Food industrial biowaste-based magnetic activated carbons as sustainable adsorbents for anthropogenic mercury emissions.

Bio-derived magnetic activated carbons from industrial chestnut shell waste have been obtained through a novel, optimized and sustainable methodology where impregnation, pyrolysis, acid washing or other intermediate steps commonly used in the activation process were eliminated saving time, energy and costs. The resulting materials (MACs) were obtained at 220-800 °C showed interesting properties: textural (SBET up to 568 m2 g-1) and magnetic (different iron species developed), depending on the activation temperature employed. Data showed outstanding results when MACs were tested for Hg removal in pollution emissions at 150 °C in lab-scale device. In MACs obtained at 500-600 °C, where the highest concentration of magnetite was found, the best Hg adsorption capacity was achieved, while it decreased when metallic iron or iron carbides were present (MACs obtained at 800 °C). Moreover, the difference of Hg0 removal/adsorption in N2+O2 and Simulated Flue Gas atmosphere between MACs obtained at 500 and 600 °C pointed out the influence on Hg removal of additional parameters, as surface chemistry and the existence of sulfur or chloride. The determination of Hg species in post-retention solids confirmed the mercury oxidation by high-valence iron ions (Fe3+) and the involvement of physisorption and chemisorption processes for the gas-solid interaction mechanism.

Exploitation of artichoke byproducts to obtain bioactive extracts enriched in inositols and caffeoylquinic acids by Microwave Assisted Extraction.

Byproducts from artichoke represent the majority of the mass collected from the plant and constitute an interesting source of bioactive compounds such as inositols and caffeoylquinic acids. In this work, a microwave assisted extraction (MAE) methodology was developed for the simultaneous extraction of these compounds from artichoke stalks, leaves, receptacles and external bracts. Optimal MAE conditions to maximize the extraction of these bioactives and the antioxidant activity were 97 °C, 3 min, ethanol:water (50:50, v/v). Moreover, a GC-MS methodology was also developed for the simultaneous determination of these compounds in a single run; optimal derivatization conditions were achieved using hexamethyldisilazane and N,O-bis(trimethylsilyl)trifluoroacetamide with 1% trimethylchlorosilane. Artichoke receptacle extracts were the richest in caffeoylquinic acids (28-35 mg g-1 dry sample), followed by the bracts (9-18 mg g-1 dry sample), while those from leaves showed the highest concentrations of inositols (up to 15 mg g-1 dry sample). Receptacle extracts also had the highest antioxidant activity (123 mg TE g-1 dry sample) and the greatest concentration of total phenolic compounds (47 mg GAE g-1 dry sample). Therefore, the developed methodology could be considered as a valuable procedure to obtain and characterize bioactive ingredients with industrial interest from artichoke byproducts, opening new routes of revalorization of artichoke agro-industrial residues.

Gas chromatographic-based techniques for the characterization of low molecular weight carbohydrates and phenylalkanoid glycosides of Sedum roseum root supplements.

An extensive characterization of low molecular weight carbohydrates (LMWC) and phenylalkanoid glycosides (PAG) of Sedum roseum root supplements has been carried out for the first time by gas chromatography coupled to mass spectrometry (GC-MS) and by comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC × GC-ToF MS). Optimization of the required derivatization procedure for improved determination of PAG showed the combined use of trimethylsilylimidazole and trimethylchlorosilane as the most appropriate reagents. Up to 37 compounds were qualitative- and quantitatively characterized in different dietary supplements of S. roseum by GC-MS. In addition to the well-known rosin, rosarin, rosavin and salidroside, other carbohydrates, polyalcohols, acids, etc. were determined. Among them, several seven-carbon monosaccharides such as coriose and 2,7-anhydro-ß-d-altro-heptulose were detected for the first time in S. roseum root supplements. Sedoheptulose was found to be the most abundant compound (9-151 mg g-1), followed by rosiridin (20-81 mg g-1) and rosavin (11-56 mg g-1). The use of GC × GC-ToF MS allowed the detection and tentative assignation of 48 additional compounds mainly belonging to the phenylalkanoid glycoside, pentosyl-hexose and hexosyl-hexose families.

Pressurized liquid extraction of Aglaonema sp. iminosugars: Chemical composition, bioactivity, cell viability and thermal stability.

Pressurized liquid extraction of Aglaonema sp. iminosugars has been optimized. A single cycle under optimal conditions (80mg, 100°C, 2min) was enough to extract ⩾96% of most iminosugars. Further incubation with Saccharomyces cerevisiae for 5h removed coextracted interfering low molecular weight carbohydrates from extracts of different Aglaonema cultivars. A complete characterization of these extracts was carried out by gas chromatography-mass spectrometry: three iminosugars were tentatively identified for the first time; α-homonojirimycin and 2,5-dideoxy-2,5-imino-d-mannitol were the major iminosugars determined. α-Glucosidase inhibition activity, cell viability and thermal stability of Aglaonema extracts were also evaluated. Extracts with IC50 for α-glucosidase activity in the 0.010-0.079mgmL(-1) range showed no decrease of Caco-2 cell viability at concentrations lower than 125µgmL(-1) and were stable at 50°C for 30days. These results highlight the potential of Aglaonema extracts as a source of bioactives to be used as functional ingredients.

Analysis of iminosugars and other low molecular weight carbohydrates in Aglaonema sp. extracts by hydrophilic interaction liquid chromatography coupled to mass spectrometry.

A method by hydrophilic interaction liquid chromatography coupled to tandem mass spectrometry (HILIC-MS(2)) has been successfully developed for the simultaneous analysis of bioactive iminosugars and other low molecular weight carbohydrates in Aglaonema leaf extracts. Among other experimental chromatographic conditions, mobile phase eluents, additives and column temperature were evaluated in terms of retention time, resolution, peak width and symmetry provided for target carbohydrates. In general, narrow peaks (wh: 0.2-0.6min) with good symmetry (As: 0.9-1.3) and excellent resolution (Rs>1.8) were obtained for iminosugars using an acetonitrile:water gradient with 5mM ammonium acetate in both eluents at 55°C. Tandem mass spectra were used to confirm the presence of previously detected iminosugars in Aglaonema extracts and to tentatively identify for the first time others such as miglitol isomer, glycosyl-miglitol isomers and glycosyl-DMDP isomers. Concentration of total iminosugars varied from 1.35 to 2.84mgg(-1) in the extracts of the different Aglaonema samples analyzed. To the best of our knowledge, this is the first time that a HILIC-MS(2) method has been proposed for the simultaneous analysis of iminosugars and other low molecular weight carbohydrates of Aglaonema sp. extracts.

La codificación como instrumento en la gestión clínica de las unidades del dolor / The codification as tool in the clinic management of pain units

