Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems

BACKGROUND

For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector.

OBJECTIVE

To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept.

METHODS

A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article.

RESULTS

The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001).

CONCLUSIONS

There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.

Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature

Background

This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs).

Methods

The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital."

Results

A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations.

Conclusion

Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.

Population Interest in Information on Obesity, Nutrition, and Occupational Health and Its Relationship with the Prevalence of Obesity: An Infodemiological Study

OBJECTIVE

To identify and analyze population interest in obesity, nutrition, and occupational health and safety and its relationship with the worldwide prevalence of obesity through information search trends.

METHOD

In this ecological study, data were obtained through online access to Google Trends using the topics "obesity", "nutrition", and "occupational health and safety". Obesity data were obtained from the World Health Organization (WHO) website for crude adult prevalence and estimates by region. The variables studied were relative search volume (RSV), temporal evolution, milestone, trend, and seasonality. The temporal evolution of the search trends was examined by regression analysis (R2). To assess the relationship between quantitative variables, the Spearman correlation coefficient (Rho) was used. Seasonality was verified using the augmented Dickey-Fuller (ADF) test.

RESULTS

The RSV trends were as follows: obesity (R2 = 0.04, p = 0.004); nutrition (R2 = 0.42, p < 0.001); and occupational health and safety (R2 = 0.45, p < 0.001). The analysis of seasonality showed the absence of a temporal pattern (p < 0.05 for all terms). The associations between world obesity prevalence (WOP) and the different RSVs were as follows: WOP versus RSV obesity, Rho = -0.79, p = 0.003; WOP versus RSV nutrition, Rho = 0.57, p = 0.044; and WOP versus RSV occupational health and safety, Rho = -0.93, p = 0.001.

CONCLUSIONS

Population interest in obesity continues to be a trend in countries with the highest prevalence, although there are clear signs popularity loss in favor of searches focused on possible solutions and treatments, with a notable increase in searches related to nutrition and diet. Despite the fact that most people spend a large part of their time in the workplace and that interventions including various strategies have been shown to be useful in combating overweight and obesity, there has been a decrease in the population's interest in information related to obesity in the workplace. This information can be used as a guide for public health approaches to obesity and its relationship to nutrition and a healthy diet, approaches that are of equal utility and applicability in occupational health.

Occupational Health Applied Infodemiological Studies of Nutritional Diseases and Disorders: Scoping Review with Meta-Analysis

(1) Objective: to identify and review existing infodemiological studies on nutritional disorders applied to occupational health and to analyse the effect of the intervention on body mass index (BMI) or alternatively body weight (BW); (2) Methods: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American, and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Nutrition Disorders, "Occupational Health" and "Infodemiology", applying the filters "Humans" and "Adult: 19+ years". The search was conducted on 29 May 2021; (3) Results: a total of 357 references were identified from the bibliographic database searches; after applying the inclusion and exclusion criteria, a total of 11 valid studies were obtained for the review. Interventions could be categorised into (1) interventions related to lifestyle, physical activity, and dietary changes through education programmes, (2) interventions associated with lifestyle, physical activity, and dietary changes through the use of telemonitoring systems or self-help applications, (3) interventions tied to lifestyle, physical activity, and dietary changes through control and/or social network support groups, and (4) interventions linked to changes in the work environment, including behavioural change training and work environment training tasks. The meta-analysis demonstrated that the heterogeneity present when analysing the results for BMI was 72% (p < 0.01), which decreased to 0% (p = 0.57) when analysing the outcomes for weight, in which case the null hypothesis of homogeneity could be accepted. In all instances, the final summary of the effect was on the decreasing side for both BMI and BW; (4) Conclusions: Despite the high heterogeneity of the results reported, the trend shown in all cases indicates that the intervention methodologies implemented by empowering individuals through Web 2.0 technologies are positive in terms of the problem of overweight. Further implementation of novel strategies to support individuals is needed to overcome obesity, and, at least in the early studies, these strategies seem to be making the necessary change.

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Antibiotic Infographics Available on the Internet: Documentary Quality, Purpose, and Appropriateness as Educational Tools on Antimicrobial Resistance

Antimicrobial resistance is a major threat to global health in the 21st century. In the age of the internet and social media, infographics may constitute an effective educational resource for transmitting complete messages about antibiotics and antimicrobial resistance and driving behavioural change. We aimed to evaluate the infographics on antibiotics available on the internet in terms of their documentary quality, purpose, and appropriateness as educational tools for explaining the strategic lines defined in the World Health Organization Global Action Plan on Antimicrobial Resistance (GAP-AMR) and for conveying the One Health concept. We obtained the infographics for this cross-sectional study on 4 March 2021 by searching the terms “infographic” and “antibiotic” in Google Images. We verified infographic documentary quality by analysing the image, authorship, title, structure, date, and licence. To evaluate the purpose, we determined whether it coincided with one of the strategic objectives set out in the GAP-AMR. The degree of appropriateness depended on the type of key awareness message on antibiotic use. After obtaining these results, we performed a cross-sectional evaluation to determine how successfully these infographics conveyed the One Heath concept. We selected 247 infographics from 518 references. Of the included infographics, 97 (39%) were produced by public institutions; 58 (23%) read from left to right; 142 (57%) had an educational purpose; 156 (63%) focused on humans; 140 (57%) were subject to copyright; and 97 (39%) had no licence of any type. Almost one quarter (n = 57; 23%) included no key message on proper use of antibiotics. Infographics that included an author/promoter had a significantly higher mean number of messages that those without disclosure of authorship (1.67 vs. 0.50; p < 0.001). The infographics on antibiotics available on the internet are of moderate general quality. Most are produced by public institutions and have a clear and readable layout, but very few have a Creative Commons license to enable their reuse as informative material. The most common purpose is to improve awareness and understanding of antimicrobial resistance; few infographics focus on the remaining four strategic objectives of the GAP-AMR. It would be useful for authors of educational infographics on antibiotics to promote key messages related to antimicrobial resistance and the One Health concept, in accordance with the first objective of the WHO GAP-AMR.

