[Clinical and performance results of functional endoscopic sinus surgery]. / Resultados clínicos y asistenciales de la cirugía endoscópica nasosinusal.

Our aim was to know the clinical performance and management results of Functional Endoscopic Sinus Surgery (FESS) in Spanish hospitals. We sent a survey on the use and results of FESS to 160 Spanish public hospitals in June of 2002, obtaining a response rate of 69%. 82.9% of the interviewed hospitals carried out FESS and 17.1% of the remaining used the classic techniques of approaching the paranasal sinuses. The reported length of stay in hospital was 1.4 days for the FESS and 2.4 for the traditional surgery. The surgical time was 15 minutes shorter for the CENS, and the rate of recurrence was 16% less than for the classic surgery. As years of experience in the practice of the CENS go by, the surgical times tend to decrease, that didn't happen with the rate of recurrence. In conclusion, we consider that FESS seems to improve the analyzed clinical performance and assistential results.

[The implementation of endoscopic sinus surgery in Spain]. / Implantación de la cirugía endoscópica nasosinusal en España.

The purpose of this study is to find out more about the implementation of functional endoscopic sinus surgery (FESS) in our country. To do that, we designed a survey which was sent to 160 public hospitals (June 2002). We received the answers of 111 hospitals. 82.9% of hospitals and 58% of surgeons performed FESS, with some differences among autonomic regions. The percentage of surgeons who performed FESS was higher in small hospitals and their mean experience time was 6.2 years. We consider the implementation of endoscopic sinus surgery very high, this can reflect that there are evident advantages for those who specialists who use it.

[Organizational characteristics of primary care and hospitalization for to the main ambulatory care sensitive conditions]. / Características organizativas de la atención primaria y hospitalización por los principales ambulatory care sensitive conditions.

OBJECTIVES: To describe the variability in hospitalisation rates because of the most common ambulatory care sensitive conditions (ACSC), by town and gender; b) to describe the influence on these rates of the characteristics of primary care (reformed or non-reformed model and kind of centre), the health level of the population, geographical accessibility and other factors of a social and economic nature. DESIGN: Observational, cross-sectional study of hospital discharges and ecological study for the analysis of rates between towns. MAIN MEASUREMENTS: The rates of hospitalisation by gender for each ACSC (1997-1999), standardised for age through the indirect method by calculating the standardised rate ratios (SRR). The multivariate analysis used Poisson regression. RESULTS: In the diagnoses studied, 41% of the towns had the same number of cases observed and expected for hospitalisation of men; and 65%, for women. Chronic obstructive pulmonary disease in men and heart failure in women were the illnesses that most varied. Hospitalisation rates for most illnesses were higher in towns without a health centre or with a non-reformed model, with over 3000 inhabitants and closer to hospital, although distance from the hospital was an influential factor only in bigger towns. CONCLUSIONS: There is variability between towns in hospitalisation rates for the most common ACSC; b) the differences in hospitalisation rates for the ACSC studied are linked to organisational features of primary care, the size of the town and the distance from the hospital.

Lifestyles, environmental and phenotypic factors associated with lip cancer: a case-control study in southern Spain.

The aim of this study was to identify factors related to lip cancer (LC) considering individual characteristics and sociodemographic factors. A case-control study was carried out in the province of Granada (Andalusia, southern Spain). The cases were 105 males with squamous-cell carcinoma of the lip, diagnosed between 1987 and 1989 (aged 20-70 years) and identified by means of a population-based Cancer Registry. As controls, a randomised populational sample of 239 males, stratified by age, was used. Multiple logistic regression analysis showed that risk factors are lifetime cumulative tobacco consumption and alcohol consumption. An interaction was found between alcohol consumption and the smoking habit (leaving the cigarette on the lip): OR=23.6; 95% CI: 3.9-142.0. Other risk factors identified are clear eyes (OR=3.5; CI: 95% 1.5-8.0), sun exposure early in life and cumulative sun exposure during outdoor work (OR=11.9; 95%: CI: 1.3-108.9), and skin reaction to sun exposure (Fitzpatrick levels). Another interaction was found between skin reaction and a previous history of common sporadic warts (OR=4.4; 95% CI: 1.01-19.1). We conclude that LC is related to phenotype, skin reaction to sun exposure, cumulative and early sunlight exposure, and tobacco and alcohol consumption, as well as a low educational level. Leaving the cigarette on the lip is predictive of LC risk irrespective of cumulative tobacco consumption.

[Analysis of admissions for chronic obstructive pulmonary disease in Andalusia in 2000]. / Análisis de los ingresos por enfermedad pulmonar obstructiva crónica en Andalucía, año 2000.

OBJECTIVE: To analyze the impact of admissions for chronic obstructive pulmonary disease (COPD) in Andalusia during 2000. METHODS: All patients with DRG codes 088 and 541, which would receive ICD-9 codes 491, 492, 493.2, 494 and 496 in the cause of admission field, were extracted from the Minimum Basic Data Set for Andalusia. We compiled descriptive statistics from these data, calculated the cost per day of hospitalization for our own hospital, and then extrapolated to estimate the cost for Andalusia. RESULTS: COPD exacerbations generated 10,386 admissions in 2000, leading to 117,011 days of hospitalization. Eighty-three percent of the patients were men and the mean age was 70 12 years. The average hospital stay was 11 10 days. Huelva was the province with the shortest hospital stay (9 days). Mortality was 6.7%. The minimum expenditure generated was E 27 million, not counting the cost of intensive care unit admissions. CONCLUSIONS: Admissions due to COPD have great impact on the Andalusian health care system. Further studies are needed to evaluate alternatives to hospitalization.

[Volumetric pumps for blood transfusions. Viability in pediatrics]. / Bombas volumétricas para transfusiones sanguíneas. Viabilidad en pediatría.

UNLABELLED: The authors determine whether or not nurses should use perfusion pumps for concentrated hematin transfusions, measuring the degree of hemolysis which occurs in two distinct models. STUDY SAMPLE: Concentrated hematin transfusions by means of an infusion pump on children in a Pediatrics Intensive Care Unit at the Maternity-Pediatrics Ward in Granada. Dependent Variable: Degree of Hemolysis, measured by means of: free hemoglobin, potassium, LDH. INDEPENDENT VARIABLES: Pump; dated/used blood; hematocrit; catheter caliber; type of procedure; pump working pressure; other perfusion rhythms; infusion rhythm. Sample size. One year study group, 95% confidence rate, 0.50 prevalence of awaited hemolysis, +/- 0.05 precision (relative precision 10%). Data Obtained: Two samples are taken per transfusion: removal of blood bag, extreme distal removal system. Investigative Method: Prospective descriptive study. STATISTICAL ANALYSIS: Descriptive statistics, by means of frequency distributions. Variable analysis, multiple variable analysis. RESULTS: 55 observations were carried, of these, 50.9% corresponded to pump number one. Simple regression linear analysis showed differences in the degree of hemolysis in terms of free hemoglobin and hematocrit. Dated/used blood registered a higher hemolysis level above 75 percentile. The greater hemolysis in terms of potassium difference was associated with the type of procedure, having an average of 0.44 mEq/l, in presence of other perfusions, greater rhythm (p = 0.118), dated/used blood (p = 0.008), hematocrit (p = 0.063). The greatest difference in LDH occurred with smaller caliber catheters, other perfusions, more dated blood (p = 0.117). In multiple linear regression, results were equal to those predicted: an average difference in hemoglobin of 3.87 mg/l (p = 0.661); in potassium, 0.39 mEq/l (p = 0.138); in LDH, 53.6 (p = 0.568). This documents with verify this study have been consulted by the ROL Editorial Board and may be requested from the authors.