[Prevalence of tuberculosis infection in BCG-vaccinated and unvaccinated Mediterranean schoolchildren]. / Prevalencia de infección por tuberculosis en una población escolar mediterránea (con y sin vacunación antituberculosa).

OBJECTIVE: To determine the prevalence of tuberculous infection in schoolchildren in the province of Malaga, Spain, and to evaluate its relation to sociodemographic variables. POPULATION AND METHODS: Tuberculin skin tests were used to screen 6-year-olds in their first year of primary school in this cross-sectional study of the prevalence of infection, with calculation of 95% confidence interval (CI). Children who had not been vaccinated against tuberculosis at birth were considered to have a positive test result if they had an induration of >or=5 mm. Those who had received bacillus Calmette-Guerin (BCG) vaccination at birth were considered to have a positive test result if they had an induration size of >10 mm or >15 mm, depending on whether they came from a country with a high or low prevalence of tuberculosis, respectively. RESULTS: The prevalence of infection in the group of unvaccinated children was 1.16% (95% CI, 0.69%-1.63%). No statistically significant differences were found for any of the sociodemographic variables analyzed. The prevalence of infection in the BCG-vaccinated children was 6.66% (95% CI, 5.55%-7.77%). CONCLUSIONS: The prevalence of tuberculosis infection in our area is slightly higher than that reported after other studies conducted in Spain. This could indicate that tuberculosis continues to be a public health problem in the province of Malaga. Infection in the subgroup of BCG-vaccinated children, however, was lower than that observed in studies of immigrants in Spain who had been immunized at birth. This is probably because the majority of immigrants in our area come from countries with a low incidence of tuberculosis.

Prevalencia de infección por tuberculosis en una población escolar mediterránea (con y sin vacunación antituberculosa) / Prevalence of tuberculosis infection in BCG-vaccinated and unvaccinated mediterranean schoolchildren

Objetivo: Conocer la prevalencia de infección por tuberculosis en la población escolar de la Costa del Sol y valorar la relación de variables sociodemográficas con la prevalencia de infección tuberculosa. Población y métodos: Se trata de un estudio de corte transversal, en el que se realizó cribado tuberculínico a los niños de primer curso de primaria (6 años). El índice epidemiológico analizado fue la prevalencia de infección, con su intervalo de confianza (IC) del 95%. Se consideró positivo a la prueba de la tuberculina a todo niño que no había recibido la vacuna antituberculosa al nacer y que presentaba una induración igual o superior a 5 mm. En el subgrupo vacunado contra la tuberculosis al nacer se consideró positivos a los niños con induración superior a 10 mm o a 15 mm, según procediesen de países con elevada o baja prevalencia de tuberculosis, respectivamente. Resultados: La prevalencia de infección obtenida en el grupo de no vacunados fue del 1,16% (IC del 95%, 0,69-1,63%). No se encontraron diferencias estadísticamente significativas entre las variables analizadas. La prevalencia de infección en el subgrupo de vacunados fue del 6,66% (IC del 95%, 5,55-7,77%). Conclusiones: La prevalencia de infección tuberculosa en nuestra zona es ligeramente elevada en comparación con la observada en otros estudios realizados en nuestro país, lo que podría indicar que la tuberculosis sigue siendo un problema de salud pública en nuestra provincia. No ocurre así con el subgrupo de vacunados contra la tuberculosis, en el que, comparado con los de otros estudios realizados en nuestro país entre la población inmigrante vacunada al nacer, la prevalencia es baja, probablemente debido a que la mayoría de inmigrantes de la Costa del Sol proviene de países con baja incidencia de la enfermedad

