¿Quién realiza los controles de salud en la Comunidad Valenciana? Propuestas de mejora / Who performs health checks in the Valencian Autonomous Community? Improvement proposals

Introducción: el objetivo principal es conocer la cobertura de la enfermería pediátrica en el Programa de Salud Infantil (PSI) y como objetivos secundarios analizar la aceptación, competencia y necesidades formativas de los equipos de Pediatría y enfermería en la Comunidad Valenciana (CV). Material y métodos: estudio transversal, descriptivo, de los datos recogidos mediante encuesta online anónima realizada a pediatras y enfermeros de la CV durante dos meses de 2014 sobre quién realiza y quién debería realizar los controles del PSI y las aptitudes y necesidades formativas detectadas. Resultados: un 87% de los encuestados refirió disponer en su centro de enfermería pediátrica. Realizan controles conjuntamente, enfermera y pediatra, en un 70% de los casos. Las habilidades principales de la enfermería se consideran: consejo sobre alimentación, hábitos saludables y vacunación. La mitad de encuestados reconocen necesidades formativas. El 95% de los encuestados considera que es necesario disponer de enfermería pediátrica en los centros de salud. Uno de cada cuatro de los controles que realizan los pediatras en solitario se corresponde con las visitas iniciales del recién nacido, en la primera semana y el mes de vida. Conclusión: todas las unidades asistenciales deben estar constituidas por personal de enfermería y pediatra. Las agendas de citación de enfermería tienen que ser flexibles para permitir su participación en los controles de salud de la primera semana y primer mes de vida del niño. En los programas de formación continuada deben implementarse contenidos acordes a las necesidades detectadas en este estudio para el desempeño de su actividad en el PSI (AU)

Introduction: our main objective was to determine the overall pediatric nursing coverage on the Well Child Care (WCC) visits and the secondary objective was to assess acceptance, skills and training needs of pediatrics and nursing teams in Primary Care of the Comunitat Valenciana. Material and Methods: cross sectional descriptive study from data collected through anonymous online surveys to pediatricians and nurses for two months in 2014. They were asked about who performs and who should perform and abilities and training needs identified. Outcomes: among those responding to the survey, 87% have referred to have pediatric nursing at their offices. 70% WCC visits have been delivered jointly by pediatrician and nurse. Main nursing abilities have been considered: advice on feeding, healthy lifestyle and immunizations. Half of the respondents recognize training needs. 95% surveyed believe that it’s mandatory to have pediatric nurses in all primary care settings. One out of four visits performed by pediatricians alone corresponds to early visits along the first month of life. Conclusions: all Primary Care Units should be formed of pediatricians and nursing staff. The nursing work schedules must be flexible enough to enable their participation in the first WCC visits. In continuing education programs, the contents should be implemented according to the needs identified in this study for the performance of the activity in the WCC (AU)

Gestión clínica de un servicio de urgencias hospitalario: indicadores de calidad, benchmarking y análisis de la casuística (case-mix) / Clinical management of a hospital emergency department: quality indicators, benchmarking and case-mix analysis

Introducción: La monitorización sistemática de indicadores de calidad y de actividad asistencial, y su comparación mediante técnicas de benchmarking, son herramientas fundamentales como complemento al análisis de la casuística (case-mix), para conocer el perfil de un servicio de urgencias hospitalario (SUH).Objetivos: Analizar el comportamiento de algunos indicadores, aplicando técnicas de benchmarking, y evaluar la casuística de un SUH que dispone de un modelo de triaje de urgencias estructurado de 5 categorías (modelo andorrano de triaje: MAT).Métodos: Análisis longitudinal de todos los episodios de urgencia registrados durante el año 2002 en nuestro SUH, utilizando 2 herramientas electrónicas diseñadas para tal efecto: el programa de gestión del triaje y la estación clínica de trabajo de urgencias. Describimos nuestra casuística basándonos en el nivel de urgencia de los pacientes (grupos relacionados con la urgencia, el destino desde urgencias y la edad: GRUDE).Resultados: Durante el año 2002 se registraron en urgencias 35.731 pacientes. Los indicadores de calidad y de actividad analizados en el benchmarking mostraron un comportamiento dentro de los estándares de calidad establecidos. Respecto al análisis de la casuística, los GRUDE más frecuentes fueron el 27 (21,48 por ciento), el 28 (21,07 por ciento), el 31 (15,49 por ciento) y el 29 (13,39 por ciento); en estos 4 GRUDE se incluyó al 71,43 por ciento de los pacientes. Conclusiones: El MAT y nuestra estación clínica de trabajo han demostrado ser instrumentos que permiten realizar, con comodidad, el análisis de nuestra casuística y aportan una información fundamental a la gestión de la calidad de nuestro servicio (AU)

Estudio clínico controlado de la sacarosa como reductor de la duración del llanto en lactantes en el momento de la vacunación / Controlled clinical study of sucrose administration to reduce the duration of crying in infants undergoing vaccination

