Age norms for grating acuity and contrast sensitivity in children using eye tracking technology.

KEY MESSAGES: Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner. PURPOSE: To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test. METHODS: In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development. RESULTS: Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd. CONCLUSIONS: DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.

Review of the main colour vision clinical assessment tests. / Revisión de los principales test clínicos para evaluar la visión del color.

INTRODUCTION: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. MATERIAL AND METHODS: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. RESULTS: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). CONCLUSIONS: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients.

[II BAXTER-SENPE workshop: peripheral parenteral nutrition]. / II Mesa de Trabajo Baxter-SENPE: Nutrición Parenteral Periférica.

During the II BAXTER-SENPE workshop, a multidisciplinary nutrition expert committee discusses on indications, advantages and drawbacks of Peripheral Parenteral Nutrition (PPN), being defined as PN compounded by the three essential elements, vitamins, and minerals. Its composition implies a CH: lipids ratio of 60:40, a limited lipid daily intake (1.3 g/kg of body weight/day) and no more than 30% of total calories), and a nitrogen load not higher than 10 g of nitrogen in a maximum volume of 2500 mL. PPN can be administered by the peripheral route since its osmolarity is lower than 800 mOsm/L and pH is 6.0-7.4; in this way, possible adverse affects of central venous accesses are prevented. Currently, PPN by represent up to 50% of all PNs prescribed at a hospital Studies on efficacy, safety and pharmacoeconomic show that PPN is very useful therapeutic resource in certain clinical situations, both medical and surgical, to prevent metabolic-nutritional worsening of the patient, thus having an impact on significant reduction of complications, the number of interventions, and hospital stay.

Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis.

OBJECTIVE: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. DESIGN: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. SETTING: A medical-surgical intensive care unit (ICU) in a university hospital. PATIENTS: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost-utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12-36). Cumulative mortality was 35% in the ICU, 50% in hospital, 75% at 1 year, and 85% at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U.S. $26283 and U.S. $44602 in a "best" (cost/QALY calculated for the life expectancy in Spain) and a "worst case scenario" (cost/QALY calculated for a 68-year life expectancy), respectively. CONCLUSIONS: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.

Nutritional support in chronic renal failure: systematic review.

BACKGROUND AND AIMS: The purpose of this systematic review was to locate and assess in patients with chronic renal disease the quality of scientific evidence to establish graded recommendations based on the efficacy and effectiveness of nutritional support. METHODS: Computerized and online versions of MEDLINE (from 1989 through March 1999) and EMBASE (from 1988 through January 1999) were consulted. The Cochrane Library and the online Healthstar (from 1975) databases were also searched for clinical trials. A total of 593 studies were assessed. Following methodological review (primary reviewer), only 45 studies reviewed met criteria for selection and were analyzed by a group of experts (secondary reviewer). A final consensus was reached between the co-ordinators, experts and methodologists. RESULTS AND CONCLUSIONS: Low and very low-protein diets associated with specific enteral supplements are indicated in most patients with chronic renal disease and in patients with incipient diabetic nephropathy to slow progression of disease and to improve their overall status, contributing to improved survival (grade A recommendation). The use of protein-restricted diets in diabetic nephropathy is only indicated in type I diabetes mellitus (grade A recommendation). An improvement in nutritional parameters was found when specific diets were given in chronic renal disease (grade C recommendation).

[Never say never. Reflections on infohighways or highways of information]. / Nunca digas nunca jamás. Reflexiones sobre las infopistas o autopistas de la información.

The indiscriminate supply of unsolicited scientific information, means an overload for the professional in his assimilative intellectual process, which sometimes forces him to put aside his capacity for developing "scientific curiosity" (the basic principle of the university culture). This may cause an intimate discord between what I should do and what I can do, which may cause negative sensations in his self-esteem. With the incorporation of new means of communication, the velocity with which this information is supplied, is much higher than our capacity for assimilation, which often leads to reactions of rejection as a protective measure against such disproportionate aggression. This protective measure may be negative in our competitive society, possibly leading to the professional and even social disqualification. As we have to incorporate these new technologies into our activities, both at the professional as at the social level, getting to know them better, shall allow us to make a correct use thereof (with the latter being proportional to the depth of the former), avoiding, on the other hand, to be manipulated by its consumer offers. In this publication we give a summary of the current possibilities of using the Network, which are useful in our scientific and cultural environment (E-mail, access to scientific data bases, telematic protocols, electronic journals, etc.), with testing the possibilities of initiating our own first telematic projects, with a single finality: to potentiate the communication between all the scientific collaborators related to the discipline of nutrition, which is an aim that every scientific journal, and ours in particular, should have among its purposes.

