Modelo de análisis del uso del laboratorio por los servicios de urgencias hospitalarios basado en el nivel de urgencia según clasificación del paciente por el sistema de triaje estructurado / Model of analysis of services laboratory resource requests from emergency health services and emergency level based on the patient classification rating done by the triage system

Objetivo: El objetivo de este trabajo es describir la factibilidad y presentar los resultados obtenidos al aplicar un modelo de análisis del consumo de recursos diagnósticos del laboratorio que, en función de la distribución de las urgencias realizadas mediante el sistema de triaje estructurado, permite analizar si son usados eficientemente. Métodos: Se construyó una base de datos con el nivel de triaje (NT) del total de visitas a los Servicios de urgencias en 2017 (185.128) y las peticiones al laboratorio en 4 hospitales de la APESBG. Aplicación del sistema de triaje estructurado en todos los episodios. Se diseñaron 4 indicadores de relación entre el NT y consumo de recursos de laboratorio (número de peticiones, complejidad y unidades relativas de valor). Resultados: Cuando se analiza la complejidad de las peticiones según el NT, a mayor valor de NT (menor complejidad de la urgencia) menor es la complejidad media de las peticiones de laboratorio; las unidades relativas de valor consumidas para cada NT agrupado es superior para los niveles I, II, III 1.104.712,73 (67,68%) en comparación con las 527.526,92 (32,32%) de los niveles IV, V, destacando la diferencia entre los hospitales que más y menos unidades relativas de valor consumen en prioridades IV, V, 46% y 28%. La distribución al analizar el número de peticiones correspondiente a los NT IV, V va del 63,76% al 35,78%. Conclusiones: Es posible explotar datos de consumo de recursos del laboratorio por los servicios de urgencias en función del NT; los resultados obtenidos validan la utilidad de los indicadores propuestos como herramienta de gestión

Objective: The aim of this study is to describe the applicability and the results obtained by applying an analysis model of the use of laboratory diagnostics resources based on the distribution of patients in the emergency department made through the structured triage systems. This model allows studying whether or not they are used efficiently. Methods: A database was compiled according to the triage level (TL) of the total number of emergency visits in 2017 (185,128) and requests for laboratory analyses in 4 hospitals. The Spanish triage system was used in all the selected cases. Four indicators were designed to link the triage level and the laboratory resources used (the number of required tests, and the relative value units used in each of the triage levels). Results: When assessing the complexity of the laboratory requests based on the TL, the higher value of the TL (less complex emergency), the low-medium complexity of the requests for laboratory analyses; relative value units consumed for each clustered TL is higher for levels I, II, III 1,104,712.73 (67.68%) compared with the levels IV, V 527,526.92 (32.32%), emphasising the differences between the hospitals on the number of relative value units used in TL IV, V, 46% and 28%. When the number of requests corresponding to TL IV, V have been considered, the range runs from 63.76% to 35.78%. Conclusions: The use of the resource of laboratory requests from the emergency department as a function of the level of triage, is possible. Results validate the utility of the proposed set of indicators as a management tool

Gynaecomastia in HIV-infected men on highly active antiretroviral therapy: association with efavirenz and didanosine treatment.

BACKGROUND: Gynaecomastia has been described in HIV-infected men undergoing highly active antiretroviral therapy (HAART). However, there are insufficient data on the relationship between gynaecomastia and any specific antiretroviral drug and hormone abnormality. OBJECTIVE: To assess the frequency of gynaecomastia in HIV-infected men receiving HAART and its association with antiretroviral drugs and hormone abnormalities. METHODS: We carried out a prospective study of 1304 HIV-infected men undergoing HAART. In addition, we included a case (with gynaecomastia)-control (without gynaecomastia) analysis in the second part of this study. Cases and controls were matched according to age, HIV infection CDC clinical category, HCV infection, the date of study and the physician responsible for the patient. Patients bearing known causes of gynaecomastia were excluded. We analysed epidemiological, clinical, haematological and immunological characteristics and the use and duration of the antiretroviral therapy. In 13 cases and 13 controls a sexual hormone profile was carried out. RESULTS: A total of 30 (2.3%) HIV-infected men presented with gynaecomastia of unexplained cause. In 22 (73%) of these individuals, gynaecomastia completely resolved after a median time of 9 months (range: 5-22 months). The percentage of individuals who were receiving efavirenz and didanosine at the time of the study was higher among patients with gynaecomastia [57% vs 17% (P=0.004) and 50% vs 13% (P=0.003), respectively]. Plasma total testosterone, free testosterone index and bioavailable testosterone levels were lower in patients with gynaecomastia, whereas plasma free testosterone levels were not significantly different in either population. CONCLUSIONS: Gynaecomastia is not uncommon in HIV-infected men undergoing HAART and it is usually transient. Efavirenz and didanosine treatment are associated with the emergence of gynaecomastia. An underlying hypoandrogenism seems to contribute to the emergence of this disorder in these patients.

Hiperlactatemia sintomática en pacientes con infección por el virus de la inmunodeficiencia humana tratados con análogos de nucleósidos / Symptomatic hyperlactemia in patients infected with the human immunodeficiency virus treated with nucleoside analogues

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