Monitorización continua de un protocolo: parálisis facial a frigore / Continuous monitoring of a guideline: Bell's palsy

Introducción: La elaboración y revisión de protocolos de actuación neuropediátrica permite reducir la variabilidad de nuestra práctica médica, mejorando la asistencia. Se presenta la monitorización de nuestro protocolo de parálisis facial a frigore (PFP). Material y métodos: Se revisan los informes de urgencias e historias clínicas de los niños valorados en consulta de Neuropediatría por PFP entre julio de 2006 y agosto de 2009 (grupo 2), para conocer el grado de cumplimiento vigente de los criterios de calidad del protocolo y compararlos con los de la revisión previa (grupo 1, de marzo de 2003 a junio de 2006). También se actualizan las evidencias científicas surgidas sobre el tema. Resultados: El porcentaje de cumplimiento del grupo 1 con respecto al 2ha pasado de 85,1 a 100% en constancia de descripción de la mímica facial, de 11,1 a 31,6% en descripción de existencia o no de vesículas sugestivas de herpes zóster, de 77,7 a 84,2% en constancia de fundoscopia, y de 77,7 a 86,8% en describir la normalidad del resto de los pares craneales. Se recoge por primera vez en grupo 2 la entrega de hoja informativa para padres y pediatras, con el 21,1%. Discusión: El audit médico permite evaluar nuestra actuación y establecer líneas de mejora según las deficiencias encontradas. Se insiste en seguir mejorando la constancia escrita de los datos más relevantes y recordar la importancia de entrega de la hoja informativa para padres y pediatras, como forma de asegurar el continuum asistencial (AU)

Introduction: The preparation and review of child neurology guidelines can reduce the variability of our medical practice, thus improving health care. We present the continuous monitoring of our Bell's palsy guideline. Material and methods: Emergency and medical reports of the children seen in Child Neurology surgery from July 2006 to August 2009 (group 2) are reviewed for the purpose of finding out the present level of compliance with guideline quality criteria and compare it with the previously reviewed period (group 1, from March 2003 to June 2006). Scientific evidence on this topic is also updated. Results: Comparing the compliance rate in group 1 with group 2 shows a rise in group 2 from 85.1% to 100% in facial expression description, from 11.1% to 31.6% on whether or not there is evidence of Herpes Zoster vesicles, from 77.7% to 84.2% whether or not there is evidence fundoscopic examination, and from 77.7% to 86.8% as regards cranial nerve function remaining normal. The rate of fact sheet issue, recorded for the first time in group 2, is 21.1%. Discussion: Medical auditing allows us to evaluate our medical practice and set up ways for improvement according to the deficiencies found. We insist on striving to improve the written record of the most relevant data and never overlook the importance of issuing the fact sheets to parents and paediatricians, to ensure continuity of medical care (AU)

[Continuous monitoring of a guideline: Bell's palsy]. / Monitorización continua de un protocolo: parálisis facial a frigore.

INTRODUCTION: The preparation and review of child neurology guidelines can reduce the variability of our medical practice, thus improving health care. We present the continuous monitoring of our Bell's palsy guideline. MATERIAL AND METHODS: Emergency and medical reports of the children seen in Child Neurology surgery from July 2006 to August 2009 (group 2) are reviewed for the purpose of finding out the present level of compliance with guideline quality criteria and compare it with the previously reviewed period (group 1, from March 2003 to June 2006). Scientific evidence on this topic is also updated. RESULTS: Comparing the compliance rate in group 1 with group 2 shows a rise in group 2 from 85.1% to 100% in facial expression description, from 11.1% to 31.6% on whether or not there is evidence of Herpes Zoster vesicles, from 77.7% to 84.2% whether or not there is evidence fundoscopic examination, and from 77.7% to 86.8% as regards cranial nerve function remaining normal. The rate of fact sheet issue, recorded for the first time in group 2, is 21.1%. DISCUSSION: Medical auditing allows us to evaluate our medical practice and set up ways for improvement according to the deficiencies found. We insist on striving to improve the written record of the most relevant data and never overlook the importance of issuing the fact sheets to parents and paediatricians, to ensure continuity of medical care.

