Indicadores de calidad en la atención dermatológica a pacientes con dermatitis atópica. Documento de consenso de la Academia Española de Dermatología y Venereología / Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology

El grado de conocimiento y aplicación de las guías de práctica clínica sobre el manejo de la dermatitis atópica son desconocidos en nuestro entorno. El objetivo de este estudio es elaborar indicadores de calidad basados en las guías de práctica clínica existentes, para mejorar la atención de los pacientes. Tras una búsqueda bibliográfica de guías de práctica clínica, un grupo de 11 panelistas seleccionó las de mayor calidad mediante el instrumento AGREE II. Posteriormente se extrajeron recomendaciones con alto nivel de evidencia y propusieron un indicador de calidad asistencial asociado a un estándar para medir el grado de cumplimiento de cada recomendación. De los 150 indicadores propuestos, se obtuvo consenso en 21 de ellos tras la realización del método Delphi modificado. La implementación de los indicadores consensuados en este estudio pretende estandarizar las actuaciones de los profesionales sanitarios para mejorar la calidad asistencial de los pacientes con dermatitis atópica

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered

Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology. / Indicadores de calidad en la atención dermatológica a pacientes con dermatitis atópica. Documento de consenso de la Academia Española de Dermatología y Venereología.

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.

Políticas de igualdad en el proceso editorial. Importancia de incluir el nombre de pila en las publicaciones científicas / Editorial Policies and Equality: The Importance of Publishing an Author's Given Name

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Implantación y desarrollo de un sistema integrado de gestión de calidad según la norma ISO 9001: 2015 en un Servicio de Dermatología / Implementation and Operation of an Integrated Quality Management System in Accordance With ISO 9001: 2015 in a Dermatology Department

Los sistemas de gestión de calidad (SGC) son herramientas que sirven para estructurar, controlar y mejorar las actividades habituales que se desarrollan en una organización o servicio. La norma ISO 9001:2015 es una norma reconocida internacionalmente que proporciona los recursos necesarios para ayudar a una organización a mejorar su rendimiento, basándose en el principio de planificar-hacer-controlar-actuar, con el fin de obtener una mejora continua. En sanidad es una herramienta clave para la gestión de los servicios ofrecidos a los pacientes. La certificación de calidad ISO permite demostrar el cumplimiento de dicha norma, de acuerdo a unos estándares de calidad establecidos. El proceso de implantación de un SGC siguiendo esta norma debe seguir varias fases, que culminan con la realización de una auditoría externa que, una vez superada, permite obtener la certificación de calidad ISO 9001:2015. En este artículo se describen los pasos a seguir para obtener dicha certificación en un Servicio de Dermatología

Quality management systems (QMS) are tools that serve to structure, control and improve the usual activities that take place in an organization or service.The ISO 9001:2015 is an internationally recognized standard, which provides the necessary resources to help an organization to improve its performance, based on the principle of plan-do-control-act, in order to obtain continuous improvement. In the field of health, it is an essential tool for the management of the services offered to patients. The ISO quality certification allows to demonstrate compliance, according to established quality standards. The process of implementing a QMS follows several phases that culminate with the completion of an external audit, which once passed, allows obtaining the quality certification ISO 9001:2015. This article describes the steps to follow to obtain this certification in a Dermatology Service

Implementation and Operation of an Integrated Quality Management System in Accordance With ISO 9001:2015 in a Dermatology Department. / Implantación y desarrollo de un sistema integrado de gestión de calidad según la norma ISO 9001:2015 en un Servicio de Dermatología.

Quality management systems (QMS) are tools that serve to structure, control and improve the usual activities that take place in an organization or service. The ISO 9001:2015 is an internationally recognized standard, which provides the necessary resources to help an organization to improve its performance, based on the principle of plan-do-control-act, in order to obtain continuous improvement. In the field of health, it is an essential tool for the management of the services offered to patients. The ISO quality certification allows to demonstrate compliance, according to established quality standards. The process of implementing a QMS follows several phases that culminate with the completion of an external audit, which once passed, allows obtaining the quality certification ISO 9001:2015. This article describes the steps to follow to obtain this certification in a Dermatology Service.

Persistent Desquamation of the Scalp as a Manifestation of Tinea Capitis in Sub-Saharan Children.

Scalp hyperkeratosis of childhood is most often associated with atopic or seborrheic dermatitis. However, in black children can be associated with tinea capitis. We undertook a retrospective study in all Sub-Saharan children presenting with chronic scalp scaling between June 2010 and June 2013, to determine whether chronic desquamation of the scalp is a clinical manifestation of tinea capitis. The criterion used to diagnose tinea capitis was a positive mycolological culture. Of the 23 Sub-Saharan African children attended, 12 (43.4%) presented with chronic scalp flaking. Mycological culture was performed in 9 of the 12 cases. The culture was positive in 6 out of 9, so 26% of the Sub-Saharan African children attended were diagnosed with tinea capitis. In 52.1% of the cases with persistent scalp scaling the culture was positive. In conclusion, chronic scaling of the scalp may well be the sole form of presentation of tinea capitis in Sub-Saharan children.

