Tasa de egreso hospitalario por episodio depresivo recurrente en los años 2018-2021 en Chile / Hospital discharge rate due to recurrent depressive episode in the years 2018-2021 in Chile

Introducción: La depresión es un trastorno del ánimo frecuente, cuya recurrencia altera su manejo y pronóstico. El objetivo del trabajo es describir la tasa de egreso hospitalario (TEH) por episodio depresivo recurrente (EDR) entre 2018-2021 en Chile, según sexo, edad y gravedad. Materiales y métodos: Estudio observacional y transversal que considera los egresos hospitalarios por EDR en el período 2018-2021 en Chile (N=1551). Se utilizaron las bases de datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadística. Las variables estudiadas fueron sexo, grupo etario y gravedad. No requirió aprobación de comité de ética. Resultados: Se observó la menor TEH en 2020 con 1,91 egresos por cada 100.000 habitantes. Las mujeres sobresalieron durante todo el período con una TEH de 3,68 egresos por cada 100.000 habitantes. Destacó el grupo de 15 a 19 años con la mayor TEH en ambos sexos con 5,3 egresos por cada 100.000 habitantes. Respecto a gravedad, las hospitalizaciones se concentraron en pacientes de diagnóstico no especificado. Discusión: La pandemia de COVID 19 podría explicar la disminución de la TEH en 2020, al reducirse el diagnóstico y hospitalización por EDR; presumiblemente debido al fenómeno de reconversión de camas. La TEH es mayor en el sexo femenino, lo cual es concordante con la literatura. El predominio del grupo de 15 a 19 años discrepa de la evidencia, la cual indica que suele concentrarse en individuos de 25 a 64 años. Conclusión: Las TEH por EDR se concentraron en mujeres jóvenes. Es relevante conocer la epidemiología local para focalizar los recursos en la detección oportuna de factores de riesgo, para evitar episodios graves y disminuir su recurrencia.

Introduction: Depression is a common mood disorder, whose recurrence alters its management and prognosis. The aim of the paper is to describe the hospital discharge rate (HED) for recurrent depressive episode (RDE) between 2018-2021 in Chile, according to sex, age and severity. Materials and methods: Observational and cross-sectional study considering hospital discharges due to DRE in the period 2018-2021 in Chile (N=1551). The databases of the Department of Health Statistics and Information and the National Institute of Statistics were used. The variables studied were sex, age group and severity. Ethics committee approval was not required. Results: The lowest HTE was observed in 2020 with 1.91 discharges per 100,000 inhabitants. Females stood out during the entire period with an HTE of 3.68 discharges per 100,000 population. The 15-19 years age group stood out with the highest HTE in both sexes with 5.3 admissions per 100,000 inhabitants. In terms of severity, hospitalizations were concentrated in patients with unspecified diagnosis. Discussion: The COVID 19 pandemic could explain the decrease in HTE in 2020, with a reduction in diagnosis and hospitalization for RDE, presumably due to the bed conversion phenomenon. HTE is higher in the female sex, which is consistent with the literature. The predominance of the 15 to 19 years age group disagrees with the evidence, which indicates that it tends to be concentrated in individuals aged 25 to 64 years. Conclusion: HTE due to DRE was concentrated in young women. It is important to know the local epidemiology in order to focus resources on the timely detection of risk factors to avoid serious episodes and reduce their recurrence.

Conexión de registros sanitarios: base poblacional de salud de Andalucía / Health record linkage: Andalusian health population database

OBJETIVO: Describir el desarrollo de un sistema de información que conecta datos procedentes de múltiples registros, sanitarios y otros, para su uso con fines asistenciales, de administración, gestión, evaluación, inspección, investigación y salud pública. MÉTODO: Conexión determinística de datos pseudonimizados de una población de 8,5 millones de habitantes, procedentes de Base de datos de usuarios, Historia clínica electrónica DIRAYA, Conjunto mínimo básico de datos (hospitalización, cirugía mayor ambulatoria, urgencias hospitalarias y hospital de día médico) y sistemas de información de salud mental, pruebas de imagen, pruebas analíticas, vacunas, pacientes renales y farmacia. Se utilizó un codificador automático para los diagnósticos clínicos y se definieron 80 enfermedades crónicas para su seguimiento. La arquitectura del sistema de información constó de tres capas: datos (base de datos Oracle 11g), aplicaciones (MicroStrategy BI) y presentación (MicroStrategy Web, librerías JavaScript, HTML 5 y hojas de estilo CSS). Se implantaron medidas para la gobernanza del sistema. RESULTADOS: Se incluyeron datos de 12,5 millones de personas que fueron usuarias entre los años 2001 y 2017, con 435,5 millones de diagnósticos. El 88,7% de estos diagnósticos fueron generados por el codificador automático. Los datos se presentan mediante informes predefinidos o consultas dinámicas, ambos exportables a ficheros CSV para su tratamiento fuera del sistema. Analistas expertos pueden acceder directamente a las bases de datos y realizar extracciones mediante SQL o tratar directamente los datos con herramientas externas. CONCLUSIÓN: El trabajo ha mostrado cómo la conexión de registros sanitarios abre nuevas posibilidades en el análisis de datos

