Atitudes de profissionais da saúde em relação ao comportamento suicida / Health professionals' attitude toward suicidal behavior

Resumo Introdução O suicídio ocupa um lugar de destaque entre os agravos que atingem as populações devido ao grande impacto familiar, psicossocial e econômico. A atenção básica à saúde é o primeiro local onde são atendidos indivíduos que apresentam comportamento suicida, e as atitudes dos profissionais podem ser determinantes para a evolução dos casos. Objetivo Verificar as atitudes de profissionais da atenção básica diante do comportamento suicida. Método Estudo transversal, com aplicação do Questionário de Atitudes em Relação ao Comportamento Suicida aos profissionais da atenção básica do município de Barbacena-MG. Resultados A maioria da amostra foi representada por agentes de saúde, do sexo feminino, com idade entre 30-39 anos e com instrução média. Foram observadas mais atitudes positivas entre os médicos e os enfermeiros quando comparados aos outros profissionais. Não foram verificadas diferenças significativas das atitudes em relação ao sexo e à idade dos participantes. Conclusão Os técnicos de enfermagem e os agentes de saúde apresentaram atitudes mais negativas em relação aos demais. Esse é um dado que deve ser levado em conta nos programas de capacitação. O treinamento dos profissionais deve contemplar habilidades cognitivas e mudanças nas atitudes que possam favorecer a empatia e a compreensão do comportamento suicida, priorizando a capacitação dos agentes de saúde.

Abstract Background Suicide and suicide attempts occupy a prominent place among diseases affecting the population due to their great impact on family, psychosocial and economy. Health professionals' attitudes are important since their knowledge and view about suicide can significantly influence their behavior toward patients. Objective To verify the attitudes of health care professionals towards the suicidal patients. Method This is a cross-sectional study in which we applied the Suicide Behavior Attitude Questionnaire to health care professionals in the city of Barbacena, Minas Gerais. Results The majority of the sample was represented by health agents, female, age between 30 and 39 years, with average level of education. Doctors and nurses had the most positive attitudes when compared to other professionals. There were no significant differences in attitudes regarding gender and age of participants. Conclusion The results indicated that nursing technicians and health agents presented more negative attitudes when compared to doctors and nurses. This is a relevant fact and should be taken into account by the training programs. The training of professionals should contemplate cognitive skills and changes in attitudes that may favor the empathy and understanding of these behaviors.

Frecuencia de Hipertensión Arterial en pacientes de primera consulta en consultorio externo de la Primera Cátedra de Clínica Médica, Hospital de Clínicas, año 2012 / Frequency of high blood pressure in patients at first attendance to the Ambulatory Care of the First Department of Internal Medicine, Clinicas Hospital in 2012

La hipertensión arterial es un factor de riesgo para el desarrollo de enfermedades cardiovasculares, principales causas de mortalidad en todo el mundo. El objetivo de este trabajo fue determinar la frecuencia de hipertensión arterial y su asociación con otros factores de riesgo cardiovascular en pacientes de primera consulta en el consultorio de la Primera Cátedra de Clínica Médica del Hospital de Clínicas, FCM, UNA en 2012. Se realizó un estudio observacional, descriptivo, retrospectivo, con componente analítico en el que se estudió a pacientes entre 18 y 90 años, seleccionados por muestreo aleatorio simple. En el periodo de estudio se registraron 4.046 historias clínicas en primera consulta, y 3.854 fueron consideradas para la aleatorización. Se estudiaron las variables demográficas, antropométricas, bioquímicas, presencia de hipertensión arterial, diabetes mellitus tipo 2, consumo de alcohol y tabaco. Se analizaron las historias clínicas de 457 pacientes con una edad media de 44,13±17 años; 48,23±18 años en hombres y 46,61±11 años en mujeres, 300 (66%) fueron mujeres. La frecuencia de la hipertensión arterial ± IC95% fue de 30,41±4,2%, sin diferencia significativa entre mujeres y hombres (32,33±4,3% versus 28±4,1%). La obesidad fue el factor de riesgo cardiovascular más frecuente. Alrededor del 60% de los pacientes presentaba uno o más factores de riesgo cardiovascular. La hipertensión arterial se asoció con la obesidad (OR: 4,427; IC95%: 2,345-4,876; p=0,032), la diabetes (OR: 2,141; IC 95%: 1,261-2,347; p=0,005) y niveles de c-HDL <35 mg/dl (OR: 1,761; IC 95%: 1,116-1,876; p= 0,001). Las altas frecuencias de hipertensión arterial y obesidad observadas en esta población coinciden con los datos reportados a nivel nacional y estuvo asociada significativamente a otros factores cardiovasculares.

