Syphilis in Men Who Have Sex With Men: A Warning Sign for HIV Infection

OBJECTIVE

To describe the clinical and epidemiological characteristics of syphilis in men who have sex with men (MSM) in an area of Mallorca, Spain.

METHODS

We performed a retrospective analysis of syphilis cases in MSM seen at a hospital in Mallorca between January 2005 and June 2013.

RESULTS

Fifty-five cases of syphilis were recorded in MSM during the study period (34.3% of all cases diagnosed), and 74.5% of these patients had human immunodeficiency virus (HIV) coinfection. The two diseases had been diagnosed simultaneously in 70.7% of this population. Patients with HIV coinfection had a median CD4 count of 456cells/μL (range, 29-979 cells/μL). Syphilis was diagnosed clinically in 49.1% of cases and by screening in the remaining 50.9%. The most common form of syphilis was late latent or indeterminate syphilis (41.9% of cases). In the group of men with syphilis, MSM had a higher risk of HIV infection.

CONCLUSIONS

A majority of MSM with syphilis had HIV coinfection. HIV screening is therefore essential in this population and could even result in early diagnosis.

[Blood-stream catheter related infection in inpatient children receiving parenteral nutrition]

Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN) use seems to be a risk factor for developing a catheter-related infection (CRI).

MATERIAL & METHODS

In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years) who received parenteral nutrition while in hospital. All episodes of fever + positive blood culture were recorded. Infection rate was defined as number of episodes/1000 Parenteral nutrition days.

RESULTS

48 positive blood cultures was obtained from 120 patients. Infection rate was 37.8/1000 days. Incidence was significantly higher in infants and toddlers (52% vs 29.8%, p = 0.016). Most frequent organisms were coagulase negative Staph. (56.8%), Gram negative bacilli (20.8%), Staph aureus (12.5%) and fungus (12.5%). No difference in incidence were found according to the underlying disease or the length of PN use.

CONCLUSIONS

Infection rate in our PN inpatient patients was significantly higher. PN may represent a risk factor for developing a CRI. Specific measurements and policies need to be implemented to overcome present situation.

[Dental health of children and adolescents of Navarra, 2007 (4th edition)]

BACKGROUND

With five years having passed since the last survey (2002), a new survey was carried out, the 4th since 1987. The aim is to determine the state of oral health of children and adolescents in Navarre and its evolution.

POPULATION AND METHODS

The sample (n=1.397) was selected through multistage probability sampling, taking as a unit the classrooms of the 1st and 6th year of Primary Education and the 2nd of Compulsory Secondary Education. The fieldwork was carried out in the months of April and May 2007 by two calibrated teams of examiners. Health variables studied: caries (measured with WHO criterion and extended criterion), periodontal state and malocclusion. The data were computerised with Access XP 2003 SP3; the statistical analysis with SPSS Windows v.15.0.

RESULTS

Ten point eight percent of the sample is of foreign origin. The prevalence of caries in temporary dentition at 6 years is 35.9% with a DFT of 1.26, in permanent dentition, 28.5% and 46.4% at 12 and 14 years; the average of affected teeth 0.63 and 1.28 respectively. The index of restoration is 26.1% in temporary dentition and 68.9 and 74.1% in permanent; those of foreign origin show more caries (p<0.05) and less treatment (p<0.05) than those of Spanish origin. Sixty-two point eight percent of 14 year olds show gingival bleeding and 16.8%, calculus; 14.7% malocclusion and 19.1% wear orthodontic appliances. Conclusions. Caries are stabilised in temporary dentition in the general population, but fall significantly amongst natives (those of Spanish origin); in permanent dentition they continue their tendency to fall, although more moderately. Navarre is amongst the regions with a lower level of caries and a higher index of restoration. Immigrants show significantly more caries. The index of restoration falls slightly with respect to previous years. The periodontal health figures are poor. Malocclusion and orthodontic appliance wearers are stabilised.

Economic benefits for the family of inactivated subunit virosomal influenza vaccination of healthy children aged 3-14 years during the annual health examination in private paediatric offices

Taking the results of a prospective cohort study by our group that evaluated the effectiveness of the inactivated subunit virosomal influenza vaccine (Inflexal V), Crucell-Berna) in the prevention of influenza-related diseases and the reduction of its negative economic consequences, the economic costs and benefits for the family of vaccinating a theoretical cohort of 1000 healthy children aged 3-14 years with no risk factors with one dose of vaccine during the yearly health examination were quantiified. The economic analysis was carried out from the family perspective and the time horizon of the study was established at 6 months. In the base case, the net present value was 21,551.62 euros (21.5 euros per vaccinated child), and the benefit-cost ratio was 2.15, meaning that 1.15 euros is saved per euro invested.

Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia

The utility of procalcitonin levels to improve the accuracy of clinical and microbiological parameters in diagnosing ventilator-associated pneumonia (VAP) was evaluated. Sequential measurement of procalcitonin and C-reactive protein levels and the calculation of the simplified Clinical Pulmonary Infection Scores (CPIS) were performed in 44 patients mechanically-ventilated for >48 h with neither active infection for the duration or suspicion of VAP. Patients who developed extrapulmonary infection were excluded. In total, 20 cases were suspected of having VAP and diagnosis was microbiologically confirmed in nine. In patients with confirmed VAP, procalcitonin levels were higher than in those without VAP. C-reactive protein levels and CPIS were lower in patients without suspected VAP, but could not discriminate confirmed and nonconfirmed suspicion of VAP. The best sensitivity and specificity (78 and 97%, respectively) corresponded to procalcitonin. The CPIS resulted in the same sensitivity, but had a lower specificity (80%). C-reactive protein had the worst sensitivity (56%), but a good specificity (91%). A CPIS >or=6 combined with serum levels of procalcitonin >or=2.99 ng.mL(-1) did not improve the sensitivity (67%), but resulted in 100% specificity. Procalcitonin might be useful in the diagnosis of ventilator-associated pneumonia. Combined values of Clinical Pulmonary Infection Scores and procalcitonin below the cut-off points excluded false-positive diagnoses of ventilator-associated pneumonia.

[The future of health management in neurology]

Nowadays a humanized and scientific sanitary assistance continues to be very important. The management generically and specifically in Neurology implies two basic supposes (account system and management control) and six fundamental disciplines (knowledge of the facts, choose of finalities, meeting and organization of resources, organization of functional structures, motivation of persons, and finally control and global evaluation). The value of a Department Neurology resides in the value of its staff, fundamentally doctors, and because of its intensive use of technology can reach competitive advantages with its coordination with Neurosurgery, Neuropathology and Neuroradiology.

Análisis y clasificación de las urgencias hospitalarias mediante los Ambulatory Patient Groups

AIM

To assess the feasibility and results of application of Ambulatory Patient Groups (APG) patient's classification system to the case-mix of patients seen at the Emergency Departments (ED) of 6 Barcelona metropolitan area hospitals.

METHODS

Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU). Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes.

RESULTS

A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the ED were common and simple procedures. Fifteen APG's grouped 50% of all cases seen at the ED.

CONCLUSIONS

The ED Uniform Discharge Data Set (CMBDAU) developed is a valid instrument for describing the case-mix seen at the ED, and its grouping by means of the APG system provides consistent and meaningful results. The widespread use of systems like APG in the ED requires a former validation of relative weights assigned in the US system. The availability of human and technical resources must also be assessed, in order to guarantee the quality and sustainability of such a system.

Immunogenicity and reactogenicity of the adult tetanus-diphtheria vaccine. How many doses are necessary?

The immunogenicity and reactogenicity of the tetanus-diphtheria adult type vaccine was compared in two groups: group I (n = 201, 18-30 years old, presumably vaccinated with the DTP vaccine) and group II (n = 147, > or = 45 years old, without vaccination antecedents). Before vaccination, the seroprotection levels for tetanus were 90.5% (group I) and 30.6% (group II). These rose to 99.5% and 81.7%, respectively, after administration of one vaccine dose. For diphtheria, prevaccination seroprotection levels were 38.3% (group I) and 19.0% (group II). These rose to 85.8% and 65.7%, respectively, after vaccination. The logistic regression analysis showed an association between antibody titre and age. In group II, 3 doses of Td vaccine were needed to reach titres similar to those achieved in group I with a single dose. Stated reactogenicity was greater in: young subjects, women, those with higher titres of tetanus antibodies and those receiving other vaccines simultaneously. These results confirm the need for vaccination schedules adapted to the characteristics of each population age-group.

[Impact of hospital admissions for pneumonia in a tertiary Spanish hospital]

BACKGROUND

Impact of hospital admissions for pneumonia during 1998 in the Hospital Clínic, Barcelona.

PATIENTS AND METHOD

Retrospective information on the hospitalizations for pneumonia was collected.

RESULTS

During 1998 a total of 626 adult were admitted with a hospital diagnosis of pneumonia (72% were >/= 65 years). The average length of stay was 10 days. Half of these patients were previously hospitalized during the preceding 5 years.

CONCLUSIONS

Hospital admissions due to pneumonia (17 cases per 1.000 hospitalizations) accounted for an estimated cost of 2.3% of the cost of all the hospitalized patients.

Prevalence of hepatitis B infection in long-stay mentally handicapped adults

The objective was to determine the prevalence of hepatitis B virus (HBV) infection in long-stay institutionalized mentally handicapped adults and to develop a vaccination programme for them. The study was carried out in 1994. The subjects were 171 mentally handicapped adults aged 37-76 (median age 56) with a median hospital stay of 30 years (range 6-47). Markers for infection were determined using ELISA. Seronegative patients were vaccinated using the standard schedule, and the titre of antiHBs reached was determined later. The prevalence of seropositive subjects was 81.3%. Seropositive subjects had a longer hospital stay (median stay of 32 years, range: 15-47) than seronegative ones (median stay of 15 years, range: 6-33). A total of 43.3% of the vaccinated subjects developed antiHBs antibodies (GMT: 135 IU/l). The high prevalence of HBV exposure is probably a legacy of a past era which is reflected in patients with prolonged institutionalisation in a closed regime. The need for immediate vaccination of mentally handicapped subjects is of the utmost importance, as it has been shown that the response to the vaccine worsens with age.