[26th Conference of the Spanish Society of Quality in Healthcare: a good balance between quality, innovation, science and participation]. / XXVI Congreso de la Sociedad Española de Calidad Asistencial: un buen equilibrio entre calidad e innovación, ciencia y participación.

The experience and learning process of preparing a scientific conference programme, organising and conducting a conference ccompletes the quality circle with the quantitative and qualitative assessment of the process and results. The transmission of this experience and learning process through this paper will improve the performance of committees of future conference venues, partners and participants and collaborators. The method for performing this evaluation is the assessment of the activities of both the scientific and organising committees of the XXVI Conference of the Spanish Society of Quality Healthcare in October 2008 in Zaragoza. The methodology evaluated the observance of the timetable and tasks assigned to the committees in the Congress Manual of the society along with the presentation of final results of the congress concerning scientific participation and overall satisfaction. There were a total of 1211 communications with a rejection rate of 9.1%. Of the total, 577 communications were presented in oral format and 544 in poster format. Aragon was the community of origin of 24% of communications. By subject areas, those of most interest were patient safety, organisational and management processes, and patient perspectives. A total of 83 participants attended 7 of the 11 workshops offered. The average attendance for each workshop was 12 people. The response rate to the assessment of workshops questionnaire was 54.2% with an average score of 4 (scale of 1 to 5). A total of 1131 people attended the conference of which 17% (193) were SECA associates. Out of a total of 1075 overall satisfaction conference questionnaires distributed there was a response rate of 9.30% (100). The scientific content was assessed with an average score of 3.6 and the organization with 3.87, both on a total score of 5 points. According to the number of abstracts received, number of conferences, level of satisfaction with the scientific program and organisation, we can conclude that the XXVI Conference of the Society has been a success, although we are still in our continuous quality improvement circle that will make conferences even better.

Estrategias de mejora a partir de la evaluación continua de un protocolo: cefalea afebril en pediatría / No disponible

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[Quality as management tool. Actions to improve efficiency in neurological care]. / La calidad como herramienta de gestión. Actuaciones para mejorar la eficiencia en la atención neurológica.

INTRODUCTION: Quality of care involves meeting the needs and expectations of patients with the lowest consumption of resources and in accordance with scientific knowledge. In this context it is important to know if the changes in medical care procedures based on scientific and technical aspects of the quality positively impacts both efficiency measures and perceived quality. METHODS: Prospective study carried out during the 2000-2006 period at the neurology department of a public hospital with has 1303 beds. Changes in medical care introduced: adequacy of a high resolution hospitalization zone, setting up of three care pathways (transient ischemic attach [TIA], multiple sclerosis exacerbation and first epileptic seizure) and practice guidelines for stroke, and implementation of neurological care at the emergency department. RESULTS: There has been an increase in the number of patients treated in the emergency department of the hospital (17%), although the number of admissions has stabilized. In the neurology department, the number of admissions has decreased by 20%, especially those arising from TIA (decrease by 47%), the average stay has been reduced by 30% (especially in demyelinating and vascular disease, which has fallen by 50%). Adjusted average length of stay has remained below 1 and the complexity index above 1. Satisfaction with the information and health care has undergone little change. CONCLUSIONS: The changes in clinical practice to improve the quality of care have been associated with improvements in the efficiency indicators but not in patient satisfaction. The improvement in the perceived quality probably requires specific actions.

La calidad como herramienta de gestión. Actuaciones para mejorar la eficienciaen la atención neurológica / Quality as management tool. Actions to improve efficiency in neurological care

Introducción. La calidad asistencial supone satisfacer las necesidadesy expectativas de los pacientes con el menor consumo de recursosy de acuerdo al conocimiento científico. En este contexto esimportante conocer si los cambios en los procesos asistenciales basadosen aspectos científico-técnicos de la calidad repercuten positivamentetanto en medidas de eficiencia como de calidad percibida.Métodos. Estudio prospectivo durante el período 2000-2006realizado en el servicio de neurología de un hospital de tercer nivelde la red del Sistema Nacional de Salud que dispone de 1.303 camas.Cambios asistenciales introducidos: adecuación de una zona de hospitalizaciónde alta resolución, implantación de tres vías clínicas(accidente isquémico transitorio [AIT], exacerbación de esclerosismúltiple y primera crisis epiléptica) y del proceso de atención al pacientecon ictus y mejora de la atención neurológica en el servicio deurgencias.Resultados. En el hospital se ha producido un incremento en elnúmero de urgencias atendidas (17%), estabilizándose el número deingresos. En neurología ha disminuido el número de ingresos en un20%, especialmente los debidos a AIT (disminución del 47 %), la estanciamedia se ha reducido en un 30% (especialmente en patologíavascular y desmielinizante, donde ha disminuido un 50 %), elíndice de estancia media ajustada al funcionamiento se ha mantenidopor debajo de 1 y el índice de complejidad por encima de 1. La satisfaccióncon la información y atención médica han experimentadopocos cambios.Conclusiones. Los cambios de práctica clínica para mejorar lacalidad asistencial se han asociado con mejoras en los indicadores deeficiencia, pero no en los de satisfacción del paciente. La mejora decalidad percibida probablemente requiera actuaciones específicas (AU)

Introduction. Quality of care involves meeting the needsand expectations of patients with the lowest consumption of resourcesand in accordance with scientific knowledge. In this contextit is important to know if the changes in medical care proceduresbased on scientific and technical aspects of the qualitypositively impacts both efficiency measures and perceived quality.Methods. Prospective study carried out during the 2000-2006period at the neurology department of a public hospital with has1303 beds. Changes in medical care introduced: adequacy of ahigh resolution hospitalization zone, setting up of three carepathways (transient ischemic attach [TIA], multiple sclerosis exacerbationand first epileptic seizure) and practice guidelines forstroke, and implementation of neurological care at the emergencydepartment.Results. There has been an increase in the number of patientstreated in the emergency department of the hospital (17%),although the number of admissions has stabilized. In the neurologydepartment, the number of admissions has decreased by20%, especially those arising from TIA (decrease by 47 %), theaverage stay has been reduced by 30% (especially in demyelinatingand vascular disease, which has fallen by 50%). Adjustedaverage length of stay has remained below 1 and the complexityindex above 1. Satisfaction with the information and health carehas undergone little change.Conclusions. The changes in clinical practice to improvethe quality of care have been associated with improvements in theefficiency indicators but not in patient satisfaction. The improvementin the perceived quality probably requires specific actions (AU)

[Facial paralysis reported in a paediatric emergency department: actuation protocol reviewed and verified]. / Parálisis facial en urgencias de pediatría: actualización de nuestro protocolo y autoevaluación.

INTRODUCTION: As result of our aim to improve the quality standard of our emergency system, work has been carried out in relation to the development and monitorization of effective clinical protocols in the department of paediatric practice. PATIENTS AND METHODS: An evidence based review approach was taken to design a clinical protocol about Bell's palsy condition for the paediatric emergency department. Previous protocol approved in March 2003 was reviewed accordingly with the new designed protocol's quality standards. The Bell's palsy cases reported since March 2003 until June 2006 to paediatric emergency department were analyzed. RESULTS: A total of 27 patients affected by Bell's palsy were reported to the hospital's emergency department. Facial expression was described in 85.19% of the cases. Cranial nerves normal function was reported in 77.78%. Fundoscopic examination was described in 77.78% and otoscopic findings in 44.44%; the absence of herpes vesicles was analyzed only in 11.11%. All patients received steroid therapy (prednisone) and the treatment resulted in the complete recovery. The mean time to resolution was 58.6 days. CONCLUSIONS: In order to improve hospital's quality standards, clinical protocols should be designed and verified regularly to ensure the proper performance. Medical auditing also contributes to improve effectiveness in health attendance.

