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Resumen Objetivo Valorar los cambios en la calidad percibida por los pacientes que precisaron atencion urgente hospitalaria antes y durante el periodo de alarma por la pandemia covid-19. Metodos Estudio observacional descriptivo retrospectivo usando Net Promoters Score (NPS), que clasifica a los pacientes como promotores o detractores. Se midieron 3 dimensiones de calidad percibida (accesibilidad, profesionales e informacion) en 160 pacientes dados de alta a domicilio antes del periodo de alarma y en otros 160 en los primeros 2 meses durante ella. Se comprobo, mediante aceptacion de lotes (LQAS), un estandar ≥90% promotores y ≤10% detractores, en diferentes vias de acceso y horarios. Los factores relacionados con la probabilidad de que un paciente fuera promotor o detractor se analizaron mediante regresion logistica. Resultados La puntuacion media fue menor en accesibilidad que en las otras dimensiones (8,6 vs. 9,1 y 9,0; p La probabilidad de que un paciente fuera promotor fue mayor durante la alarma (OR 1,85; p Conclusiones La calidad percibida durante el periodo de alarma ha mejorado, en la que su propia declaracion es el factor mas influyente. La mejora es patente en pacientes pediatricos y oftalmologicos, pero imperceptible en gestantes o traumatologia, quiza porque la pandemia ejercio como correctora de la adecuacion.

Resumen Objetivos Conocer la adecuacion en la prevencion de la enfermedad tromboembolica en ancianos ingresados en servicios medicos, asi como algunos factores asociados, como medicion necesaria para mejorar la calidad y la seguridad. Pacientes y metodos Estudio descriptivo retrospectivo en hospital de tercer nivel, que incluyo a ancianos que ingresaron en servicios medicos. Se realizo muestreo aleatorizado simple no proporcional estratificado por servicio. El riesgo se midio a traves de las escalas Padua e IMPROVE, ajustando segun numero de altas. Para evaluar la adecuacion por servicio se uso un plan secuencial de aceptacion de lotes (LQAS) con 3 niveles, bueno (estandar 95%, umbral 70%), aceptable (estandar 95%, umbral 50%) y no aceptable. Resultados Se evaluaron 72 casos de 8 servicios. El 51,4% de los pacientes presentaba alto riesgo de enfermedad tromboembolica (Padua ≥ 4) y el 23,6% de sangrado (IMPROVE ≥ 7). Ademas de la edad avanzada, las puntuaciones ajustadas se debieron especialmente a cancer (22%) y movilidad reducida (19%) para Padua y sexo masculino (13%) e insuficiencia renal (12%) para IMPROVE. La adecuacion global ajustada fue del 57,5% (IC 95%: ± 19,0%). La OR para conducta adecuada al no iniciar medicacion, 1,56 (IC 95%: 1,07-2,26). La adecuacion por servicio no es uniforme: todos los lotes fueron aceptados, en 3 con nivel «bueno» y en 5 con «aceptable». Conclusiones La adecuacion de profilaxis tromboembolica en nuestro hospital mantiene niveles aceptables, aunque no homogeneos. Existe una oportunidad de mejora que ha de aprovecharse. Los datos pueden ayudar a decidir las intervenciones, siendo LQAS util para optimizar el esfuerzo evaluativo.

To determine the suitability of the prevention of thromboembolic disease in elderly patients admitted to medical departments, as well as some associated factors, such as the measures required in order to improve quality and safety.A retrospective study in a tertiary level hospital that included elderly patients that were admitted to medical departments. A simple, non-proportional, randomised sample was used, stratified by department. The risk was measured using the Padua prediction model and the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) adjusting depending on the number of discharges. A Lot Quality Assurance Sampling (LQAS) plan was used with three levels, good, (standard 95%, threshold 70%), acceptable (standard 95%, threshold 50%), and not acceptable.A total of 72 cases from 8 departments were evaluated. Just over half (51.4%) of patients had a high risk of thromboembolic disease (Padua≥4), and 23.6% of bleeding (IMPROVE≥7). Besides the advanced age, the adjusted scores were particularly due to cancer (22%) and reduced mobility (19%) for Padua, and male gender (13%) and renal failure (12%) for IMPROVE. The adjusted overall suitability was 57.5% (95%CI: ±19.0%). The OR for suitable conduct on not starting medication, 1.56 (95%CI: 1.07-2.26). The suitability by department was not uniform: all the lots were acceptable, in 3 with level "good" and in 5 with "acceptable".The suitability of thromboembolic prophylaxis in the study hospital maintains acceptable levels, although not homogeneous. There is an opportunity for improvement that must be taken. The data obtained may help in deciding interventions, with LQAS being useful to optimise the evaluation effort.