Introducción: los principales instrumentos de información para la gestión clínica se basan en la recogida sistemática de datos clínicos, que se materializa en el CMBD, y en la utilización de sistemas de clasificación de pacientes, siendo los AP-GRD los adoptados en nuestro país por la administración sanitaria. Los datos necesarios para realizar la agrupación en GRD están contenidos en el CMBD y entre ellos están: diagnóstico principal, intervenciones o procedimientos y diagnósticos secundarios, que deben estar codificados con la CIE-9-MC. El sistema GRD es un instrumento de gestión, que permite una contabilidad analítica, a través de los pesos relativos de cada GRD. Objetivos: mostrar la codificación de los diagnósticos que se realizan en una Unidad Multidisciplinar de Dolor Crónico mediante la CIE-9-MC, único sistema reconocido a nivel institucional, y evidenciar la importancia que tiene la codificación correcta de los diagnósticos de dolor para obtener los GRD que describan más adecuadamente el grado de complejidad de los procesos tratados, con su correspondiente 'coste por proceso'. Material y métodos: se han revisado las historias clínicas para obtener la información necesaria para realizar la codificación. A cada diagnóstico se le asigna un código principal y si es preciso uno o varios códigos secundarios. Se debe asignar un código para el procedimiento realizado. Una vez realizada la codificación, junto con los datos necesarios de cada paciente, se obtienen los diferentes GRD, con sus pesos correspondientes. Resultados: se han codificado diagnósticos con la CIE-9-MC desde el año 2002 al 2012, realizando una base de datos con la codificación de los diagnósticos más frecuentes en una Unidad de Dolor. Se ha obtenido cada año información sobre la agrupación de patologías mediante GRD, y su peso correspondiente. De 2002 a 2009 el GRD más frecuente fue el 243, 'Patología médica de columna vertebral' en el 57% de los casos. A partir del año 2010 se introdujo la nueva codificación que incluye el código 338 y como consecuencia cambiaron los GRD. La categoría 338, 'Dolor no clasificado bajo otros conceptos', se enmarca dentro del capítulo de Enfermedades del Sistema Nervioso y Órganos de los Sentidos. Los GRD más frecuentes han sido: 035, 'Otros trastornos del sistema nervioso, sin CC' en el 42,28% de los casos; 243 'Patología médica de columna vertebral' en el 18% y 019 'Trastornos de nervios craneales y periféricos sin CC' en el 15,5%. Se describen las características de estos GRD y los diagnósticos de dolor que se han incluido en cada uno de ellos. Conclusiones: el uso de la codificación de diagnósticos y procedimientos con la CIE-9-MC supone un esfuerzo por unificar el lenguaje que se utiliza en la práctica clínica. Es preciso que la codificación se realice correcta y consistentemente para obtener resultados que reflejen la actividad real que se realiza en un servicio y lo que cuesta. Para que realmente la codificación influya en la gestión clínica por procesos, es fundamental que los responsables de las unidades conozcan estas herramientas. A medio plazo, se instaurará en la actividad clínica en España el uso de la CIE-10-MC (AU)

Introduction: The main tools of information for clinical management are based on the systematic collection of clinical data, which is embodied in the MDS (Minimum Basic Data Set), and the use of patient classification systems, being the AP-DRGs those adopted in our country for the health administration. The data needed to perform the grouping DRGs are contained in the MDS and among them are: The main diagnosis, interventions or other procedures performed and secondary diagnoses, which should be coded with ICD-9-CM. The DRG system is a management tool that allows an analytical accounting system, through the relative weights of each DRG. Objectives: To show the codification of diagnoses that are carried out in a Multidisciplinary Unit of Chronic Pain by ICD-9- CM, unique system officially recognized by our health services, and demonstrate the importance that correct coding of diagnoses of pain has to obtain the DRGs that best describe the degree of complexity of the processes that are treated, with the corresponding 'cost per case'. Material and methods: We reviewed the medical records to obtain the information necessary to perform the encoding. For each diagnoses a master code (main diagnoses) is assigned and if necessary one or more secondary codes are added. It is assigned a code for the procedure performed. Once the codification is obtain, along with the necessary data for each patient, the various DRGs are obtained, with their corresponding weights. Results: Diagnoses were coded with ICD-9-CM from 2002 until 2012, performing a database with encoding of the most common diagnoses in a chronic pain unit. It has been obtained each year information about grouping of pathologies by DRG, and its weights. From 2002 to 2009 the most common DRG was the 243, 'Medical pathology of spine', that account for 57% of cases. Beginning in 2010, the new codification was introduced, including the code 338 and as a consequence the DRGs changed. The category 338, 'Pain not classified under other concepts', is part of the chapter of Diseases of the Nervous System and Senses Organs. The most frequent DRGs were: 035 'Other disorders of nervous system without CC', 42.28% of cases; 243 'Medical pathology spine' 18% and 019 'Disorders of cranial and peripheral nerves without CC' 15.5%. The characteristics of these DRGs are described together the diagnoses of pain that are included in each of them. Conclusions: The use of coding diagnoses and procedures with ICD-9-CM is an effort to unify the language used in clinical practice. It is necessary that the coding is done correctly and consistently to get results that reflect real activity that takes place in a service and what it costs. In order for the codification to become relevant in the clinical management by processes, it is essential that the unit managers must be familiar with these tools. In the medium term, the used of ICD-10-CM will be established in clinical practice in Spain (AU)

Evaluation of different hydrophilic stationary phases for the simultaneous determination of iminosugars and other low molecular weight carbohydrates in vegetable extracts by liquid chromatography tandem mass spectrometry.

