Implementación y evaluación de un programa de gestión de calidad para el monitoreo de glucómetros en un hospital universitario / Implementation and evaluation of a management program quality for monitoring glucometers in a hospital academic

Introducción: El uso de dispositivos portátiles para controlar la glucemia se ha extendido en los últimos años a las entidades hospitalarias, porque proporcionan un resultado rápido al realizarse al lado de la cama del paciente (point-of-care testing). Objetivo: Describir el proceso y los resultados de la implementación de un programa de gestión de calidad para el control de glucómetros hospitalarios. Materiales y Métodos: Se presenta la implementación de un programa de gestión de calidad para evaluar 50 glucómetros pertenecientes a siete áreas críticas del Hospital Italiano de Buenos Aires (Unidad Coronaria, Terapia Intensiva de Adultos y Pediátrica, Terapia Intermedia, Central de Emergencias de Adultos y Pediátrica, Unidad de Cuidados Intensivos Neonatológicos), desde el 1 de enero de 2014 hasta la actualidad, basado en tres estrategias: control diario, análisis mensual (precisión y exactitud) y control de muestras paralelas. Resultados: Luego de instaurar este programa y analizar los datos de los primeros 17 meses, se requirió un recambio total de 292 glucómetros: 150 debido al control de calidad diario, 119 por el análisis mensual y 23 por el control de muestras paralelas. Esto implicó retirar 17/50 glucómetros por mes. Conclusiones: Si bien estos dispositivos son útiles por su rápida respuesta, el 34,6% debió ser reemplazado por no haber superado alguno de los requisitos planteados en las estrategias de evaluación. La peor performance fue en los niveles de hipoglucemia, situación de interés para la rápida toma de decisiones. Es importante destacar la necesidad de aplicación de un plan de calidad para glucómetros sobre la base de un diseño propio y a medida de la institución para garantizar la seguridad del paciente.(AU)

Introduction: The use of portable devices for glycemic control has been extended in recent years to hospital entities, because they provide a rapid result when they are performed at or near the patient's bedside (point of care testing). Objective: To describe the process and results of the implementation of a quality management program to control of hospital glucometers. Materials and Methods: We present the implementation of a quality management program to evaluate 50 glucometers belonging to seven critical areas of Hospital Italiano de Buenos Aires (Coronary Unit, Adult and Pediatric Intensive Care Unit, Intermediate Therapy, Adult and Pediatric Emergency Center, Unit of Neonatal Intensive Care), from January 1, 2014 to the present, based on three strategies: Daily Control, Monthly Analysis and Control of Parallel Samples. Results: After implementing this program and analyzing the first 17 months, the substitution of 292 glucometers was required: 150 due to daily quality control, 119 per monthly analysis and 23 due to control parallel samples. This involved withdrawing 17/50 glucometers monthly. Conclusions: Although these devices are useful because of their rapid response, 34.6% had to be replaced because they exceeded the requirements presented in the evaluation strategies. The worst performance was in levels of hypoglycemia, a situation of interest for rapid decision-making. It is important to emphasize the need to apply a quality plan for glucometers based on an own design and suitable for the institution to guarantee the safety of the patient.(AU)

Morbilidad en mujeres postmenopáusicas pobres / Morbidity in postmenopausal women with poverty

Background: Less favored social classes usually have more unhealthy life-styles and a more difficult access to Health Resources. Aim: To study the possible association between poverty and some common diseases, in a population of postmenopausal women. Material and Methods: Four hundred and forty nine poor women aged 56 ± 12 years and 776 consecutive women aged 53 ± 12 years, answered a personal interview about their lifestyles and medications used. Their medical records were reviewed and they were subjected to a complete physical examination, including weight and height measurement. A fasting blood sample was also obtained. Poverty was defined according to criteria of the Spanish National Institute of Statistics that is based on the income in Euros and the number of family members that share such income. Results: A higher proportion of poor women live in rural areas. They were shorter, had a higher weight and thus a higher body mass index, smoked less and drank less alcohol than their non-poor counterparts drink. The consumption of caffeine, the actual calcium intake and the physical activity during leisure time was similar in both groups. Compared with their counterparts, poor women had a higher prevalence of diabetes mellitus (15.9 and 10.1 percent respectively, p = < 0.01), obesity (44.2 and 24.3 percent respectively, p < 0.01) hypertension (24.3 and 16.4 percento respectively, p<0.01) and autoimmune rheumatic diseases (7.8 and 4.8 percent> respectively, p = 0.03). A multiple logistic regression model showed that obesity, hypertension, diabetes mellitus, smoking, alcohol consumption and living in rural areas, were independently associated to poverty. Conclusions: Poor postmenopausal women have a higher prevalence of diabetes mellitus, obesity, autoimmune rheumatic diseases and hypertension and lower frequency of smoking and alcohol consumption than their affluent counterparts do.