Análisis de la actividad del Servicio de Urgencias Tocoginecológicas en un hospital materno infantil de alta complejidad / Analysis of the activity of the Gynecology and Obstetrics Emergency Service in a highly complex maternal and child hospital

El objetivo de este artículo es el de determinar la actividad del Servicio de Urgencias como paso previo para elaborar un plan estratégico de mejora que refuerce los puntos débiles y premie los puntos fuertes. Se analizaron las altas de este servicio durante una semana, y se registraron múltiples variables. La mayor actividad del servicio se desarrolla con pacientes obstétricas de tercer trimestre, los días laborables y en turno diurno, el 60,7% son visitas adecuadas, y urgentes el 51,6%. Se ingresan al 28% de las pacientes. Se concluye que existe una gran actividad con pacientes parturientas, de que es inútil el crear un sistema de triage, se constata que existe una buena dotación de medios pero que escasea el personal (AU)

The aim of this work is to determine the activity of the emergency service as a prior step to designing a strategic improvement plan which will strengthen the weak points and reward the strong points. It has been observed that the department’s greatest activity is with third-term obstetric patients, on work days and during the daytime. It also concludes that there is intense activity with patients in labour for whom it is useless to create a selection system and, furthermore, the resources are good in spite of staff shortages (AU)

Incidencia de infecciones vaginales diagnósticadas por citolog¡a cervicovaginal: en mujeres mayores de 40 años: Hospital Miliar Dr. Carlos Arvelo / Incidence of vaginal infections diagnosed by cervicovaginal cytology in women older than 40 years: Hospital Militar Dr. Carlos Arvelo

Las infecciones son probablemente, la patología más frecuente de consulta en ginecología. La abundante y molesta sintomatología que suele acompañar a estos procesos lleva a la mujer a consultar con su médico. Las infecciones vaginales o vaginitis se puede ocasionar por virus, bacterias, hongos o parásitos, estos gérmenes pueden estar en la vagina solos o asociados. Clínicamente pueden distinguirse según los síntomas y signos, pero el diagnóstico definitivo se establece por citología y/o microbiología. Los cambios hormonales durante la pubertad, en la adolescencia, el ambarazo y la menopausia, predisponen a la mujer a contraer vaginitis, al igual que la falta de higiene adecuada, sensibilidad a ciertos jabones, utilización de anticonceptivos, entre otros. En este tarbajo se presenta la casuística de esta patología en las pacientes examinadas entre enero y diciembre de 2004 en el Departamento de Ginecología y Obstetricia de nuestro hospital.

Increasing breastfeeding rates in New York City, 1980-2000.

Our objective was to determine temporal patterns of breastfeeding among women delivering infants in New York City (NYC) and compare national breastfeeding trends. All hospitals in NYC with obstetric units were contacted in May and June 2000 to provide information on the method of infant feeding during the mother's admission for delivery. Feeding was categorized as "exclusive breastfeeding," "breast and formula," or "exclusive formula." The first two categories were further grouped into "any breastfeeding" in the analysis. Hospitals were classified as "public" and "private," and patients were classified by insurance type as "service" and "private." Data between public and private hospitals and service and private patients were compared. Breast-feeding trends over time were compared by using previous iterations of the same survey. Of 16,932 newborns, representing approximately 80.0% of all reported live births in the city during the study period, 5,305 (31.3%) were exclusively breastfed, 6,189 (36.6%) were fed a combination of breast milk and formula, and the remaining 5,438 (32.1%) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed compared with infants discharged from public hospitals (33% vs. 21%, respectively). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (39.6% vs. 22.9%, respectively) and to use a combination of breast and formula (i.e., any breastfeeding) (73.6% vs. 62.0%, respectively). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25.0% to 31.0%, the percentage of combined feeding increased from 8.0% to 37.0%, and the percentage of any breastfeeding increased from 33.0% to 68.0%. NYC has more than doubled the rate of breastfeeding since 1980. However, there is much progress to be made, and continued efforts are vital to maintain current gains in breastfeeding, improve the rates further, and prolong the duration of breastfeeding.

