The Effect of Honey, Aloe Vera, and Hydrocolloid Dressing on the Healing Process of Murine Excisional Wounds.

Chronic ulcers are a major health problem associated with high costs and a loss of quality of life. Because of this, the search for products that accelerate wound healing is a constant, given the need for alternatives that help to alleviate this serious health problem. We analyzed the efficacy of 2 natural products-honey and aloe vera-versus hydrocolloid (HC) dressings as a control group in healing full-thickness wounds. For this purpose, we performed full-thickness excisions of the skin, including the panniculus carnosus, in mice. We inserted a nitrile ring into the subcutaneous cellular tissue simulating the second-intention wound healing course. We found that aloe vera reduced the diameter of the wounds compared to honey (p < .001) and the control group (p < .001).

Validation of the knowledge evaluation questionnaire of the cardiopulmonary resuscitation training program in high school students.

There is an urgent need for generalized training in cardiopulmonary resuscitation (CPR) techniques, starting with secondary education. Validated instruments for assessing the efficacy of such interventions are not yet available. This study aimed to validate an evaluation questionnaire of a CPR training program for high school students, to analyze the levels of readability, difficulty, reliability, and content validity, as well as the fit the purpose for which they were designed, the trait they are intended to measure. An instrumental study was conducted in 2 phases. In the first phase, an inter-judge validation was carried out with 11 experts in CPR accredited instructors of basic and advanced CPR by the American Heart Association. In the second phase, the psychometric properties were evaluated from the perspective of Item Response Theory. During May of the 2017/18 and 2018/19 academic years, 259 4th-year secondary school students from a high school in the southeastern area of the island of Gran Canaria (mean age: 15.78 years; 50.60% male) were surveyed anonymously using the questionnaire to be validated. The questionnaire was easily readable (74.12 Flesch-Szigriszt Index); the difficulty level (Easy/Very Easy) in the context of this secondary school level of education and the ability level of the respondents overlapped sufficiently and there was no gender bias. The questionnaire was able to discriminate between respondents of slightly more than 7 levels of expertise, from low knowledge of CPR to high knowledge of CPR (Separation Index 7.53). The model fit was excellent (infit = 1/outfit = 1.01). The content validity index was adequate. The separation index and reliability exceeded what was considered adequate for guaranteed use. The level of difficulty of the items and the level of ability of the respondents is in line with the educational level of the students. The questionnaire did not produce a gender bias in response probability. The questionnaire is easily understandable and can discriminate between different levels of ability without differential gender bias, and its reliability is outstanding, as it exceeds the minimum criteria.

Treatment of multiple sclerosis with rituximab: A Spanish multicenter experience.

Introduction: Rituximab (RTX) is considered a potential therapeutic option for relapsing-remitting (RRMS) and progressive forms (PMS) of multiple sclerosis (MS). The main objective of this work was to investigate the effectiveness and safety of rituximab in MS. Patients and methods: Observational multicenter study of clinical and radiological effectiveness and safety of rituximab in RRMS and PMS. Results: A total of 479 rituximab-treated patients were included in 12 Spanish centers, 188 RRMS (39.3%) and 291 (60.7%) PMS. Despite standard treatment, the annualized relapse rate (ARR) the year before RTX was 0.63 (SD: 0.8) and 156 patients (41%) had at least one gadolinium-enhanced lesion (GEL) on baseline MRI. Mean EDSS had increased from 4.3 (SD: 1.9) to 4.8 (SD: 1.7) and almost half of the patients (41%) had worsened at least one point. After a median follow-up of 14.2 months (IQR: 6.5-27.2), ARR decreased by 85.7% (p < 0.001) and GEL by 82.9%, from 0.41 to 0.07 (p < 0.001). A significant decrease in EDSS to 4.7 (p = 0.046) was observed after 1 year of treatment and this variable remained stable during the second year of therapy. There was no evidence of disease activity in 68% of patients. Infusion-related symptoms were the most frequent side effect (19.6%) and most were mild. Relevant infections were reported only in 18 patients (including one case of probable progressive multifocal leukoencephalopathy). Conclusion: Rituximab could be an effective and safe treatment in RRMS, including aggressive forms of the disease. Some selected PMS patients could also benefit from this treatment.

