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INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

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BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

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Objetivo: La finalidad del estudio fue la estimación del grado en que los médicos consideran que la carga de trabajo puede generar problemas en la seguridad de los pacientes (SP). Metodología: Estudio descriptivo realizado mediante cuestionario remitido electrónicamente a médicos de hospitales públicos del Servicio Aragonés de Salud. Resultados y conclusión: Se obtuvo una tasa de respuesta del 9% (177 respuestas válidas; N: 1.600 médicos). Un 48,6% opinaba que durante el último año, al menos una vez a la semana, la presión asistencial excedió de lo que podría considerarse como una atención médica segura. El 28% consideró que durante el último año tuvo que atender a demasiados pacientes. El 17% afirmó que no había sido posible registrar en la historia clínica la totalidad de los resultados importantes de las exploraciones realizadas. Los resultados ponen de manifiesto la preocupación de los profesionales por el impacto de la carga asistencial sobre la repercusión en la calidad de la asistencia y la seguridad del paciente

Objective: The aim of this study was to estimate the degree to which physicians consider that the workload can reduce patient safety. Methodology: Descriptive study carried out by means of a questionnaire sent electronically to doctors from public hospitals of Aragón (Spain). Results and conclusion: A response rate of 9% was obtained (177 valid responses, N: 1.600 doctors). A 48.6% think that during the last year, at least once a week, the workload of care has exceeded what they consider a safe medical care. A 28% of the respondents,during the last year, has had to attend to too many patients. 17% affirm that it has not been possible to record in the clinical history all the important results of the explorations carried out. The results highlight the professionals concern about the impact of the workload on patient safety and quality of care

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OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

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Objetivos: Testar la fiabilidad interobservador de la guía de cribado y del formulario modular de revisión (MRF2) para identificar eventos adversos (EA). Comparar la incidencia de EA entre un grupo de pacientes sometidos a precauciones de aislamiento de contacto y gotas por gripe frente a un grupo de pacientes no aislados. Método: Estudio de casos y controles anidados en una cohorte. Los casos son 50 pacientes sometidos a precauciones de aislamiento por gripe, y los controles son 50 pacientes ingresados y no aislados. Resultados: La incidencia de EA varía entre el 10 y el 26% por efecto del observador (26% [IC 95%: 17,4-34,60%]; 10% [IC 95%: 4,12-15,88%]; 23% [IC 95%: 14,75-31,25%]). Es siempre menor en la cohorte expuesta al aislamiento que en la no expuesta, y esa diferencia alcanza significación estadística cuando aplicamos el criterio de máxima exigencia en la definición de caso. La concordancia respecto del cribado fue buena (porcentaje simple de concordancia superior al 76%; índice Kappa entre 0,29 y 0,81). La concordancia respecto de la identificación precisa de EA relacionado con la asistencia fue menor (porcentaje de concordancia entre el 50 y el 93,3%; índice Kappa de 0,20 a 0,70). Conclusiones: Antes de realizar un estudio epidemiológico sobre EA hay que analizar la fiabilidad interobservador para mejorar la precisión de los resultados y, por ende, la validez del estudio. Los revisores presentan diferentes grados de concordancia. El índice Kappa muestra niveles elevados para la guía de cribado, no así para la identificación de EA. Sin una buena metodología no se pueden garantizar los resultados alcanzados y, consecuentemente, las decisiones tomadas a partir de ellos. Por tanto, los investigadores han de ser garantes del método utilizado y este debe acercarse lo más posible al óptimo alcanzable (AU)

Objective: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. Methods: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. Results: The AE incidence ranges from 10 to 26% depending on the observer (26% [95% CI: 17.4%-34.60%], 10% [95% CI: 4.12%-15.88%], and 23% [95% CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). Conclusions: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable (AU)

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Objetivo: Analizar el respeto a la intimidad de los pacientes en el ámbito de los servicios de urgencias hospitalarios (SUH) de Aragón. Método: Estudio prospectivo llevado a cabo mediante la cumplimentación de un cuestionario por parte de los pacientes sobre la valoración del respeto a la intimidad durante su asistencia en los SUH de diferentes hospitales de Aragón, con respuestas de cinco opciones graduales de escala Likert. Se realizó un muestreo estratificado aleatorio de los pacientes dados de alta de cada uno de los servicios incluidos. Resultados: Se analizaron 3.949 cuestionarios de pacientes. La intimidad auditiva fue valorada con una puntuación media de 3,93 (mínimo 1, máximo 5), (IC95%: 3,89-3,96). En cuanto a la privacidad visual, la puntuación media fue de 4,32 (IC 95% 4,29-4,35). La intimidad global obtuvo una puntuación media de 4,17 (IC 95% 4,15-4,21).Se halló mayor puntación en los varones vs mujeres en la intimidad auditiva (3,97 vs3,90, p < 0,05), en la intimidad visual (4,35 vs 4,30, p < 0,05) y en la intimidad global(4,21 vs 4,16, p < 0,05). Los centros privados y los de tamaño pequeño obtuvieron mejores puntuaciones en todos los ámbitos de la intimidad estudiados (p < 0,01).Conclusiones: La percepción de los pacientes sobre el respeto a la intimidad en losSUH es valorada como adecuada entre un 64-92%, y la peor puntuada fue la intimidad auditiva. Aunque las valoraciones pueden considerarse positivas, dado que evaluamos un derecho, ha de intentar alcanzarse el 100% en la percepción de respeto de la intimidad por parte de todos los pacientes (AU)

Objective: To analyze patients' perception of respect for their privacy in hospital emergency departments in Aragon. Methods: In a prospective survey patients were asked to evaluate respect for their privacy while they were treated in hospital emergency departments. Assessments were expressed on a 5-point Likert scale. The study population was a stratified random sample of patients discharged from each of the participating hospital emergency departments. Results: A total of 3949 patient questionnaires were analyzed. The mean score for auditory privacy was 3.93 (range, 1-5;95% CI, 3.89-3.96). The mean score for visual privacy was 4.32 (95% CI, 4.29-4.35). The overall privacy score was a mean of 4.17 (95% CI, 4.15-4.21). The mean scores for men were higher for auditory privacy (3.97 vs 3.90 for women, P<.05), visual privacy (4.35 vs 4.30, P<.05), and overall privacy (4.21 vs 4.16, P<.05). Private and small hospitals received better scores on all aspects of privacy (P<.01).Conclusions: Privacy is adequately respected in hospital emergency departments according to 64% to 92% of patients. Auditory privacy is the aspect that receives the lowest ratings. Although these scores can be considered positive, we must attempt to achieve a higher level that will be perceived as fully respectful given that privacy is a basic patient right (AU)

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The bronchial response to physical exercise on a treadmill was analyzed in 48 patients with mild to moderate extrinsic asthma diagnosed by clinical criteria and a positive methacholine test, and in 36 non-asthmatic subjects. Bronchoconstriction secondary to physical exercise was documented by measuring the percent fall in PEF in different post-exercise control times. Significant differences (p < 0.00001) were observed between bronchial response in asthmatic and non-asthmatic patients. By using ROC curves an optimal cut-off was obtained in a fall equal to or greater than 6% 10 minutes post-exercise, with a sensitivity of 0.75 and an specificity of 0.923. The bronchial challenge test with physical exercise on a treadmill, within the limits of the studied sample, can be used as a method for detecting BHR in asthmatic patients.

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