[Triage in primary care emergency services]. / Triaje en los servicios de urgencia de atención primaria (sistema de triaje en atención primaria).

OBJECTIVE: To design and validate a triage system for emergency services in primary care. METHODS: A classification of 5 priority levels was used (red, orange, yellow, green and blue). The first phase of the project was documentation, a classification based on the International Classification of Primary Care (ICPC2), and grouping the reasons for consultation with their respective decision trees into 97 different codes. The second phase was a pilot with 115 patients in which two independent evaluators performed triage. In the third stage of validation, triage was carried out on patients arriving at the emergency services (23,168 patients) over an eight month period, with continuous monitoring of the results. RESULTS: The level of concordance between two independent observers in the patients of the pilot obtained a Kappa of 0.7. The time of triage was 108.82sec (SD; 94.14). The main reasons for consultation were ear, nose and throat problems (27.6%), respiratory (15.7%), and musculoskeletal (14%). Distribution by priority: red (0.1%), orange (8.3%), yellow (17.9%), green (62.7%), blue (11%). Triage discharges/hospital admittance levels: 3.79/3.36 (P<.05). Professionals agreed with the triage level in more than 99% of cases. CONCLUSIONS: The triage system shows good interobserver agreement results, has a good correlation with the referral hospital, and there was no disagreement with the opinion of professionals.

Triaje en los servicios de urgencia de atención primaria (sistema de triaje en atención primaria) / Triage in primary care emergency services

Objetivo. Diseñar y validar un sistema de triaje para los servicios de urgencia de atención primaria. Material y métodos. Se utilizó una clasificación en 5 niveles de prioridad. La primera fase del proyecto fue de documentación, se partió de la clasificación CIAP2 y se agruparon los diferentes códigos en 97 motivos de consulta con sus respectivos árboles de decisión. La segunda fase consistió en una prueba piloto con 115 pacientes en los que 2 evaluadores independientes llevaron a cabo el triaje. En la tercera fase de validación se realizó el triaje en los pacientes que acudieron a los servicios de urgencia (23.168 pacientes) durante 8 meses con un seguimiento continuo de los resultados. Resultados. Se comprobó el grado de concordancia entre 2 observadores independientes en los pacientes de la prueba piloto obteniéndose un índice Kappa de 0,7. El tiempo medio de triaje fue de 108,82 sg (dt 94,14). Los principales motivos de consulta fueron los problemas otorrinolaringológicos (27,6%), respiratorios (15,7%) y del aparato locomotor (14%). Distribución por prioridad: rojos (0,1%), naranjas (8,3%), amarillos (17,9%), verdes (62,7%), azules (11%). Media nivel triaje en altas/hospitalizados: 3,79/3,36 (p<0,05). Los profesionales estuvieron de acuerdo con el nivel de triaje en más del 99% de los casos. Conclusiones. El sistema de triaje presenta unos buenos resultados de concordancia entre observadores y tiene una buena correlación con la derivación hospitalaria, no encontrándose discordancias con la opinión de los profesionales(AU)

Objective. To design and validate a triage system for emergency services in primary care. Methods. A classification of 5 priority levels was used (red, orange, yellow, green and blue). The first phase of the project was documentation, a classification based on the International Classification of Primary Care (ICPC2), and grouping the reasons for consultation with their respective decision trees into 97 different codes. The second phase was a pilot with 115 patients in which two independent evaluators performed triage. In the third stage of validation, triage was carried out on patients arriving at the emergency services (23,168 patients) over an eight month period, with continuous monitoring of the results. Results. The level of concordance between two independent observers in the patients of the pilot obtained a Kappa of 0.7. The time of triage was 108.82sec (SD; 94.14). The main reasons for consultation were ear, nose and throat problems (27.6%), respiratory (15.7%), and musculoskeletal (14%). Distribution by priority: red (0.1%), orange (8.3%), yellow (17.9%), green (62.7%), blue (11%). Triage discharges/hospital admittance levels: 3.79/3.36 (P<.05). Professionals agreed with the triage level in more than 99% of cases. Conclusions. The triage system shows good interobserver agreement results, has a good correlation with the referral hospital, and there was no disagreement with the opinion of professionals(AU)

Evaluación del grado de estrés laboral en los profesionales sanitarios de los centros de salud del Área IV de Asturias / Evaluation of the levels of stress at work found in health professionals in health centres in Area IV of Asturias

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No disponible

Costes calidad de vida-artritis reumatoide. Estudio económico y de la calidad de vida de los pacientes con artritis reumatoide en España. Resultados preliminares / The costs and quality of life in rheumatoid arthritis study in Spain. Preliminary results

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El estrés laboral: un nuevo factor de riesgo. ¿Qué sabemos y qué podemos hacer? / Stress at work: a new risk factor. What do we know and what can we do?

