Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud / Detecting doubts and training needs of family doctors of a health centre

OBJETIVO: Detectar las dudas y las necesidades formativas de los médicos de familia de un centro de salud urbano y docente durante la práctica clínica habitual. MATERIAL Y MÉTODOS: Estudio descriptivo transversal de un mes de duración en un centro de salud urbano de Madrid. Los médicos de familia del equipo fueron entrevistados tras la consulta sobre las dudas que habían tenido, eligiendo dos de ellas. Las dudas no resueltas en las dos semanas siguientes se agruparon por materias y según las taxonomías vigentes. Posteriormente se elaboró un programa docente para resolverlas. RESULTADOS: Participaron 19 de los 21 médicos del centro, y en el periodo de estudio atendieron a 10.678 pacientes. Se detectaron 0,44 dudas por cada 10 pacientes atendidos. De las 384 dudas elegidas, el 83,34% fueron clínicas y el 16,66%, no clínicas. El 51,2% de estas quedaron sin resolver en los 15días tras la consulta. Los métodos para su resolución fueron las bases científicas de internet (PubMed, UpToDate y guías de práctica clínica, principalmente; 38%), seguido de la consulta a otros colegas (34,9%). CONCLUSIONES: La mayoría de las dudas generadas durante la consulta son clínicas, aunque existe una carga importante de preguntas burocráticas. Más de la mitad de las dudas no se resuelven durante la consulta ni en los 15días posteriores. Las bases de datos científicas en internet son la principal fuente de información, seguida de la consulta a otros colegas. Deberían mejorar los tiempos por paciente y el acceso a fuentes de información fiables y ágiles, para mejorar estos aspectos

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate

[Detecting doubts and training needs of family doctors of a health centre]. / Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud.

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate.

[Epidemiologic survey of acute poisoning in the south area of the community of Madrid. The VEIA 2000 Study]. / Vigilancia epidemiológica de la intoxicación aguda en el Area Sur de la Comunidad de Madrid: Estudio VEIA 2000.

OBJECTIVE: Extensive observational studies of acute intoxications (AI) allow the detection of trend changes indispensable for the design of preventive actions. VEIA is an evolutional study of AI attended at the Emergency Services of the Hospital "Doce de Octubre" of Madrid over all-round annual periods (1979, 1985, 1990, 1994 and 1997); we present the results of 2000 and compare them with those of previous years. METHODS AND RESULTS: An identical method was used. The hospital attended 1,128 AI, 88% of them voluntary. There were 451 suicide attempts. Forty four per cent of drugs involved were benzodiazepines. Alcohol represented 75% of non-pharmacological toxic substances and drugs, 19%. CONCLUSIONS: An increase of AI caused by alcohol and drugs was observed among women, as well as a decrease of suicide attempts, which reflects an approximation of man/woman roles. An aging trend was observed in suicide attempts (Is suicide "outmoded" among young people?), along with two patterns: Suicide attempts with drugs had a mortality rate of 0.1% and suicide attempts without drugs, of 3%. Two out of five men attempting suicide had drug addictions. There had been a reduction of benzodiazepines use and substitution of aspirin for paracetamol and of other analgesics for NSAID. Alcohol was the predominant non-pharmacological toxic substance, but had decreased 11%. Drugs, that had surpassed the traditional poisons (gases, solvents, etc.) represented 40% more than in 1997. When 1994 and 2000 were compared, heroine had not changed significantly, but cocaine had increased from 13 cases to 67 and amphetamines type MDMA had increased geometrically.

