Efectividad de la evaluación de historias clínicas informatizadas en un hospital universitario / Effectiveness of an assessment of computerised medical records in a university hospital

Objetivo. Evaluar una muestra de historias clínicas informatizadas (HCI) suficientemente representativa de los distintos ámbitos asistenciales de un hospital universitario y verificar, al mismo tiempo, la efectividad de una intervención consistente en la divulgación interna de los resultados para mejorar el cumplimiento de las historias verificado en una segunda evaluación. Métodos. Se revisaron 1.132 episodios de 2012 (preintervención que se compararon con los 1.270 de 2013 (postintervención). Las auditorías de historias clínicas consistieron en la revisión ciega por pares de muestras aleatorizadas de episodios asistenciales, proporcionales a la actividad de cada servicio clínico, y evaluados de la misma forma. Resultados. Se encontró una mejora significativa en hospitalización (p = 0,000) en todos los apartados de la HCI analizados (p = 0,002), especialmente significativa para el motivo de consulta, cuya cumplimentación se incrementó en un 8,5% (p < 0,05), pero también en los apartados de registro del proceso actual (7,1%), exploración física (4,7%), alergias (3,9%) y curso clínico (3,6%). También mejoró la valoración del informe de alta en su conjunto (p = 0,001). En las visitas de seguimiento ambulatorio se observó una mejora significativa en los 4apartados evaluados (p < 0,05) y también global (p = 0,000). Conclusiones. En las condiciones del estudio, la difusión del los resultados de cumplimiento de las HCI resultó efectiva para mejorar la calidad de los registros. Así mismo, los resultados han permitido poner en marcha actuaciones de revisión de los procesos de trabajo en ciertos servicios y también el rediseño parcial de la interfaz: ha sido una metodología aceptada por la organización y reproducible (AU)

Objective. The objective of this study was to evaluate a sample of electronic medical records (EMR) that was sufficiently representative of the different areas of care in a university hospital, as well as to verify the effectiveness of an initial intervention through a second evaluation. Methods. Medical records audits were performed in 2012 and 2013 by a blind peer review of random samples of care episodes, proportional to the activity of each clinical department, and with the same evaluation method being applied to all of them. Results. More than 1,000 episodes of care were reviewed in the 2audits. A significant improvement was found in hospital admissions (P=.000) in all the sections of the EMR analysed (P=.002), and was especially significant for the reason for consultation, for which its completion increased by 8.5% (p<.05), and also in the sections of the current process record (7.1%), physical examination (4.7%), allergies (3.9%), and clinical course (3.6%). The assessment of the discharge report, as a whole, showed an improvement (P=.001). In outpatient follow-up visits, a significant positive improvement was observed in the 4sections evaluated (P<.05), and also overall (P=.000). Conclusions. According to study conditions, the dissemination of the results was effective in improving the quality of the EMR. The results have made it possible to implement actions to review the work processes in certain departments, and also the partial redesign of the interface on being a reproducible methodology accepted by the organisation (AU)

[Effectiveness of an assessment of computerised medical records in a university hospital]. / Efectividad de la evaluación de historias clínicas informatizadas en un hospital universitario.

OBJECTIVE: The objective of this study was to evaluate a sample of electronic medical records (EMR) that was sufficiently representative of the different areas of care in a university hospital, as well as to verify the effectiveness of an initial intervention through a second evaluation. METHODS: Medical records audits were performed in 2012 and 2013 by a blind peer review of random samples of care episodes, proportional to the activity of each clinical department, and with the same evaluation method being applied to all of them. RESULTS: More than 1,000 episodes of care were reviewed in the 2audits. A significant improvement was found in hospital admissions (P=.000) in all the sections of the EMR analysed (P=.002), and was especially significant for the reason for consultation, for which its completion increased by 8.5% (p<.05), and also in the sections of the current process record (7.1%), physical examination (4.7%), allergies (3.9%), and clinical course (3.6%). The assessment of the discharge report, as a whole, showed an improvement (P=.001). In outpatient follow-up visits, a significant positive improvement was observed in the 4sections evaluated (P<.05), and also overall (P=.000). CONCLUSIONS: According to study conditions, the dissemination of the results was effective in improving the quality of the EMR. The results have made it possible to implement actions to review the work processes in certain departments, and also the partial redesign of the interface on being a reproducible methodology accepted by the organisation.

Calidad de vida en niños con trastorno por déficit de atención con o sin hiperactividad (TDAH) / Quality of life in children with attention deficit hyperactivity disorder

Introducción: el trastorno por déficit de atención e hiperactividad (TDAH) es el problema del neurodesarrollo más frecuente en la infancia. La definición de trastorno hace alusión a aquellos problemas que con sus efectos generan malestar en las personas y en su entorno. De origen multifactorial, con base neurobiológica, fuerte predisposición genética e interacción con factores ambientales. Un 75% de niños con TDAH seran adolescentes con TDAH, y de estos, un 50% serán adultos con TDAH. Provoca un gran impacto a nivel cognitivo, emocional y social. El objetivo del estudio consiste en valorar la repercusión del TDAH en el ámbito familiar, escolar y social, desde la óptica de la Atención Primaria, mediante el concepto de calidad de vida relacionada con la salud (CVRS), definida como la autopercepción subjetiva e individual de los pacientes respecto a su salud, así como el grado de bienestar físico, social y psicológico respecto a la enfermedad y al tratamiento. Material y métodos: para valorar la CVRS prospectivamente se aplicó el cuestionario KINDL® a dos grupos de niños de 6 a 16 años, uno recientemente diagnosticado de TDAH, sin haber iniciado tipo alguno de tratamiento, y otro de niños sin TDAH. Resultados: el resultado, tanto de la valoración global de la CVRS, como de sus seis dimensiones, muestra diferencias significativas con una percepción de calidad menor en el grupo de niños con TDAH respecto al grupo control. Conclusión: por tanto, el TDAH compromete seriamente la calidad de vida de los niños que lo padecen (AU)

Introduction: the Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. It’s definition points toward those problems which originate discomfort in persons and their environment. ADHD has a multifactorial origin, with a neurobiological basis, strong genetic component and interaction with environmental factors. Nearly 75% of children with ADHD will be adolescents with ADHD, and 50% of them will be adults with ADHD. This disorder causes a great impact at cognitive, emotional and social levels. The objective of this study is to evaluate the impact of ADHD over the family, school and social relationships of affected children under the view of primary care, using the concept of Health Related Quality of Life (HRQoL), defined as the individual and subjective patient’s self-perception related to their own health, as well as the degree of physical, psychological and social welfare in respect to the disease and the treatment. Material and methods: KINDL® was used in the evaluation of HRQoL. It was applied to two groups children aged from 6 to 16 years old. One group included children with a recent diagnosis of ADHD and still not treated with any therapy. The other group consisted in children without ADHD. Results: results showed that the global score of HRQoL as well as the six dimensions which compose this measure have significant differences. The HRQoL is significantly lower in the group of ADHD children when compared with the control group. Conclusion: as a main conclusion, ADHD impairs seriously the quality of life of children who suffer such disorder (AU)

Trastorno por déficit de atención con o sin hiperactividad en los niños con síndrome de Down / Attention deficit disorder with or without hyperactivity or impulsivity in children

Los niños con síndrome de Down tienen una prevalencia más elevada que el resto de población general de presentar trastorno por déficit de atención con o sin hiperactividad o impulsividad (TDAH). El diagnóstico e identificación del TDAH es importante porque puede afectar el rendimiento escolar y causar trastornos de la conducta. El objetivo de este trabajo es doble. En primer lugar, se considera en esta revisión la repercusión del TDAH en los niños con síndrome de Down. En segundo lugar, se presenta un análisis sistemático de los artículos publicados en la bibliografía científica relativos a los tests utilizados para el diagnóstico de TDAH en niños con síndrome de Down (AU)

Children with Down’s syndrome show a higher prevalence of attention deficit disorder with or without hyperactivity or impulsivity (ADHD) than the rest of the general population. The diagnosis and identification of ADHD is important because it can affect performance at school and cause behavioural disturbances. This research study has two objectives. First of all, in this review we consider the repercussions that ADHD has on Down’s syndrome children. Secondly, we present a systematic analysis of the articles published in the scientific literature relating to the tests used to diagnose ADHD in Down’s syndrome children (AU)

Interoperabilidad: una función imprescindible para la aistencia sanitaria / Interoperability: an essential function for health care assistance

Se define la interoperabilidad como la capacidad que tiene dos o más sistemas para intercambiar información y utilizarla de inmediato en su lógica de proceso interno. Se distinguen cuatro tipos de interoperabilidad. La técnica, basada en una estandarización de los mensajes a intercambiar. La semántica, en la que la estructura de los mensajes intercambiados está autodefinida siguiedo unmodelo de eferencia y es interpretable por sistemas distintos. Pero también cabe hablar d einteroperabiliad organizativa y cultura, imprescindibles para establecer una colaboración efectiva. Los modelos asistenciales actuales tienden a interrelacionarse cada ez más para adecuar y escalar la eficiencia de los recursos puestos a disposición de la resolución de los problema del paciente. Para tal escenario es obligado la adopción de los estándares y los modelos de referencia que capacitan los sistemas y disminuyen los costes de implemenación (AU)

Interoperability is defined as the ability to have two or more systems for exchanging information and using it immediately in its internal logic processes. Four types of interoperability can be distinguished: technical, semantic, and organizational and culture. Currently existing models are interrelated to offer bigger and better resolution of patients problems. In this context, we must adopt the standards and benchmarks that enable systems and reduce implementation costs (AU)

Camino hacia una historia clínica informatizada / The path towards computerised clinical records

Los hospitales que vienen ejerciendo sus labores asistenciales desde hace años tienen el reto de efectuar la transición definitiva al mundo digital para adquirir con ello todas las ventajas que ofrecen las nuevas tecnologías, optimizando procesos ya existentes y facilitando la realización de otros nuevos. Sin embargo, esta transición es difícil porque precisa una aproximación peculiar que debe ser cuidadosa y disponer de financiación adecuada para poder realizar el cambio y la transformación requerida, no solo de las infraestructuras sino también de los recursos humanos. Con la desaparición de algunos roles tradicionales aparecen otros de nuevos para la administración y el cuidado de la documentación electrónica, que ofrecen la oportunidad de la reconversión de los trabajadores si se les proporciona la formación adecuada. Este es un gran reto para las instituciones sanitarias, especialmente para aquellas que ya se han avanzado en el camino de la incorporación decidida de la informatización de los procesos

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Tablas de crecimiento actualizadas de los niños españoles con síndrome de Down / Update growth charts based on spanish children with Down’s síndrome

La Fundació Catalana Síndrome de Down (FCSD) publicó en 1998 las primeras curvas de crecimiento de niños y adolescentes con Síndrome de Down (SD) de nuestro país. En las presentes curvas se utiliza una metodología estadística más adecuada que asegura una mayor exactitud y precisión; también se incluyen muchas más mediciones efectuadas desde entonces. Para su elaboración se han utilizado un total de 1.736 mediciones, desde el nacimiento hasta los 15 años exactos, descartándose 18 por tratarse de valores erróneos. De las 1.718 mediciones restantes, 763 (44,4%) corresponden a mujeres y 955 (55,6%) a hombres. En el análisis del crecimiento en longitud/talla se demuestra un patrón parecido entre niños y niñas alcanzando una máxima diferencia hacia la adolescencia. Con relación al peso se comprueba una gran variabilidad y dispersión que aumenta con la edad, especialmente a partir de la edad escolar

