Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain.

BACKGROUND: Occupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity. The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC. METHODS: A cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability. RESULTS: We identified 48 AEs (15.3% of medical records, 95% CI 11.3-19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%). CONCLUSIONS: The AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

[Implementation of good quality and safety practices. Descriptive study in a occupational mutual health centre]. / Implantación de buenas prácticas en calidad y seguridad. Estudio descriptivo en una mutua laboral.

OBJECTIVE: To describe the level of implementation of quality and safety good practice elements in a Mutual Society health centre. METHOD: A Cross-sectional study was conducted to assess the level of implementation of good practices using a questionnaire. Some quality dimensions were also assessed (scale 0 to 10) by a set of 87 quality coordinators of health centres and a random sample of 54 healthcare professionals working in small centres. RESULTS: Seventy quality coordinators and 27 professionals replied (response rates 80% and 50%, respectively. There were no differences in the assessment of quality attributes between both groups. They identified as areas for improvement: use of practice guidelines (7.6/10), scientific and technical skills (7.5/10), and patient satisfaction (7.7/10). Availability and accessibility to clinical reports, informed consent, availability of hydro-alcoholic solution, and to record allergies, were considered of high importance to be implemented, with training and research, improvements in equipment and technology plans, adherence to clinical practice guidelines and the preparation of risk maps, being of less importance. CONCLUSION: The good practices related to equipment and resources have a higher likelihood to be implemented, meanwhile those related to quality and safety attitudes have more barriers before being implemented. The mutual has a similar behaviour than other healthcare institutions.

Near-infrared spectroscopy measurement of regional tissue oxyhemoglobin saturation during hemorrhagic shock.

Adequate resuscitation of patients from shock states depends on restoration of oxygen delivery (DO2) to tissues. Direct measurement of systemic DO2 during shock states requires invasive techniques such as pulmonary artery catheterization. These experiments were performed to examine the ability of near-infrared spectroscopy (NIRS), to measure regional tissue oxygenation in a large-animal model of hemorrhagic shock, and to compare these measures to global measures of oxygen delivery. Splenectomized female pigs (n = 11) were anesthetized, instrumented, and monitored. NIRS probes were placed on the leg, in the stomach via nasogastric tube, and on the liver during laparotomy. Hemorrhagic shock was induced by phlebotomy of 28% of blood volume. After 1 hour, resuscitation was with shed blood and crystalloid until cardiac output plateaued. Measurements of physiologic parameters, blood gases, lactate, intramucosal pH, and NIRS values for regional tissue hemoglobin oxygen saturation (StO2), and cytochrome a,a3 redox state were recorded at intervals throughout the experiment. Tissue oxygenation as measured by oxyhemoglobin saturation and cytochrome a,a3 redox (NIRS) correlated with measures of systemic DO2 throughout the experiment. The liver probe demonstrated blunted changes in tissue oxygenation suggesting relatively protected circulation. Intramucosal pH did not correlate well with DO2. Regional tissue oxygenation as measured by NIRS shows excellent correlation with global oxygen delivery. NIRS may allow estimation of systemic oxygen delivery using rapid non-invasive techniques.

Systematic study of parameters influencing the action of Rose Bengal with visible light on bacterial cells: comparison between the biological effect and singlet-oxygen production.

As part of a project to study different methods for the disinfection of effluent water, the inactivation of different microorganisms (Escherichia coli, Deinococcus radiodurans and spores of Bacillus subtilis) using a combination of a photosensitizer (Rose Bengal) with simulated sunlight and oxygen was determined under various environmental conditions (temperature, pH index). In parallel, the singlet-oxygen (1O2) production was also measured under the same conditions. Whereas the vegetative cells could be inactivated much more efficiently at increased temperature and altered index of pH, the production of 1O2 remained essentially the same under these alterations. Additionally, the relations among the sensitivities of different cell types to be killed by our photodynamic treatments (PDT) were opposite to those found after exposure to ionizing radiation. The results of photodynamic experiments do not reflect the cells' capacity to repair DNA strand breaks. Spores of B. subtilis, as a nonvegetative system, could not be inactivated by illuminations up to 100 J cm-2. Together, these findings indicate that DNA is not the primary target, the inactivation of which leads to the killing of our test organisms. Instead, the cellular envelope appears to be the component being assaulted by our PDT.

