Cultura de seguridad clínica en cirugía ortopédica y traumatología. Influencia de una intervención formativa / Patient safety culture in orthopaedics surgery. Influence of a training activities plan

Objetivo: Conocer las características de la cultura de seguridad clínica en cirugía ortopédica y traumatología, valorando la influencia de una intervención formativa en su tendencia evolutiva. Población y metodología: Estudio observacional ecológico con intervención formativa. La población objeto de estudio fueron los profesionales del Servicio de Cirugía Ortopédica y Traumatología del Hospital Clínic Universitario de Barcelona. Se utilizó la versión española del cuestionario HSOPS para valorar la cultura de seguridad clínica. Resultados: El porcentaje de respuestas válidas obtenidas fue superior al 60% en las dos mediciones de la cultura realizadas. Las 12 dimensiones consideradas mejoraron su tendencia. El trabajo en equipo dentro del servicio se identificó como una dimensión de fortaleza del modelo. Conclusiones: La intervención formativa ha consolidado una tendencia favorable. La mejora de la cultura de seguridad clínica requiere tiempo y actuaciones periódicas (AU)

Objective: The purpose of this paper is to measure patient safety culture in orthopaedics surgery and to assess the influence of a training activities plan. Methodology: We performed an ecological observational study with a training intervention. Study population included all professionals of Orthopaedics and Traumatology Service of the Clinic Hospital of Barcelona. We used the Spanish version questionnaire HSOPS in order to evaluate safety culture among staff. Results: The percentage of valid questionnaires obtained was above 60% in the two surveys of patient safety culture. The twelve dimensions considered have improved trend. Teamwork climate inside the unit has been identified as a stronghold dimension. Conclusions: The training intervention developed has consolidate a positive trend. The improvement of the patient safety culture needs time and continual actions (AU)

Increasing rates in Clostridium difficile infection (CDI) among hospitalised patients, Spain 1999-2007.

Limited information is available on the burden and epidemiology of Clostridium difficile infection (CDI) in Spain. The present report communicates the secular trends in prevalence of CDI among hospitalised patients in Spain from 1999 through 2007. Data were obtained through the EPINE study (Estudio de prevalencia de las infecciones nosocomiales en los hospitales españoles), a point prevalence study series of nosocomial infections among patients admitted to hospital in Spain. A total of 378 cases with CDI were identified. Median age was 74 years. Prevalence rates of CDI increased from 3.9 to 12.2 cases per 10,000 hospitalised patients and showed a significantly increasing secular trend from 1999 through 2007 (prevalence rate ratio per each year increment 1.09; 95% CI 1.05 - 1.14). Percentage of hospitalised patients receiving antimicrobials increased linearly from 36.0% in 1999 to 40.7% in 2007 (p <0.001) and was strongly correlated to CDI prevalence (R square = 0.73; regression coefficient =1.194, 95% CI= 1.192 - 1.196).

[Estimation of prevalence, incidence and sex ratio of transsexualism in Catalonia according to health care demand]. / Estimación de la prevalencia, incidencia y razón de sexos del transexualismo en Cataluña según la demanda asistencial.

OBJECTIVE: To estimate the epidemiology of transsexualism in the autonomous community of Catalonia according to data gathered at the Hospital Clinic of Barcelona, the single public hospital providing specialized psychiatric and endocrinological care for transsexual patients in this community. PATIENTS AND METHODS: Prevalence was calculated on the basis of the total number of patients diagnosed of transsexualism (ICD-10, F64.0) at the Hospital Clinic and living in Catalonia, and the incidence by counting all new cases of transsexuals for the last 5 years, based on the population census between 15 and 65 years of age. RESULTS: During the period from 1996 through 2004 a total of 201 subjects were referred to this hospital with complaints of gender dysphoria. Transsexualism was diagnosed in 182 patients, 161 of whom were living in Catalonia. This yields a prevalence rate in Catalonia of 1:21,031 males and 1:48,096 females. The sex ratio was 2.6. Annual incidence in the last five years was 0.73/100,000/year. DISCUSSION: The low prevalence compared with recently published data from European Union countries may be due to the relatively few years of data collection and to the low clinical demand because surgical procedures costs are not covered by the public health insurance. In contrast, the high incidence may be due to the increasing demand since 2000, when a more benevolent and tolerant social climate in Spain started.

