A phase 1b study of the MET inhibitor capmatinib combined with cetuximab in patients with MET-positive colorectal cancer who had progressed following anti-EGFR monoclonal antibody treatment.

Background Overcoming resistance to anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (mAbs) in patients with KRAS wildtype (WT) metastatic colorectal cancer (mCRC) could help meet the needs of patients with limited treatment options. Methods In this phase 1b study, patients with N/KRAS WT, MET-positive mCRC who had progressed following anti-EGFR mAb treatment received escalating oral doses of capmatinib (150, 300, and 400 mg) twice daily plus weekly intravenous cetuximab (at the approved dose). The primary objective was to establish a recommended dose for expansion (RDE) of capmatinib in combination with cetuximab. Safety, preliminary activity, pharmacokinetics, and pharmacodynamics were also explored. Results Thirteen patients were enrolled. No patients experienced a dose-limiting toxicity at investigated doses; the RDE was established as capmatinib 400 mg twice daily plus cetuximab. All patients experienced adverse events (AEs) suspected to be related to the study treatment. Five patients (38.5%) reported study-drug-related AEs of grade 3/4 in severity. No patients achieved a complete or partial response according to RECIST v1.1; however, tumor shrinkage of 29-44% was observed in 4 patients. Conclusions Capmatinib plus cetuximab was well tolerated. Preliminary signs of activity were observed. Further investigation is warranted to obtain efficacy data and refine predictive biomarkers of response. Clinical trial registration NCT02205398.

A Phase Ib/II, open-label, multicenter study of INC280 (capmatinib) alone and in combination with buparlisib (BKM120) in adult patients with recurrent glioblastoma.

PURPOSE: To estimate the maximum tolerated dose (MTD) and/or identify the recommended Phase II dose (RP2D) for combined INC280 and buparlisib in patients with recurrent glioblastoma with homozygous phosphatase and tensin homolog (PTEN) deletion, mutation or protein loss. METHODS: This multicenter, open-label, Phase Ib/II study included adult patients with glioblastoma with mesenchymal-epithelial transcription factor (c-Met) amplification. In Phase Ib, patients received INC280 as capsules or tablets in combination with buparlisib. In Phase II, patients received INC280 only. Response was assessed centrally using Response Assessment in Neuro-Oncology response criteria for high-grade gliomas. All adverse events (AEs) were recorded and graded. RESULTS: 33 patients entered Phase Ib, 32 with altered PTEN. RP2D was not declared due to potential drug-drug interactions, which may have resulted in lack of efficacy; thus, Phase II, including 10 patients, was continued with INC280 monotherapy only. Best response was stable disease in 30% of patients. In the selected patient population, enrollment was halted due to limited activity with INC280 monotherapy. In Phase Ib, the most common treatment-related AEs were fatigue (36.4%), nausea (30.3%) and increased alanine aminotransferase (30.3%). MTD was identified at INC280 Tab 300 mg twice daily + buparlisib 80 mg once daily. In Phase II, the most common AEs were headache (40.0%), constipation (30.0%), fatigue (30.0%) and increased lipase (30.0%). CONCLUSION: The combination of INC280/buparlisib resulted in no clear activity in patients with recurrent PTEN-deficient glioblastoma. More stringent molecular selection strategies might produce better outcomes. TRIAL REGISTRATION: NCT01870726.

Effect of bleaching agent and topical fluoride application on color and gloss of dental ceramics.

The aim of this study was to evaluate the effect of 16% carbamide peroxide and 1.23% acidulated phosphate fluoride application and their association with a change in color (ΔE*) and brightness of dental ceramic submitted to different finishing procedures. A total of 120 test specimens were fabricated and randomly divided into 3 groups (n = 40) according to the type of finishing: glazing; polishing; or polishing and glazing. Initial color and brightness readouts were taken, and the finished specimens were divided into groups (n = 10) according to the treatment to which they were submitted: fluoride; bleaching; bleaching and fluoride; or control. After this, final color and brightness readouts were taken. The type of polishing had no influence on ΔE* or brightness (P > 0.05). Regardless of which solution was used, a decrease in brightness occurred only for the group treated with bleach and fluoride (P < 0.05). The results showed the use of fluoride after bleaching may interfere with the esthetics of a restoration.