Association of Serum Neurofilament Light Chain Levels at Disease Onset With Disability Worsening in Patients With a First Demyelinating Multiple Sclerosis Event Not Treated With High-Efficacy Drugs.

Importance: The value of serum neurofilament light chain (sNfL) levels for predicting long-term disability in patients with multiple sclerosis (MS) remains controversial. Objective: To assess whether high sNfL values are associated with disability worsening in patients who underwent their first demyelinating MS event. Design, Setting, and Participants: This multicenter cohort study included patients who underwent their first demyelinating event suggestive of MS at Hospital Universitario Ramón y Cajal (development cohort; June 1, 1994, to September 31, 2021, with follow-up until August 31, 2022) and 8 Spanish hospitals (validation cohort; October 1, 1995, to August 4, 2020, with follow-up until August 16, 2022). Exposures: Clinical evaluations at least every 6 months. Main Outcomes and Measures: The main outcomes were 6-month confirmed disability worsening (CDW) and an Expanded Disability Status Scale (EDSS) score of 3. Levels of sNfL were measured in blood samples obtained within 12 months after disease onset using a single molecule array kit. The cutoffs used were sNfL level of 10 pg/mL and a standardized score (z score) of 1.5. Multivariable Cox proportional hazards regression models were used to evaluate outcomes. Results: Of the 578 patients included in the study, 327 were in the development cohort (median age at sNfL analysis, 34.1 years [IQR, 27.2-42.7 years]; 226 female [69.1%]) and 251 patients were in the validation cohort (median age at sNfL analysis, 33.3 years [IQR, 27.4-41.5 years]; 184 female [73.3%]). The median follow-up was 7.10 years (IQR, 4.18-10.0 years). Levels of sNfL greater than 10 pg/mL were independently associated with higher risk of 6-month CDW and an EDSS of 3 in the development cohort (6-month CDW: hazard ratio [HR], 2.39; 95% CI, 1.39-4.12; P = .002; EDSS of 3: HR, 4.12; 95% CI, 2.18-7.77; P < .001) and the validation cohort (6-month CDW: HR, 1.61; 95% CI, 1.07-2.42; P = .02; EDSS of 3: HR, 2.03; 95% CI, 1.23-3.33; P = .005). Highly effective disease-modifying treatments were associated with lower risks of 6-month CDW and an EDSS of 3 in patients with high baseline sNfL values. Conclusions and Relevance: This cohort study found that high sNfL values obtained within the first year of disease were associated with long-term disability worsening in MS, suggesting that sNfL level measurement may help identify optimal candidates for highly effective disease-modifying treatments.

Multi-centre validation of a flow cytometry method to identify optimal responders to interferon-beta in multiple sclerosis.

BACKGROUND AND OBJECTIVES: Percentages of blood CD19+CD5+ B cells and CD8+perforin+ T lymphocytes can predict response to Interferon (IFN)-beta treatment in relapsing-remitting multiple sclerosis (RRMS) patients. We aimed to standardize their detection in a multicenter study, prior to their implementation in clinical practice. METHODS: Fourteen hospitals participated in the study. A reference centre was established for comparison studies. Peripheral blood cells of 105 untreated RRMS patients were studied. Every sample was analyzed in duplicate in the participating centre and in the reference one by flow cytometry. When needed, participating centres corrected fluorescence compensations and negative cut-off position following reference centre suggestions. Concordance between results obtained by participating centres and by reference one was evaluated by intraclass correlation coefficients (ICC) and Spearman correlation test. Centre performance was measured by using z-scores values. RESULTS: After results review and corrective actions implementation, overall ICC was 0.86 (CI: 0.81-0.91) for CD19+CD5+ B cell and 0.89 (CI: 0.85-0.93) for CD8+ perforin+ T cell quantification; Spearman r was 0.92 (0.89-0.95; p <0.0001) and 0.92 (0.88-0.95; p <0.0001) respectively. All centres obtained z-scores≤0.5 for both biomarkers. CONCLUSION: Homogenous percentages of CD19+CD5+ B cells and CD8 perforin+ T lymphocytes can be obtained if suitable compensation values and negative cut-off are pre-established.