The Fundació Catalana Síndrome de Down (FCSD) published in 1998 the first growth charts based on Down’s syndrome children from our country. The new charts are made using a statistically more specific methodology; it makes these charts more accurate and precise. There are also included more measurements taken since then. A total of 1,736 measurements has been used to make the charts, from birth to 15 years old exactly, 18 wrong values wore rojected. From the remaining 1,718 measurements, 763 (44.4%) were in females and 955 (55.6%) in males. In the analysis of length/height we can see a similar pattern between boys and girls, the maximum difference between both groups is in the adolescence time. There is a great variability in relation to the weight, the dispersion between males and females increases with the age, especially from the school age on

[Guillain-Barre syndrome: a study of 13 children]. / Síndrome de Guillain-Barré. Análisis de 13 casos pediátricos.

A group of 13 children, aged 2 to 14 years, and diagnosed with Guillain-Barré syndrome has been analyzed. Clinical features and outcome were retrospectively studied. In 75% of the patients there was an infectious illness previous to the neurologic symptoms and in four children the etiologic agent was demonstrated. Motor deficits affecting the limbs and muscle stretch reflexes were absent in all thirteen patients. Cranial nerve involvement showed-up in 46%. Meningitic symptoms occurred in 62% of the cases. One of the children developed the Fisher syndrome variant. Two patients required assisted ventilation. Three children showed associated immunologic abnormalities, with one of the patients having a selective IgA deficiency, another child showing an increment in IgE and the other Kawasaki syndrome. We have not demonstrated differences in the outcome between the patients with corticoid treatment.

[Hemolytic uremic syndrome. Evaluation of clinical and prognostic factors]. / Síndrome hemolítico urémico. Valoración de factores clínicos y pronósticos.

Ten patients with hemolytic uremic syndrome (HUS) were admitted to our ICU during the last 7 years. The mean age at entry was 26 month old. Only one child was more than 2 years of age. A greater incidence of this illness was noted during the summer season. Almost all cases (90%), were severe with arterial hypertension and requiring peritoneal dialysis. HUS is a multisystemic disorder with early renal involvement, but the possibility of other sites being affected must be kept in mind. Half of the patients presented extrarenal manifestations of disease, including: seizures (30%), colonic ischemia requiring intestinal resection, and heart failure with lung edema due to severe hypertension. The two parameters that were helpful in determining the prognosis were the interval of renal insufficiency (greater than 14 days) and neurologic impairment, with the later being of most importance.

[Diagnostic methodology of genome alteration]. / Metodología diagnóstica de las alteraciones del genoma.

Advances in molecular biology have produced great results concerning with the knowledge about hereditary mechanisms and gene diseases. In the last twenty years the development of discoveries have exceeded the information of clinical pediatricians, and the technology of genetic engineering, evolved from the properties of the DNA molecule, give us powerful diagnostic tools much more specific than those of classical cytogenetics limited to gross disorders of cariotype. Cellular cultures, autoradiography and electrophoresis have been very useful to develop molecular genetics. Using hybridomas a gene can be located into one chromosome. After wards the restriction map may be represented and employed as routine diagnostic procedure. Final objective is the genetic map with the complete sequence of normal and abnormal genes. To do so, more sophisticated methods are coming that still belong to the field of research.

[Newborn infants of diabetic mothers. Clinical study in the period 1980-1985]. / Recién nacido de madre diabética. Estudio clínico del período 1980-1985.

An statistical analysis is reported on specific problems of the infant of diabetic mother during the period 1980-1985, with a total of 287 newborns. Complications in this sample are exposed, and significant differences demonstrated in gestational age, fetal distress, hypocalcemia, polycythemia, jaundice, respiratory distress syndrome and associated problems according to clinical type of diabetes mellitus. High percentage of congenital malformations is pointed-out with a predominance of cardiac septal defects. Diabetological control was closer in insulin-dependent group, therefore, its effect has been studied separately. A lower rate of hypoglycemia was found in those under control, while infant of insulin-dependent diabetic mother showed a better compliance between weight and gestational age and a lower rate of respiratory distress syndrome.