Hypertension is a risk factor for the development of cardiovascular disease, the leadingcauses of mortality worldwide. The aim of this study was to determine the frequency ofhypertension and its association with other cardiovascular risk factors, in patients at theirfirst appointment in the Outpatient Careof Medical Clinic, Clinical Hospital, School ofMedicine, in 2012.An observational, descriptive, retrospective study with an analytical component was conducted, in which we studied patients aged 18 to 90 years, selected bysimple random sampling. In the study period, there were a total of 4,046 medical recordsin the first query, 3,854 met the inclusion criteriaand were considered for randomization.Demographic, anthropometric, biochemical variables, blood pressure, type 2 diabetesmellitus, alcohol and tobacco consumption were studied.The sample size was457medical recordswhichwere analyzed,the overall mean age was 44.13±17 years (men:48.23±18 years; women: 46.61±11 years), 300 patients (66%) were women. The overallfrequency ofhypertension (95% CI) was 30.41±4.2%, with no significant statisticaldifference (p=0.261) between women and men (32.33±4.3% versus 28±4.1%). Obesitywas the most frequent cardiovascularriskfactor. Almost 60% of patients had one ormore cardiovascular risk factors. Hypertension was associated with obesity (OR: 4.427,95% CI 2.345 to 4.876,p=0.032), diabetes (OR: 2.141, 95% CI: 1.261 to 2.347,p=0.005) and HDL-C<35 mg/dl (OR: 1.761, 95% CI: 1.116 to 1.876,p=0.001). The highfrequency of hypertension and obesity observed in this population are consistent withdata reported at the national level and was significantly associated with othercardiovascular factors.

Does combined multichannel intraluminal esophageal impedance and manometry predict postoperative dysphagia after laparoscopic Nissen fundoplication?

Laparoscopic Nissen fundoplication (LNF) is an effective treatment for gastroesophageal reflux disease; however, some patients develop dysphagia postoperatively. Manometry is used to evaluate disorders of peristalsis, but has not been proven useful to identify which patients may be at risk for postoperative dysphagia. Multichannel intraluminal impedance (MII) evaluates the effective clearance of a swallowed bolus through the esophagus. We hypothesized that MII combined with manometry may detect those patients most at risk of developing dysphagia after LNF. Between March 2003 and January 2007, 74 patients who agreed to participate in this study were prospectively enrolled. All patients completed a preoperative symptom questionnaire, MII/manometry, and 24-h pH monitoring. All patients underwent LNF. Symptom questionnaires were administered postoperatively at a median of 18 months (range: 6-46 months), and we defined dysphagia (both preoperatively and postoperatively) as occurring more than once a month with a severity >or=4 (0-10 Symptom Severity Index). Thirty-two patients (43%) reported preoperative dysphagia, but there was no significant difference in pH monitoring, lower esophageal sphincter pressure/relaxation, peristalsis, liquid or viscous bolus transit (MII), or bolus transit time (MII) between patients with and without preoperative dysphagia. In those patients reporting preoperative dysphagia, the severity of dysphagia improved significantly from 6.8 +/- 2 to 2.6 +/- 3.4 (P < 0.001) after LNF. Thirteen (17%) patients reported dysphagia postoperatively, 10 of whom (75%) reported some degree of preoperative dysphagia. The presence of postoperative dysphagia was significantly more common in patients with preoperative dysphagia (P= 0.01). Patients with postoperative dysphagia had similar lower esophageal sphincter pressure and relaxation, peristalsis, and esophageal clearance to those without dysphagia. Neither MII nor manometry predicts dysphagia in patients with gastroesophageal reflux disease or its occurrence after LNF. The presence of dysphagia preoperatively is the only predictor of dysphagia after LNF.

