RESUMO
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.
Assuntos
Procedimentos Clínicos , Urticária/diagnóstico , Urticária/terapia , Doença Aguda , Doença Crônica , HumanosRESUMO
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.
Assuntos
Procedimentos Clínicos , Cistos/diagnóstico , Cistos/terapia , Dermatopatias/diagnóstico , Dermatopatias/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , HumanosRESUMO
OBJECTIVES: We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. METHODS: For this cross-sectional study, out of 450 HIV-infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured (January 2009 to December 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load (VL), CD4 cell count, and concentrations of 25(OH)-vitamin D [25(OH)-D], parathyroid hormone (PTH), albumin and calcium. Vitamin D status cut-off points were: (1) deficiency (vitDd): 25(OH)-D < 20 ng/mL; (2) insufficiency (vitDi): 25(OH)-D from 20 to 29.99 ng/mL; and (3) optimal (vitDo): 25(OH)-D ≥ 30 ng/mL. RESULTS: The percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty-nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV-1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs.â Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2-94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13-4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25-8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10-7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01-0.6; P = 0.018). CONCLUSIONS: Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.
Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/sangue , Inibidores da Protease de HIV/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/sangue , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , População Negra , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Inibidores da Protease de HIV/efeitos adversos , Helioterapia , Humanos , Masculino , Pacientes Ambulatoriais , Espanha/epidemiologia , Carga Viral , Vitamina D/uso terapêutico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etiologia , Adulto JovemAssuntos
Inibidores da Agregação Plaquetária/uso terapêutico , Sevoflurano/uso terapêutico , Úlcera Varicosa/tratamento farmacológico , Administração Tópica , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Inibidores da Agregação Plaquetária/administração & dosagem , Estudos Retrospectivos , Sevoflurano/administração & dosagem , Resultado do Tratamento , CicatrizaçãoRESUMO
OBJECTIVE: Define a minimum set of indicators for person-focused-care applying for type 2 diabetes mellitus (DM2), as a complementary metric to current clinical-healthcare indicators. METHODS: Qualitative consensus-building study (involving professionals and patients) structured in three stages: Metaplan to capture information, Delphi to agree on criteria and indicators, and consensus conference to ensure feasibility and relevance of the proposal. RESULTS: Consensus was reached on a total of nine indicators upon: shared decision-making, self-care, adherence, renal function screening, activities of daily living, individualized therapeutic plan, vascular risk assessment, working life and human treatment. These indicators were grouped into three dimensions: the person with oneself, the person with one's family, and the person with the health system. CONCLUSIONS: These indicators make it possible to establish alternative metrics to determine the degree of progress in a person-centered attention in case of DM2.
Assuntos
Diabetes Mellitus Tipo 2 , Atividades Cotidianas , Consenso , Técnica Delphi , Diabetes Mellitus Tipo 2/terapia , Humanos , Pesquisa QualitativaRESUMO
BACKGROUND: Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS: Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS: The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS: The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS: The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
Assuntos
Acreditação/normas , Atitude do Pessoal de Saúde , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Inovação Organizacional , Humanos , EspanhaRESUMO
OBJECTIVE: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. METHODS: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. RESULTS: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. CONCLUSIONS: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it.
Assuntos
Testes Hematológicos/normas , Sistemas de Informação , Recursos Humanos de Enfermagem/educação , Manejo de Espécimes/normas , Centros Médicos Acadêmicos , Adulto , Avaliação de Desempenho Profissional , Contaminação de Equipamentos , Feminino , Testes Hematológicos/instrumentação , Humanos , Masculino , Agulhas , Melhoria de Qualidade , Fatores de Risco , Dispositivos de Acesso VascularRESUMO
BACKGROUND: Alpha and beta interferon (IFN-alpha and beta) treatment is associated with the synthesis of thyroid autoantibodies and the development of autoimmune thyroid diseases. METHODS AND RESULTS: We have retrospectively evaluated their effect in patients with chronic viral hepatitis (CH) (n = 118) and multiple esclerosis (ME) (n = 10). Thyroid dysfunction has been detected in 7.4% of patients, and seroconversion in 4.7%. CONCLUSIONS: Pre-treatment antithyroid antibodies do not predispose to altered thyroid function, after IFN therapy; their presence should not contraindicate IFN treatment.
