[Protocol of pre-surgical neurophysiological evaluation in epilepsy resistant to treatment]. / Protocolo de evaluación neurofisiológica prequirúrgica en epilepsia resistente a tratamiento.

INTRODUCTION: Nowadays approximately twenty per cent of epileptic patients who are on a pharmacological treatment carry on their fits. Their instability can be eliminated with an operation in any center that is specialized in epileptic surgery. The center must have a cross disciplinary team. DEVELOPMENT: The ideal operation is one that only eliminates the tissue needed to end up with the fits The main goal of the neurophysiological evaluation is to delimit the cerebral area that generates an epileptogenic activity so as to be able to eliminate it without causing further damage. We present a medical record of pre-surgical neurophysiological evaluation that we would like to put into practice in our department in coordination with the services of neurology, radiodiagnosis, and neurosurgery. This medical record contains the following sections: 1. Selection of patients. 2. Non invasive pre-surgical evaluation. 3. Invasive pre-surgical evaluation. 4. Postsurgical evaluation. The invasive pre-surgical evaluation constitutes the most interesting part of the whole process, it allows thanks to intracranial registers to locate accurately epileptogenic focuses; what is more, it allows to carry out a functional mapping of areas that cannot be explored with surface techniques; and finally this evaluation allows to open new fields of investigation about the way in which the encephalon works. CONCLUSION: Epilepsy surgery is a subject to develop in Spain in which the neurophysiologic exploration is something essential.

[Referrals from primary care to pneumology: influence of attendance patterns and specialisation]. / Derivaciones desde atención primaria a neumología: influencia del modelo asistencial y especialización.

OBJECTIVE: To study the number and quality of the referrals from primary care to pneumology. To analyse their relationship to specialist medical training and the attendance pattern. DESIGN: A descriptive, retrospective study. SETTING: A Pneumology Clinic at the Peripheral Specialities Centre at Cartuja (Granada). PATIENTS AND OTHER PARTICIPANTS: 597 referrals were gathered. These were for all the patients referred from primary care to this clinic from may to december 1992. MEASUREMENTS AND MAIN RESULTS: The overall population referral rate per 100,000 inhabitants and month of study was 39.73. The out-clinic doctors referred twice as many patients as health centre (HC) doctors, with OR = 2.01 (1.70 < OR < 2.36). Taken together, general physicians referred three times more than family doctors, with OR = 3.04 (2.54 < OR < 3.78). Regarding the quality of the referral documents, HC doctors accompanied a referral with sufficient information eleven times more often than out-clinic doctors, with OR = 11.38 (6.13 < OR < 21.47). Family doctors contributed this "correct" information thirteen times more often than general physicians without specialist training: OR = 13.50 (8.06 < OR < 22.67). CONCLUSIONS: The number and quality of referrals appear to be closely related to the attendance pattern and in particular to the specialist training of health professionals.