[Analysis of an incident notification system and register in a critical care unit]. / Análisis del registro de un sistema de notificación de incidentes en una unidad de cuidados críticos.

OBJECTIVE: To analyse the incident communicated through a notification system and register in a critical care unit. METHODOLOGY: A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. STUDY VARIABLES: incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. RESULTS: Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. CONCLUSIONS: Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication.

[Nursing perception of communication with intensive care unit patients family members]. / Percepción de las enfermeras sobre la comunicación con la familia de pacientes ingresados en un servicio de medicina intensiva

INTRODUCTION: Communication is referred as one of the most important needs by the families of intensive care unit patients. AIM OF THE STUDY: To analyze nursing perception of the communication process with the family members of an intensive care unit patient. MATERIALS AND METHODS: Transversal study (December 2012) with a questionnaire Nurse Activities for Communicating with Families (NACF), cross-culturally adapted by Santana Cabrera et al. Participants: intensive care unit nurses from a third level university hospital. Descriptive analysis of variables and inferential statistics with Chi-square and Kruskal-Wallis, statistic program SPSS 17.0; significant P < .05. RESULTS: Complementation was of 80% (132 out of 166 nurses). The average experience was of 9.6 ± 7.95 years. 55.9% sometimes explain to families the treatment and equipment of the patient and a 37% almost always. Nurses talk to the families about the disease and the treatment given to the patient always/almost always in 59% of the cases and sometimes in a 35.38%. 54,6% talk to the family about their feelings sometimes and a 28.46% almost always. A 47.8% notify always/almost always changes on the care plan. 87.9% ensure patient comfort always/almost always. There is no relation between years of experience in ICU and the outcomes of the questionnaire. There is a relation between the different kinds of ICUs and the information given about disease and treatment. DISCUSSION: Nurses tend to inform more about technical aspects than feelings related to the families. Patient comfort is the most referred item regardless of years of experience and the kind of intensive care unit.

[Analysis of constipation in severe trauma patients]. / Análisis del estreñimiento en pacientes con traumatismo grave.

OBJECTIVES: To evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). MATERIALS AND METHOD: A retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student's T test and Chi-square of SPSS 17.0. Significance level P<.05. RESULTS: A total of 80 patients fulfilled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P>.05). CONCLUSIONS: There is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically.

[Audit of the bedside monitor alarms in a critical care unit]. / Auditoría de las alarmas del monitor de cabecera en una unidad de cuidados críticos.

AIMS: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). METODOLOGY: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. RESULTS: 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O(2) saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10 sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. CONCLUSION: The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude.

[Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)]. / Valoración del dolor en la aspiración de secreciones traqueales en pacientes con traumatismo craneal mediante la Escala de conductas indicadoras de dolor (ESCID).

OBJECTIVE: To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. MATERIAL AND METHOD: An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5 minutes before, meanwhile and 15 minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P<.05). RESULTS: Pain was assessed on 27 patients. 82% suffered from severe head trauma and 18% moderate. The average pain value during nursing procedure day 1 was 3, 18±2.6, day 3: 2, 59±2 and day 6: 3, 94±2.3. There was a significant increase in mean pain while performing suctioning during the three days of assessment (P<.05); however no significant differences between the average pain value on the three days of the assessment (P>.05) were shown. Data for the painless procedure were significantly different on day 6 (P<.05) CONCLUSION: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected.

Changes in reward-induced neural activity upon Cafeteria Diet consumption.

Excessive consumption of highly palatable foods rich in sugar and fat, often referred to as "junk" or "fast" foods, plays a central role in the development of obesity. The highly palatable characteristics of these foods activate hedonic and motivational mechanisms to promote food-seeking behavior and overeating, which is largely regulated by the brain reward system. Excessive junk food consumption can alter the functioning of this reward system, but exact mechanisms of these changes are still largely unknown. This study investigated whether long-term junk food consumption, in the form of Cafeteria (CAF) diet, can alter the reward system in adult, female Long-Evans rats, and whether different regimes of CAF diet influence the extent of these changes. To this end, rats were exposed to a 6-week diet with either standard chow, or ad libitum daily access to CAF diet, 30 % restricted but daily access to CAF diet, or one-day-a-week (intermittent) ad libitum access to CAF diet, after which c-Fos expression in the Nucleus Accumbens (NAc), Prefrontal Cortex (PFC), and Ventral Tegmental Area (VTA) following consumption of a CAF reward of choice was examined. We found that all CAF diet regimes decreased c-Fos expression in the NAc-shell when presented with a CAF reward, while no changes in c-Fos expression upon the different diet regimes were found in the PFC, and possibly the VTA. Our data suggests that long-term junk food exposure can affect the brain reward system, resulting in an attenuated activity of the NAc-shell.

[Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation]. / Aplicación de la Escala de conductas indicadoras de dolor (ESCID) en el paciente con trauma grave no comunicativo y ventilación mecánica.

OBJECTIVE: To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. MATERIAL AND METHOD: A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. RESULTS: A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. CONCLUSION: An increase on the ESCID score was observed while performing the procedures.

A presumptive new locus for autosomal dominant hypercholesterolemia mapping to 8q24.22.

Molecular testing of patients with autosomal dominant hypercholesterolemia (ADH) fails to detect a causal functional mutation in 15.25% of subjects. We studied an ADH pedigree in which known ADH-causing genes (LDLR, APOB and PCSK9) were excluded. Genome-wide analysis on 15 family members detected significant association for ADH and dbSNP RS ID rs965814 (G/A), located in 8q24.22 cytoband. ADH was significantly associated to rs965814 G allele (p < 0.05) in a case-control study based on 200 unrelated ADH subjects without LDLR or APOB gene defects and 198 normolipidemic controls. We chose 24 markers for a detailed analysis of 8q24.22 cytoband, now based on an extended set of family members (21 individuals). One particular 24 marker haplotype was significantly associated to both higher total and low-density lipoprotein-cholesterol concentrations. Similar results were found for a shorter haplotype, composed of the distal six markers from the complete haplotype. Therefore, a presumptive new locus for ADH could be located in 8q24.22 cytoband, a region not previously linked or associated to ADH.

[Evaluation of the compliance of semirecumbent position between 30-45° in intubated patients]. / Evaluación del cumplimiento de cabeceros elevados entre 30-45° en pacientes intubados.

AIMS: To determine compliance of the standard "semirecumbent position between 30-45° in patients with artificial airway (AA)". To know the opinion of the professionals on this issue. MATERIAL AND METHODS: An observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. DATA COLLECTED: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ2; p<0.05=significant. RESULTS: A total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30-45°). Professionals with <1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30°. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p<0.05). It was <30° in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p<0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases. CONCLUSIONS: Measured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard.

Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).

[Diagnostic blood losses in severe trauma patients]. / Pérdidas sanguíneas diagnósticas en pacientes con trauma grave.

OBJECTIVE: To analyze diagnostic (blood drawings) and iatrogenic (Continuous Renal Replacement Therapy, CRRT) blood losses (BL) in severe trauma patients. METHOD: A one-year descriptive, prospective and observational study. We included patients over 15 years of age, admitted with severe trauma and who had a score of > or =16 on the Injury Severity Index (ISS). Those patients in whom limitation of therapeutic effort had been indicated were excluded. A total of 225 patients with 1619 days of evolution were analyzed for volume of BL/day/patient, type of diagnostic test, clinical outcome and utilization of CRRT. The variables were described as mean +/- standard deviation with the Student's T test. RESULTS: Average blood loss of patient per day was 55.5+/-32.2 cc. Statistically significant differences were found between the blood volume drawn when the first day was compared to the second day, 73.5+/-32.2 vs. 56.3+/-21.9 (p<0.001); clinical outcome (alive vs death) 54.8+/-33 vs. 60.7+/-24.9 (p<0.05); severity (ISS<31 or > or =31) 54.65+/-20 vs. 61.5+/-28.5 (p<0.001), No RRT vs RRT: 50.9+/-18.9 vs. 97.2+/-72.6 (p<0.001). CONCLUSIONS: The greatest diagnostic BL occurs during the resuscitation phase, in the patients who die, in those with greater severity and those undergoing CRRT.

Are the olive oil and other dietary lipids related to cancer? Experimental evidence.

