The Identified Skeletal Collection of the School of Legal Medicine: a contemporary osteological collection housed in Universidad Complutense de Madrid, Spain.

ABSTRA: Osteological collections are an important resource for the development of methods to assist in the study of skeletal remains in archeological and/or forensic contexts. The aim is to describe the current characteristics of the Identified Skeletal Collection of the School of Legal Medicine and its historical context. The Identified Skeletal Collection of the School of Legal Medicine of the Complutense University of Madrid consists of 138 male and 95 female individuals, born between 1880 and 1980 and deceased between 1970 and 2009. The minimum age of the sample is perinatal and the maximum age is 97 years. The collection is an essential tool for forensic research, given that its population characteristics can be extrapolated to those of present-day Spain. Access to this collection offers unique teaching opportunities as well as provides the information necessary to develop various lines of research.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs.

OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

[Utility of the classification analysis in the typology of the the suicide attempt in a hospital population.] / Utilidad del análisis de clasificación en la tipología del intento de suicidio en una población hospitalaria.

OBJECTIVE: Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid. METHODS: In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated. RESULTS: Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting. CONCLUSIONS: The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature.

OBJETIVO: Las personas que intentan suicidarse no constituyen un grupo homogéneo. Numerosos estudios acreditan distintos subtipos de individuos con intentos de suicidio. Una de las principales aplicaciones del análisis de clasificación es la segmentación y selección de las características del sujeto. El objetivo de este estudio fue identificar grupos de sujetos con intentos de suicidio y descubrir las relaciones entre ellos en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: En un estudio de caso-control se aplicó la técnica de árbol de clasificación basado en el algoritmo CHAID (Chi-square automatic interaction detector), incluido en el programa SPSS 23.0, sobre una muestra de 201 sujetos ingresados en un hospital de alta complejidad de Madrid. Se evaluaron la impulsividad, la conflictividad de pareja, los antecedentes psiquiátricos y la depresión. RESULTADOS: Se obtuvieron tres subtipos o perfiles diferenciables del sujeto vinculados al intento de suicidio (perfil alto 144 casos 71,64%, medio 35 casos 17,41% y bajo 22 casos 10,94% de patrones básicos de riesgo), con alto valor de aplicación al ámbito clínico. CONCLUSIONES: Las tipologías encontradas permiten adecuar medidas preventivas sobre el intento de suicidio y realizar intervenciones clínicas focalizadas de carácter preventivo y predictor.

[Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid.] / Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid.

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation.

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural.

Spanish allele and haplotype database for 32 X-chromosome Insertion-Deletion polymorphisms.

X-chromosome markers have been proved to be decisive both complementing and solving kinship analysis, particularly when autosomal markers are not able to produce adequate likelihood ratios between different hypothesis. On the other hand, Pereira et al., (2012) have demonstrated that 32 Insertion/Deletion (InDel) markers located on the X-Chromosome have a very important power of discrimination in human populations, being a novel tool in the forensic and population fields. So, the aim of the present work was testing the forensic and population genetic efficiency of the 32 X-InDel polymorphisms in the Spanish population, and subsequently build an allele/haplotype frequencies database. To accomplish this objective, a total of 555 samples comprising male individuals from 13 Spanish regions were analysed for the above mentioned 32 X-InDels in two independent laboratories. A pairwise FST analysis was performed in order to understand if the studied Spanish sub-populations present significant differences among them, detecting possible population substructure. Also, linkage disequilibrium analyses were computed to investigate the presence of association between markers in the Spanish population. After Bonferroni correction, the absence of significant differences among the studied regions supports a global Spanish population database. Concerning LD, besides previously reported linked markers MID356-MID357 and MID3690-MID3719-MID2089, we also detected significant association between MID3703-MID3774, even after Bonferroni correction. Finally, after computing allele and haplotype frequencies, forensic efficiency parameters were calculated (PDmales = 99.999976 %; PDfemales = 99.99999999998 %). Mean exclusion chance values for duos were 0.999 and trios 0.99999. These results reinforce the suitability of the 32 X-InDels marker set both in identification and kinship studies.