[Proposed scoring system for biomedical scientific publications]. / Propuesta de un modelo de baremación para las publicaciones científicas en biomedicina.

There are no bibliometric formulas currently available to measure the intrinsic quality of scientific publications. Nonetheless, publication assessment is an inescapable feature of academic and professional evaluation although it is not always done fairly. This paper proposes a scoring system that combines several of the variables most often used for evaluation: article length, inclusion in biomedical databases, impact factor of the journals publishing the articles, and number of citations received during the 2 years following publication. Articles can be classified in 20 categories and assigned scores depending on how the factors are combined. The scoring system's advantage is that it limits excessive weight given to extreme impact factors and corrects differences due to varying citing behaviors in different Science Citation Index categories. Finally, scores are classified by type of article, number of co-authors, and arthorship order. When applying this system, it would be sufficient to evaluate candidates' 5 best articles in order to establish quantitative differences between them, reducing administrative costs and the workloads of assessment committees.

Propuesta de un modelo de baremación para las publicaciones científicas en Biomedicina / Proposed scoring system for biomedical scientific publications

No existen fórmulas bibliométricas que puedan medir la calidad intrínseca de las publicaciones científicas; sin embargo, la valoración de los artículos con fines curriculares es una formalidad ineludible, aunque ello no siempre se consigue resolver con justicia. En el presente artículo se propone un modelo de baremo en el que se combinan algunos de los parámetros más frecuentes de evaluación: extensión de los artículos, inclusión en las bases de datos biomédicas, factor de impacto de las revistas donde fueron publicados y número de citas recibidas durante los dos años siguientes al de publicación. Dependiendo de la combinación de estos factores, los artículos se clasifican en 20 categorías a las que se les adjudica un valor numérico. El modelo de baremo presenta la ventaja de limitar las desproporciones existentes entre los valores extremos de factor de impacto y soslaya las diferencias debidas a los distintos hábitos de citación que se observan en revistas pertenecientes a distintas categorías temáticas del Science Citation Index. Finalmente se reparte la puntuación obtenida en función del tipo de artículo, del número de coautores y de su posición ordinal. Con este baremo, bastaría evaluar los cinco mejores artículos de cada participante para establecer diferencias cuantitativas entre ellos, lo cual reduciría el trabajo de los tribunales evaluadores y los costes administrativos

There are no bibliometric formulas currently available to measure the intrinsic quality of scientific publications. Nonetheless, publication assessment is an inescapable feature of academic and professional evaluation although it is not always done fairly. This paper proposes a scoring system that combines several of the variables most often used for evaluation: article length, inclusion in biomedical databases, impact factor of the journals publishing the articles, and number of citations received during the 2 years following publication. Articles can be classified in 20 categories and assigned scores depending on how the factors are combined. The scoring system's advantage is that it limits excessive weight given to extreme impact factors and corrects differences due to varying citing behaviors in different Science Citation Index categories. Finally, scores are classified by type of article, number of co-authors, and arthorship order. When applying this system, it would be sufficient to evaluate candidates’ 5 best articles in order to establish quantitative differences between them, reducing administrative costs and the workloads of assessment committees

A photometric redshift of z = 6.39 +/- 0.12 for GRB 050904.

Gamma-ray bursts (GRBs) and their afterglows are the most brilliant transient events in the Universe. Both the bursts themselves and their afterglows have been predicted to be visible out to redshifts of z approximately 20, and therefore to be powerful probes of the early Universe. The burst GRB 000131, at z = 4.50, was hitherto the most distant such event identified. Here we report the discovery of the bright near-infrared afterglow of GRB 050904 (ref. 4). From our measurements of the near-infrared afterglow, and our failure to detect the optical afterglow, we determine the photometric redshift of the burst to be z = 6.39 - 0.12 + 0.11 (refs 5-7). Subsequently, it was measured spectroscopically to be z = 6.29 +/- 0.01, in agreement with our photometric estimate. These results demonstrate that GRBs can be used to trace the star formation, metallicity, and reionization histories of the early Universe.