[Peripheral parenteral nutrition: myth or reality?]. / Nutrición parenteral periférica: mito o realidad?

In the changing world of parenteral nutrition, daily doubts about methods arise which are not easily resolved. Controversy thus occurs on conceptual changes in energy requirements according to different levels of aggression, or as to the different utilisation of nutrients according to aggression, or referred to the most effective relations between energy and plastic substrates or the indication of and maintenance time for perioperative parenteral nutrition. While all these questions remain alive, recent years have seen the addition of a further polemical subject: is hypocalorific peripheral parenteral nutrition effective as nutritional backup for surgical patients? What are its indications and limitations? Answers to these questions require in the first place the establishment of criteria which clarify concepts that may not always be used precisely, perhaps due to their indiscriminate application (perioperative, peripheral, hypocalorific nutrition, etc.) After reviewing the physiological basis for this type of backup, we then make an evaluation of the effects of perioperative parenteral nutrition in terms of the evolution of the illness, before making a critical analysis of a variety of studies carried out by different writers, in an attempt to extract common conclusions from the diverse results on the efficacy of this type of nutritional backup.

[Folates in human nutrition, Different clinical situations in which folate deficiencies exist]. / Folatos en nutrición humana. Diferentes situaciones clínicas en las que existe déficit de folatos.

The alimentary surveys carried out on various sectors of the population in industrialized countries have shown the existence of chronic clinically silent deficiency in micronutrients. In some cases, as in folates, their lability against conservation techniques, the change in alimentary habits, the abuse of alcohol and the great quantity of frequently used drugs which interfere in their absorption, diminish their content in the diet and their bio-availability. The appearance of macrocytic anemia is a late deficiency sign, and therefore in situations of an increase need and in patients included in the risk groups, a supplemental intake must be given in order to avoid irreversible lesions if it is not possible to monitor the folate levels. There are risk groups in which various etiological factors come into play, acting at a different metabolic level on the folates and making more difficult their dietetic or pharmacological compensation even if supply is considerably increased. We studied these factors independently and in each specific situation (old people, patients with liver disease, alcoholics, pregnant women and nursing mothers, neonates, children, malabsorption syndromes, gastrectomy, AIDS, anaesthesia and patients being treated with antifolic medication), evaluating their mechanisms of action and their potentiation in determined specific situations.

[The value of life. Development of an assessment system for therapeutic strategies]. / El valor de la vida. desarrollo de un sistema asesor de estrategia terapéutica (SAETA).

The wide therapeutic supply which a present is available for diverse disorders, together with a excess of indiscriminate scientific information, occasionally complicates the possibility of acquiring a wide experience in the treatment of certain patients (limited experience). To acquire genuinely useful experience, it is necessary to accumulate simiular experiences from our environment, with it being necessary to precisely define, in an objective manner, concepts which until now are difficult to quantify (risk of mortality or morbidity, survival, quality of life, etc.). The definition of these parameters, shall favor the creation of homogenous groups (isoseverity indices), which is the first step in the evaluation of more complex conceps, such as; quality of life, increase of life expectancy, quality adjusted life years (QALY's), and beneficial application, all of which validated in diverse hospital media. Based on the previous, we would obtain other calculated parameters; the benefit (of the patient), the use (of the procedure), and the efficacy (of the physician or the unit). Once these parameters have been standarized, it shall be possible to compare them with the results published in other media, considered to be standards, with the aim of establishing the corresponding self-evaluation. The evaluation of the cost of each process, is a compulsory procedure, to produce, if possible, based on the previous results, a better distribution of the means without a decrease in the quality of assistance. With the aim of evaluating the results in an objective and quantifiable manner, we have worked these last years on developing assessment applied to the evaluation of predictive and isoseverity indices, such as the cost/benefit evaluation in critical, geriatric, and oncological patients, and in those with artificial nutrition in the home. The fruit of this labor has come together in the production of a computerized information system (SAETA), which builds de previously validated modules into is structure, thus permiting the storage and subsequent multifactoral analysis of the results.

[Exocrine pancreatic insufficiency. Organic and functional deficiencies]. / Insuficiencias pancreáticas exocrinas. Deficiencias orgánicas y funcionales.

