture in hospitals of the Spanish National Health System]. / Análisis de la cultura sobre seguridad del paciente en los hospitales del Sistema Nacional de Salud español.

BACKGROUND AND OBJECTIVES: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS. MATERIAL AND METHOD: The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA. RESULTS: A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians. CONCLUSIONS: Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.

Abordajes quirúrgicos al tronco encefálico. Parte 1: anatomía de superficie del tronco encefálico / Surgical approaches to brain stem. Part 1: anatomy surface of the brain stem

El tronco encefálico se ubica en la fosa posterior, en íntima relación con el cerebelo e importantes estructuras vasculares. Contiene en su interior tractos de sustancia blanca que vinculan entre sí cerebro, tronco encefálico, médula espinal y cerebelo. Contiene en su interior los núcleos de origen de los diez últimos pares craneanos y núcleos que regulan funciones, como la mirada lateral, la deglución o incluso el ciclo sueño - vigilia. Puede ser afectado por diversos tipos de patologías, como tumores, malformaciones vasculares, procesos infecciosos, inflamatorios o desmielinizantes. El presente es el primer artículo de cuatro, destinados a analizar los abordajes quirúrgicos más frecuentes al tronco encefálico. En esta primera parte se describen aquí los principales aspectos de la anatomía de superficie del tronco cerebral. (AU)

Abordajes quirúrgicos al tronco encefálico. Parte 1: anatomía de superficie del tronco encefálico / Surgical approaches to brain stem. Part 1: anatomy surface of the brain stem

El tronco encefálico se ubica en la fosa posterior, en íntima relación con el cerebelo e importantes estructuras vasculares. Contiene en su interior tractos de sustancia blanca que vinculan entre sí cerebro, tronco encefálico, médula espinal y cerebelo. Contiene en su interior los núcleos de origen de los diez últimos pares craneanos y núcleos que regulan funciones, como la mirada lateral, la deglución o incluso el ciclo sueño - vigilia. Puede ser afectado por diversos tipos de patologías, como tumores, malformaciones vasculares, procesos infecciosos, inflamatorios o desmielinizantes. El presente es el primer artículo de cuatro, destinados a analizar los abordajes quirúrgicos más frecuentes al tronco encefálico. En esta primera parte se describen aquí los principales aspectos de la anatomía de superficie del tronco cerebral. (AU)

Abordajes quirúrgicos al tronco encefálico. Parte 1: anatomía de superficie del tronco encefálico / Surgical approaches to brain stem. Part 1: anatomy surface of the brain stem

El tronco encefálico se ubica en la fosa posterior, en íntima relación con el cerebelo e importantes estructuras vasculares. Contiene en su interior tractos de sustancia blanca que vinculan entre sí cerebro, tronco encefálico, médula espinal y cerebelo. Contiene en su interior los núcleos de origen de los diez últimos pares craneanos y núcleos que regulan funciones, como la mirada lateral, la deglución o incluso el ciclo sueño - vigilia. Puede ser afectado por diversos tipos de patologías, como tumores, malformaciones vasculares, procesos infecciosos, inflamatorios o desmielinizantes. El presente es el primer artículo de cuatro, destinados a analizar los abordajes quirúrgicos más frecuentes al tronco encefálico. En esta primera parte se describen aquí los principales aspectos de la anatomía de superficie del tronco cerebral.

[Adrenal incidentalomas. A disease on the increase]. / Incidentalomas suprarrenales. Una enfermedad en auge.

INTRODUCTION: Adrenal incidentalomas are unsuspected, clinically silent adrenal lesions discovered incidentally by imaging tests performed a priori for problems unrelated to the adrenal glands. The aim of this study was to present a series of incidentalomas and review the diagnostic process and treatment techniques. PATIENTS AND METHOD: Of a series of 63 patients studied and/or treated for adrenal disease, there were 34 patients with adrenal incidentalomas. The mean age of the patients with incidentaloma was 50.6 years. There were 23 women (67.6%) and 11 men (32.3%). All patients underwent hormonal investigations to rule out hyperfunction. Imaging techniques consisted of ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) to determine the size and characteristics of the lesion. In patients with an indication for surgery, the lateral transabdominal approach was used in laparoscopic surgery and the anterior approach was used in open surgery. RESULTS: Of the 34 patients, 23 patients (67.6%) (18 women and 5 men) with a mean age of 50.9 years underwent surgery. The mean tumoral diameter was 10.18 cm. Incidentalomas were located in the right adrenal gland in 16 patients and in the left adrenal gland in 7 patients. Laparoscopic surgery was performed in 9 patients (39.1%) and open surgery was performed in the remaining 14 (60.8%). The mean length of hospital stay was 8.6 days in open surgery and 4 days in laparoscopic surgery. Complications consisted of pneumonia in 2 patients (8.6%). There was no intraoperative mortality in the series. Surgery was not performed in 11 patients (32.3%) (5 women and 6 men) with a mean age of 56.3 years. The mean size of the tumor in these patients, identified by CT, was 2.5 cm. These patients underwent subsequent monitoring with a mean follow-up of 32 months. CONCLUSIONS: Due to the high resolution of ultrasonography, CT and MRI, as well as the greater number of radiological investigations performed, identification of adrenal incidentalomas has increased. In our series these tumors represented 53.9% of adrenal disease.

