Resultados del test molecular GynEC®-DX en aspirados endometriales con dictamen histológico no concluyente / Results of GynEC®-DX molecular test in endometrial aspirates with inconclusive histological assessmen

Objetivo: medir el porcentaje de resultados concluyentes obtenidos mediante el test de diagnóstico molecular GynEC®-DX en un grupo de pacientes con resultado anatomopatológico insuficiente o no concluyente en la biopsia obtenida mediante aspirado endometrial. Material y métodos: estudio multicéntrico prospectivo, en el que se realizó el test de diagnóstico molecular en una nueva toma de aspirado endometrial tras un resultado no concluyente previo en el estudio histológico. Resultados: se obtuvo un resultado concluyente en el 89,4% (n = 84) de las 94 pacientes reclutadas. En este estudio, el test demostró una sensibilidad del 100%, una especificidad del 88,2%, y un valor predictivo negativo del 100%. Conclusiones: el test de diagnóstico molecular consiguió establecer un resultado determinante en el 89,4% de los casos en los que el patólogo no pudo obtener un diagnóstico mediante análisis histológico (AU)

Objective: To estimate the percentage of conclusive result obtained with GynEC®-DX molecular diagnostic test in a group of patients with an insufficient or inconclusive pathological result in the endometrial aspirate biopsy. Material and methods: Prospective multicenter study where the molecular diagnostic test was carried out in a new endometrial aspirate sample. Results: A conclusive result was obtained in 89.4% (n = 84) of the 94 patients recruited. The molecular test had a sensitivity of 100%, a specificity of 88.2% and a negative predictive value of 100%. Conclusions: The molecular diagnostic test was able to establish a determining result in 89.4% of the cases in which the pathologist could not obtain a diagnosis by histological analysis (AU)

Análisis de la seguridad clínica en el proceso de cirugía mayor ambulatoria. Utilización de metodología Lean-Healthcare / No disponible

Objetivo: Reducir los efectos adversos del proceso quirúrgico de cirugía mayor ambulatoria (CMA). Material y métodos: El método de trabajo que se ha seguido ha sido utilizando la metodología Lean-Healthcare y sus herramientas. Se ha realizado la identificación de riesgos desde el Gemba (lugar de trabajo) y valoración según la escala NPR (número prioritario de riesgo) de la metodología AMFE (análisis modal de fallos y efectos). En este sentido se ha trabajado en grupo para hacer una descomposición funcional del proceso CMA del servicio de cirugía general desde la recepción de los volantes en la secretaría de consultas externas hasta el momento en que se da de alta al paciente en la visita de consultas externas y se cierra el proceso. Seguidamente se valoraron y priorizaron los riesgos y se identificaron las causas. Se definió un plan de trabajo que se inició durante una semana Gemba. Durante la valoración de riesgos se han ido incorporando personas conocedoras de cada fase del proceso, lo que ha permitido la aportación de diferentes puntos de vista y el consenso de las decisiones. Se han priorizado 25 acciones a realizar para dar respuesta a los objetivos del proyecto. Resultados: Después de realizar la semana Gemba, el equipo del proyecto se volvió a reunir para calcular por segunda vez el NPR (ocurrencia y detección) de los riesgos priorizados y trabajados. La gravedad no se ha vuelto a valorar ya que si realmente el error impacta sobre el paciente las consecuencias son las mismas. El índice NPR mejoró entre un 92 y un 40%. Las actuaciones iniciadas que han permitido mejorar el índice NPR han sido las siguientes: definición de los ítems a recoger en la historia (..) (AU)

Objective: The reduction of side effects in the surgical process of ambulatory surgery. Material and methods: The work type that has been followed is Lean-Healthcare methodology and its tools. The identification of risks has been realized from Gemba (work place) and a score according to the NPR scale and AMFE methodology. According to this, the workload is realized in-group to make a functional decomposition of the mayor ambulatory surgery of general surgery since the reception of the flyer in the general consult until the discharge and the closing of the process. Following assessment and priorization of the risks and identification of the probable causes and a work plan was defined that started in a Gemba week. During the risk assessment the incorporation of knowledgeable people inevery stage of the process, this has allowed the contribution of different views and consensus decisions, and 25 actions have been prioritized to meet the project objectives (..) (AU)

[Primary septicemias in pediatric patients. Hospital Infantil de la Paz (1990-1993)]. / Septicemias primarias en enfermos pediátricos. Hospital Infantil de la Paz (1990-1993).

BACKGROUND: Septicemias comprise more than one third of nosocomial infections in children. Their risk factors are related with the exposition time, therefore they are evaluated in relationship to it. PATIENTS AND METHODS: Prospective observational study along 4 years in surgical children and in those entered in the Internal Medicine Unit patients of a children Hospital, with stays higher than two days. Data were collected from admission to discharge. Bivariant analysis of stay time until infection with Wilcoxon-Gehan test, followed by Cox regression with time interaction terms for the risk factors that did not fulfill the requisite of proportional risks. RESULTS: 4,098 children were studied. 3.8% suffered primary septicemia and more than one half had coagulase-negative staphylococci. Cox regression showed the following risk factors: type of surgery, peripheral and central venous catheter, urinary catheterization, stay previous to surgery and duration of intervention. The protection factors were more than 3 days of antibiotherapy, age higher than 1 year and male sex. The factors with interaction with time were: stay previous to surgery, sex and duration of intervention. CONCLUSIONS: The stay previous to surgery, antibiotherapy reduction and duration of instrumentations are risk factors susceptible to be modified in order to reduce the incidence of infection in children. Protection by means of antibiotics requires to be evaluated through an ad hoc designed study.

Zuclopenthixol decanoate in schizophrenia: serum levels and clinical state.

Serum concentrations of zuclopenthixol were determined in a group of 20 patients treated with a depot preparation, zuclopenthixol decanoate in Viscoleo. Clinical assessments according to a Clinical Global Impression (CGI) scale, Comprehensive Psychological Rating Scale (CPRS), 16-item subscale for schizophrenia, and the UKU side effect scale were performed on 3 consecutive days of injection. The serum concentrations showed a limited individual variation and a high and significant correlation between dose and serum concentration. One patient had a particularly high serum concentration of zuclopenthixol. This patient also had an elevated concentration of the N-dealkyl metabolite, but a low concentration of the sulphoxide. For serum concentrations versus clinical state and side effects some significant correlations were found. All correlations were positive, which means that the higher the serum concentration the poorer the clinical state of the patient. We think that this probably reflects a common clinical pattern of increasing the dose, when the antipsychotic response is unsatisfactory. The study also showed that for moderately ill patients, who were given the optimum dose of drug, the subgroup of patients not experiencing side effects had significantly lower serum concentrations than the subgroup with side effects.