[Identification of the epidural space: usual practice among Spanish anesthesiologists]. / Identificación del espacio epidural en la práctica habitual de los anestesiólogos españoles.

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it.

[Techniques for identifying the epidural space]. / Técnicas de identificación del espacio epidural.

A large part of the success of epidural anesthesia rests on correct identification of the epidural space. The last hundred years have seen the description of numerous techniques for locating the space in the most straightforward, effective, safe, and reliable manner. To evaluate the advantages and disadvantages of these approaches and the complications associated with each, we carried out a MEDLINE search using the following key words: "epidural analgesia," "epidural anesthesia," "epidural space," "identification," and "loss of resistance" (LOR). Traditional, complementary, and instrument-guided techniques used to identify the epidural space were analyzed. The results of clinical trials comparing different LOR techniques were evaluated. LOR with air, with isotonic saline, or a combination of both were the techniques shown to be simplest and safest. With respect to safety, LOR with air led to the greatest number of complications (pneumocephalus, air embolism, insufficient analgesia, higher incidence of dural puncture, nerve root compression, subcutaneous emphysema). When a small air bubble is created inside the syringe, LOR with saline solution is reliable and teachable, as well as safe and effective.

Identificación del espacio epidural en la práctica habitual de los anestesiólogos españoles / Identification of the epidural space: usual practice among Spanish anesthesiologists

OBJETIVO: Indagar los métodos de identificación del espacio epidural que utilizan los anestesiólogos españoles en su práctica habitual. MATERIAL Y MÉTODOS: Mediante una encuesta por Internet se interrogó a los anestesiólogos españoles acerca de los métodos con los que habían aprendido la técnica durante su período de formación, el método que utilizan con mayor frecuencia en la actualidad y el método que consideraban más conveniente para el aprendizaje de los anestesiólogos en período de formación. RESULTADOS: Respondieron la encuesta 617 anestesiólogos. Las técnicas más frecuentes con las que aprendieron a realizar la anestesia epidural fueron: pérdida de resistencia con aire (LOR-A = 58,5%), LOR con solución salina (LOR-S = 31,9%); LOR con salino + burbuja de aire (LOR-B = 6,1%), método de la gota pendiente = 2,4%. El 14,2% de quienes aprendieron la técnica con LOR-A ha cambiado de método, al igual que el 28,4% de quienes aprendieron con LOR-S. Actualmente utilizan LOR-A = 59,2%, LOR-S = 32,4% y LOR-B = 6%. Para el aprendizaje de los nuevos médicos internos residentes (MIR), los encuestados recomiendan: LOR-A (48,5%) y LOR-S (37,8%). La técnica de LOR-B es aconsejada por una proporción de anestesiólogos mucho mayor de la que lo emplean en su práctica habitual (12,6%). El 26,4% de quienes utilizan la técnica de LOR-A recomiendan a los MIR que utilicen otro método. CONCLUSIONES: El método de identificación del espacio epidural más utilizado en España es el de LOR-A; sin embargo, más de una cuarta parte de sus usuarios no lo aconsejan (AU)

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it (AU)

Técnicas de identificación del espacio epidural / Techniques for identifying the epidural space