Incidentalomas suprarrenales. Una enfermedad en auge / Adrenal incidentalomas. A disease on the increase

Introducción. Se considera incidentaloma suprarrenal la lesión adrenal no sospechada, clínicamente silente, descubierta casualmente por estudios de imagen realizados a priori, por problemas no relacionados con las glándulas suprarrenales. Nuestro objetivo es presentar nuestra serie de incidentalomas, revisando el proceso diagnóstico y las técnicas de tratamiento. Pacientes y método. Presentamos 34 casos catalogados como incidentalomas de una serie de 63 pacientes estudiados y/o tratados por enfermedad suprarrenal. La edad media de los pacientes con incidentaloma fue de 50,6 años, 23 de los cuales fueron mujeres (67,6%) y 11, varones (32,3%). A todos se les realizó un estudio hormonal para descartar hiperfunción. Como técnica de imagen se les realizó ecografía, tomografía computarizada (TC) y/o resonancia magnética (RM) para precisar el tamaño y las características de la lesión. En los casos en que se indicó cirugía, la técnica utilizada, en caso de cirugía laparoscópica, fue la vía transabdominal lateral y, en caso de cirugía abierta, la vía anterior. Resultados. De los 34 casos, hemos intervenido a 23 pacientes (67,6%) (18 mujeres y 5 varones) con una edad media de 50,9 años. El tamaño medio de los tumores es de 10,18 cm de diámetro. En la suprarrenal derecha se localizaron 16 casos y en la izquierda, 7. Se realizó cirugía laparoscópica en 9 casos (39,1%) y en los 14 casos restantes (60,8%) se practicó cirugía abierta. La estancia media en caso de cirugía abierta fue de 8,6 días y en cirugía laparoscópica, de 4 días. Como complicaciones ha habido 2 casos de neumonía (8,6%). No hay mortalidad intraoperatoria en la serie. No se han intervenido 11 casos (32,3%) (5 mujeres y 6 varones), con una edad media de 56,3 años. El tamaño medio del tumor en estos pacientes, según la TC, es de 2,5 cm. Estos pacientes se han sometido a controles posteriores con un seguimiento medio de 32 meses. Conclusiones. La alta resolución de la ecografía, la TC y la RM, así como el mayor número de exploraciones radiológicas realizadas, ha incrementado el número de incidentalomas suprarrenales, como ocurre en nuestra serie, donde suponen el 53,9% de la patología suprarrenal (AU)

Introduction. Adrenal incidentalomas are unsuspected, clinically silent adrenal lesions discovered incidentally by imaging tests performed a priori for problems unrelated to the adrenal glands. The aim of this study was to present a series of incidentalomas and review the diagnostic process and treatment techniques. Patients and method. Of a series of 63 patients studied and/or treated for adrenal disease, there were 34 patients with adrenal incidentalomas. The mean age of the patients with incidentaloma was 50.6 years. There were 23 women (67.6%) and 11 men (32.3%). All patients underwent hormonal investigations to rule out hyperfunction. Imaging techniques consisted of ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) to determine the size and characteristics of the lesion. In patients with an indication for surgery, the lateral transabdominal approach was used in laparoscopic surgery and the anterior approach was used in open surgery. Results. Of the 34 patients, 23 patients (67.6%) (18 women and 5 men) with a mean age of 50.9 years underwent surgery. The mean tumoral diameter was 10.18 cm. Incidentalomas were located in the right adrenal gland in 16 patients and in the left adrenal gland in 7 patients. Laparoscopic surgery was performed in 9 patients (39.1%) and open surgery was performed in the remaining 14 (60.8%). The mean length of hospital stay was 8.6 days in open surgery and 4 days in laparoscopic surgery. Complications consisted of pneumonia in 2 patients (8.6%). There was no intraoperative mortality in the series. Surgery was not performed in 11 patients (32.3%) (5 women and 6 men) with a mean age of 56.3 years. The mean size of the tumor in these patients, identified by CT, was 2.5 cm. These patients underwent subsequent monitoring with a mean follow-up of 32 months. Conclusions. Due to the high resolution of ultrasonography, CT and MRI, as well as the greater number of radiological investigations performed, identification of adrenal incidentalomas has increased. In our series these tumors represented 53.9% of adrenal disease

Evaluación y mejora del protocolo de cuidados de vías venosas centrales en una unidad de cuidados intensivos / Evaluation and improvement of the management of central venous catheters in an intensive care unit

