ABSTRACT
INTRODUCTION/BACKGROUND: The G8 score is a widespread screening tool for geriatric frailty in oncology. The aim of this study was to evaluate the scores and relevance of G8 items in a standard screening of geriatric patients with uro-oncologic diseases to better understand the results of the assessment. METHODS: Eighty-two consecutive uro-oncologic geriatric patients aged 75 years and older were evaluated. All patients underwent a G8 screening that consisted of 8 items. Patients with a G8 score above 14 were considered geriatric "fit", while others were considered to be "frail". Overall results and single item scores were evaluated. Clinical data were gathered from patients' charts. RESULTS: The mean age of the patients was 82 years (min. 75-max. 102). In 36 of the patients, the G8 score indicated "no-frailty", and in 46 patients, the G8 score indicated "frailty". The mean G8 score was 12.9 (min 4-max 17 pts). Item analysis revealed that points were most often lost in items H (polypharmacy), P (comparison of health status to peers) and Age. Fifty-nine, 56 and 52 patients lost points on item Age, item H and item P, respectively. In contrast, the majority of patients reached the maximum score for nutritional items [i.e., items A (food intake), B (weight loss) and F (body mass index (BMI))]. For item A, 73 patients reached the maximum score; for item B, 62 patients reached the maximum score; and for item F, 72 patients reached the maximum score. There were no differences in this distribution pattern when comparing tumour entities, sex, and patients with local vs. metastatic disease. CONCLUSION: The present study revealed a high percentage of suspicious test results. Potential reasons for these findings include the low threshold of the G8 overall score and the fact that in some items, points were easily lost. Modifications of the test should be considered.
Subject(s)
Frailty , Neoplasms , Aged , Humans , Aged, 80 and over , Surveys and Questionnaires , Geriatric Assessment/methods , Frailty/diagnosis , Health StatusABSTRACT
PURPOSE: Oral-facial-digital (OFD) syndromes constitute a heterogeneous group of embrionary development disorders. There are at least 11 different forms, with a broad spectrum of clinical features, causing an important problem with the diagnosis. There are only a few reports in the recent literature, and there is no surgical technique described for its correction. MATERIALS AND METHODS: We present a newborn female referred to the Cleft Lip and Palate Division of our hospital with facial dysmorphology; her mother was affected by an incomplete form of this syndrome. Genetic investigation showed a mutation not reported before in the literature. We present the clinical features and a new surgical approach for its correction. RESULTS: OFD syndrome type I (OFD I) is characterised by several clinical features, including incomplete central upper lip cleft, bifid tongue, intraoral hamartomas, upper lip frenula and soft palate cleft. With this technique, we get a good aesthetic result. CONCLUSION: OFD I is extremely infrequent and it is important to differentiate it from other forms of OFD. We want to emphasise the importance of performing a correct differential diagnosis in patients affected by palate cleft who have intraoral masses or feeding problems, to rule out incomplete forms of this syndrome. Surgical correction of the malformations associated with this syndrome is a challenge for the paediatric surgeon, because none of the previously reported techniques approach the reparation of this central labial defect.
Subject(s)
Hamartoma/surgery , Mouth Neoplasms/surgery , Orofaciodigital Syndromes/diagnosis , Orofaciodigital Syndromes/surgery , Diagnosis, Differential , Female , Humans , Infant, Newborn , Magnetic Resonance Imaging , Orofaciodigital Syndromes/geneticsABSTRACT
Muchas técnicas quirúrgicas realizadas en la cirugía pediátrica presentan una curva de aprendizaje lenta(1), el volumen de pacientes objeto de nuestra especialidad y la existencia de patologías complejas, que requieren gran entrenamiento y habilidad quirúrgica, han llevado a nuestro servicio a poner en marcha un programa formativo integral de cirugía experimental. Este programa, basado en la simulación y en la realización de procedimientos invasivos y mínimamente invasivos en modelos anatómicos reales, tiene como objetivo principal instruir de manera eficaz y global a los residentes, para así conseguir una mejoría de la formación técnica, y un aumento de la seguridad de los pacientes fruto de la experiencia y competencia adquirida en el campo de experimentación. Este trabajo presenta las características principales, objetivos y resultados obtenidos con este programa formativo e intenta promoverla incorporación de programas de simulación y experimentación en animales vivos como una parte esencial de la formación del residente de cirugía pediátrica (AU)
Many surgical procedures performed in pediatric surgery have a slow learning curve(1), the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident (AU)
Subject(s)
General Surgery/education , Pediatrics/education , Models, Animal , Models, Anatomic , Teaching Materials/supply & distribution , Patient SimulationABSTRACT
Many surgical procedures performed in pediatric surgery have a slow learning curve, the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident.
Subject(s)
Models, Animal , Pediatrics/education , Specialties, Surgical/education , AnimalsABSTRACT
En este artículo se afronta el debate sobre nuevos modelos de gestión hospitalaria. Se ha utilizado una triple metodología: análisis de fuentes secundarias, entrevistas a fondo y reuniones de grupo, y una encuesta a gerentes de centros hospitalarios con 400 camas o más. Principales resultados: Hay una gran consistencia y complementariedad en las aportaciones de estas 3 vías. Las nuevas formas jurídico-administrativas de gestión, así como las áreas de gestión clínica, comienzan a abrirse camino en estos hospitales con lentitud; los gerentes demandan mayor autonomía en la gestión y apuestan por la profesionalización de la gerencia a partir de una formación específica (AU)
Subject(s)
Humans , Organization and Administration , Hospital Administration , Models, Organizational , Spain , Surveys and QuestionnairesABSTRACT
Este trabajo presenta un análisis empírico de la productividad para una muestra de 40 servicios del Complejo Hospitalario Juan Canalejo, utilizando para ello el Análisis Envolvente de Datos (DEA).Se calcula la eficiencia técnica global (ETG) y su descomposición en eficiencia de escala (EE) y en eficiencia técnica pura (ETP). Esta información permitirá obtener conclusiones acerca de la adecuada dimensión de los servicios, así como la posibilidad de ahorros en los recursos utilizados y la posibilidad de incremento de la producción para el nivel actual de inputs. Por último se sugieren las futuras líneas de ampliación y mejora de la investigación inicial (AU)
Subject(s)
Hospital Departments , Efficiency, Organizational , Spain , 28599 , Surgery Department, HospitalABSTRACT
Introducción: La cumplimentación del CMBDAH constituye la base del sistema de medida y gestión del producto hospitalario del SNS, mediante la clasificación GRD. Un elemento clave es la integración de la información clínica mediante la codificación. Objetivo: Analizar la calidad de la codificación realizada por personal médico no formado específicamente y valorar la cualificación necesaria para esta tarea. Material y métodos: Unidades de estudio: Informes de alta muestreados por conglomerados. Análisis: Comparativo de variables indicadoras de calidad de la codificación realizada por los clínicos mencionados respecto a un codificador experto. Resultados: Se estudiaron 178 informes. Análisis técnico de la codificación: Diagnóstico Principal: Un 30,9 per cent no tenían bien seleccionado el diagnóstico principal. De los que lo tenían el 44,4 per cent estaban mal codificados. Diagnósticos Secundarios: El codificador experto asignó 3,1 códigos por informe por 1,2 de los clínicos. Fueron correctos un 23,3 per cent. Análisis comparativo de la asignación en GRD: En un 32,0 per cent hubo concordancia. De los que no hubo acuerdo, en un 29,8 per cent hubo mala selección del diagnóstico principal. En un 43,8 per cent el GRD resultante de la codificación de los clínicos del servicio fue el 470.Conclusiones: El nivel de calidad de la codificación realizada por los clínicos fue bajo. La imagen de la casuística que se obtendría sería diferente de la realmente tratada por el servicio. Es conveniente y necesario contar con personal especializado en Sistemas de Información Sanitarios que desarrollen la tarea de codificación de los episodios generados en el hospital, para garantizar la máxima calidad en estos procesos (AU)
Subject(s)
Humans , Diagnosis , Hospital Information Systems , Medical Records , 34002 , Algorithms , Patient DischargeABSTRACT
The present work describes the process by which the pilot project of clinical management of the Hospital Complex Juan Canalejo, designated as "Heart Area", was implemented. In the first section, the needs and reasons that led to the undertaking of this project are explained. The project's objectives and operative strategies are listed. In the Material and Methods section, three basic aspects of the "Heart Area" are described: selection criteria of the "Area", its structure and function, and its foundation and development. In the Results section, we compare the activity undertaken in the "Area" to the situation present prior to its implementation, in relation to quality and costs. Finally, in the Conclusions, we comment on the important implications that our project can have within the Hospital Complex Juan Canalejo as well as in the health care field in general.
Subject(s)
Cardiology Service, Hospital , Cardiac Surgical Procedures , Cardiology Service, Hospital/economics , Cardiology Service, Hospital/organization & administration , Emergencies , Evaluation Studies as Topic , Heart Diseases/complications , Heart Diseases/surgery , Heart Diseases/therapy , Humans , Pilot Projects , Spain , Surgical Procedures, OperativeABSTRACT
OBJECTIVE: To report a case of ureterohydronephrosis secondary to an undiagnosed appendiceal abscess. METHODS/RESULTS: Herein we describe a case of a 4-year-old girl with right ureterohydronephrosis arising from extrinsic compression of the right ureter due to an undiagnosed appendiceal abscess. The patient was treated with intravenous antibiotics and the abscess was drained. Regular isotope and US assessments showed both the residual retroperitoneal fibrosis and renoureteral dilation had decreased. CONCLUSIONS: Acute appendicitis is still the most common cause of emergency abdominal operations in children. Although the symptoms are easily recognizable and generally lead to the correct diagnosis in most cases, the peculiarities of childhood can lead to errors in the diagnosis resulting in the complications reported herein. We emphasize the usefulness of ultrasound in the diagnosis and conservative treatment is advocated.
Subject(s)
Abscess/complications , Appendix , Escherichia coli Infections/complications , Hydronephrosis/microbiology , Ureteral Diseases/microbiology , Cecal Diseases/complications , Child, Preschool , Humans , MaleABSTRACT
The authors present an observation of omphalopagus conjoined twins with successful separation. They comment on the etiopathogenic factors, obstetrical problems, investigation of the extent of the union and operative timing.