Estimación de la prevalencia, incidencia y razón de sexos del transexualismo en Cataluña según la demanda asistencial / Estimation of prevalence, incidence and sex ratio of transsexualism in Catalonia according to health care demand

Introducción. Se realiza una estimación de la distribución epidemiológica del transexualismo en Cataluña según la demanda observada en el Hospital Clínic de Barcelona, que es el único hospital público que proporciona atención psiquiátrica y endocrinológica especializada a estos pacientes en esta comunidad autónoma. Pacientes y método. La prevalencia se calculó según el número total de pacientes diagnosticados de transexualismo (CIE-10, F64.0) en el Hospital Clínic residentes en Cataluña y la incidencia según el número de pacientes con nuevo diagnóstico durante los últimos 5 años en relación con los datos de población de edad entre 15 y 65 años. Resultados. Entre los años 1996 y 2004 solicitaron atención por disforia de género un total de 201 pacientes. Se diagnosticó transexualismo en 182 pacientes, de los cuales 161 vivían en Cataluña. La prevalencia estimada de transexualismo en Cataluña fue de 1:21.031 varones y 1:48.096 mujeres. La razón de sexos fue de 2,6 a favor del grupo de transexuales hombre a mujer. La incidencia media anual en los últimos 5 años fue de 0,72/100.000 habitantes/año. Discusión. La baja prevalencia observada, en comparación con los datos publicados por países de la Unión Europea, se puede atribuir al período corto de recogida de datos y a la baja demanda registrada al no estar financiado el tratamiento de reasignación de sexo por el Sistema Nacional de Salud. La elevada incidencia se puede atribuir al incremento de la demanda desde el año 2000, que coincide con un clima social de mayor aceptación y tolerancia

Objective. To estimate the epidemiology of transsexualism in the autonomous community of Catalonia according to data gathered at the Hospital Clinic of Barcelona, the single public hospital providing specialized psychiatric and endocrinological care for transsexual patients in this community. Patients and methods. Prevalence was calculated on the basis of the total number of patients diagnosed of transsexualism (ICD-10, F64.0) at the Hospital Clinic and living in Catalonia, and the incidence by counting all new cases of transsexuals for the last 5 years, based on the population census between 15 and 65 years of age. Results. During the period from 1996 through 2004 a total of 201 subjects were referred to this hospital with complaints of gender dysphoria. Transsexualism was diagnosed in 182 patients, 161 of whom were living in Catalonia. This yields a prevalence rate in Catalonia of 1:21,031 males and 1:48,096 females. The sex ratio was 2.6. Annual incidence in the last five years was 0.73/100,000/year. Discussion. The low prevalence compared with recently published data from European Union countries may be due to the relatively few years of data collection and to the low clinical demand because surgical procedures costs are not covered by the public health insurance. In contrast, the high incidence may be due to the increasing demand since 2000, when a more benevolent and tolerant social climate in Spain started

[Do physicians know the cost of the treatments and tests they prescribe?]. / Conocen los médicos el coste de los tratamientos y pruebas que solicitan?

OBJECTIVE: To determine the degree of knowledge among physicians regarding the cost of diagnostic tests and commonly used drugs. INDIVIDUALS AND METHODS: An interview was obtained with a representative sample of 164 physicians from a total of 338 (accuracy +/- 3.55), distributed in interns/residents (n:119) and staff members (n:45) from the divisions of Surgery (n:81) and Medicine (n:83) at Hospital Clinic i Provincial, Barcelona. The questionnaire included 15 questions, 10 regarding drugs and 5 diagnostic tests, with 5 possible answers. An arbitrary scoring system was used (correct answer: 5 points; approximate; 3 points; mistake: 1 point) and the percentage of right answers (correct and approximate answers) was also evaluated versus mistakes. The Student "t" test, the analysis of variance and the chi 2 test were used to compare the results. RESULTS: The overall score reached was 2.72 +/- 0.41. Differences between residents vs staff and medicine vs surgery were not significant. The score in questions regarding diagnostic tests was significantly higher than that obtained for drug cost among all group. The percentages of right answers (correct and approximate answers) were 58.8%-61.7% (drugs) and 58.3-60.8% (tests), with no differences among groups. Differences regarding year of residence were also not significant. CONCLUSIONS: The knowledge degree on costs of some drugs and diagnostic tests among physicians is deficient. It is necessary to find standards that contribute to increase the level of information regarding costs derived from the health care delivery process among health care professionals.