Tendencia de la hospitalización por ictus isquémico en adultos jóvenes de la Región de Murcia durante el periodo 2006-2014 / Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014

Introducción: Estudios recientes en Europa y Estados Unidos muestran un posible aumento de la incidencia y la hospitalización por ictus isquémico en adultos jóvenes, sin embargo, en España la información disponible de la tendencia es escasa. Por ello planteamos analizar la tendencia de hospitalización por ictus isquémico en adultos menores de 50 años en la Región de Murcia entre 2006 y 2014. Método: Se realizó un estudio retrospectivo de las altas de hospitalización por enfermedad cerebrovascular (ECV) extraídas del Registro del conjunto mínimo de datos al alta hospitalaria. Se obtuvieron las tasas estandarizadas, desagregadas según edad y subtipo de ECV. La tendencia de los episodios fue analizada mediante regresión de joinpoint, obteniendo la tasa estandarizada anual calculada y el porcentaje de cambio anual (PCA). Resultados: Se identificaron un total de 27.064 altas por ECV en los 9 años del estudio. Los episodios generados por ictus isquémico fueron los más numerosos (61,0%), en pacientes entre 18 y 49 años; entre los años extremos, se registró un aumento del 26% de los episodios por ictus isquémico y del 29,2% de las tasas, mientras que en la regresión de joinpoint no se observó tendencia (PCA = 2,74%, p ≥ 0,05). Por el contrario, en mayores de 49 años esta tendencia fue descendente (PCA = –1,24%, p < 0,05). Conclusiones: No se ha identificado una tendencia en la hospitalización por ictus isquémico en adultos jóvenes a pesar del descenso en adultos de mayor edad. Sería importante identificar las causas de este comportamiento desigual para desarrollar medidas específicas dirigidas al grupo de menor edad. (AU)

Introduction: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. Method: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). Results: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC = –1.24%, P<.05). Conclusions: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults. (AU)

Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014.

INTRODUCTION: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P ≥ .05). By contrast, a downward trend was identified in individuals older than 49 (APC = -1.24%, P < .05). CONCLUSIONS: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.

Tratamiento inmunosupresor en pulsos en esclerosis múltiple durante el desescalado de la epidemia por SARS-CoV-2. Algoritmo de seguridad / Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: Safety algorithm

INTRODUCCIÓN: La pandemia por SARS-CoV-2 está condicionando los abordajes diagnósticos, terapéuticos y asistenciales establecidos en esclerosis múltiple (EM). Durante las fases inicial y pico de la epidemia, los fármacos modificadores del curso de la EM caracterizados por ser inmunosupresores administrados en pulsos (TIP), vieron pospuesta su administración debido a la incertidumbre sobre su influencia en la infección, principalmente en contagiados/contagiosos asintomáticos/presintomáticos. El objetivo de este trabajo es presentar un algoritmo basado en criterios de seguridad que permita reanudar los TIP durante la fase de desescalado. MÉTODOS: Se elabora un algoritmo, cuya estructura se sustenta en la experiencia clínica en EM de los autores y en una revisión bibliográfica del conocimiento acumulado, que facilita la detección de contagiosos asintomáticos, presintomáticos o con síntomas leves de SARS-CoV-2, con el objetivo de evitar la administración de TIP y contagios por contacto prolongado en hospital de día (HdD). RESULTADOS: Algoritmo con doble filtro clínico-microbiológico consistente en la aplicación telemática de un listado de comprobación de síntomas y después realización de PCR para SARS-CoV-2 en exudado nasofaríngeo, a las 48 y 24 h antes del TIP programado respectivamente. CONCLUSIÓN: Considerando el balance beneficio-riesgo, la aplicación del algoritmo resultaría ventajosa pese a que no se conoce la proporción real de asintomáticos/presintomáticos contagiosos. La realización sistemática de PCR, como test con mayor sensibilidad en la fase presintomática de la infección, en combinación con un sistema de detección precoz de síntomas, reduciría contagios y favorecería la identificación de pacientes con riesgo antes de su exposición a TIP

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT

Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: Safety algorithm. / Tratamiento inmunosupresor en pulsos en esclerosis múltiple durante el desescalado de la epidemia por SARS-CoV-2. Algoritmo de seguridad.

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.

[Thymectomy in thymomatous and non-thymomatous myasthenia gravis: analysis of a cohort of 46 patients]. / Timectomía en miastenia grave timomatosa y no timomatosa: análisis de una cohorte de 46 pacientes.

INTRODUCTION: Factors predicting remission after thymectomy for myasthenia gravis are not well known. AIM: To analyze the clinical evolution of the patients after this intervention and discuss about predictors of response. PATIENTS AND METHODS: We retrospectively reviewed all clinical data of thymectomies in myasthenia gravis patients performed at our hospital between 2006 from 2016. Using the MGFA-PIS classification, «complete stable remission¼, «pharmacologic remission¼, «minimal manifestations¼ and «improved¼ were defined as «good clinical outcome¼, and «unchanged¼, «worse¼, «exacerbation¼ or «died¼, as «poor clinical outcome¼. RESULTS: In 46 consecutive thymectomies for myasthenia gravis, women comprised 71.7%. Median age was 37 years and 10.9% had concomitant autoimmune disorders associated. Thymoma (23.96%) was more frequent in older patients (53 ± 20 vs 33 ± 24 years) and men (54.5% vs 18.8%). A year after thymectomy, 28.2% of patients were in poor clinical outcome group and 54.3% had good clinical outcome. On univariate analysis, thymomatous myasthenia was associated with poor clinical outcome a year after surgical intervention. After ten years of follow-up, 9.8% reached complete stable remission, a total of 32 patients (78%) had a favourable outcome and thymoma was not correlated. CONCLUSION: Thymectomy is considered an effective treatment for myasthenia gravis but the benefit is not immediate. The presence of thymoma may determine a worse initial clinical response following thymectomy in patients with myasthenia gravis.

TITLE: Timectomía en miastenia grave timomatosa y no timomatosa: análisis de una cohorte de 46 pacientes.Introducción. En la actualidad, los factores predictores de remisión de la enfermedad en la miastenia grave tras una timectomía no están claramente establecidos. Objetivo. Analizar la evolución clínica de los pacientes tras esta intervención y abordar los posibles determinantes pronósticos. Pacientes y métodos. Se analizaron retrospectivamente los registros de pacientes con miastenia grave timectomizados en nuestro centro entre 2006 y 2016. Se utilizó la escala Miasthenya Gravis Foundation of America-Post Intervention Status agrupando las categorías «remisión completa estable¼, «remisión farmacológica¼, «manifestaciones mínimas¼ y «mejoría¼ como «buen resultado clínico¼, y las categorías «sin cambios¼, «empeoramiento¼, «exacerbación¼ y «muerte¼, como «mal resultado clínico¼. Resultados. Se analizaron 46 timectomías de pacientes con miastenia grave, un 71,7% mujeres. La mediana de edad era de 37 años y el 10,9% asociaba enfermedades autoinmunes. El timoma (23,9%) fue más frecuentes en los varones (54,5% frente a 18,8%) y a mayor edad (53 ± 20 frente a 33 ± 24 años). Un año después de la timectomía, el 28,2% se encontraba en el grupo de mal resultado clínico, y un 54,3%, en el de buen resultado clínico. En el análisis univariante, el timoma se asoció a peor resultado clínico al año de la intervención. Tras diez años de seguimiento, 32 pacientes (78%) alcanzaron un buen resultado clínico, un 9,8% en remisión completa estable, y el timoma no se correlacionó como factor de mal pronóstico. Conclusión. La timectomía se considera un tratamiento efectivo, pero sin beneficio inmediato. La presencia de timoma podría determinar una respuesta clínica inicial peor tras la realización de una timectomía en pacientes con miastenia grave.

Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. / Tendencia de la hospitalización por ictus isquémico en adultos jóvenes de la Región de Murcia durante el periodo 2006-2014.

INTRODUCTION: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC=2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC=-1.24%, P<.05). CONCLUSIONS: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.

¿Por qué se retrasa el tratamiento de reperfusión en pacientes con código ictus? Un análisis cualitativo / Why is reperfusion therapy delayed in stroke code patients? A qualitative analysis

Introducción. La eficacia y la seguridad del tratamiento de reperfusión en el ictus isquémico agudo es tiempo-dependiente y presenta una ventana terapéutica limitada que constituye el principal criterio de exclusión. Iniciativas que monitoricen la calidad asistencial resultan imprescindibles para diseñar intervenciones de mejora dirigidas a garantizar mejores tiempos de atención y de aplicación de dichos tratamientos. Objetivos. Identificar y clasificar las causas potenciales de retraso en la administración del tratamiento de reperfusión del ictus en un hospital de referencia para el tratamiento integral del ictus agudo. Material y métodos. El proyecto se desarrolló en el Hospital Clínico Universitario Virgen de la Arrixaca. Se evaluó a 337 pacientes con ictus isquémico agudo tratados con terapias de reperfusión. Para el análisis cualitativo se constituyeron 2 grupos de trabajo e investigación: uno promotor, que diseñó y dirigió todo el proyecto, y otro multidisciplinar, que sirvió como fuente de información y como mecanismo de implicación activa de todos los profesionales de la cadena asistencial del ictus. Con la información recogida en 3 reuniones se elaboraron los flujogramas y un diagrama causa-efecto. Resultados. Con base en las herramientas anteriores, se identificaron las causas potenciales de demora, que fueron clasificadas de acuerdo con un criterio operativo en estructurales inmodificables, modificables con evidencia conocida y de repercusión hipotética. Destacaron, por su importancia en el diseño de futuras intervenciones de mejora, las causas modificables como la variabilidad en el seguimiento de protocolos establecidos, la ausencia de procedimientos en algunos puntos del circuito, etc. Conclusiones. El conocimiento de las causas de demora en la aplicación del tratamiento de reperfusión ha sido solo el punto de partida, pero se ha tratado de un paso indispensable para el diseño y la puesta en marcha de intervenciones de mejora de los tiempos de atención al paciente con «código ictus» (AU)

Background. Efficacy and safety of reperfusion therapy in acute ischaemic stroke is time-dependent and has a limited therapeutic window, which is, in fact, the main exclusion criterion. Initiatives to evaluate the quality of care are essential to design future interventions and ensure the shortest management times and application of such treatments. Objective. The aim of the study is to identify and classify potential causes of delay in the administration of reperfusion therapy in a tertiary hospital, a reference for the comprehensive treatment of acute ischaemic stroke. Material and methods. The project was developed in Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. A total of 337 patients with acute ischaemic stroke treated with reperfusion therapies were evaluated. For qualitative analysis, 2 working groups were formed: an advocacy group that designed and directed the entire project, and a multidisciplinary one, which served as a source of information and a mechanism for active involvement of all professionals in the stroke-care chain. Information was collected in 3 meetings and then, both the flowcharts and the cause-effect diagram were prepared. Results. Based on the above tools, potential causes of delay were identified and classified according to an operational criterion into unmodified structures, and modifiable ones with known evidence and hypothetical repercussions. Modifiable ones are noted for their importance in the design of future improvement interventions in stroke care. Some of them are: Variability in following established protocols, lack of procedures in some parts of the stroke-care chain, etc. Conclusion. Knowledge of the current situation has just been the starting point, but it has been an essential requisite for the design and implementation of a quality improvement program to shorten in-hospital stroke code times (AU)

Evolución fatal tras trombólisis de un ictus secundario a endocarditis infecciosa / Fatal outcome following thrombolysis for stroke secondary to infectious endocarditis

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[Why is reperfusion therapy delayed in stroke code patients? A qualitative analysis]. / ¿Por qué se retrasa el tratamiento de reperfusión en pacientes con código ictus? Un análisis cualitativo.

BACKGROUND: Efficacy and safety of reperfusion therapy in acute ischaemic stroke is time-dependent and has a limited therapeutic window, which is, in fact, the main exclusion criterion. Initiatives to evaluate the quality of care are essential to design future interventions and ensure the shortest management times and application of such treatments. OBJECTIVE: The aim of the study is to identify and classify potential causes of delay in the administration of reperfusion therapy in a tertiary hospital, a reference for the comprehensive treatment of acute ischaemic stroke. MATERIAL AND METHODS: The project was developed in Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. A total of 337 patients with acute ischaemic stroke treated with reperfusion therapies were evaluated. For qualitative analysis, 2 working groups were formed: an advocacy group that designed and directed the entire project, and a multidisciplinary one, which served as a source of information and a mechanism for active involvement of all professionals in the stroke-care chain. Information was collected in 3 meetings and then, both the flowcharts and the cause-effect diagram were prepared. RESULTS: Based on the above tools, potential causes of delay were identified and classified according to an operational criterion into unmodified structures, and modifiable ones with known evidence and hypothetical repercussions. Modifiable ones are noted for their importance in the design of future improvement interventions in stroke care. Some of them are: Variability in following established protocols, lack of procedures in some parts of the stroke-care chain, etc. CONCLUSION: Knowledge of the current situation has just been the starting point, but it has been an essential requisite for the design and implementation of a quality improvement program to shorten in-hospital stroke code times.

La formación en neurofisiología en el programa educativo de la especialidad de neurología en España / Neurophysiology training in the Neurology Specialist Education Program in Spain

Introducción: el periodo formativo en neurofisiología es una parte sustancial del programa de la especialidad de neurología en Espa˜na. La Comisión Nacional de Neurología (CNN), que es el órgano dependiente de los Ministerios de Sanidad y Educación, debe velar por el cumplimiento del programa. Material y métodos: durante el primer semestre de 2008 la CNN envió a cada una de las 69 unidades docentes acreditadas para la formación de neurología en Espa˜na un cuestionario para que los responsables docentes de cada unidad lo contestaran, donde se preguntaba sobre este periodo formativo. Resultados: de los 69 cuestionarios remitidos se recibieron 49 cumplimentados, lo que supone una tasa de respuesta del 71%. El periodo formativo de neurofisiología del programa de la especialidad de neurología se realiza en Espa˜na en el mismo hospital en 44 centros (90%); los 5 restantes envían sus NeF a 4 hospitales diferentes. La Unidad que realiza el periodo formativo de neurofisiología está integrada en el servicio de neurología en 19 (39%) hospitales, es independiente en 27 (55%) y la fórmula es mixta en 3 (6%). El 69% de los tutores docentes estaba satisfecho con la formación, pero en el 90% de los hospitales en los que la unidad estaba integrada en neurología y en el 65% de los que no existía esta relación. Los neurólogos en formación informan EEG en el 49% de las unidades docentes, realizan EMG/ENG en el 57% e informan potenciales evocados en el 35% tras su periodo formativo. Conclusiones: aunque el grado de satisfacción es alto, el nivel de responsabilidad que asumen los neurólogos en formación durante la rotación por neurofisiología parece que no cumple las exigencias previstas en el programa formativo, especialmente en aquellas unidades no integradas en servicios de neurología (AU)

Introduction: the training period in neurophysiology is a substantial part of the Neurology Specialist Program in Spain. The National Neurology Committee (La Comisión Nacional de Neurología (CNN), which is the body reporting to the Ministries of Health and Education, must ensure compliance to the Program. Material and methods: during the first trimester of 2008, the CNN sent a questionnaire, in which there was a question asking about this training period, to each of the managers of the 69 teaching units accredited for neurology training in Spain, for them to answer. Results: of the 69 questionnaires issued, 49 were received completed, which was a response rate of 71%. The neurophysiology training period of the neurology specialist program in Spain was carried out in the same hospital in 44 teaching unit (90%): the remaining 5 sent their neurology trainees to 4 different hospitals. The Unit that carried out the neurophysiology training period was incorporated into the Neurology Department in 27 (55%) cases, and the formula was mixed in 3 (6%). A total of 69% of tutors were satisfied with the training, but was 90% in the hospitals where the unit was integrated into Neurology, and was 65% where this relationship did not exist. The neurologists in training were informed about EEG in 49% of education units, performed EMG/ENG 57%, and informed about evoked potentials in 35% after their training period. Conclusions: although the level of satisfaction is high, the level of responsibility assumed by the neurologists in training during their rotation into neurophysiology does not appear to comply to the demands laid out in the training program, particularly in these units not integrated into Neurology Departments (AU)

Fe de errores de «La guardia específica de neurología en la formación del médico residente en España» / Erratum. Specific neurology emergency training of medical residents in Spain

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Neurophysiology training in the Neurology Specialist Education Program in Spain.

INTRODUCTION: The training period in neurophysiology is a substantial part of the Neurology Specialist Program in Spain. The National Neurology Committee (La Comisión Nacional de Neurología (CNN), which is the body reporting to the Ministries of Health and Education, must ensure compliance to the Program. MATERIAL AND METHODS: During the first trimester of 2008, the CNN sent a questionnaire, in which there was a question asking about this training period, to each of the managers of the 69 teaching units accredited for neurology training in Spain, for them to answer. RESULTS: Of the 69 questionnaires issued, 49 were received completed, which was a response rate of 71%. The neurophysiology training period of the neurology specialist program in Spain was carried out in the same hospital in 44 teaching unit (90%): the remaining 5 sent their neurology trainees to 4 different hospitals. The Unit that carried out the neurophysiology training period was incorporated into the Neurology Department in 27 (55%) cases, and the formula was mixed in 3 (6%). A total of 69% of tutors were satisfied with the training, but was 90% in the hospitals where the unit was integrated into Neurology, and was 65% where this relationship did not exist. The neurologists in training were informed about EEG in 49% of education units, performed EMG/ENG 57%, and informed about evoked potentials in 35% after their training period. CONCLUSIONS: Although the level of satisfaction is high, the level of responsibility assumed by the neurologists in training during their rotation into neurophysiology does not appear to comply to the demands laid out in the training program, particularly in these units not integrated into Neurology Departments.

La guardia específica de Neurología en la formación del médico residente en España / Specific neurology emergency training of medical residents in Spain

Introducción: La formación en urgencias neurológicas es fundamental en el programa formativo de los residentes de Neurología. La Comisión Nacional de Neurología (CNN), decidió obtener información sobre el grado en que la Unidades Docentes de Neurología acreditadas posibilitan la realización de guardias específicas de Neurología y su grado de tutorización. Métodos: Realización de una encuesta a los tutores de las Unidades Docentes de Neurología para comprobar que se cumplen los criterios de la formación en guardias de neurología indicados en el programa oficial de formación.Resultados: Se obtuvo respuesta del 98,5% de las unidades docentes de Neurología que existen. En el 47% el médico de plantilla de Neurología tiene guardias de presencia física de 24 horas supervisando directamente al médico residente de Neurología. En el resto existe una diversidad de modelos que no cumplen de manera completa los criterios establecidos por el programa de especialidad. La distribución de los distintos modelos de guardias de Neurología varía mucho entre las distintas unidades docentes y entre las distintas Comunidades Autónomas. Sólo el 65% de los médicos residentes de Neurología realizan su formación en unidades docentes de Neurología que tienen guardias de Neurología autorizadas de manera correcta.Conclusiones: Hay una variabilidad injustificada en el cumplimiento de los criterios de formación en guardias de Neurología en las distintas unidades docentes distribuidas por todo nuestro país, habiendo diferencias de formación entre unos médicos residentes en Neurología y otros (AU)

Introduction: Training in emergency neurological illness is very important for the neurologist today. The Neurology National Commission has decided to obtain information on the work duties of neurologist residents in the different neurology units of the hospitals of our country and the supervision of the training in urgent pathology. Method: A survey of adult neurology program directors to find out if their hospital fulfils the program criteria for the residents duty work. Results: A response rate of 98.5% was obtained. In 47% of the neurology training units a neurologist supervised resident duty work 24hours a day. In the rest of the neurology training units they did not fulfil all the training program criteria. We analysed the differences between the neurologist training units, and there are great differences between the hospitals and all regions and communities in our country. Only 65% of neurology residents do their education in neurology units who fullfill the national program criteria on training on urgent neurology pathologyConclusions: There is too much diversity in resident duty work in neurologist training units and not all the units meet the national training program requirements (AU)

Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria / Quality of records in OMI-AP of the patients with stroke followed in primary care

Objetivos. 1) Conocer el grado de registro y control de los factores de riesgo cardiovascular en los pacientes con ictus atendidos en atención primaria en la región de Murcia mediante historia clínica informatizada. 2) Analizar el tratamiento farmacológico registrado en los pacientes con ictus. Material y método. Estudio observacional descriptivo, retrospectivo, valorado a través de los registros en OMI (historia clínica electrónica) en todas las zonas de salud del Servicio Murciano de Salud. Se seleccionó una muestra de 407 pacientes con ictus. Las variables analizadas fueron: tipo de ictus, tiempo de evolución, factores de riesgo cardiovascular registrados, enfermedades cardiovasculares registradas, medicación y grado de control de los factores de riesgo modificables. Resultados. Los factores de riesgo cardiovascular registrados fueron hipertensión arterial (81,1%), dislipemia (72,5%), diabetes (41,3%), obesidad abdominal (22,9%), y tabaquismo (8,8%). Las enfermedades cardiovasculares registradas fueron la cardiopatía isquémica (22,1%), fibrilación auricular (13,8%), nefropatía (11,8%), infarto agudo de miocardio (5,7%) e hipertrofia ventricular izquierda (3,4%). El 2,5% (10) de los pacientes registrados cumplieron con todos los criterios de buen control. El LDL colesterol estaba controlado (<100mg/dl) y registrado en el 24,8% de los pacientes y la presión arterial en el 41,3%. Según OMI-AP recibían tratamiento con antihipertensivos el 78,1% de los pacientes, con hipolipemiantes el 47,4% y con antiagregantes o anticoagulantes el 79,1%. Conclusiones. Los pacientes que han sufrido un ictus y según los datos registrados en OMI-AP presentan un deficiente control de sus factores de riesgo cardiovascular(AU)

Objectives. 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. Material and Methods. Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. Material and Methods. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. Results. Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hipertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. Conclusions. According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors(AU)

[Specific neurology emergency training of medical residents in Spain]. / La guardia específica de Neurología en la formación del médico residente en España.

INTRODUCTION: Training in emergency neurological illness is very important for the neurologist today. The Neurology National Commission has decided to obtain information on the work duties of neurologist residents in the different neurology units of the hospitals of our country and the supervision of the training in urgent pathology. METHOD: A survey of adult neurology program directors to find out if their hospital fulfils the program criteria for the residents duty work. RESULTS: A response rate of 98.5% was obtained. In 47% of the neurology training units a neurologist supervised resident duty work 24 hours a day. In the rest of the neurology training units they did not fulfil all the training program criteria. We analysed the differences between the neurologist training units, and there are great differences between the hospitals and all regions and communities in our country. Only 65% of neurology residents do their education in neurology units who fulfill the national program criteria on training on urgent neurology pathology CONCLUSIONS: There is too much diversity in resident duty work in neurologist training units and not all the units meet the national training program requirements.

[Quality of records in OMI-AP of the patients with stroke followed in primary care]. / Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria.

OBJECTIVES: 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. MATERIAL AND METHODS: Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. RESULTS: Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hypertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. CONCLUSIONS: According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors.

Análisis de las unidades docentes de neurología en España y cumplimientode los criterios de acreditación / Analysis of the neurology teaching unit in Spain and compliance of accreditation criteria

Introducción. Ante la promulgación de la Ley de Ordenación dela Profesiones Sanitarias y la publicación del nuevo programa de laespecialidad de neurología, la Comisión Nacional de Neurología considerónecesario conocer la situación actual de las unidades docentes(UD) acreditadas para la especialidad en lo referente a los criterios deacreditación vigentes. El objetivo de este trabajo es conocer dichasituación.Métodos. Estudio transversal mediante una encuesta de cumplimentaciónvoluntaria (cuestionario ad hoc) remitida por correoen el año 2005 a todas UD acreditadas en ese momento. Incluyópreguntas específicas respecto a los requerimientos estructurales,humanos y de organización contemplados en dichos criterios deacreditación.Resultados. Se remitieron 64 cuestionarios (porcentaje de respuesta:76,6%). El 87 % de las UD cumplían los requisitos estructuralespara la asistencia neurológica, aunque el 21 % tenían menos de4 despachos para consulta y menos de 15 camas neurológicas. El 25%de las UD no cumplían los requisitos en lo referente a los facultativos deplantilla con dedicación a tiempo completo. Aunque prácticamente el100% cumplían los requisitos organizativos cuantitativos asistenciales,sólo el 69 % refirieron tener guardias de neurología, aunque porel diseño del cuestionario no es posible conocer su grado de tutorización.Prácticamente el 100% cumplen los requisitos de docencia einvestigación.Conclusiones. Aunque el grado de cumplimiento de los actualesCA es alto, existen deficiencias preocupantes, fundamentalmente enrelación al número de facultativos de plantilla contratados a tiempocompleto y a la disponibilidad de guardias de neurología debidamentetutorizadas (AU)

Introduction. Faced with the promulgation of the HealthCare Professionals Ordinance Law and the publication of the newprogram of the Neurology training, the National Committee ofneurology has considered it necessary to know the current situationof the Teaching Units (TU) accredited for the neurology trainingin regards to the existing accreditation criteria (AC). Thepurpose of this study is to know said situation.Methods. A cross-sectional study performed by a voluntarilyfilled-out survey (ad hoc questionnaire) sent by regular mailin the year 2005 to all the TU accredited at that time. It includedspecific questions regarding the structural, human andorganizational requirements contemplated in those accreditationcriteria.Results. A total of 64 questionnaires were sent (response percentage:76.6%). Eighty seven percent of the TU met the structuralrequirements for neurological care, although 21 % had fewerthan 4 offices for visits and fewer than 15 neurology beds. A totalof 25 % of the TU did not met the requirements in regards to fulltimestaff members. Although almost 100% met the quantitativecare organizational requirements, only 69 % reported that therewere neurology duties. However, the grade of the tutorial systemcould not be known due to the survey design. Almost 100% metthe teaching and research requirements.Conclusions. Although the compliance grade of the currentAC is high, there are important deficiencies, basically related tothe number of full-time staff professionals and the availability ofduly tutorized neurology duties (AU)

[Analysis of the neurology teaching unit in Spain and compliance of accreditation criteria]. / Análisis de las unidades docentes de neurología en España y cumplimiento de los criterios de acreditación.

INTRODUCTION: Faced with the promulgation of the Health Care Professionals Ordinance Law and the publication of the new program of the Neurology training, the National Committee of neurology has considered it necessary to know the current situation of the Teaching Units (TU) accredited for the neurology training in regards to the existing accreditation criteria (AC). The purpose of this study is to know said situation. METHODS: A cross-sectional study performed by a voluntarily filled-out survey (ad hoc questionnaire) sent by regular mail in the year 2005 to all the TU accredited at that time. It included specific questions regarding the structural, human and organizational requirements contemplated in those accreditation criteria. RESULTS: A total of 64 questionnaires were sent (response percentage: 76.6%). Eighty seven percent of the TU met the structural requirements for neurological care, although 21 % had fewer than 4 offices for visits and fewer than 15 neurology beds. A total of 25 % of the TU did not met the requirements in regards to full-time staff members. Although almost 100% met the quantitative care organizational requirements, only 69 % reported that there were neurology duties. However, the grade of the tutorial system could not be known due to the survey design. Almost 100% met the teaching and research requirements. CONCLUSIONS: Although the compliance grade of the current AC is high, there are important deficiencies, basically related to the number of full-time staff professionals and the availability of duly tutorized neurology duties.