Los cuidados a la sociedad. La Seguridad Humana y la gestión del riesgo desde la perspectiva enfermera / Society cares. Human security and risk management from the nurse perspective

Los desafíos a los que las sociedades han de hacer frente en relación a la seguridad y a la gestión del riesgo son un reto para la enfermería y un nuevo campo de estudio denominado Cuidados a la sociedad. En relación a la seguridad, el Programa de Naciones Unidas para el Desarrollo abre un marco teórico que insta a los estados a formular políticas bajo el paraguas de la Seguridad Humana. La seguridad no debe contemplarse solo desde el punto de vista de ausencia de violencia física sino de garantía de derechos, oportunidades y calidad de vida de las personas. Por otro lado, los riesgos a los que las diferentes sociedades han de hacer frente son muchos y complejos y todos ellos son susceptibles de, por un lado, perjudicar la salud de los individuos, y por el otro, de generar amenazas a gran escala con capacidad para vulnerar la salud de la sociedad y alterar los sistemas sanitarios. La enfermería debe abordar estos conceptos determinantes y abarcar conocimientos más allá de los cuidados clínicos a los individuos y desarrollar los Cuidados a la sociedad

The challenges that the society has to tackle related to security and risk management are a dare for Nursery and a new field of study called Society Cares. In relation with the security, United Nations Program for Development develops a theoretical framework which urges the countries to create Human Security policies. Security must be taken into account not only as a lack of physical violence, but also as a guarantee of rights, opportunities and quality for people's lives. On the other hand, all societies have to tackle a lot of different and difficult risks and all of them may be prejudicial for people's health and they can also create threats on a large scale and are able to hurt society health and to change healthy systems. Nursery must deal with these determining concepts and cover knowledge which goes beyond people's clinical cares and it must also develop Society Cares

Validación de un cuestionario sobre la percepción del profesorado del manejo de situaciones de emergencias en el ámbito escolar / Validation of a questionnaire on the teaching staff’s view of how emergency situations are handled at school

OBJETIVOS: desarrollar un instrumento para evaluar la percepción de los profesores de su capacidad para el manejo y control de las situaciones de emergencias en el ámbito escolar no universitario, así como determinar la validez de constructo y la consistencia interna de dicho instrumento. MÉTODO: estudio de validación de un instrumento desarrollado en el curso 2009/10 en centros escolares no universitarios de la provincia de Las Palmas, con la participación de 432 profesores. Para determinar la estructura factorial y validez de constructo del cuestionario se llevaron a cabo un análisis factorial explora- torio y un análisis factorial confirmatorio. La consistencia interna se determinó mediante el Alpha de Cronbach. RESULTADOS: con base en el análisis factorial exploratorio se establecieron dos posibles soluciones estructurales, de cuatro y cinco factores. De acuerdo al análisis factorial confirmatorio el ajuste de ambos modelos fue bueno con un ligero mejor ajuste a favor del modelo de cuatro factores. Los coeficientes Alfa de Cronbach obtenidos fueron F1= 0,922; F2= 0,904; F3= 0,860; y F4= 0,815. La varianza explicada total, según el análisis de componentes principales, es de 65,59%. CONCLUSIONES: a expensas de que sería preciso aún llevar a cabo una validación discriminante y convergente, así como determinar la fiabilidad del test-retest, el cuestionario desarrollado para evaluar la capacidad del profesorado en el manejo y control de las situaciones de emergencias en el ámbito escolar presenta un adecuado fundamento psicométrico. Por lo tanto, se constituye como una herramienta válida y fiable que puede facilitar el aporte de soluciones integrales formativas adaptadas a las necesidades de los docentes