Introduction Keratoacanthoma is a fast-growing crateriform skin tumor. Approximately 25% of such tumors undergo malignant transformation and develop areas of squamous cell carcinoma (SCC). The presence of laminin-322 has been associated with progression to invasive forms of SCC. The aim of this study was to determine whether or not immunohistochemical staining for laminin-322 would be of value in distinguishing between keratoacanthomas, keratoacanthomas with areas of squamous cell carcinoma, and SCCs. Material and methods Seventy-four lesions were selected from the pathology archives of our hospital and divided into 4 groups: 20 keratoacanthomas without SCC, 20 keratoacanthomas with areas of squamous cell carcinoma, 20 invasive SCCs (8 with crateriform morphology) unrelated to keratoacanthoma, and 14 problem lesions (keratoacanthomas with areas suggestive of SCC). All 74 lesions were stained for laminin-322. Results Laminin-322 staining was strongly positive both in areas of SCC in keratoacanthomas with malignant transformation and in invasive SCCs (mostly at the invasive front of the SCC). However, in benign keratoacanthomas, it was only weakly positive and furthermore it was confined to isolated cells or small groups of cells. The 14 problem lesions were reexamined after laminin-322 staining and 8 were diagnosed as keratoacanthomas with incipient SCC and 6 as keratoacanthomas without SCC. Conclusions Laminin-322 staining is different in keratoacanthomas and SCCs and would thus be a useful test for differentiating keratoacanthomas from both invasive SCCs and keratoacanthomas with areas of squamous cell carcinoma. It would also be of value in diagnosing keratoacanthomas with areas suggestive of SCC or with incipient SCC.

Resumen Introduccion El queratoacantoma (QA) es un tumor cutaneo crateriforme, de crecimiento rapido; aproximadamente el 25% de los QA presentan transformacion maligna (QAm), observandose areas de carcinoma epidermoide (CE). La laminina-332 se ha relacionado con progresion a fases invasoras en diversos CE. El objetivo de este estudio es evaluar si la tincion con laminina-332 es util para distinguir QA, QAm y CE. Material y metodos Seleccionamos 74 casos del archivo de Anatomia Patologica. Se analizaron 4 grupos: 20 QA sin CE, 20 QAm con areas evidentes de CE, 20 CE invasores sin relacion con QA (8 con morfologia crateriforme) y 14 casos «problema» (QA con «dudosas» areas de CE). Posteriormente se realizo tincion inmunohistoquimica para laminina-332 a todas estas lesiones. Resultados En las areas de CE asociado a QAm y en los CE invasores, la tincion con laminina fue positiva de forma intensa, habitualmente en el frente invasor del CE, a diferencia de los QA, en que la tincion fue positiva solo de forma debil y focal, en celulas aisladas o en pequenos «grupos» celulares. Los casos «problema» se reexaminaron tras valorar la tincion con laminina-332 (8 se diagnosticaron de QA con CE incipiente, 6 de QA sin CE). Conclusiones La tincion con laminina-332 es diferente en los QA respecto a los CE, por lo que ayudaria a diferenciar los QA de los CE invasores y de las areas de CE en QAm, asi como en el diagnostico de QA con «dudosas» areas de CE y QA con CE incipientes.

Keratoacanthoma is a fast-growing crateriform skin tumor. Approximately 25% of such tumors undergo malignant transformation and develop areas of squamous cell carcinoma (SCC). The presence of laminin-322 has been associated with progression to invasive forms of SCC. The aim of this study was to determine whether or not immunohistochemical staining for laminin-322 would be of value in distinguishing between keratoacanthomas, keratoacanthomas with areas of squamous cell carcinoma, and SCCs.Seventy-four lesions were selected from the pathology archives of our hospital and divided into 4 groups: 20 keratoacanthomas without SCC, 20 keratoacanthomas with areas of squamous cell carcinoma, 20 invasive SCCs (8 with crateriform morphology) unrelated to keratoacanthoma, and 14 problem lesions (keratoacanthomas with areas suggestive of SCC). All 74 lesions were stained for laminin-322.Laminin-322 staining was strongly positive both in areas of SCC in keratoacanthomas with malignant transformation and in invasive SCCs (mostly at the invasive front of the SCC). However, in benign keratoacanthomas, it was only weakly positive and furthermore it was confined to isolated cells or small groups of cells. The 14 problem lesions were reexamined after laminin-322 staining and 8 were diagnosed as keratoacanthomas with incipient SCC and 6 as keratoacanthomas without SCC.Laminin-322 staining is different in keratoacanthomas and SCCs and would thus be a useful test for differentiating keratoacanthomas from both invasive SCCs and keratoacanthomas with areas of squamous cell carcinoma. It would also be of value in diagnosing keratoacanthomas with areas suggestive of SCC or with incipient SCC.