[Diagnostic agreement of primary care and minor surgery in a basic health area]. / Concordancia diagnóstica entre atención primaria y cirugía menor en una zona básica de salud.

AIM: Minor Surgery (MS) is an ever-increasing programmed activity in Primary Health Care Centres (PHC). The aim of this study is to establish the clinical and histopathology diagnostic agreement between PHC and MS and evaluating the efficacy of this activity. METHODS AND MATERIALS: A retrospective, observational, and reliability study was performed. A total of 234 patient specimens were sent to Histopathology between January 2014 and December 2018 in basic health area of San Benito-La Laguna, Santa Cruz de Tenerife. Of these, 203 specimens met criteria, with 31 being excluded due to death or absence of diagnosis. Sociodemographic and diagnostic variables were analysed, and 10 possible diagnoses were grouped into 3 categories according to their nature. Cohen kappa coefficient was used as the main evaluation measure. RESULTS: The majority of specimens were obtained from women (51.2%), and the mean age was 52.82±17.82 years. The most frequently referred lesion was the epidermoid cyst (20.2-21.67%). A clinical-pathological agreement of 60% was obtained in Minor Surgery, with a specificity of 98.3% and a sensitivity of 61.9%. In Primary Care agreement was 36.1%, with a specificity of 98.4% and a sensitivity of 42.8%. Infectious lesions represented the largest concordance difference obtained, with 27% less in Primary Care compared to Minor Surgery. CONCLUSIONS: Minor Surgery is an effective support in the initial diagnosis of lesions referred for evaluation at Primary Care. However, it is necessary to implement improvements in diagnostic efficacy of Primary Care.

Caracterización de la productividad quirúrgica del Hospital Docente Clínico Quirúrgico Aleida Fernández Chardiet, 2010 - 2017 / Surgical productivity characterization of the Aleida Fernández Chardiet Clinical Teaching Hospital, 2010 - 2017

Introducción: la mayor parte de los hospitales, tienen un programa de control de calidad asistencial. Han utilizado, como método básico, la monitorización de la actividad asistencial a través de las comisiones clínicas o de los estudios puntuales en profundidad de los problemas detectados, a través de los auditores médicos. Objetivo: caracterizar la actividad quirúrgica departamental en el Hospital Docente Clínico Quirúrgico Aleida Fernández Chardiet en el periodo comprendido desde 2010 - 2017. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo. Se caracterizó la actividad quirúrgica departamental en el hospital y periodo mencionado. Del departamento de estadística y de las actas del Comité de Evaluación de Intervenciones Quirúrgicas se obtuvieron los datos necesarios para esta investigación. El universo estuvo constituido por el total de cirugías realizadas por el departamento quirúrgico en el periodo estudiado, en total 22 378. Resultados: hubo un aumento de la cirugía mayor del departamento a expensas de la cirugía ambulatoria. La cirugía menor siempre ha sido superior a la mayor y aunque la menor ambulatoria se disminuyó, la menor de urgencia se ha incrementado. El departamento de cirugía general es el de mayor productividad del servicio. Las suspensiones quirúrgicas han afectado la productividad quirúrgica del departamento. El índice de reintervenciones ha disminuido en el hospital. Conclusiones: el departamento mantiene la productividad quirúrgica y logra disminuir la cirugía menor ambulatoria y las reintervenciones (AU).

Introduction: most of the hospitals, have a program of Control of Assistance Quality, they have used, as basic method, control of the assistance activity through the Clinical Commissions or of the punctual studies in depth of the detected problems, through the medical auditors. Objective: to describe the departmental surgical activity at AleidaFernández Chardiet Clinical Teaching Hospital from 2010 to 2017. Methods: a longitudinal and retrospective descriptive observational study was carried out. The departmental surgical activity in the hospital in the mentioned period was characterized. The necessary data were obtained from the statistic department and from the records of the Evaluation of Surgical Interventions Committee. The universe was formed by all the surgeries carried out by the surgical department in the studied period, in total 22 378. Results: there was an increase of the major surgery of the department taking into account the increasing of the ambulatory surgery. The minor surgery has always been higher than the major surgery and although the ambulatory minorone decreased, the urgency minor surgery has been increased. The general surgery department has the highest productivity of the service. The surgical interruptions have affected the surgical productivity of the department. The reinterventions index has diminished in the hospital. Conclusions: the department maintains the surgical productivity andmanages to diminish the ambulatory small surgery and the reinterventions (AU).

[Trained eye vs. gold standard]. / Ojo clínico vs. gold standard.

OBJECTIVE: To determine the degree of correlation between the clinical diagnosis prior to the minor surgery process and its concordance with the results of histopathology report, as well as to determine the surgical data of little clinical importance compared to that which is really necessary and cost-effective. MATERIAL AND METHOD: A descriptive, observational, retrospective and transversal study was conducted of the Minor Surgery Activities of a clinic in the Ciudad Real Health Centre I. RESULTS: A total of 124 surgical specimens were sent for clinical diagnostic comparison, of which, the main clinical diagnoses were: intradermal melanocytic nevi (34.67%), seborrheic keratosis (11.30%), and epidermoid or sebaceous cysts (10.48%). A correlation of 68% was obtained. The protocols of the work centre have been followed to carry out this study in relation to the confidentiality of the data. CONCLUSIONS: These results were analysed and compared with other similar works performed in the field of minor surgery in Primary Care, being able to affirm that there is a good correlation between the initial clinical diagnosis and the histopathology results.