OBJECTIVE: To describe the development of an information system that connects data from multiple health records to improve assistance to patients, health services administration, management, evaluation, and inspection, as well as public health and research. METHOD: Deterministic connection of pseudonymized data from a population of 8.5 million inhabitants provided by: a users database, DIRAYA electronic medical records, minimum basic data sets (inpatients, outpatient mayor surgery, hospital emergencies and medical day hospital), mental health information systems, analytical and image tests, vaccines, renal patients, and pharmacy. An automatic coder was used to code clinical diagnoses and 80 chronic pathologies were identified to follow-up. The architecture of the information system consisted of three layers: data (Oracle Database 11g), applications (MicroStrategy BI) and presentation (MicroStrategy Web, JavaScript libraries, HTML 5 and CSS style sheets). Measures for the governance of the system were implemented. RESULTS: Data from 12.5 million health system users between 2001 and 2017 were gathered, including 435.5 million diagnoses, 88.7% of which were generated by the automatic coder. Data can be accessed through predefined reports or dynamic queries, both exportable to CSV files for processing outside the system. Expert analysts can directly access the databases and perform queries using SQL or directly treat the data with external tools. CONCLUSION: The work has shown that the connection of health records opens new possibilities for data analysis

PREPARING FOR VANESSA'S LAW: COLLABORATION BETWEEN THE MEDICAL RECORDS AND PHARMACY DEPARTMENTS AT A CANADIAN HOSPITAL CENTER.

BACKGROUND AND OBJECTIVE: In the context of Vanessa's Law, the medical records department and the pharmacy team of a mother-child hospital collaborated to create a system for coding adverse drug reactions (ADRs). This study was conducted to validate the coding of ADRs by the medical records team. MATERIAL AND METHODS: This retrospective descriptive study covered 12 months of coding of hospitalization data by the medical records team (November 1, 2017, to October 31, 2018). The pharmacy team performed twice-monthly analysis to validate the ADR data, based on coded information for drugs and associated clinical manifestations. RESULTS: Over the 12-month study period, a total of 755 ADRs were coded by the medical records department (i.e., 2.1 ADRs per day, corresponding to 7.1% of admissions). For 34 (4.5%) of these ADRs, the pharmacy team made a change to the code originally assigned by the medical records department. Eighty-five (11.5%) of the coded ADRs were deemed serious, as defined by Health Canada, but only 13 (15%) of these serious ADRs were reported to the regulatory authority. The new process allowed clinical manifestation codes to be associated with individual drugs in the pharmacy's Med-Echo-Plus® software, which facilitated interpretation of the data. Following this study, coding practices were reviewed, a coding algorithm was developed, and the codes for 18 drugs were clarified. CONCLUSION: This study highlights the feasibility of establishing a link between the medical records and pharmacy departments to validate the coding of ADRs. At the study hospital, this linkage has identified serious ADRs, for which reporting will soon be required by Health Canada.

Use of mixed methods to investigate case definitions to improve the identification of serious injury cases from hospital episode data.

INTRODUCTION: It has been commonplace internationally, when using hospital data, to use the principal diagnosis to identify injury cases and the first external cause of injury code (E-code) to identify the main cause. Our purpose was to investigate alternative operational definitions of serious non-fatal injury to identify cases of interest for injury surveillance, both overall and for four common causes of injury. METHODS: Serious non-fatal injury cases were identified from New Zealand (NZ) hospital discharge data using an alternative definition: that is, case selection using principal and additional diagnoses. Separately, identification of cause used all E-codes on the discharge record. Numbers of cases identified were contrasted with those captured using the usual definition. Views of NZ government stakeholders were sought regarding the acceptability of the additional cases found using these alternative definitions. Views of international experts were also canvassed. RESULTS: When using all diagnoses there was a 7% increase in 'all injury' cases identified, a 17% increase in self-harm cases and 8% increase in falls cases. Use of all E-codes resulted in a 4% increase in self-harm cases, 2% increase in assault cases and 1% increase in both falls and motor vehicle traffic crash cases. DISCUSSION: A case definition based solely on principal diagnosis fails to count a material number of serious non-fatal injury cases that are of interest to the injury prevention community. There is a need, therefore, to use an alternative case definition that includes additional diagnoses. Use of multiple E-codes to classify cause of injury should be considered.