The exocrine pancreas is a gland which secretes water, enzymes and electrolytes into the intestinal lunar. These enzymes for the normal digestion of food and a deficit, whether due to a seduced secretion (chronic pancreatitis, cystic fibrosis), or dysfunction in the chronology of their secretion (following truncal vagotomy) will cause malabsorption which often develops, in clinical terms, into malnutrition sometimes this functional deficit is secondary to other pathologies or surgical operations which alter the digestive tract physiology, preventing the correct combination of nutrients and pancreatic enzymes together with the biliary salts. The outcome is malabsorption, mainly of fast and fat soluble vitamins. As the onset is slow and forms part of a chronic, pathology, diagnosis is difficult, for which reason it is included in the general group of malabsorption due to pancreatic insufficiency or surgical sequelae, finally resulting in pancreatic failure or problems following surgery. The purpose of this publication is to review one by one all the situations in which there is an alteration in the function of the pancreatic enzymes, with emphasis on cases in which a defined malabsorption syndrome will result, and in which the prescription of exogenous pancreatic enzymes will imposiue the picture.

[Carbohydrates--no glucose--in parenteral nutrition. A fading concept?]. / Hidratos de carbono--no glucosa--en nutrición parenteral. Concepto periclitado?

An update is made on the binominal use/benefit of non-glucose carbohydrates (polyalcohols or polyols) in parenteral nutrition. The most recently published results, despite the controversy from different areas, have motivated the updating of the criteria metabolic aspects, indications and contraindications of the different carbohydrates alternatives of glucose (xylitol, sorbitol, glycerol, fructose), in the parenteral nutrition of patients with different degrees of aggression and situations of glucose intolerance or insulin resistance. It is known that, due to causes which are not entirely understood, non-glucose carbohydrates have not yet been considered as effective energy sources alternative to glucose in clinical situations described as unfavorable for their use. However, we may consider that in view of our own experience and that of previous publications, these carbohydrates have not only not decreased their use expectancy but, on the contrary, have increased as their advantages were clinically confirmed, without the appearance of major complications in this therapeutic modality. For this reason we consider that the understanding of the characteristics and the different metabolic aspects (pharmacological dose) of the polyols must make us review their clinical use, both alone as in different combinations.

[National Task Force on Home and Ambulatory Artificial Nutrition. NADYA. The NADYA Group]. / Grupo de Trabajo Nacional en Nutrición Artificial Domiciliaria y Ambulatoria. NADYA. Grupo NADYA.

When a patient needs parenteral or enteral nutrition, be it in a transitory way or as a permanent form, and hospitalization is not strictly required, this treatment should take place in the home of the patient whenever possible. The support with artificial nutrition can be equally efficient, improving the life expectancy ad the quality of life of patients who would otherwise be faced with a much prolonged hospital stay. The Ambulatory and Home Artificial Nutrition group (NADYA) is a multidisciplinary team of health care professionals, from different areas of the national territory, who are dedicated to Clinical Nutrition. With the objective of promoting health and well-being of patients undergoing treatment, and to ease the therapeutic activity of the implicated professionals, this group has developed a series of suggestions for the practice of enteral or parenteral nutrition in the home of the patient. These suggestions include specifications about the technical team, criteria for selection and training of the patients, routes of access, formulas and material needed, follow up characteristics, and associated complications, and the represent a consensus of the regulations necessary for the guarantee of an adequate level of security and efficiency of the at home care of patients who require artificial nutrition support.

[Parenteral nutrition in the pre- and early postoperative periods. Unsolved problems and contradictions]. / Parenteral'noe pitanie v do- i rannem posleoperatsionnom periode nereshennye voprosy i protivorechiia.

The analysis of early published and own clinical investigations dedicated study of parenteral nutrition in pre- and early postoperative periods was represented. Special attention was paid to contradictory conclusions being result of these investigations. The recommendations were given about cases when it is necessary to apply the parenteral nutrition in pre- and early postoperative periods, and when it is necessary to refuse it.

