Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care.

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE: To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS: A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS: Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS: The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation.

OBJECTIVE: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. DESIGN: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. STUDY SCOPE AND SUBJECTS: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. RESULTS: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition.

Metallic species in atmospheric particulate matter in Las Palmas de Gran Canaria.

In this work, we quantified the total, water-soluble and insoluble fractions of 12 metallic species (Na, Ca, K, Mg, Fe, Zn, Cr, Ni, Cu, Cd, Pb and Mn) present in total suspended particulates (TSP) in an urban area with heavy traffic (about 80 000 vehicles/day) of Las Palmas de Gran Canaria (Canary Islands). Experimental measurements were made from July to December 2003 on a total of 42 samples (7 per month). Particulate matter (TSP) was collected in fiber filters and high volume samplers. PM10 levels were estimated assuming the PM10 fraction is about 70% of all TSP. Total fractions was determined gravimetrically. Water-soluble fraction was extracted by sonication. Concentrations of metallic elements were analyzed by flame atomic absorption spectrophotometer. Temporal changes in the concentrations of the target elements were examined and a multivariate approach used to identify the primary sources for each species. Mean value for TSP is 71.92microg/m3. The water-soluble fraction consisted mainly of Na, Ca, Mg, and K. The insoluble fraction contained higher concentrations of all elements than the soluble except Na. In the water-soluble fraction, Na, K, Ca and Mg were found to come mainly from natural sources; Cr, Pb, Cd, Ni, Zn and Cu from anthropogenic sources.

Polycyclic aromatic hydrocarbons in ambient air particles in the city of Las Palmas de Gran Canaria.

Concentration levels, seasonal variation and winter/summer ratios of 11 polycyclic aromatic hydrocarbons (PAHs) in the TSP of Las Palmas de Gran Canaria city were determined. The study area is under the influence of heavy traffic (80000 vehicles/day). Pyr/BaA, Pyr/Flt, B(ghi)P/I(cd)P and B(b+k)F/B(ghi)P ratios were calculated; the values of these two last suggest a strong influence of diesel fuel burning. Levels of TSP and TSP-bound PAHs were also established. The hazard potential of PAHs in terms of carcinogenicity of BaP is acceptable. Potential risk on the basis of TEFs is also studied.

[Prevalence of asthma in schoolchildren from the Mexican city Hermosillo]. / Prevalencia de asma en niños escolares de la ciudad mexicana de Hermosillo.

Asthma is a very common disease, but its prevalence greatly varies from region to region, even in the same country. In the northwest of Mexico there is a lack of epidemiological studies on this disease. In this work a standardized questionnaire (ISAAC) was applied to parents of children attending 8 primary schools in the Mexican city of Hermosillo, Sonora. Of 3000 questionnaires sent, 1489 (49%) were acceptably answered. Children were of either sex and 9.1 +/- 1.8 years old (mean +/- SD). From this population, 74 (10.4%) out of 713 male and 67 (8.6%) out of 776 female children had an affirmative response to que question "Have you ever had asthma?", from which we conclude that global prevalence of asthma in the studied sample was 9.5%, an intermediate figure among those reported from other studies performed in Mexico.

[Epidemiologic monitoring system for the diabetic patient; use of computerized technology in the quality of medical care]. / Sistema de vigilancia epidemiológica para el paciente diabético; el uso de tecnología computacional en la calidad de la atención médica.

OBJECTIVE: To describe an instrument for epidemiologic surveillance of diabetes mellitus and evaluating the quality of care in primary health care. MATERIAL AND METHODS: The study was conducted from January 1, 1998, to June 30, 1999, at the Epidemiology and Health Services Research Unit of the Mexican Institute for Social Security (IMSS), in Hermosillo, Sonora. A single data collection form was designed, which contains items included in the diabetes care clinic of the Unit of Family Medicine of the Mexican Institute of Social Security. RESULTS: We developed and implemented a software program to enter data from the paper format and to generate individual and group reports on attendance to scheduled medical visits, medical history, evolution of signs and symptoms, laboratory tests, and medication. CONCLUSIONS: Electronic data systems allow the availability of reliable and continuing information for surveillance of the comprehensive care of the diabetic patient.

[Acceptance and use of medicinal plants in family medicine]. / Aceptación y uso de herbolaria en medicina familiar.

OBJECTIVE: To explore the degree of usage of therapeutic medical plants among the patients, physicians and health workers in a local Family Medical Care Unit of the Mexican Institute of Social Security (IMSS)). MATERIAL AND METHODS: A transversal descriptive study was performed. A questionnaire focusing on two variables was designed and validated. It was applied to 60 family physicians, a randomized sample of 130 health workers and another of 264 patients of the Family Mediccal Care Unit. Response percentage was 78%. RESULTS: The study found that 83% of family physicians accept the therapeutic use of herbal medicine; moreover, 75% use it as a therapeutic resource. Among health workers, acceptance and use was 100%, while in patients the level of acceptance was of 92% and of use it was 90%. Differences between groups are significant (p < 0.05). The more frequently used plants are Gordolobo (Gnaphalium sp.), Eucalyptus (Eucalyptus sp., probably E. globulus), spearmint (Mentha sp.), camomile (Matricaria chamomilla) and prickly pear cladodes (the vegetative parts of the prickly pear, Opuntia sp. Probably Opuntia ficus indica). CONCLUSIONS: This information agrees with previous reports about Mexico, however, in this case, data were gathered in urban areas where physicians have been trained in the biomedical paradigm of medicine.