Concordancia en la codificación de enfermedades procedimientos quirúrgicos en el informe estadístico hospitalización en Tucumán 2014-2015 / Concordance in the coding of diseases surgical procedures in the statistical report hospitalization in Tucumán 2014-2015

INTRODUCCIÓN La información de morbilidad y epidemiología del informe estadístico de hospitalización (IEH) repercute en las estadísticas y en la toma de decisiones en salud. En 2013, el 71,8% (61002) de los IEH fueron codificados en 6 servicios hospitalarios de Tucumán, y controlados o recodificados en el Departamento de Estadísticas de Servicios de Salud (DESS). Esto representó doble carga de trabajo. OBJETIVOS Evaluar el grado de acuerdo en codificación de enfermedades y procedimientos quirúrgicos entre el DESS y 6 hospitales públicos entre septiembre de 2014 y junio de 2015. Describir características de codificadores y evaluar proporción de indexación, déficit y excesos en codificación. MÉTODOS Se realizó un estudio de concordancia en codificación. Incluyó una encuesta autoadministrada con muestreo aleatorio estratificado y afijación proporcional según codificación. Se estimó el grado de acuerdo con el estadístico Kappa (K), con IC95%. Se consideró significativo un valor de p<0,05. RESULTADOS Se estudiaron 12 codificadores. Edad 27 a 55 años; siete eran técnicos en estadísticas. Mediana de codificación 5,5, P25-75(2­9,5) años. Codificación diaria mín-máx.:1,5-5 horas. Seis codificadores consultaron a menudo al manual digital de codificación CIE 10 y al manual impreso de procedimientos en salud. Se evaluaron 2255 IEH, el 60,57% (1366) contenía segundo diagnóstico y el 54,01% (1218), un procedimiento quirúrgico codificado. Grado de acuerdo en codificación entre DESS-hospitales: K=0,74 (IC95%: 0,73-0,74) en diagnóstico principal; K=0,61 (IC95%: 0,61-0,62) en segundo diagnóstico; y K=0,75 (IC95%: 0,72-0,77) en procedimientos quirúrgicos, p<0,05. Se halló indexación del diagnóstico principal en 10,02% (226/2255, IC95%: 8,78-11,26) de los IEH, sin diferencias en 5 hospitales, p>0,05. En los hospitales hubo un exceso de codificación en el segundo diagnóstico (13,51% [184/1362, IC95%: 11,6915,33]) y en procedimientos quirúrgicos (6,79% [79/1218, IC95%: 5,38- 8,20]) de los IEH. DISCUSIÓN El grado de acuerdo en la codificación fue bueno

Estudio CURIE-2017: Nociones de los estudiantes del internado rotativo de medicina del Hospital Carlos Andrade Marín (Quito) con respecto al uso y aplicación de estudios imagenológicos / CURIE-2017 Study: Notions of the students of the rotating medical internship of the Carlos Andrade Marín Hospital (Quito) regarding the use and application of general imaging studies

La solicitud inadecuada de estudios médicos basados en imágenes es un problema en Ecuador y otros países. El estudio se realizó con el objetivo de establecer el nivel de conocimientos de 125 internos rotativos de un hospital de Quito, procedentes de varias universidades locales, en el uso de estudios imagenológicos. Ellos tuvieron en general un bajo desempeño en la prueba de conocimientos, por lo que se recomienda instaurar el uso de criterios más apropiados en la enseñanza de radiología en las universidades.

Wrong application of medical image studies is an issue in Ecuador and other countries. This study was done to stablish the level of knowledge on image studies of 125 fellows from several local universities working at a hospital in Quito. The results show low performance in the knowledge test, therefore recomendation is to establish better teaching criteria on radiology subject at Universities.

[The REVELA13 observatory to study new cases of bladder tumor among women living in Bouches-du-Rhône county]. / Rôle de l'observatoire REVELA13 dans l'épidémiologie des tumeurs de vessie des femmes dans les Bouches-du-Rhône.

