Protein S deficiency and retinal arteriolar occlusion in pregnancy.

PURPOSE: To report two cases of retinal arteriolar occlusion in pregnant women with transient protein S (PS) deficiency. METHODS: Observational case reports. RESULTS: Two pregnant women in their 30s presented with a paracentral scotoma in their right and left eye, respectively. In both cases the only risk factor for vascular occlusion was pregnancy. Systemic diseases were excluded. Free and functional PS activity was physiologically reduced in both patients. In Case 1, free PS was 47% and functional PS was 22%. In Case 2, free PS was 43% and functional PS was 25%. These levels of PS seem to be lower than those published for normal pregnancy. CONCLUSIONS: There might be a special relationship between PS deficiency and the development of arterial occlusion in pregnant women. A direct effect may be possible. Although the prevalence and incidence of vasoocclusive disease in these patients are low, PS deficiency should be considered as another risk factor. Further studies are necessary to evaluate changes in PS and to assess its relationship with thromboembolic events during pregnancy.

[Intraocular pressure after treatment for thyroid-associated ophthalmopathy]. / Presión intraocular post-tratamiento de la oftalmopatía tiroidea.

OBJECTIVE: To evaluate the change in the intraocular pressure (IOP) in subjects with thyroid-associated orbitopathy (TAO) treated with orbital decompression, extraocular muscle surgery or methylprednisolone pulse therapy. METHODS: The charts of 31 subjects with TAO who visited in our department between 1998 and 2004 were analyzed. Subject age, gender, diagnosis and treatment for glaucoma, use of systemic steroids, procedure performed and pre-operative and post-operative IOP in the primary position and in upgaze, were all evaluated. RESULTS: Of the 20 eyes that underwent orbital decompression, the mean pre-operative IOP was 17.35 (3.86 SD) mmHg and 22.45 (6.36 SD) mmHg in upgaze. The post-operative IOP was 14.24 (3.43 SD) mmHg and 18.20 (4.74 SD) mmHg in upgaze. The mean pre-operative IOP in the 10 eyes who had strabismus surgery was 18.9 (3.07 SD) mmHg and 22.4 (6.14 SD) mmHg in upgaze. The post-operative IOP was 16.6 (3.50 SD) mmHg and 18.6 (3.33 SD) mmHg in upgaze. In the 12 patients treated with methylprednisolone pulse therapy, the mean pre-treatment IOP was 21.33 (6.42 SD) mmHg and 24.45 (8.15 SD) mmHg in upgaze. After the treatment the mean IOP was 17.33 (4.38 SD) mmHg and 20.08 (4.86 SD) mmHg in upgaze. In subjects with a pre-operative IOP>or=21 mmHg or in treatment for glaucoma we observed a greater reduction in IOP (p<0.005). CONCLUSIONS: We have observed a significant reduction in IOP in the three groups of patients after treatment for TAO, however no significant difference was found between the methods used.

[Choroidal detachment associated with delayed spontaneous ocular hypotony]. / Desprendimiento coroideo asociado a hipotonía ocular espontánea tardía.

CASE REPORTS: We report two cases of delayed spontaneous hypotony associated with choroidal detachment and hypotony maculopathy. Both patients had undergone uneventful cataract extractions 10 and 6 years prior to the occurrence of apparently spontaneous hypotony. Trabeculectomy was combined with phacoemulsification in one of them. Both had been receiving timolol at the time of presentation. DISCUSSION: Delayed spontaneous hypotony, without recent ocular surgery or trauma, represented a challenge in both the diagnosis and management processes in these patients. We have analysed the main causes.

Endoscope-assisted transscleral suture fixation of intraocular lenses.

We describe a new method for placing transscleral sutures when fixating posterior chamber intraocular lenses to the sulcus. An intraocular microendoscope with an 18 gauge probe is used for direct sulcus observation and needle position assessment. The straight needle of a 10-0 polypropylene suture and the tip of the probe are placed in a 16 gauge silicone rubber tube to hold them together. Fixing the needle to the endoscope allows a direct view of its tip and requires only one hand. The other hand is used to grasp the tip of the needle when it comes out under the scleral flap after passing through the sulcus. Assessment of needle position with an endoscope avoids surgically induced iris root or ciliary body damage. Fixing the needle to the endoscope simplifies the surgical technique.

[What do patients think of public hospitals? Analysis of the perceived quality levels of 5 hospitals]. / Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales.

OBJECTIVE: To compare the opinions of patients assisted in 5 hospitals. DESIGN: Descriptive study based in a survey by mail has been used in all cases. INSTRUMENTS: The SERVQHOS questionnaire. SUBJECTS: 930 patients. Answer rate around 35%. RESULTS: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality. CONCLUSION: The patients value the hospital positively although there are an important number of unsatisfied patients.

Absenteeism as a symptom of occupational ill-health in hospitals and its repercussion on quality assurance.