Interés poblacional, a través de las tendencias de búsqueda de información, sobre acoso laboral y sexual en España y su asociación con los datos de búsqueda mundiales

Introducción: Analizar y relacionar el interés poblacional, a través de las tendencias de búsqueda de información, sobre acoso laboral (AL) y sexual (AS) en España y su asociación con los datos de búsqueda mundiales. Método: Estudio ecológico, los datos se obtuvieron mediante acceso online a Google Trends, utilizándose los términos «acoso laboral» y «acoso sexual» como tema. Variables estudiadas: volumen de búsqueda relativo (VBR), hito, tendencia y estacionalidad. Fecha consulta 14/01/2022. Resultados: A nivel mundial, mediana del VBR para AL = 25 y para AS = 37 con tendencia para AL de R2 = 0,04 y AS de R2 = 0,43. Se observó un hito de VBR = 100 en noviembre de 2017 en AS. A nivel español mediana del VBR para AL = 21 y para AS = 8 con tendencia para AL de R2 = 0,38 y AS de R2 = 0,06, observándose un hito de VBR = 100 en febrero de 2005 en AL. Conclusiones: Si bien las tendencias sobre AL y AS presentaron una línea decreciente fue a partir de noviembre de 2017 cuando se observó un cambio de modelo en las búsquedas sobre AS. El movimiento MeToo fue el principal responsable de este cambio, siendo incluso el principal hito observado en la tendencia de AS a nivel español y, en mayor medida, a nivel mundial.

The Effects of the Exogenous Melatonin on Shift Work Sleep Disorder in Health Personnel: A Systematic Review

(1) Background: To know the medical documentation related to exogenous melatonin in sleep disorders caused by shift work in health personnel; (2) Methods: Systematic and critical review. Data were obtained by looking up the bibliographic data base: MEDLINE (via Pubmed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The used terms, as descriptors and text in the title and abstract record fields, were "Health Personnel", "Melatonin" and "Sleep Disorders", Circadian Rhythm, by using the following filters: "Humans", "Adult: 19+ years" and "Clinical Trial". The search update was in December 2021. The documentary quality of the articles was assessed using the CONSORT questionnaire. (3) Results: Having applied the inclusion and exclusion criteria, 10 clinical essays were selected out of 98 retrieved references. CONSORT scores ranged from a minimum of 6.0 to a maximum of 13. 7 with a median of 10.2. According to the SIGN criteria, this review presented "1-"evidence with a grade of recommendation B. The intervention dose via administration of exogenous melatonin ranged between 1 and 10 mg. It was not mentioned whether the route of administration was by fast or slow absorption. The outcomes showed decreased daytime sleepiness, lessened sleep onset latency, diminished night-time awakenings, increased total sleep period and improved daytime attention in the melatonin-treated group; (4) Conclusions: Exogenously administered melatonin is effective in shift worker health personnel that are suffering from sleep disorders, and given its low adverse effects and tolerability, it might be recommended. A great disparity was evidenced in terms of dose, follow-up periods and type of melatonin, small participant population, same age ranges and young age. Therefore, new trials would be needed to amend these observations in order to have full evidence that is able to ensure the efficacy of exogenous melatonin in the studied population.

Impact of Variation in Pill/Package Appearance of Drugs on Patients' Behavior: A Systematic Review

OBJECTIVE

This systematic review aims to identify and critically evaluate the available evidence on the impact of switches in pill appearance/packaging on patient's behavior.

METHODS

Studies from inception to March 2021 were searched across MEDLINE through PubMed, the Cochrane Library, Embase, and Scopus. Included studies carried out an original evaluation in English or Spanish language that evaluated the impact of switches in pill appearance/packaging on patient's behavior. Two authors independently extracted study data and evaluated studies for methodological quality according to the STROBE guidelines.

RESULTS

Ten studies were included, and the mean (SD) number of STROBE criteria satisfied was 17.2 (3.9). Three of 5 studies found a significant association between change in pill appearance and persistence to treatment; the 3 studies that evaluated the impact of a change on adherence to treatment found a significant association; 1 of the 2 studies that evaluated the relationship between a change a clinical outcome found a significant association with the prevalence of uncontrolled blood pressure; and 1 study showed lower rates of switchbacks to the branded product compared with patients who switched to generic drug products, with different appearance.

