Calidad percibida en una unidad de demencias: el portavoz del paciente como proveedor de información / Perceived quality in a dementia unit: patients' caregivers as information providers

INTRODUCCIÓN: Las unidades de demencia (UD) realizan un abordaje integral y especializado de las personas con demencia. Su evaluación suele limitarse a aspectos asistenciales. El objetivo del trabajo fue conocer la satisfacción y calidad percibida por familiares/cuidadores de pacientes atendidos por una UD. MÉTODOS: Encuesta autocumplimentada con cuestionario de elaboración propia a 236 acompañantes de pacientes ya conocidos en la UD durante 2015, estructurada en 6 dimensiones (accesibilidad, organización, profesionalidad, trato, información e infraestructura) y analizada mediante tasas de problemas. RESULTADOS: Tasa de respuesta de 53,4%, resultando la mayoría mujeres, cónyuges o familiares de primer grado de los pacientes. La tasa de problemas global fue 15,0% (IC 95%: 13,9-16,1), con amplias variaciones por dimensión: desde 0,1% (IC 95%: 0,0-0,4) en "trato" y "profesionalidad" hasta 49,3% IC 95%: 45,4-53,2) en «información». La espera se percibe excesiva a partir de 30min. Los problemas de información se centraron en actividades no directamente asistenciales. La satisfacción fue 8,29/10 (mediana 8; DE: 1,45) con 77,3% (IC 95%: 69,8-74,8) de puntuaciones excelentes. El 99% recomendarían la UD. CONCLUSIONES: El cuestionario ha ofrecido una visión global de la calidad percibida por los familiares/cuidadores de los pacientes atendidos, y permitido identificar y priorizar dónde implantar acciones correctoras. Ha demostrado ser una herramienta útil para evaluar y mejorar la calidad asistencial en las UD

INTRODUCTION: Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. METHODS: We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. RESULTS: A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. CONCLUSIONS: This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs

Perceived quality in a dementia unit: patients' caregivers as information providers. / Calidad percibida en una unidad de demencias: el portavoz del paciente como proveedor de información.

INTRODUCTION: Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. METHODS: We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. RESULTS: A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. CONCLUSIONS: This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs.

Changes in performance, skinfold thicknesses, and fat patterning after three years of intense athletic conditioning in high level runners.

OBJECTIVES: To determine if the changes in specific skinfold sites induced by intense athletic conditioning over a three year period were associated with changes in running performance in high level athletes. METHODS: Thirty seven top class runners (eight male and five female sprint trained, 16 male and eight female endurance trained) volunteered to participate in the study. The athletes were divided into class A (n = 18) and class B (n = 17), with class A having the best performance. Biceps, triceps, subscapular, pectoral, iliac crest, abdominal, front thigh, and medial calf skinfold thickness and the best running performance were recorded at the beginning and after one, two, and three years of training. A one way analysis of variance and a linear regression analysis were conducted to determine changes and association between performance and skinfold thicknesses. Analyses were controlled for sex, sprint event or endurance event, and class. RESULTS: Training resulted in a significant increase in performance and decreases in sum of six skinfolds, abdominal, front thigh, and medial calf skinfolds, and the ratio of extremity to trunk skinfolds (E/T, Sigmatriceps, front thigh, medial calf/Sigmasubscapular, iliac crest, abdominal). There were no significant differences in body weight. Except for the abdominal skinfold, there was no significant difference in trunk skinfolds. Significant differences in these changes were observed by sex for E/T, which decreased and increased in male and female runners respectively, and by class. Class B runners significantly improved performance, with decreased skinfold thicknesses in the lower limb. There were no significant changes in performance or skinfold thicknesses in class A runners. Improvements in performance were consistently associated with a decrease in the lower limb skinfolds. CONCLUSIONS: On the basis of these findings, anthropometric assessment of top class athletes should include an evaluation of all skinfolds. The loss of body fat appears to be specific to the muscular groups used during training. The lower limb skinfolds may be particularly useful predictors of running performance.

