Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency.

BACKGROUND: Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration. METHODS: Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated. RESULTS: Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049). CONCLUSION: Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.

[Cost-effectiveness analysis of fracture liaison services in Catalonia]. / Análisis de coste-efectividad de las Unidades de Coordinación de Fracturas en Cataluña.

OBJECTIVE: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service. METHODS: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses. RESULTS: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case. CONCLUSIONS: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

Tratamiento médico del aborto del primer trimestre: igual eficacia, más eficiencia / Medical treatment of abortion in the first trimester: Equal effectiveness, more efficiency

Antecedentes: La pérdida gestacional precoz acontece en el 10-20% de todas las gestaciones clínicas, siendo el 85% previos a la semana 12 de amenorrea. El aborto involuntario conlleva una carga muy significativa en los recursos destinados a sanidad, alcanzado un coste económico nacional en Reino Unido de 471 millones de libras esterlinas por año (533,06 millones de euros), cifra extrapolable a otros países industrializados. Según una revisión sistemática reciente no hay ensayos bien diseñados en gestaciones del primer trimestre que arrojen una evidencia consolidada sobre cuál es el mejor método de tratamiento de aborto del primer trimestre y existen diferentes estudios que han tratado de evidenciar reducción de costes con resultados contradictorios. Material y métodos: Se realiza un estudio de diseño observacional, retrospectivo y longitudinal. Se revisaron 892 pacientes diagnosticadas de aborto espontáneo durante el primer trimestre de gestación, en el periodo comprendido entre enero de 2013 y diciembre de 2016. En nuestro estudio hemos querido evaluar la efectividad del misoprostol vaginal como tratamiento médico para el aborto espontáneo en el primer trimestre, en comparación con el legrado obstétrico/evacuador y, cuantificar la diferencia en los costos de ambos procedimientos a través de un estudio de minimización de costes. Resultados: De las 892 pacientes reclutadas, se realizó tratamiento médico con misoprostol en 517 (57,95%) y tratamiento quirúrgico mediante legrado evacuador en 375 (42,05%). La efectividad del tratamiento médico fue del 82% (426/517). Con respecto al tratamiento quirúrgico la efectividad resultó del 100%. La tasa de éxito del tratamiento médico fue superior en el subgrupo de pacientes con aborto incompleto (92,9%), en comparación con los grupos de gestación anembrionada (85,7%) y aborto diferido (78,2%). Conclusiones: El tratamiento médico del aborto es un manejo seguro y aceptado por las pacientes...(AU)

Background: Early pregnancy loss occurs in 10-20% of all clinical pregnancies, 85% being prior to week 12 of amenorrhea. Miscarriage entails a very significant burden on healthcare resources, reaching a national economic cost in the United Kingdom of £471 million per year (€533.06 million), a figure that can be extrapolated to other industrialized countries. According to a recent systematic review, there are no well-designed trials in first-trimester pregnancies that provide consolidated evidence on what is the best first-trimester abortion treatment method, and there are different studies that have tried to demonstrate cost reduction with contradictory results. Material and methods: An observational, retrospective and longitudinal design study was carried out. 892 patients diagnosed with spontaneous abortion during the first trimester of pregnancy were reviewed, in the period between January 2013 and December 2016. In our study, we wanted to evaluate the efficacy of vaginal misoprostol as a medical treatment for spontaneous abortion in the first trimester, in comparison with obstetric curettage-evacuator, and to quantify the difference in the costs of both procedures through a cost minimization study. costs. Results: Of the 892 recruited patients, medical treatment with misoprostol was performed in 517 (57.95%) and surgical treatment by curettage in 375 (42.05%). The effectiveness of medical treatment was 82% (426/517). With respect to surgical treatment the effectiveness of 100%. The success rate of medical treatment was higher in the subgroup of patients with incomplete abortion (92.9%), compared to the anembryonic gestation (85.7%) and delayed abortion (78.2%) groups. Conclusions: The medical treatment of abortion is a safe management and accepted by the patients. The adequate selection of candidate patients leads to an increase in the success rate and a decrease in costs...(AU)

Analysis of the reasons for requesting HIV serology in the emergency department other than those defined in the targeted screening strategy of the "Urgències VIHgila" program and its potential inclusion in a future consensus document.

OBJECTIVE: To describe other reasons for requesting HIV serology in emergency departments (ED) other than the 6 defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future. METHODS: Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (IC95%) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was >0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative. RESULTS: There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from endemic countries (7.41%, 0.91-24.3), lymphopenia (4.76%, 0.12-23.8), plateletopenia (4.37%, 1.20-10.9), adenopathy (3.45%, 0.42-11.9), meningoencephalitis (3.12%, 0.38-10.8) and drug use (2.50%, 0.68-6.28). Sensitivity analysis confirmed efficiency in 6 of them: endemic country origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin. CONCLUSION: The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from an endemic country, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin.

