Adverse events in the global healthcare practice of an Occupational Mutual Insurance Company in Spain

BACKGROUND

Patient safety is currently a main issue in healthcare practice. Adverse events (AEs) management is a key instrument for the application of strategies to prevent harm to patients.

OBJECTIVE

To analyze the type, severity and preventability, according to validated scales, of AEs occurring annually in the healthcare practice of an Occupational Mutual Insurance Company in order to implement action plans to improve patient safety.

METHODS

We analyzed the reported AEs in an Incident Reporting System and AEs detected in the Audit program of clinical records as a result of treating injured or ill workers in our 88 ambulatory care centers.

RESULTS

We detected 28 AEs in the clinical records (CR), representing 0.05 AE/CR, with maximum values in the COM sample (26 AEs, 0.11) and much lower in INT (1 AEs, 0.02) and MIN (1 AE, 0.02). The most frequent AE type was procedure-related, followed by infection and care. AEs of severity level D (11 cases) and E (9 cases) predominated, while level F was also detected (6 cases). Intermediate values in preventability (3 and 4) predominated, 61.5% were preventable. With the Incident Reporting System, 27 AEs were identified, predominated by procedural type. Most reported AE severities was in levels E (10 cases) and C (8 cases), 89% were preventable.

CONCLUSION

Our company detects AEs via the Incident Reporting System and annual Audit program of clinical records, both of which are complementary, and may result in the implementation of more effective Patient Safety measures.

Risk Management in the Ambulatory Care Process in a Mutual Benefit Association Covering Work-Related Accidents and Diseases: Applying Modified Failure Mode and Effect Analysis (FMEA) Methodology

AIM

To assess the impact of different forms of use of failure mode and effect analysis methodology for risk prioritization in the ambulatory care process in a mutual benefit association covering work-related accidents and diseases.

METHODS

The study is based on a previously drafted and individually prioritized risk map by a multidisciplinary team made up of patient safety committee members from health care centers and clinics in a mutual benefit association covering work-related accidents and diseases. The professionals mainly carry out their work in the field of management (individual manager group (IMG)). A group formed by clinicians subsequently completed 2 prioritizations: one based on the individual opinions of each of the members (individual clinical group (ICG)) and another in a consensual way (consensual clinical group (CCG)) as recommended by failure mode and effect analysis methodology. The risk prioritization was compared in the 3 groups (IMG, ICG, and CCG).

RESULTS

The risk prioritization by the IMG defines 7 extreme risks (risk prioritization ≥ 275). When the clinical group prioritizes them in an individual way (ICG), there is no extreme risk, whereas when it does so in a consensual way (CCG), there are 21 extreme risks. With respect to the coincidences of existing causes between the 3 groups, it is noted that the "risk of falls" is rated by both the clinical and the manager group but prioritized differently. On the other hand, the ICG and CCG coincide in that pressure on health care services can contribute to carrying out incomplete anamnesis. They also both consider that internal and external waiting lists and holiday periods can cause a delay in the starting of rehabilitation. The IMG and the CCG show similarity in the risk assessment of overprescribing medication and that multiple computer sessions are initiated. Finally, the IMG and the ICG coincide in the "lack of delivery of the medication leaflet".

CONCLUSIONS

The point of view of the clinicians is important in the risk prioritization of the ambulatory health care process. The difference in the risk prioritization between the clinical group at individual level and after consensus is remarkable.

Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain

BACKGROUND

Occupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity. The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC.

METHODS

A cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability.

RESULTS

We identified 48 AEs (15.3% of medical records, 95% CI 11.3-19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%).

CONCLUSIONS

The AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

Patient Safety Culture in Mutual Insurance Companies in Spain

OBJECTIVES

The aim of the study was to assess the safety culture in a mutual insurance sector, searching for improvement opportunities. This sector offers health insurance for work-related injuries and occupational illnesses and represents an annual volume of patients corresponding to approximately 10% of the working population in Europe.

METHODS

A cross-sectional study was conducted to assess the safety culture in the mutual insurance sector in Spain. All physicians, nurses, and physiotherapists (N = 816) working in the organization in hospitals, outpatient clinics, and managerial settings were invited to reply to an online survey.

RESULTS

A total of 499 professionals completed the questionnaire (response rate, 61%). Two dimensions were assessed: attitudinal (5 items) and instrumental (5 items). There were no differences between professional profiles or centers in the attitudinal (7.8; standard deviation, 1.3; 95% confidence interval, 7.6-7.9) or instrumental (8.5; standard deviation, 1.0; 95% confidence interval, 8.5-8.6) factors. The lowest level of implementation (<9 points) was related to the following: open disclosure after an adverse event (73%), having a quality and safety plan (75%), prioritizing the improvement of patient care (75%), and involving patients when making decisions on potential treatments (63%). Managers showed lower scores than the rest of professionals' groups (P < 0.05).

CONCLUSIONS

This intent is to introduce a patient safety culture assessment in the mutual insurance companies. These results may encourage the implementation of quality and safety plans in this sector by paying more attention to attitudinal aspects.

