Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave.

INTRODUCTION: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. METHODS: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ2 and ANOVA tests were used. RESULTS: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 ("Staffing", with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 ("Expectation of actions by management/supervision of the service") with 85.29% of positive responses, and 5 ("Teamwork") with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. CONCLUSIONS: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

[Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave]. / Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19.

Introduction: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing¼, with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service¼) with 85.29% of positive responses, and 5 («Teamwork¼) with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

National survey on the indicators of quality in Bioethics of the SEMICYUC in the departments of Intensive Care Medicine in Spain. / Encuesta nacional sobre los indicadores de calidad en Bioética de la SEMICYUC, en los servicios de Medicina Intensiva en España.

INTRODUCTION: Multiple interventions are performed in critical patients admitted to Intensive Care Units (ICUs). This study explores the presence in the daily practice of ICUs of elements related to the 6 bioethics quality indicators of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units, and the participation of their members in the hospital ethics committees. MATERIALS AND METHODS: A multicenter observational study was carried out, using a survey exploring descriptive aspects of the ICUs, with 25 questions related to bioethics quality indicators, and assessing the participation of ICU members in the hospital ethics committees. The ICUs were classified by size (larger or smaller than 10 beds) and type of hospital (public/private-public concerted center, with/without teaching). RESULTS: The 68 analyzed surveys revealed: daily informing of the family (97%), carried out in the information room (82%); end-of-life care protocols (44%); life support limitation form (48.43%); and physical containment protocol (40%). Compliance with the informed consent process referred to different procedures is: tracheostomy (92%), vascular procedures (76%), and extrarenal clearance (25%). The presence of ICU members in the hospital ethics committee is currently frequent (69%). CONCLUSIONS: Information supplied to relatives is adequate, although there are ICUs without an information room. Compliance with the informed consent requirements of various procedures is insufficient. The participation of ICU members in the hospital ethics committees is frequent. The results obtained suggest a chance for improvement in the bioethical quality of the ICU.

Usefulness of cardiac resynchronisation therapy devices and implantable cardioverter defibrillators in the treatment of heart failure due to severe systolic dysfunction: systematic review of clinical trials and network meta-analysis.

AIM: To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. METHODS: A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. RESULTS: 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. CONCLUSIONS: The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options.

Bladder neck rupture following perineal bull horn injury: a surgical challenge.

Pelvic-abdominal injuries caused by goring are serious lesions which require rapid diagnosis and urgent treatment in the context of a polytraumatized patient. The simultaneous rupture of both the bladder and the prostatic-membranous urethra occurs in 10%-29% of males with pelvic fractures but bladder neck injuries in adults are rarer. Unstable pelvic fractures, bilateral fractures of the ischiopubic branches (also referred to as fractures from falling astride) and the diastasis of the pubic symphysis are those that have the greatest likelihood of injuring both the posterior urethra and the bladder. We present a case of perineal bull horn injury with muscle laceration, bone fractures, scrotal avulsion and rupture of the bladder neck involving the right ureter which required two operations to be repaired.

Intensity of continuous renal replacement therapies in patients with severe sepsis and septic shock: a systematic review and meta-analysis.

The purpose of this study was to assess the efficacy of continuous renal replacement therapies in patients with severe sepsis or septic shock, with or without acute kidney injury. We performed a systematic search in Medline, Embase, Web of Knowledge, Cochrane Library and Clinicaltrials.gov and a hand search of the retrieved studies. We included both randomised controlled clinical trials and subgroups of randomised trials that assessed the effect of continuous renal replacement therapies (at traditional or high doses) and reported clinical outcomes in adult patients with severe sepsis or septic shock. The study selection and data extraction were performed by duplicate. Analysis of heterogeneity and meta-analysis was performed according to the Cochrane Collaboration guidelines for conducting systematic reviews of interventions. Twelve studies (1895 patients) met the inclusion criteria. Pooling of all studies resulted in a mortality risk ratio of 0.96 (95% confidence interval 0.83 to 1.12). The studies showed moderate statistical heterogeneity (I2 statistic 52%, P = 0.02). The effect on mortality was not modified (interaction P values non significant) by the dose of continuous renal replacement therapies, the severity of illness or the risk of bias. The available evidence suggests that these therapies in patients with severe sepsis or septic shock are not associated with an improvement in other outcomes such as haemodynamics, pulmonary gas exchange, multiple organ dysfunction syndrome or length of stay. The best available evidence does not support the routine use of continuous renal replacement therapies (at traditional or high doses) in patients with severe sepsis or septic shock.

[Prognostic value of the sTREM-1 plasma values in patients with sepsis: a cohort study]. / Valor pronóstico de los niveles plasmáticos de sTREM-1 en pacientes con sepsis: un estudio de cohortes.

OBJECTIVE: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. DESIGN: Prospective cohort study. SETTING: Two general Intensive Care Units. PATIENTS: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. VARIABLES OF INTEREST: Mortality at 28 days. RESULTS: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5 pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90 pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). CONCLUSIONS: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

[Prevention of respiratory risks]. / Prevención de riesgos respiratorios.

A need for oxygen is determined by the base pathology a patient suffers which produces immobilization, due to being bedridden and due to the problems which began due to an organic insufficiency associated with muscular weakness, a failure in the respiratory system, insufficient sputum, and cardiovascular alterations. This article deals with those alterations which cause a need to provide oxygen to a patient and its prevention in bedridden patients.

[Pelvic recurrence of urothelial tumor, after radical cysto-prostatectomy with orthotopic neo-bladder]. / Recidiva pélvica de tumor urotelial, tras cistoprostatectomía radical con neovejiga ortotópica.

We present a case of an urothelial tumor pelvic recurrence, five months after radical cystoprostatectomy. No fat infiltration was demonstrated in the pathological study of the transurethral resection pieces. The treatment was a radical cystoprostatectomy with an ileal ortothopic Hautmann type neo-bladder. The pathological study of the surgical piece demonstrated fat infiltration in some points but urethra and lymphatic nodes free.

[Retroperitoneal fibrosis caused by pancreatitis in an HIV+ patient]. / Fibrosis retroperitoneal por pancreatitis en paciente VIH+.

Retroperitoneal fibrosis is a rare inflammatory disease, in which the fibrosis plate leads to the compression of the affected structures. There are several causes of retroperitoneal fibrosis like specific and unspecific inflammatory diseases. In the specific group of retroperitoneal fibrosis we find the one due to pancreatitis. We do present a rare case of retroperitoneal fibrosis caused by a pancreatitis in a HIV+ patient.

[Secondary prostatic lymphoma in a kidney transplant patient]. / Linfoma de próstata secundario en paciente trasplantado renal.

Lymphoma involving the prostate is rare, both as a primary and as a secondary presenting. Usually the prognosis remains poor. The clinical presentation is similar to that of other lower urinary tract obstructions, in fact prostatic lymphoma must be considered in patients with these symptoms, particularly in patients with prior history of systemic lymphoma. We report a case of a kidney transplantation in a male patient, diagnosis of lymphoma non Hodgkin, with later recurrence in prostate.

[Laparoscopic diagnosis of Hodgkin's disease. Report of a case]. / Diagnóstico mediante laparoscopia de enfermedad de Hodgkin. A propósito de un caso.

Laparoscopic Surgery with diagnosis objectives in Urology, has many others indications related with different medical specialties, apart from the ones for the urologic area (ectopic test, linfadenectomy, etc...). In our case, the Services of Urology and Hematology, diagnosed a Hodgkin's disease case. The Service of Hematology realized treatment and evolution. Sometimes, the unspecific clinical presentations of the Hodgkin's disease, shows adenopatics masses, detected by Ecografy or TAC. Treatment and prognosis of the Hodgkin's disease, are related with the histological subtype and its spreading.

[Appendix mucinous cystadenoma]. / Cistoadenoma mucinoso apendicular.

Mucous cystadenomas are benign epithelial tumours with great mucous content inside. Despite being non-malignant, they acquired great size, compressing and displacing important structures and organs of the zone, with theirs unlucky outcomes. Surgical exeresis is very difficult, being almost impossible its total exeresis, showing great frequency of relapse. We present an appendix mucous cystadenoma case in a 54 years old patient.

[Endoscopic ureteral resection in radical nephroureterectomy: report of our experience]. / Desinserción ureteral endoscópica en la nefroureterectomía radical: presentación de nuestra experiencia.

We want to present our clinic and chirurgical experience in eight patients, using the radical nephroureterectomy with endoscopical resection of the ureter, as a safe and valid technique, in urothelial tumours localized in the upper urinary tract.

[Urethral amyloidosis]. / Amiloidosis localizada de la uretra.

Localized amyloidosis of the urethra is a rare pathological entity. Biopsy is required to make the appropriate diagnosis. Although localized therapy is available for obstructing, symptomatic lesions, asymptomatic lesions may be followed with conservative management and spontaneous regression has been reported. An appropriate medical evaluation should be performed to determine the presence of systemic amyloidosis.