Dentists Survey on Adverse Events During Their Clinical Training.

BACKGROUND: Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS: A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS: Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS: The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS: Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.

Eleven Basic Procedures/Practices for Dental Patient Safety.

OBJECTIVES: This study aimed to help alleviate the shortage of reliable information on clinical care issues; the Spanish Observatory of Dental Patient Safety (OESPO) has resorted to the study of legal claims by patients and searched those which produced clinical problems. METHODS: Based on OESPO data, this article proposes 11 basic procedures/practices for dental patient safety to help mitigate most preventable adverse events. RESULTS: The sample of the OESPO is large (415 adverse events studied), but it has the bias of a judicial source. However, the results provide an interesting approach to clinical safety in dentistry. When studying in detail the causes that led to preventable adverse events, it can be seen that most of these (and most severe) events have been caused by a small number of erroneous behaviors. CONCLUSIONS: Most preventable adverse events during the dental health care are produced by a relatively small number of causes. Therefore, a few basic safety procedures can reduce significantly these preventable adverse events.

[Typologies of Madrid's citizens (Spain) at the end-of-life: cluster analysis]. / Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters.

OBJECTIVE: To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. METHOD: The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. RESULTS: Five clusters stand out. Cluster 1: a group who preferred not to answer numerous questions (5%). Cluster 2: in favour of receiving palliative care and euthanasia (40%). Cluster 3: would oppose assisted suicide and would not ask for spiritual assistance (15%). Cluster 4: would like to receive palliative care and assisted suicide (16%). Cluster 5: would oppose assisted suicide and would ask for spiritual assistance (24%). CONCLUSIONS: The following four clusters stood out. Clusters 2 and 4 would like to receive palliative care, euthanasia (2) and assisted suicide (4). Clusters 4 and 5 regularly practiced their faith and their family members did not receive palliative care. Clusters 3 and 5 would be opposed to euthanasia and assisted suicide in particular. Clusters 2, 4 and 5 had not completed an advance directive document (2, 4 and 5). Clusters 2 and 3 seldom practiced their faith. This study could be taken into consideration to improve the quality of end-of-life care choices.

Utilidad de análisis modal de fallos y efectos para mejorar la seguridad en el movilización del paciente crítico intubado / Usefulness of failure mode and effects analysis for improving mobilization safety in critically ill patients

Abstract Introduction: Patient safety has become a core value in health organizations, requiring the use of significant resources in order to avoid accidents during hospital stay. Health care can create risks, and patient safety is the most important objective in care quality. Failure Mode and Effects Analysis (FMEA) is a preventive tool that helps anticipate potential errors and adverse events, setting up barriers to prevent them from happening, or mitigating their effects or, in the event they do happen, mitigating their impact on the most vulnerable link in health care, namely, the patient. Objectives: To analyze, using the FMEA tool, mobilization of intubated critical ill patients in the Intensive Care Unit. Method: A brainstorming session was held within the service to identify the most frequent potential errors in the process. Subsequently, the FMEA method with its different phases was applied, prioritizing risk according to the RPN (Risk Priority Number) index and selecting improvement actions for those with an RPN greater than 300. Results: The result was the identification of 101 failure modes, of which 46 exceeded the RPN of 300. As a result of this work, 63 improvement actions have been proposed for those failure modes with NPR scores above 300. Conclusion: The conclusion of the study is that FMEA was a useful tool for anticipating potential failures in the process and proposing improvement actions for those that exceeded an RPN of 300.