Encuesta a la población para valoración y conocimiento de su percepción sobre actividades preventivas / Population survey to determine perceptions on preventive activities

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[Effectiveness of preventive activities analyzed within the framework of health centers involved in the Program for Preventive Activities and Health Promotion (PAPPS) of the semFYC. Group for the Evaluation of PAPPS]. / Efectividad de las actividades preventivas analizada en el ámbito de centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la semFYC. Grupo de Evaluación del PAPPS.

OBJECTIVE: To find the effectiveness of a programme of preventive activities for adults (hypertension, tobacco and alcohol) measured by the number of cases identified, the evaluation of the initial interventions and the degree of control over the identified factors. DESIGN: Retrospective study: review of clinical records. SETTING: Primary care. Multi-centre study: health centres from the whole of Spain. PATIENTS: 7562 clinical records of patients over 20, who participated voluntarily and were extracted by systematic sampling from 378 care units (doctor and nurse) at 85 health centres committed to the Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC). The study period was from May 1 1995 to April 30 1997. MEASUREMENTS AND MAIN RESULTS: Age, sex, data on tobacco habit, alcohol consumption and blood pressure were obtained through a questionnaire (recording the actions taken, date of diagnosis, initial assessment and subsequent monitoring). 28.3% were tobacco-dependent, 6.9% consumed too much alcohol, and 22.2% had hypertension. About 20% cases of each risk factor were detected during the study period. Giving up tobacco was recorded in 7.6% of smokers, and giving up alcohol in 19.7% of excess drinkers. 78.6% of hyperintense patients had acceptable-optimum control. CONCLUSIONS: The number of cases detected shows that the PAPPS programme performs acceptably. The tobacco and drink given up and the hypertension control attained due to the intervention are similar to the published trials. The PAPPS is an effective programme for controlling risk factors in primary care.

Efectividad de las actividades preventivas analizada en el ámbito de centros de salud adscritos al programa de actividades preventivas y de promoción de la salud (papps) de la semfyc / Analysis of the effectiveness of preventive actions in health centres committed to the programme of Preventive Activities and Health Promotion (PAPPS) of the semFYC

Objetivo. Conocer la efectividad de un programa de actividades preventivas en el adulto (hipertensión arterial [HTA], tabaco y alcohol) medida por el número de casos detectados, evaluación de las intervenciones iniciales y el grado de control de los factores detectados. Diseño. Retrospectivo; revisión de historias clínicas. Emplazamiento. Atención primaria. Estudio multicéntrico: centros de salud de toda España. Población. Un total de 7.562 historias clínicas de pacientes de edad mayor de 20 años, extraídos mediante muestreo sistemático de 378 unidades asistenciales (médico + enfermera) de 85 centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) que participaron voluntariamente. El período de estudio fue entre el 1 de mayo de 1995 y el 30 de abril de 1997. Mediciones y resultados principales. Mediante cuestionario, se obtuvo: edad, sexo y datos sobre hábito tabáquico, consumo de alcohol y toma de presión arterial (consta la actividad, fecha del diagnóstico, valoración inicial y control posterior). La proporción de individuos con tabaquismo fue del 28,3 por ciento, de consumo excesivo de alcohol 6,9 por ciento y de HTA 22,2 por ciento. Alrededor de un 20 por ciento de casos de cada factor de riesgo fue detectado en el período de estudio. Estaba registrado el abandono del hábito en un 7,6 por ciento de fumadores y en el 19,7 por ciento de los bebedores excesivos. Un 78,6 por ciento de los hipertensos tenía un grado de control aceptable-óptimo. Conclusiones. El número de casos detectados indica un aceptable rendimiento del programa PAPPS. En cuanto al resultado de la intervención, los abandonos del hábito tabáquico y consumo de alcohol, así como el grado de control de la HTA son cercanos a los ensayos publicados. El PAPPS es un programa efectivo para el control de factores de riesgo en atención primaria (AU)

[Users-physicians: in search of new ways of detecting problems of quality]. / Usuarios-médicos: a la búsqueda de nuevas técnicas de detección de problemas de calidad.

OBJECTIVE: 1) To develop experimentally a method of detecting quality problems in primary care, based on the patient's analysis of his/her overall health-care experience. 2) To perceive and assimilate, from the point of view of the providers, aspects of care related to patients' expectations. DESIGN: A descriptive concurrent study in which "user-doctors" visit their general practitioners as patients. SETTING: Health centres, located in Aragón and Rioja. PARTICIPANTS: Thirty-two doctors doing a doctorate. INTERVENTION: Filling-out of a semi-structured questionnaire and individual elaboration of a report analysing the different care stages: appointment, waiting, visit and referrals. Main variables of the study: accessibility, waiting time, comfort, doctor's interest, quality of information, satisfaction, treatment received. For each stage, in line with prior expectations, the detection of problems, the search for positive aspects and the analysis of the care situation with corrective measures were proposed. MEASUREMENTS AND MAIN RESULTS: Problems detected: difficulty of telephone contact, uncomfortable and lengthy wait, health staff smoking, scant interest from the doctor, no greeting on entry, interruptions during the visit, insufficient information. Positive aspects: facilities in choice of appointment, cordiality of treatment, personal call by the doctor, punctuality. CONCLUSIONS: The method is simple, economical, sensitive in detecting problems felt by the users, and feasible as a complement to other systems used in our ambit.

[The validity of the system of obligatory disease declaration for the epidemiologic surveillance of meningococcal meningitis]. / Validez del sistema de enfermedades de declaración obligatoria para la vigilancia epidemiológica de la meningitis meningocócica.

In Spain meningococcic meningitis is a disease of obligatory declaration which is declared under the name of "Meningococcic infection". In this section other process are also included with the declaration being made under suspicion, with no knowledge of the degree of fulfillment and the significance of the official data. To know this the clinical history of meningitis patients of all the hospitals in Aragon from January 1985 to December 1988 were reviewed comparing the results with those from the system of obligatory disease declaration. The degree of fulfillment for meningococcic meningitis was 90% with the annual rates of incidence of meningococcic meningitis being 1.11 to 2.13 fold higher, according to hospitalary data, higher than the rates of the obligatory disease declaration system.

[Time-series analysis applied to nosocomial infection]. / Análisis de series temporales aplicado a la infección nosocomial.

BACKGROUND: In this study we introduce a new view of hospital infection, to apply time series techniques to it. Our objective is to complement hospital infection's epidemiological surveillance by means of obtaining alert and alarm thresholds that make easy to the epidemiologist the decision of intervention, in case they are exceeded. METHODS: We have used the classic time series analysis described by Rumeau-Rouquette, and ARIMA (Autoregresive Integrated Moving Average) models developed by Box and Jenkins. The study focus on three hospital units: one intensive care, one long term care and one surgical unit. The nosocomial infection intervals have been calculated with a 68% (1SD) and 95% (2SD) confidence levels. RESULTS: We detect an ascending general trend in the last two units, without the detection of seasonal variations. Two ARIMA (1, 0, 0) models we obtained for surgery and long term care, discarding other better adjusted models, more complex and difficult to obtain, but with no real advantage in prediction power. Confidence intervals were calculated with both methods. We did not find general trend and seasonal variations for intensive care unit. No model was considered valid, because of its high random component. The nosocomial infection intervals have been calculated with mean +/- 1SD and mean +/- 2SD. CONCLUSIONS: We think that more precise knowledge of hospital infection, with a high random component in our study, can be in addition useful to assign priority to human and material resources.

[Hepatitis B virus vaccination in the province of Saragossa]. / Vacunación de hepatitis B en la provincia de Zaragoza.

We have studied 3001 hepatitis B vaccination protocols, during the period 1982-89, in three hospitals of Zaragoza. 87.24% of the vaccinations have been conducted on health staff, meanwhile other epidemiological important groups (drug users) don't have been attended. The seroprevalence of HBsAg was 0.96% at the prevaccination study. The cleaning staff and the hemodialyzed patients had the greatest ones (5.69% and 3.33%). The administration of the vaccine failed due to rejection in 25.50% and to withdrawal in 8.09%. Only 8.65% don't have developed antibodies after vaccination.