Impact of Minimally Invasive Intra-Capsular Metatarsal Osteotomy on Plantar Pressure Decrease: A Cross-Sectional Study.

Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority.

Understanding the petal effect: Wetting properties and surface structure of natural rose petals and rose petal-derived surfaces.

The petal effect is identified as a non-wetting state with high drop adhesion. The wetting behavior of petal surfaces is attributed to the papillose structure of their epidermis, which leads to a Cassie-Baxter regime combined with strong pinning sites. Under this scenario, sessile drops are pearl shaped and, unlike lotus-like surfaces, firmly attached to the surface. Petal surfaces are used as inspiration for the fabrication of functional parahydrophobic surfaces such as antibacterial or water-harvesting surfaces. In this work, two types of rose petals were replicated by using a templating technique based in Polydimethylsiloxane (PDMS) nanocasting. The topographic structure, the condensation mechanism under saturated environments and the wetting properties of the natural rose petal and their negative and positive replicas were analyzed. Finally, we performed prospective ice adhesion studies to elucidate whether petal-like surfaces may be used as deicing solutions.

[Descriptive analysis of hospital activity indicators published by the Autonomous Regional Governments in the Spanish National Health System.] / Análisis descriptivo de los indicadores de actividad hospitalaria publicados por las consejerías de salud.

OBJECTIVE: The supply of health activity data by health regional governments does not have a current study of the issue. The aim of this study was to analyze and describe the indicators of hospital activity related to public health organizations (health departments in the Spanish National Health System) showing the most notable experiences in this regard. METHODS: Observational study. General Internet search engines were used to find and evaluate institutional web portals (Ministry of Health, regional health governments) detailing existence, availability, accessibility and quality of information (aggregation, update, format, gender and age vision) of hospital management activity offered between 2015-2019. Descriptive statistics were used with estimation of inter-observer concordance. RESULTS: Generation of a list of 22 web portals for public health services. All the institutions evaluated had information on hospital activity. It is complex to find, freely available, disaggregated (14), updated (2018), in PDF format (15), gender vision: 2 (Catalonia and Madrid). No. of indicators per region: between 10 and 99 (average=54). Kappa agreement index (κ)=0.84. Notable contributions: Catalonia and Madrid, with other practices to highlight (Castilla y León, Murcia). CONCLUSIONS: The analysis of the management information offered by health regional governments shows a generic pattern of information that is difficult to access, disaggregated and updated at least two years from the time of the study, with a wide range of indicators, reduced contribution of the gender vision and in PDF format, which makes research and teaching difficult.

OBJETIVO: La oferta de datos de actividad sanitaria por las consejerías de salud no dispone de un estudio actual de la cuestión. El objetivo de este trabajo fue analizar y describir los indicadores de actividad hospitalaria relacionada con las organizaciones sanitarias públicas (consejerías de salud/sanidad en el Sistema Nacional de Salud español) mostrando las experiencias más notables en este sentido. METODOS: Estudio observacional. Se utilizaron buscadores generales de Internet para encontrar y valorar portales web institucionales (Ministerio de Sanidad, consejerías de sanidad/salud autonómicas) detallando existencia, disponibilidad, accesibilidad y calidad de la información (agregación, actualización, formato, visión de género y edad) de actividad de gestión hospitalaria ofrecida entre 2015-2019. Se usó estadística descriptiva con la estimación de la concordancia interobservadores. RESULTADOS: Se generó un listado de 22 webs de servicios públicos de salud. Todas las instituciones valoradas disponían de información sobre actividad hospitalaria. Es compleja de encontrar, de libre acceso, desagregada (14), actualizada (2018), en formato PDF (15), visión de género: 2 (Catalunya y Madrid). Nº de indicadores por región: entre 10 y 99 (promedio=54). Índice de acuerdo Kappa (κ)=0,84. Aportaciones notables: Cataluña y Madrid, con otras prácticas a resaltar (Castilla y León, Murcia). CONCLUSIONES: El análisis de la información de gestión ofrecida por las consejerías de salud muestra un patrón genérico de información de difícil acceso, desagregada y actualizada como mínimo a dos años vista desde el momento del estudio, con un rango amplio de indicadores, reducida aportación de la visión de género y en formato PDF que dificulta la investigación y docencia.

