Patient Safety Culture in a Tertiary Hospital: A Cross-Sectional Study.

Patient safety (PS) culture is the set of values and norms common to the individuals of an organization. Assessing the culture is a priority to improve the quality and PS of hospital services. This study was carried out in a tertiary hospital to analyze PS culture among the professionals and to determine the strengths and weaknesses that influence this perception. A cross-sectional descriptive study was carried out. The AHRQ Questionnaire on the Safety of Patients in Hospitals (SOPS) was used. A high perception of PS was found among the participants. In the strengths found, efficient teamwork, mutual help between colleagues and the support of the manager and head of the unit stood out. Among the weaknesses, floating professional templates, a perception of pressure and accelerated pace of work, and loss of relevant information on patient transfer between units and shift changes were observed. Among the areas for improvement detected were favoring feedback to front-line professionals, abandoning punitive measures and developing standardized tools that minimize the loss of information.

Evolution of the Public-Health Response to COVID-19 Pandemic in Spain: A Descriptive Qualitative Study.

The capacity of hospitals and primary care centres has, rightfully, been at the centre of public and political debate on resource availability and control measures during the outbreak of COVID-19 and lockdown. Thus, the aim of this study is to describe the public and professional perceptions towards the evolution of the COVID-19 public-health response, in order to analyse and learn lessons for future health policies in similar situations in the future. A descriptive qualitative study was conducted through 41 in-depth interviews between January and June 2021. Twenty-one healthcare professionals and twenty service users participated in our study. The participants were recruited using purposive sampling. After our data analysis, three main themes emerged: (i) experiences during an unprecedented public health threat: the impact and challenges of early control measures, and outcomes for the public image of nursing; (ii) overcoming the impact of the outbreak on the healthcare system: professional coping strategies in the context of the pandemic, and institutional considerations in hospitals and primary care; and (iii) the efficiency of resource management during the outbreak: perceptions of professionals and healthcare users. Health providers and service users demand structural and organisational changes, as well as resource-optimisation strategies for front-line workers. Nurses need to be involved in decision making in order to provide evidence-based guidelines and ensure well-resourced and supported care practice.

Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review.

AIM: To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster. BACKGROUND: The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care. EVALUATION: A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines. KEY ISSUES: Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster. CONCLUSIONS: Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Novice nurse's transitioning to emergency nurse during COVID-19 pandemic: A qualitative study.

AIM: To explore the experiences and perceptions of recent nursing graduates working in emergency departments during the COVID-19 outbreak. BACKGROUND: Overcrowding in emergency departments has been one of the most prominent issues arising in these units for more than 20 years. However, it has become even more problematic due to the novelty of the coronavirus pandemic, which has forced hospitals to recruit larger numbers of beginner nursing staff as the number of quarantined health professionals increases. METHODS: Sixteen semi-structured interviews were conducted in Spanish emergency departments, which were analysed and synthesized using content analysis. RESULTS: Three major themes emerged from the data analysis: (a) Fears and concerns, (b) Organisational issues and (c) Support for novice nurses. CONCLUSIONS: Our findings may help to understand how shadowing periods as a learning programme for nurses, continuing professional development, evidence-based apps and better planning are needed to ensure both novice nurses' confidence in emergency departments and expert emergency room nurses' ability to cope with complications in critical situations. IMPLICATIONS FOR NURSING MANAGEMENT: Training periods that include shadowing expert emergency room nurses, along with evidence-based technology, provide an opportunity to support novice nurses' transition into the workplace. These measures would provide a safety net and would increase novice nurses' confidence as well as high-quality care.

Diagnostico de hipobetalipoproteinemia en un nino de 8 años? / Diagnosis of hypobetalipoproteinemia in an 8-year-old child? / Diagnostico hipobetalipoproteinemia numa crianca de 8 anos?