CONCLUSIONS

This systematic review showed an impact of the change in pill/package appearance on patients' behavior in 7 of the 10 studies included. Generic switching may lead to unintended consequences on patients' behavior, mainly regarding adherence to treatment.

Altmetrías, ¿novedad o complemento del análisis de citas?

La cultura de evaluación de la producción científica en la medida en que el conocimiento fue percibido como un valor estratégico experimentó un sustancial crecimiento. Hasta el momento, estos impactos del conocimiento generado se están midiendo a través de técnicas bibliométricas que giran alrededor del análisis de consumo de información y que están sustentadas en los trabajos sobre fundamentación teórica de Garfield y Price. Desde estos primeros estudios se desarrolló todo un culto alrededor de los indicadores de la actividad científica que, como todo «dogma», tiene sus creyentes y sus impíos…

Trends and Seasonality of Information Searches Carried Out through Google on Nutrition and Healthy Diet in Relation to Occupational Health: Infodemiological Study

This study aimed to analyze and relate the population interest through information search trends on Nutrition and Healthy Diet (HD) with the Occupational Health (OH). Ecological and correlational study of the Relative Search Volume (RSV) obtained from Google Trends query, segmented in two searched periods concerning antiquity; date of query: 20 April 2021. The RSV trends for the analyzed three Topics were: Nutrition (R² = 0.02), HD (R² = 0.07) and OH (R² = -0.72). There was a good positive correlation between Nutrition and OH (R = 0.56, p < 0.001) and a moderate one between HD and OH (R = 0.32, p < 0.001). According to seasons, differences were verified between RSV means in the Topics HD (p < 0.01) and OH (p < 0.001). Temporal dependence was demonstrated on Nutrition searches (Augmented Dickey-Fuller = -2.35, p > 0.05). There was only a significant relationship between the RSV Topic HD (p < 0.05) for the Developing and Least Developed countries. The data on the analyzed RSV demonstrated diminishing interest in the search information on HD and OH as well as a clearly positive trend change in recent years for Nutrition. A good positive correlation was observed between the RSV of nutrition and OH whereas the correlation between HD and OH was moderate. There were no milestones found that may report a punctual event leading to the improvement of information searches. Temporal dependence was corroborated in the RSV on Nutrition, but not in the other two Topics. Strangely, only an association was found on HD searches between the Developing and Least Developed Countries. The study of information search trends may provide useful information on the population's interest in the disease data, as well as would gradually allow the analysis of differences in popularity, or interest even between different countries. Thus, this information might be used as a guide for public health approaches regarding nutrition and a healthy diet at work.

Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression

OBJECTIVE

To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health.

METHOD

This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021.

RESULTS

A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise.

CONCLUSIONS

Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).

[Effects derived from occupational exposure to hazardous substances in pregnant working women: systematic review]

OBJECTIVE

To review the effects derived from occupational exposure on pregnant working women exposed to hazardous substances.

METHODS

Critical analysis of the works retrieved by systematic review in MEDLINE (PubMed), EMBASE, Cochrane Library, Scopus, Web of Science, LILACS and MEDES, up to January 2021. The Search Equation was developed by means of the descriptors «Pregnancy», «Hazardous Substances» and «Occupational Exposure», as well as using related Entry Terms and the filters «Humans» and «Adult: 19+ years». The quality of the articles was evaluated via the STROBE questionnaire and the level of evidence and the grade of recommendation via the SIGN criteria.

RESULTS

Out of the 420 references retrieved (366 digitally and 54 manually) and after applying the inclusion and exclusion criteria, 35 articles were selected. The STROBE evaluation obtained a median of 15.32, and the SIGN criteria, a 2+ level of evidence and a C grade of recommendation. Article obsolescence was high (Burton-Kebler half-life: 22.0; Price index: 0.00%). In 25 out of 35 articles, the exposure is to organic solvents. In 22 articles, congenital anomalies were notified.

CONCLUSIONS

The reviewed articles exhibited high obsolescence and a degree of evidence and recommendation that did not allow to fully ensure the validity and reliability of the observations made. The results manifested the association between the exposure to dangerous substances and the occurrence of different damages regarding the health of a pregnant worker and her offspring. The most common exposure was to organic solvents and the most observed effect was congenital alterations.

Perception of risk of exposure in the management of hazardous drugs in home hospitalization and hospital units

OBJECTIVE

To assess the perception of risk of exposure in the management of hazardous drugs (HDs) through home hospitalization and hospital units.

MATERIAL AND METHODS

A questionnaire was released, at the national level, to health professionals with HD management expertise. Questionnaire included 21 questions that were scored using a Likert scale: 0 (null probability) to 4 (very high probability). The internal consistency and reliability of the questionnaire were calculated using Cronbach's alpha and the intraclass correlation coefficient, respectively.

RESULTS

144 questionnaires (response rate 70.2%) were obtained: 65 (45.1%) were nurses, 42 (28.9%) occupational physicians, and 37 (26.1%) were pharmacists. Cronbach's alpha was 0.93, and intraclass correlation coefficient was 0.94 (95% CI 0.91-0.97; p-value < 0.001). The mean probability was 1.95 ± 1.02 (median 1.9; minimum: 0.05; 1st quartile 1.1; 3rd quartile 2.6; and maximum 4). Differences were observed in scoring among professional groups (occupational physicians versus nurses (1.6/2.1, p = 0.044); pharmacists versus nurses (1.7/2.1, p = 0.05); and occupational physicians versus pharmacists (1.6/1.7, p = 0.785), due mainly to the administration stage (p = 0.015).

CONCLUSIONS

The perception of risk of exposure was moderate, being higher for nurses. It would be advisable to integrate HDs into a standardized management system (risk management model applicable to any healthcare center) to improve the safety of health professionals.

Assessing the risk of using hazardous drugs in Hospital-at-Home Units: a big data study protocol

OBJECTIVE

This article describes a study protocol for the implementation of quality and traceability control in the hazardous  medication circuit through an analysis of risks and the development and  introduction of a Big Data-based software application aimed at performing  a continuous and dynamic audit of the whole system. Method: A standardized graphical modeling tool called Business Process Model Notation will be used to generate a detailed description of each of the stages in the hazardous medication circuit with a view to  ensuring full traceability of the system. The information on each stage will  be collected in a flowchart, which will be used -together with each event's likelihood of occurrence and severity- as a basis to calculate the  criticality index of the different control points established and to determine  any control measures that may be required. The flowcharts will  also be used to develop the technological support needed to capture  all such data as may be relevant to the model. Proper quality control of the process will be ensured by client software agents intended to allow  automatic applica tion of efficient data processing tools at the different  phases. In addition, Big Data methodologies, in particular machine  learning, will be used to develop algorithms based on the repository of  generated data to come up with patterns capable of improving the  protocols to be applied. Lastly, proper operation of the process will be  ensured by means of clinicalpharmaceutical verification and a full  technical-documentary review of control and registration systems.

CONCLUSIONS

The development of a risk management system based on  mobile technology will allow integration of hazardous drugs into a standardized system, ensuring the safety, quality, and traceability of the hazardous medication handling process.

[Malignant Skin Neoplasms in Workers in the Fishing Industry: Systematic Review]

OBJECTIVE

To review the scientific literature related to the effects of occupational exposure to risk factors for skin neoplasms in fishery workers.

METHOD

Critical analysis of the papers recovered through systematic review from en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). STOROBE guidelines were followed to evaluate their quality.

RESULTS

After attributing inclusion and exclusion criteria to the search, 11 articles were accepted for review and critical analysis. In 7 of them, a statistically significant association was obtained between skin neoplasia and occupational exposure in fishermen.

CONCLUSIONS

Despite having found studies that were significant in terms of the relationship of malignant lesions and exposure to ultraviolet radiation in the workplace, some of them did not control possible biases, therefore the results should be taken with caution.

[Impact and prestige indicators of SciELO network health sciences journals: comparative study.]

OBJECTIVE

The use of bibliometric indicators to measure the quality of scientific journals is a general practice in all areas of science. The WoS and Scopus databases continue to be the reference sources to obtain bibliographic indicators. Others such as SciELO network offer indicators about Ibero-American science, which are scarcely collected in WoS and Scopus. The aim of this work was to analyze the association of the indicators proposed by SciELO for health sciences journals, with the most widely used impact and indicators and to study the complementarity of the existing prestige indicators.

METHODS

Analytical correlational study between SciELO indicators, with impact and prestige indicators from Journal Citation Report, Scopus and Web of Science. The results refer to 2018, the most recent and complete data available. Association between the qualitative variables was analyzed using the chi-square test, and the analysis of variance (ANOVA) was performed for the quantitative variables using the Tukey method as a post hoc test. To obtain the relationship between quantitative variables, Pearson's correlation coefficient was used and Spearman's coefficient for ordinal variables. The level of significance used in all the hypothesis tests was α≤0.05.

RESULTS

The SciELO Impact Factor showed a weak correlation both, with Journal Citation Report (R=0.36; p=0.003), and Scopus Cite Score (R=0.39; p=0.001). The association between the H index of the Web of Science andthe H index of Scopus with the H index of SciELO was weak in both cases (R=0.45; p<0.001 and R=0.340; p=0.003).

CONCLUSIONS

Indicators proposed by SciELO, for health journals, did not show an association with those of WoS or Scopus. The weak correlation between Impact Factor and Cite Score with SciELO Impact Factor, converts the latter into a necessary "metrics" to assess journals excluded from the "mainstream" and fundamentally those from the Latin American region. The need of using the prestige indicators to fill in the impact indicators, has not been proven in this study.

Consensus to identify the dangerous drugs risks in hospital pharmacy services

OBJECTIVE

To identify the hazards and define the theoretical  occupational risks arising from the process of handling hazard drugs in  hospital pharmacy services on the basis of expert consensus.

METHOD

An expert consensus was conducted (nominal group and documentary techniques) using a mixed method of two face-to-face rounds (meeting of participants and approval of proposals) and  three masked rounds (individualized review). The analysis was applied  to the field of hospital pharmacy. The stages of the process were  designed using the standardized graphical Business Process Model and Notation.

RESULTS

A specific flowchart was obtained for the management and  traceability of hazardous drugs. All general process phases were  characterized. A management chart included operations addressing the  reception and storage, compounding, conservation, and dispensation of  hazardous drugs in hospital pharmacy services. This chart provides a  description of the chemical hazards and exposure routes.

CONCLUSIONS

The hazardous drug process should be integrated in a standard management system to improve the safety of patients and  healthcare professionals. Efficiency can maximized and procedural  incidents minimized, thereby ensuring the quality and the safety of  hazardous drugs handling in hospital pharmacy services. Once hazards  are identified, risk assessment should be implemented using a  systematic and preventative methodology to minimize the risk and  severity of any adverse event.

Las revistas de ciencias de la salud de la red SciELO: un análisis de su visibilidad en el ámbito internacional

El objetivo de este trabajo fue conocer y analizar la presencia de las revistas de ciencias de la salud, presentes en la red SciELO, en las principales bases de datos bibliográficas, con el fin de conocer sus datos de circulación y visibilidad. A partir de los resultados obtenidos se pudo concluir que las colecciones de Brasil y Colombia fueron las que presentaron mayores niveles de circulación en las bases de datos bibliográficas estudiadas y, en consecuencia, una mayor visibilidad internacional. La mayor presencia fue en las bases LILACS y Scopus que duplicaron los datos de MEDLINE, Web of Science o Embase; la presencia en CINHAL o PsycINFO fue poco más que testimonial. Las publicaciones en inglés obtuvieron mejores resultados en relación a su circulación.

Las referencias bibliográficas de los términos sobre enfermedades de transmisión sexual en la edición española de la Wikipedia

Este estudio quiso comprobar la corrección de las referencias bibliográficas existentes en los términos sobre enfermedades de transmisión sexual (ETS) de la edición española de la Wikipedia y probar su validez para acceder al documento fuente. De los resultados obtenidos se pudo concluir que el porcentaje de error de las referencias de los términos sobre ETS en la edición española de la Wikipedia fue elevado, variado y múltiple. Estos datos dificultan el proceso de transmisión de la información al no permitir recuperar la referencia para su consulta, interrumpiendo así el vínculo establecido entre la investigación actual, la precedente y la futura. Sería interesante extender la campaña «1Lib1Ref» a la corrección de las referencias bibliográficas ya existentes.

[What is the diet of the immigrant population resident in Spain? Results based on a systematic review]

Diet is a principal determinant of health and is interrelated with socioeconomic factors and the acculturation of immigrants. The aim of this study was to examine the existing evidence on food, nutrition, and diet amongst immigrant populations in Spain, its relationships with their countries of origin, and to evaluate the methodological quality of these studies. A systematic review was carried out that included seventeen cross-sectional studies, 71% of them were of average quality and only one was excellent; seven dealt with adolescents and ten dealt with adults, with a total of 9,871 participants. Insights on immigrant diet and nutrition were heterogeneous because the participant groups in these studies were from several different countries, each of which has distinct cultural and geographical characteristics. Adolescent diet was of lower quality, positively correlated to socioeconomic level; acculturation and length of residence were related to both positive (such as healthier dietary patterns, better adhesion to intake recommendations) and negative aspects (higher intake of meat or bakery products, lower intake of vegetables or fish, among others). Adults show a better intake of macronutrients, but a lower intake of micronutrients and non-observance of some intake recommendations; acculturation and length of residence were related to healthier dietary patterns, significantly related to type of employment. Immigrants from Mediterranean countries show a healthier diet than other immigrants, although the quality of their diet is worse than that of their peers in their countries of origin. Finally, the quality of the diet of non-Mediterranean immigrants improves when they become resident in Spain.

Legionelosis ocupacional en mayores de 18 años: revisión sistemática

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: “Legionnaires’ Disease” “Legionellosis” “Occupational Exposure” “Occupational Diseases”. Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

A BPMN Based Notation for the Representation of Workflows in Hospital Protocols

Flowcharts used for hospital protocols have a series of ambiguities and limitations in order to express some types of information. In this article, a notation proposal for flowcharts that partially avoids these problems is presented. This new notation is an adaptation of BPMNE2, an extension of the Business Process Model and Notation (BPMN), which allows direct modelling of procedures that follow the Hazard Analysis and Critical Control Points (HACCP) model. The new notation has been validated in the hospital context, specifically in the field of hazardous drugs (HDs). To measure usability from the perspective of the health staff and auditors, the System Usability Scale (SUS) was used. A total of 47 experts took part in the assessment, resulting in a SUS score of 71, that corresponds to an acceptable level of usability. The feedback provided by these participants allows us to discover benefits and drawbacks of the proposal. Also, it is noteworthy that 76.6% of professionals prefer to migrate to the new notation from the ISO 5807:1985 notation, the most commonly used model. In addition to the direct benefits of this notation from the human point of view, its machine-understandable nature provides the required support for its integration into software tools for intelligent monitoring and auditing.

Guidelines for safe handling of hazardous drugs: A systematic review

Objective

To review the scientific literature related to the safe handling of hazardous drugs (HDs).

Method

Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017.

Results

In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs.

Conclusions

Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.

Management of the General Process of Parenteral Nutrition Using mHealth Technologies: Evaluation and Validation Study

Background

Any system applied to the control of parenteral nutrition (PN) ought to prove that the process meets the established requirements and include a repository of records to allow evaluation of the information about PN processes at any time.

Objective

The goal of the research was to evaluate the mobile health (mHealth) app and validate its effectiveness in monitoring the management of the PN process.

Methods

We studied the evaluation and validation of the general process of PN using an mHealth app. The units of analysis were the PN bags prepared and administered at the Son Espases University Hospital, Palma, Spain, from June 1 to September 6, 2016. For the evaluation of the app, we used the Poststudy System Usability Questionnaire and subsequent analysis with the Cronbach alpha coefficient. Validation was performed by checking the compliance of control for all operations on each of the stages (validation and transcription of the prescription, preparation, conservation, and administration) and by monitoring the operative control points and critical control points.

Results

The results obtained from 387 bags were analyzed, with 30 interruptions of administration. The fulfillment of stages was 100%, including noncritical nonconformities in the storage control. The average deviation in the weight of the bags was less than 5%, and the infusion time did not present deviations greater than 1 hour.

Conclusions

The developed app successfully passed the evaluation and validation tests and was implemented to perform the monitoring procedures for the overall PN process. A new mobile solution to manage the quality and traceability of sensitive medicines such as blood-derivative drugs and hazardous drugs derived from this project is currently being deployed.

Web 2.0 Tools in the Prevention of Curable Sexually Transmitted Diseases: Scoping Review

Background

The internet is now the primary source of information that young people use to get information on issues related to sex, contraception, and sexually transmitted infections.

Objective

The goal of the research was to review the scientific literature related to the use of Web 2.0 tools as opposed to other strategies in the prevention of curable sexually transmitted diseases (STDs).

Methods

A scoping review was performed on the documentation indexed in the bibliographic databases MEDLINE, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PsycINFO, Educational Resources Information Center, the databases of Centro Superior de Investigaciones Científicas in Spain, and the Índice Bibliográfico Español de Ciencias de la Salud from the first available date according to the characteristics of each database until April 2017. The equation search was realized by means of the using of descriptors together with the consultation of the fields of title register and summary with free terms. Bibliographies of the selected papers were searched for additional articles.

Results

A total of 627 references were retrieved, of which 6 papers were selected after applying the inclusion and exclusion criteria. The STDs studied were chlamydia, gonorrhea, and syphilis. The Web 2.0 tools used were Facebook, Twitter, Instagram, and YouTube. The 6 papers used Web 2.0 in the promotion of STD detection.

Conclusions

Web 2.0 tools have demonstrated a positive effect on the promotion of prevention strategies for STDs and can help attract and link youth to campaigns related to sexual health. These tools can be combined with other interventions. In any case, Web 2.0 and especially Facebook have all the potential to become essential instruments for public health.

Efectos adversos asociados al uso de anabolizantes en deportistas: revisión sistemática

Objetivo: Revisar la documentación científica sobre los efectos adversos de los agentes anabolizantes en las personas adultas que practican deporte. Método: Estudio descriptivo transversal y análisis crítico de los trabajos recuperados mediante revisión sistemática. Los datos se obtuvieron de la consulta directa y acceso, vía Internet, a las siguientes bases de datos bibliográficas del ámbito de las ciencias de la salud: MEDLINE (vía PubMed), The Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science y PsycINFO hasta octubre de 2017. Se consideró adecuado el uso de los Descriptores «Sports», «Anabolic Agents/Adverse effects», utilizando los filtros: «Clinical Trial», «Comparative Study», «Humans» y «Adult:19+years». Resultados:De las 108 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron para la revisión 15 artículos. En los listados bibliográficos se encontró 1 trabajo. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario CONSORT, las puntuaciones oscilaron entre 11,5 y 15,5 sobre una puntuación máxima de 25. Conclusiones: Los trabajos revisados presentaban una obsolescencia superior a lo esperado en el área de las ciencias de la salud. Los artículos estaban redactados preferentemente en inglés. Se observó, en la revisión, que los EAA presentaban efectos adversos, sobre todo a nivel cardiovascular, conductual y aparición de efectos secundarios asociados al consumo de anabolizantes. Si bien, existen discrepancias entre la magnitud de los mismos a nivel cardiovascular y su potencial daño.

The methodological quality of systematic reviews indexed in the MEDLINE database

Purpose

The purpose of this paper is to describe and analyse the methodology quality of the literature search protocols of systematic reviews and to assess the relevance of the search filter that applies PubMed for retrieving this type of publication of the MEDLINE database.

Design/methodology/approach

For the selection of the document type, a literature search about nutritional and metabolic diseases was carried out in MEDLINE and the PubMed filter was used for retrieving “Systematic Reviews”, selecting “Nutritional and Metabolic Diseases” from the Medical Subject Headings (MeSH) database as Major Topic to determine the area of knowledge. Data analysis was carried out using “External Logistic Biplot”, a novel multivariate statistical technique in the field of medical documentation.

Findings

The results highlight the large variability of the methodology used in the literature search protocols of the systematic reviews analysed and confirm the low precision of the filter used by PubMed for the recovery of systematic reviews.

Originality/value

The Logistic Biplot used in this research allows an optimal categorization of the different documentary typologies and classifies the documents by their methodological quality, demonstrating its usefulness for the future development of the bibliometric analysis.

Disorders induced by direct occupational exposure to noise: Systematic review

Background:

To review the available scientific literature about the effects on health by occupational exposure to noise.

Materials and Methods:

A systematic review of the retrieved scientific literature from the databases MEDLINE (via PubMed), ISI-Web of Knowledge (Institute for Scientific Information), Cochrane Library Plus, SCOPUS, and SciELO (collection of scientific journals) was conducted. The following terms were used as descriptors and were searched in free text: “Noise, Occupational,” “Occupational Exposure,” and “Occupational Disease.” The following limits were considered: “Humans,” “Adult (more than 18 years),” and “Comparative Studies.”

Results:

A total of 281 references were retrieved, and after applying inclusion/exclusion criteria, 25 articles were selected. Of these selected articles, 19 studies provided information about hearing disturbance, four on cardiovascular disorders, one regarding respiratory alteration, and one on other disorders.

Conclusions:

It can be interpreted that the exposure to noise causes alterations in humans with different relevant outcomes, and therefore appropriate security measures in the work environment must be employed to minimize such an exposure and thereby to reduce the number of associated disorders.

Análisis bibliométrico de la producción científica existente en la base de datos bibliográfica MEDLINE sobre la fibra dietética

Introducción: El objetivo del presente estudio es evaluar, mediante análisis bibliométrico, la producción científica existente sobre la fibra dietética recopilada en la de datos MEDLINE, vía PubMed.Material y métodos: Estudio descriptivo transversal. Se calculó el tamaño muestral mediante la estimación de parámetros poblacionales en una población infinita (n=386). El método de muestreo fue el aleatorio simple sin reemplazo.Resultados: La tipología documental más frecuente fue el artículo original con 177 documentos (45,9%; IC95%: 40,9-50,1), siendo el índice de productividad de 2,25. La edad de los documentos analizados fue de 17,7 años (IC95%: 16,4-18,9), con mediana de 15,5 años. Lo documentos revisados estaban predominantemente escritos en inglés, en 352 ocasiones (91,2%; IC95%: 88,4-94,0), seguidos del alemán en 11 artículos (2,9%; IC95%: 1,2-4,5), del ruso en 7 ocasiones (1,8%; IC95%: 0,5-3,1) y español con 6 artículos (1,6%; IC95%: 0,3-2,8). Las revistas que presentaron 15 o más trabajos, en los resultados de búsqueda efectuada son 4: American Journal of Clinical Nutrition con 31 referencias (8,0%; IC95%: 5,3-10,7), Journal of Animal Science con 20 referencias (5,2%; IC95%: 3,0-7,4), British Journal of Nutrition con 16 referencias (4,2%; IC95%: 2,2-6,1) y European Journal of Clinical Nutrition con 15 referencias (3,9%; IC95%: 2,0-5,8).Conclusiones: Este estudio indica que la fibra dietética es una temática altamente investigada, donde el inglés sigue siendo el idioma mayoritario. Los descriptores se encuentran en línea con la temática a estudio.

Análisis bibliométrico de los sistemas de medicación hospitalarios

Objetivo: Análisis bibliométrico de la producción científica sobre los sistemas de medicación hospitalariaen bases de datos internacionales.Método: Estudio descriptivo transversal. Los datos se obtuvieron de las bases de datos MEDLINE (Pub-Med), SCOPUS, COCHRANE LIBRARY y LILACS hasta la fecha actual (2016). El término utilizado enla búsqueda fue “Medication System Hospital”. Se analizaron los principales indicadores bibliométricos,como Descriptores MeSH.Se segmentó la búsqueda por épocas (primera y segunda época, desde el año 1966 hasta 1998 incluido,primera época y desde 1999 a 2016 incluido, segunda época).Resultado: Se obtuvieron 881 referencias recuperadas en 388 revistas. El tipo documental de mayorfrecuencia fue el artículo original. La edad media de los documentos analizados fue de 21,16 años. La distribución geográfica, fue primero estadounidense (EEUU): con 263 trabajos. Las publicaciones con ≥10 trabajos fueron 8. Hubo diferencias significativas entre los descriptores analizados por épocas.Conclusiones: Los estudios sobre los sistemas de medicación hospitalaria son un área temática en decrecimiento, con una gran fragmentación y poco uniforme, sin grandes grupos de referencia ni una basesólida desde la que se puedan continuar estudios posteriores. El inglés es el idioma mayoritario. Los descriptores utilizados son acordes a la temática de estudio.

Information systems in clinical pharmacy applied to parenteral nutrition management and traceability: a systematic review

OBJECTIVE

To review the scientific literature on clinical pharmacy information systems applied to parenteral nutrition (PN) management and traceability.

METHOD

A systematic review of the documents retrieved from the MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts (IPA) and Google Scholar databases up to May, 2016. The terms used, as descriptors and free text, were: "Parenteral Nutrition" and "Drug Information Services". The quality of the articles was assessed using the STROBE Questionnaire. The search was completed through consultation with experts and the bibliographic review of the articles selected.