Flebotomía (sangría) terapéutica en domicilio / Therapeutic phlebotomy (bloodletting) at home

Introducción: Paciente de sexo femenino de 86 años de edad, seguida en la unidad de hematología de nuestro hospital por una anemia normocitica-normocromica que tras tratamiento con darbopoetina alfa 40 mcg subcutánea semanal durante tres meses, es diagnostica-da de poliglobulia. Se solicitó flebotomía terapéutica de 400 cc de sangre. Tras su realización, se realiza control analítico resultando hemoglobina: 14.8mg/dl y hematocrito:42.2% (valores en rango). Desarrollo de la experiencia: El procedimiento se llevó a cabo en casa de la paciente sin necesidad de movilizarla de su cama, pues se encuentra encamada. Extraemos la cantidad de sangre indicada en la prescripción(400cc), sin ninguna complicación. Conclusiones: En este caso pudimos realizar un procedimiento de rango hospitalario en el domicilio de la paciente, liberando, por un lado, a los familiares de la “carga” del desplazamiento al hospital, y por otro, protegiendo la paciente de complicaciones relacionadas con la asistencia hospitalaria (infecciones nosocomiales, desorientación entre otras).Así mismo, con menos recursos, pudimos realizar una atención humanizada y segura, logrando el objetivo terapéutico. (AU)

Introduction:An 86-year-old woman with normocytic-normochromic anemia was diagnosed with polyglobulia after three months of weekly treatment with subcutaneous Darbopoetin alfa 40 mcg. She was treated with a Therapeutic phlebotomy of 400 cc of blood. The post treatment blood analysis showed values within range, Hemoglobin 14.8mg/dl and Hematocrit 42.2%. Development of Experience: The procedure was carried out in the patient’s house avoiding to move her from her own bed since she is a bedbridden patient. The ammount of blood prescribed, 400 cc, was drawn without any com-plications.Conclusions: This time, we have been able to develop a procedure that ussually we have to perform in the hospital in the patient best enviroment, her house. Avoiding both, the patient to be expose to the potential complication from an hospital enviroment ( infeccions, desorientation as many others) and the family to move the patient from her own bed. In summary, we reach the terapeuthic goal with an holistic and safe care attention but using less resources. (AU)

Antioxidant activity, cytotoxicity, phenolic content, and phytochemical composition of Pithecellobium Diversifolium benth: a pilot study / Atividade antioxidante, citotóxica, conteúdo fenólico e composição fitoquímica de Pithecellobium Diversifolium benth: um estudo piloto / Actividad antioxidante, citotóxica, contenido fenólico y composición fitoquímica de Pithecellobium Diversifolium benth: un estudio piloto

Species of Pithecellobium (Fabaceae) are used in traditional medicine to treat diabetes, cough, bronchitis, and inflammation. This study aims to evaluate the content and determine the antioxidant activity, phenolic compounds content, and cytotoxicity of the extract and the fractions of Pithecellobium diversifolium. This is unprecedented research with an exotic species from the Caatinga, northeastern Brazil, using High-performance Liquid Chromatography-Electrospray Ionization-Mass Spectrometry (HPLC-ESI-MS). The MeOH fractions of leaves and stem barks showed a high content of flavonoids (198.1 ± 106.50 and 542.7 ± 2.52 mg EqQ/g). The CH2Cl2 fraction of peels showed a high content of total phenolic compounds (516.7 ± 3.00 mg EqAG /g). The DPPH test showed that the CH2Cl2 fraction (leaves) held an EC50 of 0.08 ± 0.02, a higher value than that observed for the standards used in the test­Butylated hydroxyanisole (BHA), Butylated hydroxytoluene (BHT), and ascorbic acid. The AcOEt and MeOH fractions of peels presented moderate cytotoxicity with values below 500 µg/mL. The MeOH fraction of leaves showed seven major compounds: myricetin, quercetin, quercetin-arabinofuranoside, apigenin-triglycosides, and apigenin-diglucoside, being the last three unpublished in studies involving the genus. The tests conducted in this study show the potential of P. diversifolium as a promising source of biomolecules with therapeutic applicability.

Espécies de Pithecellobium (Fabaceae) são usadas na medicina tradicional para tratar diabetes, tosse, bronquite e inflamação. Este estudo teve como objetivo avaliar o teor e determinar a atividade antioxidante, o teor de compostos fenólicos e a citotoxicidade do extrato e das frações de Pithecellobium diversifolium, uma pesquisa inédita com uma espécie exótica da Caatinga do Nordeste do Brasil, utilizando a instrumentação Clae-IES. As frações MeOH das folhas e cascas do caule apresentaram alto teor de flavonoides (198,1 ± 106,50 e 542,7 ± 2,52 mg EqQ/g). A fração CH2Cl2 das cascas apresentou um elevado teor de compostos fenólicos totais (516,7 ± 3,00 mg EqAG/g). O teste DPPH mostrou que a fração CH2Cl2 (folhas) apresentou um EC50 de 0,08 ± 0,02, valor superior ao observado para os padrões utilizados no teste ­ Butil hidroxianisol (BHA), Butil hidroxitolueno (BHT) e ácido ascórbico. As frações AcOEt e MeOH das cascas apresentaram citotoxicidade moderada com valores inferiores a 500 µg/mL. A fração MeOH das folhas apresentou sete compostos majoritários: miricetina, quercetina, quercetina-arabinofuranosídeo, apigenina-triglicosídeos e apigenina-diglucosídeo, sendo os três últimos inéditos em estudos envolvendo o gênero. Os testes realizados demonstram o potencial de P. diversifolium, uma promissora fonte de biomoléculas com aplicabilidade terapêutica.

