Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo / Quality of care indicators for benign prostatic hyperplasia. A qualitative study

OBJETIVO: Valorar posibles indicadores de calidad de la atención a la hiperplasia benigna de próstata (HBP) y sus fortalezas y debilidades para su incorporación a los sistemas de información sanitaria. DISEÑO: Reunión de expertos, estructurada siguiendo procedimientos adaptados de las técnicas de grupo nominal y método de consenso Rand. Emplazamiento: Escuela Valenciana de Estudios de la Salud. Participantes y/o contextos: Participaron 40 panelistas (74% médicos, 70% del ámbito de la atención primaria) con experiencia en el manejo de la HBP pertenecientes a 15 Departamentos de la Agencia Valenciana de Salud. MÉTODO: Se realizaron 3 talleres simultáneos (exploración y diagnóstico, tratamiento farmacológico y adecuación y resultados) en los que se valoraron los 15 indicadores seleccionados por el grupo coordinador. RESULTADOS: Once de los 15 indicadores obtuvieron puntuaciones en el rango de alta relevancia. Los 5 mejor valorados fueron: el uso de alfabloqueante + inhibidores de la 5 alfa-reductasa a partir de determinado nivel de gravedad, el tacto rectal en la valoración inicial, el seguimiento con el Índice Internacional de Síntomas Prostáticos (IPSS), la tasa de sondaje urgente en urgencias hospitalarias, la valoración inicial con el IPSS y el uso de alfabloqueante previo a la retirada de sonda por retención aguda de orina. CONCLUSIONES: Parte de los indicadores valorados pueden ser útiles para su incorporación a los sistemas de información sanitaria

OBJECTIVE: To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. DESIGN: Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. Setting: Valencian School of Health Studies. Participants and/or contexts: Forty panel lists (74% doctors, 70% from primary care settings)with experience in the management of BPH from 15 departments of the Valencia Health Agency. METHOD: Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. RESULTS: Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. CONCLUSIONS: Some of the assessed indicators can be useful for incorporation into health information systems

[Quality of care indicators for benign prostatic hyperplasia. A qualitative study]. / Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo.

OBJECTIVE: To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. DESIGN: Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. SETTING: Valencian School of Health Studies. PARTICIPANTS AND/OR CONTEXTS: Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. METHOD: Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. RESULTS: Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. CONCLUSIONS: Some of the assessed indicators can be useful for incorporation into health information systems.

[Development and validation of a new questionnaire to assess health care satisfaction and the device in stomized patients: espejo questionnaire]. / Cuestionario espejo. Valorar la satisfacción de pacientes ostomizados con la atención sanitaria y el dispositivo.

OBJECTIVES: To develop a questionnaire to measure the satisfaction of stomatised patients with healthcare professionals and with the stomal device. METHODS: An initial review of the literature was performed and in meetings with experts, the most relevant items were selected. In a pilot study with patients that had been recently stomatised (three months from intervention), the comprehensibility and discriminatory ability of each item was tested. Items were eliminated on the grounds of frequent "no response" or low correlation with others on the provisional scale (determined by means of Cronbach's alpha). RESULTS: Following meetings with experts, 12 items were eliminated by reason of irrelevance or low frequency of use. Subsequently by means of administration of the questionnaire to a sample of 72 patients, five more items were selected for elimination. An analysis of the 13 items that remained confirmed an acceptable level of reliability (Cronbach's alpha of 0.917) and also the significant differences in the global scores between the patients who have had stoma for more than three months (higher satisfaction) and patients who had been recently stomatised. The items in the questionnaire referred to aspects of easy and comfort of use of the stoma, as well as satisfaction with information received and interaction with healthcare professionals from the point of view of the patient. CONCLUSIONS: This is the first questionnaire to measure satisfaction with healthcare professionals and the stomal device from the perspective of the stomatised patient. In a subsequent study the other properties of the measurement tool (validity responsiveness and longitudinal validation) will be evaluated.

A prospective, longitudinal, multicenter, cohort quality-of-life evaluation of an intensive follow-up program for patients with a stoma.

The creation of a stoma can profoundly affect a patient's quality of life. A prospective, 3-month multicenter study was conducted to evaluate stoma patient quality of life among volunteers receiving standard clinical follow-up (S) and those receiving intensive follow-up via telephone (I). A total of 336 patients volunteered to participate; 187 in the S group and 149 in the I group; mean age 63+/-14 years, 65.85% male; the majority (64.3%) had a colostomy. The Stoma Quality of Life Index (SQLI) score was determined at the initial and final visits. No statistically significant difference between the I and S groups was found at baseline except for the subcategory social concerns (P = 0.0123). At 3 months, statistically significant changes were observed between the overall SQLI score of both groups--scores were 58.8 (17.7) and 72.8 (14.6) at baseline and 3 months, respectively (P < 0.0001); in particular, for the subcategories patient satisfaction (P = 0.0173) and medical experience (P = 0.0330). Patients in the I group showed a positive but not statistically significant change in three subscales of the SQLI questionnaire; the I group presented slightly lower differences in the percentage of complications related to the stoma, need for emergency assistance, and for hospitalization. Differences in quality-of-life perceptions also were reflected among geographic areas. Preoperative ostomy nurse care was found to be associated with a greater probability for improvement in select SQLI subscales. The results of this study confirm that personal support and help received pre- and post surgery from ostomy care nurses may enhance ostomate overall quality of life and when additional intensive follow-up was introduced, certain aspects of quality of life improved. The study underscores the need for clinician awareness of their role in patient quality of life.

Detección sérica de PSA mediante un test rápido (SD Bioline PSA) / Fast tenst serum PSA determination (Sd Bioline PSA)

OBJETIVO: En los últimos años han aparecido numerosos test semicuantitativos para la determinación de PSA, basados en la inmunocromatografía, realizados sobre suero o plasma. Presentamos nuestra experiencia en el uso del test SD BIOLINE PSA, que se realiza en plasma o suero para determinación cualitativa de PSA de forma rápida, y que usa como punto de corte 3 ng/mL. MÉTODO: Se analizaron un total de 54 pacientes que estuvieron ingresados en nuestra sala de hospitalización. Se extrajeron dos muestras de sangre a todos los paciente una para determinación cuantitativa de PSA en el laboratorio de nuestro hospital y otra para la determinación cualitativa con el test SD BIOLINE PSA, posteriormente comparamos ambos resultados. Dos urólogos interpretaron de forma independiente el test sin conocer los valores de PSA obtenidos en laboratorio. Para calcular el efecto del tiempo de lectura del test se leyó a los 15, 20 y 25 minutos. Los resultados fueron clasificados en una tabla de contingencia clásica, lo cual nos permitió calcular la sensibilidad y especificidad del test, así como el valor predictivo positivo y el valor predictivo negativo. RESULTADOS: La edad media fue de 71.1 años (rango de 43-96 años). De los 54 pacientes sometidos al estudio 26 (48.14%) tuvieron un PSA > 3 ng/mL (media 18,5 ng/mL, rango 3.9-66.9 ng/mL) y 28 (51.86%) presentaron un PSA < 3 ng/mL (media 0.8 ng/mL, rango 0-2.9 ng/mL), en el análisis ordinario. Los resultados en cada intervalo y por observador fueron los siguientes: 15 minutos: Observador 1: sensibilidad(S) 76.92%, especificidad (E) 100%, valor predictivo positivo (VPP) 100%, valor predictivo negativo (VPN) 82.35%; Observador 2: S 76.92%, E 100%, VPP 100%, VPN 82.35. 20 minutos: Observador 1: S 100%, E 93.33%, VPP 92.30%, VPN 100%; Observador2: S 100%, E 93.33%, VPP 92.30%, VPN 100%. 25 minutos: Observador 1: S 100%, E 85.71%, VPP 86.66%, VPN 100%; Observador 2: S 92.30%, E 92.85%, VPP 92.30%, VPN 92.85%. CONCLUSIONES: El test SDBioline cumple las características necesarias para ser utilizado como prueba de detección del PSA, es simple, rápido, barato, poco invasivo y presenta una buena efectividad (AU)

OBJECTIVES: Over the last years numerous semiquantitative PSA tests have appeared , based on serum or plasma immunochromatography. We present our experience using the SD BIOLINE PSA test, which is performed with plasma or serum for fast qualitative determination of PSA; the cut point is 3 ng/ml. METHODS: We analized 54 patients who were admitted in our hospital ward. Two blood samples were obtained from every patient, one for cuantitative PSA determination at the hospital laboratory and the other one for qualitative determination with the SD BIOLINE PSA test, and the results were compared.. Two urologists independently interpreted the test without knowing the PSA values from the lab. To calculate the effect of test reading time, readings were performed at 15, 20 and 25 minutes. Results were classified in a classic contingency table, which enabled us to calculate sensitivity and specificity of the test, as well as positive and negative predictive values. RESULTS: Mean age was 71.1 years (range 43-96 yr). From 54 patients in the study 26 (48.14%) had a PSA > 3 ng/ml (Mean 18.5 ng/ml, range 3.9-66.9 ng/ml) and 28(51.86%) PSA < 3 ng/mL (mean 0.8 ng/mL, range 0-2.9 ng/mL), in the conventional test. Results for each interval and observer were: 15 min: Observer 1: Sensitivity (S) 76,92%, specificity (E) 100%, positive predictive value (PPV) 100% , negative predictive value(NPV) 82.35%; Observer 2: S 76.92%, E 100% , PPV 100%, NPV 82.35%. 20 minutes: Observer 1: S 100%, E 93.33%, PPV 92.30%, NPV 100%; Observer 2: S 100%, E 93.33%, PPV 92.30% ,NPV 100%. 25 minutes: Observer 1: S 100% , E 85.71%, PPV 86.66%, NPV 100%; Observer 2: S 92.30%, E 92.85%, PPV 92.30%, NPV 92.85%. CONCLUSIONS: The SD Bioline PSA test complies with the characteristics required to be used as a test for prostate cancer detection, it is simple, fast, cheap, not much invasive, and has a good efficacy (AU)

Protocolos de enfermería urológica como necesidad en la relación especializada-primaria Comparativa 1996-2006 / No disponible

No disponible

Mitos de la morfina entre el personal de enfermeria urológica / No disponible

Los enfermos con cáncer de origen urológico, sufren dolor con elevada frecuencia, sobre todo en las últimas fases de la enfermedad. Aliviar este síntoma tan molesto debe ser una prioridad de todo el personal sanitario. Considerándose el control del mismo, como uno de los factores que más influyen en la valoración subjetiva, de la calidad del servicio que reciben los pacientes. Hoy en día la O.M.S. considera que uno de los medicamentos más eficaces, para el control del dolor es la morfina y sus derivados. Lamentablemente los opiáceos, hoy en día todavía suscitan temores míticos entre los profesionales sanitarios, en la mayoría de los casos totalmente injustificados, como una vez más se demuestra en el presente estudio (AU)

The patients with urologic cancer, suffer pain with high frequency, mainly in the last phases of the disease. To alleviate this so annoying symptom must be a priority of all the sanitary personnel. Considering the control of he himself, like one of the factors that influence more in the subjective valuation, of the quality of the service that receives the patients. Nowadays the O.M.S considers that one of the most effective medicines, for the control of the pain is morphine and its derivatives. Lamentably the opiate ones, nowadays still provoke mythical fears between the sanitary professionals, in most of the cases totally false, once again it is demonstrated in the present study (AU)

Beneficios del ejercicio físico en la recuperación del paciente intervenido de Bricker / No disponible

No disponible