Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios.

PURPOSE: Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS: The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS: Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION: MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

Procedimiento radioguiado en la cirugía mínimamente invasiva del hiperparatiroidismo primario / Radio-guided procedure in minimally invasive surgery for primary hyperparathyroidism

La paratiroidectomía mínimamente invasiva, de elección en la mayoría de casos de hiperparatiroidismo primario, muestra una elevada tasa de detección, fundamentada en una precisa localización preoperatoria mediante gammagrafía con MIBI (SPECT/TC) y ecografía cervical. La paratiroidectomía mínimamente invasiva radioguiada es una técnica aún más efectiva, acorta los tiempos quirúrgicos y mantiene una mínima incisión y escasas complicaciones; permite además la comprobación inmediata de la exéresis de la lesión paratiroidea y es especialmente interesante en pacientes con adenomas ectópicos o antecedentes quirúrgicos cervicales. En el presente trabajo se exponen las indicaciones, los protocolos y las diferencias entre los dos procedimientos disponibles de cirugía radioguiada mínimamente invasiva de paratiroides (MIBI y ROLL). (AU)

Minimally invasive parathyroidectomy, of choice in most cases of primary hyperparathyroidism, shows a high detection rate, based on precise preoperative localization by MIBI scintigraphy (SPECT/CT) and neck ultrasound. Radio-guided minimally invasive parathyroidectomy is an even more effective technique, which shortens surgical times, maintains minimal incision and few complications, allows immediate verification of parathyroid adenoma removal and is especially interesting in patients with ectopic lesions or cervical surgical history. In this paper, the indications, protocols and differences between the two available radio-guided parathyroid surgery procedures (MIBI and ROLL) are exposed. (AU)

Radio-guided procedure in minimally invasive surgery for primary hyperparathyroidism.

Minimally invasive parathyroidectomy, of choice in most cases of primary hyperparathyroidism, shows a high detection rate, based on precise preoperative localization by MIBI scintigraphy (SPECT/CT) and neck ultrasound. Radioguided minimally invasive parathyroidectomy is an even more effective technique, which shortens surgical times, maintains minimal incision and few complications, allows immediate verification of parathyroid adenoma removal and is especially interesting in patients with ectopic lesions or cervical surgical history. In this paper, the indications, protocols and differences between the two available radioguided parathyroid surgery procedures (MIBI and R.O.L.L.) are exposed.

High-risk clones and novel sequence type ST4497 of Klebsiella pneumoniae clinical isolates producing different alleles of NDM-type and other carbapenemases from a single tertiary-care centre in Egypt.

Enterobacteria producing NDM carbapenemases represent a severe diagnostic and therapeutic challenge in healthcare settings. Infections caused by NDM-positive strains are usually associated with high mortality rates and very limited treatment options. A total number of 33 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates were included in this study, comprising 30 recovered from clinical diagnostic samples and 3 cultured from screening rectal swabs taken at patient admission. Bacterial identification was performed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) and antibiotic susceptibility testing was performed by reference broth microdilution and a commercial automated method. Isolates were investigated for carbapenemase production using the ß-CARBA test, the modified carbapenem inactivation method (mCIM) and, for the 30 clinical isolates, by MALDI-TOF/MS, using the MBT STARⓇ-Carba IVD Kit. Carbapenem resistance genes were characterised by PCR and sequencing. Seven different blaNDM gene variants were identified in 94% of the isolates, whilst three variants of blaOXA-48-like were detected in 27% of the isolates. Most CRKP corresponded to high-risk clones (ST147, ST11 and ST15). Novel ST4497 is reported for the first time in this study as well as the first emergence of K. pneumoniae ST231 producing OXA-232 in Egypt. These results indicate an ongoing evolution of the blaNDM genes in our area and confirm the need for a maintained surveillance system in order to monitor the spread of these mobile blaNDM genes.