Las especies de Pithecellobium (Fabaceae) se utilizan en la medicina tradicional para tratar diabetes, tos, bronquitis e inflamación. Este estudio tuvo como objetivo evaluar el contenido y determinar la actividad antioxidante, el contenido de compuestos fenólicos y la citotoxicidad del extracto y de las fracciones de Pithecellobium diversifolium, un estudio inédito con una especie exótica de la Caatinga de la región Nordeste de Brasil, que utilizó la instrumentación HPLC-ESI. Las fracciones MeOH de hojas y cortezas de tallo mostraron un alto contenido de flavonoides (198,1 ± 106,50 y 542,7 ± 2,52 mg EqQ/g). La fracción CH2Cl2 de las cortezas presentó un alto contenido de compuestos fenólicos totales (516,7 ± 3,00 mg EqAG/g). El ensayo DPPH mostró que la fracción CH2Cl2 (hojas) tenía EC50 de 0,08 ± 0,02, valor superior a lo observado para los estándares utilizados en el ensayo ­Butilhidroxianisol (BHA), butilhidroxitolueno (BHT) y ácido ascórbico. Las fracciones AcOEt y MeOH de las cortezas presentaron una citotoxicidad moderada con valores inferiores a 500 µ g/mL. La fracción MeOH de las hojas contiene siete compuestos principales: miricetina, quercetina, quercetina-arabinofuranosido, apigenina-triglucósidos y apigenina-diglucósido, de los cuales los tres últimos son inéditos en estudios sobre el género. Las pruebas realizadas demuestran el potencial de P. diversifolium, una fuente prometedora de biomoléculas con aplicabilidad terapéutica.

Enfoque hacia el uso de energías alternativas en establecimientos de atención médica / Approach to the use of alternative energies in medical care facilities

Introducción: El tema del cambio climático y sus efectos, en la salud, educación y transporte, es un tema emergente, que pretende la optimización del consumo y la eficiencia energética. Esta investigación se plantea como objetivo,la caracterización del uso y aprovechamiento de energías, en establecimientos de atención médica de la región capital durante el año 2022, considerando la distribución energética, eficiencia y fuentes primarias de energía utilizadas en este país. Métodos: Se trata de una investigación descriptiva, transversal y prospectiva,a través del análisis cuali-cuantitativo, con el uso de informantes clave quienes consideran importante la iluminación natural en los espacios y el mayor aprovechamiento energético en áreas como la quirúrgica y consulta externa. Resultados: Surge el uso de la energía solar, eólica e hidráulica como recursos energéticos aprovechables, así como la sostenibilidad y la mantenibilidad en el diseño y rediseño de infraestructuras hospitalarias. Los tipos de energías utilizados en Venezuela, siguen correspondiendo ala hidráulica y combustibles fósiles, se conoce la tecnología e implementación de paneles solares para la mejoría del cambio climático, la huella del carbono, el uso de energías verdes y reducción de combustibles fósiles. Su aceptación depende de regulaciones y la concientización energética como elementos fundamentales para el cambio.

Introduction: The issue of climate change and itseffects, in health, education and transportation, is an emergingissue, which aims at the optimization of energy consumption andefficiency. e objective of this research is to characterize the useand exploitation of energy in health care facilities in the capitalregion during the year 2022, considering the energy distribution,efficiency and primary energy sources used in this country.Methods: This is a descriptive, cross-sectional and prospectiveresearch, through qualitative-quantitative analysis, with the useof key informants who consider important the natural lightingin the spaces and the greater use of energy in areas such assurgery and outpatient care. Results: The use of solar, windand hydraulic energy emerged as usable energy resources, aswell as sustainability and maintainability in the design andredesign of hospital infrastructures. The types of energy used inVenezuela continue to correspond to hydraulics and fossil fuels; the technology and implementation of solar panels is known forthe improvement of climate change, the carbon footprint, theuse of green energy and reduction of fossil fuels. Their acceptancedepends on regulations and energy awareness as fundamental elements for change.

[Influence of leadership style on knowledge management and hospital efficiency]. / Influencia del liderazgo en gestión del conocimiento y eficiencia hospitalaria.

OBJECTIVE: To analyse the effect of leadership style on knowledge management in hospitals and hospital efficiency based on the opinion of experts in hospital management, applying fuzzy cognitive maps (FCM). METHOD: FCM are relational models that can be used to graphically represent expert opinion and knowledge to infer cause-effect relationships between different concepts. The use of FCM as a simulation tool allows the evaluation of possible scenarios based on different leadership styles in hospitals. RESULTS: In the resulting augmented matrix, standardized effects range from 0.02 to 0.84, with the highest value representing the strongest relationship between knowledge exploitation and hospital efficiency. From the viewpoint of experts, knowledge creation within the hospital also influences hospital efficiency. Regarding variables reflecting leadership characteristics, positive effects have been identified, though with varying intensities, between authority, benevolence, and charisma, both in terms of knowledge creation and exploitation, as well as hospital efficiency. The transformational leadership style is associated with coefficients having higher values for knowledge management and hospital efficiency. CONCLUSIONS: Experts suggest that hospitals with authoritarian leadership styles would exhibit lower levels of knowledge creation and management, as well as lower hospital efficiency. On the other hand, they associate hospitals managed with a paternalistic leadership style with better values in both knowledge creation and exploitation, as well as hospital efficiency, compared to the authoritarian leadership style. Finally, they attribute the highest levels in aspects related to knowledge management and hospital efficiency to the transformational leadership style.