Revisión de los principales test clínicos para evaluar la visión del color / Review of the main colour vision clinical assessment tests

Introducción: Las deficiencias congénitas en la visión del color afectan a un 8% de la población masculina y a un 0,5% de la femenina. El estudio de la visión del color es un proceso complejo debido a diversos factores: la propia psicofísica de la visión y la dificultad de establecer modelos matemáticos para su análisis, la vaga correlación de los resultados entre unos test y otros y la influencia de factores externos como la iluminación, la condición de los test o la experiencia del examinador y del paciente. En el presente documento se realiza una revisión simplificada de los principales test disponibles en la práctica clínica para evaluar la visión del color. Material y métodos: Tras realizar una filtrada revisión preliminar de la bibliografía relacionada con el estudio de la visión del color en el motor de búsqueda PubMed, se determinaron los test mayormente utilizados en la práctica clínica. Se realizó una interpretación atendiendo a su frecuencia de uso y el propósito para el que eran utilizados. A continuación, se procedió con un estudio bibliográfico de cada test en particular, atendiendo al diseño de los estímulos presentados, su población diana y su sensibilidad y especificidad. Resultados De las 95 publicaciones que mostró el buscador PubMed, en 41 de ellas los investigadores utilizaron test de colores en su metodología. De los 64 test de color utilizados, 19 eran diferentes (contando como distintos los test adaptados por grupos de investigación, 4, y aquellos realizados online, 2). El orden de empleo de los test es el siguiente: test de Ishihara (10,88%), Farnsworth-Munsell (7,04%), Farnsworth-Munsell 100 Hue (6,4%), Cambridge Colour Test (3,84%), Hardy-Rand-Rittler (3,2%), test propios desarrollados por los grupos (2,56%), el anomaloscopio (1,28%), los test online (1,28%) y, finalmente, Colour Assessment and Diagnosis (0,64%), Pflüger Trident Colour Plates (0,64%), Toothguide Training Box (0,64%), Lanthony Desaturated D-15 (0,64%), City University Test (0,64%), Universal Colour Discrimination Test (0,64%) y Rabin Cone Contrast Test (0,64%). Conclusiones El gold standard en cuanto a la evaluación de la visión del color es el anomaloscopio, instrumento incompatible con la práctica clínica diaria. Su manejo es relativamente complicado, exige disponibilidad de tiempo para su aplicación y es difícilmente comprensible por población infantil. Sin embargo, es posible alcanzar una fiel aproximación mediante la combinación de algunos de los test enumerados en este artículo. Los test expuestos son una buena alternativa para determinar la presencia de discromatopsias en ambientes cercanos a la práctica clínica diaria o en entornos menos controlados que un estudio clínico. El inconveniente principal del amplio elenco de test disponibles para el estudio de la visión del color es la dificultad para comparar los resultados entre test, ya que los datos publicados suelen tener unidades distintas, requiriendo experiencia para su correcta interpretación. En la actualidad, no existe unanimidad sobre qué test de color resulta ser el más completo; es recomendable utilizar al menos 2 para asegurar los diagnósticos y tener una información más completa sobre la percepción visual de los pacientes

Introduction: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. Material and methods: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. Results: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). Conclusions: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients

Desarrollo de una base de datos interrrelacionada para la toma de decisiones clínicas en un servicio de cirugía general / Development of an interrelated datebase for clinical decisión making in a general surgery department

Introducción: Con el fin de obtener datos estructurados para la monitorización y evaluación de indicadores clínicos y de gestión que sirviesen de apoyo en la toma de decisiones clínicas elaboramos una base de datos interrelacionada (BDI) a partir de registros hospitalarios existentes. Material y Métodos: Diseño prospectivo de una cohorte de intervenciones quirúrgicas programadas realizadas en el Servicio de Cirugía General de un hospital universitario de tercer nivel. Se obtuvieron un total de 4.572 registros entre el 1 de enero de 2011 y el 31 de marzo de 2013. A cada registro se le asoció información proporcionada por diferentes bases hospitalarias: Conjunto Mínimo Básico de Datos (CMBD), el sistema de gestión de pacientes (HP-HIS) e información aportada por un cirujano experto como auditor, que estableció el procedimiento principal depurado, deducido del informe quirúrgico y de alta del paciente. Los procedimientos se agruparon en 9 áreas quirúrgicas, y se clasificó su complejidad en tres grados. Resultados y Conclusiones: La BDI permite monitorizar la actividad de un servicio quirúrgico con un elevado volumen de actividad, alta complejidad técnica, gran número de cirujanos, y pacientes con variadas comorbilidades, etc. En un futuro inmediato se pretende evaluar la fiabilidad de los datos analizando el registro del procedimiento principal en HP-HIS y CMBD frente a la Historia Clínica. En una segunda etapa, se realizará la evaluación de diversos indicadores validados, que sirvan, mediante la comparación con los estándares, de apoyo en la toma de decisiones clínicas: eventos adversos, gravedad de estos, evitabilidad, desviaciones de la tendencia, etc