There is a wealth of evidence supporting the relationship between dietary lipids and cancer, particularly those of the breast, colon and rectum and prostate. The main support comes from the international correlational studies and, especially, from experimental ones. The evidence from human analytical studies is less consistent because of several conflicting findings, probably due to methodological issues. Experimentally, it has been clearly demonstrated that quantity and type of dietary lipids as well as the particular critical phases of the carcinogenesis in which they act, are the essential factors in this relationship. Thus, whereas high dietary intake of n-6 polyunsaturated fatty acids (PUFA), primarily LA, and saturated fat has tumor-enhancing effects, long chain n-3 PUFA, CLA and GLA have inhibitory effects. Monounsaturated fatty acids (MUFA), mainly OA, present in high quantities in olive oil, seem to be protective although some inconsistent results have been reported. Bioactive compounds of virgin olive oil may also account for the protective effect of this oil, which is the main source of fat in the Mediterranean diet. Experimental studies have also provided evidence of several putative mechanisms of action of dietary lipids on cancer. Lipids can influence the hormonal status, modify cell membranes structure and function, cell signalling transduction pathways and gene expression, and modulate the function of the immune system. Although further studies are needed to evaluate and verify these mechanisms in humans, based on the multiple ways dietary lipids can act, they may have an important influence on tumorigenesis.

Chromatin structure of the regulatory regions of pS2 and cathepsin D genes in hormone-dependent and -independent breast cancer cell lines.

We have compared the DNase I hypersensitivity of the regulatory region of two estrogen-regulated genes, pS2 and cathepsin D in hormone-dependent and -independent breast carcinoma cell lines. This strategy allowed the identification of two important control regions, one in pS2 and the other in cathepsin D genes. In the hormone-dependent MCF7 cell line, within the pS2 gene 5'-flanking region, we detected two major DNase I hypersensitive sites, induced by estrogens and/or IGFI: pS2-HS1, located in the proximal promoter and pS2-HS4, located -10.5 Kb from the CAP site, within a region that has not been cloned. The presence of these two DNase I hypersensitive sites correlates with pS2 expression. Interestingly in MCF7 cells, estrogens and IGFI induced indistinguishable chromatin structural changes over the pS2 regulatory region, suggesting that the two transduction-pathways converge to a unique chromatin target. In two cell lines that do not express pS2, MDA MB 231, a hormone-independent cell line that lacks the estrogen receptor alpha, and HE5, a cell line derived from MDA MB 231 by transfection that expresses estrogen receptor alpha, there was only one hormone-independent DNase I hypersensitive site. This site, pS2-HS2, was located immediately upstream of pS2-HS1. In MCF7 cells, two major DNase I hypersensitive sites were present in the 5'-flanking sequences of the cathepsin D gene, which is regulated by estrogens in these cells. These sites, catD-HS2 and catD-HS3, located at positions -2.3 Kb and -3.45 Kb, respectively, were both hormone-independent. A much weaker site, catD-HS1, covered the proximal promoter. In MDA MB 231 cells, that express cathepsin D constitutively, we detected an additional strong hormone-independent DNase I hypersensitive site, catD-HS4, located at position -4.3 Kb. This region might control the constitutive over-expression of cathepsin D in hormone-independent breast cancer cells. All together, these data demonstrate that a local reorganization of the chromatin structure over pS2 and cathepsin D promoters accompanies the establishment of the hormone-independent phenotype of the cells.

Effects of gamma-linolenic acid and oleic acid on paclitaxel cytotoxicity in human breast cancer cells.

