Bridging the educational gap in terms of digital competences between healthcare institutions' demands and professionals' needs.

BACKGROUND: Healthcare professionals with insufficient digital competence can be detrimental to patient safety and increase the incidence of errors. In order to guarantee proper care, healthcare organizations should provide opportunities to learn how to use technology, especially for those professionals who have not received training about this topic during their undergraduate studies. OBJECTIVE: This exploratory study aimed to conduct surveys among Spanish healthcare professionals to determine whether their organisations had trained them in the use of healthcare technology and the areas where most emphasis was placed. METHODS: 1624 Spanish healthcare professionals responded to an ad hoc online survey 7 questions related to the digital skill training offered by the healthcare organisations they work for. RESULTS: Nurses were the most widely represented group, making up 58.29% of the total, followed by physicians namely 26.49%. Only 20% of the nurses surveyed had received some training from their institution related to healthcare technology. According to the participants' responses, physicians received significantly more training in this area than nurses. Training related to database searching for research purposes or computer management followed the same trend. Nurses also received less training than physicians in this area. 32% of physicians and nurses paid for their own training if they did not receive any training from institutions. CONCLUSIONS: Nurses receive less training, on topics such as database searching or management, from the healthcare centres and hospitals where they work. Moreover, they also have fewer research and digital skills. Both of these factors may lead to deficits in their care activities, and have adverse effects on patients. Not to mention fewer opportunities for professional progress.

Respiration tracking using the Wii remote game controller.

Respiration exercises are an important part in the pulmonary rehabilitation of COPD (chronic obstructive pulmonary disease) patients. Furthermore, previous research has demonstrated that showing respiration pattern helps the patients to improve their breathing skills. We have developed a low cost and non-invasive prototype based on the Wii remote game controller infrared camera to provide BPM (breaths per minute) measurement as feedback. It can also be a comfortable solution without wires, batteries or any kind of electronics but just wearing passive markers. The lab evaluation with 7 healthy individuals showed that this approach is feasible when users are resting of their exercise. The BPM monitored during the tests presented less than 15% of maximum error and the RMSE (root mean square error) was lower than 6% in all the tests. Further research is needed to evaluate and adapt the system for COPD patients. In addition, more work is needed to develop applications that can be built to motivate and guide the users.

Trends in overweight and misperceived overweight in Spain from 1987 to 2007.

OBJECTIVE: To examine trends in overweight and misperceived overweight in adults (≥ 20 years) and children (5-15 years) of Spain from 1987 to 2007. METHODS: Data were obtained from five cross-sectional studies, representative of the population of Spain in 1987, 1995, 1997, 2001 and 2006/2007. Self-reported weight and height were used to obtain the body mass index (BMI). Overweight was defined in adults as BMI of ≥ 25 kg m⁻², and in children using age- and sex-specific BMI cutoffs proposed by the International Obesity Task Force. People with overweight were considered to have misperceived overweight when adults considered their weight or their child's weight to be normal or less than normal. RESULTS: From 1987 to 2006/2007, the prevalence of overweight increased in absolute terms by 14.1% in men and 10.3% in women. Concurrently, the frequency of misperceived overweight remained relatively stable, approximately 35% in men, but rose from 16.5 to 20.8% in women. From 1995/1997 to 2006/2007, the prevalence of overweight increased in absolute terms by 3.2% in boys and 4.6% in girls. Over the same period, there was an absolute 8% increase in misperception of overweight among children of both sexes. As a result, during 2006/2007, approximately 60% of parents did not correctly perceive the weight status of their overweight children. Moreover, misperceived overweight was highest for younger children, and for those whose parents had a higher education. CONCLUSIONS: The obesity epidemic in Spain has been accompanied by an increased misperception of overweight in women and children of both sexes. Our results warn of the low family's readiness to modify the environment and lifestyle needed to control overweight.

Successful repair of a transected intrathoracic trachea after chest trauma.

A 28-year-old man had a transection of the intrathoracic trachea in a head-on collision. Prompt diagnosis with a flexible bronchoscope, expeditious thoracotomy, and distal tracheal intubation proved lifesaving and allowed for meticulous repair of the disrupted trachea. The patient is asymptomatic 1 year later.

