Estudio de los exitus con diagnóstico secundario de desnutrición en un hospital de tercer nivel / Study of death with secondary diagnosis of malnutrition in a third level hospital

Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los sujetos hospitalizados, toma entidad propia denominándose “desnutrición hospitalaria”. Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos (AU)

BACKGROUND: Malnutrition is a major public health problems, according to WHO, is the leading cause of death, when it affects the group of hospitalized patients, making denominating separate entity "hospital malnutrition". OBJECTIVES: The overall objective is to quantify the main diagnoses frequently high, causing exitus, with secondary diagnosis of malnutrition. METHODS: This is a descriptive study, which included all hospital discharges in 2011 and first half of 2012, which have been exitus and whose secondary diagnosis of malnutrition, with the total of 33. We performed a descriptive analysis, effected the Mann-Whitney nonparametric test (p < 0.05).RESULTS: The most frequent main diagnoses among 33 analyzed are high sepsis (12.1%), liver metastases (9.1%), pneumonia (6.1%), acute respiratory failure (6.1%) and renal acute renal (6.1%).CONCLUSIONS: Although the most frequent primary diagnosis of sepsis, by grouping the diagnoses, the most frequent DRG is respiratory disease, so it has to make comprehensive and quality coding to adjust the relative weight of the same reality. It is essential to specify the source of clinical information used for coding, the degree of malnutrition, for greater specificity in the data (AU)

[Study of death with secondary diagnosis of malnutrition in a third level hospital]. / Estudio de los exitus con diagnóstico secundario de desnutrición en un hospital de tercer nivel.

BACKGROUND: Malnutrition is a major public health problems, according to WHO, is the leading cause of death, when it affects the group of hospitalized patients, making denominating separate entity "hospital malnutrition". OBJECTIVES: The overall objective is to quantify the main diagnoses frequently high, causing exitus, with secondary diagnosis of malnutrition. METHODS: This is a descriptive study, which included all hospital discharges in 2011 and first half of 2012, which have been exitus and whose secondary diagnosis of malnutrition, with the total of 33. We performed a descriptive analysis, effected the Mann-Whitney nonparametric test (p < 0.05). RESULTS: The most frequent main diagnoses among 33 analyzed are high sepsis (12.1%), liver metastases (9.1%), pneumonia (6.1%), acute respiratory failure (6.1%) and renal acute renal (6.1%). CONCLUSIONS: Although the most frequent primary diagnosis of sepsis, by grouping the diagnoses, the most frequent DRG is respiratory disease, so it has to make comprehensive and quality coding to adjust the relative weight of the same reality. It is essential to specify the source of clinical information used for coding, the degree of malnutrition, for greater specificity in the data.

Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los sujetos hospitalizados, toma entidad propia denominándose "desnutrición hospitalaria". Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos.

Are the health messages in schoolbooks based on scientific evidence? A descriptive study.

BACKGROUND: Most textbooks contains messages relating to health. This profuse information requires analysis with regards to the quality of such information. The objective was to identify the scientific evidence on which the health messages in textbooks are based. METHODS: The degree of evidence on which such messages are based was identified and the messages were subsequently classified into three categories: Messages with high, medium or low levels of evidence; Messages with an unknown level of evidence; and Messages with no known evidence. RESULTS: 844 messages were studied. Of this total, 61% were classified as messages with an unknown level of evidence. Less than 15% fell into the category where the level of evidence was known and less than 6% were classified as possessing high levels of evidence. More than 70% of the messages relating to "Balanced Diets and Malnutrition", "Food Hygiene", "Tobacco", "Sexual behaviour and AIDS" and "Rest and ergonomics" are based on an unknown level of evidence. "Oral health" registered the highest percentage of messages based on a high level of evidence (37.5%), followed by "Pregnancy and newly born infants" (35%). Of the total, 24.6% are not based on any known evidence. Two of the messages appeared to contravene known evidence. CONCLUSION: Many of the messages included in school textbooks are not based on scientific evidence. Standards must be established to facilitate the production of texts that include messages that are based on the best available evidence and which can improve children's health more effectively.

Variability in the prioritization of patients for cataract extraction.