The purpose of the present study was to evaluate the importance of absenteeism due to illness in the hospital organization. A measurement of absenteeism due to illness among hospital professionals of the National Health System in the Alicante province (Spain) during the years 1988, 1989 and 1990 was carried out, as well as its repercussion on quality assurance in health care. The absenteeism index (frequency) was 5.39, 6.38 and 6.79 in 1988, 1989 and 1990, respectively. The extent of absenteeism (duration) in 1988 was 19.7 days per worker, and was 24.23 in 1989 and 26.45 in 1990. Hospitals with more than 400 beds presented during these periods poor absenteeism self-control. Maintenance personnel, nurses, administrative personnel and graduates had, in this order, the highest scores of days lost. We show that the dimension of Intrinsic Job Satisfaction, Extrinsic Job Satisfaction and Job Monotony are interrelated with absenteeism.

[Job satisfaction and stress among general physicians in the public health system]. / Satisfacción y estrés laboral en médicos generalistas del sistema público de salud.

OBJECTIVE: To determine: 1) the level of job satisfaction and job stress among general practitioners of National Health Service, and 2) the most common sources of stress of their job. DESIGN: Descriptive study based in a meal survey with bivariate and multivariate analysis of data. SETTING: Primary Care Centers of the Valencian Health Service. SUBJECTS: 216 general practitioners were questioned. Of these 127 answered on time (102 male; age 39.55 years; response rate of 58.80%). MEASUREMENTS AND MAIN RESULTS: The Font Roja-AP Questionnaire (to evaluate job satisfaction and stress) and the Tabarca Inventory (to determine sources of stress) were used. Social relationship at work, intrinsic job satisfaction, job distension and variety at work were in hierarchy order the principal reasons of job satisfaction. On the other hand, interruptions of family life, emergency calls, monotony and practice administration and the doctor-patient communication aspects were in hierarchy order the principal reasons of job stress. CONCLUSIONS: The general practitioners work yield job satisfaction. Moderate job stress has been observed among general practitioners. The most important sources of stress were interruptions of family life and other conditions which disturb intimacy.

Comparison of the results of first and second cataract eye surgery.

OBJECTIVE: To compare the outcomes of second eye cataract surgery with those of first eye surgery. In particular, to evaluate changes in visual acuity (VA), visual function, and health status after the first and second eye surgeries. DESIGN: A cohort (case series) analysis of patients recruited in a clinical trial. PARTICIPANTS: A total of 403 consecutive patients with indication of noncombined first eye or second eye cataract surgery were recruited in 3 public hospitals in Barcelona, Spain. First eye surgery patients are compared to second eye surgery patients. INTERVENTION: Patients were evaluated both before surgery and 4 months after surgery by a standardized telephone interview and clinical examination. MAIN OUTCOME MEASURES: Visual acuity, visual function index (VF-14), a 14-item instrument designed to measure visual function, and the Sickness Impact Profile (SIP), a generic measure of health status. RESULTS: Full data were obtained from 315 (78%) patients: 249 who underwent first eye surgery only and 66 different patients who underwent second eye surgery. Significant improvement was found in both groups of patients for best-corrected VA in the operated eye (4.4 Snellen lines, P < 0.001; 4.2 Snellen lines, P < 0.001, respectively), VA in the better eye (2.8 Snellen lines, P < 0.001; 1.4 Snellen lines, P < 0.001), and visual function (26.3 Snellen lines, P < 0.001; 17.0 Snellen lines; P < 0.001). Four months after the operation, the VF-14 of the second eye group was slightly better (93.4 vs. 88.5; P = 0.09; score range: 0, worst, to 100, best). Psycho-social SIP scores improved in both groups (4.8, P < 0.001; 3.1, P = 0.016). Physical SIP score improved only in the first eye surgery group (1.8, P = 0.003) but not in the second eye surgery group (-1.0, P = 0.338; score range: 0, best, to 100, worst). CONCLUSIONS: The results of our study suggest that patients undergoing second eye cataract surgery show significant improvements in VA, visual function, and psycho-social health status. However, global and physical health status does not change after second eye cataract surgery.

Presión intraocular post-tratamiento de la oftalmopatía tiroidea / Intraocular pressure after treatment for thyroid associated ophthalmopaty

