Estudio comparativo entre clorhexidina alcohólica 2% tintada con aplicador y povidona yodada en la preparación del campo quirúrgico en cirugía limpia de pared abdominal (hernia umbilical y eventración) / Comparative study between alcoholic chlorhexidine 2% tinted with applicator and povidone iodine in the preparation of the surgical field in clean surgery of abdominal wall (umbilical hernia and ventral hernia)

Introducción: existe suficiente evidencia sobre la mayor eficacia de la clorhexidina alcohólica con respecto a la povidona yodada en la asepsia quirúrgica en cirugía limpia-contaminada, pero no la suficiente evidencia en cirugía limpia de pared abdominal. Objetivo: comparar la eficacia en la prevención de la infección del sitio quirúrgico en cirugía limpia de la pared abdominal tras la utilización de estos dos antisépticos en la preparación del campo operatorio. Pacientes y Métodos: estudio observacional retrospectivo. La obtención de datos se ha realizado a través de la historia clínica electrónica. Se seleccionaron 398 pacientes que cumplían los criterios de inclusión, intervenidos de hernia umbilical y eventración desde enero 2017 a diciembre 2018. Se dividieron en dos grupos según el tipo de antiséptico utilizado. Grupo de povidona yodada 199 y grupo de clorhexidina alcohólica 199 pacientes. El criterio de valoración principal es la infección del sitio quirúrgico, en los 30 días posteriores a la cirugía. Se analizaron las frecuencias y distribuciones de variables sexo, edad, antecedentes personales, riesgo anestésico, tipo de intervención, profilaxis antibiótica, tiempo de intervención, presencia de drenaje, estancia y complicación infecciosa. Los resultados se presentan como una media, desviación estándar y varianza para las variables cuantitativas y en proporciones emparentadas para variables cualitativas. La tasa de infección en los dos grupos se compara mediante la prueba del Chi2 con un valor de P < 0,05 como intervalo de confianza, para valorar si la diferencia entre los dos antisépticos, es estadísticamente significativa. El análisis estadístico se realizó mediante el programa SPSS. Resultados: la edad de los pacientes, el sexo, antecedentes personales, riego anestésico, tipo de patología, profilaxis antibiótica, tiempo de intervención, la presencia de drenaje, estancia, el tipo de intervención quirúrgica y el patrón de uso de antibióticos profilácticos en ambos grupos no mostraron diferencias estadísticamente significativas (p> 0.05), lo cual pone de manifiesto la homogeneidad de los grupos y por lo tanto son comparables. Cinco (2,5%) pacientes desarrollaron infección del sitio quirúrgico en el grupo de la povidona yodada y 3 (1,5%) en el grupo de la clorhexidina alcohólica. Las enterobacterias fueron los gérmenes patógenos más frecuentes cultivados en las heridas infectadas. Conclusión: aunque la tasa de infección del sitio quirúrgico en el grupo de clorhexidina alcohólica es menor con respecto al grupo de povidona yodada, el análisis estadístico demuestra que esta diferencia no es estadísticamente significativa (p = 0,7210); por tanto, estos dos antisépticos son igualmente eficaces en la preparación del campo operatorio en cirugía limpia de pared abdominal

Introduction: There is sufficient evidence on the greater efficacy of alcoholic chlorhexidine compared to povidone iodine in surgical asepsis in clean-contaminated surgery, but not enough in clean abdominal wall surgery. Objective: To compare the efficacy in the prevention of infection of the surgical site in clean surgery of the abdominal wall after the use of these two antiseptics in the preparation of the operative field. Patients and Methods: Retrospective observational study. The data collection has been done through the electronic medical record. We selected 398 patients randomly operated on for umbilical hernia and ventral hernia from January 2017 to December 2018. They were divided into two groups according to the type of antiseptic used. Povidone iodine 199 group and alcoholic chlorhexidine group 199 patients. The main endpoint is infection of the superficial surgical site, within 30 days after surgery. We analyzed the frequencies and distributions of sex, age, personal history, anesthetic risk, type of intervention, antibiotic prophylaxis, time of intervention, presence of drainage, stay and infectious complication. The results are presented as a mean, standard deviation and variance for the quantitative variables and in related proportions for qualitative variables. The infection rate in the two groups is compared by the Chi2 test with a P value of < 0.05 as the confidence interval, to assess whether the difference between the two antiseptics in clean surgery is statistically significant. The statistical analysis was carried out using the SPSS pro-gram. Results: The age of the patients, sex, personal history, anesthetic irrigation, type of pathology, antibiotic prophylaxis, time of intervention, the presence of drainage, stay, the type of surgical intervention and the pattern of use of prophylactic antibiotics in both groups did not show statistically significant differences (p > 0.05), which shows the homogeneity of the groups and therefore comparable. Five (2.5%) patients developed surgical site infection in the povidone-iodine group and 3 (1.5%) patients in the alcoholic chlorhexidine group. Enterobacteria were the most frequent pathogens cultured in infected wounds. Conclusion: Although the infection rate of the surgical site in the alcoholic chlorhexidine group is lower with respect to the povidone-iodine group, the statistical analysis shows that this difference is not statistically significant (p = 0.7210); therefore, these two antiseptics are equally effective for the preparation of the operative field in clean abdominal wall surgery