How is the nursing activity shown by the Spanish regional health ministries?

OBJECTIVE: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. METHOD: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to "nursing/nurse/midwife" was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. RESULTS: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in "PDF" format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. CONCLUSIONS: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.

Design of a Three-Dimensional-Printed Surgical Glove for Minimal-Incision Podiatric Surgery.

BACKGROUND: Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery. METHODS: Three individuals with different experience levels (an undergraduate student, a master's student, and an experienced podiatric physician) performed an Akin osteotomy, a Reverdin osteotomy, and a basal osteotomy of the first metatarsal. RESULTS: The average measurements of each osteotomy and the angle of the basal osteotomy do not reveal significant differences among the three surgeons. A shorter deviation from the planned measurements has been observed in variables corresponding to the Akin osteotomy (the maximum deviation in the measurement of the distance from the proximal medial end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.67 mm, and the maximum deviation from the proximal lateral end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.00 mm). As for the Reverdin osteotomies, the maximum deviations in the measurement of the distance from the proximal medial end of the osteotomy to the first metatarsophalangeal joint interline were 3.60 and 3.53 mm in the expert and undergraduate surgeons, respectively. All of the osteotomies were precise among the groups, reducing the learning curve to the maximum. CONCLUSIONS: The three-dimensional-printed prototype has been proven effective in guiding surgeons to perform different types of osteotomies. Minimal deviations from the predefined osteotomies were found among the three surgeons.

¿Qué transmiten las memorias públicas oficiales sobre la actividad pediátrica? / What do official public reports convey about paediatric activity?

Introducción: la Pediatría es una especialidad médica que se desarrolla en Atención Primaria y hospitalaria. Saber cómo se exponen de manera oficial los resultados de la actividad asistencial de esta especialidad puede ser el primer paso para comparar los mismos y establecer un clima de transparencia y confianza en el sistema, así como para establecer y priorizar acciones de mejora. Material y métodos: estudio observacional descriptivo. Se localizaron sitios web institucionales (Ministerio de Sanidad, consejerías de sanidad). Se analizó la información de la actividad pediátrica, su accesibilidad, nivel de agregación, actualización, formato y visión de género y edad. Se valoró la concordancia interobservadores. Resultados: 17 instituciones aportaron indicadores. Los más utilizados fueron: consultas atendidas, presión asistencial y frecuentación. El acceso a la información fue libre, complejo y actualizado a dos años (2019). Los datos estaban en su mayoría desagregados (15) y expuestos en formato PDF. N.º de indicadores: entre 1 y 38 (media, 9). Solo cuatro regiones mostraron una visión de género y de edad. Índice de acuerdo Kappa (κ): 0,89. Conclusiones: la información ofrecida por las instituciones sanitarias relacionada con los indicadores y resultados de actividad pediátrica es heterogénea. Para ganar transparencia y confianza, y para mejorar la comparación entre organizaciones, su obtención debería ser más sencilla, homogénea y clara (AU)

Introduction: paediatrics is a medical specialty that unfolds in the primary care and hospital settings. Knowing how the outcomes of paediatric practice are officially reported may be the first step to compare them and establish a culture of transparency and trust in the system, and to establish and prioritise improvement actions.Material and methods: descriptive observational study. We identified institutional websites (Ministry of Health, regional health authorities) and analysed the information on paediatric care delivery, its accessibility, level of aggregation, recency, formatting and analysis of sex and age. We assessed inter-observer agreement.Results: 17 institutions provided information on indicators. The most used were the visits managed, caseloads and frequency of health care utilization. The information is free, difficult to access, and updated within the past 2 years (2019). Most of the data were disaggregated (15) and in PDF format. The number of indicators ranged from 1 to 38 (mean, 9). Only 4 regions presented information based on sex and age. We found a Cohen kappa coefficient (κ) of 0.89.Conclusions: the information on health care indicators and outcomes of paediatric care provided by healthcare institutions is heterogeneous. To gain transparency and trust, and to facilitate the comparison between organizations, it should be easier to obtain, homogeneous and clearer. (AU)