[Analysis of the cost-effectiveness relationship in the empirical treatment in patients with infections of the lower respiratory tract acquired in the community]

BACKGROUND

Cost of treatment of community-acquired infections in Spain is an important factor in overall health expenditures. The aim of this study was to assess the direct health costs related with the treatment of patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) due to infection, using different antibiotic options, and to identify main cost drivers.

METHODS

A basic decision analysis model was developed, including probabilities estimation derived from the literature review, supplemented when needed by the opinion of a panel of 8 Spanish physicians (Delphi technique). Four groups of antibiotics were included (macrolides, beta-lactam, fluoroquinolones and cephalosporins) in two different groups: patients with CAP without hospital admission criteria and patients with AECB due to respiratory infection. The analytic horizon and the perspective used were those of the Spanish National Health Service. Direct cost were assessed (drugs, outpatient visits, hospital admissions, diagnostic tests). Indirect cost were not included in the model. Final costs uses as main outcome measure the average cost per patient treated. All results were calculated following a fold-back technique. Sensitivity analysis were included allowing for variations in several clinically relevant parameters.

RESULTS

1. Patients with CAP: Hospital admissions, directly related to the effectiveness rate of initial empirical antibiotic therapy, were the main cost driver (50%-70%). Acquisition costs of initial antibiotic therapy only account for 2%-13% of total costs. 2. Patients with AECB: Outpatient visits are the main cost driver for these group of patients (49% of total costs). Hospital admission costs are also an important cost driver (40%-51% of total costs). Acquisition costs of initial antibiotic therapy account for 4%-28% of total costs. Clinical effectiveness of first antibiotic option is the main variable regarding the cost-effectiveness rate.

CONCLUSION

The model here presented showed that acquisition costs of first empirical antibiotic therapy are only a small proportion of total costs related with the management of community acquired lower respiratory tract infections in Spain. The clinical effectiveness rate of the first antibiotic used is the main variable which determines the final average cost per patient cured. For patients with lower respiratory tract infections the therapeutic option with a better cost-effectiveness ratio must be chosen, in order to minimize the risk of therapeutic failure after first line therapy, and should not be selected only by its lower acquisition costs.

Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome

Noninvasive and invasive diagnostic techniques have been shown to achieve comparable performances in the evaluation of suspected ventilator-associated pneumonia (VAP). We studied the impact of both approaches on outcome in a prospective, open, and randomized study in three intensive care units (ICUs) of a 1,000-bed tertiary care university hospital. Patients with suspected VAP were randomly assigned to noninvasive (Group 1) versus invasive (Group 2) investigation (tracheobronchial aspirates [TBAS] versus bronchoscopically retrieved protected specimen brush [PSB] and bronchoalveolar lavage [BAL]. Samples were cultured quantitatively, and BAL fluid (BALF) was examined for intracellular organisms (ICO) additionally. Initial empiric antimicrobial treatment was administered following the guidelines of the American Thoracic Society (ATS) and adjusted according to culture results (and ICO counts in Group 2). Outcome variables included length of ICU stay and mechanical ventilation as well as mortality. Overall, 76 patients (39 noninvasive, 37 invasive) were investigated. VAP was microbiologically confirmed in 23 of 39 (59%) and 23 of 37 (62%) (p = 0.78). There were no differences with regard to the frequencies of community-acquired and potentially drug-resistant microorganisms (PDRM). Antimicrobial treatment was changed in seven patients (18%) of Group 1 and 10 patients (27%) of Group 2 because of etiologic findings (including five of 17 with ICO = 2% (p = not significant [NS]). Length of ICU stay and mechanical ventilation were also not significantly different in both groups. Crude 30-d mortality was 31 of 76 (41%), and 18 of 39 (46%) in Group 1 and 14 of 37 (38%) in Group 2 (p = 0.46). Adjusted mortality was 16% versus 11% (p = 0.53), and mortality of microbiologically confirmed pneumonia 10 of 23 (44%) in both groups (p = 1.0). We conclude that the outcome of VAP was not influenced by the techniques used for microbial investigation.

[Comparative analysis of articles published by Spanish authors (1993-1997) in biomedical journals with high impact factor]

BACKGROUND

To identify the Spanish scientific production amongst different areas of clinical knowledge, and to compare it with those of five other European Union countries.

METHOD

Review of MEDLINE data base, for the period 1993-1997. Search limited to four journals, selected, for 10 different medical specialties (Cardiology, Endocrinology, Infectious Diseases, Gastroenterology-Hepatology, Haematology, Nephrology, Pneumology, Neurology, Oncology, Rheumatology). Articles published by authors from Germany, France, Italy, The Netherlands, Sweden and Spain. Journals included in the Internal Medicine subject classification were independently analysed. Data were also related with several econometric indexes.