Synthesis of deoxyfluoro sugars from carbohydrate precursors.

Results obtained over the past decade concerning the introduction of the fluorine atom into carbohydrate molecules, either by nucleophilic substitution or electrophilic addition reactions, are summarised. The first section mainly deals with the triflate/fluoride tandem sequence and the DAST-reaction. In the discussion, emphasis is given to the dependency of the reaction course on the stereochemical and protecting group features. Possible reaction pathways are direct substitution (with inversion or retention of configuration), rearrangement (combined with substitution and inversion of configuration at both of the centres involved) and elimination. Based on the assumption of cyclic transition states or transient intermediates (formed through participation of neighbouring groups), far-reaching mechanistic generalisations were made. On this basis, isolated examples from the literature, which are not in accordance with these generalisations, are specifically brought to attention. Results from the recently introduced reaction of safe and easy to handle N-F fluorinating agents with glycals are also reported. This approach allows the simple and stereoselective access to a series of 2-deoxy-2-fluoro aldopyranoses, as well as the synthesis of various C-1-substituted derivatives by an easy one-pot reaction. However, the same method applied to furanoid glycals is rather poor with respect to stereoselectivity. Finally, considerations on the importance of fluorine-specific reactions of the S(N)-type in related fields of organic synthesis are made.

Transglycosylation reactions with a crude culture filtrate from Thermoascus aurantiacus.

Some characteristics of regioselectivity and acceptor tolerance in transglycosylation reactions, catalysed by a crude culture filtrate from Thermoascus aurantiacus, were examined by employing methanol and monosaccharides as acceptors. When beta-D-mannopyranosyl fluoride was employed as the donor, the anomeric configuration of the newly formed bond was found to depend on the structure of the acceptor used.

Simultaneous detection of different glycosidase activities by 19F NMR spectroscopy.

A fast method for the simultaneous detection of different glycosidolytic activities in commercially available enzyme preparations and crude culture filtrates was found in using, as substrate, a mixture of different glycosyl fluorides and 19F NMR spectroscopy as a screening technique. Accompanying studies regarding the hydrolytic stability of these fluorides in various buffer systems, as well as conditions of their long-term storage, were carried out. A simple procedure for the preparation of beta-D-mannopyranosyl fluoride in gram quantities is given.

Energy loss of a charged particle in a magnetized quantum plasma.

This paper investigates the stopping power of a weakly coupled magnetized plasma. The effect of the Larmor rotation of the heavy charged test particle is carefully analyzed. The dielectric formalism is employed to obtain a general expression for the stopping power. A quantum mechanical form of the random-phase approximation dielectric function is used so that an arbitrary cutoff procedure is not required. Simple analytical expressions for the stopping power have been found for the cases of high and low projectile velocity of the test particle. The dependence of the stopping power on the angle of incidence is studied. A comparison with numerical solutions is given. It is found that in general a magnetic field reduces the stopping power of the plasma at high velocities, while it increases the stopping power at low velocities.

Stopping power of strongly coupled electronic plasmas: sum rules and asymptotic forms.

The stopping power of coupled electronic plasmas is investigated. Within the dielectric formalism and employing the method of frequency moments for the dielectric function we obtain a general formula describing the linear stopping power of a coupled plasma. Analytical results for the low- and high-projectile-velocity asymptotic forms are obtained. A sum rule for the plasma heavy ions linear stopping power projectile velocity distribution is established to be related to the dielectric permeability "negative" frequency moment. This permits for a simple interpretation of stopping power data.

Evolution of induced axial magnetization in a two-component magnetized plasma.

In this paper, the evolution of the induced axial magnetization due to the propagation of an electromagnetic (em) wave along the static background magnetic field in a two-component plasma has been investigated using the Block equation. The evolution process induces a strong magnetic anisotropy in the plasma medium, depending nonlinearly on the incident wave amplitude. This induced magnetic anisotropy can modify the dispersion relation of the incident em wave, which has been obtained in this paper. In the low frequency Alfven wave limit, this dispersion relation shows that the resulting phase velocity of the incident wave depends on the square of the incident wave amplitude and on the static background magnetic field of plasma. The analytical results are in well agreement with the numerically estimated values in solar corona and sunspots.

