[Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool]. / Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool.

INTRODUCTION: The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers¼ in the Global Trigger Tool (GTT). SETTING: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. RESULTS: Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). CONCLUSIONS: The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers¼ for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary.

Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool / Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool

Introducción. La implantación del listado de verificación quirúrgica (LVQ) por la OMS ha permitido mejorar la seguridad de los pacientes. El objetivo ha sido evaluar el grado de cumplimiento del LVQ incorporando los no cumplimientos como triggers o pistas en la herramienta Global Trigger Tool (GTT). Material y métodos. Ámbito: hospital geriátrico de agudos con 200 camas. Estudio retrospectivo. Periodo de estudio: 2011-2014. Se utilizó el formulario del LVQ y la metodología del GTT para el análisis de historias clínicas y el cumplimiento del LVQ desde el año 2011 hasta el año 2014. Para el grado del daño se usaron las categorías del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Resultados. Se analizaron 227 historias de pacientes dados de alta (23,6%) de todas las historias electrónicas (1,7% de las intervenciones en los 4 años). El 100% de las historias contenían el LVQ, el 94,4% de los ítems estaban cubiertos y 28,2% de los LVQ tenían todos los ítems cumplimentados en las 3 fases del proceso. Los efectos adversos quirúrgicos disminuyeron del 16,3% en el año 2011 al 9,4% en el año 2014 (p=0,2838, no significativo) y el cumplimiento de todos los ítems del LVQ aumentó del 18,6 al 39,1% (p=0,0246, significativo). Conclusiones. La herramienta GTT permite sistematizar con un menor coste de tiempo la búsqueda de historias clínicas al azar para evaluar el cumplimiento del LVQ y considerar a los no cumplimientos del LVQ como triggers para su análisis posterior. Esta estrategia no ha sido nunca contemplada en el GTT ni en la sistemática del LVQ (AU)

Introduction. The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers» in the Global Trigger Tool (GTT). Material and methods. Setting: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. Results. Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). Conclusions. The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers» for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary (AU)

Errores en el uso de antimicrobianos: la epidemia silenciosa para la seguridad de pacientes / Antimicrobial drugs errors: the silent epidemic in patient safety

Introducción. Los errores en el uso de medicamentossuponen una de las primeras causas de sucesos adversos enlos hospitales. El objetivo ha sido evaluar los errores en eluso de antimicrobianos producidos en una unidad de nuestrohospital en el bienio 2005-2006.Métodos. Se recogieron todos los errores mediante elformulario de notificación voluntaria IR2 del Servicio Nacionalde Salud inglés y se clasificaron los mismos en funcióndel tipo de proceso, tipos de errores, sus causas y factorescontribuyentes, así como la severidad de los mismos.También se analizaron los posibles errores teóricos y los costesasociados.Resultados. Los errores en el uso de antimicrobianos seprodujeron en un 1,3% de los pacientes ingresados (0,84 casospor cada 1.000 órdenes médicas). Por tipo de proceso loserrores más frecuentes fueron debidos a la administración(32,4%) y la dispensación (44,1%). Por tipo de error: medicamentoerróneo (32,4%), la causa-raíz principal fueron losfactores humanos (58,8 %) y como factor contribuyente elmal diseño de tareas (55,9 %). En un 5,9 % se catalogaroncomo sucesos severos, especialmente el grupo de los betalactámicos,y como vía, la endovenosa (50%).Conclusiones. Los sucesos adversos relacionados con eluso de antimicrobianos, muy frecuentes y a veces severos,suponen una epidemia silenciosa al no ser detectados si nose utiliza la metodología específica de seguridad de pacientes.Suponen unos costes nada desdeñables para un hospital (AU)

Introduction. Prescribed drugs and the mistakes inthe administration to patient is the first cause of adverseevents in the hospitals. The aim of this study has been toevaluate antimicrobial drug mistakes in one of our hospitalwards in a two year period 2005 and 2006.Methods. All the errors were reported through theNational Health Service IR2 form (England) on a voluntarybasis and classified by means of process, type oferrors, their causes and contributory factors, as well asthe severity. We analyzed the economic costs.Results. A 1.3% of the inpatients had an antimicrobialerror in the administration to the patient (0.84 by1,000 prescribing orders). Classified by processes, the administration(32.4%) and dispensation (44.1%) were themost frequent errors. By type of error: the erroneous medication(32.4%), the main root cause the human factors(58.8 %) and the contribution factor due to design oftasks (55.9 %). The 5.9% of errors were severe events,mainly in the group of the betalactamic drugs, andmainly by parenteral administration (50%).Conclusions. Antimicrobial drug errors, frequentand sometimes severe, suppose a silent epidemic notbeing detected without the patient safety methodology.They represent a high cost for a hospital (AU)

Actualización en Medicina de Familia: Habilidades técnicas en la consulta para el diagnóstico de las vaginitis infecciosas / Update in Family Medicine: Technical skills in medical visit for diagnosis of infectious vaginitis

