[Safety and tolerance of transrectal ultrasound-guided (TRUS) biopsy in the diagnosis of prostate cancer]. / Seguridad y tolerancia de la punción-biopsia transrectal guiada por ultrasonidos (TRUS), en el diagnóstico del carcinoma de próstata.

OBJECTIVE: To identify the complications and possible associated factors observed in patients with suspected prostate cancer undergoing transrectal ultrasound-guided (TRUS) biopsy. PATIENTS AND METHODS: A prospective analysis of the TRUS biopsy procedures performed between 1995-2005. Descriptive statistics: mean, standard deviation, percentage, and 95% confidence intervals. Inferential statistics: t-test, chi-square analysis, 95% confidence intervals, and odds ratio (OR). EPI-Info Program 3.2.2-2005 of the WHO. RESULTS: A total of 1067 patients underwent the procedure; 913 (85%; CI: 83.3; 87.6) reported no pain or only slight pain. Clinical complications were detected in 284 cases (26.6%; CI: 24.2; 27.4). Self-limiting hematuria and rectorrhagia accounted for 82% of all complications. Observation and/or hospital admission was required in 7 cases (0.6%; CI: 0.3; 0.8). Immediate US follow-up after puncture registered complications in 302 cases (28.3%; CI: 26.6; 29.3). Periprostatic and/or submucosal hematoma in 264 cases accounted for 87% of these complications. The complications observed during US were related to: a history of prior urological pathology (OR = 1.52; CI: 1.31; 1.73; p = 0.005) and increased pain (OR = 5.63; CI: 5.60; 5.66 p < 0.001). The clinical complications were associated with: altered coagulation (OR = 1.67; CI: 1.64; 1.70 ;p = 0.045) and increased pain (OR = 0.37; CI: 0.32; 0.42 p < 0.001). The complications detected during US were not translated to clinical complications (OR = 0.16; CI: 0.13; 0,20 p < 0.001). CONCLUSIONS: TRUS biopsy is well tolerated by patients in our environment. Clinical complications are minimal and generally self limiting and rarely require hospital care. The role of the radiologist can be important for improving patients' tolerance of the test and reducing complications.

Seguridad y tolerancia de la punción-biopsia transrectal guiada por ultrasonidos (TRUS), en el diagnóstico del carcinoma de próstata / Safety and tolerance of transrectal ultrasound-guided (TRUS) biopsy in the diagnosis of prostate cancer

Objetivo. Identificar las complicaciones y los posibles factores asociados observados en pacientes con sospecha de carcinoma de próstata, sometidos a punción para una biopsia TRansrectal guiada por UltraSonografía (TRUS). Pacientes y métodos. Análisis prospectivo de los protocolos TRUS realizados entre los años 1995-2005. Estadística descriptiva: media, desviación estándar, porcentaje e intervalos de confianza al 95%. Estadística inferencial: pruebas de la "t" de Student y ji al cuadrado, intervalos confianza al 95% y odds ratio (OR). Programa EPI-Info 3.2.2-2005 de la Organización Mundial de la salud (OMS). Resultados. Se analizan 1.067 pacientes, de los cuales 913 (85% intervalo de confianza [IC]: 83,3; 87,6) refieren la sensación dolorosa como ausente o leve. Se detectan complicaciones clínicas en 284 casos (26,6% IC: 24,2; 27,4). La hematuria y la rectorragia autolimitadas suponen el 82% del total de los pacientes. En 7 casos (0,6% IC: 0,3; 0,8) se requirió observación y/o ingreso hospitalario. El control ecográfico inmediato postpunción registra complicaciones en 302 casos (28,3% IC: 26,6; 29,3). Hay hematoma periprostático, hematoma submucoso o combinados en 264 casos que suponen el 87% de las complicaciones. Las complicaciones observadas en la ecografía guardan relación con: antecedente de patología urológica previa (OR =1,52; IC: 1,31; 1,73; p = 0,005), sensación dolorosa aumentada (OR = 5,63; IC: 5,60; 5,66; p < 0,001). Las complicaciones clínicas se asocian con: coagulación alterada (OR = 1,67; IC: 1,64; 1,70; p = 0,045) y aumento de la sensación dolorosa (OR = 0,37; IC: 0,32; 0,42; p < 0,001). Las complicaciones detectadas en la ecografía no se traducen en complicaciones clínicas (OR = 0,16; IC: 0,13; 0,20; p < 0,001). Conclusiones. La punción biopsia transrectal en nuestro medio es una técnica bien tolerada por el paciente, con escasa repercusión clínica, generalmente autolimitada y que excepcionalmente precisa de atención hospitalaria. El papel del radiólogo puede ser determinante para mejorar la tolerancia del paciente a la prueba y disminuir las complicaciones (AU)

Objective. To identify the complications and possible associated factors observed in patients with suspected prostate cancer undergoing transrectal ultrasound-guided (TRUS) biopsy. Patients and methods. A prospective analysis of the TRUS biopsy procedures performed between 1995-2005. Descriptive statistics: mean, standard deviation, percentage, and 95% confidence intervals. Inferential statistics: t-test, chi-square analysis, 95% confidence intervals, and odds ratio (OR). EPI-Info Program 3.2.2-2005 of the WHO. Results. A total of 1067 patients underwent the procedure; 913 (85%; CI: 83.3; 87.6) reported no pain or only slight pain. Clinical complications were detected in 284 cases (26.6%; CI: 24.2; 27.4). Self-limiting hematuria and rectorrhagia accounted for 82% of all complications. Observation and/or hospital admission was required in 7 cases (0.6%; CI: 0.3; 0.8). Immediate US follow-up after puncture registered complications in 302 cases (28.3%; CI: 26.6; 29.3). Periprostatic and/or submucosal hematoma in 264 cases accounted for 87% of these complications. The complications observed during US were related to: a history of prior urological pathology (OR = 1.52; CI: 1.31; 1.73; p = 0.005) and increased pain (OR = 5.63; CI: 5.60; 5.66 p < 0.001). The clinical complications were associated with: altered coagulation (OR = 1.67; CI: 1.64; 1.70 ;p = 0.045) and increased pain (OR = 0.37; CI: 0.32; 0.42 p < 0.001). The complications detected during US were not translated to clinical complications (OR = 0.16; CI: 0.13; 0,20 p < 0.001). Conclusions. TRUS biopsy is well tolerated by patients in our environment. Clinical complications are minimal and generally self limiting and rarely require hospital care. The role of the radiologist can be important for improving patients' tolerance of the test and reducing complications (AU)

Paciente depresivo

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : introducción, definición y clasificación, criterios diagnósticos, valoración inicial y seguimiento, tratamiento, datos de la medicina basada en la evidencia relacionados con la depresión, algoritmos y anexos. También incluye una guía de consulta rápida.

Gestión clínica de la decisión terapéutica: intervención desde un Servicio de Farmacia de Área de Salud / Clinical management of therapeutic decision-making: intervention on the part of a health area pharmacy service

Introducción. La actividad médica obliga a tomar constantemente decisiones terapéuticas, a menudo en uncorto lapso de tiempo. La variabilidad clínica también se refleja en la toma de decisiones terapéuticas. Lasmedidas de formación-actualización no han demostrado eficacia permanente.Objetivos. a) Diseñar una estrategia formativa capaz de proporcionar al médico la metodología para evaluarla información científica y tomar decisiones terapéuticas, y b) evaluar el impacto de dicha intervención.Metodología. Estudio de intervención para evaluar el impacto de una estrategia educativa de formación endecisión terapéutica e investigación clínica, aleatorizado, comparativo antes-después, con doble grupo controly simple ciego.Grupo de intervención (participantes del curso); grupo control positivo (centros que reciben las sesiones);grupo control negativo (centros que no reciben las sesiones). Evaluación de resultados mediante indicadoresde uso relativo de medicamentos: hipolipemiantes, antibióticos (respiratorio, otorrinolaringología, urinario),antihipertensivos, antidiabéticos. Análisis previo basal, intermedio y final.Resultados. Tras la intervención, se obtiene una mejora de:­ 2,74% en dosis diaria definida (DDD) de diuréticos/DDD antihipertensivos.­ 3,74% en DDD metformina/DDD antidiabéticos orales.­ 4,25% en DDD simvastatina/DDD reductores del colesterol y triglicéridos.Conclusiones. La intervención ha sido muy bien aceptada por el grupo de alumnos y por el grupo de médicosque reciben las sesiones.• Los resultados en cuanto a la implementación de las propuestas formativas en los indicadores de uso de losmedicamentos no han sido homogéneos y, en algunos casos, contrapuestos.• Otros aspectos, como los factores psicológicos, de comunicación y de habilidades docentes deben ser planteadosen distintos proyectos formativos

