Referencia asertiva y éxito terapéutico, estudio transversal en gestantes del hospital Belén de Trujillo

La elevada tasa de mortalidad materna está asociada a las altas tasas de referencia inoportuna, en este contexto, el sistema de referencia y contrarreferencia es fundamental para mejorar los índices sanitarios de nuestras gestantes. De modo, que evaluar la asertividad de la referencia es una piedra angular de la calidad de atención reflejando el impacto que hay en el éxito terapéutico en gestantes. Objetivo: Analizar la asociación de la referencia asertiva con el éxito terapéutico en las gestantes del Hospital Belén de Trujillo Métodos: Estudio observacional, transversal y analítico. Se llevó a cabo entrevistas físicas utilizando la encuesta SERVQUAL y se realizó revisión de historias clínicas. Resultados: De las 196 gestantes que ingresaron al servicio de alto riesgo reproductivo del Hospital Belén de Trujillo, el 23% tuvieron referencia asertiva, el 18,4% iniciaron tratamiento en la primera hora de su ingreso; el 15,3% presentó complicaciones, con una estancia hospitalaria promedio de 4.5 días, una gestante con referencia asertiva tiene 5,654 veces más posibilidad de tener satisfacción del usuario (OR 11.2735; IC 95% 1.520 – 21.027). Conclusiones: De cada 10 gestantes referidas al Hospital Belén de Trujillo, solo 3 tienen referencia asertiva, la referencia asertiva reduce las complicaciones y estancia hospitalaria e incrementa 11 veces la probabilidad de satisfacción de la atención percibida por el paciente.The high maternal mortality rate is associated with high rates of untimely referral, in this context, the referral and counter-referral system is essential to improve the health indices of our pregnant women. Thus, assessing the assertiveness of referral is a cornerstone of the quality of care reflecting the impact on the therapeutic success in pregnant women. Objective: To analyze the association of assertive referral with therapeutic success in pregnant women at Hospital Belén de Trujillo. Methods: Observational, cross-sectional and analytical study. Physical interviews were conducted using the SERVQUAL survey and medical records were reviewed. Results: Of the 196 pregnant women admitted to the high reproductive risk service of Hospital Belén de Trujillo, 23% had assertive referral, 18.4% initiated treatment within the first hour of admission; 15.3% presented complications, with an average hospital stay of 4.5 days, a pregnant woman with assertive referral is 5.654 times more likely to have user satisfaction (OR 11.2735; 95% CI 1.520 - 21.027). Conclusions: Of every 10 pregnant women referred to Hospital Belén de Trujillo, only 3 have assertive referral, assertive referral reduces complications and hospital stay and increases 11 times the probability of satisfaction with the care perceived by the patientTesi

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective