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BACKGROUND: Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient. OBJECTIVE: The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method. MATERIALS AND METHODS: The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit. RESULTS: In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value < 2.2 × 10-16). The bias and 95% confidence intervals were 0.135 and -0.821-1.091 cmH2O, respectively. Measurements in patients with DSIAP versus Kron's method shown a very good correlation (r = 0.973, p-value < 5.46 × 10-13), while the bias and confidence intervals were 0.018 and -3.461-3.496 mmHg, respectively. CONCLUSIONS: The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.

ANTECEDENTES: La medición de la presión intraabdominal (PIA) generalmente se realiza con el método de Kron, a pesar de presentar inconvenientes como la infusión de agua en la vejiga del paciente. OBJETIVO: Introducir un nuevo sensor desechable para medir la PIA (SDPIA) que aborda algunas limitaciones del método de Kron. MÉTODO: Se probó el SDPIA en pruebas in vitro y clínicas. La técnica se contrastó con el método de Kron empleando la correlación de Pearson y el análisis de Bland-Altman. Para las pruebas in vitro se realizaron 159 mediciones simulando la PIA en la vejiga. Para las pruebas clínicas se realizaron 20 mediciones en pacientes con monitorización rutinaria de la PIA en la unidad de cuidados intensivos. RESULTADOS: En las mediciones in vitro se encontró una alta correlación (r = 0.99; p < 2.2 × 10−16). El sesgo para la diferencia entre los dos métodos de medición fue de 0.135 cmH2O, con un intervalo de confianza del 95% de −0.821 a 1.091 cmH2O. En las mediciones clínicas también se encontró una alta correlación (r = 0.973; p < 5.46 × 10−13) para la diferencia entre los dos métodos de medición de 0.18, con un intervalo de confianza del 95% de −3.302 a 3.650 mmHg. CONCLUSIONES: Los resultados sugieren que el SDPIA propuesto muestra un desempeño similar al de los transductores de presión actualmente en uso clínico, mientras sobrelleva algunas limitaciones de estos últimos.

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BACKGROUND: The dynamic interactions of severe infectious diseases with epidemic potential and their hosts are complex. Therefore, it remains uncertain if a sporadic zoonosis restricted to a certain area will become a global pandemic or something in between. OBJECTIVE: The objective of the study was to present a surveillance system for acute severe infections with epidemic potential based on a deterministic-stochastic model, the StochCum Method. DESIGN: The StochCum Method is founded on clinical, administrative, and sociodemographic variables that provide a space/time map as a preventive warning of possible outbreaks of severe infections that can be complemented based on the sum of all the first accumulated cases. If the outbreak is happening in high-risk areas, an early warning can be elicited to activate the health response system and save time while waiting for the confirmation of symptomatic cases. RESULTS: The surveillance system was tested virtually for 1 month on admissions to the emergency room of a public hospital located in Mexico City, Mexico. It promptly identified simulated cases of acute respiratory infections with epidemic potential. CONCLUSIONS: The StochCum Method proved to be a practical and useful system for conducting epidemic surveillance on a hospital network.

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In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.

En el presente artículo se presentan algunas reflexiones sobre el proceso de atención en los servicios de urgencias médicas, así como algunos de los retos que enfrentan estos componentes fundamentales del sector salud de nuestro país. Se hace énfasis en el creciente volumen y la complejidad de los casos atendidos en estos servicios, lo cual contribuye a su saturación.

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INTRODUCTION: In most places all over the world­including our country­services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. OBJECTIVE: To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. MATERIAL AND METHODS: The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. RESULTS: The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. CONCLUSIONS: This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

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OBJECTIVE: To evaluate the implementation and proper use of policies and procedures for food handling to prevent nosocomial gastrointestinal infections in major General Hospitals and Public Institutions of Health in Mexico. MATERIAL AND METHODS: We performed a cross-sectional study of food services in 54 second-level general hospitals from these institutions: Mexican Institute of Social Security (IMSS), Institute of Security and Social Services for State Workers (ISSSTE), and the Ministry of Health (SESA). A questionnaire was made to identify risk factors for food contamination. In the statistical analysis, we determined the relative frequency of food handling complying with the norm; a qualitative analysis was performed using an intentional non-probabilistic sampling, targeting department heads, managers, and operational staff. The qualitative variables were verified through non-parametric tests. RESULTS: From 54 hospitals evaluated, 81% had procedure and operation manuals, 35% prepared and stored food according to NOM-251-SSA1-2009, 52% performed ongoing training, 62% had a record of microbiological analysis done to staff and 81% done to foods, and 31% had first in first out (FIFO) temperature control systems. CONCLUSIONS: Second-level health institutions in Mexico have deficiencies in the implementation of norms and procedures to handle, store, and prepare food that can lead to gastrointestinal outbreaks of nosocomial infections in patients, health staff, and visitors. In order to ensure the quality of food preparation for distribution and consumption in hospitals, it is necessary that food services comply with current norms and regulations, updating policies and procedures, and training their staff continuously.