Estudios isotópicos en nefrourología pediátrica / No disponible

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Pancarditis por Salmonella entérica. Diagnóstico de localización mediante exploración con 67Galio / Enteric salmonella pancarditis. Diagnosis of site by examination with 67Gallium

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[Is it necessary to use an isotopic diuretic renogram in grade II pyelocaliceal dilatations diagnosed with ultrasonography?]. / Es necesario efectuar un renograma isotópico diurético en las dilataciones pielocaliciales grado II ecográfico?

PURPOSE: The increasing number of ultrasonographically detected asymptomatic, renal dilations have caused a lot of explorations to be performed in these patients. The Society of Fetal Urology proposed a four grades classification of echographic renal dilations and renographic studies are recommended in grades II to IV. However we have observed that grade II dilations don't evolve to obstruction. The aim of this work is to evaluate the obstruction rate in this group of patients, and the necessity or not of practising diuretic renography. MATERIAL AND METHODS: We studied 42 children diagnosed of grade II renal dilation during a 1.5 year period. Left side was more frequently affected, 23 cases, 7 cases were bilateral what means 49 affected renal units. There was a male predominance (69%). Mean age at diagnosis was 2 months (0 to 36 months). Seventy nine per cent were prenatally diagnosed. RESULTS: The MAG-3 renal scan showed 48 unobstructed renal units and 1 obstructed. The F-15 variant was made in 15 cases by a doubtful curve or retarded elimination. The patient with obstructive curve presented an 15 mm renal pelvic diameter echographically measured and the intravenous urography showed a higher dilation being operating on. The mean time follow up was 23.5 months (13 to 53 months) without any change. CONCLUSION: Grade II pielocalicial dilations with renal pelvis lesser than 15 mm can be echographically controlled without renal scan. It should be performed only if renal dilation increases.

Papel de la medicina nuclear en el diagnóstico de muerte cerebral / Role of nuclear medicine in the diagnosis of brain death

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¿Es necesario efectuar un renograma isotópico diurético en las dilataciones pielocaliciales grado II ecográfico? / Is it necessary to perform a diuretic isotopic renography in grade II pelocalicial dilations diagnosed by means of ultrasound?

El incremento de riñones dilatados detectados por ecografía (ECO), la mayoría asintomáticos, ha provocado que estos niños acudan a consulta para valoración y tratamiento adecuado. La Sociedad de Urología Fetal ha clasificado las dilataciones renales, mediante ECO, en IV grados, recomendándose estudios renográficos en los grados II, III y IV. Desde hace años observamos que las dilataciones grado II no suelen presentar obstrucción, por lo que el objetivo del trabajo consiste en valorar la incidencia de obstrucción en este grupo y, por lo tanto, la necesidad o no de efectuar renograma isotópico diurético. MATERIAL Y MÉTODOS: Durante 1,5 años estudiamos 42 niños con dilatación pielo-calicial ecográfico grado II, mediante renograma isotópico diurético tipo MAG-3. Hubo mayor afectación del lado izquierdo con 23 casos y 7 fueron bilaterales, lo que totaliza 49 unidades renales dilatadas. Predominaron los varones (69 por ciento) y la edad media al diagnóstico fue de 2 meses (0 a 36 meses). Un 79 por ciento presentó diagnóstico prenatal. RESULTADOS: El MAG-3 mostró 48 riñones con curva no obstructiva y uno obstructiva. En 15 niños se efectuó ad-más la variante F-15 por curva dudosa o eliminación retrasada. El paciente con curva obstructiva presentó un diámetro pélvico de 15 mm en la ECO, estudiándose con urografía intravenosa (UIV) que evidenció una dilatación mayor, grado III, por lo que fue intervenido. El tiempo medio de seguimiento ha sido de 23,5 meses (13 a 53 meses), no apreciando ningún cambio y, por consiguiente, no modificando la actitud tomada. CONCLUSIÓN: Hoy en día las dilataciones pielo-caliciales grado II ecográfico con diámetro pélvico inferior a 15 mm se pueden controlar con ECO sin renograma, ya que no son obstructivas, realizándose éste último si aumenta el grado de dilatación (AU)