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Aunque son muchos los indicadores de calidad (IC) definidos para establecer un sistema común, homogéneo y fiable de evaluación sobre la actividad en los servicios de urgencias, es escasa la información acerca de los IC relacionados con las emergencias atendidas en el ámbito extrahospitalario. El objetivo de este trabajo es identificar y analizar, a través de la literatura científica publicada, los IC específicos de dicha atención ante emergencias fuera del contexto hospitalario. Se realizó una revisión sistemática de la literatura según las recomendaciones PRISMA. Se exploraron 5 bases de datos y se elaboraron protocolos de búsqueda para localizar estudios que aportasen información sobre IC para evaluar la atención en emergencias extrahospitalarias, entre noviembre de 2017 y julio de 2018, tanto en inglés como en español. Se analizaron un total de 22 estudios y se identificaron un total de 333 IC en emergencias extrahospitalarias que fueron clasificados en clínicos y no clínicos, con sus subdominios correspondientes para cada grupo. El número de IC no clínicos identificados en la búsqueda fue superior, pudiendo concluir que son los más utilizados para evaluar la atención en las emergencias extrahospitalarias en la actualidad y dejando la puerta abierta para el diseño e implementación de nuevos IC capaces de evaluar la actividad fuera del contexto hospitalario. Although many health care quality indicators have been defined for establishing a common, homogeneous, and reliable system for assessing emergency department care, less information is available on the use of indicators of quality in attending emergencies outside the hospital. We aimed to identify and analyze quality indicators that have appeared in the literature on out-of-hospital emergencies. This systematic review of the literature followed the ations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We developed protocols for searching 5 databases to locate studies using quality indicators to evaluate care in out-of-hospital emergencies. Studies were published between July 2017 and July 2018 in either English or Spanish. We identified 22 studies naming 333 quality indicators in out-of-hospital emergencies. The indicators were classified as clinical or nonclinical; within each of these 2 sets, we also identified domains, or subcategories. As nonclinical quality identifiers were more numerous in the literature, it seems that they are the ones most often used to assess out-of-hospital emergency care at this time. This finding leaves the door open to designing and implementing new indicators able to measure quality of care in this clinical setting.

Delta(9) tetrahydrocannabinol (THC) through its action on cannabinoid type 1 receptor (CB(1)R) is known to activate dopamine (DA) neurotransmission. Functional evidence of a direct antagonistic interaction between CB(1)R and DA D(2) receptors (D(2)R) suggests that D(2)R may be an important target for the modulation of DA neurotransmission by THC. The current study evaluated in rodents the effects of chronic exposure to THC (1 mg/kg/day; 21 days) on D(2)R and D(3)R availabilities using the D(2)R prefering antagonist and the D(3)R preferring agonist radiotracers [(1)(8)F]fallypride and [(3)H] (+) PHNO respectively. At 24 h after the last THC dose D(2)R and D(3)R densities were significantly increased in midbrain. In caudate/putamen (CPu) THC exposure was associated with increased densities of D(2)R with no change in D(2)R mRNA expression whereas in nucleus accumbens (NAcc) both D(3)R binding and mRNA levels were upregulated. These receptor changes which were completely reversed in CPu but only partially reversed in NAcc and midbrain at 1 week after THC cessation correlated with an increased functionality of D(2)/(3)R in vivo based on findings of increased locomotor suppressive effect of a presynaptic dose and enhanced locomotor activation produced by a postsynaptic dose of quinpirole. Concomitantly the observations of a decreased gene expression of tyrosine hydroxylase in midbrain together with a blunted psychomotor response to amphetamine concurred to indicate a diminished presynaptic DA function following THC. These findings indicate that the early period following THC treatment cessation is associated with altered presynaptic D(2)/(3)R controlling DA synthesis and release in midbrain with the concurrent development of postsynaptic D(2)/(3)R supersensitivity in NAcc and CPu. Such D(2)/(3)R neuroadaptations may contribute to the reinforcing and habit forming properties of THC.

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