Situación actual de las unidades del dolor crónico en la Región de Murcia / No disponible

Objetivo: conocer la situación actual, en términos de organización y administración, de las Unidades del Dolor Crónico (UDO) de los hospitales públicos de la Región de Murcia. Material y método: encuesta on-line que exploraba aspectos de estructura y de proceso, dirigida a cada uno de los responsables de las UDO de todos los hospitales públicos del Servicio Murciano de Salud. Resultados: respondieron el 87,5% de las UDO, que representan una cobertura poblacional del 90% de la Región, todas ellas dirigidas por un anestesiólogo, de las que el 85,7% eran multi-disciplinares. Cada UDO realiza una media de 4,6 consultas y 0,75 quirófanos semanales. El 42,8% dedican a la asistencia menos de 8 h a la semana. Con una demora media para primera demanda de 66 días y de 49,2 para las revisiones, siendo la demanda mensual de primeras visitas de 32,5 pacientes. Algunas UDO expresan rechazar ciertos procesos dolorosos. El 42,8% realiza triaje, pero solo el 28,6% utiliza para ello criterios explícitos. Sólo el 28,6% emplea criterios explícitos de derivación, y solo el 57,1% dispone de protocolos de actuación clínica. Conclusiones: las UDO de la Región de Murcia presentan una gran disparidad en accesibilidad, presión asistencial, continuidad en los cuidados, gestión de la demanda y estructura, lo que hace muy difícil la posibilidad de comparación de resultados entre centros, al no disponer de la homogeneidad necesaria en la estructura y en los procesos asistenciales (AU)

Objective: to know about the current situation in terms of organization and management of Chronic Pain Clinics (UDO) of public hospitals in the Region of Murcia. Material and methods: on-line questionnaires that explored aspects of structure and process, addressed to each of the heads of the UDO of every public hospitals of Murcia Health Service. Results: the 87.5% of the UDO answered the questions, representing a 90% of population coverage in the region, all of them directed by an anaesthesiologist, 85.7% of which were multi-disciplinary. Each UDO develops an average of 4.6 consults per week and 0.75 operating rooms. 42.8% of them dedicate less than 8 h per week to assistance. With an average delay of 66 days for the first demand and 49.2 days for the reviews, being the monthly demand for the first visits of 32.5 patients. Some UDO expresses rejection to certain painful processes. 42.8% of them make triage, but only 28.6% use explicit criteria for it. Furthermore, only 28.6% use explicit criteria to send patients to another hospital, and only 57.1% have clinical intervention protocols. Conclusions: UDO in the Region of Murcia has a wide disparity in accessibility, workload, continuity of care, demand management and structure, making it very difficult to compare the results between units, due to the lack of the necessary homogeneity in the structure and care processes (AU)

La producción científica española en anestesiología y reanimación 1983-1995 / Scientific productivity in anesthesia and postoperative recovery in Spain, 1983-1995

OBJETIVOS: Cuantificar y analizar la información disponible internacionalmente sobre la producción científica de la anestesiología española en el período 1983 a 1995. MATERIAL: Publicaciones realizadas por autores españoles que se hallan indizadas en tres repertorios o bases de datos electrónicas: el índice Médico Español (IME) Medline y Embase (correspondiente a Excerpta Médica). MÉTODO: Estudio bibliométrico de la producción contenida en las tres bases, determinando la cuantificación, evolución temporal de los documentos circulantes, el solapamiento y las características de la producción. RESULTADOS: Durante el período estudiado fueron indizados en los tres repertorios un total de 2.608 trabajos producidos por anestesiólogos españoles (IME 79 por ciento Medline 54 por ciento Excerpta 29,5 por ciento). El crecimiento medio anual fue del 16,7 por ciento, con un período de duplicación de 10,2 años. CONCLUSIONES: El crecimiento es exponencial, similar al de otras disciplinas y cumple la ley de Price. Las tres bases recogen mayoritariamente la producción científica de los anestesiólogos españoles. IME y Medflne son los repertorios más importantes para la literatura anestesiológica española. Excerpta presenta el mayor crecimiento en la recopilación de las tres bases. Es imprescindible la inclusión de las tres bases en búsquedas bibliográficas y estudios bibliométricos sobre la anestesiología española (AU)

[Spanish scientific production in anesthesiology and resuscitation 1983-1995]. / La producción científica española en anestesiología y reanimación 1983-1995.

OBJECTIVE: To quantify and analyze the information available internationally on Spanish scientific productivity in anesthesiology from 1983 through 1995. MATERIAL: Publications by Spanish authors indexed in three electronic databases: the Spanish Indice Médico (SIM), MedLine, and Embase (belonging to Excerpta Médica). METHOD: A bibliometric study of productivity as reflected by entries in the 3 databases, quantifying documents in circulation, change over time in circulating documents, overlap, and article's characteristics. RESULTS: During the period studied, a total of 2608 papers by Spanish anesthesiologists were indexed in the 3 databases (SIM 79%, Medline 54%, Excerpta Médica 29.5%). Annual growth was 16.7%, with a period of 10.2 years until duplication. CONCLUSION: Growth is exponential in anesthesiology, as in other disciplines, and the distribution satisfies Price's law. The 3 databases are the major collectors of the papers of Spanish anesthesiologists. The SIM and MedLine are the main indexers of Spanish-authored articles in the literature. Excerpta presents the largest growth on the compilation of articles. The inclusion of the three databases is essential in bibliographic searches and bibliometric studies on Spanish anesthesiology.

[Nutritional parameters and morbimortality in clinical hospitalization]. / Parámetros nutricionales y morbimortalidad en hospitalización clínica.

The prevalence of malnutrition in patients admitted to hospital in the region of Northwest Murcia and its repercussion on the morbidity rate and length of admission are studied. A protocol of nutritional evaluation according to the computer programme EDECAN-MED was applied, and the corresponding statistical treatment of data and results was done. We find that anthropometric data lack predictive value and that deterioration in the values for albumin, basal energy expenditure and nutritional prognostic index are associated with increased morbidity/mortality and prolongation of the length of hospital stay. The most valuable predictive datum of the length of hospital stay was the nutritional prognostic index, in spite of it being an index of surgical risk.

[The development of an informational logic support for aiding diagnosis and treatment. The Edecan-Med program. I. The assessment of nutritional status]. / Elaboración de soporte lógico informático para ayuda al diagnóstico y tratamiento. Programa Edecan-Med. Parte I: Valoración del estado nutricional.

We present the elaboration of an informatic program (Informatic Logic Support [SLI]) as a clinical help in diagnosis and treatment, for use by compatible computers PC. In this first part dedicated to artificial nutrition, we explain the scientific support, the capture of anthropometric and biochemical data, the processing, the results and the conclusions delivered by the computer that inform us about all the calculated nutritional parameters the type of malnutrition, the surgical risk of morbimortality (nutritional prognostic), and the caloric needs.

[Cardiovascular response to orotracheal intubation using midazolam or etomidate in anesthesia induction]. / Respuesta cardiovascular a la intubación orotraqueal utilizando midazolam o etomidato en la inducción anestésica.

By means of the present study, we compare the variations in the cardiovascular response to the orotracheal intubation while using midazolam or etomidate during the anesthetic induction. For this purpose, we studied 2 groups of 10 patients each one which were premedicated with fentanyl and atropine, and succinylcholine as muscle relaxant. We took the data at a basal state, 10 minutes after premedication and 0, 1, 2, 3, 4, 5 and 10 minutes after the intubation handling. As hemodynamic data we registered heart rate, systolic and diastolic blood pressure and the rate product (PRP). In both groups, the peak response occurred two minutes after intubation in all the studied parameters. Systolic and diastolic blood pressure as well as PRP were significantly lower with midazolam. We conclude that midazolam and etomidate do not prevent the cardiovascular response to the intubation handling, although midazolam smooths pressure response.

[Mixed benzodiazepine poisoning and reversal with flumazenil (Ro 15-1788)]. / Intoxicación benzodiacepínica mixta y reversión por flumacenil (Ro 15-1788).

A case of 17 year old female with acute benzodiazepines (800 mg of bentazepan and 400 mg de chlordiazepoxide) and tricyclic antidepressants (500 mg of imipramine) self poisoning is reported. Initial examination showed comatous patient (Glasgow coma scale 7, sedation scale 4) and a critical respiratory failure with a suspicious of pulmonary aspiration of gastric contents. Supportive measures were started and flumazenil administered intravenous (0.1 mg/min) until a total dose of 1.2 mg; 15 minutes later neurological state was absolutely normal. We conclude that flumazenil is a selective and useful benzodiazepine antagonist in the treatment of acute benzodiazepine poisoning.