Objective: To determine the prevalence of tuberculous infection in schoolchildren in the province of Malaga, Spain, and to evaluate its relation to sociodemographic variables. Population and methods: Tuberculin skin tests were used to screen 6-year-olds in their first year of primary school in this cross-sectional study of the prevalence of infection, with calculation of 95% confidence interval (CI). Children who had not been vaccinated against tuberculosis at birth were considered to have a positive test result if they had an induration of é5 mm. Those who had received bacillus Calmette­Guerin (BCG) vaccination at birth were considered to have a positive test result if they had an induration size of >10 mm or >15 mm, depending on whether they came from a country with a high or low prevalence of tuberculosis, respectively. Results: The prevalence of infection in the group of unvaccinated children was 1.16% (95% CI, 0.69%-1.63%). No statistically significant differences were found for any of the sociodemographic variables analyzed. The prevalence of infection in the BCG-vaccinated children was 6.66% (95% CI, 5.55%-7.77%). Conclusions: The prevalence of tuberculosis infection in our area is slightly higher than that reported after other studies conducted in Spain. This could indicate that tuberculosis continues to be a public health problem in the province of Malaga. Infection in the subgroup of BCG-vaccinated children, however, was lower than that observed in studies of immigrants in Spain who had been immunized at birth. This is probably because the majority of immigrants in our area come from countries with a low incidence of tuberculosis

[Arterial blood gases study in patients with stable chronic obstructive pulmonary disease in accordance with spirometric values]. / Gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica estable según los valores de la espirometría.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. PATIENTS AND METHOD: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was < or = 92%; we evaluated the best predicted FEV1 cut-off value. RESULTS: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. CONCLUSIONS: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases.

Gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica estable según los valores de la espirometría / Arterial blood gases study in patients with stable chronic obstructive pulmonary disease in accordance with spirometric values

Fundamento y objetivo: Conocer cuándo debemos realizar gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable según los valores espirométricos. Pacientes y método: Se ha realizado un estudio transversal en pacientes diagnosticados de EPOC, en fase estable, con espirometría y pulsioximetría. Se excluyó a los pacientes con asma, síndrome de apneas del sueño o insuficiencia respiratoria secundaria a otro proceso. Consideramos insuficiencia respiratoria si la saturación de oxígeno por pulsioximetría era del 92% o menor y analizamos el valor del volumen espiratorio forzado en el primer segundo (FEV1) en porcentaje del teórico que mejor sirve de punto de corte. Resultados: Incluimos a 467 pacientes, con una edad media (desviación estándar) de 64 (8) años y FEV1 medio del 44% (14%). Presentaron insuficiencia respiratoria 2 pacientes (1,5%) con FEV1 mayor del 50% y el 23,6% de los pacientes con FEV1 entre el 41 y el 50%. El punto de corte del FEV1 del 50% presentó una sensibilidad (0,98) y un valor predictivo negativo (0,98) superiores al punto de corte del FEV1 del 40% (sensibilidad de 0,75 y valor predictivo negativo de 0,87). Conclusiones: La proporción de pacientes con EPOC estable con insuficiencia respiratoria aumenta a partir de valores del FEV1 menores del 50%, por lo que aconsejamos realizar gasometría arterial a partir de este punto de corte

Background and objetive: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. Patients and method: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was ¾92%; we evaluated the best predicted FEV1 cut-off value. Results: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. Conclusions: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases

[Organization of visits in Spanish ICU]. / Organización de las visitas de familiares en las unidades de cuidados intensivos en España.

UNLABELLED: It is a fact that visits in the intensive care units (ICU) have always been very restrictive due to diverse criteria. Nowadays, some of them have been progressively liberalized, giving to the relatives more satisfaction and a better cover to their necessities. In our country there are no surveys about the organization of these visits at the present time, apart from some exceptional cases which commentate the situation in a particular center. OBJECTIVE: Know how are visits organized in the intensive cares units in Spain. DESIGN: cross-sectional study; scope: 98 ICU of different Spanish hospitals; studied variables: the number of visits, their duration, the number of relatives in each visit, the number of relatives visiting the patients at the same time, the amount of information each day, the professional that informs, the use of written information and information by telephone, preventive measures taken before the entry in the unit, how relatives take part in the cares, location of the waiting room and use or not of a protocol of attention to relatives. INSTRUMENTATION: The information has been obtained by a questionnaire placed in a web site of the Internet and directed to professionals of different Intensive cares units. RESULTS: The ninety and eight evaluated units represent 37 Spanish provinces from all the autonomous communities. The most frequently noticed pattern for the organization of visits shows a restrictive character of the visits in Spain. CONCLUSIONS: There are clear differences in the organization of visits between the studied ICU and no connection between the most common practice and what the survey, after evaluating the necessities of the relatives, recommends. These recommendations are: more visits, more flexibility of schedules, more integration of the relatives in the patients cares, broach the information from diverse disciplines, washing hands as the only necessary measure to be taken by the relatives.

