Estudio SEPHCAT: análisis de los servicios de emergencias prehospitalarios en Cataluña / Prehospital emergency services in Catalonia: the SEPHCAT análisis

Objetivo: Describir las principales características de todos los servicios de emergencias prehospitalarios (SEPH) existentes en Cataluña. Método: Una encuestadora profesional entrevistó a los responsables clínicos de todos los SEPH de Cataluña. La encuesta fue preparada por los autores, y abordaba diversos aspectos organizativos, profesionales, laborales, formativos, docentes y de investigación. Las preguntas contenidas en la encuesta solo permitían respuestas cerradas, y hacían referencia a la situación en 2015. Resultados: Se identificaron 13 SEPH (11 públicos, 2 privados), que recibieron 2.482.627 consultas (16,4% a SEPH privados) y realizaron 943.849 atenciones (11,8% por SEPH privados). Había 336 bases de soporte vital básico y 73 de avanzado, con instalaciones mayoritariamente consideradas de tamaño suficiente y calidad buena. Se contrataron 1.374.845 horas anuales (753.995 de médico y 620.850 de enfermero), el 23,4% de ellas por SEPH privados, que globalmente corresponderían a 815 puestos de trabajo a jornada completa (447 de médico, 368 de enfermero). La dotación de médicos/enfermeros era relativamente estable durante el día, pero decaía un 31%/9% de madrugada. La especialidad médica mayoritaria era medicina familiar y comunitaria (56,8%), el 21,3% no tenía formación especializada, y el 6,5% tenía título de doctor. Había médicos/enfermeros profesores universitarios de grado en el 61,5%/46,2% de los SEPH; y de postgrado en el 46,2%/84,6%. Recibían estudiantes de medicina/enfermería en prácticas de grado el 15,4%/15,4% de los SEPH, y de postgrado el 69,2%/76,9%. Conclusiones: La actividad de los SEPH en Cataluña es elevada; un 12% la desarrollan SEPH privados, y globalmente implica a un número alto de médicos y enfermeros, los cuales además desarrollan un rol docente y, en menor medida, investigador

Objective: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study). Methods: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staff’s training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015. Results: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1 374 845 person-hours/y (753 995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses. Conclusions: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research

Prehospital emergency services in Catalonia: the SEPHCAT analysis. / Estudio SEPHCAT: análisis de los servicios de emergencias prehospitalarios en Cataluña.

OBJECTIVES: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study). MATERIAL AND METHODS: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staff's training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015. RESULTS: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1374845 person-hours/y (753995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses. CONCLUSION: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research.

OBJETIVO: Describir las principales características de todos los servicios de emergencias prehospitalarios (SEPH) existentes en Cataluña. METODO: Una encuestadora profesional entrevistó a los responsables clínicos de todos los SEPH de Cataluña. La encuesta fue preparada por los autores, y abordaba diversos aspectos organizativos, profesionales, laborales, formativos, docentes y de investigación. Las preguntas contenidas en la encuesta solo permitían respuestas cerradas, y hacían referencia a la situación en 2015. RESULTADOS: Se identificaron 13 SEPH (11 públicos, 2 privados), que recibieron 2.482.627 consultas (16,4% a SEPH privados) y realizaron 943.849 atenciones (11,8% por SEPH privados). Había 336 bases de soporte vital básico y 73 de avanzado, con instalaciones mayoritariamente consideradas de tamaño suficiente y calidad buena. Se contrataron 1.374.845 horas anuales (753.995 de médico y 620.850 de enfermero), el 23,4% de ellas por SEPH privados, que globalmente corresponderían a 815 puestos de trabajo a jornada completa (447 de médico, 368 de enfermero). La dotación de médicos/enfermeros era relativamente estable durante el día, pero decaía un 31%/9% de madrugada. La especialidad médica mayoritaria era medicina familiar y comunitaria (56,8%), el 21,3% no tenía formación especializada, y el 6,5% tenía título de doctor. Había médicos/enfermeros profesores universitarios de grado en el 61,5%/46,2% de los SEPH; y de postgrado en el 46,2%/84,6%. Recibían estudiantes de medicina/enfermería en prácticas de grado el 15,4%/15,4% de los SEPH, y de postgrado el 69,2%/76,9%. CONCLUSIONES: La actividad de los SEPH en Cataluña es elevada; un 12% la desarrollan SEPH privados, y globalmente implica a un número alto de médicos y enfermeros, los cuales además desarrollan un rol docente y, en menor medida, investigador.

SUHCAT study, part 5: Comparison of staff and chiefs' perceptions of emergency department quality in Catalonia. / Estudio SUHCAT-5: comparación de la percepción de la calidad de los servicios de urgencias de Cataluña entre los profesionales sanitarios y sus responsables.

OBJECTIVES: To study the perceptions of Catalan Society of Emergency Medicine (SoCMUE) members who staff hospital emergency departments regarding measures taken to cope with overcrowding, staff rest areas, and staff size. MATERIAL AND METHODS: Descriptive cross-sectional analysis of a survey sent to SoCMUE members. We compared opinions expressed by physicians and nurses in this survey and also compared them to opinions expressed by heads of departments in prior SUHCAT studies. RESULTS: Responses were received from 363 members who worked in hospital departments. More nurses than physicians expressed the opinion that ambulance unloading was habitually blocked (P=.045), patients were being redirected (P<.001), and staffing was inadequate (P=.007). When the results of our SoCMUE survey were compared to those of the earlier SUHCAT surveys of department chiefs, we found that more SoCMUE members believed that measures to cope with overcrowding are frequently applied, quality in rest areas is poorer, and staffing is inadequate. CONCLUSION: Physicians and nurses who are members of SoCMUE and work in hospital emergency departments have different views on measures taken to cope with overcrowding, quality of rest areas, and staff size. In addition, the SoCMUE members' opinions differed from those of respondents in prior SUHCAT studies.

