Patient Experience in a Spanish Pediatric Emergency Department.

OBJECTIVES: To study the experience reported by pediatric patients when visiting a pediatric emergency department (PED). METHODS: This was a prospective descriptive study, carried out in November 2014. A 12-question survey was developed, based on the Picker Patient Experience Questionnaire. The aim was to assess patient experience of children between 8 and 18 years old, attended in the PED of a high-complexity pediatric hospital. Questions were about the waiting time and setting, medical staff explanations and actions, treatment, and discharge. The questionnaires were administered and filled in by the children themselves at discharge. RESULTS: One-hundred seventy questionnaires were completed; 17.1% of respondents had to wait longer than expected, and 44.7% said that there was not enough to do when waiting to be seen. Pain was not correctly treated (3%), there was a lack of privacy (14.7%), and the information provided to the patients during the visit was wanting (10%). However, 80% said that they had been well treated. CONCLUSIONS: The patient experience of children in our PED was positive, although some aspects should be improved such as offering entertainment in the waiting area, increasing privacy during the medical visit, and giving better explanations to the children.

Parent experience in the resuscitation room: how do they feel?

The aim of this study is to describe the experience of parents present in the resuscitation room during the attention given to their children in the pediatric emergency department, and to identify areas for improvement in this regard. This was a prospective study carried out in a third-level pediatric hospital. Children with life-threatening pathologies are treated in the resuscitation room of the pediatric emergency department. A survey was carried out among parents present in the resuscitation room during the period September 2016-August 2017. Excluded were the parents of children that died and those with a language barrier. The parents were interviewed in person or over the phone within 72 h of the care provided in the resuscitation room. Fifty surveys were completed (15 in person and 35 by phone). Forty mothers and 10 fathers responded, with an average age of 41. In the resuscitation room, 39 parents were accompanied by a health professional and 22 were given information about how the resuscitation room operated. The feelings most frequently reported by the parents were nervousness (39) and trust in the healthcare provided (20). All of the parents wished to be present. They felt that their presence was beneficial for the child (46), for themselves (50), and for the healthcare personnel (28).Conclusion: The experience of the parents in our resuscitation room is a positive one. Nevertheless, some aspects need to be improved, such as accompaniment of the parents and the information that they are provided. What is Known: • There is an international recommendation for parental presence during invasive procedures and cardiopulmonary resuscitation. • Few studies have been carried out on how parents in the resuscitation room feel and how they encounter the experience. What is New: • Even though most of the parents feel nervous in the resuscitation room, they expressed confidence in the medical team and they would wish to be present under similar circumstances.

Patient experience in the pediatric emergency department: do parents and children feel the same?

The objectives are to describe the experience of children and parents in a pediatric emergency service (PED) and to determine whether there are differences of opinion between the two groups. This was a descriptive study. A questionnaire was designed based on the Picker questionnaire on the patient experience. From July through December 2015, a survey was made of the children aged 8-18 treated in the PED, as well as of their parents. The proportion of dissatisfaction was determined. A total of 514 questionnaires (257 children, 257 parents) were completed. The most poorly rated aspects according to the children and parents were the entertainment activities (43.2%), the waiting time (23.7%), and the treatment for pain (10.5%). Differences were detected in the experiences of the children and the parents regarding the overlong waiting time (28.0% children vs 19.5% parents; p = 0.023), inadequate explanations (7.0 vs 1.6%, p = 0.002), inadequate treatment for pain (14.4 vs 6.6%; p = 0.004), and insufficient privacy (11.7 vs 2.7%; p < 0.001). CONCLUSION: The entertainment activities during the wait and the waiting time are the two elements viewed most negatively by the children and the parents. The children tend to evaluate certain aspects of their experience as patients more negatively, which needs to be borne in mind in order to improve the attention provided. What is Known: • Studying the experience of patients is a key point in patient-centered medicine. • The experience of the pediatric patient has been little studied to date. The experience of the children is often inferred from that of their parents. Nevertheless, the experience of the children as patients might be different. What is New: • Overall, the experience of children and parents in the pediatric emergency department in the study is positive. Some aspects of the experience in emergency are poorly rated by the children, such as the waiting time, the information provided, treatment for pain, and privacy during the visit. • The experience of the children (and not merely that of their parents) needs to be studied in order to improve those areas that are rated poorly do as to enrich the experience in the emergency department.

Electrophoretic mobility of supercoiled, catenated and knotted DNA molecules.

We systematically varied conditions of two-dimensional (2D) agarose gel electrophoresis to optimize separation of DNA topoisomers that differ either by the extent of knotting, the extent of catenation or the extent of supercoiling. To this aim we compared electrophoretic behavior of three different families of DNA topoisomers: (i) supercoiled DNA molecules, where supercoiling covered the range extending from covalently closed relaxed up to naturally supercoiled DNA molecules; (ii) postreplicative catenanes with catenation number increasing from 1 to ∼15, where both catenated rings were nicked; (iii) knotted but nicked DNA molecules with a naturally arising spectrum of knots. For better comparison, we studied topoisomer families where each member had the same total molecular mass. For knotted and supercoiled molecules, we analyzed dimeric plasmids whereas catenanes were composed of monomeric forms of the same plasmid. We observed that catenated, knotted and supercoiled families of topoisomers showed different reactions to changes of agarose concentration and voltage during electrophoresis. These differences permitted us to optimize conditions for their separation and shed light on physical characteristics of these different types of DNA topoisomers during electrophoresis.

Direct Evidence for the Formation of Precatenanes during DNA Replication.

The dynamics of DNA topology during replication are still poorly understood. Bacterial plasmids are negatively supercoiled. This underwinding facilitates strand separation of the DNA duplex during replication. Leading the replisome, a DNA helicase separates the parental strands that are to be used as templates. This strand separation causes overwinding of the duplex ahead. If this overwinding persists, it would eventually impede fork progression. In bacteria, DNA gyrase and topoisomerase IV act ahead of the fork to keep DNA underwound. However, the processivity of the DNA helicase might overcome DNA gyrase and topoisomerase IV. It was proposed that the overwinding that builds up ahead of the fork could force it to swivel and diffuse this positive supercoiling behind the fork where topoisomerase IV would also act to maintain replicating the DNA underwound. Putative intertwining of sister duplexes in the replicated region are called precatenanes. Fork swiveling and the formation of precatenanes, however, are still questioned. Here, we used classical genetics and high resolution two-dimensional agarose gel electrophoresis to examine the torsional tension of replication intermediates of three bacterial plasmids with the fork stalled at different sites before termination. The results obtained indicated that precatenanes do form as replication progresses before termination.

[Clinical safety audits for primary care centers. A pilot study]. / Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto.

OBJECTIVE: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. DESIGN: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. SETTING: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). PARTICIPANTS: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. METHODS: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. EXCLUSION CRITERIA: no collaboration. RESULTS: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. DISCUSSION AND CONCLUSIONS: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security.

Impact of a Disaster Drill on Waiting Times in a Pediatric Emergency Department.

OBJECTIVE: Emergency departments should improve their preparedness for mass casualty incidents (MCIs) through periodic drills. These exercises are conducted while maintaining regular care. The aim of this study was to determine the impact of a disaster drill in a pediatric emergency department (PED) on real patients' waiting times. METHODS: On September 10, 2019, a 4-h disaster drill was conducted in the PED of a tertiary pediatric hospital, with minimal staff reinforcement (2 nurses). Cases were real patients that came to the PED during the drill. The patients that visited the PED the day before were the control group. Variables analyzed were: age, sex, destination, triage level, time-to-triage, time-to-physician, length of PED stay, and percentage of patients visited within the optimal time according to triage level. RESULTS: Sixty-eight patients (case group) and 63 patients (control group) were analyzed; both groups were comparable except for the median age. There were no differences in time-to-triage, time-to-physician, and length of PED stay between the 2 groups. The percentage of patients visited within optimal time according to triage level was higher in the case group. CONCLUSIONS: Conducting an MCI drill in the PED, with minimal staff reinforcement, was not detrimental to real patients' waiting times.