Effects of a minor surgery on health related quality of life in children from different perspectives / Efectos de una intervención quirúrgica menor sobre la calidad de vida en niños desde diferentes perspectivas.

Objective: To compare the health related quality of life (HRQoL) perceptions in parents and physician regarding the patient undergoing ambulatory surgery, and to analyse the evolution of HRQoL before and after the ambulatory surgery. Method: 36 patients underwent ambulatory surgical interventions taken part in this study. The questionnaires EQ-5D-Y were administered to the patients and questionnaires EQ-5D-Y proxy to parents and physicians. Variable TTO was used. Results: Statistical differences were found at baseline between answers of patients and physicians (p < 0.05). However, after surgery, answers of patients and proxies were similar. Conclusions: Paediatric patients undergone to a minor surgery improve HRQoL after the operation and this improvement goes on a month after the surgery.

Objetivo: Comparar la percepción de la calidad de vida relacionada con la salud (CVRS) de padres y médico con respecto al paciente en población infantil sometida a una intervención quirúrgica menor, y analizar la progresión de la CVRS tras un mes de someterse a la intervención. Método: Participaron 36 pacientes sometidos a intervenciones quirúrgicas menores. Se les administró el cuestionario EQ-5D-Y, y su versión proxy correspondiente a los padres y al médico. Se utilizó la variable TTO. Resultados: Los pacientes refirieron un peor estado de salud, sobre todo en la dimensión de preocupación/tristeza, que los médicos en el preoperatorio (p < 0.05), pero la percepción postoperatoria fue similar en pacientes y adultos, atribuible al efecto techo por buena salud postoperatoria. Conclusiones: Los pacientes pediátricos sometidos a cirugía menor mejoran su CVRS tras la intervención, y esta mejora se mantiene tras un mes de la cirugía.

[Description of clinical pathological concordance and patient satisfaction in minor surgery in a Primary Care centre]. / Descripción de la concordancia clinicopatológica y satisfacción del paciente en la cirugía menor en un centro de atención primaria.

AIM: To describe the minor surgery (MS) characteristics in a Primary Care (PC) centre, and to evaluate the clinical pathological concordance and patient satisfaction. DESIGN: Descriptive and retrospective study. SETTING: Primary Care, urban health care centre, Almería, Spain. PARTICIPANTS: The population were the patients belonging to urban Primary Health Care centre, referred by their family physicians or paediatricians for the performing of MS during year 2013, and who consented to the intervention. A sample of 223 patients was obtained. MAIN MEASUREMENTS: Variables analysed were: sex, age, locations of the lesions, type of intervention, clinical diagnosis, histopathology diagnosis, complications, and patient satisfaction. The data were extracted from the medical history, the histopathology reports, and by using a satisfaction questionnaire completed by post or telephone by the patients. RESULTS: The population consisted of 53.8% males, and had a mean age of 51.12 years (SD 19.02). The location of the most intervened lesions was in the head (35.4%). Electro-surgery was the most used procedure (62.8%), with only 16.9% of the lesions being biopsied, of which the most frequent was fibroids (32.3%). The clinical pathological concordance was >80% and the Kappa index was 0.783 (P<.001). The complications presented were low. The patient's satisfaction was high. CONCLUSIONS: Although a simple MS technique like electro-surgery has become more extensive, MS in PC remains safe and satisfactory for the user.

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…

Avaliação de um programa de formação baseado no Mentoring para aquisição de habilidades em pequena cirurgia num centro de saúde urbano em Jaén, Andaluzia, Espanha / Evaluation of a training program based on Mentoring for acquisition of skills in minor surgery for professionals in an urban health center in Jaén, Andalusia, Spain / Valoración de un programa de formación basado en el Mentoring para adquisición de habilidades en cirugía menor en un centro de salud en Jaén, Andalucía, España

Objetivos: Avaliar a implantação de um programa de tutoria em habilidades para a pequena cirurgia em um centro de saúde urbano. Desenho e métodos: Estudo descritivo transversal numa zona básica de saúde urbana composta por 16000 habitantes. Recolhemos todas as intervenções cirúrgicas realizadas durante os anos de 2009, 2010 e 2011. Estas foram divididas em dois grupos. Um primeiro grupo que compreende aquelas intervenções que foram autorizadas por um médico com experiência, e outro onde encontramos as não tutoradas. Também foram considerados os tipos de intervenção, existência de consentimento informado e o envio de amostras a anatomia patológica. Resultados: Foram realizadas um total de 363 intervenções (101 em 2009, 114 em 2010 e 148 em 2011), 45% autorizadas, sem encontrar diferenças por ano de realização nem por tipo de intervenção (59% extirpação de verrugas, 25% infiltrações, 7% quistos epidérmicos). Participaram da proposta, principalmente médicos residentes (96%), seguidos de médicos de família (62%) e por último a equipe de enfermagem (29%). Um maior número de peças cirúrgicas foram enviadas a anatomia patológica nos atos cirúrgicos tutorados (83% vs 62%, p < 0.05 test c²) assim como, houve um melhor preenchimento do consentimento informado. Conclusões: O sistema de formação em habilidades por mentoring em "Pequena Cirurgia" implicou progressivamente no restante de profissionais do Centro de Saúde, aumentou a quantidade de atos cirúrgicos realizados e melhorou a qualidade do programa. Aproveitar as habilidades dos profissionais que trabalham em Atenção Primária à Saúde (APS) para formar os colegas, pode atuar como catalizador para aumentar a capacidade de resposta e inovação.

Objectives: To assess the implementation of a mentoring program for minor surgery skills in a Health Center. Design and methods: A descriptive transversal study in an urban health district with 16.000 inhabitants. Assessment of all operations performed the years 2009 to 2011, distinguishing those that have been supervised by an experienced physician, assessing: type of intervention, supervised staff, existence of informed consent and sending samples to pathology. Results: 363 operations in total (101 in 2009, 114 in 2010 and 148 in 2011), 45% tutored; no differences by years or by type of intervention (59% warts removal, 25% infiltration, 7% epidermal cysts). Mainly involved medical residents (96%), family physicians (62%) and nurses (29%). More surgical specimens are sent to pathology in the surgical acts mentored (83% vs 62%, p < 0.05 c2) as well as the completion of informed consents were improved. Conclusion: The system of training by mentoring in minor surgery skills can involve progressively the other professionals in the Health Center. Also, the mentoring increases the surgical procedures performed and improves the quality of the program. Harnessing the skills of those professionals working in primary care to train their peers can act as a catalyst to increase responsiveness and innovation.

Objetivos: Valorar la implantación de un programa de tutorización en habilidades para cirugía menor en un Centro de Salud. Material y métodos: Estudio descriptivo transversal en una zona básica de salud urbana con 16000 habitantes. Se recogen todas las intervenciones quirúrgicas realizadas los años 2009 a 2011. Se diferencian aquellas que ha sido tutorizadas por un médico experto, valorando: tipo de intervención, personal tutorizado, existencia de consentimiento informado y envío de muestras a anatomía patológica. Resultados: Se realizan en total 363 intervenciones (101 en 2009, 114 en 2010 y 148 en 2011), 45% tutorizadas sin diferencias por años ni por tipo de intervención (59% extirpación de verrugas, 25% infiltraciones, 7% quistes epidérmicos). Participan mayoritariamente médicos residentes (96%), médicos de familia (62%) y personal de enfermería (29%). Se envían más muestras a anatomía patológica en los actos quirúrgicos tutorizados (83% vs 62%, p < 0,05 test c2) y se cumplimenta mejor el consentimiento informado. Conclusiones: El sistema de formación en habilidades mediante mentoring en Cirugía Menor implica progresivamente al resto de profesionales del Centro de Salud, incrementa los actos quirúrgicos realizados y mejorar la calidad del circuito. El aprovechamiento de las habilidades de los mismos profesionales que trabajan en Atención Primaria para formar a sus compañeros puede actuar como catalizador para aumentar la capacidad de respuesta y la innovación.

Exéresis quirúrgica radical como único tratamiento del condiloma acuminado gigante: a propósito de un caso / Surgical radical excision alone as a treatment for the giant condyloma acuminatum: a case report

Los condilomas o verrugas genitales son producidos por el virus del papiloma humano del que existen más de 100 genotipos distintos. De ellos, cerca de 40 son transmitidos sexualmente. Se presenta el caso de una mujer con condiloma acuminado gigante de localización vulvo perineal y perianal, de cinco años de evolución que le dificultaba la micción, las relaciones sexuales, e incluso la marcha; además había fetidez, prurito y en ocasiones dolor. El examen histopatológico fue compatible con condiloma acuminado. Se realizó extirpación quirúrgica radical del tumor con excelentes resultados funcionales y cosméticos, sin complicaciones postoperatorias y sin recurrencias ni cicatrices hipertróficas al año de evolución. Es de interés la publicación por tratarse del primer caso que se informa en el Estado de Eritrea, país en desarrollo del cuerno africano.

Condylomas or genital warts are caused by the human papilloma virus, from which exist more than 100 different genotypes. About 40 of them are sexually transmitted. We report a case of a female patient with a giant condyloma acuminatum in the vulvar perineal and perianal regions, of around five years of course, which disturbs her urination, sexual intercourse, and even walk; accompanied by pruritus, foul-smelling, and occasionally pain. The histopathological study was compatible with condyloma acuminatum. She was treated conservatively with radical local surgical excision of the tumor with excellent functional and cosmetic results. No postoperative complications were observed. A year later there were neither recurrences nor hypertrophic scars. We consider interesting to publish it due to it’s the first case published in the state of Eritrea, developing country of the horn of Africa.