OBJETIVO: Conocer la percepción de los socios de la Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE) con actividad laboral en servicios de urgencias hospitalarios (SUH) respecto a las medidas frente al colapso, las áreas de descanso y la dimensión de la plantilla, y compararla con la de sus responsables. METODO: Estudio descriptivo transversal mediante encuesta enviada a los socios de SoCMUE. Se compararon las respuestas dadas entre el estamento médico y enfermero, y con los resultados de los estudios SUHCAT 1 y 2. RESULTADOS: Participaron 363 socios. Los enfermeros opinan más frecuentemente que los médicos que es habitual impedir la descarga de ambulancias (p = 0,045), redireccionar pacientes (p < 0,001) y que sus plantillas son insuficientes (p = 0,007). Los socios de SoCMUE perciben mayor frecuencia en la puesta en marcha de todas las medidas para hacer frente al colapso, peor calidad de las áreas de descanso y una plantilla insuficiente en comparación con la opinión de los responsables de los SUH. CONCLUSIONES: Los médicos y enfermeros socios de la SoCMUE que trabajan en los SUH tienen una percepción diferente en aspectos relacionados con las medidas frente al colapso, áreas de descanso y dimensión de la plantilla, que difiere también de la opinión de sus responsables.

Estudio SUHCAT-5: comparación de la percepción de la calidad de los servicios de urgencias de Cataluña entre los profesionales sanitarios y sus responsables / SUHCAT study, part 5: Comparison of staff and chiefs' perceptions of emergency department quality in Catalonia

Objetivo. Conocer la percepción de los socios de la Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE) con actividad laboral en servicios de urgencias hospitalarios (SUH) respecto a las medidas frente al colapso, las áreas de descanso y la dimensión de la plantilla, y compararla con la de sus responsables. Método. Estudio descriptivo transversal mediante encuesta enviada a los socios de SoCMUE. Se compararon las respuestas dadas entre el estamento médico y enfermero, y con los resultados de los estudios SUHCAT 1 y 2. Resultado. Participaron 363 socios. Los enfermeros opinan más frecuentemente que los médicos que es habitual impedir la descarga de ambulancias (p = 0,045), redireccionar pacientes (p < 0,001) y que sus plantillas son insuficientes (p = 0,007). Los socios de SoCMUE perciben mayor frecuencia en la puesta en marcha de todas las medidas para hacer frente al colapso, peor calidad de las áreas de descanso y una plantilla insuficiente en comparación con la opinión de los responsables de los SUH. Conclusión. Los médicos y enfermeros socios de la SoCMUE que trabajan en los SUH tienen una percepción diferente en aspectos relacionados con las medidas frente al colapso, áreas de descanso y dimensión de la plantilla, que difiere también de la opinión de sus responsables (AU)

Objective. To study the perceptions of Catalan Society of Emergency Medicine (SoCMUE) members who staff hospital emergency departments regarding measures taken to cope with overcrowding, staff rest areas, and staff size. Methods. Descriptive cross-sectional analysis of a survey sent to SoCMUE members. We compared opinions expressed by physicians and nurses in this survey and also compared them to opinions expressed by heads of departments in prior SUHCAT studies. Results. Responses were received from 363 members who worked in hospital departments. More nurses than physicians expressed the opinion that ambulance unloading was habitually blocked (P=.045), patients were being redirected (P< 001), and staffing was inadequate (P=.007). When the results of our SoCMUE survey were compared to those of the earlier SUHCAT surveys of department chiefs, we found that more SoCMUE members believed that measures to cope with overcrowding are frequently applied, quality in rest areas is poorer, and staffing is inadequate. Conclusion. Physicians and nurses who are members of SoCMUE and work in hospital emergency departments have different views on measures taken to cope with overcrowding, quality of rest areas, and staff size. In addition, the SoCMUE members' opinions differed from those of respondents in prior SUHCAT studies (AU)

[Occupational aspects of emergency medicine practice in Catalonia: the OPENCAT opinion survey]. / Opinión de los profesionales acerca de diversos aspectos laborales de los servicios de urgencias y emergencias de Cataluña: Estudio OPENCAT.

OBJECTIVES: To gather information on the contracting and training of members of the Catalan Society of Emergency Medicine (SoCMUE) who work in emergency medicine and services in Catalonia. To survey their opinions on certain aspects of resource availability and working conditions. MATERIAL AND METHODS: Cross-sectional descriptive study based on a survey sent to SoCMUE members. We studied the opinions of 5 types of respondent: hospital physicians, out-of-hospital physicians, hospital nurses, out-of-hospital nurses, and emergency medical technicians. Responses were grouped to compare the opinions of physicians and nurses and workers in hospital and prehospital settings. RESULTS: We received 616 responses from 1273 members (48.4% response rate). More physicians than nurses come from outside Catalonia and have contracts specifically linked to emergency care; in addition, physicians have done less postgraduate training in emergency medicine. More hospital staff than prehospital staff have permanent contracts linked to the department where they work. More hospital physicians are specialized in internal medicine than in family and community medicine. The opinion that emergency services are inadequately staffed was widespread. Most respondents believed that patient transport is good or adequate. However, respondents working in prehospital services expressed a lower opinion of transport. Great difficulty in combining work with family (life achieving work-life balance) was expressed by 13.5% overall, and more often by hospital staff. Some type of aggression was experienced by 88.2%; 60% reported the event to superiors. Nurses reported aggression more often than physicians. A police report was filed by 10.1%. CONCLUSION: Emergency medicine working conditions can be improved in Catalonia according to members of SoCMUE. Relations between groups of professionals are not optimum in some aspects.