Presència dels familiars al box de crítics dels serveis d’urgències / Presencia de los familiares en el box de críticos de los servicios de urgencias / Family presence in the resuscitation room of pediatric emergency departments

Fonament. La presència dels familiars és cada cop més habitual als serveis d’urgències pediàtriques (SUP), on participen activament en la presa de decisions, els tractamentsi les cures del pacient.Objectiu. 1) Conèixer la proporció de SUP catalans en quèla presència dels familiars és habitual als boxs de crítics ien quines condicions. 2) Descriure els problemes que se’nderiven.Mètode. Estudi descriptiu multicèntric. Se sol·licita als responsables dels SUP que complimentin una enquesta sobrela presència de familiars als boxs de crítics (protocol, ubicació, acompanyament dels familiars, problemes derivats).Resultats. S’envien divuit enquestes, i s’obtenen setze respostes (taxa de resposta 88,8%) d’hospitals de mitjana(12/16) i alta (4/16) complexitat. Tots els SUP disposen debox de crítics i en 15/16 s’ofereix als familiars ser-hi presents durant l’atenció de l’infant; en un SUP no s’ofereixaquesta opció perquè l’espai és reduït, malgrat que la troben necessària. Dos SUP disposen de protocol. Durantl’atenció al pacient greu, els familiars estan acompanyatsper algun sanitari (11/16), però intermitentment (7/16). Espermeten un o dos familiars, sempre que ho desitgin(13/16) o després de l’estabilització inicial (2/16). Dos responsables manifesten problemes derivats, com el nerviosisme i l’agressivitat familiar.Conclusions. La presència de familiars als boxs de crítics éshabitual als SUP enquestats, sense problemes destacables.No obstant això, s’han detectat alguns aspectes millorables(elaboració de protocols i acompanyament dels familiars). (AU)

Fundamento. La presencia de familiares es cada vez más habitualen los servicios de urgencias pediátricas (SUP), colaborando en latoma de decisiones, tratamientos y cuidados del paciente. Objetivo. 1) Conocer la proporción de SUP catalanes en los que lapresencia de familiares es habitual en el box de críticos y en quécondiciones. 2) Describir problemas derivados.Método. Estudio descriptivo multicéntrico. Se solicita a los responsables de los SUP cumplimentar una encuesta sobre la presenciade familiares en el box de críticos (protocolo, ubicación, acompañamiento de los familiares, problemas derivados).Resultados. Se envían 18 encuestas y se obtienen 16 respuestas(tasa de respuesta (88,8%) de hospitales de mediana (12/16) yalta (4/16) complejidad. Todos los SUP disponen de box de críticos y en 15/16 se ofrece la presencia de familiares durante laatención del paciente crítico, en uno de ellos no está permitida porespacio reducido, pero la consideran necesaria. Dos SUP disponende protocolo. Los familiares están acompañados por algún profesional sanitario (11/16), pero de manera intermitente (7/16). Sepermiten 1 o 2 familiares, siempre que lo deseen (13/16) o después de la estabilización inicial (2/16). Dos responsables notificanproblemas puntuales (nerviosismo y agresividad familiar).Conclusiones. La presencia de familiares en los boxes de críticoses habitual en los SUP participantes, sin problemas destacables.Se han detectado algunos aspectos de mejora (elaboración de protocolos y acompañamiento de los familiares). (AU)

Background. Family presence is common in pediatric emergencydepartments (PED), and relatives actively collaborate in decisionmaking, treatment, and patient care.Objective. 1) To identify the proportion of Catalan PED where family presence is allowed in the resuscitation room and to describethe characteristics of family presence. 2) To describe the problemsthat arise from the presence of family members.Method. A multicenter descriptive study was designed. Chiefphysicians of PED were asked to participate via email in a surveyasking about the PED characteristics and the family presence inthe resuscitation room (protocol, location, relatives’ companion,problems).Results. 18 surveys were sent, obtaining 16 responses (responserate 88.8%) from middle (12/16) and high (4/16) complexity hospitals. All the PED have a resuscitation room, and family presence is offered in 15 of them (in one hospital family presence is notallowed because of limited space). 2 PEDs have a written protocolabout family presence in the resuscitation room. Family membersare accompanied by a healthcare worker (11/16), but not continuously (7/16). One or two relatives are usually allowed to be present in the resuscitation room, for as long as they desire (13/16)or after initial stabilization (2/16). Two chief physicians reportedoccasional problems (family anxiety and aggressivity).Conclusions. Family presence in the resuscitation room is commonin Catalan PED, without significant related problems. However,some aspects should be improved, particularly related to writtenprotocols and accompaniment of family members. (AU)

Single session of sprint interval training elicits similar cardiac output but lower oxygen uptake versus ramp exercise to exhaustion in men and women.

