Temporary hospitals in times of the COVID pandemic. An example and a practical view.

We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.

Guía de práctica clínica de la SECT sobre el manejo de pacientes con neumotórax espontáneo / SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax

Esta guía de práctica clínica (GPC) surge como iniciativa del comité científico de la Sociedad Española de Cirugía Torácica. Para elaborar dicha GPC se han formulado las preguntas PICO (paciente, intervención, comparación y outcome o variable resultado) sobre distintos aspectos del neumotórax espontáneo. Para la evaluación de la calidad de la evidencia y elaboración de las recomendaciones se han seguido las directrices del grupo de trabajo Grading of Recommendations, Assessent, Development and Evaluation (GRADE).(AU)

This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery. We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax. For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.(AU)

SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax

This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery. We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax. For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.

Acerca de las interconsultas a los neurólogos formuladas desde urgencias / Regarding emergency department consultations with neurologists

No disponible

Epidemiology of asthma exacerbations and their relation with environmental factors in the Basque Country.

BACKGROUND: Asthma is a highly prevalent chronic inflammatory disease characterised by reversible airflow obstruction and hyperreactivity and inflammation of the airways. Factors that cause and/or trigger asthma attacks include host-related factors (genetic predisposition, obesity and sex) and environmental factors (allergens, infections, occupational sensitisation, smoking status, pollution and diet). OBJECTIVE: To describe the epidemiology of asthma exacerbations (AEs) in the Basque Country and to explore its relationship with potentially associated environmental variables. We studied a total of 31,579 emergency department (ED) visits and 28,189 hospitalisations due to asthma. We describe the trends, incidence, seasonality and the influence of age and sex, as well as of exposure to NO2 , CO, PM, O3 , and pollen, temperature, relative humidity and flu status. We calculated the Pearson's R correlation coefficient for the study variables. RESULTS: The incidence was 486 and 88.9 cases per 100,000 people for ED visits and hospitalisations, respectively. Slightly over half (53.5%) of the ED cases were male, while females represented 62.6% of the hospital admissions. Hospitalisations are tending to decrease in children and increase in over 64-year-olds. Peaks in cases occur at the beginning of autumn in children and in winter in adults. AEs were correlated positively with exposure to NO2 , CO and to the influenza virus and negatively with temperature and exposure to O3 . These relationships vary, however, with age and season. CONCLUSIONS AND CLINICAL RELEVANCE: Rates of hospitalisation for AEs and trends in these rates over time are different in adults and children with the patterns varying by sex, season and environmental conditions.

Efecto de una estrategia de mejora de la calidad asistencial basada en la medición sistemática de indicadores en tres procesos clínicos de alta prevalencia en urgencias y comunicación de los resultados a los profesionales / Effect of a strategy for improving quality of care based on systematic measurement of and feedback on quality indicators in 3 highly prevalent emergency department situations

Objetivo: Evaluar los efectos de la monitorización continua de indicadores en dos procesos clínicos diferentes en urgencias (manejo de la agudización asmática y atención del cólico nefrítico) y en el uso de fármacos opiáceos mayores; y determinar el efecto de la comunicación de sus resultados a sus profesionales y de las intervenciones formativas encaminadas a la mejora de sus indicadores. Método: En el año 2005 se inició una política de medición sistemática de distintos aspectos de la atención médica en diferentes patologías prevalentes en urgencias de acuerdo a protocolos consensuados y se definieron indicadores para su cuantificación. Cuando se observaban desviaciones destacables de los estándares, se pusieron en marcha sesiones informativas, revisión de casos y acciones formativas continuadas basadas en sesiones clínicas. Se analizan los resultados del periodo 2006-2012. Se cuantificaron mensualmente de forma retrospectiva los siguientes indicadores: A) agudización asmática: registro de la frecuencia respiratoria, realización del peak-flow, radiografía de tórax y gasometría arterial, e indicación de ingreso; B) cólico nefrítico: medición del grado de dolor mediante una escala de categoría numérica (ECN), realización de radiología de abdomen y de ecografía, interconsulta al servicio de urología, ingreso en observación de urgencias o en hospitalización y reatenciones en urgencias en menos de 72 horas; y C) empleo de opiáceos mayores en los procesos habituales. Resultados: Se evaluaron 1.767 agudizaciones asmáticas 6.114 cólicos nefríticos y la administración de 22.751 ampollas de opiáceos. Se incluyó el 100% de los registros. En 2006, la mayoría de indicadores se encontraban por debajo de los estándares recomendados. Las acciones formativas evidenciaron mejoras discretas (en algunos casos estadísticamente significativas): A) agudización asmática: aumentó la medición de frecuencia respiratoria (p = 0,13) y disminuyeron las radiografías (p < 0,05), gasometrías arteriales (p = 0,66) e ingresos en planta (p = 0,66): B) cólico nefrítico: incrementaron la medición del dolor (p = 0,59), los ingresos en observación (p < 0,001), y disminuyeron radiografías (p < 0,01) y ecografías (p = 0,07), interconsultas con urología (p<0,05), ingresos hospitalarios (p = 0,01) y reatenciones a las 72 horas (p < 0,55); y C) incrementó el uso de opiáceos mayores para el control del dolor (p = 0,001). Al final del periodo, sólo en 4 de 13 indicadores se había alcanzado el estándar propuesto. Conclusión: La monitorización continua de procesos clínicos asociada a una estrategia predefinida de mejora continua basada en la definición de criterios de calidad en los procesos clínicos, la medición sistemática mediante indicadores y la comunicación de los resultados a los profesionales tienen efectos positivos, aunque éstos son discretos y se hacen más evidentes en el medio y largo plazo

Objectives: To assess the effect of ongoing measurement of quality indicators affecting 2 different clinical processes that are highly prevalent in emergency care (acute asthma exacerbation and nephritic colic) and also on the use of major opiates; to determine the effect of giving staff information about the results of measurements and providing training on how to improve the quality indicators. Methods: Systematic recording of measures relating to various aspects of care for processes that are highly prevalent in the emergency department caseload. Records were started in 2005. The quality-of-care indicators reflected consensusbased protocols. When substantial deviations from recommendations were identified, sessions to provide information and training were scheduled. The sessions included reviews of cases. The results of these strategies were analyzed for 2006 through 2012. Statistics on the following indicators were compiled retrospectively month by month. For asthma exacerbations, we compiled data on the recording of respiratory frequency and peak-flow volume, the ordering of chest x-rays and arterial blood gas analysis, and admissions. For nephritic colic, we examined the recording of pain assessment on a categorical numerical pain scale, the ordering of abdominal x-rays and ultrasound imaging, urology consultations, admissions to the observation area or hospital ward, and emergency revisits within 72 hours. We also collected data on the use of major opiates. Results: A total of 1767 asthma exacerbations, 6114 cases of nephritic colic, and 22 751 prescriptions for opiates were evaluated during the study period. All records were included. Most quality indicators failed to meet recommended levels in 2006. The training strategy led to small changes, only some of which reached statistical significance. In the treatment of asthma exacerbation, the number of x-rays ordered decreased (P<.05). The measurement of respiratory frequency tended to rise in frequency but the difference was not significant (P=.13), and the frequencies of orders for arterial blood gas analyses and rates of hospital admissions were similar (P=.66 in both cases). In the treatment of nephritic colic, admissions to the observation area increased (P<.001) and hospital admissions decreased (P=.01). Urology consultations and the number of x-rays also decreased (P<.05 and P<.01, respectively), while the number of ultrasound imaging studies tended to decrease (P=<.07). Revisits remained similar (P<.55). The use of opiates for pain control increased (P=.001). Targets had been reached for only 4 of 13 indicators at the end of the study period. Conclusions: The systematic monitoring of statistics on clinical processes as part of a strategy to improve quality-of-care indicators and feedback on results during training sessions has had some positive effects. However, the changes have been small and they became evident only over the medium to long term

Prompt gamma imaging with a slit camera for real-time range control in proton therapy.