La hipobetalipoproteinemia familiar es un trastorno hereditario autosomico dominante que afecta a las lipoproteinas que contienen Apo B, una proteina indispensable para el transporte de los quilomicrones en el intestino y que ademas participa en la sintesis y transporte de las VLDL en el higado. La concentracion de Apo B se usa junto con otras pruebas lipidicas para establecer el riesgo individual de un paciente de desarrollar enfermedad cardiovascular. Presentacion del caso: Paciente de 8 anos, varon, que acude a la consulta de Pediatria del Hospital Universitario Virgen Macarena de Sevilla con sintomas de dolor abdominal, deposiciones blandas y diarreicas, sobrepeso y unas quebradizas. El paciente fue derivado al laboratorio para su estudio con sospecha de hipobetalipoproteinemia. Se le solicito un hemograma, frotis sanguineo, pruebas de coagulacion, bioquimica general y estudio de riesgo vascular. Los datos del estudio bioquimico descartaron la celiaquia (IgA 174 mg/dL [100- 400 mg/dL] y antitransglutaminasa 5 U/mL [< 20]). Las determinaciones incluidas en el perfil de riesgo cardiovascular (RCV) fueron: colesterol total 83 mg/dL (45 mg/dL), c-LDL 32 mg/dL (< 160 mg/dL), colesterol no HDL 35 mg/dL, c-VLDL 3 mg/dL (< 40 mg/dL), trigliceridos 28 mg/dL, Apo-A1 112 mg/dL (119-240 mg/dL), Apo B-100 25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (< 3 mg/dL), Lp (a) 2 mg/dL (< 30 mg/ dL), homocisteina 5,8 µmol/L (< 15 µmol/L), vitamina A 42 µg/dL (50-200 µg/ dL), vitamina E 1051 µg/dL (50-180 µg/dL) y 25-(OH) D 48,9 ng/mL (30-54 ng/mL) en intervalos de normalidad. El HLA-27 fue negativo. Tras encontrar hallazgos bioquimicos de bajas concentraciones de lipoproteinas con Apo B, se le solicito al paciente una prueba de saliva para realizacion de estudio genetico de LipochipR para mutaciones en el gen de Apo B y PCSK9. Se concluye que el paciente presento una disminucion de la concentracion de las lipoproteinas que contienen Apo B y trigliceridos. La sintomatologia de dolor abdominal y heces pastosas apoyaron el diagnostico clinico. La inexistencia de deficit vitaminico, retraso mental, acantocitosis y demas sintomatologia asociada, hizo pensar en una herencia heterocigota, que con las herramientas disponibles no se pudo describir geneticamente ya que LipochipR no detecta positividad para este paciente para una mutacion de cambio de aminoacidos en el gen y exon de Apo 26, PCSK9-7, PCSK9-4, PCSK9-10.

Familial hypobetalipoproteinemia is a dominant autosomal inherited disorder that affects lipoproteins containing Apo B. It is an essential protein for the transport of chylomicrons in the intestine and it is involved in the synthesis and transport of VLDL in the liver. This concentration is used along with other lipid tests to establish a patient's individual risk of developing cardiovascular disease. This is the case of an 8 year-old male patient who presented at the University Hospital Virgen Macarena in Seville with symptoms of abdominal pain, loose stools and diarrhea, overweight and broken nails. The patient was referred to the laboratory for examination with suspected hypobetalipoproteinemia. He was requested a complete blood count, blood smear, coagulation, biochemistry and vascular risk study. Biochemical data discarded celiac disease (IgA 174 mg/dL [100-400 mg/dL] y antitransglutaminase antibody 5 U/mL [< 20]). Determinations were RCV's profile: Total cholesterol 83 mg/dL (45 mg/dL), c-LDL 32 mg/dL (< 160 mg/dL), non-HDL cholesterol 35 mg/dL, c-VLDL 3 mg/dL (< 40 mg/dL), triglycerides 28 mg/dL, Apo-A1 112 mg/dL (119-240 mg/dL), Apo B-100 25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (< 3 mg/dL), Lp (a) 2 mg/dL (< 30 mg/dL), Homocysteine 5,8 µmol/L (< 15 µmol/L), Vitamin A 42 µg/dL (50-200 µg/dL), Vitamine E 1051 µg/dL (50-180 µg/dL) and 25-(OH) D 48,9 ng/mL (30-54 ng/mL) in normal ranges. HLA-27 Negative. After biochemical findings of low concentrations of lipoproteins with Apo B100, the patient was requested a saliva test for genetic study conducting LipochipR for mutations of Apo B and PCSK9. It can be concluded that the patient had a decreased concentration of lipoproteins containing Apo-B and triglycerides. The symptoms of abdominal pain and tarry stools supported the clinical diagnosis. The lack of vitamin deficiency, mental retardation, acanthocytosis and other associated sintomatology, made it possible to consider it an heterozygous inheritance. which could not be genetically described with the tools available since LipochipR does not detect in this patient positivity for a mutation to the amino acid change in the gene and exon 26 of Apo, Apo 26, PCSK9-7, PCSK9- 4, PCSK9-10.

Hypobetalipoproteinemia familiar e um disturbio autossomico hereditario dominante que afeta as lipoproteinas contendo Apo--B, uma proteina essencial para o transporte de quilomicrons no intestino e esta envolvido na sintese e transporte de VLDL no figado. A concentracao de Apo-B e utilizada, juntamente com outros testes lipidicos, para estabelecer o risco individual de um paciente de desenvolver doencas cardiovasculares. O caso e o de um paciente de 8 anos, do sexo masculino, que se apresenta para consulta de Pediatria do Hospital Universitario Virgen Macarena, em Sevilha, com sintomas de dor abdominal, fezes brandas e diarreia, sobrepeso e unhas quebradicas. O paciente foi derivado ao laboratorio para exame com suspeita de hypobetalipoproteinemia. Foi pedido um hemograma completo, esfregaco de sangue, coagulacao, bioquimica geral e estudo de risco vascular. Os dados do estudo bioquimico descartaram a doenca celiaca (IgA 174 mg/dL [100-400 mg/dL] e Antitrasglutaminase 5 U/mL [<20]). As determinacoes incluidas no perfil de risco cardiovascular (RCV) foram colesterol total 83 mg/dL (45 mg/dL), LDL-C 32 mg/ dL (<160 mg/dL), colesterol nao-HDL de 35 mg/dL, VLDL-C 3 mg/dL (<40 mg/dL), triglicerideos de 28 mg/dL, Apo-A1 112 mg/ dL (119-240 mg/dL), Apo B-100-25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (<3 mg/dL) de Lp (a) 2 mg/dL (<30 mg/dL), homocisteina de 5,8 µmol/L (<15 µmol/L), a vitamina A 42 µg/dL (50-200 µg/dL), vitamina E 1051 µg/dL (50-180 µg/dL) e 25- (OH) D 48,9 ng/mL (30-54 ng/mL) em intervalos de normalidade. O HLA-27 foi negativo. Depois de encontrar achados bioquimicos de baixas concentracoes de lipoproteinas com apo-B, foi solicitado ao paciente um teste de saliva para estudo genetico de LipochipR para mutacoes no gene de Apo-B e PCSK9. Conclui-se que o paciente apresentou uma diminuicao na concentracao das lipoproteinas contendo Apo-B e triglicerideos. Os sintomas de dor abdominal e fezes pastosas apoiaram o diagnostico clinico. A inexistencia de deficit vitaminico, retardo mental, acantocitose e outros sintomas associados fez pensar numa heranca heterozigotica, que com as ferramentas disponiveis nao se pode descrever geneticamente ja que LipochipR nao detecta positividade para este paciente para uma mutacao de mudanca de aminoacidos no gene e exon de Apo 26, PCSK9-7, PCSK9- 4, PCSK9-10.

Diagnostico de hipobetalipoproteinemia en un nino de 8 años? / Diagnosis of hypobetalipoproteinemia in an 8-year-old child? / Diagnostico hipobetalipoproteinemia numa crianca de 8 anos?

La hipobetalipoproteinemia familiar es un trastorno hereditario autosomico dominante que afecta a las lipoproteinas que contienen Apo B, una proteina indispensable para el transporte de los quilomicrones en el intestino y que ademas participa en la sintesis y transporte de las VLDL en el higado. La concentracion de Apo B se usa junto con otras pruebas lipidicas para establecer el riesgo individual de un paciente de desarrollar enfermedad cardiovascular. Presentacion del caso: Paciente de 8 anos, varon, que acude a la consulta de Pediatria del Hospital Universitario Virgen Macarena de Sevilla con sintomas de dolor abdominal, deposiciones blandas y diarreicas, sobrepeso y unas quebradizas. El paciente fue derivado al laboratorio para su estudio con sospecha de hipobetalipoproteinemia. Se le solicito un hemograma, frotis sanguineo, pruebas de coagulacion, bioquimica general y estudio de riesgo vascular. Los datos del estudio bioquimico descartaron la celiaquia (IgA 174 mg/dL [100- 400 mg/dL] y antitransglutaminasa 5 U/mL [< 20]). Las determinaciones incluidas en el perfil de riesgo cardiovascular (RCV) fueron: colesterol total 83 mg/dL (45 mg/dL), c-LDL 32 mg/dL (< 160 mg/dL), colesterol no HDL 35 mg/dL, c-VLDL 3 mg/dL (< 40 mg/dL), trigliceridos 28 mg/dL, Apo-A1 112 mg/dL (119-240 mg/dL), Apo B-100 25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (< 3 mg/dL), Lp (a) 2 mg/dL (< 30 mg/ dL), homocisteina 5,8 Amol/L (< 15 Amol/L), vitamina A 42 Ag/dL (50-200 Ag/ dL), vitamina E 1051 Ag/dL (50-180 Ag/dL) y 25-(OH) D 48,9 ng/mL (30-54 ng/mL) en intervalos de normalidad. El HLA-27 fue negativo. Tras encontrar hallazgos bioquimicos de bajas concentraciones de lipoproteinas con Apo B, se le solicito al paciente una prueba de saliva para realizacion de estudio genetico de LipochipR para mutaciones en el gen de Apo B y PCSK9. Se concluye que el paciente presento una disminucion de la concentracion de las lipoproteinas que contienen Apo B y trigliceridos. La sintomatologia de dolor abdominal y heces pastosas apoyaron el diagnostico clinico. La inexistencia de deficit vitaminico, retraso mental, acantocitosis y demas sintomatologia asociada, hizo pensar en una herencia heterocigota, que con las herramientas disponibles no se pudo describir geneticamente ya que LipochipR no detecta positividad para este paciente para una mutacion de cambio de aminoacidos en el gen y exon de Apo 26, PCSK9-7, PCSK9-4, PCSK9-10.(AU)

Familial hypobetalipoproteinemia is a dominant autosomal inherited disorder that affects lipoproteins containing Apo B. It is an essential protein for the transport of chylomicrons in the intestine and it is involved in the synthesis and transport of VLDL in the liver. This concentration is used along with other lipid tests to establish a patients individual risk of developing cardiovascular disease. This is the case of an 8 year-old male patient who presented at the University Hospital Virgen Macarena in Seville with symptoms of abdominal pain, loose stools and diarrhea, overweight and broken nails. The patient was referred to the laboratory for examination with suspected hypobetalipoproteinemia. He was requested a complete blood count, blood smear, coagulation, biochemistry and vascular risk study. Biochemical data discarded celiac disease (IgA 174 mg/dL [100-400 mg/dL] y antitransglutaminase antibody 5 U/mL [< 20]). Determinations were RCVs profile: Total cholesterol 83 mg/dL (45 mg/dL), c-LDL 32 mg/dL (< 160 mg/dL), non-HDL cholesterol 35 mg/dL, c-VLDL 3 mg/dL (< 40 mg/dL), triglycerides 28 mg/dL, Apo-A1 112 mg/dL (119-240 mg/dL), Apo B-100 25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (< 3 mg/dL), Lp (a) 2 mg/dL (< 30 mg/dL), Homocysteine 5,8 Amol/L (< 15 Amol/L), Vitamin A 42 Ag/dL (50-200 Ag/dL), Vitamine E 1051 Ag/dL (50-180 Ag/dL) and 25-(OH) D 48,9 ng/mL (30-54 ng/mL) in normal ranges. HLA-27 Negative. After biochemical findings of low concentrations of lipoproteins with Apo B100, the patient was requested a saliva test for genetic study conducting LipochipR for mutations of Apo B and PCSK9. It can be concluded that the patient had a decreased concentration of lipoproteins containing Apo-B and triglycerides. The symptoms of abdominal pain and tarry stools supported the clinical diagnosis. The lack of vitamin deficiency, mental retardation, acanthocytosis and other associated sintomatology, made it possible to consider it an heterozygous inheritance. which could not be genetically described with the tools available since LipochipR does not detect in this patient positivity for a mutation to the amino acid change in the gene and exon 26 of Apo, Apo 26, PCSK9-7, PCSK9- 4, PCSK9-10.(AU)

Hypobetalipoproteinemia familiar e um disturbio autossomico hereditario dominante que afeta as lipoproteinas contendo Apo--B, uma proteina essencial para o transporte de quilomicrons no intestino e esta envolvido na sintese e transporte de VLDL no figado. A concentracao de Apo-B e utilizada, juntamente com outros testes lipidicos, para estabelecer o risco individual de um paciente de desenvolver doencas cardiovasculares. O caso e o de um paciente de 8 anos, do sexo masculino, que se apresenta para consulta de Pediatria do Hospital Universitario Virgen Macarena, em Sevilha, com sintomas de dor abdominal, fezes brandas e diarreia, sobrepeso e unhas quebradicas. O paciente foi derivado ao laboratorio para exame com suspeita de hypobetalipoproteinemia. Foi pedido um hemograma completo, esfregaco de sangue, coagulacao, bioquimica geral e estudo de risco vascular. Os dados do estudo bioquimico descartaram a doenca celiaca (IgA 174 mg/dL [100-400 mg/dL] e Antitrasglutaminase 5 U/mL [<20]). As determinacoes incluidas no perfil de risco cardiovascular (RCV) foram colesterol total 83 mg/dL (45 mg/dL), LDL-C 32 mg/ dL (<160 mg/dL), colesterol nao-HDL de 35 mg/dL, VLDL-C 3 mg/dL (<40 mg/dL), triglicerideos de 28 mg/dL, Apo-A1 112 mg/ dL (119-240 mg/dL), Apo B-100-25 mg/dL (40-125 mg/dL), us-PCR 1,47 mg/dL (<3 mg/dL) de Lp (a) 2 mg/dL (<30 mg/dL), homocisteina de 5,8 Amol/L (<15 Amol/L), a vitamina A 42 Ag/dL (50-200 Ag/dL), vitamina E 1051 Ag/dL (50-180 Ag/dL) e 25- (OH) D 48,9 ng/mL (30-54 ng/mL) em intervalos de normalidade. O HLA-27 foi negativo. Depois de encontrar achados bioquimicos de baixas concentracoes de lipoproteinas com apo-B, foi solicitado ao paciente um teste de saliva para estudo genetico de LipochipR para mutacoes no gene de Apo-B e PCSK9. Conclui-se que o paciente apresentou uma diminuicao na concentracao das lipoproteinas contendo Apo-B e triglicerideos. Os sintomas de dor abdominal e fezes pastosas apoiaram o diagnost