Evaluación de la calidad percibida en el servicio de oftalmología de un hospital universitario / Assessment of perceived quality in the opthalmology departament of the universitary hospital

Objetivo: El objetivo de este estudio es conocer la Calidad Percibida por los enfermos atendidos en el Servicio de Oftalmología del Hospital Clínico Universitario de Barcelona, entre el 1 de Octubre y el 30 de Noviembre de 2000.Material y método: Para la realización de este estudio, los pacientes debían responder una encuesta de opinión de forma voluntaria. Dicha encuesta constaba de una pregunta abierta con el fin de poder recoger posibles comentarios, y 29 preguntas cerradas en relación con la filiación, características del ingreso y permanencia en el hospital, trato e información recibida, habitabilidad y hostelería, así como la valoración general del servicio. Resultados: Se han valorado 66 cuestionarios de un total de 343 encuestas entregadas (19,24 per cent de participación), y se ha objetivado un elevado grado de satisfacción, de manera que más del 90 per cent de los pacientes encuestados han valorado como excelente o buenos los aspectos referentes al trato recibido, habitabilidad y hostelería, siendo este porcentaje ligeramente inferior en los aspectos relativos a la información recibida. El 93 per cent de los encuestados volverían a ingresar en el mismo centro y la puntuación media del servicio recibido ha sido de 7,77.Conclusiones: El aumento de la satisfacción del usuario en un hospital público universitario, está condicionado por la mejora de las condiciones ambientales y de hostelería del centro (AU)

[Predictive factors of hospital admission in ambulatory surgery at a regional hospital]. / Factores predictores del ingreso hospitalario en la cirugía ambulatoria de un hospital comarcal.

BACKGROUND: Hospital admission following ambulatory surgery is a valid measure of morbidity and a quality indicator. To improve the efficiency of an ambulatory surgery unit it is essential to study the factors associated with unexpected hospital admission. Our goal was to analyze the association of age, ASA, type of surgical and anesthetic procedures, surgical duration, pain, vomiting and surgical and anesthetic complications with unexpected hospital admission. PATIENTS AND METHODS: Retrospective case-control study. The cases were all patients who underwent ambulatory surgery in the Viladecans Hospital (Barcelona, Spain) from October 1990 till May 1996 (n = 6,071), cases (n1 = 93), controls (n0 = 552). Logistic regression models with a predictive variable and multiple logistic regression were obtained. OR and 95% CI were calculated. RESULTS: Age was not significant for admission. ASA greater than status 1 (OR: 3.4 [1.4-9]); p = 0.01), the procto-perineo-sacrococcygeal procedures have significant risk (OR: 35 [4-304]; p < 0.00001), and other types of surgery were not significant. General, spinal anaesthesia and non-spinal locoregional ones with sedation were not significant (p > 0.2), but spinal anesthesia with deep sedation carried a significant risk (OR: 20 [3-122]; p < 0.00001). Surgical duration higher than 40 min (OR: 22 [5-94]; p < 0.00001), pain (OR: 12 [3-55]; p < 0.00001) and vomiting (OR: 8.5 [1.2-59]; p = 0.03) were significant factors in predicting hospital admission. CONCLUSIONS: The factors related with unexpected hospital admission following ambulatory surgery were: surgical and anesthetic complications, pain, procto-perineal and sacrococcigeal procedures, spinal anesthesia with profound sedation and a surgical duration time higher than 40 min.

[The cost-effectiveness of pneumococcal vaccination in Catalonia]. / Coste-efectividad de la vacunación neumocócica en Cataluña.

BACKGROUND: Pneumococcal vaccine is an effective preventive measure against pneumococcal infections. Cost-effectiveness of pneumococcal vaccination of 5 or more years aged population of Catalonia has been evaluated in this study. METHODS: Cost-effectiveness has been estimated in terms of net cost per life-year gained (LYG) and net cost per quality adjusted life year gained (QALY). To calculate the net program cost, a cost of 1200 pesetas ($ 10) per individual has been assumed and averted disease cost in hospital and primary health care have been calculated. RESULTS: Pneumococcal vaccination could obtain 3,360 LYGs and 6,463 QALYs in the population of Catalonia. The program cost has been estimated at 2,800 million pesetas. Cost-effectiveness in million pesetas is 10.1 per LYG and 4.3 QALY in the age group from 5 to 24; 4.2 per LYG and 1.9 per QALY in the age group from 25 to 44; 1.0 per LYG and 0.5 per QALY in the age group from 45 to 44, and it is negative (benefits > costs) in the age group of 65 years old and over. CONCLUSIONS: Pneumococcal vaccination is cost-effective in individuals aged 65 or more, and has a favourable ratio in those aged from 45 to 64.

Deaths from poisoning in Barcelona (Spain), 1986-1989.

Between 1986 and 1989, 3226 violent deaths were recorded in Barcelona, 489 of which were due to poisoning. The yearly distribution of these 489 deaths was: 1986, 74; 1987, 98; 1988, 134; and 1989, 183. Of all poisoning deaths, 316 were due to narcotic opiates use, 54 to the inhalation of toxic gases, 49 to the use of psychoactive agents, 37 to caustic products and the others 33 cases to various toxic agents (insecticides, methanol, solvents, mushrooms, etc.). Opioid use is currently the leading cause of death by poisoning in Barcelona, and affects a young population with a mean age between 25 and 27 years. In the groups corresponding to toxic gases and psychoactive drugs, the mean ages are 48 and 45.7 years, respectively. The oldest population was found in the group where death was caused by caustic agents, where the mean age is 56.5 years. The male sex was predominant in all groups except that of caustic agents, where 56.8% of the victims were women. This study confirms the notable increase in opiate- related deaths in the city of Barcelona (up from 27 cases in 1987 to 158 in 1989) and shows stability in the numbers for the other groups. Among the different hypotheses concerning of this remarkable increase in deaths related to opiate use, the aging of consumers and changes in the purity or composition of the product seem to be the most probable.

[Tuberculosis epidemiology in Catalonia: 1982-1989]. / Epidemiología de la tuberculosis en Cataluña: 1982-1989.

The epidemiological indicators of tuberculosis in Catalonia and their trends since 1982 were evaluated. It was shown that the reported morbidity rate has increased because of an increased number of reports, but it probably is still lower than the real one. The epidemiological value of the parameters of tuberculous infection was also shown, particularly the yearly infection rate (YIR), or probability of an individual to be infected. In spite of the multiple interferences that these indexes may have undergone during the past BCG vaccination campaign, their reduction is very important, the yearly reduction of YIR being estimated in 11%.

[Influence of health education on compliance with antituberculous chemoprophylaxis in children: a community trial]. / Influencia de la educación sanitaria en el cumplimiento de la quimioprofilaxis antituberculosa en niños: ensayo comunitario.

Antituberculous chemoprophylaxis with isoniazide during a period of one year is very useful although it is not readily accepted. A community trial is designed in order to test if three health education interventions increase patients compliance with such treatment in case of tuberculin positive children who are not ill. The two interventions performed by nurses, one by phone, and the second one by a home visit, resulted in statistically significant difference when compared to the control group. This did not occur, however, with the intervention performed by the doctor in his office. A cost-effectiveness study demonstrates that the most efficient intervention has been the phone call.