La Seguridad del Paciente se ha convertido en un reto y en una prioridad de todos los sistemas sanitarios. Se ha implantado políticas internacionales con el objetivo de reducir el número de ...incidentes relacionados con Seguridad del Paciente. Todavía son muchos los pacientes que sufren daños derivados de la atención sanitaria. Además, su impacto se extiende no solo a los familiares y allegados, sino también a los propios profesionales, a las instituciones sanitarias y todo ello con un coste económico y emocional con importantes consecuencias para todos los implicados. La mayoría de estudios realizados han ido dirigidos a conocer la epidemiología de los eventos adversos, a conocer sus causas y sus consecuencias. Se han promovido numerosas prácticas seguras con el objetivo de reducir los riesgos relacionados con la atención sanitaria. Recientemente han cobrado mayor relevancia aspectos relacionados con la actuación posterior a un evento adverso (EA). La gestión del riesgo implica entre otras acciones, la identificación, notificación y el análisis de los EA que señalen los fallos latentes en el sistema y la causa raíz con el objetivo último de establecer acciones de mejora y evitar su recurrencia. De forma paulatina estas estrategias se han ido incorporando en las políticas institucionales y mejorando con ello la cultura de seguridad. Pero todavía existen partes del proceso, que en nuestro ámbito se encuentran en su etapa más inicial, tales como el proceso de información sobre los EA a los pacientes y sus familiares y el soporte a los profesionales tras verse implicados en un EA. Todo ello debe construirse en un marco de confianza y credibilidad.
New variants of SARS-CoV-2 Cantón, Rafael; De Lucas Ramos, Pilar; García-Botella, Alejandra ...
Revista española de quimioterapia,
10/2021, Letnik:
34, Številka:
5
Journal Article
Odprti dostop
The emergence and spread of new variants of SARS-CoV-2 has produced enormous interest due to their possible implication in the improved transmissibility of the virus, their consequences in the ...individual evolution of the infection, as well as in the possible escape from the immunity generated by the current vaccines. The variants that attract most attention are those of public health concern, including B.1.1.7 (UK), P.1 (Brazilian) and B.1.351 (South African). This list is extended by the variants of interest that emerge and are expanding in certain countries but are found sporadically in others, such as B.1.427 and B.1.429 (Californians) or B.1.617 (Indian). Whole genome sequencing or strategies specifically targeting the spicule gene are used in the microbiology laboratories for characterization and detection. The number of infected individuals, the sanitary situation of each country, epidemiological measures and vaccination strategies influence its dispersion and new variants are expected to emerge. This emergence can only be avoided today by increasing the vaccinated population in all countries and by not relaxing epidemiological containment measures. It is not excluded that in the future it will be necessary to revaccinate against new variants.
COVID-19: Some unresolved issues Gómez-Pavón, J; González Del Castillo, J; Martín-Delgado, M C ...
Revista española de quimioterapia,
10/2022, Letnik:
35, Številka:
5
Journal Article
Odprti dostop
Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the ...Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.
Insights for COVID-19 in 2023 Martín Sánchez, F J; Martínez-Sellés, M; Molero García, J M ...
Revista española de quimioterapia,
04/2023, Letnik:
36, Številka:
2
Journal Article
Odprti dostop
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA ...vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
Monkeypox in humans: a new outbreak Martín-Delgado, M C; Martín Sánchez, F J; Martínez-Sellés, M ...