Medicalizar los equipos de rescate en montaña: justificación socio-económica en base a la evolución de la mortalidad en el Pirineo Central / Medicalization of mountain rescue teams: social and economic approach based on mortality evolution in Central Pyrenees

Introducción: El montañismo mejora la salud física y mental de las personas que los practican contribuyendo a lograr un menor gasto socio-sanitario. Todos los deportes tienen efectos colaterales no deseados: accidentes y lesiones. Las operaciones de rescate en montaña implican dificultades logísticas y ambientales que exponen a numerosos e importantes riesgos, pero se han incorporado sanitarios en estas operaciones de rescate ya que acortar los tiempos de intervención médica y el tratamiento apropiado in situ disminuyen la morbi-mortalidad de los accidentados. En España hay muchas Comunidades Autónomas (CCAA) sin rescate en montaña medicalizado. La realidad de los accidentes de montaña: En España hay 5,4 muertos por cada 100 rescatados en montaña. En Aragón, se contabilizan 3,5 muertos/100 accidentados rescatados. El 11,3% de los rescatados en Aragón entre 1999 y 2008 presentaba un índice Glasgow entre 13 y 9 y el 12,9% tenían un Glasgow < 9 (grave). Un 6,3% de los pacientes rescatados sufrieron politraumatismos. Un 63,7% de los rescatados presentaban un índice de gravedad NACA≥III que hace referencia a pacientes que requieren asistencia médica en el lugar del accidente. En Aragón se medicaliza el rescate en montaña desde 1998. También están medicalizados estos rescates en Asturias, Cantabria y Castilla-León. Los efectos de la medicalización del rescate en montaña: Existen claras diferencias entre las prestaciones que establecen unas CCAA y otras. La "medicalización del rescate" supone un médico o enfermera específicamente formado en Medicina de Urgencias en Montaña integrado en los equipos de rescate. Esto mejora la eficacia del primer tratamiento en el lugar del accidente, por difícil que sea el acceso, mejorando la supervivencia y disminuyendo la morbilidad. En Aragón, la tasa de mortalidad media ha pasado del 9,32% antes de la medicalización del rescate al 3,45% en los 15 años de rescate medicalizado con médicos y enfermeras CUEMUM, lo que supone una disminución del 62%. Mientras que la tasa de mortalidad media en España en el mismo periodo ha pasado del 8,8% al 6,8%; lo que supone una disminución del 12,5%. La relación coste-beneficio: Calculamos a la baja que los accidentes de montaña en España cuestan más de 375 millones Euros al año. En Aragón estimamos que superan los 50 millones Euros al año. La disminución de la tasa de mortalidad en un 62% ha supuesto un ahorro de más de 175 millones Euros. Conclusiones: La medicalización del rescate es un derecho y un deber con claros beneficios socio-sanitarios. La asistencia médica in situ disminuye la morbi-mortalidad y el gasto público. España debe mejorar la prevención, además de garantizar la medicalización de los rescates en todo el territorio con sanitarios formados en Medicina de Urgencias en Montaña

