Workplace aggressions on hospital workers: A current and prevalent problem with a high demand for training.

BACKGROUND: Workplace aggressions on hospital workers is a very frequent and under-reported problem. OBJECTIVE: The novel objective of our study was to analyze the number of workplace aggressions per hospital worker. Other objectives of the study were to analyze the management knowledge and interest in receiving training on aggressions by hospital workers. METHODS: An anonymous survey was handed out among all professionals in a university hospital. RESULTS: A total of 1118 anonymous surveys were collected. The responders declared that throughout their working life they had suffered some sort of verbal aggression in the hospital in 766 cases (68.5%) and physical aggression in 393 cases (35.2%). Multiple logistic regression analyses found higher risk of receiving physical and verbal aggression in the nursing category and in the Emergency, Critical Care or Psychiatry Units, and a higher risk of receiving physical aggression in women. The score on the level of personal knowledge regarding the legal, physical, and psychological management of aggressions (score 0-10 for each of the 3 aspects) was 2.91±2.68 in legal management, 2.97±2.77 in psychological management and 2.91±2.76 in physical management. The opinion about the interest of receiving training (score from 0 to 10) on the legal management of hospital aggressions was 8.90±1.72, on psychological management was 8.85±1.78 and on physical management was 8.88±1.78. CONCLUSIONS: Workplace aggression on hospital workers mainly affects women, the nursing category and the Emergency, Critical Care or Psychiatry Units. Hospital workers showed little knowledge on the topic but a great interest in receiving training.

Clinical validation of the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study.

BACKGROUND AND STUDY AIMS: The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE I) criteria were recently updated (EPAGE II), but no prospective studies have used these criteria in clinical practice. The aim of the current study was to validate the EPAGE II criteria in an open-access endoscopy unit. PATIENTS AND METHODS: A prospective observational study was conducted in an open-access endoscopy unit at a tertiary care referral center. Consecutive outpatients (n = 1004; mean age 58.9 ±â€†13.1 years; 45 % men) were referred for diagnostic colonoscopy between September 2009 and February 2010. The appropriateness of colonoscopy was assessed based on EPAGE II criteria, and the relationship between appropriateness and both referral doctor and detection of significant lesions was examined. The effectiveness of EPAGE II criteria in assessing appropriateness was measured by means of sensitivity, specificity, and positive and negative predictive values for detecting significant lesions. RESULTS: Colonoscopic cecal intubation was achieved in 956 patients (95.2 %). Most referral doctors were gastroenterologists (58.0 %) and the most common indication was colorectal cancer (CRC) screening (35.2 %). EPAGE II criteria were applicable in 968 patients (96.4 %); of these patients, the indication was appropriate in 778 (80.4 %), inappropriate in 102 (10.5 %), and uncertain in 88 (9.1 %). Patients with appropriate or uncertain indications based on EPAGE II criteria had more relevant endoscopic findings than those with inappropriate indications (38.8 % vs. 24.5 %; OR 1.95, 95 %CI 1.22 - 3.13; P < 0.005). Sensitivity and negative predictive value of EPAGE II criteria for detecting significant lesions were 93.1 % (95 %CI 90 % - 96 %) and 75.5 % (95 %CI 67 % - 84 %), respectively, whereas for advanced neoplastic lesions these values were 98.0 % (95 %CI 95 % - 100 %) and 98.0 % (95 % CI 95 % - 100 %), respectively. Adherence to EPAGE II recommendations was an independent predictor of finding a significant lesion (OR 1.93, 95 %CI 1.20 - 3.11; P = 0.007). CONCLUSIONS: EPAGE II is a simple, valid score for detecting inappropriate colonoscopies in clinical practice.

Economic impact of periprosthetic hip fractures.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of "PPHF". We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

Economic impact of periprosthetic hip fractures. / [Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF¼. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1 139 650.17. The average cost was €14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

Public awareness of colorectal cancer and screening in a Spanish population.

