Documentation of antibiotic prescribing controls in UK NHS hospitals

Objectives: To identify the types, prevalence and nature of antibiotic prescribing control documents within NHS hospitals in the UK. Methods: A self-completion postal questionnaire was sent to each Chief Pharmacist at 465 NHS hospitals in 2001/2002. This contained questions covering hospital demographics, and hospital antibiotic prescribing control documentation, including format, dissemination, approval and review processes. Results: In total, 253 (54%) completed questionnaires were returned. Of these, 168 respondents' hospitals had an antibiotic formulary, 107 had a policy for antibiotic prescribing and 216 had guidelines on antibiotic use. All three types of antibiotic prescribing documents were used by 82 hospitals but 18 did not have any documents; 44% of formularies, 45% of policies and 35% of guidelines were available electronically. The Drug and Therapeutics Committee was the most frequently cited body for document approval and approximately one-third of documents had been approved during the current year of the questionnaire. Only about one-half of responding hospitals had an annual review of documents. Conclusions: Despite publication of high-profile national guidance in response to growing concerns regarding antimicrobial resistance, there has been little increase in the use of antibiotic prescribing control documents in NHS hospitals over the past decade. It is clear that appropriate controls for antibiotic prescribing are not yet universally applied in the UK and recommendations for action have been proposed. © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.

Incorporation of the Health Care System in the West

A reflection is made, from an interpretative perspective, on the historical evolution of health care in the West. It starts from the moment that this became a way to intervene the sick and an instrument for healing diseases, focusing on original documents and written sources which account for results of historical research, which range from XV century until today. To do this, it tries to understand the health care as an ideographic body of knowledge consisting of five pieces of a puzzle composed by: the state policy of hospitals accumulation implemented in Spain, the accumulation of medical practices in what is currently Germany, the hospital wards in England, the nosological rationality in France, and the US sanitizing machine; all these movements as producers of closely linked health care developments, that are nothing more than collective actions regulated by social norms around health.

Robust gap repair in the contractile ring ensures timely completion of cytokinesis

Cytokinesis in animal cells requires the constriction of an actomyosin contractile ring, whose architecture and mechanism remain poorly understood. We use laser microsurgery to explore the biophysical properties of constricting rings in Caenorhabditis elegans embryos. Laser cutting causes rings to snap open. However, instead of disintegrating, ring topology recovers and constriction proceeds. In response to severing, a finite gap forms and is repaired by recruitment of new material in an actin polymerization-dependent manner. An open ring is able to constrict, and rings repair from successive cuts. After gap repair, an increase in constriction velocity allows cytokinesis to complete at the same time as controls. Our analysis demonstrates that tension in the ring increases while net cortical tension at the site of ingression decreases throughout constriction and suggests that cytokinesis is accomplished by contractile modules that assemble and contract autonomously, enabling local repair of the actomyosin network. Consequently, cytokinesis is a highly robust process impervious to discontinuities in contractile ring structure.

Privacy and Data Protection in Elderly Healthcare: Threats and Legal Warranties

The progressive aging of the population requires new kinds of social and medical intervention and the availability of different services provided to the elder population. New applications have been developed and some services are now provided at home, allowing the older people to stay home instead of having to stay in hospitals. But an adequate response to the needs of the users will imply a high percentage of use of personal data and information, including the building up and maintenance of user profiles, feeding the systems with the data and information needed for a proactive intervention in scheduling of events in which the user may be involved. Fundamental Rights may be at stake, so a legal analysis must also be considered.

Effects of exposure to formaldehyde and tobacco smoking on genotoxicity biomarkers

Formaldehyde (FA) is a colour less gas widely used in the industry and hospitals as an aqueous solution, formalin. It is extremely reactive and induces various genotoxic effects in proliferating cultured mammalian cells. Tobacco smoke has been epidemiologically associated to a higher risk of development of cancer, especially in the oral cavity, larynx and lungs, as these are places of direct contact with many carcinogenic tobacco’s compounds. Approximately 90% of human cancers originate from epithelial cells. Therefore, it could be argued that oral epithelial cells represent a preferred target site for early genotoxic events induced by carcinogenic agents entering the body via inhalation and ingestion. The cytokinesis-blocked micronucleus assay (CBMN) in human lymphocytes is one of the most commonly used methods for measuring DNA damage, namely the detection of micronucleus, nucleoplasmic bridges, and nuclear buds.

