Sensibilidad y dolor en distonías focales de la mano / Sensitivity and pain in focal dystonia of the hand

Introducción: Considerando las evidencias acumuladas actualmente es importante estudiar la fisiopatología tanto sensorial como motora de las distonías focales para comprenderlas y mejorar su tratamiento. Por ello, los objetivos del presente estudio son evaluar las aferencias somatosensoriales de los pacientes con distonía focal o segmentaria con afectación del miembro superior, comprobar si se corresponde con la mano de más uso, analizar la tolerancia al dolor y examinar la posible relación con la percepción del dolor en los pacientes con distonía segmentaria de la mano.MétodosSe contó con una muestra total de 24 participantes: 12 pacientes con distonía focal de la mano y 12 sujetos sin distonía. Todos ellos fueron evaluados con un algómetro electrónico (Somedic AB®, Farsta, Suecia), con los monofilamentos de Semmes-Weinstein y con la escala visual analógica.ResultadosLos datos hallados muestran, en la población estudiada, una mayor afectación en la sensibilidad superficial comparada con el grupo control, tanto en la mano dominante como en la no dominante, así como presencia de dolor (p > 0,001). Además, el grupo de distonía focal obtuvo una correlación negativa entre el dolor percibido y en el umbral de tolerancia de dolor a la presión (rho = −0,83; p < 0,001).ConclusionesLas personas con distonía segmentaria de la mano presentan una alteración en la sensibilidad y manifiestan mayor dolor percibido que las personas sin distonía. Se requieren más estudios con una muestra mayor que detecten las implicaciones clínicas y cotidianas, tanto del dolor objetivo como subjetivo. (AU)

Introduction: A growing body of evidence highlights the importance of understanding both the sensory and the motor pathophysiology of focal dystonia in order to improve its treatment. This study aims to evaluate somatosensory afferences in patients with focal or segmental dystonia affecting the upper limbs, to analyse whether the dominant limb is more frequently affected, to analyse pain tolerance, and to examine the potential association with pain perception in patients with hand dystonia.MethodsWe recruited 24 participants: 12 patients with focal hand dystonia and 12 individuals without dystonia. All participants were evaluated with a digital algometer (Somedic SenseLab AB®, Farsta, Sweden), a Semmes-Weinstein monofilament test, and the visual analogue scale for pain.ResultsAccording to our data, patients showed greater impairment in surface sensitivity than controls, both in the dominant and the non-dominant hands, as well as greater presence of pain (P > .001). Furthermore, the dystonia group showed a negative correlation between perceived pain and pressure pain tolerance threshold (rho = −0.83; P < .001).ConclusionsPatients with focal hand dystonia presented alterations in sensitivity and more severe perceived pain than individuals without dystonia. Future studies with larger samples should aim to analyse the clinical implications and everyday impact of both objective and subjective pain. (AU)

Sensitivity and pain in focal dystonia of the hand.

INTRODUCTION: A growing body of evidence highlights the importance of understanding both the sensory and the motor pathophysiology of focal dystonia in order to improve its treatment. This study aims to evaluate somatosensory afferences in patients with focal or segmental dystonia affecting the upper limbs, to analyse whether the dominant limb is more frequently affected, to analyse pain tolerance, and to examine the potential association with pain perception in patients with hand dystonia. METHODS: We recruited 24 participants: 12 patients with focal hand dystonia and 12 individuals without dystonia. All participants were evaluated with a digital algometer (Somedic SenseLab AB®, Farsta, Sweden), a Semmes-Weinstein monofilament test, and the visual analogue scale for pain. RESULTS: According to our data, patients showed greater impairment in surface sensitivity than controls, both in the dominant and the non-dominant hands, as well as greater presence of pain (P > .001). Furthermore, the dystonia group showed a negative correlation between perceived pain and pressure pain tolerance threshold (rho = -0.83; P < .001). CONCLUSIONS: Patients with focal hand dystonia presented alterations in sensitivity and more severe perceived pain than individuals without dystonia. Future studies with larger samples should aim to analyse the clinical implications and everyday impact of both objective and subjective pain.

[Strategy for planning and execution of a large-scale SARS-CoV-2 seroprevalence study on teaching hospital workers during a pandemic situation]. / Estrategia de planificación y ejecución de un estudio a gran escala de seroprevalencia de SARS-CoV-2 en trabajadores de un hospital universitario durante una situación de pandemia.