Introduction: In order to obtain structured monitoring and evaluation of clinical and management indicators that would serve to support clinical decision making, we have created an interrelated database (BDI) from existing hospital records. Methods: Prospective cohort of scheduled surgeries performed in the Department of General Surgery of a university hospital. A total of 4,572 records were recorded between January 1, 2011 and March 31, 2013. Each record was linked to information provided by different hospital databases: Minimum Basic Data Set (CMBD), the patient management system (HP-HIS) and information provided by a skilled surgeon as auditor, who established the main refined procedures obtained from the surgical and discharge reports. The procedures were grouped into nine surgical areas and classified into three complexity grades. Results and Conclusions: The BDI allows monitoring the activity of a surgical Department with a high volume of activity, high technical complexity, many surgeons and patients with several comorbidities, etc. In the immediate future, we intend to assess the reliability of the BDI data comparing the record of the main procedure in HP-HIS and CMBD to the medical record. In a second stage, we intend to assess several validated indicators that may serve, through a comparison with the standards, as support in the making of clinical decisions: adverse events, their severity and preventability, deviations from the trend, etc

Fiabilidad de un Base de Datos interrelacionada para la toma de decisiones clínicas en un servicio de cirugía general / Reliability of the records in an interrelated database for clinical decisión making in a general surgery department

Introducción: A partir de una base de datos interrelacionada elaborada con registros de las cirugías programadas del Servicio de Cirugía General de un hospital universitario de tercer nivel, evaluamos la discrepancia en el registro del procedimiento quirúrgico principal en la Historia Clínica (HC) comparándolo con el del Conjunto Mínimo Básico de Datos (CMBD) y el del sistema de gestión de pacientes (HP-HIS). Se elaboraron propuestas de mejora ante las discordancias encontradas. Material y Métodos: Se establecieron 4 grados de menor a mayor discrepancia en el registro (0,1,2,3). Se agruparon los grados en no discrepantes (0 y 1) y discrepantes (2 y 3). Se calculó la frecuencia (n, %) de registros discrepantes para cada procedimiento y área quirúrgica. Se analizó la discrepancia cruzada entre HP-HIS y CMBD. Se identificaron las áreas quirúrgicas con mayor grado de discrepancia. Se evaluó la asociación entre la discrepancia y la complejidad del procedimiento. Resultados: En CMBD las discrepancias (grados 2 y 3) supusieron el 27,7% de los registros y en HP-HIS el 25,2%. Las áreas quirúrgicas con mayor porcentaje de registros discrepantes en CMBD y HP-HIS fueron recto (25,3% y 21,4%) y colon (17,2% y 20,7%). Hubo asociación significativa entre complejidad y discrepancia. Conclusiones: Las áreas quirúrgicas peor registradas fueron colon y recto tanto en HP-HIS como en CMBD. Las IQ más complejas presentaron valores más altos de discrepancia. La deficiente codificación en HP-HIS repercutiría en la información de gestión, y en el CMBD repercutiría en el índice de complejidad del servicio y en el GRD final

Introduction: Using data from an interrelated data base made up of records of scheduled surgeries (IQ) in a General Surgery Department of a university hospital, we evaluated the discrepancy in the main procedure between medical history records (HC), Basic Minimum Data Set (CMBD) and the HP-HIS (patient management system). In addition, we made proposals for improving the discrepancies found. Material and methods: Four degrees of discrepancy were established in the records (0,1,2,3). Grades were grouped into not discrepant (0 and 1) and discrepant (2 and 3). Frequency (n,%) of discrepant records for each procedure and surgical area was calculated. Cross discrepancy between HP-HIS and CMBD was analyzed. Surgical areas with greater discrepancies were identified. The association between the discrepancy and the complexity of the procedure was evaluated. Results. Discrepancies (grades 2 and 3) accounted for 27.7% of the records in CMBD and 25.2% in HP-HIS. Surgical areas with the highest percentage of discrepant records in CMBD and HP-HIS were rectum (25.3% and 21.4%) and colon (17.2% and 20.7%). There was significant association between complexity and discrepancy. Conclusions: The worst registered surgical areas were colon and rectum (both in HP-HIS and MDS). More complex IQ discrepancy showed higher values. A poor coding in HP-HIS would affect management information, and a deficient coding in CMBD would affect both the complexity index of the Department and the final GRD