[Professional and psychological impact of second victims among hospital healthcare professionals]. / Impacto laboral y psicológico de las segundas víctimas entre los profesionales sanitarios hospitalarios.

OBJECTIVE: To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV). MATERIAL AND METHODS: Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05. RESULTS: 75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6). CONCLUSIONS: Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.

[Small bowel tumors: experience at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"]. / Tumores de intestino delgado: experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

BACKGROUND: Malignant tumors of the small bowel are uncommon and include multiple histologic strains, which helps explain the existing limited understanding of them. The aim of this study was to evaluate surgically treated small bowel tumors and to determine the clinical and pathological characteristics that can have an impact on patient outcome. METHODS: A retrospective, observational, and descriptive study was carried out. The case records of patients with small bowel tumor that were surgically treated at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" from 1990 to August 2011 were analyzed using the SPSS version 17.0 statistical package. RESULTS: Thirty-eight small bowel tumor patients were found that had been operated on within the time frame studied. Fifteen of them were women (39.50%) and 23 were men (60.50%), and the mean age was 55.6 years. The histologic distribution was 13 adenocarcinomas (34.20%), 10 neuroendocrine tumors (26.30%), 8 sarcomas (21.10%) and 4 lymphomas (10.50%). There was an increase in the incidence of sarcomas and adenocarcinomas, whereas lymphomas and neuroendocrine tumors were evenly distributed. CONCLUSIONS: An increase in small bowel tumor incidence in the last few years was observed and adenocarcinoma was the most frequent tumor in the study population. It is important to have a high degree of suspicion for this disease when patients present with symptoms such as gastrointestinal bleeding, bowel obstruction, anemia, and weight loss, because early diagnosis is essential for guaranteeing favorable outcome.

Aplicación de un programa de control de infecciones intrahospitalarias en establecimientos de salud de la Región San Martín, Perú / Implementation of a nosocomial infection control program in health facilities in San Martin region, Peru

Objetivo: Aplicar un programa de control de infecciones intrahospitalarias (IIH) para modificar conocimientos, actitudes y prácticas (CAP) del personal de salud y su efecto sobre la prevalencia de IIH en establecimiento de salud de San Martín, Perú, Julio 2000-Enero 2001. Materiales y métodos: Estudio prospectivo de intervención. Se determinó la prevalencia basal, intermedia y final de IIH y se evaluó los cambios en CAP con la metodología investigación-acción. Participó personal del Hospital de Apoyo Banda Shilcayo (HABS), Hospital Nueva Cajamarca (HNC), Centro Materno Perinatal, Centro de Salud LLuyllucucha, localizados en zonas rurales. Se utilizaron indicadores estandarizados nacionales. Resultados: Los médicos tuvieron la menor participación (62,0 por ciento); y el personal técnico la mayor (90,0 por ciento). Las prácticas adecuadas de lavado de manos y materiales, utilización de ropas y guantes, manejo de objetos punzo-cortantes y exposición afluidos aumentaron significativamente (p<0,01). El mismo comportamiento tuvieron las actitudes de limpieza, desinfección y esterilización en centro quirúrgico. El HABS presentó la prevalencia basal más alta de IIH (26,8 por ciento), mientras que el HNC la menor (15,4 por ciento). 36,0 por ciento fueron casos de gérmenes aislados en hemocultivos de pacientes sin foco infeccioso establecido. 36,0 por ciento correspondió a infecciones de herida operatoria, 5,0 por ciento neumonías, 2,0 por ciento endometritis puerperales, 5,0 por ciento infecciones en pacientes quemados y 16,0 por ciento infecciones urinarias. Enterobacter aerógenes (32,0 por ciento) y Pseudómonas aeuroginosa (24,0 por ciento) fueron las bacterias más frecuentes. La prevalencia de IIH disminuyó (de 25,7 por ciento a 15,2 por ciento) (p>0,05). Conclusiones: La aplicación de un programa de control de IIH logró mejorar significativamente las actitudes y prácticas en establecimientos de salud de San Martín, Perú