Assuntos
Antivirais/efeitos adversos , Hepatite Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Tireoidite Autoimune/induzido quimicamente , Tireoidite Autoimune/imunologia , Doença Aguda , Adulto , Anticorpos Anti-Idiotípicos/biossíntese , Anticorpos Anti-Idiotípicos/imunologia , Feminino , Hepatite Crônica/virologia , Humanos , Iodeto Peroxidase/imunologia , Masculino , Estudos Retrospectivos , Testes de Função Tireóidea/métodos , Tireoidite Autoimune/diagnósticoRESUMO
UNLABELLED: BASICS: Evaluate the nutritional status of HIV positive patients who are admitted to hospital for some acute process, and their evaluation, without nutritional support, during the admission. METHODS: Prospective study in HIV positive patients. Nutritional evaluation (on admission and on release); (1) anthropometric (weight, size, triceps, fold, circumference of the arm, and muscular circumference of the arm, and (2) biochemical (albumin, cholesterol, triglycerides, lymphocytes, pre-albumin, and transferrin). Statistical study: comparison of the paired means and chi squared test. RESULTS: 60 patients. Mean age 32 +/- 4.8 years, 76% men and 23% women. Staging: AIDS 84.8%, non-AIDS 15.2%. Main reason for admission: Infection (80%). Mean stay: 14 days +/- 9.5. Initial nutritional evaluation: normal: 1.7%, protein malnutrition: 5.3%, caloric malnutrition: 38.5%, mixed malnutrition: 54.3%, 85% of the patients refer weight loss. 21 patients (35%) were followed up. There were no significant differences in the anthropometric nor in the biochemical parameters, except in the levels of pre-albumin and transferrin, which improved (p < 0.001). Nutritional evaluation on release: normal: 9.5%, caloric malnutrition: 66.5%, mixed malnutrition: 23.7%. There were no cases of protein malnutrition. CONCLUSIONS: The vast majority of the HIV+ patients who are admitted, are malnourished, and after curing the acute process, 90.5% of them remain malnourished. The anthropometric measurements, albumin, cholesterol, and triglycerides do not vary during the hospital admission, despite the treatment and the clinical improvement. The increase of proteins with a short half life is due to controlling the infection, which is why these are not good parameters for the nutritional evaluation in these patients.
Assuntos
Infecções por HIV , Distúrbios Nutricionais/diagnóstico , Estado Nutricional , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/terapia , Adulto , Feminino , Infecções por HIV/complicações , Infecções por HIV/terapia , Soropositividade para HIV/complicações , Hospitalização , Humanos , Tempo de Internação , Masculino , Distúrbios Nutricionais/etiologia , Distúrbios Nutricionais/terapia , Estudos Prospectivos , Deficiência de Proteína/diagnóstico , Deficiência de Proteína/etiologia , Deficiência de Proteína/terapiaRESUMO
UNLABELLED: It has been suggested that adding fibre to enteral nutrition (EN) formulas may achieve a normalization of the gastrointestinal tract's functions by reducing the incidence of diarrhoea and constipation. However, this supposition is based on the demonstrated effect of fibre in natural feeding. There have so far been no firm recommendations on the use, amount or type of fibre that is most advisable in EN. GOAL: To establish the scientific evidence existing on the benefits gained by adding fibre to EN formulas compared with the use of fibre-free formulas. MATERIAL AND METHODS: Bibliographical search on PubMed, on the register of Randomized Prospective Trials (RPT) of the Cochrane Library and manual search. INCLUSION CRITERIA: RPT comparing fibre-free formulas with isocaloric ad isonitrogen formulas containing fibre in total EN. Four independent reviewers revised the references selected. The data were analyzed using the RevMan 4.1 programme from the Cochrane Library. RESULTS: Of 286 references, 25 fulfilled the inclusion criteria. The data were grouped by population and outcome variable. The addition of fermentable fibre to the EN formulas tends to reduce the incidence of diarrhoea in