Gestión de casos: Análisis de costo eficiencia en continuidad de cuidados de Pacientes crónicos complejos / Case management: cost-effectiveness analysis in continuity of patient care of the Complex Chronic Patients Unit

Objetivo: Evaluar la relación entre los costes asociados al número y días de ingresos previos y posteriores a la inclusión a la Unidad de pacientes crónicos complejos (PCC). Métodos: Se realizó un análisis de coste-efectividad, descriptivo, con cálculo de medias y desviaciones típicas; además de utilizar la t-Student para muestras pareadas, con el software SPSS v20.0, para un nivel de significación alfa <0,05. Los resultados del cómputo se obtuvieron de la Unidad de Codificación de los pacientes captados por la enfermera gestora de casos, y que sobrevivieron un año en seguimiento por la Unidad PCC. Resultados: Se captaron un total de 132 PCC, con un total de 563 ingresos previos, a 204 post inclusión. La media de número de ingresos al año antes fue de 4,27 (DT: 3,35), y se redujo a 1,55 (DT: 1,74). Por otro lado, el número de días de estancia hospitalaria total se redujo de 3.835 a 1.897 días, que equivale una diferencia de coste estimado en 11165.164,36 de euros. La media de días de ingreso antes fue de 29,05, y se redujo a 14,37 días, encontrando una significación estadística (p<0,001) entre días de ingresos previos y posteriores. Conclusiones: La inclusión en la Unidad PCC garantiza, mediante el liderazgo por la enfermera gestora de casos, una mejora coste-efectiva sin gastos añadidos, por optimizar recursos ya existentes interniveles asistenciales, mediante la identificación de PCC y sus necesidades prioritarias, planificación al alta con informes individualizados y garantizando el contacto. (AU)

Objective: Evaluate the relationship between the costs associated with the number and days of admission before and after inclusion in the Complex Chronic Patients Unit (CCP). Methods: A descriptive cost-effectiveness analysis was performed, with calculation of arithmetic averages and standard deviations; in addition to using the t-Student for paired samples, with the SPSS Enfermería GlobalNº 72 Octubre 2023Página 78v20.0 software, for a significance level alpha <0.05. The results of the computation were obtained from the Coding Unit of the patients recruited by the case manager nurse, who survived one year of follow-up by the CCP Unit. Results: A total of 132 CCP were recruited, with a total of 563 previous admissions, which were reduced to 204 post inclusion. The average number of admissions of the previous year was 4.27 (SD: 3.35), and it was reduced to 1.55 (SD: 1.74). On the other hand, the number of days of total hospital stay was reduced from 3,835 to 1,897 days, which is equivalent to a difference in estimated cost of 11,165,164.36 euros. The average number of days of admission before was 29.05, and it was reduced to 14.37 days, finding a statistical significance (p<0.001) between days of admission before and after. Conclusions: Inclusion in the CCP Unit guarantees, through the leadership of the case manager nurse, a cost-effective improvement without added expenses, by optimizing already existing interlevel care resources, through the identification of CCP and their priority needs, discharge planning with reports individualized and guaranteeing contact. (AU)

Eficiência em saúde pública: a trajetória de um conceito proveniente da engenharia / Efficiency in public health: the trajectory of a concept from engineering

RESUMO A temática mais geral desta pesquisa diz respeito à eficiência na administração pública e sua manifestação na saúde pública. Em um contexto neoliberal, marcado por políticas de austeridade, em que as restrições orçamentárias em relação às políticas sociais são um dos aspectos principais, a análise sobre o que significa eficiência torna-se uma questão de pesquisa relevante. As diferentes ideias sobre eficiência, constituídas e modificadas ao longo da história, exercem influência na gestão dos recursos públicos. Neste sentido, este artigo tem como objetivo descrever a trajetória de desenvolvimento do conceito de eficiência na administração pública, mais especificamente na área de saúde pública. Para alcançar este objetivo, foi realizado um ensaio teórico, no qual desenvolve-se um argumento teórico-analítico destinado a orientar pesquisas empíricas em relação ao tema da eficiência na gestão em saúde. Este argumento é baseado em três pressupostos: ao longo de um século de desenvolvimento do conceito de eficiência na administração pública, este conceito ainda é fortemente carregado de pressupostos oriundos da engenharia; esses pressupostos, por sua vez, se conectam diretamente com princípios da economia neoclássica, que estão na base de perspectivas neoliberais aplicadas à gestão pública; e na área da saúde, o conceito de eficiência fundado apenas em pressupostos da economia de mercado é insuficiente, necessitando ser articulado aos conceitos de eficácia e efetividade.

ABSTRACT This article aims to describe the development trajectory of the concept of efficiency in public administration, more specifically in the area of public health. To achieve this objective, a theoretical essay was carried out, in which a theoretical-analytical argument was developed to guide empirical research in relation to the issue of efficiency in health management. This argument is based on three assumptions: over a century of development of the concept of efficiency in public administration, this concept is still heavily loaded with assumptions from engineering; these assumptions, in turn, are directly connected with principles of neoclassical economics, which underlie neoliberal perspectives applied to public management; and in the health area, the concept of efficiency based only on market economy assumptions is insufficient, needing to be articulated with the concepts of efficacy and effectiveness.

