[Proposals for the study of the second victim phenomenon in Spanish Primary Care Centres and Hospitals]. / Propuestas para el estudio del fenómeno de las segundas víctimas en España en atención primaria y hospitales.

OBJECTIVE: To identify the Spanish studies conducted since 2014 on second victims. Its main objective was to identify a global response to the second victim problem, assessing the impact of adverse events (AE) on caregivers and developing of a set of tools to reduce their impact. METHOD: Descriptive studies in which a sample of managers and safety coordinators from Hospitals and Primary Care were surveyed to determine the activities being carried out as regards second victims, as well as a sample of health professionals to describe their experience as a second victims. Qualitative studies are included to design a guide of recommended actions following an AE, an online awareness program on this phenomenon, an application (app) with activities on safety that are the responsibility of the managers, and a web tool for the analysis of AEs. RESULTS: A total of 1,493 professionals (managers, safety coordinators and caregivers) from eight Spanish regions participated. The guide of recommendations, the online program, and the developed applications are accessible on the website: www.segundasvictimas.es, which has received more than 2,500 visits in one year. DISCUSSION: Study results represent a starting point in the study of the second victim phenomenon in Spain. The tools developed raise the awareness of the medical healthcare community about this problem, and provide professionals with basic skills to manage the impact of AEs.

[Strategies in measuring nursing care]. / Estrategias de medida de los cuidados de enfermería.

When resources are limited, the balance between the supply and the demand of nursing care is becoming more and more necessary. This situation justifies the use of tools to measure work charges in nursing. This article analyses the relationship between work charges and time estimation in nursing care. From a bibliographical review on this topic it discusses possibilities and techniques of time estimation for the nursing care given to a patient, as well as the caring time he or she requires. Two different approaches and some conclusions from the analysis of both of them are showed: first; the direct method, i.e. that of measuring caring levels; and secondly, the indirect method, that is a system for classifying patients. The interest of the direct method is advocated because of its clarity, external validation possible integration in nursing care plans.

[Intensity of care during inappropriate hospital stay: Research Project in Nursing and Appropriateness Evaluation Protocol]. / Intensidad de cuidados durante las estancias hospitalarias inapropiadas: Project Research in Nursing y Appropriateness Evaluation Protocol.

OBJECTIVE: To determine the proportion of inappropriate hospital stays, their typology and the level of nursing care in Diagnosis Related Groups(DRG). To evaluate the use of the PRN (Project Research in Nursing) register forms, when determining AEP (Appropriateness Evaluation Protocol). METHOD: A cross-sectional study was performed on 494 patients classified with one of the 10 more frequent DRG in the hospital from February to July 1997. Information from patient clinical histories, PRN register forms, sociodemographic data, and nursing care activities were used. The appropriateness of hospital stay to AEP was assessed on the day prior to discharge. Comparison of inappropriate stays with appropriate stays was performed by chi-square test for categorical variables and Student t-test for continuous variables. The independent associated factors with inappropriateness of hospital stay, were estimated using a log regression model. RESULTS: Out of 417 valid cases, hospital stay was considered appropriate in 269 (64.5%) patients and inappropriate in 148 (35.5%) patients. Mean-age of inappropriate stays was significantly higher than that of appropriate stays (70.06 +/- 13.84 vs 61.57 +/- 15.07, p < 0.05). Care intensity for inappropriate stays was larger than that of appropriate stays (median 137 [minimal value 45, maximal value 355] vs median 95 [minimal value 35, maximal value 131] p < 0.001). Care time in mobilization, elimination and hygiene activities was longer in inappropriate stays than in appropriate stays. In a log regression model, the age, feeding care intensity, therapy care intensity and DRG assigned to each process were independent predictive factors of inappropriate stays. For application of AEP, 56.9% of cases were reviewed using PRN register forms and 43.1% were reviewed using the case history. CONCLUSIONS: From the DRG examined, patients who undertook inappropriate stays consumed a large intensity of nursing basic activities; therefore, they may be candidates for receiving home care and/or sociosanitary care. PRN register forms afforded a decreased review time on applying the AEP.

[The elderly with AIDS. Case report]. / Ancianos con SIDA. Reflexiones a propósito de un caso.

When we speak about AIDS, even today, we rarely associate it with the elderly. Nonetheless, nursing care reality demonstrates that AIDS cases are more numerous all the time inside this population group known as the third generation. We should not forget that sex is a personal experience that can be practiced at all ages, and is not limited only to the young, and that preventive measures are necessary in all situations. Therefore, it is interesting to share what these authors reflect about this topic; they refer to a real case. It will probably be necessary to change the established schemes and consider this age group to be one in need of information on the possibilities of contagion. It will also be essential to carry out faster diagnoses and to develop educational measures as well as continuing professional development procedures in order that the elderly be considered susceptible to suffer this disease and to improve the treatment provided to the elderly. AIDS does not discriminate. Therefore, we cannot discriminate either.