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Las infecciones nosocomiales presentan un gran reto para la medicina hospitalaria, en general, y para las Unidades de Cuidados Intensivos, en particular. Su elevada prevalencia, la gran morbilidad y mortalidad asociadas, el incremento de la estancia hospitalaria y, en consecuencia, los costos de la atención médica han hecho que los programas de vigilancia, control y prevención de infecciones nosocomiales sean una parte toral de los protocolos de seguridad para el paciente y un indicador de calidad de la atención médica.

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INTRODUCTION: Overcrowd of emergency rooms affects efficiency and quality of medical care. OBJECTIVES: To describe the mathematical-computational system modified overcrowd index which measures in real time and in four levels of warnings (non crowded, crowded, overcrowded and extreme overcrowded) emergency room saturation in a network of hospitals, from only seven simple variables (number of available beds, physicians and nurses, number of patients in the waiting room, in medical consultation and admitted for further evaluation, as well as number of critically ill patients admitted). MATERIALS AND METHODS: The modified overcrowd index was exhaustively tested with 245,280 virtual transactions from seven hospitals in an uninterrupted schedule basis simulating hourly surveillance for four years. RESULTS: From 224 episodes of overcrowd, 216 (97%) where correctly identified and verified by the network of hospitals warnings, its time series also provided useful information about available personnel and resource distribution within the hospital network. CONCLUSIONS: Modified overcrowd index is an efficient tool detecting emergency room overcrowd outbreaks in a network of hospitals.

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INTRODUCTION: sequential measurement of intra-abdominal pressure is of paramount importance for an early detection and appropriate therapeutic management of intra-abdominal hypertension and abdominal compartment syndrome. OBJECTIVE: to validate a device and technique developed to measure intra-abdominal pressure (an innovation of the Foley urinary catheter named intra-abdominal pressure catheter). METHODS: three different sets of measurements where done to test the intra-abdominal pressure catheter device: I. 50 measurements were done with the intra-abdominal pressure catheter device and compared against those measurements done using a manometer graded in cm H(2)O; II. Direct measurement of intra-abdominal pressure in five patients during elective laparoscopy vs the intraabdominal pressure catheter device; and III. Measurement of intra-abdominal pressure by the Kron method (Gold standard) vs intra-abdominal pressure catheter device in three patents with intra-abdominal hypertension/abdominal compartment syndrome. Measurements where compared with Pearson correlation test and Bland Altman statistics. RESULTS: I.Intra-abdominal pressure catheter vs graded manometer: r = 0.99, with a mean pressure difference of 0.27 ± 0.23 mmHg, CI (0.039 to 0.092 mmHg). II. Direct measurement of intra-abdominal pressure during laparoscopy vs intra-abdominal pressure catheter device: r = 0.93, with a mean pressure difference of 0.18 ± 0.84 mmHg, CI (-1.46 to 1.83 mmHg) and III. Measurement of intra-abdominal pressure by the Kron Method vs intra-abdominal pressure catheter device: r = 0.81, with a mean pressure difference of -0.41 ± 0.87, CI (-2.12 mmHg to 1.30 mmHg). CONCLUSIONS: the intra-abdominal pressure catheter device is a safe and reliable instrument for measuring intra-abdominal pressure.

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BACKGROUND: The recent pandemic influenza AH1N1 virus made it clear that planning for medical disaster response is critical. OBJECTIVE: To know the responsiveness of a sample of highly specialized hospitals in Mexico to a medical disaster, with the previous pandemic influenza AH1N1 as reference. METHODS: A survey was conducted among the Medical Directors of a sample of highly specialized hospitals, covering: previous experience with the pandemic influenza, space considerations, material resources, staff, logistics, and current general perspectives. Descriptive statistics were used for analysis. RESULTS: A 95% response was obtained from the institutions (19 hospitals). Of these, 47.4% considered that the medical institution was not ready to respond to pandemic influenza. The median surge capacity for the Intensive Care Unit beds was 30% (range 0 to 32 beds). The least reserve in medication was found in the antivirals (26.3%). Only 47.4% considered having enough intensive care nurses and 57.9% enough respiratory technicians; 42.1% would not have an easy access to resources in an emergency. CONCLUSIONS: Prevention is key in responsiveness to medical disasters, and therefore the basic steps for planning strategies must be considered.

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