Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean: Análisis Parcial de Costos e Impacto Económico de la Angioplastia Coronaria Ambulatoria en un Hospital Privado del Caribe.

OBJECTIVES: This study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022. METHODS: This study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a "first-come-first-served" approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient. RESULTS: PCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference. CONCLUSIONS: PCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.

Prospective study about the security and efficacy of treatment without antibiotic therapy of patients diagnosed with acute uncomplicated diverticulitis after launching a protocol at a tertiary hospital.

INTRODUCTION: The main objective of our study is to analyze the results in our hospital after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis. METHODS: Our observational, prospective, single-center study was developed after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis (AUD) in January 2021. The follow-up period was from January 1, 2021 to September 30, 2023. Variables evaluated by the study have included demographic and analytical variables, as well as those related to diagnosis and whether the patients needed to start antibiotic treatment, inpatient treatment, or surgical procedures. RESULTS: In total, 199 patients were diagnosed with AUD, 75 of whom were treated without antibiotic therapy as outpatients. Seven of these patients needed to start antibiotic treatment because of adverse evolution; none of these patients required surgical procedures. The need for inpatient treatment, urgent care, or surgical procedures is similar to the group of patients treated with antibiotics. The main risk factor of failure of outpatient treatment without antibiotic therapy identified by the study was the presence of bacteriuria at diagnosis. CONCLUSIONS: Our results confirm previous reports, observing that treatment without antibiotic therapy in selected patients with AUD is safe.

Orientaciones para el manejo ambulatorio de adultos que viven con VIH en Chile / Guidelines for the primary care of adult people living with HIV in Chile

El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.

Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.

Vancomicina contra metronidazol en infección por Clostridioides difficile leve-moderada de manejo ambulatorio / Vancomycin or metronidazole in the outpatient treatment of mild-moderate Clostridioides difficile infection

INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.

BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.

Resultados de una encuesta nacional sobre el manejo de los pacientes diagnosticados de diverticulitis aguda no complicada / Results of a national survey about the management of patients with acute uncomplicated diverticulitis

Introducción: El manejo de los pacientes diagnosticados de diverticulitis aguda no complicada ha evolucionado en los últimos años, y según diversas guías clínicas internacionales actuales, el tratamiento ambulatorio y sin antibioterapia puede ser utilizado en pacientes seleccionados. El objetivo de este estudio es evaluar la adhesión de los distintos centros nacionales a estas y otras recomendaciones en esta enfermedad. Métodos: Se realizó una encuesta online a nivel nacional que se dio a conocer a través de diversas aplicaciones informáticas y se analizaron estadísticamente los resultados obtenidos. Resultados: Participaron 104 cirujanos, representando 69 centros hospitalarios nacionales. En el 82,6% de los centros, se realiza manejo ambulatorio de los pacientes diagnosticados de diverticulitis aguda no complicada. El 23,2% de los centros tiene implantado un protocolo de tratamiento sin antibioterapia en pacientes seleccionados, mientras que en los centros que no siguen estas recomendaciones, las razones principales son las dificultades logísticas para su desarrollo (49,3%) y la ausencia de evidencia actual para ello (44,8%). Se han encontrado diferencias estadísticamente significativas al comparar la implantación de dichos protocolos entre centros con unidades acreditadas avanzadas y aquellas que no, con mayores tasas de manejo ambulatorio y sin antibioterapia en los centros acreditados avanzados (p≤0,05). Conclusiones: A pesar de ser una enfermedad muy frecuente, existe mucha heterogeneidad en su tratamiento a nivel nacional, por lo que sería recomendable la unificación de criterios diagnósticos y de tratamiento mediante la colaboración de las sociedades científicas y la simplificación de la puesta en marcha de protocolos hospitalarios.(AU)

Introduction: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesion among national centres to these and others recommendations related to this pathology. Methods: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. Results: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centers, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centers that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centers with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (P≤.05). Conclusions: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.(AU)

Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares / Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