OBJECTIVE: The aim of this study was to compare time spent waiting for cataract extraction across various hospitals and to determine if it was influenced by severity of disease or patient characteristics. DESIGN: Ambispective cohort study. Clinical, sociodemographic, and health-related quality of life data were collected along with time spent on the waiting list. SETTING: Twelve hospitals in four regions of Spain. PARTICIPANTS: A total of 4043 patients who were waiting for being intervened on cataracts in the participant centres were recruited prospectively. Exposition variables Priority was assigned retrospectively using a previously validated scoring system. MAIN OUTCOME MEASURE: Time spent on waiting list. RESULTS: Statistically significant differences in time spent on the waiting list (P < 0.0001) were observed across the hospitals, even after adjusting for pathology, age, social dependency, laterality of the cataract and number of inappropriate interventions in each centre. Waiting time was not correlated with preintervention visual acuity, preintervention visual function measured by the VF-14 or priority score. CONCLUSIONS: Allocation of cataract surgery does not appear to be correlated with the need for surgery or the likely benefit to be derived from it in the Spanish participant centres. The use of explicit and standardized priority criteria could provide a fairer, more rational way to manage waiting lists for this procedure and may help to reduce unnecessary variation on access to health care.

[Presence of current child and adolescent health priorities in school textbooks]. / Presencia de las actuales prioridades de salud infantil y adolescente en los libros de texto escolares.

BACKGROUND: Textbooks are an educational tool for learning health habits. The aim of this study was to determine how these textbooks present the health priorities defined by health organizations to children and teenagers. METHOD: We performed a descriptive study in 3 steps: a) the priorities defined by health organizations were identified; b) the messages on health in the textbooks used in the schools of a municipality were identified, and c) the extent to which these messages fitted the priorities established was analyzed. RESULTS: The World Health Organization, the European Union, the Spanish Ministry of Health and Consumption, and the Spanish Society of Public Health and Healthcare Administration define 24 priorities. One hundred textbooks were collected, with 663 health messages. The priorities most frequently covered in the textbooks were diet, physical exercise and the impact of environmental contamination. The least frequently covered topics was bullying, child maltreatment, poverty, self harm, and obesity. The latter topic was especially lacking in kindergartens and elementary schools. CONCLUSIONS: The health messages contained in school textbooks are not well adapted to the priorities defined by health organizations.

Presencia de las actuales prioridades de salud infantil y adolescente en los libros de texto escolares / Presence of current child and adolescent health priorities in school textbooks

Introducción: Los libros de texto escolares son una herramienta didáctica para aprender hábitos saludables. El objetivo de este estudio es conocer cómo se recogen en los libros las prioridades de salud infantil y adolescente definidas por las autoridades sanitarias.Métodos: Estudio descriptivo en 3 fases: a) identificación de las prioridades según las autoridades sanitarias; b) identificación de los mensajes sobre salud de los textos usados en los colegios de un distrito municipal, y c) observación de cómose adecuan estos mensajes a las prioridades.Resultados: La Organización Mundial de la Salud, la UniónEuropea, el Ministerio de Sanidad y Consumo, y la Sociedad Española de Salud Pública y Administración Sanitaria definen 24 prioridades. Se recogieron 100 libros de texto y 663 mensajes sobre salud. Las prioridades tratadas con más frecuencia son la alimentación, el ejercicio físico y el impacto de la contaminación medioambiental. Las menos tratadas son elacoso escolar, el maltrato infantil, la pobreza, la autolesión y la obesidad, esta última especialmente en educación infantil y primaria.Conclusiones: Los mensajes sobre salud de los libros no se ajustan suficientemente a las prioridades definidas por las autoridades

Background: Textbooks are an educational tool for learning health habits. The aim of this study was to determine how these textbooks present the health priorities defined by health organizationsto children and teenagers.Method: We performed a descriptive study in 3 steps: a) the priorities defined by health organizations were identified; b) the messages on health in the textbooks used in the schools of a municipality were identified, and c) the extent to which these messages fitted the priorities established was analyzed.Results: The World Health Organization, the European Union, the Spanish Ministry of Health and Consumption, and the Spanish Society of Public Health and Healthcare Administration define 24 priorities. One hundred textbooks were collected, with 663 health messages. The priorities most frequently covered in the textbooks were diet, physical exercise and the impact of environmental contamination. The least frequently covered topics was bullying, child maltreatment, poverty, self harm,and obesity. The latter topic was especially lacking in kindergartens and elementary schools.Conclusions: The health messages contained in school textbooks are not well adapted to the priorities defined by health organizations

Textural analysis in the diagnosis of benign and malignant breast cells.