Objetivo: Evaluar los cambios en la presión intraocular (PIO) en pacientes afectos de oftalmopatía tiroidea (OT) tratados mediante descompresión orbitaria, cirugía sobre músculos extraoculares, o pulsos endovenosos de 6-metil-prednisolona. Material y métodos: Se han analizado los datos de 31 pacientes que fueron tratados en nuestro Servicio entre 1998-2004. Las variables utilizadas han sido: edad, sexo, diagnóstico y tratamiento de glaucoma, tratamiento esteroides sistémicos, tipo de operación, PIO pre y postoperatoria en posición primaria de mirada (PPM) y posición en mirada hacia arriba (PMA). Resultados: En los 20 ojos en que se realizó descompresión orbitaria, la PIO media preoperatoria en PPM fue de 17,35 (DE: 3,86) mmHg y de 22,45 (DE: 6,36) mmHg en PMA. La PIO postoperatoria en PPM fue de 14,24 (DE: 3,43) mmHg y de 18,20 (DE: 4,74) mmHg en PMA. En los 10 ojos de pacientes intervenidos de estrabismo, la PIO preoperatoria en PPM fue de 18,9 (DE: 3,07) mmHg y de 22,4 (DE: 6,14) mmHg en elevación. La PIO postoperatoria en PPM fue de 16,6 (DE: 3,50) y de 18,6 (DE: 3,33) mmHg en elevación. En los 12 pacientes, 24 ojos, que recibieron pulsos la PIO en PPM era de 21,33 (DE: 6,42) mmHg y de 24,45 (DE: 8,15) mmHg en elevación. Después del tratamiento, la PIO en PPM fue de 17,33 (DE: 4,38) mmHg y de 20,08 (DE: 4,86) mmHg en PMA. En los pacientes con una PIO preoperatoria ³ 21 mmHg o en tratamiento para glaucoma se ha observado un descenso más marcado de la PIO (p < 0,005). Conclusiones: Se ha observado un descenso significativo de la PIO en los tres grupos de pacientes postratamiento de la OT

Objective: To evaluate the change in the intraocular pressure (IOP) in subjects with thyroid-associated orbitopathy (TAO) treated with orbital decompression, extraocular muscle surgery or methylprednisolone pulse therapy. Methods: The charts of 31 subjects with TAO who visited in our department between 1998 and 2004 were analyzed. Subject age, gender, diagnosis and treatment for glaucoma, use of systemic steroids, procedure performed and pre-operative and postoperative IOP in the primary position and in upgaze, were all evaluated. Results: Of the 20 eyes that underwent orbital decompression, the mean pre-operative IOP was 17.35 (3.86 SD) mmHg and 22.45 (6.36 SD) mmHg in upgaze. The post-operative IOP was 14.24 (3.43 SD) mmHg and 18.20 (4.74 SD) mmHg in upgaze. The mean pre-operative IOP in the 10 eyes who had strabismus surgery was 18.9 (3.07 SD) mmHg and 22.4 (6.14 SD) mmHg in upgaze. The post-operative IOP was 16.6 (3.50 SD) mmHg and 18.6 (3.33 SD) mmHg in upgaze. In the 12 patients treated with methylprednisolone pulse therapy, the mean pre-treatment IOP was 21.33 (6.42 SD) mmHg and 24.45 (8.15 SD) mmHg in upgaze. After the treatment the mean IOP was 17.33 (4.38 SD) mmHg and 20.08 (4.86 SD) mmHg in upgaze. In subjects with a pre-operative IOP ³ 21 mmHg or in treatment for glaucoma we observed a greater reduction in IOP (p < 0.005). Conclusions: We have observed a significant reduction in IOP in the three groups of patients after treatment for TAO, however no significant difference was found between the methods used

Marketing sanitario y calidad asistencial: reflexiones para el diseño de los servicios quirúrgicos / Health care marketing and quality of public health care: reflections for the design of surgery departments

La preocupación por la calidad asistencial constituye hoy día un elemento común en todas las instituciones sanitarias. Sin embargo, no siempre es fácil de satisfacer, ya que las barreras a la calidad son muy diversas aunque suelen tener su origen en determinados desajustes estructurales y organizativos. Si bien no cabe duda de la mayor trascendencia de los aspectos de calidad técnica de la prestación sanitaria, cada día se hace más evidente que el paciente desempeña un papel destacado a la hora de valorar la calidad de la asistencia sanitaria, lo que conlleva sustanciales cambios en el modo de hacer de los profesionales. Lo más importante es reconocer que para conseguir mejorar la calidad es necesario conocer las necesidades y expectativas de los pacientes y saber convertirlas en requisitos y en objetivos asistenciales. En este artículo se revisan algunas cuestiones clave que pueden ayudar a mejorar la gestión en los servicios quirúrgicos (AU)

¿Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales / What do patients think of public hospitals? Analysis of the perceived quality level of five hospitals

Objetivo: Analizar las opiniones de pacientes atendidos en cinco hospitales públicos. Diseño: Estudio descriptivo basado en encuesta por correo. Instrumentos: Cuestionario SERVQHOS. Sujetos: 930 sujetos. Tasa de respuesta del 35 por ciento. Resultados: Un 19 por ciento de los pacientes no recomendaría el hospital. El 59,2 por ciento se mostró satisfecho y un 3,1 por ciento muy insatisfecho. Conocer el nombre del médico y enfermera/o son predictores del nivel de calidad percibida. La frecuencia con que el paciente dijo haber sido informado no predijo el nivel de calidad atribuido al hospital. Edad y sexo no mostraron relación con el nivel de calidad percibida. Conclusión: Los pacientes valoran positivamente los hospitales aunque existe un porcentaje de insatisfechos importante (AU)