Implantación de un plan de calidad en un servicio de urgencias y su impacto en la satisfacción del paciente / Implementation of an emergency department health care quality plan and its impact on patient satisfaction

Objetivo: Analizar el impacto de la implantación de un plan de calidad para mejorarla gestión de la demanda de atención urgente, en la evolución de las reclamaciones de los usuarios y su grado de satisfacción. Método: Estudio longitudinal observacional descriptivo prospectivo. Periodo de estudio: enero 2007 a diciembre 2010. Líneas del plan de calidad: desarrollo del plan funcional, un plan dirigido a la información y seguridad clínica, un sistema de gestión por procesos, un plan de actuación en formación y docencia con el desarrollo de un cuadro de mandos y un sistema de autoevaluación para el análisis de resultados. Análisis estadístico: test t de Student para variables continuas y la ji al cuadrado para dicotómicas o el Test exacto de Fisher y la corrección de Yates como test no paramétricos. Variables: urgencias atendidas/mes, número de reclamaciones y sus motivos, tiempos de estancia media en urgencias y demora admisión-1ª atención médica, y encuestas de opinión. Resultados: Se han incluido 210 reclamaciones: 81 en 2007, 59 en 2008, 48 en2009 y 22 en 2010. El 76,2% de ellas han sido por demora asistencial, seguidas por aquellas relacionadas con la disconformidad con las normas de organización (7,1%).Hay una reducción progresiva del porcentaje de reclamaciones respecto al total de urgencias atendidas con un valor de la ji al cuadrado de tendencia lineal de 28,28(p < 0,01). Tras la implantación del programa de calidad en 2008, disminuyeron un73,5% las reclamaciones por demora y dejaron de producirse reclamaciones por falta de intimidad y por accidentes en el centro. Conclusiones: El análisis de las reclamaciones es una herramienta útil de monitorización de la calidad asistencial. La implantación de un sistema de gestión de la calidad, se convierte en esencial en la mejora de la atención urgente del paciente sin costes adicionales (AU)

Objective: To analyze the effect of a quality control plan for improving emergency deparment case management interms of complaints received and patient level of satisfaction. Methods: Longitudinal, descriptive, prospective observational study. Time frame: January 2007 to December 2010.The health care quality plan involved the development of a viable plan; a campaign to impart information on patient and staff safety; a management system based on processes; and procedures for training and education, including a balanced scorecard and a system for self assessment of results. Outcome measures: emergencies attended monthly, number of claims and reasons for them, mean stay in the emergency department, delay from admission to first physician visit, and a user satisfaction survey. Results: A total of 210 claims were studied; 81 were filed in 2007, 59 in 2008, 48 in 2009, and 22 in 2010. Delays motivated 76.19% of the claims; disagreements about organizational procedures motivated 7.14%. More claims are received during summer months. After the program was implemented in 2008, complaints about delays decreased by73.53% and no further complaints about lack of privacy and accidents within the hospital were received. Conclusions: Claims analysis is a useful tool for monitoring health care quality. A health care quality management program is essential for improving emergency care without generating additional costs (AU)

Predominio del genotipo G9 de rotavirus en Valencia y Castellón entre 2005 y 2007 / Predominance of G9 rotavirus in Valencia and Castellón between 2005 and 2007

Introducción: Las infecciones por rotavirus son la causa más frecuente de gastroenteritis aguda en la infancia. Existen disponibles vacunas para su prevención, pero su uso todavía es limitado y estos virus continúan infectando a la población infantil, principalmente en los meses fríos del año. Objetivos: Caracterizar los genotipos G (VP7) y P (VP4) de rotavirus detectados en niños con gastroenteritis aguda y determinar la prevalencia de las cepas de rotavirus con genotipo G9 en 3 departamentos de Salud Pública de la Comunidad Valenciana. Pacientes y métodos: Se estudiaron de forma prospectiva 541 muestras de heces de niños con gastroenteritis desde octubre de 2005 a septiembre de 2008. Se analizó la presencia de rotavirus por métodos de ELISA o inmunocromatografía y se identificaron los genotipos G y P de las cepas de rotavirus mediante transcripción inversa y amplificación en cadena de la polimerasa. Resultados: Se caracterizaron los genotipos G y P en un total de 525 muestras (97%), y resultaron predominantes las cepas G9P[8] (56,5%) y G1P[8] (29,9%). Durante el período de tiempo estudiado, G9P[8] fue la combinación G/P más frecuente en las temporadas 2005–2006 y 2006–2007, y se encontró en el 81,2 y en el 64,7% de las muestras, respectivamente. Sin embargo, en la temporada 2007–2008 fueron las cepas G1P[8] las más frecuentes (68,8%), y G9P[8] disminuyó a un 7,2%. Conclusiones: Las cepas de rotavirus G9P[8] se diseminaron rápida y ampliamente durante los períodos 2005–2006 y 2006–2007, y suplantaron a otros genotipos anteriormente predominantes (G1, G4) en nuestra área geográfica. Su incidencia descendió bruscamente en la temporada 2007–2008, en la que las cepas G1P[8] resultaron ser nuevamente las que se detectaron más frecuentemente (AU)

