[A multicenter study of emergencies in basic general hospitals in Catalonia]. / Estudio multicéntrico de las urgencias en hospitales generales básicos de Catalunya.

The demand of the hospital emergency services was evaluated by the analysis of 11650 emergencies seen during one week in 22 county hospitals. A modified ICHPPC-2 was used for the codification of diagnoses. The mean age of the patients was 30.6 years. The distribution through the days of the week was homogeneous and the duration of the hospital stay was lower than 2 hours in 85%. 80% of the patients went to the hospital by their own decision. The emergency cases were considered as non-justified in 22.4%, mild emergencies in 56.5%, and severe emergencies in 17%. 75.9% of patients were sent back to their homes, and 11.8% were admitted to the hospital. The predominant groups of emergencies were trauma (33.9%), respiratory diseases (11.8%), ill-defined signs and symptoms (9.3%), and osteomuscular (6.7%), digestive (5.8%) and infective (4.7%) diseases. The indispensable requirements to be collected for a better knowledge of emergency services are evaluated.

[The COMBELL project. Analysis of the medical clinical competence]. / El proyecto COMBELL. Un análisis de la competencia clínica médica.

BACKGROUND: The most frequent tests for evaluate medical education in Spain, do not analyze clinical competence. The aims of this project was to introduce a method for the assessment of clinical skills using the simulation methodology with standardized patients. METHODS: All 83 first-year medical residents were evaluated. Three evaluation exercises were used in all study. The first was 10 standardized patients encounters, the second was 100 multiple choice questions, and the third 60 clinical images. Sixty-four last year medical students were evaluated using the same 10 standardized patients. RESULTS: The global mean score for the residents was 56.7% for all the encounters, and was lower in physical examination and patients notes. The global mean score for the students was 57.1% and was also lower in physical examination. We did not find correlations between clinical competence assessment, multiple choice-questions, MIR exam and clinical images. CONCLUSIONS: Our results show that: this assessment method was successful; the clinical competence levels of our residents and students, and the lack of statistical correlation between this method and other methods, which, basically analyze cognitive capacities.

[Inflammatory response, cholesterol metabolism, and arteriosclerosis]. / Respuesta inflamatoria, metabolismo del colesterol y arteriosclerosis.

The goal of the present review consists on the relationship between inflammatory disorders, such as that represented by systemic granulomatous diseases like sarcoidosis, and the cholesterol metabolism and its implication in the atherosclerosis process. Serum amyloid A is an acute phase reactant that transiently binds to the high density lipoproteins during an inflammatory response. Serum amyloid A may act either displacing apo A-I, which in turn result in increased catabolism of high density lipoproteins, or inhibiting lecithin-cholesterol acyltransferase activity which leads to low levels of esterified serum cholesterol. This lipoprotein alteration together with a direct effect of the serum amyloid A on the endothelium of the atheromatous plaque suggest a potential pathophysiological link between the inflammatory responses expressed by the serum concentrations of amyloid A and the development of the atherosclerotic process.

[Massive hemoptysis secondary to mycotic aortic aneurysm]. / Hemoptisis masiva secundaria a aneurisma micótico aórtico.

A case of aortic aneurysms caused by fungus, following a sepsis of prostatic origin which produced the death of the patient after a massive hemoptysis, is presented. The postmortem study showed an aortic-pulmonary fistula as the cause of massive hemoptysis. We comment on the clinical features and the etiology of the different types of mycotic aneurysms. The advances in diagnosis techniques, the suspicion and the medical-surgical therapy are the factors which improved the prognosis of this serious disease.

[Correlation between clinical and autopsy diagnoses at a general hospital]. / Análisis de concordancia entre diagnósticos clínicos y de autopsia en un hospital general.

In the past years, the number of hospital clinical autopsies have significantly decreased, with the risk of loosing some of the functions of this procedure, among which the evaluation of the diagnostic accuracy, which has been considered as a health care quality index, stands out. In this paper, the consistency between clinical diagnosis and autopsies in a general hospital is studied, as well as its association to some potentially relevant factors. We review 91 autopsies performed in patients dying in the Service of Internal Medicine during a period of six years. Each case was classified though consensus among a clinician and a pathologist into: mayor clinicopathological discrepancy, minor discrepancy or complete consistency. The relationship between consistency and age, sex, average length of stay in the hospital and study period was analyzed. The 91 autopsies were performed on 64 men and 27 women. The mean age was 63 years and the average length of study in the hospital was 9.7 days. The global consistency was 71.4%. In 15 (16.5%) cases, a major discrepancy was observed and in 11 (12.1%), a minor discrepancy. No differences were observed in the degree of consistency with respect to age, sex, average length of stay and study period. Cardiovascular diseases showed the greatest proportion of major discrepancies at the expense of three cases of pulmonary thromboembolism. We conclude that the degree of concordance in this study is consistent with other studies and we discuss the relevance of clinical autopsies regarding several aspects of health care.

¿Qué hacen los internistas? Respuestas innovadoras a nuevas necesidades / What do internists do? Innovative answers to new requirements

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Calidad de los informes de alta hospitalaria por embolia pulmonar / Quality of pulmonary embolism's hospital discharge reports

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