Adecuación del uso de los servicios médicos de urgencias por parte del paciente adolescente

Objetivo: Comparar la adecuación de las consultas a urgencias del paciente adolescente que está siendo atendido por el pediatra (12 a 14 años) y los que ya no lo están (15 a 18 años). Métodos: Estudio transversal con pacientes en edades entre 12 y 18 años que acudieron al Servicio de Urgencias del Hospital La Salud de Valencia durante el 2018. Los criterios de adecuación se basaron en el Protocolo de Adecuación de Urgencias Hospitalarias. Las variables de adecuación se describieron mediante frecuencias y como método de comparación se utilizó el test exacto de Fisher y la razón de momios. En todos los casos los contrastes de hipótesis fueron bilaterales, con un nivel de confianza de 95 % y la hipótesis nula (Ho) se rechazó con valor p<0,05. Resultados: Del total de episodios, el 64,9 % (n= 226) fueron adecuados al servicio de urgencias. Esta distribución fue similar dentro de cada uno de los grupos de edad y no se pudo establecer diferencia significativa entre ambos (p= 0,283). Se encontraron diferencias significativas en los criterios de intensidad diagnóstica y tiempo de atención por sexos. Conclusiones: Las cifras son indicativas del mal uso del servicio de urgencias, por una parte, del paciente adolescente, tanto si está siendo seguido por el pediatra como si no. Ello puede ser una señal del vacío asistencial en el que se encuentran estos pacientes.Objective:Compare the adequacy of emergency consultations of the adolescent patients being cared by the pediatricians (12 to 14 years) and those who are not (15 to 18 years).Method:Cross-sectional study with patients in the ages from 12 to 18 years who attended the Emergency Service of La Salud Hospital in Valencia during 2018. The adequacy criteria were based on the Adequacy Protocol of Hospital Emergencies. Adequacy variables weredescribed by frequencies and Fisher's exact test and odds ratio were used as a comparison method. In all cases, the hypothesis contrasts werebilateral, with a confidence level of 95% and the null hypothesis (Ho) was rejected with p<0.05 value.Results:Of the total episodes, 64.9% (n= 226) were suitable for emergency services. This distribution was similar within each of the age groups and no significant difference could be made between the two (p= 0.283). Significant differences were found in the criteria of diagnostic intensity and attention time by gender.Conclusions:The figures are indicative of misuse of the emergency service by a part of the adolescent patients, whether or not they are being followed up by the pediatrician. This may be a sign of the healthcare gap in which these patients are located

Adecuación del uso de los servicios médicos de urgencias por parte del paciente adolescente

Objetivo: Comparar la adecuación de las consultas a urgencias del paciente adolescente que está siendo atendido por el pediatra (12 a 14 años) y los que ya no lo están (15 a 18 años). Métodos: Estudio transversal con pacientes en edades entre 12 y 18 años que acudieron al Servicio de Urgencias del Hospital La Salud de Valencia durante el 2018. Los criterios de adecuación se basaron en el Protocolo de Adecuación de Urgencias Hospitalarias. Las variables de adecuación se describieron mediante frecuencias y como método de comparación se utilizó el test exacto de Fisher y la razón de momios. En todos los casos los contrastes de hipótesis fueron bilaterales, con un nivel de confianza de 95 % y la hipótesis nula (Ho) se rechazó con valor p<0,05. Resultados: Del total de episodios, el 64,9 % (n= 226) fueron adecuados al servicio de urgencias. Esta distribución fue similar dentro de cada uno de los grupos de edad y no se pudo establecer diferencia significativa entre ambos (p= 0,283). Se encontraron diferencias significativas en los criterios de intensidad diagnóstica y tiempo de atención por sexos. Conclusiones: Las cifras son indicativas del mal uso del servicio de urgencias por una parte del paciente adolescente, tanto si está siendo seguido por el pediatra como si no. Ello puede ser una señal del vacío asistencial en el que se encuentran estos pacientes. Objective: Compare the adequacy of emergency consultations of the adolescent patients being cared by the pediatricians (12 to 14 years) and those who are not (15 to 18 years). Method: Cross-sectional study with patients in the ages from 12 to 18 years who attended the Emergency Service of La Salud Hospital in Valencia during 2018. The adequacy criteria were based on the Adequacy Protocol of Hospital Emergencies. Adequacy variables were described by frequencies and Fisher's exact test and odds ratio were used as a comparison method. In all cases, the hypothesis contrasts were bilateral, with a confidence level of 95% and the null hypothesis (Ho) was rejected with p<0.05 value. Results: Of the total episodes, 64.9% (n= 226) were suitable for emergency services. This distribution was similar within each of the age groups and no significant difference could be made between the two (p= 0.283). Significant differences were found in the criteria of diagnostic intensity and attention time by gender. Conclusions: The figures are indicative of misuse of the emergency service by a part of the adolescent patients, whether or not they are being followed up by the pediatrician. This may be a sign of the healthcare gap in which these patients are located