Revista española de quimioterapia,
12/2022, Letnik:
35, Številka:
6
Journal Article
Odprti dostop
Infection caused by Monkeypox Virus (MPVX) has small rodents as its natural reservoir and both monkeys and humans are occasional hosts. The causative agent is an Orthopoxvirus (MPVX) that was ...isolated in monkeys in 1958 and proved capable of passing to humans in 1970. It remained contained in Africa, causing isolated episodes of infection, until 2003 when an outbreak occurred in the United States following importation of animals from that continent. Since then, anecdotal cases have continued to be reported outside Africa, usually very clearly linked to travelers to those countries, but in May 2022, a broad outbreak of this disease has begun, now affecting several continents, with the emergence of human cases of MPVX (H-MPVX) infection mainly among Men that have Sex with Men (MSM). The disease has an incubation time ranging from 5 to 15 days and is characterized by the presence of pustules, fever, malaise and headache. The presence of significant regional lymphadenopathy is a differential feature with episodes of classical smallpox. Proctitis and pharyngitis, with minimal skin lesions, may be another form of presentation. Diagnosis can be confirmed by PCR testing of lesions or by demonstration of MPVX in other body fluids or tissues, although in the appropriate epidemiologic setting the clinical picture is highly suggestive of the disease. Effective drug treatment has been developed as part of programs to protect against potential bioterrorist agents and smallpox vaccinees are known to have high protection against monkeypox. New vaccines are available, but neither the drugs nor the vaccines are yet freely available on the market. The prognosis of the disease appears, at least in adults in developed countries, to be good, with very low mortality figures and much less aggressive behavior than that described in classical smallpox. Isolation measures, essential for the control of the outbreak, have been published by the health authorities.
Many studies have been conducted in intensive care units (ICUs) to identify the stress factors involved in the health of professionals and the quality and safety of care. The objectives are to ...identify the psychometric scales used in these studies to measure stressors and to assess their relevance and validity/reliability.
All peer-reviewed full-text articles published in English between 1997 and 2016 and focusing on an empirical quantitative study of job stressors were identified through searches on seven databases and editorial portals.
From the 102 studies analyzed, we identified 59 different scales: 17 "all settings scales" (16 validated scales), 20 "healthcare settings scales" (13 validated scales), and 22 "ICU settings scales" (two validated scales). All these scales used measured stressors from at least one of the following eight broad categories: High job demands, Problematic relationships with other professionals, Lack of control over work situations and career, Lack of organizational resources, Problematic situations with users and relatives, Dealing with ethical- and moral-related situations, Risk management issues, and Disadvantages in comparison to other occupational situations. The "all settings scales" and "healthcare settings scales," the most often validated, did not measure, or only slightly measured, the stressors most specific to ICUs. Where these were taken into account, the authors were forced to develop their own tools or modify existing scales without testing the validity of the tool used.
This review highlights the lack of a tool that meets both the criteria of validity and relevance with regard to the specificity of work in ICUs. Future research must focus on developing reliable/valid tools covering all types of relevant stressors to ensure the quality of the studies carried out in this field.
Cross-sectional study to know if tracheostomy influences the time on mechanical ventilation and reduces the ICU stay in patients with SARS-CoV2. From February 14 to May 31, 2020, 29 patients: 23 men ...and 6 women, with an average age (SD) of 66.4 years (±6,2) required tracheostomy. The average intensive care unit (ICU) stay was 36 days 31–56.5. The average days on mechanical ventilation was 28,5 days (±9.7). Mean time to tracheostomy was 15.2 days (±9.5) with an average disconnection time after procedure of 11.3 days (±7.4). The average hospital stay was 55 days 39–79. A directly proportional relation between the number of days of MV and the number of days from ICU admission until tracheostomy showed a significant value of p = 0.008. For each day of delay in tracheostomy, the days of mechanical ventilation were increased by 0.6 days. There was no relation between days to tracheostomy and days to disconnection (p = 0.092). PaO2 / FiO2 (PAFI) before tracheostomy and Simplified Acute Physiology Score III (SAPS III) at admission presented a statistical relation with mortality, with an OR of 1.683 (95%CI; 0.926–2.351; p = 0.078) and an OR of 1.312 (CI95%: 1.011–1.703; p = 0.034) respectively. The length of stay in the ICU until the tracheostomy was not related to the risk of death (p = 0.682). PEEP and PaO2/FiO2 (PAFI) at admission and before tracheostomy and APACHE II, SAPS III and SOFA at admission did not show influence over time on MV. We conclude that the delay in tracheostomy increase the days on mechanical ventilation but does not influence stay or mortality.
