Mejora de habilidades en la seguridad del paciente implementando una estrategia de entrenamiento en el personal asistencial / Skill improvement in patient safety through training strategy implementation in health-care workers / Melhora de habilidades na segurança do paciente implementando uma estratégia de treinamento no pessoal assistencial

En la actualidad, la sofisticación de la tecnología en el sector sanitario ofrece ventajas para el diagnóstico y tratamiento de los pacientes; sin embargo, los riesgos y eventos adversos que acompañan a esta nueva generación de tecnología son una tendencia creciente a nivel global. Hay muchos factores que contribuyen a este escenario, especialmente el error humano que aumenta en las instituciones de salud cuando el proceso de incorporación tecnológica no incluye la adecuada formación del personal. El objetivo de este proyecto es contribuir a la seguridad de los pacientes y ofrecer servicio de calidad en la atención sanitaria. Para ello debe implementarse una estrategia de capacitación del personal en el uso adecuado de la tecnología para ofrecer un servicio responsable, comprometido y profesional.

Currently, the sophistication of technology in the health-care industry offers advantages for the diagnosis and treatment of patients; however, the risks and adverse events that go with this new generation of technology are a growing tendency worldwide. There are many factors that contribute to this scenario, but especially the increase in human error in health-care institutions when the process of technological incorporation does not include appropriate personnel training. The objective of this project is to contribute to patient safety and offer quality healthcare. In order to offer a responsible, committed, and professional service,a strategy of training personnel in the appropriate use of technology must be implemented.

Na atualidade a sofisticação da tecnologia no sector sanitário oferece vantagens para o diagnóstico e tratamento dos pacientes, no entanto, os riscos e eventos adversos que acompanham esta nova geração de tecnologias são uma tendência crescente a nível global. Existem muitos fatores que contribuem a este palco: especialmente o erro humano que aumenta nas instituições de saúde quando o processo de incorporação tecnológica não inclui a adequada formação do pessoal. O objetivo deste projeto é contribuir à segurança dos pacientes e oferecer atenção de qualidade na atenção sanitária, a implementação de uma estratégia de capacitação do pessoal no uso adequado da tecnologia para oferecer um serviço responsável, comprometido e profissional.

Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer.

OBJECTIVES: To determine the efficacy of a three-fold reduced dose (RD, 27 mg) of intravesical bacille Calmette-Guérin (BCG) against the standard dose (81 mg) in patients with superficial bladder cancer, assessing recurrence, progression and differences in toxicity. PATIENTS AND METHODS: Five hundred patients with superficial bladder cancer (Ta, T1, Tis) were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG Connaught strain (weekly x six and thereafter fortnightly x six) either with the standard or RD instillation. RESULTS: All but one of the 500 patients were evaluable for efficacy and toxicity (252 in the standard arm and 247 in the RD arm). The median follow-up was 69 months (maximum 104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm developed recurrences; the median time to recurrence has not yet been attained, but at 5 years the mean (sd) percentage of recurrence-free patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms, respectively. In patients presenting with multifocal tumours, the standard dose was more effective against recurrences than the RD (P=0.0151). In those with G3 and high-risk tumours overall, the superiority of the standard dose was marginal (P=0.060 and P=0.082). Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD arm progressed to invasive disease; the median time to progression has not yet been attained, but the percentage of progression-free patients at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms, respectively. The standard dose was more effective than the RD against progression only in patients with multifocal disease (P=0.048). Twelve (4.8%) cystectomies were performed in the standard and 15 (6.1%) in the RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%) from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD arm. Overall the disease-specific death rate was lower for those patients who completed the scheduled treatment. The cause-specific survival at 5 years did not differ between the arms (P=0.76) but there was a trend toward better cause-specific survival for patients with multifocal tumours in the standard arm. Toxicity differed between the arms, significantly more patients having no toxicity in the RD arm, and fewer having delayed instillations or withdrawing. However, severe systemic toxicity occurred even in patients treated with the RD, in a similar proportion to those receiving the standard dose. CONCLUSION: Overall, the RD gave similar results for recurrence and progression but with significantly less toxicity. However, patients with multifocal tumours fared better with the standard dose and there was a trend towards better recurrence rates in patients with high-risk tumours. We recommend continuing to use the standard dose for high-risk tumours, while we consider the reduced dose safe and effective for intermediate-risk lesions and for maintenance schedules.

