Indicator for patient safety: Readmission within 30 days for nosocomial infection.

Objetivos: Describir la frecuencia de reingresos en 30 días por infección nosocomial en el “Hospital Torrecárdenas” de Almería. Materiales y métodos: 25.653 episodios. El reingreso por infección nosocomial (IN): proporción de pacientes al alta de cada uno de los episodios hospitalarios durante el periodo de estudio que son reingresados de modo urgente en 30 días con IN, ya conste como diagnóstico principal del nuevo ingreso. Resultados: Proporción de reingresos por IN es 2,6‰ (IC95% 2,0 – 3,3), que supone un total de 67 episodios de reingreso por IN (5,0% del total). Unidad con mas reingresos por IN: UGC de urología 9,7‰ (IC95% 1,9 – 17,4)). Mayor probabilidad de reingreso se asocia al sexo masculino, a una mayor edad, a determinados diagnósticos y servicio al alta. Las unidades de hospitalización con más reingresos: salud mental, obstetricia, oncología radioterápica, oncología y reumatología, sin embargo, las unidades con mas reingresos por IN: urología, angiología y C.Vascular, oncología, neumología y cardiología. Las enfermedades que destacan como reingreso por IN: “otras alteraciones de uretra y vías urinaria” “infección postoperatoria, no clasificada en otro lugar”. Discusión y conclusiones: Se ha caracterizado el patrón de reingresos por IN en el hospital de Torrecárdenas, utilizándose para ser utilizado para implementar acciones preventivas y como un indicador de calidad asistencial.Objectives: To describe the frequency of readmission within 30 days for nosocomial infection at the “Hospital Torrecardenas” of Almeria. Material and methods: The source is from 1/1/2007 to 31/1/2008 CMBDh, analyzed 25,653 episodes. Readmissions for nosocomial infection (NI): proportion of patients at discharge for each hospital episode during the study period that are so urgently readmitted in 30 days with IN, and is credited as the primary diagnosis of new entry or as a diagnosis secondary. Descriptive analysis of variables such as age, sex, high service, month high, episode duration and primary diagnosis, using association between variables.Results: The proportion of readmissions by IN is 2.6 ‰ (IC95% 2,0–3,3), representing a total of 67 episodes of readmission for IN (5.0% of readmissions). The unit with more readmissions for IN was the hospital's urology unit (9.7 ‰ (IC95% 1,9–17,4)). A higher probability of readmission was associated with male gender, older age, certain diagnostic and service to hospital discharge. Inpatient units with more readmissions: mental health, obstetrics, radiation oncology, oncology and rheumatology, however, drives with more readmissions IN: urology, Angiology and Vascular C., oncology, pulmonology and cardiology. The diseases that stand out as readmission for IN are “other disorders of urethra and urinary tract” “postoperative infection, not elsewhere classified”. Conclusions: We have characterized the pattern of readmissions due to infections in the hospital Torrecárdenas, used to be used to implement preventive measures as an indicator of quality

Impact Factor: outdated artefact or stepping-stone to journal certification?

A review of Garfield's journal impact factor and its specific implementation as the Thomson Reuters Impact Factor reveals several weaknesses in this commonly-used indicator of journal standing. Key limitations include the mismatch between citing and cited documents, the deceptive display of three decimals that belies the real precision, and the absence of confidence intervals. These are minor issues that are easily amended and should be corrected, but more substantive improvements are needed. There are indications that the scientific community seeks and needs better certification of journal procedures to improve the quality of published science. Comprehensive certification of editorial and review procedures could help ensure adequate procedures to detect duplicate and fraudulent submissions.Comment: 25 pages, 12 figures, 6 table

Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence

Tetania secundaria a raquitismo carencial.

Case Reports; English Abstract; Journal Article;Hypocalcemia is an uncommon illness in children. In developed countries the incidence of rickets has decreased significantly, although last years this pathology is increasing at the expense of immigration. Its etiology is due to different factors such as low sun exposure, inadequate clothing and bad feeding and excessive contributions in phytates, exclusive breastfeeding and genetic factors. We report a case of a teenager 13 year old from Pakistan, who consulted for myoclonus, paresthesias, hand midwife and asymmetry walking. The laboratory emphasizes hypocalcemia deficit of 25 (OH) D and increased parathyroid hormone. Administration of calcium and vitamin D along with changes in his diet normalized clinical and laboratory parameters. Due to increased migration, the lack of sun exposure and inadequate supply this disease which was almost forgotten will appear another time.YesLa hipocalcemia es un proceso infrecuente en la edad pediátrica. En países desarrollados la incidencia de raquitismo ha disminuido de manera espectacular, aunque en los últimos años existe un resurgimiento dependiente prácticamente del fenómeno migratorio. Su etiología se debe a diferentes factores como son escasa exposición solar, inadecuada indumentaria y alimentación con pocos aportes lácteos y excesivos en fitatos, lactancia materna exclusiva y factores genéticos. Se presenta un caso clínico de un adolescente de 13 años de origen Pakistaní, q consultó por mioclonias, parestesias, mano en comadrona y asimetría en la marcha. En la analítica destaca hipocalcemia, déficit de 25(OH) D y aumento de paratohormona. La administración de calcio y vitamina D junto a la modificación de su dieta normalizaron los parámetros analíticos y la clínica. Debido al incremento de la migración, a la escasez de exposición solar e inadecuada alimentación esta enfermedad casi olvidada volverá a vers

Thyroid Function and Thyroid Autoimmunity in Relation to Weight Status and Cardiovascular Risk Factors in Children and Adolescents: A Population-Based Study.

In obese subjects, slight increases have been observed in thyrotropin [thyroid-stimulating hormone (TSH)] levels, but data in children are scarce. The aim of this study was to evaluate whether thyroid function and autoimmunity vary with weight status in a healthy population of children and adolescents and to determine whether hyperthyrotropinemia is associated with any cardiovascular risk factor. This cross-sectional epidemiological study was conducted in Almería (Spain) on a representative sample of 1317 healthy subjects aged 2-16 years. Thyroid function, thyroid autoimmunity and cardiovascular risk factors were measured. Chi-square test, analysis of variance and multiple linear regression were used in the statistical analyses. The obese children and adolescents had thyrotropin levels (mean ± standard deviation) of 3.12±2.44 mU/L. These levels were higher than those of overweight subjects (2.79±1.51 mU/L) and of normal weight subjects (2.73±1.30 mU/L) (p=0.02). Levels of free thyroxine and urinary iodine did not differ significantly between the groups. The prevalence (95% confidence interval) of thyroid autoimmunity was lower in the individuals with normal weight (2.9%; 2.0-4.2) than in the overweight (6.3%; 3.9-9.9) and obese subjects (5.6%, 2.5-11.3) (p=0.02). TSH levels were associated with obesity (β=0.36; p Obese children and adolescents had higher levels of thyrotropin than those who were overweight and of normal weight. The differences among the groups were of very little clinical significance and could possibly be linked to the higher prevalence of thyroid autoimmunity in obese subjects. The hyperthyrotropinemia in these subjects was not associated with any cardiovascular risk factor