OBJECTIVE: to develop an instrument to evaluate the view of teaching staff on their ability to handle and control emergency situations in non-university school surroundings, and to determine the validity of the instrument's construct and its internal consistency. METHOD: a validation study conducted on an instrument developed over the 2009/10 academic year at non-university schools in the province of Las Palmas, with 432 participating teachers. In order to determine its factorial structure and validity of the questionnaire's construct, exploratory and confirmatory factorial analyses were carried out. Internal consistency was tested with the Cronbach Alpha. RESULTS: based on an exploratory factorial analysis, two possible structural solutions were established, of four and five factors. According to the confirmatory factorial analysis, both models were accordingly adjusted, with a slightly smaller adjustment in favour of the four factor model. The Cronbach Alpha coefficients obtained were F1= 0.922; F2= 0.904; F3= 0.860; and F4= 0.815. The total explained variance, according to the main component analysis, was 65.59%. CONCLUSIONS: without prejudice to the need for a discriminating and convergent validation and an examination of test-retest reliability, the questionnaire completed to evaluate the teaching staff's capacity to handle and control emergency situations in school surroundings is adequately justified in psychometric terms. Consequently, it is a valid and reliable tool that is able to provide comprehensive formative solutions adapted to teachers' needs

Effects of diazoxide in multiple sclerosis: A randomized, double-blind phase 2 clinical trial.

OBJECTIVE: The aim of this study was to test the safety of diazoxide and to search for signs of efficacy in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: In this multicenter, randomized, placebo-controlled, double-blind trial (treatment allocation was concealed), 102 patients with RRMS were randomized to receive a daily oral dose of diazoxide (0.3 and 4 mg/d) or placebo for 24 weeks (NCT01428726). The primary endpoint was the cumulative number of new T1 gadolinium-enhancing lesions per patient, recorded every 4 weeks from week 4 to week 24. Secondary endpoints included brain MRI variables such as the number of new/enlarging T2 lesions and the percentage brain volume change (PBVC); clinical variables such as the percentage of relapse-free patients, relapse rate, and change in the Expanded Disability Status Scale score; and safety and tolerability. RESULTS: Diazoxide was well-tolerated and it produced no serious adverse events other than 1 case of Hashimoto disease. At the 2 doses tested, diazoxide did not improve the primary endpoint or the MRI and clinical variables related to the presence of new lesions or relapses. Patients treated with diazoxide showed reduced PBVC compared with the placebo group, although such changes could be confounded by the higher disease activity of the treated group and the vascular effects of diazoxide. CONCLUSION: At the doses tested, oral diazoxide did not decrease the appearance of new lesions evident by MRI. The effects in slowing the progression of brain atrophy require further validation. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with RRMS, diazoxide (0.3 and 4 mg/d) does not significantly change the number of new MRI T1 gadolinium-enhancing lesions.

Análisis de las causas de exodoncia en dentición permanente en pacientes que acuden a la consulta de odontología de un Centro de Salud de Atención Primaria / Analysis of the causes of permanent teeth extraction in patients that attend a Dentistry Practitioner at a Primary Care Centre

Introducción: El presente estudio persigue conocer las causas de exodoncia en la consulta de odontología de Atención Primaria en el Centro de Salud Juncal (Torrejón de Ardoz) y valorar que diente/s es/son los más subsidiarios de ser extraídos, ver si hay un mayor número de exodoncias según edad y sexo, conocer la frecuencia de extracciones en población inmigrante y conocer la carga que suponen las exodoncias en el contexto de la presión asistencial diaria en la unidad de Salud bucodental. Método: Realizamos un estudio de campo, epidemiológico descriptivo, observacional transversal, siendo la población de estudio los pacientes mayores de 6 años que acuden a la consulta a demanda de odontología de Atención Primaria y que se les exodoncia uno o varios dientes de la dentición permanente. Resultados: Se realizaron 773 exodoncias, un 48% a varones y un 52% a mujeres. La media de edad fue 46,72 años y el grupo con mayor número de exodoncias fue el comprendido entre 60-69 años (21,73 %). La caries fue la causa más frecuente de exodoncia (63,9%), seguida de la enfermedad periodontal (17,6%) y la alteración de la erupción de los cordales (6,7 %). Conclusiones: Es necesario potenciar el desarrollo de actividades de promoción y prevención dental en la población infantil de 6-15 años en Atención Primaria e implementar actividades de higiene oral en población adulta, para disminuir la tasa de exodoncias en las unidades de Salud bucodental (AU)