Objetivo mostrar la efectividad y seguridad del sevoflurano tópico tras la administración ambulatoria y prolongada en los pacientes con úlceras vasculares refractarias. Métodos estudio observacional retrospectivo de pacientes con úlceras vasculares dolorosas refractarias a terapias habituales y que fueron tratados con sevoflurano tópico durante al menos 36 meses. Se recogieron las variables: edad, sexo, antecedentes médicos, comorbilidad asociada, etiología de úlcera y tratamiento médico. Se analizó la mejoría clínica y la variación de la superficie de las úlceras vasculares. Para cuantificar la intensidad del dolor basal e irruptivo antes y después del tratamiento se utilizó la escala visual analógica. Resultados del total de pacientes tratados, 9 cumplían los criterios de inclusión. La edad media fue de 74,8 ± 7,5 años. Los casos 2 y 9 fallecieron durante el seguimiento. La acción analgésica del sevoflurano tópico fue rápida (3,1 ± 2,1 min), intensa (escala visual analógica: 7 ± 1,1 a 1,4 ± 1,1 puntos) y duradera (de 6 a 24 h). Salvo el caso 4, todos experimentaron una reducción de la superficie (15,1 ± 5,0 a 2,7 ± 4,2) de las úlceras vasculares y no se observó tolerancia a lo largo del tiempo. Conclusión la aplicación de sevoflurano tópico es una estrategia analgésica y reepitelizante para las úlceras vasculares que presenta un perfil correcto de seguridad (AU)

Objective To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. Methods Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. Results Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. Conclusion Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile (AU)

Results of a national survey about the management of patients with acute uncomplicated diverticulitis.

INTRODUCTION: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesión among national centres to these and others recommendations related to this pathology. METHODS: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. RESULTS: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centres, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centres that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centres with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (p ≤ .05). CONCLUSIONS: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers. / Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares.

OBJECTIVE: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. METHODS: Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. RESULTS: Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. CONCLUSION: Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile.

Analysis of variables that can interfere with clinical outcomes of patients presented with vocal or swallowing complaints / Análise das variáveis que podem interferir no desfecho de casos clínicos de pacientes com queixas de voz ou deglutição

ABSTRACT Purpose: to analyze sociodemographic variables that may interfere with the clinical outcome of patients with voice or swallowing complaints. Methods: a descriptive, retrospective, cross-sectional, observational study in which the medical records of patients above 18 years old treated at the Voice Clinic of the Speech-Language-Hearing Service of the Rio de Janeiro University Hospital between 2010 and 2018, were analyzed, including 81 medical records - 47 from females and 34 from males. Patients were divided according to three types of outcomes, namely: discharge, dismissal, and abandonment. The sociodemographic variables were sex, marital status, education level, income, whether they were occupational voice users, and the main complaint. The relative and absolute frequencies were calculated to analyze the results, and the Pearson´s chi-square test was used for inferential analysis (significance level of 5%). Results: sociodemographic variables were not significantly associated with the outcomes when the type of complaint (voice or swallowing) was not considered, separately. The study found a significantly higher frequency of patients with voice complaints who were discharged from speech-language-hearing therapy (p = 0.020). The higher frequency of such patients who abandoned therapy was significantly associated with an income of up to one minimum wage (p = 0.041). People with swallowing complaints were not significantly associated with sociodemographic variables. Conclusion: the most frequent outcome was treatment abandonment. In this study, low family income was associated with treatment abandonment by patients with voice complaints. Patients with swallowing complaints had a lower frequency of treatment abandonment and discharge than patients with voice complaints.

RESUMO Objetivo: analisar as variáveis sociodemográficas que podem interferir no desfecho de casos clínicos de pacientes com queixas de voz ou deglutição. Métodos: estudo observacional, transversal, descritivo e retrospectivo. Foram analisados os prontuários de pessoas maiores de 18 anos atendidas na Clínica de Voz do Serviço de Fonoaudiologia do Hospital Universitário do Rio de Janeiro de 2010 a 2018. Foram incluídos 81 prontuários, sendo 47 de participantes do gênero feminino e 34 do masculino. Os pacientes foram divididos quanto a três tipos de desfecho: alta, desligamento e abandono. As variáveis sociodemográficas estudadas foram gênero, estado civil, escolaridade, renda, ser ou não profissional da voz e queixa principal. Para análise dos resultados, foram contabilizadas as frequências relativa e absoluta e, para análise inferencial, foi utilizado o teste Qui-Quadrado de Pearson (nível de significância de 5%). Resultados: as variáveis sociodemográficas não estiveram significantemente associadas aos desfechos estudados quando não se considerou o tipo de queixa (de voz ou de deglutição) de forma separada. Especificamente, observou-se uma frequência significativamente maior de pacientes com queixa de voz e que receberam alta fonoaudiológica (p=0,020). Nestes pacientes, houve associação significativa entre a frequência maior de pacientes que abandonaram a terapia e que possuíam renda de até um salário-mínimo (p=0,041). Não houve associações significativas nas pessoas com queixas de deglutição e as variáveis sociodemográfica estudadas. Conclusão: o desfecho mais frequente foi o abandono ao tratamento. Neste estudo, a baixa renda familiar esteve associada ao abandono do tratamento por pacientes com queixa de voz. Pacientes com queixas de deglutição apresentaram menor frequência de abandono ao tratamento e menos alta do que pacientes com queixas de voz.

