Actividad de la consulta de enfermería en un Servicio de Reumatología

Objetivo: Valorar la actividad de la consulta de enfermería en el Servi- cio de Reumatología y Metabolismo Óseo del Hospital General Univer- sitario de Valencia. Métodos: Estudio retrospectivo en el que se mide la actividad de la consulta de enfermería durante el año 2016 y se comparan los resul- tados obtenidos con los del año anterior y con los presentados en un estudio a nivel nacional en el que se evaluaron todas las actividades de enfermería detalladas por el Grupo de Trabajo de Enfermería de la Sociedad Española de Reumatología (GT ESER). Resultados: Se analizan las actividades realizadas en la consulta de enfermería, diferenciándolas según los códigos asistenciales en los que se definen. Se observan un total de 509 (25,8%) actividades incluidas en la agenda ME47: Intervenciones de Enfermería, 654 (41%) en la agenda ME48: Consulta Telefónica y 809 (33,2%) en la agenda ME49: Consulta presencial, educación y valoración. En comparación con el año 2015 se observó un incremento significativo en todas las agendas, y según los datos del estudio analizado, las actividades coinciden con las que se llevan a cabo por un mayor número de profesionales a nivel nacional. Conclusiones: Las actividades realizadas por los profesionales de enfer- mería cobran mayor importancia con el paso de los años, aumentando tanto la cantidad como la calidad de éstas. Además, la consulta del Hospital General Universitario de Valencia cumple con todos los están- dares de calidad publicados por la Sociedad Española de Reumatología

Presentación de dos casos de granuloma eosinófilo

La histiocitosis de Langerhans o histiocitosis X es una enfermedad proliferativa benigna que afecta a las células dendríticas presentando un amplio espectro clínico, desde el granuloma eosinófilo óseo aislado, que es su manifestación más frecuente, hasta la afectación multisistémica con fallo orgánico que puede ser resistente a la quimioterapia. Por ello el pronóstico es variable y depende del número de órganos afectados y de su alteración funciona

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally