array:21 [
  "pii" => "X2013251411052216"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
  "estado" => "S300"
  "fechaPublicacion" => "2011-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2011;31:457-63"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5183
    "formatos" => array:3 [
      "EPUB" => 263
      "HTML" => 4226
      "PDF" => 694
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699511052219"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
      "estado" => "S300"
      "fechaPublicacion" => "2011-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2011;31:457-63"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12817
        "formatos" => array:3 [
          "EPUB" => 309
          "HTML" => 11723
          "PDF" => 785
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Vigilancia de infecciones y otros eventos adversos en pacientes en hemodiálisis en el área sur de Gran Canaria"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "457"
            "paginaFinal" => "463"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Surveillance for Infections and Other Adverse Events in Dialysis Patients in Southern Gran Canaria"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "10605_108_8422_es_10605_t1.jpg"
                "Alto" => 141
                "Ancho" => 600
                "Tamanyo" => 96164
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Características de la población y tasa de eventos por acceso vascular"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Anna Quori, A. Quori, Jesús Molina-Cabrillana, E. Baamonde-Laborda, Eduardo Baamonde-Laborda, C. García-Cantón, Cesar García-Cantón, M.M. Lago-Alonso, Maria del Mar Lago-Alonso, A. Toledo-González, Agustin Toledo-González, Elvira Monzón-Jiménez, Elvira Monzón-Jimenez, D. Jiménez-Díaz, Dora Jimenez-Díaz, M. Checa-de-Andrés, Monica Checa-de-Andrés, J. Molina-Cabrillana"
            "autores" => array:18 [
              0 => array:2 [
                "nombre" => "Anna"
                "apellidos" => "Quori"
              ]
              1 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Quori"
              ]
              2 => array:2 [
                "nombre" => "Jesús"
                "apellidos" => "Molina-Cabrillana"
              ]
              3 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Baamonde-Laborda"
              ]
              4 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Baamonde-Laborda"
              ]
              5 => array:2 [
                "Iniciales" => "C."
                "apellidos" => "García-Cantón"
              ]
              6 => array:2 [
                "nombre" => "Cesar"
                "apellidos" => "García-Cantón"
              ]
              7 => array:2 [
                "Iniciales" => "M.M."
                "apellidos" => "Lago-Alonso"
              ]
              8 => array:2 [
                "nombre" => "Maria del Mar"
                "apellidos" => "Lago-Alonso"
              ]
              9 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Toledo-González"
              ]
              10 => array:2 [
                "nombre" => "Agustin"
                "apellidos" => "Toledo-González"
              ]
              11 => array:2 [
                "nombre" => "Elvira"
                "apellidos" => "Monzón-Jiménez"
              ]
              12 => array:2 [
                "nombre" => "Elvira"
                "apellidos" => "Monzón-Jimenez"
              ]
              13 => array:2 [
                "Iniciales" => "D."
                "apellidos" => "Jiménez-Díaz"
              ]
              14 => array:2 [
                "nombre" => "Dora"
                "apellidos" => "Jimenez-Díaz"
              ]
              15 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Checa-de-Andrés"
              ]
              16 => array:2 [
                "nombre" => "Monica"
                "apellidos" => "Checa-de-Andrés"
              ]
              17 => array:2 [
                "Iniciales" => "J."
                "apellidos" => "Molina-Cabrillana"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251411052216"
          "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052216?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052219?idApp=UINPBA000064"
      "url" => "/02116995/0000003100000004/v0_201502091411/X0211699511052219/v0_201502091412/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251411052208"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.May.10873"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:464-70"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5050
      "formatos" => array:3 [
        "EPUB" => 268
        "HTML" => 4176
        "PDF" => 606
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Ozone postconditioning in renal ischaemia-reperfusion model. Functional and morphological evidences"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "464"
          "paginaFinal" => "470"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Poscondicionamiento con ozono en un modelo de isquemia-reperfusión renal. Pruebas funcionales y morfológicas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10873_108_19657_en_t1_10873.jpg"
              "Alto" => 113
              "Ancho" => 600
              "Tamanyo" => 73876
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Effect of ozone oxidative postconditioning based on renal function evidence"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Aimee Fernández Iglesias, A. Fernández Iglesias, Lucía González Núñez, L. González Núñez, José Luis Calunga Fernández, J.L. Calunga Fernández, Sandra Rodríguez Salgueiro, S. Rodríguez Salgueiro, Elsa Santos Febles, E. Santos Febles"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Aimee"
              "apellidos" => "Fernández Iglesias"
            ]
            1 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Fernández Iglesias"
            ]
            2 => array:2 [
              "nombre" => "Lucía"
              "apellidos" => "González Núñez"
            ]
            3 => array:2 [
              "Iniciales" => "L."
              "apellidos" => "González Núñez"
            ]
            4 => array:2 [
              "nombre" => "José Luis"
              "apellidos" => "Calunga Fernández"
            ]
            5 => array:2 [
              "Iniciales" => "J.L."
              "apellidos" => "Calunga Fernández"
            ]
            6 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Rodríguez Salgueiro"
            ]
            7 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Rodríguez Salgueiro"
            ]
            8 => array:2 [
              "nombre" => "Elsa"
              "apellidos" => "Santos Febles"
            ]
            9 => array:2 [
              "Iniciales" => "E."
              "apellidos" => "Santos Febles"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052200"
        "doi" => "10.3265/Nefrologia.pre2011.May.10873"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052200?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052208?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052208/v0_201502091637/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251411052224"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.May.10828"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:449-56"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4873
      "formatos" => array:3 [
        "EPUB" => 271
        "HTML" => 3941
        "PDF" => 661
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Exploring the opinion of CKD patients on dialysis regarding, end-of-life and Advance Care Planning"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "449"
          "paginaFinal" => "456"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evaluación de la opinión de los pacientes con enfermedad renal crónica en diálisis respecto al fin de la vida y la planificación anticipada de cuidados"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10828_108_19074_en_t1.jpg"
              "Alto" => 352
              "Ancho" => 600
              "Tamanyo" => 185294
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient characteristics at the moment of the survey"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " Ethics and Nephrology Group of the S.E.N.,  Ética y Nefrología de la S.E.N., J.A. Sánchez-Tomero, A. Rodríguez-Jornet, S. Balda, S. Cigarrán, J.C. Herrero, F. Maduell, J. Martín, R. Palomar"
          "autores" => array:10 [
            0 => array:1 [
              "apellidos" => "Ethics and Nephrology Group of the S.E.N."
            ]
            1 => array:1 [
              "apellidos" => "Ética y Nefrología de la S.E.N."
            ]
            2 => array:2 [
              "Iniciales" => "J.A."
              "apellidos" => "Sánchez-Tomero"
            ]
            3 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Rodríguez-Jornet"
            ]
            4 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Balda"
            ]
            5 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Cigarrán"
            ]
            6 => array:2 [
              "Iniciales" => "J.C."
              "apellidos" => "Herrero"
            ]
            7 => array:2 [
              "Iniciales" => "F."
              "apellidos" => "Maduell"
            ]
            8 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Martín"
            ]
            9 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "Palomar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052227"
        "doi" => "10.3265/Nefrologia.pre2011.May.10828"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052227?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052224?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052224/v0_201502091636/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Surveillance for Infections and Other Adverse Events in Dialysis Patients in Southern Gran Canaria"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "457"
        "paginaFinal" => "463"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Anna Quori, A. Quori, Jesús Molina-Cabrillana, E. Baamonde-Laborda, Eduardo Baamonde-Laborda, C. García-Cantón, Cesar García-Cantón, M.M. Lago-Alonso, Maria del Mar Lago-Alonso, A. Toledo-González, Agustin Toledo-González, Elvira Monzón-Jiménez, Elvira Monzón-Jimenez, D. Jiménez-Díaz, Dora Jimenez-Díaz, M. Checa-de-Andrés, Monica Checa-de-Andrés, J. Molina-Cabrillana"
        "autores" => array:18 [
          0 => array:4 [
            "nombre" => "Anna"
            "apellidos" => "Quori"
            "email" => array:1 [
              0 => "aquoric@gobiernodecanarias.org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "Iniciales" => "A."
            "apellidos" => "Quori"
            "email" => array:1 [
              0 => "aquoric&#64;gobiernodecanarias&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jes&#250;s"
            "apellidos" => "Molina-Cabrillana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Baamonde-Laborda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Baamonde-Laborda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "C."
            "apellidos" => "Garc&#237;a-Cant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Cesar"
            "apellidos" => "Garc&#237;a-Cant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          7 => array:3 [
            "Iniciales" => "M.M."
            "apellidos" => "Lago-Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Maria del Mar"
            "apellidos" => "Lago-Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          9 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Toledo-Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Agustin"
            "apellidos" => "Toledo-Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Elvira"
            "apellidos" => "Monz&#243;n-Jim&#233;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Elvira"
            "apellidos" => "Monz&#243;n-Jimenez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          13 => array:3 [
            "Iniciales" => "D."
            "apellidos" => "Jim&#233;nez-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Dora"
            "apellidos" => "Jimenez-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          15 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Checa-de-Andr&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          16 => array:3 [
            "nombre" => "Monica"
            "apellidos" => "Checa-de-Andr&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          17 => array:3 [
            "Iniciales" => "J."
