Abstract Objective: Lack of awareness of the risks associated with the use of medical gases amongst health professionals and health organizations is concerning. The objective of this study is to redefine the use process of medical gases in a hospital setting. Method: A sentinel event took place in a clinical unit, the incorrect administration of a medical gas to an inpatient. A multidisciplinary cause-root analysis of the sentinel event was carried out. Different improvement points were identified for each error detected and so we defined a good strategy to ensure the safe use of these drugs. Results: 9 errors were identified and the following improvement actions were defined: storage (gases of clinical use were separated from those of industrial use and proper identification signs were placed), prescription (6 protocols were included in the hospital´s Computerized Physician Order Entry software), validation (pharmacist validation of the prescription to ensure appropriate use of these), dispensation (a new protocol for medical gases dispensation and transportation was designed and implemented) and administration (information on the pressure gauges used for each type of gas was collected and reviewed). 72 Signs with recommendations for medical gases identification and administration were placed in all the clinical units. Specific training on the safe use of medical gases and general safety training was imparted. Conclusions: The implementation of a process that integrates all phases of use of medical gases and applies to all professionals involved is presented here as a strategy to increase safety in the use of these medicines.

Resumen Objetivo: Existe una falta de concienciación sobre los riesgos asociados al uso de los gases medicinales tanto por parte de los profesionales como por parte de las organizaciones sanitarias, que no han definido estrategias que garanticen la seguridad en su utilización. Nuestro objetivo fue redefinir el circuito de utilización de los gases medicinales en el ámbito hospitalario. Método: En una unidad de hospitalización tuvo lugar un evento centinela, la administración incorrecta de un gas medicinal a un paciente ingresado. Un equipo multidisciplinar realizó el análisis causa-raíz del evento. Se propusieron áreas de mejora encaminadas a actuar sobre los errores detectados y así definir un programa que garantizara la seguridad en el uso de los gases medicinales. Resultados: Se identificaron nueve errores y se definieron acciones de mejora en: almacenamiento (separación e identificación de los gases de uso clínico y de los de uso industrial); prescripción (inclusión de seis protocolos en el programa de prescripción electrónica); validación (revisión de la prescripción de los gases medicinales por un farmacéutico); dispensación (implantación de un protocolo de traslados), y administración (información sobre los manómetros utilizados para cada tipo de gas). Además, se impartió formación relativa al uso de los gases medicinales. Se colocaron 72 pósteres en las unidades clínicas con recomendaciones para su uso seguro. Conclusiones: La implantación de un circuito que integra todas las fases de utilización de los gases medicinales e implica a todos los profesionales involucrados se presenta como la estrategia dirigida a aumentar la seguridad en la utilización de estos medicamentos.

Background and aim: The presence of specific human leukocyte antigen-DQ2 and DQ8 seems to be necessary for celiac disease development, but the real contribution of its typing for screening is still uncertain. We aim to conduct a systematic review and meta-analysis of the diagnostic performance of human leukocyte antigen typing tests for celiac disease screening. Methods: Systematic review of published studies assessing accuracy of human leukocyte antigen DQ2 and DQ8 typing for the detection of celiac disease were selected. MEDLINE and EMBASE were searched from 1st January 2004 until 31st December 2013. Two independent researchers carried out selection and classification of studies, data extraction and analysis. Meta-analysis combining sensitivities, specificities and likelihood ratios of HLA-DQ2 and DQ8 for the diagnosis of celiac disease were carried out. Results: 6 studies including 1303 individuals were finally evaluated. Pooled sensitivity was 98% (95% confidence interval: 97-99). Overall specificity was 45% (95% confidence interval: 41-48). Regarding specificity, studies were heterogeneous and a subgroup analysis was done according to the type of population included. Overall negative likelihood ratio was 0.05 (0.03-0.09). Conclusions: Due to its great sensitivity and low negative likelihood ratio, human leukocyte antigen-DQ2/DQ8 typing would be an appropriate test for ruling out celiac disease in the general population suffering related symptoms, and even more in at risk population.

The PREDAPS study aims to determine the risk of developing diabetes and the risk of vascular complications in patients with prediabetes and identify factors associated with those risks. It is a prospective observational study of a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects with no alterations in glucose metabolism. The data at baseline were obtained from patients attending primary care centers in Spain throughout 2012. Subjects with prediabetes were classified into three groups: those who had only altered the fasting blood glucose levels -between 100 and 125mg/dl-, those who had only altered the HbA1c level -between 5.7 and 6.4% - and those who had altered both parameters. Information on sociodemographic characteristics, personal and family history, lifestyle and drug therapy was obtained from medical records and the interview with the doctor in the consultation. It was also performed a physical examination to determine weight, height, waist circumference and blood pressure were performed and blood and urine analysis. The PREDAPS study may help to reduce uncertainty in individual prevention strategies in subjects with prediabetes. Annual monitoring of patients recruited for five years will enable to know the risk of developing diabetes type 2 and the risk of macro-and microvascular complications in the three groups of subjects with prediabetes and determine the factors associated with those risks.