Estudio comparativo epidemiológico de la enfermedad cutánea en población infantil inmigrante y autóctona en Alicante / Comparative Epidemiologic Study of Skin Diseases in Foreign Children and Children of Spanish Origin in Alicante, Spain

INTRODUCCIÓN: En estudios anteriores realizados en nuestro país se ha constatado que la población extranjera e inmigrante puede tener enfermedades diferentes a la población autóctona. Sin embargo, no existe ningún estudio diseñado sobre población infantil inmigrante en España. MATERIAL Y MÉTODOS: El objetivo de este estudio fue el de analizar las dermatosis de la población inmigrante infantil y compararlas con la población autóctona. Se incluyó a todos los pacientes menores de 15 años que fueron atendidos en la sección de dermatología entre enero de 2007 y diciembre de 2007. RESULTADOS: Durante el periodo de estudio se registraron 3.108 episodios de consulta en población pediátrica, de ellos 2.661 (85,6%) correspondieron a población autóctona y 447 (14,3%) a población inmigrante. La población infantil inmigrante acudió a la consulta (11,4%) más que la población autóctona (6%) (p < 0,001), consultando menos en la consulta ambulatoria especializada (59,6 vs 68,8%) (p < 0,001) y más por urgencias. La escabiosis (ORa: 10,6; IC 95%: 4,71-24,10), las picaduras de artrópodos (ORa: 2,80; IC 95%: 1,14-6,87), la hipopigmentación (ORa: 2,61; IC 95%: 1,06-6,44) y la dermatitis atópica (ORa: 1,65; IC 95%: 1,19-2,31) fueron más frecuentes en la población inmigrante. El nevus melanocítico fue más frecuente en la población autóctona (ORa: 0,50; IC 95%: 0,30-0,83). CONCLUSIONES: Existen diferencias tanto en la forma de consultar como en la frecuencia de las dermatosis presentadas en la población infantil autóctona e inmigrante

INTRODUCTION: Previous studies in Spain have shown that the foreign and immigrant populations can have different diseases to Spanish-born individuals. However, no comparative study has specifically investigated foreign children in Spain. MATERIAL AND METHODS: The objective of the study was to compare skin diseases in foreign children with those in children born in Spain of Spanish parents. We included all patients under 15 years of age who were seen in our dermatology department between January 2007 and December 2007. RESULTS: During the study period, 3108 pediatric patients were seen in the dermatology department. Of these, 2661 (85.6%) were Spanish and 447 (14.3%) were foreigners. Foreign children sought medical care more often (11.4%) than Spanish children (6%) (P < 0.001) and made less use of the specialist outpatient clinic (59.6% vs 68.8% [P < 0.001]) and more use of emergency care. Complaints observed more frequently in the foreign children were scabies (adjusted odds ratio [aOR], 10.6; 95% CI, 4.71-24.10), arthropod bites (aOR, 2.80; 95% CI, 1.14-6.87), hypopigmentation (aOR, 2.61; 95% CI, 1.06-6.44), and atopic dermatitis (aOR, 1.65; 95% CI, 1.19-2.31). Melanocytic nevus was observed more frequently in Spanish children (aOR, .50; 95% CI, .30-.83). CONCLUSIONS: Differences between children born in Spain of Spanish parents and foreign children were found for type of visit and frequency of skin diseases

Comparative epidemiologic study of skin diseases in foreign children and children of Spanish origin in Alicante, Spain.

INTRODUCTION: Previous studies in Spain have shown that the foreign and immigrant populations can have different diseases to Spanish-born individuals. However, no comparative study has specifically investigated foreign children in Spain. MATERIAL AND METHODS: The objective of the study was to compare skin diseases in foreign children with those in children born in Spain of Spanish parents. We included all patients under 15 years of age who were seen in our dermatology department between January 2007 and December 2007. RESULTS: During the study period, 3108 pediatric patients were seen in the dermatology department. Of these, 2661 (85.6%) were Spanish and 447 (14.3%) were foreigners. Foreign children sought medical care more often (11.4%) than Spanish children (6%) (P<.001) and made less use of the specialist outpatient clinic (59.6% vs 68.8% [P<.001]) and more use of emergency care. Complaints observed more frequently in the foreign children were scabies (adjusted odds ratio [aOR], 10.6; 95% CI, 4.71-24.10), arthropod bites (aOR, 2.80; 95% CI, 1.14-6.87), hypopigmentation (aOR, 2.61; 95% CI, 1.06-6.44), and atopic dermatitis (aOR, 1.65; 95% CI, 1.19-2.31). Melanocytic nevus was observed more frequently in Spanish children (aOR, .50; 95% CI, .30-.83). CONCLUSIONS: Differences between children born in Spain of Spanish parents and foreign children were found for type of visit and frequency of skin diseases.