INTRODUCTION: The REVELA13 observatory is a unique epidemiological tool listing the new cases of kidney tumors, bladder tumors and acute leukaemias in the Bouches-du-Rhône county (France). Aim was to exploit for the first time data from this observatory regarding new cases of bladder tumors≥T1 in women from 2012 to 2014. MATERIALS: This epidemiological study was observational and descriptive. Fifteen non-nominative variables from the REVELA13 database were analyzed in order to describe the clinical and pathological characteristics of the incident cases as well as their spatial and temporal distribution. The incidence rates expressed in new cases per year per 100000 inhabitants were standardized on the world age, calculated with 95 % confidence intervals and compared to national estimates for the same period. RESULTS: Incident bladder tumor cases were recorded in 291 women, corresponding to a standardized incidence on the world age of 3.85 [3.32-4.37] new cases per year per 100,000 population, 54 % higher than the national estimates of 2012 and 2015. Median age of diagnostic was 75.9 years. Sex ratio was 19.41 % (W/M). Tumors were predominantly non-muscle-invasive (52 %), high grade (69 %) and without associated carcinoma in situ (Cis) (49 %). The two most affected territories were Marseille and Aubagne-La Ciotat. CONCLUSION: The REVELA13 observatory has improved our epidemiological knowledge on female bladder tumors in Bouches-du-Rhône county and highlighted a local over incidence. LEVEL OF EVIDENCE: 3.

[Who will kick off the digital transformation of health?] / Qui initiera la transformation digitale de la santé?

Over the past few years, numerous medical digital initiatives have blossomed, displaying tangible signs of efficacy in improving, for example, medication adherence or lifestyle. Such patient-centered solutions free themselves, at least conceptually, from the silos between the major players in healthcare (pharmaceutical industry, health authorities, hospitals, payers). The lack of a global rethinking of patient care has resulted in structural fragility. This could provide fertile ground for the arrival of players from the digital world, called "pure players", who could radically rethink and disrupt business models by proposing personalized digital solutions based on patients' needs. Thus, in the management of chronic disease, such as cardiovascular disease or type 2 diabetes, "pure players" could bring about a paradigm shift via a commitment to achieve results which are driven by real-world outcome assessment rather than being means-driven.

Traspaso de información en Medicina Intensiva / Handover in Intensive Care

El traspaso de información (TI) es una tarea frecuente y compleja que lleva implícito el traspaso de la responsabilidad del cuidado del paciente. Las deficiencias en este proceso se asocian a importantes brechas en la seguridad clínica e insatisfacción de pacientes y profesionales. Los esfuerzos por estandarizar el TI se han incrementado en los últimos años, dando pie a la aparición de herramientas mnemotécnicas. Globalmente las prácticas locales del TI son heterogéneas y el nivel de formación, bajo. El objetivo de esta revisión es enfatizar la importancia del TI y proporcionar una estructura metodológica que favorezca el TI efectivo en las UCI, reduciendo el riesgo asociado a este proceso. Específicamente, se hace referencia al TI durante los cambios de guardia y los turnos de enfermería, durante el traslado de los pacientes a otras áreas diagnósticas y terapéuticas y en el momento del alta de UCI. También se contemplan las situaciones de urgencia y se señala la potencial participación de pacientes y familiares. Por último, se proponen fórmulas para la medición de la calidad y se mencionan posibles mejoras en este proceso, especialmente en el ámbito de la formación

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training

Assessment of US Hospital Compliance With Regulations for Patients' Requests for Medical Records.

Importance: Although federal law has long promoted patients' access to their protected health information, this access remains limited. Previous studies have demonstrated some issues in requesting release of medical records, but, to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process. Objective: To evaluate the current state of medical records request processes of US hospitals in terms of compliance with federal and state regulations and ease of patient access. Design, Setting, and Participants: A cross-sectional study of medical records request processes was conducted between August 1 and December 7, 2017, in 83 top-ranked US hospitals with independent medical records request processes and medical records departments reachable by telephone. Hospitals were ranked as the top 20 hospitals for each of the 16 adult specialties in the 2016-2017 US News & World Report Best Hospitals National Rankings. Exposures: Scripted interview with medical records departments in a single-blind, simulated patient experience. Main Outcomes and Measures: Requestable information (entire medical record, laboratory test results, medical history and results of physical examination, discharge summaries, consultation reports, physician orders, and other), formats of release (pick up in person, mail, fax, email, CD, and online patient portal), costs, and request processing times, identified on medical records release authorization forms and through telephone calls with medical records departments. Results: Among the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 6 of the hospitals (7%) were noncompliant with state requirements for processing times. Conclusions and Relevance: The study revealed that there are discrepancies in the information provided to patients regarding the medical records release processes and noncompliance with federal and state regulations and recommendations. Policies focused on improving patient access may require stricter enforcement to ensure more transparent and less burdensome medical records request processes for patients.

