Análisis de la cultura de seguridad del paciente en un hospital universitario / Analysis of the patient safety culture in a university hospital

OBJETIVO: 1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus fortalezas y debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras. MÉTODO: Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español. RESULTADOS: La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente). CONCLUSIONES: La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad

OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception

[Analysis of the patient safety culture in a university hospital]. / Análisis de la cultura de seguridad del paciente en un hospital universitario.

OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception.

[Mesenteric panniculitis as the initial manifestation of a B cell lymphoma]. / Paniculitis mesentérica como manifestación inicial de un linfoma de células B.

Mesenteric panniculitis is an uncommon clinical entity which sometimes may be associated with hematologic, gastrointestinal and urological neoplasms. The diagnostic procedure ofchoice is based on obtaining a tissue sample for histopathological study usually through apercutaneous procedure. Treatment is indicated in symptomatic cases.

[Epiploic appendagitis: a rare cause of abdominal pain]. / Apendagitis epiploica, causa poco frecuente de dolor abdominal.

BACKGROUND: Epiploic appendagitis is an atypical cause of abdominal pain whose knowledge could avoid diagnostic or treatment errors. Diagnosis has been performed with abdominal ultrasound or tomography with the only treatment being nonsteroidal anti-inflammatory drugs. OBJECTIVE: To analyze patients diagnosed in our hospital. METHODS: We performed a 4-year retrospective and descriptive study (March 2009-March 2013) of patients diagnosed with epiploic appendagitis in our hospital. RESULTS: Seventeen patients were included, 14 females and three males with a median age of 57 years. Symptom delay was 72 h. Abdominal pains were located in the left lower quadrant in 64.7% and right lower quadrant in 35.3% of patients. Blood test demonstrated leukocytes 6,300 (5,000-9,500), neutrophils 61.6% (57-65.8), and C reactive protein 1.5 (0.85-2.92). Diagnosis was confirmed with abdominal ultrasound or tomography in 88.2% and intraoperatively in 11.8%. CONCLUSIONS: Epiploic appendagitis was more frequent in women. Abdominal pain was located in the lower quadrant, more predominant in left than right. Blood tests were normal except for increased levels of C-reactive protein. Diagnosis was made mostly preoperatively due to imaging tests, avoiding unnecessary surgical intervention.

ANTECEDENTES: la apendagitis epiploica es una causa poco frecuente de dolor abdominal cuyo conocimiento podría evitar errores diagnósticos y terapéuticos. El diagnóstico suele establecerse mediante ecografía o tomografía abdominal; el tratamiento es sintomático, con antiinflamatorios. OBJETIVO: analizar los casos diagnosticados en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo y descriptivo de pacientes con diagnóstico de apendagitis epiploica durante 4 años (marzo 2009 a marzo 2013). RESULTADOS: se incluyeron 17 pacientes, 14 mujeres y 3 hombres, con una mediana de edad de 57 años. El periodo de latencia de los síntomas fue 72 horas. En 64.7% de los pacientes el dolor abdominal se localizó en el cuadrante inferior izquierdo y en 35.3% en el derecho. Laboratorio: leucocitos 6,300 (5,000-9,500), neutrófilos 61.6% (57- 65.8), proteína C reactiva 1.5 (0.85-2.92). El diagnóstico se confirmó mediante ecografía o tomografía abdominal en 88.2%, e intraoperatorio en 11.8%. CONCLUSIONES: la apendagitis epiploica fue más frecuente en mujeres. La clínica fue dolor abdominal en los cuadrantes inferiores, más frecuente en el lado izquierdo, con RESULTADOS de laboratorio normales, excepto la elevación de la proteína C reactiva. En la mayoría de los casos el diagnóstico se estableció preoperatoriomente, gracias al uso de pruebas radiológicas que evitó las intervenciones quirúrgicas innecesarias.

[Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis]. / Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas.

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5%) and 7AD (1.5%). DA was more frequent in women (57%) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61%) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1% (range 84.6 to 89.6%) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6% (range 75.1 to 86.4%) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43%) and 80 AA (18%). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas / [Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis].

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5

) and 7AD (1.5

). DA was more frequent in women (57

) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61

) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1

(range 84.6 to 89.6

) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6

(range 75.1 to 86.4

) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43

) and 80 AA (18

). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas. / [Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis].

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5

) and 7AD (1.5

). DA was more frequent in women (57

) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61

) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1

(range 84.6 to 89.6

) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6

(range 75.1 to 86.4

) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43

) and 80 AA (18

). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

[Acute abdomen due to perforated appendicular mucocele]. / Abdomen agudo por mucocele apendicular perforado.

Primary neoplasms of the appendix are present in approximately 0.2% to 0.3% of appendectomy specimens. Generally affect middle-age adults and elderly people. Approximately 30% to 50% of appendiceal neoplasms manifest with acute appendicitis by luminal obstruction. The definitive diagnosis is histological. We must avoid simple laparoscopic appendectomy and adopt an open procedure with a laparotomy appendectomy for a bening process. Right hemicolectomy is indicated when a malignant condition is suspected Follow-up is recommended in this pathology due to the risk of associated malignant neoplasms. We report a case of perforated appendiceal mucocele in a 84-year-old man presented as an acute abdomen.

[Leiomyomatosis peritonealis disseminata]. / Leiomiomatosis peritoneal difusa.

Leiomyomatosis peritonealis disseminata (LPD) is a rare, benign proliferative process characterized by multiple smooth muscle nodules throughout the peritoneum. Predominantly affects women in their reproductive years. The cause of LPD is unknown although it may be associated with high estrogen state. The clinical appearance mimics a peritoneal carcinomatosis and the radiologic findings are unspecific. So, the definitive diagnosis is histological. Treatment must be individualized depending on age, hormonal status and symptomatology. To date, less than 140 cases have been reported. We report a case of LPD in a 50-year-old woman presented as an intestinal obstruction.