Calidad asistencial de la psicología clínica en el Servicio Andaluz de Salud evaluada por los facultativos / Quality of care of Clinical Psychology in the Andalusian Health Service as assessed by professionals

Objetivo: evaluación de la calidad asistencial de los servicios de psicología clínica en el Servicio Andaluz de Salud (SAS) desde la perspectiva de los/as facultativos/as. Método: investigación descriptiva; se elaboró un cuestionario de 39 ítems que evalúa diferentes dimensiones de la calidad asistencial (prevención, accesibilidad, idoneidad de intervenciones de evaluación y tratamiento, seguridad, y coordinación); han participado 83 facultativos/as especialistas de psicología clínica del SAS, lo que supone un 32’17% de la población de referencia en el momento de la recogida de datos.Resultados:la calidad asistencial actual de las prestaciones de psicología clínica en el SAS, partiendo de una ratio de 3,05 facultativos por cada100.000 habitantes, es deficiente, sobre todo en las variables de prevención, intensidad de las intervenciones de tratamiento y seguridad, y especialmente preocupante en los dispositivos del segundo nivel asistencial.Conclusiones: es urgente aumentar el número de profesionales especialistas en psicología clínica por cada 100.000 habitantes para reducir el riesgo que supone para los usuarios la deficiente intensidad con que se practican los tratamientos psicológicos; asimismo, es necesario establecer estándares de la carga de trabajo de los psicólogos clínicos para poder ofrecer una calidad asistencial adecuada, e integrar indicadores medibles de calidad en los sistemas de información de salud mental (AU)

Objective: Evaluation of healthcare quality of clinical psychology services in the Andalusian Health Service (SAS) from the perspective of the facultative. Method: Descriptive research. For data collection, a 39-item questionnaire was developed that assesses various dimensions of quality (prevention, accessibility, suitability of evaluation and treatment interventions, safety, and care coordination). A sample of 83 clinical psychologists responded to the questionnaire, representing 32.17% of the reference population, 258 facultative who, at the time of data collection make up the SAS staff. Results: The current quality of care of clinical psychology services in the SAS, based on a ratio of 3.05 clinical psychologists per 100,000 inhabitants, is deficient, especially in the dimensions of prevention, intensity of treatment interventions, and safety, and worrisome in the 2nd level of care. Conclusions: It is urgent to increase the ratio of clinical psychologists/100,000 inhabitants to reduce the risk posed for users by the deficient intensity with which psychological treatments are currently practiced. It is necessary to esta-blish standards for the workload of clinical psychologists in order to offer an adequate quality of care, and to integrate measurable indicators of quality in mental health information systems (AU)

Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.

PURPOSE: Abdominal wall hernia secondary to open abdomen management represents a surgical challenge. The hernia worsens due to lateral muscle retraction. Our objective was to evaluate if Botulinum Toxin Type A (BTA) application in lateral abdominal wall muscles modifies its thickness and length. METHODS: A clinical trial of male trauma patients with hernia secondary to open abdomen management was performed from January 2009 to July 2011. Thickness and length of lateral abdominal muscles were measured by a basal Computed Tomography and 1 month after BTA application. A dosage of 250 units of BTA was applied at five points at each side between the external and internal oblique muscles under ultrasonographic guidance. Statistical analysis for differences between basal and after BTA application measures was performed by a paired Student's t test (significance: p < 0.05). RESULTS: Seventeen male patients with a mean age of 35 years were included. There were muscle measure modifications in all the patients. Left muscle thickness: mean reduction of 1 ± 0.55 cm (p < 0.001). Right muscle thickness: mean reduction of 1.00 ± 0.49 cm (p < 0.001). Left muscle length: mean increase of 2.44 ± 1.22 cm (p < 0.001). Right muscle length: mean increase of 2.59 ± 1.38 cm (p < 0.001). No complications secondary to BTA or recurrences at mean follow-up of 49 months were observed. CONCLUSIONS: BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.

Toll-like receptors in secondary obstructive cholangiopathy.

Secondary obstructive cholangiopathy is characterized by intra- or extrahepatic bile tract obstruction. Liver inflammation and structural alterations develop due to progressive bile stagnation. Most frequent etiologies are biliary atresia in children, and hepatolithiasis, postcholecystectomy bile duct injury, and biliary primary cirrhosis in adults, which causes chronic biliary cholangitis. Bile ectasia predisposes to multiple pathogens: viral infections in biliary atresia; Gram-positive and/or Gram-negative bacteria cholangitis found in hepatolithiasis and postcholecystectomy bile duct injury. Transmembrane toll-like receptors (TLRs) are activated by virus, bacteria, fungi, and parasite stimuli. Even though TLR-2 and TLR-4 are the most studied receptors related to liver infectious diseases, other TLRs play an important role in response to microorganism damage. Acquired immune response is not vertically transmitted and reflects the infectious diseases history of individuals; in contrast, innate immunity is based on antigen recognition by specific receptors designated as pattern recognition receptors and is transmitted vertically through the germ cells. Understanding the mechanisms for bile duct inflammation is essential for the future development of therapeutic alternatives in order to avoid immune-mediated destruction on secondary obstructive cholangiopathy. The role of TLRs in biliary atresia, hepatolithiasis, bile duct injury, and primary biliary cirrhosis is described in this paper.

Serum oxidative stress is increased in patients with post cholecystectomy bile duct injury.

BACKGROUND: Post-cholecystectomy bile duct injuries are identified by the onset of jaundice as well as elevated bilirubin and alkaline phosphatase levels during the peri-operative period. It is unknown how serum oxidative stress markers are modified in patients with post-cholecystectomy bile duct injuries. OBJECTIVE: To determine serum oxidative stress marker levels (lipid peroxidation by-products, nitrites/nitrates and total antioxidant capacity) in patients with post-cholecystectomy bile duct injuries. PATIENTS AND METHODS: A prospective, transversal and analytical study was designed with two groups. Group 1: 5 healthy volunteer subjects. Group 2: 52 patients with post-cholecystectomy bile duct injuries (43 female and 9 male). An elective bilio-digestive reconstruction was performed at week 8. The serum oxidative stress marker levels were quantified by colorimetric method. RESULTS: Patients with bile duct injuries had a significant increased serum lipid peroxides (malondialdehyde and 4-hydroxy-alkenals) and nitric oxide metabolites (nitrites/nitrates) levels compared to the control group. In contrast, total antioxidant capacity in patients with bile duct injuries remained similar compared to healthy controls. CONCLUSIONS: The results show that oxidative stress is usually associated to bile duct injury.

[Osteoporosis in all young daughters of a mother with multiple osteoporotic fractures. A case of familial osteoporosis]. / Osteoporosis en todas las hijas jóvenes de una madre con múltiples fracturas osteoporóticas. Un caso de osteoporosis familiar.

We herein describe a family whose female members are all osteoporotic: a postmenopausal mother and her three premenopausal daughters. The mother aged 60 presented axial and peripheral fractures, and very low bone mineral density (BMD). She reported that her grandmother had suffered a hip fracture. The eldest daughter aged 30 suffered multiple vertebral fractures during pregnancy and lactation associated with very low BMD. In view of these observations, the other two daughters aged 29 and 27 years respectively were evaluated. BMD was found to be severely diminished according to densitometric values for osteoporosis established by WHO, but they had no history of bone fractures. Probably the strong genetic component in bone mass is responsible for the severely diminished BMD observed in all the women in this family, as well as the occurrence of bone fractures in two of them. To our knowledge, there are no similar reports in the literature. Our results evidence the importance of evaluating bone mass in the offspring of an individual presenting severe osteoporosis, in order to detect family members with low bone mass and at high risk of developing bone fractures.

Osteoporosis en todas las hijas jóvenes de una madre con múltiples fracturas osteoporóticas. Un caso de osteoporosis familiar. / [Osteoporosis in all young daughters of a mother with multiple osteoporotic fractures. A case of familial osteoporosis]

We herein describe a family whose female members are all osteoporotic: a postmenopausal mother and her three premenopausal daughters. The mother aged 60 presented axial and peripheral fractures, and very low bone mineral density (BMD). She reported that her grandmother had suffered a hip fracture. The eldest daughter aged 30 suffered multiple vertebral fractures during pregnancy and lactation associated with very low BMD. In view of these observations, the other two daughters aged 29 and 27 years respectively were evaluated. BMD was found to be severely diminished according to densitometric values for osteoporosis established by WHO, but they had no history of bone fractures. Probably the strong genetic component in bone mass is responsible for the severely diminished BMD observed in all the women in this family, as well as the occurrence of bone fractures in two of them. To our knowledge, there are no similar reports in the literature. Our results evidence the importance of evaluating bone mass in the offspring of an individual presenting severe osteoporosis, in order to detect family members with low bone mass and at high risk of developing bone fractures.

[Efficient use of the operating room]. / Uso eficiente del quirófano.

BACKGROUND: To know whether the operating room is efficient requires continual evaluation of the equipment, the competency of personnel included and the level of complexity of the surgical procedures. This evaluation is in the institutional hospital center. The centers. The centers use them for internal control. However, they are slightly or not at all going in the productivity analysis of the operating room for decision making. OBJECTIVE: To identify the elements that favor suboptimal use of operating rooms and in each case, to propose solution for more efficient use. TYPE OF STUDY: Prospective, observational, transversal and comparative. MATERIAL AND METHODS: The study was carried out means of structured questionnaires with the times for surgical interventions in two operating rooms over sixty days. They were conducted the gynecology and general surgery areas. We compared real times against ideal times, and also the complexity levels. STATISTICAL ANALYSIS: Fisher's test p < 0.05 was considerate significant. RESULTS: One hundred and twenty-five surgical procedure were performed, 57.6% during the morning shift (MS) and 42.2% during the evening shift (ES). A total of 66.4% corresponded to complexity level IIII, 84.8% were elective surgeries, 58.4% corresponded to general surgeries, and 41.6% to gynecologic surgical interventions. The delay in times entering the operating room was 20.5 min in MS compared to 4.3 min in ES p < 0.05. In more complex procedures, we found greater delay in surgical time. CONCLUSIONS: The efficient use of the operating room depends on the complying of specific functions in the programmed time of the surgical equipment involved, systematic supervision, and the complexity level.

Sistema de información perinatal: Historia clínica perinatal base / Perinatal onformation system: Perinatal clinical history bases

A pesar de que la Historia Clínica es una pieza fundamental para un sistema de información adecuado y para un mejor ardenamiento de los servicios de salud, son notorias las deficiencias de que ésta adolece en la mayoría de los países de Latinoamérica. Como respuesta a ese problema, a inicios de la década de los ï70, el Centro Latinoamericano de Perinatología y Desarrollo Humano (CLAP) con sede en Montevideo, propuso un modelo de Historia Clínica Perinatal (HCPB) adoptado luego por varios países del Continente. Despues de dos años de trabajo, el equipo técnico del CLAP elaboró el Sistema Informático Perinatal. En esta tarea intervinieron obstetras, neonatólogos, sanitaristas, enfermeras, ingenieros de sistemas, bioestadístas y otros profesionales