Resumen Introducción: La seguridad del paciente ha adquirido un valor estratégico en las organizaciones sanitarias, empleando numerosos recursos para evitar accidentes durante la estancia hospitalaria. La asistencia sanitaria puede generar un riesgo y la seguridad del paciente es el objetivo más importante de la calidad asistencial. AMFE es una herramienta preventiva, lo que supone una anticipación a los posibles errores y eventos adversos, poniendo barreras para que no sucedan o si lo hacen mitigar sus efectos sobre la parte más vulnerable de la atención sanitaria, el paciente. Objetivos: Analizar, a través de la herramienta AMFE (Análisis Modal de Fallos y Efectos), la movilización del paciente crítico intubado en la Unidad de Cuidados Intensivos. Método: Para ello se realizó una tormenta de ideas dentro del servicio para decidir los posibles errores más frecuentes en el proceso. Posteriormente, se aplicó el método AMFE, con sus fases, priorizando el riesgo conforme al índice NPR (Numero de Priorización de Riesgo), seleccionando acciones de mejora en los que tienen un NPR mayor de 300. Resultados: Como resultado hemos obtenido 101 modos de fallo de los cuales 46 superaban el NPR de 300. Tras nuestro resultado, se han propuesto 63 acciones de mejora en aquellos modos de fallo con puntuaciones NPR superiores a 300. Conclusiones: La conclusión del estudio es que AMFE permite anticiparnos a los posibles fallos del proceso para proponer acciones de mejora en aquellos que superan un NPR de 300.

Contribution of dental tissues to sex determination in modern human populations.

OBJECTIVES: Accurate sex estimation is an essential step for the reconstruction of the biological profile of human remains. Earlier studies have shown that elements of the human permanent dentition are sexually dimorphic. The aims of this study are to determine the degree of sexual dimorphism in the dental tissue volumes and surface areas of mandibular canines and to explore its potential for reliable sex determination. METHOD: The teeth included in this study (n = 69) were selected from anthropological collections from Spain, South Africa and Sudan. In all cases, the sex of the individuals was known. The teeth were scanned and three-dimensional (3D) measurements (volumes and surfaces areas) were obtained. Finally, a dsicriminant function analysis was applied. RESULTS: Our results showed that sexual dimorphism in canine size is due to males having greater amounts of dentine, whereas enamel volume does not contribute significantly to overall tooth size dimorphism. Classification accuracy of the multivariable equations tested on slightly worn teeth ranged from 78 to 90.2% for the crossvalidation, and from 71.43 to 84.62% for the hold-out sample validation. When all functions were applied together, the sex was correctly assigned 92.30% of the time. CONCLUSIONS: Our results suggest that the 3D variables from mandibular canine dental tissues are useful for sex determination as they present a high degree of dimorphism. The results obtained show the importance of 3D dental tissue measurements as a methodology in sex determination, which application should be considered as a supplemental method to others.

[End-of-life decisions: results of the expert-validated questionnaire]. / Decisiones al final de la vida: resultados del cuestionario validado por expertos.

OBJECTIVE: To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. METHOD: A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. RESULTS: The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. CONCLUSION: Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid.

[Design of a questionnaire on the knowledge and attitudes of the population of Madrid (Spain) facing the end-of-life]. / Elaboración de un cuestionario sobre conocimientos y actitudes de la población madrileña frente al final de la vida.

OBJECTIVE: To create and validate a questionnaire about knowledge and attitudes of the general population in Madrid (Spain) about life's end stage. METHOD: A descriptive study designed as a structured self-administered questionnaire, validated by seven Madrid Health Service professional experts and assessed through a pilot study. RESULTS: The questionnaire consisted of 42 questions, divided into six modules: 1) decisions and psychological-physical care at life's end; 2) palliative care; 3) euthanasia and assisted suicide; 4) advance directives document; 5) spiritual factors; and 6) socio-demographic data. CONCLUSIONS: The questionnaire was a useful, indirect method to ascertain the opinion of life's end in the Autonomous Region of Madrid. If it were applied in primary health care and hospital care, comparisons could be made among users in different autonomous regions of Spain.

Análisis causa-raíz sobre evento adverso producido en la Clínica Odontológica Docente Asistencial, Facultad de Odontología, Universidad de La Frontera, Chile / Cause-root analysis on an adverse event generated at the Dental Clinic, Faculty of Dentistry, Universidad de La Frontera, Chile

El Análisis de Causa-Raíz (ACR) es una forma de estudio retrospectivo de eventos adversos destinado a detectar las causas subyacentes de los mismos para proteger a los pacientes mediante la modificación de los factores dentro del sistema de salud que los provocaron y prevenir sus recurrencias. Si bien esta concepción centrada en la seguridad del paciente ha visto un importante auge en la atención médica, la odontología no ha sido llevada de igual manera probablemente por presentar daños más leves, procedimientos ambulatorios (con la consiguiente falta de seguimiento de muchos eventos adversos) y prácticas fundamentalmente privadas (cuyos conflictos afectarían potencialmente los resultados comerciales). Dado que no hay precedentes en Chile, se presenta un evento adverso producido en la Clínica Odontológica Docente Asistencial de la Facultad de Odontología de la Universidad de La Frontera y su ACR, desarrollado como primera intervención del Centro Chileno para la Observación y Gestión del Riesgo Sanitario de esa institución. Se plantean las necesidades de implementar un sistema explícito de categorización de eventos adversos en esa disciplina y de apoyar políticas de cultura en seguridad para el paciente odontológico, y se discute el papel de las instituciones universitarias para reconocer las áreas de vulnerabilidad en sus clínicas y así reforzar y mejorar la calidad de sus prácticas sanitarias.

Root cause analysis (RCA) is a retrospective study of adverse events performed to detect the underlying causes of these events to protect patients by modifying the factors within the health system that caused them and preventing their recurrences. Although this paradigm focused on patient safety has seen a significant increase in medical care, dentistry has not been carried out in the same way, probably because of milder injuries, outpatient procedures (with the consequent lack of follow-up of many adverse events) and basically private practices (whose conflicts would potentially affect commercial outcomes). Since there is no precedent in Chile, we present an adverse event produced at the Dental Clinic of the Faculty of Dentistry of the University of La Frontera and its RCA, performed as the first intervention of the Chilean Center for the Observation and Management of Health Risk of that institution. The needs to implement an explicit system of categorization of adverse events in this discipline and to provide support for cultural safety policies for the dental patient are discussed. The role of university institutions in recognizing areas of vulnerability in their clinics and to strengthen and improve the quality of their health practices is also discussed.

Amitraz changes NE, DA and 5-HT biosynthesis and metabolism mediated by alterations in estradiol content in CNS of male rats.

Amitraz is a formamidine insecticide/acaricide that alters different neurotransmitters levels, among other neurotoxic effects. Oral amitraz exposure (20, 50 and 80 mg/kg bw, 5 days) has been reported to increase serotonin (5-HT), norepinephrine (NE) and dopamine (DA) content and to decrease their metabolites and turnover rates in the male rat brain, particularly in the striatum, prefrontal cortex, and hippocampus. However, the mechanisms by which these alterations are produced are not completely understood. One possibility is that amitraz monoamine oxidase (MAO) inhibition could mediate these effects. Alternatively, it alters serum concentrations of sex steroids that regulate the enzymes responsible for these neurotransmitters synthesis and metabolism. Thus, alterations in sex steroids in the brain could also mediate the observed effects. To test these hypothesis regarding possible mechanisms, we treated male rats with 20, 50 and 80 mg/kg bw for 5 days and then isolated tissue from striatum, prefrontal cortex, and hippocampus. We then measured tissue levels of expression and/or activity of MAO, catechol-O-metyltransferase (COMT), dopamine-ß-hydroxylase (DBH), tyrosine hydroxylase (TH) and tryptophan hydroxylase (TRH) as well as estradiol levels in these regions. Our results show that amitraz did not inhibit MAO activity at these doses, but altered MAO, COMT, DBH, TH and TRH gene expression, as well as TH and TRH activity and estradiol levels. The alteration of these enzymes was partially mediated by dysregulation of estradiol levels. Our present results provide new understanding of the mechanisms contributing to the harmful effects of amitraz.

Utility of Failure Mode and Effect Analysis to Improve Safety in Suctioning by Orotracheal Tube.

