[Adverse events in emergency departments. Review of reconsultations as a data source]. / Eventos adversos en los servicios de Urgencias. Revisión de reconsultas como fuente de datos.

OBJECTIVE: To identify potential adverse events that occur in an emergency department by reviewing cases of patients who make repeat visits. METHOD: A retrospective study of clinical data of patients returning to the emergency department within a period of less than one week in October 2006 with the aim of identifying problems that occurred in the first visit. The review was conducted by senior doctors of the same service who measured the reliability of the first intervention, by checking between observer agreement. The Chi square test was used to calculate the comparison ratios. RESULTS: We studied 311 cases. Of these, 203 cases (79.6%) returned to the department without been given a previous appointment and for a reason connected with the first visit. The progress was poor in 83.7% of cases. We reviewed the causes of the poor outcomes, with the most frequent being "natural progress of the process" in 75 cases (44.1%), followed by problems in treatment in 73 cases (42.9%). The effects on the patient were evaluated, and it was shown that there were consequences for the patient in 36 cases (21.2%). Of these 36 cases, 11 were considered as avoidable (30.5%) by the evaluators and 1% of clear failures in performance in patients returning to emergency rooms. In the part of if, in opinion of the evaluadores, there had been a clear failure in the first performance zoned like such 3 cases, two with consequences for the patient and 1 without consequences. CONCLUSIONS: In the conditions of the study, the internal evaluation of the reconsultas allows to identify the adverse events occurred and know his causes. This could facilitate the learning and the improvement of the culture of security.

Vigilância pós-alta e o seu impacto na incidência da infecção do sítio cirúrgico / Post-discharge surveillance and ITS impact ON surgical site infection incidence

As infecções do sítio cirúrgico (ISC) por sua elevada incidência e repercussões associadas, representam importante problema dentre as infecções hospitalares. Objetivou-se neste estudo determinar a incidência da ISC de pacientes submetidos à cirurgia para obesidade mórbida (COM) e gástrica por outras causas (CGOC), durante a internação e após alta. Foram acompanhados em dois hospitais terciários, de ensino da cidade de São Paulo, entre agosto de 2001 e março de 2002, conforme metodologia NISS, 158 pacientes, sendo 81 submetidos à COM e 77 à CGOC, por um período de 30dias. Notificou-se 64 ISC, 6,3 por cento durante a internação e 34,1 por cento após a alta. Durante a internação, a incidência de ISC foi de 5,0 por cento no grupo COM e de 7,8 por cento no CGOC e com a vigilância pós-alta, estas taxas aumentaram para 55,6 por cento e 24,7 por cento, respectivamente, demonstrando que vigilância pós-alta no pacientes cirúrgico é uma importante ferramenta para obter dados confiáveis e redirecionar as políticas de prevenção e controle da ISC.

Because of their high incidence and associated repercussions, Surgical Site Infections (SSI) are an important problem among hospital-acquired infections. The aim of this study was to determine the incidence of SSIs in patients submitted to morbid obesity and gastric surgeries for other causes during the hospitalization and post-discharge periods. In this survey, conducted in two teaching hospitals in the city of São Paulo between August of 2001 and March of 2002, in accordance to the NISS methodology, 158 patients were followed - 81 had been submitted to morbid obesity surgeries and 77 to gastric surgeries for other causes. In 64 cases there occurred SSI, of which 6.3 percent during hospitalization and 34.1 percent after discharge. During hospitalization, the incidence of SSI was 5 percent in the morbid obesity surgeries group and 7.8 percent in the gastric surgeries for other causes group; in the post-discharge period, the figures increased to 55.5 percent and 24.7 percent respectively. These results confirm the importance of following surgical patients after discharge and demonstrate that post-discharge surveillance is an important tool for obtaining dependable data and redirect SSI's prevention and control policies.

Las infecciones del sitio quirúrgico (ISC) por su elevada inci-dencia y repercusiones asociadas, representan importante problema entre las infecciones hospitalarias. Fue objetivado en este estu-dio determinar la incidencia de la ISC de pacientes sometidos a la cirugía para obesidad mórbida (COM) e gástrica por otras causas (CGOC), durante la internación y pos alta. Fueron acompañados en dos hospitales terciarios, de enseñanza de la ciudad de São Paulo, entre agosto de 2001 y marzo de 2002, según metodología NISS, 158 pacientes, siendo 81 sometidos a la COM e 77 a la CGOC, por un periodo de 30 días. Se notificó 64 ISC, 6,3 por ciento durante la internación y 34,1 por ciento después del alta. Durante la internación, la incidencia de ISC fue de 5,0 por ciento en el grupo COM y de 7,8 por ciento en el CGOC y con la vigilancia pos-alta, estas tasas aumentaron para 55,6 por ciento y 24,7 por ciento, respectivamente, demostrando que vigilancia pos-alta en los pacientes quirúrgicos es una importante herramienta para obtener datos confiables y reencaminar las políticas de prevención y control de la ISC.