HLA-A*9, a probable secondary susceptibility marker to ankylosing spondylitis in Basque patients.

HLA-B27 is strongly associated to ankylosing spondylitis (AS). The objective of our study was to analyze HLA-B27 association, B27 subtype distribution and frequency of other HLA class I and DR antigens in a group of Basque AS patients. HLA class I antigens were typed serologically and HLA-B27 and A9 subtypes were determined by DNA typing in samples from 46 patients with AS, 54 B27-positive spondyloarthropathies, 82 healthy subjects and 20 B27-positive controls. A class I HLA 9.2 kb PvuII restriction fragment length polymorphism (RFLP), previously associated with AS, was analyzed in a representative group of patients and controls. We found that HLA-B*2705 conferred a relative risk of 126 for AS in this group. HLA-A9 (A*2402) allele was significantly increased in AS patients compared with healthy controls and B27-positive control group (Pcorr<0.0001) and also increased in patients affected with peripheral arthritis. No association between class I HLA 9.2 Kb RFLP and AS was found. These results suggest that HLA-A*9 allele itself or another linked gene could act as a secondary and independent susceptibility allele to AS.

An immunogenetic study of familial scleroderma.

OBJECTIVE: To study the role of the HLA system in the genetic susceptibility to familial systemic sclerosis (SSc). METHODS: HLA class I antigens were determined by classic serological methods and HLA-DRB, -DQA and -DQB genes were analysed by genetic typing in 36 individuals belonging to two families with several individuals affected by SSc. RESULTS: The results did not show any association of the inheritance to SSc with any particular HLA allele in these families but revealed a striking frequency of ANA autoantibodies in healthy spouses of the members of these families. CONCLUSION: The otherwise infrequent familial incidence of SSc does not appear to be primarily linked to the HLA system in this study but it is suggested that other unknown exogenous environmental factors could be implicated in the development of the disease in families.

Dehiscencia de la sutura anastomótica del colon. Revisión de 25 dehiscencias en 100 pacientes operados de colon / Dehiscence of colon anastomotic suture

Se hace un estudio de 100 pacientes operados de colon con resección y anastomosis primaria, por distintas patologías, encontrándose un 25 porciento de dehiscencias con una mortalidad del 32 porciento a consecuencia de las mismas. A las patologías tumorales e inflamatorias les correspondió el 84 porciento de la dehiscencias. La anemia, la hipoproteinemia y la diabetes fueron factores importantes de esta complicación. Los operados de urgencia (sin preparación) presentaron un índice mayor de morbilidad y mortalidad, que los operados electivamente (preparados). La preparación rápida resultó ser más eficaz que la prolongada y la asociación de sulfatalidina y neomicina las drogas más eficaces. Se observó una mayor frecuencia de dehiscencia en el colon izquierdo y una mayor mortalidad en el colon derecho. La taquicardia, fiebre, dolor y diarrea fueron los síntomas más relevantes (AU)

Carcinomas múltiples de colon (Sincrónicos y Metacrónicos); reporte de un caso / Colon multiple (synchronous and metachronous) carcinomas. One case report

Se revisan brevemente los carcinomas múltiples y entre ellos los de colon. Se presenta un paciente con lesiones múltiples de este órgano donde fueron descubiertos 3 en el colon transverso con características de tener posiblemente orígenes distintos; y una nueva lesión, 4 1/2 años después, de reciente formación y con toda certeza de distinto origen. Se revisan los criterios exigidos actualmente para aceptar las lesiones sincrónicas y metacrónicas. Se ilustran los estudios histológicos de los distintos tumores (AU)

Mortalidad por dehiscencia de la sutura de colon. Revisión de 100 casos / Mortality for dehiscence of colon suture. One-hundred case review

Se estudian 100 pacientes operados de colon con resección y anastomosis primaria por distintas patologías. Se analizan las dehiscencias de las suturas encontradas en la serie y los pacientes que fallecieron a consecuencia de las mismas. Se valora la anemia, proteínas séricas y patologías asociadas en los fallecidos, el material y tipo de sutura empleados, enfatizándose en la preparación del colon. Se observa una mayor frecuencia de dehiscencias en el colon izquierdo y una mayor mortalidad en el colon derecho. La causa más frecuente de mortalidad por dehiscencia lo constituyó la peritonitis generalizada (AU)

Frecuencia de metástasis tireocervicales con tiroides no aumentado: revisión estadística / Incidence of thyrocervical metastases with non-increased thyroid: a statistical review

Se presenta 31 operados de carcinoma del tiroides en los que el tipo papilar constituyó casi la mitad de la serie (49 porciento). Se seleccionaron las distintas variedades para tres grupos, según la relación entre volumen de la glándula, y existencia de metástasis cervicales o no de la operación. Se estudió el grupo en que la glándula era normal y había una o más metástasis en el cuello en el momento de la intervención, que en ocasiones tenían hasta 10 años de evolución. Se señalan los diagnósticos que se hicieron de las mismas, valor del gammagrama, tipo de intervención quirúrgica y evolución de los operados que pudieron ser chequeados (AU)