Colonoscopy quality assessment.

AIM: Colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. MATERIAL AND METHOD: This is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. RESULTS: Indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). CONCLUSIONS: Quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.

[Minor surgery in primary care: is continuing education within the team a valid strategy for improving quality?]. / Cirugía menor en atención primaria: es válida la formación continuada intraequipo como estrategia de mejora de calidad?

OBJECTIVE: To evaluate the impact of continuing education within the team (FCI, in Spanish) on the quality of minor surgery. DESIGN: Study of level of quality. SETTING. Primary care. PARTICIPANTS: First evaluation: all the lesions referred for biopsy during 1998 (62 samples). Second evaluation: those referred in 1999-2000 (150). MAIN MEASUREMENTS: Four explicit criteria regulating procedure and result were designed: C1, sufficient information; C2, correct referral; C3, correct extirpation of lesion; C4, clinical-pathological concordance. Request forms and anatomical-pathological reports were assessed. Evaluation was before and after corrective measures (FCI and organisational changes designed to support FCI). The Kappa index of inter-observer concordance, the Compliance Index and Fisher's Z index were analysed. RESULTS: 62 lesions were included in the first evaluation, with high reliability for C1 and C4, good for C2 and moderate for C3. 150 lesions were included in the second evaluation. The compliance indices showed statistically significant increases from the first to the second evaluation for C1 (38.09% and 50.66%, relative improvement of 19%) and C4 (68.85% and 85.2%, relative improvement of 53%). C2 showed an improvement, but without statistical significance (87.30% and 92.66%). The compliance index for C3 dropped (94.73% and 87.50%). 5.33% of cases in the second evaluation (8 biopsies) were malignant or pre-malignant lesions, compared with 20.96% in the first (P<.05). 100% of these latter showed free resection limits. 77.99% of lesions studied through a biopsy in the second evaluation were nevus, seborrhoeic keratosis or dermatofibroma. CONCLUSIONS: FCI is a valid strategy for improving the quality of programmes of minor surgery in primary care. There was significant improvement in the identification of malignant and pre-malignant pathology, in correct referral and in the clinical-pathological concordance of the lesions.

[Alcohol consumption among 7th grade students of EGB]. / Consumo de alcohol entre escolares de séptimo de EGB.

OBJECTIVES: To identify habits of alcohol consumption among school-children and analyse their ways of thinking about the question. DESIGN: A descriptive study of observation, using a crossover method, and carried out by means of a self-administered questionnaire. SETTING: Those EGB schools within the Molina de Segura (Murcia) Health Area which accepted the questionnaire. PARTICIPANTS: The 534 7th-year EGB students who attended class on the day of the field work. MEASUREMENTS AND RESULTS: We used the questionnaire elaborated by Torres Hernández to collect the data and that by Eysenck and Eysenck (EPI type A) to evaluate the replies' reliability. We analysed 478 of the 534 questionnaires which exceeded level 4 of the sincerity scale. We found that 83.3% had tried alcohol on some occasion, 2.5% drank it daily, 14.2% had consumed alcohol before the age of 10 and 19.5% had got drunk on some occasion. Cider and beer were the drinks preferred. We found no significant differences for gender. 91.6% thought that alcohol damaged health, 83.7% that it affected studies and 94.1% sport. 10.7% thought that it did not create dependence. CONCLUSIONS: We underline the high percentage of alcohol consumption in young people and their early starting-age, as well as the change in the patterns of traditional female behaviour in relation to alcohol consumption. We emphasise the need for Health Education among schoolchildren.

[Morbidity caused by industrial accidents in a health zone]. / Morbididad por accidentes de trabajo en una zona de salud.

OBJECTIVE: The aim of the present study is to discover the morbidity produced by workplace accidents among the earning population of Molina de Segura Health Area. DESIGN: This was a descriptive crossover study. Site. The study was carried out in the Primary Care framework, in the Molina de Segura Health Area and with the collaboration of the Labour Health Unit of Insalud-Murcia. PATIENTS AND OTHERS PARTICIPANTS: Over a year a total of 774 cases of time off work due to workplace accidents, out of a total of 9,302 workers, were examined. 679 cases of workers resident in Molina de Segura were included in the study, whose time-off dates fell between July 1, 1989 and June 30, 1990 and where the company for which they worked was based or had its trading name located in Molina. MAIN MEASUREMENTS AND RESULTS: Of the total cases of time off work studied, 539 (79.4%) were men and 140 (20.6%) were women. The pathologies most often found were "blows, bruisings and crushings" (22.8%), "wounds and cuts" (16.8%), "back pain" (10.5%), "strains" (9.4%) and "fractures" (4.5%). A statistically significant association was found between being "a man" and "back pain"; and "a woman" and "sprains". CONCLUSIONS: The predominant pathologies among workplace accidents are of a less serious nature. Some pathologies owing to workplace accidents are mistakenly referred to the health services as ordinary illness. There is insufficient compliance by health professionals with filling in the forms for time off work and return to work.