            "apellidos" => "Molina-Cabrillana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => " Centro de Hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria  "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => " Centro hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,   "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil Las Palmas de Gran Canaria  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Vigilancia de infecciones y otros eventos adversos en pacientes en hemodi&#225;lisis en el &#225;rea sur de Gran Canaria"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17360_en_10605tt1.jpg"
            "Alto" => 148
            "Ancho" => 600
            "Tamanyo" => 81937
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics and rate of events by type of vascular access"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Health care-related adverse events are the subject of much attention in all health institutions&#44; and morbidity and mortality for nosocomial infections have a significant impact on this issue&#46;<span class="elsevierStyleSup">1</span> Chronic renal failure &#40;CRF&#41; patients who are on haemodialysis have a high risk of contracting infections due to the technical complexity of the health care they receive as well as the immunosuppressive state they usually find themselves in&#46; These infections are the second-leading cause of death among haemodialysis patients&#44; with an attributed mortality rate of 14&#37;&#46;<span class="elsevierStyleSup">2 </span>Especially important are infections in vascular access points&#44; which are the leading cause of bacteraemia and loss of the vascular access in these patients&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The type of vascular access &#40;VA&#41; directly affects the risk of developing infections and is the most important risk factor in the development of bacteraemia and VA infection&#44; which from lowest risk to highest are&#58; arteriovenous fistulas &#40;AVF&#41;&#44; endovascular prostheses&#44; tunnelled catheters&#44; and non-tunnelled catheters&#46;<span class="elsevierStyleSup">4-9</span> The frequency with which VA are used varies according to the characteristics of the health system and the population being treated&#46; For example&#44; haemodialysis patients with a high prevalence of diabetes tend to have a lower rate of AVF and a greater use of catheters&#46;<span class="elsevierStyleSup">8</span> In the United States&#44; where the first VA placed in a patient was a permanent catheter to be later replaced by an endovascular prosthesis &#40;graft&#41;&#44; the &#8220;Fistula First&#8221; campaign has been recently instated in order to raise awareness on and promote AVF as the vascular access of choice and to increase the probability that patients receive the safest type of VA&#46;<span class="elsevierStyleSup">11&#44;12</span> At the same time&#44; widespread use of antibiotics has led to the potential problem of microbial resistance&#44; and haemodialysis has historically been one of the health care fields in which the appearance of new resistant strains have been observed for the first time&#46;<span class="elsevierStyleSup">13-15</span></p><p class="elsevierStylePara">Epidemiological surveillance of infectious events and antibiotic resistance can help understand the baseline state of a health care field and can provide important information when developing plans for improving and implementing future measures for control&#46; It can also provide data for evaluating the possible impact of the activities meant to prevent and control bacterial resistance&#46;<span class="elsevierStyleSup">4&#44;16&#44;17</span></p><p class="elsevierStylePara">In 1999&#44; the Centres for Disease Control &#40;CDC&#41; in the United States implemented the first epidemiological surveillance system for haemodialysis&#44; known as the Dialysis Surveillance Network &#40;DSN&#41;&#44;<span class="elsevierStyleSup">2&#44;3</span> which was consolidated in the recently created National Healthcare Safety Network &#40;NHSN&#41;&#46; In Europe&#44; this type of surveillance is less frequent&#44; since it was only in 2006 that the creation of multicentre systems was organised&#44; with the production of standardised guidelines&#44; indicators&#44; and recommendations&#46;<span class="elsevierStyleSup">18-23</span></p><p class="elsevierStylePara">Within this context&#44; we took interest in the implementation of a surveillance system for bacterial infections in haemodialysis patients in the southern region of Gran Canaria&#44; with the objective of quantifying and analysing the epidemiological characteristics of &#40;infectious and non-infectious&#41; adverse events and to identify possible opportunities for improvement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODOLOGY</span></p><p class="elsevierStylePara">Prospective study on the incidence of certain adverse events and infections&#44; applying the methodology used by the CDC through the DSN&#44; including all &#40;chronic&#41; haemodialysis patients&#44; with stratification based on the type of vascular access&#46;<span class="elsevierStyleSup">2</span> The study period was six months&#44; from March to September of 2008&#46; The patients under surveillance were treated in the haemodialysis unit of the tertiary <span class="elsevierStyleItalic">Hospital Universitario Insular de Gran Canaria </span>&#40;Gran Canaria Island University Hospital&#41; and at a peripheral health centre &#40;Avericum&#41; in the southern region of Gran Canaria&#46; Patients were treated at one centre or the other based on clinical criteria&#46; Patients underwent dialysis from Monday to Saturday on morning or afternoon shifts&#44; with a total of 79 available workstations distributed in the following manner&#58;</p><p class="elsevierStylePara">1&#46; Hospital&#46; 25 workstations&#58; 16 in the general treatment room&#44; four in a room for hepatitis C virus &#40;HCV&#41;&#44; two in a room for Hepatitis B virus &#40;HBV&#41;&#44; two in a room for human immunodeficiency virus &#40;HIV&#41;&#44; and one in isolation&#46;</p><p class="elsevierStylePara">2&#46; Avericum&#46; 54 workstations&#58; 50 in a general treatment room and four in a room for patients with HCV&#46;</p><p class="elsevierStylePara">We obtained indicators in the following manner&#58;</p><p class="elsevierStylePara">1&#46; Denominator &#40;census&#41;&#58; we obtained our data from those patients that received haemodialysis during the first two days of each month&#44; stratifying them by type of VA&#46; In this way&#44; we were able to safely estimate the number of patient&#47;month&#44; since the patients are always the same and rotate in fixed shifts&#46; The total number of patients treated during the first two days of each month produced the number of patients for that month&#46; Using this information for the study period&#44; we produced a value for the total number of patients per month&#44; which was stratified by type of VA&#46; We used this formula because of the low internal variability of patients on haemodialysis and in order to facilitate data collection by the department staff&#46;</p><p class="elsevierStylePara">2&#46; Numerator &#40;<span class="elsevierStyleItalic">incident cases</span>&#41;&#58; a <span class="elsevierStyleItalic">case</span> was any patient that required hospitalisation and&#47;or antibiotic treatment and&#47;or produced a positive blood culture&#46;</p><p class="elsevierStylePara">a&#41; Hospitalisation was defined as when the dialysis patient was admitted to any hospital department for over 24 hours due to any reason&#59; a case file was produced for each hospitalisation&#46;</p><p class="elsevierStylePara">b&#41; Each time that systemic antibiotic treatment was administered to these patients&#44; a <span class="elsevierStyleItalic">case</span> file was created&#44; except for instances during the hospitalisation process&#44; since this was considered as the same event&#46; Repeated treatments of the same antibiotic treatment within a 21-day period were considered as the same case&#46;</p><p class="elsevierStylePara">c&#41; In the case of positive blood cultures&#44; even in the absence of hospitalisation or antibiotic treatment&#44; a case file was produced&#46; A positive blood culture test 21 days after the previous one was also considered a new case&#46;</p><p class="elsevierStylePara">3&#46; Interpretation of the indicators&#58; the rates observed show the mean percentage of patients that register a new case every month&#46; For example&#44; a rate of 3&#46;0&#37; during the month of January indicates that an average of 3&#37; of patients had an adverse event during that month&#46;</p><p class="elsevierStylePara">For patients that developed repeated VA-related infections over time&#44; the first&#44; second&#44; third&#44; and even fourth events were considered&#44; according to the data collection protocol established by the NHSN&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Data collection and analysis</span></p><p class="elsevierStylePara">During the first week of each month over the course of the surveillance period&#44; the nursing staff at both centres compiled all of the necessary census information&#44; indicating the total number of patients that received dialysis&#44; stratified by type of vascular access&#46;</p><p class="elsevierStylePara">For each individual <span class="elsevierStyleItalic">case</span>&#44; the nephrology staff created a new epidemiological case file&#46; Each month&#44; the case files were sent to the study coordinator in the preventive medicine department&#44; where the data were reviewed and stored in the computer file&#46;</p><p class="elsevierStylePara">A case file was produced for all infectious and non-infectious problems associated with the VA &#40;thrombosis&#44; haemorrhage&#44; etc&#46;&#41;&#44; death&#44; and cardiovascular problems&#44; whereas hospitalisations for more than 24 hours that were due to any other cause were classified as incident cases in the &#8220;other&#8221; category&#46;</p><p class="elsevierStylePara">In case of an infectious pathology&#44; the attending physician recorded the diagnosis in the case file&#44; and the final classification of the infection was performed by the surveillance coordinator in the preventive medicine department&#44; according to the CDC<span class="elsevierStyleSup">16</span> criteria for the following infections&#58; VA infections&#58; local infections and with secondary bacteraemia &#40;catheter-related&#41;&#44; bacteraemia &#40;non-catheter related&#41;&#44; skin and soft tissue infections &#40;non-surgical&#41;&#44; pneumonia&#44; and urinary tract infections &#40;UTI&#41;&#46;</p><p class="elsevierStylePara">In the data analysis section&#44; we calculated the frequencies of categorical variables and used chi-square tests for comparing proportions using SPSS software&#44; version 17&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">We amassed a total of 1545 patient&#47;month&#44; with a monthly mean of 221 patients&#44; although with major differences between the two dialysis centres&#44; both in the number and type of VA&#44; as expressed in Table 1&#46; The distribution of types of VA was different between the two centres&#44; with a greater proportion of AVF than permanent catheters in patients attended at the peripheral health centre&#44; and an inverse relationship observed at the hospital&#44; where permanent catheters were more common&#46; They all were Hickman type catheters&#44; reaching 71&#46;5&#37; of the total&#46; A very low proportion of the VA were prostheses or non-tunnelled temporary catheters &#40;both were less than 5&#37; of the total&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Incident cases</span></p><p class="elsevierStylePara">We observed a total of 134 incident cases and the majority of them &#40;53&#46;7&#37;&#41; were for antibiotic treatment administration&#46; The rate of incident cases &#40;expressed as 100 patient&#47;month&#41; varied significantly between the two different health centres and&#44; above all&#44; between the different types of vascular access used&#46; Rates were much higher in patients attended at the hospital and in those with higher-risk types of vascular access &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Non-infectious events</span></p><p class="elsevierStylePara">The rates of adverse events varied greatly&#44; but the risk gradient for type of VA was maintained&#44; except for those cases classified as &#8220;other&#44;&#8221; which were much frequent in patients with AVF&#46; The rate of lost vascular access points varied widely based on the type of access used&#46; Throughout the surveillance period&#44; we observed the loss of two AVF and one endovascular prosthesis due to non-infectious causes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Infectious events</span></p><p class="elsevierStylePara">We identified 41 infectious events related to the vascular access&#44; with an incidence of 8&#46;6 cases per 100 patient&#47;month&#44; 33 cases of bacteraemia related to the vascular access&#44; and 8 cases of local infection&#46; These infectious events caused the loss of 9 VA &#40;seven permanent catheters and two temporary ones&#41;&#46; As shown in Table 2&#44; the rates of infectious events varied according to the type of vascular access used&#44; especially in the infections of the VA&#44; whereas the rate of infections not related to the VA &#40;wounds&#44; UTI&#44; and respiratory infections&#41; were similar among different types&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Use of antibiotics and microbiological cultures</span></p><p class="elsevierStylePara">In all&#44; we administered 66 different systemic antibiotic treatments &#40;in monotherapy or combined&#41;&#44; and the global percentage of microbiological cultures taken before starting treatment was 73&#46;2&#37;&#46; In the hospital&#44; cultures were taken in 82&#46;2&#37; of treated cases&#44; and in 91&#37; if there was a suspicion of bacteraemia and&#47;or an infected VA&#44; whereas cultures were taken in only 56&#46;7&#37; of cases in which antibiotic treatment was administered in the peripheral centre&#44; with 90&#37; of VA-related infections being diagnosed&#46; Cultures were not taken in cases of repeated infectious event in the same patient &#40;second&#44; third&#44; and fourth events&#41;&#46; When diagnosing a patient with a wound infection&#44; cultures were taken in 70&#37; of cases before prescribing treatment&#44; in 50&#37; of cases of UTI&#44; and in none of the cases of respiratory infections&#46; In 78&#37; of cases&#44; empirical treatment was given with vancomycin and ceftazidime when a VA-related infection was suspected&#44; and was adjusted according to an antibiogram in 90&#37; of cases&#46; The overall rate of specific use of vancomycin was 4&#46;4&#37; patient&#47;month in the hospital&#44; and 0&#46;8&#37; in the peripheral centre&#59; these rates also varied by type of VA &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">Table 3 shows the bacterial isolations by infection type &#40;only for first events&#44; not including repeated cultures of the same microorganism&#41;&#46; We isolated multi-resistant microorganisms in only four cases&#44; and the proportion of infections caused by gram-positive bacteria was similar to that of gram-negative bacteria&#44; both in VA-related infections and others&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">We performed a surveillance study of the appearance of adverse events in a chronic haemodialysis population&#46; In Spain little experience has been gained in this field&#44; and so this study could contribute to understanding the situation within this population&#46;<span class="elsevierStyleSup">18&#44;24</span> Compared with data from Spain and Europe in general&#44;<span class="elsevierStyleSup">7&#44;24</span> our health care area uses a 20&#37; lower proportion of AVF &#40;mean in Spain&#58; 79&#46;5&#37;&#41; and endovascular prostheses &#40;mean&#58; 10&#46;5&#37;&#41;&#44; whereas permanent catheters are used 3&#46;5 times more frequently &#40;35&#46;5&#37; vs the rate in Spain of 9&#46;9&#37;&#41;&#46;</p><p class="elsevierStylePara">The frequency of using VA varied between the two centres&#46; Patients with an AVF or a permanent catheter accounted for 60&#46;5&#37; of all such patients&#44; and the frequency of using AVF was greater in the peripheral centre &#40;71&#46;5&#37;&#41; than in the hospital &#40;34&#37;&#41;&#44; whereas permanent catheters had a similar distribution in the two health centres&#46; On the other hand&#44; the use of prostheses and temporary catheters was quite low&#44; and so the data regarding patients with these types of accesses may not have been representative so we have not shown their results&#46; This is not an ideal situation&#44; taking into account that the majority of scientific societies and medical authorities recommend the AVF&#44; given its lower rate of occurrence of adverse events&#46;<span class="elsevierStyleSup">5-12&#44;19-22&#44;26-28</span></p><p class="elsevierStylePara">The rates of adverse events were higher in patients with permanent catheters than in those with fistulas or prostheses&#44; both in the peripheral and central hospital centres&#44; coinciding with results from other authors around the world&#46;<span class="elsevierStyleSup">3&#44;7-9&#44;25&#44;29</span> The rate of hospitalisation is twice as high in the group of patients with permanent catheters than in the AVF group&#44; as well as the rate of infections related to the vascular access point &#40;both in local infections and bacteraemias&#41;&#46;</p><p class="elsevierStylePara">In patients on haemodialysis in the United States&#44; the rates of catheter-related bacteraemias is estimated at 0&#46;9-2&#46;0 events per patient-year&#46;<span class="elsevierStyleSup">2</span> Similarly&#44; surveillance data indicate that hospitalisation rates have increased by 29&#37; due to bacteraemia&#44; and 24&#37; due to cellulitis&#44; since 1993&#46;<span class="elsevierStyleSup">3</span> Ferrero et al&#44;<span class="elsevierStyleSup">29</span> in a similar study carried out in Italy&#44; observed a 0&#46;18&#37; rate of bacteraemia associated with the vascular access&#44; which is a lower rate than that presented by the NHSN<span class="elsevierStyleSup">3&#44;25</span> and the values we observed &#40;1&#46;3 and 4&#46;4 episodes per 100 patients&#47;month in patients with AVF and permanent catheters&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Non-infectious adverse events had a similar pattern to infectious events&#44; with greater rates for permanent catheters and patients treated at the hospital&#46;</p><p class="elsevierStylePara">With regard to antibiotic treatment and laboratory use&#44; the data indicate a good overall situation&#44; with a low incidence of multi-resistant bacteria and a rational use of health resources &#40;antibiotic agents and microbiological cultures&#41;&#46; However&#44; there is room for improvement&#44; especially with regard to antibiotic treatment without previous culture&#44; such as in the case of respiratory infections&#46; The rate of use of vancomycin was between 0&#46;1 and 1&#46;9 per 100 patients&#47;month in patients with AVF&#44; and between 2&#46;8 and 5&#46;5 for patients with permanent catheters&#44; which are acceptable results when compared with the 2006 data from the DSN&#44;<span class="elsevierStyleSup">3</span> falling below the 75<span class="elsevierStyleSup">th</span> percentile&#46; In our health care field&#44; this type of empirical treatment&#44; adjusted to the antibiogram results&#44; continues to be the treatment of choice&#44; taking into consideration the low incidence of multi-resistant bacteria and the absence of bacteria resistant to vancomycin&#46;</p><p class="elsevierStylePara">Our study has some limitations&#46; In the first place&#44; it had a descriptive design&#44; and so we cannot estimate risk&#46; We cannot conclude that the presence of an AVF causes a lower risk of infectious events&#44; since this would require a more analytical study design &#40;experimental&#44; cohorts&#44; or case&#47;control&#41;&#46; Even so&#44; the approximations made using the epidemiological surveillance design used here can be useful&#44; especially because our results are consistent with those from other studies&#46;<span class="elsevierStyleSup">3&#44;24&#44;28</span> Also&#44; the study period was quite short&#44; only seven months&#44; although we believe that the sample size of 1545 patient&#47;month may offer a good estimation of the incidence of adverse events&#46; However&#44; we did not establish a predetermined sample size&#44; since the primary objective of the study was to detect problems associated with the treatment of patients on chronic haemodialysis&#46; Finally&#44; we must point out that the scarce experience with this type of study in our field has revealed errors in the estimation of parameters&#46;</p><p class="elsevierStylePara">Nevertheless&#44; our study has detected some areas for improvement&#44; such as the lack of cultures taken in respiratory infections&#46; However&#44; the high rate of use of permanent long-term catheters compared to AVF represents the most critical point in morbidity and mortality&#44; health costs&#44; quality of health care&#44; and patient safety&#44; which is not dependent on the workers in our haemodialysis units&#44; since we also depend on health professionals from other fields&#44; such as vascular surgeons and hospital administrators&#44; as stated in the &#8220;Change package overview&#8221; promoted by the &#8220;Fistula First&#8221; campaign in the USA&#46;<span class="elsevierStyleSup">11</span> Our data show that the increased risk of an adverse event is also higher in our area &#40;without basing ourselves solely on data from previous studies&#41;&#44; and should be used to motivate health care professionals that work in treating these patients to increase the rate of AVF as the VA of choice and to reduce the overall use of permanent catheters such as a long-term VA&#46;</p><p class="elsevierStylePara">The implication of hospital administrators and vascular surgeons in this matter is considered indispensable in order to achieve these objectives&#46;</p><p class="elsevierStylePara">The surveillance programme that we presented here is easy to implement&#44; consumes few resources&#44; and is well accepted by health care professionals working in haemodialysis units&#46; Moreover&#44; it provides useful information for introducing improvement and control measures&#44; and that have been demonstrated to reduce the rates of infections and improve the use of antibiotics&#46;<span class="elsevierStyleSup">3&#44;24&#44;29</span> Finally&#44; our results can be useful for the planning and coordination of clinical management of haemodialysis patients&#44; becoming a key factor in the development of multi-disciplinary strategies for ensuring patient safety&#46;<span class="elsevierStyleSup">1&#44;3&#44;16-19</span></p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17360&#95;en&#95;10605tt1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17360_en_10605tt1.jpg" alt="Population characteristics and rate of events by type of vascular access"></img></a></p><p class="elsevierStylePara">Table 1&#46; Population characteristics and rate of events by type of vascular access</p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17361&#95;en&#95;10605tt2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17361_en_10605tt2.jpg" alt="Rates of adverse events expressed per 100 patients&#47;month"></img></a></p><p class="elsevierStylePara">Table 2&#46; Rates of adverse events expressed per 100 patients&#47;month</p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17362&#95;en&#95;10605tt3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17362_en_10605tt3.jpg" alt="Microorganisms isolated by type of infection"></img></a></p><p class="elsevierStylePara">Table 3&#46; Microorganisms isolated by type of infection</p>"
    "pdfFichero" => "P1-E523-S3000-A10605-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440915"
          "palabras" => array:1 [
            0 => "Acceso vascular"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440917"
          "palabras" => array:1 [
            0 => "Seguridad del paciente"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440919"
          "palabras" => array:1 [
            0 => "Infecci&#243;n nosocomial"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440921"
          "palabras" => array:1 [
            0 => "Di&#225;lisis"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440923"
          "palabras" => array:1 [
            0 => "Vigilancia"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440916"
          "palabras" => array:1 [
            0 => "Vascular access"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440918"
          "palabras" => array:1 [
            0 => "Patient safety"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440920"
          "palabras" => array:1 [
            0 => "Nosocomial infection"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440922"
          "palabras" => array:1 [
            0 => "Dialysis"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440924"
          "palabras" => array:1 [
            0 => "Surveillance"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Bacterial infections pose a major challenge to risk management activities in the area of chronic haemodialysis&#44; as vascular access-related infections are the main cause of mortality among these patients&#46; <span class="elsevierStyleBold">Methods&#58;</span> Prospective surveillance study lasting 7 months &#40;March-September&#44; 2008&#41; at two haemodialysis units in a district health area Gran Canaria&#44; Spain&#46; We used the methodology proposed by CDC&#180;s Dialysis Surveillance Network&#46; <span class="elsevierStyleBold">Results&#58;</span> 1545 patients&#47;month were recorded&#44; 60&#46;5&#37; with an arteriovenous fistula &#40;AVF&#41;&#44; 35&#46;5&#37; with a permanent catheter &#40;PC&#41;&#44; 3&#46;0&#37; with grafts and 1&#46;0&#37; with temporary catheters&#46; The rate of adverse events was 8&#46;6 cases per 100 patients&#47;month&#44; 9&#46;1 for AVF patients&#44; and 2&#46;9 for PC&#46; Nevertheless&#44; the other types of infections &#40;respiratory&#44; urinary tract&#44; skin and chronic ulcers&#41; showed similar rates&#46; Microbiological cultures were taken in 82&#46;2&#37;&#44; but this rate increased to 91&#46;0&#37; when a vascular access-related infection was suspected&#46; Empirical treatment was adjusted to antibiogram results in 90&#46;0&#37; of occasions&#46; A low incidence of multi-resistant microbes was observed&#46; Gram-positive and gram-negative bacteria appeared in similar proportions&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Vascular access is the main risk factor for infectious events&#46; Epidemiological surveillance has allowed us to detect areas of improvement in different settings&#44; acting as a key element in risk management and patient safety&#46;</p>"
      ]
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> Las infecciones bacterianas representan un gran desaf&#237;o en las estrategias de gesti&#243;n del riesgo&#44; prevenci&#243;n y seguridad de los pacientes en hemodi&#225;lisis&#59; entre ellas&#44;&#160;las infecciones del acceso vascular &#40;AV&#41; suponen la primera causa de morbimortalidad&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Estudio de siete meses de duraci&#243;n sobre la&#160;incidencia de determinados eventos adversos e infecciones&#160;&#40;marzo-septiembre de 2008&#41; en las unidades de hemodi&#225;lisis del &#193;rea Sanitaria Sur de Gran Canaria &#40;hospital y centro perif&#233;rico&#41; mediante el empleo de la&#160; metodolog&#237;a del Dialysis Surveillance Network de los Centers for Diseases and Control &#40;CDC&#41; de los Estados Unidos&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Se incluyeron&#160;1&#46;545 pacientes&#47;mes&#44; un 60&#44;5&#37; con f&#237;stulas AV&#160;&#40;FAV&#41;&#44; un 35&#44;5&#37;&#160;conectados a cat&#233;teres permanentes &#40;CP&#41;&#44; un 3&#44;0&#37; tratados con pr&#243;tesis y un 1&#44;0&#37; con cat&#233;teres temporales&#46; La incidencia de eventos fue 8&#44;6 casos por 100 pacientes-mes&#44; y fue de&#160;9&#44;1 para las FAV y de 2&#44;9 para los CP&#44;&#160;mientras que las tasas de otras infecciones &#40;respiratorias&#44; de herida o de&#160;orina&#41; fueron similares&#46; Se pidieron cultivos antes del tratamiento antibi&#243;tico en el 82&#44;2&#37; de los casos&#44; m&#225;s si la sospecha era de bacteriemia y&#47;o de infecci&#243;n AV &#40;91&#44;0&#37;&#41;&#46; El 9&#44;0&#37; de tratamientos se ajustaron con antibiograma&#46; Destaca una baja incidencia de bacterias mutirresistentes&#44; mientras que las infecciones relacionadas con el AV fueron causadas en una proporci&#243;n similar por bacterias grampositivas y gramnegativas&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span> El AV es el principal factor de riesgo para el desarrollo de infecciones&#46; La vigilancia epidemiol&#243;gica he permitido detectar oportunidades de mejora en &#225;mbitos asistenciales distintos&#44; y se integra como elemento fundamental en el desarrollo de estrategias multidisciplinarias de seguridad del paciente&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17360_en_10605tt1.jpg"
            "Alto" => 148
            "Ancho" => 600
            "Tamanyo" => 81937
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics and rate of events by type of vascular access"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17361_en_10605tt2.jpg"
            "Alto" => 314
            "Ancho" => 600
            "Tamanyo" => 160733
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Rates of adverse events expressed per 100 patients&#47;month"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17362_en_10605tt3.jpg"
            "Alto" => 132
            "Ancho" => 600
            "Tamanyo" => 80577
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Microorganisms isolated by type of infection"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "To Err Is Human Institute of Medicine. Washington DC: Library of The Congress, 2000;1-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2.\u{A0}Tokars J, Millar E, Stein G. New national surveillance system for hemodiálisis-associated infections: initial results. Am J Infect Control 2002;30(5):288-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12163863" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3.\u{A0}Klevens RM, Edwards JR. Dialysis Surveillance Report: National Healthcare Safety Network (NHSN) Summary 2006. Semin Dial 2008;21(1):24-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712005530"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4.\u{A0}Klevens RM, Tokars JJ, Andrus M. Electronic reporting of infections associated with hemodialysis Nephrology News & Issues June 2005 37-43. Disponible en: http://www.cdc.gov/nhsn/PDFs/dataStat/2006_DialysisSurvReport.pdf. Accedido 02/08/2010"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5.\u{A0}Ravani P, Spergel LM, Asif A, Roy-Chaudhury P, Besarab A. Clinical epidemiology of arteriovenous fistula in 2007. J Nephrol 2007;20:141-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17514618" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "6.\u{A0}Hoggard J, Saad T, Schon D, Vesely TM, Royer T. Guidelines for venous access in patients with chronic kidney disease. Semin Dial 2008;21(2):186-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18364015" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "7.\u{A0}Rayner HC, Besarab A, Brown WW, Disney A, Salto A, Pisoni RL. Vascular access results from the Dialysis Outcome and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines. Am J Kidney Dis 2004;44(Suppl2):S22-S26."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.\u{A0}Ethier J, Mendelssohn DC, Elder S, Hasegawa T, Akizwa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant 2008;23:3219-26. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511606" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9.\u{A0}Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among haemodialysis patients. Kidney Int 2002;62:620-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12110026" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hajaar J, Marc R. Surveillance des infections chez les hemodialysés croniques. Néphrologie 2004;25:133-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15291141" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "U.S. Department oh Health & Human Services, Center for Medicare & Medicaid Services. Fistula First Breakthrough (Website). Disponible en: http://fistulafirst.org. Accedido Septiembre 2007."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Allon M, Robbin ML. Increasing arteriovenous fistulas in haemodialysis patients: problems and solutions. Kidney Int 2002;62:1109-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12234281" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bailey JL, Balter P, Berns J, Butera E, Depner T, Douglas C, et al. Recommendation for preventing transmission of infections among chronic hemodialysis patients. MMWR Recommendation and Reportsl 2001;50(RR05):1-43. Disponible en: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Collins A, Forrest B, Klevens RM, Patel DDS, Arduino MJ, Fosheim G, et al. Invasive Methicillin-resistant Staphylococcus aureus infections among dialysis patient. MMWR Recommendation and Reports 2007;59(RR09):197-9. Disponible en: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5609a3.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "McDonald LC, Hageman JC. Vancomycin-intermediate and resistant Staphylococcus aureus: What the nephrologist needs to know. Nephrol News Issues 2004;18(12):63-75."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Horan TC, Gaynes RP. Surveillance of nosocomial infections. In: Mayhall CG, ed. Hospital epidemiology and infection control (3rd ed.).\u{A0}Philadelphia: Lippincott Williams & Wilkins, 2004;\u{A0}1659-1702."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gaynes R, Richards C, Edwards J, Emori T, Horan T, Echanove JA, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11294727" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Guidance on infection control in healthcare settings in Europe. Recommended practices, standards and indicators for healthcare associate infections and antibiotic resistance. Disponible en: http://helics.univ-lyon1.fr/Standards and Indicators.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "NICE Final Guidelines. Prevention oh healthcare-associated infections in primary and community care. June 2003. Disponible en: http://www.nice.org.uk/nicemedia/pdf/Infection_control_fullguideline.pdf"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tordoir JH, Mickley V. European guidelines for vascular access: clinical algorithms on vascular access for hemodialysis. EDTNA ERCA 2003;29:131-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "European Best Practice Guidelines Expert Group on Hemodialysis, European Renal Association. Section I. Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant 2002;17(Suppl 7):7-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12386205" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. Guía de acceso vascular. Noviembre, 2004. Disponible en: http://www.senefro.org/modules/subsection/files/guia_acceso_vascular.pdf?check_idfile=984"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Medicina Preventiva, Salud Pública e Higiene. Documento de consenso sobre recomendaciones y recursos necesarios para un programa de control de la infección nosocomial en los hospitales españoles. Disponible en: http://www.mpsp.org/mpsp/index.html"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rodríguez Hernandez J, López Pedret J, Piera L. El acceso vascular en España: análisis de su distribución, morbilidad y sistemas de monitorización. Nefrología 2001;21(1):45-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11344961" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Edwards J, MStat K, Peterson BBA, Yi Mu P, Shailendra Ph, Allen-Bridson K, et al. National Healthcare safety Network (NHSN) report. Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rehman R, Schmidt RJ, Moss AH. Ethical and legal obligation to avoid long-term tunneled catheter access. Clin J Am Soc Nephrol 2009;4:456-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19158368" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Konner K. A primer on the AV fistula-Achille¿s heel, but also «Cinderella» of hemodialysis. J Am Soc Nephrol 1999;14:2094-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970903321X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kevan R, McDonald S. Vascular access and all-cause mortality; a propensity score analysis. J Am Soc Nephrol 2004;15:477-86. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14747396" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ferrero S, Saltarelli M, Quori A, Campobasso M, Argentero P. Dialysis surveillance monitoring bloodstream and vascular infections. G Ital Nefrol 2008;25:347-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18473306" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673613617547"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "George A, Tokars JL, Clutterbuck EJ, Bamford KB, Pusey C, Holmes AH. Reducing dialysis associated bacteraemia, and recommendations for surveillance in the UK: prospective study. BMJ 2006;332:1435-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052216/v0_201502091637/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000004/v0_201502091636/X2013251411052216/v0_201502091637/en/P1-E523-S3000-A10605-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052216?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Surveillance for Infections and Other Adverse Events in Dialysis Patients in Southern Gran Canaria
Vigilancia de infecciones y otros eventos adversos en pacientes en hemodiálisis en el área sur de Gran Canaria
Anna Quoria, A.. Quorib, Jesús Molina-Cabrillanaa, E.. Baamonde-Labordac, Eduardo Baamonde-Labordad, C.. García-Cantóne, Cesar García-Cantónf, M.M.. Lago-Alonsoe, Maria del Mar Lago-Alonsof, A.. Toledo-Gonzáleze, Agustin Toledo-Gonzálezf, Elvira Monzón-Jiméneze, Elvira Monzón-Jimenezf, D.. Jiménez-Díazc, Dora Jimenez-Díazd, M.. Checa-de-Andrése, Monica Checa-de-Andrésf, J.. Molina-Cabrillanab
a Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria Spain,
b Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,
c Centro de Hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria
d Centro hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria Spain,
e Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,
f Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil Las Palmas de Gran Canaria Spain,
Read
10132
Times
was read the article
2559
Total PDF
7573
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251411052216"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
  "estado" => "S300"
  "fechaPublicacion" => "2011-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2011;31:457-63"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5183
    "formatos" => array:3 [
      "EPUB" => 263
      "HTML" => 4226
      "PDF" => 694
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699511052219"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
      "estado" => "S300"
      "fechaPublicacion" => "2011-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2011;31:457-63"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12817
        "formatos" => array:3 [
          "EPUB" => 309
          "HTML" => 11723
          "PDF" => 785
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Vigilancia de infecciones y otros eventos adversos en pacientes en hemodi&#225;lisis en el &#225;rea sur de Gran Canaria"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "457"
            "paginaFinal" => "463"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Surveillance for Infections and Other Adverse Events in Dialysis Patients in Southern Gran Canaria"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "10605_108_8422_es_10605_t1.jpg"
                "Alto" => 141
                "Ancho" => 600
                "Tamanyo" => 96164
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Caracter&#237;sticas de la poblaci&#243;n y tasa de eventos por acceso vascular"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Anna Quori, A. Quori, Jes&#250;s Molina-Cabrillana, E. Baamonde-Laborda, Eduardo Baamonde-Laborda, C. Garc&#237;a-Cant&#243;n, Cesar Garc&#237;a-Cant&#243;n, M.M. Lago-Alonso, Maria del Mar Lago-Alonso, A. Toledo-Gonz&#225;lez, Agustin Toledo-Gonz&#225;lez, Elvira Monz&#243;n-Jim&#233;nez, Elvira Monz&#243;n-Jimenez, D. Jim&#233;nez-D&#237;az, Dora Jimenez-D&#237;az, M. Checa-de-Andr&#233;s, Monica Checa-de-Andr&#233;s, J. Molina-Cabrillana"
            "autores" => array:18 [
              0 => array:2 [
                "nombre" => "Anna"
                "apellidos" => "Quori"
              ]
              1 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Quori"
              ]
              2 => array:2 [
                "nombre" => "Jes&#250;s"
                "apellidos" => "Molina-Cabrillana"
              ]
              3 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Baamonde-Laborda"
              ]
              4 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Baamonde-Laborda"
              ]
              5 => array:2 [
                "Iniciales" => "C."
                "apellidos" => "Garc&#237;a-Cant&#243;n"
              ]
              6 => array:2 [
                "nombre" => "Cesar"
                "apellidos" => "Garc&#237;a-Cant&#243;n"
              ]
              7 => array:2 [
                "Iniciales" => "M.M."
                "apellidos" => "Lago-Alonso"
              ]
              8 => array:2 [
                "nombre" => "Maria del Mar"
                "apellidos" => "Lago-Alonso"
              ]
              9 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Toledo-Gonz&#225;lez"
              ]
              10 => array:2 [
                "nombre" => "Agustin"
                "apellidos" => "Toledo-Gonz&#225;lez"
              ]
              11 => array:2 [
                "nombre" => "Elvira"
                "apellidos" => "Monz&#243;n-Jim&#233;nez"
              ]
              12 => array:2 [
                "nombre" => "Elvira"
                "apellidos" => "Monz&#243;n-Jimenez"
              ]
              13 => array:2 [
                "Iniciales" => "D."
                "apellidos" => "Jim&#233;nez-D&#237;az"
              ]
              14 => array:2 [
                "nombre" => "Dora"
                "apellidos" => "Jimenez-D&#237;az"
              ]
              15 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Checa-de-Andr&#233;s"
              ]
              16 => array:2 [
                "nombre" => "Monica"
                "apellidos" => "Checa-de-Andr&#233;s"
              ]
              17 => array:2 [
                "Iniciales" => "J."
                "apellidos" => "Molina-Cabrillana"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251411052216"
          "doi" => "10.3265/Nefrologia.pre2011.Apr.10605"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052216?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052219?idApp=UINPBA000064"
      "url" => "/02116995/0000003100000004/v0_201502091411/X0211699511052219/v0_201502091412/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251411052208"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.May.10873"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2011;31:464-70"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5050
      "formatos" => array:3 [
        "EPUB" => 268
        "HTML" => 4176
        "PDF" => 606
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Ozone postconditioning in renal ischaemia-reperfusion model&#46; Functional and morphological evidences"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "464"
          "paginaFinal" => "470"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Poscondicionamiento con ozono en un modelo de isquemia-reperfusi&#243;n renal&#46; Pruebas funcionales y morfol&#243;gicas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10873_108_19657_en_t1_10873.jpg"
              "Alto" => 113
              "Ancho" => 600
              "Tamanyo" => 73876
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Effect of ozone oxidative postconditioning based on renal function evidence"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Aimee Fern&#225;ndez Iglesias, A. Fern&#225;ndez Iglesias, Luc&#237;a Gonz&#225;lez N&#250;&#241;ez, L. Gonz&#225;lez N&#250;&#241;ez, Jos&#233; Luis Calunga Fern&#225;ndez, J.L. Calunga Fern&#225;ndez, Sandra Rodr&#237;guez Salgueiro, S. Rodr&#237;guez Salgueiro, Elsa Santos Febles, E. Santos Febles"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Aimee"
              "apellidos" => "Fern&#225;ndez Iglesias"
            ]
            1 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Fern&#225;ndez Iglesias"
            ]
            2 => array:2 [
              "nombre" => "Luc&#237;a"
              "apellidos" => "Gonz&#225;lez N&#250;&#241;ez"
            ]
            3 => array:2 [
              "Iniciales" => "L."
              "apellidos" => "Gonz&#225;lez N&#250;&#241;ez"
            ]
            4 => array:2 [
              "nombre" => "Jos&#233; Luis"
              "apellidos" => "Calunga Fern&#225;ndez"
            ]
            5 => array:2 [
              "Iniciales" => "J.L."
              "apellidos" => "Calunga Fern&#225;ndez"
            ]
            6 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Rodr&#237;guez Salgueiro"
            ]
            7 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Rodr&#237;guez Salgueiro"
            ]
            8 => array:2 [
              "nombre" => "Elsa"
              "apellidos" => "Santos Febles"
            ]
            9 => array:2 [
              "Iniciales" => "E."
              "apellidos" => "Santos Febles"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052200"
        "doi" => "10.3265/Nefrologia.pre2011.May.10873"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052200?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052208?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052208/v0_201502091637/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251411052224"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.May.10828"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2011;31:449-56"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4873
      "formatos" => array:3 [
        "EPUB" => 271
        "HTML" => 3941
        "PDF" => 661
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Exploring the opinion of CKD patients on dialysis regarding&#44; end-of-life and Advance Care Planning"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "449"
          "paginaFinal" => "456"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evaluaci&#243;n de la opini&#243;n de los pacientes con enfermedad renal cr&#243;nica en di&#225;lisis respecto al fin de la vida y la planificaci&#243;n anticipada de cuidados"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10828_108_19074_en_t1.jpg"
              "Alto" => 352
              "Ancho" => 600
              "Tamanyo" => 185294
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient characteristics at the moment of the survey"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " Ethics and Nephrology Group of the S&#46;E&#46;N&#46;,  &#201;tica y Nefrolog&#237;a de la S&#46;E&#46;N&#46;, J.A. S&#225;nchez-Tomero, A. Rodr&#237;guez-Jornet, S. Balda, S. Cigarr&#225;n, J.C. Herrero, F. Maduell, J. Mart&#237;n, R. Palomar"
          "autores" => array:10 [
            0 => array:1 [
              "apellidos" => "Ethics and Nephrology Group of the S&#46;E&#46;N&#46;"
            ]
            1 => array:1 [
              "apellidos" => "&#201;tica y Nefrolog&#237;a de la S&#46;E&#46;N&#46;"
            ]
            2 => array:2 [
              "Iniciales" => "J.A."
              "apellidos" => "S&#225;nchez-Tomero"
            ]
            3 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Rodr&#237;guez-Jornet"
            ]
            4 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Balda"
            ]
            5 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Cigarr&#225;n"
            ]
            6 => array:2 [
              "Iniciales" => "J.C."
              "apellidos" => "Herrero"
            ]
            7 => array:2 [
              "Iniciales" => "F."
              "apellidos" => "Maduell"
            ]
            8 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Mart&#237;n"
            ]
            9 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "Palomar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052227"
        "doi" => "10.3265/Nefrologia.pre2011.May.10828"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052227?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052224?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052224/v0_201502091636/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Surveillance for Infections and Other Adverse Events in Dialysis Patients in Southern Gran Canaria"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "457"
        "paginaFinal" => "463"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Anna Quori, A. Quori, Jes&#250;s Molina-Cabrillana, E. Baamonde-Laborda, Eduardo Baamonde-Laborda, C. Garc&#237;a-Cant&#243;n, Cesar Garc&#237;a-Cant&#243;n, M.M. Lago-Alonso, Maria del Mar Lago-Alonso, A. Toledo-Gonz&#225;lez, Agustin Toledo-Gonz&#225;lez, Elvira Monz&#243;n-Jim&#233;nez, Elvira Monz&#243;n-Jimenez, D. Jim&#233;nez-D&#237;az, Dora Jimenez-D&#237;az, M. Checa-de-Andr&#233;s, Monica Checa-de-Andr&#233;s, J. Molina-Cabrillana"
        "autores" => array:18 [
          0 => array:4 [
            "nombre" => "Anna"
            "apellidos" => "Quori"
            "email" => array:1 [
              0 => "aquoric&#64;gobiernodecanarias&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "Iniciales" => "A."
            "apellidos" => "Quori"
            "email" => array:1 [
              0 => "aquoric&#64;gobiernodecanarias&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jes&#250;s"
            "apellidos" => "Molina-Cabrillana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Baamonde-Laborda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Baamonde-Laborda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "C."
            "apellidos" => "Garc&#237;a-Cant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Cesar"
            "apellidos" => "Garc&#237;a-Cant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          7 => array:3 [
            "Iniciales" => "M.M."
            "apellidos" => "Lago-Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Maria del Mar"
            "apellidos" => "Lago-Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          9 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Toledo-Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Agustin"
            "apellidos" => "Toledo-Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Elvira"
            "apellidos" => "Monz&#243;n-Jim&#233;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Elvira"
            "apellidos" => "Monz&#243;n-Jimenez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          13 => array:3 [
            "Iniciales" => "D."
            "apellidos" => "Jim&#233;nez-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Dora"
            "apellidos" => "Jimenez-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          15 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Checa-de-Andr&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          16 => array:3 [
            "nombre" => "Monica"
            "apellidos" => "Checa-de-Andr&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          17 => array:3 [
            "Iniciales" => "J."
            "apellidos" => "Molina-Cabrillana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => " Centro de Hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria  "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => " Centro hemodiálisis Avericum, Telde, Las Palmas de Gran Canaria Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria,   "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Nefrología, Complejo Hospitalario Universitario Insular Materno-Infantil Las Palmas de Gran Canaria  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Vigilancia de infecciones y otros eventos adversos en pacientes en hemodi&#225;lisis en el &#225;rea sur de Gran Canaria"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17360_en_10605tt1.jpg"
            "Alto" => 148
            "Ancho" => 600
            "Tamanyo" => 81937
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics and rate of events by type of vascular access"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Health care-related adverse events are the subject of much attention in all health institutions&#44; and morbidity and mortality for nosocomial infections have a significant impact on this issue&#46;<span class="elsevierStyleSup">1</span> Chronic renal failure &#40;CRF&#41; patients who are on haemodialysis have a high risk of contracting infections due to the technical complexity of the health care they receive as well as the immunosuppressive state they usually find themselves in&#46; These infections are the second-leading cause of death among haemodialysis patients&#44; with an attributed mortality rate of 14&#37;&#46;<span class="elsevierStyleSup">2 </span>Especially important are infections in vascular access points&#44; which are the leading cause of bacteraemia and loss of the vascular access in these patients&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The type of vascular access &#40;VA&#41; directly affects the risk of developing infections and is the most important risk factor in the development of bacteraemia and VA infection&#44; which from lowest risk to highest are&#58; arteriovenous fistulas &#40;AVF&#41;&#44; endovascular prostheses&#44; tunnelled catheters&#44; and non-tunnelled catheters&#46;<span class="elsevierStyleSup">4-9</span> The frequency with which VA are used varies according to the characteristics of the health system and the population being treated&#46; For example&#44; haemodialysis patients with a high prevalence of diabetes tend to have a lower rate of AVF and a greater use of catheters&#46;<span class="elsevierStyleSup">8</span> In the United States&#44; where the first VA placed in a patient was a permanent catheter to be later replaced by an endovascular prosthesis &#40;graft&#41;&#44; the &#8220;Fistula First&#8221; campaign has been recently instated in order to raise awareness on and promote AVF as the vascular access of choice and to increase the probability that patients receive the safest type of VA&#46;<span class="elsevierStyleSup">11&#44;12</span> At the same time&#44; widespread use of antibiotics has led to the potential problem of microbial resistance&#44; and haemodialysis has historically been one of the health care fields in which the appearance of new resistant strains have been observed for the first time&#46;<span class="elsevierStyleSup">13-15</span></p><p class="elsevierStylePara">Epidemiological surveillance of infectious events and antibiotic resistance can help understand the baseline state of a health care field and can provide important information when developing plans for improving and implementing future measures for control&#46; It can also provide data for evaluating the possible impact of the activities meant to prevent and control bacterial resistance&#46;<span class="elsevierStyleSup">4&#44;16&#44;17</span></p><p class="elsevierStylePara">In 1999&#44; the Centres for Disease Control &#40;CDC&#41; in the United States implemented the first epidemiological surveillance system for haemodialysis&#44; known as the Dialysis Surveillance Network &#40;DSN&#41;&#44;<span class="elsevierStyleSup">2&#44;3</span> which was consolidated in the recently created National Healthcare Safety Network &#40;NHSN&#41;&#46; In Europe&#44; this type of surveillance is less frequent&#44; since it was only in 2006 that the creation of multicentre systems was organised&#44; with the production of standardised guidelines&#44; indicators&#44; and recommendations&#46;<span class="elsevierStyleSup">18-23</span></p><p class="elsevierStylePara">Within this context&#44; we took interest in the implementation of a surveillance system for bacterial infections in haemodialysis patients in the southern region of Gran Canaria&#44; with the objective of quantifying and analysing the epidemiological characteristics of &#40;infectious and non-infectious&#41; adverse events and to identify possible opportunities for improvement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODOLOGY</span></p><p class="elsevierStylePara">Prospective study on the incidence of certain adverse events and infections&#44; applying the methodology used by the CDC through the DSN&#44; including all &#40;chronic&#41; haemodialysis patients&#44; with stratification based on the type of vascular access&#46;<span class="elsevierStyleSup">2</span> The study period was six months&#44; from March to September of 2008&#46; The patients under surveillance were treated in the haemodialysis unit of the tertiary <span class="elsevierStyleItalic">Hospital Universitario Insular de Gran Canaria </span>&#40;Gran Canaria Island University Hospital&#41; and at a peripheral health centre &#40;Avericum&#41; in the southern region of Gran Canaria&#46; Patients were treated at one centre or the other based on clinical criteria&#46; Patients underwent dialysis from Monday to Saturday on morning or afternoon shifts&#44; with a total of 79 available workstations distributed in the following manner&#58;</p><p class="elsevierStylePara">1&#46; Hospital&#46; 25 workstations&#58; 16 in the general treatment room&#44; four in a room for hepatitis C virus &#40;HCV&#41;&#44; two in a room for Hepatitis B virus &#40;HBV&#41;&#44; two in a room for human immunodeficiency virus &#40;HIV&#41;&#44; and one in isolation&#46;</p><p class="elsevierStylePara">2&#46; Avericum&#46; 54 workstations&#58; 50 in a general treatment room and four in a room for patients with HCV&#46;</p><p class="elsevierStylePara">We obtained indicators in the following manner&#58;</p><p class="elsevierStylePara">1&#46; Denominator &#40;census&#41;&#58; we obtained our data from those patients that received haemodialysis during the first two days of each month&#44; stratifying them by type of VA&#46; In this way&#44; we were able to safely estimate the number of patient&#47;month&#44; since the patients are always the same and rotate in fixed shifts&#46; The total number of patients treated during the first two days of each month produced the number of patients for that month&#46; Using this information for the study period&#44; we produced a value for the total number of patients per month&#44; which was stratified by type of VA&#46; We used this formula because of the low internal variability of patients on haemodialysis and in order to facilitate data collection by the department staff&#46;</p><p class="elsevierStylePara">2&#46; Numerator &#40;<span class="elsevierStyleItalic">incident cases</span>&#41;&#58; a <span class="elsevierStyleItalic">case</span> was any patient that required hospitalisation and&#47;or antibiotic treatment and&#47;or produced a positive blood culture&#46;</p><p class="elsevierStylePara">a&#41; Hospitalisation was defined as when the dialysis patient was admitted to any hospital department for over 24 hours due to any reason&#59; a case file was produced for each hospitalisation&#46;</p><p class="elsevierStylePara">b&#41; Each time that systemic antibiotic treatment was administered to these patients&#44; a <span class="elsevierStyleItalic">case</span> file was created&#44; except for instances during the hospitalisation process&#44; since this was considered as the same event&#46; Repeated treatments of the same antibiotic treatment within a 21-day period were considered as the same case&#46;</p><p class="elsevierStylePara">c&#41; In the case of positive blood cultures&#44; even in the absence of hospitalisation or antibiotic treatment&#44; a case file was produced&#46; A positive blood culture test 21 days after the previous one was also considered a new case&#46;</p><p class="elsevierStylePara">3&#46; Interpretation of the indicators&#58; the rates observed show the mean percentage of patients that register a new case every month&#46; For example&#44; a rate of 3&#46;0&#37; during the month of January indicates that an average of 3&#37; of patients had an adverse event during that month&#46;</p><p class="elsevierStylePara">For patients that developed repeated VA-related infections over time&#44; the first&#44; second&#44; third&#44; and even fourth events were considered&#44; according to the data collection protocol established by the NHSN&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Data collection and analysis</span></p><p class="elsevierStylePara">During the first week of each month over the course of the surveillance period&#44; the nursing staff at both centres compiled all of the necessary census information&#44; indicating the total number of patients that received dialysis&#44; stratified by type of vascular access&#46;</p><p class="elsevierStylePara">For each individual <span class="elsevierStyleItalic">case</span>&#44; the nephrology staff created a new epidemiological case file&#46; Each month&#44; the case files were sent to the study coordinator in the preventive medicine department&#44; where the data were reviewed and stored in the computer file&#46;</p><p class="elsevierStylePara">A case file was produced for all infectious and non-infectious problems associated with the VA &#40;thrombosis&#44; haemorrhage&#44; etc&#46;&#41;&#44; death&#44; and cardiovascular problems&#44; whereas hospitalisations for more than 24 hours that were due to any other cause were classified as incident cases in the &#8220;other&#8221; category&#46;</p><p class="elsevierStylePara">In case of an infectious pathology&#44; the attending physician recorded the diagnosis in the case file&#44; and the final classification of the infection was performed by the surveillance coordinator in the preventive medicine department&#44; according to the CDC<span class="elsevierStyleSup">16</span> criteria for the following infections&#58; VA infections&#58; local infections and with secondary bacteraemia &#40;catheter-related&#41;&#44; bacteraemia &#40;non-catheter related&#41;&#44; skin and soft tissue infections &#40;non-surgical&#41;&#44; pneumonia&#44; and urinary tract infections &#40;UTI&#41;&#46;</p><p class="elsevierStylePara">In the data analysis section&#44; we calculated the frequencies of categorical variables and used chi-square tests for comparing proportions using SPSS software&#44; version 17&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">We amassed a total of 1545 patient&#47;month&#44; with a monthly mean of 221 patients&#44; although with major differences between the two dialysis centres&#44; both in the number and type of VA&#44; as expressed in Table 1&#46; The distribution of types of VA was different between the two centres&#44; with a greater proportion of AVF than permanent catheters in patients attended at the peripheral health centre&#44; and an inverse relationship observed at the hospital&#44; where permanent catheters were more common&#46; They all were Hickman type catheters&#44; reaching 71&#46;5&#37; of the total&#46; A very low proportion of the VA were prostheses or non-tunnelled temporary catheters &#40;both were less than 5&#37; of the total&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Incident cases</span></p><p class="elsevierStylePara">We observed a total of 134 incident cases and the majority of them &#40;53&#46;7&#37;&#41; were for antibiotic treatment administration&#46; The rate of incident cases &#40;expressed as 100 patient&#47;month&#41; varied significantly between the two different health centres and&#44; above all&#44; between the different types of vascular access used&#46; Rates were much higher in patients attended at the hospital and in those with higher-risk types of vascular access &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Non-infectious events</span></p><p class="elsevierStylePara">The rates of adverse events varied greatly&#44; but the risk gradient for type of VA was maintained&#44; except for those cases classified as &#8220;other&#44;&#8221; which were much frequent in patients with AVF&#46; The rate of lost vascular access points varied widely based on the type of access used&#46; Throughout the surveillance period&#44; we observed the loss of two AVF and one endovascular prosthesis due to non-infectious causes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Infectious events</span></p><p class="elsevierStylePara">We identified 41 infectious events related to the vascular access&#44; with an incidence of 8&#46;6 cases per 100 patient&#47;month&#44; 33 cases of bacteraemia related to the vascular access&#44; and 8 cases of local infection&#46; These infectious events caused the loss of 9 VA &#40;seven permanent catheters and two temporary ones&#41;&#46; As shown in Table 2&#44; the rates of infectious events varied according to the type of vascular access used&#44; especially in the infections of the VA&#44; whereas the rate of infections not related to the VA &#40;wounds&#44; UTI&#44; and respiratory infections&#41; were similar among different types&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Use of antibiotics and microbiological cultures</span></p><p class="elsevierStylePara">In all&#44; we administered 66 different systemic antibiotic treatments &#40;in monotherapy or combined&#41;&#44; and the global percentage of microbiological cultures taken before starting treatment was 73&#46;2&#37;&#46; In the hospital&#44; cultures were taken in 82&#46;2&#37; of treated cases&#44; and in 91&#37; if there was a suspicion of bacteraemia and&#47;or an infected VA&#44; whereas cultures were taken in only 56&#46;7&#37; of cases in which antibiotic treatment was administered in the peripheral centre&#44; with 90&#37; of VA-related infections being diagnosed&#46; Cultures were not taken in cases of repeated infectious event in the same patient &#40;second&#44; third&#44; and fourth events&#41;&#46; When diagnosing a patient with a wound infection&#44; cultures were taken in 70&#37; of cases before prescribing treatment&#44; in 50&#37; of cases of UTI&#44; and in none of the cases of respiratory infections&#46; In 78&#37; of cases&#44; empirical treatment was given with vancomycin and ceftazidime when a VA-related infection was suspected&#44; and was adjusted according to an antibiogram in 90&#37; of cases&#46; The overall rate of specific use of vancomycin was 4&#46;4&#37; patient&#47;month in the hospital&#44; and 0&#46;8&#37; in the peripheral centre&#59; these rates also varied by type of VA &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">Table 3 shows the bacterial isolations by infection type &#40;only for first events&#44; not including repeated cultures of the same microorganism&#41;&#46; We isolated multi-resistant microorganisms in only four cases&#44; and the proportion of infections caused by gram-positive bacteria was similar to that of gram-negative bacteria&#44; both in VA-related infections and others&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">We performed a surveillance study of the appearance of adverse events in a chronic haemodialysis population&#46; In Spain little experience has been gained in this field&#44; and so this study could contribute to understanding the situation within this population&#46;<span class="elsevierStyleSup">18&#44;24</span> Compared with data from Spain and Europe in general&#44;<span class="elsevierStyleSup">7&#44;24</span> our health care area uses a 20&#37; lower proportion of AVF &#40;mean in Spain&#58; 79&#46;5&#37;&#41; and endovascular prostheses &#40;mean&#58; 10&#46;5&#37;&#41;&#44; whereas permanent catheters are used 3&#46;5 times more frequently &#40;35&#46;5&#37; vs the rate in Spain of 9&#46;9&#37;&#41;&#46;</p><p class="elsevierStylePara">The frequency of using VA varied between the two centres&#46; Patients with an AVF or a permanent catheter accounted for 60&#46;5&#37; of all such patients&#44; and the frequency of using AVF was greater in the peripheral centre &#40;71&#46;5&#37;&#41; than in the hospital &#40;34&#37;&#41;&#44; whereas permanent catheters had a similar distribution in the two health centres&#46; On the other hand&#44; the use of prostheses and temporary catheters was quite low&#44; and so the data regarding patients with these types of accesses may not have been representative so we have not shown their results&#46; This is not an ideal situation&#44; taking into account that the majority of scientific societies and medical authorities recommend the AVF&#44; given its lower rate of occurrence of adverse events&#46;<span class="elsevierStyleSup">5-12&#44;19-22&#44;26-28</span></p><p class="elsevierStylePara">The rates of adverse events were higher in patients with permanent catheters than in those with fistulas or prostheses&#44; both in the peripheral and central hospital centres&#44; coinciding with results from other authors around the world&#46;<span class="elsevierStyleSup">3&#44;7-9&#44;25&#44;29</span> The rate of hospitalisation is twice as high in the group of patients with permanent catheters than in the AVF group&#44; as well as the rate of infections related to the vascular access point &#40;both in local infections and bacteraemias&#41;&#46;</p><p class="elsevierStylePara">In patients on haemodialysis in the United States&#44; the rates of catheter-related bacteraemias is estimated at 0&#46;9-2&#46;0 events per patient-year&#46;<span class="elsevierStyleSup">2</span> Similarly&#44; surveillance data indicate that hospitalisation rates have increased by 29&#37; due to bacteraemia&#44; and 24&#37; due to cellulitis&#44; since 1993&#46;<span class="elsevierStyleSup">3</span> Ferrero et al&#44;<span class="elsevierStyleSup">29</span> in a similar study carried out in Italy&#44; observed a 0&#46;18&#37; rate of bacteraemia associated with the vascular access&#44; which is a lower rate than that presented by the NHSN<span class="elsevierStyleSup">3&#44;25</span> and the values we observed &#40;1&#46;3 and 4&#46;4 episodes per 100 patients&#47;month in patients with AVF and permanent catheters&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Non-infectious adverse events had a similar pattern to infectious events&#44; with greater rates for permanent catheters and patients treated at the hospital&#46;</p><p class="elsevierStylePara">With regard to antibiotic treatment and laboratory use&#44; the data indicate a good overall situation&#44; with a low incidence of multi-resistant bacteria and a rational use of health resources &#40;antibiotic agents and microbiological cultures&#41;&#46; However&#44; there is room for improvement&#44; especially with regard to antibiotic treatment without previous culture&#44; such as in the case of respiratory infections&#46; The rate of use of vancomycin was between 0&#46;1 and 1&#46;9 per 100 patients&#47;month in patients with AVF&#44; and between 2&#46;8 and 5&#46;5 for patients with permanent catheters&#44; which are acceptable results when compared with the 2006 data from the DSN&#44;<span class="elsevierStyleSup">3</span> falling below the 75<span class="elsevierStyleSup">th</span> percentile&#46; In our health care field&#44; this type of empirical treatment&#44; adjusted to the antibiogram results&#44; continues to be the treatment of choice&#44; taking into consideration the low incidence of multi-resistant bacteria and the absence of bacteria resistant to vancomycin&#46;</p><p class="elsevierStylePara">Our study has some limitations&#46; In the first place&#44; it had a descriptive design&#44; and so we cannot estimate risk&#46; We cannot conclude that the presence of an AVF causes a lower risk of infectious events&#44; since this would require a more analytical study design &#40;experimental&#44; cohorts&#44; or case&#47;control&#41;&#46; Even so&#44; the approximations made using the epidemiological surveillance design used here can be useful&#44; especially because our results are consistent with those from other studies&#46;<span class="elsevierStyleSup">3&#44;24&#44;28</span> Also&#44; the study period was quite short&#44; only seven months&#44; although we believe that the sample size of 1545 patient&#47;month may offer a good estimation of the incidence of adverse events&#46; However&#44; we did not establish a predetermined sample size&#44; since the primary objective of the study was to detect problems associated with the treatment of patients on chronic haemodialysis&#46; Finally&#44; we must point out that the scarce experience with this type of study in our field has revealed errors in the estimation of parameters&#46;</p><p class="elsevierStylePara">Nevertheless&#44; our study has detected some areas for improvement&#44; such as the lack of cultures taken in respiratory infections&#46; However&#44; the high rate of use of permanent long-term catheters compared to AVF represents the most critical point in morbidity and mortality&#44; health costs&#44; quality of health care&#44; and patient safety&#44; which is not dependent on the workers in our haemodialysis units&#44; since we also depend on health professionals from other fields&#44; such as vascular surgeons and hospital administrators&#44; as stated in the &#8220;Change package overview&#8221; promoted by the &#8220;Fistula First&#8221; campaign in the USA&#46;<span class="elsevierStyleSup">11</span> Our data show that the increased risk of an adverse event is also higher in our area &#40;without basing ourselves solely on data from previous studies&#41;&#44; and should be used to motivate health care professionals that work in treating these patients to increase the rate of AVF as the VA of choice and to reduce the overall use of permanent catheters such as a long-term VA&#46;</p><p class="elsevierStylePara">The implication of hospital administrators and vascular surgeons in this matter is considered indispensable in order to achieve these objectives&#46;</p><p class="elsevierStylePara">The surveillance programme that we presented here is easy to implement&#44; consumes few resources&#44; and is well accepted by health care professionals working in haemodialysis units&#46; Moreover&#44; it provides useful information for introducing improvement and control measures&#44; and that have been demonstrated to reduce the rates of infections and improve the use of antibiotics&#46;<span class="elsevierStyleSup">3&#44;24&#44;29</span> Finally&#44; our results can be useful for the planning and coordination of clinical management of haemodialysis patients&#44; becoming a key factor in the development of multi-disciplinary strategies for ensuring patient safety&#46;<span class="elsevierStyleSup">1&#44;3&#44;16-19</span></p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17360&#95;en&#95;10605tt1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17360_en_10605tt1.jpg" alt="Population characteristics and rate of events by type of vascular access"></img></a></p><p class="elsevierStylePara">Table 1&#46; Population characteristics and rate of events by type of vascular access</p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17361&#95;en&#95;10605tt2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17361_en_10605tt2.jpg" alt="Rates of adverse events expressed per 100 patients&#47;month"></img></a></p><p class="elsevierStylePara">Table 2&#46; Rates of adverse events expressed per 100 patients&#47;month</p><p class="elsevierStylePara"><a href="grande&#47;10605&#95;108&#95;17362&#95;en&#95;10605tt3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10605_108_17362_en_10605tt3.jpg" alt="Microorganisms isolated by type of infection"></img></a></p><p class="elsevierStylePara">Table 3&#46; Microorganisms isolated by type of infection</p>"
    "pdfFichero" => "P1-E523-S3000-A10605-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440915"
          "palabras" => array:1 [
            0 => "Acceso vascular"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440917"
          "palabras" => array:1 [
            0 => "Seguridad del paciente"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440919"
          "palabras" => array:1 [
            0 => "Infecci&#243;n nosocomial"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440921"
          "palabras" => array:1 [
            0 => "Di&#225;lisis"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440923"
          "palabras" => array:1 [
            0 => "Vigilancia"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440916"
          "palabras" => array:1 [
            0 => "Vascular access"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440918"
          "palabras" => array:1 [
            0 => "Patient safety"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440920"
          "palabras" => array:1 [
            0 => "Nosocomial infection"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440922"
          "palabras" => array:1 [
            0 => "Dialysis"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440924"
          "palabras" => array:1 [
            0 => "Surveillance"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Bacterial infections pose a major challenge to risk management activities in the area of chronic haemodialysis&#44; as vascular access-related infections are the main cause of mortality among these patients&#46; <span class="elsevierStyleBold">Methods&#58;</span> Prospective surveillance study lasting 7 months &#40;March-September&#44; 2008&#41; at two haemodialysis units in a district health area Gran Canaria&#44; Spain&#46; We used the methodology proposed by CDC&#180;s Dialysis Surveillance Network&#46; <span class="elsevierStyleBold">Results&#58;</span> 1545 patients&#47;month were recorded&#44; 60&#46;5&#37; with an arteriovenous fistula &#40;AVF&#41;&#44; 35&#46;5&#37; with a permanent catheter &#40;PC&#41;&#44; 3&#46;0&#37; with grafts and 1&#46;0&#37; with temporary catheters&#46; The rate of adverse events was 8&#46;6 cases per 100 patients&#47;month&#44; 9&#46;1 for AVF patients&#44; and 2&#46;9 for PC&#46; Nevertheless&#44; the other types of infections &#40;respiratory&#44; urinary tract&#44; skin and chronic ulcers&#41; showed similar rates&#46; Microbiological cultures were taken in 82&#46;2&#37;&#44; but this rate increased to 91&#46;0&#37; when a vascular access-related infection was suspected&#46; Empirical treatment was adjusted to antibiogram results in 90&#46;0&#37; of occasions&#46; A low incidence of multi-resistant microbes was observed&#46; Gram-positive and gram-negative bacteria appeared in similar proportions&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Vascular access is the main risk factor for infectious events&#46; Epidemiological surveillance has allowed us to detect areas of improvement in different settings&#44; acting as a key element in risk management and patient safety&#46;</p>"
      ]
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> Las infecciones bacterianas representan un gran desaf&#237;o en las estrategias de gesti&#243;n del riesgo&#44; prevenci&#243;n y seguridad de los pacientes en hemodi&#225;lisis&#59; entre ellas&#44;&#160;las infecciones del acceso vascular &#40;AV&#41; suponen la primera causa de morbimortalidad&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Estudio de siete meses de duraci&#243;n sobre la&#160;incidencia de determinados eventos adversos e infecciones&#160;&#40;marzo-septiembre de 2008&#41; en las unidades de hemodi&#225;lisis del &#193;rea Sanitaria Sur de Gran Canaria &#40;hospital y centro perif&#233;rico&#41; mediante el empleo de la&#160; metodolog&#237;a del Dialysis Surveillance Network de los Centers for Diseases and Control &#40;CDC&#41; de los Estados Unidos&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Se incluyeron&#160;1&#46;545 pacientes&#47;mes&#44; un 60&#44;5&#37; con f&#237;stulas AV&#160;&#40;FAV&#41;&#44; un 35&#44;5&#37;&#160;conectados a cat&#233;teres permanentes &#40;CP&#41;&#44; un 3&#44;0&#37; tratados con pr&#243;tesis y un 1&#44;0&#37; con cat&#233;teres temporales&#46; La incidencia de eventos fue 8&#44;6 casos por 100 pacientes-mes&#44; y fue de&#160;9&#44;1 para las FAV y de 2&#44;9 para los CP&#44;&#160;mientras que las tasas de otras infecciones &#40;respiratorias&#44; de herida o de&#160;orina&#41; fueron similares&#46; Se pidieron cultivos antes del tratamiento antibi&#243;tico en el 82&#44;2&#37; de los casos&#44; m&#225;s si la sospecha era de bacteriemia y&#47;o de infecci&#243;n AV &#40;91&#44;0&#37;&#41;&#46; El 9&#44;0&#37; de tratamientos se ajustaron con antibiograma&#46; Destaca una baja incidencia de bacterias mutirresistentes&#44; mientras que las infecciones relacionadas con el AV fueron causadas en una proporci&#243;n similar por bacterias grampositivas y gramnegativas&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span> El AV es el principal factor de riesgo para el desarrollo de infecciones&#46; La vigilancia epidemiol&#243;gica he permitido detectar oportunidades de mejora en &#225;mbitos asistenciales distintos&#44; y se integra como elemento fundamental en el desarrollo de estrategias multidisciplinarias de seguridad del paciente&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17360_en_10605tt1.jpg"
            "Alto" => 148
            "Ancho" => 600
            "Tamanyo" => 81937
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics and rate of events by type of vascular access"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17361_en_10605tt2.jpg"
            "Alto" => 314
            "Ancho" => 600
            "Tamanyo" => 160733
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Rates of adverse events expressed per 100 patients&#47;month"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10605_108_17362_en_10605tt3.jpg"
            "Alto" => 132
            "Ancho" => 600
            "Tamanyo" => 80577
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Microorganisms isolated by type of infection"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "To Err Is Human Institute of Medicine. Washington DC: Library of The Congress, 2000;1-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2.\u{A0}Tokars J, Millar E, Stein G. New national surveillance system for hemodiálisis-associated infections: initial results. Am J Infect Control 2002;30(5):288-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12163863" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3.\u{A0}Klevens RM, Edwards JR. Dialysis Surveillance Report: National Healthcare Safety Network (NHSN) Summary 2006. Semin Dial 2008;21(1):24-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712005530"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4.\u{A0}Klevens RM, Tokars JJ, Andrus M. Electronic reporting of infections associated with hemodialysis Nephrology News & Issues June 2005 37-43. Disponible en: http://www.cdc.gov/nhsn/PDFs/dataStat/2006_DialysisSurvReport.pdf. Accedido 02/08/2010"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5.\u{A0}Ravani P, Spergel LM, Asif A, Roy-Chaudhury P, Besarab A. Clinical epidemiology of arteriovenous fistula in 2007. J Nephrol 2007;20:141-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17514618" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "6.\u{A0}Hoggard J, Saad T, Schon D, Vesely TM, Royer T. Guidelines for venous access in patients with chronic kidney disease. Semin Dial 2008;21(2):186-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18364015" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "7.\u{A0}Rayner HC, Besarab A, Brown WW, Disney A, Salto A, Pisoni RL. Vascular access results from the Dialysis Outcome and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines. Am J Kidney Dis 2004;44(Suppl2):S22-S26."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.\u{A0}Ethier J, Mendelssohn DC, Elder S, Hasegawa T, Akizwa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant 2008;23:3219-26. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511606" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9.\u{A0}Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among haemodialysis patients. Kidney Int 2002;62:620-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12110026" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hajaar J, Marc R. Surveillance des infections chez les hemodialysés croniques. Néphrologie 2004;25:133-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15291141" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "U.S. Department oh Health & Human Services, Center for Medicare & Medicaid Services. Fistula First Breakthrough (Website). Disponible en: http://fistulafirst.org. Accedido Septiembre 2007."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Allon M, Robbin ML. Increasing arteriovenous fistulas in haemodialysis patients: problems and solutions. Kidney Int 2002;62:1109-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12234281" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bailey JL, Balter P, Berns J, Butera E, Depner T, Douglas C, et al. Recommendation for preventing transmission of infections among chronic hemodialysis patients. MMWR Recommendation and Reportsl 2001;50(RR05):1-43. Disponible en: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Collins A, Forrest B, Klevens RM, Patel DDS, Arduino MJ, Fosheim G, et al. Invasive Methicillin-resistant Staphylococcus aureus infections among dialysis patient. MMWR Recommendation and Reports 2007;59(RR09):197-9. Disponible en: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5609a3.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "McDonald LC, Hageman JC. Vancomycin-intermediate and resistant Staphylococcus aureus: What the nephrologist needs to know. Nephrol News Issues 2004;18(12):63-75."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Horan TC, Gaynes RP. Surveillance of nosocomial infections. In: Mayhall CG, ed. Hospital epidemiology and infection control (3rd ed.).\u{A0}Philadelphia: Lippincott Williams & Wilkins, 2004;\u{A0}1659-1702."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gaynes R, Richards C, Edwards J, Emori T, Horan T, Echanove JA, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11294727" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Guidance on infection control in healthcare settings in Europe. Recommended practices, standards and indicators for healthcare associate infections and antibiotic resistance. Disponible en: http://helics.univ-lyon1.fr/Standards and Indicators.htm"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "NICE Final Guidelines. Prevention oh healthcare-associated infections in primary and community care. June 2003. Disponible en: http://www.nice.org.uk/nicemedia/pdf/Infection_control_fullguideline.pdf"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tordoir JH, Mickley V. European guidelines for vascular access: clinical algorithms on vascular access for hemodialysis. EDTNA ERCA 2003;29:131-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "European Best Practice Guidelines Expert Group on Hemodialysis, European Renal Association. Section I. Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant 2002;17(Suppl 7):7-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12386205" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. Guía de acceso vascular. Noviembre, 2004. Disponible en: http://www.senefro.org/modules/subsection/files/guia_acceso_vascular.pdf?check_idfile=984"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Medicina Preventiva, Salud Pública e Higiene. Documento de consenso sobre recomendaciones y recursos necesarios para un programa de control de la infección nosocomial en los hospitales españoles. Disponible en: http://www.mpsp.org/mpsp/index.html"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rodríguez Hernandez J, López Pedret J, Piera L. El acceso vascular en España: análisis de su distribución, morbilidad y sistemas de monitorización. Nefrología 2001;21(1):45-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11344961" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Edwards J, MStat K, Peterson BBA, Yi Mu P, Shailendra Ph, Allen-Bridson K, et al. National Healthcare safety Network (NHSN) report. Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rehman R, Schmidt RJ, Moss AH. Ethical and legal obligation to avoid long-term tunneled catheter access. Clin J Am Soc Nephrol 2009;4:456-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19158368" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Konner K. A primer on the AV fistula-Achille¿s heel, but also «Cinderella» of hemodialysis. J Am Soc Nephrol 1999;14:2094-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970903321X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kevan R, McDonald S. Vascular access and all-cause mortality; a propensity score analysis. J Am Soc Nephrol 2004;15:477-86. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14747396" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ferrero S, Saltarelli M, Quori A, Campobasso M, Argentero P. Dialysis surveillance monitoring bloodstream and vascular infections. G Ital Nefrol 2008;25:347-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18473306" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673613617547"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "George A, Tokars JL, Clutterbuck EJ, Bamford KB, Pusey C, Holmes AH. Reducing dialysis associated bacteraemia, and recommendations for surveillance in the UK: prospective study. BMJ 2006;332:1435-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052216/v0_201502091637/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000004/v0_201502091636/X2013251411052216/v0_201502091637/en/P1-E523-S3000-A10605-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052216?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 11 6 17
2024 October 60 33 93
2024 September 72 26 98
2024 August 81 56 137
2024 July 64 30 94
2024 June 83 46 129
2024 May 74 32 106
2024 April 58 44 102
2024 March 46 22 68
2024 February 52 33 85
2024 January 25 28 53
2023 December 32 26 58
2023 November 44 33 77
2023 October 74 38 112
2023 September 256 28 284
2023 August 227 22 249
2023 July 72 34 106
2023 June 88 21 109
2023 May 72 41 113
2023 April 33 15 48
2023 March 39 18 57
2023 February 40 29 69
2023 January 40 22 62
2022 December 64 28 92
2022 November 59 41 100
2022 October 49 51 100
2022 September 35 37 72
2022 August 50 54 104
2022 July 31 36 67
2022 June 45 42 87
2022 May 35 18 53
2022 April 32 50 82
2022 March 50 56 106
2022 February 45 41 86
2022 January 32 25 57
2021 December 42 47 89
2021 November 42 35 77
2021 October 71 47 118
2021 September 63 44 107
2021 August 49 44 93
2021 July 49 40 89
2021 June 31 34 65
2021 May 67 43 110
2021 April 153 96 249
2021 March 88 47 135
2021 February 76 24 100
2021 January 66 22 88
2020 December 41 19 60
2020 November 50 15 65
2020 October 14 18 32
2020 September 24 10 34
2020 August 46 9 55
2020 July 45 31 76
2020 June 29 25 54
2020 May 37 5 42
2020 April 39 21 60
2020 March 30 19 49
2020 February 52 21 73
2020 January 63 25 88
2019 December 44 29 73
2019 November 51 21 72
2019 October 28 15 43
2019 September 41 20 61
2019 August 33 15 48
2019 July 39 22 61
2019 June 57 14 71
2019 May 44 6 50
2019 April 90 42 132
2019 March 44 15 59
2019 February 18 12 30
2019 January 40 23 63
2018 December 88 36 124
2018 November 101 15 116
2018 October 84 12 96
2018 September 78 12 90
2018 August 54 14 68
2018 July 62 17 79
2018 June 58 15 73
2018 May 64 20 84
2018 April 48 12 60
2018 March 59 11 70
2018 February 31 3 34
2018 January 55 6 61
2017 December 48 10 58
2017 November 51 6 57
2017 October 48 11 59
2017 September 51 11 62
2017 August 30 8 38
2017 July 49 13 62
2017 June 40 29 69
2017 May 51 6 57
2017 April 49 10 59
2017 March 27 8 35
2017 February 32 16 48
2017 January 23 10 33
2016 December 88 14 102
2016 November 74 17 91
2016 October 99 15 114
2016 September 149 22 171
2016 August 283 29 312
2016 July 201 14 215
2016 June 156 0 156
2016 May 137 0 137
2016 April 119 0 119
2016 March 79 0 79
2016 February 120 0 120
2016 January 126 0 126
2015 December 153 0 153
2015 November 116 0 116
2015 October 91 0 91
2015 September 90 0 90
2015 August 71 0 71
2015 July 78 0 78
2015 June 31 0 31
2015 May 60 0 60
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?