Organización de las visitas de familiares en las unidades de cuidados intensivos en España / Organization of visits in Spanish ICU

Históricamente, las visitas en las unidades de cuidados intensivos (UCI) han sido muy restrictivas atendiendo a diversos criterios. En algunas de ellas se han liberalizado de forma progresiva propiciando mayor satisfacción en los familiares y mejor cobertura de sus necesidades. En nuestro entorno, no hemos encontrado estudios que reflejen la organización actual de dichas visitas, salvo casos concretos en los que se comenta la organización particular del centro en cuestión. Objetivo: Conocer cómo se organizan las visitas en las UCI en España. Material y método: Estudio transversal, realizado en el ámbito de 98 UCI de distintos hospitales españoles. Se estudiaron las siguientes variables: número de visitas diarias; duración de éstas; número de familiares en cada visita; número de familiares que visitan a los pacientes de forma simultánea; número de informaciones diarias; profesional que informa; utilización de información escrita y telefónica; medidas preventivas previas a la entrada en la unidad; implicación de los familiares en los cuidados; localización de la sala de espera y utilización o no de protocolo de atención a familiares. Los datos se obtuvieron mediante un cuestionario ofrecido a través de una página web en Internet a los profesionales de las distintas UCI participantes. Se realizó un análisis de distribución de frecuencias de las variables discretas estudiadas. Resultados: Las 98 unidades valoradas representan a 37 provincias españolas repartidas por todas las comunidades autónomas. El patrón organizativo de las visitas más frecuentemente observado refleja un carácter restrictivo de las visitas en España. Conclusiones: La organización de las visitas de familiares en las UCI españolas es muy variable. El patrón habitual es restrictivo y no se corresponde con las recomendaciones surgidas del análisis de la evidencia disponible: «más visitas, mayor libertad de horarios, mayor implicación de los familiares en los cuidados de los pacientes y un abordaje multidisciplinar de la información»

It is a fact that visits in the intensive care units (ICU) have always been very restrictive due to diverse criteria. Nowadays, some of them have been progressively liberalized, giving to the relatives more satisfaction and a better cover to their necessities. In our country there are no surveys about the organization of these visits at the present time, apart from some exceptional cases which commentate the situation in a particular center. Objective: know how are visits organized in the intensive cares units in Spain. Material and method: Design: cross-sectional study; scope: 98 ICU of different Spanish hospitals; studied variables: the number of visits, their duration, the number of relatives in each visit, the number of relatives visiting the patients at the same time, the amount of information each day, the professional that informs, the use of written information and information by telephone, preventive measures taken before the entry in the unit, how relatives take part in the cares, location of the waiting room and use or not of a protocol of attention to relatives. Instrumentation: The information has been obtained by a questionnaire placed in a web site of the Internet and directed to professionals of different Intensive cares units. Results: The ninety and eight evaluated units represent 37 Spanish provinces from all the autonomous communities. The most frequently noticed pattern for the organization of visits shows a restrictive character of the visits in Spain. Conclusions: There are clear differences in the organization of visits between the studied ICU and no connection between the most common practice and what the survey, after evaluating the necessities of the relatives, recommends. These recommendations are: more visits, more flexibility of schedules, more integration of the relatives in the patients cares, broach the information from diverse disciplines, washing hands as the only necessary measure to be taken by the relatives

Readmission rate as an indicator of hospital performance: the case of Spain.

