Impact of KRASG12 mutations on survival with trifluridine/tipiracil plus bevacizumab in patients with refractory metastatic colorectal cancer: post hoc analysis of the phase III SUNLIGHT trial.

BACKGROUND: In metastatic colorectal cancer (mCRC), KRAS mutations are often associated with poorer survival; however, the prognostic impact of specific point mutations is unclear. In the phase III SUNLIGHT trial, trifluridine/tipiracil (FTD/TPI) plus bevacizumab significantly improved overall survival (OS) versus FTD/TPI alone. We assessed the impact of KRASG12 mutational status on OS in SUNLIGHT. PATIENTS AND METHODS: In the global, open-label, randomized, phase III SUNLIGHT trial, adults with mCRC who had received no more than two prior chemotherapy regimens were randomized 1 : 1 to receive FTD/TPI alone or FTD/TPI plus bevacizumab. In this post hoc analysis, OS was assessed according to the presence or absence of a KRASG12 mutation in the overall population and in patients with RAS-mutated tumors. RESULTS: Overall, 450 patients were analyzed, including 302 patients in the RAS mutation subgroup (214 with a KRASG12 mutation and 88 with a non-KRASG12RAS mutation). In the overall population, similar OS outcomes were observed in patients with and without a KRASG12 mutation [median 8.3 and 9.2 months, respectively; hazard ratio (HR) 1.09, 95% confidence interval (CI) 0.87-1.4]. Similar OS outcomes were also observed in the subgroup analysis of patients with a KRASG12 mutation versus those with a non-KRASG12RAS mutation (HR 1.03, 95% CI 0.76-1.4). FTD/TPI plus bevacizumab improved OS compared with FTD/TPI alone irrespective of KRASG12 mutational status. Among patients with a KRASG12 mutation, the median OS was 9.4 months with FTD/TPI plus bevacizumab versus 7.2 months with FTD/TPI alone (HR 0.67, 95% CI 0.48-0.93), and in patients without a KRASG12 mutation, the median OS was 11.3 versus 7.1 months, respectively (HR 0.59, 95% CI 0.43-0.81). CONCLUSIONS: The presence of a KRASG12 mutation had no detrimental effect on OS among patients treated in SUNLIGHT. The benefit of FTD/TPI plus bevacizumab over FTD/TPI alone was confirmed independently of KRASG12 status.

Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain.

BACKGROUND: Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. OBJECTIVES: To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. METHODS: This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and cost-effectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. DISCUSSION: This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. CONCLUSION: The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.

Unravelling the polarity of InN quantum dots using a modified approach of negative-spherical-aberration imaging.

InN quantum dots (QDs) are considered to be promising nanostructures for different device applications. For any hexagonal AB-stacking semiconductor system, polarity is an important feature which affects the electronic properties. Therefore, the determination of this characteristic on any wurtzite (semi)polar III-N compound or alloy is essential for defining its applicability. In this paper, the polarity of InN QDs grown on silicon by indium droplet epitaxy plus nitridation and annealing was determined by a modified approach combining exit wave reconstruction with negative-spherical-aberration high-resolution lattice imaging using TEM. Comparing the micrographs of two QDs from the same TEM specimen with the simulated images of InN slab structures generated under the same conditions as of the experiments, it was confirmed that the QDs of the present study are N polar. Given that the settlement of material's polarity has always been a tedious, indirect and controversial issue, the major value of our proposal is to provide a straightforward procedure to determine the polar direction from atomic-resolution focal series images.

Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica / Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy

Hemos empleado un nuevo dispositivo para prevenir la tromboembolia pulmonar (TEP) durante una trombectomía farmacomecánica en una mujer puérpera de 25 años. El catéter Angel(R) (BiO2 Medical Inc. Golden, CO) es un dispositivo temporal que combina la función de filtro de vena cava (FVC) con la de un catéter venoso central de triple luz. Normalmente, la prevención de la TEP durante la trombectomía farmacomecánica se realiza implantando un FVC. Las complicaciones asociadas al FVC aumentan con el tiempo de implantación. Su recuperabilidad no es total y la iatrogenia es posible tanto al implantarlo como al retirarlo. En nuestra experiencia, este nuevo dispositivo puede ser implantado y extraído de forma mucho más sencilla. Creemos interesante dar a conocer este dispositivo como una posible alternativa al FVC para prevenir la TEP durante la trombectomía farmacomecánica, como exponemos en este caso

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel(R) catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy

Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy. / Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica.

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.

Selective area growth of AlN/GaN nanocolumns on (0001) and (11-22) GaN/sapphire for semi-polar and non-polar AlN pseudo-templates.

Despite the strong interest in optoelectronic devices working in the deep ultraviolet range, no suitable low cost, large-area, high-quality AlN substrates have been available up to now. The aim of this work is the selective area growth of AlN nanocolumns by plasma assisted molecular beam epitaxy on polar (0001) and semi-polar (11-22) GaN/sapphire templates. The resulting AlN nanocolumns are vertically oriented with semi-polar {1-103} top facets when grown on (0001) GaN/sapphire, or oriented at 58° from the template normal and exposing {1-100} non-polar top facets when growing on (11-22) GaN/sapphire, in both cases reaching filling factors ≥80%. In these kinds of arrays each nanostructure could function as a building block for an individual nano-device or, due to the large filling factor values, the overall array top surfaces could be seen as a quasi (semi-polar or non-polar) AlN pseudo-template.

Nefrectomías en riñón no funcionante, ¿estamos haciendo lo correcto? / Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?

Objetivos. Presentar nuestra experiencia en el manejo quirúrgico del riñón poco o no funcionante, revisando las indicaciones de nefrectomía y sus resultados a largo plazo. Material y métodos. Estudio retrospectivo de los pacientes intervenidos de nefrectomía en nuestro centro entre los años 2010 y 2014. Se revisaron sus historias clínicas y se recogieron una serie de variables sociodemográficas y clínicas, prestando especial atención a la resolución o no de la sintomatología que motivó la cirugía. Resultados. Realizamos un total de 18 nefrectomías. La edad media fue de 6,5 años (11 meses - 15 años). La indicación de cirugía se realizó por infecciones del tracto urinario (ITUS) de repetición en 7 casos, hipertensión arterial renovascular (HTAR) en 5, dolor en 2, aumento de tamaño en 2 y dificultad para el seguimiento en otros 2 pacientes. La nefrectomía se realizó vía laparoscópica en 16 casos y abierta en 2. La mediana de la estancia hospitalaria fue de 48 horas. La tasa de complicaciones fue del 5,55% tanto intraoperatoriamente (1 caso de sangrado) como postoperatoriamente (1 caso de enfisema subcutáneo). En todos los casos se objetivó resolución de la sintomatología salvo en 3, 2 pacientes presentaron ITUS y 1 HTA persistente. Conclusiones. La nefrectomía es un procedimiento seguro en niños con una tasa baja de complicaciones. La selección adecuada de los casos y un correcto estudio multidisciplinar previo son aspectos fundamentales para obtener buenos resultados clínicos y evitar complicaciones postoperatorias

Aim of the study. To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys. Methods. Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery. Main results. A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents’ preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT. Conclusions. Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications

Titanium induced polarity inversion in ordered (In,Ga)N/GaN nanocolumns.

We report on the formation of polarity inversion in ordered (In,Ga)N/GaN nanocolumns grown on a Ti-masked GaN-buffered sapphire substrate by plasma assisted molecular beam epitaxy. High-resolution transmission electron microscopy and electron energy-loss spectroscopy reveal a stacking fault-like planar defect at the homoepitaxial GaN interface due to Ti incorporation, triggering the generation of N-polar domains in Ga-polar nanocolumns. Density functional theory calculations are applied to clarify the atomic configurations of a Ti monolayer occupation on the GaN (0002) plane and to prove the inversion effect. The polarity inversion leads to an enhanced indium incorporation in the subsequent (In,Ga)N segment of the nanocolumn. This study provides a deeper understanding of the effects of Ti mask in the well-controlled selective area growth of (In,Ga)N/GaN nanocolumns.

[Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?] / Nefrectomías en riñón no funcionante, ¿estamos haciendo lo correcto?

AIM OF THE STUDY: To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys. METHODS: Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery. MAIN RESULTS: A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents' preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT. CONCLUSIONS: Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications.