RESULTS

From the 153 references retrieved in our search, after applying inclusion and exclusion criteria, only 6 articles were selected for review. In three of them, flowcharts or some kind of graphical notation were designed in order to develop standard management systems, while three were based on computer programs. In two of the articles selected, a comprehensive management system had been designed for PN control and traceability.

CONCLUSIONS

PN must be integrated within a standardized system, to ensure its quality and reduce the risks associated with this therapy. The development of technologies applied to PN would enable to set up management systems that are more complete and easier to apply in a real setting. Therefore, we think it will be necessary to generate new specific articles and developments associated with PN management and traceability, in order to allow their constant monitoring and assessment.

Towards a Mobile-Based Platform for Traceability Control and Hazard Analysis in the Context of Parenteral Nutrition: Description of a Framework and a Prototype App

Background

The parenteral nutrient (PN) mixtures may pose great risks of physical, microbiological, and chemical contamination during their preparation, storage, distribution, and administration. These potential hazards must be controlled under high levels of excellence to prevent any serious complications for the patients. As a result, management control and traceability of any of these medications is of utmost relevance for the patient care, along with ensuring treatment continuity and adherence.

Objective

The aim of this study is to develop a mobile-based platform to support the control procedures and traceability services in the domain of parenteral nutrient (PN) mixtures in an efficient and nonintrusive manner.

Methods

A comprehensive approach combining techniques of software engineering and knowledge engineering was used for the characterization of the framework. Local try-outs for evaluation were performed in a number of application areas, carrying out a test/retest monitoring to detect possible errors or conflicts in different contexts and control processes throughout the entire cycle of PN. From these data, the absolute and relative frequencies (percentages) were calculated.

Results

A mobile application for the Android operating system was developed. This application allows reading different types of tags and interacts with the local server according to a proposed model. Also, through an internal caching mechanism, the availability of the system is preserved even in the event of problems with the network connection. A set of 1040 test traces were generated for the assessment of the system under various environments tested. Among those, 102 traces (9.81%) involved conflictive situations that were properly taken care of in this paper by suggesting solutions to overcome them.

Conclusions

A mobile oriented system was generated and tested in order to allow enhanced control and quality management of PN mixtures that is easy to integrate into the daily praxis of health care processes.

[THE TEN MOST CITED ARTICLES OF THE JOURNAL "NUTRICION HOSPITALARIA"]

After 36 years of continued publication of the journal Nutrición Hospitalaria, a list with the ten most cited articles published in it is elaborated. The top ten most cited articles in the world literature and stratification according to language, English or Spanish, subject, or period of time published are also analyzed. Nutr Hosp is the most important Ibero latin American nutrition journal. Nutr Hosp published 369 items in 2014 gaining the fourth position among all the world's journals devoted to nutrition. Article publication in English, or simultaneously in Spanish and English and Open Access policy probably benefit the number of citations.

[SOME CONSIDERATIONS ABOUT THE INTRINSIC VALUE OF THE IMPACT FACTOR OF SCIENTIFIC JOURNALS]

The reason of higher number of citations of some articles is discussed. Some considerations about the journals' impact factor, its merits and its pitfalls are also made. Scientific journals' impact factor, popularized by the Institute for Scientific Information, has become an objective parameter for authors' evaluation and also for institutions and other related circumstances. There is no reason for the impact factor's gap between some English journals and those written in other languages. English journals probably benefit of the "Mathew's effect", according to which eminent scientists are more rewarded by similar contributions than others less known. It is paradoxical that most of the major achievements of our age do not appear among the 100 most cited articles. There is no homogeneity among all the articles appearing in each scientific journal: half of the articles are cited ten times more than the other half. However, those articles cited 0 times are credited like the better ones. Each article should be evaluated by its own citations, which would be its impact factor; the authors should be evaluated by their H index.

Development of the management for parenteral nutrition traceability in a standard hospital

OBJECTIVE

to develop the traceability control and the hazard analysis in the processes of parenteral nutrients (PN).

METHOD

a standardized graphical notation was generated, describing in detail each of the stages in the overall process. The presence of hazards was analysed by sequencing decisions. The existence of Control Points (CP) or Critical Control Points (CCP) was estimated by Criticality Index (CI) for each hazard taking into account the probability of occurrence and the severity of the damage. The threshold for the IC was set in 6.

RESULTS

a specific flow chart for the management and traceability of PN was obtained, defining each of the stages in CPs (validation and transcription of the prescription and administration) or CCPs (preparation, storage and infusion pump -flow and filter-). Stages regarding the delivery, the recovery and the recycle of the packing material of PNs are not considered CPs and, therefore, they were not included in the dashboard.

CONCLUSIONS

PN must be dealt with in the frame of a standardized management system in order to improve patient safety, clinical relevance, maximize resource efficiency and minimize procedural issues. The proposed system provides a global management model whose steps are fully defined, allowing monitoring and verification of PN. It would be convenient to make use of a software application to support the monitoring of the traceability management and to store the historical records in order to evaluate the system.