Introduction: Mountaineering improve the physical and mental health of people who practices it. All sports have a collateral not wished effects: accidents and sport injuries. Although mountain rescue operations involve logistic and environmental difficulties that expose everybody to important risks, alpine countries have joined sanitary people in these rescue operations because they know shorten times of medical intervention and an appropriate treatment in place diminish mortality and sequels, and consequently, social and sanitary expenses. Many mountain regions in Spain have not medical services in mountain rescue teams. The facts of mountain casualties: There were 5,4 fatalities for every 100 rescued people in mountains in Spain. There were 3,5 fatalities for every 100 rescued people in Aragon. 6,3% of rescued patients suffered polytraumatisms. 63,7% of rescued people in mountains in Aragon presented a NACA index ≥ III (that means they need medical assistance in the place of the accident). 11,3% of people rescued in Aragon between 1999 and 2008 had a Glasgow Index among 13 and 9 and 12,9% had a Glasgow Index < 9. Mountain rescue operations are medicalized in Aragon since 1998. Also, mountain rescues are medicalized in Asturias, Cantabria y Castilla-León. Effects of medicalized mountain rescue operations: There are important differences between some regions in Spain about medical services in mountain rescues. Medicalization means to have a doctor or nurse specifically trained in Mountain Emergency Medicine integrated in rescue teams. This improves the efficiency of first treatments on the field, despite the difficulties of access, improving survival and diminishing morbidity. In Aragon, the rate of average mortality has changed from 9,32% before the medicalization of mountain rescue to 3,45% during medicalization with CUEMUM physicians and nurses, which supposes a decrease of 62% in 15 years. Whereas the rate of mortality in Spain was changed to 8,8% to 6,8% in the same period what supposes a decrease of 12,5%. Cost-benefit analysis: We calculate downwards that mountain casualties in Spain costs more than 375 million Eurosper year. They overcome 50 million Euros per year in Aragon. This region has save of more than 175 million Euros with this decrease of mortality of 62%. Conclusions: Medicalization of mountain casualties is a human right and a duty with clear social and sanitary benefits. The medical assistance on the field diminishes morbidity and mortality and the public expenditure. Spain must to improve the prevention and to guarantee the medicalization of mountain rescues in the whole Spanish regions with nurses and physicians trained in Mountain Emergency Medicine

Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña / Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia

Introducción. Un ambiente laboral favorable facilita que las enfermeras realicen su trabajo con mayor satisfacción y en mejores condiciones, hecho que podría influir en la calidad de los resultados obtenidos en los centros sociosanitarios. Los objetivos del estudio fueron: 1) Identificar la tipología de centros en función del ambiente laboral percibido por las enfermeras; y 2) describir las características individuales de las enfermeras relacionadas con dicha valoración. Métodos. Estudio observacional, descriptivo, prospectivo y transversal, multicéntrico realizado el último trimestre de 2014. Se administró a las enfermeras de las unidades de atención intermedia un cuestionario con el Practice Environment Scale of the Nursing Work Index (PES-NWI), que evalúa 5 factores del entorno laboral mediante 31 ítems. Se recogieron también variables sociodemográficas, laborales/profesionales y formativas. Resultados. De 501 enfermeras en 14 centros participaron 388 (77% de respuesta). La puntuación media del PES-NWI fue 84,75. Nueve centros obtuvieron una valoración del entorno laboral «favorable» y 5 «mixto». El factor mejor valorado fue «relaciones laborales» y el peor «dotación/adecuación de recursos». El turno de trabajo rotativo, trabajar en varias unidades, tener responsabilidades de gestión y tener máster universitario fueron características de las enfermeras que se relacionaron con una mejor percepción del entorno. Conclusiones. En la mayoría de los centros el ambiente laboral fue percibido como favorable. Algunas características laborales/profesionales y formativas se relacionaron con la valoración del entorno laboral (AU)

Introduction. A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. Methods. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. Results. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a 'favourable' working environment and five 'mixed'. The best valued factor was 'work relations' and the worst was 'resource provision/adaptation'. Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. Conclusions. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment (AU)

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia]. / Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña.

INTRODUCTION: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. METHODS: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. RESULTS: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. CONCLUSIONS: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.

[SANITARY WASTE IN THE HOSPITAL SETTING: ATTITUDE OF HEALTH PROFESSIONALS TOWARD ADVANCED MANAGEMENT OF SANITARY WASTE]. / Residuos sanitarios en el ámbito hospitalario (y 3).

OBJECTVE: The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. METHODS: Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in,the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. RESULTS: Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 andp = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. CONCLUSIONS: The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service.

[MANAGEMENT OF HEALTHCARE WASTE IN THE HOSPITAL SETTING. UNDERSTANDING RISK MANAGEMENT]. / Gestión de los residuos sanitarios en el ámbito hospitalario (2).

