Missing patients in "Major Trauma Registry" of Navarre: incidence and pattern.

BACKGROUND: Trauma registries (TR) collect information about trauma patients according to inclusion criteria, and it helps to establish protocols to improve care. However, all TR deal with incompleteness. The aim of this study is to assess the number of patients not included despite fulfilling inclusion criteria in our regional TR and identifying the predictors for being missing. METHODS: The sample was randomly selected. Two months of each year from 2010 to 2014 (5 years) were selected, and medical files of all patients attended in the emergency department room during those months were studied. Patients who were already correctly included in the TR were assigned to the 'included' group, and patients who should have been but were not to the 'missing' group. The multivariable logistic regression analysis was performed to identify predictors for being missed from the TR. RESULTS: Of a total of 200, 79 (40 % approximately) were identified as missing. We defined the characteristic profiles of missing patients and found that the hospital RTS and the number of injuries are independent predictors to be missing in our trauma registry, with an adjusted odds ratio of 1844 [95 % (1092-3114) and 0.574 (95 % CI 0.428-0.770)], respectively. CONCLUSIONS: Overall, 40 % of the patients who met the inclusion criteria of the TR were not included in the registry. Our results can be generalized to other trauma records based on Utstein style, because we think probably that this fact is also happening in other databases.

Hemoneumotórax espontáneo masivo idiopático en una mujer joven / Spontaneous massive idiopathic haemopneumothorax in a young woman

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Calidad y acreditación de los servicios de urgencias / Quality and accreditation of emergency departments

El concepto de calidad está ligado al mundo sanitariodesde muy antiguo y es uno de los elementosestratégicos en que se fundamenta la transformación ymejora de los sistemas sanitarios modernos. El estudiode la calidad en la asistencia sanitaria supone abordajesdiversos dado que entraña significados distintospara los pacientes, profesionales y gestores. En los últimosaños se están introduciendo, de forma progresiva,sistemas formales de gestión de calidad, como son lacertificación según las Normas ISO-9000, el sistema deacreditación de la Joint Commission on Accreditation ofHealthcare Organizations (JCAHO) y el modelo europeode excelencia (EFQM).La gestión por procesos es otra herramienta encaminadaa conseguir los objetivos de calidad total en elproceso asistencial y abordar los problemas de saluddesde una visión centrada en el paciente. Una asistenciasanitaria de calidad es aquella que se proporcionacon una práctica clínica basada en pruebas, conforme alos conocimientos científicos actuales, siguiendo guíasclínicas elaboradas con criterios de medicina basadaen la evidencia, con el menor riesgo para los pacientesy los familiares, con la mayor eficiencia y con la mayorsatisfacción para usuarios y el personal sanitario.La acreditación de centros y servicios sanitarioses, sin duda, el método de garantía de calidad más aceptado.Podemos definirlo como el proceso de evaluaciónexterna al que se somete una organización sanitaria,basado en la revisión de unos criterios o estándaresconsensuados, cuyo cumplimiento manifiesta que esecentro desarrolla su funciones con parámetros de calidad,al menos, cercanos a la excelencia(AU)

The concept of quality has been linked to thehealth care world since the remote past and is one ofthe strategic elements on which the transformationand improvement of modern health systems is based.Study of quality in health care involves differentapproaches given that it holds different meanings forpatients, professionals and managers. In recent yearsformal systems of quality management have been progressivelyintroduced, such as certification accordingto the ISO-9000 Norms, the system of accreditation ofthe Joint Commission on Accreditation of HealthcareOrganizations (JCAHO) and the European Model of Excellence(EFQM).Management by processes is another tool directedtowards achieving the aims of total quality in the careprocess and tackling health problems centred on thepatient. Quality health care involves evidence basedclinical practice; based on current scientific knowledge,following clinical practice guidelines based on evidence,with the least risk for patients and relatives, involvinggreater efficiency and greater satisfaction for usersand health personnel.The accreditation of health care centres and servicesis, without doubt, the most widely accepted methodfor guaranteeing quality. It can be defined as theprocess of external evaluation to which a health organisationis subjected, based on a review of certain acceptedcriteria and standards, whose fulfilment demonstratesthat that centre is developing its functions withinparameters of quality that at least approach excellence(AU)

Atención sanitaria a las catástrofes / Health care in catastrophes

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[Study of the demand for home care by the Pamplona Extrahospital Emergency Services in 1995]. / Estudio de la demanda de atención domiciliaria en 1995 del Servicio de Urgencias Extrahospitalario de Pamplona.

The present paper is a retrospective descriptive study, carried out in the Special Casualty Service (Servicio Especial de Urgencias) of Pamplona. It evaluates 8,411 cases of calls from homes, extracted from an aleatory sample stratified by day of the week and season of the year, with a N=647. The diagnoses were codified according to the ICHPPC-2 of the WONCA and the statistical study with SPSS/PC+V 4.0. The monthly average was 701 calls from homes, with a daily average of 19 (from Monday to Friday), with 38 on Sundays and holidays. With respect to distribution by time, on working days 66.5% were distributed between 15.00 and 22.00 hours, while on Sundays and holidays 51% fell between 8.00 and 13.00 hours. The overall rate of use was situated at 32.71/1,000 inhabitants and year (with extreme rates in Mendillorri=7.42 and II Ensanche=57.35). In 74% of the cases a doctor or nurse visited the home. The most frequent cause for home care are illnesses of the respiratory apparatus with 23.5%. Some 40.9% of the patients attended were over 75 years of age. The conclusions are: 1. There is a low rate of home care. 2. Those requiring such visits are of an advanced age. 3. Illnesses of the respiratory apparatus are the most frequent cause of demand. 4. The zones of most demand are those where a Health Centre has not been set up as such.

Effect of chronic alcoholism on neuronal nuclear size and neuronal population in the mammillary body and the anterior thalamic complex of man.

The effect of chronic alcoholism on neuronal nuclear size and neuronal population of two memory-related diencephalic centres, the mammillary body and the anterior thalamic complex, has been examined in 24 chronic male alcoholics and 22 age-matched male controls. Cases were subdivided into three age groups (30-44 years, 45-59 years and 60-75 years). The results showed a significant reduction in both neuronal numbers and nuclear size in alcoholics compared to controls. Differences were especially high in the youngest alcoholics. The intensity of liver damage (steatosis vs. cirrhosis) did not have any significant effect. Moreover, an age-related decrease of neuronal number and karyometry was seen in controls but not in alcoholics. Our results suggest that chronic alcoholism accelerates the rate of neuronal loss in the mammillary body and anterior thalamic complex to a degree equivalent to aging. Likewise, chronic alcoholism impairs the compensatory increase in neuronal nuclei area seen in normal aging in these same structures. Our findings show that medial diencephalic memory centres are damaged in chronic alcoholism, which may contribute to the clinical symptomatology of these persons.

Chronic alcoholism decreases neuronal nuclear size in the human entorhinal cortex.

The effect of chronic alcoholism in the neuronal nuclear area (karyometry) of the lateral entorhinal cortex at three rostro-caudal levels (rostral, intermediate and caudal) has been studied in 19 alcoholic subjects and in 15 aged-matched controls. Cases were distributed into three groups according to their age (29-44, 45-60 and 61-70 years of age). In the second group (45-60 years), the nuclear size in layers II and III of the caudal entorhinal cortex showed a very significant decrease compared to controls. The first group (29-44 years) also showed a significant reduction in size, while the third group presented the smallest differences. The presence of cirrhosis in the alcoholic group did not vary the observed results. Thus, chronic alcoholism significantly decreases the nuclear size in layers II and III of the lateral entorhinal cortex, and thus the entorhinal output to the hippocampus may be altered in alcoholism.

Short-term ethanol intoxication in rat. Effect on the entorhinal cortex.

The effect of short-term ethanol intoxication in systems implicated in memory and other cognitive functions in rats has been assessed by studying the variation in the karyometry of the neurons in the different layers of the lateral entorhinal cortex. The analysis showed that short-term ethanol consumption produced a reduction in the nuclear area of neurons in layers V and VI, and to a lesser extent, in layers II and III. These results suggest that the deep layers of the entorhinal cortex are more sensitive to ethanol intoxication, thus more likely affecting cortical and subcortical projections than the hippocampal output.