Dor pélvica crônica em mulheres: o caminho para a alta ambulatorial / Dolor pélvico crónico en mujeres: el camino hacia el alta ambulatoria / Chronic pelvic pain in women: the path to outpatient discharge

Resumo Objetivo Compreender o significado da dor pélvica crônica sob a ótica das mulheres diagnosticadas e analisar os fatores determinantes para a alta ambulatorial. Métodos Pesquisa de natureza qualitativa, tendo como referencial teórico metodológico a Pesquisa Social do tipo Estratégica. Participaram do estudo 14 mulheres, sendo sete em seguimento ambulatorial e sete que receberam alta, no ambulatório de ginecologia de um hospital universitário no município de Goiânia, Goiás, Brasil. Foram realizadas entrevistas semiestruturadas, com questões norteadoras. A análise dos resultados baseou-se na modalidade temática da análise de conteúdo, segundo Bardin. Resultados A análise dos dados culminou em três categorias temáticas: "Antes da dor", "Convivendo com a dor" e " Tratando a dor". O abandono afetivo parental, o luto, o desentendimento com os pais e dificuldades na infância foram proeminentes antes do início da dor. O surgimento da dor relacionou-se ao nascimento dos filhos, menarca, cirurgias e conflitos familiares. A convivência com a dor promoveu grande sofrimento, medo, prejuízo aos relacionamentos e à atividade laboral. A melhora do estado emocional e das condições financeiras, a resolução dos conflitos matrimoniais, a oportunidade de poder expressar-se e conversar com outras pacientes, o uso de medicamentos e alguns procedimentos cirúrgicos foram determinantes para o controle da dor e da alta ambulatorial. Conclusão A dor pélvica crônica relacionou-se a sofrimentos socioeconômicos, emocionais e físicos. A resolução destes aspectos contribuíram para a alta ambulatorial.

Resumen Objetivo Comprender el significado del dolor pélvico crónico bajo la perspectiva de mujeres diagnosticadas y analizar los factores determinantes para el alta ambulatoria. Métodos Investigación de naturaleza cualitativa, que utilizó el marco referencial teórico metodológico de la investigación social estratégica. Participaron en el estudio 14 mujeres, de las cuales siete estaban realizando seguimiento ambulatorio y siete fueron dadas de alta, en consultorios externos de ginecología de un hospital universitario en el municipio de Goiânia, Goiás, Brasil. Se realizaron entrevistas semiestructuradas, con preguntas orientadoras. El análisis de los resultados se basó en la modalidad temática del análisis de contenido, de acuerdo con Bardin. Resultados El análisis de los datos culminó en tres categorías temáticas: Antes del dolor, Convivir con el dolor y Tratar el dolor. El abandono afectivo parental, el duelo, falta de entendimiento con los padres y dificultades en la infancia fueron prominentes antes del inicio del dolor. El surgimiento del dolor se relacionó con el nacimiento de los hijos, menarca, cirugías y conflictos familiares. La convivencia con el dolor causó gran sufrimiento, miedo, perjuicio en las relaciones y en la actividad laboral. La mejora del estado emocional y de las condiciones financieras, la resolución de los conflictos matrimoniales, la oportunidad de poder expresarse y hablar con otras pacientes, el uso de medicamentos y algunos procedimientos quirúrgicos fueron determinantes para el control del dolor y el alta ambulatoria. Conclusión El dolor pélvico crónico se relacionó con el sufrimiento socioeconómico, emocional y físico. La resolución de estos aspectos contribuyó al alta ambulatoria.

