RESUMEN
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.
Asunto(s)
Servicio de Urgencia en Hospital/normas , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Humanos , MuestreoRESUMEN
We sought to compare the safety and efficacy of laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without lymphadenectomy and open surgery in women with endometrial cancer. A systematic review of the literature was undertaken. Bibliographic searches of the Health Technology Assessment, National Health Service Economic Evaluation, DARE, Cochrane Database of Systematic Reviews, MEDLINE, Embase, Pascal Biomed, and Cinahl databases were made. This study sought to include systematic reviews, health technology assessment reports, and randomized clinical trials comparing laparoscopic surgery (LS) with open surgery for the treatment of endometrial cancer. The quality of the included studies was assessed using a clinical trial checklist. The clinical studies finally included were 4 randomized clinical trials. The short-term results described show that LS offers advantages with respect to postoperative recovery, including reduced bleeding, a need for fewer days of intravenous fluid therapy, and a reduced need for pain killers. In addition, intraoperative and postoperative complications were fewer among those who underwent LS in all the studies consulted. The mean hospital stay of those who underwent LS was 3 to 4 days shorter, and they returned to normal activity sooner. The number of lymph glands resected was the same with both techniques. The LS was associated with a better quality of life after surgery. With respect to long-term results, no significant differences were found in relation to overall, disease-free or cause-specific survival, according to 1 study. The short-term results of LS are equivalent or better than those achieved with open surgery, whereas the long-term results obtained by both seems equivalent but more studies are needed assessing this outcome.