[Interobserver agreement in reading tuberculin tests]. / Estudio de la concordancia interobservador en la lectura de la prueba de la tuberculina.

BACKGROUND: The aim of the study was to evaluate the variability between four observers in the reading of the tuberculin test (TT). METHODS: The study was carried out in the Centro de Salud Mendiguchía Carriche (Madrid) 72 subjects. By direct inspection, four observers read tuberculin determination (skin induration) independently in each subject. To assess variability, the kappa index (K) was calculated. RESULTS: On considering the variable as a dichotomous one, with a cut-off point of 5 mm was 0.88; and of 10 mm, 0.78. Upon considering the index as qualitative in four categories the kappa index in 0 mm was 0.89; in 1-4 mm, 0.24; in 5-9 mm, 0.40 and greater than 9 mm, 0.79. In eight of the subjects studied, the variability observed in reading the test had conditioned further different clinico-epidemiologic attitudes. CONCLUSIONS: The degree of concordance when reading TT is significantly lower at the 1-4 mm and 5-9 mm intervals.

[A prospective study on the time elapsed until admission at the coronary unit of patients with acute myocardial infarct. Apropos of 180 cases]. / Estudio prospectivo sobre el tiempo transcurrido hasta el ingreso en la unidad coronaria de los enfermos con infarto agudo de miocardio. A propósito de 180 casos.

We have carried out a prospective study to evaluate the time from the onset of symptoms until the admission to coronary care unit in 180 patients with acute myocardial infarction. We have evaluated the causes resulting in a delay and their consequences on the prognosis. The data were obtained with a clinical questionnaire from the patients and/or his family and from a review of the clinical records. The mean time since the onset of symptoms until the admission to the coronary care unit was 5.4 hours, being significantly shorter in the patients who did not call for prehospital attention. The major delay was attributable to the patient (delay in asking for medical attention); therefore, it is mandatory to implement measures of health education. Prehospital attention did not provide any diagnostic or therapeutic improvement in 30% of patients. Thus, we suggest that community care education on coronary artery disease should be improved.