Iminosugars are considered potential drug candidates for the treatment of several diseases, mainly as a result of their α-glycosidase inhibition properties. A method by hydrophilic interaction liquid chromatography tandem mass spectrometry has been optimized for the first time for the simultaneous determination of complex mixtures of bioactive iminosugars and other low molecular weight carbohydrates (LMWC) in vegetable extracts. Three hydrophilic stationary phases (sulfoalkylbetaine zwitterionic, polyhydroxyethyl aspartamide and ethylene bridge hybrid (BEH) with trifunctionally bonded amide) were compared under both basic and acidic conditions. The best sensitivity (limits of detection between 0.025 and 0.28ngmL-1) and overall chromatographic performance in terms of resolution, peak width and analysis time were obtained with the BEH amide column using 0.1% ammonium hydroxide as a mobile phase additive. The optimized method was applied to the analysis of extracts of hyacinth bulbs, buckwheat seeds and mulberry leaves. Iminosugar and other LMWC structures were tentatively assigned by their high resolution daughter ions mass spectra. Several iminosugars such as glycosyl-fagomine in mulberry extract were also described for the first time. Among the extracts analysed, mulberry showed the widest diversity of iminosugars, whereas the highest content of them was found in hyacinth bulb (2.5mgg-1) followed by mulberry (1.95 mgg-1).

Characterization of trimethylsilyl ethers of iminosugars by gas chromatography-mass spectrometry.

A combination of gas chromatographic retention data (linear retention indices) on two different stationary phases (100% methyl- and 50% phenylmethylsilicone) and electron impact mass spectrometric relative abundances for characteristic m/z ratios of 12 trimethylsilylated piperidine and pyrrolidine iminosugars are reported. These results have been related to their structural features and applied to the characterization of iminosugar composition of an Aglaonema treubii root extract. Seven iminosugars were detected in this extract, two of them were described for the first time.

Optimization of pressurized liquid extraction of inositols from pine nuts (Pinus pinea L.).

Pressurized liquid extraction (PLE) has been used for the first time to extract bioactive inositols from pine nuts. The influence of extraction time, temperature and cycles of extraction in the yield and composition of the extract was studied. A quadratic lineal model using multiple linear regression in the stepwise mode was used to evaluate possible trends in the process. Under optimised PLE conditions (50°C, 18 min, 3 cycles of 1.5 mL water each one) at 10 MPa, a noticeable reduction in extraction time and solvent volume, compared with solid-liquid extraction (SLE; room temperature, 2h, 2 cycles of 5 mL water each one) was achieved; 5.7 mg/g inositols were extracted by PLE, whereas yields of only 3.7 mg/g were obtained by SLE. Subsequent incubation of PLE extracts with Saccharomyces cerevisiae (37°C, 5h) allowed the removal of other co-extracted low molecular weight carbohydrates which may interfere in the bioactivity of inositols.

Characterization by the solvation parameter model of the retention properties of commercial ionic liquid columns for gas chromatography.

For the first time, four commercial ionic liquid columns (SLB-IL59, SLB-IL76, SLB-IL82 and SLB-IL100) for gas chromatography have been comprehensively evaluated in terms of efficiency, polarity and solvation properties. Grob tests and McReynolds constants showed that they were all high-efficiency columns of high polarity, but with low inertness to compounds with hydrogen bonding capabilities. The solvation parameter model was used to characterize the solvation interactions of the four columns in the 80-160°C temperature range. Results revealed that all the ionic liquids studied can be considered moderately hydrogen-bond acid and highly cohesive stationary phases, on which the dominant contributions to retention were the dipolar-type and hydrogen-bond base interactions, while π-π and n-π interactions were barely significant. The SLB-IL59 column provided the best separation of homologs, while the SLB-IL76 and SLB-IL100 columns had the most basic and the most acidic phases, respectively. A principal component analysis for the commonly used stationary phases in capillary GC showed that these commercial ionic liquid columns fill an empty area of the available selectivity space, which clearly enhances the separation capacity of this technique.

