¿Podemos mejorar el tratamiento de los síndromes coronarios agudos en la atención primaria? / Can we improve the management of acute coronary syndromes in primary care?

ObjetivoEvaluar un plan de formación sobre el tratamiento del síndrome coronario agudo (SCA) en la atención primaria.DiseñoEstudio transversal comparativo antes-durante-después.EmplazamientoÁreas de salud de Lleida, Alto Pirineo y Arán del 2003 to 2006.ParticipantesPacientes con SCA atendidos en la Unidad de Medicina Intensiva y la Unidad Coronaria del Hospital Universitario Arnau de Vilanova de Lleida, ingresados tras un contacto previo con la atención primaria en su domicilio, consultorio local o centro de salud.IntervencionesPlan de formación dirigido a establecer unos protocolos de actuación en los SCA asistidos en la atención primaria (administrar ácido acetilsalicílico, nitroglicerina y cloruro mórfico, realizar un electrocardiograma y establecer una vía venosa permeable, y agilizar los tiempos asistenciales).Medidas principalesSe analizó la tendencia lineal en los 3 períodos de estudio a través de la razón de prevalencias y el test de tendencia lineal.ResultadosLa intervención consiguió un incremento estadísticamente significativo y lineal en la aplicación de todas las medidas terapéuticas propuestas, a excepción de la nitroglicerina, que partía del nivel basal más elevado. La realización de un electrocardiograma consiguió niveles casi óptimos. Los tiempos asistenciales contemplados mejoraron sensiblemente.ConclusionesLos planes de formación constituyen un instrumento útil para mejorar la asistencia de los SCA en la atención primaria. Adelantar el diagnóstico y el inicio del tratamiento debería redundar en una disminución de su morbimortalidad(AU)

ObjectiveTo evaluate a training programme in the primary care of acute coronary syndrome.DesignA before-during-after comparative cross-sectional study.SettingHealth areas of Lleida, High Pyrenees and Aran (Spain), from 2003–2006.ParticipantsPatients with acute coronary syndrome admitted to the intensive medicine unit and the coronary unit of the Arnau de Vilanova University Hospital of Lleida after being referred from home, general practitioner or health centre.InterventionA training program was introduced to establish protocols of pre-hospital performance in acute coronary syndrome (the administration of acetylsalicylic acid, nitroglycerin and morphine chloride, the performing of an electrocardiogram, the insertion of an intravenous tube and to speed up care times).Main measuresLinear trend of the three periods of the study was analyzed through prevalences ratio and linear trend test.ResultsThe intervention showed a statistically significant linear increase in the application of the aforementioned therapeutic procedures, with the exception of nitroglycerin, which started out with a higher baseline level, and an improvement of care times. The application of an electrocardiogram obtained almost optimal levels. Care times considerably improved.ConclusionsTraining programs are a useful tool in improving treatment of acute coronary syndromes in primary care. Advance diagnosis and an early start to treatment almost certainly results in a decrease of its morbidity-mortality(AU)

[Can we improve the management of acute coronary syndromes in primary care?]. / ¿Podemos mejorar el tratamiento de los síndromes coronarios agudos en la atención primaria?

OBJECTIVE: To evaluate a training programme in the primary care of acute coronary syndrome. DESIGN: A before-during-after comparative cross-sectional study. SETTING: Health areas of Lleida, High Pyrenees and Aran (Spain), from 2003-2006. PARTICIPANTS: Patients with acute coronary syndrome admitted to the intensive medicine unit and the coronary unit of the Arnau de Vilanova University Hospital of Lleida after being referred from home, general practitioner or health centre. INTERVENTION: A training program was introduced to establish protocols of pre-hospital performance in acute coronary syndrome (the administration of acetylsalicylic acid, nitroglycerin and morphine chloride, the performing of an electrocardiogram, the insertion of an intravenous tube and to speed up care times). MAIN MEASURES: Linear trend of the three periods of the study was analyzed through prevalences ratio and linear trend test. RESULTS: The intervention showed a statistically significant linear increase in the application of the aforementioned therapeutic procedures, with the exception of nitroglycerin, which started out with a higher baseline level, and an improvement of care times. The application of an electrocardiogram obtained almost optimal levels. Care times considerably improved. CONCLUSIONS: Training programs are a useful tool in improving treatment of acute coronary syndromes in primary care. Advance diagnosis and an early start to treatment almost certainly results in a decrease of its morbidity-mortality.

Intoxicación aguda por organofosforados tras ingestión de fruta fresca: ¿síndrome intermedio? / Acute orgonophosphate poisoning after fruit intake: an intermediate syndrome?

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