critically-ill and post-surgery patients (OR = 0.66; 95% CI 0.46-0.95; p = 0.19). The use of formulas with insoluble fibre seems to increase the frequency of depositions and reduce the need for laxatives in immobilized patients receiving long-term EN but the data are insufficient. In people with normal gastrointestinal functions, the frequency of depositions is similar when using formulas with and without fibre (DPM = -0.97; 95% CI -0.12-[-0.02]; p < 0.0001). CONCLUSION: There is currently insufficient evidence to recommend the systematic use of formulas containing fibre in total EN. However, in critically-ill and post-surgery patients, the use of formulas with fermentable fibre tends to reduce the incidence of diarrhoea. Although information is still lacking. The formulas with insoluble fibre seem to diminish constipation in chronic EN, whereas in other situations where the digestive system is working appropriately, no benefit has been shown. It is necessary to increase the number and quality of these trials in order to be able to establish firm recommendations on the use of EN formulas containing fibre.
Assuntos
Fibras na Dieta , Nutrição Enteral , HumanosRESUMO
INTRODUCTION: Parenteral nutrition (PN) is a form of nutrition that can be very beneficial, but it does have some indications and complications that should be taken into consideration. With this work we would like to describe the characteristics of our patients with PN, as well as their follow up, and to evaluate the appropriateness of its prescription. MATERIAL AND METHODS: Retrospective study carried out at a hospital with 415 beds. All patients who received PN during the first six months of 1996 were reviewed. Inadequacy criteria are established and a nutritional assessment was carried out by means of clinical and analytical parameters. Catheter infections were recorded according to specific criteria and the clinical and analytical evolution of the patients was followed. RESULTS: A total of 83 patients were given parenteral nutrition. The most frequent indication was prolonged fasting after a surgical resection of the digestive apparatus. The most common nutritional status when beginning the PN was severe protein malnutrition (23%). There were 33 cases (39.7%) of PN that was not indicated and/or potentially avoidable. A catheter infection was reported in 7 cases (8.4%).
Assuntos
Nutrição Parenteral , Doenças do Sistema Digestório/cirurgia , Seguimentos , Unidades Hospitalares , Humanos , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/normas , Cuidados Pós-Operatórios , EspanhaRESUMO
Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.
Assuntos
Meios de Contraste/efeitos adversos , Urografia/efeitos adversos , Intoxicação por Água/etiologia , Adulto , Meios de Contraste/administração & dosagem , Feminino , Humanos , Injeções IntravenosasRESUMO
OBJECTIVE: To analyse the results of the 27th Conference of the Spanish Society for Quality in Health Care (SECA) held in Seville (October 2009). MATERIAL AND METHODS: A retrospective descriptive study was conducted using the conference databases. POPULATION: All abstracts received (1231). 36 pairs of reviewers using explicit criteria evaluated abstracts and assignment as Experiences or Electronic Communications. Participant satisfaction in the Conference and Workshops was evaluated by an anonymous questionnaire. RESULTS: A total of 1213 communications were accepted. The average score of accepted abstracts was 6.38 ± 0.95 points. Experiences had an average score of 7.55 ± 0.41 points, while Electronic Abstracts had an average score of 6.26 ± 0.9 points. Andalusia (557) and Catalonia (140) had the highest amount of abstracts in the Conference, but Murcia and Andalusia obtained the highest rates per million inhabitants. CONCLUSIONS: The assessment of abstracts and organising a national conference are methodologically complex processes. Accountability for actions and decisions made by the Organising and Scientific Committees are an ethical requirement of transparency.
