Comunicación informatizada entre un centro de salud y su hospital de referencia / Computer communication between an ambulatory centre and its hospital of reference

Fundamento. Analizar la demanda de información médica solicitada desde un equipo de atención primaria a su hospital de referencia, durante un periodo de 18 meses. Material y métodos. Pacientes asignados a 5 consultas de un equipo de atención primaria, que tenían abierta historia clínica informatizada en su hospital de referencia. En 1995 se estableció una comunicación informática vía módem, entre dicho equipo y la "Red de Área Local" de su hospital de referencia. Esta conexión permite a los miembros del equipo conocer en tiempo real la historia clínica hospitalaria de sus pacientes (informes, exploraciones complementarias…) y los informes de laboratorio y radiología solicitados desde el equipo de atención primaria. Se analizaron las consultas efectuadas durante un periodo de 18 meses (Marzo 96-Agosto 97). Resultados. Se efectuaron 523 consultas (29,06 mensuales). Un 93,7 por ciento de los pacientes consultados tenían abierta historia clínica informatizada. Los servicios más consultados fueron: Radiología (28,7 por ciento), Laboratorio (25,2 por ciento) y Medicina Interna (16,3 por ciento). Las partes de la historia clínica más consultadas fueron las correspondientes al resultado de pruebas complementarias: radiología simple (27,3 por ciento), hematología y bioquímica (24,7 por ciento), otras exploraciones (23,7 por ciento). Un 67,5 por ciento de las búsquedas fueron consideradas como "resolutivas" por el médico consultante. Se empleó una media de 4 minutos y 13 segundos por consulta. Conclusiones. La información principalmente requerida por el médico de familia fue el resultado de pruebas complementarias y, en particular, de laboratorio y radiología. La comunicación informatizada entre atención primaria y atención especializada va a ser un sistema efectivo y probablemente eficiente para mejorar la comunicación entre ambos niveles (AU)

[Computer communication between an ambulatory centre and its hospital of reference]. / Comunicación informatizada entre un centro de salud y su hospital de referencia.

BACKGROUND: To analyse the demand for medical information requested by a primary care team from its hospital of reference over an 18 month period. MATERIAL AND METHODS: Patients assigned to 5 surgeries of a primary care team, which had computerised clinical records available in its hospital of reference. In 1995 computerised communication via modem was set up between this team and the "Local Area Network" of its hospital of reference. This connection allows members of the team to carry out real time consultations of the hospital clinical records of their patients (reports, complementary explorations...) and the laboratory and radiology reports requested by the primary care team. Consultations made over an 18 month period (March 96 - August 97) were analysed. RESULTS: Five hundred and twenty three consultations were made (29.06 per month). Ninety three point seven per cent of the patients concerning whom consultations were made had a computerised clinical record available. The most consulted services were: Radiology (28.7%), Laboratory (25.2%) and Internal Medicine (16.3%). The most consulted parts of the clinical record were those corresponding to the results of complementary tests: simple radiology (27.3%), haematology and biochemistry (24.7%), other explorations (23.7%). Some 67.5% of the searches were considered "resolutive" by the consulting doctor. An average of 4 minutes 13 seconds were employed per consultation. CONCLUSIONS: The information principally required by the family doctor was the results of complementary tests and, in particular, from the laboratory and radiology. Computerised communication between primary care and specialised care is going to be an effective, and probably efficient, system for improving communication between the two levels.

[Arterial hypertension and lipid metabolism]. / Hipertensión arterial y metabolismo lipídico.

The frequent connection between essential hypertension and lipid metabolism alterations has led doctors to look for possible pathogenic links between them. Common genetic factors as well as exogenous factors, like diet, have been described. The pathogenic mechanisms through which genetic or exogenic causes work, would be changes in cellular functions. This would be especially so in the case of membrane transporters and insulin resistance which may be a consequence, or a cause, of high blood pressure, but which give rise to lipid metabolism alterations. It is advisable to follow dietetic hygiene measures to combat hypertension and dyslipemic disorders, such as: weight loss, reduction of saturated fats fibre intake reduction of salt and alcoholic drinks, abstaining from tobacco and doing regular aerobic exercise. We will choose the drugs whose structure and doses will not alter lipid levels and will increase insulin sensitivity.

Hipertensión arterial y metabolismo lipídico / Hypertension and lipid metabolism

La frecuente asociación entre hipertensión arterial esencial y alteraciones del metabolismo lipídico ha llevado a buscar posibles relaciones patogénicas entre ambas alteraciones. Se han descrito factores genéticos comunes así como factores exógenos, como la dieta. Los mecanismos patogénicos a través de los cuales actuarían las causas genéticas o exógenas serían los cambios en funciones celulares, especialmente alteraciones en los transportadores de membrana y la resistencia insulínica que puede ser consecuencia o causa de la hipertensión arterial, pero que origina también alteraciones en el metabolismo lipídico. Se recomienda seguir medidas higiénico dietéticas para cotrarrestar hipertensión y dislipemia: regulación de peso, reducción de grasas saturadas, aporte de fibra, reducción de sal, reducción de bebidas alcohólicas, supresión del tabaco y desarrollo continuado de ejercicio físico aeróbico. Se elegirán los fármacos que por su estructura o dosificación no alteren o mejoren el perfil lipídico y favorezcan la sensibilidad insulínica (AU)

[The approach to pulmonary ventilation change]. / Aproximación a la alteración ventilatoria pulmonar.

