ABSTRACT
OBJETIVOS: hasta el momento no existen trabajos de auditorías clínicas que evalúen la práctica clínica en la enfermedad pulmonar obstructiva crónica (EPOC) en el ámbito de consultas externas. El presente trabajo es un primer proyecto piloto que tiene por objetivo evaluar la variabilidad de la práctica clínica para la EPOC en este ámbito asistencial. MÉTODO: proyecto piloto de auditoría de historias clínicas llevada a cabo en consultas externas de Neumología en 9 hospitales públicos de Andalucía entre octubre 2013 y septiembre 2014. El objetivo era auditar 80 casos por centro, repartidos durante los 4 trimestres del año. La información se recogió mediante cuestionario estandarizado con 182 variables. Los datos se describen con medias y rangos interhospitalarios para evaluar la variabilidad. RESULTADOS: durante el año de estudio se analizaron 621 historias. Los pacientes eran mayoritariamente hombres, en la séptima década de la vida, con un porcentaje de fumadores activos del 26,2%, un considerable número de comorbilidades y mayoritariamente del ámbito urbano. Los datos indican que la atención sanitaria es en general correcta como promedio, pero indicando áreas de mejora en algunos puntos y una considerable variabilidad entre centros con diferencias significativas (p <0,001) para los cambios intercentro de la mayoría de las variables. CONCLUSIONES: la atención sanitaria al paciente con EPOC en consultas externas de Neumología en Andalucía muestra una considerable variabilidad que probablemente no pueda ser explicada sólo por la condición clínica del paciente. Estudios futuros deberán dilucidar qué factores inciden en esta variabilidad
OBJECTIVES: To date, there have been no clinical audits that evaluate clinical practice for chronic obstructive pulmonary disease (COPD) in outpatient clinics. This study is the first pilot project that aims to evaluate the variability in clinical practice for COPD in this healthcare setting. METHOD: A medical history audit pilot project carried out in outpatient pulmonology clinics in 9 public hospitals in Andalusia from October 2013 to September 2014. The objective was to audit 80 cases per center, distributed across the 4 quarters of the year. Information was collected using a standardized questionnaire with 182 variables. Data is described as averages and inter-hospital ranges to evaluate variability. RESULTS: 621 histories were analyzed during the year of the study. Patients were primarily male, in the seventh decade of life, 26.2% were active smokers, there were a considerable number of comorbidities and subjects lived in mainly urban areas. Data indicates that healthcare is generally appropriate on average, but there are areas of improvement in some points and there is a considerable variability between centers with significant differences (p <0.001) for inter-center changes for the majority of variables. CONCLUSIONS: Healthcare for patients with COPD in outpatient pulmonology clinics in Andalusia shows considerable variability that likely cannot be explained solely by the patient's clinical condition. Future studies must clarify what factors come into play in this variability
Subject(s)
Humans , Male , Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Outpatient Clinics, Hospital/standards , Pilot Projects , Medical Audit , Quality of Health Care/organization & administration , Quality of Health Care/standards , 28599ABSTRACT
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Subject(s)
Adult , Male , Humans , Hamartoma , Bronchial Neoplasms , Radiography, Thoracic , Tomography, X-Ray Computed , Bronchoscopy , Diagnosis, Differential , Laser TherapyABSTRACT
We expose a case of sarcoidosis with pulmonary and intrathoracic ganglion infection added to an infrequent testicular and epididymal affection simultaneously. We only have found this association in six cases in the revised literature, but we didn't found the affection of Morgagni's hydatid by sarcoidosis. The presence of testicular mass and hilar adenopathies in young patients make us to think about a diagnostic threat. The inguinal treatment with testicular biopsy has been chosen like the diagnostic management in this case.
Subject(s)
Epididymis , Lung Diseases/diagnosis , Sarcoidosis/diagnosis , Testicular Diseases/diagnosis , Adult , Biopsy , Epididymis/pathology , Humans , Lung/pathology , Lung Diseases/pathology , Male , Orchitis/diagnosis , Orchitis/pathology , Radiography, Thoracic , Sarcoidosis/pathology , Testicular Diseases/pathology , Testis/pathologyABSTRACT
Se presenta un caso de sarcoidosis con afectación pulmonar y ganglionar intratorácica al que se añade una infrecuente afectación del testículo y epididimo simultáneamente. En la literatura revisada sólo hemos encontrado esta asociación en seis casos. No hemos encontrado descrita la afectación por sarcoidosis de la hidátide de Morgagni. La presencia de masa testicular y adenopatías hiliares en pacientes jóvenes plantea en muchas ocasiones un reto diagnóstico. El abordaje inguinal con biopsia testicular intraoperatoria ha sido el procedimiento diagnóstico elegido en este caso (AU)
Subject(s)
Adult , Male , Humans , Biopsy , Lung/pathology , Orchitis/diagnosis , Orchitis/pathology , Radiography, Thoracic , Sarcoidosis/pathology , Testicular Diseases/pathology , Testis/pathology , Lung Diseases/pathology , Epididymis/pathology , Sarcoidosis/diagnosis , Testicular Diseases/diagnosis , Lung Diseases/diagnosisSubject(s)
Catheterization, Central Venous/adverse effects , Hydrothorax/etiology , Aged , Aged, 80 and over , Female , Humans , Male , Time FactorsABSTRACT
5-aminosalicylic acid (5-ASA) has been used to treat inflammatory bowel disease satisfactorily. Lung disease related to 5-ASA administration has been described only rarely. We report a case of alveolitis related to 5-ASA treatment in a woman with Crohn's disease. We review the literature and describe clinical, biological and radiological manifestations, along with the clinical course of this complication.
