ABSTRACT
INTRODUCTION: The medical conditions shared by hospital emergency services and community-hospital neurology clinics (CHNC) have not been described, and the quality of the medical care received in these conditions has not been evaluated in our environment. METHODS: Over a 2 month period, those patients presenting at any of the seven CHNC in a Health Care Area 1 of Madrid due to previously attended medical conditions in the emergency services were systematically registered. The area neurologists of the CHNC collected administrative and clinical variables and made a judgment on the medical care (primary outcome measure) and diagnoses (secondary outcome measure) received. RESULTS: A total of 181 patients were included (mean age: 58 years; 60% women). The inclusion rate was one patient per working day, and 31% of patients were visited out of the established quota number of patients for the clinic. The most frequent reasons for visiting the emergency room were: headache (20%), focal neurological syndrome (16%) and loss of consciousness (14%). The most frequent diagnoses at the CHNC were: primary headache (19 %), stroke (11%) and epilepsy (9 %). Emergency care was deemed correct in 56 % of patients. When the patients with intervention were compared to those with no intervention, participation of the neurology service in the emergency room was associated to a greater percentage of correct diagnoses (59% vs. 41%; p=0.019) and care (69% vs. 47%; p=0.003). CONCLUSIONS: The medical conditions shared with the emergency services represent a small but relevant proportion of the patients assisted in the CHNC. Some of these conditions (primary headaches, syncopes) should be canalized into primary health care. Others (epilepsy) require a circuit between emergency room and CNNC, but the appointment system should be adapted. The intervention of a neurologist in the emergency room raises the quality of the care.
Subject(s)
Emergency Service, Hospital/standards , Hospitals, Community/standards , Nervous System Diseases/therapy , Aged , Female , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Quality of Health Care , SpainABSTRACT
El quilotórax es una complicación conocida, aunque poco frecuente de algunas neoplasias entre las que se incluye el linfoma. La pérdida continua de quilo induce un profundo deterioro del estado nutricional e inmunológico de los pacientes, que sólo puede evitarse mediante un soporte nutricional adecuado y precoz. Su manejo es motivo de controversia, en particular en relación al tipo de soporte nutricional más adecuado y a la conveniencia del tratamiento conservador frente al quirúrgico.Presentamos el caso de un paciente de 41 años diagnosticado de quilotórax secundario a linfoma B en el que se mantuvo un soporte nutricional mixto (nutrición enteral exenta de grasas vía oral y nutrición parenteral total) y posterior pleurodesis con talcaje, con resultados óptimos. Revisamos la literatura y discutimos los aspectos más controvertidos de su manejo (AU)
Chylothorax is a well-known, albeit infrequent, complication in certain neoplasias including lymphomas. The continuing loss of chyle leads to a profound deterioration in patients nutritional and immunological status, prevented only by appropriate early nutritional support. There is currently some dispute over its handling, particularly with regard to the most appropriate type of nutritional support and the suitability of conservative treatment versus surgery. The present paper describes the case of a 41-year-old patient diagnosed as having secondary chylothorax following B-cell lymphoma where mixed nutritional support (fat-free enteral nutrition by mouth and total parenteral nutrition) was given, followed by talc pleurodesis, with optimal results. There is a review of the literature and a discussion of the most controversial aspects of its management (AU)