Introduction: The aim of this study is to describe the causes of tooth extraction in the Primary health dental clinic in Juncal health Centre (Torrejón de Ardoz) and evaluate which tooth/teeth is/are the most susceptible to be extracted, determinate if there is a high number of dental extractions depending of the age and sex, know the dental extraction incidence in the immigrant population and the burden of tooth extractions into the daily healthcare context at the Oral health unit. Method: An epidemiological descriptive, prospective observational field study has been done, in the study population of patients older than 6 years of age who come to the Primary health dental clinic demanding treatments and one or several permanent teeth extractions. Results: 773 tooth extractions were done: 48% in male and a 52% in female. The average age was 46.72 years and the group with the highest number of dental extractions was the one between 60-69 years old (21.73%). Caries was the main reason of tooth extraction (63.9%), followed by the periodontal disease (17.6%) and the wisdom tooth problems (6.7%). Conclusions: Dental promotion is necessary to encourage the development of preventive activities among child population between 6-15 years old in Primary health and improving oral hygiene conduct among adult population to reduce the rate of tooth extractions at the Oral health unit (AU)

First report of parasitism by Ophidascaris robertsi (Nematoda) in a sugar glider (Petaurus breviceps, Marsupialia).

Third-stage larvae of Ophidascarsis robertsi (Nematoda: Ascaridoidea) were found on necropsy in a female sugar glider, Petaurus breviceps (Marsupialia: Petauridae), two in heart chambers and one free in the peritoneal cavity. The animal was bred in captivity and had previous contact with Australian pythons captured in nature, which could be the source of the infection. The histopathologic diagnosis was intraluminal and perivascular pulmonary hemorrhage possibly due to the parasitosis. It is the first report of parasitism by O. robertsi in a sugar glider.

¿Están los profesores de los centros escolares de la provinciade Las Palmas preparados ante situaciones de emergencias? / Are the professors in schools at the Las Palmas province prepared for emergency situations?

Objetivo: describir el nivel de vulnerabilidad al que está sometida la comunidad educativa, según el nivel formativo de los profesores y estudiantes como primeros respondientes. Metodología: estudio descriptivo transversal a una muestra de 432profesores a los que se les pasó un cuestionario de respuesta estructurada, tipo Likert, durante el curso escolar 2009-2010.Resultados: se destaca que un 50% de los docentes encuestados no es consciente ni percibe riesgos en sus actividades cotidianas, por lo que tampoco tiene actitudes de autoprotección. Además, su formación y capacitación básica para hacer frente a situaciones de urgencias en el centro no parece ser la apropiada, ya que solo un 23,13%de la muestra se considera preparada o bien preparada para hacer frente e intervenir en una situación de urgencia, mientras que el 31,12%se considera nada preparado y el 45,40% poco preparado. Por otra parte, a pesar de que se hacen simulacros en la mayoría de los centros(71,7%), no existen programas específicos de autoprotección y prevención para el alumnado. Conclusiones: en la comunidad escolar estudiada, los niveles objetivos de vulnerabilidad de la comunidad educativa son preocupantes en cuanto a que no están lo suficientemente formados. Aunque estos datos no constituyen una novedad, y son fuente continua de preocupación por parte de los equipos directivos de los centros educativos por la alta responsabilidad civil e incluso penal que ello conlleva, se debe seguir insistiendo en la formación y en la preparación de los docentes, dado que la realidad escolar así lo demanda, sobre todo, cuando lo que se preconiza es un modelo de integración de los niños con problemas de salud crónicos. La figura de la enfermera escolares la respuesta apropiada para establecer una atención de salud escolar segura, eficaz y eficiente (AU)

Objective: to describe the level of insecurity the educational community is subject to, according to the level of training by professors and students as first respondents. Methodology: transversal descriptive study on a sample of 432 professors, who answered a Likert-type structured response questionnaire, during the 2009-2010 term. Results: it stands out that 50% of professors included in the survey are neither aware of nor perceive any risks in everyday activities, and therefore they don’t have any self-protection attitudes either. Moreover, their basic training for facing emergency situations at school does not seem to be appropriate, as only 23.13% of the sample consider themselves to be prepared or well prepared to face and act in an emergency situation, while 31.12% consider themselves not prepared, and 54-40% not well prepared. On the other hand, even though emergency drills are conducted in most schools (71.7%),there are no specific self-protection and prevention programs for pupils. Conclusions: in the school community subject to this study, the objective levels of insecurity in the educational community are a matter of concern, in terms of not having enough training. Even though these data are not new, and represent a continuous source of concern by the school managing teams, regarding the high civil and even criminal responsibility entailed, it is necessary to keep insisting upon the training and preparation of teachers, because school reality demands it, particularly when aiming at a model of integration for children with chronic conditions. The school nurse is the adequate answering order to establish a safe, effective and efficient school healthcare (AU)

Expansion of the NKG2C+ natural killer-cell subset is associated with high-risk carotid atherosclerotic plaques in seropositive patients for human cytomegalovirus.

