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.

Primary total hip arthroplasty with a fully porous-coated uncemented stem: up to twenty-eight years. Retrospective cohort study.

PURPOSE: The use of cementless prosthesis has increased in the last 30 years with the aim of improving the long-term results of total hip arthroplasties in young and active patients. Encouraging results have recently been reported for cementless titanium and cobalt chromium stems. However, there are few studies with long-term follow-up, and the majority have analysed several models of uncemented stems due to their modifications over the years. Therefore, the aim was to assess the long-term survival rate of the Mittelmeier Mark III or Autophor 900-S stem. METHODS: A retrospective cohort study of both gender patients under 70 years old with at least one implanted Mittelmeier Mark III uncemented stem was performed. Survival rate was defined as the proportion of stems that did not need a surgical revision from any cause. Clinical status was evaluated using the Merle d'Aubigne scale modified by Matta (excellent/good/fair/poor). RESULTS: Between 1990 and 1999, 73 stems were implanted. The mean (SD) age at surgical time was 49.3 (9.9) years, and the median (range) of follow-up was 22 (1-28) years. The overall survival rate was 93% (68/73, 95%CI: 85-97%). The stem revisions were due to stem breakage (n = 2), to aseptic loosening (n = 2) and to septic loosening (n = 1). Clinical results were: excellent 84%, good 15% and fair 1.5%. CONCLUSIONS: The Mittelmeier Mark III stem had an excellent survival rate with a stable long-term fixation and excellent clinical outcomes.

Evolución en una década del riesgo quirúrgico en cirugía coronaria según el predictor euroscore logístico. Estudio monocéntrico / Evolution in a decade of surgical risk in coronary surgery according to the logistic euroscore predictor. Monocentric study

Introducción: Numerosos estudios avalan la modificación del perfil de riesgo de los pacientes sometidos a cirugía coronaria en los últimos años. Es trascendental investigar la evolución de dicho perfil de riesgo y sus factores condicionantes en Canarias. Objetivos: Comparar el riesgo estimado por EuroSCORE Logístico de los pacientes intervenidos en 2003 y 2012 (objetivo primario), así como los factores condicionantes del mismo (objetivo secundario). Material y métodos: 260 pacientes consecutivos intervenidos de cirugía coronaria, incluyendo procedimientos cardio-quirúrgicos asociados, en el Servicio de CCV del HUC (173 en 2003 y 87 en 2012). Los factores condicionantes del perfil de riesgo de cada paciente se obtuvieron del informe de alta que figura en el SAP, y se recogieron en Microsoft Office Excel 2007. Se calculó el riesgo teórico quirúrgico de cada paciente conforme al EuroSCORE Logístico. Se utilizó el paquete estadístico SPSS® v.12.0. Resultados: El riesgo estimado por el EuroSCORE no varió (p=0.243). Las medianas fueron 5.865 en 2003 y 5.330 en 2012. Los factores de riesgo tampoco variaron, exceptuando: creatinina (p<0.001), con una mediana de 0.9 mg/dl en 2003 y 0.8 mg/dl en 2012; angina inestable (p<0.001), 41% en 2003 y 17.2% en 2012; IAM (p<0.05), 22% en 2003 y 6.9% en 2012; cirugía distinta a coronaria aislada (p<0.001), 12.1% en 2003 y 31% en 2012; y cirugía sobre la aorta torácica (p<0.05), 0% en 2003 y 2.3% en 2012. Conclusión: El riesgo teórico estimado por el EuroSCORE Logístico en cirugía coronaria no varió. La mayoría de los factores de riesgo, como edad, sexo femenino, enfermedad pulmonar crónica, arteriopatía extracardiaca, disfunción neurológica o cirugía cardiaca previa, tampoco variaron. Sí cambiaron: disminuyeron los valores de creatinina y la prevalencia de angina inestable e IAM; y aumentaron las cirugías distintas a coronaria aislada

Introduction: Risk profile change of patients undergoing coronary artery bypass grafting (CABG) in recent years is supported by numerous studies. Studying the evolution of the risk profile and its conditioning factors on the Canary Islands is transcendental. Objectives: To compare the mortality predicted by Logistic EuroSCORE in patients undergoing CABG in 2003 and 2012 (primary objective), and also its risk factors (secondary objective). Methods: 260 patients who underwent CABG in the Cardiovascular Surgery Department of the University Hospital of the Canary Islands were selected (173 patients in 2003 - 87 patients in 2012), including those who underwent other major cardiac procedures than isolated CABG. Risk factors were obtained from the discharge summary contained in SAP, and were collected in Microsoft Office Excel 2007. The surgical theoretical risk of each patient in accordance with the logistic EuroSCORE was calculated. Statistical software package SPSS(R) v.18.0 was used to analyze the predicted mortality and its risk factors. Results. The mortality predicted by EuroSCORE has not changed (p=0.243). The medians were 5.865 in 2003 and 5.330 in 2012. Risk factors have not changed either, except: creatinine (p<0.001), whose median was 0.9 mg/dl in 2003 and 0.8 mg/dl in 2012; unstable angina (p<0.001), 41% in 2003 and 17.2% in 2012; myocardial infarction (p<0.05), 22% in 2003 and 6.9% in 2012; other major surgery than isolated CABG (p<0.001), 12.1% in 2003 and 31% in 2012; and surgery on thoracic aorta (p<0.05), 0% in 2003 and 2.3% in 2012. Conclusion: The mortality predicted by Logistic EuroSCORE in coronary surgery has not changed. Most of the risk factors, such as age, female sex, chronic pulmonary disease, extracardiac arteriopathy, neurological dysfunction or previous cardiac surgery, have not change either. Some risk factors have changed: creatinine values and prevalence of unstable angina and myocardial infarction decreased; and other major cardiac procedures than isolated CABG increased, including surgery on thoracic aorta

Using Landsat image time series to study a small water body in Northern Spain.

Ramsar Convention and EU Water Framework Directive are two international agreements focused on the conservation and achievement of good ecological and chemical status of wetlands. Wetlands are important ecosystems holding many plant and animal communities. Their environmental status can be characterised by the quality of their water bodies. Water quality can be assessed from biophysical parameters (such as Chlorophyll-a concentration ([Chla]), water surface temperature and transparency) in the deeper or lacustrine zone, or from bioindicators (as submerged aquatic vegetation) in the shallow or palustrine zone. This paper proves the use of Landsat time series to measure the evolution of water quality parameters and the environmental dynamics of a small water body (6.57 ha) in a Ramsar wetland (Arreo Lake in the North of Spain). Our results show that Landsat TM images can be used to describe periodic behaviours such as the water surface temperature or the phenologic state of the submerged vegetation (through normalized difference vegetation index, NDVI) and thus detect anomalous events. We also show how [Chla] and transparency can be measured in the lacustrine zone using Landsat TM images and an algorithm adjusted for mesotrophic Spanish lakes, and the resulting values vary in time in accordance with field measurements (although these were not synchronous with the images). The availability of this algorithm also highlights anomalies in the field data series that are found to be related with the concentration of suspended matter. All this potential of Landsat imagery to monitor small water bodies in wetlands can be used for hindcasting of past evolution of these wetlands (dating back to 1970s) and will be also useful in the future thanks to the Landsat continuity mission and the Operational Land Imager.

Tissue radiation response with maximum Tsallis entropy.

The expression of survival factors for radiation damaged cells is currently based on probabilistic assumptions and experimentally fitted for each tumor, radiation, and conditions. Here, we show how the simplest of these radiobiological models can be derived from the maximum entropy principle of the classical Boltzmann-Gibbs expression. We extend this derivation using the Tsallis entropy and a cutoff hypothesis, motivated by clinical observations. The obtained expression shows a remarkable agreement with the experimental data found in the literature.

Immune system-tumour efficiency ratio as a new oncological index for radiotherapy treatment optimization.

A dynamical system model for tumour-immune system interaction together with a method to mimic radiation therapy are proposed. A large population of virtual patients is simulated following an ideal radiation treatment. A characteristic parameter, the immune system-tumor efficiency ratio (ISTER) is introduced. ISTER dependence of treatment success and other features are studied. Radiotherapy treatment dose optimization, following ALARA (As Low As Reasonably Achievable) criterion, as well as a patient classification are drawn from the statistics results.

Assessment of cancer immunotherapy outcome in terms of the immune response time features.

A cytokine-based periodic immunotherapy treatment is included in a model of tumour growth with a delay. The effects of dose schedule are studied in the case of a weak immune system and a growing tumour. We find the existence of 'metastable' states (that may last for tens of years) induced by the treatment and also potentially adverse effects of the dosage frequency on the stabilization of the tumour. These two effects depend on the delay between the tumour growth and the immune system response, the cytokine dose burden, and other parameters considered in the model.

