Tumor borderline de ovario en adolescente / A borderline ovarian tumour in an adolescent

El cáncer de ovario es la causa de más de 140.000 muertes en el mundo. La edad, la nuliparidad y la historia familiar de cáncer ovárico se han asociado con mayor riesgo. Los tumores borderline de ovario se caracterizan por presentar un curso clínico y un pronóstico claramente más favorables que el cáncer ovárico invasivo. El uso de marcadores tumorales no ha mostrado utilidad en la detección temprana de la enfermedad, por lo que un alto grado de sospecha, junto con la exploración física y estudios de imagen, es clave para su diagnóstico. Presentamos el caso de una adolescente con tumor borderline de ovario sin clínica previa que se detectó en la exploración ecográfica realizada en el centro de salud (AU)

Ovarian cancer is responsible for over 140,000 deaths worldwide. Age, nulliparity and family history of ovarian cancer have been associated with increased risk. Borderline ovarian tumours are characterised by a clearly more favourable clinical course and prognosis than invasive ovarian cancer. The use of tumour markers has not proved useful in the early detection of disease, so a high level of suspicion, along with physical examination and imaging studies are the key to diagnosis. We present the case of an adolescent with a borderline ovarian tumor without previous clinical symptoms which was detected on ultrasound performed in the clinic (AU)

Mejora de la actuación ante las infecciones urinarias en un centro de salud mediante un ciclo de garantía de calidad. Análisis mediante muestreo por lotes / Improvement in the clinical management of urinary infections in a health centre by means of a quality management cycle. Analysis using lot quality assurance sampling

ObjetivoMejorar la efectividad clínica en el abordaje de las infecciones urinarias mediante un ciclo de garantía de calidad.MétodosDiseño: estudio pre-post. Se analizaron los indicadores de tratamiento de la infección urinaria en el año previo a la intervención y a los 6 y a los 18 meses de producirse ésta.MétodosÁmbito: médicos de familia. Centro de salud urbano.MétodosIntervención y mediciones principales: se seleccionó una guía de práctica clínica para el abordaje de la infección urinaria, mediante método de consenso entre profesionales y mediante la utilización del documento de evaluación Appraisal of Guidelines Research and Evaluation (AGREE). Los puntos esenciales del protocolo elegido e indicadores de evaluación eran la prescripción de tratamiento con una dosis única de 3 g de fosfomicina por vía oral sin realización de tira reactiva de orina ni urocultivo a aquellas pacientes que cumplieran criterios de inclusión. Los resultados basales de estos indicadores, así como los de la primera evaluación a los 6 meses de iniciada la intervención, se comunicaron y se analizaron con los médicos del centro. La medición se ha realizado mediante auditoría de historias clínicas, seleccionadas mediante un plan de muestreo por lotes.ResultadosAl partir de un nivel de cumplimiento de los indicadores, en el mejor de los casos, de un 52%, al año y medio de la intervención todos los indicadores principales habían alcanzado un nivel de calidad aceptable del 90% (α del 5% y β del 10%).ConclusionesLa introducción de un ciclo de mejora para el abordaje de las infecciones urinarias en nuestro ámbito parece modificar el comportamiento de los profesionales sanitarios y mejorar la efectividad(AU)

AimTo improve clinical effectiveness of the management of urinary tract infections in a primary care centre by means of a Management Quality Cycle.DesignPre-post test.SettingUrban primary care centre.Participants and main outcome measuresWe selected a clinical practice guideline for management of urinary tract infection by way of consensus among doctors, and using the evaluation document AGREE. The main points of the protocol chosen, and evaluation indicators were: the prescription of treatment with a single dose of 3 grams of fosfomycin orally without performing a urine strip or urine culture to those patients who met the protocol inclusion criteria. The results of these baseline indicators, as well as evaluation at six months after the intervention started, were reported and discussed with the doctors of medical centre. The measurement was conducted by audit of medical records selected by lot quality assurance sampling (LQAS).ResultsStarting from a level of compliance of the indicators of, at best 52%, at 18 months after the intervention all major indicators had reached an acceptable quality level of 90% (5% alpha and beta 10%).ConclusionsThe introduction of a Management Quality Cycle for management urinary tract infections in our area, appears to modify the behaviour of health professionals and improve the clinical effectiveness(AU)

[Improvement in the clinical management of urinary infections in a health centre by means of a quality management cycle. Analysis using lot quality assurance sampling]. / Mejora de la actuación ante las infecciones urinarias en un centro de salud mediante un ciclo de garantía de calidad. Análisis mediante muestreo por lotes.

AIM: To improve clinical effectiveness of the management of urinary tract infections in a primary care centre by means of a Management Quality Cycle. DESIGN: Pre-post test. SETTING: Urban primary care centre. PARTICIPANTS AND MAIN OUTCOME MEASURES: We selected a clinical practice guideline for management of urinary tract infection by way of consensus among doctors, and using the evaluation document AGREE. The main points of the protocol chosen, and evaluation indicators were: the prescription of treatment with a single dose of 3 grams of fosfomycin orally without performing a urine strip or urine culture to those patients who met the protocol inclusion criteria. The results of these baseline indicators, as well as evaluation at six months after the intervention started, were reported and discussed with the doctors of medical centre. The measurement was conducted by audit of medical records selected by lot quality assurance sampling (LQAS). RESULTS: Starting from a level of compliance of the indicators of, at best 52%, at 18 months after the intervention all major indicators had reached an acceptable quality level of 90% (5% alpha and beta 10%). CONCLUSIONS: The introduction of a Management Quality Cycle for management urinary tract infections in our area, appears to modify the behaviour of health professionals and improve the clinical effectiveness.

Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes.

The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.

[Risk factors associated with falls in institutionalized elderly population. A prospective cohort study]. / Factores de riesgo de caídas en una población anciana institucionalizada. Estudio de cohortes prospectivo.

BACKGROUND: Falls in elderly subjects are a frequent cause of morbidity and mortality. The present study investigated risk factors associated with falls in institutionalized elderly subjects. PATIENTS AND METHODS: The subjects of this prospective cohort study were 190 persons aged 65 years or older, who were able to walk unassisted. We recorded sociodemographic variables, morbidity, drugs, functional capacity, cognitive status, gait and balance. Crude and adjusted density ratios (DR) were calculated and Cox proportional risk analysis was performed. RESULTS: A total of 121 falls occurred in 7 persons, for a fall rate of 0.75 per person per year. Independent risk factors identified with multivariate analysis were diabetes mellitus (DR = 3.6), slow gait (DR = 1.7), failed Romberg test (DR = 3.2) and fall(s) during the previous 12 months (DR = 1.9). Drugs that were associated with significant risk were digitalis, antiarrhythmics, neuroleptics, antidepressants and oral bronchodilators. A higher number of chronic diseases acted as a protective factor. CONCLUSIONS: The main risk factors associated with falls in elderly were easy to identify. Analysis of these factors can help to identify elderly persons with a high risk of falls, and thus focus appropriate preventive measures on these subjects.

[Frequency, characteristics and consequences of falls in a cohort of institutionalized elderly patients]. / Frecuencia, características y consecuencias de las caídas en una cohorte de ancianos institucionalizados.

OBJECTIVE: Falls in the elderly are a major problem because of their high morbility and mortality rates and health expenditures. However, there are few studies about this problem in our country. The purpose of the present study was to know the frequency, features and consequences of falling among institutionalized elders. METHODS: We carried out a prospective cohort study using a sample of 190 persons aged 65 years and older living in two nursing homes. All subjects underwent a comprehensive evaluation at the onset of the study. During a mean follow-up period of 310 days, all falls were recorded. RESULTS: There were a total of 121 falls in 72 (37.9%) subjects, twenty five of whom (34.7%) experienced two or more falls. The fall incidence per person-year was 0.75. As compared with males, females had a density ratio (DR) of 2 (1.2-3.2; 95% confidence interval-CI). Falling was more frequent in the bedrooms and living rooms (43.8%). DISCUSSION: This results agree with others studies about the high fall incidence in the elderly and bring out new features about circumstances and consequences of falls.