Gran parte del éxito de una anestesia epidural se basa en la correcta identificación del espacio epidural. En los últimos 100 años se han descrito numerosas técnicas intentando localizar el espacio de la manera más simple, efectiva, segura y fiable. Para juzgar las técnicas empleadas para la identificación del espacio epidural, sus ventajas, inconvenientes y/o complicaciones se ha realizado una búsqueda en Medline entrecruzando las palabras clave "epidural analgesia", "epidural anesthesia", "epidural space", "identification" y "loss of resistance". Se analizan las técnicas clásicas de identificación del espacio epidural, así como los principales métodos complementarios o instrumentales. Se evalúan los resultados de los ensayos clínicos en los que se comparan las distintas técnicas de pérdida de resistencia (LOR). Las técnicas basadas en la LOR, mediante el uso de aire, solución salina isotónica o una combinación de ambos, han demostrado ser las más simples y efectivas. Con respecto a la seguridad, la técnica de LOR con aire es la que presenta más complicaciones (neumoencéfalo, embolismo aéreo, analgesia insuficiente, mayor incidencia de punciones durales accidentales, compresión de raíces nerviosas, enfisema subcutáneo). Si a la técnica de LOR con solución salina, se le agrega una pequeña burbuja de aire dentro de la jeringa, la técnica, además de efectiva y segura, resulta más fiable y su enseñanza más didáctica

A large part of the success of epidural anesthesia rests on correct identification of the epidural space. The last hundred years have seen the description of numerous techniques for locating the space in the most straightforward, effective, safe, and reliable manner. To evaluate the advantages and disadvantages of these approaches and the complications associated with each, we carried out a MEDLINE search using the following key words: "epidural analgesia," "epidural anesthesia," "epidural space," "identification," and "loss of resistance" (LOR). Traditional, complementary, and instrument-guided techniques used to identify the epidural space were analyzed. The results of clinical trials comparing different LOR techniques were evaluated. LOR with air, with isotonic saline, or a combination of both were the techniques shown to be simplest and safest. With respect to safety, LOR with air led to the greatest number of complications (pneumocephalus, air embolism, insufficient analgesia, higher incidence of dural puncture, nerve root compression, subcutaneous emphysema). When a small air bubble is created inside the syringe, LOR with saline solution is reliable and teachable, as well as safe and effective

[Analysis of bibliographic citations received by Spanish anesthesiologists for work indexed by Science Citation Index, 1988-2002]. / Análisis de las citas bibliográficas recibidas por las publicaciones de los anestesiólogos españoles (incluidas en el Science Citation Index) en el período 1988-2002.

OBJECTIVE: To analyze the international impact of articles published by authors in Spanish anesthesiology departments. METHOD: Citable articles indexed by Science Citation Index between 1988 and 2002 and authored by members of Spanish departments of anesthesiology were considered. Citations were counted 2 years and 5 years after publication. Authors and institutions were ranked according to number of citations received. We also determined the journals Spanish anesthesiologists most often chose for publishing their work. RESULTS: Of the 322 citable articles identified, 61.8% were cited in the 2 years following publication (total 587 citations), and 79.5% were cited within 5 years (total 1472 citations). The most frequently cited articles received 17 citations in 2 years and 45 in 5 years after publication. Articles from the Department of Anesthesiology of Hospital Clinic i Provincial of Barcelona received the largest number of citations (333 citations in 5 years). The author with the highest rate of citations received 11.57 per article. The author with the largest number of citations received 86. Anesthesia & Analgesia was the journal publishing the largest number of articles by Spanish anesthesiologists (35 articles). CONCLUSION: This citation analysis shows the international impact of publications by Spanish anesthesiologists.

Los colegios invisibles / The invisible colleges

No disponible

Identification of Cucumisin (Cuc m 1), a subtilisin-like endopeptidase, as the major allergen of melon fruit.

BACKGROUND: Allergenic components in melon extracts have not been described in spite of the fact that melon (Cucumis melo) is a frequent allergy-eliciting fruit. The aim of this study was to evaluate allergenic components in melon extract and to report the identification of cucumisin as a major melon allergen. MATERIALS AND METHODS: Sera from 35 patients allergic to melon were selected on the basis of clinical symptoms, skin prick tests and oral challenge test. Allergenic components were detected by sodium dodecyl sulphate polyacrylamide gel electrophoresis and immunoblotting. Molecular characterization of IgE-binding bands was performed by N-terminal amino acid sequencing. RESULTS: More than 10 IgE-binding bands, between 10 and 80 kDa, were identified in melon extract. Out of them, four IgE-binding bands were major allergens: 14 kDa, 36 kDa, 54 kDa and 67 kDa. These major allergens, except 14 kDa band, showed the same N-terminal sequence: T-T-R-S-W-D-F-L. Research conducted with protein databases identified this N-terminal sequence as cucumisin, an alkaline serine protease, which shares structural homology with microbial subtilisin. The molecular mass of the identified bands corresponds with different molecular forms of cucumisin produced during the processing or degradation of the enzyme: 67 kDa native cucumisin, 54 kDa mature cucumisin and 36 kDa NH2-terminal cucumisin fragment. CONCLUSION: Cucumisin (Cuc m 1) and several N-terminal cucumisin fragments are the major allergens of melon. The ubiquitous distribution of this protein family (cucumisin-like proteases) in many plant species and its high structural similarity suggest its potential role as a new panallergen in plant foods.