Fracturas del pilón tibial. Influencia del tipo de fractura y de la exactitud de la reducción articular en el pronóstico / Fractures of the tibial plateau. Influence of the type of fracture and precision of the articular reduction on the prognosis

Se realizó un estudio retrospectivo en 43 pacientes tratados de 45 fracturas de pilón tibial entre 1990 y 1998. Según la clasificación de Rüedi y Allgöwer 6 fracturas eran tipo I (13,3 por ciento), 6 tipo II (13,3 por ciento) y 33 tipo III (73,3 por ciento). El tratamiento realizado fue manipulación e inmovilización en botín de yeso en 8 fracturas, las seis del tipo I y dos del tipo II. En las 37 fracturas restantes se realizó osteotaxis y osteosíntesis. Los resultados clínicos obtenidos fueron excelentes-buenos en 27 de las fracturas (60 por ciento), valorados por parámetros objetivos, pero solo en 16 de las fracturas (35,5 por ciento) cuando se valoraron por parámetros subjetivos. Se apreciaron mejores resultados clínicos objetivos/subjetivos cuando se consiguió una buena reducción articular y cuanto menor era el grado de desplazamiento y hundimiento de la fractura; en estos casos fue más difícil obtener una buena reducción articular. En 2 fracturas (25 por ciento) tratadas conservadoramente y en 17 (46 por ciento) tratadas quirúrgicamente se presentó al menos una complicación. Las fracturas de pilón tibial son fracturas graves, por la frecuencia de lesiones de partes blandas y de otras estructuras con que se asocian y por los resultados mediocres derivados de su tratamiento, que son peores en las fracturas tipo III y cuando no se consigue una correcta reducción articular (AU)

Plasma parathyroid hormone related-protein levels in patients with cancer, normocalcemic and hypercalcemic.

Hypercalcemia in patients with cancer may reflect the synthesis and secretion into circulation of parathyroid hormone-related protein (PTHrP) produced by the tumor. In the present study, we have measured circulating PTHrP concentrations in healthy subjects and patients using a new immunoradiometric assay (IRMA) that is specific for the 1-86 amino acid sequence of molecule, and in plasma collected with protease inhibitors. Plasma concentrations of PTHrP(1-86) were greater than the detection limit of the assay (0.3 pmol/l) in healthy subjects. All patients with hypercalcemia-associated cancer had PTHrP(1-86) levels significantly greater (median 7.74 pmol/l, P < 0.05) than healthy subjects or patients with cancer and normal serum calcium, primary hyperparathyroidism and hyperparathyroidism secondary to chronic renal failure. Plasma PTHrP and corrected serum calcium were correlated in patients with hypercalcemia-associated cancer. In one patient, a marked decrease in PTHrP and calcium levels was observed following surgery. Our results suggest that this IRMA for PTHrP(1-86) may be useful for diagnosis and monitoring of PTHrP-producing tumors induced hypercalcemia.

Automated quantification of TSH in serum by a chemiluminescent enzyme immunometric assay: analytical validation.

Thyroid stimulating hormone (thyrotropin; TSH) in serum was assayed with the Immulite-TSH, a fully automated solid-phase third-generation immunoassay analyzer that has a chemiluminescent detection system. The intraassay CV ranged from 3.6% to 6.2% for TSH mean concentrations from 0.025 to 32.12 mIU/L and the interassay CV ranged from 7.9% to 10% for TSH mean concentrations between 0.023 and 31.93 mIU/L. The analytical and functional detection limits of the assay were 0.001 and 0.0068 respectively. No interference was observed by any of the compounds: bilirubin, triglycerides, and hemoglobin. To compare the accuracy of Immulite-TSH with that of a conventional immuno-radiometric assay (Orion Diagnostica Irma-TSH), we examined 153 patient samples with TSH concentrations ranging approximately 0.2 to 100 mIU/L. At TSH concentration approximately 0.15 the precision was greater for Immulite-TSH than for Irma TSH (3.8% vs 11.87%) intraassay CV and (8.6% vs 35.4%) interassay CV. We concluded that Immulite-TSH is a rapid and precise third-generation assay, totally automated and the results can be provided to the clinician within 1 to 2 h of receipt of the patient's sample.

Chylous cysts of the mediastinum: report of a case and review of the literature.

Life-threatening spontaneous chylothorax is a rare clinical entity. Correct diagnosis and understanding of its pathogenesis is paramount in order to apply definite surgical treatment. A case of a ruptured multilocular chylocyst around the thoracic duct and cysterna chyli is presented. Multiple bilateral aspirations, right thoracostomy, right thoracotomy, a frustrated attempt to ligate the thoracic duct, and an attempt to insert a pleuroperitoneal shunt, were all unsuccessful. Definite surgery accomplished rehabilitation of the patient after a 5 1/2 month hospitalization. Revision of the literature and vindicative historical facts are presented.