[Care for the terminal cancer patient in a primary care district]. / Atención al paciente oncológico terminal en un distrito de atención primaria.

OBJECTIVE: To analyse medical care for terminal cancer patients (TCP) in a health district. DESIGN: A descriptive, crossover study. SETTING: primary care in an urban environment. PATIENTS: 227 patients who died of cancer between January 1994 and June 1995 and who came under the nine primary care teams (PCT) studied. MEASUREMENTS AND MAIN RESULTS: Information bases: mortality records and clinical histories from the PCT. VARIABLES STUDIED: age, sex, type of tumour, date of diagnosis of terminal illness, whether treated or not with morphine and (if so) the doses, place of death and the care activity engendered. Univariant analysis with standard means and deviations for the quantitative variables, frequencies for the qualitative ones and the Chi squared test for comparison. 64% were male. Most common neoplasias were, in order: lung, colon and stomach. 78 patients (49%) received morphine treatment, datum related to age. Average morphine dose was 80 mg in 24 hours. CONCLUSIONS: Patient treatment was inadequate because morphine, the lodestone of terminal cancer care, was insufficiently used. In contradiction with WHO recommendations, most patients died in hospital. Specific training programmes should be created for PC professionals with the aim of improving their handling of terminal cancer patients.

[HIV/AIDS infection in Area 11 of Madrid: a panorama from the primary care viewpoint]. / La infección VIH/sida en el Area 11 de Madrid: una panorámica desde la atención primaria.

OBJECTIVES: To find the clinical and epidemiological characteristics of HIV-positive patients and to study the possible differences between patients attended by primary care teams (PCT) and by the hospital specialist unit (SU). DESIGN: A descriptive cross-sectional study. SETTING: Six PCTs in Villaverde, Usera and Carabanchel (Madrid). PATIENTS: Those infected with HIV and in the morbidity records between January 1992 and January 1995. MEASUREMENTS AND MAIN RESULTS: 274 cases were studied. The most important risk practice was being IDU (intravenous drugs user) (80.3%). The most definitive and linked AIDS-related illness was Tuberculosis (39.7%). Patients treated with Zidovudine (or AZT) were monitored by PCTs (p = 0.004), as were those not needing day-hospital treatment (p = 0.0005). CONCLUSIONS: HIV infection in our environment follows the typical clinical and epidemiological pattern of this country: transmitted by IDUs, with its most frequent associated infection being tuberculosis. With the exception of AZT or day-hospital treatment, its clinical and epidemiological features are similar in PCTs and SUs. Information and responsible participation of PCT professionals in caring for HIV-positive patients are the key strategies for guaranteeing the quality of health care delivery.

[Dynamic high-contrast computed tomography in the diagnosis of pancreatic necrosis]. / Tomografía computada dinámica de alto contraste en el diagnóstico de necrosis pancreática.

UNLABELLED: This work intended to find out whether dynamic high-contrast computed axial tomography (CAT scan) in effective and more useful than conventional computed tomography for the diagnosis of pancreatic necrosis in patients with severe acute pancreatitis. BACKGROUND: Although many methods have been used to predict the severity and extent of pancreatic necrosis, few studies have assessed computed tomography. METHODS: Longitudinal, prospective and comparative study was performed on consecutive patients with severe acute pancreatitis in which dynamic high-contrast computed tomography and conventional computed tomography were carried out. RESULTS: In pancreatic necrosis, pancreatic densities were lower. Necrosis by itself was also associated with higher severity scores, but not with a higher mortality rate. However, mortality rates were influenced by the extent of pancreatic necrosis. Sensitivity of 100%, specificity of 68%, positive predictive and negative predictive values of 100 and 42% were achieved. STATISTICS: Densities of TCNL and TCAC were analyzed using student's t test of independent samples. The correlation of the aorta/pancreas index and the presence of necrosis was analyzed using a linear correlation test. CONCLUSIONS: The authors conclude that dynamic high-contrast computed tomography is more effective than conventional computed tomography in diagnosing pancreatic necrosis. Moreover, the diagnosis of pancreatic necrosis and its extent makes it possible to formulate a prognosis as to severity of the disease.