Valor de la ecografia de extremidades inferiores para el diagnostico de la trombosis venosa profunda en un servicio de urgencias / Value of ultrasound imaging of the lower limbs for diagnosing deep vein thrombosis

Objetivos: Describir las caracteristicas de los pacientes con trombosis venosa profunda(VTP); valorar la concordancia entre la (..)(AU)

Objectives: 1) To describe the characteristics of patients with these symptoms. 2) To assess agreement between compression ultrasonography performed in the ED and Doppler ultrasound imaging in radiology. 3) To assess the efficacy of a diagnostic algorithm that includes ultrasound imaging, clinical characteristics, and laboratory findings. Methods: Descriptive study of consecutive patients attending the ED complaining of symptoms suggestive of DVT. We applied a diagnostic algorithm requiring physical examination, D-dimer assessment, pretest probability (Wells score), and ED compression ultrasonography. Results: Thirty-seven patients were included; 48.65% were men. Pretest probability according to the Wells score was low for 9 patients (24.3%; 95% confidence interval [CI], 9.1%-39.5%), moderate for 10 (27.0%; 95% CI, 11.4%-42.7%),and high for 18 (48.6%; 95% CI, 31.2%-66.1%). D-dimer level was not significantly associated with the findings of compression ultrasonography. The ¦Ê index for agreement between compression ultrasonography and the gold standard(Doppler ultrasound in the radiology department) was 1. Sensitivity was 100% (95% CI, 96.1%-100%), specificity91.7% (95% CI, 71.9%-100%) , positive predictive value 92.9% (95% CI, 75.8%-100%), and negative predictive value100% (95% CI, 95.4%-100%).Conclusions: The algorithm tested appears to be valid for evaluating patients who may have DVT. There is a high level of agreement between compression ultrasonography of the lower extremities in the ED and ultrasound findings reported by the radiology department (AU)

Evolución de la prescripción de analgésicos opioides en atención primaria, especializada y hospitalaria del Área Sanitaria de Puertollano. 2001-2006 / No disponible

Objetivos: describir la evolución del consumo de analgésicos opioides en el Área Sanitaria de Puertollano en el periodo 2001-2005 y evaluar el mismo tras la puesta en marcha en 2006 de un recurso de Cuidados Paliativos como medida de resultado. Método: análisis de los cinco opioides mayores más prescritos. Los datos de consumo se obtuvieron del archivo informático del Servicio de Farmacia. Se evaluaron las prescripciones realizadas por Atención Primaria, médicos especialistas y en el hospital, expresado en DHD (dosis diaria definida por mil habitantes por día) para los dos primeros niveles y en DDD (dosis diaria definida)/100 estancias para el tercero, entre los años 2001-2006. Resultados: en Atención Primaria se observa un incremento progresivo en el consumo global de opioides, pasando de 0,68 a 2,89 DHD. Por fármacos, destaca la prescripción de opioides de liberación transdérmica, que se incrementa desde 0,51 DHD en 2001 hasta 2,80 DHD en 2006, representando este año el 93% de las DHD totales. Las DHD prescritas por médicos especialistas aumentan de forma más moderada, de 0,02 a 0,06, y en 2006 disminuyen ligeramente. Sólo las de morfina oral se incrementan acusadamente en este último año, pasando de 0,0003 DHD en 2005 a 0,0064 DHD en 2006. También aquí las DHD de fármacos administrados en parches suponen casi la totalidad del grupo(99,2% en 2001), aunque disminuye el porcentaje ligeramente en 2006 (90,2%). En el ámbito hospitalario, no se observa correlación entre las DDD consumidas, ni de manera global ni para cada uno de los fármacos, con el número de estancias hospitalarias. Sin embargo en 2006 existe un incremento importante del consumo global y de morfina en particular (60,8% de las DDD/100 estancias totales), que supera por vez primera al de opioides de liberación transdérmica (31,6%), sin que una variación apreciable del case-mix lo justifique. Conclusiones: se observa un incremento continuado en las DHD prescritas tanto por médicos especialistas como en Atención Primaria. Sin embargo, el consumo en el hospital evoluciona de forma errática. Este comportamiento parece cambiar coincidiendo con el inicio de la actividad del Equipo Hospitalario de Cuidados Paliativos (AU)