OBJECTIVES: To investigate screening intentions and previous uptake of colorectal cancer (CRC) screening tests in a general population in Spain; and to determine knowledge about CRC, risk perceptions, major barriers to screening and perceived benefits of screening. STUDY DESIGN: Cross-sectional study. METHODS: Six hundred consecutive Spanish individuals over 50 years of age completed a questionnaire to determine their screening intentions, previous CRC diagnostic procedures, and knowledge about screening procedures, risk factors for CRC, 5-year prognosis, warning signs and symptoms, incidence, age-related risk and perceived barriers to screening. RESULTS: Although 78.8% of subjects reported that they were willing to participate in CRC screening, only 12% had ever undergone a screening test, and none with screening intention. Awareness of a breast cancer screening test [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.04-2.70; P = 0.035], visiting a general practitioner in the preceding year (OR 3.08, 95% CI 1.86-5.08; P < 0.0001), awareness of risk factors (OR 2.32, 95% CI 1.49-3.61; P < 0.001), awareness of CRC signs or symptoms (OR 1.65, 95% CI 1.03-2.64; P = 0.04) and belief in the efficacy of CRC screening (OR 8.85, 95% CI 1.53-51.3; P = 0.01) were independent predictors for intention to participate in CRC screening. The most common reasons given for refusing screening were 'CRC tests might be dangerous' (28.2%), 'CRC tests might be painful' (17.9%) and 'feeling healthy' (16.2%). CONCLUSION: Although reported willingness to undergo CRC screening was high, CRC knowledge and actual uptake of CRC screening were low. An educational intervention to reduce barriers and increase awareness could improve uptake of CRC screening.

Metformin-associated hyperlactacidaemia acidosis: Diagnosis rate in standard clinical practice and its relationship with renal failure. / Acidosis con hiperlactacidemia por metformina: frecuencia de su diagnóstico en la práctica clínica habitual y relación con la insuficiencia renal.

BACKGROUND AND OBJECTIVES: Observational study on the difference between the number of cases of acidosis with hyperlactacidaemia suspected of being caused by metformin diagnosed in standard clinical practice and the incidence of this condition according to the datasheet. The study also explored the relationship between renal function and metformin-associated hyperlactacidaemia acidosis. PATIENTS: We identified cases of acidosis between 2013 and 2014 by analysing the minimum basic data set and laboratory requests. We selected patients who presented venous lactate levels >2.7 mmol/L at the time they were treated and for whom the use of outpatient metformin was confirmed. The causal relationship with metformin was independently evaluated by several researchers. The incident cases were calculated based on the number of patients who had been dispensed a drug containing metformin during the same period in the study area. RESULTS: We identified 476 cases of acidosis. Metformin was suspected of causing the condition of acidosis with hyperlactacidaemia in 20 of these cases, which represents an incidence rate of 6.57/10,000 patients. Eighty-five percent of the cases presented acute renal failure. CONCLUSIONS: The apparent incidence of acidosis with hyperlactacidaemia in patients treated with metformin is greater than that established in the datasheet (<1/10,000). The onset of metformin-associated hyperlactacidaemia acidosis is related to acute renal impairment.

Economic impact of periprosthetic hip fractures / Impacto económico de las fracturas periprotésicas de cadera

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

[Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera / Economic impact of periprosthetic hip fractures

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

[Adverse events caused by activated charcoal in an emergency services survey]. / Encuesta sobre los eventos adversos relacionados con el uso de carbón activado en urgencias y emergencias.

BACKGROUND: There are few studies in Spain on the use of activated charcoal (AC) in acute poisoning via the digestive tract, and more specifically on its protocol and adverse events following its administration. The aim of this article is to know the experience in the use of AC by doctors and nurses of the Spanish emergency services. METHOD: Survey developed using Google Docs to health professionals in emergency services. RESULTS: Three hundred and sixty-four questionnaires were received, 52% of them from doctors. Catheterization prior to the use of AC in 74.5% of patients was performed, and did not use a catheter in 13%. The application of AC was considered correct in 37.4%, and overall it was used in 92.4% of cases. The lateral safety position was used in 46.2%, antiemetics in 86.5% and isolation of the airway in case of coma (GCS<8) in 60%. The most described adverse events were vomiting of AC (61%), epixtasis when the catheter was positioned (51.1%), and its incorrect positioning (36%). Inhaling vomit occurred in 11.8% and inhaling carbon in 4.7%. Seven point one percent stated that the adverse events had been life-threatening to patients. No relation was found between the protocol and serious or life-threatening adverse events, nor between these latter and clinical safety measures. CONCLUSIONS: The incidence of adverse events according to the information provided by professionals in this survey of clinical practice might be higher than the incidence found in the literature.