Propuestas para el estudio del fenómeno de las segundas víctimas en España en atención primaria y hospitales / Proposals for the study of the second victim phenomenon in Spanish primary care centres and hospitals

Objetivo. Identificar los enfoques metodológicos y avances de un conjunto de estudios que se han realizado en España desde 2014 en la línea de investigación sobre segundas víctimas, mediante la evaluación del impacto de los eventos adversos (EA) en los profesionales sanitarios. Elaborar un conjunto de herramientas de ayuda para reducir su impacto. Método. Estudio descriptivo en el que se encuestó a directivos y coordinadores de seguridad de hospitales y atención primaria para conocer qué actividades se estaban llevando a cabo en materia de segundas víctimas, y a profesionales asistenciales para describir su posible experiencia como segundas víctimas, junto a estudios cualitativos para diseñar una guía de acciones recomendadas tras un EA, un programa online de sensibilización sobre este fenómeno, una app con actividades en seguridad responsabilidad de los directivos y una herramienta web para el análisis de los EA. Resultados. Participaron 1.493 profesionales (directivos, coordinadores de seguridad y personal asistencial) de 8 comunidades autónomas. La guía de recomendaciones, el programa online y las aplicaciones desarrolladas se encuentran accesibles en el sitio web: www.segundasvictimas.es, que recibió más de 2.500 visitas en un año. Discusión. Los resultados del estudio representan un punto de partida en el estudio del fenómeno de las segundas víctimas en España. Las herramientas desarrolladas sensibilizan a la comunidad sanitaria acerca de esta problemática y dotan a los profesionales de habilidades para gestionar el impacto de los EA (AU)

Objective. To identify the Spanish studies conducted since 2014 on second victims. Its main objective was to identify a global response to the second victim problem, assessing the impact of adverse events (AE) on caregivers and developing of a set of tools to reduce their impact. Method. Descriptive studies in which a sample of managers and safety coordinators from Hospitals and Primary Care were surveyed to determine the activities being carried out as regards second victims, as well as a sample of health professionals to describe their experience as a second victims. Qualitative studies are included to design a guide of recommended actions following an AE, an online awareness program on this phenomenon, an application (app) with activities on safety that are the responsibility of the managers, and a web tool for the analysis of AEs. Results. A total of 1,493 professionals (managers, safety coordinators and caregivers) from eight Spanish regions participated. The guide of recommendations, the online program, and the developed applications are accessible on the website: www.segundasvictimas.es, which has received more than 2,500 visits in one year. Discussion. Study results represent a starting point in the study of the second victim phenomenon in Spain. The tools developed raise the awareness of the medical healthcare community about this problem, and provide professionals with basic skills to manage the impact of AEs (AU)

[Respiratory thermal exchanges in man as a function of inspired gas temperature]. / Les échanges thermiques respiratoires chez l'homme en fonction de la température de gaz inspiré.

1. Measurements of respiratory water vapor loses (MEH20) and of respiratory evaporative (WEV) and convective (WCV) heat losses were made on four of five subjects at three levels of inspired gas temperatures (T1): 10 degrees C, 22 degrees C, 40 degrees C, and at almost constant water vapour pressure (8.5 to 11 torrs). For T1 = 22 degrees C and P1H20 = 8.5 torrs, the mean value of MEH20 is 29.5 +/- 1.6 mg of water per dm3 of ventilated gas (BTPS), while the values of WEV and WCV are respectively 8.1 +/- 1.9 watts and 1.6 +/- 0.4 watts. 2. When T1 increases, MEH20 and WEV increases and WCV decreases. Results show that WCV changes in sign and becomes a thermal gain when T1 is higher than core temperature. The total respiratory heat drain, convective plus evaporative, involved of the conditioning of respiratory gases is a small part of the total body heat balance (approximately 15%). However this heat drain which slowly decreases when T1 increases, represents the largest energy expenditure of the human organism in respiratory function.

Respiratory water loss as a function of ventilatory or environmental factors.

Since expired gas is not water-saturated (Ferrus et al., 1980, Respir. Physiol. 39: 367-381), its water content should depend on biological or environmental factors other than expired gas temperature. In order to verify this hypothesis, multiple linear regression relationships between MEH2O, the mass of water expired per litre of BTPS ventilated gas and respiratory frequency (f) or period (TR), tidal volume (VT), ventilation (V), temperature of inspired gas (TI), density of inspired gas mixture (rho I), partial pressure of water in inspired gas (PIH2O) were computed from 345 experiments performed on 7 subjects. This analysis shows that MEH2O is positively and significantly correlated to TI (0.22 mg . dm-3 . degrees C-1), to PIH2O (0.14 mg . dm-3 . Torr-1), and to TR (0.87 mg . dm3 . s-1). MEH2O is negatively and significantly correlated to f (-0.27 mg . dm-3(cy . min-1)-1) to rho I (-0.06 mg . dm-3(g . dm-3)-1) and to V (-0.09 mg . dm-3(dm3 . min-1)-1). There is no statistical correlation between MEH2O and VT. It is concluded that the respiratory water loss depends to a large degree on respiratory or environmental conditions. This dependence supports the previously published results suggesting that expired gas is not water saturated.