Vigilancia epidemiológica de la intoxicación aguda en el Área Sur de la Comunidad de Madrid: estudio VEIA 2000 / Epidemiologic survey of acute poisoning in the south area of the community of madrid. The veia 2000 study

Objetivo: Extensos estudios observacionales sobre intoxicaciones agudas (IA) permiten detectar cambios de tendencia imprescindibles para diseñar actuaciones preventivas. VEIA es un estudio evolutivo de las IA atendidas en Urgencias del Hospital 12 de Octubre de Madrid en periodos anuales completos [1979 (1,2), 1985 (3), 1990 (4), 1994 (5) y 1997 (6)], presentamos el 2000 y comparamos los resultados con los previos. Métodos y resultados: El método se mantiene idéntico. 1.128 IA 88 por ciento voluntarias. 451 intentos de suicidio. Las benzodiazepinas son el 44 por ciento de los medicamentos; El alcohol el 75 por ciento de los tóxicos no farmacológicos y las drogas el 19 por ciento. Conclusiones: En las mujeres aumentan las IA por alcohol y drogas y disminuyen los intentos de suicidio, ello supone una aproximación de los roles hombre/mujer. Hay un envejecimiento en los IS (¿se "pasa de moda" suicidarse entre los jóvenes?) y advertimos dos pautas: IS con medicamentos con 0,1 por ciento de mortalidad y por no-medicamentos con 3 por ciento. Dos de cada cinco hombres con IS son adictos. Disminuyen las benzodiazepinas, el paracetamol sustituye a la Aspirina y los AINE a los restantes analgésicos. El alcohol es el tóxico no-farmacológico predominante, pero disminuye un 11 por ciento. Las drogas, que ahora superan a los venenos tradicionales (gases, disolventes, etc.) suponen un 40 por ciento más que en 1997. Al comparar 1994 y 2000, la heroína no cambia pero la cocaína pasa de 13 casos a 67 y las anfetaminas tipo MDMA crecen de modo geométrico (AU)

Hernia de Spiegel en la consulta de Atención Primaria: a propósito de un caso / Spigelian hernia: a case report

La hernia de Spiegel o eventración lateral espontánea, es una protusión a través de la aponeurosis de Spiegel, que es la región de la aponeurosis del transverso del abdomen situada por fuera del borde de la vaina del recto, pero por dentro de la línea de Spiegel; dicha línea es el punto en que el músculo transverso se continúa con su tendón aponeurótico plano. Presentamos el caso de un varón de 69 años que consulta por dolor abdominal crónico de tipo intermitente con exploración abdominal anodina, al que después de dos años se le diagnostica de una hernia de Spiegel (AU)

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[The epidemiological surveillance of acute poisoning in 1997 (a study of 1140 cases from the area south of the Madrid Community)]. / Vigilancia epidemiológica de la intoxicación aguda 1997 (estudio de 1.140 casos del área sur de la Comunidad de Madrid).

UNLABELLED: Following a line of work we studied 1,140 acute poisoning (AP) attended at the Internal Medicine Emergency Department at 12 de Octubre Hospital, Madrid, in 1997. The incidence increased up to 157/100,000 inhabitants. Mean age was 36 years (SD: 15 y), median, 32 years. Self-inflicted AP: 1,052 cases (92%); the suicide attempt was the most common type (509, 48%). Among males, the alcoholic intoxication (332, 59%) predominated. Among accidental AP (88 cases), 90% occurred at home. Poisons: drugs. Drugs were used for 78% of suicide attempts. The relative incidence of benzodiazepines increased (47%) and that of antidepressive drugs decreased (11%). A remarkable increase in the "other drugs" group was noted, as well as the association of drugs and non-drugs (10%). Alcohol use increased significantly (249 cases more than in 1994), as well as drugs although to a lesser extent, breaking the trend observed in the last few years. Cocaine is now the most common (among women heroin is still the leading cause); 5 AP were caused by synthesis drugs (extasis, MDMA) and an increase was observed with "other drugs". ANTECEDENTS: suicide attempts: depression (30%) and previous attempts (19%); ethylism: alcoholism (40%); AP with other drugs: drug abuse (52%). Admitted to ICU: 1.4%. The mortality rate decreased to 0.08%.