Objetivo: Mejorar el cumplimiento del protocolo existente en la unidad de cuidados intensivos (UCI) para el cuidado de las vías venosas centrales, así como el registro de las actividades relacionadas que se llevan a cabo. Material y método: Se establecieron 6 criterios de calidad, todos ellos relativos al registro de las actividades de enfermería en relación con los cuidados de las vías centrales en pacientes ingresados en la UCI. Se realizó una evaluación del cumplimiento de estos criterios antes y después de su inclusión en un registro informatizado. Resultados: En una primera evaluación, el número total de incumplimientos fue de 164 (44,5%). Tras implantar la intervención diseñada, dicho número fue de 81 (24,5%). El mayor porcentaje de incumplimientos correspondió a 2 criterios: el relativo al registro de la manipulación de las vías y el relativo al registro de posibles alergias. En todos los criterios evaluados se observó una mejoría estadísticamente significativa, excepto para el criterio relativo al registro del número de días de instauración de la vía (C3), que ya presentaba un cumplimiento del 100% antes de la intervención. Conclusiones: La actualización del protocolo en el manejo de vías venosas centrales y su informatización ha supuesto una mejora en el registro de las actividades relacionadas con este proceso. Todo ello implica una disminución de la variabilidad

Objective: To improve compliance with the protocol for the management of central venous catheters in our intensive care unit (ICU) as well as record-keeping of related activities. Material and method: Six quality criteria were established. These criteria concerned record-keeping by nurses of activities related to the management of central venous catheters in patients admitted to the ICU. Compliance with these criteria before and after the introduction of a computerized registry was evaluated. Results: In the first evaluation, 164 (44.5%) errors were found. In the second evaluation, this number was 81 (24.5%). The greatest percentage of errors corresponded to 2 criteria: the criterion relating to catheter manipulation and that relating to recording of possible allergies. A statistically significant improvement was achieved for all criteria except for that relating to catheter dwelling time (C3) with 100% compliance in the first evaluation. Conclusions: Updating and computerization of the protocol for the management of central catheters improved record-keeping of related activities, which implies that variability decreased

Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department.

Primary spontaneous pneumothorax is a common abnormality for which there is a variety of treatments. This study presents the results of a year's evaluation of a clinical pathway (CP). A series of 34 patients treated during 1 year before CP development was analyzed to identify the weak points. To address these weak points, the CP includes associated protocols. In the CP, 31 patients were evaluated during 1 year; the results were compared with those of the pre-CP series. The mean length of stay of the pre-CP patients and the CP patients was 7.3 days and 5.0 days, respectively. The number of radiographs fell from 4.3 to 3.2. The rate of complications and readmissions is similar in both groups. The mean cost per process dropped from 1863 [UNKNOWN] to 1168 [UNKNOWN]. The CP for pneumothorax successfully manages to reduce both the variability in care patterns and hospital costs, justifying the work involved in its development and implementation.

Vía clínica para el tratamiento del neumotórax espontáneo primario en un servicio de cirugía general / Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department

Introducción. El neumotórax espontáneo primario (NEP) es una enfermedad frecuente que se trata de forma variable en los diferentes sistemas sanitarios e incluso entre los médicos dentro de un mismo servicio. En nuestro servicio de cirugía general se atiende a entre 30 y 40 pacientes al año con NEP y hay una significativa variabilidad en su asistencia, lo que motivó la iniciativa de elaborar una vía clínica (VC) basada en el análisis del proceso, la búsqueda de estudios con la mayor evidencia científica y el consenso de los profesionales. El objetivo de este trabajo es presentar los resultados tras 1 año de evaluación de la VC. Pacientes y método. Se analizó una serie previa de 34 enfermos tratados durante el año previo a la elaboración de la vía para identificar los puntos débiles y las áreas de mejora. Para dar respuesta y solución a los puntos débiles identificados, la VC incluye protocolos asociados y documentos principales de la VC. Durante un año se ha atendido a 31 pacientes incluidos en la VC, cuyos resultados se han comparado con los de la serie previa. Resultados. La estancia media de los pacientes antes de la implantación de la vía ha sido de 7,3 días y los pacientes incluidos en la vía tuvieron una estancia de 5,0 días. El número de radiografías ha disminuido también de 4,3 a 3,2. La tasa de complicaciones y reingresos es similar en ambos grupos. El coste medio por proceso ha disminuido de 1.863 a 1.168 €. Conclusión. La VC del neumotórax puede disminuir la variabilidad de las actuaciones profesionales y los costes hospitalarios, lo que justifica el esfuerzo de su elaboración e implantación (AU)

Introduction. Primary spontaneous pneumothorax (PSP) is a common entity. Treatment varies widely across different health systems and even among doctors in the same department. In our general surgery department 30 to 40 patients with PSP are treated each year and there is significant variability in care delivery. This prompted the development of a clinical pathway (CP) based on analysis of the process, a search for studies with the greatest scientific evidence and professional consensus. The aim of this study was to present the results after 1 year's evaluation of the CP. Patients and method. A series of 34 patients treated in the year prior to the design of the pathway was analyzed to identify weak points and areas for improvement. To address these weak points the CP included associated protocols and principal documents. Thirty-one patients included in the CP were treated over 1 year and the results were compared with those of the pre-pathway series. Results. The mean length of stay in the pre-pathway patients was 7.3 days compared with 5.0 days in the pathway patients. The number of radiographs also fell from 4.3 to 3.2. The rate of complications and re-admissions was similar in both groups. The mean cost per process decreased from 1863 € to 1168 €. Conclusion. The CP for pneumothorax reduced both variability in professional care patterns and hospital costs, justifying the work involved in its development and implementation (AU)