[Quality of postoperative analgesia protocols in a local hospital]. / Evaluación de la aplicación de protocolos de analgesia postoperatoria en un hospital comarcal: estudio de calidad.

OBJECTIVES: To demonstrate that the introduction of a nursing based Acute Pain Service (APS) leads to better postoperative pain management and a decrease in treatment-related adverse events. To assess the quality criteria of postoperative pain control and discuss their compliance. MATERIALS AND METHODS: A total of 116 major elective surgeries were assessed between November and December 2010 and compared to those collected between November and December 2007 before the introduction of the APS. The following variables were studied: sociodemographic data, type of surgery and postoperative analgesia, pain ratings (numeric verbal scale- NVS) per nursing shift (48 hours), compliance of quality criteria in pain management, and a patient satisfaction survey. RESULTS AND CONCLUSIONS: Despite there being a higher number of surgeries related to expected moderate-intense pain, better scores in pain ratings were obtained both at rest (86.1% ± 11.2 vs 50.7% ± 12.1 NVS ≤ 3, p=.0001) and during activity (73.9% ± 10.8 vs 50.1% ± 12.1 NVS ≤ 5, p=.0026) in surgical wards, but treatment-related side effects did not decrease with the analgesics and there was no increase treatment-related patient satisfaction. The data analysis showed that there is still a deficiency in the recording of the pain scores by nursing shift (70 ± 6.1 vs 40 ± 11.9, p=.0002).

Evaluación de la aplicación de protocolos de analgesia postoperatoria en un hospital comarcal: estudio de calidad / Quality of postoperative analgesia protocols in a local hospital

Objetivos: Demostrar que la implantación de una unidad de dolor agudo basada en enfermería permite un mejor control del dolor postoperatorio y disminuye los efectos adversos debidos a la medicación analgésica, y evaluar los criterios de calidad del manejo del dolor postoperatorio y su cumplimiento. Material y métodos: Se evaluaron en total 116 intervenciones de cirugía mayor programada entre noviembre y diciembre de 2010 y se compararon con los datos recogidos entre noviembre y diciembre de 2007 antes de la implantación de la unidad de dolor agudo. Se estudiaron las siguientes variables: datos sociodemográficos, tipo de cirugía, tipo de anestesia y de analgesia postoperatoria, evaluación del dolor mediante la aplicación de escalas de dolor (escala verbal numérica [EVN]) por turno de enfermería (48 h), cumplimiento de criterios de calidad (medición de indicadores de efectividad, confort, seguridad, calidad percibida y adecuación) y encuesta de satisfacción del paciente. Resultados y conclusiones: En 2010 el número de cirugías asociadas a dolor esperado moderado-severo fue mayor (el 88 frente al 58,5%); sin embargo, se consiguen mejores puntuaciones en las escalas de dolor, tanto en reposo (el 86,1 ± 11,2 frente al 50,7 ± 12,1% EVN <= 3; p = 0,0001) como en movimiento (el 73,9 ± 10,8 frente al 50,1 ± 12,1% EVN <= 5; p = 0,0026) en unidades de hospitalización. No disminuyeron los efectos adversos relacionados con los analgésicos ni aumentó la satisfacción del paciente con el tratamiento analgésico recibido. El análisis de los datos permite señalar que el registro de la escala de dolor por turno de enfermería sigue siendo deficitario (el 70 ± 6,1 frente al 40 ± 11,9%; p = 0,0002)(AU)

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Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria / Factors associated with patient satisfaction with hospital care

