Browsing by Subject "Guidelines"

Now showing 1 - 4 of 4
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    Open Access
    Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans
    (Springer, 2024-07-26) Plasencia Martínez, Juana María; Otón González, Elena; Sánchez Canales, Marta; Ortiz Mayoral, Herminia; Cotillo Ramos, Estefanía; Casado‑Alarcón, Nuria Isabel; Ballesta Ruiz, Mónica; Villaverde González, Ramón; García Santos, José María; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
    Purpose: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach. Methods: Adult patients seen in our emergency department between 2017–2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited. Results: We recruited 702 patients, with median age 62 [47–76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89–94.5%), 27.5% (22.5–33.0%), 63.3% (59.2–67.2%), and 71.9% (62.7–80.0%), to diagnose RCRF, and 97.4% (93.4–99.1%), 21.3% (17.8–25.1%), 31.5% (27.7–35.4%), and 95.6% (90.1–98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6–100%); the negative likelihood ratio 0.08 (0.01–0.57), and sensitivity remained at 97.8% (82.2–99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF. Conclusions: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.
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    Publication
    Open Access
    Digital image analysis of the tissue surface areas of site-designated and bilaterally pooled prostate biopsies
    (Universidad de Murcia. Departamento de Biología Celular e Histología, 2018) Koivusalo, Laura; Kaipia, Antti; Kujala, Paula; Isola, Jorma; Tolonen, Teemu T.
    Initial reports about the length of bilaterally pooled biopsies showed alarming tissue loss compared to individual biopsies, but the current understanding of “noodle biopsies” and better embedding techniques may have improved their quality. Here, we implemented digital image analysis to study the differences in tissue surface areas between individual and pooled cores. Prostate biopsy reports from 1242 consecutive patients were reviewed. Urologist-dependent bias on the biopsy quality was eliminated by identifying four urologists who submitted equally individual and bilaterally pooled biopsies. Digital image analysis was applied to the tissue surface areas of 936 virtual slides containing 1440 biopsy cores (12 cores per patient x 120 patients) taken by the four urologists. The median (range) surface areas were 73.8 mm2 (40.1-102.5) for the site-designated (n=57) and 77.1 mm2 (49.5-119.2) for the bilaterally pooled biopsies (n=63) (p=0.19). For three urologists, the median surface areas were 69.5 mm2 (60.4-93.2), 75.5 mm2 (48.2-98.7) and 78.2 mm2 (47.1-92.7) for the site-designated and 79.2 mm2 (49.5-116.4), 69.3 mm2 (49.6-119.2) and 79.2 mm2 (55.1-96.7) for the pooled biopsies, respectively (p=0.58-0.75). For one urologist, the median surface area was marginally higher for the pooled biopsies, 68.1 mm2 (40.1-102.5) vs. 81.6 mm2 (62.7-108.8) (p=0.03). In conclusion, the histological yields of individual and pooled prostate biopsies were practically equal. The results should not be considered as a recommendation to increasingly submit unspecified bilateral cores but to encourage pathology laboratories to embed and cut all received prostate biopsies with special attention, regardless of submission type.
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    Open Access
    Europa y la violencia escolar
    (Universidad de Zaragoza, Asociación Universitaria de Formación del Profesorado (AUFOP), 2001) Etxeberria Balerdi, Félix
    Las instituciones europeas y los responsables educativos están manifestando en los últimos años una gran preocupación por el fenómeno de la violencia escolar, especialmente la violencia entre iguales. En este texto queremos hacer un análisis de la respuesta europea en materia de violencia escolar y mostrar las aportaciones que se han hecho en ese terreno a lo largo de los últimos años, así como ofrecer las grandes líneas por las que se rige la política comunitaria a la hora de enfrentarse al problema. Ofrecemos al lector el análisis de la corta pero rica experiencia europea y las conclusiones del examen de los principales textos, programas y encuentros que se han realizado hasta la fecha.
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    Open Access
    Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach
    (2021-05) Ruzafa Martinez, Maria; Ramos Morcillo, Antonio Jesús; Harillo Acevedo, Francisco David; Enfermería
    Background: Current literature provides poor information about the implementation of health-promoting clinical practice guidelines (CPGs) and their longitudinal monitoring. Purpose: The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs. Design: A mixed-methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach. Methods: The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre-implementation year (2011), 3 years of implementation (2012-2014), and 2 years of post-implementation (2015-2016). The sample was composed of mother-infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis. Findings: In the 6 years of monitoring, 7,842 mother-infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12-1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95-3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06-1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17). Conclusions: The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave-shaped dynamic. Clinical relevance: Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.