Evaluación de la vía clínica de la cirugía de la hernia inguinal en un servicio de cirugía general / Evaluation of a clinical pathway of the inguinal hernia repair in a general surgery service

Objetivo. El objetivo de este trabajo es conocer el grado de implantación de la vía clínica (VC) de la hernia inguinal (HI) y su impacto en la satisfacción del paciente. Material y método. El 2 de enero de 2008 se implantó en nuestro hospital la VC de la HI tras 3 meses de estudio piloto. Se estudió a todos los pacientes intervenidos de HI e incluidos en la VC durante el año 2008. Los criterios de evaluación incluyen el grado de cumplimiento, los indicadores de efectividad en la atención clínica y los indicadores de satisfacción basados en la encuesta. Resultados. Tras la implantación de la VC y después de un año de la puesta en marcha se realizaron 582 reparaciones de HI. Se excluyó del estudio a 85 casos (14,6%) por no cumplir los criterios de inclusión. Finalmente el estudio se realizó con 497 pacientes. Edad media: 56,6 años (21–88); 49 mujeres (9,8%) y 448 hombres (90,2%); 273 hernias derechas (54,3%) y 224 hernias izquierdas (45,7%); 473 hernias primarias (95,2%) y 24 hernias reproducidas (4,8%); 441 hernias unilaterales (88,7%) y 56 hernias bilaterales (11,3%). Estancia media: 1,1 días (1–11). Grado de cumplimiento de la estancia: 96,8%. Grado de cumplimiento de la profilaxis quirúrgica: 87,7%. Grado de cumplimentación de los registros de la VC por enfermería: 86,5%. Grado de cumplimentación de los registros de la VC por el personal médico: 80,7%. Morbilidad global: 16%. Consentimiento informado correctamente cumplimentado: 97,8%. Entrega del informe definitivo el día del alta: 98,6%. Se recogieron 369 encuestas de satisfacción (índice de respuesta del 74,2%). Grado de satisfacción de la información recibida: 96%. Correcto tratamiento del dolor: 87,6%. Estancia adecuada: 81%. Hostelería entre aceptable y buena: 95%. Grado de satisfacción con la atención recibida: 97,5%. El 97,4% de los pacientes estudiados recomendaría a un familiar este servicio. Conclusión. La puesta en marcha de la VC de la HI ha supuesto una buena integración de los servicios implicados en esta. Los pacientes han manifestado un alto nivel de satisfacción con el servicio recibido, pero hay aspectos que debemos mejorar en la información y la comunicación con el paciente, en los protocolos de actuación, en los criterios de evaluación, en los registros de la VC y en el modelo de la encuesta de satisfacción(AU)

Objective. The objective of this work is to assess the level of implementation of an inguinal hernia clinical pathway and its impact on the patient satisfaction. Material and method. An inguinal hernia repair clinical pathway was introduced in our service in January 2008. We studied all patients included in the clinical pathway since its introduction. The evaluation variables included: level of implementation, indicators of effectiveness in clinical care, and indicators of satisfaction based on a questionnaire. Results. During the first year of introducing the clinical pathway we operated on 582 patients for hernia repair. We excluded 85 cases (14.6%) from the study, due to not fulfilling the inclusion criteria. The study was finally conducted with 497 patients, 49 (9.8%) women and 448 (90.2%) men. The mean age of these patients was 56.6 (21–88) years old. A right hernia repair was performed on 273 cases (54.3%) and 224 (45.7% on the left hernia. In 473 (95.2%) it was a primary hernia and a recurrence in 24 (4.8%). In 441(88.7%) it was a unilateral hernia and 56 (11.3%) a bilateral hernia. Results. The mean length of hospital stay was 1.1 (1–119) days. The level of compliance with length of hospital stay was 96.8%. The level of compliance with surgical prevention was 87.7%. Level of document management by the nursing staff was 86.5% and for doctors it was 80,7%. Overall morbidity was 6%. The informed consent was correctly executed in 97,8% of the cases and 98.6% of patients were given a final report on the day of leaving hospital. A total of 369 satisfaction questionnaires were collected, which was a response rate of 74.2%. Almost all (96%) patients were satisfied with the received information, 87.6% said their pain was managed correctly, and 81% found stay appropriate, and 95% said their hospital stay was between acceptable and good. The level of satisfaction with the care received was 97.5%, and 97.4% of the patients studied would recommend the hospital to a friend or family. Conclusion. The introduction of a clinical pathway for inguinal hernia repair has led to a good integration, the services involved in the same. Patients have expressed a high level of satisfaction with the service received, but there are aspects that we must improve: in the information and communication with the patient, the action protocols, evaluation criteria, the VC ¿clinical pathway? Registers, and the satisfaction survey model(AU)

[Evaluation of a clinical pathway of the inguinal hernia repair in a general surgery service]. / Evaluación de la vía clínica de la cirugía de la hernia inguinal en un servicio de cirugía general.

