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PURPOSE: This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. DESIGN/METHODOLOGY/APPROACH: Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. FINDINGS: It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. ORIGINALITY/VALUE: The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.

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PURPOSE: The aim of this study was to determine the information needs of primary care physicians in Spain and to describe their information-seeking patterns. METHODS: This observational study took place in primary care practices located in Madrid, Spain. Participants were a random stratified sample of 112 primary care physicians. Physicians' consultations were video recorded for 4 hours. Clinical questions arising during the patient visit and the sources of information used within the consultation to answer questions were identified. Physicians with unanswered questions were followed up by telephone 2 weeks later to determine whether their questions had since been answered and the sources of information used. Clinical questions were classified by topic and type of information. RESULTS: A total of 3,511 patient consultations (mean length, 7.8 minutes) were recorded, leading to 635 clinical questions (0.18 questions per consultation). The most frequent questions were related to diagnosis (53%) and treatment (26%). The most frequent generic type of questions was "What is the cause of symptom x?" (20.5%). Physicians searched for answers to 22.8% of the questions (9.6% during consultations). The time taken and the success rate in finding an answer during a consultation and afterward were 2 minutes (100%) and 32 minutes (75%), respectively. CONCLUSIONS: Primary care physicians working in settings where consultations are of short duration have time to answer only 1 in 5 of their questions. Better methods are needed to provide answers to questions that arise in office practice in settings where average consultation time is less than 10 minutes.

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OBJECTIVES: To determine the information needs of primary care physicians by identifying the frequency and type of questions arising during consultation, and by describing the information-search pattern. DESIGN. Observational, descriptive, multi-centre study. SETTING: Primary care practices in Madrid, Spain. PARTICIPANTS: Random sample, proportionally stratified by area (urban/rural) and specialty (general practitioner/paediatrician), of 208 primary care physicians out of a total of 1182 physicians; 112 agreed to take part. INTERVENTIONS: Physicians consultations were video-recorded for four hours. Between patients, they were asked to pose all the clinical questions arising during the patient visit and the sources of information used to answer them. Unresolved questions were followed up by phone 2 weeks later to check if answers had been found and what sources of information had been used. Clinical questions were classified by topic and type. MAIN MEASUREMENTS: Number of questions posed and their answers; topic and type of information; information resources used. RESULTS: A total of 3511 patient consultations, leading to 635 clinical questions, were recorded. The most frequent questions were on pharmacology (10%) for general practitioners, and infectious disease (19%) for paediatricians. The most frequent type of question was on the cause/interpretation of a clinical finding (44% for general practitioners and 48% for paediatricians). Answers to 39% of the questions were not sought. A 86% of the answers sought were solved, mainly using the drug compendium (35%) or a text-book (18%). CONCLUSIONS: Primary care physicians tried to resolve less than two-thirds of the questions asked, and mainly did so through readily available printed material. Better methods are needed to provide answers to questions that arise in clinical practice.

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Se ofrece a los profesionales sanitarios una revisión acerca de la vacunación en el inmigrante adulto que puede servir como herramienta en la consulta. En líneas generales, el inmigrante adulto debe recibir las dosis vacunales que aseguren un estado vacunal similar al de la población autóctona. Se recomienda la triple vírica, la vacuna de la polio inactivada, y la vacuna de difteria y tétanos en su formulación de adultos. Otras vacunas como la gripe, neumococo, meningococo y Haemophilus influenzae tipo b (Hib) se emplearán siguiendo las recomendaciones empleadas con la población autóctona. La gestión correcta de las cartillas de vacunación es de especial importancia en la población inm

The present article provides health professionals with a review on vaccination in adult immigrants, which could be useful in daily clinical practice. In general, adult immigrants should receive the same vaccination doses as the native population. The mumps, measles, and rubella (MMR) vaccine, the inactivated polio vaccine, and the adult tetanus diphtheria toxoid (Td) vaccine are recommended. Other vaccines such as the influenza, pneumococcal, and Haemophilus influenzae type b (Hib) vaccines should be used following the recommendations for the native population. Correct management of the immunization card is especially important in the immigrant population

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Objetivo. Determinar las necesidades de información de los médicos de atención primaria mediante la descripción de la frecuencia y tipo de preguntas clínicas, así como el patrón de búsqueda. Diseño. Estudio observacional, descriptivo, multicéntrico. Emplazamiento. Consultas de atención primaria. Áreas de Salud 1, 3, 8, 9 y 10 de Madrid. Participantes. Muestra aleatoria estratificada por zona (urbana/rural) y especialidad (médico de familia/pediatra) de 208 médicos de atención primaria de una población de 1.182, de los que finalmente aceptaron participar 112. Intervenciones. Se grabó mediante cámara de vídeo a los médicos durante 4 h de consulta. Especificaron entre paciente y paciente las preguntas que les surgían y las fuentes de información utilizadas para resolverlas. Las preguntas sin resolver fueron seguidas mediante contacto telefónico 2 semanas después para valorar si se habían obtenido respuestas y las fuentes utilizadas. Las preguntas se clasificaron por tema y tipo. Mediciones principales. Número de preguntas clínicas y respuestas; tema y tipo de información; recursos de información utilizados. Resultados. Se grabó a 3.511 pacientes que generaron 635 preguntas. El tema más frecuente fue la farmacología (10%) entre los médicos de familia y las enfermedades infecciosas (19%) entre los pediatras. El tipo más frecuente fue la causa/interpretación de un hallazgo clínico (el 44% en medicina de familia y el 48% en pediatría). El 39% de las dudas no se buscaron. De las buscadas, se resolvió el 86%, a través del vademécum (35%) y libros de texto (18%). Conclusiones. De las preguntas generadas, menos de dos tercios se intentaron resolver, sobre todo mediante material impreso de fácil acceso. Se necesitan métodos capaces de dar respuesta a las necesidades de información que surgen en la consulta de atención primaria

Objectives. To determine the information needs of primary care physicians by identifying the frequency and type of questions arising during consultation, and by describing the information-search pattern. Design. Observational, descriptive, multi-centre study. Setting. Primary care practices in Madrid, Spain. Participants. Random sample, proportionally stratified by area (urban/rural) and specialty (general practitioner/paediatrician), of 208 primary care physicians out of a total of 1182 physicians; 112 agreed to take part. Interventions. Physicians consultations were video-recorded for four hours. Between patients, they were asked to pose all the clinical questions arising during the patient visit and the sources of information used to answer them. Unresolved questions were followed up by phone 2 weeks later to check if answers had been found and what sources of information had been used. Clinical questions were classified by topic and type. Main measurements. Number of questions posed and their answers; topic and type of information; information resources used. Results. A total of 3511 patient consultations, leading to 635 clinical questions, were recorded. The most frequent questions were on pharmacology (10%) for general practitioners, and infectious disease (19%) for paediatricians. The most frequent type of question was on the cause/interpretation of a clinical finding (44% for general practitioners and 48% for paediatricians). Answers to 39% of the questions were not sought. A 86% of the answers sought were solved, mainly using the drug compendium (35%) or a text-book (18%). Conclusions. Primary care physicians tried to resolve less than two-thirds of the questions asked, and mainly did so through readily available printed material. Better methods are needed to provide answers to questions that arise in clinical practice

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