La calidad en el Bloque Quirúrgico del Hospital Clínico San Cecilio. La perspectiva del cliente interno / Quality in the anesthesia department of San Cecilio Hospital from the professionals' perspective

Objetivo. Evaluar la calidad de los servicios prestados por el Bloque Quirúrgico (BQ) del Hospital Clínico Universitario San Cecilio (HUSC), desde el punto de vista del personal sanitario del hospital. Material y métodos. Emplazamiento: Andalucía. Participantes: 134 profesionales con contacto con el BQ del HUSC. Instrumento: cuestionario de elaboración propia, con las siguientes dimensiones: accesibilidad, trato personal, confortabilidad, calidad científico-técnica (escala 1-5 puntos), satisfacción global (escala 0-10) y propuestas de mejora. El análisis incluyó estudio descriptivo, correlación, diferencia de medias (según sexo, frecuencia de la relación y unidad de gestión clínica [UGC]) y modelo de regresión lineal. Resultados. La calidad del trato tuvo una media de 4,2 puntos (DT 0,5), la calidad científico-técnica de 4,0 (DT 0,5), la accesibilidad de 3,3 (DT 0,7), el confort del personal sanitario de 3,3 puntos (DT 0,9) y de los pacientes de 2,6 (DT 1,0). La satisfacción total con las prestaciones del BQ fue de 7,1 (escala 0-10). La evaluación del BQ es mejor entre las mujeres y las UGC con menos de 10 profesionales. Peor valoración se recibe por parte de las UGC con contacto diario con el BQ. Entre las propuestas de mejora se recogieron: reducir listas de espera, crear espacios de información a familiares, mejorar las condiciones laborales, la formación y la satisfacción del personal del BQ, la comunicación y colaboración interprofesional. Conclusiones. La evaluación realizada por profesionales sanitarios de otras UGC muestra la necesidad de formación del personal del BQ, así como de intervenciones en la organización e infraestructuras, con el objetivo de mejorar la calidad asistencial y la satisfacción general de profesionales y ciudadanía (AU)

Objective. To evaluate the quality of the services provided by the anaesthesia department of the San Cecilio Clinical University Hospital, from the health professionals’ point of view. Material and methods. Location: Andalusia. Participants: 134 health professionals in contact with the hospital anaesthesia department. Tool: self-administered questionnaire, measuring: accessibility, personal treatment, comfort, scientific and technical quality (scale 1 to 5), overall satisfaction (scale 0 to 10), and suggestions for improvement. A descriptive statistical and correlation analysis were performed, including mean differences (by sex, frequency of contact with the anaesthesia department, and unit), as well as a regression model. Results. The quality of personal treatment received a mean of 4.2 points (SD 0.651), the scientific and technical quality 4.00 points (SD 0.532), accessibility 3.3 (SD 0.795), professional comfort 3.30 (SD 0.988), and patient comfort 2.62 points (SD 1.051). Overall satisfaction obtained a mean of 7.1 points (0 to 10 scale). Women and professionals working in units with less than 10 people had a better general evaluation of the anaesthesia department. The worse perspective was that of staff with daily contact with the anaesthesia department. Among the suggestions for improvement there were: Reducing waiting lists, creating special rooms to give information to families, improving working conditions, training and work satisfaction for staff, and achieving better communication and collaboration between health professionals. Conclusions. The internal evaluation shows the need for training strategies and organisational interventions in the anaesthesia department, in order to achieve a better quality and satisfaction for both professionals and patients (AU)

[Quality in the anesthesia department of San Cecilio Hospital from the professionals' perspective]. / La calidad en el Bloque Quirúrgico del Hospital Clínico San Cecilio. La perspectiva del cliente interno.

OBJECTIVE: To evaluate the quality of the services provided by the anaesthesia department of the San Cecilio Clinical University Hospital, from the health professionals' point of view. MATERIAL AND METHODS: Location: Andalusia. PARTICIPANTS: 134 health professionals in contact with the hospital anaesthesia department. Tool: self-administered questionnaire, measuring: accessibility, personal treatment, comfort, scientific and technical quality (scale 1 to 5), overall satisfaction (scale 0 to 10), and suggestions for improvement. A descriptive statistical and correlation analysis were performed, including mean differences (by sex, frequency of contact with the anaesthesia department, and unit), as well as a regression model. RESULTS: The quality of personal treatment received a mean of 4.2 points (SD 0.651), the scientific and technical quality 4.00 points (SD 0.532), accessibility 3.3 (SD 0.795), professional comfort 3.30 (SD 0.988), and patient comfort 2.62 points (SD 1.051). Overall satisfaction obtained a mean of 7.1 points (0 to 10 scale). Women and professionals working in units with less than 10 people had a better general evaluation of the anaesthesia department. The worse perspective was that of staff with daily contact with the anaesthesia department. Among the suggestions for improvement there were: Reducing waiting lists, creating special rooms to give information to families, improving working conditions, training and work satisfaction for staff, and achieving better communication and collaboration between health professionals. CONCLUSIONS: The internal evaluation shows the need for training strategies and organisational interventions in the anaesthesia department, in order to achieve a better quality and satisfaction for both professionals and patients.

Manejo anestesico del sindrome Hellp / Anesthesic management of Hellp syndrome

Síndrome HELLP es una forma grave de hipertensión inducida por el embarazo que afecta gravemente a la madre y al feto. Se caracteriza por hemólisis, elevación de enzimas hepáticas y trombopenía. El manejo anestésico de este síndrome es complejo y debe basarse en las características de la enfermedad preeclámptica la situación materna y fetal así como la urgencia del proceso

[Inadequate secretion of atrial natriuretic peptide in children with acute brain injury]. / Secreción inadecuada de péptido natriurético auricular en niños con daño cerebral agudo.

OBJECTIVE: Fluid and electrolyte disturbances are frequent after acute brain damage. Atrial natriuretic peptide (ANP), which can also be found in brain tissue, could be a hormone implicated in such disorders (cerebral salt wasting syndrome). PATIENTS AND METHODS: Plasma ANP levels were analyzed in 50 children with acute neurological deterioration (secondary to traumatic, infectious, convulsive tumor or vascular disorders) evaluated according to the modified Glasgow Coma Scale (GCS). Hemodynamic stability was determined by standard monitoring. ANP, renin and aldosterone levels were determined by RIA and the results compared with a control group of healthy children. RESULTS: There was an increase in ANP levels in children with brain injury in comparison to the control group (p < 0.001), but not in children under one year of age. Renin and aldosterone were also significantly increased in this group of patients, with no difference in ANP, renin or aldosterone level found in function of their GCS score. All patients were hemodynamically stable and no correlation between hemodynamic and hormone variables was seen. Mechanical ventilation did not influence the hormone levels. CONCLUSIONS: There is an important increase in ANP levels in patients with acute neurological pathologies, but it was not related to the hemodynamic condition and its importance has yet to be established. One of its possible consequences is a secondary hypotonic/hypovolemic condition, a potentially dangerous event for the patient with intracranial hypertension that needs immediate treatment. Differentiation of this syndrome from inappropriate vasopressin secretion could be very important in children with acute brain injury.

Induction of interleukin-1 alpha production by Porphyromonas gingivalis in mononuclear blood cell cultures from periodontitis patients.

The capacity of mononuclear blood cells to produce interleukin-1 alpha (IL-1 alpha) after stimulation with Porphyromonas gingivalis in cell culture was studied. The results obtained with cells from periodontitis patients were compared with those from a control population. The concentration of IL-1 alpha in serum and saliva was also determined and compared with the concentration in mononuclear blood cell cultures. No significant relationship was found between the incidence of periodontitis or severity of the lesions and IL-1 alpha production in the presence of P. gingivalis. Nevertheless, 11 of 30 periodontitis patients, showed levels > 30 pg/ml of IL-1 alpha in mononuclear blood cell cultures stimulated by P. gingivalis, whereas only three healthy control showed these titers of IL-1 alpha.