OBJECTIVE: The objective of this work is to assess the level of implementation of an inguinal hernia clinical pathway and its impact on the patient satisfaction. MATERIAL AND METHOD: An inguinal hernia repair clinical pathway was introduced in our service in January 2008. We studied all patients included in the clinical pathway since its introduction. The evaluation variables included: level of implementation, indicators of effectiveness in clinical care, and indicators of satisfaction based on a questionnaire. RESULTS: During the first year of introducing the clinical pathway we operated on 582 patients for hernia repair. We excluded 85 cases (14.6%) from the study, due to not fulfilling the inclusion criteria. The study was finally conducted with 497 patients, 49 (9.8%) women and 448 (90.2%) men. The mean age of these patients was 56.6 (21-88) years old. A right hernia repair was performed on 273 cases (54.3%) and 224 (45.7% on the left hernia. In 473 (95.2%) it was a primary hernia and a recurrence in 24 (4.8%). In 441(88.7%) it was a unilateral hernia and 56 (11.3%) a bilateral hernia. The mean length of hospital stay was 1.1 (1-119) days. The level of compliance with length of hospital stay was 96.8%. The level of compliance with surgical prevention was 87.7%. Level of document management by the nursing staff was 86.5% and for doctors it was 80,7%. Overall morbidity was 6%. The informed consent was correctly executed in 97,8% of the cases and 98.6% of patients were given a final report on the day of leaving hospital. A total of 369 satisfaction questionnaires were collected, which was a response rate of 74.2%. Almost all (96%) patients were satisfied with the received information, 87.6% said their pain was managed correctly, and 81% found stay appropriate, and 95% said their hospital stay was between acceptable and good. The level of satisfaction with the care received was 97.5%, and 97.4% of the patients studied would recommend the hospital to a friend or family. CONCLUSION: The introduction of a clinical pathway for inguinal hernia repair has led to a good integration, the services involved in the same. Patients have expressed a high level of satisfaction with the service received, but there are aspects that we must improve: in the information and communication with the patient, the action protocols, evaluation criteria, the VC ¿clinical pathway? Registers, and the satisfaction survey model.

[Use of antiparkinsonian agents in Castilla-La Mancha. Estimate of prevalence of Parkinson disease]. / Consumo de antiparkinsonianos en Castilla-La Mancha. Estimación de la prevalencia de la enfermedad de Parkinson.

INTRODUCTION: Research concerning the prevalence of Parkinson disease (PD) are scarce; in addition with different methodologies. Therefore it is not possible to determine its true impact on public health in Castilla-La Mancha (CLM), Spain. OBJECTIVE: Determine the prevalence of PD in CLM (332.0 and 332.1 of the ICD-9th revision) by the consumption of antiparkinsonian drugs. PATIENTS AND METHODS: Calculating the daily defined doses (DDD) per 100,000 inhabitants (10(5)) for each of the prescribed antiparkinsonian drugs (Therapeutic Group, N04A), during 1994-1996 for each of the province of CLM. The data from prescriptions have been obtained from the Pharmaceutical Service of the Health and Consume Ministry of Spain, which cover 100% of the population. RESULTS: The DDD determination's of L-Dopa per 10(5) inhabitants, a prevalence of 270.24 (IC 95%: 239.2-304.7) is estimated for the whole population. The consumption of L-Dopa by provinces and years (1994-1996) allows to know the distribution of PD in CLM. CONCLUSIONS: The numbers obtained place to CLM in a middle-high prevalence; although methodological differences do not allow definitive conclusions.

[Malignant digestive tumor mortality in Castilla-La Mancha (1975-1990)]. / Mortalidad por tumores digestivos malignos en Castilla-La Mancha (1975-1990).

BACKGROUND: The study investigates the temporary trend of the mortality by digestive malignant tumours in Castilla-La Mancha from 1975 to 1990. MATERIAL AND METHODS: Standardized rates were calculated by direct method, using world and european population as standard, truncated rates (35-64 years old) and cumulative rates (0-74 years old) according to tumoral location and sex. RESULTS: In both sexes the mortality by colon cancer has increased whereas the mortality by stomach cancer has decreased. These changes observed are similar with those observed in other epidemiologic studies. CONCLUSION: Driving a 15 year period a significant change in mortality due to colonic and gastric cancer has occurred in Castilla-La Mancha.