[Expanding the portfolio of laboratory services in primary care does not increase the cost]. / Ampliar la cartera de servicio de laboratorio en Atención Primaria no incrementa el gasto.

INTRODUCTION: Our health care system gives crucial importance to Primary Care, since it is the first step in medical care. The family doctor becomes the filter of the diseases that they attend to and direct the patients to the different services according to their needs. Therefore, a very important role is granted that conflicts with the limitation in access to diagnostic tests. However, in reality it appears that the Primary Care professionals have limitations in order to access complementary tests. MATERIAL AND METHOD: After the publication of a list of accessible laboratory tests for Primary Care, the use of these tests was evaluated without any type of limitation, except for the adequacy of the tests to the diagnosis, as happens in the hospital during 6months, measuring the number of determinations and the relative units of value used. A comparison was made with a previous period and with the activity developed. RESULTS: After 6months of follow-up and with equal care activity, the use of laboratory diagnostic tests decreased by 24%, and the relative value units decreased by 10%. CONCLUSIONS: Access to the portfolio of laboratory services for Primary Care does not translate into an increase in spending, while sending a positive message about the role that primary health care should play in our health system.

[Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care]. / Influencia de un observador en la hemólisis producida durante las extracciones de muestras sanguíneas en atención primaria.

OBJECTIVE: To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. MATERIAL AND METHODS: Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. RESULTS: The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. CONCLUSIONS: An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care.

[Gender differences in the use of tumour markers]. / Diferencias de género en el uso de marcadores tumorales.

INTRODUCTION AND OBJECTIVE: Gender is one of the factors that can influence the use of health resources. The use of tumour markers is widespread, due to the importance of these in monitoring cancer development. The aim of this study is to analyse the influence of gender on the use of tumour markers, and to investigate whether there are differences in their use. MATERIAL AND METHODS: A longitudinal, retrospective and descriptive study, with a 2-year follow-up, was conducted in the catchment area of the University Hospital of Padua. An analysis was performed on 23,059 analytical requests for tumour markers. A descriptive and frequency analysis was performed on all variables. The statistical analysis was performed using Chi squared, Student t and Mann-Whitney U to test for significance. RESULTS: The number of requests for women (1.5) was lower than men (1.6). In patients with tumour pathology, the number of requests was higher than in patients without tumour disease. In the analysis by disease and gender, the difference remained significant. As regards the number of tumour markers per request, the difference between genders was also significant: 2.13 in males versus 2.85 in women. Similar results were obtained when requests for tumour markers linked to gender-related diseases were eliminated. CONCLUSIONS: There are differences in the use of tumour markers by gender with the number of requests for male patients being higher than for females. However, the number of tumour markers per request is greater in women than in men.

Utilidad de los sistemas analíticos a la cabecera del enfermo en condiciones emergentes y con accesibilidad limitada / Utility of the Point-of-Care-Testing devices in emergent conditions and with limited accessibility

Introducción: La seguridad del paciente es uno de los objetivos principales de todo sistema sanitario. El Hospital de Ronda atiende a más de 120.000 habitantes. Da cobertura a seis áreas básicas de salud, en total treinta y un puntos de atención médica. La Comarca de la Serranía de Ronda es un entorno rural montañoso. Presenta una amplia dispersión geográfica y comunicaciones difíciles por carretera. El tiempo medio de acceso al hospital de Ronda es de 60 minutos. El perfil poblacional de la comarca es característico de una zona rural. Metodología: El análisis sobre seguridad del paciente constató que la dispersión geográfica y la dificultad de acceder al hospital eran problemas prioritarios. Se proporcionó a los equipos móviles urgentes de sistemas analíticos portátiles (i-STAT, Abbott) capaces de realizar analíticas rápidas y fiables a la cabecera del enfermo. Resultados y conclusiones: Los profesionales han valorado muy positivamente esta medida al poder resolver mayor número de asistencias sin tener que trasladar al paciente (AU)

Introduction: Patient safety is one of the main objectives in our health system for the continuous improvement of quality of care and the promotion of clinical excellence. The Ronda Hospital covers a population of more than 120,000 inhabitants in two different provinces, being split into six Basic Health Areas with their corresponding health centres plus three associated Medical Centres, making thirty one points of care that have to be staffed. The rural area of Serranía de Ronda, due to being mountainous, is geographically complicated. It is widely dispersed and communication it has a difficult transportation due to be carried out by secondary roads, which are even worse during winter. The average travelling times to Ronda Hospital, which is the only hospital in the region, is around 60 minutes. The population profile of the Rural Area is characteristic of an ageing population. Methodology: An analysis of Patient Safety showed the geographical dispersion and difficulty to get to hospital was detected as priority problems and those which had most influence on patient safety. Ten dry chemical analysers (i-STAT, Abbott) have been installed in the ambulances which attend the reference population. Results and Conclusions: The professionals positively value the availability of another diagnostic tool, as well as having had a response to their demands to the referred patient safety (AU)

Utilidad de los sistemas de información en psiquiatría: análisis de un hospital general básico / The efectiveness of information systems in Psychiatry: analisis of a Standard General Hospital

En este trabajo se realiza un análisis descriptivo de los 2.175 ingresos producidos en la Unidad de Hospitalización Psiquiátrica del Hospital Punta Europa de Algeciras durante siete años (1995-2001), utilizando como fuente de información el conjunto mínimo básico de datos al alta hospitalaria (CMBDH), obteniéndose y analizando los Grupos Relacionados de Diagnóstico de los pacientes ingresados por el mismo GDR en el periodo de tiempo de estudio. Se evalúa la utilidad de éste sistema de indicadores para la gestión de un Servicio de Psiquiatría. Creemos que los GDR son un indicador útil de la calidad asistencial, pero es preciso continuar investigando en nuestro país (AU)

Clear cells carcinoma of fallopian tubes associated with tubal endometriosis. Case report and review.

Our case report describes a patient with clear cell fallopian tube carcinoma (histological grade 3; stage (FIGO): III c.) associated with an endometrial cyst of the tube wall.

[Pre and post-operative autotransfusion. A comparative study of hematology, biochemistry and red cell metabolism in pre-donated blood and blood from post-operative surgical drainage]. / Autotransfusión pre y postoperatoria. Estudio comparativo de la hematología, bioquímica y metabolismo eritrocitario en sangre predonada y sangre de drenaje postoperatorio.

PURPOSE: The widespread use of aggressive surgical procedures, along with the increasing incidence of traffic accidents, has raised the necessity of homologous blood beyond the supplies of blood banks. This fact, plus the risks of homologous transfusion and the costs of blood bank maintenance, has prompted the advance of blood saving procedures such as autotransfusion, both in the pre-deposit (preoperative autotransfusion, POA) and the surgical drainage reinfusion (postoperative autotransfusion, SDR) modalities. As there is some controversy about the use of one or the other of the above procedures, the purposes of this study were: 1) to analyse the haematological and biochemical characteristics of blood, both pre-donated and stored at 4 degrees C for 4 weeks, and that recovered from surgical drains, from patients subjected to programmed orthopaedic or heart surgery; 2) to assess the metabolic and functional state of red cells attained from that blood, and 3) to compare the results achieved. MATERIAL AND METHODS: The following data were examined: red cell count, haematocrit, haemoglobin, red cell indicates, white cell count, platelet count, free plasma haemoglobin, red cell morphology, glucose, cholesterol, triglycerides, phospholipids, serum proteins and their fractions, ions, histamine, red cell glucose and amino acid transport, and ATP and 2,3-DPG content. RESULTS: The red cells, haemoglobin and haematocrit concentrations in POA blood did not show significant variations during the storage for 4 weeks and their values were significantly higher than found in drained blood. The biochemical values showed heterogeneous variations. Glucose and amino acid uptake by red cells of POA blood slightly decreased in the first 2 weeks of storage but always less than measured in SDR red cells. In POA blood it was noticed a progressive decrease in intra-erythrocytic ATP and 2,3 DPG, those levels being normal in SDR. DISCUSSION: In spite of lower haematocrit and haemoglobin but higher free plasma haemoglobin content, drained blood had higher ATP and 2,3-DPG concentration than pre-deposit, stored blood. Drained blood showed also less ion alterations and probably a lesser immunosuppressor capability. Thus, postoperative blood recovery seems a good source of red cell, with high oxygen transport power, and so, alone or in combination with pre-donated blood, it may contribute to reduce the necessities for homologous blood and decrease its risks.

[Chronic metabolic syndrome: a predictive model of risk of macrovascular events?]. / El síndrome metabólico crónico: un modelo predictivo de riesgo de episodios macrovasculares?

OBJECTIVES: To establish a predictive model of the risk of macrovascular complications in patients with Chronic Metabolic Syndrome by means of multiple logistic regression analysis. To identify Chronic Metabolic Syndrome as an independent health problem, given its frequency and importance in the genesis of macrovascular complications. DESIGN: A descriptive observational study. SETTING: An urban Health District in Malaga. PATIENTS: 47 patients with Chronic Metabolic Syndrome were chosen by systematic randomised sampling. MEASUREMENTS AND MAIN RESULTS: The best predictive model of macrovascular events was established as the one which included high values of the Waist-Hip index, blood pressure, Fibrinogenaemia and basal Glucaemia, and low values of HDL cholesterol. CONCLUSIONS: 1. A model to predict macrovascular events in patients with Chronic Metabolic Syndrome included high values of the Waist-Hip index, blood pressure, Fibrinogenaemia and basal Glucaemia, and low values of HDL cholesterol. 2. We believe that this association should be considered an independent health problem on the list of problems, with the name Syndrome X or Chronic Metabolic Syndrome.