La importancia de determinar el agente infeccioso de una vaginitis es porque Trichomonas vaginalis es transmitida sexualmente, puede identificarse en el 30-80% de los compañeros sexuales de mujeres infectadas y también puede actuar como vector de otras enfermedades de transmisión sexual, mientras que la vaginosis bacteriana puede causar patología ginecológica y obstétrica. Si bien es tentador tratar las vaginitis empíricamente basándose en la historia y síntomas de la paciente, muchos estudios han demostrado que los síntomas y las características de la leucorrea no son buenos predictores de la etiología de las vaginitis. Dada la poca correlación entre los síntomas y signos de las vaginitis y su etiología, y la importancia de tener un diagnostico etiológico, el clínico debe de tener unas habilidades técnicas de diagnóstico analítico inmediato (point of care testing). Este artículo trata de proporcionar a los médicos de Atención Primaria los conocimientos técnicos necesarios que faciliten el diagnóstico etiológico de las vulvovaginitis infecciosas en la cabecera de la paciente (AU)

It is very important to determine the etiology of vaginitis because Trichomonas vaginalis is transmitted sexually and may be identified in 30% to 80% of the male sexual partners of infected women. Trichomoniasis is associated with and may act as a vector for other venereal diseases while bacterial vaginosis could lead to an obstetric and gynecological disease. Although it is tempting to treat vaginitis empirically on the grounds of the background and symptoms of the patient, many studies have shown that the symptoms and characteristics of the vaginal discharge are not good indicators of the etiology of vaginitis. Given the low correlation between the symptoms and the signs of vaginitis and its etiology and the importance of having an etiologic diagnosis, the clinician should have the necessary technical skills for an immediate analytical diagnostic (point of care testing). This article seeks to provide Primary Care Physicians with the necessary expertise to facilitate the etiological diagnosis of infectious vulvovaginitis at this primary attention (A)

De piojos y literatura / Of lice and literature

Los piojos aparecieron con el "Homo sapiens" y hay registros de su presencia desde muy antiguo. Transmiten diferentes enfermedades y son ectoparásitos en la cabeza, cuerpo y área genital. El piojo del cuerpo es conocido en Europa desde el siglo XV cuando en Granada, el tifus epidémico o tabardillo mató 20.000 personas. El piojo de la cabeza está presente en la literatura y nosotros revisamos este aspecto en las obras de William Shakespeare, la vida de Samuel Pepys y la poesía de Robert Burns y Arthur Rimbaud (AU)

Herpes simplex virus type 2 seroepidemiology in Spain: prevalence and seroconversion rate among sexually transmitted disease clinic attendees.

BACKGROUND: Only limited data on the seroprevalence of herpes simplex virus type 2 (HSV-2) are available from European countries. Until recently, serologic tests for HSV-2 serotyping have been hampered by cross-reactivity to type-common antigens. The present study aims at providing data on the prevalence of HSV-2 infection in a group of STD clinic attendees using a reliable type-specific immunoassay. GOAL: To evaluate the seroprevalence of HSV-2 and the accumulated incidence of clinical genital herpes infection in a sample of Spanish sexually transmitted disease (STD) clinic attendees. STUDY DESIGN: The study consisted of two parts. First, a cross-sectional study of HSV-2 seroprevalence was conducted in patients with STDs. Second, a prospective cohort study was undertaken to evaluate the accumulated incidence of infection by HSV-2 and of clinical episodes of genital herpes in HSV-2-negative patients included in the first study during a follow-up period of 6 to 18 months. RESULTS: Of the 374 patients (129 men, 245 women) studied, 25% were seropositive for HSV-2 (12% of men, 30% of women). Antibodies to HSV-2 were related to female gender (odds ratio, 2.7; P < 0.001) and to the number of sexual partners (odds ratio, 4.1; P < 0.001). Fifty-two percent of patients (145 of 281 patients) who were initially seronegative returned to the clinic for a second serologic testing, of whom 1% (2 of 145 patients) had seroconverted. None of the patients developed genital herpes during the follow-up period. CONCLUSION: The relatively high seroprevalence (25%) and the low rate (4%) of HSV-2 previously reported in the general population in Spain suggest that the virus circulation may be restricted to certain risk groups. Therefore, future healthcare measures may target specific groups, such as patients with STDs.

[Intestinal parasitosis of the canine population in the principate of Asturias]. / Parasitosis intestinal en la población canina del Principado de Asturias.

A study is made of coprological samples from 354 dogs, 252 of them male and 102 female. Parasitism was found in 94 dogs (26.5%), of which 14 (15%) showed two or more associated parasites. The Councils with the highest degree of parasitism were: Peñamellera Baja (77.7%), Ribadedeva (57.1%), Castropol (53.8%), Ribadesella (50%), Piloña (46.6%), and Tapias de Casariego (44.4%). The parasites most frequently isolated were: Anciostoma Caninum (19.2%), Trichuris vulpis (8.2%), Cystoisospora canis (3%), Toxocara spp. (1.1%), and Toxascaris leonina (1.1%). The difference in the degree of parasitism in females over 1 year of age (26.6%), and of males over 1 year of age (19.6%) is statistically significant (p greater than 0.05). No eggs were found of Taenia spp., which points to the positive effects of the measures taken against the hydatid cyst, based on the biannual administration of Praziquantel to the canine population.