Concordancia diagnóstica entre atención primaria y psiquiatra en derivaciones a Centro Comunitario de Salud Mental en Talca / Diagnostic Concordance between Primary Care and psychiatrist in Communitary Mental Health Center in Talca

Psychiatric diseases have a high presence in Chilean population. Most of the cases are treated in the primary care. Despite this, and because of their complexity, some cases need specialist care. Is important the appropriate referral to secondary care which can be measured by the diagnostic concordance. The purpose of this study is to analyze the diagnostic concordance between primary care and the evaluation of Psychiatrists in secondary level at Communitary Mental Health Center (COSAM) in Talca. METHODOLOGY: Cross-sectional descriptive study. All medical files of the patients older than 15 years old treated at COSAM were examined from August 2012 to November 2013. Moreover, the diagnostics of both primary care derivation and Psychiatrists of COSAM were compared with Kappa Index. RESULTS: The general concordance between the diagnostics of primary care level and COSAM was moderated (kappa index: 0.54). Higher in men than in women. The results showed a high concordance in the diagnostic of eating disorders and Dementia, a moderated concordance in the diagnostic of Bipolar Disorder and Panic Disorder. Finally, a low concordance in the diagnostic of General Anxiety Disorder (GAD), Personality Disorder and Major Depressive Disorder.Although the concordance in the derivations to COSAM is moderated, higher than international studies, the concern is in the failure in the diagnostic of the Bipolar Disorder, an inappropriate treatment can be prescribed if there is not a correct diagnostic.

Tratamiento médico del embarazo ectópico no complicado; experiencia del hospital regional de Talca / Medical treatment of uncomplicated ectopic pregnancy: regional hospital of Talca experience

El tratamiento médico del embarazo ectópico (EE) no complicado es una alternativa para el manejo de esta patología. Existen distintos criterios para su uso y las tasas de éxito publicadas son variadas. Realizamos una revisión de 34 casos de pacientes con diagnóstico de EE no complicado en el Hospital Regional de Talca, reportándose una tasa de éxito con dosis única de metotrexato de 65%. Un 20,5% de las pacientes requirieron una dosis adicional de metotrexato. La tasa total de éxito con tratamiento médico alcanzó un 73.5%. El manejo médico es una alternativa efectiva a la cirugía en pacientes bien seleccionadas. Se debe evaluar de manera local los criterios de inclusión para el tratamiento médico del EE no complicado.

Medical treatment of non complicated ectopic pregnancy is an alternative for the management of this pathology. There are different criteria for it's use, and published success rates are heterogeneous. We reviewed 34 cases of patients with diagnosis of no complicated ectopic pregnancy in Hospital Regional de Talca, and we reported a success rate of 65% with a single dose of methotrexate. 20,5% of patients needed an additional dose of medication. The global success rate of medical treatment was 73,5%. No surgical management is an effective alternative for well-selected patients. The criteria for medical treatment of no complicated EE must be evaluated locally.