Paro cardiorrespiratorio extrahospitalario. Realidad de un hospital terciario chileno / Out of hospital cardiac arrest events at an urban Hospital in Chile

Background: The incidence of out of hospital cardiac arrest (OHCA) is approximately 20 to 140 per 100.000 inhabitants. International registries, based on Utstein criteria have allowed standardized reporting of OHCA profiles and outcomes in different countries. We proposed to create a local OHCA registry. Aim: To assess the quality of the information about OHCA currently recorded in medical records according to Utstein guidelines. Material and Methods: A retrospective analysis of medical records of patients arriving in the emergency room of a public hospital with OHCA during a 3-year period. Data regarding the patient characteristics, event and outcomes were analyzed. Results: During the revision period, 317 patients arrived with an OHCA. None of the medical records had complete data on items that are considered a minimum requirement by Utstein guidelines. Mean age of patients was 63 years old, 60% were men, the most common arrest rhythm was asystole (43%) and 8% of patients were discharged alive. Conclusions: Data recorded in medical records is insufficient to inform the profile of OHCA. A prospective registry is currently being implemented based on the information provided by this study. This registry should optimize reporting and data analysis.

Burnout en médicos residentes de especialidades y subespecialidades: estudio de prevalencia y variables asociadas en un centro universitario / Burnout in resident doctors of specialties and subspecialties: study of prevalence and associated variables in a university center

Introducción: El burnout es un síndrome caracterizado por agotamiento emocional, despersonalización y bajo sentido de logro personal. Los médicos residentes de especialidad y subespecialidad constituyen una población de riesgo por la alta carga laboral y la interferencia con su vida personal. Nuestro objetivo fue evaluar la prevalencia de burnout y su asociación con variables sociodemográficas, en residentes de especialidad y subespecialidad de la Pontificia Universidad Católica de Chile (PUC). Métodos: Se realizó una encuesta electrónica a los residentes de especialidad y subespecialidad de la PUC, que incluyó el "Inventario de Burnout de Maslach" (22 preguntas divididas en 3 dimensiones). Se sumaron los puntos de cada dimensión y se clasificó a los residentes en riesgo de burnout al presentar altos índices de agotamiento emocional y/o despersonalización. El análisis estadístico incluyó un análisis univariado y multivariado. Resultados: 415 encuestas fueron contestadas (tasa de respuesta 86 por ciento). El 38,3 por ciento de los residentes cumplió criterios de burnout, con un 41,9 por ciento en residentes de especialidad y 24,1por ciento en residentes de subespecialidad. En el análisis por subgrupos, la mayor prevalencia se encontró en especialidades quirúrgicas (55,3por ciento). Los residentes extranjeros, los programas de especialidad (comparados con subespecialidad) y los programas de especialidades quirúrgicas se asociaron de manera independiente a burnout (OR 3,8 IC95 por ciento 1,4-10,5, p=0,01; OR 2,3 IC95 por ciento 1,3-4,1, p<0,01 y OR 1,7 IC95 por ciento 1,1-2,7; p=0,02, respectivamente). La carga laboral horaria no se asoció de manera independiente a burnout (p=0,19). Conclusión: Los residentes de especialidad y subespecialidad presentan una alta prevalencia de burnout. Adicionalmente, ser extranjero, el pertenecer a un programa de especialidad y los programas de especialidades quirúrgicas se asocian de manera independiente a burnout.(AU)

Introduction: Burnoutis a pathological syndrome characterized by emotional exhaustion, depersonalization and low sense of personal accomplishment. Residents from medical specialties and subspecialties constitute a population at risk for high work overload and interference in personal life. The aim of this study was to evaluate the prevalence of burnout and its associations with sociodemographic variables, in specialty and subspecialty residents of the Pontificia Universidad Católica de Chile (PUC). Methods: An electronic survey was answered by residents of specialty and subspecialty of PUC. It included the "Maslach Burnout Inventory" (which consists of 22 questions divided into 3 dimensions). The points of each dimension were added and burnout was defined as a high score on depersonalization or emotional exhaustion subscales. Statistical analysis included an univariate and multivariate analysis. Results: 415 surveys were answered (response rate 86 percent). 38.3 percent of residents met criteria for burnout, with a percentage of 41.9 percent for specialty residents and 24.1 percent for subspecialty residents. In the subgroup analysis, the highest prevalence was found in surgical specialties (55.3 percent). Foreign residents, medical residency programs (compared to sub specialization programs) and surgical programs were independently associated with burnout (OR 3.8 IC95 percent1.4-10.5, p=0.01; OR 2.3 IC95 percent 1.3-4.1, p<0.01 y OR 1.7 IC95% 1.1-2.7; p=0.02, respectively). There was no independent association between duty hours and burnout (p=0.19). Conclusion: Specialty and subspecialty residents have a high prevalence of burnout. Additionally, foreign residents, participation in a speciality residency (compared to subspecialties programs) and surgical residencies are independently associated to burnout. (AU)

Evaluación de la carga laboral en residentes Chilenos de especialidades y subespecialidades médicas / Workload assessment in Chilean residents of specialties and medical subspecialties

Introducción: La sobrecarga laboral horaria es un importante problema en los programas de especialización médica. Se asocia a mayor prevalencia de depresión, burnout, deserción, e impacta en la calidad de vida de los residentes. Nuestro objetivo fue cuantificar las horas semanales de carga laboral horaria en residentes de especialidad y subespecialidad de la Pontificia Universidad Católica de Chile (PUC). Métodos: Se realizó una encuesta electrónica a los residentes de especialidad y subespecialidad de la Pontificia Universidad Católica de Chile (2013). Esta incluyó autorreporte de horas semanales trabajadas (jornada habitual, turnos presenciales y turnos de llamada). Para el análisis se consideraron solo las horas presenciales (jornada habitual y turnos presenciales Resultados: se obtuvieron 415 respuestas (tasa de respuesta 86%). Los residentes de especialidad reportaron una jornada de 52,8 ± 20,3 horas semanales más un promedio de 22,6 ± 22,5 horas de turnos presenciales semanales. Los residentes de programas de subespecialidad reportaron una jornada de 55,9 ± 22,2 horas semanales más un promedio de 23 ± 3,9 horas de turnos presenciales semanales. De los 53 programas evaluados, el 22,6 por ciento sobrepasó el límite recomendado por la Dirección de Postgrado PUC (80 horas semanales). Cinco programas reportaron 90-100 horas semanales (todas especialidades o subespecialidades quirúrgicas) y 7 programas reportaron 80-90 horas semanales (3 subespecialidades médicas, 1 subespecialidad quirúrgica, 2 especialidades médicas y 1 especialidad quirúrgica). Conclusión: los residentes de especialidades y subespecialidades médicas en la Pontificia Universidad Católica de Chile están sometidos a una carga horaria significativa. Los programas quirúrgicos presentaron la mayor sobrecarga horaria presencial, con un promedio mayor al recomendado a nivel internacional. (AU)

Introduction: Residents work hours' overload constitutes an important problem in medical postgraduate residency programs. It has been associated to an increased prevalence of depression, burnout, attrition and affects quality of life of residents. The aim of our study was to quantify the duty hours in residents of specialty and subspecialty at the Pontificia Universidad Católica de Chile (PUC). Methods: An electronic survey was performed to residents of specialty and subspecialty at PUC (2013). It included an auto report of the duty hours worked in a week (regular working day, night shifts and on call shifts). We only included for analysis the face hours (regular working day and night shifts). Results: 415 surveys were answered (response rate 86percent). Specialty residents reported 52.8 ± 20.3 regular working hours per week plus an average of 22.6 ± 22.5 hours of night shifts. Subspecialty residents reported 55.9 ± 22.2 regular working hours per week plus an average of 23 ± 3.9 hours of night shifts. From the 53 evaluated programs, 22.6 percent exceeded the limit recommended in the PUC Postgraduate Office (80 hours per week). Five programs reported 90-100 hours per week (all were surgical specialties and subspecialties) and 7 programs reported 80-90 hours per week (3 medical subspecialties, 1 surgical subspecialty, 2 medical specialties and 1 surgical specialty). Conclusion: The residents of specialty and subspecialty from medical postgraduate programs at PUC are subject to a significant workload. The surgical programs present the highest time workload, with a greater average than the internationally recommended.(AU)

Proceso de alta hospitalaria, revisión de la literatura / The discharge process

Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and transfers an overwhelming amount of information to patients. Often, it is limited to the writing of the discharge summary, with a primary emphasis on the drug list. Since the rise of hospitalism in 1996, a greater emphasis has been placed on understanding this process and in developing interventions to make it more effective and safe. In our country, little is known about how this process is taking place. Probably the absence of financial penalties for readmissions has influenced in the lack of study and development of this process. In the USA the knowledge of the discharge process is well advanced, and several strategies have been developed for reducing adverse events, medication errors, and 30-days readmissions. Other interventions have increased patient satisfaction and the degree of knowledge about their conditions. The aim of this paper is to do a comprehensive review of the literature, to provide healthcare teams with various tools that could improve both the discharge process as well as the discharge summary. The final objective is to optimize the safety and satisfaction of our patients and the hospital metrics of quality.

Informática biomédica / Biomedical informatics

Biomedical Informatics is a new discipline that arose from the need to incorporate information technologies to the generation, storage, distribution and analysis of information in the domain of biomedical sciences. This discipline comprises basic biomedical informatics, and public health informatics. The development of the discipline in Chile has been modest and most projects have originated from the interest of individual people or institutions, without a systematic and coordinated national development. Considering the unique features of health care system of our country, research in the area of biomedical informatics is becoming an imperative.

Diagnóstico y manejo de la hipoglicemia en adultos diabéticos hospitalizados: evaluación de competencias en un equipo profesional multidisciplinario de salud / Competences on hypoglycemia management among healthcare professionals in a clinical hospital

Background: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal. Aim: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital. Material and Methods: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital. Results: Respondents had a mean of 60 percent of correct answers, without significant differences between groups. The capillary blood glucose level that defines hypoglycemia was known by most of the respondents, but the value that defines severe episodes was known only by 60 percent. The initial management and follow up was well known only for severe episodes. Less than 50 percento knew the blood glucose value that required continuing with treatment. Conclusions: Although most professionals are able to recognize hypoglycemia, the knowledge about is management if insufficient.

Microdosis de vacuna BCG en cáncer vesical etapas A y B1: estudio cooperativo filial sur de urología / Microdosage of BCG vaccine in bladder cancer in stage A and B1: cooperative study of the south urology filial

Se estudian 47 pacientes operados de cáncer vesical y manejados posteriormente con un protocolo de instilaciones de 1 mg de vacuna BCG duarante 1 año. 38 pacientes etapa A y 9 pacientes etapa B1. El porcentaje de recidivas presentadas fue de 10,6%; con 0% de recidivas en los pacientes etapa B1 y 13,2 en los pacientes etapa A. La única complicación fue irritación vesical moderada en 6,3% de los pacientes. El promedio de observación de los enfermos tratados fue de 36 meses, siendo 84 meses el mayor y 12 meses el menor