[Summary of the consensus document: "Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery"]. / Resumen del documento de consenso «Guías de práctica clínica para el manejo del síndrome de bajo gasto cardiaco en el postoperatorio de cirugía cardiaca¼

Low cardiac output syndrome is a potential complication in cardiac surgery patients and is associated with increased morbidity and mortality. This guide provides recommendations for the management of these patients, immediately after surgery and following admission to the ICU. The recommendations are grouped into different sections, addressing from the most basic concepts such as definition of the disorder to the different sections of basic and advanced monitoring, and culminating with the complex management of this syndrome. We propose an algorithm for initial management, as well as two others for ventricular failure (predominantly left or right). Most of the recommendations are based on expert consensus, due to the lack of randomized trials of adequate design and sample size in patients of this kind. The quality of evidence and strength of the recommendations were based on the GRADE methodology. The guide is presented as a list of recommendations (with the level of evidence for each recommendation) for each question on the selected topic. For each question, justification of the recommendations is then provided.

[Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery]. / Guías de práctica clínica para el manejo del síndrome de bajo gasto cardíaco en el postoperatorio de cirugía cardíaca.

The low cardiac output syndrome is a potential complication in cardiac surgery patients and associated with increased morbidity and mortality. This guide is to provide recommendations for the management of these patients, immediately after surgery, admitted to the ICU. The recommendations are grouped into different sections, trying to answer from the most basic concepts such as the definition to the different sections of basic and advanced monitoring and ending with the complex management of this syndrome. We propose an algorithm for initial management, as well as two other for ventricular failure (predominantly left or right). Most of the recommendations are based on expert consensus because of the lack of randomized trials of adequate design and sample size in this group of patients. The quality of evidence and strength of the recommendations were made following the GRADE methodology. The guide is presented as a list of recommendations (and level of evidence for each recommendation) for each question on the selected topic. Then for each question, we proceed to the justification of the recommendations.

Madeleine Leininger: un análisis de sus fundamentos teóricos / Madeleine Leininger: an analysis of its theoretical foundations

El presente artículo tiene como propósito hacer un análisis de los fundamentos teóricos de la propuesta de Madeleine Leininger, que se sustenta en dos disciplinas; Antropología y Sociología. El trabajo contiene los antecedentes biográficos de la autora, planteamientos de la antropología filosófica, social y cultural, a partir de los cuales se hacen inferencias en relación a los constructos utilizados por Leininger. Finalmente se establece que la Enfermería requiere del conocimiento del ser humano que vive dentro de una estructura social donde la cultura determina el estado de bienestar/ salud.

The present article has like intention make an analysis of the theoretical foundations of the proposal of Madeleine Leininger, that is sustained in two disciplines; Anthropology and Sociology. The work contains the biographical antecedents of the author, expositions of the philosophical, social and cultural anthropology, from which inferences in relation to the constructos used by Leininger become. Finally one settles down that the nursing requires of the knowledge of the human being who lives within a social structure where the culture determines the well-being state health.

Estudio del tiempo de demora asistencial en urgencias hospitalarias. Estudio multicéntrico en los servicios de urgencias hospitalarias de la Comunidad Valenciana / Multicentre study on waiting time in emergency departments at the Valencian Community

Objetivos: Definir dos indicadores de calidad: demora asistencial y demora diagnóstica, comparar dichas demoras en relación con la gravedad de las patologías, y comprobar si sirven para valorar la calidad asistencial de los diferentes servicios de urgencias hospitalarias (SUH). Método: Estudio observacional, multicéntrico y prospectivo realizado entre diciembre de 2002 y junio de 2003 mediante la recogida de datos semanal, en un día determinado, a los pacientes atendidos de 8 h a 15 h en los SUH. Los episodios se recopilan y gestionan en una base de datos Access, y se procesan con el programa SPSS 11.05. Se miden los diferentes tiempos de demora y se valora la gravedad de la consulta. Se obtienen los siguientes tiempos reales: Tiempo medio de primera asistencia, Tiempo medio de diagnóstico, Tiempo medio de permanencia en Urgencias y Porcentaje de pacientes atendidos por centro; posteriormente los comparamos con los indicadores de calidad establecidos. La muestra n fue de 703 pacientes, correspondiendo: 36,1% al SUH1 (254 pacientes), 30,9% al SUH2 (217), 18,1% al SUH3 (127) y 14,9%(105) al SUH4. Resultados: Tiempo medio de primera asistencia: 27’. Tiempo medio de diagnóstico: 46’. Media de tiempo de permanencia: 74’. Porcentaje según gravedad: Crítico 1%, Grave 7%, Gravedad moderada 42%, Leve 50%. Demora global: 21,6%. Cumplimiento de estándar de oro: 78,4%. Conclusiones: Relacionar demora asistencial con gravedad es un buen método para el control de calidad de los SUH. Hay que tender a cero en la demora de los pacientes U1 y U2. Podemos llegar a un consenso de buena asistencia e incidir en los problemas que derivan en una mayor demora según la gravedad de la patología (AU)

Background: First was to analyse the medical-care and medicaldiagnosis waiting time related to the severity of pathologies in order to measure the medical care quality in different Emergency Departments (ED) and second, comparison between several hospitals. Methods: Observational, multicentred and prospective study carried out during weekdays, from December 2002 to June 2003, including all patients treated from 8 a.m. to 3 p.m. in ED It was funded by a research grant from the Conselleria de Sanidad. The participants were four ED of public hospitals at the Valencian Community. Results: The average time it takes for a patient to walk into E.D until they were visited was 27 minutes; until they were diagnosed was 46 minutes and until they leaved ED. was 74 minutes. Overal waiting-time: 21.6%. Conclusions: Relating waiting time to severity is a good method for quality control in E.D. The trend should be zero waiting time in patients U1 and U2. Analysing the obtained data we could say is possible to reach a consensus on good care practice, and studying each ED it is feasible to correct the problems that cause a major delay depending on the severity of the pathology (AU)