Multidisciplinary virtual management of pulmonary nodules.

INTRODUCTION AND OBJECTIVES: Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. MATERIALS AND METHODS: Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. RESULTS: A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). CONCLUSIONS: During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.

[The vaccination coverage in a cohort of children at 2 years of age from a health area]. / Estudio de la cobertura vacunal en una cohorte de niños de una área de salud al cumplir los dos años.

OBJECTIVES: To estimate the vaccination coverage of two-years-old children in the health district of Gijón (Spain), the number of incomplete vaccinations and their causes. To evaluate the vaccination registry coverage. DESIGN: Descriptive cross-sectional survey. SITE. Primary health care. PATIENTS: From the cohort born in 1989, living in the health district, a sample of 219 children was taken. Of these, criteria for inclusion in the study were met by 199 (90.8%), and the vaccination status was ascertained in 191 (87.2%). MAIN MEASUREMENTS AND RESULTS: The variables related with the vaccination coverage were studied through registrations or specific questionnaires. The full vaccination coverage with 3 doses of DTP, 1 dose of DT, 4 doses of VPO and one dose of MMR in the district was 92.5%. Estimating vaccination coverage using only our public registration systems, would lower it to 84.9. This result suggest that the public sector vaccination registry in Gijón under-registers immunizations. Vaccination coverage was 99.5% for first dose (3 months: DTP and VPO) and 93.5% for last doses (18 months: DT and VPO). For MMR it was 94.5%. CONCLUSIONS: Our data suggests there is a high vaccination coverage in the Gijón area. We consider population's questionnaires a satisfactory way to estimate vaccination coverage, and besides to evaluate the validity of the usual registers to use them as information resource.

[Prevalence of protozoans in children with acute diarrheal disease]. / Prevalencia de protozoos en ninos con enfermedad diarreica aguda.

PIP: A cross-sectional study was conducted in June-September 1991 in the oral rehydration unit of a children's hospital in Santo Domingo to determine the prevalence of enteric protozoa as a cause of diarrhea. The 100 randomly selected children were aged 3-35 months and had light to moderate dehydration and diarrhea of less than 15 days' duration. The relationship between the presence of protozoans and various risk factors was assessed following the model of a case control study, with children having protozoa infections considered cases and those with diarrhea but not protozoa infections considered controls. 79 of the children were under 1 year old. 36% were malnourished. 60% of the children's families had inadequate garbage disposal facilities, 23% lived in crowded conditions (defined as more than 3 persons per room), 10% drank nonpotable water, 7% lacked piped water, and 2% had no toilet facilities. 66% of the children were found to be positive for protozoa, with 26% positive for Giardia lamblia, 19% for Entamoeba histolytica, 17% for Cryptosporidium, 2% for Dientamoeba fragilis, and 2% for Isospora belli. 6 cases of mixed infection were observed. A significant relationship was found between infection and garbage disposal in the open air and between infection and ingestion of nonpotable water. The high prevalence of protozoa infection is consistent with recent clinical observations. Public health measures should be taken to improve sanitation and personal hygiene.^ieng