Objectives: to describe the trends of use for opioid analgesics in theArea of Puertollano during the period 2001-2005, and to evaluate it as an outcome measure after launching a Palliative Care Program in 2006. Method: an analysis of the five strong opioids most commonly prescribed. Data on use were obtained from the Pharmacy Service computer files. The prescription of opioid analgesics in primary, specialized, and hospital care were assessed and expressed as DHD (Defined Daily Dose per 1,000 inhabitants per day) for the two first sanitary levels, and as DDD (Defined Daily Doses)/100 hospital stays for the third one, from 2001 to 2006. Results: there is a gradual increase in the overall use of opioids that moves from 0.68 to 2.89 DHDs in primary care. The prescription of transdermal release opioids, which increased from 0.51 DHDs in 2001 to 2.80 in 2006, should be highlighted. This represents 93% of total DHDs this year. DHDs prescribed by medical specialists increased in a more moderate way, from 0.02 to 0.06, and decreased slightly in 2006. Only oral morphine DHDs increased sharply in the past year, from 0.0003 DHDs in 2005 to 0.0064 DHDs in 2006. Here, the DHDs for drugs administered in patches account for almost the entire group too (99.2% in 2001), although its share declined slightly in 2006 (90.2%).In the hospital setting no correlation between DDDs used, either overall or for each drug, and number of hospital stays was seen.However, in 2006 there was a significant increase in global consumption, particularly for morphine (60.8% of total DDDs/100 hospital stays), exceeding for the first time those of transdermal release opioids (31.6%) without a significant variation of case-mix warrants. Conclusions: there is continued growth in DHDs prescribed by both specialists and primary care physicians. However, hospital use evolves in an erratic manner. This behavior seems to be changing since palliative care teams were implemented (AU)

[Use of pyrazinamide as an indicator of tuberculosis epidemiology in Castilla-La Mancha]. / El consumo de pirazinamida como indicador de la situación epidemiológica de la tuberculosis en Castilla-La Mancha.

OBJECTIVE: To describe the use of tuberculostatic drugs in Castilla-La Mancha Spanish region along the 1999-2000 period; to estimate the number of persons who received tuberculosis treatment in 1999 and 2000; and to compare the results with the case reporting data. METHOD: The pyrazinamide use data in Castilla-La Mancha along the 1999-2000 period were obtained from the Spanish Health Ministry. The defined daily dose and the daily dose per inhabitant were used as measures for comparison. The number of persons who had received treatment was calculated and this figure was compared with the case reporting of tuberculosis respiratory, tuberculosis, other types and tuberculous meningitis. RESULTS: The incidence of registered tuberculosis cases was 192 and 182 cases in 1999 and 2000, respectively, with rates of 11.07 and 10.49 cases per 100,000 population. In 1999 and 2000, 388 and 389 people (22.41 and 22.43 cases per 100,000 population) received treatment with pyrazinamide in Castilla-La Mancha, respectively, which suggests that the rate of registered tuberculosis can show an underreporting of 50%. CONCLUSIONS: An important tuberculosis underreporting is detected, with large differences between the different provinces. Pyrazinamide use is probably the better indicator to estimate the minimum incidence of tuberculosis.

El consumo de pirazinamida como indicador de la situación epidemiológica de la tuberculosis en Castilla-La Mancha / Use of pyrazinamide as an indicator of tuberculosi's epidemiology in Castilla-La Mancha

Fundamento. Describir el consumo de fármacos antituberculosos en Castilla-La Mancha en el período 1999-2000, estimar el número de personas que realizaron tratamiento antituberculoso en 1999 y 2000 y comparar los resultados con los datos de notificación de casos. Método. Se obtuvo el consumo de pirazinamida en Castilla-La Mancha en el período 1999-2000 del Ministerio de Sanidad y Consumo. Se utilizaron la dosis diaria definida y la dosis por habitante y día para medidas de comparación. Se estimó el número de personas que habían recibido tratamiento y se comparó con la notificación de casos de "tuberculosis respiratoria", "otras tuberculosis" y "meningitis tuberculosa". Resultados. La incidencia de tuberculosis notificadas fueron 192 y 182 casos en 1999 y 2000, con tasas de 11,07 y 10,49 casos por 100.000 habitantes. En 1999 y 2000 habrían realizado tratamiento con pirazinamida en Castilla La Mancha unas 388 y 389 personas (22,41 y 22,43 casos por 100.000 habitantes), lo que sugiere que la tasa de tuberculosis notificada puede tener una subnotificación del 50 por ciento. Conclusiones. Se detecta una importante infradeclaración de tuberculosis, con grandes diferencias entre provincias. El consumo de pirazinamida es probablemente el mejor indicador para estimar la incidencia mínima de tuberculosis (AU)