OBJECTIVE: Human cytomegalovirus (HCMV), a pathogen involved in the development and progression of atherosclerosis, promotes in some individuals a marked reconfiguration of the natural killer (NK)-cell compartment whose hallmark is a persistent expansion of a peripheral blood NK-cell subset expressing the CD94/NKG2C NK receptor. We aimed to evaluate whether the HCMV-associated NK-cell compartment reconfiguration is related to carotid atherosclerotic plaque (CAP) instability. APPROACH AND RESULTS: NK receptor expression (ie, LILRB1, NKG2A, NKG2C, and killer immunoglobulin-like receptors [KIR]) by peripheral NK and T cells was evaluated in 40 patients with HCMV+ with CAP, including nonatherosclerotic strokes (n=15) and healthy subjects (n=11) as controls. High-risk CAP (n=16), defined as carotid stenosis >50% with ipsilateral neurological symptomatology in the previous 180 days, compared with non-high-risk CAP had higher %NKG2C+ NK cells (29.5 ± 22.4% versus 16.3 ± 13.2%; P=0.026; odds ratio, 1.053; 95% confidence interval, 1.002-1.106; P=0.042), with a corresponding reduction in the NKG2A+ NK subset (31.7 ± 17.8% versus 41.8 ± 15.8%; P=0.072). The proportions of NKG2C+ NK cells in high-risk CAP were inversely correlated with the CD4+/CD8+ ratio (R(Spearman)=-0.629; P=0.009) and directly with high-sensitivity C-reactive protein levels (R(Pearson) = 0.591; P=0.012), consistent with higher subclinical systemic inflammation. The intraplaque inflammatory infiltrate, evaluated in 27 CAP obtained after endarterectomy, showed a higher presence of subintimal CD3+ lymphocytes in those patients with HCMV-induced changes in the peripheral NK- and T-cell compartments. CONCLUSIONS: The expansion of NKG2C+ NK cells in patients with CAP seems to be associated with an increased risk of plaque destabilization in some patients with chronic HCMV infection.

Factors associated with early outcome in patients with large-vessel carotid strokes.

OBJECTIVE: To describe the severity and early neurological deterioration (END) in patients with symptomatic carotid stenosis and to analyse the influence of related factors. METHODS: Observational cohort study of patients with ischaemic stroke, ipsilateral carotid stenosis and without evidence of cardiac sources of embolism prospectively recorded since January 2003 to January 2012. Initial severity was categorised as mild (NIH stroke scale (NIHSS) ≤7), moderate (NIHSS 8-14) or high (NIHSS >14). Logistic ordinal and regression analyses were performed for stroke severity and END risk. RESULTS: Of 2332 ischaemic strokes attended, 338 patients were included. Stroke severity was mild in 254 (75.1%) cases, moderate in 53 (15.7%) and severe in 31 (9.2%). Adjusted ORs (95% CI) for stroke severity were: degree of carotid stenosis, 2.20 (1.55 to 3.11, p<0.001); intracranial disease, 1.93 (1.18 to 3.17, p=0.009); plasma glucose, 1.01 (1.003 to 1.02, p<0.001); and previous transient ischaemic attack (TIA), 0.37 (0.17 to 0.82, p=0.014). 78 patients (23.1%) had END. Multivariate analysis showed independent association between END and degree of carotid stenosis (OR 1.64, 1.14 to 2.34, p=0.007), previous TIA (OR 2.40, 1.25 to 4.57, p=0.008) and mean arterial pressure (OR 1.02, 1.01 to 1.04, p=0.003). CONCLUSIONS: Strokes due to large vessel disease in the carotid artery are in general of mild severity and have a high rate of END. The degree of stenosis has a clear association with higher severity and END risk.