[Smoking cessation from the community pharmacy]. / Deshabituación tabáquica desde la farmacia comunitaria.

OBJECTIVES: To evaluate the effectiveness of the intervention of the community pharmacist in a smoking-cessation program. DESIGN: A descriptive prospective study. SETTING: Two pharmacies of the Community of Madrid. PARTICIPANTS: 77 patients who wanted to participate in the smoking-cessation program. The middle age of the participants were 41.6 +/- 10.8; 51.9% were male and 42.8% female. MEASUREMENTS AND MAIN RESULTS: The quit rates of the smoking-cessation program were: 1st. month 80.5%; 3rd. month 54.5%; 6th month 45.5% and 1st. year 42.8%. The patient who use the nicotine treatment at least two months, have more probability to quit smoking successfully (p < 0.05). CONCLUSIONS: The community pharmacy could be a good place to help people to give up smoking. Results of this study show that pharmacists who counsel patients in an intensive smoking-cessation program can improve outcomes.

[Ureterosigmoidostomy detubularized with surgical staplers: C.F.C. (Original technique)]. / Ureterosigmoidostomía destubulizada mediante súturas mecánicas: C.F.C. (Técnica original).

Description of our modification of the detubulized ureterosigmoidostomy surgical technique (Castiñeiras-Ferragut-Camacho). In an attempt to shorten the surgery time, we used for these changes absorbable mechanical sutures (Poli Gia and T.A.). This paper analyzes the technical details of interest as well as the anatomicosurgical considerations that should be known prior to carry out this type of by-pass. The anatomicophysiological principles on which our developments are based are those referred by N.G. Kock15 and used by R. Hohenfellner and R. Fisch14, when they described the detubulized ureterosigmoidostomy performed manually. We believe that both surgical procedures, R. Hohenfellner & R. Fisch14 and ours (detubulized ureterosigmoidostomy, C.F.C.), are suitable alternatives to conventional ureterosigmoidostomy.

[Clinical features, diagnosis, and treatment of tumor lesions arising in the adrenal gland]. / Clínica, diagnóstico y tratamiento de los procesos tumorales desarrollados en la glándula suprarrenal.

Between 1981 and 1993, 14 patients with tumoral adrenal disease were diagnosed and treated in the Urology Services of both Hospitals. Nature of the adrenal disease was functional in 8 patients (two carcinomas and six pheochromocytomas) and non-functional in the rest (three carcinomas, two adenomas and one myelolipoma). Reference is made to the clinical manifestations and laboratory tests related to hormonal activity, depending on whether the tumour is functional or non-functional, chromaffin or non-chromaffin. Patients with functional carcinomas had Cushing's syndrome, with very clear virtilization signs. Urine 17-hydroxycorticosteroid, 17-cetosteroides and cortisol were all increased, same as plasma cortisol. Patients with pheochromocytomas had hypertension and headaches (six patients), sweating (five patients), anxiety (four patients) and loss of weight (two patients). All of them had increased urine vainillylmandelic acid and catecholamines. Clinical signs and symptoms of non-functional tumours were related to bulk growth and size (in the three carcinomas), and sometimes was highly anodyne, or even absent (in the two adenomas and the myelolipoma), the cause of discovery being accidental during an ultrasound examination. An analysis is made of the different imaging diagnostic procedures performed, such as IVU (performed in 13 patients) with a 38.4% resolutory power; ultrasound (performed in 11 patients) with an 81.8% resolution; CAT (performed in 6 patients) with a 100% resolution capacity and arteriography (performed in 3 patients) with a 100% resolution power, although patients had previously undergone ultrasound and CAT.(ABSTRACT TRUNCATED AT 250 WORDS)

[A program for the preparation of educational materials]. / Programa para la elaboración de materiales educacionales.

The article describes a program for the development of educational materials using PC computers. The program may help a teacher plan a course. The teacher can use it to formulate the general and specific course objectives, analyze the content of the objectives and materials, classify the instructional materials to be learnt and sequence the materials to be used by means of a computer. The program also allows student replies to be recorded and the results of the applications to be revised.