RESULTS

A total of 1,763 original articles published by Spanish authors were identified in the journal's sample over the analysed period (2.08 articles per 100 all published articles). Spain contributes to the total achieved by the six European countries analysed with 9.07 articles per 100 published articles. Gastroenterology-Hepatology was the medical specially which has more articles published by Spanish authors (total: 338 articles; 4.15 articles/100 published articles); and Oncology the one with less articles published (1.26 articles/100 published articles). The mean IF value per journal by article is highest for Gastroenterology-Hepatology (4.86 FI/article) and lowest for Pneumology (2.42 FI/article). Spain is the last amongst all six European countries analyzed in Endocrinology, Oncology and Haematology, and second to last in all others except for Gastroenterology-Hepatology (4th place). Mean cost for each article produced by Spanish authors in the analyzed sample was 0.49 US $ according the health expenditures per capita, and 0.07 US $ according the R+D expenditures per capita. Data from the independent analysis of Internal Medicine journals also showed that Gastroenterology and Hepatology is the subspecialty with a higher number of papers published in those journals.

CONCLUSIONS

All efforts devoted to improve the quality of Spanish biomedical research, specially in clinical research, had produced positive, but uneven, results, measured by the number and impact factor of original articles published in top ranked biomedical journals. The overall distribution of high impact factor scientific production by specialties is poor when compared to the European Union countries included in the analysis. Those results showed several improvement opportunities. Besides increasing the overall budget for R+D, its is likely that the time has come for backing the highest quality Spanish biomedical research, the one that offers greater and better chances for achieving scientifically valid results, and is published in high impact factor biomedical journals.

Cataract surgery: an analysis of patient satisfaction with medical care

INTRODUCTION

Patient satisfaction is a good performance indicator for measuring the quality of health care delivered by hospitals. Satisfaction is understood to be the positive difference between users' perceptions of their experience at the moment of discharge and their expectations at the moment of admission.

OBJECTIVE

To evaluate the expectations and the perceived quality of care in cataract surgery patients attending Hospital Clinic (HC).

METHOD

A two-stage descriptive study carried out at the HC in Barcelona, Spain. The target population consisted of patients operated on for cataracts during the 1996 calendar year. Two study groups were established: Group I, patients attending outpatient service before admission; and Group II, patients attending outpatient service after surgery. After informed consent was obtained, the patients were directly interviewed by three researchers especially trained for that purpose. The questionnaire included demographic variables and 31 questions related to expectations, all to be answered by means of a 7 points Likert's visual scale. All statistical calculations were performed using the SPSS program for Microsoft Windows.

RESULTS

A total of 148 interviews were performed: 80 (54.1%) in Group I and 68 (45.9%) in Group II. The mean age was 64.2 +/- 11.6 years. The difference between scores at admission and at discharge was nearly significant (p = 0.064) for the "information" component.

CONCLUSIONS

The study of several fields where the patient's expectations are higher or lower contributes to prioritizing efforts to improve quality. There is a need for a frequent review and update of any patient satisfaction evaluation tools that are used.

[Nosocomial infections due to opportunistic fungi: analysis of a news outbreak in the Spanish press]

BACKGROUND

To study an outbreak of media news related to nosocomial infections due to opportunistic fungi in Spanish hospitals.

METHOD

CASE DEFINITION

any news related to possible nosocomial infection due to opportunistic fungi in Spanish hospitals, published in national or local daily newspapers, over the pre-epidemic (July-December, 1998) and epidemic periods (January-June, 1999). All news were reviewed and identified using global press reports summaries, prepared by two independent sources, and were analyzed by three different observers.

RESULTS

Over the pre-epidemic period there were not any news related to nosocomial infections due to opportunistic fungi. Over the epidemic period, a total of 218 news were identified, 154 (71%) published in national newspapers and 64 (29%) in local ones. We analyzed separately 18 editorials or opinion articles related to this subject. The epidemic curve (distribution of news by week) showed an incidence news peak at week 5 (102 news, 46.7% of all news published). The media mentioned up to 19 different hospitals as institutions with possible cases of nosocomial fungal infections. After week 8, news incidence drop, and remain thereafter at minimum levels.

CONCLUSIONS

The example provided by the analysis of this outbreak of media news, related to nosocomial infections by Aspergillus an other opportunistic fungi, is useful to allow us understand how some medical news arise, develop and were transmitted. The public alert situation created in Spain was remarkable, and it is likely that there was a transient loss of confidence in the safety of public health institutions. Today's medicine requires a great and better openness to the media, and a better cooperation between both parts.

Perceived quality of care of inguinal hernia repair: assessment before and after the procedure

OBJECTIVE

Assessment of the perceived quality of care for inguinal hernia repair procedures.

DESIGN

A two-step descriptive study using specific questionnaires.

SETTING

A tertiary care University Hospital.

SUBJECTS

Random sample of patients diagnosed of inguinal hernia in 1996. Group A, patients seen at the outpatient clinic before admission; group B, patients seen for follow-up after the surgical procedure.

INTERVENTIONS

Two different questionnaires were used.

MAIN OUTCOME MEASURES

validity of the questionnaire was evaluated using Cronbach's alpha value. Scores were measured using the z value.

RESULTS

Total number of patients was 194. Both groups were comparable. The questionnaire was able to explain 66.3% of the variance. The Cronbach's alpha value was 0.90. Scores recorded were significantly different (P < 0.01) regarding the health care workers' attitude and hospital commodities' variables (rated as better than expected). Differences in scores for information supplied, overall results of the surgical procedure and food variables were not statistically significant.

