El Hospital Militar de la calle dels Tallers de Barcelona (1843-1942) / The Military Hospital in Tallers Street, Barcelona (1843-1942)

La historia de los hospitales militares de Barcelona empieza con la llegada del ejército francés y la ocupación de la ciudad durante la Guerra de la Independencia en 1808. Las necesidades de asistencia a los soldados franceses conllevan la ocupación de varios establecimientos eclesiásticos, como el convento de los Padres de San Vicente de Paúl ubicado en la calle dels Tallers, en febrero de 1809. Pese al fin de la guerra y la marcha del ejército francés, el edificio siguió como hospital hasta 1816, cuando los religiosos volvieron. En 1821 sus propietarios lo cedieron para usos sanitarios con motivo de una epidemia de fiebre amarilla. En 1832 empezó a funcionar como fábrica de tabacos hasta que en 1843 se decidió su utilización definitiva como hospital militar. Durante los cien años siguientes el centro atendió las necesidades del ejército en Barcelona y cesó sus actividades en 1942 con la entrada en pleno funcionamiento de un nuevo hospital militar construido unos años antes. La historia del Hospital Militar de Tallers fue también la de sus médicos y pacientes. Los primeros realizaron además una importante tarea científica que se reflejó en las publicaciones médicas de la época y en numerosas presentaciones académicas. Los segundos constituyeron un grupo de enfermos con necesidades específicas diferenciadas de los pacientes civiles. El conocimiento de la historia del hospital contribuye al conocimiento de la historia de la sanidad militar española en el período de cambio del paradigma médico que acaeció durante su centenaria existencia (AU)

The history of Barcelona's military hospitals starts with the arrival of the French army and the occupation of the city during the War of Independence in 1808. The necessity to care for the French soldiers entailed the occupation of various ecclesiastic establishments, such as the Convent of Saint Vincent of Paul in Tallers street, in February 1809. Despite the end of the war and the French army leaving, the building continued as a hospital until 1816, when the monks returned. In 1821 the owners ceded its use for sanitary purposes due to an outbreak of yellow fever. In 1832 it began to function as a tobacco factory until, in 1843, its definite use as a hospital was decided. During the following hundred years the hospital attended the needs of the army in Barcelona and ceased its activities in 1942 when a new military hospital, built a few years before, became fully functional. The history of the Military Hospital in Tallers was also that of its doctors and patients. The former also carried out important scientific work which is reflected in the medical publications of the era and numerous academic presentations. The latter composed a group of patients with specific needs different from those of the civilian population. Knowledge of the history of the hospital contributes to the history of Spanish military healthcare in a period of change within the medical model that took place during its centenary existence (AU)

[Anesthesias for the youngest and the oldest: pediatric and geriatric practice in Catalonia, Spain]. / Anestesias en Cataluña en las edades extremas: pediatría y geriatría.

BACKGROUND AND OBJECTIVE: The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it. PATIENTS AND METHOD: We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years). RESULTS: Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%. CONCLUSIONS: Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization.

[Prospects in light of the Catalan survey of 23,136 anesthetic procedures (ANESCAT 2003)]. / Perspectivas a la luz de la encuesta de 23.136 anestesias en Cataluña (ANESCAT 2003).

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends.

Anestesias en Cataluña en las edades extremas: pediatría y geriatría / Anesthesias for the youngest and the oldest: pediatric and geriatric practice in Catalonia, Spain

Fundamento y objetivo: Analizar las características de los pacientes en los extremos de la edad y conocer el tipo y frecuencia de procedimientos para los que se administra anestesia. Pacientes y método: De los cuestionarios de la encuesta ANESCAT 2003 se analizaron los datos registrados en pacientes menores de 14 años (grupo pediatría) y mayores de 65 (grupo geriatría). Resultados: El porcentaje de anestesias en pacientes menores de 14 años fue el 6,3% del total y en mayores de 65, el 32,9%. Se administró anestesia a 2 niños por cada niña, mientras que el 55% de los mayores de 65 años fueron mujeres. Los procedimientos con anestesia más frecuentes en menores de 14 años fueron la amigdalectomía y/o la adenoidectomía (19,3%), los procedimientos no quirúrgicos (11,5%), la circuncisión (10,6%), la herniorrafia inguinal (8,3%) y la apendicectomía (4,2%); en la población geriátrica fueron la cirugía de cataratas (31,9%), los procedimientos no quirúrgicos (9,5%), la herniorrafia inguinal (4,4%), la sustitución total de rodilla (3,6%), la cirugía transuretral de vejiga (3,2%) y la reparación de la fractura del cuello de fémur (2,6%). Debido a la alta incidencia de apendicectomía entre los 8 y 14 años y de cirugía del cuello de fémur por encima de los 85 años, la proporción de urgencias en estas edades fue aproximadamente del 30%. Conclusiones: Los pacientes pediátricos y geriátricos y los procedimientos para los que se les administra anestesia presentan unas singularidades que deberán considerarse a corto plazo a fin de desarrollar nuevas estrategias terapéuticas e introducir cambios en la organización sanitaria

Background and objective: The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it. Patients and method: We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years). Results: Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%. Conclusions: Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization

Perspectivas a la luz de la encuesta de 23.136 anestesias en Cataluña (ANESCAT 2003) / Prospects in light of the catalan survey of 23'136 anesthetic procedures (ANESCAT 2003)

El estudio ANESCAT 2003 ha proporcionado datos fiables de toda la actividad de la especialidad de anestesiología en una comunidad de 6,7 millones de habitantes y, a falta de información oficial, permite prever y planificar las necesidades de anestesia y la organización de la especialidad. Ha permitido conocer que en Cataluña (España), en 2003, recibieron anestesia 9 de cada 100 habitantes, con un alto porcentaje de pacientes mayores y de alto riesgo y una alta frecuencia de anestesia en obstetricia y áreas no quirúrgicas. Se ha obtenido información inédita sobre las características de la actividad quirúrgica y, por tanto, se convierte en una herramienta para la planificación sanitaria. La previsión del aumento de la población y de su progresivo envejecimiento anuncia unos incrementos de la demanda de anestesia del 12 y el 20% en los años 2008 y 2013, respectivamente, aunque medidas bruscas de política sanitaria pueden aumentar la demanda de forma imprevisible. A esto hay que añadir el crecimiento de la demanda de otras áreas de la especialidad ligadas a la medicina perioperatoria, los cuidados críticos y el tratamiento del dolor. El ámbito de desarrollo de la anestesiología supera en un 30% la anestesia quirúrgica y se caracteriza por una gran variedad de actuaciones, con diferencias notables en complejidad, que exigen una reorganización de los recursos humanos, de equipamiento y de los programas de formación de especialistas. La densidad de anestesiólogos encontrada, de 12,7 por 100.000 habitantes, está asociada actualmente a un déficit de estos profesionales, déficit que, dada la pirámide de edades y el número actual de residentes, es previsible que perdure en los próximos 5 años, con una crisis grave de recursos humanos en un plazo de 10 años. La encuesta ANESCAT 2003 demuestra la capacidad de una sociedad científica y sus profesionales para analizar la asistencia sanitaria que les corresponde y prevenir los efectos de los cambios esperables

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends