Notification system of incidents without damage in the health system of Castilla y León (Spain)

Introduction and objective: Patient safety is an important part of the quality work in the Regional Health Management of Castilla y León. Numerous projects are part of this line, including the no-harm incident reporting system. Objective: Reporting incidents without harm can significantly improve patient safety and improve an organization's safety culture. Material and method: After an exhaustive analysis of the available systems, it was decided to develop an own system, SISNOT (system of notification of incidents without damage), which followed the characteristics recommended by the international organisms in relation to these systems in the health field. Results: 3249 notifications were made through SISNOT, between primary and specialized care, of which 48% could have had high damage in case of reoccurrence of the incident. Conclusions: The implementation of SISNOT has been carried out in all hospitals and in primary care. The results obtained are unequal in each unit. This is due to numerous local barriers: leadership, characteristics of professionals, etc. Although there is a common, lack of safety culture. This is a challenge to keep working.Introducción y objetivo: La seguridad del paciente es una parte importante del trabajo en calidad en la Gerencia Regional de Salud de Castilla y León. Numerosos proyectos forman parte de esta línea, entre ellos, el sistema de notificación de incidentes sin daño. Objetivo: Notificar incidentes sin daño puede mejorar significativamente la seguridad de los pacientes y mejorar la cultura de seguridad de una organización. Material y método: Después de un exhaustivo análisis de los sistemas disponibles, se decidió desarrollar un sistema propio, SISNOT (sistema de notificación de incidentes sin daño), que seguía las características recomendadas por los organismos internacionales en relación a estos sistemas en el ámbito sanitario. Resultados: se han realizado 3249 notificaciones mediante SISNOT, entre atención primaria y especializada, de las cuales el 48% podrían haber tenido un daño elevado en caso de volverse a producir el incidente. Conclusiones: La implantación de SISNOT se ha realizado en todos los hospitales y en atención primaria. Los resultados obtenidos son desiguales en cada unidad. Esto es debido a numerosas barreras locales: liderazgo, características de los profesionales, etc. Aunque hay una común, la falta de cultura de seguridad. Esto supone un reto a seguir trabajando

Consumption of aspartame and other artificial sweeteners and risk of cancer in the Spanish multicase‐control study (MCC‐Spain)

Use of artificial sweeteners (AS) such as aspartame, cyclamate, saccharin and sucralose is widespread. We evaluated the association of use of aspartame and other AS with cancer. In total 1881 colorectal, 1510 breast, 972 prostate and 351 stomach cancer and 109 chronic lymphocytic leukaemia (CLL) cases and 3629 population controls from the Spanish Multicase-Control (MCC-Spain) study were recruited (2008-2013). The consumption of AS, from table-top sweeteners and artificially sweetened beverages, was assessed through a self-administered and validated food frequency questionnaire (FFQ). Sex-specific quartiles among controls were determined to compare moderate consumers ( third quartile) vs non consumers (reference category), distinguishing aspartame-containing products and other AS. Unconditional logistic regression models were used to estimate adjusted OR and 95%CI, and results were stratified by diabetes status. Overall, we found no associations between the consumption of aspartame or other AS and cancer. Among participants with diabetes, high consumption of other AS was associated with colorectal cancer (OR=1.58, 95% CI 1.05-2.41, P trend=.03) and stomach cancer (OR=2.27 [0.99-5.44], P trend=.06). High consumption of aspartame, was associated with stomach cancer (OR=2.04 [0.7-5.4], P trend=.05), while a lower risk was observed for breast cancer (OR=0.28 [0.08-0.83], P trend=.03). In some cancers, the number of cases in participants with diabetes were small and results should be interpreted cautiously. We did not find associations between use of AS and cancer, but found associations between high consumption of aspartame and other AS and different cancer types among participants with diabetes

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Sistema de notificación de incidentes sin daño en el sistema de salud de Castilla y León

Introduction and objective: Patient safety is an important part of the quality work in the Regional Health Management of Castilla y León. Numerous projects are part of this line, including the no-harm incident reporting system. Objective: Reporting incidents without harm can significantly improve patient safety and improve an organization's safety culture. Material and method: After an exhaustive analysis of the available systems, it was decided to develop an own system, SISNOT (system of notification of incidents without damage), which followed the characteristics recommended by the international organisms in relation to these systems in the health field. Results: 3249 notifications were made through SISNOT, between primary and specialized care, of which 48% could have had high damage in case of reoccurrence of the incident. Conclusions: The implementation of SISNOT has been carried out in all hospitals and in primary care. The results obtained are unequal in each unit. This is due to numerous local barriers: leadership, characteristics of professionals, etc. Although there is a common, lack of safety culture. This is a challenge to keep working.Introducción y objetivo: La seguridad del paciente es una parte importante del trabajo en calidad en la Gerencia Regional de Salud de Castilla y León. Numerosos proyectos forman parte de esta línea, entre ellos, el sistema de notificación de incidentes sin daño. Objetivo: Notificar incidentes sin daño puede mejorar significativamente la seguridad de los pacientes y mejorar la cultura de seguridad de una organización. Material y método: Después de un exhaustivo análisis de los sistemas disponibles, se decidió desarrollar un sistema propio, SISNOT (sistema de notificación de incidentes sin daño), que seguía las características recomendadas por los organismos internacionales en relación a estos sistemas en el ámbito sanitario. Resultados: se han realizado 3249 notificaciones mediante SISNOT, entre atención primaria y especializada, de las cuales el 48% podrían haber tenido un daño elevado en caso de volverse a producir el incidente. Conclusiones: La implantación de SISNOT se ha realizado en todos los hospitales y en atención primaria. Los resultados obtenidos son desiguales en cada unidad. Esto es debido a numerosas barreras locales: liderazgo, características de los profesionales, etc. Aunque hay una común, la falta de cultura de seguridad. Esto supone un reto a seguir trabajando