Puerta Del Research Articles

Validez y fiabilidad del índice de personalización de cuidados en una unidad médica hospitalaria

Objectives To determine the validity and reliability of the personalised nursing care index (PNCI). Methods A descriptive study was carried out in the Puerta del Mar Hospital (Cádiz) of the Andalusian Health Service, which included all patients admitted to an Internal Medicine ward from May 2007 to July 2008. A descriptive analysis was performed on the population included in the study. Furthermore, reliability was analysed with the 20-Kuder-Richardson coefficient and a correlation matrix between PNCI items; and validity via a maximum likelihood factorial analysis, and a ROC curve to determine sensitivity and specificity. Results A total of 219 people were included in the survey, of whom 74.4% were patients and 26.6% caregivers. The percentages of males and females were similar with a mean age of 62.5 years and 48.4% finished basic school education. The 20-Kuder-Richarson value was 0.835; and a positive correlation between items, which corresponded to 3 groups of items (factors). The maximum likelihood factorial analysis confirmed the 3 items-factor groups with a Promax rotation due to the high correlation between them. The maximum explained variance was 91.42%. The ROC curve area was 90.1% with a cut-off point of 8, for a sensitivity of 79.9% and a specificity of 90.6%. Conclusions The PCNI is reliable, with the internal consistency coefficient value in between an optimum range. Furthermore, factors obtained from the matrix correlation inter-items were confirmed with a factorial analysis, resulting in a high explained variance. The curve ROC area is excellent compared to the gold standard, considered as the perception of confidence relationship.

El ciclo de la Dormición en el claustro de la catedral de Pamplona

The portal called the « puerta Preciosa » (ca 1330), which leads from the cloister of the Cathedral of Pamplona to the dormitory, presents on its tympanum a large number of scenes that illustrate the events that occurred at the end of the life of the Virgin, before the Assumption. The Assumption itself is recounted on the tympanum of the portal that opens into the cathedral from the cloister (« puerta del Amparo », ca 1320). Two other portals in the cloister depict scenes of the Passion and Resurrection of Christ. This article discusses the particularities of the iconographic cycle of the Dormition and Glorification of the Virgin and its sources. Comparisons with contemporary cycles of the Dormition, as well as links between the portals in the cloister, point up parallelisms between the final moments in the lives of the Virgin and Christ.

Stratigraphy, geochronology, and geochemistry of the Laramide magmatic arc in north-central Sonora, Mexico

The Laramide magmatic arc in the Arizpe-Mazocahui quadrangle of north-central Sonora, Mexico, is composed of volcanic rocks assigned to the Tarahumara Formation and several granitic plutons that intrude it. The arc was built over juxtaposed crustal basements of the Caborca and Mazatzal provinces. A basal conglomerate of the >4-km-thick Tarahumara Formation overlies deformed Proterozoic igneous rocks and Neoproterozoic to Early Cretaceous strata, thus constraining the age of a contractional tectonic event that occurred between Cenomanian and early Campanian time. The lower part of the Tarahumara Formation is composed of rhyolitic ignimbrite and ash-fall tuffs, andesite flows, and interbedded volcaniclastic strata, and its upper part consists of rhyolitic to dacitic ignimbrites, ash-fall tuffs, and volcaniclastic rocks. The Tarahumara Formation shows marked lateral facies change within the study area, and further to the north it grades into the coeval fluvial and lacustrine Cabullona Group. The age of the Tarahumara Formation is between ca. 79 and 59 Ma; the monzonitic to granitic plutons have ages of ca. 71–50 Ma. The informally named El Babizo and Huépac granites, La Aurora and La Alamedita tonalities, and the Puerta del Sol granodiorite compose the El Jaralito batholith in the southern part of the area.

Evaluación de la calidad del procedimiento de biopsia selectiva de ganglio centinela en pacientes con cáncer de mama

The Sentinel Lymph Node Biopsy (SLNB) has been demonstrated to be a safe alternative to axillary lymph node dissection in breast cancer staging. The multidisciplinary team must do it with rigor and demonstrate that they have fulfilled some essential criteria. Objective To evaluate the quality of the procedure in the Breast Pathology Unit of Hospital Puerta del Mar, using the self-evaluation guidelines of the Spanish Society of Senology and Breast Pathology. Material and method These guidelines establish some objective and measurable evaluation criteria related to the aspects that intervene in the SLNB. Each criterion is associated to 4 levels of quality standards. There are 3 essential criteria of mandatory fulfillment to implement SLNB in the clinical practice. They evaluate care experience (6 criteria), operative aspects (18 criteria, 3 essential) and scientific activity (8 indicators). The initial validation phase included 50 patients and the application phase 120 patients (February 2009). Results Three essential criteria related to the detection of the sentinel node (98%), accredited sensitivity (90%), and mean number of axillary sentinel nodes (2.1) were fulfilled. The application of self-evaluation guidelines in our Unit obtained a global score of 39 out of 71 points, quality level II being the most prevalent. Conclusion During the validation phase, our unit fulfilled the criteria established to implement the procedure. Following that, the use of this guideline accredits the good practice of the SLNB procedure and makes it possible to identify the areas of improvement, in our case, those related to the scientific and training activities.