Evaluation of the influence of the ADH3 ILE349VAL polymorphism in the frequency of genotoxicity biomarkers in workers exposed to formaldehyde and tobacco smoking

Formaldehyde (FA) is a colourless gas widely used in the industry and hospitals as an aqueous solution, formalin. It is extremely reactive and induces various genotoxic effects in proliferating cultured mammalian cells. Tobacco smoke has been epidemiologically associated to a higher risk of development of cancer, especially in the oral cavity, larynx and lungs, as these are places of direct contact with many carcinogenic tobacco’s compounds. Genetic polymorphisms in enzymes involved in the metabolism are very important and can make changes in the individual susceptibility to disease. Alcohol dehydrogenase class 3 (ADH3), also known as formaldehyde dehydrogenase dependent of glutathione, is the major enzyme involved in the formaldehyde oxidation, especially in the buccal mucosa. The polymorphism in study is a substitution of an isoleucine for a valine in codon 349. The cytokinesis-blocked micronucleus assay (CBMN) in human lymphocytes is one of the most commonly used methods for measuring DNA damage, namely the detection of micronucleus, nucleoplasmic bridges, and nuclear buds, classified as genotoxicity biomarkers.

Avaliação da cultura de segurança do doente em meio hospitalar : investigação ação numa unidade de radioterapia

RESUMO Introdução e objetivos As organizações internacionais responsáveis pela Qualidade na Saúde e Segurança do doente (Organização Mundial da Saúde, União Europeia), recomendam aos Estados membros a avaliação da cultura de segurança, como condição essencial para se introduzir mudanças nos comportamentos dos profissionais e nas organizações prestadoras de cuidados de saúde, e alcançar melhores níveis de segurança e de qualidade nos cuidados de saúde prestados aos doentes. Constitui objetivo geral deste trabalho contribuir para a implementação da cultura de segurança do doente nos profissionais envolvidos na prestação de cuidados de saúde, concorrendo para a avaliação da cultura de segurança do doente e, consequentemente para a garantia da qualidade dos cuidados prestados. Metodologia 1ª fase – pré-estudo: através da revisão de literatura identificamos o instrumento mais adequado para avaliar a cultura de segurança do hospital, traduzimos e validámos o instrumento. 2ª fase – desenvolvemos um estudo exploratório-descritivo, transversal, retrospetivo, em 3 hospitais portugueses e um estudo exploratório-descritivo, longitudinal, prospetivo, de investigação-ação, numa unidade de radioterapia. Resultados O Hospital Survey on Patient Safety Culture é o instrumento que revela as adequadas características para a avaliação da cultura de segurança nos hospitais portugueses. No que diz respeito à avaliação da cultura de segurança em três hospitais portugueses, podemos destacar que o trabalho em equipa, a expectativas do supervisor e a aprendizagem organizacional são as dimensões com melhores resultados apesar da frequência das notificações e das respostas ao erro não punitivas apresentarem os piores resultados. Verificou-se que a URT se encontra em franca evolução, o que se torna visível sobretudo na adesão à notificação que aumentou à medida que o tempo foi passando. O envolvimento de todos no desenho da intervenção e nas atividades a decorrer na unidade, foi preponderante para a melhoria da segurança do doente. Conclusões Temos consciência que existem muitas questões por responder e que na realidade não há receitas nem diretrizes que possam afirmar que existem relações de causalidade, confrontando uma determinada ação com a consequente mudança cultural. No entanto, estamos convictos que o envolvimento de todos os membros da organização/unidade, o compromisso forte da liderança, uma comunicação efetiva e uma notificação não punitiva são ingredientes essenciais para a melhoria contínua da cultura de segurança do doente.

Acute myocardial infarction in the Brazilian State of São Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system

OBJECTIVE: To determine the following parameters in the Brazilian State of São Paulo: 1) the percentage of deaths due to acute myocardial infarction (AMI) occurring in hospitals; 2) the percentage of deaths due to AMI occurring in public health system hospitals as compared with all in-hospital deaths due to AMI between 1979 and 1996; 3) the fatality due to AMI in public health system hospitals from 1984 to 1998. METHODS: Data were available on the Datasus Web site (the health information agency of the Brazilian Department of Health) that provided the following: a) number of deaths resulting from AMI in hospitals; b) number of deaths resulting from AMI in public health system hospitals; c) number of hospital admissions due to AMI in public health system hospitals. RESULTS: The percentage of in-hospital deaths due to AMI increased from 54.9 in 1979 to 68.6 in 1996. The percentage contribution of the public health system to total number of deaths due to AMI occurring in hospitals decreased from 22.9 in 1984 to 13.7 in 1996; fatality due to AMI occurring in public health system hospitals had an irregular evolution from 1984 to 1992 and showed a slight trend for increased frequency from 1993 to 1998. CONCLUSION: The percentage of in-hospital deaths due to AMI has been increasing. Deaths resulting from AMI in public health system hospitals have decreased when compared with the total number of deaths due to AMI in all hospitals. Fatality due to AMI in public health system hospitals did not decrease from 1992 to 1998.

