{"id":130163,"date":"1996-01-01T00:00:00","date_gmt":"1996-01-01T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/el-papel-de-la-necropsia-en-la-valoracion-de-la-calidad-asistencial-en-oncologia\/"},"modified":"1996-01-01T00:00:00","modified_gmt":"1996-01-01T00:00:00","slug":"el-papel-de-la-necropsia-en-la-valoracion-de-la-calidad-asistencial-en-oncologia","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/el-papel-de-la-necropsia-en-la-valoracion-de-la-calidad-asistencial-en-oncologia\/","title":{"rendered":"El papel de la necropsia en la valoracion de la calidad asistencial en oncolog\u00eda."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Isabel Busquier Hernandez <\/strong><\/h2>\n<p>La necropsia podria utilizarse dentro de un sistema de control de calidad asistencial ya que, a pesar del avance de las tecnicas diagnosticas y en contra de su supuesta perdida de valor en la medicina actual, ofrece discrepancias clinico-patologicas de importancia por su impacto en la supervivencia. Son evaluables 311 necropsias de los pacientes fallecidos bajo la responsabilidad medica del servicio de hematolog\u00eda y oncolog\u00eda medica del hospital clinico universitario de Valencia, entre 1988 y 1991. Se consideran hasta un maximo de tres causas de muerte, entre las que destacan las infecciosas (161 neumonias, 76 sepsis) y la progresion tumoral. Con un porcentaje de necropsias del 71.5% se obtienen discrepancias clinico-patologicas con impacto en la supervivencia en un 37%, clase 1 en 8.4% y clase 2 en 28.6% (segun la clasificacion de goldman modificada por anderson (ref 31). Veintitres de las 26 clase 1 estan relacionadas con procesos infecciosos. La autopsia tiene un escaso rendimiento en relacion con el diagnostico histologico del tumor, con una sensibilidad del 98% y discrepancias clase 1 y 2 en 2.6%. En global los indices de exactitud de la causa de muerte considerando el proceso diagnostico en su conjunto muestran malos resultados con una sensibilidad menor del 80% en su mayoria. Destaca el embolismo pulmonar con una sensibilidad (s) del 11%, la neumonia con s del 39% y las micosis con s del 5% (1 verdadero positivo\/20 diagnosticos autopsicos). Entre los diversos factores clinicos estudiados, en el analisis univariante solo la edad (riesgo relativo (rr) de 2.9), el diagnostico de leucemia (rr=2.7), shock septico (rr=2.7) y neutropenia &lt;1000\/mm3 en el momento de la muerte (rr=3.1) se relacionan significativamente con el hallazgo de discrepancias clase 1. En el analisis multivariante de regresion logistica tan solo la edad y la neutropenia son factores de prediccion de un diagnostico discrepante clase 1.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>El papel de la necropsia en la valoracion de la calidad asistencial en oncolog\u00eda.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 El papel de la necropsia en la valoracion de la calidad asistencial en oncolog\u00eda. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Isabel Busquier Hernandez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Universitat de val\u00e9ncia (estudi general)<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 01\/01\/1996<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Andres Cervantes Ruiperez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal:  Garc\u00eda Conde Bru Javier <\/li>\n<li>Jaime Merino Sanchez (vocal)<\/li>\n<li>Avelino Senra Varela (vocal)<\/li>\n<li>Francisco Javier Vera Sempere (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Isabel Busquier Hernandez La necropsia podria utilizarse dentro de un sistema de control de calidad asistencial ya [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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