Improvement of a gas chromatographic method for the analysis of iminosugars and other bioactive carbohydrates.

The analysis of derivatised iminosugars and other bioactive low molecular weight carbohydrates present at low concentrations in different vegetable extracts (hyacinth, mulberry and buckwheat) required the improvement of a previously developed gas chromatographic method. Among the different parameters optimized, the temperature of the injection port, evaluated for the first time, resulted to be the most important. Thus, 240 °C was chosen as a tradeoff to achieve the required volatility, to avoid degradation and to provide symmetric peaks for bioactive carbohydrates highly retained such as glycosyl inositols. GC-MS operating under selective ion monitoring (SIM) acquisition mode and GC-FID provided limits of detection and quantitation for the target compounds of 0.2 and 0.7 ng g(-1) and of 1 and 3 ng g(-1) on average, respectively. Therefore, both methodologies could be considered appropriate to extend the range of quantitation of these bioactives.

Codificación clínica con la CIE9MC / No disponible

No disponible

Derivatization of carbohydrates for GC and GC-MS analyses.

GC and GC-MS are excellent techniques for the analysis of carbohydrates; nevertheless the preparation of adequate derivatives is necessary. The different functional groups that can be found and the diversity of samples require specific methods. This review aims to collect the most important methodologies currently used, either published as new procedures or as new applications, for the analysis of carbohydrates. A high diversity of compounds with diverse functionalities has been selected: neutral carbohydrates (saccharides and polyalcohols), sugar acids, amino and iminosugars, polysaccharides, glycosides, glycoconjugates, anhydrosugars, difructose anhydrides and products resulting of Maillard reaction (osuloses, Amadori compounds). Chiral analysis has also been considered, describing the use of diastereomers and derivatives to be eluted on chiral stationary phases.

[Comparative study of the effectiveness two of hyperoxygenated fatty acids in the treatment of grade I ulcers in geriatric hospitalized patients]. / Estudio comparativo de efectividad de dos ácidos grasos hiperoxigenados en el tratamiento de úlceras de grado I en pacientes geriátricos hospitalizados.

OBJECTIVE: To evaluate whether there is equivalence between two treatments for grade I ulcers with a base of hyperoxygenated fatty acids, AGHO and Mepentol: AGHO and phytotherapy. METHOD: A randomized, controlled, triple blind clinical trial was conducted with patients admitted at the Elderly Ward at San Carlos Hospital in Madrid between November 2006 and January 2008. There were two treatment groups: Experimental and control. A theoretical limit of 15% was determined between both groups. We took a random sample of patients admitted to the Elderly Ward, which produced a sample of 151 sores. The control group received treatment with Mepentol and the experimental group received AGHO. The assignment to the group was at random. The output variable was healing of erythema within the first 72h. We calculated the absolute difference in the incidence of healing between both treatments with a level of confidence of 95%. RESULTS: The sample at the end of the study was 148 (72 control and 76 experimental). There was a healing incidence of 55.6% in the control group and 69.7% in the experimental group (p=0.074). The difference in the incidence of healing between both treatments was 14% (95% CI: 29% to -1%). The upper limit of the confidence interval of the difference is outside the margin of equivalence. CONCLUSIONS: We cannot conclude that the treatment with AGHO fatty acids is equivalent to Mepentol treatment. With both treatments the healing is clinically significant.