Introduction. The practice of medicine constantly obliges physicians to make therapeutic decisions, oftenwithin short periods of time. Clinical variability is also reflected in therapeutic decision-making. Measuresfor training and updates have not been shown to have a lasting efficacy.Objectives. 1) To design a training strategy capable of providing the physician with the methodology toevaluate scientific information and make decisions in therapeutics and 2) to evaluate the impact of thisintervention.Methodology. A randomized, comparative, single-blind intervention study, with a before-and-after designand two control groups, to evaluate the impact of an educational strategy involving training in therapeuticdecision-making and clinical research.Intervention group (participants in the course), positive control group (centers in which the sessions areoffered), negative control group (centers in which the sessions are not offered). The results were evaluatedaccording to indicators of the relative utilization of lipid-lowering agents, antibiotics (for respiratory tract;ear, nose and throat; and urinary tract infections), antihypertensives, antidiabetic agents, with pre-studybaseline, mid-study and final analyses.Results. At the end of the intervention, the following improvements were observed: increase of 2.74% in defineddaily dose (DDD) of diuretics/DDD of antihypertensives, of 3.74% in DDD of metformin/DDD of oralantidiabetic agents and of 4.25% in DDD of simvastatin/DDD of cholesterol and triglyceride-loweringdrugs.Conclusions. The intervention was well accepted by the group of students and the group of physicians whoattended the sessions. The results with respect to the implementation of the proposed training in drug utilizationwere inconsistent and, in some cases, conflicting. Psychological factors and those involving communicationand teaching skills should be addressed in future training projects

[Impact of an intervention on the waiting-list for medical specialists in a health area]. / Impacto de una intervención sobre la lista de espera de especialidades médicas en un área de salud.

OBJECTIVE: To evaluate the impact on waiting-lists and waiting time of an intervention that modified the appointment system in specialist out-patients. DESIGN: Intervention study. Intervention group, medical specialists (MS); and control group, surgical specialists (SS). Comparison of variables. Analysis at one year (1997) and at two years (1998) of the intervention in the two groups.Setting. Area 20 of the health board for the Community of Valencia, a Southern county in the province of Alicante, which had 12 health districts and included specialist care. PARTICIPANTS: The first-visit diary for medical and surgical specialist clinics.Interventions. Redistribution of MS first visits in proportion with the population over 14 by areas. Health centre self-management of specialist appointments. Introduction of visits of choice and second-visit re-scheduling from specialist care. Introduction of clinical protocols for action and referral. MEASUREMENTS: Referral percentage. Patients seen in primary care and at medical and surgical specialist clinics. Days waiting to be seen by a specialist. Patients on waiting list. Index of waiting for consultations. RESULTS: Referral ranged between 5.1% and 5.8%. There was a significant drop (P<.05) in the mean number of days an MS patient had to wait vs the SS (37 vs 48 in 1997 and 34 vs 50 in 1998), and in the number of MS consultations being waited for. There was a significant difference in the index of waiting for a consultation (P<.05) in favour of MS (17.74 vs 25.45 in 1997, and 16.77 vs 34.92). CONCLUSIONS: The intervention optimised specialist medical health care in terms of the number of consultations and reduction of waiting time, with an improvement of these variables against SS.