Respiratory water loss.

Two kinds of studies have been conducted in order to measure respiratory water loss: a single breath study of instantaneous variations in relative gas humidity of air expired during one respiratory cycle and a multibreath study of the average values of water vapor in air expired during several successive cycles of steady state ventilation. In the first case, relative gas humidity is computed from results obtained by thermometry and mass spectrometry; in the second case, average water vapor content of expired air is calculated from plethysmographic spirometry and expired water collection. Both experiments showed that mixed expired gas is not fully water saturated. The multibreath study showed that the mass of water lost per liter of ventilated gas is not a function of ventilation per se but rather increases as tidal volume rises and decreases as respiratory frequency diminishes. The mass of water lost per cycle of steady state ventilation increases with tidal volume so that mean expired gas volume may be considered as a mixture of dry gas and water saturated gas. The single breath study showed that unsaturated gas is expired in the first part of expirate followed by wet saturated gas in the second part. The numerical values given by the two kinds of studies are in close agreement.

Heat and water respiratory exchanges: comparison between mouth and nose breathing in humans.

The temperatures (TI, TE) of inspired and expired gas and the mass of expired water (MEH2O) have been measured in four subjects at rest during mouth and nose breathing of dry air at room temperature. TI and TE were measured by copper-constantan thermocouples, MEH2O by freezing and ventilatory parameters by total body plethysmography. During mouth breathing, temperatures are significantly higher (TI = 28.1 degrees C, TE = 31.5 degrees C) and the amount of expired water larger (MEH2O = 27.8 mg dm-3 BTPS) than during nose breathing (TI = 24.8 degrees C; TE = 29.6 degrees C; MEH2O = 26.6 mg dm-3 BTPS). From these experimental data the appropriate computations show clearly that in humans, while either nose or mouth breathing, the expired air is not water saturated; the latent heat exchanges represent the larger part of the respiratory heat exchanges; the counter current expiratory heat recovery is imperfect; in terms of heat and water respiratory exchanges, no large difference exists between the oral and nasal routes. This last point is confirmed by the calculation of a difference less than 10% in the total respiratory heat losses between mouth and nose breathing.

Intensidad de cuidados durante las estancias hospitalarias inapropiadas: project research in nursing y appropriateness evaluation protocol / Nursing intensity in inappropriate hospital stays: Project Research in Nursing and Appropriateness Evaluation Protocol

Objetivo: Determinar la proporción de las estancias inapropiadas y la tipología e intensidad de cuidados de enfermería en las mismas, en determinados grupos de diagnósticos relacionados (GDR).Métodos: En una cohorte de pacientes ingresados entre los meses de febrero a julio del año 1997, se estudió la intensidad de cuidados de enfermería y la adecuación del penúltimo día de estancia. La población de estudio fueron 494 pacientes ingresados en el Consorci de l'Hospital de la Creu Roja de l 'Hospitalet de Llobregat, que al alta se clasificaron en uno de los 10 GDR más frecuentes. La información utilizada se obtuvo a partir de la historia clínica y de las hojas de registro del sistema PRN. Se evaluaron variables datos sociodemográficos del paciente, actividades de cuidados de enfermería y la adecuación del uso de la hospitalización con el AEP, el día anterior al alta. Para la comparación de las estancias inapropiadas con las apropiadas, se realizó un análisis de ji cuadrado para la comparación de variables categóricas y la t de Student para las continuas. Mediante un modelo de regresión logística se estudiaron los factores asociados de forma independiente con la inadecuación de la estancia. Resultados: De los 417 procesos válidos, en 269 (64,5 por ciento) se consideró la estancia apropiada y en 148 (35,5 por ciento) inapropiada. La edad media de las estancias inapropiadas fue significativamente superior a las estancias apropiadas (70,06 ñ13,84 vs 61,57 ñ 15,07, p < 0,05). La intensidad de cuidados para las estancias inapropiadas fue mayor que en las apropiadas (mediana 137 (valor mínimo 45, valor máximo 355) vs mediana 95 (valor mínimo 35, valor máximo 1310) p < 0,001). Las estancias inapropiadas presentaron un tiempo de cuidar significativamente mayor que las estancias apropiadas, en las actividades de movilización, eliminación e higiene. En un modelo de regresión logística, la edad, la intensidad de cuidados en la alimentación, en los tratamientos y el GDR asignado a cada proceso, fueron factores predictivos independientes de estancia inapropiada. La aplicación del AEP se pudo hacer en el 56,9 por ciento de los procesos con las hojas de registro del PRN y el 43,1 por ciento se revisaron mediante la historia clínica. Conclusiones: En los GDR estudiados, los pacientes que presentan estancias inapropiadas, consumen una mayor intensidad de cuidados básicos de enfermería, por lo que serían candidatos de recibir una asistencia a domicilio y/o socio-sanitaria. Las hojas de registro del PRN permiten disminuir el tiempo de revisión al aplicar el AEP (AU)