OBJETIVO: Investigar las condiciones contractuales y formativas de los socios de la Societat Catalana de Medicina d'Urgències i Emergéncies (SoCMUE) que trabajan en el ámbito de la Medicina de Urgencias y Emergencias (MUE) en Cataluña, y su percepción acerca de algunos recursos disponibles y aspectos de su práctica laboral. METODO: Estudio descriptivo transversal mediante encuesta enviada a los socios de SoCMUE. Se distinguieron médicos hospitalarios y extrahospitalarios, enfermeros hospitalarios y extrahospitalarios, y técnicos en emergencia sanitaria (TES). Se realizaron agrupaciones de médico/enfermero y hospitalario/extrahospitalario. RESULTADOS: Respondieron 616 de 1.273 socios (48,4%). Respecto a los enfermeros, los médicos tienen mayor porcentaje de profesionales no comunitarios, contratos más vinculados a urgencias/emergencias, y han realizado menos formación de postgrado en MUE. Los profesionales hospitalarios, respecto a los extrahospitalarios, tienen mayor proporción de contratos fijos y vinculados al propio servicio, han realizado menos formación de postgrado, y la proporción de especialistas en medicina interna es mayor y en medicina familiar y comunitaria menor. Existe la percepción generalizada de plantillas insuficientes. La transferencia de pacientes es considerada mayoritariamente buena o correcta, pero es peor percibida por extrahospitalaria. El 13,5% refiere una conciliación familiar imposible, más frecuentemente en el ámbito hospitalario. El 88,2% ha sufrido algún tipo de agresión, el 60% lo comunicó a sus superiores (enfermeros más que médicos) y el 10,1% lo denunció judicialmente. CONCLUSIONES: Para los socios de la SoCMUE, en la práctica de la MUE en Cataluña, existen algunas condiciones laborales mejorables y la relación entre colectivos de profesionales es poco óptima en algunos aspectos.

Opinión de los profesionales acerca de diversos aspectos laborales de los servicios de urgencias y emergencias de Cataluña: Estudio OPENCAT / Occupational aspects of emergency medicine practice in Catalonia: the OPENCAT opinion survey

Objetivo. Investigar las condiciones contractuales y formativas de los socios de la Societat Catalana de Medicina d'Urgencies i Emergencies (SoCMUE) que trabajan en el ámbito de la Medicina de Urgencias y Emergencias (MUE) en Cataluña, y su percepción acerca de algunos recursos disponibles y aspectos de su práctica laboral. Método. Estudio descriptivo transversal mediante encuesta enviada a los socios de SoCMUE. Se distinguieron médicos hospitalarios y extrahospitalarios, enfermeros hospitalarios y extrahospitalarios, y técnicos en emergencia sanitaria (TES). Se realizaron agrupaciones de medico/enfermero y hospitalario/extrahospitalario. Resultados. Respondieron 616 de 1.273 socios (48,4%). Respecto a los enfermeros, los médicos tienen mayor porcentaje de profesionales no comunitarios, contratos más vinculados a urgencias/emergencias, y han realizado menos formación de postgrado en MUE. Los profesionales hospitalarios, respecto a los extrahospitalarios, tienen mayor proporción de contratos fijos y vinculados al propio servicio, han realizado menos formación de postgrado, y la proporción de especialistas en medicina interna es mayor y en medicina familiar y comunitaria menor. Existe la percepción generalizada de plantillas insuficientes. La transferencia de pacientes es considerada mayoritariamente buena o correcta, pero es peor percibida por extrahospitalaria. El 13,5% refiere una conciliación familiar imposible, más frecuentemente en el ámbito hospitalario. El 88,2% ha sufrido algún tipo de agresión, el 60% lo comunico a sus superiores (enfermeros más que médicos) y el 10,1% lo denuncio judicialmente. Conclusión. Para los socios de la SoCMUE, en la práctica de la MUE en Cataluña, existen algunas condiciones laborales mejorables y la relación entre colectivos de profesionales es poco optima en algunos aspectos (AU)

Objective. To gather information on the contracting and training of members of the Catalan Society of Emergency Medicine (SoCMUE) who work in emergency medicine and services in Catalonia. To survey their opinions on certain aspects of resource availability and working conditions. Methods. Cross-sectional descriptive study based on a survey sent to SoCMUE members. We studied the opinions of 5 types of respondent: hospital physicians, out-of-hospital physicians, hospital nurses, out-of-hospital nurses, and emergency medical technicians. Responses were grouped to compare the opinions of physicians and nurses and workers in hospital and prehospital settings. Results. We received 616 responses from 1273 members (48.4% response rate). More physicians than nurses come from outside Catalonia and have contracts specifically linked to emergency care; in addition, physicians have done less postgraduate training in emergency medicine. More hospital staff than prehospital staff have permanent contracts linked to the department where they work. More hospital physicians are specialized in internal medicine than in family and community medicine. The opinion that emergency services are inadequately staffed was widespread. Most respondents believed that patient transport is good or adequate. However, respondents working in prehospital services expressed a lower opinion of transport. Great difficulty in combining work with family (life achieving work-life balance) was expressed by 13.5% overall, and more often by hospital staff. Some type of aggression was experienced by 88.2%; 60% reported the event to superiors. Nurses reported aggression more often than physicians. A police report was filed by 10.1%. Conclusion. Emergency medicine working conditions can be improved in Catalonia according to members of SoCMUE. Relations between groups of professionals are not optimum in some aspects (AU)

Opinión de los responsables de los servicios de urgencias hospitalarios de Cataluña acerca de la creación de la especialidad de Medicina de Urgencias y Emergencias / Catalan hospital emergency department heads’ opinions on the creation of a residency program for specializing in emergency medicine

Objetivo: Conocer la opinión de los responsables de los servicios de urgencias hospitalarios (SUH) de Cataluña respecto al soporte e impacto que tendría la creación de la especialidad primaria de Medicina de Urgencias y Emergencias (MUE). Método: Se solicitó la opinión a los responsables de SUH respecto al respaldo a una futura especialidad primaria de MUE (personal, en su servicio y en su hospital) y la estimación del impacto (cualitativo y económico) que tendría en su SUH. Se compararon las respuestas en función del tipo de hospital y SUH y de su afiliación a la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Resultados: Contestaron 79 de los 82 responsables de los SUH de Cataluña (96%), que percibieron una posición favorable a la creación de la especialidad, tanto ellos personalmente (93,7%; IC 95%: 85,8-97,9) como en sus SUH (88,6%; 79,4- 94,7) y hospitales (48,7%; 36,7-59,6). El 82,0% (71,7-89,8) opinó que la especialidad tendría un efecto positivo a corto plazo y el 94,8% (87,2-98,6) que también lo tendría a medio-largo plazo, y respecto al impacto económico, la opinión mayoritaria fue que sería neutro (60,3%; 48,6-71,2). Los responsables de SUH con actividad media, de hospitales privados y no afiliados a SEMES consideraron más frecuentemente que la creación de la especialidad encarecería el SUH (p < 0,05). Conclusiones: Los responsables de los SUH catalanes tienen una opinión favorable y también la perciben en su servicio y su hospital respecto a la creación de la especialidad primaria de MUE y consideran que tendría efectos beneficiosos a corto, medio y largo plazo para el SUH, con un escaso impacto económico (AU)

