A hospital incident reporting system (2016-2019) : Learning from notifier's perception on incidents'risk, severity and frecuency of adverse events

Incident reporting systems (IRSs) are considered safety culture promoters. Nevertheless, they have not been contemplated to monitor professionals' perception about patient safety related risks. This study aims to describe the characteristics and evolution of incident notifications reported between 2016 and 2019 in a high complexity reference hospital in Barcelona and explores the association between notifications' characteristics and notifier's perception about incidents severity, probability of occurrence and risk. The main analysis unit was notifications reported. A descriptive analysis was performed and taxes by hospital activity were calculated. Odds ratios were obtained to study the association between the type of incident, the moment of incident, notifiers' professional category, reported incident's severity, probability and incidents' calculated risk. Through the study period, a total of 6379 notifications were reported, observing an annual increase of notifications until 2018. Falls (21.22%), Medical and procedures management (18.91%) and Medication incidents (15.49%) were the most frequently notified. Departments reporting the highest number of notifications were Emergency room and Obstetrics & Gynaecology. Incident type and notifiers' characteristics were consistently included in the models constructed to assess risk perception. Pharmaceutics were the most frequent notifiers when considering the proportion of staff members. Notification patterns can inform professionals' patient risk perception and increase awareness of professionals' misconceptions regarding patient safety

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged >= 15 years with a continued SO prescription for >= 3 months during 2013-2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged >= 15 years prescribed SO for >= 3 months continuously in 2013-2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <euro18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs

Condroma intracraniano

Os autores apresentam um raro caso de condroma intracraniano apenso ao etmóide e esfenóide, determinando exoftalmo e síndrome de lesão expansiva intracraniana. Os aspectos clínicos, patogenéticos e histopatológicos são discutidos

B-cell leukemia transdifferentiation to macrophage involves reconfiguration of DNA methylation for long-range regulation

Hematopoiesis is a highly regulated process that, starting from hematopoietic stem cells (HSCs) with self-renewal capacity in the adult human bone marrow, is able to generate all different types of mature blood cells. The classical view of hematopoiesis defines binary branching points from these HSCs that segregate lineages and direct differentiation to terminally differentiated functional cell types [1]. However, the described hierarchical model can be complemented with the emerging data that suggest the existence of hematopoietic stem and progenitor cells with a continuum of transitory differentiation stages, including cells with early lineage priming that generate distinct blood cell types according to the physiological or pathological environment [2]

B-cell leukemia transdifferentiation to macrophage involves reconfiguration of DNA methylation for long-range regulation

Hematopoiesis is a highly regulated process that, starting from hematopoietic stem cells (HSCs) with self-renewal capacity in the adult human bone marrow, is able to generate all different types of mature blood cells. The classical view of hematopoiesis defines binary branching points from these HSCs that segregate lineages and direct differentiation to terminally differentiated functional cell types [1]. However, the described hierarchical model can be complemented with the emerging data that suggest the existence of hematopoietic stem and progenitor cells with a continuum of transitory differentiation stages, including cells with early lineage priming that generate distinct blood cell types according to the physiological or pathological environment [2]

Psicocirurgia nos distúrbios do comportamento

Com base em casuística de 170 pacientes operados mediante diversos procedimento neurocirúrgicos, os autores relatam a experiência obtida na terapia de doenças mentais e de distúrbios do comportamento. Frizam que as extensas intervenções sobre os lobos frontais vem sendo substituídas pelas pequenas lesões estereotáxicas seletivas a atraumáticas, destinada especialmente ao tratamento da psiconeuroses rebeldes à terapêutica médica e, também, dos distúrbios do comportamento, casos em que este tipo de psicocirurgia vem fornecendo resultados promissores