Spacelab concept and its utilization for science.

The first part of the paper is devoted to the presentation of the Spacelab concepts, for which detailed design studies are at present being carried out by ESRO. The second part concentrates on the utilization of the Spacelab for the various fields of science, namely: (1) Atmospheric and space plasma physics, (2) Astronomy and astrophysics, (3) Material science and (4) Life sciences. The advantages of using the Spacelab for observations in these fields as compared to conventional automated satellites are highlighted.

Equation of states for classical Coulomb systems: use of the Hubbard-Schofield approach.

An effective method based on the Hubbard-Schofield approach [Phys. Lett. A 40, 245 (1972)] is developed to calculate the free energy of classical Coulomb systems. This method significantly simplifies the derivation of the cluster expansion. A diagrammatic representation of the cluster integrals is proposed. Simple rules providing the leading order in density n of each diagrammatic contribution are found. We calculate the n(3) contribution and recover the results at the order n(5/2) obtained by the traditional method of resummation of diverging Mayer bonds.

[The status of afebrile infantile convulsions within the epilepsy spectrum--a follow-up of 55 patients]. / Die Stellung afebriler Säuglingskrämpfe innerhalb der Epilepsie--Eine Verlaufskontrolle bei 55 Patienten.

In an earlier study we observed 411 patients with cerebral convulsions, 118 of whom had the first convulsion during the 1 year of life. Among these 118 children we found 76 with afebrile convulsions. In this study we present the development and outcome in 55 patients with afebrile convulsions in the 1 year of life which could be observed for some years, most of them up to the present. In 25 infants the fits started in the newborn period, and in 30 infants after the 1 month; they were divided into groups with and without risk factors in the history. Benign neonatal convulsions were found in about one-third of children, with a good prognosis. These convulsions are divided into a dominantly inherited but rarely observed form and idiopathic benign neonatal convulsions. In contrast, among the newborns with risk factors in the history we found only half with a positive development. The results in the 30 infants with convulsions after the 1 month were similar with respect to risk factors in the history of risks. The 15 infants without risks had a good prognosis. Only 3 patients had oligoepilepsy. However, in the 15 patients with risks only 3 developed normally, 6 had no fits, but were neurologically or mentally handicapped, and 7 had fits and disability. We believe that afebrile convulsions without risk factors after the 1 month could be considered a late manifestation of benign newborn convulsions.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for early supply independent mitochondrial dysfunction in patients developing multiple organ failure after trauma.

OBJECTIVE: To determine whether early supply independent mitochondrial oxidative dysfunction occurs in trauma patients who develop multiple organ failure (MOF). DESIGN: Prospective focused observational trial. METHODS: High-risk patients were aggressively resuscitated while being continuously monitored by near infrared spectroscopy. Near infrared spectroscopy monitoring strips allow for a direct comparison of changes in tissue oxyhemoglobin levels (HbO2), which reflect local oxygen supply, and cytochrome a,a3 redox, which reflects mitochondrial oxygen consumption. Under normal conditions, HbO2 and a,a3 redox are tightly coupled. On the other hand, decoupled HbO2 and a,a3 redox is a sign of mitochondrial oxidative dysfunction. Outcomes included MOF, oxygen delivery, oxygen consumption, lactate, and the presence of decoupled HbO2 and a,a3 redox. RESULTS: Twenty-four high-risk patients were studied; nine (38%) developed MOF. At 12 hours of resuscitation, MOF and non-MOF patients did not have statistically different oxygen delivery and oxygen consumption, but lactate levels were significantly higher in MOF patients. Additionally, HBO2 and a,a3 redox were decoupled in eight (89%) MOF patients compared with two (13%) non-MOF patients (p < 0.05). CONCLUSION: Severely injured trauma patients who develop MOF preferentially display evidence of mitochondrial oxidative dysfunction early in the course of their resuscitation despite early goal-oriented maximization of oxygen delivery.