Objective: To understand the opinions of emergency department (ED) heads in Catalonia on their support for a residency program for specializing in emergency medicine (EM) and on their beliefs about the impact such a program would have. Methods: Heads of ED were asked if there would be support (from them, their staff, and their hospital) for a residency program to train specialists in EM. They were also asked their opinion on the impact that specialization would have on quality of care and costs in their department. Responses were compared by type of hospital and ED and by affiliation or not with the Spanish Society of Emergency Medicine (SEMES). Results: Responses were received from 79 of the 82 heads of hospital EDs in Catalonia (96%). They reported that favorable opinions toward creation of an EM specialization were held by them personally (93.7%; 95% CI, 85.8%–97.9%), by their in their departments (88.6%; 95% CI, 79.4%–94.7%), and by staff in their hospitals (48.7%; 95% CI, 36.7%–59.6%). A majority thought that the impact of specialization would be good in the short term (82.0%; 95% CI, 71.7%–89.8%) and in the medium and long term (94.8%; 95% CI, 87.2%–98.6%). The respondents were neutral about whether there would be an impact on costs (60.3%; 95% CI, 48.6%–71.2%). More heads in mid-sized hospitals, private hospitals, and nonmembers of SEMES thought that creating a specialty would raise ED costs (p<0,05). Conclusions: The heads of Catalan ED, their staff, and their hospitals’ staffs hold favorable opinions of the proposal to create a residency program allowing specialization in EM. They foresee short-, medium-, and long-term benefits for the EDs and scarce impact on costs (AU)

[Catalan hospital emergency department heads' opinions on the creation of a residency program for specializing in emergency medicine]. / Opinión de los responsables de los servicios de urgencias hospitalarios de Cataluña acerca de la creación de la especialidad de Medicina de Urgencias y Emergencias.

OBJECTIVES: To understand the opinions of emergency department (ED) heads in Catalonia on their support for a residency program for specializing in emergency medicine (EM) and on their beliefs about the impact such a program would have. MATERIAL AND METHODS: Heads of ED were asked if there would be support (from them, their staff, and their hospital) for a residency program to train specialists in EM. They were also asked their opinion on the impact that specialization would have on quality of care and costs in their department. Responses were compared by type of hospital and ED and by affiliation or not with the Spanish Society of Emergency Medicine (SEMES). RESULTS: Responses were received from 79 of the 82 heads of hospital EDs in Catalonia (96%). They reported that favorable opinions toward creation of an EM specialization were held by them personally (93.7%; 95% CI, 85.8%-97.9%), by their in their departments (88.6%; 95% CI, 79.4%-94.7%), and by staff in their hospitals (48.7%; 95% CI, 36.7%-59.6%). A majority thought that the impact of specialization would be good in the short term (82.0%; 95% CI, 71.7%-89.8%) and in the medium and long term (94.8%; 95% CI, 87.2%-98.6%). The respondents were neutral about whether there would be an impact on costs (60.3%; 95% CI, 48.6%-71.2%). More heads in mid-sized hospitals, private hospitals, and nonmembers of SEMES thought that creating a specialty would raise ED costs (p<0,05). CONCLUSION: The heads of Catalan ED, their staff, and their hospitals' staffs hold favorable opinions of the proposal to create a residency program allowing specialization in EM. They foresee short-, medium-, and long-term benefits for the EDs and scarce impact on costs.

OBJETIVO: Conocer la opinión de los responsables de los servicios de urgencias hospitalarios (SUH) de Cataluña respecto al soporte e impacto que tendría la creación de la especialidad primaria de Medicina de Urgencias y Emergencias (MUE). METODO: Se solicitó la opinión a los responsables de SUH respecto al respaldo a una futura especialidad primaria de MUE (personal, en su servicio y en su hospital) y la estimación del impacto (cualitativo y económico) que tendría en su SUH. Se compararon las respuestas en función del tipo de hospital y SUH y de su afiliación a la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). RESULTADOS: Contestaron 79 de los 82 responsables de los SUH de Cataluña (96%), que percibieron una posición favorable a la creación de la especialidad, tanto ellos personalmente (93,7%; IC 95%: 85,8-97,9) como en sus SUH (88,6%; 79,4- 94,7) y hospitales (48,7%; 36,7-59,6). El 82,0% (71,7-89,8) opinó que la especialidad tendría un efecto positivo a corto plazo y el 94,8% (87,2-98,6) que también lo tendría a medio-largo plazo, y respecto al impacto económico, la opinión mayoritaria fue que sería neutro (60,3%; 48,6-71,2). Los responsables de SUH con actividad media, de hospitales privados y no afiliados a SEMES consideraron más frecuentemente que la creación de la especialidad encarecería el SUH (p < 0,05). CONCLUSIONES: Los responsables de los SUH catalanes tienen una opinión favorable y también la perciben en su servicio y su hospital respecto a la creación de la especialidad primaria de MUE y consideran que tendría efectos beneficiosos a corto, medio y largo plazo para el SUH, con un escaso impacto económico.