Assuntos
Qualidade da Assistência à Saúde , Congressos como Assunto , Sociedades Científicas , EspanhaRESUMO
La incorporación de nuevos fármacos al arsenal terapéutico, la actualización de las guías de práctica clínica y los hallazgos fisiopatológicos recientemente comunicados hacen que el manejo y conocimiento de la urticaria sea un tema de candente actualidad. La Sección territorial andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en los pacientes con urticaria. Presentamos un enfoque centrado en el paciente, y en el que se muestra su devenir en el sistema sanitario y la interrelación entre la atención primaria y hospitalaria, garantizando un punto clave, su continuidad asistencial
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity a key feature of quality
Assuntos
Humanos , Urticária/epidemiologia , Assistência Centrada no Paciente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Planejamento de Assistência ao Paciente , Padrões de Prática MédicaRESUMO
Las lesiones cutáneas benignas representan un motivo de consulta frecuente, tanto en atención primaria como en las consultas de dermatología. Sin embargo, existe una amplia variabilidad en el acceso de los usuarios al diagnóstico y tratamiento de las lesiones cutáneas benignas, debido principalmente a que no se establecieron criterios explícitos y homogéneos para el abordaje de los pacientes con lesiones benignas. Con el objetivo principal de reducir la variabilidad en la atención a las personas con lesiones quísticas o tumorales benignas la Sección Territorial Andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en este tipo de lesiones
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type
Assuntos
Humanos , Masculino , Feminino , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/terapia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde , Diagnóstico , Terapêutica/instrumentação , Terapêutica/métodos , Terapêutica , Ceratose Seborreica/patologia , Ceratose Seborreica/cirurgia , Ceratose Seborreica/terapia , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/métodos , Procedimentos Cirúrgicos Dermatológicos , Dermatologia/instrumentação , Dermatologia/métodos , Sistemas de Saúde , Consenso , EspanhaRESUMO
OBJECTIVE: To assess the validity of the use of IGF-1, IGFBP-1 and IGFBP-3 as biochemical markers of nutritional status in prepubertal healthy children. DESIGN: Cross-sectional survey. SETTING: Healthy children from the Madrid area. PARTICIPANTS: Prepubertal children (aged 7-10 years) with a body mass index (BMI) above the 90th percentile (n = 25) and below the 10th percentile (n = 31) were selected from 2,559 included in the CAENPE study (Food Intake and Nutritional Status in Schoolchildren from Madrid). RESULTS: Overweight children were found to have higher serum levels of IGF-1 (306+/-162.2 vs. 209+/-71.2 ng/ml, p<0.001) and IGFBP-3 (3.3+/-1.0 vs. 2.9+/- 0.5 mg/l, p<0.01) and lower serum levels of IGFBP-1 (4.3+/-3.9 vs. 13.8+/-7.4 microg/l, p<0.01). There was a positive correlation with BMI, for IGF-1 and IGFBP-3, and negative correlation for IGFBP-1. No differences in albumin and transferrin concentrations were observed between both groups of children. CONCLUSION: IGF-1, IGFBP-1 and IGFBP-3 clearly classify over- and underweight prepubertal children, showing a good correlation with BMI. They can be used as biochemical markers of caloric nutritional status in this population.
