[Teaching basic life support to the general population. Alumni intervention analysis]. / Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos.

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas¼ conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. MAIN VARIABLES OF INTEREST: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

[Experience of patients with immune-mediated inflammatory diseases seen in a multidisciplinary integrated care unit]. / Experiencia de los pacientes con enfermedades inflamatorias inmunomediadas atendidos en una unidad de atención integral multidisciplinar.

OBJECTIVE: To describe the aspects with the greatest impact on the satisfaction of patients treated in a multidisciplinary unit specialising in immune-mediated inflammatory diseases (IMIDs) and to identify areas for improvement in the care model. METHODS: Cross-sectional descriptive study using a satisfaction survey structured in three blocks: sociodemographic variables, functional aspects of the unit and satisfaction with the professionals. Immediate satisfaction was measured on aspects related to the care received, the physical structure and the likelihood of recommending the unit. RESULTS: A total of 168 patients completed the surveys, the mean score of overall satisfaction with the unit was 4.75 (SD:0.4). The regression model showed the relationship between overall satisfaction and unit signage (OR:3.558, p=0.045, 95% CI: 1.027-12.33), coordination between professionals (OR:9.043, p=0.000, 95% CI: 2.79-29.28) and participation in decision making (OR: 44.836, p=0.000, 95% CI: 5.49-365.97). In terms of immediate satisfaction, the overall Net Promoter Score (NPS) was 87 (excellent). The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so they have been considered an area for improvement The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so both were considered areas for improvement. CONCLUSIONS: Coordination between intra-centre professionals and patient participation in decision-making explain the excellent level of patient satisfaction. The monitoring of satisfaction has made it possible to implement immediate improvement actions.

[Exploration and approach to artificial airway dysphagia]. / Exploración y abordaje de disfagia secundaria a vía aérea artificial.

Airway isolation by endotracheal intubation or tracheostomy impedes or even interrupts speech and swallowing. Pharyngeal and laryngeal impairment frequently occurs after extubation or de-cannulation, common consequences being dysphonia, dysphagia and the aspiration of oral secretions, food, or fluids. Aspiration often leads to pneumonia and eventually death. Although the literature reports a high frequency of dysphagia following intubation and tracheostomy, the data vary considerably, and the true incidence of oropharyngeal dysphagia following artificial airway isolation remains to be established. We conducted a systematic review of the available evidence, in order to assess oropharyngeal dysphagia physiology, diagnosis and treatment.

[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

[Descending thoracic aortic rupture, endoprosthetic treatment]. / Rotura de aorta torácica descendente. Tratamiento endoprotésico.

Aortic rupture, independently of its location and etiology, is an extremely serious condition that leads to death rapidly. There is currently no consensus on whether endovascular treatment of the descending thoracic aortic rupture is superior to conventional surgical repair in terms of mid-or long-terms outcome. We describe our experience with 13 patients from January 2005 to January 2009 to evaluate the results in patients with descending thoracic aortic rupture undergoing endoprosthetic management.

[Perceived quality of care by frequent paediatric healthcare users: A qualitative approach]. / Calidad percibida en población hiperfrecuentadora infantil: una aproximación cualitativa.

INTRODUCTION: Assessing the perceived quality of a healthcare department by its users is essential in a quality management system. In Paediatric Emergency Departments (PED), the demand for urgent care has increased in recent years, as well as an increase in frequent attendance. Paying attention to the opinions of these habitual users by means of qualitative methodology is particularly suitable for assessing the quality of care and identifying opportunities to improve the PED. METHODS: Two focus groups were held with parents of patients (with and without a chronic disease) who visited the PED on 10or more occasions per year in a third level hospital. RESULTS: The participants were satisfied overall with the PED. The treatment received was very positively valued, and they never felt that they had received poorer care due to being frequent users. As main strengths, they also highlighted the professional expertise, the friendliness of staff, the quality of information given, the medication received on discharge from hospital, and the follow-up carried out by the PED. The major improvement opportunities identified included: the contagion risks, the lack of coordination between different levels of care, and the need to improve the inclusion of families in the health care process. CONCLUSIONS: Due to the contributions made by these parents, several improvement strategies have been introduced, such as the implementation of sharing information protocols in shift changes, professional training courses, the establishment of a liaison person between the PED and Primary Care, and a proposal to the Hospital Management Department to assess the identified needs.

[Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. / Impacto de una estrategia de mejora de calidad asistencial y gestión de riesgos en un servicio de urgencias pediátricas.

INTRODUCTION: Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS: A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS: The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION: It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.

[Evaluation of effectiveness of corrective measures arising from incident notifications in a paediatric emergency department]. / Evaluación de la efectividad de acciones correctivas derivadas de la notificación de incidentes en urgencias pediátricas.

OBJECTIVE: To analyse the effectiveness of corrective measures arising from the analysis of safety incident notifications in the Paediatric Emergency Unit. METHODS: A quasi-experimental, prospective, and single-centre study was carried out between 2015 and 2018. In the first phase, incidents notified throughout one year were analysed. Corrective measures were then implemented for 5 specific kinds of incidents. These incidents were finally compared to those notified within 12 months after the implementation of those measures. Results were expressed as relative risk and relative risk reduction. RESULTS: A total of 1587 safety incidents were notified (0.9% of patients treated) between January 2015 and December 2017. After implementation of corrective measures, there was a decrease in all kinds of incidents notifications analysed. The incidents related to patient identification were reduced by 60.9% (RR 0.39, 95% CI; 0.25-0.60), and those regarding communication between professionals were reduced by 74.5% (RR 0.25, 95% CI; 0.12-0.55). Incidents related to sedation and analgesic procedures totally disappeared. No significant reduction was found in incidents concerning the triage system, or in those related to rapid intravenous rehydration procedures. CONCLUSIONS: The implementation of improvement actions arising from the analysis of voluntary notification of incidents is an effective strategy to improve patient effective strategy to improve.

Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos / Teaching basic life support to the general population. Alumni intervention analysis

OBJETIVOS: Estudiar la tasa de detección e intervención en situaciones de urgencia extrahospitalaria por parte de los alumnos de cursos de soporte vital básico (SVB). Definir variables de los alumnos asociados a una mayor tasa de detección e intervención. Estudio de eficiencia de las intervenciones. DISEÑO: Estudio descriptivo transversal. Ámbito: Comarca del Poniente de Almería. PACIENTES: Alumnos de un plan de formación masiva en SVB a población general «Plan Salvavidas» desarrollado entre 2003 y 2009. Intervención: En 2010 se encuestó a los alumnos del «Plan Salvavidas» sobre si habían presenciado situaciones de urgencia y datos relacionados con dichas situaciones. Variables principales: Tasa de detección de situación de urgencias. Intervención en situaciones de urgencias. Perfil sociodemográfico de intervinientes. RESULTADOS: Tres mil ochocientos sesenta y cuatro alumnos formados fueron llamados por teléfono: obtuvimos respuestas de 1.098, el 63,9% fueron mujeres, la edad media fue 26,61 ± 10,6. Un 11,75% habían presenciado situaciones de urgencia, de media 3 años tras el curso. Un 23,3% de las urgencias fueron paradas cardíacas. Los alumnos intervinieron en un 98% de los casos posibles. La relación de los alumnos con la víctima era inexistente en el 63% de los casos, la mayoría se presenciaron fuera del domicilio. Se asoció a una mayor tasa de detección de situaciones de urgencia: ser trabajador del ámbito sanitario y ser mayor de 18 años. CONCLUSIONES: En nuestra serie la tasa de urgencias extrahospitalarias presenciadas tras los cursos de SVB fue del 11,75%. El intervencionismo fue alto. La población diana más eficiente fueron los trabajadores del ámbito sanitario