Estudio SUHCAT (1): mapa físico de los servicios de urgencias hospitalarios de Cataluña / SUHCAT study, part 1: a map of the physical characteristics of hospital emergency services in Catalonia

Objetivo: Describir las características físicas de los servicios de urgencias hospitalarios (SUH) de Cataluña y su relación con diferentes características del SUH y del hospital. Método: Se entrevistó a los jefes de 79 de los 82 SUH de Cataluña (96%) que respondieron un cuestionario de 353 preguntas. Una parte de ellas hacía referencia a las características físicas y estructurales de los SUH. Las respuestas se tabularon globalmente y de forma detallada en función de la actividad del SUH (alta, media o baja), el uso del hospital (privado o público) y la complejidad del hospital público (alta tecnología o alta resolución, de referencia, comarcal). Resultados: En la mitad de SUH, su estructura física fue construida o reformada en los 4 años previos. El 59,5% de los SUH cuenta con un área observación (AO) (más los SUH de alta actividad y los hospitales públicos de mayor complejidad). El 35% tiene unidad de corta estancia en su hospital: en el 68% trabajan urgenciólogos, en el 46% éstos son los únicos facultativos especialistas y el 61% depende del SUH. En 2011, los SUH realizaron 3.949.885 atenciones (0,53 atenciones por habitante y año), el 16% en hospitales privados. La mediana (p25-p75) de ingresos fue del 9% (6-12). Un 34,2% incrementa su actividad por motivos de temporalidad turística, durante los cuales sólo el 37,0% aumenta el personal y el 18,5% la estructura. Los índices de fallecimientos, altas sin atención médica y reconsultas a las 72 horas son de 0,05% (0,00-0,13), 1,1% (0,3-2,5) y 4,5% (3,5-5,6), respectivamente (todos ellos mejores en los SUH de menor actividad, los hospitales privados y los hospitales públicos de menor complejidad). El 77,2% colocan identificativos a los pacientes y el 20,3% a los acompañantes, el 84,8% permite el acompañamiento permanente en el área de primera asistencia (APA) y el 59,5% en el AO. Un 36,7% de SUH no tiene ningún tipo de vigilancia (más frecuente en SUH de baja actividad, en hospitales privados y en hospitales públicos de baja complejidad). La superficie dedicada a actividad asistencial es 364 m2 (230-1200), con 13 boxes (7-26) en APA (2 para pacientes críticos) y 8 (4-13) en AO. Estos espacios se calificaron insuficientes en el 50,7% de SUH (más frecuente en hospitales públicos que privados) y su calidad deficiente el 16,5%. En caso de necesidad, las APA pueden aumentar su capacidad un 11% (0-50%) y las AO un 0% (0-5%). La disponibilidad de pruebas complementarias depende del tipo de SUH y de hospital. El 44,3% y el 13,7% tienen la radiología convencional y el escáner, respectivamente, en el propio SUH. El 49,4% dispone de ecógrafo propio y un 10% (0-30%) de sus urgenciólogos sabe utilizarlo. La informatización de la información asistencial es superior al 90% con la excepción del ECG digitalizado (48,8%) y la receta electrónica (25,5%). El 74,7% de SUH dispone de los tiempos asistenciales, pero sólo un 10% los muestra a los usuarios. Conclusiones: El presente estudio pone de manifiesto la realidad estructural de los SUH catalanes y señala diversas oportunidades de mejora

Objective: To describe the physical characteristics of hospital emergency departments in Catalonia, Spain, with reference to other characteristics of the departments and the hospitals. Methods: The heads of 79 of the 82 hospital emergency departments in Catalonia (96%) responded to a 353-item questionnaire and were personally interviewed. This study analyzes information from items referring to the departments' facilities. Statistics were compiled for the entire dataset and for three levels of emergency department volumen (high, medium, and low), for private and public hospital status, and for complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local). Results: Half the departments had premises built or remodelled in the last 4 years; 59.5% had an observation area. Such areas were more often available in high-volume hospitals and public health service hospitals with a higher degree of complexity. A short-stay area was available in 35% of the emergency departments: 68% had staff physicians who were specialized in emergency medicine, 46% were staffed exclusively by emergency physicians, and 61% were under the emergency department’s supervision. In 2011, these departments managed 3 949 885 emergencies (0.53 visits/inhabitant/ y); 16% were handled in private hospitals. The median (25th-75th percentile) admission rate was 9% (6%-12%). Volume increased during the high tourist season for 34.2% of the departments; only 37.0% of them hired additional staff at these times and 18.5% increased the available space. Rates for mortality, discharge without care, and revisits within 72 hours were 0.05% (0.00-0.13), 1.1% (0.3-2.5), and 4.5% (3.5-5.6), respectively. All these rates were lower in lower-volume hospitals, private hospitals, and less complex public hospitals. Patient identification bracelets were used in 77.2% of the departments. An accompanying person was allowed at all times in the initial assessment area in 84.8% and in the observation area in 59.5%. Security personnel were not provided in 36.7% of the departments; this rate was higher in lower-volume hospitals, private hospitals, and less complex public hospitals. The departments had a median surface area of 364 (230-1200) m2, 13 (7-26) initial treatment rooms or spaces (2 for critical cases), and 8 (4-13) observation-area beds. A 50,7% of the respondents considered their facilities were inadequate (an opinion expressed more often for public hospitals than for private ones), and 16,5% reported that the quality of available spaces was unsatisfactory. The area designated for initial treatment could be increased at 11% (0%–50%) of the hospitals, but 0% (0%-5%) could increase the number of observation beds. The availability of complementary tests was related to type of emergency department and hospital. Conventional radiography could be performed in 44.3% of the departments and computed tomography in 13.7%. Although 49.4% had ultrasound machines, only 10% (0%-30%) of the emergency physicians knew how to use one. High-quality information systems were in place in 90% of the hospitals, although only 48.8% had digitized electrocardiography and 25.5% could prescribe electronically. Although 74.7% of the departments compiled time statistics, only 10% shared the information with users. Conclusions: This study reveals the physical conditions of Catalan hospital emergency departments and identifies several ways they can be improved

Estudio SUHCAT (2): mapa funcional de los servicios de urgencias hospitalarios de Cataluña / SUHCAT study, part 2: a map of the functional characteristics of hospital emergency services in Catalonia