Sprint interval training (SIT) elicits comparable long-term adaptations versus continuous exercise training (CEX) including increased maximal oxygen uptake (VO2max) and fat utilization. However, there is limited research examining acute hemodynamic responses to SIT. The aim of this study was to examine hemodynamic responses to low-volume SIT. Active men (n=6, VO2max = 39.8 ± 1.7 mL/kg/min) and women (n=7, VO2max = 37.3 ± 5.7 mL/kg/min) performed a ramp-based VO2max test (RAMP) to determine workload for the SIT session. Subjects returned within 1 wk and completed a session of SIT consisting of six 30-s bouts of "all-out" cycling at 130% maximal workload (Wmax) interspersed with 120 s of active recovery. Continuously during RAMP and exercise and recovery in SIT, VO2 was obtained and thoracic impedance was used to estimate heart rate (HR), stroke volume (SV), and cardiac output (CO). Results revealed no significant differences in COmax (p = 0.12, 19.7 ± 2.4 L/min vs. 20.3 ± 1.8 L/min) but lower SVmax (p = 0.004, 110.4 ± 15.7 mL vs. 119.4 ± 15.5 mL) in RAMP versus SIT. HRmax from SIT (179.0 ± 11.8 b/min) was lower (p = 0.008) versus RAMP (184.4 ± 7.9 b/min). Peak VO2 (L/min) was lower (p < 0.001) in response to SIT (2.43 ± 0.82 L/min) compared to RAMP (2.84 ± 0.82 L/min). Hemodynamic variables increased linearly across SIT bouts and remained significantly elevated in recovery. Sprint interval training consisting of 3 min of supramaximal exercise elicits similar CO yet lower VO2 compared to RAMP.

Parental presence during invasive procedures in a Spanish pediatric emergency department: incidence, perspectives, and related anxiety.

BACKGROUND: Family presence during invasive procedures (IPs) is infrequent in Spanish pediatric emergency departments (PEDs), despite the benefits of family presence. OBJECTIVES: To investigate the proportion of relatives who wish to be present during IP, to determine the percentage of relatives who stayed during IP in our PED, and to evaluate parental anxiety. METHODS: A prospective observational study was carried out in a PED of an urban, tertiary-care university-affiliated hospital in Barcelona (Spain). A written survey was given to the relatives of children who were admitted to the PED during the month of November 2009. RESULTS: Of the 365 given questionnaires, 213 (58.4%) were completed. Ninety-nine percent of surveys were answered by the parents. Mean age of respondents was 37 years (74.6% were women). IPs were performed on 73.3% of patients, and 97.4% of IPs were performed in the presence of relatives. Parents were present during blood sampling (98%), urethral catheterizations (97%), lumbar punctures (LP; 72%), simple wound repair (62%), and fracture reductions (37%). Parents wanted to stay during blood sampling (98%), urethral catheterization (89.9%), LP (82.4%), simple wound repair (88.6%), and fracture reduction (86.5%). Respondents (51.6%) believed that parents should decide on their own whether their presence was desirable. Parents were least anxious during blood sampling and were most nervous during LP. CONCLUSION: Most of the parents wish to stay beside their children during IPs. In our PED, parents were present for more than 95% of IPs. The more invasive the procedure is, the more anxious parents feel.

Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto / Clinical safety audits for primary care centers. A pilot study