•For each day of delay in tracheostomy, the days of mechanical ventilation were increased by 0.6 days.•Timing of the tracheostomy did not influence days of disconnection from mechanical ventilation, ICU stay, or mortality.•There was no relationship between days to tracheostomy and days to disconnection.•Respiratory variables (PEEP and PaO2 / FiO2 on admission and before tracheostomy) and patient severity scales (APACHE II, SAPS III and SOFA on admission) did not show influence over time on mechanical ventilation.•The length of stay in the ICU until the tracheostomy was not related to the risk of death.
Purpose
To identify key components and variations in family-centered care practices.
Methods
A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire ...covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate.
Results
The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6–8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness.
Conclusions
This study emphasizes the need to prioritize healthcare providers’ mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.
Abstract Purpose The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential ...Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. Materials and methods EPIPUSE (Evolución y pronóstico de los pacientes con ingreso prolongado en UCI que sufren un empeoramiento, Evolution and prognosis of long intensive care unit stay patients suffering a deterioration ) study is a prospective, observational study during a 3-month recruitment period in 75 Spanish ICUs. We focused on patients admitted in the ICU for 7 days or more with complications of adverse events that involve organ dysfunction impairment. Demographics, clinical variables, and serialized SOFA after a supervening clinical deterioration were recorded. Univariate and multivariate analyses were performed, and a predictive model was created with the most discriminating variables. Results We included 589 patients who experienced 777 cases of severe complication or adverse event. The entire sample was randomly divided into 2 subsamples, one for development purposes (528 cases) and the other for validation (249 cases). The predictive model maximizing specificity is calculated by minimum SOFA + 2 * cardiovascular risk factors + 2 * history of any oncologic disease or immunosuppressive treatment + 3 * dependence for basic activities of daily living. The area under the receiver operating characteristic curve is 0.82. A 14-point cutoff has a positive predictive value of 100% (92.7%-100%) and negative predictive value of 51% (46.4%-55.5%) for death. Conclusions EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.
Laparoscopic Pyeloplasty: Always Dismembered? Amón Sesmero, José Heriberto; Delgado, Marcos Cepeda; de la Cruz Martín, Beatriz ...
Journal of endourology,
07/2016, Letnik:
30, Številka:
7
Journal Article
Recenzirano
To compare three laparoscopic surgical techniques for the treatment of ureteropelvic junction obstruction (UPJO), assessing their difficulty, operating time, effectiveness, and complications.
The ...clinical histories of 54 patients with UPJO who underwent a laparoscopic procedure between June 2003 and September 2013 were reviewed. Anderson-Hynes (A-H) pyeloplasty was performed on 34 patients, nondismembered pyeloplasty on 11 cases (8 Y-V Foley plasty and 3 Fenger plasty), and cephalad vascular displacement or Hellström technique (HT) on 9 patients. The patients were selected for the different techniques depending on the findings during the procedures, according to renal pelvic size and the presence of crossing vessels. We compared the techniques according to intraoperative and postoperative outcomes. Complications were interpreted following the Clavien-Dindo classification. The success rate was defined as the absence of clinical symptoms and normal diuretic renography. Analysis of variance and chi-square tests were used for the statistical analysis.
Mean follow-up was 55.58 months. The success rate achieved was 88.5% for A-H pyeloplasty, 90.9% for nondismembered pyeloplasty, and 100% for HT (p > 0.05). HT was the least time-consuming: 124 ± 30 vs 202 ± 44 minutes of A-H pyeloplasty and 147 ± 27 minutes of nondismembered plasty (p < 0.005). Mean hospital stay was 6.7 ± 1.4 days for A-H pyeloplasty, 6.6 ± 2 days for nondismembered pyeloplasty, and 3.42 ± 1.5 days for HT (p < 0.05). The postoperative complication rate was 21.1% for A-H pyeloplasty, 18.8% for nondismembered pyeloplasty, and 12.5% for HT (p > 0.05). None of the cases required open surgery, and urinary fistula was the most frequent complication.
Intraoperative observation of ureteropelvic junction allows selecting cases to undergo nondismembered pyeloplasty techniques, achieving similar results to A-H pyeloplasty, reducing operating time, complication rate, and hospital stay.
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