UNLABELLED: The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. OBJECTIVE: To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). METHODOLOGY: The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. RESULTS: Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 and 4.03, respectively. Referring to items with free and spontaneous response association, 44.8% of workers consider HW as a biohazard, 29.6% consider it as waste material, 22.1% state that it must be managed properly and 3.5% described it as unknown residues. CONCLUSION: The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW A 63.2% report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8% that are harmful to public health. Although it should be noted that only 44.8% think that HW are toxic and dangerous.

Residuos sanitarios en el ámbito hospitalario (y 3). Actitud de los profesionales de la salud frente a la gestión avanzada / Sanitary waste in the hospital setting: attitude of health professionals toward advanced management of sanitary waste

Objetivos. Conocer la actitud que tienen los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio frente a la gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo transversal de la variable Actitud y explicativo del grado de concordancia entre Actitud, Conocimiento y Percepción de Riesgo. El tamaño de la muestra fue de 176 profesionales sanitarios de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de 44 ítems con respuestas medidas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. La Actitud media de los profesionales sanitarios estudiados es de 4.40, con una desviación típica de 0.4, en una escala de 1 a 5 donde 1 se considera una Actitud muy negativa y 5 muy positiva. De acuerdo con los valores obtenidos con la Categoría Profesional, tenemos que los técnicos auxiliares de cuidados de enfermería dan un valor medio de Actitud de 4.45, las enfermeras de 4.36, los médicos de 4.27 y los técnicos de laboratorio de 4.47. En los coeficientes de correlación de Pearson entre la Actitud, la Percepción de Riesgo, la Valoración Global y el Nivel de Conocimiento, se obtuvieron unos valores de r = 0.172 y p = 0.023, r = -0.156 y p = 0.039, y r = 0.013 y p = 0.865, respectivamente. Tras analizar los valores promedio de las variables Conocimiento, Percepción de Riesgo, Actitud y Valoración Global, se obtuvieron diferencias significativas a través del ANOVA, en nivel de Conocimiento en función de la Categoría Profesional y Servicio Asistencial, no así en el resto de categorías. Conclusiones. El análisis de los resultados sugiere que los profesionales de la salud tienen, en general, una Actitud muy positiva frente a la gestión de los RS. Se observa una relación muy significativa entre la Actitud, la Percepción de Riesgo y la Valoración Global. En cuanto al análisis de la Varianza, se obtuvo una diferencia significativa en el nivel de Conocimiento según la Categoría Profesional y el Servicio Asistencial (AU)

Objective. The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. Methods. Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. Results. Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 and p = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. Conclusions. The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service (AU)

Gestión de los residuos sanitarios en el ámbito hospitalario (2): Percepción de riesgo frente a la gestión / Management of healthcare waste in the hospital setting. Understanding risk management

Objetivo. Identificar la percepción de riesgo que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo y/o explicativo. El tamaño de la muestra fue de 177 participantes (técnicos auxiliares en cuidados de enfermería, enfermeras, médicos y técnicos de laboratorio) de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, para analizar las variables laborales y de percepción de riesgo para la salud laboral y la seguridad personal, tanto para la población en general como para la salud pública, con preguntas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. El nivel medio de percepción de riesgo de los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (baja percepción) a 5 (alta percepción), es de 3.71, 3.75, 3.83 y 4.03, respectivamente. En referencia a los ítems con respuesta de asociación libre y espontánea, el 44.8 % de profesionales consideran los RS un riesgo biológico, el 29.6 % lo consideran material de desecho, el 22.1 % manifiestan que deben gestionarse correctamente y un 3.5 % los describen como residuos desconocidos. Conclusiones. Los resultados sugieren que todos los profesionales de la salud tienen en general una percepción de riesgo alta, siendo los técnicos de laboratorio los que tienen una percepción más alta respecto al riesgo real de la gestión inadecuada de los RS. El 63.2 % manifiesta que se ha de realizar una gestión adecuada para preservar su salud laboral; el 59 % responde que son un riesgo biológico para la población en general y el 47.8 % que son nocivos para la salud pública. Aunque cabe destacar que solo el 44.8 considera que los RS son tóxicos y peligrosos (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). Methodology. The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. Results. Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 y 4.03, respectively. Referring to items with free and spontaneous response association, 44.8 % of workers consider HW as a biohazard, 29.6 % consider it as waste material, 22.1 % state that it must be managed properly and 3.5 % described it as unknown residues. Conclusions. The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW. A 63.2 % report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8 % that are harmful to public health. Although it should be noted that only 44.8 % think that HW are toxic and dangerous (AU)

