ABSTRACT
BACKGROUND: Osteoporotic hip fractures have posed a significant burden to society, and more epidemiological data is required. OBJECTIVE: To compare the epidemiological differences of hip fracture patients in Spain and China. METHOD: This was a retrospective comparative study. Comparisons were made in terms of morbidity, demographic and anthropometric characteristics, length of stay, cost of hospitalization, and mortality by consulting the medical histories of osteoporotic hip fractures in two hospitals. The t test was used for measurement data, and the X2 test was used for count data. The difference is statistically significant when p< 0.05. RESULTS: A total of 757 patients were enrolled in this study, with 426 from Virgen Macarena University Hospital (HUVM) and 331 from Xi'an Daxing Hospital (XDH). The average age was 81.4 ± 9.26 and 76.0 ± 8.08 years; the proportion of women was 74.9% and 68.0%, respectively. The incidence of osteoporotic hip fractures in Seville residents over 50 years old was approximately 239 per 100,000 residents, compared to 158 per 100,000 residents in Xi'an. The timing of surgery in Spanish patients was significantly longer than in Chinese patients, 78.7 ± 48.2 vs. 60.7 ± 43.1 hours, p= 0.000. There were 81 deaths in Spain and 43 deaths in China during the one-year follow-up period (p= 0.026). CONCLUSIONS: In terms of incidence, demographics, surgical methods, and mortality, there are significant differences between hip fracture patients in Seville, Spain and Xi'an, China.
Subject(s)
Hip Fractures , Osteoporotic Fractures , Humans , Female , Aged , Aged, 80 and over , Middle Aged , Retrospective Studies , Osteoporotic Fractures/epidemiology , Hip Fractures/epidemiology , Hip Fractures/etiology , Incidence , Spain/epidemiologyABSTRACT
Introducción El informe de alta es un documento básico al finalizar un proceso asistencial, y es un elemento clave en el proceso de codificación. De su correcta redacción, fiabilidad y exhaustividad dependerán los datos que sirvan para determinar la producción hospitalaria. Material y métodos Partimos de la hipótesis de que, analizando la concordancia del informe de alta con los datos cotejados en la documentación del episodio, podremos recodificar todos aquellos casos infracodificados, imputándolos así a un grupo relacionado por el diagnóstico (GRD) más adecuado. Analizamos en 24 pacientes outliers la correcta cumplimentación de tipo y motivo de ingreso, antecedentes personales y medicación, resumen del episodio, diagnósticos principal y secundarios, procedimiento quirúrgico, evolución durante el episodio y número de diagnósticos y procedimientos enumerados, concordancia con la información real del episodio y los cambios teóricos entre los GRD antes y después del análisis. Resultados De 24 casos, 6 informes son válidos y claros; 4, válidos aunque poco claros; 9 son insuficientes y 5, claramente inválidos. La comparación de los GRD recalculados tras la interpretación de los datos del episodio no muestra diferencias significativas, mediante test de Wilcoxon, encontrándose tan solo modificaciones en 5 casos (p = 0,680).Conclusiones La calidad del informe de alta depende de la correcta inclusión de todos los datos del CMBD, en concordancia con el episodio. Las discordancias historia/informe pueden modificar el GRD que, en nuestra serie, no es estadísticamente significativo. La autoauditoría del informe de alta hospitalaria permite establecer líneas de mejora, al disminuir los errores de información (AU)
Background The discharge report is a basic document at the end of a care process, and is a key element in the coding process, since its correct wording, reliability and completeness are factors used to determine the hospital production. Material and methods From a hypothesis based on the analysis of the consistency between the discharge report and data collected from the routine clinical notes during admission, we should be able to re-code all those mis-coded, thus placing them in a more appropriate diagnosis-related group (DRG). A total of 24 patient outliers were analysed for the correct filling in of the type and reason for admission, personal history, medication, anamnesis, primary and secondary diagnosis, sugical procedure, outcome, number of diagnostic and procedures cited, concordance between discharge report and history and recoding of the DRG. Results From a total of 24 episodes, 6 had precise and valid reports, 4 were valid but not precise enough, 9 were insufficient, and 5 were clearly invalid. The recoded DRG after the documentation review was not significantly different, according to the Wilcoxon test, being changed in only 5 cases (P = .680).Conclusion Quality in discharge reports depends on an adequate minimum data set (MDS) in concordance with the source documentation during admission. Discordance can change the DRG, despite it not being significantly different in our series. Self-audit of discharge reports allows quality improvements to be developed along with a reduction in information mistakes (AU)
Subject(s)
Humans , Case Management/organization & administration , Patient Discharge/standards , Continuity of Patient Care/organization & administration , Surgery Department, Hospital/organization & administration , Hospital Information Systems/organization & administration , Clinical Coding/organization & administrationABSTRACT