Projecte d’instal·lacions sostenibles d’una masia rural aïllada

En aquest projecte es vol donar solució a la contaminació que es produeix a les llars ja sigui en forma de gasos d’efecte hivernacle o la contaminació d’aqüífers i rius per les aigües residuals d’aquestes. Els objectius a aconseguir són la disminució del consum d’energia de la llar, reduint així el consum de combustibles fòssils, amb la conseqüent disminució de gasos d’efecte hivernacle i l’estalvi econòmic que això suposa. I per altra banda la depuració de les aigües residuals, tot i que actualment totes les grans poblacions de Catalunya de més de 10.000 habitants ja disposen de EDARS i en pocs anys en tindran totes les de més de 2000 habitants. Però en aquest cas es tracta d’una població molt petita que no disposa de xarxa de clavegueram. En primer lloc s’ha plantejat un sistema de calefacció d’energia geotèrmica que ens permet aprofitar l’energia tèrmica que es va emmagatzemant a la terra degut a l’escalfor del sol i que ens permet extreure d’aquesta fins a ¾ parts de l’energia tèrmica necessària per el sistema de calefacció. En segon lloc es planteja un sistema de producció d’energia elèctrica per panells fotovoltaics que produeixi el consum elèctric anual familiar, tot i que no de forma directe, sinó venent l’energia a la xarxa elèctrica i comprant-la després de la xarxa. Per últim es projecta un sistema de depuració d’aigües per mitjà d’un aiguamoll artificial que permetrà a la casa, que no disposa de xarxa de clavegueram, retornar les aigües residuals en bones mediambientals a l’entorn rural que envolta l’edificació, sense perjudicar la fauna i els rius que l’envolten

Projecte de reforma d’un habitatge unifamiliar entre mitgeres i adequació de les instal•lacions al Codi Tècnic de l’Edificació

Remodelació d’un habitatge unifamiliar de dos plantes entre mitgeres a Campdevànol amb l’adequació de les instal•lacions al Codi Tècnic de d’Edificació (CTE). L’estudi incideix especialment en l’estalvi energètic i la millora de l’eficiència energètica

Disseny i càlcul de les façanes i del lluernari del vestíbul d’entrada de la torra Iberdrola

El projecte Torre Iberdrola s’engloba en les actuacions urbanístiques de Bilbao per a regenerar espais industrials no utilitzats situats al Paseo de la Ribera, la Avenida Abandoibarra i la passarel•la Pedro Arrupe. La Torre Iberdrola, situada a la parcel•la 204 del PERI de Abandoibarra (veure plànol nº2), en el districte de Abando (Bilbao), és un gratacels d’oficines de 41 plantes amb una altura total de 165 metres i una superfície construïda total d’aproximadament 62.100 m2 sobre rasant. A més, l’edifici a construir consta de 5 plantes sota rasant amb una superfície total construïda d’aproximadament 32.100 m2. L’objecte del present projecte és presentar la solució acordada conjuntament entre l’arquitecte Pelli Clarke Pelli Architects, les consultories Buro Happold i IDOM, i BELLAPART per a l’execució del revestiment del vestíbul d’entrada de la Torre Iberdrola

Projecte bàsic i d'execució de rehabilitació i ampliació d'edifici plurifamiliar entre mitgeres situat al Carrer Roger de Flor, 105 de Granollers (Barcelona)

L’edifici a rehabilitar està situat en una important avinguda de l’eixample oest de Granollers. En l’actualitat l’edifici es troba a ple rendiment, amb l’ús de magatzem i obrador a la planta baixa i planta primera, i com a habitatge a les plantes segona i tercera. En concret es tracta de la formació d’un total de 6 habitatges i 5 trasters, a més de la reforma general del nucli de comunicació vertical on s’incorpora l’ascensor i la construcció de la paret mitgera que delimitarà l’espai de l’edifici en la seva projecció vertical. La rehabilitació també té com a objectiu reforçar els forjats, en els quals s’ha detectat aluminosi, així com l’enderroc d’envans a la segona i tercera planta per construir una millor distribució que permeti augmentar el nombre d’habitatges per planta

Patient safety management from the perspective of nurses

OBJECTIVE To evaluate the actions of patient safety management developed in hospitals, from the perspective of nurses. METHOD This is a cross-sectional, descriptive study of the survey type. Participants were seven hospitals, in which seven nurse managers and 49 sector coordinator nurses (n = 56) answered the instrument prepared by the author. RESULTS The results showed that 100% of hospitals have an adverse event reporting system, 71.4% have a Risk Management Committee and 80% have discussions about the events. There is agreement that these discussions lead to favorable changes for patient safety in the surveyed institutions. The employees' fear of punishment for their faults, and the underreporting of events were the aspects of greatest weakness found. CONCLUSION The institutions should develop organizational policies focused on stimulating event notification and on the implementation of measures directed to a non-punitive organizational culture.