Atypical image of pneumoperitoneum secondary to colon perforation.

The case was a 66-year-old female with a diagnosis of bilateral ovarian carcinoma with peritoneal carcinomatosis and liver metastases. She had only undergone one cycle of chemotherapy and could not be given other cycles because of her poor general condition. She was admitted due to intermittent vomiting for a week and severe heartburn, with the last stool passed two days before, presenting abdominal distension and lower abdominal pain, without signs of peritonism and no peristaltic sounds. After performing several complementary tests a computed tomography scan showed a large amount of intra-abdominal air, which was thought to be a possible transverse colon volvulus, that caused extrinsic compression on the stomach. A colonoscopy was performed in an attempt to devolvulate, which was unsuccessful.

Mujer de 60 años con problemas de visión y lesiones cutáneas / A 60-year-old woman with visual impairment and cutaneous lesions

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El efecto Fausto: sobre la legibilidad y comprensión de los informes clínicos de alta hospitalaria / Faustus’ effect: on the readability and understanding of hospital discharge reports

Una insuficiente comprensión del informe clínico de alta puede tener consecuencias relevantes. La dificultad de lectura es una barrera de comunicación que se ha relacionado, entre otros, con un aumento de los costes asistenciales y un escaso cumplimiento terapéutico. Desconocemos el grado de dificultad en la lectura de los informes clínicos de alta hospitalaria en nuestro país. Se plantea este estudio con el objetivo de demostrar que la dificultad de lectura de los informes de alta es mayor que la deseada según un estándar recomendado y que la legibilidad de comprensión, probablemente, se asocia con la modalidad de redacción empleada. Se han revisado 166 informes de alta de un servicio de medicina que se clasificaron en 2 subgrupos según el estilo de redacción: a) descriptivo --caracterizado por un continuo y exhaustivo detalle de datos técnicos--, y b) narrativo --que se erige sobre expresiones a priori más sencillas y menos cuantitativas--. Se determinó la complejidad de lectura mediante el índice de Flesch y el recuento de «palabras blindadas». El índice de Flesch medio de todos los informes fue de 53 puntos (muy por debajo del nivel de legibilidad recomendado), y la diferencia fue más evidente en el subgrupo descriptivo que en el narrativo. Los informes descriptivos contenían más palabras blindadas que los narrativos. Se concluye que la legibilidad de los informes de alta excede la capacidad de lectura de la mayoría de los pacientes. El estilo narrativo es más comprensible que el descriptivo

Inadequate comprehension of the discharge report can have serious repercussions. Reading difficulty hampers communication and has been related to increased healthcare costs and poor therapeutic compliance, among other factors. The readability of hospital discharge reports in Spain is unknown. The aim of the present study was to demonstrate that the readability of discharge reports is lower than recommended standards and that readability is probably associated with the writing style used. We reviewed 166 discharge reports from an internal medicine department. The discharge reports were classified in 2 subgroups according to the writing style used: a) descriptive (characterised by continuous and exhaustive details of technical data), and b) narrative (based on expressions that were a priori simpler and less quantitative). Readability was determined through the Flesch Index and a count of technical terms that patients would find unfamiliar (including abbreviations). The mean Flesch Index score for all the discharge reports was 53 points, which was much lower than the recommended readability level. This difference was more evident in the descriptive than in the narrative subgroup. Descriptive reports contained more technical terms than did narrative reports. In conclusion, the reading difficulty of the discharge reports exceeds the reading level of most patients. Narrative style is more easily understood than descriptive style

Sobre "toma de decisiones al finalde la vida" / About "taking decisions at the end of life"

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