Quality of trauma care and trauma registries.

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research.

[Parenteral periferic nutrition: non surgical indications]. / Indicaciones no quirúrgicas de la nutrición parenteral periférica.

INTRODUCTION: Peripheral Parenteral Nutrition, defined as a mixture of micronutrients, vitamins and minerals with lower osmolarity of 800 mOsm/L, it avoids the risk of the central catheter. It has traditionally been used in postoperative patients, but really medical conditions can also benefit from it either as complementary, or as the only one source of nutrients, since a high number of patients require less caloric intake than previously believed. OBJECTIVE: Evaluation of the use of peripheral parenteral nutrition in non postoperative hospitalized patients, reasons for its prescription and duration. MATERIAL AND METHODS: 368 patients who required peripheral parenteral nutrition were studied by the Nutrition Support Unit for 54 months, in a Tertiary Hospital of 1,560 beds, from all, specialties excluding postoperative patients. The study include the mechanisms that led to its use in all its forms: the only one nutritional support or complementing insufficient Enteral Nutrition or Oral Diet. RESULTS: Oncology and Critical Care were the most prescribed pathologies, followed by Pancreatitis, Inflammatory Bowel Disease and HIV and a miscellany of clinical pathologies. Gastrointestinal pathology (pain, diarrhea or vomiting) was the most frequent cause, both in critically ill as in non-critical patients. CONCLUSIONS: Although enteral route is preferred and raised primarily in most patients studied, there are many causes that might impair or nullify it. Peripheral parenteral nutrition is an alternative when caloric intake is impossible or insufficient or refused by the patient, as it minimizes the complications of the central catheter.

Indicaciones no quirúrgicas de la nutrición parenteral periférica / Parenteral periferic nutrition: non surgical indications

Introducción: La Nutrición Parenteral Periférica, definida como la mezcla de macronutrientes, vitaminas y minerales con osmolaridad menor de 800 mOsm/L, permite evitar los riesgos del catéter central. Clásicamente ha sido utilizada en postoperados, pero actualmente la patología médica también puede beneficiarse de ella, bien como única fuente de nutrientes, ya que un alto porcentaje de pacientes precisan menor aporte calórico de lo que se creía, o como complementaria. Objetivo: Evaluación de la utilización de la Nutrición Parenteral Periférica en pacientes hospitalizados no postoperados, razones de su prescripción y su duración. Material y método: Se estudiaron 368 pacientes de todas las especialidades sin incluir postoperados con Nutrición Parenteral Periférica prescrita por la Unidad de Nutrición en un Hospital Terciario de 1.560 camas durante 54 meses, estudiándose los mecanismos que llevaron a su utilización en todas sus variantes: soporte único nutricional o complementando a Nutrición Enteral o Dieta Oral insuficiente. Resultados: Las patologías en las que se ha prescrito más frecuentemente han sido la Oncológica y Críticos, siguiendo en número la Pancreatitis, Enfermedad Inflamatoria Intestinal y VIH y una miscelánea de cuadros clínicos. La causa más frecuente ha sido la patología digestiva (dolor, diarrea o vómitos) tanto en pacientes críticos como en no críticos. Conclusiones: Aunque la vía enteral es de elección y así se ha planteado primariamente en la mayoría de los pacientes del estudio, existen múltiples causas que la impiden total o parcialmente. La Nutrición Parenteral Periférica es una alternativa cuando la ingesta es imposible o insuficiente o existe negativa por parte del enfermo, ya que minimiza las complicaciones al no precisar vía central (AU)

Introduction: Peripheral Parenteral Nutrition, defined as a mixture of micronutrients, vitamins and minerals with lower osmolarity of 800 mOsm/L, it avoids the risk of the central catheter. It has traditionally been used in postoperative patients, but really medical conditions can also benefit from it either as complementary, or as the only one source of nutrients, since a high number of patients require less caloric intake than previously believed. Objective: Evaluation of the use of peripheral parenteral nutrition in non postoperative hospitalized patients, reasons for its prescription and duration. Material and methods: 368 patients who required peripheral parenteral nutrition were studied by the Nutrition Support Unit for 54 months, in a Tertiary Hospital of 1,560 beds, from all, specialties excluding postoperative patients. The study include the mechanisms that led to its use in all its forms: the only one nutritional support or complementing insufficient Enteral Nutrition or Oral Diet. Results: Oncology and Critical Care were the most prescribed pathologies, followed by Pancreatitis, Inflammatory Bowel Disease and HIV and a miscellany of clinical pathologies. Gastrointestinal pathology (pain, diarrhea or vomiting) was the most frequent cause, both in critically ill as in non-critical patients. Conclusions: Although enteral route is preferred and raised primarily in most patients studied, there are many causes that might impair or nullify it. Peripheral parenteral nutrition is an alternative when caloric intake is impossible or insufficient or refused by the patient, as it minimizes the complications of the central catheter (AU)

[Nosocomial infective endocarditis in patients without hear prosthesis]. / Endocarditis infecciosa nosocomial en pacientes sin prótesis cardíaca.

BACKGROUND: Infective endocarditis is a complication of nosocomial bacteremia and is associated with a high mortality rate. The objective of the present study was to know the clinical and microbiological characteristics of nosocomial endocarditis (NE) diagnosed in a general hospital in a five-year period. PATIENTS AND METHODS: Twenty-one patients diagnosed of NE following Durack's criteria at Juan Canalejo Hospital from January 1990 to January 1995 were studied. Endocarditis in patients with cardiac valve prosthesis were excluded. RESULTS: NE represented 12% of the total endocarditis cases diagnosed during the study period. The mean age of patients was 52.6 years (range: 17-79 years) and male accounted for 81% of cases. NE was related to an intravascular catheter in 85.7% of cases, whereas a urinary source was found in 14.3%. Staphylococcus aureus was the microorganism recovered most frequently (62%), followed by Staphylococcus epidermidis (20%), which was always associated with intravascular catheters. Left valve involvement predominated (76.2%) and the involvement of right cavities was detected exclusively in patients with an intravascular catheter as known source of NE. Transoesophageal echocardiography detected vegetations in 19% of cases in which transthoracic echography failed to identify them. Surgery was required by 28.5% of patients and its indication was always congestive heart failure refractory to medical treatment. The overall mortality rate was 28.5%, compared with 26.8% in community acquired endocarditis. Two patients with Candida spp. endocarditis were not treated surgically and the outcome was satisfactory. CONCLUSIONS: Nosocomial endocarditis represent a significant percentage of endocarditis once endocarditis on prosthetic cardiac valves has been excluded. To remark Staphylococcus spp. in the etiology of this entity, the intravascular catheter as risk factor, and left cavities as location. Transoesophageal echocardiography is of great diagnostic usefulness. In contrast with reports in literature, the mortality rate in our series was similar to that of community endocarditis.