Metrics of efficient use of operating rooms during the SARS-CoV-2 (COVID-19) pandemic / Métrica de indicadores de uso eficiente de quirófano durante la pandemia por SARS-CoV-2 (COVID-19)

Abstract: Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min); opportunity for emergency surgeries (104.69 ± 102.55 min); starting time of anesthesia (10.11 ± 9.85 min); starting time of surgery (40.03 ± 24.68 min); time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min); turnover or replacement time (177.97 ± 174.33 min); active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work.

Resumen: Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora.

Satisfacción del usuario en la atención odontológica comunitaria en Reynosa, Tamaulipas / User ́s satisfaction of community dental care in Reynosa,Tamaulipas

Resumen Objetivo: Evaluar el nivel de satisfacción en la atención recibida por los usuarios de la Clínica Odontológica de la Universidad México Americana del Norte (CO-UMAN) Allende. Material y método: El estudio fue descriptivo, observacional, transversal y prospectivo; se aplicó una encuesta de opinión a 200 pacientes, seleccionados mediante muestreo por conveniencia en 2019, sobre la estructura, proceso y resultados de la atención; así como bio-demográficos de cada paciente. Resultados: Predominaron pacientes con edades entre 21 y 60 años (71%), mujeres (63%), casados(as) (45%), empleados(as)/amas de casa (57%) y baja frecuencia de enfermedades concomitantes (10%). A mayor edad hubo mayor frecuencia de enfermedades concomitantes (r=0.26; p<0.05) y satisfacción en el servicio (r=0.26; p<0.05); con otras enfermedades concomitantes la satisfacción del paciente fue menor (r=-0.39; p<0.05). Los pacientes indican que hay más satisfacción (de 2.6 a 5.4 veces) al recibir un servicio adecuado o mejor. La satisfacción del paciente y la calidad de la atención de la clínica se asoció positivamente (p<0.05) con los trámites sencillos, trato por parte del odontólogo; confianza en la calidad de los servicios recibidos; relación costo/beneficio; puntualidad en la atención y efectividad del tratamiento odontológico recibido. Los coeficientes canónicos estandarizados indicaron mayor contribución en la satisfacción del usuario: las instalaciones e infraestructura de la clínica (0.479); atención del personal y proceso administrativo (0.543); atención del odontólogo (0.700); confianza en la atención y percepción del servicio recibido (0.660) y pobre relación con edad (0.078), género (0.030), estado civil (-0.040) y ocupación del paciente (0.065). Conclusión: No obstante que la cantidad y calidad del servicio de la CO-UMAN se ha incrementado y mejorado sustantivamente, es necesario desarrollar un plan de mejora continua para alcanzar estándares de calidad total.

Abstract Objective: To evaluate the level of satisfaction in the care received by the users of the Dental Clinic of the Universidad México Americana del Norte (DC-UMAN) Allende. Material and method: The study was descriptive, observational, cross-sectional, and prospective. In 2019, an opinion survey on the structure, proceedings, and results of the care, as well as bio-demographics of each patient was applied to 200 patients selected by convenience sampling. Results: Patients aged between 21 and 60 years (71%), women (63%), married (45%), employees/housewives (57%) and a low frequency of concomitant diseases (10%) predominated. At an older age, there was a higher frequency of concomitant diseases (r=0.26; p<0.05) and satisfaction in the service (r=0.26; p<0.05); with other concomitant diseases, patient satisfaction was lower (r=-0.39; p<0.05). Patients indicated that there is more satisfaction (from 2.6 to 5.4 times) when receiving an adequate or better service. Patient satisfaction and the quality of clinic care were positively associated (p<0.05) with simple procedures, treatment by the dentist, confidence in the quality of the services received, cost-benefit ratio, punctuality in the care and effectiveness of the dental treatment received. The standardized canonical coefficients indicated a greater contribution to user satisfaction from the facilities and infrastructure of the clinic (0.479), staff attention and administrative process (0.543), dental care (0.700), trust in care and perception of the service received (0.660) and poor relationship with age (0.078), gender (0.030), marital status (-0.040), and occupation (0.065) of the patient. Conclusion: Although the quantity and quality of the DC-UMAN service has increased and improved substantially, it is necessary to develop a continuous improvement plan to achieve total quality standards.

Efecto de la especificidad de la carga en el día previo a la competición en ciclistas Masters de Montaña. Un estudio piloto / Efeito da especificidade da carga no dia anterior à competição em ciclistas de Mountain-Bike Masters. Um estudo piloto / Effect of load specificity on the day before competition in Mountain-Bike Masters cyclists. A pilot study

Objetivo: El presente estudio pretendió evaluar el efecto la especificidad del estímulo aplicado en la sesión de entrenamiento el día previo a lacompetición sobre el rendimiento deportivo en ciclistas Máster de Mountain bike (MTB).Método: Los participantes (n = 5, VO2máx. 60.8 ± 9.92 ml/kg/min) realizaron 3 tipos diferentes sesiones de trabajo en el día previo a la competición(situación de control; situación específica; situación inespecífica). El rendimiento de los ciclistas fue evaluado mediante un test de 5 minutos all-out amáxima intensidad.Resultados: Se observó una menor cadencia media en la situación de trabajo específica vs. la situación control (diferencia de medias estandarizadas =0.68 [IC 95%, 0.20 - 1.16; d=1.74]). Además, existieron diferencias para la frecuencia cardíaca (FC) media al comparar la situación control vs. la situacióninespecífica (diferencia de medias estandarizadas = 0.45 [IC 95%, 0.12 - 0.78; d=3.34]). La eficiencia mecánica (potencia/pulso) resultó ser mayor en lasituación de trabajo específica vs. la situación control (diferencia de medias estandarizadas = −0.08 [IC 95%, −0.17 - 0.00; d=1.21]), observándose unatendencia a la significación entre las situaciones específica vs inespecífica. Finalmente, los ciclistas mostraron una mayor FC y potencia al comparar lasituación control frente a las situaciones intervenidas en los primeros 120s del test.Conclusión: Las tres situaciones de trabajo en el día previo a la competición propuestas obtuvieron un rendimiento similar, aunque se observó una menorcadencia media y una mayor eficiencia mecánica para la sesión de trabajo especifica, pudiendo ser beneficiosa para la mejora del rendimientocompetitivo en ciclistas máster de MTB.(AU)

Objective: To compare the effect of the specificity of the stimulus applied in a pre-competition training session the day before performing a 5 min all-outtest in Mountain bike (MTB) masters cyclists.Method: Participants (n = 5, VO2máx. 60.8 ± 9.92 ml/kg/min) performed 3 different types of training sessions on the day before the competition (controlsituation; specific situation; non-specific situation). The cyclists' performance was evaluated by means of a 5-minute all-out test at maximum intensity.Results: A lower average cadence was observed in the specific situation vs. the control situation (standardised mean difference = 0.68 [95% CI, 0.20 -1.16; d=1.74]) Moreover, there were differences for mean heart rate (HR) when comparing the control vs. non-specific situation (standardised meandifference = 0.45 [95% CI, 0.12 - 0.78; d=3.34]). Mechanical efficiency (power/pulse) was found higher in the specific situation vs. the control situation(standardised mean difference = −0.08 [95% CI, −0.17 - 0.00; d=1.21]), a tendency towards significance between the specific vs. non-specific situationswas observed. Finally, the cyclists showed higher HR and power when comparing the control situation versus the intervened situations in the first 120sof the test.Conclusion: The 3 proposed pre-competition situations had a similar sports performance, although a lower average cadence and a higher mechanicalefficiency were observed for the specific situation, which could be beneficial for the improvement of competitive performance in MTB masters cyclists.(AU)

Objetivo: Comparar o efeito da especificidade do estímulo aplicado numa sessão de treino pré-competição no dia anterior à realização de um teste de 5min em ciclistas masters de Mountain bike (MTB).Método: Os participantes (n = 5, VO2máx. 60.8 ± 9.92 ml/kg/min) realizaram 3 tipos diferentes de ativações (situação de controlo; situação específica;situação não específica) antes da realização do teste. O desempenho dos ciclistas foi avaliado através de um teste de 5 minutos em intensidade máxima.Resultados: Foi observada uma cadência média mais baixa na situação de trabalho específica em comparação com a situação de controlo (diferençamédia padronizada = 0.68 [IC 95%, 0.20 - 1.16; d=1.74]). Além disso, verificaram-se diferenças na frequência cardíaca média (FC) quando se comparou asituação de controlo com a situação não específica (diferença média padronizada = 0.45 [IC 95%, 0.12 - 0.78; d=3.34]). Verificou-se que a eficiênciamecânica (potência/pulso) era mais elevada na situação de trabalho específica do que na situação de controlo. (diferença média padronizada = −0.08 [IC95%, −0.17 - 0.00; d=1.21]), observou-se uma tendência para a significância entre as situações específicas e não específicas. Por fim, os ciclistasapresentaram uma FC e uma potência mais elevadas quando comparada a situação de controlo versus as situações intervencionadas nos primeiros 120sdo teste.Conclusão: As três situações de trabalho no dia pré-competitivo proposto obtiveram um desempenho semelhante, embora se tenha observado umacadência média mais baixa e uma maior eficiência mecânica para a situação específica, o que poderá ser benéfico para a melhoria do desempenhocompetitivo dos ciclistas masters de BTT.(AU)

RECALSEEN 2021. Resources and quality in the Endocrinology and Nutrition units of the National Health System of Spain.

OBJECTIVES: RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U_EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented. MATERIAL AND METHODS: Cross-sectional descriptive study of the S-U_EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U_EyN' consultants; and 2. analysing the acute general hospital discharges from S-U_EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS. RESULTS: 112 responses from S-U_EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U_EyN sample includes 24 more centers than in 2017. 54% of the S-U_EyN were endocrinology departments. The median number of endocrinologists per S-U_EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U_EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U_EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management. CONCLUSIONS: RECALSEEN is a useful project for the analysis of S-U_EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement.