Gestión de los residuos sanitarios en el ámbito hospitalario. Nivel de conocimiento y valoración Global / Sanitary waste in the hospital setting: Knowledge level and overall rating

Los residuos sanitarios representan un peligro potencial para los trabajadores sanitarios. Dado el alto riesgo de infección en los accidentes laborales, la gestión correcta de los residuos sanitarios minimiza el riesgo y mejora las condiciones laborales y ambientales. Objetivos. Identificar el nivel de conocimiento que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS) y valorar de forma global la gestión de los mismos. Metodología. Estudio descriptivo transversal con 178 participantes (auxiliares, enfermeras, médicos y técnicos de laboratorio), de 3 hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, que analizabalas variables laborales, el conocimiento y la valoración global de la gestión de los RS. Resultados. El nivel medio de conocimiento sobre los RS delos auxiliares, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (valor mínimo) a 15 (valor máximo), es de 10.59, 10.61, 8.92 y 8.39, respectivamente. La valoración global que hacen los auxiliares, las enfermeras, los médicos y los técnicos de laboratorio de la gestión de los RS en una escala de 1 (valor mínimo) y 5 (valor máximo), es de 2.89, 2.93, 2.88, 2.94, respectivamente. Conclusiones. Los resultados sugieren que las enfermeras y los auxiliares tienen un nivel de conocimiento aceptable con respecto a la gestión correcta de los RS. En cambio, los médicos y técnicos de laboratorio tienen un nivel de conocimiento inferiorsobre la segregación y eliminación adecuada de los RS. En cuanto a la valoración global, se obtienen valores aceptables, y muy similares, entre las diferentes categorías de profesionales estudiadas, en relación con la gestión correcta de los RS en los centros asistenciales donde realizan su actividad laboral (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. The current study was aimed at identifying the knowledge that health workers have about classification and management of sanitary waste. Methodology. The current study is a descriptive, cross-sectional study of 178 health workers (physicians, nurses, nurse assistants, lab technicians) of 3 hospitals in Barcelona. Results. Using a score from 1 (minimum) to 15 (maximum) to assess the knowledge, the average value for nurse assistants, nurses, physicians and lab technicians was 10.59, 10.61, 8.92 and 8.39, respectively. The global assessment of sanitary waste management (using a score from 1 to 5) was 2.89, 2.93, 2.88 and 2.94, respectively. Conclusions. These results suggest that nurses and nurse assistants have a good level of knowledge about the management of sanitary waste. By contrast, physicians and laboratory technicians have a lower level of knowledge compared to nurses and nurse asistants in relation to segregation and disposal of sanitary waste. Concerning the global assessment, the level is good, without differences between the different categories of health workers (AU)

Description of the OXA-23 ß-lactamase gene located within Tn2007 in a clinical isolate of Acinetobacter baumannii from Spain.

A carbapenem-resistant Acinetobacter baumannii expressing blaOXA-23 was recovered from an intensive care unit patient in a third-level hospital from Spain. Genetic analysis showed the association of this carbapenemase with the transposon Tn2007 located in a plasmid of 10 kb. The isolate was classified as ST-1. This strain has shown a potential ability to displace other endemic strains in the hospital and is the first reported identification of A. baumannii carrying blaOXA-23 related to Tn2007 in Spain.