El estudio PREDAPS pretende determinar el riesgo de desarrollo de diabetes y aparición de complicaciones vasculares en sujetos con prediabetes e identificar los factores asociados. Se trata de un estudio observacional de seguimiento de una cohorte de 1.184 sujetos con prediabetes y otra cohorte de 838 sujetos sin alteraciones en el metabolismo de la glucosa. Los datos de la etapa basal se obtuvieron de pacientes que acudieron a centros de Atención Primaria en España a lo largo del año 2012. Los sujetos con prediabetes fueron clasificados en tres grupos: aquellos que sólo tenían alteradas las cifras de glucemia en ayunas -entre 100 y 125 mg/dl-, aquellos que sólo tenían alterado el nivel de HbA1c -entre 5,7 y 6,4%- y aquellos que tenían alterados ambos parámetros. La información sobre sus características sociodemográficas, antecedentes familiares y personales, estilos de vida y tratamiento farmacológico se obtuvo de la historia clínica y de la entrevista realizada en la consulta por el médico. Se realizó un examen físico para determinar peso, talla, perímetro de la cintura y presión arterial y se realizaron análisis de sangre y orina. El estudio PREDAPS puede contribuir a disminuir la incertidumbre en las estrategias individuales de prevención en los sujetos con prediabetes. El seguimiento anual durante cinco años de los participantes posibilitará conocer el riesgo de desarrollo de diabetes mellitus tipo 2 y el de complicaciones macro y microvasculares en los tres grupos de sujetos con prediabetes, así como averiguar los posibles factores asociados a esos riesgos.

The PREDAPS study aims to determine the risk of developing diabetes and the risk of vascular complications in patients with prediabetes and identify factors associated with those risks. It is a prospective observational study of a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects with no alterations in glucose metabolism. The data at baseline were obtained from patients attending primary care centers in Spain throughout 2012. Subjects with prediabetes were classified into three groups: those who had only altered the fasting blood glucose levels -between 100 and 125mg/dl-, those who had only altered the HbA1c level -between 5.7 and 6.4% - and those who had altered both parameters. Information on sociodemographic characteristics, personal and family history, lifestyle and drug therapy was obtained from medical records and the interview with the doctor in the consultation. It was also performed a physical examination to determine weight, height, waist circumference and blood pressure were performed and blood and urine analysis. The PREDAPS study may help to reduce uncertainty in individual prevention strategies in subjects with prediabetes. Annual monitoring of patients recruited for five years will enable to know the risk of developing diabetes type 2 and the risk of macro-and microvascular complications in the three groups of subjects with prediabetes and determine the factors associated with those risks.

El estudio PREDAPS pretende determinar el riesgo de desarrollo de diabetes y aparición de complicaciones vasculares en sujetos con prediabetes e identificar los factores asociados. Se trata de un estudio observacional de seguimiento de una cohorte de 1.184 sujetos con prediabetes y otra cohorte de 838 sujetos sin alteraciones en el metabolismo de la glucosa. Los datos de la etapa basal se obtuvieron de pacientes que acudieron a centros de Atención Primaria en España a lo largo del año 2012. Los sujetos con prediabetes fueron clasificados en tres grupos: aquellos que sólo tenían alteradas las cifras de glucemia en ayunas -entre 100 y 125 mg/dl-, aquellos que sólo tenían alterado el nivel de HbA1c -entre 5,7 y 6,4%- y aquellos que tenían alterados ambos parámetros. La información sobre sus características sociodemográficas, antecedentes familiares y personales, estilos de vida y tratamiento farmacológico se obtuvo de la historia clínica y de la entrevista realizada en la consulta por el médico. Se realizó un examen físico para determinar peso, talla, perímetro de la cintura y presión arterial y se realizaron análisis de sangre y orina. El estudio PREDAPS puede contribuir a disminuir la incertidumbre en las estrategias individuales de prevención en los sujetos con prediabetes. El seguimiento anual durante cinco años de los participantes posibilitará conocer el riesgo de desarrollo de diabetes mellitus tipo 2 y el de complicaciones macro y microvasculares en los tres grupos de sujetos con prediabetes, así como averiguar los posibles factores asociados a esos riesgos.