Objetivo. Identificar la influencia sobre la alta satisfacciónde factores sociodemográficos, asistenciales y decomunicación.Material y Métodos. Estudio de corte transversal medianteencuesta telefónica a pacientes dados de alta duranteel mes de septiembre de 2006. Instrumento de medida:cuestionario SERQVHOS. Como medida de fuerza de asociaciónse ha utilizado la odds ratio (OR) y su intervalode confianza (IC) al 95%. Para el ajuste por factores deconfusión se ha utilizado el análisis de regresión logística.Resultados. La tasa de respuesta fue del 80,9%. Al evaluarla influencia de características sociodemográficas, se observaque los usuarios con nacionalidad no pertenecientea la Unión Europea mostraron mayor satisfacción que losespañoles (OR=3,01 IC 95%: 1,40-3,51), y los entrevistadoscon estudios primarios resultaron más satisfechos que losuniversitarios (OR=2,85 IC 95% [1,88-4,35]). En cuanto afactores asistenciales, en los pacientes con reingresos porla misma categoría diagnóstica mayor se observó una menorprevalencia de alta satisfacción, con una OR de 0,67 ysignificación limítrofe. Por último, respecto a la comunicación,los tres aspectos más asociados a la alta satisfacciónfueron la identificación correcta del personal (OR: 6,22 IC95% [3,52-10,97]), recibir información suficiente sobre elestado de salud (OR: 3,83 IC 95% [1,94-7,57]) y recibir informaciónsobre el lugar y horario de información médica(OR: 2,60 IC95% [1,60-4,22]).Conclusiones. La comunicación incide favorablementeen la percepción final de la asistencia lo que justificaque se continúe trabajando en su mejora en los centrossanitarios de nuestra comunidad(AU)

Objective. To identify the influence of sociodemographic,care and communication factors on patient satisfaction.Methods. Cross-sectional study by means of a telephonicsurvey of patients discharged during September,2006. Instrument for measuring satisfaction: SERQVHOSquestionnaire. Statistical analysis: we used odds ratio(OR) and its 95% confidence interval (CI); adjustmentfor confusion factors was performed using multiple logisticregression.Results. Response rate was 80.9%. On evaluating the influenceof sociodemographic characteristics, we observedthat patients whose nationality did not correspondto the European Union were more satisfied than Spanishpatients (OR=3.01; 95% CI: 1.40-3.51); subjects who hadonly completed primary studies were more satisfiedthan those with university studies (OR = 2.85, 95% CI:1.88-4.35). With respect to care factors, patients readmittedbecause of the same major diagnostic category hadlower satisfaction (OR=0.67, bordering statistical significance).Finally, with regard to communication factors,the three aspects most associated with patient satisfactionwere: correct health-care personnel identification(OR: 6.22 95% CI: 3.52-10.97), receiving enough informationabout his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedulefor medical information (OR: 2.60, 95% CI: 1.60-4.22).Conclusions. Communication favourably affects thefinal perception of care, which justifies the continuityof its improvement in the health centres of our region(AU)

[Factors associated with patient satisfaction with hospital care]. / Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria.

OBJECTIVE: To identify the influence of sociodemographic, care and communication factors on patient satisfaction. METHODS: Cross-sectional study by means of a telephonic survey of patients discharged during September, 2006. Instrument for measuring satisfaction: SERQVHOS questionnaire. STATISTICAL ANALYSIS: we used odds ratio (OR) and its 95% confidence interval (CI); adjustment for confusion factors was performed using multiple logistic regression. RESULTS: Response rate was 80.9%. On evaluating the influence of sociodemographic characteristics, we observed that patients whose nationality did not correspond to the European Union were more satisfied than Spanish patients (OR=3.01; 95% CI: 1.40-3.51); subjects who had only completed primary studies were more satisfied than those with university studies (OR = 2.85, 95% CI: 1.88-4.35). With respect to care factors, patients readmitted because of the same major diagnostic category had lower satisfaction (OR=0.67, bordering statistical significance). Finally, with regard to communication factors, the three aspects most associated with patient satisfaction were: correct health-care personnel identification (OR: 6.22 95% CI: 3.52-10.97), receiving enough information about his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedule for medical information (OR: 2.60, 95% CI: 1.60-4.22). CONCLUSIONS: Communication favourably affects the final perception of care, which justifies the continuity of its improvement in the health centres of our region.

[Premedication with intraoperative clonidine and low-dose ketamine in outpatient laparoscopic cholecystectomy]. / Premedicación con clonidina y ketamina intraoperatoria a bajas dosis en la colecistectomía laparoscópica ambulatoria.

