[Costs of spirometry as a screening test for chronic obstructive pulmonary disease in primary care]. / Costes de la espirometría como prueba de cribado en atención primaria de la enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To calculate the costs of COPD screening by simple spirometry, conducted in primary care, in smokers and ex-smokers over 40 years old. DESIGN: Descriptive study. Cost analysis. SETTING: Semi-rural health district covering some 6000 inhabitants. PARTICIPANTS: Randomised sample of 350 smokers and ex-smokers over 40 allocated to the centre. 73 were excluded on SEFAR criteria. INTERVENTIONS AND MEASUREMENTS: Simple spirometry was conducted with an automatic, portable, dry spirometer. Costs were calculated from the time needed, the material, human resources and the number of valid spirometer readings. RESULTS: 85% of 277 had a spirometry test. 18% of the spirometry readings were not valid. 3 spirometries an hour could be done: at least 1 was pathological and a bronchodilator test was needed. The cost of a spirometry, if a professional devotes 2 hours a day for 5 years, was 10.57 euros or 8.54 euros, for doctor or nurse, respectively. Modifying the number of spirometries per year or the number of professionals trained for such a technique causes only minor changes in cost. CONCLUSIONS: Optimal cost: 9000 spirometries a year by a single nurse. However, this would entail one nurse's almost exclusive dedication. Two trained professionals raises the cost slightly and distributes the work load better, enabling more hours to be covered. Before advising any COPD screening, its costs and its real possibility of affecting active smokers (the sole preventive possibility) should be carefully assessed.

Costes de la espirometría como prueba de cribado en atención primaria de la enfermedad pulmonar obstructiva crónica / Costs of spirometry as a screening test for chronic obstructive pulmonary disease in primary care

Objetivo. Estimar los costes del cribado de la enfermedad pulmonar obstructiva crónica (EPOC) mediante espirometría simple realizada en asistencia primaria en fumadores y ex fumadores de más de 40 años. Diseño. Estudio descriptivo. Análisis de costes. Emplazamiento. Área básica de salud semirrural que atiende a unos 6.000 habitantes. Participantes. Muestra aleatoria de 350 individuos fumadores y ex fumadores > 40 años asignados al centro. Según los criterios de la SEPAR, se excluyó a 73. Intervenciones y mediciones. Se realizó una espirometría simple con un espirómetro seco, portátil y automático. Se estimaron los costes a partir del tiempo necesario, el material, los recursos humanos y el número de espirometrías válidas. Resultados. En el 85% de los 277 individuos se realizó una espirometría. El 18% de las espirometrías realizadas no fue válido. Se pueden realizar 3 espirometrías/h: al menos una será patológica y deberá realizarse una prueba broncodilatadora. El coste de una espirometría si un profesional dedica 2 h diarias durante 5 años es de 10,57 o 8,54e, según sea un médico o una enfermera. Modificar el número de espirometrías/año o el número de profesionales entrenados para esta técnica conlleva una menor modificación en los costes. Conclusiones. El coste óptimo es de 9.000 espirometrías/año realizadas por una sola enfermera; sin embargo, esto obligaría a que tuviera una dedicación casi exclusiva. Su realización por 2 profesionales preparados conlleva un moderado aumento del coste y distribuye mejor la carga, permitiendo acceder a un horario más amplio. Antes de aconsejar cualquier cribado de la EPOC se deberían valorar cuidadosamente sus costes y las posibilidades de influir en los fumadores activos (única posibilidad preventiva)

Objective. To calculate the costs of COPD screening by simple spirometry, conducted in primary care, in smokers and ex-smokers over 40 years old. Design. Descriptive study. Cost analysis. Setting. Semi-rural health district covering some 6000 inhabitants. Participants. Randomised sample of 350 smokers and ex-smokers over 40 allocated to the centre. 73 were excluded on SEFAR criteria. Interventions and measurements. Simple spirometry was conducted with an automatic, portable, dry spirometer. Costs were calculated from the time needed, the material, human resources and the number of valid spirometer readings. Results. 85% of 277 had a spirometry test. 18% of the spirometry readings were not valid. 3 spirometries an hour could be done: at least 1 was pathological and a bronchodilator test was needed. The cost of a spirometry, if a professional devotes 2 hours a day for 5 years, was 10.57 euros or 8.54 euros, for doctor or nurse, respectively. Modifying the number of spirometries per year or the number of professionals trained for such a technique causes only minor changes in cost. Conclusions. Optimal cost: 9000 spirometries a year by a single nurse. However, this would entail one nurse's almost exclusive dedication. Two trained professionals raises the cost slightly and distributes the work load better, enabling more hours to be covered. Before advising any COPD screening, its costs and its real possibility of affecting active smokers (the sole preventive possibility) should be carefully assessed

[Citrobacter freundii endocarditis]. / Endocarditis por Citrobacter freundii.

Infection by Citrobacter appears in man only in certain circumstances, since it usually acts as contaminant or colonizer. Bacteraemia by this bacillus can affect immunodeficient people, elderly people or those patients who have undergone invasive hospital processes. Although incidence of bacteraemia is low (0.3-0.9%), the death rate is very high, about 48%. This bacillus is seldom the cause of endocarditis. That is why we describe a case of endocarditis by Citrobacter freundii, in an aged person with previous valvulopathy.

Endocarditis por Citrobacter freundii / Endocarditis by citrobacter freundii

La infección por Citrobacter se produce en el hombre sólo en determinadas circunstancias, ya que normalmente se comporta como contaminante o colonizador. La bacteriemia por este bacilo ocurre en personas inmunodeficientes, ancianos o en aquellos pacientes a los que se les han realizado procesos invasivos hospitalarios. A pesar de que la incidencia de bacteriemia es baja (0,3-0,9 porciento), la mortalidad es muy elevada, situándose alrededor del 48%. Rara vez este bacilo es causa de endocarditis. Por ello describimos un caso de endocarditis por Citrobacter freundii en una persona mayor y con valvulopatía previa (AU)