A technique for spot application of fibrin glue during open heart operations.

Several techniques have been described for preparing and applying fibrin glue to control surgical bleeding. However, these methods tend to be cumbersome, expensive, or messy. Furthermore, commercial kits have not been approved by the Food and Drug Administration because of the potential risk of hepatitis contamination. Therefore, we have devised a modified, simpler technique that enables the precise, pinpoint application of fibrin glue. The risk of hepatitis transmission is substantially reduced by using cryoprecipitate plasma instead of fibrinogen from pooled donors. This technique is especially well suited for anastomoses of small vessels or for sealing suture holes in nonporous grafts.

Efficacy of metadoxine in the management of acute alcohol intoxication.

This randomized, open-label study evaluated the efficacy of 300 mg metadoxine (given intravenously) added to standard treatment compared with standard treatment alone in managing the physical and psychological signs of acute alcohol intoxication. Fifty-two acutely intoxicated patients were randomly assigned to one of two groups and followed during a 2-h period. Changes in clinical symptoms, degree of intoxication, and blood alcohol level were monitored. More patients receiving metadoxine in addition to standard therapy significantly improved by at least one degree of intoxication (one clinical category) compared with those receiving standard treatment alone (76.9% versus 42.3%, respectively). Metadoxine-treated patients also exhibited a significantly greater decrease in blood alcohol concentration compared with those receiving standard treatment alone (-105.4 +/- 61.5 mg/dl versus -60.1 +/- 38.6 mg/dl, respectively). Metadoxine improved the clinical signs of acute alcohol intoxication and accelerated alcohol clearance from the blood, thus supporting existing data. In contrast to previous data, these effects were concurrent but independent. No adverse effects were observed with metadoxine therapy.

[Bact-Alert system for hemocultures: evaluation of terminal subcultures]. / Sistema bact-alert de hemocultivos: evaluación de los subcultivos terminales.

Few laboratory microbiological procedures are as important as the isolation of microorganisms from blood. To evaluate the usefulness of the terminal subcultures, 5669 blood cultures giving negative results after 7 days of incubation in the Bact/Alert System (Organon Teknika) were studied. Bottles were distributed as follows: 1562 adult aerobic bottles, 119 adult anaerobic bottles, 3960 pediatric bottles and 28 FAN bottles. From 5669 blood cultures, 10 subcultures that yielded growth had not been detected by the system. These included 5 adult aerobic bottles and 5 pediatric bottles, 7 of these microorganisms were considered contaminants according to clinical data (2 Micrococcus spp, 1 staphylococci coagulase negative, 1 Burkholderia cepacia, 1 Peptoestreptococcus spp, 1 Corynebacterium spp, 1 Scedosporium spp) while the other 3 were considered true bacteremia (1 Pseudomonas aeruginosa, 1 Proteus mirabilis, 1 Streptococcus sanguis), although no one made any change in treatment on the basis of the previous isolation. Based on these results the routinary utilization of terminal subcultures is not advisable and should be used only for special cases or a second system of blood culture should be added according to clinical or epidemiological data.

Effectiveness of quality of life therapy for depression.

A bibliotherapy outcome study was conducted to assess the efficacy of Quality of Life. Therapy for depression. Sixteen clinically depressed community volunteers who showed an aptitude for and interest in bibliotherapy and were not suffering from other disorders met weekly to discuss a manual on Quality of Life Therapy. All subjects who completed treatment were reclassified as nondepressed and showed significant increases in quality of life and self-efficacy at the end of treatment. All but one subject maintained these improvements at a follow-up assessment. The potential for increasing the improvement rate of a treatment by matching patients to treatment modalities that fit their aptitudes, skills, and interests is discussed.

Diaphragmatic myoclonus: diagnosis by fluoroscopy and electromyography with response to phenytoin.

A 40-year-old woman presented a 6-week history of "fluttering" in her chest. A diagnosis of bilateral diaphragmatic myoclonus was made by fluoroscopy and electromyography of both hemidiaphragms. No central or peripheral cause was identified, but treatment with intravenous phenytoin had an immediate effect. With therapy, she has been symptom free for 12 months.

Analysis of casualties referred to Army physical medicine services during the Persian Gulf conflict.

This study describes the casualties referred during the Persian Gulf War and underscores the valuable role of Army physical medicine and rehabilitation (PMR) services in evaluation and early rehabilitation of wartime casualties. Data regarding demographics, injury types, medical complications, complications of immobility and functional limitations were collected by military physiatrists at five Army Medical Centers with PMR services. Active duty soldiers injured in the Persian Gulf War who were referred totalled 222. Musculoskeletal injuries occurred in 57%, peripheral nerve injuries in 44%, penetrating wounds in 32%, fractures in 28%, brain injuries in 8%, amputations in 7%, burns in 6% and spinal cord injuries in 3%. The primary referral service was orthopedics (64%). Electrodiagnosis evaluations were performed for 41% of all referrals. Lower limb and upper limb contractures occurred in 10% and 9% of patients, respectively. Ambulatory impairments were seen in 48%. Nerve injuries were associated with penetrating wounds in 68%, with amputations in 67% and with fractures in 58%.

Evaluación de la eficacia de la imagen en telefonía móvil paracirugía ambulatoria / No disponible

Introducción: Tras el alta se necesita mejorar la comunicación entre la unidad de cirugía sin ingreso y el domicilio de los pacientes para ofrecer la misma calidad asistencial y los mismos cuidados que en la cirugía con ingreso. El objetivo principal del presente estudio es validar el impacto clínico, asistencial y de gestión del sistema de m-Salud de control domiciliario telefónico asistido con imágenes de telefonía móvil y pulsioximetría en el periodo postoperatorio tras intervenciones de cirugía ambulatoria. Material y métodos: Este trabajo presenta los resultados de un estudio prospectivo randomizado de un sistema móvil-health para la monitorización postoperatoria de pacientes en los primeros días del postoperatorio en el domicilio. Se seleccionaron de forma aleatoria 310 pacientes intervenidos de cirugía ambulatoria comparables en complejidad quirúrgica. Evaluamos dos grupos: el grupo piloto (llevaba móvil con transmisión de imágenes del postoperatorio)y el grupo control (sin móvil).Resultados: Los resultados muestran que el control telefónico protocolizado por sí mismo (con o sin imágenes de telefonía móvil) es eficiente en términos de calidad de la información recibida así como en la resolución de complicaciones menores domiciliarias. El grupo piloto requirió mayor tiempo de atención que el grupo control. Conclusiones: Aunque no hayamos observado diferencias entre los dos grupos estudiados consideramos que harían falta estudios posteriores para determinar con mayor exactitud el tipo de paciente idóneo para el control mediante la imagen y pulsioximetría (..) (AU)

Introduction: The rationale behind the need to improve the communication between the ambulatory surgery unit and the patients at home after discharge from ambulatory surgery is to offer a healthcare quality at home comparable to hospital care. Nowadays this improvement is needed, taking into account that more complex operations and patients with higher co morbidity are being included in these programs. The main objective of the study is to validate the clinical impact and management system of a domiciliary control m-health device assisted by mobile phone images and pulsioximetry after ambulatory surgery. Material and methods: This paper presents the results of a randomized prospective study of an m-Health system for post-operative monitoring of patients in the early ambulatory surgery home postoperative process. About 310 patients, with surgeries comparable in complexity, were randomly selected and included in either the intervention or the control group. Results: The results shows that the phone control protocol at home in postoperative process is very efficient in terms of the quality of information received and also in the resolution of late minor complications even compared with the most traditional ways of care. The timing of control of intervention group was longer than the control group. Conclusions: Although we have not observed differences between the two groups studied believe that further studies would be needed to determine more precisely the type of patient suitable for mobile image control and pulsioximetry. In this study is considered necessary to explain clearly instructions and household tips by the relevant personnel before discharge. In the other hand the patients they should known the help paths (direct phone number) in case of necessity (..) (AU)

Sistema bact-alert de hemocultivos: evaluación de los subcultivos terminales / Bact-Alert system for hemocultures: evaluation of terminal subcultures