Quality Assurance and Patient Safety Measures: A Comparative Longitudinal Analysis

Objective: To analyze whether the results on quality assurance and safety culture in a healthcare organization are related to and affected by the actions implemented. Setting: Health Insurance of Work-related Accidents and Occupational Diseases. Methods: The study was conducted as a longitudinal observational study that analyzed the relationship of the Safety Culture and Quality Assurance measurements. Participants who were involved came from small centers with less than eight workers (N = 52), big centers (eight and more workers) (N = 707), and those centers with quality coordinators (N = 91). Data were collected during the years 2015 and 2016. Results: A total of 595 healthcare professionals responded in 2015 and 491 in 2016. The scores showed a positive progression both in Quality Assurance (T-test = 3.5, p = 0.001) and in Safety Culture (T-test = 5.6, p < 0.0001). Hence, the gradient of improvement in quality (average 5.5%) was greater compared to that of the safety culture (2.1%). Conclusions: The assessments of the quality assurance goals were consistent with the safety culture assessment. Hence, the results on Safety Culture were observed to be more stable over time.

Evolution of induced axial magnetization in a two-component magnetized plasma

In this paper, the evolution of the induced axial magnetization due to the propagation of an electromagnetic (em) wave along the static background magnetic field in a two-component plasma has been investigated using the Block equation. The evolution process induces a strong magnetic anisotropy in the plasma medium, depending nonlinearly on the incident wave amplitude. This induced magnetic anisotropy can modify the dispersion relation of the incident em wave, which has been obtained in this paper. In the low frequency Alfven wave limit, this dispersion relation shows that the resulting phase velocity of the incident wave depends on the square of the incident wave amplitude and on the static background magnetic field of plasma. The analytical results are in well agreement with the numerically estimated values in solar corona and sunspots.

Energy loss of a charged particle in a magnetized quantum plasma

This paper investigates the stopping power of a weakly coupled magnetized plasma. The effect of the Larmor rotation of the heavy charged test particle is carefully analyzed. The dielectric formalism is employed to obtain a general expression for the stopping power. A quantum mechanical form of the random-phase approximation dielectric function is used so that an arbitrary cutoff procedure is not required. Simple analytical expressions for the stopping power have been found for the cases of high and low projectile velocity of the test particle. The dependence of the stopping power on the angle of incidence is studied. A comparison with numerical solutions is given. It is found that in general a magnetic field reduces the stopping power of the plasma at high velocities, while it increases the stopping power at low velocities.

Stopping power of strongly coupled electronic plasmas: sum rules and asymptotic forms

The stopping power of coupled electronic plasmas is investigated. Within the dielectric formalism and employing the method of frequency moments for the dielectric function we obtain a general formula describing the linear stopping power of a coupled plasma. Analytical results for the low- and high-projectile-velocity asymptotic forms are obtained. A sum rule for the plasma heavy ions linear stopping power projectile velocity distribution is established to be related to the dielectric permeability "negative" frequency moment. This permits for a simple interpretation of stopping power data.

Simultaneous detection of different glycosidase activities by 19F NMR spectroscopy

A fast method for the simultaneous detection of different glycosidolytic activities in commercially available enzyme preparations and crude culture filtrates was found in using, as substrate, a mixture of different glycosyl fluorides and 19F NMR spectroscopy as a screening technique. Accompanying studies regarding the hydrolytic stability of these fluorides in various buffer systems, as well as conditions of their long-term storage, were carried out. A simple procedure for the preparation of beta-D-mannopyranosyl fluoride in gram quantities is given.

Transglycosylation reactions with a crude culture filtrate from Thermoascus aurantiacus

Some characteristics of regioselectivity and acceptor tolerance in transglycosylation reactions, catalysed by a crude culture filtrate from Thermoascus aurantiacus, were examined by employing methanol and monosaccharides as acceptors. When beta-D-mannopyranosyl fluoride was employed as the donor, the anomeric configuration of the newly formed bond was found to depend on the structure of the acceptor used.

Synthesis of deoxyfluoro sugars from carbohydrate precursors

Results obtained over the past decade concerning the introduction of the fluorine atom into carbohydrate molecules, either by nucleophilic substitution or electrophilic addition reactions, are summarised. The first section mainly deals with the triflate/fluoride tandem sequence and the DAST-reaction. In the discussion, emphasis is given to the dependency of the reaction course on the stereochemical and protecting group features. Possible reaction pathways are direct substitution (with inversion or retention of configuration), rearrangement (combined with substitution and inversion of configuration at both of the centres involved) and elimination. Based on the assumption of cyclic transition states or transient intermediates (formed through participation of neighbouring groups), far-reaching mechanistic generalisations were made. On this basis, isolated examples from the literature, which are not in accordance with these generalisations, are specifically brought to attention. Results from the recently introduced reaction of safe and easy to handle N-F fluorinating agents with glycals are also reported. This approach allows the simple and stereoselective access to a series of 2-deoxy-2-fluoro aldopyranoses, as well as the synthesis of various C-1-substituted derivatives by an easy one-pot reaction. However, the same method applied to furanoid glycals is rather poor with respect to stereoselectivity. Finally, considerations on the importance of fluorine-specific reactions of the S(N)-type in related fields of organic synthesis are made.

Systematic study of parameters influencing the action of Rose Bengal with visible light on bacterial cells: comparison between the biological effect and singlet-oxygen production

As part of a project to study different methods for the disinfection of effluent water, the inactivation of different microorganisms (Escherichia coli, Deinococcus radiodurans and spores of Bacillus subtilis) using a combination of a photosensitizer (Rose Bengal) with simulated sunlight and oxygen was determined under various environmental conditions (temperature, pH index). In parallel, the singlet-oxygen (1O2) production was also measured under the same conditions. Whereas the vegetative cells could be inactivated much more efficiently at increased temperature and altered index of pH, the production of 1O2 remained essentially the same under these alterations. Additionally, the relations among the sensitivities of different cell types to be killed by our photodynamic treatments (PDT) were opposite to those found after exposure to ionizing radiation. The results of photodynamic experiments do not reflect the cells' capacity to repair DNA strand breaks. Spores of B. subtilis, as a nonvegetative system, could not be inactivated by illuminations up to 100 J cm-2. Together, these findings indicate that DNA is not the primary target, the inactivation of which leads to the killing of our test organisms. Instead, the cellular envelope appears to be the component being assaulted by our PDT.

Equation of states for classical Coulomb systems: use of the Hubbard-Schofield approach

An effective method based on the Hubbard-Schofield approach [Phys. Lett. A 40, 245 (1972)] is developed to calculate the free energy of classical Coulomb systems. This method significantly simplifies the derivation of the cluster expansion. A diagrammatic representation of the cluster integrals is proposed. Simple rules providing the leading order in density n of each diagrammatic contribution are found. We calculate the n(3) contribution and recover the results at the order n(5/2) obtained by the traditional method of resummation of diverging Mayer bonds.

Fluorinated Carbohydrates. Some New Aspects in Synthesis and Application

Abstract:

Recent applications of glycosyl fluorides as donors in controlled di- and oligosaccharide synthesis employing chemical and enzymatic methods are presented. Within the chemical approaches significant contributions have been made by the development of fluorophilic activators displaying high stereoselectivity as well as further improvements in "reactivity fine tuning" by variation of protecting groups. In the field of enzymatic oligosaccharide synthesis progress has been made in regioselective glycosyl transfer to secondary hydroxyl groups. Additionally, promising new approaches employing fluorides derived from monosaccharides with specifically mutated glycosidases or disaccharide derived fluorides with cellulases, have been developed. From the numerous contributions regarding the synthesis of deoxy-fluoro aldoses, emphasis is placed upon side-reactions on attempted nucleophilic substitutions. Within this field modification of pentoses at C-2 using the sulfonate/fluoride route or applying diethylaminosulfur trifluoride are discussed. The increasing use of asymmetric synthesis in this field, including a new entry starting from a chiral cis-diol, is noteworthy. Scope and limitations in the synthesis of 2-deoxy-2-fluoro aldoses by electrophilic addition across the double bond of glycals by making use of the new class of N-F-fluorinating agents are presented. The important role of fluorinated carbohydrates as probes in mechanistic enzyme studies as well as their application in biomedical research is illustrated by several examples.

[The status of afebrile infantile convulsions within the epilepsy spectrum--a follow-up of 55 patients]

In an earlier study we observed 411 patients with cerebral convulsions, 118 of whom had the first convulsion during the 1 year of life. Among these 118 children we found 76 with afebrile convulsions. In this study we present the development and outcome in 55 patients with afebrile convulsions in the 1 year of life which could be observed for some years, most of them up to the present. In 25 infants the fits started in the newborn period, and in 30 infants after the 1 month; they were divided into groups with and without risk factors in the history. Benign neonatal convulsions were found in about one-third of children, with a good prognosis. These convulsions are divided into a dominantly inherited but rarely observed form and idiopathic benign neonatal convulsions. In contrast, among the newborns with risk factors in the history we found only half with a positive development. The results in the 30 infants with convulsions after the 1 month were similar with respect to risk factors in the history of risks. The 15 infants without risks had a good prognosis. Only 3 patients had oligoepilepsy. However, in the 15 patients with risks only 3 developed normally, 6 had no fits, but were neurologically or mentally handicapped, and 7 had fits and disability. We believe that afebrile convulsions without risk factors after the 1 month could be considered a late manifestation of benign newborn convulsions.(ABSTRACT TRUNCATED AT 250 WORDS)

Spacelab concept and its utilization for science

The first part of the paper is devoted to the presentation of the Spacelab concepts, for which detailed design studies are at present being carried out by ESRO. The second part concentrates on the utilization of the Spacelab for the various fields of science, namely: (1) Atmospheric and space plasma physics, (2) Astronomy and astrophysics, (3) Material science and (4) Life sciences. The advantages of using the Spacelab for observations in these fields as compared to conventional automated satellites are highlighted.