OBJETIVOS: Presentar nuestra experiencia en el manejo quirúrgico del riñón poco o no funcionante, revisando las indicaciones de nefrectomía y sus resultados a largo plazo. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes intervenidos de nefrectomía en nuestro centro entre los años 2010 y 2014. Se revisaron sus historias clínicas y se recogieron una serie de variables sociodemográficas y clínicas, prestando especial atención a la resolución o no de la sintomatología que motivó la cirugía. RESULTADOS: Realizamos un total de 18 nefrectomías. La edad media fue de 6,5 años (11 meses - 15 años). La indicación de cirugía se realizó por infecciones del tracto urinario (ITUS) de repetición en 7 casos, hipertensión arterial renovascular (HTAR) en 5, dolor en 2, aumento de tamaño en 2 y dificultad para el seguimiento en otros 2 pacientes. La nefrectomía se realizó vía laparoscópica en 16 casos y abierta en 2. La mediana de la estancia hospitalaria fue de 48 horas. La tasa de complicaciones fue del 5,55% tanto intraoperatoriamente (1 caso de sangrado) como postoperatoriamente (1 caso de enfisema subcutáneo). En todos los casos se objetivó resolución de la sintomatología salvo en 3, 2 pacientes presentaron ITUS y 1 HTA persistente. CONCLUSIONES: La nefrectomía es un procedimiento seguro en niños con una tasa baja de complicaciones. La selección adecuada de los casos y un correcto estudio multidisciplinar previo son aspectos fundamentales para obtener buenos resultados clínicos y evitar complicaciones postoperatorias.

Distinguishing cubic and hexagonal phases within InGaN/GaN microstructures using electron energy loss spectroscopy.

3D InGaN/GaN microstructures grown by metal organic vapor phase epitaxy (MOVPE) and molecular beam epitaxy (MBE) have been extensively studied using a range of electron microscopy techniques. The growth of material by MBE has led to the growth of cubic GaN material. The changes in these crystal phases has been investigated by Electron Energy Loss Spectroscopy, where the variations in the fine structure of the N K-edge shows a clear difference allowing the mapping of the phases to take place. GaN layers grown for light emitting devices sometimes have cubic inclusions in the normally hexagonal wurtzite structures, which can influence the device electronic properties. Differences in the fine structure of the N K-edge between cubic and hexagonal material in electron energy loss spectra are used to map cubic and hexagonal regions in a GaN/InGaN microcolumnar device. The method of mapping is explained, and the factors limiting spatial resolution are discussed.

Light-emitting-diodes based on ordered InGaN nanocolumns emitting in the blue, green and yellow spectral range.

The growth of ordered arrays of InGaN/GaN nanocolumnar light emitting diodes by molecular beam epitaxy, emitting in the blue (441 nm), green (502 nm), and yellow (568 nm) spectral range is reported. The device active region, consisting of a nanocolumnar InGaN section of nominally constant composition and 250 to 500 nm length, is free of extended defects, which is in strong contrast to InGaN (planar) layers of similar composition and thickness. Electroluminescence spectra show a very small blue shift with increasing current (almost negligible in the yellow device) and line widths slightly broader than those of state-of-the-art InGaN quantum wells.

Esquistosomiasis vesical con hematuria terminal en pacientes subsaharianos / Vesical Schistosomiasis With Terminal Hematuria in Sub-Saharan Patients

Objetivos: Conocer las características de la esquistosomiasis vesical por Schistosoma haematobium en pacientes inmigrantes. Material y métodos: Se presenta el estudio retrospectivo de 41 casos diagnosticados microbiológicamente en nuestro hospital en los últimos 16 años, recogiendo datos de origen, edad, forma de presentación, pruebas diagnósticas y tratamiento. Resultados: Todos eran pacientes africanos con edades comprendidas entre 4 y 32 años y presentaban hematuria macroscópica terminal. La mayoría (85%) eran varones. Se diagnosticaron con estudio microbiológico de orina en todos los casos y en uno de biopsia por cistoscopia de una lesión típica vesical. La hematuria terminal es el signo clínico más representativo. Se trataron con praziquantel. Conclusiones: La epidemiología y la hematuria terminal intermitente en pacientes africanos debe hacer sospechar esquistosomiasis vesical como primera opción diagnóstica. El estudio microbiológico de orina es una prueba rápida, no invasiva y con alta rentabilidad diagnóstica que evitaría la realización de exploraciones invasivas. Su sencillo tratamiento asegura un alto nivel de cumplimiento y consecuente eficacia