No disponible

[Quality of life and neurologic diseases]. / Calidad de vida y enfermedades neurológicas.

BACKGROUND: The development reached by many countries of our planet has allowed that in them most of the infectious diseases have diminished and that the life expectancy is over the 75 years of life. As a result of this, degenerative and chronic diseases are every day more prevalent and their treatments are longer and complex. To value quality of life in these patients and the effect of the therapy on health is at the moment a main goal of public health. OBJECTIVES: To know the origin, the evolution, and the theoretical foundation of the concept of the quality of life, as well as their measurement methods. On the other hand, to describe the characteristics of the different available questionnaires in Spain to measure the quality of life, either of generic or specific for neurologic illness. MATERIAL AND METHODS: The most important questionnaires which have been adapted and validated into Spanish have been revised. An exhaustive revision of the bibliography related with quality of life and neurology was carried out, and all the questionnaires described in these processes were revised. RESULTS: We describe the philosophy and concepts of health, quality of life (QOL) and health related quality of life (HRQL). The following generic questionnaires are described: the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Medical Outcomes Study Short Form (SF-36), the European Profile of Quality of Life (EuroQoL), the Questionnaire of Quality of Life (CCV) and the Profile of Life quality in the Chronically ill (PLC). In an exhaustive bibliographical revision on quality of life and neurology, 52 indexed papers appeared, of those which only twelve were related with those subject. The following specific questionnaires are described: Qualité de Vie et Migraine (QVM), the Parkinson's Disease Questionnaire (PDQ-39), the Functional Status Questionnaire (FSQ), the Quality of Life in Epilepsy Inventory (QOLIE-89) and their variant of 31 items. Finally two questionnaires ad hoc are described to study migraine and epilepsy. CONCLUSIONS: The incorporation of HRQL measures in patients with neurological illnesses is an increasing and valued practice by its specialists. We observe that the availability of generic tools to measure the HRQL in Spanish is wider every day, although most of these come from other cultures. The process continued in their transcultural adaptation and validation allows us to have some tools of great reliability and effectiveness that facilitate its use. In relation to the specific questionnaires on neurologic process, the supply is considerably smaller due to the recent appearance of these methods in this clinic area.

Calidad de vida y enfermedades neurológicas / Quality of life and neurological diseases

FUNDAMENTO: El desarrollo alcanzado por muchos países de nuestro planeta ha permitido que la mayoría de las enfermedades infecciosas hayan disminuido y que la esperanza de vida sobrepase los 75 años. Esto ha dado lugar a que las enfermedades degenerativas de carácter crónico sean cada día más numerosas, y sus tratamientos, prolongados y complejos. Valorar la calidad de vida de estos pacientes y el efecto que sobre ella ejercen las terapias constituyen actualmente objetivos sanitarios de primer orden. OBJETIVOS: Conocer el origen, la evolución y el fundamento teórico del concepto de calidad de vida, así como sus métodos de medida. Por otro lado, describir las características de las diferentes herramientas disponibles en España para medir la calidad de vida, bien de carácter genérico o específicamente en procesos neurológicos. MATERIAL Y MÉTODO: Se han revisado los cuestionarios más importantes que han sido adaptados y validados en nuestro país. Se realizó una revisión exhaustiva de la bibliografía relacionada con la calidad de vida y la neurología, revisándose todos los cuestionarios descritos en estos procesos. RESULTADOS: Se exponen la filosofía y los conceptos de salud, calidad de vida (CDV) y calidad de vida relacionada con la salud (CVRS). Se describen los siguientes cuestionarios genéricos: el Perfil de Salud de Nottingham (NHP), el Perfil de las Consecuencias de la Enfermedad (SIP), el Cuestionario de Salud (SF-36), el Perfil de Calidad de Vida Europeo (EuroQOL), el Cuestionario de Calidad de Vida (CCV) y el Perfil de Calidad de Vida en Enfermos Crónicos (PECVEC). En una revisión bibliográfica exhaustiva sobre calidad de vida y neurología, aparecieron 52 trabajos referenciados, de los cuales sólo 12 estaban realmente relacionados con esos descriptores. Se describen los siguientes cuestionarios específicos: Perfil de Calidad de Vida y Migraña (QVM), el Cuestionario de la Enfermedad de Parkinson (PDQ-39), el Cuestionario del Estado Funcional (FSQ), el Inventario de Calidad de Vida en Epilepsia (QOLIE-89) y su variante de 31 ítems. Finalmente se describen dos cuestionarios realizados ad hoc para estudiar la migraña y la epilepsia. CONCLUSIONES: La incorporación de la medición de la CVRS en pacientes con enfermedades neurológicas es una práctica cada día mas frecuente y valorada por sus especialistas. Observamos que la disponibilidad de herramientas genéricas para medir la CVRS en nuestra lengua es cada día más amplia, aunque la mayoría proceden de otras culturas. El proceso seguido en su adaptación transcultural y validación permite que dispongamos de unas herramientas de gran fiabilidad y eficacia que facilitan su utilización. Con respecto a los cuestionarios específicos sobre procesos neurológicos, la oferta es considerablemente menor debido a lo reciente del empleo de estos métodos en esta área de la clínica (AU)

[Estimation of the blood donation necessary for self-sufficiency of blood products]. / Estimación de la donación necesaria para conseguir la autosuficiencia de hemoderivados.

PURPOSE: To estimate the rates of donations needed to achieve self-sufficiency in haemoderivatives, thought to be at least 50 donations per one-thousand inhabitants. MATERIAL AND METHODS: A method is presented to calculate the donation rate according to the variables that could affect self-sufficiency, namely, the number of blood components prepared and deferred; the mean volume of plasma units; the amount of fresh frozen plasma (FFP) and plasma derivatives used (albumin, factor VIII and intravenous immunoglobulins); the rates of appropriate usage of FFP, red-blood cells (RBC), platelets and plasma derivatives; the use of recombinant factor VIII; the rates of albumin, factor VIII and intravenous immunoglobulin yielded by each litre of plasma; the rate of autologous transfusion; the rate of outdated haemoderivatives, and the litres of plasma obtained from plasmapheresis per donor and year. RESULTS: The achievement of self-sufficiency without a plasmapheresis programme would imply a donation rate of 59 to 143 per one-thousand inhabitants, with simultaneous outdating or RBC from 79% to 49%, respectively. With such a programme the blood donations needs would be 32 to 26 per one-thousand inhabitants, those of plasmapheresis would be 29.9 to 9.1 per one-thousand inhabitants, and the outdated RBC would range from 7.6 to 0%. CONCLUSIONS: Because of the great variations in the rates of donation needs in order to achieve self-sufficiency, every Community Blood Centre would have to establish a programme to calculate and monitor all the factors related with blood supplies in its territory.

[Evaluation of the supplies, usage, and necessity of blood components in Asturias (1990-1995)]. / Evaluación de la obtención, uso y necesidad de componentes sanguíneos en Asturias (1990-1995).

PURPOSE: To assess the effectiveness of the transfusion network in Asturias regarding the autosufficiency in the production of haemoderivatives and their usage, as well as the components of the transfusion procedure in the period 1990-1995. MATERIAL AND METHODS: The procedure data and the results of donation, production and management and transfusion of blood components were analysed in a retrospective fashion. RESULTS: The overall production of haemoderivatives in the years analysed, 1990 and 1995, was, respectively, 55.8% and 64% of the overall usage. These figures correspond to 113% and 138% when applied to blood components for transfusion, and 15.9% and 27% with regard to plasma derivatives. On the other hand, it was estimated that 113% of the necessary haemoderivatives were transfused, respectively, in 1990 and 1995, corresponding to 121% and 112% for blood components, and 108% and 149%, respectively, for plasma derivatives. CONCLUSION: The Consultive Committee of the Community Blood Centres must establish a quality assurance programme for blood transfusion in order to monitor all the different steps of the transfusion procedure and to evaluate the accomplishment of the legal norms tending to achieve auto-sufficiency in blood derivatives.

[Assessment of the acquisition, use and needs of plasma derivatives in Asturias (1990-1995)]. / Evaluación de la obtención, uso y necesidad de plasma y derivados plasmáticos en Asturias (1990-1995).

PURPOSE: To estimate the effectiveness of the Asturias transfusion network in achieving self-sufficiency in plasma, derivatives, blood and blood components in the period from 1990 to 1995. MATERIAL AND METHODS: A retrospective study of the indicators of blood donation, production, management and transfusion of fresh frozen plasma and of the clinical usage of plasma derivatives in 1990 and 1995 was carried out. RESULTS: In 1990, 26.1% of the plasma and derivatives used were produced in Asturias (108% of the plasma transfused and 15.9% of that equivalent to the plasma derivatives). On the other hand, an estimated 112.4% of the plasma needed was used (FFP, 153%; plasma derivatives, 108.7%). In 1995, 32.2% of all the plasma and derivatives used were produced here (118% of the FFP transfused and 27.2% of the equivalent to the plasma derivatives used). The usage of the plasma necessary for clinical supplies was estimated in 149.0% of the needs (FFP, 138.9%; plasma derivatives, 149.6%). The volume of plasma-equivalent used in both years was higher for albumin than for factor VII. CONCLUSIONS: The Consulting Commission of the Blood Centre, with the participation of the Services of Pharmacy, has to establish a programme aimed to monitor all the aspects related with the use of plasma and to evaluate the degree of accomplishment of the obligation of attaining self-sufficiency in plasma.

[Use of elements from the ISO 90000 system in Spanish hemotherapy]. / Uso de los elementos del sistema ISO 9000 en la hemoterapia española.

PURPOSE: To evaluate the prevalence of all twenty elements of ISO 9000 in the practice of the Blood Banks of Spain independently of being certified or not to ISO system. MATERIALS AND METHODS: By a survey sent in november 1996 to the Hospital-Based Blood Bank and Transfusional Services of 225 hospitals with more than 100 beds, and to 25 Community Blood Centers. The survey had 38 questions on the all elements of the ISO system and on other aspects of quality no directly related with it, as to be accredited by transfusional accreditation Committee, to have an hospital transfusion committee, informed consent of the transfusion and guidelines for using hemoderivatives. RESULTS: The survey was answered by 53 (21%) of hospitals and Community Blood Centers. None of the participant were certified to ISO system. The elements more used were the documentation of adverse reactions, procedures manual, validation of blood components, control of nonconforming products, and product identification and traceability, all of them used for more than 80% of participants. On the contrary, the elements less used were to have a quality unit, equipment manual, to validate the computer system, internal quality audits, criteria on purchasing, training and quality manual, all of them used by less than 30% of the participants. CONCLUSIONS: Generally speaking the elements of the ISO system more commonly used are those related to the basic ones of daily work and the least used are those related to the organisation aspects of quality. The Community Blood Centers score higher than hospital blood banks and among these, the best results are in the blood banks of hospitals more than 500 beds and the hospital accredited for teaching.

[Assessment of the transcultural equivalence of the Spanish version of the profile of quality of life for chronic patients (PECVEC)]. / Evaluación de la equivalencia transcultural de la versión española del perfil de calidad de vida para enfermos crónicos (PECVEC).

BACKGROUND: In this work the transcultural adaptation and validation of a quality of life questionnaire has been approached, taking into account its increasing interest and its practice considerations. The Profil der Lebensqualität Chronischkranker (PLC) is a German instrument and titled in Spanish. Perfil de Calidad de Vida para Enfermos Crónicos (PECVEC). The main goal of the present study is the assessment of the transcultural equivalence between the Spanish version and the original questionnaire version. SUBJECTS AND METHODS: Translations and back-translations from the original instrument, using bilingual personnel, were made. The most important goal of the study was to achieve the more accurate equivalence between the original version and the Spanish version of the questionnaire. The translations were discussed between the groups of investigators in Germany and Spain and finally adapted a pretest that showed good statistical results. The instrument was applied in two groups of subjects paired by sex and age and its validation was made. RESULTS: The results of two studies (one German and other Spanish) are compared. In the Spanish study the Cronbach's Alpha coefficient (range: 0.39-0.97) and the factorial analysis of the items showed good internal consistency. Cronbach's Alpha was higher than 0.6 for all dimensions except for the scale of Social Well-Being (0.39) with an average value 0.72. The comparison between two factorial structures showed that both are similar statistically. The adapted version showed discriminant capacity between groups ("known group validity") and the final scores of quality of life were similar to the original version. CONCLUSIONS: The adaptation process from the original version to the Spanish version has finished with a transcultural equivalence between both. This preliminary validation can be seen as an important starting point to increase, in this field, the number of instruments of assessment health-related quality of life in chronic patients in Spanish language.