Efectividad y eficiencia de la dalbavancina en condiciones reales de uso / Effectiveness and efficiency of dalbavancin in real clinical practice use

Objetivos: El tratamiento de las infecciones por Gram positivos supone un reto asistencial, en un contexto en el que están aumentando las resistencias antibióticas. La dalbavancina, gracias a su alta vida media y alta actividad frente a Gram positivos, puede ser una buena opción terapéutica. Nuestros objetivos son conocer los usos, efectividad y eficiencia de la dalbavancina en pacientes del Hospital General Universitario de Valencia. Métodos: Se realiza un estudio descriptivo retrospectivo y un análisis de costes de los pacientes tratados con dalbavancina en el Hospital General Universitario de Valencia. Resultados: 15 pacientes (con 17 episodios de infección) fueron incluidos, con un Charlson medio de 3,7. Se trataron 4 infecciones de piel y partes blandas, 6 infecciones osteoarticulares y 7 infecciones intravasculares, aislándose en el 70,6% de los casos un Gram positivo. La tasa de curación fue del 59%, sin efectos adversos por la dalbavancina ni exitus en relación con la infección. Se evitaron 239 días de hospitalización, lo cual supone un ahorro de 6.556,02 € por paciente. Conclusiones: Series clínicas como la actual permiten analizar el papel de la dalbavancina en la práctica médica habitual y demuestran su importante función en el ahorro de recursos económicos. (AU)

Objectives: The treatment of Gram-positive infections it’s a medical challenge, in a context in which antibiotic resistances are increasing. Dalbavancin, due to its long half-life and high activity against Gram-positive bacteria, could be a good therapeutic option. Our objectives are to know the uses, effectiveness and efficiency of dalbavancin in patients of the General University Hospital of Valencia. Methods: A retrospective descriptive study and a cost analysis of patients treated with dalbavancin are carried out at the General University Hospital of Valencia. Results: 15 patients (with 17 episodes of infection) were included, with a mean Charlson index of 3.7. Were treated 4 skin and soft tissue infections, 6 osteoarticular infections and 7 intravascular infections. A Gram-positive bacteria was isolated in 70.6% of the patients. The cure rate was 59%, with no adverse effects due to dalbavancin or death in relation to infection. 239 days of hospitalization were saved with outpatient treatment, which means a saving of € 6,556.02 per patient. Conclusions: Clinical series like ours allow us to analyse the role of dalbavancin in routine medical practice and demonstrate its important function in saving economic resources. (AU)

Unidad de Atención al Paciente Traqueostomizado. Una solución innovadora desde Otorrinolaringología con carácter transversal para el hospital / Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital

Antecedentes y objetivo: Los cuidados de los pacientes traqueostomizados son habilidades de alto riesgo y baja incidencia. Las estrategias de mejora de la atención sanitaria en plantas hospitalarias y en especialidades distintas a la Otorrinolaringología (ORL) basadas únicamente en la formación no han sido capaces de ofrecer una solución adecuada. Se presenta un modelo de Unidad de Atención al Paciente Traqueostomizado dirigida por el Servicio de Otorrinolaringología para atender a todos los pacientes traqueostomizados de un hospital en todas las especialidades. Material y métodos Ámbito: hospital universitario público de tercer nivel con 876 camas de hospitalización y 30 camas de UCI para 481.296 habitantes. Modelo de Unidad: unidad transversal para el hospital proporcionando atención a todos los pacientes traqueostomizados, adultos y niños, de todas las especialidades, con dedicación del 50% de una enfermera de ORL de hospitalización que se desplaza hasta la cama de hospitalización de la especialidad de cada paciente y el 50% de otra enfermera de ORL de consultas externas para los pacientes ambulatorios, con la consultoría de un especialista en ORL y coordinación de la supervisora de ORL. Resultados Se atendió en la unidad a 572 pacientes entre 2016 y 2021, el 80% varones, con una media de edad de 63±14 años. Se atendieron 14,7±2 pacientes traqueostomizados diarios y 96±4 consultas por complicaciones anuales, elevándose hasta 19 pacientes traqueostomizados diarios en 2020 y 141±8,4 consultas por complicaciones en los años 2020 y 2021, durante la pandemia por COVID-19. Se redujo la estancia media de las especialidades no ORL en 13 días a lo largo de los 6 años del estudio, aumentando la satisfacción de los profesionales de ORL y de no ORL, y la satisfacción de los usuarios.... (AU)

Background and objective: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methods Background: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results 572 patients between 2016 and 2021, 80% men, aged 63±14 years, were attended in the unit. 14.7±2 tracheostomized patients daily and 96±4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141±8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. ... (AU)

Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital.

BACKGROUND AND OBJECTIVE: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalised patients of all specialties. MATERIAL AND METHODS: Background: Third level public hospital with 876 hospitalisation beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalisation that moves to the hospitalisation bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. RESULTS: 572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the Unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. CONCLUSIONS: A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside Otorhinolaryngology.