Introduction: Rotavirus is the leading cause of acute gastroenteritis in young children worldwide. Effective vaccines to prevent rotavirus infections are currently available, although their clinical use is still limited, and rotavirus still causes many episodes of infantile gastroenteritis, mainly during the winter seasons. Objective: To characterise G (VP7) and P (VP4) genotypes of rotaviruses causing acute gastroenteritis in children and to determine the prevalence of genotype G9 rotavirus in three public health areas in the provinces of Valencia and Castellon. Patients and methods: Five-hundred and forty-one stool samples were prospectively collected from infants and children with gastroenteritis in the period between October 2005 and September 2008. They were analysed for rotavirus by ELISA or by immunochromatography. G and P genotyping was performed by reverse transcription and PCR (RT-PCR). Results: G and P rotavirus genotypes were characterised in a total of 525 faecal samples (97%), resulting in a global predominance of strains G9P[8] (56.5%) and G1P[8] (29.9%). During the period of time studied, G9P[8] was the G/P combination most frequently detected during the rotavirus seasons 2005–2006 and 2006–2007, being present in 81.2% and 64.7% of the patients, respectively. However, during the 2007–2008 season, G1P[8] strains were the most frequently found (68.8%), with a sharp decrease in G9P[8] strains to 7.2% of the samples. Conclusions: Rotavirus G9P[8] have spread rapidly and widely during the 2005–2006 and 2006–2007 seasons, replacing other previously dominant genotypes (G1, G4) in our geographic area. Its incidence has declined sharply in 2007–2008, in which G1P[8] was again the predominating genotype (AU)

[Predominance of G9 rotavirus in Valencia and Castellón between 2005 and 2007]. / Predominio del genotipo G9 de rotavirus en Valencia y Castellón entre 2005 y 2007.

INTRODUCTION: Rotavirus is the leading cause of acute gastroenteritis in young children worldwide. Effective vaccines to prevent rotavirus infections are currently available, although their clinical use is still limited, and rotavirus still causes many episodes of infantile gastroenteritis, mainly during the winter seasons. OBJECTIVE: To characterise G (VP7) and P (VP4) genotypes of rotaviruses causing acute gastroenteritis in children and to determine the prevalence of genotype G9 rotavirus in three public health areas in the provinces of Valencia and Castellon. PATIENTS AND METHODS: Five-hundred and forty-one stool samples were prospectively collected from infants and children with gastroenteritis in the period between October 2005 and September 2008. They were analysed for rotavirus by ELISA or by immunochromatography. G and P genotyping was performed by reverse transcription and PCR (RT-PCR). RESULTS: G and P rotavirus genotypes were characterised in a total of 525 faecal samples (97%), resulting in a global predominance of strains G9P[8] (56.5%) and G1P[8] (29.9%). During the period of time studied, G9P[8] was the G/P combination most frequently detected during the rotavirus seasons 2005-2006 and 2006-2007, being present in 81.2% and 64.7% of the patients, respectively. However, during the 2007-2008 season, G1P[8] strains were the most frequently found (68.8%), with a sharp decrease in G9P[8] strains to 7.2% of the samples. CONCLUSIONS: Rotavirus G9P[8] have spread rapidly and widely during the 2005-2006 and 2006-2007 seasons, replacing other previously dominant genotypes (G1, G4) in our geographic area. Its incidence has declined sharply in 2007-2008, in which G1P[8] was again the predominating genotype.

