Impacto de un modelo estandarizado para la declaración y análisis de incidentes en la mejora de un servicio de Urgencias pediátrico / Impact on the improvement of paediatric emergency services using a standardised model for the declaration and analysis of incidents

INTRODUCCIÓN: El objetivo del trabajo es analizar los cambios en la declaración de incidentes tras haber implantado un nuevo sistema de declaración y exponer las medidas aplicadas gracias a las declaraciones realizadas. PACIENTES Y MÉTODOS: En el 2012 se realizó una recogida de los incidentes declarados de forma prospectiva entre 2007 y 2011. En mayo del 2012 se realizó un cambio de modelo para aumentar las declaraciones, analizar sus causas y mejorar el retorno de información al resto del equipo. Se nombraron referentes de seguridad en cada servicio, se realizaron sesiones informativas y de difusión, y se implantó un nuevo sistema de declaración de incidentes. Con el nuevo modelo se inició un estudio prospectivo de las declaraciones durante un año y se compararon los resultados con ambos modelos. RESULTADOS: En todo el 2011 se declararon 19 incidentes en Urgencias y del 1 de junio de 2012 al 31 de mayo del 2013, 106 incidentes (5,6 veces más). Los incidentes declarados fueron de medicación (57%), identificación (26%) y procedimientos (7%). Las causas más frecuentes de estos fueron individuales del profesional (70,7%), falta de formación (22,6%) y condiciones de trabajo (15,1%). Medidas que se han aplicado a raíz de estos incidentes son el checklist quirúrgico, las monodosis de salbutamol y tablas por peso de fármacos de reanimación cardiopulmonar. CONCLUSIONES: El nuevo modelo de declaración de incidentes ha potenciado las declaraciones, ha permitido implantar mejoras y medidas preventivas, aumentando todo esto el clima de seguridad en el servicio de Urgencias

INTRODUCTION: The aim of this study is to analyse changes in the incidents reported after the implementation of a new model, and study its results on patient safety. PATIENTS AND METHODS: In 2012 an observational study with prospective collection of incidents reported between 2007 and 2011 was conducted. In May 2012 a model change was made in order to increase the number of reports, analyse their causes, and improve the feedback to the service. Professional safety representatives were assigned to every department, information and diffusion sessions were held, and a new incident reporting system was implemented. With the new model, a new observational study with prospective collection of the reports during one year was initiated, and the results compared between models. RESULTS: In 2011, only 19 incidents were reported in the Emergency Department, and between June 1, 2012 to June 1, 2013, 106 incidents (5.6 times more). The incidents reported were medication incidents (57%), identification (26%), and procedures (7%). The most frequent causes were human (70.7%), lack of training (22.6%), and working conditions (15.1%). Some measures were implemented as a result of these incidents: a surgical checklist, unit doses of salbutamol, tables of weight-standardised doses of drugs for cardiopulmonary resuscitation. CONCLUSIONS: The new model of reporting incidents has enhanced the reports and has allowed improvements and the implementation of preventive measures, increasing the patient safety in the Emergency Department

[Impact on the improvement of paediatric emergency services using a standardised model for the declaration and analysis of incidents]. / Impacto de un modelo estandarizado para la declaración y análisis de incidentes en la mejora de un servicio de Urgencias pediátrico.

INTRODUCTION: The aim of this study is to analyse changes in the incidents reported after the implementation of a new model, and study its results on patient safety. PATIENTS AND METHODS: In 2012 an observational study with prospective collection of incidents reported between 2007 and 2011 was conducted. In May 2012 a model change was made in order to increase the number of reports, analyse their causes, and improve the feedback to the service. Professional safety representatives were assigned to every department, information and diffusion sessions were held, and a new incident reporting system was implemented. With the new model, a new observational study with prospective collection of the reports during one year was initiated, and the results compared between models. RESULTS: In 2011, only 19 incidents were reported in the Emergency Department, and between June 1, 2012 to June 1, 2013, 106 incidents (5.6 times more). The incidents reported were medication incidents (57%), identification (26%), and procedures (7%). The most frequent causes were human (70.7%), lack of training (22.6%), and working conditions (15.1%). Some measures were implemented as a result of these incidents: a surgical checklist, unit doses of salbutamol, tables of weight-standardised doses of drugs for cardiopulmonary resuscitation. CONCLUSIONS: The new model of reporting incidents has enhanced the reports and has allowed improvements and the implementation of preventive measures, increasing the patient safety in the Emergency Department.