OBJECTIVE: To determine the efficacy of premedication with intraoperative clonidine in association with low-dose ketamine to reduce the need for postoperative opiate analgesia in outpatient laparoscopic cholecystectomy. PATIENTS AND METHODS: We performed a prospective study of patients undergoing outpatient laparoscopic cholecystectomy between November 2005 and November 2006. The patients were distributed randomly in 2 groups: patients in the clonidine-ketamine group received clonidine (0.15 mg orally 60 minutes before surgery) and ketamine (20-mg intravenous bolus followed by intraoperative perfusion of 20 mg h(-1)); patients in the control group did not receive this medication. Pain assessed on a verbal numerical scale, number of times rescue analgesia was required to achieve a value below 3, and adverse effects of the medication were recorded in the postoperative period. RESULTS: Thirty-one patients (16 in the clonidine-ketamine group and 15 in the control group) were enrolled. Rescue analgesia was required on 2 occasions by 25% of patients in the clonidine-ketamine group and on 2 or 3 occasions by 533% of patients in the control group. Adverse effects were reported by 87.5% of patients in the clonidine-ketamine group (mainly visual disturbances, sedation, and nausea) and by 46.7% in the control group. This difference was significant during the patients' stay in the postanesthesia recovery unit. CONCLUSIONS: Patients receiving clonidine and ketamine required less additional opiate analgesia to achieve mild pain values (<3 on the numerical verbal scale) but suffered more adverse effects during their stay in the postanesthesia recovery unit. Discharge was not delayed, however.

Premedicación con clonidina y ketamina intraoperatoria a bajasdosis en la colecistectomía laparoscópica ambulatoria / Premedication with intraoperative clonidine and low-dose ketamine in outpatient laparoscopic cholecystectomy

OBJETIVO: Comprobar la eficacia de la premedicacióncon clonidina, asociada a ketamina intraoperatoria abajas dosis, para disminuir la necesidad de analgésicosopioides postoperatorios en la colecistectomía laparoscópicaambulatoriaPACIENTES Y MÉTODOS: Se realizó un estudio prospectivoen pacientes sometidos a colecistectomía laparoscópicaambulatoria desde noviembre de 2005 anoviembre de 2006. Se distribuyeron de forma aleatoriaen 2 grupos, grupo CK a los que se administró clonidina(0,15 mg vía oral 60 minutos antes de la cirugía)y ketamina (bolo de 20 mg intravenoso seguido deperfusión intraoperatoria de 20 mg h-1), y grupo O alos que no se suministró esa medicación. Se determinóla Escala Verbal Numérica (EVN) durante el postoperatorio,número de rescates analgésicos necesariospara obtener un valor inferior a 3 y efectos adversos ala medicación.RESULTADOS: Se incluyeron 31 pacientes (16 en el grupoCK y 15 en el grupo O). 25% de los pacientes necesitaron2 rescates en el grupo A, mientras que en el grupoB 53,3% necesitaron 2 ó 3 rescates. Presentaron efectosadversos un 87,5% en el grupo CK (principalmente alteracionesvisuales, sedación y nauseas), y un 46,7% en elgrupo O. Esta diferencia fue significativa durante supermanencia en la Unidad de Recuperación Postanestésica(URPA).CONCLUSIONES: Los pacientes con clonidina y ketaminaprecisan menos analgesia adicional con opioides paraalcanzar valores de dolor leve (EVN menor de 3) perotuvieron más efectos adversos durante su permanenciaen URPA, aunque no retrasó el alta hospitalaria (AU)

OBJECTIVE: To determine the efficacy of premedicationwith intraoperative clonidine in association with low-doseketamine to reduce the need for postoperative opiateanalgesia in outpatient laparoscopic cholecystectomy.PATIENTS AND METHODS: We performed a prospectivestudy of patients undergoing outpatient laparoscopiccholecystectomy between November 2005 and November2006. The patients were distributed randomly in 2groups: patients in the clonidine-ketamine groupreceived clonidine (0.15 mg orally 60 minutes beforesurgery) and ketamine (20-mg intravenous bolusfollowed by intraoperative perfusion of 20 mg·h-1);patients in the control group did not receive thismedication. Pain assessed on a verbal numerical scale,number of times rescue analgesia was required toachieve a value below 3, and adverse effects of themedication were recorded in the postoperative period.RESULTS: Thirty-one patients (16 in the clonidineketaminegroup and 15 in the control group) wereenrolled. Rescue analgesia was required on 2 occasionsby 25% of patients in the clonidine-ketamine group andon 2 or 3 occasions by 53.3% of patients in the controlgroup. Adverse effects were reported by 87.5% ofpatients in the clonidine-ketamine group (mainly visualdisturbances, sedation, and nausea) and by 46.7% in thecontrol group. This difference was significant during thepatients’ stay in the postanesthesia recovery unit.CONCLUSIONS: Patients receiving clonidine and ketaminerequired less additional opiate analgesia to achieve mildpain values (<3 on the numerical verbal scale) but sufferedmore adverse effects during their stay in the postanesthesiarecovery unit. Discharge was not delayed, however (AU)

Prevención de la infección nosocomial de origen fúngico: verificación de la bioseguridad ambiental en quirófanos / Prevention of nosocomial infection of fungal origin: verification of the environmental biosafety in surgery rooms

Durante 36 meses se ha monitorizado prospectivamente la biodiversidad y la concentración de los hongos ambientales en el área quirúrgica hospitalaria. Se han realizado un total de 120 determinaciones, de las que el 70% presentaron crecimiento fúngico, identificándose en el 62% un único género. Se han aislado 9 géneros diferentes (Penicillium, Aspergillus, Acremonium, Dactylaria, Fusarium, Cladophialophora, Alternaria, Candida y Rodothorula), con un claro predominiode Cladophialophora. Se discuten aspectos aún sin resolver como son: la periodicidad de las tomas, la definición de área de riesgo, la interpretación de los recuentos y las especies consideradas patógenas. Actualmente, a pesar de las grandes lagunas de conocimiento, el mantenimiento de un sistema de registro continuo de los niveles de bioseguridad ambiental es fundamental, ya que en la mayor parte de las ocasiones en las que se detectan recuentos fúngicos elevados no se puede identificar la causa

The biodiversity and concentration of environmental fungi in the hospital surgical area was monitored for 36 months. A total of 120 measures were made, 70 % of which had fungal growth, a single genus being identified in 62 %. Nine different genus were isolated (Penicillium, Aspergillus, Acremonium, Dactylaria, Fusarium, Cladophialophora, Alternaria, Candida and Rodothorula) with a clear predominance of Cladophialophora. Aspects that still must be resolved are discussed. These are: periodicity of the sample obtention, definition of the area of risk, interpretation of the counts and species considered pathogenic. At present, in spite of the large gaps in knowledge, the maintenance of a continuous registry system of the environmental biosafety levels is fundamental, since the cause cannot be identified in most of the times when elevated fungal count is detected

[Prevention of nosocomial infection of fungal origin: verification of the environmental biosafety in surgery rooms]. / Prevención de la infección nosocomial de origen fúngico: verificación de la bioseguridad ambiental en quirófanos.

The biodiversity and concentration of environmental fungi in the hospital surgical area was monitored for 36 months. A total of 120 measures were made, 70% of which had fungal growth, a single genus being identified in 62%. Nine different genus were isolated (Penicillium, Aspergillus, Acremonium, Dactylaria, Fusarium, Cladophialophora, Alternaria, Candida and Rodothorula) with a clear predominance of Cladophialophora. Aspects that still must be resolved are discussed. These are: periodicity of the sample obtention, definition of the area of risk, interpretation of the counts and species considered pathogenic. At present, in spite of the large gaps in knowledge, the maintenance of continuous registry system of the environmental biosafety levels is fundamental, since the cause cannot be identified in most of the times when elevated fungal count is detected.