Calidad de las espirometrías en Atención Primaria en Cantabria 10 años después. Estudio EspiroCan / Quality of spirometry in Primary Care in Cantabria 10 years later. EspiroCan Study

INTRODUCCIÓN: Estudiar la calidad de las espirometrías realizadas en el ámbito de Atención Primaria de la Comunidad de Cantabria y el grado de cumplimiento de la normativa de dicha técnica de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). MATERIAL Y MÉTODOS: Estudio descriptivo transversal en la Comunidad de Cantabria mediante cuestionario original basado en la última normativa SEPAR. El cuestionario se distribuyó en 2018 por correo interno a los 42 Centros de Salud del Servicio Cántabro de Salud que disponen de espirómetro tras contacto personal o vía telefónica de los investigadores con los coordinadores de los Centros de Salud y responsables de enfermería. Se trata de una encuesta original, basada en las normativas de la SEPAR, con la que se evalúa la calidad del material empleado (modelo, años de funcionamiento, calibración, limpieza), así como la formación del personal que realiza las espirometrías. RESULTADOS: Se ha encuestado al personal sanitario responsable de realizar las espirometrías en los 42 Centros de Salud del Servicio Cántabro de Salud de todo el territorio cántabro, en el que se realiza una media de 564 espirometrías al mes. Un 13% de los espirómetros no se calibran nunca. Tan solo el 10,5% de los espirómetros son calibrados por el personal que realiza la prueba en el propio centro. El 53,7% de estos profesionales (N54) nunca han recibido formación específica para realizar espirometrías, y solo el 3,8% de ellos tienen experiencia en realizar la prueba, como recomienda la SEPAR. En cuanto a la limpieza de los aparatos un 30% de los técnicos no limpia el espirómetro ni el adaptador que lo une a la boquilla. CONCLUSIONES: Diez años después de nuestro estudio inicial seguimos observando un déficit de formación de nuestros profesionales de Atención Primaria, lo que podría poner en duda la validez de las espirometrías

INTRODUCTION: To study the quality of spirometry performed in Primary Care in Cantabria (Spain) and the level of compliance with the regulations of this technique of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR). MATERIAL AND METHODS: Cross-sectional descriptive study in the Community of Cantabria using an original questionnaire based on the latest SEPAR regulations. The questionnaire was distributed in 2018 by internal mail to the 42 Primary Care Centres of the Cantabrian Health Service, with the coordinators of the PCC and the nurses responsible having been personally contacted by the researchers or by telephone. This is an original survey, based on the regulations of the SEPAR, which evaluates the quality of the material used (model, years of operation, calibration, cleanliness), as well as the training of personnel who perform spirometry. RESULTS: The health personnel responsible for performing spirometry were surveyed in the 42 Primary Care Centres of the Cantabrian Health Service throughout the Cantabrian area. A mean of 564 spirometries are performed per month. A significant number (13%) of spirometers are never calibrated, and only 10.5% of the spirometers are calibrated by the personnel who perform the test in the centre itself. More than half (54, 53.7%) of these professionals have never received specific training to perform spirometry, and only 3.8% of them have experience in performing the test as recommended by SEPAR. As for the cleaning of the devices, 30% of the technicians do not clean the spirometer or the adapter. CONCLUSIONS: 10 years after our initial study lack of training is still being observed in the professionals, and probably translates into invalid spirometry

[Quality of spirometry in Primary Care in Cantabria 10 years later. EspiroCan Study]. / Calidad de las espirometrías en Atención Primaria en Cantabria 10 años después. Estudio EspiroCan.

INTRODUCTION: To study the quality of spirometry performed in Primary Care in Cantabria (Spain) and the level of compliance with the regulations of this technique of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR). MATERIAL AND METHODS: Cross-sectional descriptive study in the Community of Cantabria using an original questionnaire based on the latest SEPAR regulations. The questionnaire was distributed in 2018 by internal mail to the 42 Primary Care Centres of the Cantabrian Health Service, with the coordinators of the PCC and the nurses responsible having been personally contacted by the researchers or by telephone. This is an original survey, based on the regulations of the SEPAR, which evaluates the quality of the material used (model, years of operation, calibration, cleanliness), as well as the training of personnel who perform spirometry. RESULTS: The health personnel responsible for performing spirometry were surveyed in the 42 Primary Care Centres of the Cantabrian Health Service throughout the Cantabrian area. A mean of 564 spirometries are performed per month. A significant number (13%) of spirometers are never calibrated, and only 10.5% of the spirometers are calibrated by the personnel who perform the test in the centre itself. More than half (54, 53.7%) of these professionals have never received specific training to perform spirometry, and only 3.8% of them have experience in performing the test as recommended by SEPAR. As for the cleaning of the devices, 30% of the technicians do not clean the spirometer or the adapter. CONCLUSIONS: 10 years after our initial study lack of training is still being observed in the professionals, and probably translates into invalid spirometry.

Treatment of Bolivian mucosal leishmaniasis with miltefosine.

BACKGROUND: Although mucosal leishmaniasis is a prominent disease, it has been studied only to a limited extent. It is classically treated with parenteral antimony or, as a last resort, amphotericin B. METHODS: We treated Bolivian mucosal leishmaniasis due to Leishmania braziliensis with the oral agent miltefosine, 2.5 mg/kg/day for 28 days, and followed-up for 12 months. RESULTS: Seventy-two patients were evaluable. The cure rate for the 36 patients who had "mild" disease (i.e., affecting nasal skin and nasal mucosa) was 83%. The cure rate for the 36 patients who had more extensive disease (involving the palate, pharynx, and larynx) was 58%. Patients refused to be randomized to parenteral agents, but the cure rate for an almost contemporary group who was receiving amphotericin B (45 mg/kg over 90 days) was 7 (50%) of 14. CONCLUSIONS: In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.