[Law courts and clinical documentation]. / Juzgados y documentación clínica.

Background. Until 2004, requests for clinical documentation proceeding from the Judicial Administration on Specialist Care of Pamplona were received in six different centres and were processed independently, with different procedures, and documents were even sent in duplicate, with the resulting work load. This article describes the procedure for processing requests for documentation proceeding from the Law Courts and analyses the requests received. Methods. A circuit was set up to channel the judicial requests that arrived at the Specialist Health Care Centres of Pamplona and at the Juridical Regime Service of the Health System of Navarra-Osasunbidea, and a Higher Technician in Health Documentation was contracted to centralise these requests. A proceedings protocol was established to unify criteria and speed up the process, and a database was designed to register the proceedings. Results. In the course of 2004, 210 requests for documentation by legal requirement were received. Of these, 24 were claims of patrimonial responsibility and 13 were requested by lawyers with the patient's authorisation. The most frequent jurisdictional order was penal (43.33%). Ninety-three point one five percent (93.15%) of the requests proceeded from law courts in the autonomous community of Navarra. The centre that received the greatest number of requests was the "Príncipe de Viana" Consultation Centre (33.73%).The most frequently requested documentation was a copy of reports (109) and a copy of the complete clinical record (39). On two occasions the original clinical record was required. The average time of response was 6.6 days. Conclusions. The centralisation of administration has brought greater agility to the process and homogeneity in the criteria of processing. Less time is involved in preparing and dispatching the documentation, the dispatch of duplicate documents is avoided, the work load has been reduced and the dispersal of documentation is avoided, a situation that guarantees greater privacy for the patient.

Juzgados y documentación clínica / Law courts and clinical documentation

Fundamento. Hasta el año 2004 las solicitudes de documentaciónclínica por parte de la Administración de Justiciasobre Asistencia Especializada de Pamplona se recibían en seiscentros distintos, siendo tramitadas de manera independiente,con maneras de proceder diferentes e incluso con envío dedocumentación duplicada, con la consiguiente carga de trabajo.En el presente trabajo se describe el procedimiento para latramitación de solicitudes de documentación remitidas desdelos juzgados y analizar las solicitudes recibidas.Material y métodos. Se estableció un circuito para canalizarlas solicitudes judiciales que llegaban a los centros de AsistenciaEspecializada de Pamplona y al Servicio de Régimen Jurídicodel Servicio Navarro de Salud-Osasunbidea y se contratóun Técnico Superior en Documentación Sanitaria que las centralizara.Se elaboró un protocolo de actuación para unificar criteriosy agilizar el proceso, y se diseñó una base de datos pararegistrar las actuaciones.Resultados. Durante el año 2004 se recibieron 210 solicitudesde documentación por exigencia legal. De éstas, 24 fueronpor reclamaciones de responsabilidad patrimonial y 13 fueronsolicitadas por abogados con autorización del paciente. Elorden jurisdiccional más frecuente fue el penal (43,33%). El93,15% de las solicitudes provenían de juzgados de la propiacomunidad. El centro que mayor número de solicitudes recibiófue el Centro de Consultas “Príncipe de Viana” (33,73%). Ladocumentación solicitada más frecuente fue la copia de informes(109) y la copia de historia completa (39). En dos ocasionesse requirió historia original. El tiempo medio de respuesta fue de6,6 días.Conclusiones. La centralización de la gestión ha aportadomayor agilidad al proceso y homogeneidad en los criterios deactuación. Conlleva menos tiempo en la preparación y envío dela documentación, evita el envío de documentación duplicada,disminuye la carga de trabajo y evita la dispersión de la documentación,situación que garantiza una mayor intimidad para elpaciente

Background. Until 2004, requests for clinical documentation proceeding from the Judicial Administration on Specialist Care of Pamplona were received in six different centres and were processed independently, with different procedures, and documents were even sent in duplicate, with the resulting work load. This article describes the procedure for processing requests for documentation proceeding from the Law Courts and analyses the requests received. Methods. A circuit was set up to channel the judicial requests that arrived at the Specialist Health Care Centres of Pamplona and at the Juridical Regime Service of the Health System of Navarra-Osasunbidea, and a Higher Technician in Health Documentation was contracted to centralise these requests. A proceedings protocol was established to unify criteria and speed up the process, and a database was designed to register the proceedings. Results. In the course of 2004, 210 requests for documentation by legal requirement were received. Of these, 24 were claims of patrimonial responsibility and 13 were requested by lawyers with the patient’s authorisation. The most frequent jurisdictional order was penal (43.33%). Ninety-three point one five percent (93.15%) of the requests proceeded from law courts in the autonomous community of Navarra. The centre that received the greatest number of requests was the “Príncipe de Viana” Consultation Centre (33.73%).The most frequently requested documentation was a copy of reports (109) and a copy of the complete clinical record (39). On two occasions the original clinical record was required. The average time of response was 6.6 days. Conclusions. The centralisation of administration has brought greater agility to the process and homogeneity in the criteria of processing. Less time is involved in preparing and dispatching the documentation, the dispatch of duplicate documents is avoided, the work load has been reduced and the dispersal of documentation is avoided, a situation that guarantees greater privacy for the patient

Embarazo después de trasplante hepático / Pregnancy after liver transplant

Paciente de 27 años de edad, embarazada 2 años después de haber sufrido trasplante hepático, funcionalmente estabilizado, en tratamiento con tacrolimus. El embarazo cursó de forma completamente fisiológica. El parto se presentó a término, eutócico, y el feto fue normal (AU)

Spatial and seasonal variations of water quality in a Mediterranean catchment: the Llobregat River (NE Spain).

The Llobregat and Ter Rivers, typical Mediterranean catchments in Northeast Spain, supply water to more than 4.5 million inhabitants residing in the metropolitan area of Barcelona. The objective of this work is to study the factors that influence the surface water quality of Llobregat catchment. As such, spatial and temporal variations of more 50 water chemical parameters were monitored in 10 sampling sites for a period that extended from July 1996 to December 2000. The temperature, pH and conductivity were measured at sites, whereas metals were analysed using ICP-OES and ICP-MS instrumental techniques. The head waters of the Llobregat River catchment flow through detrital Mesozoic-Cenozoic sedimentary rocks resulting in calcium bicarbonate-type water with low mineral content. The high water quality of the waterhead is deteriorated in the upper-middle part of the catchment due to: occurrence of evaporite-bearing geological formations, and the mining and industrial activities related to potash exploitation. As a result, an obvious increase in Na, K, Mg, Cl-, Br, Rb, and Sr concentrations is reported leading to a sodium (potassium) chloride water type. This saline hydrochemical fingerprint persists downstream. This important feature renders the low water quality of the Llobregat River to be adequate for drinking supply purposes. In addition, the industrial and residential activities, specially at the lower part of the catchment, increases P, B, Mn, Fe, Pb, Al, Cr, Co, Ni, Cu, Zn, As and Sb water concentrations.

Comprehensive screening procedure for detection of stimulants, narcotics, adrenergic drugs, and their metabolites in human urine.

An analytical procedure for the detection of stimulants, narcotics, beta-blockers, beta-agonists, and many of their metabolites in urine using a solid-phase extraction procedure and gas chromatography-mass spectrometry (GC-MS) is described. These substances have been specifically banned by the Medical Commission of the International Olympic Committee (IOC) in order to prevent their abuse in sports. Urine samples are submitted to an enzymatic hydrolysis (beta-glucuronidase arylsulfatase) and extracted by means of Bond-Elut Certify columns. The residues are then selectively derivatized with N-methyl-N-trimethylsilyl-trifluoroacetamide (MSTFA), which enables the formation of trimethylsilyl derivatives of hydroxyl, acidic, and phenolic groups, and N-methyl-bis-trifluoroacetamide (MBTFA), which enables the formation of trifluoroacetamide derivatives of primary and secondary amines. A GC-MS system working in scan mode is sensitive and specific enough to detect and identify approximately 100 compounds and metabolites in urine for at least 24 h after the administration of doses typically encountered in therapeutics. Detection in selected ion monitoring mode is needed for the determination of beta-agonist agents. The method was successfully used in doping control of urine samples during the 25th Olympic Games, July 1992, in Barcelona, Spain.

Influence of the injection technique on the thermal degradation of cocaine and its metabolites in gas chromatography.

Thermal degradation of some substances due to high temperature at the injection port and/or the type of injection technique used may limit the usefulness of gas chromatography with conventional detectors or coupled to mass spectrometry. To minimize thermal degradation of cocaine and its metabolites, chromatography was performed using two different insert liners and a cool on-column inlet. When using a packed liner, marked degradation of all compounds was observed. The degradation process was reduced by the use of an open liner and, when the cool on-column inlet was employed, essentially no degradation occurred.

Simultaneous detection of methylphenidate and its main metabolite, ritalinic acid, in doping control.

Two analytical methods for the simultaneous detection in urine of methylphenidate and its main metabolite, ritalinic acid, are described. Both procedures are based on solid-phase extraction of urine samples on Bond Elut Certify columns, and capillary gas chromatographic-mass spectrometric detection of O-trimethylsilyl, N-trifluoroacetyl derivatives. The former method is used as a general screening procedure for the detection of basic polar nitrogen-containing compounds in urine such as stimulants, narcotic and adrenergic drugs. The latter procedure is proposed as a specific method to confirm methylphenidate ingestion. The two methods are sensitive enough to detect methylphenidate and ritalinic acid in urine at least for 24 h after administration of a therapeutic dose (20 mg oral dose) of methylphenidate.

Thiamine-like molecules in the cerebellar cortex of the rat: light and electron microscopic immunocytochemical investigation.

Immunocytochemical methods were used for studying the location of thiamine-like molecules in the cerebellar cortex of the rat. A positive reaction was observed in several synapses and in several dendrites. This reaction was associated with tubular formations and synaptic vesicles. A positive reaction was also found in several mitochondria and in glial cells. The possible role of thiamine-like molecules in cerebellar cortex is discussed.

Light and electron microscope immunolocalization of cytosolic malic enzyme-like activity in the rat's cerebellar cortex.

The immunocytochemical localization of malic enzyme-like activity in the cerebellar cortex of the rat at light and electron microscope levels using the PAP method was investigated. The antiserum against the malic enzyme was obtained from rabbit after having injected the chicken liver malic enzyme. The microscope observations have demonstrated the presence of a positive immunocytochemical reaction against malic enzyme in the cytosol of Bergmann glial cells and in the astrocytes of granular layer and also in several dendrites, but not in all, in the postsynaptic site. A possible role of cytosolic malic isoenzyme (cME) in the several synapses is suggested.