Abstract Objective To understand the meaning of chronic pelvic pain from the perspective of diagnosed women and analyze the determining factors for outpatient discharge. Methods This is qualitative research, using strategic social research as its theoretical methodological framework. 14 women participated in the study, seven of whom were undergoing outpatient follow-up and seven who were discharged from the gynecology outpatient clinic of a university hospital in the city of Goiânia, Goiás, Brazil. Semi-structured interviews were carried out with guiding questions. The analysis of results was based on the thematic modality of content analysis, according to Bardin. Results Data analysis culminated in three thematic categories: "Before the pain", "Living with the pain" and "Treating the pain". Parental emotional abandonment, grief, disagreement with parents and childhood difficulties were prominent before the onset of pain. The onset of pain was related to the birth of children, menarche, surgeries and family conflicts. Living with pain promoted great suffering, fear, harm to relationships and work activity. The improvement in emotional state and financial conditions, the resolution of marital conflicts, the opportunity to express oneself and talk to other patients, the use of medication and some surgical procedures were decisive for pain control and outpatient discharge. Conclusion Chronic pelvic pain was related to socioeconomic, emotional and physical suffering. The resolution of these aspects contributed to outpatient discharge.

Atendimento psicológico ambulatorial em hospital geral: reflexões de um(a) estagiário(a) de psicologia / Ambulatory psychological care in general hospital: reflections of a psychology intern / Servicio psicológico ambulatorio en hospital general: reflexiones de una pasante de psicología

Trata-se de um relato de experiência sobre a prática de estágio curricular em psicologia realizado em um ambulatório de especialidades em um hospital geral, vinculado ao Sistema Único de Saúde. O objetivo deste artigo é apresentar reflexões sobre a prática de estágio curricular na ênfase de promoção e prevenção à saúde, a partir de um relato de experiência. Num primeiro momento, apresenta-se um delineamento histórico sobre a formação do que se conhece hoje como ambulatório em saúde mental e, posteriormente, são apresentados alguns dispositivos que podem embasar a prática do psicólogo neste contexto, fundamentados na interação entre saberes trabalhados na formação em psicologia. Os resultados apontam para a necessidade das reflexões sobre as práticas que têm sido realizadas no campo ambulatorial ­ tendo em vista a necessidade de se atualizarem as definições técnicas sobre a atuação do psicólogo nessa área ­, assim como a necessidade da criação de critérios que avaliem os métodos utilizados pelos psicólogos. Dessa forma, se constata a necessidade de atualização do ensino em psicologia e da prática profissional no atendimento em saúde mental. (AU)

This paper describes a Psychology curricular internship experience at a specialty clinic managed by the Brazilian Public Health System. The goal of this paper is to discuss the practice of curricular internship required by the curricular emphasis on health promotion and prevention, based on expe-rience report. Initially, the paper explores the historical constitution of what is currently known as mental health clinic. Then, we present some tools that may support the psychologist's practice in this context, based on the interac-tion between the distinct knowledges which students must acquire to obtain a Psychology degree. The results show a need to reflect on the practices that are currently being carried out in mental health clinics ­ given the necessity to update the technical definitions that guide psychologists' work in this field ­ as well as a need to specify criteria for the evaluation of the methods employed by psychologists. Thus, we see that there is a need to update teaching in Psychology and professional practices in the field of mental health. (AU)

Este artículo presenta un relato de experiencia sobre la pasantía curricular realizada en un ambulatorio de especialidades vinculado al Sistema Único de Salud. Tiene el fin de presentar reflexiones sobre la pasantía con énfasis en la promoción a la salud y prevención basado en un informe de experiencia. En un primer momento, el artículo presenta un diseño histórico sobre la formación de lo que hoy se conoce como ambulatorio de salud mental y, posteriormente, se presentan algunos dispositivos que pueden apoyar la práctica del psicólogo en este contexto, a partir de la interacción entre conocimientos trabajados en la formación en psicología. Los resultados apuntan la necesidad de reflexionar sobre las prácticas que se han realizado en el ámbito ambulatorio - ante la necesidad de actualizar las definiciones técnicas sobre el desempeño del psicó-logo en esta área - así como la necesidad de generar criterios que evalúen las metodologías utilizadas por los psicólogos. Por lo tanto, queda evidente la necesidad de actualizar la docencia en psicología y la práctica profesional en el cuidado de la salud mental. (AU)

Morbilidad oculta por hipertensión arterial en adolescentes. Importancia del monitoreo ambulatorio de presión arterial / Hidden morbidity due to arterial hypertension in adolescents. Importance of ambulatory blood pressure monitoring