[Post-discharge surveillance and its impact on surgical site infection incidence]. / Vigilância pós-alta e o seu impacto na incidência da infecção do sítio cirúrgico.

Because of their high incidence and associated repercussions, Surgical Site Infections (SSI) are an important problem among hospital-acquired infections. The aim of this study was to determine the incidence of SSIs in patients submitted to morbid obesity and gastric surgeries for other causes during the hospitalization and post-discharge periods. In this survey, conducted in two teaching hospitals in the city of São Paulo between August of 2001 and March of 2002, in accordance to the NISS methodology, 158 patients were followed - 81 had been submitted to morbid obesity surgeries and 77 to gastric surgeries for other causes. In 64 cases there occurred SSI, of which 6.3% during hospitalization and 34.1% after discharge. During hospitalization, the incidence of SSI was 5% in the morbid obesity surgeries group and 7.8% in the gastric surgeries for other causes group; in the post-discharge period, the figures increased to 55.5% and 24.7% respectively. These results confirm the importance of following surgical patients after discharge and demonstrate that post-discharge surveillance is an important tool for obtaining dependable data and redirect SSI's prevention and control policies.

Resección histeroscópica del septo uterino en mujeres infértiles / Hysteroscopic resection of the uterine septum in infertile women

Análisis retrospectivo de 11 pacientes con útero septado sintomático que fueron tratadas con metroplastía histeroscópica en un período de 10 años. Estas pacientes presentaban un total de 16 embarazos, con 14 abortos de primer trimestre y 2 partos pretérmino inmaduros con neomortinatos, sin niños vivos. El propósito de este estudio fue mostrar la eficacia de la histeroscopia quirúrgica en resolver esta patología y mejorar el pronóstico reproductivo. Se intervinieron 7 pacientes con septo parcial y 4 con septo completo. En 8 casos hubo resección del tabique con resectoscopio y en 3 con tijera histeroscópica flexible. Se obtuvo embarazo de término en 6 pacientes (55 por ciento) con recién nacidos normales. De las 5 pacientes que no embarazaron, 3 tenían infertilidad por factor tuboperitoneal extenso, una sin relación de pareja y otra sin controles. Se demuestra la utilidad de la resección histeroscópica del útero septado en cuanto al menor tiempo de hospitalización, la baja morbilidad y los buenos resultados reproductivos.

Tratamiento quirúrgico de las malformaciones uterinas / Surgical treatment of uterine malformations

Se analizan los antecedentes clínicos de 29 pacientes portadoras de malformaciones uterinas controladas y tratadas en la Unidad de Fertilidad del Servicio y Departamento de Obstetricia y Ginecología del Hospital Clínico Regional Dr. Guillermo Grant B. de Concepción entre enero 1978 y mayo de 1990. El tipo de malformación uterina más frecuente correspondió al útero septo con 19 casos (65,5%) y con menor frecuencia útero bicorne 7 casos (24,1%) y útero didelfo 3 casos (10,4%). Se destaca la altísima frecuencia (92,8%) de pérdidas fetales (abortos y partos pretérmino) en este grupo de pacientes. Se practicó corrección quirúrgica en 24 pacientes. En 18 casos con útero septo se efectuó en 13 operación de Tompkins y en 5 operación de Jones. En 6 casos de útero bicorne se realizó en 5 operación de Strassman y en una paciente extirpación de un hemicuerpo rudimentario no comunicado. En el grupo de pacientes con seguimiento adecuado, se alcanza un 84,6%de niños vivos después de efectuar la metroplastía; comparado con un 24%antes del tratamiento quirúrgico. Se concluye, que a pesar de no contar con histeroscopía como alternativa de tratamiento del útero septo, nuestras pacientes se han visto beneficiadas de su infertilidad con los tratamientos quirúrgicos de sus anomalías uterinas