Evaluación del manejo del inhalador presurizado de dosis media en el paciente pediátrico

Objetivo principal: Evaluar el manejo del inhalador presurizado de dosis mediaen el paciente pediátrico.Meto do log ía: Estu d io e xplo r ato rio transversal y evaluativo a través de un cuestionario con preguntas cerradas. Se creó un índice (Ic; escala de 0 a 1) para valorar el uso correcto de los inhaladores. Resultados principales: La puntuación media obtenida del uso correcto fue de Ic=0,64 (d.e. +/-0,176). Aunque e ste ín dice es superior en los casos en los que se declara haber recibido una explicación (Ic=0,65) con relación a los que indican que no (Ic=0,5 3) , n o se encontró significación estadística entre dicha diferencia (p=0,331). Asimismo, se apreció que cuando es el person al d e e n fe rme r ía e s quié n realiza la explicación el índice es mayor comparado con otros profesionales (Ic=0,7; p=0,23). Conclusión principal: No se encontró ningún n iñ o que no cometiera al menos un error. Observamos un índice de uso correcto más elevado cuando la explicación parte de enfermería. Objective: Evaluate the handling of the metered-dose inhaler in the pediatric patient. Methods: Exploratory, cross-sectional, and evaluative study through a questionnaire with closed-ended questions. An index (Ic; scalefrom 0 to 1) was created to evaluate the correct use of inhalers. Results: The mean score obtained from the correct use was Ic = 0.64 (+/-0.176). Although this index is higher in the cases in which it is declared to have received an explanation (Ic = 0.65) in relation to those that indicate that it does not (Ic = 0.53), no statistical significance was found between saiddifference (p = 0.331). Likewise, we observed that when it is the nursing staff who performs the explanation , the index is higher (Ic = 0.7; p = 0.23). Conclusions: All the children made at least one mistake. Weobserve a higher rate of correct use when the explanation comes from nursing

The social act of breastfeeding: sense and representation

Introduction Many variations exist in breastfeeding practices and their meanings. These depend on the historical and sociocultural context experienced by the mothers and the symbolic constructions present in each group, moment, or place. The positive or negative view will be defined by the meanings attributed to breastfeeding, that is, the perception of their health and that of their children, and the support received by the relatives, the professionals and health institutions. Methods The goal of this study is to describe the social representation of breastfeeding by a postpartum women group from the “Hospital La Salud” in Valencia, Spain, that has chosen exclusive breastfeeding. We have chosen a crosscutting and descriptive approach based on the qualitative methodology employing in-depth interviews, using semi-structured questionnaires. Findings The mothers who participated in this study consider the ability to breastfeed as a prerogative that they possess as women that affords values and symbols to their bodies, developing the idea of a (the) useful body. These connections may create a certain amount of dependence and responsibility on the mothers, in the case in which their bodies are valued less than their children’s and their personal needs become secondary. All women in this study think that a healthy body condition consists of adequate function and must meet the breastfeeding needs in terms of milk production, provides feelings of happiness and pleasure and be able to get back their baseline condition through physiological mechanisms. Imbalance and normalcy, for most of them, were associated with constant pain, milk scarcity, daily fatigue, a general feeling of discomfort, functional limitations and, any negative feeling they generally perceived. Nevertheless, other women argue that pain is useful; they see it as something positive and necessary for their recovery. This different assessment explains the importance of each idea and the power to redirect the different perceptions of breastfeeding towards the positive axis. On the other hand, mothers who lived a negative experience may feel disenchanted and, sometimes, guilty. This feeling of guilt is due to the challenging process of defining their gender identity, which imposes significant responsibility on women: providing the best nourishment for their children. The goal of being “a perfect mother” will become a woman’s sole ethical and moral focus, accepting praise and blames for her breastfeeding performance. A woman could become the author of her self-inflicted oppression, which could generate feelings of insecurity and self-sacrifice in front of a society which does not spare women from the feelings of guilt when they neglect nursing to meet and satisfy their own needs

Utilidad de los criterios clínicos para el adecuado diagnóstico de la faringoamigdalitis en la urgencia pediátrica

Background: There are two scales (Centor and McIsaac) that describe the frequent signs and symptoms in pharyngotonsillitis and determine the attitude to be followed for diagnosis and treatment; among them, the McIsaac criteria are one of the most widely used scales. The goal of the study was to determine the predictive value of the McIsaac criteria in the diagnosis of pharyngotonsillitis due to EbhGA in a Pediatric Emergency Service. The predictive value of these criteria is decisive in the adequate use of TDR test and antibiotics as a treatment. Methods: Cross-sectional study. The target population were all patients between 0 and 14 years old treated in the Pediatric Emergency Service of the Casa de Salud Hospital of Valencia during 2016, with discharge diagnoses, tonsillitis, pharyngotonsillitis or pharyngitis and with the TDR performed. Two groups were set up according to whether TDR was positive or negative. The presence of the McIsaac criteria was studied in both groups. A sensitivity and specificity study was carried out and the Total and Bayes Probability theorems were applied as well as the likelihood ratio measures. Results: A negative result of TDR was obtained in 58.1% (n=330) and was obtained a positive result in 41.9% (n=238). At least three criteria met 48.3% (n=115) with TDR+ of which the most frequent was age >3 years (97.4%); and 46.7% (n=154) of children with TDR- where the most frequent was the absence of catarrh (91.6%). The output from the predictive analysis of meeting the McIsaac criteria was a sensitivity (P(+/E)=48.3%), a specificity (P(-/NE)=53.3%), a positive predictive value P(E/+)=42.7% and likelihood ratios LR+=1.04 and LR-=0.97. Conclusions: The results indicate a poor predictive value of the McIsaac criteria in the population being studied. The TDR test should be implanted more frequently and the McIsaac criteria should be re-evaluated for the correct diagnosis of pharyngotonsillitis due to EbhGA and with it an adequate treatment to avoid the overprescription of antibiotics.Fundamentos: Existen dos escalas (Centor y McIsaac) que describen los signos y síntomas frecuentes en la faringoamigdalitis y que determinan la actitud a seguir para su diagnóstico y tratamiento; entre ellas, los criterios de McIsaac son una de las escalas más empleadas. El objetivo del estudio fue determinar el valor predictivo de los criterios de McIsaac en el diagnóstico de la faringoamigdalitis por estreptococo beta hemolítico grupo A (EbhGA). El valor predictivo de estos criterios es determinante en la adecuada utilización de la prueba TDR y tratamiento antibiótico. Métodos: Se realizó un estudio transversal cuya población objeto fueron pacientes entre 0 y 14 años atendidos en el Servicio de Urgencias Pediátricas del Hospital Casa de Salud de Valencia durante 2016, con diagnóstico de amigdalitis, faringoamigdalitis o faringitis y con las pruebas de detección rápida del antígeno estreptocócico (TDR) realizadas. Se estudió la presencia de los criterios de McIsaac en los grupos TDR positivo y negativo. Se midió la sensibilidad y especificidad, y se aplicaron los teoremas de Probabilidades Totales y de Bayes, así como medidas de razón de verosimilitud. Resultados: Se obtuvo un resultado negativo del TDR en el 58,1% (n=330) y positivo en el 41,9% (n=238). Cumplieron al menos 3 criterios un 48,3% (n=115) de los que presentaban TDR+, de los cuales el más frecuente fue la edad mayor de 3 años (97,4%); y los cumplieron un 46,7% (n=154) de los que tenían TDR-, donde el más frecuente fue la ausencia de catarro (91,6%). El análisis predictivo de los criterios de McIsaac arrojó una sensibilidad de P(+/E)=48,3%, una especificidad de P(-/NE)=53,3%, un valor predictivo positivo de P(E/+)=42,7% y unas razones de verosimilitud de IEP+=1,04 y de IEP-=0,97. Conclusiones: Los resultados indican un bajo valor predictivo de los criterios de McIsaac en la población de estudio. Debe implantarse de forma más asidua la prueba de TDR y reevaluar los criterios McIsaac para el correcto diagnóstico de la faringoamigdalitis por EbhGA y, con ello, facilitar un adecuado tratamiento para evitar la sobreprescripción de antibióticos