El diagnóstico de un niño o adolescente como hipertenso no es tarea fácil. El principal medio para el diagnóstico de hipertensión arterial sigue siendo la presión arterial tomada en el consultorio, pero por su escasa reproducibilidad, este método tiene algunas limitaciones. Existen otros menos usados en el medio pediátrico, pero más reproducibles y confiables, como el monitoreo ambulatorio de la presión arterial, el cual permite disminuir el subdiagnóstico de hipertensión arterial. La investigación se realizó a partir de un pesquisaje efectuado con el objetivo de identificar la morbilidad oculta de hipertensión arterial en adolescentes con exceso de peso, en el área de salud del Policlínico «Chiqui Gómez Lubián», Santa Clara, Villa Clara. El caso reviste importancia para la Atención Primaria de Salud, promueve la utilización de un método diagnóstico que mejora la correcta clasificación y tratamiento de la hipertensión en edades tempranas para contribuir a la prevención de complicaciones posteriores

Diagnosing a child or an adolescent as hypertensive is not an easy task. The main way to diagnose arterial hypertension continues to be at the doctor´s office, but due to its poor reproducibility, this method has some limitations. There are other less used methods in the pediatric setting, but are more reproducible and reliable, such as ambulatory blood pressure monitoring, which makes it possible to reduce the underdiagnosis of arterial hypertension. We present a case of a male adolescent who was detected during a screening, with the objective of identifying hidden morbidity of arterial hypertension in overweight adolescents, in the health area at "Chiqui Gómez Lubián" Polyclinic, in Santa Clara, Villa Clara. The case is of great important for primary health care, promotes the use of a diagnosis method that improves the correct classification and treatment of hypertension at an early age and contributes to the prevention of subsequent complications

Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto / Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain

Introducción y objetivos En los ensayos clínicos la reducción eficaz de la presión arterial (PA) produce una disminución de la incidencia de la morbimortalidad cardiovascular (CV). Nuestro objetivo principal es conocer si en las condiciones reales de la práctica clínica el control de la PA reduce a largo plazo los eventos CV. Pacientes y métodos El estudio se realizó en 164 pacientes con hipertensión arterial (HTA) elegidos entre los pacientes que acudían a las consultas de medicina de familia por HTA. Se hizo un análisis entre los pacientes que presentaban una PA clínica inferior a 140/90mmHg y los que la tenían más elevada. Los pacientes se seguían hasta que se producía un evento CV o hasta un máximo de 20 años, en que se finalizaba el seguimiento. Resultados Del total de los 164 pacientes alcanzaron un buen control clínico de la HTA 93 (56,7%) pacientes y no lo alcanzaron 71 (42,2%). En el análisis multivariante quedó únicamente como variable predictora de eventos CV la falta de control estricto de la HTA (HR: 2,93; IC 95%: 1,45-5,89; p=0,003), y el sexo femenino fue protector para eventos CV (HR: 0,37; IC 95%: 0,18-0,74; p=0,005) Conclusiones La variable predictora fundamental de morbimortalidad CV en pacientes con HTA es la falta de control estricto de la HTA; las mujeres también tuvieron menos complicaciones CV (AU)

Introduction and aims During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. Patients and methods The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. Results Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). Conclusions The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications (AU)

Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen.

OBJECTIVE: To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS: Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS: We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION: The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.

[Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain]. / Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto.

INTRODUCTION AND AIMS: During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. PATIENTS AND METHODS: The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. RESULTS: Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). CONCLUSIONS: The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.

Estudio descriptivo de las alteraciones en pruebas de neuroimagen en pacientes con cefalea en un ámbito ambulatorio / Descriptive study of the alterations in neuroimaging tests in patients with headache in an outpatient setting

Introducción: Los estudios disponibles ofrecen una guía limitada acerca del uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio. El objetivo de este estudio fue describir y analizar la frecuencia y el porcentaje de alteraciones en neuroimagen en pacientes valorados por cefalea en una consulta de neurología, así como determinar qué datos de alarma clínicos (red flags) se asocian con mayor frecuencia a estas alteraciones. Pacientes y métodos: Realizamos un estudio observacional, descriptivo y transversal de una serie de pacientes con cefalea de la consulta de neurología del Hospital Universitario de Móstoles a los que se les realizó una prueba de neuroimagen. ResultadosSe incluyó a 279 pacientes en el estudio (190 mujeres y 89 hombres). Ningún paciente sin datos de alarma clínicos presentó alteraciones graves en la neuroimagen y, de los que presentaban datos de alarma clínicos (219 pacientes), sólo el 2,3% (cinco pacientes) presentó alteraciones graves. Los dos datos de alarma clínicos que se asociaron de forma significativa a una mayor probabilidad de alteraciones graves en la neuroimagen fueron la cefalea que se desencadena o empeora significativamente con cambios posturales o maniobras de Valsalva y la cefalea crónica diaria desde su inicio. Conclusiones: La prevalencia de alteraciones significativas en neuroimagen en pacientes con cefalea en un ámbito ambulatorio fue baja, incluso en presencia de datos de alarma clínicos, por lo que la utilidad de estos datos de alarma parece ser menor en un contexto ambulatorio. Podría ser razonable intentar reducir el uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio.(AU)