Objectives: To know the characteristics of vesical schistosomiasis caused by schistosoma hematobium in immigrant patients. Materials and methods: The retrospective study of 41 cases microbiologically diagnosed in our hospital over the last 16 years is presented. Data were collected on origin, age, presentation form, diagnostic tests and treatment. Results: All were African patients whose ages ranged from 4 to 32 years and who had terminal macroscopic hematuria. Most of the patients (85%) were men. In all of the cases, diagnosis was by a urinary microbiological study and in one case, cystoscopy with a biopsy of a typical vesical lesion. Terminal hematuria is the most representative clinical sign. They were treated with praziquantel. Conclusions: The epidemiology and intermittent terminal hematuria in African patients should lead to the suspicion of vesical schistosomiasis as the first diagnostic option. Urinary microbiological study is a rapid, non-invasive test with high diagnostic yield that would avoid performing invasive studies. Its simple treatment assures high level of compliance and consequent efficacy

Vesical schistosomiasis with terminal hematuria in sub-Saharan patients.

OBJECTIVES: To know the characteristics of vesical schistosomiasis caused by schistosoma hematobium in immigrant patients. MATERIAL AND METHODS: The retrospective study of 41 cases microbiologically diagnosed in our hospital over the last 16 years is presented. Data was collected on origin, age, presentation form, diagnostic tests and treatment. RESULTS: All were African patients whose ages ranged from 4 to 32 years and who had terminal macroscopic hematuria. Most of the patients (85%) were men. In all of the cases, diagnosis was by a urinary microbiological study and in one case, cystoscopy with a biopsy of a typical vesical lesion. Terminal hematuria is the most representative clinical sign. They were treated with praziquantel. CONCLUSIONS: The epidemiology and intermittent terminal hematuria in African patients should lead to the suspicion of vesical schistosomiasis as the first diagnostic option. Urinary microbiological study is a rapid, non-invasive, test with high diagnostic yield that would avoid performing invasive studies. Its simple treatment assures high level of compliance and consequent efficacy.

Selective area growth of In(Ga)N/GaN nanocolumns by molecular beam epitaxy on GaN-buffered Si(111): from ultraviolet to infrared emission.

Selective area growth of In(Ga)N/GaN nanocolumns was performed on GaN-buffered Si(111) substrates by plasma-assisted molecular beam epitaxy. Undoped and Si-doped GaN buffer layers were first grown on Si(111) substrates, showing photoluminescence excitonic emission without traces of other low energy contributions, in particular, the yellow band. The GaN buffer surface roughness (between 10 and 14 nm, the rms value in a 10 × 10 µm(2) area) was low enough to allow the fabrication of a thin (7 nm thick) well defined Ti nanohole mask, for the selective area growth. Ordered In(Ga)N/GaN nanocolumns emitting from the ultraviolet (3.2 eV) to the infrared (0.78 eV) were obtained. The morphology and the emission efficiency of the In(Ga)N/GaN nanocolumns emitting at a given wavelength could be substantially improved by tuning the In/Ga and total III/N ratios. An estimated internal quantum efficiency of 36% was derived from photoluminescence data for green emitting nanocolumns.

Plasmon excitation in electron energy-loss spectroscopy for determination of indium concentration in (In,Ga)N/GaN nanowires.

We demonstrate the potential of low-loss electron energy-loss spectroscopy in transmission electron microscopy as a quick and straightforward method to determine the local indium compositions in (In,Ga)N/GaN nanowires. The (In,Ga)N/GaN nanowire heterostructures are grown by plasma assisted molecular beam epitaxy on Si(111) substrates in a self-assembled way, and on patterned GaN templates in an ordered way. A wide range of indium contents is realized by varying the substrate temperatures. The plasmon peak in low-loss electron energy-loss spectroscopy exhibits a linear relation with respect to indium concentration in (In,Ga)N nanowires, allowing for a direct compositional analysis. The high spatial resolution of this method in combination with structural information from transmission electron microscopy will contribute to a basic understanding of the lattice pulling effect during (In,Ga)N/GaN nanowire growth.

Optoelectronic properties of InAlN/GaN distributed bragg reflector heterostructure examined by valence electron energy loss spectroscopy.