OBJECTIVE: To study the discriminatory capacity of textural variables to classify the nuclei of breast tumor cells as benign or malignant, using a statistical approach. STUDY DESIGN: Image analysis techniques were used to automatically segment nuclei of cells obtained by fine needle aspiration and Papanicolaou stained. The sample comprised 95 cases of malignant lesions and 47 cases of benign lesions (approximately 25 nuclei per case), and 27 textural variables were measured. Two methods were used to analyze the data: classification and regression trees (CART) and discriminant analysis. RESULTS: The variance in gray levels was the most decisive variable in the CART analysis, correctly classifying 57% and 97% of benign and malignant cases, respectively. Discriminant analysis yielded the best results, correctly classifying 79% and 85% of benign and malignant cases, respectively. CONCLUSION: The classifier obtained by a statistical approach to the textural analysis of Papanicolaou-stained nuclei did not prove useful for diagnostic discrimination. Staining techniques that are not chromatin specific are highly variable, and other features have proven more effective with this type of staining.

Procesos asistenciales integrados: modelo de evaluación y algunos resultados / Integrated care processes: evaluation model and some results. A tool for continuous

Introducción: El trabajo por procesos asistenciales integrados (PAI) introduce criterios de calidad para su monitorización. En este estudio se presenta un modelo de evaluación de las normas de calidad de los PAI en Andalucía, en atención primaria (AP) y atención especializada (AE) en 2 momentos temporales, y algunos de los resultados obtenidos en el Hospital Universitario Virgen de las Nieves (HUVN) y en el Distrito Metropolitano (DM). Material y métodos: Estudio descriptivo acerca del modelo de monitorización de las normas de calidad de algunos PAI, en AP y en AE, utilizando datos procedentes de la historia clínica digital en AP, y de las auditorías de las historias clínicas en AE (muestreo por lotes y tablas de la distribución binomial). Resultados: Se obtienen los resultados de la monitorización de las normas de calidad en atención primaria (DM) y en atención especia-lizada (HUVN) y se elabora un sistema integrado de monitorización conjunta. Se presentan resultados de los siguientes PAI (cáncer de mama, cáncer de cérvix, embarazo, parto y puerperio, hipertrofia benigna de próstata/cáncer de próstata y cuidados paliativos). Se presentan resultados de la práctica enfermera en algunas actuaciones. Se evalúa la información obtenida y se realizan propuestas de mejora. Conclusiones: El diseño y la utilización de metodología de evaluación es un requisito para conocer los resultados de las actuacio-nes y tomar decisiones para mejorar. Hay que mejorar y adaptar los sistemas de información asistenciales a las necesidades de información de los PAI. La evaluación conjunta es una etapa más en el círculo de mejora de la calidad de los procesos asistenciales integrados

Introduction: Integrated care processes (ICP) introduce quality criteria for quality monitoring. This study presents a model for evaluating the quality standards of ICPs in primary care (PC) and specialized care (SC) in Andalucia (Spain) at two time points and reports some of the results obtained in the Hospital Virgen de las Nieves (HUVN) and in the Metropolitan District (MD). Material and methods: We performed a descriptive study of the model of quality standards monitoring for some ICPs in PC and SC using data from the systematic registries produced by digital medical records in PC and medical record audits in SC. Sampling by lots and tables of binomial distribution were used. Results: The results of quality standards monitoring were obtained in PC (DM) and in SC (HUVN) and an integrated system of joint monitoring was introduced. The results of the following ICP are presented: breast cancer, cervical cancer, pregnancy, delivery and puerperium, benign hypertrophy of the prostate/prostate cancer, and palliative care. The results of nursing practice in some interventions are provided. The information obtained and proposals for improvement are made. Conclusions: The design and use of evaluation methodology is required to determine the results of interventions and to make decisions for improvement. Healthcare information systems should be improved and adapted to the needs of information from ICPs. Joint evaluation is another stage in the circle of quality improvement of ICP