Introduction: Available studies provide limited guidance on the use of neuroimaging in patients with headache in the outpatient setting. The aim of this study was to describe and analyse the frequency and the percentage of neuroimaging abnormalities in patients evaluated for headache in a neurology clinic, as well as to determine which red flags are most commonly associated with these abnormalities. Patients and methods: We conducted an observational, descriptive and cross-sectional study of a series of patients with headache from the neurology department of the Hospital Universitario de Móstoles who underwent a neuroimaging test. Results: A total of 279 patients (190 women and 89 men) were included in the study. No patient without any red flags had severe abnormalities in the neuroimaging study and, of those with red flags (219 patients), only 2.3% (five patients) displayed severe abnormalities. The two red flags that were significantly associated with an increased likelihood of severe neuroimaging abnormalities were headache that is triggered or significantly worsened by postural changes or Valsalva manoeuvres and chronic daily headache since onset. Conclusions: The prevalence of significant neuroimaging abnormalities in headache patients in an outpatient setting was low, even in the presence of red flags, and so their utility appears to be lower in an outpatient setting. It may be reasonable to try to reduce the use of neuroimaging with headache patients in the outpatient setting.(AU)

Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria / Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen

Objetivo Reportar nuestra experiencia inicial de prostatectomía radical robótica (PRR) en régimen ambulatorio. Material y métodos Análisis retrospectivo de los pacientes intervenidos de PRR en cirugía mayor ambulatoria (CMA) en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, los resultados intraoperatorios y los datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención. Resultados Identificamos un total de 35 pacientes, con una edad promedio de 60,8 ±6,88 años y un IMC de 27 ±2,9kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenían alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ±42,15 minutos y el sangrado promedio fue de 301,2 ±184,38mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%) reingresaron. Registramos una complicación intraoperatoria, 7 complicaciones postoperatorias leves (ClavienI-II) y una complicación grave (ClavienIIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento. Conclusión La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados (AU)

Objective To report our initial experience with robotic radical prostatectomy (RRP) as an outpatient procedure. Material and methods Retrospective analysis of patients who underwent RRP as major ambulatory surgery (MAS) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. Results We identified a total of 35 patients with an average age of 60,8 ±6,88years and a BMI of 27 ±2,9kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ±42,15minutes and the average blood loss was 301,2 ±184,38milliliters. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, 7 mild postoperative complications (ClavienI-II) and one severe complication (ClavienIIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. Conclusion The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients (AU)

Qualidade de vida dos doentes com cancro colorretal submetidos a quimioterapia no ambulatório / Quality of life of colorectal cancer patients undergoing outpatient chemotherapy

Introdução: Nos últimos anos, tem se verificado um aumento das doenças crónicas não transmissíveis, entre elas destacamos o cancro colorretal por ser um problema de saúde pública mundial. A avaliação da qualidade de vida (QV), constitui um importante indicador para a monitorização dos sintomas e efeitos das terapêuticas oncológicas. Deste modo, foi realizado a seguinte questão de investigação ?Qual a qualidade de vida dos doentes do foro colorretal submetidos a quimioterapia, no ambulatório? Objetivos: Analisar a QV dos doentes do foro colorretal submetidos a quimioterapia; descrever e analisar quais os fatores que influenciaram a QV; analisar a relação entre QV e as caraterísticas sociodemográficas, fatores de risco e efeitos secundários dos doentes submetidos a quimioterapia. Metodologia: Estudo quantitativo, descritivo, transversal e correlacional. A colheita de dados realizada com dois questionários: questionário de dados individuais e o instrumento de qualidade de vida Whoqol- bref (Serra et al., 2006), no período de abril a dezembro de 2022. A amostra de 50 doentes que realizaram quimioterapia num ambulatório de um hospital do centro. Foram realizados todos os procedimentos formais e éticos. Resultados: A qualidade de vida no domínio psicológico é de 76,92%, seguido de 75% no domínio social, verificando-se o valor mais baixo no domínio físico com 70,43%. No domínio físico, os doentes profissionalmente ativos percecionam uma melhor qualidade de vida (p=0,020). Nos fatores de riscos, o consumo de café é autopercecionado como indicador de melhor qualidade de vida no domínio psicológico (p=0,048). Nos efeitos secundários, os doentes sem náuseas (p=0,021), percecionam uma melhor QV no domínio físico, na ausência de alopecia, no domínio psicológico (p=0,037) e no meio ambiente (p=0,042), e na ausência de parestesias, no domínio físico (p=0,029), psicológico (p=0,004) e meio ambiente (p=0,007). A presença de anorexia é percecionada como indicador de pior QV no domínio social (p=0,030). Conclusão: Os doentes apresentam uma pior QV no domínio físico e melhor no domínio psicológico. A ausência de efeitos secundários tais como: náuseas, alopecia e parestesias indicam melhor qualidade de vida. A presença de anorexia piora a qualidade de vida no domínio social.