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. Main variables of interest: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61 ± 10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers

Influencia de los factores sociodemográficos en la adquisición de habilidades en soporte vital básico / Influence of sociodemographic factors on the learning of basic life support skills

Objetivos: Evaluar el nivel formativo alcanzado por alumnos de un plan de formación masiva en técnicas de soporte vital básico (SVB) y su relación con factores socioculturales y demográficos. Método: Desde el año 2003 hasta el 2009 se desarrolló un plan de formación masiva en SVB "Plan Salvá Vidas" en el Sureste de Andalucía. Todos los alumnos fueron registrados en una base de datos, que incluía los valores sociodemográficos: edad, género y nivel de estudios, presencia de enfermedades cardiacas en familiares y realización previa de cursos de soporte vital. Los alumnos fueron evaluados según el nivel final de adquisición de conocimientos y habilidades. Resultados: En total se formaron 3.864 alumnos, en 199 cursos. El 63,4% fueron mujeres, la edad media de los alumnos fue 26,1 (11,5) años, el 58,5% de los alumnos sólo había cursado estudios elementales. El 15,1% habían asistido previamente a algún curso relacionado con soporte vital. Un 18,9% de los alumnos tenían un familiar con cardiopatía. El 95,3% superaron los cursos de forma satisfactoria. La edad superior a 50 e inferior a 18 años y un bajo nivel de estudios se correlacionaron con peores resultados docentes (p < 0,001). La realización previa de cursos de soporte vital fue un predictor de mejores resultados (p = 0,011). Tener familiares con cardiopatía no influyó en los resultados (p = 0,118). Conclusión: Los cursos tradicionales de SVB guiados por instructor tienen unos resultados docentes satisfactorios. Las variables sociodemográficas y culturales influyen en sus resultados. Los alumnos mayores de 50 años y menores de 18 obtuvieron peores resultados (AU)

Objectives: To assess the level of skill attained by participants in a large-scale training program in basic life support (BLS) and the relation between achievement and sociodemographic characteristics. Methods: A large-scale BLS training program was implemented in Almeria, in south-eastern Andalusia, Spain, between 2003 and 2009. The following sociodemographic information was recorded for all participants: age, gender, educational level, history of heart disease in relatives, and previous BLS training. The level of achievement (knowledge and skill) was assessed at the end of training. Results: A total of 3864 participants were trained in 199 courses; 63.4% were women, the mean (SD) age was 26.13 (11.47) years, 58.5% had only received elementary school education, 15.1% had received previous BLS training, and 18.9% had a relative with heart disease. Achievement was assessed as satisfactory for 95.3% of the participants. Age over 50 years or under 18 years and a low educational level were correlated with poorer achievement (P<.001). Previous BLS training was a predictor of better results (P=.011). Having a relative with heart disease did not influence achievement (P=.118). Conclusions: Traditional instructor-led BLS training courses give satisfactory results. Sociodemographic characteristics influence achievement in BLS courses. Learners over the age of 50 years or under the age of 18 years achieve poorer results (AU)

Exploración y abordaje de disfagia secundaria a vía aérea artificial / Exploration and approach to artificial airway dysphagia

El aislamiento de la vía aérea mediante intubación translaríngea o traqueotomía, dificulta, cuando no interrumpe las funciones faríngeas y laríngeas de fonación y deglución; tras retirar el tubo translaríngeo o cánula de traqueotomía, dichas funciones no se recuperan de forma inmediata, observándose con frecuencia disfonía, disfagia y aspiraciones traqueobronquiales. La aspiración de secreciones orofaríngeas, de alimentos, así como de contenido gástrico, pueden dar lugar a infecciones respiratorias nosocomiales, en pacientes frágiles o convalecientes de afecciones severas con un aumento significativo en su morbimortalidad. La incidencia de incompetencia faríngea y laríngea, en pacientes que requieren uso de una vía aérea artificial no está bien determinada. Los estudios realizados hasta el momento sugieren una alta proporción de dichas alteraciones, tanto en pacientes recientemente extubados, como en pacientes traqueotomizados. El conocimiento de los mecanismos fisiopatológicos que condicionan la disfagia en dichos pacientes, junto con las alternativas diagnósticas y terapéuticas centrarán la actual revisión (AU)