It has been suggested that dietary interventions may improve the effectiveness of cancer chemotherapy. We have examined the combined in vitro cytotoxicity of paclitaxel and the fatty acids gamma-linolenic acid (GLA, 18:3n-6) and oleic acid (OA, 18:1n-9) in human breast carcinoma MDA-MB-231 cells. The effect of fatty acids on paclitaxel chemosensitivity was determined by comparing IC(50) and IC(70) (50 and 70% inhibitory concentrations, respectively) obtained when the cells were exposed to IC(50) and IC(70) levels of paclitaxel alone and fatty acids were supplemented either before or during the exposure to paclitaxel. The 3-4,5-dimethylthiazol-2-yl-2,5-diphenyl-tetrazolium bromide (MTT) assay was used to determine cell growth inhibition. GLA by itself showed antiproliferative effects, and a possible GLA-paclitaxel interaction at the cellular level was assessed by the isobologram and the combination-index (CI) methods. Isobole analysis at the isoeffect levels of 50 and 70% revealed that drug interaction was predominantly synergistic when GLA and paclitaxel were added concurrently for 24 h to the cell cultures. Interaction assessment using the median-effect principle and the combination-index (CI) method showed that exposure of MDA-MB-231 cells to an equimolar combination of concurrent GLA plus paclitaxel for 24 h resulted in a moderate synergism at all effect levels, consistent with the results of the isobologram analysis. When exposure to GLA (24 h) was followed sequentially by paclitaxel (24 h) only an additive effect was observed. The GLA-mediated increase in paclitaxel chemosensitivity was only partially abolished by Vitamin E, a lipid peroxidation inhibitor, suggesting a limited influence of the oxidative status of GLA in achieving potentiation of paclitaxel toxicity. When OA (a non-peroxidisable fatty acid) was combined with paclitaxel, an enhancement of chemosensitivity was found when OA was used concurrently with paclitaxel, although less markedly than with GLA. Pretreatment of MDA-MB-231 cells with OA for 24 h prior to a 24 h paclitaxel exposure produced greater enhancement of paclitaxel sensitivity at high OA concentrations than the concurrent exposure to OA and paclitaxel. The OA-induced sensitisation to paclitaxel was not due to the cytoxicity of the fatty acid itself. When these observations were extended to three additional breast carcinoma cell lines (SK-Br3, T47D and MCF-7), simultaneous exposure to GLA and paclitaxel also resulted in synergism. GLA preincubation followed by paclitaxel resulted in additivity for all cell lines. Simultaneous exposure to paclitaxel and OA enhanced paclitaxel cytotoxicity in T47D and MCF-7 cells, but not in SK-Br3 cells, whereas preincubation with OA failed to increase paclitaxel effectiveness in all three cell lines. For comparison, the effects of other fatty acids on paclitaxel chemosensitivity were examined: GLA was the most potent at enhancing paclitaxel cytotoxicity, followed by alpha-linolenic acid (ALA; 18:3n.3), eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3), whereas linoleic acid (LA; 18:2n-6) did not increase paclitaxel toxicity. These findings provide experimental support for the use of fatty acids as modulators of tumour cell chemosensitivity in paclitaxel-based therapy.

Effects of an androgenic derivative on the development of chemically-induced mammary carcinogenesis in the rat.

The effects of an androgenic derivative--danazol--on the development of dimethylbenz(a)anthracene (DMBA)-rat mammary carcinogenesis were studied. Animals in the treated group received danazol (10-12 mg/kg/day) during 169 days, starting 5 days after DMBA induction. As compared with tumours in control animals, those treated with danazol appear later and are significantly smaller. Moreover, this treatment reduced the incidence of animals affected by mammary cancer and the average number of malignant tumours in each animal. In the same way, the incidence of animals with missing nodules was significantly higher in the group treated with danazol. It is concluded that danazol has an inhibitory effect on experimental mammary tumours. This effect seems to be greater the earlier the treatment is started and the longer time it is applied.

An improved protocol to increase sensitivity of Southern blot using dig-labelled DNA probes.

The use of methods for nonradioactive labelling of nucleic acids has increased in recent years because they avoid disadvantages associated with radioisotopes. The most frequently used label is digoxigenin (DIG). The greatest problem of nonradioactive methods is their high nonspecific background mainly caused by the multistep detection. A diffuse background can mask the specific signal; furthermore nonspecific signals can make it difficult to interpret the result. In this study we have attempted to identify elements which could generate background. We have also determined the probe and antibody concentrations by which the higher sensitivity is obtained.

Experimental diets for the study of lipid influence on the induced mammary carcinoma in rats: I--Diet definition.

