[Synthetic indicator of compliance with standards for Quality Units of health centers and multicenter prospective pilot study]. / Indicador sintético de cumplimiento de estándares para Unidades de Calidad de centros sanitarios y estudio de pilotaje prospectivo multicéntrico.

BACKGROUND AND OBJECTIVE: In Spain, Quality Units play a key and unique role in advising healthcare centers on the methodology of healthcare quality. The objectives of the study were to develop computer algorithms to obtain a synthetic indicator of standard compliance for Quality Units and to pilot its functioning in these units. MATERIALS AND METHODS: The Excel program was used to establish evaluation algorithms, and quantitatively interrelate and weight various categories of standards, as a computer evaluation tool, to build a continuous improvement cycle system, and offer a global synthetic indicator of compliance. The tool was tested in a prospective multicenter pilot study, in which coordinators of Quality Units from different health centers and care settings participated, to evaluate the usefulness of the tool and compliance with the standards, in addition to analyzing the content validity of each standard. RESULTS: The formulas for the structured computer algorithms were developed, consecutively, in a «PLAN-DO-CHECK-ACT¼ improvement cycle for the 9 categories of standards, resulting in a single synthetic indicator of compliance. Twenty-one Quality Units participated in the piloting. The overall average compliance rate for the synthetic indicator was 55.63% with differences between centers (P=.002) and between categories (P<.0001), but not by autonomous communities (P=.86) or by areas (P=.97). Content validity was ensured through the variable of «understanding¼ of the standards (P<.001), and through their «justification¼ with documentary evidence (P<.001). CONCLUSIONS: The computer tool with the synthetic indicator have allowed for the evaluation of standard compliance in Quality Units of healthcare centers.

[Development and validation of standards for quality units of health centers]. / Desarrollo y validación de estándares para unidades de calidad de centros sanitarios.

OBJECTIVE: In Spain, the Quality Units advise health centres, services and professionals on the methodology of continuous improvement of the quality of care. A system based on good practice standards could provide these units with a tool to improve their results and value their work. The objective was to develop, agree on and validate standards, to properly guide and orient the functions, results and continuous improvement of the Quality Units in health centers. MATERIAL AND METHODS: A qualitative-quantitative, prospective and cross-sectional study was carried out, applying the Metaplan method, the e-Delphi technique and a simulation study. The participants were coordinators of these units, belonging to 14 Spanish Autonomous Communities and distributed in four experts' panels. They agreed on the standards to be used and evaluated the different types of validity. RESULTS: The 204 standards proposed by the scientific committee were reduced to 157 with Metaplan, to 110 with e-Delphi, and to 96 with the committee's final review (87.3% consensus, content validity). The construct validity showed a Cronbach's alpha >0.7 (P<.001); the validity of content was reaffirmed in the simulation workshop (80% "understood" each other, P<.001; and there was "documentary evidence" in 84%, P<.001); face validity was accepted (75% "related to quality dimensions", P<.001); and the validity of the criteria was verified with a sensitivity of 84.2%, a specificity of 98.3%, and a kappa index of 0.84. CONCLUSIONS: Valid standards have been developed for Quality Units in health centers.

[Epidemiological approach to acute poisoning in Asturias]. / Aproximación epidemiológica a las intoxicaciones agudas en Asturias.

Two hundred and twenty cases of acute overdoses are revised using a specific protocol. We have found a larger number of cases of overdoses to exist in women (62.73%), at an average of 32 years of age, the typical deviation being that of 15.8. Intentional overdoses are predominant (80%), 55.1% using benzodiazepines. The abuse of one sole drug (67.3%) is greater in comparison to combining drugs sole drug (67.3%) is greater in comparison to combining drugs with alcohol (10.2%). The treatment most often used was stomach pumping (49.5%), being effective in 76.1% of the cases Hospitalizations total 16.8%, with 30% remaining in observation. A comparison of our study is made with available Spanish sources, demonstrating: a) The smaller number of acute overdoses. b) The increasing importance of the acute overdoses caused by benzodiazepines and derivatives of opium, thus the interest in the use of antidotes such as Naloxone and Flumazenil which improve the prognosis of these patients. In our series in particular, there is a 0% death rate.

[Significance of flumazenil in acute benzodiazepine poisoning]. / Importancia del flumacenil en la intoxicación benzodiacepínica aguda.

Thirty-five patients over 14 years of age were evaluated, with the common feature of benzodiazepine poisoning, either as a single drug or associated with others and/or with ethanol, and who had a Glasgow score lower than 10 at admission. These patients were treated with flumazenil as a competitive antagonist drug. The results were very satisfactory. Subsequently, the possible relationship between the effect of flumazenil and the pharmacokinetic benzodiazepine profile was evaluated, and a significant relationship between the half life and the degree of resedation of the patients was found.