Few laboratory microbiological procedures are as important as the isolation of microorganisms from blood. To evaluate the usefulness of the terminal subcultures, 5669 blood cultures giving negative results after 7 days of incubation in the Bact/Alert System (Organon Teknika) were studied. Bottles were distributed as follows: 1562 adult aerobic bottles, 119 adult anaerobic bottles, 3960 pediatric bottles and 28 FAN bottles. From 5669 blood cultures, 10 subcultures that yielded growth had not been detected by the system. These included 5 adult aerobic bottles and 5 pediatric bottles, 7 of these microorganisms were considered contaminants according to clinical data (2 Micrococcus spp, 1 staphylococci coagulase negative, 1 Burkholderia cepacia, 1 Peptoestreptococcus spp, 1 Corynebacterium spp, 1 Scedosporium spp) while the other 3 were considered true bacteremia (1 Pseudomonas aeruginosa, 1 Proteus mirabilis, 1 Streptococcus sanguis), although no one made any change in treatment on the basis of the previous isolation. Based on these results the routinary utilization of terminal subcultures is not advisable and should be used only for special cases or a second system of blood culture should be added according to clinical or epidemiological data.(AU)

Sistema bact-alert de hemocultivos: evaluación de los subcultivos terminales / Bact-Alert system for hemocultures: evaluation of terminal subcultures

Few laboratory microbiological procedures are as important as the isolation of microorganisms from blood. To evaluate the usefulness of the terminal subcultures, 5669 blood cultures giving negative results after 7 days of incubation in the Bact/Alert System (Organon Teknika) were studied. Bottles were distributed as follows: 1562 adult aerobic bottles, 119 adult anaerobic bottles, 3960 pediatric bottles and 28 FAN bottles. From 5669 blood cultures, 10 subcultures that yielded growth had not been detected by the system. These included 5 adult aerobic bottles and 5 pediatric bottles, 7 of these microorganisms were considered contaminants according to clinical data (2 Micrococcus spp, 1 staphylococci coagulase negative, 1 Burkholderia cepacia, 1 Peptoestreptococcus spp, 1 Corynebacterium spp, 1 Scedosporium spp) while the other 3 were considered true bacteremia (1 Pseudomonas aeruginosa, 1 Proteus mirabilis, 1 Streptococcus sanguis), although no one made any change in treatment on the basis of the previous isolation. Based on these results the routinary utilization of terminal subcultures is not advisable and should be used only for special cases or a second system of blood culture should be added according to clinical or epidemiological data.

Sistema bact-alert de hemocultivos: evaluación de los subcultivos terminales. / [Bact-Alert system for hemocultures: evaluation of terminal subcultures]

Few laboratory microbiological procedures are as important as the isolation of microorganisms from blood. To evaluate the usefulness of the terminal subcultures, 5669 blood cultures giving negative results after 7 days of incubation in the Bact/Alert System (Organon Teknika) were studied. Bottles were distributed as follows: 1562 adult aerobic bottles, 119 adult anaerobic bottles, 3960 pediatric bottles and 28 FAN bottles. From 5669 blood cultures, 10 subcultures that yielded growth had not been detected by the system. These included 5 adult aerobic bottles and 5 pediatric bottles, 7 of these microorganisms were considered contaminants according to clinical data (2 Micrococcus spp, 1 staphylococci coagulase negative, 1 Burkholderia cepacia, 1 Peptoestreptococcus spp, 1 Corynebacterium spp, 1 Scedosporium spp) while the other 3 were considered true bacteremia (1 Pseudomonas aeruginosa, 1 Proteus mirabilis, 1 Streptococcus sanguis), although no one made any change in treatment on the basis of the previous isolation. Based on these results the routinary utilization of terminal subcultures is not advisable and should be used only for special cases or a second system of blood culture should be added according to clinical or epidemiological data.

Métodos estadísticos / Statistical methods

Manual preparado para ser utilizado en cursos de estadística básica e introductorios a la inferencia estadística. Está organizado en once capítulos, siguiendo una secuencia lógica, que contienen elementos conceptuales, principios, ilustraciones, aplicaciones y otro material auxiliar. Incluye temas referentes a la concepción moderna de la estadística, métodos estadísticos y temas relacionados con las etapas de planeamiento y recolección de datos, las distintas fases de la elaboración de datos, el análisis unidimiensional y bidimensional de datos, la teoría de muestreo, y la teoría de la decisión estadística