CONCLUSIONS

(i) The study of several fields where the patient's expectations are higher or lower contributes to prioritizing efforts to improve quality in the Surgery Department. (ii) The differences seen strongly suggest the need for patient's satisfaction surveys to be specific by diagnosis/dimension and adapted to patients' expectations.

Perceived quality of care in pregnancy assessment before and after delivery

OBJECTIVE

To assess the perceived quality of care in a group of pregnant women attended in a public Hospital.

STUDY DESIGN

All pregnant women seen at the Hospital Clinic of Barcelona in 1996. Two study groups were defined: group A, women seen at the outpatient clinic as a regular follow-up visit for pregnancy, and group B, women seen at the outpatient clinic for follow-up after delivery. A satisfaction questionnaire survey was used in a random sample of both groups of women.

RESULTS

Total number of interviews performed was 174. Both groups, A and B were comparable. Scores recorded in both groups were significantly different (P<0.01) for the clinical follow-up and privacy variables (regarded as better than expected). The difference in scores for the information supplied was also statistically significant (P<0.01), but regarded as worst than expected.

CONCLUSIONS

The analysis of satisfaction does not seem to follow a linear, straightforward explanation. The differences seen strongly suggest the need of patient's satisfaction surveys to be specific by dimension and tailored to patients' expectations.

[Excess length of stay attributable to nosocomial bacteremia: usefulness of the Hospitalization Appropriateness Protocol]

BACKGROUND

To evaluate the usefulness of the Appropriateness Evaluation Protocol (AEP) for assessing the extra length of stay attributable to nosocomial bacteremia.

PATIENTS AND METHODS

Retrospective review of the medical records (1989, 1990 and 1991) of all patients, who developed Staphylococcus aureus nosocomial bacteremia. Evaluation of hospital stay was performed using the AEP. Calculation of the kappa index and intraclass correlation coefficient.

RESULTS

A total of 158 patients were included S. aureus nosocomial bacteremia is responsible for a mean excess length of stay of 4.3 days per patient. Kappa index for the method used was 76%, and intraclass correlation coefficient was 61%.

CONCLUSIONS

The AEP has been shown to be a reliable tool for assessing the extra days of stay attributable to nosocomial bacteremia in the Spanish National Health System. The use of AEP should be extended to assess the extra stay attributable to other types of nosocomial infections.

Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group

A questionnaire survey was sent to a random sample of the Spanish network of National Health System public acute-care hospitals. Of responding institutions (representing 25% of Spanish hospital beds), nearly 75% had active surveillance programs for the prevention and control of surgical-site infections (SSIs), but only 20% performed postdischarge surveillance. Overall, perioperative antibiotic prophylaxis (PAP) was used in 84% of all surgical procedures. For 77% of procedures, there were written guidelines for the choice and use of PAP. Cefazolin was the most commonly used antibiotic (38%). Duration of PAP was shorter than 24 hours in 75% of procedures, and only a single dose was given in 52% of procedures. PAP was commonly used in breast (52%) and inguinal hernia repair (69%) procedures, as well as in laparoscopic abdominal surgery (86%). In summary, the use of PAP in Spanish hospitals is adequate, but improvements can be made in the frequency of prolonged PAP and in the use of broad-spectrum antibiotics. Surveillance systems for SSI, including postdischarge follow-up, also should be improved.

An analysis of the factors affecting the average length of stay in the otolaryngology unit

Specific factors which have an influence on the average length of stay in the otolaryngology unit of a University Hospital are studied; the patients are covered by some type of insurance and have no out-of-pocket expenses. The effect of the following variables on the average length of stay is evaluated: age, sex and type of pathology. The periods of hospitalisation are significantly longer (Mann-Whitney test) in males (p < 0.0001), in older patients (p < 0.008) and in the case of tumours, which prolong the period of stay especially of males (p < 0.0001). It is suggested that the shorter stay in the case of females may be conditioned by social and family factors.

[The rights of the hospital patient: the knowledge and perception of their fulfillment on the part of the professional. The Group in Catalonia of the Spanish Society of Care for the Health Services User]

BACKGROUND

The Customer Service Department includes the protection of the patient's rights. To analyze the work performed in this setting, we planned to quantitate and evaluate the knowledge and perception of fulfillment by medical staff.

METHODS

Multicentric cross-sectional study. The population included health care professionals in nine Catalonian hospitals. The sample was selected at random with reposition and was segmented according to professional category. Data collection was carried out by personal interview supported by a questionnaire. Differences according to institution size were analyzed.

RESULTS

A total of 1,014 professionals were interviewed; 84.4% reported to know the patient's rights and 64.4% to observe them. Significant differences (p < 0.05) according to institution size were observed.

CONCLUSIONS

Discussion and diffusion of patient's rights is an useful tool to improve knowledge and evaluate the perception of its fulfillment by health care professionals.

[Impact of sabbatical leave on hospital and university promotions]

BACKGROUND

The aim of this study was the assessment of the scientific production and impact on academic and/or hospital promotion ob sabbatical leaves of medical staff from a University hospital.

POPULATION AND METHODS

A matched case-control design was used. The Mantel-Haenszel odds ratio (ORMH) and its 95% confidence intervals were calculated. A total of 52 sabbaticals leaves were analyzed with successful matching for 43 pairs.

