Estudio sobre la reducción de eventos adversos en pacientes y problemas de bioseguridad de los profesionales derivados de la aplicación de catéteres vasculares en urgencias / Peripheral venous catheter use in the emergency department: reducing adverse events in patients and biosafety problems for staff

Objetivo: Reducir la tasa de eventos adversos (EA) derivados de catéteres vasculares periféricos (CVP) en pacientes atendidos en servicios de urgencias (SU), así como accidentes de bioseguridad en profesionales, mediante una estrategia que combine formación, protocolización de la indicación y catéteres de bioseguridad. Método: Estudio prospectivo, multicéntrico, observacional no postautorización en pacientes atendidos en el SU que precisen de CVP. El estudio tiene dos fases: en la primera se procede a formación, protocolización y monitorización mediante ua lista de comprobación, utilizando CVP convencionales. En la segunda fase se introducen CVP de bioseguridad. Se comparan ambas fases y sus resultados en la reducción de EA y bioseguridad. Resultados: Se incluyeron un total de 520 pacientes: 180 en fase I y 340 en fase II. Se evidencian deficiencias en la técnica relacionadas con la desinfección, mantenimiento del campo estéril y manejo de equipo y apósitos; algunos mejoran significativamente con la progresión del estudio en fase II. Se observaron 86 EA, 34 en Fase I (18,8%) y 52 en fase II (15,4%) (p = ns). Destaca una reducción del 50% de flebitis en fase II. Sobre bioseguridad se detectaron 8 casos (7 salpicaduras, 1 pinchazo accidental) con CVP convencionales (fase I) y 2 salpicaduras con CVP de bioseguridad (fase II), equivalente a una reducción del 36% de accidentes (p = 0,04), especialmente con catéteres de corta duración (p = 0,02). Conclusiones: La combinación de formación, protocolización de la indicación y empleo de CVP de bioseguridad se muestra como una intervención más efectiva para mejorar la seguridad del paciente y del profesional (AU)

Objectives: To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. Methods: Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. Results: A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). Conclusion: Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety (AU)

[Peripheral venous catheter use in the emergency department: reducing adverse events in patients and biosafety problems for staff]. / Estudio sobre la reducción de eventos adversos en pacientes y problemas de bioseguridad de los profesionales derivados de la aplicación de catéteres vasculares en urgencias.

OBJECTIVES: To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. MATERIAL AND METHODS: Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. RESULTS: A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). CONCLUSION: Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety.

OBJETIVO: Reducir la tasa de eventos adversos (EA) derivados de catéteres vasculares periféricos (CVP) en pacientes atendidos en servicios de urgencias (SU), así como accidentes de bioseguridad en profesionales, mediante una estrategia que combine formación, protocolización de la indicación y catéteres de bioseguridad. METODO: Estudio prospectivo, multicéntrico, observacional no postautorización en pacientes atendidos en el SU que precisen de CVP. El estudio tiene dos fases: en la primera se procede a formación, protocolización y monitorización mediante ua lista de comprobación, utilizando CVP convencionales. En la segunda fase se introducen CVP de bioseguridad. Se comparan ambas fases y sus resultados en la reducción de EA y bioseguridad. RESULTADOS: Se incluyeron un total de 520 pacientes: 180 en fase I y 340 en fase II. Se evidencian deficiencias en la técnica relacionadas con la desinfección, mantenimiento del campo estéril y manejo de equipo y apósitos; algunos mejoran significativamente con la progresión del estudio en fase II. Se observaron 86 EA, 34 en Fase I (18,8%) y 52 en fase II (15,4%) (p = ns). Destaca una reducción del 50% de flebitis en fase II. Sobre bioseguridad se detectaron 8 casos (7 salpicaduras, 1 pinchazo accidental) con CVP convencionales (fase I) y 2 salpicaduras con CVP de bioseguridad (fase II), equivalente a una reducción del 36% de accidentes (p = 0,04), especialmente con catéteres de corta duración (p = 0,02). CONCLUSIONES: La combinación de formación, protocolización de la indicación y empleo de CVP de bioseguridad se muestra como una intervención más efectiva para mejorar la seguridad del paciente y del profesional.

Metales en algas comestibles: Evaluación y estudio comparativo / Metals in edible algae: evaluation and comparative study

Los contenidos de 4 macroelementos (Na, K, Ca, Mg), 13 elementos traza (B, Ba, Co, Cr, Cu, Fe, Mn, Mo, Li, Zn, Ni, Sr, V) y 3 metales tóxicos (Al, Cd, Pb) se determinaron por espectrometría de emisión atómica por plasma acoplado inductivamente (ICP-OES) en 27 muestras de 7 especies de algas comestibles deshidratadas (Porphyra spp., Chondrus crispus, Palmaria palmata, Laminaria spp., Undari pinnatífica, Hilmanthia elongata, Ulva lactuca), procedentes de dos orígenes diferentes (la costa asiática y la Unión Europea) y comercializadas en la isla de Tenerife (Islas Canarias, España). Las concentraciones medias (mg/kg) fueron: 4281 (Na), 7179 (K), 3222 (Ca), 2458 (Mg), 38,14 (B), 2,72 (Ba), 0,11 (Co), 0,26 (Cr), 1,98 (Cu), 106 (Fe), 8,21 (Mn), 0,11 (Mo), 2,33 (Li), 10,63 (Zn), 1,02 (Ni), 1,47 (Sr), 1,54 (V), 48,71 (Al), 0,30 (Cd) y 0,17 (Pb). El consumo de algas (4 g/día) podría contribuir a las ingestas dietéticas de metales esenciales y elementos traza principalmente Mg (4,13% de la IDR en mujeres adultas y 3,54% de la IDR en hombres adultos) y Fe (2,36% de la IDR en mujeres adultas y 4,71% de la IDR en hombres adultos). Las ingestas de metales tóxicos (195 μg Al/día 1,18 μg Cd/día y 0,68 μg Pb/día) derivada del consumo de 4 g/día de las algas analizadas no representan riesgo toxicológico para los consumidores (AU)

The content of 4 macroelements (Na, K, Ca, Mg), 13 trace elements (B, Ba, Co, Cr, Cu, Fe, Mn, Mo, Li, Zn, Ni, Sr, V) and 3 toxic metals (Al, Cd, Pb) were quantified by inductively coupled plasma optical emission spectrometry (ICP-OES) in 27 samples of 7 dehydrated edible seaweed species (Porphyra spp., Chondrus crispus, Palmaria palmata, Laminaria spp., Undari pinnatífica, Hilmanthia elongata, Ulva lactuca), from two different production origins (Asian coast and European Union) and purchased in Tenerife island (Canary Islands, Spain). Mean concentrations (mg/kg) were: 4281 (Na), 7179 (K), 3222 (Ca), 2458 (Mg), 38.14 (B), 2.72 (Ba), 0.10 (Co), 0.26 (Cr), 1.98 (Cu), 106 (Fe), 8.21 (Mn), 0.11 (Mo), 2.33 (Li), 10.63 (Zn), 1.02 (Ni), 1.47 (Sr),1.54 (V), 48.71 (Al), 0.30 (Cd) and 0.17 (Pb). Daily consumption of seaweed (4 g/day) contributes to the dietary intake of metals, mainly Mg (4.13% of the RDA for adult women, and 3.54% of the RDA for adult men) and Fe (2.36% of the RDA for adult women, and 4.71% of the RDA in adult men). The estimated intakes of toxic metals derived from a daily seaweed consumption of 4 g (195 μg Al/day, 1.18 μg Cd/day and 0.68 μg Pb/day) did not reveal toxicological risks for consumers (AU)

Lower incisor position in different malocclusions and facial patterns

Introduction: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern. Objectives: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parametersare the mostreliable. Material and Methods: Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern. These teleradiographies have been performed cephalometric analysis, which include lower incisorposition belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway. Study Design: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results: The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane. Conclusions: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern (AU)

The segmented arch approach: a method for orthodontic treatment of a severe Class III open-bite malocclusion.

An open bite is a common malocclusion, and it is generally associated with several linked etiologic factors. When establishing the treatment plan, it is essential to consider every aspect of the various etiologic causes and their evolution; this will help to correct it. This article reports the case of a girl aged 10.7 years with a skeletal Class III malocclusion and an open bite. The treatment mechanics were based on compensatory dental changes performed to close the bite and correct the skeletal Class III malocclusion. The patient had a deep maxillary deficiency, and the lower facial third was severely enlarged. In this article, we aimed to describe a simple mechanical approach that will close the bite through changes in the occlusal plane (segmentation of arches). It is an extremely simple method that is easily tolerated by the patient. It not only closes the bite effectively but also helps to correct the unilateral or bilateral lack of occlusal interdigitation between the dental arches. A Class III patient with an anterior open bite is shown in this article to illustrate the effectiveness of these treatment mechanics.

True vertical validation in facial orthognathic surgery planning.

OBJECTIVES: To validate the effectiveness of the original standards of True Vertical (TV) Subnasal Line in orthognatic surgery planning. The present study evaluates the changes occurring in patients with skeletal Class II alterations programmed for orthognathic surgery with a view to improving their facial profile. STUDY DESIGN: [corrected] We showed a series of black profiles (composed by a first control group of subjects with normal occlusion, and another two additional groups comprised patients before -Group 2- and after orthognatic surgical correction of Class II malocclusion -Group 3-) for three groups of observers (orthodontists, surgeons and laypeople). The facial images became black silhouettes in order to determine a series of parameters (including aesthetic assessment) by means of the observers. Their observation were assessed using a 5-point Likert scale. RESULTS: The sample was composed of 52 profile's subjects who were tested for a total of 72 observers. Aesthetic assessment yielded mean scores of 2.57, 1.67 and 2.46 for groups 1, 2 and 3, respectively. There was a statistically significant difference (p<0.001) between group 1 versus group 2. There were no significant differences in terms of observer assessment of aesthetics, with the exception of a wider perception range among the orthodontists. Regarding the studied profile measures, significant differences were recorded for point B' and Pg' (p<0.02) between groups 2 and 3 (i.e., pre- versus post-surgery). CONCLUSIONS: The results of our study suggest the subnasale vertical and sagittal measures of the lower third of the face are decisive in facial aesthetics, and therefore also for the planning of orthognathic surgery. Consequently, these aesthetic parameters can be used as an objective tool for the planning of orthodontic treatment. Key words:Facial profile, Class II, orthognathic surgery, cephalometric analysis, facial soft tissue, subnasale vertical.

Lower incisor position in different malocclusions and facial patterns.

INTRODUCTION: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern. OBJECTIVES: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parameters are the mostreliable. Material and methods. Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern.These teleradiographies have been performed cephalometric analysis, which includelower incisor position belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway. STUDY DESIGN: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results. The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane. CONCLUSIONS: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern.

Arcos segmentados. Mecánica de cierre en las mordidas abiertas. Aportaciones clínicas / Segmented arches. Closure mechanism in open bite. Clinical contributions

La mordida abierta es una entidad muy frecuente asociada a una etiología multifactorial. De ahí que en el tratamiento haya que considerar todo el recorrido en su aparición, intentando llegar hasta los procesos etiológicos que permitan la corrección de la misma. En este trabajo, presentamos una mecánica sencilla que nos permite, mediante modificaciones en el plano oclusal (segmentación de los arcos), conseguir el cierre de la misma; este método resulta de extrema sencillez y fácilmente tolerable por el paciente. No sólo aporta un sistema eficaz en el cierre, sino una ayuda en la mecánica habitual para corregir situaciones de falta de oclusión parcial, uni o bilateral de las arcadas dentarias (AU)

Open bite is a highly common entity that is associated with a multifactorial etiology. Hence, all the steps involved in its development should be considered in its treatment, attempting to identify the etiological processes that allow this entity to be corrected. in this article, we present a simple mechanism that allows closure to be achieved through changes in the occlusal plane (arch segmentation). This method is extremely simple, and is easily tolerated by the patient. Moreover, this mechanism not only provides an effective system for closure, but also helps to correct situations of uni- or bilateral malocclusion of the dental arches (AU)

Antioxidant supplementation and lung functions among children with asthma exposed to high levels of air pollutants.

To evaluate whether acute effects of ozone, nitrogen dioxide, and particulates with mass median diameter less than 10 micro m could be attenuated by antioxidant vitamin supplementation, we conducted a randomized trial using a double-blinded design. Children with asthma (n = 158) who were residents of Mexico City were randomly given a daily supplement of vitamins (50 mg/day of vitamin E and 250 mg/day of vitamin C) or a placebo and were followed from October 1998 to April 2000. Pulmonary function tests were carried out twice a week in the morning. During the follow-up observation period, the mean 1-hour maximum ozone level was 102 ppb (SD = 47), and the mean 24-hour average PM(10) level was 56.7 micro g/m(3) (SD = 27.4). In children with moderate and severe asthma, ozone levels 1 day before spirometry were inversely associated significantly with forced expiratory flow (FEF(25-75)) (-13.32 ml/second/10 ppb; p = 0.000), FEV(1) (-4.59 ml/10 ppb; p = 0.036), and peak expiratory flow (PEF) (-15.01 ml/second/10 ppb; p = 0.04) in the placebo group after adjusting for potential confounding factors. No association between ozone and lung functions was observed in the supplement group. We observed significant differences in lung function decrements between groups for FEF(25-75) and PEF. Our results suggest that supplementation with antioxidants might modulate the impact of ozone exposure on the small airways of children with moderate to severe asthma.