Rethinking the cesarean rate: how pregnancy complications may affect interhospital comparisons.

BACKGROUND: The cesarean rate has served an integral role in the monitoring of obstetrical care, and in 2002, the national rate reached 26.1%, the highest ever reported. OBJECTIVE: We sought to describe the effect of clinical complications on hospital cesarean rates. RESEARCH DESIGN: This was a population-based cohort study. SUBJECTS: All laboring women without a previous cesarean who delivered in California in 1995 as reported through public-use hospital discharge data were included. MEASURES: Women with and without maternal, fetal, or placental complications were compared with respect to cesarean use. Using recursive partitioning algorithms, women with complications were stratified into clinically homogeneous categories, which were analyzed separately with respect to cesarean use. RESULTS: The 443,532 women delivered at 288 hospitals and included 116,170 women (26.2%) in the complicated group (cesarean rate 22.6%); and 327,362 women (73.8%) in the uncomplicated group (cesarean rate 6.7%). At the hospital level, the cesarean rates among the complicated and uncomplicated patients respectively were: median 23.5% (range, 2.2-9.9%); and median 6.5% (range, 1.8-18.2%). Recursive partitioning algorithms suggested 16 distinct clinical categories, with cesarean rates varying from 8.9% for women with asthma to 84.5% for women with an unengaged fetal head. CONCLUSIONS: Cesarean rates varied widely across complication types, and complication-specific rates varied widely among hospitals. Although the presence of pregnancy complications upon hospital admission comprised the strongest factor affecting first-time cesarean use among laboring women, the importance and interdependence of these clinical conditions has yet to be incorporated into commonly used models for cesarean rate comparisons.

Desarrollo organizacional del servicio de enfermeria del departamento de gineco-obstetricia hospital obrero - CNS: Plan estrategico

El plan de trabajo que presentamos en una propuesta estrategica, que resulta de una lectura de la realidad del servicio de enfermeria del departamento de Ginecologia y obstetricia del Hospital Obrero No. 2, de la Caja Nacioal de Salud; esta lectura comprende la organización, sus mandos directivos y otros aspectos inherentes al servicio. Se hace una descripcion de las lineas estrategicas de mayor importancia para lograr mejorar y desarrollar la organizacion del serivicio de enfermeria, que nos permitira alcanzar la vision que planteamos para el mismo...

Risk adjusting cesarean delivery rates: a comparison of hospital profiles based on medical record and birth certificate data.

OBJECTIVES: Compare the discrimination of risk-adjustment models for primary cesarean delivery derived from medical record data and birth certificate data and determine if the two types of models yield similar hospital profiles of risk-adjusted cesarean delivery rates. DATA SOURCES/STUDY SETTING: The study involved 29,234 women without prior cesarean delivery admitted for labor and delivery in 1993-95 to 20 hospitals in northeast Ohio for whom data abstracted from patient medical records and data from birth certificates could be linked. STUDY DESIGN: Three pairs of multivariate models of the risk of cesarean delivery were developed using (1) the full complement of variables in medical records or birth certificates; (2) variables that were common to the two sources; and (3) variables for which agreement between the two data sources was high. Using each of the six models, predicted rates of cesarean delivery were determined for each hospital. Hospitals were classified as outliers if observed and predicted rates of cesarean delivery differed (p < .05). PRINCIPAL FINDINGS: Discrimination of the full medical record and birth certificate models was higher (p < .001) than the discrimination of the more limited common and reliable variable models. Based on the full medical record model, six hospitals were classified as statistical (p < .01) outliers (three high and three low). In contrast, the full birth certificate model identified five low and four high outliers, and classifications differed for seven of the 20 hospitals. Even so, the correlation between adjusted hospital rates was substantial (r = .71). Interestingly, correlations between the full medical record model and the more limited common (r = .84) and reliable (r = .88) variable birth certificate models were higher, and differences in classification of hospital outlier status were fewer. CONCLUSION: Birth certificates can be used to develop cesarean delivery risk-adjustment models that have excellent discrimination. However, using the full complement of birth certificate variables may lead to biased hospital comparisons. In contrast, limiting models to data elements with known reliability may yield rankings that are more similar to rankings based on medical record data.

Chequeo ginecológico en estudiantes de enfermería del segundo, tercer y cuato cursos del Instituto "Dr. Andrés Barbero" del año 2001

Estudio descriptivo explicativo de la situación de las estudiantes de enfermería en términos de conocimiento acerca del chequeo ginecológico. Define los exámenes ginecológicos a los cuales se pueden acceder y los requisitos para realizarlos. Cita factores socioeconómicos culturales que influyen en la consulta ginecológica. Explica sugerencias oportunas para la situación analizada

La influencia de un programa psicoprofiláctico de parto en el comportamiento de la mujer gestante frente al embarazo y parto de bajo riesgo en el servico de Ginecologia y obstetricia del hospital Militar Central "Cap. Roberto Orihuela" de la ciudad de La Paz / The influence of a psychoprophylactic program for chilbirth on the behavior of pregnant women in the face the pregnancy and low-risk childbirth in the service of Gynecology and obstetrics of the hospital Military Central Kap Roberto Orihuela de la ciudad de La Paz

Mediante este trabajo de grado de demostró el resultado de apliacción de un programa psicoprofiláctico de parto a mujeres gestantes en el 3er. trimestre en el Servicio de Ginecologia y Obstetricia del Hospital Militrra Central "Cap. Roberto Orihuela" de La Paz, determinando ser un instrumento educar en el embarazo y parto y un medio de influencia para un comportamiento adecuado de la mujer frente al parto natural. Por innvestigación personal, se tiene datos que nunca se dio apoyo a la mujer gestante, mediante programas o algo similar, en este periodo de su vida en el Hospital Militar Central. Para lograr el objetivo se conformó un grupo de 49 mujeres gestantes que se dividió en dos grupos el de control 25 y de estudio 24, se trabajo del mes de octubre 2000 a enero del 2001...

Analysis, assessment, and presentation of risk-adjusted statewide obstetrical care data: the StORQS II study in Washington State. Statewide Obstetrics Review and Quality System.

OBJECTIVE: To develop an effective, concise presentation of hospital-specific birth event and delivery-related complication rates, including significant deviations from expected rates calculated using risk-adjusted peer hospital data, for distribution to all Washington State hospitals with delivery services. DATA SOURCES: Complete data for calendar year 1993, including inpatient discharge records for mothers and newborns, birth certificates, and infant death records, for 74 hospitals from Washington state source files. STUDY DESIGN: Institutions were classified into four peer groups based on presence of neonatal intensive care units, number of births, and rural/urban location. Twenty-three clinical indicators of procedure (e.g., cesarean section) and complication rates were analyzed and presented. METHODS: For each indicator, observed and expected rates (adjusted within peer group for categorized baseline risk factors) were calculated and presented by institution. Effective graphic and numeric techniques for presenting significant deviations from expected rates were developed. Results were calculated in terms of numbers of events as well as rates. Approaches applicable to institutions with small numbers of deliveries were selected. PRINCIPAL FINDINGS: Exact confidence intervals (C.I.s) for event rates were superior to binomial or Poisson approximations for small hospitals. For calculating expected rates, indirect adjustment was used due to small numbers within risk factor categories. For all indicators, observed and expected rates along with 95 percent C.I.s for the true rate were presented graphically by institution for each peer group. Transforming C.I.s into "statistically acceptable ranges" allowed hospital personnel to assess their performance in terms of actual numbers of events as well as rates. CONCLUSIONS: Readily available statistical methods and straightforward descriptive approaches allow accurate presentation of outcomes for both large and small institutions.

[Evaluation of a classification of newborns and maternity wards in the Loire-Atlantique department]. / Etude d'une classification des nouveau-nés et des maternités dans le département de Loire-Atlantique.

In order to assess the perinatal health policy in a French department in comparison with other policies, we performed a prospective transversal survey in the Loire-Atlantique for 5 weeks. Newborns were registered according to clinical data using the Paris pediatricians classification (classes 1 to 4) and maternity wards by number of health personnel and facilities using the American Academy of Pediatrician classification (I-III). 1316 newborns were registered. This survey showed that the health care organization in maternity wards is rational in the Loire-Atlantique for newborns in classes 1 and 4. However, care for newborns in classes 2 and 3 could be provided in maternity wards in classes II and III if available personnel and equipment is improved.

The cesarean decision in New York State, 1986. Economic and noneconomic aspects.

This study describes a research project involving economic and noneconomic aspects of the cesarean decision. The study was based on a 1986 data set dealing with 68,847 obstetric deliveries in New York State excluding New York City, and had the largest number of variables known to have been assembled to analyze the cesarean decision. The authors estimated a probit multiple regression in which the dependent variable was the method of delivery. The results diverge from widely held beliefs and research findings in some areas, and are of considerable interest in other areas. Contrary to other findings, the authors did not find a relationship between date of graduation from medical school and the probability of a cesarean section. More importantly, the authors failed to find much support for the idea that obstetricians perform cesareans to enrich themselves from the additional free income. However, our findings are consistent with the idea that obstetricians occasionally perform cesarean sections to manage their time, which does represent a form of economic self-interest. The study developed a proxy measure for fear of malpractice and found a negative relationship between fear of malpractice and cesarean section use. Finally, county cesarean rate and adjusted hospital cesarean section rate strongly and significantly influenced the probability that a given delivery is performed by cesarean section.

The choice of place of delivery. Effect of hospital level on mortality in all singleton births in New York City.

In an analysis of all singleton births and neonatal deaths with known birth weights and gestational ages in New York City maternity services during a three-year period (1976 to 1978), intensive care services at the hospital of birth were found to influence mortality only in preterm (less than 37 weeks' gestation) or low-birth-weight infants (less than 2251 g). By contrast, for infants who were born at term and of normal birth weight, mortality rates did not differ by level of perinatal care available at the hospital of birth. On the average, preterm and low-birth-weight infants were at a 24% higher risk of death if birth occurred outside of a level 3 center, regardless of whether birth occurred at a level 1 or level 2 hospital. Preterm and low-birth-weight infants, though constituting only 12% of births, accounted for 70% of neonatal deaths in New York City. The remaining infants, ie, those born at term and of normal birth weight, who experienced no measurable mortality advantage when born in a level 3 hospital, accounted for 88% of all births.

Costo-Paciente en el Hospital "Santa Barbara" Servicios: Obstetricia, Pediatria y Ginecologia 1972

De acuerdo al estudio realizado sobre costo paciente en el Hospital Santa Barbara y con preferencia en los servicios de obstetricia Pediatria y Ginecologia, pudimos observar que: 1.Del total de gastos asignados en el H.S.B. 77,23 por ciento corresponden a recursos personales y 22.77 a los recursos no personales, 2.El costo egreso H.S.B. es de 567.77 $b. y el costo paciente dia es de 47.31 $b. 3.Costo paciente en consultorio externo el H.S.B. es 54.91 $b. 4.En los servicios que nos interesan los diferentes costos son como sigue: 5.En ostetricia el gasto mayor se produce al atender un parto eutócico Ver cuadro No.21 6.En pediatria las mayores asignaciones corresponden a las enfermedades del aparato respiratorio, diarreas y deshidratacion Ver cuadro 22, 7.En ginecologia el gran gasto se produce por atencion del Aborto le siguien aunque un poco lejanos los tumores de Utero y Ovario