OBJECTIVE: To describe the planning and execution process of a massive seroprevalence study for SARS-CoV-2 in professionals of the Hospital Universitario Fundación Alcorcón (HUFA) (Spain). METHODS: A description is presented of the plan designed and developed at the HUFA for the execution of the extraction of the samples for serology from all the professionals who worked in the hospital between 14 and 29 April 2020. A descriptive analysis of the participation of the professionals in the study is carried out. Extraction areas, health personnel, and execution times were planned. A total of 2326 extractions were assigned to health personnel, the remaining extractions were assigned to workers from external companies. RESULTS: A total of 2641 workers (90.5%) out of 2918 candidates participated in the study. The professional category most analysed was nursing with 28.3% (n = 590). The percentage of compliance with schedule planning was 28.6%. Up to a maximum of 298 daily extractions were planned. The busiest day was the 4th day of the study with 399 extractions. CONCLUSIONS: The organising of such a large study, with a 100% coverage of those who worked in the hospital, and with such a great response from the workers involved, has led to obtaining results of high reliability in the seroprevalence study carried out. Although the percentage of participation was very high, the level of compliance with the planning was low.

Alterations in dexterity and manual function in patients with focal hand dystonia. / Descripción de la afectación de la destreza y función manual en pacientes con distonía focal de la mano.

INTRODUCTION: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. MATERIALS AND METHODS: We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). RESULTS: The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). CONCLUSIONS: Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Sensitivity and pain in focal dystonia of the hand. / Sensibilidad y dolor en distonías focales de la mano.

INTRODUCTION: A growing body of evidence highlights the importance of understanding both the sensory and the motor pathophysiology of focal dystonia in order to improve its treatment. This study aims to evaluate somatosensory afferences in patients with focal or segmental dystonia affecting the upper limbs, to analyse whether the dominant limb is more frequently affected, to analyse pain tolerance, and to examine the potential association with pain perception in patients with hand dystonia. METHODS: We recruited 24 participants: 12 patients with focal hand dystonia and 12 individuals without dystonia. All participants were evaluated with a digital algometer (Somedic SenseLab AB®, Farsta, Sweden), a Semmes-Weinstein monofilament test, and the visual analogue scale for pain. RESULTS: According to our data, patients showed greater impairment in surface sensitivity than controls, both in the dominant and the non-dominant hands, as well as greater presence of pain (P>.001). Furthermore, the dystonia group showed a negative correlation between perceived pain and pressure pain tolerance threshold (rho=-0.83; P<.001). CONCLUSIONS: Patients with focal hand dystonia presented alterations in sensitivity and more severe perceived pain than individuals without dystonia. Future studies with larger samples should aim to analyse the clinical implications and everyday impact of both objective and subjective pain.

Integración del proceso enfermero en la historia clínica electrónica de un hospital universitario / Integration of the nursing process in the electronic health record in an university hospital

Objetivo. Describir el proceso de implantación del Plan de Cuidados Individualizado Enfermero en la Historia Clínica Electrónica y su impacto en el Hospital Universitario Fundación Alcorcón. Metodología. Grupos de trabajo de enfermeras asistenciales que analizaron inicialmente las actividades enfermeras que realizaban habitualmente para crear el catálogo de diagnósticos, resultados e intervenciones. Se creó un grupo de referentes que depuró el catálogo para hacerlo manejable. Se diseñaron un plan de formación, los formularios de valoración enfermera y el Informe de Cuidados Enfermeros al alta. Resultados. En febrero de 2016 se implementó la nueva metodología en las unidades de hospitalización de adultos. Al 74,86-88,18% de los pacientes se les realizó un plan de cuidados con la nueva metodología. Entre un 69,41 y un 76,25% de los pacientes son dados de alta con un Informe de Cuidados Enfermeros conforme a la normativa. Se observó un aumento del 24,13% de los pacientes con Informe de Cuidados Enfermeros tras la implantación (p=0,000; RR 1,46; IC 95% 1,36-1,56). Se ha formado a un total de 116 enfermeras. Conclusiones. En las condiciones del estudio, la utilización de taxonomías enfermeras ha generado capacidad de reflexión y ha permitido emitir juicios enfermeros, aportar calidad de cuidados y aplicar intervenciones con unos resultados planificados. La taxonomía enfermera y el plan de cuidados en la historia clínica electrónica han permitido aumentar la comunicación interprofesional para mejorar la continuidad asistencial, a través de la mejora del Informe de Cuidados Enfermeros (AU)

Aim. To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. Methodology. Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. Results. In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. Conclusions. In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report (AU)

[Integration of the nursing process in the electronic health record in an university hospital]. / Integración del proceso enfermero en la historia clínica electrónica de un hospital universitario.

AIM: To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. METHODOLOGY: Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. RESULTS: In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. CONCLUSIONS: In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report.

Efecto del tiempo en lista de espera quirúrgica en la valoración de la cirugía por parte del paciente / Effect of the waiting time on patients’ surgery evaluation

Introducción: Analizar el efecto del tiempo en lista de espera quirúrgica en el grado de satisfacción de los pacientes de cirugía mayor ambulatoria (CMA).Material y métodos: Estudio descriptivo basado en encuestas enviadas por correo. Estudio realizado en un hospital general de la Comunidad de Madrid. Se empleó una versión adaptada de SERVQHOS. Tamaño muestral calculado a partir de la actividad quirúrgica anual considerando un error del 2 %, p = q = 0,50, nivel de confianza del 95 % y una esperanza de respuesta del 40 %.Resultados: Se analizaron 431 encuestas (tasa de respuesta del 37,2 %). El Alpha de Cronbach de SERVQHOS-CMA fue de 0,92 (IC95 % 0,90-0,93). 226 pacientes (52,4 %) informaron estar en lista de espera menos de 1 mes; solo 35 (7,4 %) esperaron más de 3 meses. 177 (41,1 %) se declararon muy satisfechos y otros 137 (31,8 %) satisfechos con la CMA. No existieron diferencias en la satisfacción en función de sexo (p = 0,09) o actividad profesional (p = 0,56). A mayor edad, mayor satisfacción (p = 0,04). La satisfacción global con la cirugía (p = 0,02) y con aspectos concretos como: resultado de la cirugía (p = 0,02), trato (p = 0,007), información (p = 0,006), atenciones de enfermería (p = 0,013), competencia de los profesionales (p = 0,001) o información una vez en casa (p = 0,002), fue menor cuando el tiempo en lista de espera fue superior a 3 meses. Conclusiones: Conforme aumenta el tiempo de permanencia en la lista de espera quirúrgica disminuye la satisfacción del paciente (AU)

Objective: To analyze the effect of time on waiting list for surgery in the satisfaction of ambulatory surgical patients. Methods: Descriptive study based on mailed surveys. Setting: general hospital in the Community of Madrid. Instrument: an adapted version of SERVQHOS. Sample size calculated from the annual surgical activity considering an error of 2 %, p = q = 0.50, confidence level of 95 % and expectancy of response of 40 %.Results: 431 responses (response rate 37.2 %) were analyzed. The Cronbach’s Alpha SERVQHOS-CMA was 0.92 (95 % CI 0.90 to 0.93). 226 patients (52.4 %) reported being on the waiting list within 1 month, only 35 patients (7.4 %) waited more than 3 months. 177 patients (41. 1%) declared themselves very satisfied and another 137 patients (31.8 %) satisfied with the CMA. No significant differences in satisfaction based on sex (p = 0.09) or occupation (p = 0.56) were found. The older patient showed more satisfaction (p = 0.04). Overall satisfaction with surgery (p = 0.02) and specific aspects as a result of surgery (p = 0.02), treatment (p = 0.007), information (p = 0.006), nursing care (p = 0.013), professionals´ competence (p = 0.001) or information once at home (0.002) was lower when the time on the waiting list was over 3 months. Conclusions: As the time that patient remains on surgical waiting list increases further satisfaction once intervened decreases (AU)

[Characteristics of patients with methicillin-resistant Staphylococcus aureus infection]. / Características de los pacientes que presentan infección por Staphylococcus areus resistente a meticilina.