Concordancia en la codificación clínica del Informe Estadístico en Hospitales Públicos en Tucumán, 2014-2015 / Agreement in Clinical Coding of Medical Records from Public Hospitals in Tucumán, 2014-2015

La información de morbilidad y epidemiología del informe estadístico de hospitalización (IEH) repercute en las estadísticas y en la toma de decisiones en salud. En 2013, el 71,8% (61 002) de los IEH fueron codificados inicialmente en seis servicios estadísticos hospitalarios públicos y controlados o recodificados posteriormente en un nivel central: el Departamento de Estadísticas de Salud de los Servicios (DESS) de la provincia de Tucumán. OBJETIVOS: Evaluar el grado de acuerdo alcanzado en codificación clínica de enfermedades y procedimientos quirúrgicos del IEH entre los codificadores hospitalarios y los del DESS entre septiembre de 2014 y junio de 2015. MÉTODOS: Se realizó un estudio de concordancia en codificación con muestreo aleatorio estratificado y afijación proporcional según producción hospitalaria. Se estimó el grado de acuerdo con el estadístico Kappa (K). RESULTADOS: Se evaluaron 2255 IEH. El 60,39% (1362) contenía codificado un segundo diagnóstico, y el 54,01% (1218), un procedimiento quirúrgico. El grado de acuerdo en la codificación entre el DESS y los hospitales fue: K=0,74 en el diagnóstico principal; K=0,61 en el segundo diagnóstico; y K=0,75 en procedimientos quirúrgicos. CONCLUSIONES: El grado de acuerdo en la codificación clínica del IEH fue bueno

Evaluación de los informes estadísticos de hospitales públicos de referencia. Tucumán, septiembre 2016-febrero 2017 / Evaluation of the statistical reports of public reference hospitals. Tucuman, September 2016-February 2017

INTRODUCCIÓN Los indicadores hospitalarios son utilizados para la gestión y toma de decisiones en salud, dependen de la integridad y calidad del Informe Estadístico de Hospitalización (IEH). OBJETIVO GENERAL Evaluar los datos contenidos en IEH de los hospitales públicos de referencia, en relación a las normativas del nivel central de estadísticas. Tucumán. Septiembre 2016-febrero 2017. Además evaluar presencia de ítems impresos. Evaluar si los IEH contienen los datos necesarios y obligatorios de identificación, morbilidad y estadía, causa externa, y evento obstétrico. METODOLOGÍA Se realizó estudio de corte transversal. Muestreo; aleatorio estratificado por hospital. Los datos fueron recopilados en una base de datos de Microsoft Office Access 2007. Para evaluar los apartados del IEH (Identificación- Internación- Causa externa- Evento obstétrico) se calculó un puntaje. Puntaje final del IEH; sumatoria de sus apartados, rango; 0-30. IEH con un puntaje ≥ al 80%, serán clasificados adecuados. Se consideró significativo una p<0,05. Se diseñarán tablas y gráficos .Se empleò el software Stata 11.1. RESULTADOS Se evaluaron 2.635 IEH. En el 50,5% (1.329/2.635; IC95%:48,5-52,3) de los IEH no estuvo impreso algún ítem. En la internación y causa externa predominaron los reparos por ausencia. El 90,2%; (IC95%: 89-91,3) de los IEH fueron de calidad adecuada. En el 94% (IC 95%:93-94,9) de los IEH fueron muy adecuados en la identificación. En la internación, el 91,7 (IC 95%:90,5-92,7) fueron considerados inadecuados; sin diferencias entre hospitales (Test de proporciones, p<.05). Los datos obstétricos fueron muy adecuados en el 97,5 % [ (432/443); IC95%: 96,6-98,7) de los IEH. En la causa externa, el 69,6% [188/270 (IC 95%: 63,8-76,5) de los IEH fue de calidad inadecuada. DISCUSIÓN La calidad de los IEH fue adecuada, garantiza información de calidad en la identificación del paciente y en el evento obstétrico, no así los de internación y causa externa a nivel hospitalario

Análisis de la toma de decisiones compartidas al final de la vida en las historias clínicas / Analysis of medical records of the making of shared end of life decisions

