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Biomedical subjects

A Trilla

Publications and source records attributed to A Trilla.

At least 37 records · Page 2Linked to original sources
PubMed1999

Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group.

A questionnaire survey was sent to a random sample of the Spanish network of National Health System public acute-care hospitals. Of responding institutions (representing 25% of Spanish hospital beds), nearly 75% had active surveillance programs for the prevention and control of surgical-site infections (SSIs), but only 20% performed postdischarge surveillance. Overall, perioperative antibiotic prophylaxis (PAP) was used in 84% of all surgical procedures. For 77% of procedures, there were written guidelines for the choice and use of PAP. Cefazolin was the most commonly used antibiotic (38%). Duration of PAP was shorter than 24 hours in 75% of procedures, and only a single dose was given in 52% of procedures. PAP was commonly used in breast (52%) and inguinal hernia repair (69%) procedures, as well as in laparoscopic abdominal surgery (86%). In summary, the use of PAP in Spanish hospitals is adequate, but improvements can be made in the frequency of prolonged PAP and in the use of broad-spectrum antibiotics. Surveillance systems for SSI, including postdischarge follow-up, also should be improved.

Antibiotic Prophylaxis↗
PubMed1999

[Use of diagnostic tests in the context of evidence-based medicine].

BACKGROUND: The advances of medicine over the last twenty years include the use of new tests and diagnostic methods in clinical practice. At the same time, we have witnessed the introduction of a strong movement, named Evidence Based Medicine, which basically includes a serious attempt for rationalizing the findings of more than 50 years of biomedical research, and to apply them properly to our patients as well as to the whole population. METHODS: Review of the published literature. All the recommendations are used in a practical example. RESULTS: Summary of the current existing recommendations for the assessment of a new diagnostic tool before its clinical application, and discussion of possible solutions for achieving a more efficient use of these tests. CONCLUSIONS: There are enough evidences for defining criteria for a uniform evaluation process of new diagnostic tests. The criteria could be useful for the clinical application of these tests.

Bias↗
PubMed1998

[Impact of sabbatical leave on hospital and university promotions].

BACKGROUND: The aim of this study was the assessment of the scientific production and impact on academic and/or hospital promotion ob sabbatical leaves of medical staff from a University hospital. POPULATION AND METHODS: A matched case-control design was used. The Mantel-Haenszel odds ratio (ORMH) and its 95% confidence intervals were calculated. A total of 52 sabbaticals leaves were analyzed with successful matching for 43 pairs. RESULTS AND CONCLUSIONS: Taking a sabbatical leaves is associated with a significant higher chance of hospital promotion (ORMH = 7.5; CI 95%, 1.71-32.78; o = 0.004), but there is not a significantly higher chance of academic promotion (ORMH = 0.66; CI del 95%, 0.23-1.83; p = 0.60).

Career Mobility↗
PubMed1998

[Assessment of patients' expectations before admission to a tertiary-care center].

BACKGROUND: The customer's final satisfaction with health services depends to some extent, on the relationship between expectancy and perceived quality. Focus groups technique helps in the knowledge of those attributes that patients identified as perceived quality. MATERIAL AND METHODS: The study was performed in the Hospital Clínic i Provincial of Barcelona (HCPB), Spain, by selecting a sample of patient's included in the admission's waiting list (1994) of three common procedures: lens extraction, abdominal hernia repair and routine pregnancy control. The patients were distributed in 12 different semi-structured interview groups (focus groups) and video-taped. From the analysis of those tapes, the main concerns and aspects highlighted by consumers were identified, following a common set of rules: wording, context, internal consistency, precision/vagueness of answers and basic ideas. RESULTS: A total of 106 patients attend the interview. Patients with loss of visual acuity underscore the contribution of quality of life improvement expected from the procedure (technical quality of the surgical procedure, physical improvement and final outcomes). Patient's with abdominal hernia repair highlight the appearance and comfort of hospital setting as the most important item. Pregnant women emphasize the importance of a good follow-up process after delivery, as well as the need for individual services (dignity and intimate). CONCLUSION: The semi-structured interview method (focus group) could be applied in the context of our hospitals, and contribute to improve quality management at our institutions, making effective the patient participation.