Can examination of WWW usage statistics and other indirect quality indicators distinguish the relative quality of medical web sites?

BACKGROUND: The Internet offers a great amount of health related websites, but concern has been raised about their reliability. Several subjective evaluation criteria and websites rating systems have been proposed as a help for the Internet users to distinguish among web resources with different quality, but their efficacy has not been proven. OBJECTIVES: To evaluate the agreement of a subset of Internet rating systems editorial boards regarding their evaluations of a sample of pediatric websites. To evaluate certain websites characteristics as possible quality indicators for pediatric websites. METHODS: Comparative survey of the Results of systematic evaluations of the contents and formal aspects of a sample of pediatric websites, with the number of daily visits to those websites, the time since their last update, the impact factor of their authors or editors, and the number of websites linked to them. RESULTS: 363 websites were compiled from eight rating systems. Only 25 were indexed and evaluated by at least two rating systems. This subset included more updated and more linked websites. There was no correlation among the Results of the evaluation of these 25 websites by the rating systems. The number of inbound links to the websites significantly correlated with their updating frequency (p<.001), with the number of daily visits (p=.005), and with the Results of their evaluation by the largest rating system, HealthAtoZ (p<.001). The websites updating frequency also significantly correlated with the RESULTS of the websites evaluation by HealthAtoZ, both about their contents (p=.001) and their total values (p<.05). The number of daily visits significantly correlated (p<.05) with the Results of the evaluations by Medical Matrix. CONCLUSIONS: Some websites characteristics as the number of daily visits, their updating frequency and, overall, the number of websites linked to them, correlate with their evaluation by some of the largest rating systems on the Internet, what means that certain indexes obtained from the usage analysis of pediatric websites could be used as quality indicators. On the other hand, the citation analysis on the Web by the quantification of inbound links to medical websites could be an objective and feasible tool in rating great amounts of websites.

[Community-acquired pneumonia: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio]. / Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad.

UNLABELLED: Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. MATERIAL AND METHODS: One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. RESULTS: The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays). CONCLUSIONS: The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.

[Plasma homocysteine levels in Spanish patients with coronary artery disease]. / Concentraciones de homocisteína en plasma en pacientes españoles con enfermedad arterial coronaria.

OBJECTIVE: A rise in plasma levels of the amino acid homocysteine (HCY) is a possible risk factor in cardiovascular disease. The mechanisms proposed to explain how HCY can increase the risk of vascular disease include its direct effect on the vascular endothelium and its role in increasing the risk of thrombosis. The present work has been designed to determine HCY levels in patients with coronary artery disease (CAD) residents in the Canary Islands and to establish whether hyperhomocysteinemia can be considered as an risk factor. METHODS: The sample studied consisted of 132 patients with, angiographically demonstrated, CAD and 18 controls with normal coronary arteries. Biochemical parameters determined included: HCY, vitamin B12, vitamin B6, folic acid, creatinine, cholesterol and its fractions, triglycerides, glucose and fibrinogen. RESULTS: Mean levels of HCY were not significantly different between the cases and controls (p = 0.37). In the distribution of HCY levels into quintiles there was no significant association between the quintiles and the occurrence of CAD (p = 0.57). Multiple logistic regression analysis in which the risk factors were compared with quintiles 2, 3, 4 and 5 of HCY did not reveal a significant relation between HCY levels and risk of CAD. CONCLUSIONS: This study questions the previously accepted consideration that hyperhomocysteinemia is a risk factor of CAD. Controlled intervention trials are, therefore, necessary to clarify the possible association between total HCY levels and cardiovascular disease.

[Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients]. / Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico.

INTRODUCTION: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). OBJECTIVES: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. METHODS: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. RESULTS: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. CONCLUSIONS: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BED.

Encuesta sobre los eventos adversos relacionados con el uso de carbón activado en urgencias y emergencias / Adverse events caused by activated charcoal in an emergency services survey

Fundamento: Existen pocos estudios en España sobre el uso de carbón activado (CA) en las intoxicaciones agudas por vía digestiva, y más concretamente sobre su protocolización y eventos adversos tras su administración. Este trabajo tiene como objetivo conocer la experiencia en el uso de CA, por los médicos y enfermeros de los servicios de urgencias y emergencias españoles. Método: Diseño de una encuesta a profesionales sanitarios de urgencias y emergencias, mediante la aplicación informática Google Docs. Resultados: Ser recibieron 364 encuestas, de ellas un 52% procedentes de facultativos. Contestaron realizar sondaje previo al uso de CA el 74,5%, y no utilizar sonda en el 13% de los pacientes. Se consideró correcta la aplicación de CA en un 37,4%, usándose globalmente en un 92,4% de los casos. La posición lateral de seguridad manifestaron usarla el 46,2%, antieméticos el 86,5% y aislaban la vía aérea en caso de coma (GCS<8) el 60%. Los eventos adversos más descritos fueron los vómitos de CA (61%), la epixtasis al colocar la sonda (51,1%) y la incorrecta colocación de la misma (36%). La broncoaspiración de vómitos les ocurrió al 11,8% y de carbón al 4,7%. Un 7,1% manifestó que los eventos adversos habían supuesto riesgo vital para los pacientes. No se halló relación entre protocolización de la asistencia y eventos adversos graves o riesgo vital, ni entre éstos y las medidas de seguridad clínica. Conclusiones: La incidencia de eventos adversos, en función de lo manifestado por los profesionales en esta encuesta sobre su práctica clínica, podría ser superior a las que se encuentran en la literatura (AU)

Background: There are few studies in Spain on the use of activated charcoal (AC) in acute poisoning via the digestive tract, and more specifically on its protocol and adverse events following its administration. The aim of this article is to know the experience in the use of AC by doctors and nurses of the Spanish emergency services. Method: Survey developed using Google Docs to health professionals in emergency services. Results: Three hundred and sixty-four questionnaires were received, 52% of them from doctors. Catheterization prior to the use of AC in 74.5% of patients was performed, and did not use a catheter in 13%. The application of AC was considered correct in 37.4%, and overall it was used in 92.4% of cases. The lateral safety position was used in 46.2%, antiemetics in 86.5% and isolation of the airway in case of coma (GCS<8) in 60%. The most described adverse events were vomiting of AC (61%), epixtasis when the catheter was positioned (51.1%), and its incorrect positioning (36%). Inhaling vomit occurred in 11.8% and inhaling carbon in 4.7%. Seven point one percent stated that the adverse events had been life-threatening to patients. No relation was found between the protocol and serious or life-threatening adverse events, nor between these latter and clinical safety measures. Conclusions: The incidence of adverse events according to the information provided by professionals in this survey of clinical practice might be higher than the incidence found in the literature (AU)

Acidosis con hiperlactacidemia por metformina: frecuencia de su diagnóstico en la práctica clínica habitual y relación con la insuficiencia renal / Metformin-associated hyperlactacidaemia acidosis: Diagnosis rate in standard clinical practice and its relationship with renal failure

