Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals.

A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.

[Diagnosis of peripheral neuropathies: a clinical and neurophysiological study]. / Sobre el diagnóstico de las neuropatías periféricas: estudio clínico y neurofisiológico.

INTRODUCTION: The diagnosis of peripheral neuropathy is based on clinical and neurophysiological features. This study aims to establish the diagnostic validity of different symptoms and clinical signs, as well as its correlation with electroneurography (ENG), to determine its sensitivity (SE), specificity (SP), positive (PLR) and negative likelihood ratio (NLR) for every peripheral neuropathies type. PATIENTS AND METHODS: A sample of 108 patients with clinical suspicion of peripheral neuropathy (pain, paresthesias, loss of strength, areflexia) was studied. ENG (nerve conduction velocity and response amplitude values in 208 nerves [Median and Posterior Tibial]) was used to confirm the diagnosis, classifying the sample in axonal group (A), demyelinating (D) and normal (N). It was made descriptive statistics of this sample, studies of SE, SP, PLR and NLR of symptoms, and association (contingency tables [Chi square] and Odds Ratio) between symptoms and clinical features. RESULTS: The patients with paresthesias, loss of strength or pathologic reflexes have larger motor latency (p< 0.01). Those with paresthesias, areflexia or pain have fewer sensitive conduction velocity (p< 0.05). Symptoms's value for sensory damage's diagnosis is (SE= 0.92, SP= 0.48, PLR= 1.78, NLR= 0.14). For motor damage (SE= 0.72, SP= 0.68, PLR= 2.25, NLR= 0.41). For axonal damage (SE= 0.83, SP= 0.44, PLR= 1.49, NLR= 0.37). And for demyelinating damage (SE= 0.92, SP= 0.44, PLR= 1.66, NLR= 0.16). CONCLUSIONS: The symptoms's combination is much more sensitive and has fewer NLR than each isolated symptom in all neuropathic damage's types. Paresthesias's presence is more indicative of sensory damage and loss of strength of motor damage. Pain is the only symptom that can aim for axonal damage than demyelinating.

Sobre el diagnóstico de las neuropatías periféricas: estudio clínico y neurofisiológico / About peripheral neuropathies diagnosis: a clinical and neurophysiological study

Introducción. El diagnóstico de neuropatía periférica está basado en los hallazgos clínicos y neurofisiológicos. Objetivo. Establecer la validez diagnóstica de los síntomas y signos clínicos, así como su correlación con los estudios de electroneurografía (ENG), para determinar su sensibilidad (S), especificidad (E), y cociente de probabilidad positivo (CPP) y negativo (CPN) en cada tipo de neuropatía. Pacientes y métodos. Muestra de 108 pacientes con sospecha clínica de neuropatía periférica (dolor, parestesias, pérdida de fuerza, arreflexia). La ENG (estudios de conducción nerviosa y valores de respuesta en amplitud de 208 nervios [mediano y tibial posterior]) se usó para confirmar el diagnóstico, clasificando la muestra en grupo axonal (A), desmielinizante (D) y normal (N). Se realizó estadística descriptiva de la muestra, estudio de S, E, CPP y CPN de los síntomas, y asociación (tablas de contingencia con ji al cuadrado y odds ratio) entre síntomas y hallazgos clínicos. Resultados. Los pacientes con parestesias, pérdida de fuerza o arreflexia tienen mayor latencia motora (p< 0,01), y aquellos con parestesias, arreflexia o dolor tienen menor velocidad de conducción sensitiva (p< 0,05). El valor de los síntomas para el diagnóstico de afección sensitiva es (S= 0,92, E= 0,48, CPP= 1,78, CPN= 0,14). Para afección motora es (S= 0,72, E= 0,68, CPP= 2,25, CPN= 0,41). Para afección axonal (S= 0,83, E= 0,44, CPP= 1,49, CPN= 0,37). Y para afección desmielinizante (S= 0,92, E= 0,44, CPP= 1,66, CPN= 0,16). Conclusiones. La combinación de los síntomas es mucho más sensible y tiene menor CPN que los síntomas aislados en todos los tipos de neuropatía. La presencia de parestesias es más indicativa de lesión sensitiva y la pérdida de fuerza de lesión motora.El dolor es el único síntoma que puede orientar más al diagnóstico de lesión axonal que desmielinizante (AU)