OBJETIVO: Describir la información ofrecida al paciente y/o su familia sobre el pronóstico de la enfermedad, mediante la evaluación de los registros clínicos de los pacientes en situación de enfermedad avanzada fallecidos en la Agencia Sanitaria Costa del Sol, Marbella, Málaga y describir las diferencias halladas en el proceso de muerte en función de la información proporcionada. MÉTODO: Estudio transversal descriptivo. Se evaluaron de forma retrospectiva 398 historias clínicas de pacientes mayores de 18 años fallecidos en los años 2009 y 2011 en la Agencia Sanitaria Costa del Sol, Marbella, por enfermedad oncológica y no oncológica según McNamara. Se examinaron los registros clínicos de los 7 últimos días de vida y se determinó la presencia o ausencia de un conjunto de 20 variables elaboradas en función de las disposiciones que recoge la ley autonómica que regula el proceso de muerte digna en Andalucía. RESULTADOS: El registro de haber informado a la familia se encontró en 311 historias clínicas (78,1%) y la constancia de haber informado al paciente sobre su pronóstico apareció reflejada en 23 historias (5,8%). Cuando la familia estaba informada del pronóstico decidió significativamente sobre las intervenciones sanitarias que se llevaron a cabo; 34,7% vs 12,6% (p = 0,001), se limitó el esfuerzo terapéutico; 57,6% vs 26,4% (p = 0,001) y se retiró la medicación previo al fallecimiento 29,3% vs 14,1% (p = 0,011). El paciente informado de su pronóstico decidió sobre las opciones planteadas; 38,1% vs 3,7% (p = 0,001) tenían manifestadas voluntades anticipadas, 21,7% vs 2,1% (p = 0,001) y se les ofreció información sobre cuidados paliativos, 30,9% vs 7,7% (p = 0,001) y otras medidas para garantizar el bienestar 43,5% vs 17,1% (p = 0,004). CONCLUSIÓN: Los profesionales sanitarios debemos ofrecer mayor información al paciente y emprender una práctica sanitaria que lo implique en la toma de decisiones al igual que se hace con la familia, así como dejar constancia por escrito de todo el proceso tal y como establecen las leyes autonómicas que garantizan una muerte digna

OBJECTIVE: Describe the information provided to the patient and/or family about the prognosis of the disease, by evaluating the clinical records of patients who died of advanced disease in the Costa del Sol Healthcare Agency, Marbella (Malaga, Spain), and describe the differences found in the death process according to the information provided. METHOD: A descriptive cross-sectional study was conducted, to obtain a retrospective analysis of the medical records of 398 terminally-ill patients aged over 18 years, who died in 2009 or 2011 in the Costa del Sol Healthcare Agency. The diseases were classified as oncological or chronic non-oncological, according to McNamara. Clinical records of the last seven days of life were examined, as well as the presence or absence of a set of 20 variables based on the regulations contained in the law regulating autonomic process of a dignified death in Andalucía. RESULTS: The family was recorded to have been informed in 311 cases (78.1%) and records showed that the patient had been informed about his/her prognosis in 23 cases (5.8%). When the family was informed of the prognosis, this had a significant influence on the health interventions carried out; 34.7% vs 12.6% (P=.001), on limitations to the treatment provided; 57.6% vs 26.4% (P=.001), and on the withdrawal of medication prior to death; 29.3% vs 14.1% (P=.011). When the patient was given this information, he/she took decisions regarding the options available; 38.1% vs 3.7% (P=.001), expressed his/her preferences beforehand; 21.7% vs 2.1% (P=.001), and was given information about palliative care; 30.9% vs 7.7% (P=.001), and other measures to alleviate discomfort; 43.5% vs 17.1% (P=.004). CONCLUSIONS: Healthcare professionals should provide more information to patients and families and perform health practices that involve patients in the decision-making process, as established in current legislation

Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data.

OBJECTIVES: To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data. PATIENTS AND METHODS: Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into 'stricture', 'incontinence' and 'other'. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics. RESULTS: A total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26-1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40-1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58-0.74). CONCLUSION: These results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.