Glomerulonefritis aguda secundaria a una infección por parvovirus B19 / Acute glomerulonephritis secundary to parvovirus B19 infection

El parvovirus B19 es un virus patógeno humano. Aunque su asociación al daño renal es rara en la edad pediátrica, se han descrito algunos casos de glomerulonefritis aguda en el contexto de una infección por parvovirus B19. Describimos el caso de una niña de 12 años de edad, previamente sana, que desarrolló edemas y proteinuria. Los estudios serológicos determinaron anticuerpos IgM antiparvovirus B19. El genoma del parvovirus B19 fue detectado mediante reacción en cadena de la polimerasa. La paciente se recuperó espontáneamente, con desaparición de la proteinuria y resolución de la hipocomplementemia. La infección por parvovirus B19 se ha asociado al daño renal y es uno de los agentes etiológicos de glomerulonefritis aguda (AU)

Parvovirus B19 is a human pathogenic virus. Even if his association with renal injury is rare, recently cases of acute glomerulonephritis during the course of parvovirus B19 infection have been described. We studied a previously healthy 12-year-old girl who developed edema and proteinuria. Serological studies determined IgM antibody titers to parvovirus B19. The parvovirus B19 genome was detected by PCR. The Parvovirus B19 infection has been associated with renal injury, may be one of the etiological agents of acute glomerulonephritis (AU)

Comparison of the removal of phthalates and other organic pollutants from industrial wastewaters in membrane bioreactor and conventional activated sludge treatment plants.

In recent years greater attention has been paid to the presence of pollutants in wastewater treatment plants, mainly because of strict environmental regulations and the possibility of reusing treated water in industrial processes. Since some organic pollutant compounds are not sufficiently removed in conventional activated sludge treatment (CAST) plants, new treatment processes have been developed, such as membrane bioreactors (MBRs). In this study a submerged membrane bioreactor (MBR) was used to treat mixed industrial wastewaters in parallel with a CAST plant. Two hydraulic retention times (HRT) of wastewater were tested as one of the operational conditions of MBR and the quality of effluents of the two processes were studied and compared. Several general quality parameters were analysed in wastewaters: chemical oxygen demand (COD), pH, conductivity, nitrogen, phosphate, suspended solids (SS) and turbidity. The two systems reduced COD by around 90%. SS was reduced by around 81% in the CAST plant and around 90% in the MBR plant. The results for the other general parameters were similar or better in the MBR process, which worked at a lower HRT. We also studied the removal of a group of six phthalates and bis(2-ethylhexyl)adipate ester by SPME/GC-MS in the two treatment plants. Most of these compounds were not completely removed in the two treatment plants and were identified at low microg l(-1) levels. We also tentatively identify some organic compounds in the wastewaters. Most of the compounds we found in the influent, MBR effluent and CAST effluent were benzene derivates, styrene, naphthalene and naphthalene derivates, and phenol derivates.

Human immunodeficiency virus and other sexually transmitted diseases in Cuban women.

A cross-sectional study was performed in 60 Cuban women of child-bearing age who were seropositive for human immunodeficiency virus (HIV) and 60 controls. Human papillomavirus (HPV) was identified most frequently, with oncogenic HPV serotypes 16, 33 and 58 detected in HIV-positive patients, and serotypes 11, 33 and 51 in the controls (relative risk 4.41; 95% CI 2.21-8.29). Syphilis and hepatitis B and C viruses were detected exclusively in HIV-seropositive women (p<0.05). Sexually transmitted diseases (STDs) appeared to pose a substantial health problem, especially for HIV-positive women. Clinics should consider screening and treatment for STDs as part of their HIV prevention programmes.

Neisseria gonorrhoeae resistant to ciprofloxacin: first report in Cuba.

BACKGROUND AND OBJECTIVES: The Cuban Ministry of Public Health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in Cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in Cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in Cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in Cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.

[Plesiomonas shigelloides, a Vibrionaceae to be taken into account]. / Plesiomonas shigelloides una Vibrionaceae en quien pensar.

The antigenic structure and antimicrobial susceptibility were studied in 99 strains isolated from patients with acute diarrhea (6 strains from an outbreak of digestive transmission disease in Santiago de Cuba) and a strain isolated from a patient who died from infections neurological syndrome (INS, meningitis). Four new serotypes (093, 994, 095, 096), which had not been described in the world classification, were identified from the Cuban isolated strains and were included in the International Serotyping Scheme by the International Reference Center located in Prague, Czech Republic. For the first time in Cuba, the circulation of serotypes 017:H11, 011: H2, 023. H1alc, 057: H3 which show cross reaction to Shiguella species was proved. Those strains from the outbreak of digestive disease belonged to serotype 050: H11 and had a thermostable toxin. The first case of infectious neurologic syndrome with Plesionomas shigelloides etiology reported in Cuba was described; the strain corresponded to serotype 050: H11. The worldwide reported pattern of antimicrobial resistance was demonstrated.

[Toxigenic Vibrio cholerae non-01]. / Vibrio cholerae No-01 toxigénico.