There is a considerable variation in the diets used in studies on the influence of dietary fat on rat mammary cancer. In view of the fact that diet is the most remarkable factor in these studies, the aim of this work was to define two experimental diets, one of them normal (N3) and another hyperlipidic (HL20), both allowing the normal growth of the rat and neither of them containing factors that could unspecifically affect mammary carcinogenesis. Semisynthetic diets were selected instead of natural ones. A normal diet (3% corn oil, 18% casein, 67.9% dextrose) and a hyperlipidic diet (20% corn oil, 23% casein, 45.9% dextrose) were defined for the rat. Both diets also contain 5% cellulose, 5.9% salt mix and 0.24% vitamin mix. In order to avoid the influence of the above mentioned unspecific factors, the control of specificity and quality of nutrients is proposed as an essential measure. Moreover, it is also necessary to adopt measures to avoid the presence of fatty acid metabolites, including the calculation of the necessary vitamin E, selenium and sulfur amino acid and the determination of factors potentially able to stimulate or inhibit carcinogenesis such as phenolic antioxidants, retinoids or the trans isomer of fatty acids. On the other had, casein, dextrose, choline and folic acid contents were modified in order to equilibrate the lipid increase experimentally introduced in the HL20 diet or to ensure the normal maintenance of the animals' metabolism. The method used is based on the concept of quality assurance.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental diets for the study of lipid influence on the induced mammary carcinoma in rats: II--Suitability of the diets.

We have previously reported one method for obtention of experimental diets for the study of the effects of dietary lipids on the rat breast carcinoma. The purpose of this second part of the study was to develop a quality control system for demonstrating the suitability of these diets. This system is essentially based on the animals' growth control, their period clinical examination as well as the anatomopathological postmortem study of the animals submitted to such diets. Two groups of weaning rats, control (C) and hyperlipidic (HL), were submitted to a low-fat diet (N3) or a high-fat polyunsaturated--corn oil--diet (HL20) respectively. At 53 days of age all animals were induced with 5mg of dimethylbenz (a) anthracene. Experiments were ended when animals reached a mean age of 214 days. The results show: 1) a normal ponderal evolution of the animals in the two experimental groups with respect to two series of the same strain fed with a standard diet, and 2) the homogeneity of growth determined by the coefficient of variance study. On the other hand, neither the weekly clinical examination nor the anatomopathological post-mortem studies revealed any pathology that could be specifically attributed to nutritional imbalance. These results confirm the suitability of both diets for rat growth. Their use in the study of the effects of dietary lipids on the mammary carcinoma would satisfy the initial aim of guaranteeing the specificity of the results.

Análisis del registro de un sistema de notificación de incidentes en una unidad de cuidados críticos / Analysis of an incident notification system and register in a critical care unit

Objetivo. Analizar los incidentes comunicados a través de un sistema de notificación y registro en una unidad de cuidados críticos. Metodología. Estudio transversal descriptivo. Se realizó un análisis de los registros de incidentes comunicados de manera anónima y voluntaria de enero de 2007 a diciembre de 2013 en una unidad de cuidados críticos de pacientes adultos con trauma grave. Variables de estudio: tipo y clase de incidente, profesional que notifica y sugerencias de medidas de mejora. Análisis descriptivo de variables. Resultados. Se comunicaron un total de 275 incidentes, de los cuales el 58,5% fueron eventos adversos. Los incidentes distribuidos por clases: medicación 33,7%; accesos vasculares-drenajes-sondas-sensores 19,6%; aparatos-equipos 13,3%; procedimientos 11,5%, vía aérea y ventilación mecánica 10%; cuidados enfermeros 4,1%; comunicación interprofesional 3%; pruebas diagnósticas 3%; identificación paciente 1,1% y transfusión 0,7%. En el grupo de medicación los errores de administración constituyeron el 62%; en el de accesos vasculares-drenajes-sondas-sensores las vías venosas centrales el 27%; en aparatos y equipos los respiradores un 46,9%; en vía aérea las autoextubaciones el 32,1%. En relación con los errores de medicación el 62% fueron incidentes sin daño. La notificación de incidentes por profesional: médicos 43%; residentes 5,6%; enfermeros 51%; técnicos auxiliares 0,4%. Conclusiones. Los incidentes que más se comunican son eventos adversos. Los sucesos relacionados con la administración de medicación son los más frecuentes, aunque la mayoría no ocasionaron daño. Los enfermeros y médicos comunican incidentes con similar frecuencia. Destaca la baja notificación de incidentes a pesar de ser un sistema anónimo y voluntario, por ello, se sugiere estudiar medidas para aumentar el grado de comunicación

Objective. To analyse the incident communicated through a notification system and register in a critical care unit. Methodology. A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. Study variables: incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. Results. Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. Conclusions. Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication