[The influence of the previous appointment in primary care consultations].
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Biomedical subjects
Publications and source records attributed to A Guarga.
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AIM: We analysed the data obtained from a tumor register kept in a Primary Care Centre (PCC) to find out the variables which contribute to the diagnostic and therapeutic evolution of our patients. DESIGN: Retrospective study on every Neoplasia registered in the Centre. PATIENTS: 293 malignant Neoplasias were recorded in the period between June 1984 and June 1990 (184 in males--62.8%; and 109 in women--37.2%). MEASUREMENTS AND MAIN RESULTS: The intervals between symptom and consultation (ISC), between consultation and referral (ICR), between referral and diagnosis (IRD) and between diagnosis and treatment (IDT) were evaluated. The average age at the moment of diagnosis was 59 (SD:13). There were 3.9% double neoplasias. The most frequent type was lung cancer with 41 cases (14%). This also occupied first place among men, whereas breast cancer did so among women. 10 tumours were diagnosed by screening: 4 breast, 5 cervix and 1 endometrium, which represent 16%, 50% and 14.3% respectively of these cancers. For all neoplasias taken together, the average time of ISC was 44.09 days (SD 73.48) and of IDT 25.75 days (SD:61.55). Given the wide variations, we assessed the most common types of tumour. CONCLUSIONS: The usefulness of keeping a tumour register in a Primary Care Centre, which could identify the factors which affect diagnostic delays and find possible corrective measures to reduce the delays, was appraised.
OBJECTIVE: Description of the general characteristics of patients with Diffuse Chronic Hepatopathy (DCH) in an ABS. DESIGN: Empirical study of a prospective and retrospective type. Site. Primary Care. ABS La Mina. Sant Adrià de Besòs. PATIENTS AND OTHER PARTICIPANTS: All patients diagnosed as suffering DCH since 1984, in line with histological or clinical--morphological criteria accepted in the literature. MAIN MEASUREMENTS AND RESULTS: Using a data base of the centre's morbidity and mortality register, 287 reports of patients over 14 years old defined as having DCH were examined. 222 cases met the established criteria. Most of these were males (68%), and to an even higher proportion in the group with alcoholic etiology (84%), which was the most common cause of DCH (64.4%). There was a lower number of complications and deaths attributable to DCH than in published hospital series. CONCLUSIONS: Among the characteristics of DCH in a natural population using the health services, it is important to note the predominance of compensated forms having a rate of complications and deaths attributable to DCH significantly lower than what was observed in hospital series. This information may be of use in planning activities at the ABS level.
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We compared the effectiveness of different methods of rapid diagnosis in the detection of asymptomatic bacteriuria in 74 females during the first trimester of pregnancy. The sensitivity, specificity and negative predictive value for the visual reading of nitrites, leukocyte sterase, bacteriuria and leukocyturia in the sediment and bacteria in Gram stain were 77%, 22%, 33%, 22% and 88%, 98%, 85%, 82%, 91% and 86%, and 97%, 89%, 90% and 90%, with and accuracy of 96%, 77%, 76%, 82% and 86%, respectively. The combination of visual readings of nitrites and Gram stain showed a sensitivity and negative predictive value of 100%. We conclude that if the reading of the reactive strip is negative, the likelihood of a positive culture is very small, and it is minimal when combined with Gram stain.
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The evaluation of markers of the health care activity, such as the reason for requesting a peripheral blood count in everyday practice and its inclusion in the clinical record, constitutes an estimate of the quality of care. To this end, we have reviewed the requests of 160 peripheral blood counts in our center during one month. It was found that the request itself and/or its cause had not been mentioned in the clinical record in 32.5% of instances. In the cases where the indication could be ascertained, it was not justified in 58.4%. Overall 72.5% of peripheral blood counts were normal. It was concluded that peripheral blood count is an over-utilized test, while its request is insufficiently recorded. This makes diagnostic decisions and the evaluation of the quality of care difficult.
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