[Clinical and performance results of functional endoscopic sinus surgery]. / Resultados clínicos y asistenciales de la cirugía endoscópica nasosinusal.

Our aim was to know the clinical performance and management results of Functional Endoscopic Sinus Surgery (FESS) in Spanish hospitals. We sent a survey on the use and results of FESS to 160 Spanish public hospitals in June of 2002, obtaining a response rate of 69%. 82.9% of the interviewed hospitals carried out FESS and 17.1% of the remaining used the classic techniques of approaching the paranasal sinuses. The reported length of stay in hospital was 1.4 days for the FESS and 2.4 for the traditional surgery. The surgical time was 15 minutes shorter for the CENS, and the rate of recurrence was 16% less than for the classic surgery. As years of experience in the practice of the CENS go by, the surgical times tend to decrease, that didn't happen with the rate of recurrence. In conclusion, we consider that FESS seems to improve the analyzed clinical performance and assistential results.

[The implementation of endoscopic sinus surgery in Spain]. / Implantación de la cirugía endoscópica nasosinusal en España.

The purpose of this study is to find out more about the implementation of functional endoscopic sinus surgery (FESS) in our country. To do that, we designed a survey which was sent to 160 public hospitals (June 2002). We received the answers of 111 hospitals. 82.9% of hospitals and 58% of surgeons performed FESS, with some differences among autonomic regions. The percentage of surgeons who performed FESS was higher in small hospitals and their mean experience time was 6.2 years. We consider the implementation of endoscopic sinus surgery very high, this can reflect that there are evident advantages for those who specialists who use it.

Resultados clínicos y asistenciales de la cirugía endoscópica nasosinusal / Clinical and performance results of functional endoscopic sinus surgery

Nuestro objetivo fue conocer los resultados clínicos y asistenciales de la Cirugía Endoscópica Nasosinusal (CENS) en hospitales españoles. Enviamos una encuesta sobre su utilización y resultados a 160 hospitales públicos españoles en junio de 2002, obteniendo una tasa de respuesta del 69 por ciento de los centros. El 82,9 por ciento de los hospitales encuestados realizaba CENS y el 17,1 por ciento restante utilizaba las técnicas clásicas de abordaje de senos paranasales. La estancia media hospitalaria declarada fue de 1,4 días para la CENS y 2,4 para la cirugía tradicional. El tiempo quirúrgico medio fue 15 minutos menor para la CENS, obteniéndose un 16 por ciento menos de recidivas frente a la cirugía clásica. A más años de experiencia en la práctica de la CENS, los tiempos quirúrgicos tienden a reducirse, lo que no ocurrió con el porcentaje de recidivas. En conclusión, consideramos que la CENS parece mejorar los parámetros clínicos y asistenciales analizados (AU)

Our aim was to know the clinical performance and management results of Functional Endoscopic Sinus Surgery (FESS) in Spanish hospitals. We sent a survey on the use and results of FESS to 160 Spanish public hospitals in June of 2002, obtaining a response rate of 69%. 82.9% of the interviewed hospitals carried out FESS and 17.1% of the remaining used the classic techniques of approaching the paranasal sinuses. The reported length of stay in hospital was 1.4 days for the FESS and 2.4 for the traditional surgery. The surgical time was 15 minutes shorter for the CENS, and the rate of recurrence was 16% less than for the classic surgery. As years of experience in the practice of the CENS go by, the surgical times tend to decrease, that didn't happen with the rate of recurrence. In conclusion, we consider that FESS seems to improve the analyzed clinical performance and assistential results (AU)

[Organizational characteristics of primary care and hospitalization for to the main ambulatory care sensitive conditions]. / Características organizativas de la atención primaria y hospitalización por los principales ambulatory care sensitive conditions.

OBJECTIVES: To describe the variability in hospitalisation rates because of the most common ambulatory care sensitive conditions (ACSC), by town and gender; b) to describe the influence on these rates of the characteristics of primary care (reformed or non-reformed model and kind of centre), the health level of the population, geographical accessibility and other factors of a social and economic nature. DESIGN: Observational, cross-sectional study of hospital discharges and ecological study for the analysis of rates between towns. MAIN MEASUREMENTS: The rates of hospitalisation by gender for each ACSC (1997-1999), standardised for age through the indirect method by calculating the standardised rate ratios (SRR). The multivariate analysis used Poisson regression. RESULTS: In the diagnoses studied, 41% of the towns had the same number of cases observed and expected for hospitalisation of men; and 65%, for women. Chronic obstructive pulmonary disease in men and heart failure in women were the illnesses that most varied. Hospitalisation rates for most illnesses were higher in towns without a health centre or with a non-reformed model, with over 3000 inhabitants and closer to hospital, although distance from the hospital was an influential factor only in bigger towns. CONCLUSIONS: There is variability between towns in hospitalisation rates for the most common ACSC; b) the differences in hospitalisation rates for the ACSC studied are linked to organisational features of primary care, the size of the town and the distance from the hospital.