Prognostic factors and staging systems in parathyroid cancer: a multicenter cohort study.

BACKGROUND: Parathyroid carcinoma (PC) is an uncommon disease that generally is detected postoperatively and traditionally is associated with a poor prognosis. Our purpose was to evaluate treatment outcomes, prognostic factors, and usefulness of some proposed staging systems for this disease. METHODS: A multicenter review of patients with surgically resected PC was performed, led by the Spanish Association of Surgery. All surgical units affiliated with its endocrine surgery section were invited to answer a questionnaire that collected several hospital-related, clinical, biochemical, operative, pathologic, and follow-up data. Their relationships with prognosis were assessed by both univariate and multivariate analysis, as well as the effectiveness of three staging systems for parathyroid carcinoma. RESULT: Of the 6,863 patients undergoing parathyroidectomy, 62 (0.9%) had PC. Of them, 12 (19.3%) died, in 5 cases (8%) because of disease, and 14 (22.6%) suffered recurrence, after a median follow-up of 55 months. The most predictive independent variables on tumor recurrence were intraoperative tumor rupture (hazard ratio [HR] 6.22; 95% confidence interval [CI] 1.19-32.36; P = .030); the presence of mitotic figures within tumor parenchyma cells (HR 4.76; 95% CI 1.24-18.21; P = .022); and allocation in class III according to Schulte differentiated staging classification (HR 5.23; 95% CI 1.41-19.31; P = .013). As to disease-specific survival, poor outcomes were associated with intraoperative tumor rupture (HR 58.71; 95% CI 2.39-1,439.96; P = .013) and distant recurrence (HR 38.74; 95% CI 3.44-435.62; P = .003). CONCLUSION: In addition to factors associated with tumor histopathology and stage, prognosis of PC is greatly influenced by surgeon's performance, which emphasizes the importance of preoperative diagnosis.

Characterisation of the first ongoing outbreak due to KPC-3-producing Klebsiella pneumoniae (ST512) in Spain.

The aim of this study was to characterise carbapenem-resistant Klebsiella pneumoniae isolates that caused an outbreak in a hospital in the south of Spain, originating from a patient transferred in 2012 from Italy. Forty-four K. pneumoniae isolates, recovered from 28 patients, were screened by PCR for extended-spectrum ß-lactamase (ESBL) and carbapenemase genes and the products were further sequenced. Plasmids were transferred by electroporation and were classified using PCR-based Inc/rep typing and IncF subtyping. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to determine the genetic relatedness of the isolates. All isolates yielded positive modified Hodge test results, harboured bla(SHV-11), bla(TEM-1) and bla(KPC-3) genes, showed an identical PFGE pattern, and were assigned to clone sequence type 512 (ST512). The bla(KPC-3) gene was located on a 140-kb K2:A-:B-plasmid. In conclusion, the successful K. pneumoniae ST512 clone caused a major outbreak in Spain from an imported case and is the first description of an outbreak in this country due to the KPC-3-producing K. pneumoniae ST512 clone.

Aproximación a la gobernabilidad enfermera en la organización sociosanitaria en Cataluña / Approach to nurse governability at social and health centres in catalonia

La cuestionada sostenibilidad de la prestación sanitaria y el replanteamiento del modelo sociosanitario en Cataluña, permiten preguntarse sobre la gobernabilidad de las organizaciones sociosanitarias, u hospitales de media estancia, y su relación con la calidad asistencial. A través de la Teoría de la gobernabilidad se podrían explorarlos elementos del modelo sociosanitario y el rol mesogestor de la enfermera en laorganización: la toma decisiones, los intereses externos e internos, la misión y valores,y la facilitación de información y herramientas. La gobernabilidad enfermera esun concepto teórico medible con impacto claro y directo en la calidad y la sostenibilidad de los cuidados

Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers canexplore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia