Evaluación de dos procedimientos quirúrgicos mediante metaanálisis y análisis de coste efectividad

Tesis doctoral inédita, leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: 25 de junio, 201

Análisis del proceso de asignación de causas de defunción en España

En este trabajo se estudia la calidad de la codificación de causas de defunción en España. Se concluye : 1. La codificación de causas de muerte ha mejorado progresivamente las últimas cuatro décadas en España. 2. El uso de códigos incorrectos (“mal definidos”, “poco específicos” e “inadecuados”) ha disminuido progresivamente las últimas décadas en España. 3. La mejoría de la calidad de la codificación se observa también para el subgrupo de las causas externas y para ambos sexos. 4. El análisis multianual de códigos (diagnósticos médicos y causas externas) permite detectar diferencias de calidad de codificación por regiones. 5. Mediante iniciativas como la formación en certificación de la defunción se podría continuar mejorando la calidad de la codificación.N

Enhanced recovery in colorectal surgery: a multicentre study

<p>Abstract</p> <p>Background</p> <p>Major colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program based on previously published protocols.</p> <p>Methods</p> <p>This prospective study, performed at 12 Spanish hospitals in 2008 and 2009, involved 300 patients. All patients underwent elective colorectal resection for cancer following an enhanced recovery program. The main elements of this program were: preoperative advice, no colon preparation, provision of carbohydrate-rich drinks one day prior and on the morning of surgery, goal directed fluid administration, body temperature control during surgery, avoiding drainages and nasogastric tubes, early mobilisation, and the taking of oral fluids in the early postoperative period. Perioperative morbidity and mortality data were collected and the length of hospital stay and protocol compliance recorded.</p> <p>Results</p> <p>The median age of the patients was 68 years. Fifty-two % of the patients were women. The distribution of patients by ASA class was: I 10%, II 50% and III 40%. Sixty-four % of interventions were laparoscopic; 15% required conversion to laparotomy. The majority of patients underwent sigmoidectomy or right hemicolectomy. The overall compliance to protocol was approximately 65%, but varied widely in its different components. The median length of postoperative hospital stay was 6 days. Some 3% of patients were readmitted to hospital after discharge; some 7% required repeat surgery during their initial hospitalisation or after readmission. The most common complications were surgical (24%), followed by septic (11%) or other medical complications (10%). Three patients (1%) died during follow-up. Some 31% of patients suffered symptoms that delayed their discharge, the most common being vomiting or nausea (12%), dyspnoea (7%) and fever (5%).</p> <p>Conclusion</p> <p>The following of this enhanced recovery program posed no risk to patients in terms of morbidity, mortality and shortened the length of their hospital stay. Overall compliance to protocol was 65%. The following of this program was of benefit to patients and reduces costs by shortening the length of hospital stay. The implantation of such programmes is therefore highly recommended.</p

Efficacy assessment of a training programme for physicians on death certification

XLI Reunión anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE). Porto (Portugal), del 5 al 8 de septiembre de 2023.Background/Objectives: Ensuring high-quality Cause of Death (CoD) statistics is fundamental to public health. Some educational initiatives have been implemented but limited research is available on the efficacy evaluation of medical courses for improving CoD certification. We aimed to assess the efficacy of a training program for physicians to improve the quality of causes of death certification in Spain. Methods: The workshop was addressed to in-training physicians (MIR Specialist training program) during 2012 and 2013 in the Spanish region of Murcia. This descriptive observational epidemiological study assessed the efficacy of medical certification of 18 face-to-face workshops by a pre/post-test, before and after the course, of three exercises of real CoD certificates given to 289 MIR during that period. We evaluated and scored (well/bad, adding up 1 point for each well done): writing, acronyms, and sequence as form indicators; placement of immediate, intermediate, and initial CoD, affixes, and omissions as concept indicators; and correct Basic Cause of Death (CABAS) as result indicators. We performed McNemar tests for all indicators (form, concept, and result). Results: We included 1,604 exercises with 17,637 items. All the items evaluated showed improvement after completing the course. Four indicators and three groups were incorrect ( 50%) at final exercises. After the course, the most notable improvements, greater than 35%, were immediate, intermediate and initial cause, causal sequence and described causes; and groups: causes, concept and causes with CABAS. In the initial test, 54% individual indicators were correct, while in the final examination, 81% were correct, with an improvement of 27% (p-value < 0.05). In 27 of the 30 comparisons (11 items for 3 exercises) there was a marked improvement after the course (p-values < 0.001). In the third exercise, immediate cause, acronyms and casual sequence, improvements were less emphatic or non-significant (p-value 0.001, 0.002, 0.278). Legible writing obtained less clear or non-significant improvements in all exercises (p-value 0.096, 0.027, 0.210). In the initial test, CABAS was correct in 67% of exercises, while in the final test was correct in 94% of exercises, with a 27% improvement (p < 0.05). Conclusions/Recommendations: The effectiveness of the training program for physicians on death certification was remarkable. Observed performance markedly improve after the educational intervention. Institutions involved should consider implementing training on death certification and should evaluate the positive impact on mortality quality statistics.N