Objetivo: Valorar el efecto de la solución de sacarosa al 75%, administrada por vía oral, sobre el tiempo de duración del llanto en la vacunación a lactantes. Material: Ensayo clínico controlado, aleatorizado, doble ciego, de solución de sacarosa al 75% o agua potable como control. Pacientes: Un total de 323 controles de salud fueron atendidos a la edad de 1,2, 4 o 6 meses para ser vacunados de hepatitis B o de difteria, tétanos, tos ferina y Haemophilus influenzae tipo B (DTPHib). Método: Se midió el tiempo de duración del llanto desde el momento de administrar la vacuna intramuscular hasta el cese del llanto arropado en el brazo materno. Resultados: La administración de 2 mL de sacarosa al 75% reduce el tiempo de duración del llanto después de la inmunización de hepatitis B o DTPHib, diferencia de medias de 5,05 seg. (IC 95% entre -9,2835 y -0,8110 seg.) (p<0,02). El número necesario de niños (NNN) a los que hay que administrar 2mL de sacarosa previo a la inmunización para obtener un tiempo de duración del llanto inferior o igual a 25 segundos (media de tiempo de duración del llanto del grupo de sacarosa) fue de 11 (IC 95%=5 a infinito). Conclusiones: Durante las inmunizaciones intramusculares, la administración de soluciones de sacarosa en altas concentraciones tiene efectos clínicamente modestos en cuanto a la reducción del tiempo de duración del llanto (AU)

Objective: To evaluate the effect of an oral sucrose solution on infant crying times in immunization clinics. Methodology: Randomised, double blind, placebo-controlled trial involving a 75% sucrose solution or drinking water as a control. Patients: A total of 323 infants receiving 1, 2, 4 or 6-month intramuscular immunization against hepatitis B virus or against diphtheria, tetanus, pertussis and haemophilus influenza type B (DTPHib). Methods: The duration of infant crying was recorded during and immediately after intramuscular vaccine injection until it ceased in the mothers’ arms. Results: The administration of 2 ml 75% surcrose reduced the infant crying time after immunization against hepatitis B virus or DTPHib, with a mean difference of 5.05 seconds (95% CI between – 9.2835 and -0.8110 seconds) (p < 0.02). The number of children to whom it was necessary to administer 2 ml of sucrose prior to immunization to obtain a crying time of less than or equal to 25 seconds (mean duration of crying in the sucrose group) was 11 (95% CI=5 to infinite). Conclusions: During intramuscular immunization, the administration of sucrose solutions at high concentrations has only clinically modest effects in terms of reducing the duration of crying (AU)

[Determinants of the use of pediatric consultations: study of child morbidity and maternal variables]. / Determinantes del uso de las consultas de pediatría: estudio de morbilidad infantil y variables maternas.

OBJECTIVE: To know the relations of the frequency of the pediatrics consultations with the maternal use of the consultations of family medicine, the maternal perception of his son's health, the events happened previously in the family, the infantile morbidity and socioeconomic condition. DESIGN: Prospective and observational study, duration 12 months. EMPLACEMENT: Primary care. PATIENTS: 261 children from 0 to 12 years old selected by systematic randomized pattern. The mother was required to have history in the center. MEASUREMENTS AND RESULTS: The dependent variable was the frequentation to the pediatric clinics, and the independent variables were the mother frequentation to the medical clinics; perception of its son's health, measured by health questionnaire; inventory of previous events according to Holmes and Rahe's questionnaire; sociodemographic variables and children morbidity registered in the medical files. The mean of infantile frequentation proved to be 10.18 visits per year (7.9 DS). 12% of children were high users and they accounted for 42% of all contacts. The variables associated to the frequentation were: age smaller than the boy, infantile morbidity and maternal frequent to the medical services, p < 0.001 for each one the variables. Those variables explained 40.8% of the variance in volume of care. CONCLUSIONS: The maternal use exercises an independent influence in the use of the pediatric services. Educative performances directed to the mother could improve this behaviour. The age is a predisposing factors of frequentation to the infantile services. The conditions of health are a potent predictor of frequentation, those children require more cares to attend their needs. Educational strategies which improve the level of maternal cares to the child in situation of illness could diminish the cares which are offered in pediatrics.

Oxygen transport of hemoglobin in high-altitude animals (Camelidae).

To clarify the mechanisms by which high-altitude Camelidae can adapt to hypoxia, the study of some blood characteristics were carried out in apacas and llamas. The results show that there is a peculiar dissociation curve of hemoglobin in alpacas which permits great affinity of hemoglobin for oxygen at lung level and the release of oxygen at the tissue level with a facility similar to that in man. Fetal hemoglobin was found high in adult alpacas (55 percent). Electrophoretic studies of hemoglobin showed that this pigment has two components, both of which have a very low mobility. Lactic dehydrogenase was found six times higher than in humans. RBC glucose-6-phosphate dehydrogenase was two times higher than in man living at the same altitude. Myoglobin was found to be higher than in man living at altitude. Alpacas have erythrocytes in which the amount of 2,3-DPG is approximately the same as in man. RBC are more resistent to hypotonic solutions than humans. The amount of lactic dehydrogenase, myoglobin, and glucose-6-phosphate dehydrogenase dimishes when alpacas are bought down to sea level.

Effect of altitude on oxygen binding by hemoglobin and on organic phosphate levels.

The relationship between oxygen dissociation and 2,3-diphosphoglycerate (2,3-DPG) in the red cell has been studied in subjects moving from low to high altitude and vice versa. Within 24 hr following the change in altitude there was a change in hemoglobin affinity for oxygen; this modification therefore represents an important rapid adaptive mechanism to anoxia. A parallel change occurred in the organic phosphate content of the red cell. While this study does not provide direct evidence of a cause-effect relationship, the data strongly suggest that with anoxia, the observed rise in organic phosphate content of the red cell is responsible for increased availability of oxygen to tissues.