Detección en urgencias de infección por VIH en pacientes que consultan por condiciones potencialmente relacionadas con infección oculta: Resultados iniciales del programa “Urgències VIHgila” / Emergency detection of HIV infection in patients consulting for conditions potentially related to occult infection: Initial results of the “Urgències VIHgila” program

Objective: To estimate the prevalence of unknown HIV infection in patients who consulted in hospital emergency services (ED) for conditions defined in the SEMES-GESIDA Consensus Document (DC), evaluate the efficiency of its im-plementation and investigate the efficiency of HIV serology determination in other conditions. Methods: Results were reviewed in 10 Catalan EDs for 12 months (July-21-June-22) after implementing CD recommendations: request HIV serology in case of suspected sexually transmitted infection, chemsex, post-exposure prophylaxis (PEP), mononucleosis syndrome, community pneumonia (18-65 y-o) or herpes zoster (18-65 y-o). Other reasons for request were included. Prevalence (%) of global seropositivity and for each circumstance was calculated, with a 95% confidence interval (95%CI). The efficient strategy was considered if the lower limit of the CI95%>0.1%. Results: A total of5,107 HIV serologies were performed: 2,847(56%) in situations specified in CD, and 2,266 (44%) in other 138 circumstances. Forty-eight unknown HIV infections were detected (prevalence=0.94%;95%CI=0.69-1.24). The prevalence was somewhat higher in DC requests (30 cas-es 1.12%) than the rest (18 cases 0.71%; p=0.16). The individualized prevalence of CD reasons ranged between 7.41% (95%CI=0.91-24.3) in chemsex and 0.42% 95%CI=0.14-0.98) in PPE, always efficient except herpes zoster (0.76%; CI95%=0.02-4.18). In other reasons, cases were detected in 12 circumstances, and in four the determination could be efficient: lymphopenia (10%;CI95%=0.25-44.5), fever with polyarthralgia-polyarthritis (7.41%;CI95% =0.91-24.3), behavioral alteration-confusion-encephalopathy (3.45%;95%CI=0.42-11.9) and fever of unknown origin (2.50%;95%CI=0.82-5.74). (AU)

Objetivo: Estimar la prevalencia de infección por VIH des-conocida en pacientes que consultan en servicios de urgencias hospitalarios (SUH) por las condiciones definidas en el Documento de Consenso (DC) de SEMES-GESIDA, evaluar la eficiencia de su implementación e investigar si en otras condiciones la determinación de serología VIH puede resultar eficiente.Método: Se revisaron los resultados obtenidos en 10 SUH catalanes durante los 12 meses (julio-21 a junio-22) siguientes a implementar las recomendaciones del DC de solicitar serología VIH a pacientes con sospecha de infección de transmisión sexual, práctica de chemsex, solicitud profilaxis post-exposición (PPE), síndrome mononucleósico, neumonía comunitaria (18-65 años) o herpes zóster (18-65 años). Se consignaron también otros motivos de solicitud. Se calculó la prevalencia (%) de seropositividad global y para cada circunstancia, con su intervalo de confianza del 95% (IC95%). Se consideró la estrategia eficiente si el límite inferior del IC95% era >0,1%.Resultados: Se realizaron 5.107 serologías VIH: 2.847 (56%) en situaciones especificadas en el DC, y 2.266 (44%) en otras 138 circunstancias. Se detectaron 48 infecciones por VIH desconocidas (prevalencia=0,94%; IC95%=0,69-1,24). La preva-lencia fue algo superior en las solicitudes ajustadas al DC (30 ca-sos, 1,12%) que en las que no (18 casos, 0,71%; p=0,16). La prevalencia individualizada para los motivos especificados en el DC osciló entre 7,41% IC95%=0,91-24,3) en práctica de chemsex y 0,42% (IC95%=0,14-0,98) en PPE, y siempre resultó eficiente, con excepción de herpes zóster (0,76%, IC95%=0,02-4,18). Respecto al resto de motivos de solicitud, se detectaron casos en 12 circunstancias, y en cuatro la determinación podría ser eficiente: linfopenia (10%, IC95%=0,25-44,5), fiebre con poliartralgias-poliartritis (7,41%, IC95%=0,91-24,3), alteración conductual-confusión-encefalopatía (3,45%,IC95%=0,42-11,9) y fiebre de origen desconocido(2,50%,IC95%=0,82-5,74)(AU)

RECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021) / RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021)

Objetivos Analizar la estructura, la actividad y los resultados de los servicios y unidades de medicina interna (UMI) del Sistema Nacional de Salud (SNS). Analizar los retos para la especialidad y realizar propuestas de políticas de mejora. Comparar los resultados de la encuesta RECALMIN 2021 con las anteriores oleadas de encuestas a las UMI (2008, 2015, 2017, 2019). Material y métodos Estudio descriptivo transversal entre las UMI en hospitales generales de agudos del SNS con datos referidos a 2020, comparándolos con los anteriores estudios. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados Entre 2014 y 2020 aumentó la frecuentación hospitalaria y las altas dadas por las UMI (promedio anual de 4 y 3,8%, respectivamente), así como las tasas interconsultas hospitalarias y primeras consultas (promedio anual: 2,1% en ambos casos). En 2020 aumentaron notablemente las consultas no presenciales. La mortalidad ajustada por riesgo y la estancia hospitalaria no mostraron cambios significativos en 2013-2020. Los progresos en la implantación de buenas prácticas y de una atención sistemática al paciente crónico complejo fueron escasos. Una constante en las encuestas RECALMIN es la variabilidad entre UMI en recursos y actividad, sin encontrarse diferencias estadísticamente significativas en relación con los resultados. Conclusiones Existe un notable margen de mejora en el funcionamiento de las UMI. La reducción de la variabilidad no justificada en la práctica clínica y las desigualdades en los resultados en salud deben ser un reto para los responsables de las UMI y para la Sociedad Española de Medicina Interna (AU)

Aims This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). Methods This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. Results Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. Conclusions There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine (AU)