Peritonitis por Saccharomyces cerevisiae en un paciente sometido a diálisis peritoneal ambulatoria / No disponible

No disponible

[Ten-year retrospective study of rotavirus infection in the province of Castellón (Spain)]. / Estudio retrospectivo de 10 años de la infección por rotavirus en la provincia de Castellón.

OBJECTIVE: To determine the percentage of rotavirus infection in children aged less than 14 years old and the epidemiology in area 02 of the province of Castellón (Spain). MATERIAL AND METHODS: We performed a retrospective study from January 1995 to December 2004 in which 14,068 stool samples from pediatric patients with acute gastroenteritis were analyzed. The variables analyzed were sex, age, origin, diagnosis of rotavirus, and date of diagnosis. Differences were considered statistically significant if p<0.05. RESULTS: Rotavirus was detected in 11.9% of the samples (1687 cases) in the 10 years of the study, 12.14 % corresponded to boys and 11.81% to girls (p=0.5459). The mean age of the population was 2.63 years. The highest percentage of cases occurred in the group aged 1- 4 years old (14.1%; p<0.001) and in outpatients (12.76%; p<0.05). In this geographical region, there was a significant tendency (p<0.001) for rotavirus to occur in the winter months. CONCLUSION: Rotavirus is one of the main causes of morbidity in children both in the hospital and the outpatient setting. Children aged less than 4 years old are most frequently affected, especially those aged 1 year. The infection appears mainly in winter.

Estudio retrospectivo de 10 años de la infección por rotavirus en la provincia de Castellón / Ten-year retrospective study of rotavirus infection in the province of Castellón (Spain)

Objetivo. El objetivo de este trabajo es conocer el porcentaje de la infección por rotavirus en niños menores de 14 años y su epidemiología en el área 02 de la provincia de Castellón. Material y métodos. Se realizó un estudio retrospectivo desde enero de 1995 hasta diciembre de 2004 en el que se analizaron 14.068 muestras de heces de pacientes pediátricos con gastroenteritis aguda. Las variables analizadas fueron: sexo, edad, procedencia, diagnóstico de rotavirus y fecha de diagnóstico. Se consideraron valores significativos p < 0,05. Resultados. El rotavirus fue detectado en el 11,9 % (1.687 casos) en los 10 años del estudio; el 12,14 % en varones y el 11,81 % en mujeres (p = 0,5459). La edad media de la población del estudio fue de 2,63 años. El grupo que presentó el mayor porcentaje de casos fue el de 1 a 4 años con el 14,1 % (p < 0,001) y pacientes ambulatorios con el 12,76 % (p < 0,05). En nuestra área, el rotavirus predomina significativamente (p < 0,001) en los meses de invierno. Conclusión. El rotavirus es una de las causas más importantes de morbilidad en la edad pediátrica en el hospital y en el ambulatorio. Afecta más frecuentemente a los niños menores de 4 años, y principalmente a los de 1 año. La infección se presentó de forma predominante en el invierno

Objective. To determine the percentage of rotavirus infection in children aged less than 14 years old and the epidemiology in area 02 of the province of Castellón (Spain). Material and methods. We performed a retrospective study from January 1995 to December 2004 in which 14,068 stool samples from pediatric patients with acute gastroenteritis were analyzed. The variables analyzed were sex, age, origin, diagnosis of rotavirus, and date of diagnosis. Differences were considered statistically significant if p < 0.05. Results. Rotavirus was detected in 11.9 % of the samples (1687 cases) in the 10 years of the study, 12.14 % corresponded to boys and 11.81 % to girls (p = 0.5459). The mean age of the population was 2.63 years. The highest percentage of cases occurred in the group aged 1- 4 years old (14.1 %; p < 0.001) and in outpatients (12.76 %; p < 0.05). In this geographical region, there was a significant tendency (p < 0.001) for rotavirus to occur in the winter months. Conclusion. Rotavirus is one of the main causes of morbidity in children both in the hospital and the outpatient setting. Children aged less than 4 years old are most frequently affected, especially those aged 1 year. The infection appears mainly in winter