Câncer de boca e orofaringe em Belo Horizonte: estudo de base hospitalar no período de 2005 a 2015 / Cancer of mouth and oropharynx in Belo Horizonte: hospital-based study in the period from 2005 to 2015

O objetivo do presente estudo foi identificar o perfil dos pacientes com câncer de boca e orofaringe referidos ao Ambulatório de Cirurgia de Cabeça e Pescoço de um hospital público em Belo Horizonte, através da revisão de prontuários dos pacientes atendidos no período de 2005 a 2015. As variáveis estudadas foram: idade, sexo, cor de pele, escolaridade, estado civil, endereço de residência, tabagismo, etilismo, localização do tumor, estadiamento clínico, diagnóstico histológico, tipo de tratamento efetuado, data de ingresso, data de realização da cirurgia e data da última consulta. A análise dos dados envolveu estatística descritiva, comparação das variáveis sociodemográficas e clínicas para o tipo de tratamento e os dois tipos de câncer por meio do teste de chi-quadrado. Adicionalmente foi realizada a análise espacial da distribuição dos casos de câncer de boca e orofaringe. Foram analisados 289 prontuários, a maioria dos pacientes eram do sexo masculino (227), brancos (117), casados (125), com média de idade de 58,6 anos. Quarenta e seis (15,9%) pacientes eram analfabetos e 147 (50,9%) primeiro grau incompleto; 72,7% dos pacientes moravam na região metropolitana de Belo Horizonte. O etilismo e tabagismo estavam presentes em 82,0% e 85,1% dos pacientes respectivamente. As localizações anatômicas mais acometidas foram base da língua, palato mole, assoalho da boca, pilar amigdalino, e borda lateral da língua. O diagnóstico de carcinoma de células escamosas foi reportado em 89,6% dos prontuários. Foi constatado o câncer em grau III e IV (avançado) em 196 (67,8%) pacientes. A média do tempo gasto desde o laudo da biópsia até a consulta no serviço de cabeça e pescoço do HC/UFMG foi 1,5 meses (1,7 DP); e entre a primeira consulta e a data da cirurgia foi 2,9 meses (4,4 DP). Segundo o tipo de câncer, 146 (50,5%) pacientes tinham câncer de boca e 143 (49,5%) câncer de orofaringe, e as comparações revelaram que os pacientes com câncer de orofaringe em comparação com os de boca foram preferivelmente: tabagistas, etilistas, diagnosticados em estádio avançado da doença, com 3 ou mais sítios afetados, receberam tratamento não cirúrgico e residiam a mais de 50km do centro hospitalar. Quanto ao tipo de tratamento efetuado 32,9% somente foram diagnosticados e não continuaram com o tratamento proposto. Quando se compara o tipo de tratamento recebido, as únicas variáveis associadas com a adesão ao tratamento foram o estadiamento clínico inicial (I/II) e ser casado. Na análise espacial foi encontrado que os bairros com maior número de casos estavam localizados principalmente nas regionais Nordeste, Noroeste e Venda Nova. Em relação às variáveis socioeconômicas (baixa renda e moradia em condição semiadequada), foi observado que a maioria dos casos ocorreram em bairros em que estas condições eram piores. Concluindo, o perfil sociodemográfico dos pacientes com câncer de boca não se difere daqueles com câncer de orofaringe atendidos no HC/UFMG

The aim of this study to identify the profiles of patients with oral and oropharyngeal cancer referred to the Departament of Head and Neck Surgery in a public hospital in Belo Horizontem, from 2005 to 2015. Medical records from the hospital were reviewed and the variables studied were age, gender, skin color, years of education, marital status, self-reported home address, smoking status, alcohol consumption, histopathologic diagnostic, the primary tumor location, the type of treatment, tumor staging, and dates of first, last consult and surgery...

A eficácia de diferentes tratamentos em pacientes com transtorno de humor: um estudo comparativo / The efficacy of different treatments in patients with mood disorder: a comparative study

A principal contribuição deste trabalho consiste em apresentar a evolução clínica de usuários de um Centro de Atenção Psicossocial na cidade de Brasília, com o diagnóstico de transtorno de humor, que utilizam antidepressivos como uma das modalidades terapêuticas, e correlacionar, com as variáveis: idade, sexo e outras formas de tratamento. Este estudo epidemiológico, descritivo, exploratório, retrospectivo e documental foi realizado com prontuários de pacientes em tratamento no CAPS-II da região administrativa de Samambaia-DF, no período de junho de 2013 a julho de 2014. Os dados foram avaliados através do Software SPSS e executadas análises descritivas e inferenciais, com o teste qui-quadrado, para verificar a associação entre as variáveis, com nível de significância de 5%. Não se obteve diferença significativa na eficácia quanto ao fármaco utilizado, no entanto, quando submetidos a outras modalidades terapêuticas, como, por exemplo, psicoterapia, os pacientes obtiveram melhora independentemente do fármaco utilizado. Conclui-se que as evoluções não dependem da escolha da classe de antidepressivos, pois as melhores respostas terapêuticas são alcançadas quando associadas a outras modalidades terapêuticas(AU)

