[Urological attendance in the Integral Health Center "Alto Palancia": model of primary-specialized integration and unique consultation]. / La asistencia urológica en el Centro Sanitario Integral "Alto Palancia": modelo de integración primaria-especializada y consulta única.

INTRODUCTION AND OBJECTIVE: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation. MATERIAL AND METHODS: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution. RESULTS: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishment smaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated. CONCLUSION: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization.

La asistencia urológica en el Centro Sanitario Integral “Alto Palancia”: modelo de integración Primaria-Especializada y Consulta Única / Urological attendance in integral center Sanitari

Introducción y objetivos: El progresivo incremento en la demanda de asistencia urológica exige establecer nuevos modelos asistenciales que eviten la saturación de consultas y mejoren la calidad en la atención al usuario. El objetivo de este trabajo es analizar la mejora de la actividad asistencial desarrollada en el Centro Sanitario Integral “Alto Palancia”, tras la instauración de nuevos modelos asistenciales basados en la integración entre Atención Primaria y Especializada y la puesta en práctica de la denominada Consulta Única. Material y métodos: Analizamos las características del Centro, funciones y actividad de la especialidad desarrollada durante el año 2002. Describimos la aplicación del modelo de Consulta Única y los elementos de integración con Atención Primaria. Analizamos la mejora de la actividad a través de indicadores, que comparamos con años precedentes. Para determinar el grado de satisfacción de los usuarios realizamos una encuesta de opinión de pacientes y/o familiares atendidos en el Centro bajo los nuevos modelos asistenciales. Finalmente analizamos las ventajas que el proceso aplicado presenta para el paciente y para la propia institución sanitaria. Resultados: El 42% de pacientes han sido atendidos mediante el modelo de Consulta Única, siendo la patología predominante la HBP en el varón y las ITUs en la mujer. El tiempo de demora para primera visita se ha reducido desde 49 días en diciembre 2001 a solo 3 en diciembre 2002. Solo el 7,7% de pacientes dados de alta para seguimiento por Atención Primaria han sido remitidos de nuevo al especialista. El tiempo que el urólogo dedica a consultas se ha reducido en un 29%, siendo este tiempo dedicado a la realización cirugía menor y exploraciones complementarias (ecografias, estudios urodinámicos, etc.). La encuesta de opinión ha puesto de manifiesto una satisfacción del usuario muy elevada. Conclusiones: El modelo de Atención Integral Primaria-Especializada y la puesta en práctica de la Consulta Única son aplicables ala especialidad de Urología, incrementando la calidad percibida por el usuario y con evidentes ventajas para la Organización Sanitaria (AU)

Introduction and objective: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation. Material and methods: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution. Results: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishmentsmaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated. Conclusion: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization (AU)

[Adrenal myelolipoma. Report of a case and review of the literature]. / Mielolipoma suprarrenal. Aportación de un caso y revisión de la literatura.

OBJECTIVES: Herein we describe an additional case of myelolipoma of the adrenal gland, an uncommon tumor of the adrenal cortex, that had been incidentally discovered during abdominal US evaluation of the biliary tree. The clinical features, diagnosis and treatment of the condition are discussed. METHODS: Surgical treatment of the biliary tree and myelolipoma was performed through a Chevron transversal incision during the same surgical session. RESULTS: Surgery achieved good results and the postoperative course was unremarkable. CONCLUSIONS: Myelolipoma is a benign nonfunctioning tumor of the adrenal cortex comprised of adipose and hematopoietic tissue. It is usually asymptomatic and incidentally discovered during diagnostic evaluation for other pathologies. The diagnosis is made by US, CT and MRI. There is no agreement on whether surgical treatment is warranted.

[Antibiotic prevention in gastroduodenal surgery]. / Profilaxis antibiótica en cirugía gastroduodenal.

The authors present a prospective randomized double-blind clinical trial, including 179 patients submitted to elective gastrointestinal surgery, for the purpose of evaluating three philosophic conceps of antibiotic prophylaxis (PA): systematic antibiotic prophylaxis for 48 h with sodium cefuroxim, 1.5 g the first dose and subsequent doses of 750 mg iv; selective antibiotic prophylaxis based on determination of preoperative gastric pH (pH less than 4, no antibiotic prophylaxis, and pH greater than 4, prophylaxis as in group I); and antibiotic therapy beginning postoperatively with cefuroxim 750 mg every 78 h for 4 days. The postoperative infection rate was 2% in the systematic prophylaxis group, 4% in the selective prophylaxis group, 24% in the antibiotic therapy group and 17.2% in the control group (p less than 0.001). The postoperative infection rate between the systematic and elective prophylaxis groups was statistically similar (p = NS). In conclusion, selective antibiotic prophylaxis has an incidence of postoperative infection similar to that of systematic prophylaxis, and, oriented by gastric pH determination, can be indicated only in patients with bacterogastria. Finally, we confirm that antibiotic therapy of postoperative onset should be eliminated as a method of prevention of postoperative infection.