RESULTS AND CONCLUSIONS

Taking a sabbatical leaves is associated with a significant higher chance of hospital promotion (ORMH = 7.5; CI 95%, 1.71-32.78; o = 0.004), but there is not a significantly higher chance of academic promotion (ORMH = 0.66; CI del 95%, 0.23-1.83; p = 0.60).

[Assessment of patients' expectations before admission to a tertiary-care center]

BACKGROUND

The customer's final satisfaction with health services depends to some extent, on the relationship between expectancy and perceived quality. Focus groups technique helps in the knowledge of those attributes that patients identified as perceived quality.

MATERIAL AND METHODS

The study was performed in the Hospital Clínic i Provincial of Barcelona (HCPB), Spain, by selecting a sample of patient's included in the admission's waiting list (1994) of three common procedures: lens extraction, abdominal hernia repair and routine pregnancy control. The patients were distributed in 12 different semi-structured interview groups (focus groups) and video-taped. From the analysis of those tapes, the main concerns and aspects highlighted by consumers were identified, following a common set of rules: wording, context, internal consistency, precision/vagueness of answers and basic ideas.

RESULTS

A total of 106 patients attend the interview. Patients with loss of visual acuity underscore the contribution of quality of life improvement expected from the procedure (technical quality of the surgical procedure, physical improvement and final outcomes). Patient's with abdominal hernia repair highlight the appearance and comfort of hospital setting as the most important item. Pregnant women emphasize the importance of a good follow-up process after delivery, as well as the need for individual services (dignity and intimate).

CONCLUSION

The semi-structured interview method (focus group) could be applied in the context of our hospitals, and contribute to improve quality management at our institutions, making effective the patient participation.

Evaluation of turnaround times as a component of quality assurance in surgical pathology

OBJECTIVE

As a part of a quality assurance program in anatomic pathology, a study was conducted to determine intralaboratory components of turnaround time according to specimen type, and to compare the present data with results obtained 2 years after implementing the program.

DESIGN

Assessment of intralaboratory turnaround times for surgical pathology reports in a sample of 501 biopsies and surgical specimens during 1992. Comparison between the basal data obtained in 1992 and the final determination in 1994 after the implementation of an improvement action.

SETTING

Surgical specimens and biopsies accessioned at the Department of Anatomic Pathology of a 913-bed acute-care teaching hospital in the city of Barcelona, Spain. STUDY SAMPLES AND PARTICIPANTS: The sample was selected from the total number of biopsies and surgical specimens accessioned on specific days by applying a table of random numbers. Data were collected from the request forms, final report copies, and laboratory registries of turnaround time-points by two resident physicians.

INTERVENTIONS

All relevant information concerning turnaround times was recorded following a standardized questionnaire developed specifically for the study.

MAIN OUTCOME MEASURES

The basal determination for turnaround time for pathologic diagnosis in 1992 was 5.7 days.

RESULTS

The mean turnaround time for the 501 specimens was 6.24 (SD = 3.16; range = 2-27 days). Turnaround times varied substantially according to specimen type. Endoscopic biopsy samples were completed by 5.19 days (SD = 2.18). Bone biopsies were finalized within a mean of 8.11 days of receipt (SD = 3.18). For the diagnosis of lymphoproliferative disorders, most lymph node specimens required special histochemical or immunohistochemical stains. The mean turnaround time for results reporting/results transmittal to the ordering physician varied between 1.14 and 1.66 days. The 1992 annual mean turnaround time for a total of 14,862 surgical pathology specimens was 5.7 days as compared with 4.2 days for a total of 17,931 surgical pathology specimens in 1994.

Characteristics of elderly inpatients at high risk of needing supportive social and health care services

A two-stage cross-sectional study was conducted in a 951-bed acute-care hospital: a first survey designed to determine the profile of patients aged > or = 64 years needing supportive social/health care services, in which 38 patients discharged between June and July, 1992 (group 1) with social/health care problems that accounted for inappropriate hospitalization days participated, and a second survey designed to identify patients aged > or = 65 years at high risk and thus facilitating the early intervention of social workers, in which 153 patients selected at random and interviewed between August and September, 1992 (group 2) participated. A significantly higher percentage of group 1 patients had no medical insurance, were admitted to hospital for treatment, lived alone, had been readmitted in the previous 6 months, suffered from dementia and/or cognitive impairment, presented with associated chronic illnesses, and showed lower Barthel index scores as compared to group 2 patients. In patients in group 2, hospital discharge was delayed due to the need of supportive social and health care services in only 27 patients. The percentage of agreement in the suitability of the resource provided was higher after (92.6%) than before the intervention (71.1%). The mean number of inappropriate hospitalization days was 3.5 days for patients in group 1 and 1.9 days for those in group 2 (p = 0.013). The early identification of elderly inpatients at high risk of needing additional supportive social and health care would help patients to find the most appropriate resource according to their individuals needs.

Prevention and control of nosocomial infections in Spain: current problems and future trends

Spain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.

[Susceptibility to measles, rubella and parotitis in young adults]

BACKGROUND

The aim of this study was to know the prevalence of antibodies against measles, rubella and parotiditis in young adults.

METHODS

The study was carried out in health care students during the academic year of 1992-1993. Demographic and geographic variables were obtained as were vaccination and history of diseases. Antibodies against measles, rubella, and parotiditis were determined by ELISA techniques with commercial reagents.

RESULTS

Three hundred and six individuals of 21.3 +/- 2.2 years (range 17-36 years) with 27.5% being males were studied. Past history of measles, rubella and parotiditis was reported in 43.5, 30.7 and 37.3%, respectively, with vaccination being 23.2, 43.8 and 20.6%, respectively. The prevalence of antibodies was 93.1% (measles), 96.4% (rubella) and 92.1% (parotiditis).

CONCLUSIONS

The prevalence of infection of measles, rubella and parotiditis in the young population studied is mainly due to infection by wild type virus. The foreseeable growth of susceptibility groups in this population which should be adequately evaluated by extensive seroepidemiologic questionnaires, favors the appearance of epidemic outbreaks. The use of the triple viral vaccine is suggested as an alternative to rubella vaccination in presumable susceptible young women.

[Epidemiologic surveillance system for reportable diseases at the hospital]

The aim of this work is to present a detection system of reportable diseases among patients attending a teaching hospital. Since January 1988, based on daily data obtained from the Admissions Department of Hospital Clínic of Barcelona (HCP) (emergency department visits and hospital admissions and discharges), the Preventive Medicine Unit identifies every day those diseases considered as reportable by the Department of Health of Catalonia, Spain. Reported cases from HCP during the 1988-1991 period were compared to cases reported from HCP in 1987, as well to the corresponding cases in the remaining hospitals of Barcelona. Between 1987 and 1988 there was a 245% increase in the reporting of Individualized Reportable Diseases and of 4345% for Numeric Reportable Diseases. The increased notification has also been shown for the most frequent Individualized Reportable Diseases: 364% for hepatitis, 195% for meningococcal infection and 233% for pulmonary tuberculosis. This system is an approach to the introduction, development and perfection of the detection process, in order to improve reporting levels in the hospital, contributing to strengthen the epidemiologic surveillance system in the community.

Hospital accreditation in Catalunya: an assessment of the performance in quality of hospitals

Information about a hospital accreditation program generally goes unpublished, and when published, it is seldom used to analyse the quality performance in a group of hospitals. This article uses the information derived from the Accreditation Program of Hospitals in Catalunya to assess the quality of the performance of hospitals in this region. Catalunya's accreditation program is publicly administered, and the advantages and disadvantages of such a model in comparison to others will also be analysed.

[Assessment of the performance of sabbatical leave: Hospital Clínic i Provincial of Barcelona (1990-1991). Research Committee of the Hospital Clínic i Provincial of Barcelona]

BACKGROUND

The development of an evaluation protocol for assessing the scientific contribution and the impact on medical care of the sabbatical leaves granted in a large Spanish teaching hospital.

METHODS

The sabbatical leaves for all faculty staff of the Hospital Clínic i Provincial of Barcelona (HCPB) were analyzed since 1980 trough 1991. The scientific production analysis was done according to the impact factor (IF) score of the Science Citation Index. Descriptive statistical techniques as well as parametric and non-parametric tests were used for comparisons.

RESULTS

A total of 52 sabbatical leaves was analyzed of all 60 leaves granted (87%). Mean duration of the leave was 7.94 +/- 3.86 months. The scientific production includes 89 original articles published in peer-reviewed medical journals, with a total score of 300.82 IF points (mean score: 5.78 +/- 7.12 IF points by leave). There were significant differences in the mean duration, number of papers published and IF points score by sabbatical leave between the Medicine, Surgery and Other Departments. In 16 cases (31%) there was a professional promotion following the sabbatical leave and in 20 cases (39%) an academic promotion. In 27 cases (60%) there was no promotion after the leave. Most of the faculty staff physicians (96%) are still employed in the same institution, and believe that the sabbatical leave has significantly contributed to their promotion (67%). A high percentage (94%) has also been able to develop afterwards the methods and techniques learned during the sabbatical leave.

CONCLUSIONS

The experience of the Hospital Clinic of Barcelona in granting sabbatical leaves has been highly positive. The scientific performance of the individuals on leave is high. Our institution has been able to add and develop most of the techniques and methods learned overseas. The future of the sabbatical leaves in other Spanish Universities and Hospitals should be regarded as a high priority target. The performance of these leaves is supported by its scientific results, that could be quantified.

Information as a fundamental attribute among outpatients attending the nuclear medicine service of a university hospital

The aim of this study was to assess outpatients' satisfaction with the service received in the nuclear medicine service of the Hospital Clinic i Provincial of Barcelona in February 1993. The patients were randomly assigned to one of two groups: group 1 received information about their diagnostic procedure, whereas group 2 did not (a control group). A questionnaire was used to assess patients' degree of satisfaction. The questionnaire was administered to 803 patients, 243 (30.26%) of whom completed it and returned it. The following factors were significantly related to high scores on the satisfaction scale: age (P < 0.015), waiting time (P < 0.001), treatment by assisting personnel (P < 0.001), treatment by personnel at the service reception (P < 0.01), waiting room habitability (P < 0.01), communication variables (P < 0.03) and low scores on the anxiety scale (P < 0.02). Group 1 perceived more positively treatment by personnel at reception (P < 0.041), treatment by assisting personnel (P < 0.027), waiting room habitability (P < 0.035) and communication variables (P < 0.001). The anxiety scale scores among this group were significantly lower. We conclude that when information is supplied to patients, their anxiety decreases before a diagnostic procedure, which significantly improves their perception of the factors that generate satisfaction among patients.