Estudio comparativo de efectividad de dos ácidos grasos hiperoxigenados en el tratamiento de úlceras de grado I en pacientes geriátricos hospitalizados / Comparative study of the effectiveness two of hyperoxygenated fatty acids in the treatment of grade I ulcers in geriatric hospitalized patients

Objetivo. Evaluar si existe equivalencia entre dos tratamientos con base de ácidos grasos hiperoxigenados, AGHO y Mepentol®: AGHO y fitoterapia. Método. Ensayo clínico aleatorizado con triple enmascaramiento, en pacientes hospitalizados en la Unidad de Geriatría del Hospital Clínico San Carlos, entre noviembre de 2006 y enero de 2008, con dos grupos de tratamiento: intervención y control. Se determinó un límite de equivalencia teórico del 15% entre ambos. El muestreo accidental de pacientes ingresados que desarrollaron úlceras grado I. La muestra calculada de 151 úlceras. Método. La intervención fue la aplicación de Mepentol® al grupo control y AGHO al grupo intervención, la asignación al grupo fue aleatoria; la variable de resultado la curación: desaparición del eritema al menos 72h. Se calcula la diferencia absoluta de incidencia de curación entre ambos tratamientos y su IC del 95%. Resultados. Finalizaron el estudio 148 úlceras (72 control y 76 intervención). Curaron 40 úlceras (55,6%) en el grupo control y 53 (69,7%) en el grupo intervención p=0,074. La diferencia de incidencia de curación entre ambos grupos de tratamiento fue del 14% (IC del 95% 29% a –1%). El límite superior del intervalo de confianza de la diferencia se encuentra fuera del margen de equivalencia. Conclusiones. No podemos concluir que el tratamiento de ácidos grasos AGHO sea equivalente al tratamiento de Mepentol®. Con ambos tratamientos la curación es clínicamente relevante(AU)

Objective.To evaluate whether there is equivalence between two treatments for grade I ulcers with a base of hyperoxygenated fatty acids, AGHO® and Mepentol®: AGHO and phytotherapy. Method. A randomized, controlled, triple blind clinical trial was conducted with patients admitted at the Elderly Ward at San Carlos Hospital in Madrid between November 2006 and January 2008. There were two treatment groups: Experimental and control. A theoretical limit of 15% was determined between both groups. We took a random sample of patients admitted to the Elderly Ward, which produced a sample of 151 sores. Method. The control group received treatment with Mepentol® and the experimental group received AGHO®. The assignment to the group was at random. The output variable was healing of erythema within the first 72h. We calculated the absolute difference in the incidence of healing between both treatments with a level of confidence of 95%. Results. The sample at the end of the study was 148 (72 control and 76 experimental). There was a healing incidence of 55.6% in the control group and 69.7% in the experimental group (p=0.074). The difference in the incidence of healing between both treatments was 14% (95% CI: 29% to −1%). The upper limit of the confidence interval of the difference is outside the margin of equivalence. Conclusions. We cannot conclude that the treatment with AGHO fatty acids is equivalent to Mepentol® treatment. With both treatments the healing is clinically significant(AU)

Labor del médico rehabilitador dentro de una Unidad Multidisciplinar del Dolor / The role of the rehabilitation doctor in a Multidisciplinary Pain Unit

Introducción. Las Unidades del Dolor tienden a estar formadas por un equipo multidisciplinar de especialistas. En 1947 Bonica, basándose en el éxito de una colaboración con un ortopeda, un neurocirujano y un psiquiatra estableció la primera clínica multidisciplinar del dolor. El objetivo del trabajo es describir la labor del médico rehabilitador en la Unidad del Dolor del Hospital 12 de Octubre. Material y método. Se describe el organigrama de trabajo del médico rehabilitador en una Unidad del Dolor y el proceso de evaluación y tratamiento que habitualmente lleva a cabo. También se ha realizado un análisis descriptivo de los pacientes que han sido atendidos durante 10 meses (noviembre 2004-agosto 2005). Resultados. Consiste en una colaboración un día por semana en la que los pacientes tras ser vistos por el equipo fijo de la Unidad reciben una valoración y tratamiento desde el punto de vista rehabilitador. Se valoraron 74 pacientes con una edad media de 59,9 años. El motivo de consulta principal fue el de dolor lumbar. Realizaron rehabilitación el 69 % y se recomendaron medidas ortoprotésicas al 46 %. El grado de satisfacción tras la visita con el médico rehabilitador de la Unidad fue bueno en el 54 % de los pacientes. Conclusiones. La experiencia de los distintos especialistas y una visión multidisciplinar del dolor ayudan a mejorar la atención y el tratamiento de nuestros pacientes. La presencia de un médico rehabilitador en una Unidad Multidisciplinar del Dolor enriquece la atención y las opciones terapéuticas de los pacientes con dolor crónico

Introduction. In a Chronic Pain Unit works a multidisciplinary equipment of specialist. In 1947, Bonica made the first multicisciplinary clinic of being based on the success of a collaboration with an orthopedics, a neurosurgerist and a psychiatrist. The objective of this work is to describe the work of the Rehabilitation doctor in the Unit of the Pain Hospital 12 de Octubre. Material and method. A description of the organizational chart of work of the rehabilitator doctor in a Unit of the Pain, and the process of evaluation and treatment has taken place that habitually carries out. Also a descriptive analysis of the patients has been made who have been taken care of during 10 months (November 2004-Agost 2005). Results. A day per week consists of a collaboration in which the patients after being seen by the stationary equipment of the Unit, receive a valuation an treatment from the rehabilitator point of view. 74 patients with an average age of 59,9 years valued themselves. The main reason for consultation was the one of lumbar pain. Of the valued patients they made rehabilitation 69 % and ortoprotésicas measures in 46 % of the cases were recommended. The degree of satisfaction after the visit with the rehabilitator doctor of the unit was good in 54 % of the patients. Conclusions. The experience of the differents specialist and the multidisciplinary viewpoint of the pain, help to improve the attention and treatment of our patients. We have shown how consultant rehabilitation doctor can be useful in a Pain Unit and improves the health care and the range of therapeutic options provided to patients with chronic pain

Codificación del dolor crónico con la clasificación internacional de enfermedades - 9ª revisión - modificación clínica (CIE-9-MC) / Codification of chronic pain with the international classification of diseases- 9 th revision - clinical modification (ICD 9-CM)

Introducción En el año 1988 el INSALUD inició el proyecto CÓDIGO, con el objeto de implantar de forma voluntaria la necesaria recogida de datos para cubrir un Conjunto Mínimo Básico de Datos (CMBD), así como la codificación con la Clasificación Internacional de Enfermedades -9ª revisión- Modificación Clínica (CIE-9-MC). Esta recogida de datos básicos es el primer paso necesario para la homologación de todos los datos de actividad hospitalaria en España así como en el ámbito europeo. Se trata de obtener información comprensible y fiable sobre los resultados de la interacción usuario/sistema de salud con objeto de poder garantizar su calidad. La adopción de sistemas de medición del producto final hospitalario basados en variables clínicas, es considerada básica en los sistemas de gestión y planificación actuales. Sin ser el único tipo de clasificación, el sistema de agrupamiento de Grupos Relacionados con el Diagnóstico (GRDs), es el más universalmente aceptado. El primer requisito para poder asignar GRDs es el de disponer de informes codificados según la CIE-9-MC. Objetivo El objetivo de este trabajo es presentar los resultados obtenidos tras la aplicación de las normas internacionales de codificación de la CIE-9-MC adaptadas para codificar los diagnósticos de dolor crónico que se realizan en nuestra Unidad Multidisciplinaria de Dolor Crónico. Material y métodos En el año 2000 se inició en nuestro hospital la implantación del sistema informático de recogida de actividad hospitalaria HP-HIS (Sistema Integral Hospitalario-Hewlett-Packard). En Mayo del 2002 nuestra Unidad se incorporó a dicho procedimiento, lo que nos obligó a tener que codificar los diagnósticos y procedimientos de los pacientes a los que se sometía a alguna técnica terapéutica o cirugía. El único sistema de codificación aceptado en España es la CIE-9-MC. No existen códigos propios de dolor crónico en la CIE-9-MC, por lo que cada código diagnóstico se ha obtenido buscando el que mejor describa el diagnóstico de dolor que se quiere codificar. En el período de cuatro años comprendido entre Mayo del 2002 y Abril del 2006, ambos inclusive, se han revisado las historias clínicas de los pacientes para obtener los datos necesarios para realizar la codificación. A cada diagnóstico se le asigna un código principal, y si se precisa un código secundario, así como un código de procedimiento. Resultados En el período de cuatro años comprendido entre Mayo del 2002 y Abril del 2006, ambos inclusive, se han codificado un total de 5393 pacientes. Ha sido posible codificar el 100% de los diagnósticos, habiéndose realizado una base de datos que reúne más de 150 diagnósticos con sus códigos correspondientes según la CIE-9-MC. Realizar la codificación nos ha permitido agrupar las patologías mediante GRDs. El GRD más frecuente ha sido el 243, cuya descripción es “Patología médica de columna vertebral”, que ha supuesto el 40-50% de los casos según los años. Conclusiones La normalización de los criterios de uso de la CIE-9-MC, requiere la necesaria formación de los profesionales que apliquen este sistema de codificación. En estos momentos la codificación de nuestros pacientes nos ha permitido la incorporación al sistema de codificación HP-HIS (Sistema Integral Hospitalario-Hewlett-Packard) y representa una mejora en la gestión de la Unidad favoreciendo los estudios clínicos, epidemiológicos, de morbilidad, mortalidad, de investigación y financiación por procesos (GRD). No obstante, pensamos que más experiencia tanto nuestra como de otros grupos de trabajo de la especialidad serían necesarias para llegar a la excelencia en el proceso de codificación del Dolor Crónico

