[Effectiveness of an intervention to improve the implementation of a surgical safety check-list in a tertiary hospital]. / Efectividad de una intervención para mejorar la cumplimentación del listado de verificación de seguridad quirúrgica en un hospital de tercer nivel.

OBJECTIVE: To determine the percentage of verification of a Surgical Safety Checklist and improvements made. DESIGN: Quasi-experimental study in 28 Clinical Management Units with surgical activity in the University Hospital Virgen del Rocio (HUVR) and University Hospital Virgen Macarena (HUVM). A situation analysis was made to estimate the completing of a Surgical Safety Checklist (SSC), after which a new system of completing the SSC was introduced as an element of improvement, which included a reusable vinyl board. Subsequently, the prevalence over two periods was calculated, to assess the effectiveness of the intervention. RESULTS: A total 1,964 SSC were reviewed in the HUVR-HUVM in June (baseline), and in December 2013 and June 2014. A percentage completion of 65.8%, 86.2%, and 88% was obtained in the HUVR, and 70.9%, 77.2%, and 75% in the HUVM, respectively. Of these SSC, 15.1% (baseline) were completed entirely in the HUVR, increasing to 36.6% (P<.001), and 89.8% (P<.001) in the last measurement. In the HUVM, 15.6% (baseline) were fully completed, increasing to 18.3% (P=.323), and 29.4% (P=.001) in the last measurement. CONCLUSION: The percentage of completion of SSC obtained is around 80%, and is similar to that reported in the literature. The re-design of the SSC procedure, including the use of a vinyl board, the designation of SSC coordinator role, and professional staff training, is effective for improve outcomes in terms of completing the SSC, and quality of the completion.

Efectividad de una intervención para mejorar la cumplimentación del listado de verificación de seguridad quirúrgica en un hospital de tercer nivel / Effectiveness of an intervention to improve the implementation of a surgical safety check-list in a tertiary hospital

Objetivo. Conocer el porcentaje de cumplimentación del listado de verificación de la seguridad quirúrgica (LVSQ) y las mejoras introducidas. Diseño. Estudio cuasiexperimental en 28 unidades de gestión clínica con actividad quirúrgica en el Hospital Universitario Virgen del Rocío (HUVR) y Virgen Macarena (HUVM). Se realizó un análisis de situación, para estimar la cumplimentación del LVSQ, tras lo cual se introdujo como elemento de mejora un nuevo sistema de cumplimentación del LVSQ, incluyendo una pizarra vinílica reutilizable. Posteriormente, se realizaron 2 cortes de prevalencia para valorar la efectividad de la intervención. Resultados. Se revisaron 1.964 LVSQ en HUVM y en HUVR en junio (basal) y diciembre de 2013, y en junio del 2014. Se obtuvo un porcentaje de cumplimentación del 65,8, 86,2 y 88% en el HUVR, y del 70,9, 77,2 y 75% en el HUVM. De estos LVSQ, en el HUVR estaban cumplimentados en su totalidad un 15,1% (basal), pasando de un 36,6 (p<0,001) a un 89,8% (p<0,001) en la última medición. En el HUVM se cumplimentaron totalmente un 15,6% (basal), pasando de un 18,3 (p=0,323) a un 29,4% (p=0,001) en la última medición. Conclusión. El porcentaje de cumplimentación LVSQ es similar al descrito en la literatura y oscila en torno al 80%. El rediseño del procedimiento del LVSQ, incluyendo el uso de una pizarra vinílica, la identificación de la figura del coordinador del LVSQ y la formación de los profesionales, es efectivo para mejorar los resultados en cuanto a cumplimentación del LVSQ y a la calidad de la cumplimentación (AU)

Objective. To determine the percentage of verification of a Surgical Safety Checklist and improvements made. Design. Quasi-experimental study in 28 Clinical Management Units with surgical activity in the University Hospital Virgen del Rocio (HUVR) and University Hospital Virgen Macarena (HUVM). A situation analysis was made to estimate the completing of a Surgical Safety Checklist (SSC), after which a new system of completing the SSC was introduced as an element of improvement, which included a reusable vinyl board. Subsequently, the prevalence over two periods was calculated, to assess the effectiveness of the intervention. Results. A total 1,964 SSC were reviewed in the HUVR-HUVM in June (baseline), and in December 2013 and June 2014. A percentage completion of 65.8%, 86.2%, and 88% was obtained in the HUVR, and 70.9%, 77.2%, and 75% in the HUVM, respectively. Of these SSC, 15.1% (baseline) were completed entirely in the HUVR, increasing to 36.6% (P<.001), and 89.8% (P<.001) in the last measurement. In the HUVM, 15.6% (baseline) were fully completed, increasing to 18.3% (P=.323), and 29.4% (P=.001) in the last measurement. Conclusion. The percentage of completion of SSC obtained is around 80%, and is similar to that reported in the literature. The re-design of the SSC procedure, including the use of a vinyl board, the designation of SSC coordinator role, and professional staff training, is effective for improve outcomes in terms of completing the SSC, and quality of the completion (AU)

Calidad de los antecedentes personales en la historia clínica electrónica hospitalaria / Quality of individual health history in in-patient electronic medical records

No disponible

Neumopericardio y rotura de aorta / Pneumopericardium and aortic rupture

El neumopericardio se define por la presencia de aire en la cavidad pericárdica. Puede provocar taponamiento cardíaco. Presentamos el caso de un varón de 21 años, que tras sufrir un accidente de moto, ingresa consciente, inquieto, con trabajo respiratorio marcado, taquipneico y saturación periférica de oxígeno del 88%. Presenta un gran enfisema subcutáneo torácico, especialmente en hemitórax derecho que se extiende al flanco abdominal. La auscultación respiratoria muestra una disminución marcada del murmullo vesicular en hemitórax derecho. Se procede a la intubación orotraqueal inmediata y canalización de una vía central y administración de cristaloides. Se realiza ecografía abdominal y toracocentesis. Se realiza una radiografía de tórax portátil que muestran hemotórax y contusión pulmonar multilobular, así como una imagen de Neumopericardio. El paciente fallece a los 15 minutos del ingreso. La necropsia demostró la presencia de rotura de aorta torácica, y se mantuvo una duda razonable respecto a la causa inmediata de la muerte, taponamiento cardíaco secundario al neumopericardio o shock hipovolémico hemorrágico (AU)

Pneumopericardium is defined as the presence of air within the pericardial sac; it may be the cause of cardiac tamponnade. We here report the case of a 21-year-old male who, after suffering a motorcycle accident, was admitted to hospital conscious but anxious, with marked dyspnoea and tachypnoea and with a peripheral oxygen saturation level of 88%. The clinical examination disclosed marked thoracic subcutaneous emphysema mainly on the right haemithorax and extending to the side of the abdomen. On auscultation there was a marked diminution of the vesicular murmur in the right haemithorax. Orotracheal intubation was performed immediately and a central venous access catheter was inserted with crystalloid administration. An abdominal ultrasound scan and thoracocentesis were performed. The plain chest film (portable apparatus) disclosed haemothorax and multilobar lung contusion and an image highly suggestive of pneumopericardium. The patient died 15 minutes after admission. The Forensic Pathology examination (the report was received later) demonstrated rupture of the thoracic aorta and posed reasonable doubts as to the immediate cause of death: cardiac tamponnade secondary to the pneumopericardium or haemorrhagic hypovolaemic shock (AU)

Selective sensitization to clavulanic acid and penicillin V.

Allergic reactions to beta-lactam antibiotics have been reported frequently and may occur because of sensitization to unique haptens or to determinants shared with other drugs. A woman who received 1 tablet of amoxicillin-clavulanic acid developed wheals and flares although she had previously tolerated the same preparation well. Levels of specific immunoglobulin (Ig) E to penicillin V, penicillin G, amoxicillin, and ampicillin were undetectable. Skin tests to amoxicillin, penicillin major determinant and minor determinant mixture were negative. The patient tolerated oral challenge with 500 mg of amoxicillin but developed wheals and flares when challenged with amoxicillin-clavulanic acid 500/125 mg. A histamine release test was negative with amoxicillin but positive with the amoxicillin-clavulanic acid and clavulanic acid. A prick test to the combination was positive. Specific IgE to penicillin V later became positive while remaining negative to other beta-lactams. No inhibition was obtained using penicillin V against clavulanic acid and amoxicillin but was complete when penicillin V was used in the solid-phase and as the inhibitor. No cross-reactivity was proven between these sensitizations.

[Eye toxicity of antimalarial agents]. / Toxicidad ocular por antimaláricos.

We relate the evolution of a patient with Systemic Lupus Erythematosus with mucocutaneous, hematological, joint and renal expression. The skin lesions were treated with Chloroquine and Hydroxychloroquine and severe ocular toxicity related with antimalarials agent was developed. We revised the antimalarials use in Rheumatology, their utility, doses, adverse events and risk factors as cumulate doses, ideal daily doses, renal function and ophthalmological reviews recommendations.

Toxicidad ocular por antimaláricos / Ocular toxicity of antimalarial drugs

En este artículo exponemos la evolución de una paciente afectada de Lupus eritematoso sistémico con expresión mucocutánea, hematológica, articular y renal. Debido a la afectación mucocutánea la paciente recibió tratamiento con cloroquina e hidroxicloroquina, presentando toxicidad ocular severa secundaria a antimaláricos.En este trabajo tratamos de hacer una revisión sobre el uso de antimaláricos en reumatología teniendo en cuenta su utilidad, dosis, efectos secundarios y factores de riesgo tales como dosis acumulada, dosis diaria por peso ideal, duración del tratamiento y función renal, así como de las recomendaciones de revisión oftalmológica en los pacientes tratados (AU)

[The use of personal sources for the study of emigration from Galicia: present state and perspectives]. / El uso de fuentes personales para el estudio de la emigracion de Galicia: estado presente y perspectivas.

PIP: "Spanish sources for the study of emigration are sparse and fragmentary.... Mortgage documents for the payment of ocean transportation enable us to appreciate the spreading action of shipping agents; official listings of draft dodgers reveal that in general the River Plate was a favorite destination, rather than Cuba or Brazil. People from Galicia emigrated from rural origins to urban destinations in America; the analysis of place of birth of emigrants residing in A Coruna at the time of emigration show that there was also, in some cases, a first stage of rural-urban migration within Galicia. The general picture of emigration from Galicia is built [up] through the combination of the existing sources in Spain." (EXCERPT)^ieng