Objetivo: Detectar procesos organizativos, infracciones de normas o actuaciones profesionales que supongan niveles de inseguridad clínica. Diseño: Estudio descriptivo transversal mediante encuesta personalizada heteroadministrada de junio de 2008 hasta febrero de 2010. Emplazamiento: Trece de los 53 equipos de atención primaria (EAP) del ICS Costa de Ponent, Barcelona. Participantes: Trabajadores de 13 EAP agrupados en: director/a, adjunto/a, responsable del servicio de admisiones y médico/a centinela. Métodos: Selección no aleatoria, aparejando centros docentes/no docentes, urbanos/rurales, pequeños/grandes. Se evaluaron 33 indicadores: 15 de procedimientos, 9 de cultura y actitud, 3 de formación y 6 de comunicación. Criterios de exclusión: no colaboración. Resultados: Características de los 55 profesionales encuestados: 84,6% de centros urbanos, 46,2% docentes y 76,9% EAP grandes. Distribución por estamentos: 13 responsables de atención al usuario, 13 adjuntos de enfermería, 13 directores y 16 médicos centinelas. Nivel de inseguridad: < 50% respuestas afirmativas por indicador. Los EAP estudiados presentaron niveles de inseguridad en: recepción de nuevos profesionales médicos, administración de inyectables, sistema de recogida de domicilios por enfermería en fines de semana, interconsultas urgentes a especialistas, pacientes agresivos, presencia de incidentes críticos sobre las agendas de los médicos y barreras de comunicación en planes terapéuticos y con inmigrantes. Discusión y conclusiones: La seguridad clínica está en la agenda de los centros de salud. Las áreas detectadas de inseguridad son fácilmente abordables, y están consideradas en el futuro sistema de acreditación de la Generalitat de Catalunya. Los médicos centinelas son más críticos que los directores y los centros docentes, rurales y pequeños, refieren mejor percepción de seguridad (AU)

Objective: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. Design: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. Setting: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). Participants: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. Methods: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. Exclusion criteria: no collaboration. Results: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. Discussion and conclusions: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security (AU)

Sacroileitis infecciosa: localización poco frecuente de osteoartritis séptica infantil / Pyogenic sacroiliitis: a non frequent localization of joint infection in childhood

No disponibleIntroducción. La sacroileitis infecciosa es una entidadpoco frecuente, de ahí la importancia de los dos casos quese presentan. Su diagnóstico sigue siendo un reto por lainespecificidad de los síntomas, la dificultad de la exploraciónfísica y la rareza de su presentación, retrasando eldiagnóstico. El diagnóstico de las artritis sépticas de la articulaciónsacroilíaca requiere técnicas de imagen. La gamagrafíaes útil para localizar las áreas de hueso inflamadas,pero ofrece poca información de la extensión en lostejidos de los alrededores, siendo necesaria alguna otraprueba diagnóstica como la TC o la RMN para valorar la extensióny la gravedad de las lesiones. Con el tratamientoprecoz y adecuado, la evolución clínica es satisfactoria,quedando sin secuelas.Observación clínica. Se describen los casos de dos niñasde 13 y 14 meses, que presentaban un cuadro de irritabilidady que no dejaban que les manipularan las extremidadesinferiores. De las exploraciones complementarias lamás útil fue la gamagrafía, donde aparecía un aumento dela captación de la articulación y, la TC (Tomografía Axial)que revelaba lesiones líticas e irregularidades en los márgenesde la articulación.Comentarios. En el diagnóstico de la sacroileitis infecciosala TC, la RMN y la gamagrafía son las técnicas diagnósticasde elección. Por otro lado, la radiografía simple enestadios iniciales puede ser normal y analíticamente los hallazgosson muy inespecíficos. Con el tratamiento adecuadosuelen curarse completamente

Introduction. Septic sacroiliitis is an infrequent entity,and hence the importance of the two cases presented. Itsdiagnosis is still a challenge due to the fact that the symptomsare unspecific, the physical exploration difficult, andits appearance rare; all this slows down the diagnosis. Thediagnosis of the sacroiliac joint’s septic arthritis requiresimaging techniques. Bone scintigraphy is useful for localizingareas of the bone that are inflamed, but it gives littleinformation about the extent of the surrounding tissues,and this makes it necessary to use other tests for the diagnosis,such as CT and NMR, in order to estimate the extentand seriousness of the injuries. Early and appropriate treatmentmakes clinical evolution satisfactory, and as a result,there are no after-effects. Clinical observation. We describe the cases of two 13and 14 month girls, whose symptoms and signs were irritability.They did not let their inferior extremities to bemanipulated. Bone scintography proved to be the mostuseful among the additional explorations; it showed an increasein the localized areas of bone inflammation in sacroiliacjoint, whereas Computed Tomography revealed injuriesof the ilium and irregularities in the joint margins.Comments. CT, NMR and bone scintography are the techniqueschosen for the diagnosis of septic sacroiliitis. Furthermore,plain radiographies of early stages can be normal andthe analyses of the findings are very unspecific. It is usuallycompletely cured by means of appropriate treatment

Febre i úlceres genitals en una nena de 2 anys / No disponible

No disponible