[A high-resolution gastroenterology clinic in Andalusia: what is it, and how should it work]. / Consulta de alta resolución de digestivo en Andalucía: qué es y cómo debe funcionar?

INTRODUCTION: The present concept in our healthcare system is that medical care should be given on an outpatient basis with hospitalization occurring only when essential. We therefore put forth the development of the "all in one" outpatient office or "high resolution" outpatient clinic. For such purpose we administered a questionnaire to various Andalusian hospitals to define and determine those aspects necessary in the development of the aforementioned outpatient office. MATERIALS AND METHODS: The questionnaire was filled out by 10 Andalusian hospitals. This is a prospective-descriptive study of responses from all 10 participating hospitals. The 27 questions inquired on the existence of such an outpatient office and the infrastructure needed to develop this service: How many patients are seen, where is it physically located, where do patients come from, criteria for assigning patients to this medical office, condition of incoming patients, whether ultrasound scans are performed, whether an integrated hospital computer system exists, nursing staff, how many visits are required before coming to a diagnosis, and finally whether this type of outpatient office is needed, and if so, why. RESULTS: Of all 10 hospitals, 5 of them had this type of clinic. All of them considered this type of outpatient service essential. The number of patients treated should be "10", in the hospital itself. There are differences as to whether patients should come from the emergency room or a primary care physician. It seems logical to assume that only patients who can be diagnosed via ultrasounds or endoscopy should be chosen. To allow an ultrasonogram the patient should visit the outpatient office in a state of "fasting" and with standard blood counts from the primary care physician. The outpatient clinic should have a computer system and its own nurse. According to participating hospitals this type of outpatient visits is very useful in our present healthcare system, as it allows higher levels of collaboration between Primary Care and the specialist; it also provides a rapid orientation regarding patient pathology, and acts as a "filter" for the rest of the healthcare system. CONCLUSIONS: The outpatient office should be tended to by an attending specialist in the field (FEA) with knowledge and experience in ultrasounds and gastrointestinal endoscopy, as well as user competency with the required computer programs. In our present-day system this can be considered a modality of high-resolution outpatient services and a model of efficiency.

[Autotransfusion after orthopedic surgery. Analysis of quality, safety and efficacy of salvaged shed blood]. / Autotransfusión postoperatoria en cirugía ortopédica. Un análisis de la calidad, seguridad y eficacia de la sangre recuperada de los drenajes postoperatorios.

A series of immunosuppressant mechanisms can manifest during surgical procedures, mediated by immune system cells or by humoral factors, to which the immunosuppressant effects of anesthesia or blood transfusion may be added, possibly further prejudicing the patient's immunological status, having important clinical repercussions such as increased incidence of postoperative infection or tumor reappearance. Autotransfusion of various types is an effective alternative to homologous transfusion as the former avoids immunodepressant effects. Preoperative autotransfusion [preoperative donation of autologous blood (PTAB)] has been shown to be one of the safest and most effective techniques and is the gold standard for autotransfusion. Problems of over collection, anemia and over transfusion that sometimes occur with PTAB can be solved with better screening procedures. Intraoperative autotransfusion (IAT) and postoperative autotransfusion (PAT) avoid such problems completely. However, IAT is only cost-effective in certain procedures (bleeding > 1,000-1,500 mL) and is not applicable in others, such as knee arthroplasty. PAT, on the other hand, in addition to being a good complement to other autotransfusion methods, may be the technique of choice in some procedures, such as knee arthroplasty, particularly if PTAB is contraindicated or if it is logistically difficult for a hospital to provide.However, in spite of its demonstrated efficacy, PAT of filtered blood has many critics, who warn of possible side effects and recommend the use of washed blood, which would make the procedure enormously more expensive unless it is performed with the same equipment used for IAT. Therefore, this review will analyze the hematologic characteristics of filtered blood, including metabolic status and survival of red blood cells, the components of the hemostatic system and inflammatory mediators, the content of fat particles and the possibility of their clearance, the incidence of infections and the dissemination of tumor cells. This analysis can reach the conclusion that salvaged filtered blood is a source of red blood cells of sufficient quality to be safely reinfused and that their reinfusion contributes significantly to reduce the need for homologous blood.