Objetivo: Describir las características organizativas y funcionales de los servicios de urgencias hospitalarios (SUH) de Cataluña y la de los médicos y enfermeros que trabajan en ellos. Método: Los responsables de 79 de los 82 SUH de Cataluña (96%) respondieron a preguntas referentes a organización y estructura directiva y ejecutiva del SUH, sistema de triaje, relación con los sistemas de emergencias médicas (SEM), volumen y características contractuales y demográficas de los médicos y enfermeros, así como de organización de su trabajo. Se estimaron los puestos de trabajo a tiempo completo para médicos y enfermeros existentes en los SUH en función de las horas totales anuales contratadas. Se analizaron las respuestas según la actividad del SUH (alta, media o baja), el uso del hospital (privado o público) y la complejidad del hospital público (alta tecnología o alta resolución, referencia, comarcal). Resultados: El 69,6% se organiza como servicio y el 53,2% tiene un jefe de servicio. El 68,4% organiza la asistencia en diferentes circuitos, preferentemente basados en un modelo mixto (triaje y especialidad). El 77,2% dispone de un sistema estructurado de triaje, casi siempre funcionando permanentemente, y en el 80,3% enfermería es la encargada. El Modelo Andorrano de Triaje es el más extendido, que clasificó como categorías 1, 2, 3, 4 y 5 al 0,7%, 5,5%, 28,2%, 47,9% y 17,8% de los pacientes, respectivamente. La organización de la jornada de los médicos es predominantemente a turnos (53,2%, preferentemente de 12 horas) y mixta (turnos y guardias, 30,4%). En 2012 se contrataron 4.894.264 horas de trabajo médico y 3.836.579 de trabajo enfermero, que suponen, respectivamente, 2.899 y 2.368 puestos de trabajo teóricos a jornada completa. De las horas de trabajo médico, el 50,4% las desarrollan médicos con contratos directamente vinculados a urgencias (73% fijos y 27% no fijos o interinos), el 19,1% médicos de otros (AU)

Objective: To describe the organization and functional characteristics of hospital emergency departments (ED) in Catalonia, Spain, as well as to describe the how these departments are staffed with physicians and nurses. Methods: The heads of 79 of the 82 hospital EDs in Catalonia (96%) responded to questions about the management structure of their department, their triage systems, relations with out-of-hospital emergency medical services, volume, contractual arrangements with staff, demographic characteristics of physicians and nurses on staff, and how their work is organized. A theoretical estimate of the number of full-time staff positions for physicians and nurses in each department was based on the total number of contracted hours each year. Statistics were compiled for three levels of ED volume (high, medium, and low), for private and public hospital status, and for level of complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local). Results: ED were organizationally separate in 69.6% of the hospitals, and 53.2% had their own department head. Organization was based on care pathways in 68.4%; the pathways usually followed a mixed model reflecting triage and specialty. A structured triage system was operating in 77.2% and was in use at all times in nearly all those departments; in 80.3%, nurses were in charge of triage. The Andorran Triage Model was the system most widely used. Triage levels 1 through 5 accounted for 0.7%, 5.5%, 28.2%, 47.9%, and 17.8% of the emergency patients, respectively. Physicians' assignments were organized in shifts (preferably 12 hours) in 53.2% of the EDs or in a combination of shifts and on-call schedules (30.4%). A total of 4 894 264 physician hours and 3 836 579 nurse hours were contracted in 2012; that number would correspond to 2899 full-time staff positions for physicians and 2368 for nurses. Physicians contracted directly by the EDs covered 50.4% of the hours (73% of the contracted physicians had permanent contracts and 27% were on temporary or training contracts); 19.1% of the hours were covered by physicians from other departments and 30.6% were covered by residents. Most of the fully trained physicians were specialists in family and community medicine (24%) and internal medicine (16.6%); 11.3% had not done residency training in a specialty. The EDs were staffed by physicians from Spain (62.8%), from other European Union (EU) countries (2.1%), and from non-EU countries (17.7%). Many of these characteristics were significantly different according to hospital category. Conclusions: In Catalonia differ in their organization and functional characteristics and in staffing characteristics. These EDs generate full-time employment for over 5000 physicians and nurses (AU)

Estudio SUHCAT (3): mapa docente e investigador de los servicios de urgencias hospitalarios de Cataluña / SUHCAT study, part 3: a map of educational and research activity in hospital emergency services in Catalonia

Objetivo: Investigar las actividades formativas, docentes e investigadoras realizadas en los servicios de urgencias hospitalarios (SUH) de Cataluña, y compararlas en función de las características de estos SUH y de los hospitales. Método: Se entrevistó a los responsables de 79 de los 82 SUH de Cataluña (96%), que respondieron a preguntas referentes a las actividades formativas en las que participan los profesionales de urgencias, las características y resultados de las actividades docentes e investigadoras llevadas a cabo por ellos y la disponibilidad de tiempos por parte de médicos y enfermeros para realizarlas. Se excluyeron de este análisis los datos referentes a la formación de residentes. Se analizaron las respuestas según la actividad del SUH (alta, media, baja), el uso del hospital (privado, público) y la complejidad del hospital público (alta tecnología o alta resolución, referencia, comarcal). Resultados: El 31,6% de SUH protege parte de la jornada laboral para la formación de sus facultativos y el 23,1% parte de la jornada de sus enfermeros, con unas medianas del 5% (p25-75: 3-10%) y el 2% (1-3%) del tiempo contratado, respectivamente. Existen sesiones propias del servicio para los facultativos y los enfermeros en el 79,7% y 94,2% de los SUH, respectivamente. La presencia de facultativos y enfermeros al congreso catalán y español y en congresos internacionales de la especialidad existió en el 79,5%, 76,9% y 25,6% de los SUH para los primeros, y en el 57,7%, 39,8% y 3,8% para los segundos. Existen estudiantes de pregrado de medicina y de enfermería en el 59,5% y el 81% de SUH, respectivamente; y de postgrado en el 22,8% y 40,5%. El 24,1% y 36,7% de SUH tienen algún profesional de medicina o enfermería, respectivamente, que imparte clases teóricas de pregrado en sus facultades, y el 35,4% y 25,3% respecto a clases de postgrado. La mediana de presentaciones anuales a congresos de los SUH catalanes en 2011 fue 2 (0-6), en tanto que la de ponencias invitadas, publicaciones científicas y profesionales que realizan investigación con continuidad fue 0 para todas ellas. En total, 28 SUH (35,4%) publicaron un total de 115 trabajos durante 2011, 71 (61,7%) en revistas con factor de impacto, y 24 (25%) y 20 (30%) SUH tienen un total de 78 facultativos y 35 enfermeros que investigan con continuidad. Globalmente, 62 facultativos de 28 SUH diferentes tenían el título de doctor, lo que supone el 5,8% de los facultativos de urgencias. En muchos de estos aspectos se produjeron diferencias significativas en función del tipo de SUH y hospital, siempre con un mejor perfil formativo y mayor participación docente e investigadora en los SUH de mayor actividad y en los hospitales públicos y de mayor complejidad. Conclusiones: Los SUH catalanes tienen un elevado papel en la actividad docente de pregrado y postgrado, tanto de medicina como de enfermería, y en cambio la actividad investigadora todavía abarca a un número excesivamente limitado de SUH y de profesionales

Objective: To describe the training, educational, and research activities of hospital emergency department staff in Catalonia, Spain, and to analyze differences in these activities between hospitals of various types. Methods: The heads of 79 of the 82 hospital emergency departments in Catalonia (96%) responded to questions about the training undertaken by emergency department staff and the characteristics and results of educational and research activities carried out by these physicians and nurses. The survey also asked about the number of hours available to staff for these activities. Medical residency training was excluded. Statistics were compiled for three levels of emergency department volume (high, medium, and low), for private and public hospital status, and for level of complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local). Results: In 31.6% of the departments, a portion of the shift was reserved for training staff physicians; 23.1% reserved time for nurse training. A median (interquartile range) of 5% (3%-10%) of contracted time was reserved for training physicians and 2% (1%-3%) was allotted for nurse training. Departmental sessions were organized for emergency physicians and nurses in 79.7% and 94.2% of the hospitals, respectively. Emergency physicians from 79.5%, 76.9%, and 25.6% of the hospitals attended the conferences of Catalan, Spanish, and international emergency medicine associations, respectively. Nurses from 57.7%, 29.8%, and 3.8% of the departments attended these conferences. Undergraduate medical students were taught in 59.5% of the departments and postgraduate training was given in 22.8%. Undergraduate nurses were taught in 81% and postgraduate training for nurses was given in 40.5%. In 24.1% of the hospitals, a staff physician was also giving classroom instruction in an undergraduate program in medicine; in 36.7% a nurse was teaching in a nursing program. In 35.4%, a physician was involved with postgraduate classroom education; a nurse was teaching such classes in 25.3%. A median of 2 (0-6) staff members gave presentations at the Catalan emergency medicine conference in 2011; with regard to invited talks at that conference, scientific publications, and ongoing research, the median number of staff members involved was 0. Twenty-eight departments (35.4%) published a total of 115 papers in 2011; 71 (61.7%) were in journals with an impact factor. Twenty-four hospitals (25%) employed 78 physicians who undertook research on a regular basis; 20 (30%) employed nurses who researched. Sixty-two physicians from 28 different departments had a PhD (5.8% of the emergency physicians). Many of these statistics differed significantly by hospital category. Departments with higher volumes and in public or complex hospitals were more engaged with training, education, and research. Conclusions: Catalan emergency departments play a strong role in undergraduate and postgraduate teaching in medicine and nursing. In contrast, the staff of these departments do not undertake research in large numbers

Carga imediata com prótese fixa provisória e cirurgia sem retalho gengival / Immediate loaded with provisional prosthesis and flapless surgery

O artigo descreve a técnica de cirurgia guiada sem retalho gengival com carga imediata provisória e subsequente avaliação do posicionamento dos implantes instalados. Material e Métodos: Paciente de 54 anos com maxila e dentula com enxerto bilateral dos seios maxilares. O planejamento cirúrgico foi realizado em software a partir dos dados da Tomografia Computadorizada Conebeam (TCCB). Estes dados foram editados para geração da guia cirúrgica virtual e com a tecnologia de prototipagem rápida foram produzidos dois protótipos. O primeiro da maxila com o arco dental para produção da estrutura da prótese fixa provisória e o segundo da guia cirúrgica, que orientou a fresagem e a colocação de seis implantes. Ao final da cirurgia a prótese provisória foi instalada. As imagens da TCCB pós-operatória foram sobrepostas às imagens do planejamento para mensuração das discrepâncias entre as posições dos implantes pré e pós-operatórios. Resultados: Em 2,5 horas seis implantes e a prótese fixa provisória foram instalados com sucesso. Os desvios médios foram: 0,64mm (OP ± 0,32mm) na região coronal; 1,22mm (OP ± 0,63) na região apical e 4,83 graus (OP ± 1,77) no desvio angular. Conclusão: Neste caso clínico. a técnica proporcionou, com sucesso, a reabilitação com implantes e prótese fixa provisória em carga imediata em 2,5 horas. Os desvios no posicionamento dos implantes estão dentro da variação encontrada na literatura.

The article describes the technique of flapless surgery with immediate load. Methods: The subject was a 54 year-old female patient with edentulous maxilla. Eight months before the surgerya sinus lifting was done with autogenous bone. The surgical planning was made in sof- tware using cone beam computerized tomography (CBCT) data.lt was edited to create two rapid prototype models, one for the maxilla with the dental arc and the other was the surgical guide. The first model was used to produce the temporary prosthesis, and the surgical template guided the drilling and placement of six implants. At the end of the surgery the prosthesis was fixed. The postoperative image was fused with the planning one to measure the linear and angular differences. Results: In two and half hours the implants and the fixed temporary prosthesis were successfully installed. The mean deviations were : 0,64mm (50 ± 0,32mm) in coronal position and 1,22mm (50 ± 0,63) in apex position, and the angular deviations was 4,83 degress (OP ± 1,77). Conclusion: Within a limited sample, this technique ma de the oral rehabilitation in two and hours possible. The deviations found are within the one in the literature.

Use of the plasma CTX for assessing the bone activity of the mandible among osteopenic and osteoporotic patients.