High-resolution monochromated electron energy loss spectroscopy (EELS) at subnanometric spatial resolution and <200 meV energy resolution has been used to assess the valence band properties of a distributed Bragg reflector multilayer heterostructure composed of InAlN lattice matched to GaN. This work thoroughly presents the collection of methods and computational tools put together for this task. Among these are zero-loss-peak subtraction and nonlinear fitting tools, and theoretical modeling of the electron scattering distribution. EELS analysis allows retrieval of a great amount of information: indium concentration in the InAlN layers is monitored through the local plasmon energy position and calculated using a bowing parameter version of Vegard Law. Also a dielectric characterization of the InAlN and GaN layers has been performed through Kramers-Kronig analysis of the Valence-EELS data, allowing band gap energy to be measured and an insight on the polytypism of the GaN layers.

Polarity determination by electron energy-loss spectroscopy: application to ultra-small III-nitride semiconductor nanocolumns.

Channeling-enhanced electron energy-loss spectroscopy is applied to determine the polarity of ultra-small nitride semiconductor nanocolumns in transmission electron microscopy. The technique demonstrates some practical advantages in the nanostructure analysis, especially for feature sizes of less than 50 nm. We have studied GaN and (Al, Ga)N nanocolumns grown in a self-assembled way by molecular beam epitaxy directly on bare Si(111) substrates and on AlN buffer layers, respectively. The GaN nanocolumns on Si show an N polarity, while the (Al, Ga)N nanocolumns on an AlN buffer exhibit a Ga polarity. The different polarities of nanocolumns grown in a similar procedure are interpreted in terms of the specific interface bonding configurations. Our investigation contributes to the understanding of polarity control in III-nitride nanocolumn growth.

Thrombosed aneurysm of ductus arteriosus: a case report.

Spontaneous aneurysms of the ductus arteriosus are rare complications of a patent ductus arteriosus. It is met at any age but it is most commonly seen in children under two months of age. Echocardiography is the best test to diagnose a ductus arteriosus, but actually the role of thoracoscopy is to help in differential diagnosis of mediastinal masses. Surgery should be recommended without delay, to avoid fatal complications, with the resection of the thrombosed aneurysm of the ductus arteriosus.

[An intervention program to improve the quality of the medical records in an Internal Medicine Department]. / Intervención para la mejora de la calidad de las historias clínicas en un Servicio de Medicina Interna.

INTRODUCTION: The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. MATERIAL AND METHODS: A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. RESULTS: Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. CONCLUSION. The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students.

Intervención para la mejora de la calidad de las historias clínicas en un Servicio de Medicina Interna / An intervention program to improve the quality of the medical records in an Internal Medicine Department

Introducción: Las historias clínicas son documentos clave en el diagnóstico, tratamiento y seguimiento de los pacientes. Por ello es necesario realizar historias clínicas de elevada calidad técnica. Aunque hay estudios que relacionan la calidad de la historia clínica con un mejor control de una determinada enfermedad, conocemos pocos que evalúen la calidad intrínseca de las historias. El objetivo de este trabajo fue analizar la calidad de las historias clínicas de nuestro Servicio de Medicina Interna y, tras intervenir, valorar la mejoría conseguida. Material y métodos: Estudio de intervención antes/después que incluyó 186 historias clínicas elaboradas por los médicos de nuestro Servicio de Medicina Interna. Se diseñó una plantilla para evaluar 16 contenidos de ellas mediante una escala tipo Likert. Se analizaron las variables ítem por ítem y con un score combinándolos. Se realizó un análisis basal y otro tres meses después, tras realizar varias intervenciones. Resultados: Se detectaron las insuficiencias de las historias al inicio (que se describen) y tras las intervenciones. Con ellas se obtuvo mejoría en prácticamente todos los ítems seleccionados, destacando la mejor cumplimentación de las alergias y los hábitos vitales. El score global mejoró también de manera significativa. Conclusión: El estudio nos ha permitido conocer nuestras insuficiencias en la elaboración de las historias clínicas. Con las intervenciones hemos aumentado su calidad. Estimamos que esta actuación ha resultado formativa para los médicos de plantilla, residentes y estudiantes de nuestro Servicio, y creemos que ha mejorado la calidad de nuestras actuaciones (AU)

Introduction: The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. Material and methods: A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. Results: Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. Conclusion The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students (AU)