Análisis descriptivo de los indicadores de actividad hospitalaria publicados por las consejerías de salud / Descriptive analysis of hospital activity indicators published by the Autonomous Regional Governments in the Spanish National Health System

Fundamentos: La oferta de datos de actividad sanitaria por las consejerías de salud no dispone de un estudio actual de la cuestión. El objetivo de este trabajo fue analizar y describir los indicadores de actividad hospitalaria relacionada con las organizaciones sanitarias públicas (consejerías de salud/sanidad en el Sistema Nacional de Salud español) mostrando las experiencias más notables en este sentido. Métodos: Estudio observacional. Se utilizaron buscadores generales de Internet para encontrar y valorar portales web institucionales (Ministerio de Sanidad, consejerías de sanidad/salud autonómicas) detallando existencia, disponibilidad, accesibilidad y calidad de la información (agregación, actualización, formato, visión de género y edad) de actividad de gestión hospitalaria ofrecida entre 2015-2019. Se usó estadística descriptiva con la estimación de la concordancia interobservadores. Resultados: Se generó un listado de 22 webs de servicios públicos de salud. Todas las instituciones valoradas disponían de información sobre actividad hospitalaria. Es compleja de encontrar, de libre acceso, desagregada (14), actualizada (2018), en formato PDF (15), visión de género: 2 (Catalunya y Madrid). Nº de indicadores por región: entre 10 y 99 (promedio=54). Índice de acuerdo Kappa (κ)=0,84. Aportaciones notables: Cataluña y Madrid, con otras prácticas a resaltar (Castilla y León, Murcia). Conclusiones: El análisis de la información de gestión ofrecida por las consejerías de salud muestra un patrón genérico de información de difícil acceso, desagregada y actualizada como mínimo a dos años vista desde el momento del estudio, con un rango amplio de indicadores, reducida aportación de la visión de género y en formato PDF que dificulta la investigación y docencia.(AU)

Background: The supply of health activity data by health regional governments does not have a current study of the issue. The aim of this study was to analyze and describe the indicators of hospital activity related to public health organizations (health departments in the Spanish National Health System) showing the most notable experiences in this regard. Methods: Observational study. General Internet search engines were used to find and evaluate institutional web portals (Ministry of Health, regional health governments) detailing existence, availability, accessibility and quality of information (aggregation, update, format, gender and age vision) of hospital management activity offered between 2015-2019. Descriptive statistics were used with estimation of interobserver concordance. Results: Generation of a list of 22 web portals for public health services. All the institutions evaluated had information on hospital activity. It is complex to find, freely available, disaggregated (14), updated (2018), in PDF format (15), gender vision: 2 (Catalonia and Madrid). No. of indicators per region: between 10 and 99 (average=54). Kappa agreement index (κ)=0.84. Notable contributions: Catalonia and Madrid, with other practices to highlight (Castilla y León, Murcia). Conclusions: The analysis of the management information offered by health regional governments shows a generic pattern of information that is difficult to access, disaggregated and updated at least two years from the time of the study, with a wide range of indicators, reduced contribution of the gender vision and in PDF format, which makes research and teaching difficult.(AU)

Color Stability of Dental Restorative Materials Submitted to Heat Sources, for Forensic Purposes.

During postmortem examination of the dental arches of carbonized victims, dental restorative materials may be found. The aim of this study was to evaluate the effect of heat source action on the color stability of composite resin (CR) and glass ionomer cement (GIC) restorations, to discriminate between them and compare with antemortem dental data. Sixty bovine teeth (30 CR and 30 GIC) were prepared (6 × 6 × 2 mm) and separated into groups (n = 10). The color readouts were taken by spectrophotometer, before and after heat action (100°C, 200°C, 300°C), in an oven for 15 min. There were color alterations for all coordinates (ΔE, ΔL*, Δa* eΔb*) for both materials. GIC presented greater change. The authors concluded that it is possible to distinguish between the materials by the color changes analyzed by instrumental method, helping victim identification.

Evaluating hazardous waste generation in for-profit outpatient haemodialysis centres.