OBJECTIVE: To study the epidemiological behaviour of pulmonary diseases with ventilation disorder to assess their development within primary care. DESIGN: Prospective study. SETTING: Primary care. Tudela West Health Centre (Navarra). PARTICIPANTS: 166 patients with one of the classic patterns of disorder found by Spirometry were chosen and monitored for a year. RESULTS: 72.3% were male with an average age of 63.2. 7.8% were new cases. 62.0% were smokers/ex-smokers. 80.1% had another associated pathology. An overall decrease in ventilatory function values was noted: this was more pronounced in cases of recurrence. 2.08 medicines were used, with smaller FEV1 [correction of FVE1]-fraction of ventricular ejection-leading to more medicines, of which the beta-adrenergics were the most common. 25.3% showed poor therapeutic compliance, deteriorating with age. 55% used inhalers badly. The number of medicines increased with decompensation. There were on average 3.5 consultations per year at the health centre. CONCLUSIONS: Tudela's findings are similar to those in other areas. There is poor therapeutic compliance among people of geriatric age. The burden of control falls on primary care.

Cytogenetic study in peripheral blood lymphocytes from asthmatic patients receiving continued therapy with theophylline.

Possible cytogenetic effects of theophylline have been investigated in asthmatic patients undergoing continuous therapy with this drug. Sister-chromatid exchanges (SCE), chromosome aberrations (CA) and proliferating rate indices (PRI) were evaluated in cultured peripheral blood lymphocytes from patients receiving theophylline alone, theophylline plus inhaled beta 2 adrenergic drugs or theophylline in combination with beta 2 adrenergic agents and corticoids. Two samples from each individual were obtained in order to perform a prospective study: before the theophylline medication (sample A) and at a time after the beginning of treatment (sample B). After treatment (66.3 +/- 37.8 days), an increase in SCE was observed without modifications either in PRI or in CA. Patients receiving beta 2 adrenergics or beta 2 adrenergics plus glucocorticoids before and during theophylline treatment, did not respond differently than those on theophylline alone.

[Rare manifestations of diabetic neuropathy]. / Manifestaciones poco frecuentes de la neuropatía diabética.

Up to 50% of diabetic patients develop neuropathies during their lives. Distal symmetric polyneuropathy is the most frequent variety, but there are other forms that are not exceptional and must be considered for the differential diagnosis of these patients. In this paper, the authors present three clinical cases of rare types of diabetic neuropathy: oculomotor cranial neuropathy (Case 1), diabetic amyotrophia (Case 2) and mixoide type with proximal asymmetrical locomotor neuropathy and distal polyneuropathy (Case 3). Their most relevant clinical characteristics are described, along with their differential diagnosis, evolution and therapeutical alternatives, in order to contribute to a better management of these patients.

[Effects of hypoxia on plasma concentrations and daily elimination of sodium, potassium and chlorine ions]. / Efectos de la hipoxia sobre las concentraciones séricas y la eliminación diaria de los iones sodio, potasio y cloruro.

Serum concentrations of Na+, K+ and Cl- are studied, as well as the elimination of these ions in urine, in patients suffering from chronic respiratory insufficiency, being classified in two groups according to the level of hypoxemia: group A (PO2 less than 6.66 KPa) and group B (PO2 less than 8 KPa). A third group C of healthy patients with analogous anthropological characteristics has served as a control group. The concentrations of serum of the three ions are noticeably similar in the three groups, but the daily elimination of Na+, K+ and Cl- is less in those suffering from respiratory insufficiency than in those of the control group, with significant statistical differences in all cases except with K+ in those suffering from pronounced hypoxemia. On analysing the correlation between the rates of elimination of ions in urine, with the plasmatic values of PO2, PCO2 and [H+] of all the patients studied, the highest values of the Pearson coefficient are found on correlating the elimination of ions with the partial pressures of oxygen, therefore suggesting that hypoxia could be the main motor inducing metabolic changes.

[Primary mediastinal seminoma (apropos of 2 cases)]. / Séminome médiastinal primitif.

Two cases of primary mediastinal seminoma in patients aged 43 and 37 respectively are reported, with remarks on the pathogenesis, clinical features, diagnosis and treatment of the disease and a review of the literature. The favourable outcome in these two cases after 1 and 7 years respectively was remarkable. Emphasis is laid on the value of thoracotomy for the diagnosis and treatment.

[Contribution of iatrogenic pathology to all pleural diseases]. / Contribution de la pathologie iatrogène à l'ensemble des maladies de la plèvre.

The contribution of iatrogenic pathology to all pleural diseases was evaluated in a series of 562 cases by studying pleural effusions or pneumothoraxes induced by medical interventions. Iatrogenic pathology accounted for 5.5% of all pleural diseases (effusion 2.5%, pneumothorax 3%). The medical interventions most frequently responsible for pleural effusion were surgical operations performed in the thorax, but also on abdominal organs located close to the diaphragm. Pneumothorax was almost always induced by diagnostic manoeuvres: essentially needle biopsy and, less frequently, transbronchial lung biopsy under fibroscopy. It must be pointed out that iatrogenic pleural lesions are small and usually asymptomatic.

Effects of chronic hypoxia on kidney function.

Renal disfunctions which appear in the chronic respiratory insufficient patient are analysed, as well as the participation of the arterial blood hypoxemia in their genesis. Renal clearances of Na, K, Cl, Ca, Mg and Pi, and those of urea and creatinine, were lower in 36 patients having chronic hypoxemia than in 15 normosemic controls, showing significant statistical differences for Na, K, Cl, Ca and urea. The correlations between the clearances of these substances and the pO2 arterial blood levels had a greater statistical significance than can be established with pCO2 or [H+] levels. Thus, the existence of a causal dependency between renal disfunction and hypoxemia may be deduced.