The antimicrobial susceptibility and the presence of a heat-stable toxin were researched into 100 non-01 Vibrio cholerae strains sent by 7 different health centers to the National Reference Laboratory of Acute Diarrheal Diseases in "Pedro Kourí" Tropical Medicine Institute. The presence of 20% toxigenic non-01 Vibrio cholerae was detected, a figure substantially higher than that reported in other geographic areas, except for endemic areas. This result will make it possible to set epidemiological alert in Cuba because these strains can be infected by CTX phages (element transporting genes that encode for choleric toxin) which will give such strains an epidemic potential similar to that of the etiologic agent of cholera. The identified strains could be studied as possible cholera vaccine candidates.

Viral isolation from cases of epidemic neuropathy in Cuba.

OBJECTIVE: To investigate the possibility of a viral agent in the central nervous system of patients with epidemic neuropathy. DESIGN: Virus isolation attempts, in cell cultures and suckling mice, from cerebrospinal fluid (CSF) of neuropathy patients and controls undergoing lumbar puncture for unrelated reasons. Serologic studies in patients, contacts, and controls. SETTING: An epidemic of optic and peripheral neuropathy affected more than 50,000 people in Cuba in 1991 through 1993. Illness was associated with dietary limitations and increased physical demands accompanying the shortages of food and fuel experienced in Cuba since 1989. Most patients responded to parenteral vitamin therapy, and the epidemic began to subside when oral vitamin supplementation was begun for the entire Cuban population. RESULTS: Coxsackievirus A9 (five isolates) and a similar, less cytopathic virus (100 isolates) were recovered from 105 (84%) of 125 CSF specimens from neuropathy patients. The strains with light cytopathic effect were antigenically related to Coxsackieviruses A9 and B4 by cross-neutralization and immunoblotting assays. Virus persisted in CSF of some patients for 1 to 12 months. Cerebrospinal fluid from patients and both types of virus from cell culture produced illness, including complete posterior flaccid paralysis, in newborn mice, and virus was reisolated from the mice. Mouse tissues and sural nerve biopsy specimens from patients were stained by immunoperoxidase and colloidal gold techniques using hyperimmune rabbit antisera against the virus with light cytopathic effect. CONCLUSIONS: Coxsackievirus A9 or an antigenically related agent with a light cytopathic effect was present in CSF of 84% of 125 patients with epidemic neuropathy. The role of these agents, probably in combination with nutritional factors, in the pathophysiology of the disease requires further investigation.

[Cuban epidemic neuropathy. III. Neutralizing antibodies to the strains isolated and to other enteroviruses in patients and healthy subjects]. / Neuropatía epidémica cubana. Parte III. Anticuerpos neutralizantes a cepas aisladas y otros Enterovirus en pacientes y personas sanas.

Determinations of neutralizing antibodies to the strain 47/93 IPK (CA9) and to the strain 590 were performed in serum samples from patients presenting with epidemic neuropathy and from a group of seemingly healthy subjects. Determinations were also done in the reference strains CA9 and CB1-6 by the microneutralization technique. Patients and their contacts showed significantly higher percentages of neutralizing antibodies to the strain 47/93 than the control group and residents of municipalities with a low rate of the disease. This difference was also confirmed regarding the geometric mean titres with the use of the reference strains CA9 and CB2-4. An increased circulation of the strain 47/93 within the infantile population from 1981 to 1993 was evidenced. Patients exhibited significantly lower percentages and geometric mean titres of neutralizing antibodies to the strain 590 than the control group, despite the fact that in 25/28 certain agents having a mild cytopathogenic effect had been isolated. The possibility of two mechanism of neutralization is stated and an hypothesis on the mechanism by which these viruses may be involved in the pathophysiology of the disease is formulated.

[Buruli ulcer in the Amansi West district, Ashanti Region, Ghana. The Cuban experience. I]. / Ulcera de Buruli en el distrito Amansie West, Región Ashanti, Ghana. Experiencia cubana. I.

A study was made on 105 patients with Buruli ulcer in the Amansie West district, Ashanti Region, Ghana, representing 37.6% of the registered patients. The Tontokrom neighborhood showed the highest prevalence: 84 x 1,000 inhabitants. Predominance of females (54%) was observed. 74.8% did agricultural work and only 3 reported a previous trauma, predominantly with one lesion. Household contacts were identified. Coverage with the BCG vaccine was low. It is concluded that there has been a real increase of the prevalence of Buruli in the region during the last years, especially among children and women. This has become a serious problem due to its invalidating and irreversible sequelae. Measures of control are proposed.

Una metodología de evaluación de impactos ambientales de proyectos de saneamiento; aplicación al caso de Palmira, Mendoza

Este estudio se realiza para identificar, prevenir e intepretar las consecuencias al bienestar humano y al entorno con el objeto de asegurar las inversiones que se lleven a cabo prevengan, controlen y/o mitiguen los efectos negativos sobre los recursos naturales y el bienestar de las personas