BACKGROUND: "Green" haemodialysis management to reduce the environmental impact of haemodialysis is growing. OBJECTIVES: Dealing with hazardous waste production could heighten healthcare professionals' awareness of this problem, and improve their healthcare involvement in environmental sustainability and environmental-friendliness. DESIGN AND MEASUREMENTS: A list of for-profit outpatient haemodialysis centres in the Valencian Community (E Spain) was compiled. Data on their hazardous waste production from 2008 to 2012 through the annual waste reports issued by official organisations competent in environmental issues were collected. RESULTS: There are 22 for-profit dialysis centres, that managed the treatment for 69.1% of all dialysis patients in the region. Data were collected from 16 centres that collectively offer 350 dialysis places (33.8% of all the places in this region). Mean annual hazardous waste production per dialysis session increased by 14% during the study period: 0.640 kg per session in 2008 vs. 0.740 kg in 2012. DISCUSSION AND CONCLUSIONS: As hazardous waste production is high, we must examine the reasons why it is growing. Information about haemodialysis waste production and management is scarce and difficult to access. Having an evaluation of its production would motivate further research, especially as end-stage kidney disease is increasing, and whose main long-term treatment, haemodialysis, produces hazardous waste and employs substantial natural resources. Minimising its environmental impact is not mission impossible.

Development of certified environmental management in hospital and outpatient haemodialysis units.

INTRODUCTION: The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. OBJECTIVES: To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. METHODS: Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. RESULTS: Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. DISCUSSION: There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact.

¿Cómo se muestra la actividad de las enfermeras por las Consejerías de Salud? / How is the nursing activity shown by the Spanish regional health ministries?

Objetivo: Analizar los indicadores de enfermería y los resultados de su actividad publicados por las Consejerías de Salud de las comunidades autónomas. Método: Estudio observacional descriptivo por 2 observadores con buscadores web localizando las memorias de actividad de las organizaciones sanitarias autonómicas. Para cada página web institucional se evaluó la existencia de información de actividad relacionada con «enfermería/enfermera/matrona». Se analizaron los indicadores de resultados asistenciales, de calidad y seguridad clínica y su presentación. Resultados: Configuración de listado de 19 entradas de servicios públicos de salud con los indicadores específicos de actividad enfermera de cada uno, partiendo de 56 webs institucionales analizadas. El perfil de indicadores más frecuentes resultante es: actividad mostrada desagregada por áreas de salud, de 2019, en «PDF», sin visión de género ni de edad, centrados en el número de consultas, frecuentación y presión asistencial en atención primaria. Conclusiones: La oferta de indicadores sanitarios presenta una gran variabilidad estatal. Se puede valorar los aportes cualitativos y cuantitativos autonómicos, centrados más en la estructura, en medir la actividad para la gestión y en el nivel de la atención primaria, pero con un escaso enfoque en la medición de buenas prácticas. Se confirma que la información publicada no refleja la realidad de la actividad enfermera, siendo llamativa la deficiencia de indicadores a nivel hospitalario.(AU)

Objective: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. Method: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to «nursing/nurse/midwife» was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. Results: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in «PDF» format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. Conclusions: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.(AU)

Desarrollo de la gestión medioambiental certificada en unidades hospitalarias y ambulatorias de hemodiálisis / Development of certified environmental management in hospital and outpatient haemodialysis units

Antecedentes: El impacto ambiental de la hemodiálisis es destacado. Está destacando la actividad en este sentido incluso a nivel bibliográfico. Los sistemas de gestión medioambiental (SGMA) voluntarios, Environmental Management and Auditing System (EMAS) e International Organization for Standardization (ISO 14001), son instrumentos destacados para la protección medioambiental junto a legislación, impuestos y beneficios fiscales. Objetivos: Conocer el grado de implantación de los SGMA en las unidades de hemodiálisis hospitalarias y ambulatorias del Sistema Nacional de Salud español, para disponer de un grupo de centros de referencia en gestión medioambiental en esta actividad sanitaria. Métodos: Elaboración de un listado por comunidades autónomas que muestre las unidades hospitalarias y ambulatorias de diálisis que disponen en 2012-2013 de EMAS o ISO 14001. Fuentes de información: Catálogo Nacional de Hospitales, Registro Español de Certificación y Acreditación Sanitaria, registros europeo y autonómicos de EMAS, registro mundial de ISO, listados de centros de diálisis de sociedades científicas y de pacientes y, respuesta de entidades acreditadas para certificación medioambiental en España e información de web institucional de cada centro sanitario identificado. Resultados: Un total de 210 hospitales cuentan con hemodiálisis, 53 (25% de centros hospitalarios con diálisis) disponen de ISO 14001 (y 15 de ellos, también EMAS), el 30% del total de puestos hospitalarios en España: 1.291 (de 4.298). Solo se registran 11 clínicas ambulatorias, todas con ISO 14001. Discusión: No existe referente oficial que muestre la implantación de los SGMA en hospitales. Confeccionar este listado ofrece una aproximación a su situación, con especial referencia a la hemodiálisis por su destacada implicación ambiental (AU)