Evaluation of the quality of the sentinel lymph node biopsy procedure in patients with breast cancer

The Sentinel Lymph Node Biopsy (SLNB) has been demonstrated to be a safe alternative to axillary lymph node dissection in breast cancer staging. The multidisciplinary team must do it with rigor and demonstrate that they have fulfilled some essential criteria. Objective To evaluate the quality of the procedure in the Breast Pathology Unit of Hospital Puerta del Mar, using the self-evaluation guidelines of the Spanish Society of Senology and Breast Pathology. Material and method These guidelines establish some objective and measurable evaluation criteria related to the aspects that intervene in the SLNB. Each criterion is associated to 4 levels of quality standards. There are 3 essential criteria of mandatory fulfillment to implement SLNB in the clinical practice. They evaluate care experience (6 criteria), operative aspects (18 criteria, 3 essential) and scientific activity (8 indicators). The initial validation phase included 50 patients and the application phase 120 patients (February 2009). Results Three essential criteria related to the detection of the sentinel node (98%), accredited sensitivity (90%), and mean number of axillary sentinel nodes (2.1) were fulfilled. The application of self-evaluation guidelines in our Unit obtained a global score of 39 out of 71 points, quality level II being the most prevalent. Conclusion During the validation phase, our unit fulfilled the criteria established to implement the procedure. Following that, the use of this guideline accredits the good practice of the SLNB procedure and makes it possible to identify the areas of improvement, in our case, those related to the scientific and training activities.

Prevalencia de dolor neuropático en pacientes con cáncer sin relación con el tratamiento oncológico previo

Objectives To determine the prevalence of neuropathic and mixed pain in the population treated in the Oncology Service of the catchment area (Cadiz-San Fernando) of the Puerta del Mar University Hospital. Patients with cancer reporting pain and who had not received prior oncological treatment that could have caused the pain were included. We also aimed to determine the demographic, clinical and psychiatric comorbidities associated with the presence of neuropathic and mixed pain in these patients. Material and methods Design: Observational, cross-sectional study. Setting Catchment area of the Puerta del Mar University Hospital (Cadiz-S. Fernando), which attends a population of 242,723 people. Study subjects: Patients diagnosed with cancer who reported pain and who had not received prior oncological treatment that could potentially have caused the pain attended in the Outpatient Oncology Department of the Puerta del Mar University Hospital. Data collection: The following scales were used: the validated Spanish version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale for the diagnosis of neuropathic pain, the Hospital Anxiety and Depression Scale (HADS) and the Brief Pain Inventory Short Form (BPI-SF). A questionnaire was employed to collect sociodemographic and clinical variables. Analysis: The prevalence of neuropathic and mixed pain (± 95% CI) was calculated in the population attending the Outpatient Oncology Department of the Puerta del Mar University Hospital.

¿Es posible alcanzar en la práctica clínica los objetivos de control metabólico establecidos para pacientes con diabetes mellitus tipo 1

To evaluate the quality of healthcare in patients with type 1 diabetes attended in the Endocrinology and Clinical Nutrition Unit of the Hospital Puerta del Mar in Cadiz (Spain). : The database included in the computer application HP-Doctor used for all patients attended in our unit (admissions, consultations and peripheral centers) was analyzed. All patients with a principal or secondary diagnosis of type 1 diabetes were included. The quality indicators analyzed were selected from the main clinical practice guidelines for these patients. A large cohort of patients with type 1 diabetes (n=489) followed-up from 2005 to 2007 was analyzed. During the study period, the mean glycated hemoglobin level (HbA(1c)) decreased from 7.78% to 7.36%, the percentage of patients with HbA(1c) lower than 7% increased from 24.6% to 27.1% and the percentage patients with a mean HbA(1c) of more than 8% decreased from 42.6% to 38.7%. In 2007, only 35.5% of patients maintained low-density lipoprotein concentrations of less than 100 mg/dl. Despite the improvement obtained in metabolic control parameters, most of the patients with type 1 diabetes studied showed inadequate glycemic and lipid control.

New insect pupation chambers (Pupichnia) from the Upper Cretaceous of Patagonia, Argentina

Three new records of insect pupation chambers are reported from two localities in the Cretaceous Chubut Group of Patagonia, Argentina: from Sierra Nevada, a new and older ichnospecies of Rebuffoichnus, R. sciuttoi isp. nov. (Coprinisphaeridae), and the first Cretaceous and South American specimens of Pallichnus dakotensis Retallack (Pallichnidae), known until now from a single North American Oligocene locality; from Cañadón Puerta del Diablo, a new type of Rebuffoichnus casamiquelai Roselli that shows some differences from known material of the ichnospecies from the same locality, suggesting a different trace maker. Affinities of P. dakotensis, interpreted originally as a cast of a lined pupation chamber, remain unknown in the light of the new material. Its micromorphology is quite simple, with no constructed wall. R. sciuttoi has a very thinly constructed wall, showing an external texture composed of lobes and fine, helically arranged ridges. Such characters are compatible with those of wasp cocoons. R. casamiquelai, interpreted originally as a coleopteran pupation chamber, has a thickly constructed wall composed of two layers of soil material, showing redistribution of clay and orientation of long grains. Macro- and micromorphology of palaeosols indicate that in both localities pupation occurred in vitric entisols developed on pyroclastic ash-fall deposits on a fluvial floodplain. These new records double the number of the few Cretaceous insect pupation chambers. This is a critical period for understanding the origin and early evolution of building behaviour in insects. Three types of Cretaceous pupation chambers can now be recognized: (1) excavated and lined, e.g. Fictovichnus and Pallichnus (Pallichnidae); (2) constructed mostly with silk, resulting in thin-walled cocoons, e.g. R. sciuttoi (Coprinisphaeridae); (3) constructed mostly with soil material, resulting in thick-walled chambers, e.g., R. casamiquelai (Coprinisphaeridae). A new ethological category, Pupichnia, is proposed for grouping ichnotaxa representing pupation chambers, which, with Calichnia representing nests, comprises the two major types of insect trace fossils in palaeosols.

Tracheotomy in Children

To inspect and describe the results of tracheotomies carried out at our ENT Department and to assess changes in indications over the last few decades. Retrospective study of 13 patients, aged 3 months to 14 years, admitted by the ENT Department to the Paediatric ICU at Puerta del Mar University Hospital for elective tracheotomy over a 92-month period. The main indication is shared by obstructive respiratory insufficiency, post-surgery extubation failure and as a means of assisting ventilation in children requiring prolonged intubation. In the last 30 years the indications for paediatric tracheotomy have changed and the number of children needing intubation for more than 20-30 days has increased. It is no longer an emergency procedure to overcome a blockage in the upper airways but has instead become a technique for maintaining assisted ventilation for the medium to long term.

Costes económicos asociados a la diabetes tipo 1

The objective of our study was to determinate the health resource utilization and economic cost associated to diabetes in a patient group with type 1 diabetes. We designed a cross-sectional study that involved 71 type 1 diabetes patients (59.4% women) with 29.2 +/- 12.2 years old mean age and 10.5 +/- 7.9 years of diabetes evolution attended in Endocrinology Service of Puerta del Mar Hospital in Cádiz. Direct and indirect cost associated to diabetes during a year period were determinated by information obtained from patient medical history and hospital, emergency, primary care and medical inspection of social insurance databases. Type 1 diabetes patients presented a total cost associated to diabetes of 3.311 euros/patient/year (95% IC: 2.202-4.420 euros/patient/year). Direct cost (2.104 euros/patient/year; 95% IC: 1.825-2.383 euros/patient/year) was higher than indirect cost (1.250 euros/patient/year; 95% IC: 291-2.225 euros/patient/year). Multiple regression analysis showed an independent association between total cost associated to diabetes (dependent variable) and variables number of hospitalizations related to diabetes (p = 0.006), pensioner situation (p = 0.02) and micro and macrovascular complications (p = 0.001). We conclude that economic cost associated to type 1 diabetes is important and presents a notable and independent increase with hospitalizations related to diabetes, pensioner situation and micro and macrovascular complications.

Epidemiological study of the influence of family and socioeconomic status in disorders of eating behaviour.

To analyse the differences in family functioning and socioeconomic status between subjects with disorders of eating behaviour and the healthy population, considering the possible relationship of these factors with the psychic characteristics of patients, with consumption of various substances, and with sexual practices. Case-control study. 'Puerta del Mar' University Hospital (Andalusia, Spain). Conducted on a sample of 120 patients with AN and BN, and 240 controls with an identical distribution by age and sex. SCOFF, eating disorder inventory (EDI), Apgar family and socioeconomic questionnaires are utilised. Patients with disorders of eating behaviour present greater family dysfunctioning than controls; among cases, this difference is greater in the acute forms, but there are no differences between recent situations or crises due to previous episodes. Family dysfunction is associated with higher scores of multiple subscales of the EDI, which is corroborated on analysing each of the Apgar parameters independently. Family functioning is not associated with other variables such as breast-feeding or consumption of toxic substances. Socioeconomic status does not differentiate cases from controls, or acute situations from evolving ones, or new episodes from other crisis episodes, although differences may be found in the psychic manifestations according to social class. It is confirmed that family functioning has an influence in these types of disorder, in their evolution and in the psychic characteristics of the patients, without any evidence being found of a relationship between these disorders and socioeconomic status.

Care resource utilization and direct costs incurred by people with diabetes in a Spanish hospital

The objective of our study was to determine the hospital care resource utilization and direct medical costs incurred for in-patients with diabetes compared with non-diabetic in-patients. The data were obtained from the records division of the Puerta del Mar University Hospital, an 800-bed tertiary care hospital in Cádiz in the south of Spain. We assessed the rate of hospital admissions, length of stay, readmissions, mortality and costs for both diabetic and non-diabetic people. People with diabetes accounted for 10.9% of total hospital discharges (2453 discharges), 15.3% of total stays (30,771 days) and 16.1% of total cost (€7,417,688). We estimated a hospitalization rate of 135 per 1000 persons with diabetes (compared with 95 per 1000 non-diabetic persons). Diabetic patients were hospitalized, on average, for 4 days longer than non-diabetic patients (12.5±14.5 (±SD) vs 8.5±10.6 days; P<0.001) and had higher risks of readmission (RR: 2.29 (95% CI: 1.91–2.74)) and of mortality during the in-patient period (2.29 (1.91–2.74)) than non-diabetic patients. The overall hospitalization cost was significantly higher in diabetic (€3023±3463) than in non-diabetic patients (€1949±2528), 55% higher than the average general cost. We conclude that the hospital care resource utilization and economic burden due to diabetes mellitus in our hospital is substantial and disproportionate to the number of affected people.

Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado

To find the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training--family & community medicine (FCM) residents--and undergraduates who had passed their course in pneumology. Crossover, descriptive study. FCM teaching unit of the Puerta del Mar Hospital (Cadiz), the Cadiz Faculty of Medicine and seven primary care centres on the Bay of Cadiz. 31 practising primary care doctors, 25 third-year FCM residents and 31 medical students were evaluated. A thirteen-point questionnaire was used to evaluate the subjects theoretical knowledge of inhalation systems. The percentage of correct replies was used to establish reply levels. Their techniques of handling different systems of inhalation (pressurised cartridge, pressurised cartridge with spacing chamber, Turbuhaler and Accuhaler) were assessed according to the guidelines of the SEPAR (Spanish Society of Pneumology and Thoracic Surgery). 26% of the practising doctors and residents answered over 75% of the questionnaire correctly, with no significant differences between the two groups (p > 0.66). No undergraduate reached 75% of correct answers. After exclusion of asthmatic participants, three of the practising doctors (9.7%) and one of the residents (4.8%) performed the technique correctly with the four systems: there were no differences between the two groups (p > 0.87). No undergraduate performed them satisfactorily. Specific training for primary care doctors in handling inhalation therapy is recommended.

Neonatal Renal Vein Thrombosis: Report of a Case

Objective: To report a case of neonatal renal vein thrombosis diagnosed by duplex scan and treated successfully with intravenous heparin. Design: Case report. Setting: Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain. Interventions: Conservative treatment with short-term intravenous heparin. Conclusions: Colour Doppler imaging rapidly assesses flow within the renal veins and inferior vena cava, and should be used as the first line of investigation in evaluating venous thrombosis in the neonatal period. In view of the few reports in the literature assessing the different therapeutic modalities of this entity, we advocate short-term anticoagulation in unilateral renal vein thrombosis in the newborn.

Inferior Vena Cava Compression Caused by Ruptured Abdominal Aortic Aneurysms: Report of Two Cases

Objective: To report two cases of inferior vena cava (IVC) and iliac vein thrombosis secondary to expansive and ruptured abdominal aortic aneurysms. Design: Case report. Setting: Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain. Patients: Patients with clinical and radiological evidence of IVC and iliac vein thrombosis secondary to a sealed rupture from expanding aortic aneurysms. Interventions: Surgical repair in one case and conservative management in the second case. Conclusions: Venous compression was relieved, avoiding the risk associated with anticoagulant therapy in the presence of an aortic aneurysm. Ultrasound scanning is useful in assessing deep venous thrombosis and detecting compressive masses such as aortic and iliac aneurysms. Inappropriate management of patients with venous obstruction from undiagnosed arterial aneurysms may cause serious complications.

Barcelona: A Preview

The sun is getting higher in the sky as you wearily sip coffee in one of the cafes in the Puerta del Sol. You are in the centre of Spain, literally, as all distances in Spain are measured from here! You contemplate the day ahead of you in Madrid. A visit to the Prado gallery before lunch, a siesta

Increase in high resistance to penicillin of clinical isolates of Streptococcus pneumoniae in Cádiz, Spain.

The aim was to determine the increase and present standing of penicillin-resistant Streptococcus pneumoniae in Cádiz, Spain. We have studied retrospectively a total of 385 strains of S. pneumoniae obtained during the years 1991, 1993 and 1995. Strains tested were isolated from clinical samples of patients attended at the University Hospital Puerta del Mar of Cádiz, Spain. The resistance rate to penicillin was 71.2% (47.0% in 1991, 72.8% in 1993 and 89.3% in 1995). The percentage of strains with high resistance was 51.4%. The increase was from 29.4% in 1991 to 75.2% in 1995. The incidence of penicillin-resistant pneumococci was more marked in nasopharyngeal carrier children (75.8%) than in invasive strains (30.2%). The increase in high resistance to penicillin in clinical isolates of S. pneumoniae is very pronounced in Cádiz, Spain.

Estudio comparativo de una sección de neonatología a través de dos técnicas de agrupación de pacientes

In this study we make a measurement of the case-mix of the neonatology section in Hospital Puerta del mar in Cadiz during the year 1990, through two methods: Diagnosis Related Groups (GRDs), and Patient Management Categories (PMCs). We compare this case-mix with other hospitals. We compare this case mix with other hospitals. We also compare both methods between themselves through a multiple lineal regression. The results point out that the complexity of casuistry attended in Cadiz was lower to those attended in other control hospitals, and that these ones worked more efficiently. As for comparison of both technics, the GRDs demonstrated to have a superior capacity than the PMCs to discriminate the casuistry.

The Prehistory of the "Episodios Nacionales"

It is common knowledge that Gald6s solia desviar toda confesi6n personal y toda discusi6n te6rica acerca de su propia obra. Berkowitz, however, after pointing out that Gald6s as evasive as most authors concludes his discussion of Don Benito's creative process with the rather surprising statement that was in reality the process of a highly methodical person who planned far ahead.2 We have one specific example of Don Benito's throwing dust in the eyes of the curious investigator in the case of Gloria, the first volume of which he said occurred to him suddenly and completely as he walked in the Puerta del Sol and was written down in a mere two weeks! While I do not doubt that the plan of the first part of the novel in its final form came from a sudden moment of inspiration, the manuscript shows that Gald6s wrote two preliminary drafts of the first part of Gloria,3 the first one very long and differing greatly from the final text. We cannot help wondering if other statements about the lack of preparation and planning are not also designed to conceal the creative process and to shroud it with mystery.4

Notes on a Journey across Tsa-Rung

Mazarredo executed a large amount of cartographic work dealing with the interior of Spain, as well as with home and foreign seas; and he was the first person to accurately determine the position of the famous Puerta del Sol. He was also the author of a geographical treatise, and one on navigation, both designed for the instruction of naval cadets. The late Admiral de Paula Pavia relates that the idea of deducing the longitude of a ship at sea by means of astro-lunar distances measured with a sextant occurred to Mazarredo suddenly and independently, one clear night in 1772, while pacing the deck of the frigate Venus with his friend and comrade Laingara; and that they instantly busied themselves with putting the project to a practical test and with elaborating the necessary calculations. Other authorities, with less romance, but doubtless greater exactitude, only claim for Mazarredo that he was the first Spanish officer to apply the lunar distance method at sea, of which, before serving in the Venus, he had already heard some vague rumours. It would certainly have been remarkable if-at that date-he had not; for certain it is that he was a man of wide knowledge, reading, and experience, and that he rendered useful and distinguished services to the navy and to his country. We therefore cordially congratulate our sister Society in having made the Santa Rosalia's voyage better known to geographers at large. B. GLANVILL CORNEY.