Previous infection and stroke: a prospective study.

BACKGROUND: Previous studies have demonstrated that infections might precipitate ischemic strokes (IS). We sought to describe, in a large prospective series, the frequency of previous infection (PI) in IS and intracerebral hemorrhage (ICH), and to assess whether any relationship with stroke subtype or outcome could be identified. METHODS: Between January 2005 and December 2010, we studied 1,981 patients with acute stroke. The presence of PI within the month before the stroke was prospectively assessed. PI was correlated with demographic data, vascular risk factors, stroke subtype, and 3-month outcome. RESULTS: A total of 193 (9.7%) patients had suffered a PI, the most common being respiratory tract infections (36.8%), flu or flu-like illness (30.1%), and gastrointestinal infections (12.4%). PI was more frequent in IS cases (10.2%) than in ICH (6.8%) (p = 0.081). Among IS cases, no differences were seen between PI and TOAST subtypes (p = 0.644). For IS, patients with PI were older (p = 0.025), had worse previous functional status (p = 0.002), suffered a more severe stroke (p = 0.002), achieved poor outcome (p = 0.001), and had higher 3-month mortality (p = 0.019). Multivariate analysis showed that IS patients with PI had previous poor functional status (OR = 1.58; p = 0.026) and suffered more severe strokes (OR = 1.02, p = 0.048). After adjustment for confounders, PI has no independent influence on 3-month outcome (OR = 1.15; p = 0.564). CONCLUSIONS: PI are observed in 9.7% of stroke cases without differences according to the TOAST subtype. PI are associated with previous poor functional status and with stroke severity, but have no independent influence on the 3-month outcome.

Oxigenoterapia de alto flujo mediante cánula nasal en urgencias pediátricas / High flow oxygen by nasal cannula in paediatric emergencies

La incorporación al servicio de urgencias pediátricas del sistema de administración de oxigenoterapia a alto flujo no invasivo ha demostrado su eficacia en el tratamiento de patologías respiratorias pediátricas, frente a los métodos tradicionales como los dispositivos de presión positiva continua (CPAP) o los sistemas de oxigenoterapia convencionales, como las gafas nasales. El sistema Vapotherm® abre la puerta a la posibilidad del control y tratamiento de patologías respiratorias en el niño que anteriormente precisaban de traslado a un servicio de cuidados críticos pediátricos. La puesta en marcha del nuevo sistema en el hospital donde trabajan los autores de este artículo hizo que se revisaran los procedimientos de actuación para los profesionales de Enfermería del citado servicio de urgencias pediátricas. El objetivo del presente trabajo es dar a conocer estos nuevos métodos que han supuesto la necesidad de creación y puesta en marcha de protocolos y programas de formación para los profesionales, permitiendo el desarrollo de nuevas competencias para mejorar la calidad científica y técnica de los cuidados enfermeros en las urgencias pediátricas (AU)

[Analysis of complaints in primary care using statistical process control]. / Análisis de las reclamaciones en atención primaria mediante el control estadístico de procesos.

OBJECTIVE: To analyze patient complaints in a Primary Health Care District (PHCD) using statistical process control methods compared to multivariate methods, as regards their results and feasibility of application in this context. MATERIAL AND METHOD: Descriptive study based on an aggregate analysis of administrative complaints. SETTING: Complaints received between January 2005 and August 2008 in the Customer Management Department in the 3rd PHCD Management Office, Madrid Health Services. Complaints are registered through Itrack, a computer software tool used throughout the whole Community of Madrid. MAIN VARIABLES: Total number of complaints, complaints sorted by Reason and Primary Health Care Team (PHCT), total number of patient visits (including visits on demand, appointment visits and home visits) and visits by PHCT and per month and year. STATISTICAL ANALYSIS: Multivariate analysis and control charts were used. RESULTS: 44-month time series with a mean of 76 complaints per month, an increasing trend in the first three years and decreasing during summer months. Poisson regression detected an excess of complaints in 8 out of the 44 months in the series. The control chart detected the same 8 months plus two additional ones. CONCLUSIONS: Statistical process control can be useful for detecting an excess of complaints in a PHCD and enables comparisons to be made between different PHC teams. As it is a simple technique, it can be used for ongoing monitoring of customer perceived quality.