Tratamiento de hemangiomas infantiles con propranolol en régimen de control ambulatorio. Estudio prospectivo / Outpatient Treatment of Infantile Hemangiomas With Propranolol: A Prospective Study

Objetivo: Valorar la efectividad y seguridad del propranolol oral (PO) para tratar hemangiomas infantiles (HI). Material y métodos: Estudio prospectivo de los HI tratados con PO entre octubre de 2008 y marzo de 2011. Fueron candidatos a tratamiento los HI en fase proliferativa con rápido crecimiento, compromiso de alguna estructura vital o ulceración y para evitar problemas funcionales o estéticos tras la fase proliferativa. Los pacientes se trataron con 2mg/kg/día de PO, y fueron controlados ambulatoriamente. Se valoró la respuesta terapéutica mediante una escala en la que se consideró la reducción del volumen, aclaramiento del color y mejoría de los síntomas del HI, además del grado de satisfacción paterna. Se registró el momento de respuesta inicial y máxima, efectos secundarios y secuelas. Resultados: Se trataron 20 casos de HI (17 niñas y 3 niños). Las localizaciones predominantes fueron: periorbitaria (20%), nariz (15%), cuello/nuca (15%) y tronco (15%). La mayoría HI fueron focales y en fase proliferativa (90%). El tratamiento se inició entre 2 y 19 meses, siendo el principal motivo para empezarlo el rápido crecimiento (50%). El inicio de respuesta se observó en el 70% de los casos a los 5 días y en solo 2 tardíamente (más de un mes). El pico máximo de respuesta se obtuvo a los 3 meses. En el 55% de casos la respuesta fue excelente, buena en el 35%, mínima en el 10% y en ninguno nula. Fueron factores predictores de respuesta el HI focal, la fase proliferativa, la localización periorbitaria y la ulceración. No hemos constatado efectos adversos importantes. Conclusión: Hemos comprobado la efectividad clínica del PO en la reducción de los HI, pero no su completa desaparición al concluir el tratamiento, persistiendo parte de su volumen, color, telangiectasias o cicatrices. El PO ha resultado seguro bajo control ambulatorio (AU)

Objective: To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. Material and method: We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2 mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. Results: We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50%of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. Conclusion: Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients (AU)

Outpatient treatment of infantile hemangiomas with propranolol: a prospective study.

OBJECTIVE: To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. MATERIAL AND METHOD: We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. RESULTS: We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50% of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. CONCLUSION: Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients.

[Annular erythema of infancy]. / Eritemas anulares en la infancia.

Many skin diseases appear as annular lesions. Some are more typical of adults or older children, whereas others usually appear in young children. Annular or figurate erythema of infancy comprises a group of dermatoses in which the primary lesion adopts an annular, oval circinate, or polycyclic pattern. Similarities in clinical presentation, age at onset, and duration of lesions mean that these conditions are difficult to diagnose; sometimes, they can only be identified by subtle differences in their clinicopathologic features. Clinical pictures enable us to distinguish one member of this group of diseases from another and also to differentiate them from other annular eruptions. For ease of description, we classify annular erythema of infancy into 2 types: conditions with a known etiology and conditions with characteristic reaction patterns but uncertain etiology.

Eritemas anulares en la infancia / Annular Erythema of Infancy

Un gran número de entidades dermatológicas adoptan formas anulares. Algunas de ellas son más propias de la edad adulta o de niños mayores, mientras que otras característicamente aparecen en niños pequeños. Los eritemas anulares o figurados de la infancia son un grupo de dermatosis en los que la lesión primaria adopta una configuración de tipo anular, circinada oval o policíclica. Sus similitudes en la forma de presentación clínica, edad de aparición y duración de las lesiones hacen que se trate de entidades de difícil diagnóstico, en ocasiones únicamente distinguibles por sutiles diferencias en sus manifestaciones clínico-patológicas. Dentro de este grupo de enfermedades distinguimos una serie de cuadros clínicos con unas características peculiares, que permiten diferenciarlos entre sí y respecto a otras erupciones de carácter anular. A modo práctico, hemos clasificado los eritemas anulares de aparición en la infancia en entidades cuya etiología está claramente establecida y en entidades cuyos patrones de reacción son característicos, pero de etiología incierta (AU)

Many skin diseases appear as annular lesions. Some are more typical of adults or older children, whereas others usually appear in young children. Annular or figurate erythema of infancy comprises a group of dermatoses in which the primary lesion adopts an annular, oval circinate, or polycyclic pattern. Similarities in clinical presentation, age at onset, and duration of lesions mean that these conditions are difficult to diagnose; sometimes, they can only be identified by subtle differences in their clinicopathologic features. Clinical pictures enable us to distinguish one member of this group of diseases from another and also to differentiate them from other annular eruptions. For ease of description, we classify annular erythema of infancy into 2 types: conditions with a known etiology and conditions with characteristic reaction patterns but uncertain etiology (AU)