Hipertensión arterial, un reto farmacológico / Arterial hypertension, a pharmacological challenge / Hhipertensão arterial, um desafio farmacológico

La hipertensión arterial (HTA) es una enfermedad crónica que afecta a más del 30% de la población adulta en todo el mundo y se caracteriza por tener una presión arterial más alta de lo normal. Se presentan los principales fármacos para el correcto manejo de la enfermedad según la gravedad de los síntomas del paciente evaluado por SCORE de riesgo cardiovascular y por sus patologías concomitantes. Objetivo. Identificar los fármacos y el tipo de tratamiento, farmacológico o no farmacológico, empleados en la HTA en cuanto a su diagnóstico, mejorando el manejo del paciente que padece esta enfermedad. Metodología. Se realizó una revisión de tipo sistemática empleando el protocolo PRISMA para la recopilación de información en trabajos procedentes de motores de búsqueda como PubMed, Scopus, Web of Science y ELSEVIER sobre el tratamiento de la Hipertensión Arterial Primaria, publicados durante enero del año 2017 hasta diciembre del año 2022. Conclusión. La hipertensión arterial sigue siendo un reto en el campo de la farmacología debido a su alta prevalencia y su asociación con múltiples enfermedades cardiovasculares. Los tratamientos disponibles son efectivos, pero no curan la enfermedad, por lo que es necesario seguir investigando nuevas opciones terapéuticas para mejorar el control y reducir el impacto en la salud pública. La educación y la prevención son herramientas importantes para reducir la incidencia de hipertensión y mejorar el manejo de la enfermedad. Con esta investigación fue posible identificar la importancia del tratamiento farmacológico y el tratamiento de tipo no farmacológico, evaluando adecuadamente el estado del paciente.

Arterial hypertension (AHT) is a chronic disease that affects more than 30% of the adult population worldwide and is characterized by higher than normal blood pressure. The main drugs for the correct management of the disease are presented according to the severity of the patient's symptoms evaluated by SCORE of cardiovascular risk and by his concomitant pathologies. Objective. To identify the drugs and the type of treatment, pharmacological or non-pharmacological, used in HT in terms of its diagnosis, improving the management of the patient suffering from this disease. Methodology. A systematic review was performed using the PRISMA protocol for the collection of information in works from search engines such as PubMed, Scopus, Web of Science and ELSEVIER on the treatment of Primary Arterial Hypertension, published during January 2017 until December 2022. Conclusion. Arterial hypertension remains a challenge in the field of pharmacology due to its high prevalence and association with multiple cardiovascular diseases. Available treatments are effective, but do not cure the disease, so it is necessary to continue investigating new therapeutic options to improve control and reduce the impact on public health. Education and prevention are important tools to reduce the incidence of hypertension and improve disease management. With this research it was possible to identify the importance of pharmacological treatment and non-pharmacological treatment, adequately assessing the patient's condition.