Antecedentes y objetivos: Estudio observacional sobre la diferencia entre el número de casos diagnosticados en situación clínica habitual de acidosis con hiperlactacidemia sospechosa de ser causada por metformina y su incidencia según la ficha técnica. Adicionalmente se exploró la relación con la función renal de la acidosis hiperlactacidémica por metformina. Pacientes: Se identificaron los casos de acidosis entre los años 2013 y 2014 mediante el análisis del CMBD y las peticiones al laboratorio. Se seleccionó a los pacientes que presentaban lactato venoso > 2,7 mmol/L en el momento de ser atendidos y para los que constaba el uso ambulatorio de metformina. La relación causal con la metformina fue evaluada independientemente por varios investigadores. Los casos incidentes se calcularon con base en el número de pacientes a los que se les había dispensado un medicamento que contuviera metformina durante el mismo periodo en el área estudiada. Resultados: Se identificaron 476 casos de acidosis, de los que en 20 se consideró que la metformina era sospechosa de causar el cuadro de acidosis con hiperlactacidemia, lo que supone una incidencia de 6,57/10.000 pacientes. El 85% de los casos presentaban insuficiencia renal aguda. Conclusiones: La incidencia aparente de acidosis con hiperlactacidemia en pacientes tratados con metformina es mayor que la establecida en la ficha técnica (inferior a 1/10.000). El desarrollo de acidosis con hiperlactacidemia por metformina está relacionado con el deterioro agudo de la función renal

Background and objectives: Observational study on the difference between the number of cases of acidosis with hyperlactacidaemia suspected of being caused by metformin diagnosed in standard clinical practice and the incidence of this condition according to the datasheet. The study also explored the relationship between renal function and metformin-associated hyperlactacidaemia acidosis. Patients: We identified cases of acidosis between 2013 and 2014 by analysing the minimum basic data set and laboratory requests. We selected patients who presented venous lactate levels >2.7 mmol/L at the time they were treated and for whom the use of outpatient metformin was confirmed. The causal relationship with metformin was independently evaluated by several researchers. The incident cases were calculated based on the number of patients who had been dispensed a drug containing metformin during the same period in the study area. Results: We identified 476 cases of acidosis. Metformin was suspected of causing the condition of acidosis with hyperlactacidaemia in 20 of these cases, which represents an incidence rate of 6.57/10,000 patients. Eighty-five percent of the cases presented acute renal failure. Conclusions: The apparent incidence of acidosis with hyperlactacidaemia in patients treated with metformin is greater than that established in the datasheet (<1/10,000). The onset of metformin-associated hyperlactacidaemia acidosis is related to acute renal impairment

Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico / Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients

Introducción: La presencia de trastorno por atracón (TA) podría influir en los resultados del bypass gástrico laparoscópico (BPGL) en el tratamiento de la obesidad mórbida. En población anglosajona, el TA suele valorarse mediante los cuestionarios Eating Disorder Examination-Questionnaire (EDE-Q) y Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objetivos: Estudiar la validez y concordancia del EDEQ y QEWP-R para el diagnóstico y valoración psicopatológica del TA en población española con obesidad mórbida intervenida mediante BPGL. Métodos: En un estudio transversal se le ha solicitado a 27 obesos mórbidos recién intervenidos mediante BPGL que cumplimentaran el EDE-Q y QEWP-R traducidos al español. Según las respuestas se han identificado los pacientes con y sin TA, evaluando posibles diferencias entre estos grupos en los ítems con interés psicométrico y midiendo la concordancia entre ambos cuestionarios. Resultados: El QEWP-R permitió diagnosticar un 25,9% de TA y el EDE-Q un 18,5%. Los pacientes con TA tuvieron mayores puntuaciones en los ítems sobre la importancia del peso o figura en la autovaloración, la interferencia en la capacidad de concentración por pensar en la comida, silueta o peso y la frecuencia del sentimiento de culpa después de comer. Entre ambos cuestionarios la concordancia diagnóstica fue escasa, pero se encontró una asociación fuerte entre los ítems con interés psicométrico. Conclusiones: El TA es frecuente en obesos mórbidos intervenidos mediante BPGL y forma un subgrupo de pacientes con más alteraciones psicopatológicas. El QEWP-R y el EDE-Q en español son cuestionarios adecuados para su valoración (AU)

Introduction: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objectives: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. Methods: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. Results: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. Conclusions: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BE (AU)

Facoemulsificación versus iridotomía láser en el glaucoma primario de ángulo cerrado. Una decisión difícil / Phacoemulsification versus laser iridotomy in primary angle closure glaucoma. A difficult decision

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