OBJECTIVE: To determine the epidemiological characteristics of infection by methicillin-resistant Staphylococcus aureus (MRSA) and changes in its prevalence in a tertiary hospital in the autonomous community of Madrid. METHOD: Between 2005 and 2007, we carried out a descriptive study of all patients with MRSA-positive cultures from the total number of admissions to the Fundación Alcorcón University Hospital. RESULTS: Of 251 MRSA-positive cultures, the infection was community-acquired in 138 patients (55%) while 112 patients (44.6%) were from nursing homes. The mean age of the patients was 76 years, with men representing 56.2% (141) of the sample. The median length of hospital stay was 17 days. Positive cultures were isolated from sputum in 21.9% (55), from blood cultures in 19.5% (49), from other locations in 19.9% (50) and from pressure ulcers, surgical wounds or urine in 55.8% of the patients (140). The latter could be classified as healthcare-related infections. The total infection rate was 5.540 per hundred. CONCLUSIONS: More than half of infected patients with MRSA infection were colonized. The most frequent locations were pressure ulcers and surgical wounds and consequently the risk of spread can be related to healthcare. In infected patients, the length of hospital stay was 4-5 times longer than average. The rate of hospital-acquired infection tended to decrease, while that of community-acquired infection increased during the study period. Hygiene measures should be implemented, quality of care should be improved, and health resources should be optimized.

Características de los pacientes que presentan infección por Staphylococcus areus resistente a meticilina / Characteristics of patients with methicillin-resistant Staphylococcus aureus infection

Objetivo. Conocer las características epidemiológicas de infección por Staphylococcus areus resistente a meticilina (SARM) y la evolución de su prevalencia en un hospital de tercer nivel de la Comunidad de Madrid. Método. Estudio descriptivo de los casos con cultivo positivo para SARM del total de los ingresos del Hospital Universitario Fundación Alcorcón durante el período 2005-2007. Resultados. De los 251 casos con cultivo positivo para SARM estudiados, en 138 (55%) su adquisición fue comunitaria y 112 (44,6%) procedían de centros sociosanitarios. La mediana de edad de los casos fue de 76 años, los varones representan el 56,2% (141). La mediana de días de ingreso hospitalario fue de 17 días. Según localización de la infección, el 21,9% (55) estaba en esputo, el 19,5% (49) en hemocultivo, el 19,9% (50) en otras localizaciones, y el 55,8% (140) en herida quirúrgica, orina y úlcera por presión, susceptibles de catalogarse como infecciones asociadas a los cuidados sanitarios. La prevalencia de infección en el período de estudio fue del 5,540¿. Conclusiones. Más de la mitad de los casos que presentaron infección por SARM estaba colonizado. Las localizaciones más frecuentes de la infección fueron la úlcera por presión y la herida quirúrgica, por lo que el riesgo de diseminación se puede relacionar con cuidados. El ingreso se prolongó entre 4 y 5 veces la estancia media hospitalaria. La prevalencia de adquisición hospitalaria tiene una tendencia descendente mientras que la de adquisición comunitaria se incrementa a lo largo del período del estudio. Implementar las medidas de higiene, mejorará la calidad asistencial de los pacientes, y la optimización de los recursos sanitarios (AU)

Objective. To determine the epidemiological characteristics of infection by methicillin-resistant Staphylococcus aureus (MRSA) and changes in its prevalence in a tertiary hospital in the autonomous community of Madrid. Method. Between 2005 and 2007, we carried out a descriptive study of all patients with MRSA-positive cultures from the total number of admissions to the Fundación Alcorcón University Hospital. Results. Of 251 MRSA-positive cultures, the infection was community-acquired in 138 patients (55%) while 112 patients (44.6%) were from nursing homes. The mean age of the patients was 76 years, with men representing 56.2% (141) of the sample. The median length of hospital stay was 17 days. Positive cultures were isolated from sputum in 21.9% (55), from blood cultures in 19.5% (49), from other locations in 19.9% (50) and from pressure ulcers, surgical wounds or urine in 55.8% of the patients (140). The latter could be classified as healthcare-related infections. The total infection rate was 5.540¿. Conclusions. More than half of infected patients with MRSA infection were colonized. The most frequent locations were pressure ulcers and surgical wounds and consequently the risk of spread can be related to healthcare. In infected patients, the length of hospital stay was 4-5 times longer than average. The rate of hospital-acquired infection tended to decrease, while that of community-acquired infection increased during the study period. Hygiene measures should be implemented, quality of care should be improved, and health resources should be optimized (AU)