Treatments delivered by proton therapy are affected by uncertainties on the range of the beam within the patient, requiring medical physicists to add safety margins on the penetration depth of the beam. To reduce these margins and deliver safer treatments, different projects are currently investigating real-time range control by imaging prompt gammas emitted along the proton tracks in the patient. This study reports on the feasibility, development and test of a new concept of prompt gamma camera using a slit collimator to obtain a one-dimensional projection of the beam path on a scintillation detector. This concept was optimized, using the Monte Carlo code MCNPX version 2.5.0, to select high energy photons correlated with the beam range and detect them with both high statistics and sufficient spatial resolution. To validate the Monte Carlo model, spectrometry measurements of secondary particles emitted by a PMMA target during proton irradiation at 160 MeV were realized. An excellent agreement with the simulations was observed when using subtraction methods to isolate the gammas in direct incidence. A first prototype slit camera using the HiCam gamma detector was consequently prepared and tested successfully at 100 and 160 MeV beam energies. Results confirmed the potential of this concept for real-time range monitoring with millimetre accuracy in pencil beam scanning mode for typical clinical conditions. If we neglect electronic dead times and rejection of detected events, the current solution with its collimator at 15 cm from the beam axis can achieve a 1-2 mm standard deviation on range estimation in a homogeneous PMMA target for numbers of protons that correspond to doses in water at the Bragg peak as low as 15 cGy at 100 MeV and 25 cGy at 160 MeV assuming pencil beams with a Gaussian profile of 5 mm sigma at target entrance.

[Quality and accreditation of emergency departments]. / Calidad y acreditación de los servicios de urgencias.

The concept of quality has been linked to the health care world since the remote past and is one of the strategic elements on which the transformation and improvement of modern health systems is based. Study of quality in health care involves different approaches given that it holds different meanings for patients, professionals and managers. In recent years formal systems of quality management have been progressively introduced, such as certification according to the ISO-9000 Norms, the system of accreditation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the European Model of Excellence (EFQM). Management by processes is another tool directed towards achieving the aims of total quality in the care process and tackling health problems centred on the patient. Quality health care involves evidence based clinical practice; based on current scientific knowledge, following clinical practice guidelines based on evidence, with the least risk for patients and relatives, involving greater efficiency and greater satisfaction for users and health personnel. The accreditation of health care centres and services is, without doubt, the most widely accepted method for guaranteeing quality. It can be defined as the process of external evaluation to which a health organisation is subjected, based on a review of certain accepted criteria and standards, whose fulfillment demonstrates that that centre is developing its functions within parameters of quality that at least approach excellence.

La informatización en urgencias y emergencias / Computerization in urgency and emergency care

Los servicios sanitarios están sufriendo una importante transformación de la mano de las tecnologías de la información y comunicación (TIC). La historia clínica informatizada en los servicios de urgencias hospitalarios (SUH) está mejorando la asistencia en este ámbito de la medicina, incrementando la seguridad de la información, el acceso a la misma y favoreciendo la implantación de la gestión clínica. En este aspecto, los SUH presentan algunas características distintivas propias como la gestión de los tiempos asistenciales, la gestión segura de las áreas asistenciales y la adquisición rápida de información relevante del paciente. Aunque existe unanimidad sobre las ventajas de la incorporación de la historia electrónica a los SUH, también la hay sobre las dificultades de implantación de estos sistemas. El factor humano es uno de los más relevantes a la hora de manejar la gestión del cambio hacia la informatización. Para minimizar el impacto debe existir apoyo a los profesionales y las aplicaciones que se desarrollen deben integrarse con el historial clínico electrónico del paciente y ofrecer funcionalidades útiles para los usuarios y los pacientes. La automatización de tareas repetitivas, la utilización de formulariosy protocolos, la implementación de mensajes que ayuden en la toma de decisiones y los sistemas de seguridad clínica deben estar muy presentes en los aplicativos informáticos. La estructura y ordenación de la información debe adecuarse a la estructura y necesidades de los SUH. Los aplicativos informáticos tienen que adaptarse a la estructura funcional de los SUH actuales dando información en tiempo real de lasituación asistencial y recogiendo información para generar los indicadores que permitirán evaluar y mejorar las diferentes áreas de trabajo: triaje, boxes, salas de observación, unidades de críticos. La gestión de la información, que nos proporcionan estos sistemas, va a permitir conocer y comparar casuística o casemix de los SUH. En definitiva, para que un aplicativo informático sea capaz de abordar la complejidad de un SUH debe contemplar tres puntos de vista: las operaciones dentro y fuera del servicio, aplicar interfaces de usuario intuitivas y multiusuario y poder realizar una buena gestión de datos tanto a nivel macro, meso y micro (AU)

The health services are undergoing a significant transformation due to information and communications technologies(ICT). Computerized clinical history in hospital emergency department (ED) is improving care in this area of medicine, increasing the security of the information, access to it and favoring the implementation of clinical management. In this aspect, the EDs present certain distinctive characteristics, such as management of care times, secure management of care areas and rapid acquisition of relevant information on the patient. While there is unanimity on the advantages of incorporating the electronic history into the EDs, there is also unanimity on the difficulties involved in implementing these systems.Human factor is one of the most relevant when it comes to handling the management of the change over to computerization. To minimize the impact there must be support for the professionals and the applications developed must be integrated into the electronic clinical historyof the patient and offer useful functional applications for users and patients. The automatization of repetitive tasks, the use of forms and protocols, the implementation of messages that help in decision making and the system of clinical security are essential in computer applications.The structure and planning of information must be adjusted to the structure and needs of the EDs. The computer applications must be adapted to the functional structure of today’s EDs, providing information in real time about the care situation and gathering information to generate indicators that will make it possible to evaluate and improve the different areas of work: triage, boxes, observation rooms, critical units. Management of information, which these systems provide us with, will make it possible to determine and compare the casuistry and case mix of the EDs. In short, for a computer application to be capable of dealing with the complexity of an ED, it must incorporate three elements: operations inside and outside the service, apply intuitive and multiuser user interfaces, and be able to carry out an efficient management of data at the macro, meso and micro levels (AU)

Calidad y acreditación de los servicios de urgencias / Quality and accreditation of emergency departments

El concepto de calidad está ligado al mundo sanitariodesde muy antiguo y es uno de los elementosestratégicos en que se fundamenta la transformación ymejora de los sistemas sanitarios modernos. El estudiode la calidad en la asistencia sanitaria supone abordajesdiversos dado que entraña significados distintospara los pacientes, profesionales y gestores. En los últimosaños se están introduciendo, de forma progresiva,sistemas formales de gestión de calidad, como son lacertificación según las Normas ISO-9000, el sistema deacreditación de la Joint Commission on Accreditation ofHealthcare Organizations (JCAHO) y el modelo europeode excelencia (EFQM).La gestión por procesos es otra herramienta encaminadaa conseguir los objetivos de calidad total en elproceso asistencial y abordar los problemas de saluddesde una visión centrada en el paciente. Una asistenciasanitaria de calidad es aquella que se proporcionacon una práctica clínica basada en pruebas, conforme alos conocimientos científicos actuales, siguiendo guíasclínicas elaboradas con criterios de medicina basadaen la evidencia, con el menor riesgo para los pacientesy los familiares, con la mayor eficiencia y con la mayorsatisfacción para usuarios y el personal sanitario.La acreditación de centros y servicios sanitarioses, sin duda, el método de garantía de calidad más aceptado.Podemos definirlo como el proceso de evaluaciónexterna al que se somete una organización sanitaria,basado en la revisión de unos criterios o estándaresconsensuados, cuyo cumplimiento manifiesta que esecentro desarrolla su funciones con parámetros de calidad,al menos, cercanos a la excelencia(AU)

The concept of quality has been linked to thehealth care world since the remote past and is one ofthe strategic elements on which the transformationand improvement of modern health systems is based.Study of quality in health care involves differentapproaches given that it holds different meanings forpatients, professionals and managers. In recent yearsformal systems of quality management have been progressivelyintroduced, such as certification accordingto the ISO-9000 Norms, the system of accreditation ofthe Joint Commission on Accreditation of HealthcareOrganizations (JCAHO) and the European Model of Excellence(EFQM).Management by processes is another tool directedtowards achieving the aims of total quality in the careprocess and tackling health problems centred on thepatient. Quality health care involves evidence basedclinical practice; based on current scientific knowledge,following clinical practice guidelines based on evidence,with the least risk for patients and relatives, involvinggreater efficiency and greater satisfaction for usersand health personnel.The accreditation of health care centres and servicesis, without doubt, the most widely accepted methodfor guaranteeing quality. It can be defined as theprocess of external evaluation to which a health organisationis subjected, based on a review of certain acceptedcriteria and standards, whose fulfilment demonstratesthat that centre is developing its functions withinparameters of quality that at least approach excellence(AU)