Impacto de una intervención sobre la lista de espera de especialidades médicas en un área de salud / Impact of an intervention on the waiting-list for medical specialist in a health area

Objetivo. Evaluar el impacto de una intervención que modifica el sistema de citación sobre las listas y el tiempo de espera de consulta externa especializada. Diseño. Estudio de intervención. Forman el grupo de intervención las especialidades médicas (EM) y el de control, las especialidades quirúrgicas (EQ). Comparación de variables. Análisis al año (1997) y a los dos años (1998) de la intervención en ambos grupos. Emplazamiento. Área 20 de la Conselleria de Sanitat de la Comunidad Valenciana, comarca sur de la provincia de Alicante, 12 zonas básicas de salud y asistencia especializada. Participantes. Agenda de primeras visitas de especializada, consultas médicas y quirúrgicas. Intervenciones. Redistribución de primeras visitas en consultas de EM proporcional a población mayor de 14 años por zonas. Autogestión desde los centros de salud de citas con especializada. Instauración de consultas preferentes y recitación de segundas visitas desde especializada. Implantación de protocolos clínicos de actuación y derivación. Mediciones. Porcentaje de derivación; pacientes atendidos en atención primaria y especialidades médicas y quirúrgicas; días de espera para visita por especialista; pacientes en lista de espera, e índice de espera por consultas. Resultados. El porcentaje de derivación oscila entre el 5,1 y el 5,8 per cent. Se observa una disminución significativa (p < 0,05) en la media de días de espera por paciente para las EM frente a las EQ (37 frente a 48 en 1997 y 34 frente a 50 en 1998), así como del número de consultas en espera para las EM. Existe una diferencia significativa del índice de espera por consulta (p < 0,05) a favor de las EM (17,74 frente a 25,45 en 1997 y 16,77 frente a 34,92 en 1998). Conclusiones. La intervención produjo una optimización de la actividad asistencial en EM en términos de número de consultas y reducción del tiempo de espera, con mejora de estas variables frente a las EQ. (AU)

[Unit of compliance with chronic prescriptions: a study of frequency of attendance]. / Unidad de cumplimentación de prescripciones crónicas: estudio de frecuentación.

OBJECTIVE: To analyse frequency of attendance at a Unit of Compliance with Chronic Prescriptions (UCCP) within a Health Centre (HC). DESIGN: A prospective study with a six-year follow-up period 1986-1992. SETTING: The study was carried out at the Florida HC, Alicante, which covers an urban population of about 20,000 inhabitants. PATIENTS AND OTHER PARTICIPANTS: The population under study were those patients who needed pharmacological treatment for a period longer than three months. The criteria of evaluation were: attendances and prescriptions dispensed at the UCCP, patient attendances avoided and time saved in medical consultations. MEASUREMENTS AND MAIN RESULTS: In 1986 there were 8,512 attendances at the UCCP (13.53% of the Centre's total attendance of 62,889), rising in 1992 to 12,884 (20.43% of the Centre's total of 63,078). In 1986 there were 18,000 prescriptions dispensed at the UCCP (16.38% of the Centre's total of 109,900) and in 1992, 41,500 (25.94% of the Centre's total of 160,000). The amount of time for medical consultations saved in the different years of the study ranged between 155 hours in 1986 and 536 in 1992. The index of prescriptions per attendance at the UCCP went up from 2.11 in 1986 to 3.22 in 1992. The index of attendances per patient and year was 12.09 in 1986 and 7.82 in 1992. CONCLUSIONS: A centralized unit for compliance with chronic treatments lessens the frequency of attendance for medical consultations, improves the patient's access renewed treatment and leads to a considerable saving in care time.

[Spontaneous hematoma of the sheath of the rectus muscles of the abdomen. Experience in primary care]. / Hematoma espontáneo de la vaina de los músculos rectos del abdomen. Experiencia en atención primaria.

AIM: Presentation of 3 cases of spontaneous hamatoma of the sheath of the rectus muscles in the abdomen. DESIGN: Retrospective clinical observations. LOCATION: Primary Care. PATIENTS: Two males (23 and 28 years old) and a woman (64 years old) who were clinically examined because the reported an acute abdominal pain. RESULTS: Clinical observations. CONCLUSIONS: We should consider the diagnosis of spontaneous hematoma of the sheath of the rectus muscles in the abdomen, differentiating it from a diagnosis of the acute abdomen.