Evaluación de la calidad de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía / Evaluation of the Andalusia Public Health System hospital websites in the period 2010-2012

Objetivos: Evaluar la calidad, la accesibilidad y la presencia de herramientas 2.0 de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía. Métodos: Estudio observacional descriptivo durante el periodo 2010-2012. Las variables analizadas fueron: calidad, accesibilidad y presencia de herramientas 2.0. La calidad se evaluó mediante el cuestionario de Bermúdez-Tamayo, la accesibilidad con la herramienta Test de Accesibilidad Web y las herramientas 2.0 por observación directa. Resultados: Disponían de página web en 2010, 31 de los 45 hospitales (68,9%), incrementándose hasta 34 (75,5%) en 2012. La puntuación media + desviación estándar (DE) del cuestionario de calidad Bermúdez Tamayo fue de 11,1 + 3,8 puntos en 2010 y de 12,3 + 3,9 puntos en el año 2012, observándose una diferencia entre las medias de 0,25 (IC del 95%, 0,00 a 0,50) estadísticamente significativa (p = 0,007). En la evaluación de la accesibilidad, solo 7 páginas webs (n = 31) en 2010 y 10 (n = 34) en 2012 cumplían criterios legales de accesibilidad. El uso de herramientas 2.0 se incrementó a lo largo del estudio. En 2010 disponían de este tipo de herramientas el 19,4% (n = 6) de las páginas webs de los hospitales y en 2012 el 58,8% (n = 20). Conclusiones: La calidad evaluada con el cuestionario Bermúdez-Tamayo, en general, fue buena. Sin embargo, se observó un incumplimiento de la legislación en materia de accesibilidad, que debe ser revisada y adaptada a la normativa legal vigente. Se constató la incipiente utilización de los recursos web 2.0 como estrategias de educación y comunicación en materia de salud (AU)

Objectives: Evaluate the quality, accessibility and presence of Web 2.0 tools in the Andalusia Public Health System hospitals websites Methods: Observational, descriptive study carried out between 2010 and 2012. The variables analyzed were: quality, accessibility and innovation. The quality was evaluated using a Bermudez-Tamayo questionnaire. Accessibility was measured using the Web Accessibility Test (TAW) tool. Web 2.0 tools were identified by direct observation. Results: A total of 31 of the 45 hospitals (68.9%) had a website in the year 2010, increasing to 34 (75.5%) in 2012. The average score + standard deviation (SD) of the Bermudez-Tamayo quality questionnaire was 11.1 + 3.8 points in 2010, and 12.3 + 3.9 points in 2012, observing a statistically significant difference of 0.25 being observed between the means (P=.007), 95% CI; 0.00 to 0.50) In the accessibility evaluation only 7 websites (n = 31) in 2010, and 10 (n = 34) in 2012, fulfilled the legal criteria for accessibility. The use of Web 2.0 tools has increased throughout the study. In 2010, 19.4% (n = 6) of the hospital websites had this type of tool, in comparison to 58.8% (n = 20) in 2012. Conclusions: In general, the quality of the websites studied is good. However, current legislation regarding accessibility is not fulfilled and must be revised and adapted to the current legal rules. There is an incipient use of Web 2.0 resources as education and communication strategies with regard to health

[Evaluation of the Andalusia Public Health System hospital websites in the period 2010-2012]. / Evaluación de la calidad de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía.

OBJECTIVES: Evaluate the quality, accessibility and presence of Web 2.0 tools in the Andalusia Public Health System hospitals websites METHODS: Observational, descriptive study carried out between 2010 and 2012. The variables analyzed were: quality, accessibility and innovation. The quality was evaluated using a Bermudez-Tamayo questionnaire. Accessibility was measured using the Web Accessibility Test (TAW) tool. Web 2.0 tools were identified by direct observation. RESULTS: A total of 31 of the 45 hospitals (68.9%) had a website in the year 2010, increasing to 34 (75.5%) in 2012. The average score+standard deviation (SD) of the Bermudez-Tamayo quality questionnaire was 11.1+3.8 points in 2010, and 12.3+3.9 points in 2012, observing a statistically significant difference of 0.25 being observed between the means (P=.007), 95% CI; 0.00 to 0.50) In the accessibility evaluation only 7 websites (n=31) in 2010, and 10 (n=34) in 2012, fulfilled the legal criteria for accessibility. The use of Web 2.0 tools has increased throughout the study. In 2010, 19.4% (n=6) of the hospital websites had this type of tool, in comparison to 58.8% (n=20) in 2012. CONCLUSIONS: In general, the quality of the websites studied is good. However, current legislation regarding accessibility is not fulfilled and must be revised and adapted to the current legal rules. There is an incipient use of Web 2.0 resources as education and communication strategies with regard to health.

[Care of patients who have undergone bariatric surgery]. / Cuidados en pacientes intervenidos de cirugía bariátrica.

A wide range of problems are caused by obesity, since patients are affected not only physically, but also psychologically, socially and in their working life, with major socio-economic consequences. The application of technical surgical has opened a new field in the treatment of this complex illness, long term treatment being the only effective kind for morbid obesity. With most surgical techniques, the patient should control food intake for life and maintain some adapted habits of physical activity. For this reason it is necessary for professionals in different areas to help patients to develop strategies to persevere with their programs. Evaluation of the patient's physical and psychological needs should be carried out prior to the planning of appropriate measures. Outpatient follow-up must focus on educating, motivating, training and advising the patient nutritionally, so that he or she is able to modify his or her eating habits and maintain a healthy lifestyle during the pre- and postoperative phases. Evaluation using Patterns serves as a tool to analyze disorders in the patient. Once the situation has been evaluated, we can proceed to the nursing diagnoses (NIC) on which we will base the interventions and pertinent activities which, in combination with those carried out by other members of the multidisciplinary team, will achieve optimum results. With all the information obtained, properly organized and discussed by the team, it is possible to personalize the Planning of Care with food registration, food choice, elaboration of a weekly diet, and the general dietary recommendations. Each of the results obtained (NOC) is evaluated in terms of the possible indicators, on the corresponding scale of measurement. In addition to patient motivation, effective instructions about changes in lifestyle and the need to accept treatment and follow-up are the key to positive collaboration with the multi-professional team in the application of strategies.

Cuidados en pacientes intervenidos de cirugía bariátrica / Care of patients who have undergone bariatric surgery

La problemática que padecen los pacientes con obesidad es muy amplia, ya que ésta les afecta, no sólo en el aspecto físico, sino en el psíquico, social y laboral, con un importante impacto socio-económico. La aplicación de técnicas quirúrgicas ha abierto un nuevo campo en el tratamiento de esta compleja enfermedad, siendo la única posibilidad de tratamiento efectiva a largo plazo en la obesidad mórbida. Con la mayor parte de las técnicas quirúrgicas el paciente debe controlar la ingesta de por vida y mantener unos hábitos de actividad física adecuados. Por este motivo se hace preciso que profesionales de diferente perfil trabajen en el desarrollo de las estrategias a seguir. Esta valoración de las necesidades físicas y psicológicas del paciente, condiciona la planificación de los cuidados más adecuados. El seguimiento en la consulta de enfermería se centra en educar, motivar, adiestrar y asesorar nutricionalmente al paciente, para que sea capaz de modificar sus hábitos alimentarios y mantener un estilo de vida saludable durante las etapas de pre y post cirugía. La valoración por Patrones nos sirve de herramienta para analizar las alteraciones en el paciente. Una vez valorada la situación sobre las necesidades de Cuidados, podemos realizar los Diagnósticos Enfermeros de los que se derivan las intervenciones (CIE) y actividades pertinentes, que se suman a las realizadas por el resto del equipo pluriprofesional logrando así los mejores resultados. Con toda la información obtenida, debidamente ordenada y confrontada entre el equipo, se puede personalizar la Planificación de Cuidados con el registro alimentario, la elección de alimentos, la elaboración de una dieta semanal, las recomendaciones dietéticas generales,... Cada uno de los Resultados obtenidos (CRE) se evalúan con los posibles Indicadores, dentro de la Escala de medición correspondiente. Una buena instrucción acerca de los cambios en el estilo de vida y la necesidad de acatar el tratamiento y seguimiento posterior, además de la motivación por parte del paciente, son las claves de una buena colaboración con el equipo pluriprofesional de control en la aplicación de las estrategias (AU)

A wide range of problems are caused by obesity, since patients are affected not only physically, but also psychologically, socially and in their working life, with major socio-economic consequences. The application of technical surgical has opened a new field in the treatment of this complex illness, long term treatment being the only effective kind for morbid obesity. With most surgical techniques, the patient should control food intake for life and maintain some adapted habits of physical activity. For this reason it is necessary for professionals in different areas to help patients to develop strategies to persevere with their programs. Evaluation of the patient’s physical and psychological needs should be carried out prior to the planning of appropriate measures. Outpatient follow-up must focus on educating, motivating, training and advising the patient nutritionally, so that he or she is able to modify his or her eating habits and maintain a healthy lifestyle during the pre- and postoperative phases. Evaluation using Patterns serves as a tool to analyze disorders in the patient. Once the situation has been evaluated, we can proceed to the nursing diagnoses (NIC) on which we will base the interventions and pertinent activities which, in combination with those carried out by other members of the multidisciplinary team, will achieve optimum results. With all the information obtained, properly organized and discussed by the team, it is possible to personalize the Planning of Care with food registration, food choice, elaboration of a weekly diet, and the general dietary recommendations. Each of the results obtained (NOC) is evaluated in terms of the possible indicators, on the corresponding scale of measurement. In addition to patient motivation, effective instructions about changes in lifestyle and the need to accept treatment and follow-up are the key to positive collaboration with the multi-professional team in the application of strategies (AU)

GC-MS analysis of dichlobenil and its metabolites in groundwater.

We have developed a new method for the determination of the widely used herbicide 2,6-dichlorobenzonitrile (dichlobenil) and its major metabolites 2,6-dichlorobenzamide (BAM) and 2,6-dichlorobenzoic acid (2,6-DCBA) in groundwater samples. The procedure is based on solid phase extraction (SPE) combined with a derivatization procedure before GC-MS analysis in order to quantify analytes simultaneously. This method can be used from regulatory laboratories for monitoring the presence of dichlobenil and its metabolites during testing groundwater samples quality.

Organic tracers identification as a convenient strategy in industrial landfills monitoring.

Today, a significant environmental problem is due to the presence of industrial landfills, some of them old, which can release toxic compounds into the environment (Chemosphere 42 (2001) 415; Chemosphere 31 (1995) 3455). The identification of directly linked to the leachate tracers of contamination in the wells around the landfills, as early markers of a potential risk for the environment and/or man, is a good strategy for an early evaluation of contamination. Our protocol developed for wells water characterization is based on solid phase extraction combined with GC-MS and HPLC-MS/MS. In this way a list of organic contaminants of a specific industrial landfill is obtained, giving a solid basis also for the risk assessment. Here we present some specific examples and the use of these pollutants for environmental monitoring.

Determination of aluminium and chromium in slurried baby food samples by electrothermal atomic absorption spectrometry.

Electrothermal atomic absorption spectrometry was used to determine aluminium and chromium in different types of baby foods. Samples without previous treatment were introduced into the atomizer as suspensions, which were prepared in a medium containing 0.1% (w/v) Triton X-100 (for chromium) or 10% (v/v) ethanol (for aluminium), 5% (v/v) concentrated hydrogen peroxide, and 0.5% (v/v) concentrated nitric acid. The slurries were homogenized with a potter and introduced directly into the furnace. The presence of nitric acid allowed a substantial amount of analyte to be extracted to the liquid phase. No matrix effect was observed and aqueous standard solutions were used for calibration. The detection limits were 4 and 50 pg for chromium and aluminium, respectively; characteristic masses were 3.8 pg for chromium and 18 pg for aluminium. Reliability of the procedures was checked by statistically comparing the results with those obtained with a previous microwave oven mineralization stage and by analyis of several certified reference materials. Values for the aluminium content ranged between 0.4 and 3.0 microg/g, and for chromium between 0.003 and 0.06 microg/g.

Lipohiperplasia de la válvula de bauhin / Lipoid hyperplasia of Bauhin's valve

Se presentan en este trabajo 2 casos clínicos relacionados con una afección poco frecuente como es la lipohiperplasia de la válvula ileocecal, con interés adicional en el diagnóstico diferencial con tumores malignos de la región cecal. Se ilustra con iconografía excepcional, aportando el interés de la TAC para el diagnóstico. A continuación se hace una revisión bibliográfica sobre el tema (AU)

Determination of copper, cobalt, nickel, and manganese in baby food slurries using electrothermal atomic absorption spectrometry.

The analytical conditions for the electrothermal atomic absorption spectrometric determination of copper, manganese, nickel, and cobalt in different types of baby foods using slurried samples are presented. Suspensions were prepared in a medium containing 0.1% w/v Triton X-100, 30% v/v concentrated hydrogen peroxide, 1% v/v concentrated nitric acid, 1% w/v ammonium dihydrogenphosphate (only for copper atomization), and one drop of silicon antifoam. The slurries were homogenized by using a potter and were introduced directly into the furnace. The amount of analyte extracted to the liquid phase was investigated. The graphite furnace conditions were optimized for each element. No matrix effect was observed, and calibration could be carried out using aqueous standard solutions. The detection limits were 3.4, 2.1, 5.4, and 3.7 pg for copper, manganese, nickel, and cobalt, respectively. The reliability of the procedures was checked by statistically comparing the results obtained with those found by using a previous microwave-oven mineralization stage and by analyzing several certified reference materials.

Fast determination of lead and copper in dairy products by graphite furnace atomic absorption spectrometry.

A rapid and direct procedure for determining lead and copper in dairy products by electrothermal atomic absorption spectrometry (ETAAS) is described. Samples are slurried in a medium containing 50% v/v hydrogen peroxide, 1% v/v nitric acid, 0.5% w/v dihydrogen phosphate, and 20% v/v ethanol and directly injected into the furnace with no previous mineralization. Calibration is performed with aqueous standards. Limits of determination were 0.4 and 2.4 ng/mL for copper and lead, respectively. The reliability of the procedure was checked by comparison with the acid mineralization procedure and by analyzing 3 certified reference milk samples.

Serum and tissue CEA in colorectal cancer: clinical relevance.

PURPOSE: This article is an analysis of the information derived from the determination of tumor-tissue concentration of CEA in patients with colorectal cancer. To ascertain the relationship between tumor marker content with the histologic aspects and serologic levels of CEA of this neoplam. MATERIALS AND METHODS: 136 patients with colorectal adenocarcinoma and 41 with colorectal benign processes are analyzed and followed during an average time of 27 months. The CEA of the serum were obtained preoperatively and postoperatively and measured by radioimmunoassay (RIA). Tissular CEA levels were determined with RIA. The histological characteristics are analyzed (Dukes classification, grade of differentiation, index of atypia, microscopic vascular and lymphatic involvement. RESULTS: 1) The cut off point of the tissular CEA with the best sensitivity and specificity for the diagnosis of normal mucosa is 386 ng/mg and for tumoral tissue is 1160 ng/mg. 2) There is no correlation between tissue and serologic CEA value. 3) The tissular level of CEA have a significant statistical correlation with Dukes stage (p < 0.003); other histological characteristics were no significative. 4) There are significant statistical correlations between serologic CEA and relapse but no with survival rates. CONCLUSIONS: 1) Serologic CEA levels depend on numerous factors. 2) There aren't correlations between preoperative serologic levels and tissular CEA levels. 3) Tissular CEA do not predict what patients will have an elevated serologic CEA level in relapse.