The aim of this study was to determine whether the plasma CTX bone remodeling marker is useful for indicating the bone metabolic activity level of the mandible. Thirty-six patients were selected; all were postmenopausal and aged 50 years or over. In accordance with the WHO criteria for osteoporosis, a control group was set up (n = 10) in which the T-score was greater than -1 and a diseased group with T-score less than -1. Using MDP-(99m)Tc samples, the radioisotope uptake in the femoral neck (R(2)) and mandibular body (R(1)) was analyzed. A third examination was performed using the plasma CTX biochemical bone-modeling marker. The inferential results for the diseased group showed that Ln(R(1)) presented a statistically significant linear relationship with Ln(CTx) (p = 0.067) and with the T-score (p = 0.018). The plasma CTX bone remodeling marker is useful for monitoring the bone metabolic activity of the mandible.

Use of the plasma CTX for assessing the bone activity of the mandible among osteopenic and osteoporotic patients

The aim of this study was to determine whether the plasma CTX bone remodeling marker is useful for indicating the bone metabolic activity level of the mandible. Thirty-six patients were selected; all were postmenopausal and aged 50 years or over. In accordance with the WHO criteria for osteoporosis, a control group was set up (n = 10) in which the T-score was greater than -1 and a diseased group with T-score less than -1. Using MDP-99mTc samples, the radioisotope uptake in the femoral neck (R2) and mandibular body (R1) was analyzed. A third examination was performed using the plasma CTX biochemical bone-modeling marker. The inferential results for the diseased group showed that Ln(R1) presented a statistically significant linear relationship with Ln(CTx) (p = 0.067) and with the T-score (p = 0.018). The plasma CTX bone remodeling marker is useful for monitoring the bone metabolic activity of the mandible.

[The emergency department short stay unit and the hospital at home as alternatives to standard inpatient hospitalisation]. / La unidad de corta estancia de urgencias y la hospitalización a domicilio como alternativas a la hospitalización convencional.

The emergency short stay unit (ESSU) is a support unit for the accident and emergency services and a clear alternative to the conventional hospitalisation of patients needing urgent care, who are affected by the re-aggravation of certain chronic diseases (whether seasonal o not) or by moderate short-evolution pathologies. Hospitalisation at home is one alternative making it possible to undertake the care and treatment characteristic of a hospital in the home of the patient, with greater comfort and intimacy. The origin of the patient might be the conventional hospital, the emergency service or ESSU. A suitable selection of patients is essential in both alternatives to conventional hospitalisation, using strict criteria that are both clinical and socio-family in nature. Their correct use assures a significant saving in stays in conventional hospital units, a reduction of the average stay in hospital medical and surgical services and less pressure on the accident and emergency service, since they increase the availability of beds both for programmed admission and for urgent admission in conventional hospitalisation and thus improve patient outflow in the accident and emergency service.

O papel da vitamina D3 e da osteocalcina no metabolismo ósseo: uma análise necessária para se otimizar a osseointegração / The role of vitamin D3 and osteocalcin in the bone metabolism: a necessary analysis to optimize the osteointegration

A necessidade de uma melhor compreensão do metabolismo ósseo tornou-se crescente na Odontologia. O advento da implantodontia demandou a busca por boas condições de tecido ósseo visando à colocação de implantes osseointegráveis e também pela necessidade de preparo prévio de leitos receptores em áreas que necessitam de enxerto ósseo até as grandes reconstruções no campo da cirurgia buco-maxilo-facial que buscam reconstruir estruturas ósseas perdidas decorrentes de trauma ou de destruição tumoral tendo como área doadora a região ilíaca. A osteocalcina, produto da ação osteoblástica, intimamente relacionada à mineralização da matriz óssea tem sua ação estimulada pela vitamina D3 e é imprescindível para o processo de mineralização do tecido ósseo. Neste trabalho procurou-se fazer uma revisão dos aspectos mais importantes relacionados à atuação destas duas substâncias no metabolismo ósseo.

The need of a better understanding of the bone metabolism became growing in Dentistry. The coming of the implantology demanded the search for good conditions of bone tissue seeking to the placement of implants and also for the need of previous preparation in order to receive bone grafts in areas that need bone to great reconstructions in the of maxillofacial surgery which looks upon to rebuild bone structures lost by trauma or tumoral damages, which tends as donor area, the iliac bone. The osteocalcin, product of the osteoblastic action, intimately related to the mineralization of the bone matrix, keeps its action stimulated by the vitamin D3 and is indispensable for the process of the bone tissue mineralization. This paper intend to a revision of the most important aspects related to the performance of these two substances in the bone metabolism.

Biological factors and overestimation of left ventricular ejection fraction by gated SPECT.

BACKGROUND: Some patients present an overestimated left ventricular ejection fraction (LVEF) on electrocardiogram-gated myocardial scintigraphy (gated SPECT). OBJECTIVE: To establish the relationship between biological factors and overestimated LVEF. METHODS: We selected 3838 patients who underwent gated SPECT between May 20, 2000 and September 16, 2005 with normal perfusion images and LVEF > or =50%. The following variables were analyzed: gender (29.4% females and 70.6% males), age (from 20 to 94 years - mean: 56 years), weight (from 33.5 to 150 kg - mean: 79.6 kg), height (from 138 to 220 cm - mean: 171 cm) and BMI (from 13.9 to 54 - mean: 27.2). In a subgroup of 1002 patients who underwent echocardiogram, the diastolic diameter (from 36 to 68 mm - mean 47.5 mm) and systolic diameter (from 22 to 41 mm - mean 29.8 mm) variables were included. The patients were divided into two groups: normal LVEF (< or =80%) and overestimated LVEF (>80%). The odds ratio (OR) for presenting an overestimated LVEF was calculated for each variable using logistic regression. RESULTS: The following odds ratios were found (p < 0.005): female gender OR = 3.585 (95%CI: 2.745 to 4.683), age in years OR = 1.020 (95%CI: 1.011 to 1.029) and height in cm OR = 0.893 (95%CI: 0.829 to 0.962). Weight and BMI were not significantly associated with LVEF (p>0.2). In the subgroup of 1002 patients, a statistically significant influence was found in overestimated LVEF values for the systolic diameter, gender and height variables. CONCLUSION: Although systolic diameter influences the overestimation of LVEF, the gender and height variables have an independent influence on LVEF overestimation by gated SPECT.