Incidents related to critical patient safety during in-hospital transfer.

OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.

Ectopic expression of the atypical HLH FaPRE1 gene determines changes in cell size and morphology.

PACLOBUTRAZOL RESISTANCE (PRE) genes code atypical HLH transcriptional regulators characterized by the absence of a DNA-binding domain but present an HLH dimerization domain. In vegetative tissues, the function of these HLH proteins has been related with cell elongation processes. In strawberry, three FaPRE genes are expressed, two of them (FaPRE2 and FaPRE3) in vegetative tissues while FaPRE1 is fruit receptacle-specific. Ubiquitous FaPRE1 accumulation produced elongated flower receptacles and plants due to the elongation of the main aerial vegetative organs, with the exception of leaves. Histological analysis clearly demonstrated that the observed phenotype was due to significant changes in the parenchymal cell's morphology. In addition, transcriptomic studies of the transgenic elongated flower receptacles allowed to identify a small group of differentially expressed genes that encode cell wall-modifying enzymes. Together, the data seem to indicate that, in the strawberry plant vegetative organs, FaPRE proteins could modulate the expression of genes related with the determination of the size and shape of the parenchymal cells.

Incidents related to critical patient safety during in-hospital transfer. / Incidentes relacionados con la seguridad del paciente crítico durante los traslados intrahospitalarios.

OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.

Standard comparison of local mental health care systems in eight European countries.

AIMS: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. METHODS: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. RESULTS: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. CONCLUSIONS: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.

The balance of adult mental health care: provision of core health versus other types of care in eight European countries.

AIMS: Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. 'Core health care' refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. 'Other care' is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, 'other care' does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify 'core health' and 'other care' services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services. METHODS: The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or 'Main Types of Care' (MTC) as the standard for international comparison, following the DESDE-LTC system. RESULTS: In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as 'other care', significant variation was found in the typology and characteristics of these services across the eight study areas. CONCLUSIONS: The functional distinction between core health and other care overcomes the traditional division between 'health' and 'social' sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.

[Changes in quality of life in patients undergoing bariatric surgery following 24-months: comparison between gastric bypass and tubular vertical gastrectomy]. / Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular.

BACKGROUND: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. METHODS: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. RESULTS: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. CONCLUSION: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term. Key words. Bariatric surgery. Quality of life. Morbid obesity.

Incidentes relacionados con la seguridad del paciente crítico durante los traslados intrahospitalarios / Incidents related to critical patients afety during in hospital transfer

Objective: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators.DesignA prospective, observational and non-intervention cohort study was carried out.SettingA 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital.PatientsAll IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study.Main measurementsDemographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT.ResultsA total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable.ConclusionsAfter the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents (AU)

Objetivo: Analizar los incidentes relacionados con la seguridad del paciente (IRSP) durante los traslados intrahospitalarios (TIH) del paciente crítico tras la aplicación de un protocolo, así como sus factores de riesgo. Evaluar la seguridad durante los traslados mediante indicadores de calidad.DiseñoEstudio de cohorte, prospectivo, observacional y no intervencionista.ÁmbitoUnidad de Cuidados Intensivos (UCI) polivalente de 10 camas de un hospital universitario de segundo nivel.PacientesSe incluyen todos los TIH de pacientes críticos realizados de UCI a pruebas diagnósticas y a quirófano entre marzo de 2011 y marzo de 2017.Principales variables del estudioVariables demográficas, gravedad de los pacientes, prioridad del traslado, momento del día, motivo y tipo de equipo del traslado. Se recogen comprobaciones pre-traslado e IRSP. Análisis semestral de indicadores de calidad diseñados para el TIH.ResultadosDe los 805 traslados registrados, la mayoría urgentes (53,7%) y para pruebas diagnósticas (77%), 112 traslados (13,9%) presentaron algún tipo de IRSP, 54% relacionado con el equipamiento y 30% con el equipo y la organización. En 19 (2,4%) traslados se produjeron eventos adversos. En el análisis multivariante los factores de riesgo fueron la ventilación mecánica y el equipo que realiza el traslado. La evolución de los indicadores relacionados con los traslados es significativamente favorable.ConclusionesTras la aplicación de un protocolo de TIH, los IRSP son bajos y el principal factor de riesgo es la ventilación mecánica invasiva. La experiencia del equipo que realiza el TIH influye en la detección de un mayor número de incidentes (AU)

[Hospital morbidity of elderly population in Andalusia (Spain)]. / Morbilidad hospitalaria aguda de las personas mayores de Andalucía.

INTRODUCTION: In recent years we have seen in Spain a significant increase in the number of old people. The aim of this work was to determine hospital morbidity among the elderly. MATERIALS AND METHODS: We studied the morbidity among patients older than 65 years admitted at the hospitals of our Andalusian public health system that belongs to the Spanish National Health System. We analysed the minimal basic data set at discharge (MBDSD) over a period from January 1998 to December 1999, both inclusive. RESULTS: In the 32 hospitals studied, a total of 25,255 hospital discharges of patients older than 65 years were recorded. This means an annual hospitalization rate in this age group of 15.2% (95 % CI: 15.1-15.3). The most frequent causes of hospitalisation are: diseases of the circulatory system (20.7%), diseases of the respiratory system (14.0%), diseases of the digestive system (11.6%). CONCLUSIONS: The old population of Andalusia (Spain) has a high rate of hospital morbidity, specially for people older than 75 years, and significant variations are seen between the different provinces of the Andalusian Region. Their hospitalization is due mainly to chronic diseases of developed countries.

Oral cabergoline. Single-dose inhibition of puerperal lactation.

Cabergoline, a new dopaminergic drug with a long-lasting prolactin inhibitory effect, was investigated at different single oral doses administered to puerperas who wished to inhibit their lactation. The study was prospective, randomized and double blind and included 140 puerperas divided into three groups of 40 women each treated with cabergoline and one group of 20 women who received a placebo. The tested doses were 1.0, 0.75 and 0.5 mg, administered orally within 24 hours after delivery. Prolactin levels were measured immediately before drug administration and then after 6 and 12 hours as well as on days 2, 3, 4, 5 and 14 after delivery. At those times the subjects were examined for milk secretion, breast engorgement, pain and possible side effects. In cases of symptoms requiring treatment, an additional 1 mg of cabergoline was administered. Complete inhibition of lactation up to day 14 was obtained in 90.2% of the women given 1 mg, 62.5% of those given 0.75 mg, 45% of those given 0.5 mg and 20% of those given a placebo. Four subjects experienced mild and transient side effects.

[Gastric collision tumor with osseous metaplasia]. / Tumor de colisión gástrico con metaplasia osea.

Neuroendocrine cells are frequently found in gastric tumours, although they rarely make up more than one third of the total number of tumour cells. When juxtapositioning of the two kinds of tumour cells occurs a "collision tumour" is formed. These have been described to occur with varying frequency throughout the digestive tract. They are uncommon in the stomach. We describe a case, of a gastric collision tumour in which an adenocarcinoma coexisted with a carcinoide tumour and there were zones of bony metaplasia in the transition area between the two tumors. Positive CEA, VIP, beta-HCG and TSH on inmunohistochemical analysis was found.

[Ectopic pancreas]. / Páncreas ectópico.

We describe ten cases of ectopic pancreas operated on in the Hospital General Universitario, Alicante, between 1970 and 1994. Average age of patients was 47.7 (range 3-75); five men and five women. In four cases there was associated digestive tract bleeding, three had chronic gastroduodenal ulcers, two pancreaticobiliary disease, and one suprarenal abnormalities. In four cases the ectopic gland was found in the gastric antrum; in four cases in the duodenum and in the remaining two cases in the first jejunal loop. Average diameter was 2.3 cm (range 0.6-6). In six cases complete pancreas tissue was found, in three an exocrine pancreas and in one a purely endocrine pancreas. In two patients the presence of the choristoma and the clinical findings due to erosion of the subjacent mucosa may be related. In one case the finding of cholelithiasis, intradiverticular papilla, and periampullar ectopia together with clinical features of recurrent pancreatitis may also be linked. In the remaining seven cases no relationship was found between the ectopic pancreas and the clinical features. Our series suggest that simple resection is best to avoid complications.

[Granular cell tumor of the bile duct: an infrequent location]. / Tumor de células granulosas en la vía biliar: una localización poco frecuente.

We report a case of granular cell tumor of the cystic duct. We have found only 47 such tumors of the biliary tract reported in the literature. Main symptoms at presentation are abdominal pain or obstructive jaundice. The clinical diagnosis is often difficult and the differential diagnosis is established with other more frequent conditions, including malignant neoplasms. Surgical excision is curative.

Development and usefulness of an instrument for the standard description and comparison of services for disabilities (DESDE).

OBJECTIVE: Mental health research has made significant progress in international comparison and instrument development. This study reports the adaptation of the European Service Mapping Schedule (ESMS) to the assessment of services for persons with disabilities. METHOD: Qualitative groups were used to develop the Description and Evaluation of Services for Disabilities in Europe (DESDE). The psychometric analysis of DESDE covered: feasibility, inter-rater reliability, descriptive validity and internal validity. A demonstration study was also carried out. RESULTS: Compared to the original ESMS, a new main branch and several sub-branches were added. We identified 826 services for persons with disabilities, which provided 1284 main types of care. The feasibility and reliability was good for the majority of codes. Only 6% of services were not properly classified. The Boolean factor analysis supported the internal validity of DESDE. CONCLUSION: DESDE is a useful and reliable instrument for the assessment of services for persons with disabilities.

[Breast cancer in a male. Report of a case]. / Cáncer de mama en el sexo masculino. A proposito de un caso.

The authors studied the clinical history of a male patient, 51 years old, from Puerto Armeulles, Chiriquí, with the diagnosis of breast carcinoma, III A, who was treated with simple mastectomy and systemic cytotoxic therapy, with 5 FU, Adriamycin and Cyclophosphamide at three weeks intervals, completing six cycles, followed by radiotherapy to the tumor site and the areas of lymphatic drainage, and hormonal therapy with Tamoxifen. The patient is now in good health and without clinical, radiographic or enzymatic evidence of tumoral activity, twelve months after the diagnosis.

[Sarcoma of soft tissues induced by radiation. Presentation of a case and review of the literature]. / Sarcoma de tejidos blandos inducido por radiación. Presentación de un caso y revisión de la literatura.

The clinical history of a 57 y/o female who had breast cancer diagnosed at 40 years of age and who was treated with right radical mastectomy followed by irradiation of the right chest and adjacent lymphatics is presented. Recurrences of the breast cancer were treated with combination chemotherapy. Eighteen years after the original diagnosis and irradiation she presented with a new primary tumor of a different histologic type in the site of the prior irradiation. This tumors had an extremely aggressive, fatal course.

[Breast cancer]. / Cáncer de mama.

The authors reviewed the clinical records of 31 patients with carcinoma of the breast diagnosed at the Dr. Rafael Hernández Hospital in Chiriquí from January 1988 to December 1990. All the patients were women and the average age was 51.9 years. 41.9% of the patients were classified Stage 1; 29%, Stage 2; 16.1%, Stage IIIA; and 12.8%, Stage IIIB. 74% of the patients were treated with a modified radical mastectomy, radiation and hormonal therapies. Systemic cytotoxic therapy was given to 77% of the patients. Total survival 48 months after diagnosis was 83.3% in patients at Stage I; 66%, at Stage II; 40%, at Stage IIIA; and 0%, in patients at Stage IIIB.

[An endodermal sinus tumor of the ovary. A case report]. / Tumor de seno endodérmico del ovario. Presentación de un caso.

The authors present the clinical history of a 15-year-old young woman, student, from David, Chiriquí, who complained of menstrual irregularities associated with the sensation of a mass in the right iliac fossa. Exploratory laparotomy revealed a right ovarian tumor, which was totally resected. The histopathological examination showed an endodermal sinus tumor, stage one, in the right ovary. The patient received four cycles of cytotoxic i.v. therapy every 3 weeks, after surgery, with vinblastine 6 mg/m2 body surface (B.S.) on days 1 and 2, bleomycin 15 u daily for 5 days, cisplatin 20 mg/m2 B.S. daily for 5 days, plus hydration with normal saline (5 to 6 l/day). Follow up studies with abdominal and pelvic sonograms, chest x-ray, feto protein and physical examination have not shown evidence of tumor activity 36 months after diagnosis.

Transcriptional organization and regulation of an antibiotic export complex in the producing Streptomyces culture.

Three open reading frames (ORFs) in the actII region of the actinorhodin biosynthetic gene cluster of Streptomyces coelicolor A3(2), which are involved in the export of the antibiotic are carried on two divergent transcripts. A monocistronic transcript carries actII-ORF1, encoding a putative repressor protein, and a bicistronic transcript codes for actII-ORF2 and -ORF3, whose products have been postulated to form an antibiotic export complex. The actII-ORF1 and actII-ORF2/3 transcripts each have a single promoter and the promoters for the two transcripts overlap. Both promoters are most active in cultures that have developed to the stage of actinorhodin production. The promoters resemble consensus promoters of the vegetative class in Escherichia coli and Streptomyces. We also demonstrate that these promoters are expressed in E. coli and use this finding to reveal a regulatory role for the repressor, using the xylE reporter gene on promoter-probe shuttle vectors and regulated expression of the actII-ORF1 gene under control of Plac. The actII-ORF2/3 promoter is strongly repressed by the ORF1 product and the ORF1 product also represses its own promoter. The finding that the operator/promoter arrangement, and regulatory interconnection, of an antibiotic export/repressor gene pair in Streptomyces strikingly resemble those for tetracycline resistance in bacteria of clinical importance supports the hypothesis of an evolutionary origin of such genes in an ancestral actinomycete.

Neuron types and organisation of the rabbit dorsal lateral geniculate nucleus.

The Golgi technique was employed in order to study the types of neurons composing the dorsal lateral geniculate nucleus and to elucidate its organisational features in the rabbit. Four types of neurons were identified based on differences in perikaryon size or the particular features of their dendrites and dendritic appendages. Types 1 and 2 were comparable to the relay cells previously identified in functional and morphological studies in other mammals as projecting upon the visual cortex. Type 3 cells were morphologically identified as interneurons. Type 4 neurons, not described in detail in the present paper, were observed along the nuclear periphery underlying the optic tract. Types 1 and 2 neurons along with their dendritic trees were orientated in planes which converged radially in the anteromedial region of the nucleus. Retinal afferent fibres from the optic tract traversed the nucleus as part of a longitudinal fibre system, running parallel to the planes of cell orientation, to establish synapses with the relay neurons.