Concordancia clínica y patológica en tumores conjuntivales: Análisis de 195 casos / Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases

Propósito Evaluar la concordancia entre el diagnóstico clínico y patológico en tumores conjuntivales en una unidad especializada en oncología ocular. Métodos Estudio retrospectivo de pacientes consecutivos con tumores conjuntivales diagnosticados en la Unidad de Oncología Ocular del Hospital Universitario de Valladolid desde 1992 hasta 2017. Los tumores se clasificaron según su origen (epitelial, melanocítico, linfoide y otros) y grado de malignidad (benigno, premaligno, maligno). Se realizó biopsia en los casos de lesiones sintomáticas o en crecimiento. Como indicador de concordancia entre el diagnóstico clínico y el patológico se utilizo el estadístico kappa (κ) de Cohen. Resultados Cuatrocientos sesenta y dos pacientes fueron atendidos de manera consecutiva, requiriendo biopsia en 195 (42,2%). La concordancia con el diagnóstico anatomopatológico fue satisfactoria en 154 (79%) casos. El análisis según el grado de malignidad mostró la menor tasa de concordancia en las lesiones benignas (n = 83; 91,6%) y premalignas (n = 62; 90,3%), con una concordancia total en las lesiones malignas (n = 50; 100%); el valor κ fue de 0,90. Los mayores índices de concordancia se encontraron en las lesiones epiteliales, melanocíticas y de partes blandas, con valores κ de 1, 0,8 y 1 respectivamente. El peor índice de concordancia se observó en lesiones linfoides, con un valor κ de 0,3. Conclusiones La mayoría de los tumores conjuntivales fueron correctamente identificados clínicamente. Las lesiones benignas y malignas mostraron la mayor tasa de precisión; sin embargo, las lesiones premalignas pueden ocultar enfermedad microinvasiva que puede pasar desapercibida en el examen clínico. La biopsia es esencial para un diagnóstico y un tratamiento precisos (AU)

Purpose The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. Methods A retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid, and others) and degree of malignancy (benign, premalignant, and malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen's kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. Results Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen's kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1, respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. Conclusions Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment (AU)

Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases.

PURPOSE: The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS: retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS: Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION: Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

[Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain]. / Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España.

Objective: To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results: Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95% CI,1.10-90.25; p = 0.04, respectively). Conclusions: The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students.

INTRODUCTION: Hand hygiene is crucial to prevent cross infection. Healthcare students are in a prime position to learn hand hygiene skills. The aim of this study was to analyze hand hygiene behavioral intentions of healthcare students before and after contact with the patient and to compare the knowledge of and attitude towards hand hygiene between medical and nursing students. METHODS: In a descriptive survey research design, convenience selection of a sample of medical students (n=657) and nursing students (n=303) was done from modules taught by the Department of Preventive Medicine and Public Health in both Medicine and Nursing undergraduate degrees in four Spanish universities. The hand hygiene Questionnaire, a validated instrument to evaluate behavior, knowledge, and attitudes, was used. RESULTS: A significantly lower percentage of students reported always or almost always carrying out hand hygiene before contact with the patient or invasive procedures in comparison to the percentage complying after contact with secretions or with the patient. Although hand hygiene knowledge appears acceptable, its importance is not sufficiently valued. CONCLUSIONS: There are deficiencies in behavioral intention, knowledge, and attitudes related to hand hygiene in medical and nursing students. Better results are observed among nursing students, especially those who have received specific training.

The long-term post-operative electromyographic evaluation of patients who have undergone carpal tunnel decompression.

We present the electromyographic (EMG) results ten years after open decompression of the median nerve at the wrist and compare them with the clinical and functional outcomes as judged by Levine's Questionnaire. This retrospective study evaluated 115 patients who had undergone carpal tunnel decompression at a mean of 10.47 years (9.24 to 11.36) previously. A positive EMG diagnosis was found in 77 patients (67%), including those who were asymptomatic at ten years. It is necessary to include both clinical and functional results as well as electromyographic testing in the long-term evaluation of patients who have undergone carpal tunnel decompression particularly in those in whom revision surgery is being considered. In doubtful cases or when there are differing outcomes, self-administered scales such as Levine's Questionnaire should prevail over EMG results when deciding on the need for revision surgery.

Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad / Adequacy of the admissions and care provided to the patients with community-acquired pneumonia

Objetivo. El objetivo de este estudio es conocer la adecuación de los ingresos hospitalarios por neumonía adquirida en la comunidad (NAC) aplicando la Regla de Clasificación Pronóstica de Fine Modificada y si la atención del paciente se realiza según los indicadores de calidad que la Infection Diseases Society of America (IDSA) recomienda. Pacientes y métodos. Estudio retrospectivo y transversal que analiza la adecuación de ingresos hospitalarios de todos los pacientes atendidos con NAC en el Hospital Clínico Universitario de Valladolid durante el año 2006. A todos los pacientes se les aplicó la Regla de Clasificación Pronóstica de Fine Modificada para evaluar la adecuación de ingresos hospitalarios analizando la comorbilidad asociada, los parámetros de gravedad y los indicadores de calidad. Resultados. Se detectaron 23 casos (6,07%) de NAC que ingresaron de manera inadecuada de los cuales 5 eran clase I (21,7%), 10 clase II (43,4%) y 8 clase III (34,7%). La EPOC (32,5%) y la hipoxemia (36%) fueron la comorbilidad y el factor de riesgo más implicados a la hora de justificar el ingreso de las NAC de bajo riesgo. Se evidenciaron 25 (32,89%) altas inadecuadas desde Urgencias y con respecto a su PSI se encontró: clase I: 2 (8%); clase II: 10 (40%); clase III: 7 (28%); clase IV: 4 (16%); clase V: 0; Fine desconocido: 2. La comorbilidad más implicada en las altas inadecuadas fue la EPOC (10 [40%]). Se realizaron: hemocultivos en 160 casos (42,2%), radiografía de tórax en 379 (100%), gasometría y/o oximetría de pulso en 379 (100%), y determinación de Ag de Streptococcus pneumoniae y Legionella en orina en 14 (87,5%) de los 16 casos de NAC que precisaron ingreso en UCI. Conclusión. La Regla de Clasificación Pronóstica de Fine Modificada puede ser muy útil a la hora de evaluar la adecuación de ingresos y para decidir la necesidad de ingresos hospitalarios por NAC. Destaca la adecuada atención de los pacientes con NAC según los indicadores de calidad establecidos por la IDSA(AU)

Background. The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. Patients and methods. A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. Results. We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. Conclusion. The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out(AU)

[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)

[Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid]. / Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid.

OBJECTIVES: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. MATERIALS AND METHODS: Observational study of descriptive cross-field of a sample of 557 adolescents (14-18 years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole´s cutoff points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacy ratio. RESULTS: Excess weight is similar in both sexes (17%), but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. CONCLUSIONS: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E.

La investigación cualitativa, el rigor en el muestreo estructural / Qualitative research: rigour in structural sampling

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[Study on the immediate care clinics of the Internal Medicine Department (University Clinic Hospital of Valladolid)]. / Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid).

BACKGROUND: Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. METHODS: Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. RESULTS: Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. CONCLUSIONS: We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved.

Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid) / Study on the inmediate care clinics of the Internal Medicine Department (Universitary Clinic Hospital of Valladolid)

Introducción. Diversos estudios han encontrado un alto porcentaje de ingresos inadecuados en los servicios de Medicina Interna. Para paliar esta situación se creó la Consulta de Atención Inmediata en Medicina Interna (CAIMI), en la que se estudia a pacientes con sospecha de patología grave, pero que su estado físico les permita un estudio ambulatorio al día siguiente de haber ido a Urgencias. Las pruebas solicitadas tendrían prioridad sobre las del resto de consultas. Métodos. Estudio descriptivo, retrospectivo, mediante la revisión de las historias clínicas de los pacientes atendidos en la CAIMI durante los dos primeros años. Resultados. Nuestro servicio atendió en la CAIMI a 726 personas (el 52,2% varones) con una edad media de 54,12 años. El 18,6% de los pacientes atendidos precisó el ingreso; el 66,7% de ellos desde la primera consulta. En la mayoría de los casos parece relacionarse con el hecho de acortar un estudio que se prevé largo. A pesar de ello estimamos que se han evitado 1,4 ingresos al día. El tiempo medio de estudio empleado fue de 33,20 días, muy superior al esperado, debido a la alta prevalencia de patología inespecífica valorada y déficit de organización hospitalaria. Se decidió estudiar al 76,6% de los pacientes enviados, lográndose el diagnóstico en el 63,3% del total de pacientes. Sin embargo, la CAIMI fue insuficiente al precisar el ingreso o la derivación a otras especialidades en el 27,3% de los casos. Conclusiones. Creemos que la CAIMI puede ser útil para mejorar la eficiencia de los servicios de Medicina Interna, aunque para ello es necesario solucionar los importantes déficit encontrados

Background. Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. Methods. Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. Results. Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. Conclusions. We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved

[Trend changes in the adenotonsillar surgery]. / Cambios de tendencia en la cirugía adenoamigdalar.

UNLABELLED: In order to evaluate possible trend changes in the epidemiological factors of adenotonsillar surgery, a total of 1,958 operations performed between 1992 and 2002 were reviewed. RESULTS: One third of the operations were to remove tonsils in comparison with the two thirds that were to remove adenoids. Three procedures were used: 59% adenoidectomies, 28% adenotonsillectomies and 13% tonsillectomies. During the study period, the percentage of adenotonsillectomies decreased, whereas the number of adenoidectomies increased. In general, this kind of surgery is mainly performed on males. CONCLUSIONS: Although we have not discovered variations regarding gender and average age for the operations, adenotonsillar surgery has increased over recent years and the percentage ratio of the various procedures has altered as a result of new indications.

Cambios de tendencia en la cirugía adenoamigdalar / Trend changes in the adenotonsillar surgery

A fin de evaluar posibles cambios de tendencia en los factores epidemiológicos de la cirugía adeno-amigdalar, se revisan 1958 intervenciones realizadas entre los años 1992 y 2002. RESULTADOS: se extirparon 1/3 de anginas frente a 2/3 de vegetaciones adenoideas mediante 3 procedimientos: 59% de adenoidectomías, 28% de adeno-amigdalectomías y 13% de amigdalectomías. Durante el período de estudio se ha ido reduciendo el porcentaje de adeno-amigdalectomías, aumentando el de adenoidectomías. En general es una cirugía que predomina en varones. CONCLUSIONES: Aunque no hemos detectado variaciones en cuanto al sexo y edad media de realización, en esta revisión comprobamos que la cirugía adeno-amigdalar ha ido en aumento a lo largo de estos años modificándose la relación porcentual de los distintos procedimientos, creemos que como resultado de nuevas indicaciones

In order to evaluate possible trend changes in the epidemiological factors of adenotonsillar surgery, a total of 1,958 operations performed between 1992 and 2002 were reviewed. Results: One third of the operations were to remove tonsils in comparison with the two thirds that were to remove adenoids. Three procedures were used: 59% adenoidectomies, 28% adenotonsillectomies and 13% tonsillectomies. During the study period, the percentage of adenotonsillectomies decreased, where as the number of adenoidectomies increased. In general, this kind of surgery is mainly performed on males. Conclusions. Although we have not discovered variations regarding gender and average age for the operations, adenotonsillar surgery has increased over recent years and the percentage ratio of the various procedures has altered as a result of new indications

[Perceptions and expectations on primary health care: a new form of identifying improvements in the care system]. / Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención.

OBJECTIVE: To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. DESIGN: Qualitative study using discussion groups and open interviews during the period January-May 2003. SETTING: Health areas of Valladolid, Spain. PARTICIPANTS: The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. METHOD: 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. RESULTS: The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. CONCLUSIONS: Personalized care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training.

Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención / Perceptions and expectations of primary health care: a new form of identifying in the care system

Objetivo. Analizar las opiniones de los usuarios de atención primaria sobre la atención que reciben e identificar las principales áreas de satisfacción. Diseño. Estudio cualitativo mediante grupos de discusión y entrevistas abiertas durante el período enero-mayo de 2003. Emplazamiento. Áreas de salud de Valladolid. Participantes. Los criterios de inclusión fueron: haber acudido alguna vez a la consulta de atención primaria y tener entre 35 y 80 años. La captación se ha realizado a través de informadores clave, mediante la técnica de bola de nieve. Método. Se realizaron 6 grupos de discusión y entrevistas con representantes de 3 asociaciones de enfermos y una de vecinos. Se llevó a cabo un muestreo estructural en función de las variables que influyen en la satisfacción. Las conversaciones fueron recogidas en cintas magnetofónicas y transcritas literalmente en papel. El análisis de los textos ha sido realizado por dos investigadoras y se ha buscado la concordancia entre ambas. Resultados. Las áreas principales relacionadas con la satisfacción han sido: el trato recibido de los profesionales, que se valora como una parte fundamental de la atención, unida a la calidad técnica, la continuidad de los cuidados, los servicios de admisión, los trámites burocráticos, las barreras para acceder a los servicios especializados y las listas de espera. Conclusiones. La atención personalizada, el tiempo dedicado por el profesional, la continuidad de los cuidados y las listas de espera son las principales áreas relacionadas con la satisfacción percibida por los pacientes. Las posibles respuestas para mejorar esta situación son: la implementación de cambios en la gestión y la organización asistencial que simplifiquen los procesos, la inversión de recursos (humanos y económicos), los cambios en el modelo de relación profesional-paciente y la mejora en la formación de pregrado y posgrado

Objective. To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. Design. Qualitative study using discussion groups and open interviews during the period January-May 2003. Setting. Health areas of Valladolid, Spain. Participants. The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. Method. 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. Results. The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. Conclusions. Personalised care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training

Prevalencia de hepatitis A y hepatopatías crónicas: un reto a desarrollar / Prevalencie of hepatitis A and chronic hepatopathies: a challenge to be developed

Getting deeper into the whys and wherefores of primary care research (AU)