Assuntos
Peso Corporal , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Fator de Crescimento Insulin-Like I/análise , Estado Nutricional , Biomarcadores/análise , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Radioimunoensaio , Reprodutibilidade dos Testes , Albumina Sérica/análise , Espanha , Inquéritos e Questionários , Transferrina/análiseRESUMO
Objetivo. Analizar los resultados del 27 Congreso de la Sociedad Española de Calidad Asistencial (SECA) celebrado en Sevilla (octubre de 2009). Material y método. Estudio descriptivo, retrospectivo, utilizando como fuente de información la base de datos de los comités del congreso. Población. Todas las comunicaciones recibidas (1.231). Evaluación de las comunicaciones por 36 parejas de evaluadores mediante criterios explícitos puntuables y asignación como experiencias o comunicaciones electrónicas. La satisfacción de los participantes en el congreso y en los talleres fue evaluada mediante un cuestionario anónimo. Resultados. Se aceptaron 1.213 comunicaciones. La puntuación media del total de comunicaciones aceptadas fue de 6,38±0,95 puntos. Las experiencias tienen una puntuación media de 7,55±0,41 puntos, mientras que las comunicaciones electrónicas tienen una puntuación media de 6,26±0,9 puntos. En cifras absolutas son Andalucía y Cataluña las comunidades autónomas que más comunicaciones presentaron (557 y 140, respectivamente) aunque, tras el cálculo de la tasa por millón de habitantes, la Región de Murcia (76,43) y Andalucía (67,91) obtuvieron las cifras más elevadas. Conclusiones. La evaluación de comunicaciones y la organización de un congreso de ámbito nacional son un proceso metodológicamente complejo. La rendición de cuentas de las acciones y decisiones realizadas por los Comités Organizador y Científico son un requisito ético de transparencia(AU)
Objective. To analyse the results of the 27th Conference of the Spanish Society for Quality in Health Care (SECA) held in Seville (October 2009). Material and methods. A retrospective descriptive study was conducted using the conference databases. Population. All abstracts received (1231). 36 pairs of reviewers using explicit criteria evaluated abstracts and assignment as Experiences or Electronic Communications. Participant satisfaction in the Conference and Workshops was evaluated by an anonymous questionnaire. Results. A total of 1213 communications were accepted. The average score of accepted abstracts was 6.38±0.95 points. Experiences had an average score of 7.55±0.41 points, while Electronic Abstracts had an average score of 6.26±0.9 points. Andalusia (557) and Catalonia (140) had the highest amount of abstracts in the Conference, but Murcia and Andalusia obtained the highest rates per million inhabitants. Conclusions. The assessment of abstracts and organising a national conference are methodologically complex processes. Accountability for actions and decisions made by the Organising and Scientific Committees are an ethical requirement of transparency(AU)
Assuntos
Humanos , Masculino , Feminino , Avaliação das Necessidades/organização & administração , Pesquisa sobre Serviços de Saúde , Congressos como Assunto/estatística & dados numéricos , Pesquisa/organização & administração , Aprendizagem , Sociedades Médicas/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , 34002 , Pesquisa/normas , Avaliação das Necessidades/normas , Controle de Qualidade , Sociedades Médicas/tendências , Congressos como Assunto/normas , Pesquisa/tendências , Indicadores de Qualidade de Vida , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/organização & administraçãoRESUMO
No disponible
Assuntos
Pessoa de Meia-Idade , Masculino , Humanos , Síndrome Maligna NeurolépticaRESUMO
En circunstancias fisiológicas la osmolalidad plasmática se regula por dos mecanismos complementarias: la hormona antidiurética (ADH) y la sed. Cuando se produce una disminución de la osmolalidad por incremento del agua en el organismo se inhibe la sensación de sed y la secreción de ADH, siendo el exceso de agua eliminado por el riñón. Cuando aumenta la osmolalidad se libera ADH, que disminuye la pérdida de agua por el riñón, y aparece la sed, produciendo ingreso de agua por vía digestiva.La intoxicación acuosa aguda es excepcional en personas sin patología psiquiátrica crónica. Presentamos un caso de intoxicación acuosa aguda durante la realización de una urografía intravenosa. La intoxicación se produjo por una ingesta acuosa excesiva junto con la liberación de ADH por estrés psicológico, que impidió la eliminación de agua por el riñón.De los 9 casos semejantes previamente descritos, la mayoría han sido en mujeres y en el contexto de la preparación de pruebas diagnósticas. (AU)