The main contribution of this work is to present the clinical evolution of the users of one Psychosocial Care Center in Brasília with a diagnosis of mood disorder, using antidepressants as one of therapeutic modalities, and correlate with the variables: age, sex and other forms of treatment. This epidemiological, descriptive,exploratory, retrospective and documentary study was conducted with medical records of treatment in patients at CAPS-II administrative region of Samambaia-DF, from June 2013 to July 2014. Descriptive and inferential analyzes were evaluated by SPSS Software using chi-square test to verify the association between variables, withsignificance level of 5%. It has not obtained a significant difference in efficacy on the drug used, however, when undergoing other therapies, such as psychotherapy, patients had improvements regardless of the drug used. Concluding that developments do not depend of the choice of antidepressant class, as the best therapeutic responses are achieved when combined with other therapeuticmodalities (AU)

Administración de esteroides y talidomida para el control del eritema nodoso leproso durante 17 años en el hospital para enfermedades tropicales de Londres / No disponible

Objetivos: La prednisolona y la talidomida se administran frecuentemente en el control del eritema nodoso leproso (ENL) y proporcionan alivio a los pacientes con esta condición en todo el mundo. Sin embargo, tanto el ENL como sus tratamientos causan gran morbilidad. Este trabajo describe el espectro del ENL observado en el Hospital para Enfermedades Tropicales de Londres (HTD), la utilización de esteroides y el uso de esteroides y talidomida en su control y las consiguientes complicaciones. Metodología: Se llevó a cabo una revisión retrospectiva de los pacientes diagnosticados con ENL entre 1996 y 2013. Los datos se obtuvieron de los archivos clínicos, incluyendo la severidad y duración del episodio, además del tratamiento y efectos adversos. Resultados: Entre 1996 y 2013 se diagnosticaron 30 pacientes con ENL. El índice bacteriológico (IB) promedio en el momento del diagnóstico fue > 4.65, superior al aceptado en otros estudios. La mayoría de los pacientes desarrollaron ENL durante el tratamiento (67%) y presentaron ENL crónico (57%). La duración media del ENL fue de 60 meses (rango 9-192); los pacientes con IB > 4.5 presentaron períodos de tiempo más largos. El 87% de los pacientes recibieron prednisolona durante 9 meses; 33% desarrolló efectos adversos, incluyendo diabetes e hipertensión; el 87% de los pacientes recibió talidomida durante 16 meses y el 65% presentó efectos adversos. No hubo casos de embarazo o tromboembolismo. El 77% de los pacientes dejó la prednisolona a los dos meses de iniciar la talidomida. No hubo casos de fallecimiento en nuestro grupo. Conclusión: Describimos el curso clínico del ENL en un país no endémico con acceso a la talidomida y prednisolona. El ENL puede durar mucho más que el tiempo descrito anteriormente y tiene un gran impacto sobre la salud del paciente. En el Reino Unido, la talidomida es esencial para cesar la administración de los esteroides, prevenir efectos adversos y la mortalidad por esteroides, lo cual esté documentado en otros trabajos

Objectives: Prednisolone and thalidomide are commonly used in the management of erythema nodosum leprosum (ENL) and bring relief to patients with this condition worldwide. However, both ENL and its treatments can cause significant morbidity. This study describes the spectrum of ENL seen at The Hospital for Tropical Diseases, London (HTD), the use of steroids and thalidomide in its management and the complications of their use. Study Design: We conducted a retrospective audit of patients diagnosed with ENL between 1996 and 2013. Data were obtained from hospital records including severity and length of disease, together with treatments received and adverse effects. Results: Between 1996 and 2013, 30 patients were diagnosed with ENL. The median bacillary index (BI) at diagnosis was 4.65, higher than in previous studies. Most patients developed ENL during leprosy treatment (67%) and had chronic ENL (57%). The median length of ENL was 60 months (range 9-192); patients with BI. 4.5 had significantly longer duration of disease. 87% patients received prednisolone for median nine months; 35% developed adverse effects including diabetes and hypertension. 87% patients received thalidomide for median 16 months; 65% complained of side effects. There were no pregnancies or venous thromboembolisms. 77% patients stopped prednisolone within two months of starting thalidomide. There were no deaths in our cohort. Conclusion: We describe the clinical course of ENL in a non-endemic country with access to thalidomide and prednisolone. ENL may last far longer than previously described and has significant impact on a patient’s health. In the UK, thalidomide is essential as a steroid-sparing agent, to prevent the adverse effects and mortality of longterm steroids which have been documented elsewhere