Medicina intensiva
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The utility of using quality indicators as a tool to measure the common practice and evaluate efficacy of measures established to improve quality has been demonstrated, making it possible to identify and make known the improvements carried out. The project "Quality indicators in the critical patient" has been conducted by the Spanish Society of Intensive and Critical Medicine (SEMICYUC) under the methodological management of the Foundation Avedis Donabedian (FAD) of Barcelona. Its objective was to develop key indicators in the care of the critical patient, considering the following as added values: reaching an agreement on the quality criteria in these patients and providing the professionals with a potent and reliable instrument for clinical evaluation and management, introducing common evaluation methods that make it possible to unify the measure, making a comparative evaluation (benchmarking), having information that makes it possible to develop quality plans (quantitative, objective, reliable and valid data) and having a system that assures total quality of care to the critical patient.
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Multicenter Study
[Evaluation of the reproducibility of the data collection for the APACHE II, APACHE III adapted for Spain and the SAPS II in nine intensive care units in Spain].
To assess reproducibility in data collection and its influence on the calculation of the severity scoring and mortality risk in APACHE II, APACHE III adapted for Spain and SAPS II. ⋯ In this study, APS was the most influential factor on the reproducibility of severity scores and risk of death prediction. Admission diagnosis assignment had no significant impact on the reproducibility of the predicted mortality risk.
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Multicenter Study
[Mortality and hospital stay adjusted for severity as indicators of effectiveness and efficiency of attention to intensive care unit patients].
To evaluate effectiveness and efficiency of ICU care using the APACHE III model customized for Spain. ⋯ The SMR was 0.9 (95% CI: 0.82-0.99), SRUPI was greater than 1 in 3 of 9 hospitals, According the SMR and SRUPI only one hospital was qualified as an outlier. CONCLUSIONS; In this study, no relationship was found between quality of care and use of resources. Moreover, this methodology may be a useful tool in order to detect deviations from the standard of care and use of resources, and in this way to lead to the analysis of different causes, the differences among hospitals being taken into account.
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Multicenter Study
[The effectiveness of training schemes in the treatment of acute coronary syndrome at health centers].
A preliminary evaluation of the impact of a training program on pre-hospitalization care of acute coronary syndrome (ACS). ⋯ A training scheme for general practitioners (GP) is essential to ensure appropriate care of patients with this condition.
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Hemodynamic monitoring is a key element in the care of the critical patients, providing an unquestionable aid in the attendance to diagnosis and the choice of the adequate treatment. Minimally invasive devices have been emerging over the past few years as an effective alternative to classic monitoring tools. The esophageal echoDoppler is among these. ⋯ Although several studies have demonstrated the usefulness of the esophageal Doppler in the surgical scene, there is scarce and dispersed evidence in the literature on its benefits in critical patients. Nevertheless, its advantages make it an attractive element to take into account within the diagnostic arsenal in the intensive care. The purpose of the following article is to describe how it works, its degree of validation with other monitoring methods and the role of esophageal echoDoppler as a minimally invasive monitoring tool for measuring cardiac output in the daily clinical practice, contributing with our own experience in the critical patient.