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

[The vaccination of medical and nursing students against hepatitis B]

BACKGROUND

Vaccination against the hepatitis B virus (HBV) of health care staff during their studies would have the advantage of early prevention when the prevalence of infection is presumably low.

METHODS

The population to be protected is made up of 1533 medical and nursing students. In those who accepted, anti-HBc was determined and information was obtained concerning circumstances of exposure to HBV. Vaccination was offered to all the cases of negative anti-HBc. Individuals receiving 3 doses of the vaccination (20 micrograms at 0, 1 and 6 months) were seen at 4-7 months of the last dose to determine the anti-HBs titers achieved.

RESULTS

One thousand sixty-five students (70%) accepted inclusion into the prevaccination anti-HBc study and 1,029 (3.4%) were anti-HBc negative. Only older age and previous transfusions and jaundice were significantly associated to greater prevalence of infection by HBV. The adherence to 1, 2 or 3 doses of the vaccination was 96%, 94% and 87%, respectively. Following the 3 doses, > or = 10 UI/I of anti-HBs were detected in 97% of the cases studied with geometric measurement of the responders being 1580 U/I. The titer had an inverse relation which was not significant with age.

CONCLUSIONS

The high participation in the program of anti-hepatitis B vaccination and the excellent immune response observed leads to the recommendation of systemic vaccination to future health care professionals during their study period. Furthermore, the low prevalence of previous HBV infection advises against previous detection of anti-HBc with immunization of the whole collective being more effective.

[The quality perceived by the consumers of the outpatient consultation services of a university hospital]

With the objective to know the perceived quality of the assistance by the customers of the outpatient facilities in a teaching hospital, the information gathered in 1,970 self-administered, volunteer, anonymous questionnaires was analyzed, being obtained from the 4,756 consultations done in the outpatients department during a one week period. Different aspects of the physician's visit are discussed, together with the attention received from the paramedic personnel and other viewpoints pertaining to the organization and conditions of the waiting area. There is a high level of satisfaction among the users of the outpatients department, more pronounced in the "medical" area, in relation with the physician's consultation as well as with the attention from paramedics or in the adherence to appointments. The results suggest that in those physicians' offices where the relationship of the patient with the unit is less frequent, users show more criticism in comparison with those offices where almost all patients consult because of chronic ailments. We underline the importance of this type of perceived quality studies within the quality control policies, as a complement of the analysis of technical quality.

[Risk of nosocomial infection in elderly patients admitted to a university hospital]

BACKGROUND

A high percentage of current hospital visits are made by the elderly. The aim of this work is to quantify the risk of contracting a nosocomial infection among elderly patients admitted to a university hospital.

METHODS

From the patients admitted from the emergency unit, outpatients and the waiting list, 6 patients of different age groups were chosen each day by a simple random sampling. The criteria of nosocomial infection were those of the CDC. The analysis of the information was made with the programme EPIINFO version 5. The chi 2 tests and Fisher's exact test were used to compare proportions.

RESULTS

The rate of nosocomial infection in the group aged over 64 was 14.8%, showing statistically significant differences with respect to other age groups (p = 0.001). In this group the predominant infection was urinary, with an odds-ratio of 3.69, in comparison with the 25 to 44 age group. A prolonged hospital stay (> 15 days) has proved to be closely related to the risk of nosocomial infection in all age groups (p < 0.0001) in patients over 64.

CONCLUSIONS

The greater risk of contracting nosocomial infections in the elderly makes it advisable to develop specific prevention programmes for this group, and the fitness of accommodations the length of stay to the care needs suitable to the hospital level.

[The radiology demand in primary care]

AIM

To contribute a preliminary study, which allows the best use of the demand criteria and acceptance mechanisms of radiological explorations at the primary care level.

DESIGN

Retrospective and observational study. SITE. Public Health Care Center Poblenou, in the Barcelona area.

PATIENTS

A random sample of patients covering 15,000 X-Ray explorations.

MEASUREMENTS AND MAIN RESULTS

The parameters evaluated were: the type of x-ray; the existence of otherwise of pathology; the physician requesting the x-ray; and the patient's age and sex. Results show greater use by the feminine sex (56%), with statistically significant differences (p less than 0.0008) (1 degree of freedom). The overall pathology rate was 43%, also with significant differences between different groups of doctors (p less than 0.0001) (3 degrees of freedom). 52% of the investigations were on patients over 50.

CONCLUSIONS

In general, the high percentage in primary care of pathological explorations should be noted; as should the variation in pathology rates between different groups of doctors, which suggests possible differences of criteria in the use of radiological indicators. The high percentage of patients of an advanced age will have to be considered in the planning of radiological services.