A hipertensão arterial (HTA) é uma doença crônica que afeta mais de 30% da população adulta em todo o mundo e é caracterizada por pressão arterial acima do normal. Os principais medicamentos para o correto manejo da doença são apresentados de acordo com a gravidade dos sintomas do paciente, conforme avaliado pelo SCORE, risco cardiovascular e patologias concomitantes. Objetivo. Identificar os medicamentos e o tipo de tratamento, farmacológico ou não farmacológico, utilizados na hipertensão arterial em termos de seu diagnóstico, melhorando o manejo do paciente que sofre dessa doença. Metodologia. Foi realizada uma revisão sistemática utilizando o protocolo PRISMA para a coleta de informações em trabalhos de mecanismos de busca como PubMed, Scopus, Web of Science e ELSEVIER sobre o tratamento da Hipertensão Arterial Primária, publicados de janeiro de 2017 a dezembro de 2022. Conclusões. A hipertensão arterial continua sendo um desafio no campo da farmacologia devido à sua alta prevalência e associação com várias doenças cardiovasculares. Os tratamentos disponíveis são eficazes, mas não curam a doença, portanto, são necessárias mais pesquisas sobre novas opções terapêuticas para melhorar o controle e reduzir o impacto na saúde pública. A educação e a prevenção são ferramentas importantes para reduzir a incidência de hipertensão e melhorar o controle da doença. Com essa pesquisa, foi possível identificar a importância do tratamento farmacológico e do tratamento não farmacológico, avaliando adequadamente a condição do paciente.

Tolerabilidad del paciente durante la cistoscopia y la cauterización de tumores vesicales en consulta: análisis multivariante de los factores de riesgo / Patient tolerability during office cystoscopy and bladder tumor cauterization: A multivariate analysis of risk factors

Objetivo La cistoscopia y la cauterización realizadas en el quirófano suponen un coste elevado y exponen a los pacientes a los riesgos asociados a la anestesia. La tolerabilidad de los pacientes durante la cistoscopia y la cauterización en la consulta es fundamental para el tratamiento ambulatorio del cáncer de vejiga y otras enfermedades urológicas. Se evaluaron los factores de riesgo asociados con el dolor percibido en la cistoscopia flexible en consulta, evaluando de manera independiente a un subgrupo de pacientes con cáncer de vejiga sometidos a cauterización. Materiales y métodos Análisis retrospectivo de 110 encuestas anónimas de pacientes completadas después de una cistoscopia y/o cauterización. La información de la encuesta incluía la edad, el sexo, la indicación de la cistoscopia, el número de cistoscopias previas, el número de cauterizaciones ambulatorias previas, la ansiedad antes/durante la cistoscopia y el dolor durante la cistoscopia y/o la cauterización. Se realizaron análisis univariantes/multivariantes y de regresión lineal para evaluar la asociación del dolor con los parámetros clínicos. Resultados El promedio del dolor percibido durante la cistoscopia (1,75±1,331) no difirió significativamente cuando se realizó también la cauterización (2,37±2,214) (p<0,001) (p=0,2840). Los pacientes del grupo de menor edad (<66 años) indicaron mayor ansiedad (p=0,0005), más dolor durante la cistoscopia (p=0,004) y la cauterización (p<0,001). Aunque el nivel de ansiedad general de los pacientes durante el procedimiento era bajo (1-3/10), se asoció con cierto nivel de dolor durante la cistoscopia (p=0,0005) y la cauterización (p<0,000). En el análisis multivariante, la ansiedad fue el único predictor independiente del dolor durante la cistoscopia (p=0,03; OR: 6,52; IC 95%:1,2-35,6) y la cauterización (p=0,0012; OR: 3,4; IC 95%:1,6-7,0)(AU)

Objective Cystoscopy and cauterization performed in the operating room is expensive and exposes patients to anesthesia risks. Patient tolerability during office cystoscopy and cauterization is critical to the office management of bladder cancer and other urologic diseases. We evaluated the risk factors for pain of flexible cystoscopy in the office-setting with emphasis on a sub-group of bladder cancer patients who underwent cauterization. Materials and methods Retrospective analyses of 110 anonymous patient surveys completed after cystoscopy and/or cauterization. Survey information included age, gender, purpose of cystoscopy, number of prior cystoscopies, prior number of office-cauterizations, anxiety prior/during cystoscopy, and pain during cystoscopy and/or cauterization. Univariate/multivariate and linear-regression analyses were performed to evaluate the association of pain with clinical parameters. Results Average pain during cystoscopy (1.75±1.331) was not significantly different when cauterization was also performed (2.37±2.214) (P<.001) (P=.2840). Patients in the lower age group (<66 years) indicated higher anxiety (P=.0005), more pain at cystoscopy (P=.004) and cauterization (P<.001). Although the patient's overall anxiety level was low (1–3/10), it was associated with some pain during cystoscopy (P=.0005) and cauterization (P<.000). In multivariate analysis, anxiety was the only independent predictor of pain during cystoscopy (P=.03, OR: 6.52, 95%CI: 1.2-35.6) and cauterization (P=.0012, OR: 3.4, 95%CI: 1.6-7.0) (AU)