International publishing in anaesthesia - how do different countries contribute?

BACKGROUND: The evaluation of the international distribution in biomedicine research is a subject that creates expectations. This study assesses the recent evolution of world-wide distribution of research in the anaesthesiology field and discusses some of the possible factors which could give rise to changes in the interpretation of absolute results. METHODS: A search on Medline was run to obtain the source country of the journal articles (with abstract) from 10 important anaesthesia journals in the 1997-2001 period. The data were analysed and standardized to journal impact factor values of each publication and population size. Annual evolution in the number of publications in the countries with the largest scientific production was analysed. Furthermore, the distribution of articles by country of origin was studied for each journal. RESULTS: The 9724 publications came from 65 countries. In absolute numbers, the USA leads research in anaesthesiology (24.4%). The evaluation of the contribution of the more productive countries revealed a progressive increase in the German contribution (from 5.1% to 9.4%) and a decrease in the American contribution (from 28.6% to 21.8%) over the 5 years analysed. In relative terms, Finland, Sweden and Denmark were the most productive countries per million inhabitants (8.8, 7.2 and 6 publications/year, respectively). CONCLUSION: The geographic distribution of the publications on anaesthesiology must not only be analysed in absolute numbers, where the USA is the most productive. The North-European countries show the largest production/number of inhabitants ratio; whereas the largest percentage increase during the period is found in Germany.

[Evaluation and evolution of the scientific production by Spanish anesthesiology departments]. / Evaluación y evolución de la producción científica de los departamentos de anestesiología españoles.

OBJECTIVES: To count the scientific publications coming from Spanish departments of anesthesiology and rank them by productivity using various bibliometric tools. To examine the evolution of productivity between 1992 and 2001. METHOD: Abstracts of articles from Spanish anesthesiology departments were located on Medline. Hospital departments were ranked by productivity based on number of publications. Other classifications were established based on the international impact of articles measured by "net" impact factor (IF) of the journals and "relative" IF (according to the category assigned by Journal Citation Reports [JCR]). The evolution of scientific productivity was analyzed by five-years periods. RESULTS: We located 644 entries for articles published in Spanish journals and 182 for articles in journals outside Spain. Ten departments of anesthesiology produced 68% of the articles in non-Spanish journals. Hospital Clinic i Provincial in Barcelona was the most productive (55 publications, 27 in foreign journals). Hospital del Mar published articles in journals with the highest IF (mean 2.63). When IF results were adjusted by JCR category, Hospital Clinic i Provincial had the best quantitative and qualitative indexes. Hospital Torrecardenas had the best evolution in scientific productivity in the last five years. CONCLUSION: The scientific productivity of Spanish anesthesiology departments has evolved favorably over the past 10 years, led by Hospital Clinic i Provincial.

[Database application for information on post-surgical evolution after functional neurosurgery]. / Programa de base de datos sobre evolución posquirúrgica de la neurocirugía funcional.

INTRODUCTION: A series of quantitative scales have been established internationally to evaluate the functional state of patients affected by movement disorders, such as Parkinson s disease. The values of these parameters offered by each patient, measured at different moments during his or her illness, allow us to conduct studies into their evolution as well as perform statistical studies about the casuistics. AIM. To provide a tool that enables us to study this vast amount of material in an efficient, sure and, above all, automated manner. Materials and methods. We selected the most interesting variables from the international protocols. We also designed and developed a database application for use under the Windows environment using Delphi 3.0 language and compiler and Structured Query Language. RESULTS: We designed, developed and validated a database system so as to be able to handle automatically the information on the clinical evolution of patients who had undergone functional neurosurgery. This system not only enables us to collect all relevant pre and post surgical information but also allows fast searches and selection, data processing using descriptive statistical techniques and the exportation of the data in a standard format. The system, which also allows final double blind clinical evaluation of each patient to be performed, has been used successfully in the Movement Disorders Clinic at the CIREN for over three years. CONCLUSIONS: This system allows for a considerable saving in the amount of time and effort needed for the post surgical evolution of patients, while also increasing the reliability of the results obtained.

Programa de base de datos sobre evolución posquirúrgicade la neurocirugía funcional / Database application for information on post-surgical evolution after functional neurosurgery

Introducción. Internacionalmente se han establecido una serie de escalas cuantitativas de evaluación del estado funcional de pacientes afectados por trastornos del movimiento, como la enfermedad de Parkinson. Los valores de estos parámetros en cada paciente, medidos en diferentes momentos de su enfermedad, permiten realizar estudios evolutivos en cada uno de ellos, así como estudios estadísticos de la casuística. Objetivo. Contar con una herramienta automatizada para el estudio de todo este volumen de información de forma eficiente y segura. Materiales y métodos. Se seleccionaron las variables de mayor interés de los protocolos internacionales, además de diseñar y desarrollar un programa de base de datos en entorno Windows, utilizando el lenguaje y compilador Delphi 3.0. y el lenguaje estructurado de consultas. Resultados. Se diseñó, desarrolló y validó un sistema de base de datos para el manejo automatizado de la información de la evolución clínica de los pacientes de la neurocirugía funcional, que no sólo permite la recogida de toda la información pre y posquirúrgica de relevancia, sino también su rápida búsqueda y selección, su procesamiento estadístico descriptivo y su exportación en formato estándar. El sistema, que posibilita además la realización de una evaluación clínica final doble a ciegas de cada paciente, se utiliza con éxito en la Clínica de Trastornos del Movimiento del CIREN, desde hace más de tres años. Conclusiones. Este sistema permite un considerable ahorro de tiempo y esfuerzo para el estudio de la evolución posquirúrgica de los pacientes, así como un aumento de la fiabilidad de los resultados (AU)

[Spanish doctoral dissertations on anesthesiology and the scientific publications of their authors]. / Tesis doctorales españolas sobre Anestesiología y publicaciones científicas de sus autores.

OBJECTIVES: To determine whether obtaining a doctorate is a factor that promotes the research careers of the authors. To analyze the dissemination of Spanish doctoral theses in anesthesiology by looking at the publications they generate. MATERIAL AND METHODS: The TESEO data base was searched for theses on anesthesiology written between 1976 and June 2001. The Medline database was then searched for publications related to each author's thesis. The search identified papers related to each thesis as well as those in which the thesis director was a coauthor. RESULTS: Two hundred twenty-eight theses (9.12 theses/year) were found. Twenty-four authors were not anesthesiologists. The universities of Barcelona (28), Valencia (24), Navarra (23), Autónoma de Barcelona (21), Complutense de Madrid (18) and Cádiz (18) accounted for most of the theses read. The doctoral degree recipients also co-authored 1,833 publications, as the first authors of 649 articles, of which 216 (33.3%) were published before the corresponding thesis was read. Only 127 articles were related to theses. Ninety-seven authors (42.5%) published no article as first author and 22 (9.6%) accomplished no publication as co-author. The thesis director was listed in 154 of the 228 theses in the TESEO database. In this subgroup, 39 doctoral thesis authors published 58 related articles, with the director included among the co-authors in 41 of them. CONCLUSION: Spain produces few doctoral theses on anesthesiology. Most writers of doctoral theses do not publish the results in journals with international readerships. These findings call into question the efficacy of the doctoral thesis as a factor that promotes research.