OBJECTIVE: The objective of the study was to use the Failure Mode and Effect Analysis (FMEA) tool to analyze the technique of secretion suctioning on patients with an endotracheal tube who were admitted into an intensive care unit. MATERIALS AND METHODS: Brainstorming was carried out within the service to determine the potential errors most frequent in the process. After this, the FMEA was applied, including its stages, prioritizing risk in accordance with the risk prioritization number (RPN), selecting improvement actions in which they have an RPN of more than 300. RESULTS: We obtained 32 failure modes, of which 13 surpassed an RPN of 300. After our result, 21 improvement actions were proposed for those failure modes with RPN scores above 300. CONCLUSIONS: FMEA allows us to ascertain possible failures so as to later propose improvement actions for those which have an RPN of more than 300.

[Liability for loss of chance in neurological conditions in the Spanish public healthcare system]. / Responsabilidad por pérdida de oportunidad asistencial en patologías neurológicas en la medicina pública española.

OBJECTIVE: To analyse the sentences due to loss of chance that were passed by the Contentious-Administrative Court (i.e., in public medicine), in which both the origin of the disease to be treated and the damages were neurological. METHODS: We analysed the 90 sentences concerning neurological conditions that referred to the concept of loss of chance that were passed in Spain from 2003 (year of the first sentence) until May 2014. FINDINGS: Of the 90 sentences, 52 (57.8%) were passed due to diagnostic error and 30 (33.3%), due to inadequate treatment. 72 (80.0%) of the sentences were passed from 2009 onwards, which equates to more than a 300% increase with respect to the 18 (20.0%) issued in the first six years of the study (from 2003 to 2008). Most of the patients (66.7%) were men, and a 61.1% presented sequelae. Hypoxic-ischaemic encephalopathy (14.4%) and spinal cord disorders (14.4%) were the most common conditions to lead to sentencing. CONCLUSIONS: The litigant activity due to loss of chance in neurological disease in the Spanish public healthcare system has significantly increased in the last few years. The sentences were mainly passed because of diagnostic error or inadequate treatment.

[Responsibility for the loss of opportunity in malignant cancer care in the Spanish public healthcare system]. / Responsabilidad por pérdida de oportunidad asistencial en patología oncológica maligna en la medicina pública española.

OBJECTIVE: The loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes. METHOD: We analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014. RESULTS: Of the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences. CONCLUSIONS: The litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.

Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010.

INTRODUCTION: The effort to increase patient safety has become one of the main focal points of all health care professions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. OBJECTIVES: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. MATERIAL AND METHOD: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. RESULTS: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. CONCLUSION: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred.

Proposal of a "Checklist" for endodontic treatment.

OBJECTIVES: On the basis of the "Surgical Checklist" proposed by the WHO, we propose a new Checklist model adapted to the procedures of endodontic treatment. STUDY DESIGN: The proposed document contains 21 items which are broken down into two groups: those which must be verified before beginning the treatment, and those which must be verified after completing it, but before the patient leaves the dentist's office. RESULTS: The Checklist is an easy-to-use tool that requires little time but provides, order, logic and systematization by taking into account certain basic concepts to increase patient safety. DISCUSSION: We believe that the result is a Checklist that is easy to complete and which ensure the fulfillment of the key points on patient safety in the field of endodontics. Key words:Checklist, endodontics, patient safety, adverse event.

The clinical safety of disabled patients: proposal for a methodology for analysis of health care risks and specific measures for improvement.

The clinical risks associated with health care have been a known factor since ancient times, and their prevention has constituted one of the foundations of health care. However, concern for the risks involved in health care treatments has risen very significantly in recent years, becoming a modern current of concern for clinical health care risks which is referred to by the name of "patient safety" in the scientific literature. Unfortunately, there are no studies on patient safety in dental practice or case studies of adverse events in this practice. In addition to the lack of studies on adverse events in regular dental practice, there are even fewer references to treatment for disabled patients. In this article, we provide a "proposal for analysis" of the clinical risks associated with treating disabled patients, which will make it possible to evaluate the health care risks associated with the treatment of patients who have a specific disability, at one determined moment and in one specific environment.