Análisis de las reclamaciones en atención primaria mediante el control estadístico de procesos / Analysis of complaints in primary care using statistical process control

Objetivo: Analizar las reclamaciones de un área de atención primaria mediante técnicas de control estadístico de procesos, y compararlas con técnicas multivariables en cuanto a sus resultados y su factibilidad de aplicación en este medio. Material y método: Estudio descriptivo con análisis agregado de las reclamaciones administrativas. Período del estudio: reclamaciones recibidas desde enero de 2005 a agosto de 2008. Fuente de datos: la Unidad de Gestión de Usuarios de la Gerencia de Atención Primaria Área 3, Servicio Madrileño de Salud registra las reclamaciones en el programa track, utilizado en toda la Comunidad de Madrid. Mediciones principales: número total de reclamaciones, reclamaciones por motivo y por equipo de atención primaria, número de consultas totales (incluye consultas a demanda, concertadas y domicilio) y consultas por EAP, mes y año. Análisis estadístico: aplicación de técnicas multivariables y gráficos de control. Resultados: Serie temporal de 44 meses con una mediana de 76 reclamaciones/mes, una tendencia incremental en los primeros 3 años y descensos durante el verano. La regresión de Poisson permite detectar un exceso de reclamaciones en 8 de los 44 meses de la serie. El gráfico de control identifica los mismos puntos y 2 adicionales. Conclusiones: El control estadístico de procesos puede resultar útil para detectar excesos de reclamaciones en un área de salud y comparar entre unidades asistenciales. Su fácil aplicación permite realizar una monitorización continua de la calidad percibida por los usuarios (AU)

Objective: To analyze patient complaints in a Primary Health Care District (PHCD) using statistical process control methods compared to multivariate methods, as regards their results and feasibility of application in this context. Material and method: Descriptive study based on an aggregate analysis of administrative complaints. Setting: Complaints received between January 2005 and August 2008 in the Customer Management Department in the 3 rd PHCD Management Office, Madrid Health Services. Complaints are registered through track, a computer software tool used throughout the whole Community of Madrid. Main variables: Total number of complaints, complaints sorted by Reason and Primary Health Care Team (PHCT), total number of patient visits(including visits on demand, appointment visits and home visits) and visits by PHCT and per month and year. Statistical analysis: Multivariate analysis and control charts were used. Results: 44-month time series with a mean of 76 complaints per month, an increasing trend in the first three years and decreasing during summer months. Poisson regression detected an excess of complaints in 8 out of the 44 months in the series. The control chart detected the same 8 months plus two additional ones. Conclusions: Statistical process control can be useful for detecting an excess of complaints in a PHCD and enables comparisons to be made between different PHC teams. As it is a simple technique, it can be used for ongoing monitoring of customer perceived quality (AU)

[Lipid profile evolution during the first year of treatment with beta interferon in multiple sclerosis]. / Perfil lipídico durante el primer año de tratamiento con interferón beta en pacientes con esclerosis múltiple.

BACKGROUND AND OBJECTIVE: Treatment with beta interferon (IFNbeta) might alter the lipid profile. Plasmatic levels of total cholesterol and low density lipoprotein-cholesterol have been associated with the number of plaques in magnetic resonance of patients with demyelinating syndromes. PATIENTS AND METHOD: Retrospective analysis of total cholesterol and triglyceride levels during the first year of treatment with IFNbeta in multiple sclerosis patients and association between lipid levels and disease activity, compared to patients using glatiramer acetate (GA). RESULTS: 84 patients under IFNbeta and 23 GA patients were studied. Mean total cholesterol plasmatic levels lowered during the first year, whereas triglyceride levels rose since the first 6 months. These changes were more intense in the IFNbeta(1a) intramuscular group. No changes were observed in the GA group. Lipid changes were not associated with disease activity. CONCLUSIONS: In multiple sclerosis patients, triglyceride levels rise whereas total cholesterol levels decrease during the first year of treatment with IFNbeta. These changes do not seem to be related with disease activity.