OBJECTIVES: Hospital readmission rate is currently used as a quality of care indicator, although its validity has not been established. Our aims were to identify the frequency and characteristics of potential avoidable readmissions and to compare the assessment of quality of care derived from readmission rate with other measure of quality (judgment of experts). DESIGN: cross-sectional observational study; SETTING: acute care hospital located in Marbella, South of Spain; STUDY PARTICIPANTS: random sample of patients readmitted at the hospital within six months from discharge (n = 363); INTERVENTIONS: review of clinical records by a pair of observers to assess the causes of readmissions and their potential avoidability; MAIN MEASURES: logistic regression analysis to identify the variables from the databases of hospital discharges which are related to avoidability of readmissions. Determination of sensitivity and specificity of different definitions of readmission rate to detect avoidable situations. RESULTS: Nineteen percent of readmissions were considered potentially avoidable. Variables related to readmission avoidability were (i) time elapsed between index admission and readmission and (ii) difference in diagnoses of both episodes. None of the definitions of readmission rate used in this study provided adequate values of sensitivity and specificity in the identification of potentially avoidable readmissions. CONCLUSIONS: Most readmissions in our hospital were unavoidable. Thus, readmission rate might not be considered a valid indicator of quality of care.

[Non invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis]. / Metaanálisis de la eficacia de la ventilación no invasiva en la exacerbación aguda de la enfermedad pulmonar obstructiva crónica.

BACKGROUND AND OBJECTIVES: The purpose of this study was: 1) To determine the effect of non invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure, and 2) To find out whether there are differences in the results according to the site where ventilation in applied. PATIENTS AND METHOD: Meta-analysis of randomized controlled trials (RCTs) published included studies in MEDLINE, EMBASE, Cochrane Controled Trials Register and Teseo. Study selection included RCTs in COPD patients with acute respiratory failure with PaCO2 > 45 mmHg or pH < 7.35, with underwent NIV versus standard therapy. Mortality, rate of tracheal intubation and length of stay were analized. Individual studies were rated as to their validity and quality by two investigators using the Jadad score. A different meta-analysis was made for intensive-care unit (ICU) RCTs and wards RCTs. RESULTS: Five ICU RCTs and four ward RCTs were included. There was a reduction in hospital mortality (ICU, OR = 0.35; 95% confidence interval [CI], 0.15 to 0.83; n = 166; p = 0.02; ward, OR = 0.39; 95% CI, 0.20 to 0.76; n = 296; p = 0.005) and in the need for intubation (ICU, OR = 0.18; 95% CI, 0.10 to 0.35; n= 219; p < 0,00001; ward, OR = 0.43; IC 95%, 0.24-0.78; n = 270; p = 0.006). Length of stay was lower in the NIV group upon ICU trials (WMD, 3.7 days; 95% CI, 5.46 to 1.93 days). Only one ward RCT showed significant differences in the length of stay. Published data did not allow a meta-analysis for length of stay. CONCLUSIONS: NIV decreases mortality and the need for intubation in COPD patients with acute respiratory failure both in ICU and ward. In ICU non-invasive ventilation decreases the length of stay too.

Metaanálisis de la eficacia de la ventilación no invasiva en la exacerbación aguda de la enfermedad pulmonar obstructiva crónica / Non invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis

FUNDAMENTO Y OBJETIVOS: Valorar la eficacia de la ventilación no invasiva (VNI) en la enfermedad pulmonar obstructiva crónica (EPOC) en fracaso respiratorio agudo (FRA) y saber si hay diferencias en los resultados en función del lugar de aplicación. MATERIAL Y MÉTODO: Se realizó un metaanálisis de ensayos controlados aleatorizados (ECA) publicados en Medline, EMBASE, Registro de Ensayos Clínicos Controlados de la Colaboración Cochrane y Teseo hasta junio de 2002. Se efectuó una selección de los ECA en EPOC con FRA y pH sanguíneo 45 mmHg, con VNI frente a tratamiento estándar, y se analizaron mortalidad, tasa de intubación y días de estancia. La validez y calidad de los ECA fueron analizadas por dos investigadores con la escala de Jadad. Realizamos metaanálisis diferentes para los estudios de unidades de cuidados intensivos (UCI) y planta. RESULTADOS: Se incluyeron 5 ECA de UCI y 4 de planta. Se encontró una reducción de la mortalidad (UCI, odds ratio [OR] = 0,35; intervalo de confianza [IC] del 95 por ciento, 0,15-0,82; n = 166; p = 0,02; planta, OR = 0,40; IC del 95 por ciento, 0,21-0,75; n = 330; p = 0,005) y del número de intubaciones (UCI, OR = 0,18; IC del 95 por ciento, 0,10-0,35; n = 219; p < 0,00001; planta, OR = 0,43; IC del 95 por ciento, 0,24-0,78; n = 270; p = 0,006). La estancia media fue menor en UCI (diferencia media ponderada de -3,7 días; IC del 95 por ciento, -5,46 a -1,93; n = 196; p = 0,00004).Sólo un ECA de planta demostró diferencias entre ambos grupos en la estancia media; los datos publicados no permitieron realizar metaanálisis acerca de la estancia. CONCLUSIONES: La VNI reduce la mortalidad y la necesidad de intubación en pacientes con EPOC en FRA cuando se aplica tanto en UCI como en planta. En la UCI la VNI reduce también los días de hospitalización (AU)

Bombas volumétricas para transfusiones sanguíneas. Viabilidad en pediatría / Volumetric pumps for blood transfusions. Their viability in pediatrics

Se determina si Enfermería puede utilizar bombas de perfusión en transfusión de concentrado de hematíes en Pediatría, midiendo el grado de hemólisis en dos modelos distintos. Metodología: Unidad de estudio: Transfusiones de concentrado de hematíes por bomba de infusión a niños en U.C.I.P., H.M.I. Granada. Variable dependiente. Grado hemólisis, medido mediante: Hemoglobina libre, Potasio, LDH. Variables independientes: bomba; Antigüedad sangre; Hematócrito; Calibre catéter; Tipo vía; Presión de trabajo bomba; Ritmo otras perfusiones; Ritmo infusión. Tamaño muestra. Población de un año, nivel de confianza 95 por ciento, prevalencia de hemólisis esperada 0,50, precisión +-0,05 (precisión relativa 10 por ciento). Recogida datos. Realizamos dos muestras por transfusión: Extracción de bolsa, Extracción extremo distal sistema. Tipo investigación. Estudio descriptivo prospectivo. Análisis estadístico. Estadística descriptiva, mediante distribución frecuencias. Análisis variante. Análisis multivariante. Resultados: De 55 observaciones, 50,9 por ciento correspondió a la bomba 1. El análisis de regresión lineal simple mostró diferencias en grado de hemólisis en diferencia de hemoglobina libre y hematócrito. La antigüedad de sangre registró mayor nivel de hemólisis en diferencia de hemoglobina libre y hematócrito. La antigüedad de sangre registró mayor nivel de hemólisis encima del percentil 75. La mayor hemólisis en diferencia de potasio se asoció al tipo de vía, con promemdio de 0,44 mEq/l, a existencia de otras perfusiones, mayor ritmo (p=0,118), antigüedad de sangre (p = 0,008) y hematócrito (p = 0,117). En regresión lineal múltiple, a igualdad de predictoras: para diferencia de hemoglobina, un promedio de 3,87 mg/l (p = 0,661), de potasio, 0,39 mEq/1 (p = 0,138), de LDH 53,6 (p = 0,568). Los documentos que prueban la validez del estudio han sido consultados por el Consejo de Redacción de ROL y pueden solicitarse a los autores (AU)