Airway isolation by endotracheal intubation or tracheostomy impedes or even interrupts speech and swallowing. Pharyngeal and laryngeal impairment frequently occurs after extubation or de-cannulation, common consequences being dysphonia, dysphagia and the aspiration of oral secretions, food, or fluids. Aspiration often leads to pneumonia and eventually death. Although the literature reports a high frequency of dysphagia following intubation and tracheostomy, the data vary considerably, and the true incidence of oropharyngeal dysphagia following artificial airway isolation remains to be established. We conducted a systematic review of the available evidence, in order to assess oropharyngeal dysphagia physiology, diagnosis and treatment (AU)

Rotura de aorta torácica descendente. Tratamiento endoprotésico / Descending thoracic aortic rupture, endoprosthetic treatment

Resumen La rotura de la aorta, independientemente de su localización y etiología, es unaafección extremadamente grave que conduce a la muerte rápidamente. En el momento actualno hay consenso sobre si el tratamiento endovascular de la rotura de la aorta torácica descendentees superior al tratamiento quirúrgico convencional a medio y largo plazo. En esta serie,de 13 casos, describimos nuestra experiencia y evaluamos los resultados en pacientes tratadosde forma endoprotésica desde enero de 2005 hasta enero de 2009 (AU)

Abstract Aortic rupture, independently of its location and etiology, is an extremely seriouscondition that leads to death rapidly. There is currently no consensus on whether endovasculartreatment of the descending thoracic aortic rupture is superior to conventional surgical repair interms of mid-or long-terms outcome. We describe our experience with 13 patients from January2005 to January 2009 to evaluate the results in patients with descending thoracic aortic ruptureundergoing endoprosthetic management (AU)

Tratamiento de necrólisis epidérmica tóxica con ciclosporina A / Toxic epidermal necrolysis treated with cyclosporin A

El síndrome de Lyell o necrólisis epidérmica tóxica (NET) es una toxicodermia extremadamente grave e infrecuente; se caracteriza por la necrosis y el posterior desprendimiento de la epidermis en grandes áreas cutáneas tras una reacción idiosincrásica a un fármaco. Los pacientes que la padecen presentan idénticas complicaciones fisiopatológicas que los grandes quemados. Tradicionalmente se ha tratado con inmunomoduladores como los corticoides, inmunoglobulinas, ciclofosfamida, talidomida o plasmaférisis, obteniéndose una respuesta variable y enalgunos casos contradictoria.Desde finales de los años noventa, se ha ensayado en series limitadas la ciclosporina A comoinmunomodulador único en pacientes con NET, mejorando resultados en términos de supervivencia respecto a estudios con otros fármacos. En este artículo se presentan 3 casos consecutivos de NET tratados con ciclosporina A (AU)

Lyell’s syndrome or toxic epidermal necrolysis (TEN) is an extremely rare and dangerous severe skin disorder characterized by a high proportion of cutaneous lesions leading tonecrosis and subsequent shedding of the epidermis over large areas of skin after an idiosyncraticreaction triggered by a drug. The patients who suffer it pathophysiologically have similar complications to those seen in major burns.TEN traditionally has been treated with immunomodulators such as glucocorticoids, intravenousgammaglobulin, cyclophosphamide, thalidomide or plasmapheresis. A variable, and sometimes contradictory response, has been obtained in some series.Cyclosporin A has been tested as a single immunomodulator in patients with TEN since the end of the 90 s in a limited number series. The results have improved in regards to survival compared with studies with other drugs.We report three consecutive cases of toxic epidermal necrolysis treated with cyclosporin Ain this article (AU)