Sensitivity and Specificity of Cephalometric Measures for the Diagnosis of Sagittal Skeletal Malocclusion

Objective: To evaluate and compare sensitivity and specificity of ANB, Wits, APDI and AF-BF to diagnose sagittal skeletal malocclusions, in children between 6 to 12 years old, using ROC curves, a widely accepted method for the analysis and evaluation of diagnostic tests. Material and Methods: A descriptive-comparative study of diagnostic tests was conducted. From a population of 3,000 children, a non-probabilistic sample of 209 was selected. The clinical classification of the patients as class I, II or III, made by a group of experts based on the visual inspection of models and photographs, was chosen as the gold standard. After calibration (ICC>0.94) the variables were measured in cephalograms. Eight ROC curves were plotted (I vs II, and I vs III for each one of the variables). The area under the curve was measured and compared (Ji-square test). Cut points were established. Results: To discriminate Class I from II, ANB showed the largest area under the curve (AUC) (0.876) and the cut point (best sensitivity and specificity) was at 5.75°. To discriminate class I from III, Wits showed the largest AUC (0.874) with a cut point of -3.25 mm. There were no statistical differences between the AUC for the four variables (p=0.48 y p=0.38 for class I-II and I-III). Conclusion: ANB and Wits performed better for the diagnosis of class II and III, respectively. Cut points in children were different from those reported in adults.

Morphological differences in lower facial third soft tissues in children with and without gingival smile: A cross-sectional comparative study.

AIM: The aim of the present study was to establish the relationship between lower facial third and smile type in silent mixed-dentition patients. METHODS: This cross-sectional study, approved by the ethics committee, was conducted in a population of 2760 children, from which a convenient sample of 198 was included: 75 with gingival smile (GS) and 123 without GS (1:1.64). Clinical examination and videos were taken. Occlusal relation, overjet (OJ), overbite (OB), superior lip length at rest, superior lip length while smiling (SLLS), lower facial third height (LFTH), mid-facial third height (MFTH), clinical crown length, and lip lift ability (LLA) were measured by two calibrated examiners (intraclass correlation coefficient: ≥.95). A normality test and demographic and bivariate analyses were undertaken. A non-paired Student's t test was carried out in order to observe statistically-significant differences between variables. RESULTS: There were no differences between sexes or associations between LFTH and GS. Statistically-significant differences (P < .05) in MFTH, SLLS, LLA, OJ, and OB were found. A logistic regression model showed that the sum of LLA (odds ratio [OR]: .65, 95% confidence intervals [CI]: .50,.83]) and OB (OR: .88, 95% CI: .82, .93]) were GS predictive factors in 81.3% of cases. CONCLUSIONS: OB and LLA are GS predictive factors in prepubertal participants. There is no relation between LFTH and GS.

Craniocervical Posture in Children with Class I, II and III Skeletal Relationships

Objective: To describe the characteristics of craniocervical posture of children aged between 6 and 11 years and its relationship to their sagittal skeletal classification. Material and Methods: This descriptive cross-sectional study involved 107 children (55 girls - 52 boys), aged between 6 and 11 years. The sample included no previous orthodontically/orthopedic treated and systemically healthy children. After proper calibration, lateral skull radiographs, taken for diagnosis purpose for maxillary orthopedic treatment, were obtained by the same operator in natural head position. A radiographic analysis was made using a NEMOTEC software: 13 variables were registered: age, gender, ANB angle (to classify sagittal skeletal relationships) and 10 variables related to craniocervical posture: cervical lordosis, hyoid triangle, craniocervical angle, intervertebral spaces: C0-C1, C1-C2 and distances NSL-Ver, NLVer, ML-Ver, OPT-Hor, CVT-Hor. To evaluate the reliability of measures, 15 randomly selected radiographs were re-measured by the same investigator two weeks after the initial analysis. Results: Intra-class correlation coefficients were in a range of 0.945-0.996. Lordosis, CCA, C1-C2, OPT-Hor y CVT-Hor, values were higher in male than in female children (p<0.05). No statistically significant differences were found among groups of sagittal skeletal relationships, but class III children had a tendency to higher craniocervical flexion; 66.3% of the studied group presented rectified lordotic curvature and class II subjects presented increased values of NSL-Ver, NL-Ver and MLVer. Class I children had the lowest values for OPT-Hor and CVT-Hor. Conclusion: All craniocervical postural variables were higher in boys than in girls. No differences were found in this study between cervical postural variables with different malocclusion.

Influence of Facial and Occlusal Characteristics on Gummy Smile in Children: A Case-Control Study

Objective: To determine the association between occlusal and soft tissue characteristics with the presence of gingival smile (GS) in a pediatric population with inter-transitional mixed dentition. Material and Methods: Case-control study was performed with a probabilistic sample of 163 children in inter-transitional mixed dentition (age:8.8 years ±0.8). Cases were 37 children with GS, and controls were 126 children without GS. Occlusal variables were assessed through clinical examination, and soft tissue variables were assessed through photograms. Kappa test and intraclass correlation coefficient were done (0.87-0.96). The association between malocclusion, gender, and types of smile was assessed using a Chi square test. Comparison of quantitative variables in smile groups was made by Student t test. A multivariate binary logistic regression was performed. Results: Class II malocclusion, short upper lip at smile and short incisor clinical crown, were risk factors for gummy smile (OR= 10.4, 95%CI 3.07- 34.95, OR= 2.1, 95%CI 1.44- 3.13 and OR= 2.5 95%CI 1.34- 4.54 respectively). Lower facial height was a protective factor against GS (OR= 0.76; 95%CI 0.69- 0.85). The logistic regression model explains 48% of GS variability. Conclusion: Class II malocclusion is considered a risk factor for gummy smile. Other variables associated to gummy smile were short upper lip and short incisor clinical crown. Clinicians should considered these aspects in clinical examination of each patient to provide an adequate diagnostic and plan of treatment to control and/or correct a GS.

Mapa de conflictos éticos intrahospitalarios / Map of intrahospital ethical conflicts

Objetivo: Conocer los conflictos que enfrentan a diario a los pacientes y sus familiares con los médicos y la enfermería del hospital, para disponer de un mapa de conflictos que permita conocer las situaciones más relevantes de dificultad ética. Material y método: Se realizan 3 grupos focales, con la participación de 8 médicos (jefes de servicio) y 12 del personal de enfermería (supervisores) del Hospital Comarcal del Noroeste de la Región de Murcia. Al finalizar cada grupo focal, los participantes rellenaron un cuestionario sobre 10 problemas éticos, con el fin de priorizar los conflictos. Resultados: La edad media del personal de enfermería que participó en el estudio fue de 41 ± 6, y la de los médicos, de 51 ± 5 años. Se identifican 47 conflictos éticos entre los médicos, y 59 entre el personal de enfermería, que se agrupan en 5 áreas de riesgo: profesional, asistencial, social, organizacional, y legal. De los identificados, 14 entre los médicos y 16 entre el personal de enfermería, adquieren mayor importancia, y destacan los problemas de información, de recursos sociosanitarios, de la inexistencia de normas de régimen interno que regulen el quehacer diario, y del desconocimiento de las expectativas de los pacientes y de la legislación vigente. Los conflictos más importantes a los que deberán enfrentarse los médicos y el personal de enfermería son el uso inadecuado de recursos limitados y la deficiente información a los pacientes. Conclusiones: Identificamos los conflictos éticos entre pacientes/familiares y médicos/personal de enfermería en un hospital de área. Un mapa de conflictos es una buena herramienta para gestionar los riesgos éticos, tanto desde las comisiones de ética, como desde los órganos de dirección del hospital

Objective: To explore the most common conflicts routinely occurring between patients/families and physicians/nurses in order to identify the most important ethical dilemmas. Material and method: Three focus group interviews were conducted with the participation of 12 members of the nursing staff (supervisors), and eight physicians (heads of department) in a district hospital in the north-west of Murcia (Spain). At the end of each focus group interview, the participants completed a brief questionnaire with the aim of prioritizing conflicts. Results: The mean age was 41 ± 6 years in participating nurses and 51 ± 5 years in physicians. Forty-seven ethical conflicts were identified by physicians, and 59 by nurses. These conflicts were grouped into five risk areas: professional, clinical, social, organizational, and legal. Of the dilemmas identified, 14 in the physicians' group and 16 in the nurses' groups were major, notably those related to patient information, health and social resources, non-existence of internal norms regulating daily work, lack of knowledge of patient expectations, and current legislation. The most important problems faced by physicians and nurses were inappropriate use of scarce resources and inadequate patient information. Conclusions: This study identified the ethical conflicts between patients/families and health care professionals in a district hospital. Listing ethical conflicts provides ethics committees and hospital administrations with a useful framework for the management of these dilemmas

El dolor agudo en nuestros hospitales: un problema de gestión / Acute pain in Spanish hospitals: a problem of management

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Reingeniería de procesos aplicada a la analgesia epidural obstétrica / Reengineering od processes applied in epidural analgesia labor

Objetivo: La reingeniería de procesos se define como volver a reinventar la manera de organizarse para conseguir avances sin precedentes en la calidad. Este artículo resume los resultados tras cuatro años de aplicar esta técnica al proceso de analgesia epidural en el parto. Material y métodos: Describimos el nuevo diseño del proceso de analgesia epidural obstétrica (AEO). Evaluamos el grado de su implantación mediante las tasas de parto con analgesia epidural. Comparamos nuestros resultados con los hospitales de nuestra región mediante técnicas de monitorización externa. Resultados: Nuestro hospital ostenta las mayores tasas consolidadas de partos bajo analgesia epidural (93,3 por ciento), y está por encima de los hospitales de nuestro entorno que representan la excelencia relativa del grupo. Los hospitales públicos de nuestra región adolecen de falta de homogeneidad entre ellos. Conclusiones: La reingeniería del proceso de AEO ha demostrado ser útil para conseguir y consolidar elevadas tasas de partos bajo analgesia epidural (AU)

Ineficacia de las medidas educativas en el manejo del dolor agudo para disminuir su prevalencia en el hospital y elevar la satisfacción de los pacientes / No disponible

Objetivo: Conocer si las medidas educacionales en el manejo del dolor, impartidas a médicos y enfermeras, son suficientes para hacer descender la prevalencia de dolor intrahospitalario y elevar la satisfacción de los pacientes. Pacientes y método: Se realizan 2 cortes de prevalencia de dolor intrahospitalario en un intervalo de 6 meses. Participaron 62 pacientes hospitalizados en el primer corte (C1) y 65 en el segundo (C2). Entre ambos cortes se impartió un curso sobre el correcto control del dolor y se difundió un cartel informativo, así como los resultados del C1, a todo el personal sanitario del hospital. Se valoró mediante encuesta en qué medida la actuación educativa entre los cortes modificó la prevalencia de dolor y la satisfacción de los pacientes. Resultados: No hubo diferencias significativas entre ambos cortes en la proporción de pacientes con dolor en las 24 h anteriores a la encuesta, ni en los niveles de intensidad expresados, ni en la prescripción a demanda, ni tampoco en la proporción de pacientes que consiguió alivio o la satisfacción con el alivio obtenido. El porcentaje de pacientes que pidió alivio, así como la constancia en la historia de órdenes de tratamiento, fue significativamente inferior en C2. La satisfacción del paciente con la respuesta a su demanda de alivio fue menor en C2 que en C1. La satisfacción del paciente, tanto con la respuesta a su demanda de alivio como con el nivel de alivio obtenido, no se asoció con la intensidad de su dolor ni con la obtención de alivio. Encontramos un porcentaje importante de pacientes que, aun con dolor moderado-intenso, no reclamaron tratamiento analgésico. Conclusiones: Las medidas educativas sobre el control adecuado del dolor impartidas a médicos y enfermeras no consiguieron hacer descender los niveles de prevalencia de dolor dentro del hospital. Igualmente, estas medidas no mejoraron la satisfacción de los pacientes con el control de su dolor (AU)

Objective: To determine whether training doctors and nurses in pain management is effective in decreasing the prevalence of intrahospital pain and in increasing patient satisfaction. Patients and method: Two cross-sections of the prevalence of intrahospital pain were carried out with a 6-month interval. Sixty-two inpatients participated in the first cross-section (C1) and 65 in the second (C2). Between the two cross-sections, training was given on pain control, an informative poster was distributed, and the results of the first survey were made known to all the hospital’s medical staff. A survey was used to evaluate the extent to which the training between the cross-sections modified the prevalence of pain and patient satisfaction. Results: No significant differences were found between the groups in the proportion of patients with pain 24 hours prior to the surveys, in pain intensity, in prescription on demand, or in the proportion of patients that obtained relief or expressed satisfaction with the relief obtained. The proportion of patients who asked for more pain relief, as well as orders for treatment in the medical records was significantly lower in C2. Patient satisfaction with the response to requests for pain relief was lower in C2 than in C1. Patient satisfaction, both with the response to requests for pain relief and with the degree of relief obtained, was not associated with pain intensity or with the pain relief obtained. A considerable percentage of patients with moderate or intense pain did not request analgesic treatment. Conclusions: The training in adequate pain management given to physicians and nurses did not decrease the prevalence of pain within the hospital or improve patient satisfaction with pain management (AU)

Prevalencia y factores asociados con el síndrome de burnout en enfermería de atención hospitalaria / Prevalence and factors associated with burnout syndrome in hospital nurses

Objetivo: Determinar la prevalencia del síndrome de burnout en las enfermeras y auxiliares de un hospital comarcal de Murcia, así como su distribución según diferentes variables sociodemográficas y laborales. Además, comprobar la tridimensionalidad del síndrome. Método: Estudio descriptivo transversal, dirigido a la totalidad (223) de los trabajadores dependientes de la dirección de enfermería, mediante cuestionario autoadministrado y anónimo, compuesto por el Maslach Burnout Inventory y variables sociodemográficas y laborales. Se relacionó cada dimensión del síndrome de burnout con las variables independientes. Resultados: Contestó el cuestionario el 64,1 per cent de los trabajadores. Presentó puntuaciones elevadas en agotamiento emocional el 26,5 per cent (intervalo de confianza [IC] del 95 per cent: 21,6-31,8), y en despersonalización el 30,0 per cent (IC del 95 per cent: 24,9-35,1). Puntuó bajo en falta de realización personal el 20,2 per cent (IC del 95 per cent: 15,4-25,1).Las puntuaciones en desrealización fueron menores en las enfermeras que en las auxiliares, en las jóvenes, y en las de menor antigüedad en la profesión. Las puntuaciones en despersonalización fueron menores en el personal interino. Las tres dimensiones se correlacionaron entre sí. Conclusiones: Detectamos niveles de este síndrome preocupantemente elevados entre nuestra enfermería y similares a los encontrados en otras encuestas nacionales. Los equipos directivos deberían adoptar medidas correctoras en las dimensiones más afectadas (AU)

Satisfacción laboral de los profesionales en un hospital comarcal de murcia / Profesionals' job satisfation in a country hospital in Murcia

Objetivo: Conocer el nivel de satisfacción laboral y analizar sus componentes (cuestionario Font Roja), en los trabajadores de un hospital comarcal. Métodos: Estudio descriptivo transversal. Población de estudio: todos los trabajadores del hospital del noroeste de Murcia (401). Se utiliza el cuestionario de satisfacción Font Roja (27 ítems valorados por escala Likert 1-5) y un cuestionario que recoge variables sociodemográficas y asociadas al puesto de trabajo. Se relaciona cada dimensión de la satisfacción laboral con las variables independientes. Resultados: Ciento noventa y nueve de 401 trabajadores respondieron al cuestionario (49,6 por ciento). La satisfacción global fue de 3,21 (IC95 por ciento: 3,16-3,26). Las dimensiones menos valoradas han sido la presión laboral (2,06, IC95 por ciento: 2,02-2,10) y la promoción profesional (1,60, IC95 por ciento: 1,55-1,65). Las dimensiones más valoradas son la competencia profesional (3,92, IC95 por ciento: 3,88-3,96) y la relación con los superiores (4,02, IC95 por ciento: 3,95-4,09).Conclusiones: Los trabajadores se encuentran medianamente satisfechos con el trabajo que desempeñan. Los equipos directivos deberían adoptar medidas correctoras en los ítems peor valorados (AU)