Implantacion de la cirugía endoscopica nasosinusal en España / The implementation of endoscopic sinus surgery in Spain

El objetivo del trabajo es conocer la implantación existente de la Cirugía Endoscópica Nasosinusal (CENE) en nuestro país. Para ello, se diseñó una encuesta que se envió a 160 hospitales de la red pública española (junio / 2002). Se obtuvo una participación de 111 hospitales; de los cuales el 82,9 por ciento realizaban CENS con un porcentaje de especialistas implicados en la técnica del 58 por ciento, existiendo algunas diferencias entre Comunidades Autónomas. En los hospitales más pequeños el porcentaje de facultativos que realizaban CENS fue mucho mayor que en los grandes hospitales regionales. La experiencia media obtenida se situó en 6,2 años. Consideramos que el grado de implantación de CENS obtenido es muy elevado, lo que puede reflejar que las ventajas de su uso son muy evidentes para los clínicos que la utilizan (AU)

The purpose of this study is to find out more about the implementation of functional endoscopic sinus surgery (FESS) in our country. To do that, we designed a survey which was sent to 160 public hospitals (June 2002). We received the answers of 111 hospitals. 82.9% of hospitals and 58% of surgeons performed FESS, with some differences among autonomic regions. The percentage of surgeons who performed FESS was higher in small hospitals and their mean experience time was 6.2 years. We consider the implementation of endoscopic sinus surgery very high, this can reflect that there are evident advantages for those who specialists who use it (AU)

Lifestyles, environmental and phenotypic factors associated with lip cancer: a case-control study in southern Spain.

The aim of this study was to identify factors related to lip cancer (LC) considering individual characteristics and sociodemographic factors. A case-control study was carried out in the province of Granada (Andalusia, southern Spain). The cases were 105 males with squamous-cell carcinoma of the lip, diagnosed between 1987 and 1989 (aged 20-70 years) and identified by means of a population-based Cancer Registry. As controls, a randomised populational sample of 239 males, stratified by age, was used. Multiple logistic regression analysis showed that risk factors are lifetime cumulative tobacco consumption and alcohol consumption. An interaction was found between alcohol consumption and the smoking habit (leaving the cigarette on the lip): OR=23.6; 95% CI: 3.9-142.0. Other risk factors identified are clear eyes (OR=3.5; CI: 95% 1.5-8.0), sun exposure early in life and cumulative sun exposure during outdoor work (OR=11.9; 95%: CI: 1.3-108.9), and skin reaction to sun exposure (Fitzpatrick levels). Another interaction was found between skin reaction and a previous history of common sporadic warts (OR=4.4; 95% CI: 1.01-19.1). We conclude that LC is related to phenotype, skin reaction to sun exposure, cumulative and early sunlight exposure, and tobacco and alcohol consumption, as well as a low educational level. Leaving the cigarette on the lip is predictive of LC risk irrespective of cumulative tobacco consumption.

[Analysis of admissions for chronic obstructive pulmonary disease in Andalusia in 2000]. / Análisis de los ingresos por enfermedad pulmonar obstructiva crónica en Andalucía, año 2000.

OBJECTIVE: To analyze the impact of admissions for chronic obstructive pulmonary disease (COPD) in Andalusia during 2000. METHODS: All patients with DRG codes 088 and 541, which would receive ICD-9 codes 491, 492, 493.2, 494 and 496 in the cause of admission field, were extracted from the Minimum Basic Data Set for Andalusia. We compiled descriptive statistics from these data, calculated the cost per day of hospitalization for our own hospital, and then extrapolated to estimate the cost for Andalusia. RESULTS: COPD exacerbations generated 10,386 admissions in 2000, leading to 117,011 days of hospitalization. Eighty-three percent of the patients were men and the mean age was 70 12 years. The average hospital stay was 11 10 days. Huelva was the province with the shortest hospital stay (9 days). Mortality was 6.7%. The minimum expenditure generated was E 27 million, not counting the cost of intensive care unit admissions. CONCLUSIONS: Admissions due to COPD have great impact on the Andalusian health care system. Further studies are needed to evaluate alternatives to hospitalization.