Introduction: The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. Objectives: To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. Methods: Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. Results: Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001.Discussion: There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact (AU)

Effect of polishing and brushing on removal of cigarette smoke stains from artificial teeth / Efecto del pulido y cepillado en la eliminación de manchas de humo de cigarrillo en dientes artificiales

Color alteration is still a disadvantage of acrylic resin teeth and this problem seems to be greater in smokers. The objective of this study was to evaluate the efficiency of polishing and brushing on removal of stains from artificial teeth submitted to cigarette smoke. Forty denture teeth of distinct shades (62 and 69) were selected. The teeth were divided into 4 groups (n= 10), according to the tooth shade and method of stain removal performed: Groups 1 and 2 were submitted to the smoke of 20 cigarettes, and after new color readouts, were submitted to polishing with pumice stone and Spanish white paste. Groups 3 and 4 were submitted to 4 cycles of 5 cigarettes interspersed with standardized manual brushing. The values of color stability (DE) were compared using 2-way ANOVA, Bonferroni test (p<0.05). For all the groups, color change occurred at clinically unacceptable levels (E>3.3). After exposure to 20 cigarettes, the greatest degree of color change occurred for teeth in shade 62. Polishing significantly reduced the color change for groups 1 and 2, however, without significant difference between them. For Groups 3 and 4 there was no difference between the teeth of shade 62 and 69. When the treatments for each tooth shade were compared alone, there was similarity between polishing and brushing irrespective of the shade of samples. Routine manual brushing and common clinical polishing methods were capable of removing a large portion of staining caused by cigarettes, and there was no difference between the methods.

La alteración del color sigue siendo una desventaja de los dientes de resina acrílica y este problema parece ser mayor en los fumadores. El objetivo de este estudio fue evaluar la eficacia de pulido y cepillado en la eliminación de manchas de los dientes artificiales presentados al humo del cigarrillo. Se seleccionaron cuarenta dientes de la dentadura de tonos diferentes (62 y 69). Los dientes fueron agrupados en 4 grupos (n= 10), de acuerdo con el color del diente y el método de eliminación de manchas realizado: Los grupos 1 y 2 fueron sometidos al humo de 20 cigarrillos, y después de nuevas lecturas de color, se pulieron con piedra pómez piedra y pasta blanca española. Los grupos 3 y 4 se sometieron a 4 ciclos de 5 cigarrillos intercalados con cepillado manual estandarizado. Los valores de estabilidad del color (Delta E) se compararon mediante las pruebas de ANOVA de dos vías y Bonferroni (p<0,05). Para todos los grupos, el cambio de color se produjo a niveles no aceptables clínicamente (DE>3,3). Después de la exposición a 20 cigarrillos, el mayor grado de cambio de color se produjo para los dientes de tono 62. El pulido redujo significativamente el cambio de color para los Grupos 1 y 2, sin diferencia significativa entre ellos. Para los Grupos 3 y 4 no hubo diferencia entre los dientes de tono 62 y 69. Cuando los tratamientos para cada color de diente se compararon individualmente, hubo similitud entre el pulido y el cepillado, independientemente del tono. El cepillado manual rutinario y los métodos comunes de pulido clínicos fueron capaces de eliminar una gran parte de manchas causadas por los cigarrillos, sin diferencia entre los métodos.

Hacia el liderazgo de Enfermería en el cuidado del medio ambiente / Towards Nursing leadership in environmental care

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El paciente. ¿Es posible ayudar a los pacientes a decidir? / Patient series. Is it possible to help patients to decide?

No disponible

No disponible