Cataract Extraction↗
PubMed1997

Characteristics of elderly inpatients at high risk of needing supportive social and health care services.

A two-stage cross-sectional study was conducted in a 951-bed acute-care hospital: a first survey designed to determine the profile of patients aged > or = 64 years needing supportive social/health care services, in which 38 patients discharged between June and July, 1992 (group 1) with social/health care problems that accounted for inappropriate hospitalization days participated, and a second survey designed to identify patients aged > or = 65 years at high risk and thus facilitating the early intervention of social workers, in which 153 patients selected at random and interviewed between August and September, 1992 (group 2) participated. A significantly higher percentage of group 1 patients had no medical insurance, were admitted to hospital for treatment, lived alone, had been readmitted in the previous 6 months, suffered from dementia and/or cognitive impairment, presented with associated chronic illnesses, and showed lower Barthel index scores as compared to group 2 patients. In patients in group 2, hospital discharge was delayed due to the need of supportive social and health care services in only 27 patients. The percentage of agreement in the suitability of the resource provided was higher after (92.6%) than before the intervention (71.1%). The mean number of inappropriate hospitalization days was 3.5 days for patients in group 1 and 1.9 days for those in group 2 (p = 0.013). The early identification of elderly inpatients at high risk of needing additional supportive social and health care would help patients to find the most appropriate resource according to their individuals needs.

Activities of Daily Living↗
PubMed1996

Nosocomial infections in Spain: results of five nationwide serial prevalence surveys (EPINE Project, 1990 to 1994). Nosocomial Infections Prevalence Study in Spain.

OBJECTIVE: To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN: Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING: A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

Acute Disease↗
PubMed1996

Prevention and control of nosocomial infections in Spain: current problems and future trends.

Spain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.

Anti-Bacterial Agents↗
PubMed1995

Error in medicine.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1995

[Assessment of the performance of sabbatical leave: Hospital Clínic i Provincial of Barcelona (1990-1991). Research Committee of the Hospital Clínic i Provincial of Barcelona].

BACKGROUND: The development of an evaluation protocol for assessing the scientific contribution and the impact on medical care of the sabbatical leaves granted in a large Spanish teaching hospital. METHODS: The sabbatical leaves for all faculty staff of the Hospital Clínic i Provincial of Barcelona (HCPB) were analyzed since 1980 trough 1991. The scientific production analysis was done according to the impact factor (IF) score of the Science Citation Index. Descriptive statistical techniques as well as parametric and non-parametric tests were used for comparisons. RESULTS: A total of 52 sabbatical leaves was analyzed of all 60 leaves granted (87%). Mean duration of the leave was 7.94 +/- 3.86 months. The scientific production includes 89 original articles published in peer-reviewed medical journals, with a total score of 300.82 IF points (mean score: 5.78 +/- 7.12 IF points by leave). There were significant differences in the mean duration, number of papers published and IF points score by sabbatical leave between the Medicine, Surgery and Other Departments. In 16 cases (31%) there was a professional promotion following the sabbatical leave and in 20 cases (39%) an academic promotion. In 27 cases (60%) there was no promotion after the leave. Most of the faculty staff physicians (96%) are still employed in the same institution, and believe that the sabbatical leave has significantly contributed to their promotion (67%). A high percentage (94%) has also been able to develop afterwards the methods and techniques learned during the sabbatical leave. CONCLUSIONS: The experience of the Hospital Clinic of Barcelona in granting sabbatical leaves has been highly positive. The scientific performance of the individuals on leave is high. Our institution has been able to add and develop most of the techniques and methods learned overseas. The future of the sabbatical leaves in other Spanish Universities and Hospitals should be regarded as a high priority target. The performance of these leaves is supported by its scientific results, that could be quantified.

Education, Medical, Continuing↗
PubMed1995

A cluster of fever and hypotension on a surgical intensive care unit related to the contamination of plasma expanders by cell wall products of Bacillus stearothermophilus.

OBJECTIVE: To evaluate an outbreak of fever and hypotension after cardiac surgical procedures and the role of polygeline, a plasma expander. DESIGN: Unmatched case-control study. SETTING: A six-bed cardiac surgery intensive care unit (SICU) of the Hospital Clinic of Barcelona (Spain), a 940-bed public teaching hospital. PATIENTS: Eight cases and 25 control patients admitted to the SICU over a 4-week epidemic period. MAIN OUTCOME MEASURES: Development of hypotension (systolic blood pressure < or = 90 mm Hg or a drop of 40 mm Hg from baseline systolic blood pressure) and fever (axillary temperature > 38.5 degrees C) within 24 hours of a cardiac surgical procedure. RESULTS: The single risk factor significantly different between cases and controls was the total volume of polygeline used throughout the surgical procedure for extracorporeal circulation: a median of 1,250 mL (mean, 1,312.5 +/- 842.5 mL) in cases versus 500 mL (mean, 566.0 +/- 159.9 mL) in controls (P = .0029). By multiple logistic regression analysis, polygeline use was the single risk factor significantly related to the outcome (odds ratio, 8.75; CI95, 1.36 to 56.2; P = .01). Neither blood cultures from patients nor cultures of the polygeline used yielded growth of any microorganism. Stopping use of the implicated polygeline lot controlled the outbreak. CONCLUSIONS: Use of polygeline was associated with an outbreak of fever and hypotension in a SICU. Information from the manufacturer indicated the likelihood of contamination of the product with Bacillus stearothermophilus components. The manufacturer has since changed the production and control processes, and no further adverse events have been seen.

Bacterial Proteins↗
PubMed1995

Components of a clinical trial: historical development, study personnel, and nursing roles.

Nurses within dialysis settings encounter research in many forms, from nursing research to clinical trials. Nurses may participate in the research being conducted in a variety of roles from principle investigator, to study coordinator or institutional review board member, and in some cases study participant. This article will explore the many roles nurses play within research, elements of a clinical trial, and historical influences.

Clinical Trials as Topic↗
PubMed1995

Identifying high risk patients for Staphylococcus aureus infections: skin and soft tissue infections.

Staphylococcus aureus is the causative organism for many skin and soft tissue (SST) infections. Some SST infections have severe systemic complications, such as bacteraemia and sepsis. S. aureus is the cause of 75% of primary pyodermas. Pre-existing conditions, like tissue injury (ulcers, wounds) or tissue inflammation (exudative dermatitis), and also underlying disorders (such as poorly controlled insulin-dependent diabetes mellitus or cancer) are some of the risk factors for secondary infection with S. aureus. In S. aureus-infected primary skin disorders (impetigo, recurrent eczema), 2% mupirocin ointment has proved effective in several clinical trials. S. aureus is responsible for 25% of all burn-wound infections, and burn units could be the point of entry and source of spread of methicillin-resistant S. aureus infection outbreaks. Mupirocin (2% ointment) has also proven effective for topical treatment of these infections. Pressure sores develop in 6% of all patients admitted to acute and chronic health care institutions. An average of three aerobic species (including S. aureus) plus one anaerobic species are isolated when infected. Infectious complications are responsible for 60-80% of all intravenous drug user (IVDU) hospital admissions, 5-20% being due to S. aureus infective endocarditis (IE). The origin of IE in IVDUs is probably the skin. Data from a Collaborative Spanish Study of IVDU infectious complications (including more than 10,000 episodes) are discussed.

Burns↗