Seguimiento de los pacientes atendidos conjuntamente por un equipo de Atención Primaria y su programa de Atención Domiciliaria y Equipos de Soporte / Follow-up of patients jointly cared for by a Primary Care unit, its Home Care program, and a Home Care Support Unit

Objetivo: analizar el seguimiento médico de pacientes atendidos conjuntamente por un Equipo de Atención Primaria (EAP) y un equipo del Programa de Atención Domiciliaria y Equipos de Soporte (PADES). Diseño: estudio descriptivo retrospectivo. Emplazamiento: área básica de salud urbana. Participantes: pacientes asignados al centro atendidos los últimos 4 años por ambos equipos. Mediciones principales: a partir de la revisión de las historias clínicas se obtuvieron las siguientes variables: edad, sexo, origen de solicitud delPADES, diagnóstico, visitas realizadas, coordinación entre ambos equipos, intervalos entre solicitud [primera visita PADES, alta, éxitus (media recortada),motivo de alta PADES] y uso de opioides potentes. Resultados: ciento dos pacientes: 53 mujeres (52%); edad media 72,2 años (DE 14,7). Origen solicitud: EAP 45%, hospital 43%, otros 12%. El66% eran pacientes con patología oncológica. Cuando el EAP originó la solicitud la patología oncológica representaba un 49%. La media del intervalo entre la solicitud y la primera visita del PADES fue de 4,1 (DE 3,8)días. Media de visitas realizadas por PADES 5,63 (DE 6,39) y por EAP 3,3(DE 4,5). Existía coordinación en el 55,9%. Media recortada del intervalo entre la primera visita y el alta de 52,9 días (IC 95% 47,2-109); y entre la primera visita y el éxitus de 81,6 días (IC 95% 70,1-146,4). Motivo de alta: ingreso en centro socio sanitario 37%, éxitus 28%, seguimiento por EAP15%, ingreso hospitalario 15% y en curso 5%. Uso de opioides potentes: 41,2% casos, iniciándose por PADES u hospital. Conclusiones: la patología neoplásica es la más prevalente. Debería mejorar la coordinación entre ambos equipos. El intervalo entre la visita y el éxitus de 3 meses refleja una derivación a tiempo. Falta de inicio de opioides potentes por EAP (AU)

Objective: to analyze the medical care of patients jointly seen by a primary care unit (PCU) and a home care support unit (HCSU). Design: a restropective descriptive study. Setting: an urban health area. Participants: patients assigned to a medical center and followed by both units during the last four years. Main measures: the following variables were obtained from a review of clinical data: age; sex; source of HCSU requests; diagnosis; visits; coordination between both units; time lapsed between HCSU request, first visit, discharge, death (average); reasons for discharge from HCSU; potent opioid prescription. Results: in all 102 patients: 53 women (52%); age 72.2 years (SD14.7). Origin of request: PCU 45%, hospital 43%, other 12%; 66% of patients had an oncologic disease. When requests came from the PCU oncologic disease represented 49%. Average time lapsed between anHCSU request and the first visit was 4.1 (SD 3.8) days. Average number of visits performed by the HCSU was 5.63 (SD 6.39); by the PCU was 3.3 (SD4.5) days. There was coordination in 55.9% of cases. Average time lapsed between the first visit and patient discharge was 52.9 days (95% CI 47.2-109). Average time between the first visit and death was 81.6 days (95% CI70.1-146.4). Reason for discharge: admitted to palliative care beds, 37%; death, 28%; PCU follow-up, 15%; admission to hospital, 15%; still under care, 5%. Use of potent opioids: 41.2% of patients - all started by theHCSU or hospital. Conclusions: oncologic disorders are the most commonly seen diseases.Coordination between both teams should improve. The interval between the first visit and death - 3 months - reflects in-time referrals.The PCU does not start prescriptions for potent opioids (AU)

Inhibitory effect of peak 2-4 of uremic middle molecules on platelet aggregation.

It is well-known that uremic patients present prolonged bleeding times as a common complication. Factors responsible for this disorder have been extensively investigated. In order to elucidate the possible role of uremic middle molecules as responsible for the bleeding tendency observed in uremia, we have studied the effect on platelet aggregation of middle molecules obtained from uremic plasma by Sephadex and ion-exchange chromatography. Our results show that some purified middle molecular fractions have a specific inhibitory activity on platelet aggregation and suggest an important role for these compounds in the pathogenesis of uremic bleeding.

Changes in body compartments on different types of haemodialysis.

Changes in plasma volume (PV), extracellular volume (ECV) and intracellular volume (ICV) were studied in seven patients on conventional haemodialysis (HD) and in six patients on stable hypertonic HD. Weight loss and ultrafiltration were similar in both groups. Before HD the spaces of 125RISA (PV), 35SO4Na2 (ECV) and 3H2) (total body water, TBW) were simultaneously determined ICV = TBW - ECV. At the end of HD the space of 35SO4Na2 was again tested. PV and ECV diminished more on conventional HD than on hypertonic HD, whereas ICV increased on conventional HD and decreased on hypertonic HD. The handling of plasma osmolality during HD is an effective method for modifying transcompartmental body fluid shifts in HD by distributing weight loss between intracellular and extracellular spaces allowing for a better maintenance of plasma volume.