[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

[Critically ill patient isolation: risk or protection?] / Aislamiento del paciente crítico: ¿riesgo o protección?

INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

[Identification of adverse events in hospitalised influenza patients]. / Identificación de eventos adversos en pacientes hospitalizados por gripe.

OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

[An analysis of the treadmill exercise test in a population of mild and moderate extrinsic asthmatics]. / Análisis de la prueba de ejercicio de la cinta sin fin en una población de asmáticos extrínsecos leves y moderados.

The bronchial response to physical exercise on a treadmill was analyzed in 48 patients with mild to moderate extrinsic asthma diagnosed by clinical criteria and a positive methacholine test, and in 36 non-asthmatic subjects. Bronchoconstriction secondary to physical exercise was documented by measuring the percent fall in PEF in different post-exercise control times. Significant differences (p < 0.00001) were observed between bronchial response in asthmatic and non-asthmatic patients. By using ROC curves an optimal cut-off was obtained in a fall equal to or greater than 6% 10 minutes post-exercise, with a sensitivity of 0.75 and an specificity of 0.923. The bronchial challenge test with physical exercise on a treadmill, within the limits of the studied sample, can be used as a method for detecting BHR in asthmatic patients.