Violencia doméstica y profesionales sanitarios: conocimientos, opiniones y barreras para la infradetección / Domestic violence and sanitaries professionals: knowledge, opinions and barriers for the low detection

Objetivos: A pesar de las mejoras de coordinación entre los servicios de salud, más del 70 por ciento de los casos de Violencia Doméstica (VD) siguen siendo invisibles a ojos de los sanitarios. Pretendemos conocer el grado de formación que sobre el tema tienen los profesionales sanitarios, detectar barreras de actitud, barreras organizativas de los servicios y analizar opiniones de mejora frente al problema de la infradetección. Métodos: Encuesta anónima dirigida a 116 profesionales de un servicio de urgencias hospitalario (médicos, enfermeras y auxiliares), valorando los objetivos propuestos. Resultados: La participación fue del 74 por ciento. En un test de conocimientos solo se obtuvo un 51,1 por ciento de respuestas correctas. Las principales barreras de actitud fueron la desmotivación y desconocimiento. Hasta un 66 por ciento de los profesionales no suelen plantearse la VD como un diagnóstico diferencial más en su actividad diaria y más del 50 por ciento de los sanitarios no plantea soluciones al problema. Como barreras organizativas destacan una creciente presión asistencial que limita el tiempo de asistencia y la ausencia de personal experto durante las 24 horas de trabajo. Conclusiones: La VD sigue siendo una auténtica desconocida para los sanitarios de urgencias, considerándola más como un problema social que sanitario. Elaborar planes formativos periódicos es una buena medida pero insuficiente para paliar la infradetección. Es necesario además, controlar la presión asistencial, formar un "grupo de expertos en VD" que asesoren, supervisen y participen en la actividad clínica diaria y crear un sistema de vigilancia activa que monitorice y detecte problemas de mejora (AU)

Análisis de los ingresos por enfermedad pulmonar obstructiva crónica en Andalucía, año 2000 / Analysis of admissions for chronic obstructive pulmonary disease in Andalusia in 2000

OBJETIVO: Analizar el impacto que han tenido los ingresos por enfermedad pulmonar obstructiva crónica (EPOC) en Andalucía durante el año 2000. MÉTODOS: Se seleccionaron del Conjunto Mínimo Básico de Datos de Andalucía 2000 todos los pacientes con el código GRD 088 y aquellos con GRD 541 que tuvieran como causa de ingreso algunos de estos códigos CIE-9: 491, 492, 493.2, 494 y 496. Con estos datos se realizó un estudio descriptivo. Posteriormente, se realizó el cálculo del coste de una estancia en nuestro centro y se extrapoló al resto de Andalucía, calculando el coste mínimo generado. RESULTADOS: Durante el año 2000 hubo 10.386 ingresos por reagudización de EPOC, lo que generó 117.011 estancias. El 83 per cent de los ingresos fueron varones. La edad media fue de 70 ñ 12 años. La estancia media fue de 11 ñ 10 días. La provincia con la estancia menor fue Huelva con 9 días. La mortalidad fue del 6,7 per cent. El gasto sanitario mínimo generado fue de 27 millones de euros (4.500 millones de pesetas), sin contar con las estancias de UCI. CONCLUSIONES: Los ingresos por EPOC generan un gran impacto asistencial y económico en la sanidad andaluza. Son necesarios estudios que valoren otras alternativas al ingreso (AU)

[Volumetric pumps for blood transfusions. Viability in pediatrics]. / Bombas volumétricas para transfusiones sanguíneas. Viabilidad en pediatría.

UNLABELLED: The authors determine whether or not nurses should use perfusion pumps for concentrated hematin transfusions, measuring the degree of hemolysis which occurs in two distinct models. STUDY SAMPLE: Concentrated hematin transfusions by means of an infusion pump on children in a Pediatrics Intensive Care Unit at the Maternity-Pediatrics Ward in Granada. Dependent Variable: Degree of Hemolysis, measured by means of: free hemoglobin, potassium, LDH. INDEPENDENT VARIABLES: Pump; dated/used blood; hematocrit; catheter caliber; type of procedure; pump working pressure; other perfusion rhythms; infusion rhythm. Sample size. One year study group, 95% confidence rate, 0.50 prevalence of awaited hemolysis, +/- 0.05 precision (relative precision 10%). Data Obtained: Two samples are taken per transfusion: removal of blood bag, extreme distal removal system. Investigative Method: Prospective descriptive study. STATISTICAL ANALYSIS: Descriptive statistics, by means of frequency distributions. Variable analysis, multiple variable analysis. RESULTS: 55 observations were carried, of these, 50.9% corresponded to pump number one. Simple regression linear analysis showed differences in the degree of hemolysis in terms of free hemoglobin and hematocrit. Dated/used blood registered a higher hemolysis level above 75 percentile. The greater hemolysis in terms of potassium difference was associated with the type of procedure, having an average of 0.44 mEq/l, in presence of other perfusions, greater rhythm (p = 0.118), dated/used blood (p = 0.008), hematocrit (p = 0.063). The greatest difference in LDH occurred with smaller caliber catheters, other perfusions, more dated blood (p = 0.117). In multiple linear regression, results were equal to those predicted: an average difference in hemoglobin of 3.87 mg/l (p = 0.661); in potassium, 0.39 mEq/l (p = 0.138); in LDH, 53.6 (p = 0.568). This documents with verify this study have been consulted by the ROL Editorial Board and may be requested from the authors.