Introduction In 1988, the National Health Institute (INSALUD) in Spain started up the project CODIGO, in order to establish on a voluntary basis the necessary collection of data to cover a Minimum Basic Data Set (CMBD) as well as the codification with the International Classification of Diseases –9th revision – Clinical Modification (ICD-9-MC). This collection of basic data is the first necessary step for the homologation of all the hospital activity data in Spain as well as in the European environment. The aim was to obtain comprehensible and reliable information on the results of the health user-system interaction in order to ensure quality. The adoption of methods to measure hospital final products based on clinical variables is considered essential for current management and planning. Although it is not the only available one, the cluster system of Diagnosis Related Groups (DRGs) is the most universally accepted. The first requirement to be able to assign DRGs is obtaining reports codified according to the ICD-9-MC. Objective The objective of this work is to present the results obtained after adapting the ICD-9-MC international norms of codification for chronic pain carried out in our Chronic Pain Unit. Material and methods In 2000 our hospital adopted the HP-HIS (Hewlett-Packard- Hospital Integral System), a computer system of hospital activity collection. In May 2002 our Unit was incorporated to this procedure, and we started to codify the diagnoses and procedures from the patients undergoing therapeutic techniques or surgery. The only code system accepted in Spain is the ICD-9-MC. Specific codes of chronic pain do not exist in the ICD-9-MC, so that each diagnosis code has been obtained looking for the one that better describes the pain diagnosis that needs to be codified. In the four year period between May 2002 and April 2006, both inclusive, the clinical records of patients attended have been reviewed to obtain the necessary data to carry out the codification. For each diagnosis, a main code and if necessary a second code are assigned, as well as a procedure code. Results In the four year period between May 2002 and April 2006, both inclusive, 5393 patients records have been codified. It has been possible to codify 100% of the diagnoses, and to create a database that gathers more than 150 diagnoses with their corresponding codes according to the ICD-9- MC. The implementation of the codification system has permitted the classification of pathologies by means of DRGs. The most frequent DRG has been number 243, described as “Medical pathology of spine" that included 40-50% of cases depending of the year. Conclusions The normalization of the criteria for use of the ICD-9-MC, requires the necessary education of professionals implementing this codification system. In these moments the codification of our patients has allowed us the incorporation to the code system HP-HIS (Hewlett-Packard- Hospital Integral System) and it represents an improvement for the administration of the Unit facilitating clinical studies, epidemiological surveys, morbidity, mortality and investigation and financing for processes (DRG) studies. Nevertheless, our experience and that of other peer groups will be necessary to achieve excellence in the process of codification for Chronic Pain