[Effectiveness of an early discharge program after normal childbirth]. / Efectividad de un programa de alta precoz tras parto normal.

OBJECTIVE: To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. MATERIAL AND METHODS: Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. RESULTS: A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. CONCLUSIONS: The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes.

[Results of applying a paediatric early warning score system as a healthcare quality improvement plan]. / Resultados de la aplicación de una escala de alerta clínica precoz en pediatría como plan de mejora de calidad asistencial.

OBJECTIVES: The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively. MATERIAL AND METHODS: An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score. RESULTS: The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases. CONCLUSIONS: PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.

Vacunación de gripe en niños con diagnóstico de diabetes mellitus tipo 1 en un área suburbana de Madrid / Influenza vaccination in children with type I mellitus diabetes in a suburban area in Madrid

Objetivo: determinar la tasa de vacunación frente a la gripe en el grupo de pacientes con diabetes mellitus (DM) tipo 1 en seguimiento en nuestro centro. Material y métodos: en los pacientes con diagnóstico de DM tipo 1 se realiza un estudio transversal descriptivo analizando la tasa de vacunación frente a la gripe. Resultados: se incluyen 37 pacientes (varones/mujeres: 1,6/1). La edad media es 9,7 años y el tiempo de evolución de la enfermedad tres años. El 51,3% ha sido vacunado contra la gripe en 2010, frente al 80% en 2009. Los niños con un tiempo de evolución entre tres y seis años son los menos vacunados (22% de los vacunados), frente al resto (56%). Conclusiones: la cobertura vacunal frente al virus de la gripe es escasa en nuestro medio, aunque superior a la referida para el territorio español (36,7%). Es necesaria la recomendación de la vacunación antigripal a pacientes diabéticos (AU)

Objective: To determine the rate of flu vaccination in the group of patients followed in our hospital because of type 1 diabetes. Methods: A descriptive study is conducted in patients with type 1 diabetes, analyzing the rate of vaccination against influenza. Results: 37 patients were included (male/female: 1.6/1). The mean age was 9.7 years and the mean duration of disease 3 years. 51.3% patients have been vaccinated against influenza in 2010 versus 64.86% in 2009. Children with a disease evolution between 3 and 6 years are the least vaccinated (22% vaccinated), compared to the rest (56%). Conclusions: Vaccination coverage against influenza virus is low in our area, although higher than the referred in Spanish population (36.7%). Recommendation on influenza vaccination is required in diabetic patients (AU)

Displasia evolutiva de cadera: controversia sobre el cribado ecográfico universal / Developmental hip dysplasia: controversy on universal echographic screening

Pese a la elevada incidencia de displasia de cadera clínicamente importante (3-5 casos por cada 1000 recién nacidos vivos) y a los ampliamente estudiados factores de riesgo principales (parto de presentación podálica, sexo femenino y antecedentes familiares de displasia evolutiva de cadera), no se ha conseguido encontrar una estrategia efectiva que reduzca la incidencia de casos tardíos. Reabrimos, a propósito de un caso, la controversia existente acerca del cribado ecográfico universal en la patología osteomuscular más frecuente de la infancia (AU)

Despite the elevated incidence of clinically relevant hip dysplasia (3-5 per 1000 live births) and the broadly studied main risk factors (breech position, female sex and family cases), we have not achieved an effective prevention strategy, and so the detection of late cases has not decreased. We reopen, following a case, the existent controversy upon universal ultrasound screening on the most frequent musculo-skeletal disorder in the infancy (AU)

[Silent celiac disease: exploring the iceberg in the school-aged population]. / Enfermedad celíaca silente: explorando el iceberg en población escolar.

BACKGROUND: Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD. OBJECTIVES: To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases). METHODS: We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid. RESULTS: A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5. CONCLUSIONS: We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

Enfermedad celíaca silente: explorando el iceberg en población escolar / Silent cardiac disease: exploring the iceberg in the school-aged population

Fundamento: Los estudios epidemiológicos realizados sobre población infantil no seleccionada han demostrado una elevada prevalencia de enfermedad celíaca silente y una baja relación de enfermedad celíaca conocida frente a no diagnosticada. Objetivos: Realizar un cribado de enfermedad celíaca silente en población escolar, caracterizar clínicamente a estos pacientes y valorar su prevalencia global (casos silentes más sintomáticos). Métodos: Se determinaron anticuerpos antiendomisio (EMA), inmunoglobulina A (IgA) sérica y anticuerpos antigliadina IgG (AGA IgG), si existía déficit de IgA, a los escolares de 10 a 12 años del área IX de Madrid. Resultados Se han estudiado 3.378 niños (47,8% de la muestra). Quince fueron EMA positivos y uno déficit de IgA tuvo AGA IgG positivos. La enfermedad celíaca se confirmó mediante biopsia intestinal en 12 niños, lo que representa una prevalencia de enfermedad celíaca silente de 1/281. Siete de los 12 niños mostraban hallazgos clínicos, entre los que los más frecuentes fueron ferropenia, aftas orales recurrentes y malnutrición leve. Previamente a este estudio de detección habían sido diagnosticados 7 enfermos celíacos en la misma población, con lo que la prevalencia global calculada ascendería a 1/220 y la relación entre enfermedad celíaca conocida y no diagnosticada sería de 1/3,5. Conclusiones: Se confirma una elevada prevalencia de enfermedad celíaca silente en nuestro medio. La relación entre enfermedad celíaca conocida y silente es una de las mayores de la bibliografía y podría relacionarse con un importante nivel de alerta frente a esta enfermedad por parte de los pediatras de nuestra área de salud. Un mejor conocimiento de los síntomas menores de la enfermedad celíaca disminuirá el número de casos de enfermedad celíaca no diagnosticada (AU)