Estudio de la relación entre la complejidad del centrohospitalario y la satisfacción del usuario que ingresa desde urgencias con la atención de enfermería recibida en esta área / Hospitalized patients’ satisfaction with emergency department nursing care: a descriptive, cross-sectional, multicenter study of whether satisfaction differs according to hospital complexity

Objetivos: El objetivo principal de este trabajo fue determinar si el grado de satisfacción de los usuarios hospitalizados con el cuidado enfermero prestado en el servicio de urgencias hospitalario (SUH) guarda relación con la complejidad del centro. Método: Estudio descriptivo, transversal y multicéntrico, con una muestra aleatoria de390 usuarios que ingresaron desde el SUH. Se utilizó la escala LOPSS-12 y un cuestionario de variables sociodemográficas y de salud. Resultados: La satisfacción media con la atención de enfermería, en una escala donde 1se identifica como muy satisfecho y 7 muy insatisfecho, fue de 2,34 (DE = 0,98). No se hallaron diferencias significativas de las puntuaciones medias totales según la complejidad del centro hospitalario, aunque sí respecto a varios aspectos del cuidado enfermero: la posibilidad de compartir sentimientos y de hacer preguntas, la participación en la planificación de la atención, la empatía y comunicación emocional y la posibilidad de solicitar información mayor en centros de alta complejidad y la rapidez en contestar las llamadas y la amabilidad (mayor en los centros de baja complejidad). La satisfacción de los usuarios se asoció significativamente a un menor tiempo de estancia en el SUH. Conclusiones: En este estudio encontramos un nivel medio-alto de satisfacción de los usuarios con la atención de enfermería de urgencias. La satisfacción no se mostró asociada con la complejidad del centro analizado. No obstante, determinados aspectos del cuidado enfermero sí registraron diferencias relevantes que pueden ser tenidas en cuenta para establecer estrategias de mejora que permitan incrementar los niveles de satisfacción con la atención de enfermería (AU)

Objective: The main aim of this study was to determine if hospitalized patients’ satisfaction with emergency department nursing care differs between hospitals of greater or lesser complexity. Methods: Descriptive, cross-sectional, multicenter study of a random sample of 390 users of emergency services who were admitted to hospital. Data were collected with the La Monica-Oberst Patient Satisfaction Scale and a standardized questionnaire on personal and health-related patient details. Results: On a scale of 1 to 7 reflecting patient satisfaction with nursing care (1, very satisfied; 7, very disatisfied), the mean (SD) score overall was 2.34 (0.98). No significant differences in the overall satisfaction scores were found in relation to hospital complexity, but differences were detected for certain aspects of nursing: the chance to share feelings and ask questions (better in greater complexity hospitals) and participation in care planning, empathy and emotional communication, the chance to request information, and promptness in response to calls and kidness of nurses (better inbessen complexity hospitals). Higher user satisfaction was associated with a shorter emergency department stay. Conclusions: We found a medium to high level of patient satisfaction with emergency nursing care in this study. Overall satisfaction was unrelated to type of hospital (complexity). However, certain aspects of care did show differences between more and less complex hospitals. These aspects can be taken into account when planning ways to improve satisfaction with nursing care (AU)

Coronary artery fistula as a bypass of a left anterior descending coronary artery stenosis.

We present a case of coronary artery fistula originating from the proximal left anterior descending coronary artery anterior to a critical atheromatous stenosis, draining into the main trunk of the pulmonary artery and with a third branch draining into the coronary vessel itself, distal to the lesion. The diagnosis was made when we were performing a diagnostic coronary arteriography on a patient with unstable angina. The possible association of the fistula and coronary atherosclerosis is discussed.

Clinical experience with retrograde lung preservation.

Previous reports and our own experimental work suggest increased vascularity of the tracheobronchial wall when retrograde lung preservation is used. This principle was clinically applied in 21 consecutive lung transplant recipients (10 single and 11 bilateral). Lung preservation was achieved via the left atrial appendage and drainage was obtained through the pulmonary artery. Pneumoplegic preservation was achieved with modified Euro-Collins solution. Cardioplegia was induced by the standard method and the heart, harvested by different teams, did not exhibit left ventricular dilatation. Thirty-two bronchial anastomoses without wrapping were performed. No primary lung graft failure was documented. Cardiopulmonary bypass was instituted in three cases of pulmonary hypertension; however, this was deemed unnecessary in the remainder of the cases of bilateral transplantation while the second organ was being implanted. All bronchial anastomoses were followed between 2 and 28 months. A single instance of bronchial anastomosis dehiscence was observed on the 30th postoperative day. However, no stents were employed in this series, and no strictures or anastomotic granulomas have been reported so far. All the hearts could be used satisfactorily except for one primary graft failure. In conclusion, retrograde lung preservation is feasible in clinical lung transplantation, with simultaneous harvesting of the heart. The impact of retrograde lung preservation on the late clinical outcome remains to be seen.