BACKGROUND: The discharge report is a basic document at the end of a care process, and is a key element in the coding process, since its correct wording, reliability and completeness are factors used to determine the hospital production. MATERIAL AND METHODS: From a hypothesis based on the analysis of the consistency between the discharge report and data collected from the routine clinical notes during admission, we should be able to re-code all those mis-coded, thus placing them in a more appropriate diagnosis-related group (DRG). A total of 24 patient outliers were analysed for the correct filling in of the type and reason for admission, personal history, medication, anamnesis, primary and secondary diagnosis, sugical procedure, outcome, number of diagnostic and procedures cited, concordance between discharge report and history and recoding of the DRG. RESULTS: From a total of 24 episodes, 6 had precise and valid reports, 4 were valid but not precise enough, 9 were insufficient, and 5 were clearly invalid. The recoded DRG after the documentation review was not significantly different, according to the Wilcoxon test, being changed in only 5 cases (P = .680). CONCLUSION: Quality in discharge reports depends on an adequate minimum data set (MDS) in concordance with the source documentation during admission. Discordance can change the DRG, despite it not being significantly different in our series. Self-audit of discharge reports allows quality improvements to be developed along with a reduction in information mistakes.
Subject(s)
Hospital Units/organization & administration , Medical Records/standards , Patient Discharge , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative , Diagnosis-Related Groups , Humans , Quality ControlABSTRACT
Introducción: La desarterialización hemorroidal guiada por doppler (THD) es una técnica no exerética para el tratamiento de las hemorroides, consistente en la ligadura de las ramas distales de la arteria rectal superior. El propósito de este trabajo es evaluar la seguridad y eficacia de esta técnica tras un seguimiento de un año. Material y método Se intervienen 30 pacientes mediante THD por hemorroides sintomáticas grado II o III. La media de edad fue de 49,9 años (30-70 años). En todos se utilizó el dispositivo THD®. Los procedimientos se realizaron bajo anestesia intradural en régimen de corta estancia. Evaluamos tiempo operatorio, dolor, sangrado, estancia postoperatoria, complicaciones y síntomas tras 3-6 y 12 meses. Resultados El tiempo operatorio medio fue de 23 minutos (15-50). El valor de dolor según la escala visual analógica (EVA) fue durante el primer día de 5,5 (el 90% requirió analgesia). Tras el segundo día, sólo 2 pacientes necesitaron analgesia. Un paciente describió dolor persistente hasta los 3 meses, 2 sangrado leve. Una reintervención por trombosis hemorroidal al 10° día. No otras complicaciones. No reingresos. Estancia media: 1,4 días (0-2), y el restablecimiento de actividad diaria normal se realizó a los 7-8 días. 26 pacientes (87%) describen tenesmo, autolimitado en 3 meses. Tras un año, 2 pacientes han sido reintervenidos, 3 han recurrido (2 prolapsos leves y 1 sangrado ocasional). La tasa de resolución total fue del 80%.ConclusionesLa desarterialización hemorroidal guiada por doppler parece ser efectiva tras un año, con un porcentaje de complicaciones bajo (AU)
Introduction: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. Material and method: A total of 30 patients were operated on using DG-HAL for grade II or IIIhaemorrhoids. The mean age was 49.9 years (30-70 years). The THD1 (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. Results: The mean operating time was 23 minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10thday. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. Alarge majority (87%) of patients described having tenesmus, which disappeared in 3months.After one year, two patients had had further operations, 3 had recurrences (2 slightprolapses and 1 occasional bleeding). The success rate was 80%.Conclusions: Haemorrhoidal de arterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hemorrhoids/surgery , Ligation/methods , Peripheral Arterial Disease/surgery , Pain, Postoperative/epidemiology , Postoperative Hemorrhage/epidemiology , Surgery, Computer-Assisted/methods , Treatment OutcomeABSTRACT
INTRODUCTION: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. MATERIAL AND METHOD: A total of 30 patients were operated on using DG-HAL for grade II or III haemorrhoids. The mean age was 49.9 years (30-70 years). The THD® (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. RESULTS: The mean operating time was 23minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to 3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10(th) day. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. A large majority (87%) of patients described having tenesmus, which disappeared in 3 months. After one year, two patients had had further operations, 3 had recurrences (2 slight prolapses and 1 occasional bleeding). The success rate was 80%. CONCLUSIONS: Haemorrhoidal dearterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications.
