Biomedical subjects
Publications and source records attributed to A Vallés.
A case with a high adenosine deaminase (ADA) level in pleural effusion due to Waldenström's macroglobulinemia is reported. This is the first case of this disease which is described as a cause of an increased pleural ADA.
PURPOSE: The haematological assistance in Catalonia is based upon the district hospitals, in the first step, and the stage III hospitals located usually in higher population nuclei, in the second step. The purpose of this work was to analyse the resources of the "primary haematological assistance" network provided by the district hospitals, to evaluate them and to propose a model for their organisation. MATERIAL AND METHODS: An enquiry was carried out to all members of the Grup de Treball d'Hospitals Comarcals de Catalunya (Catalonia's District Hospitals Task Force). The evaluable data included demographic figures of the population assisted, personnel of each haematological area, organising structure, clinical activity, cytomorphology, blood banks, laboratories and continuous formation activities. RESULTS: The enquiry was answered by 15 of the 21 district hospitals (71.4%) with haematologists in Catalonia. The population assisted in those hospitals is 2,100,000 (ranging between 55,000 an 450,000). All centres are integrated in the National Health network. Eleven of the hospitals analysed have only one haematologist (73.3%). If his dedication is 100% of the time, this would represent a doctor for 105,000 people. The time devoted to work is 690 hours a week for all the population, with a mean of 3,043. Four patients assisted per hour. The total number of hospital beds is 3,353 (50-450), with a mean number of 1 haematologist for every 167.6 beds. The number of patients hospitalized due to blood diseases ranges between 3 and 13 per month. Six of the 15 centres are adjunct to the outpatient clinic. Two centres have a blood bank and 7 have developed an autotransfusion programme. All the centres but one perform oral anticoagulant treatment follow-up, the number of patients assisted ranging from 20 to 210 per week. None of the hospitals has a separate Haematology Service; in most of them haematology is structurally and functionally dependent from Laboratories and in some there is a mixed Laboratory/Internal Medicine functional organisation, depending of the Medical Direction. No haematologist is ever on call specifically for his specialty. Continuous formation activities are carried out in 9 of the 15 centres (60%). COMMENT: Several measures are proposed to improve the haematological assistance, acting on different levels: continuous formation, patient flows and circuits, resident doctors training, anticoagulant treatment network, organisation models, credit cards from the Spanish Association of Haematology.
AIM: To contribute a preliminary study, which allows the best use of the demand criteria and acceptance mechanisms of radiological explorations at the primary care level. DESIGN: Retrospective and observational study. SITE. Public Health Care Center Poblenou, in the Barcelona area. PATIENTS: A random sample of patients covering 15,000 X-Ray explorations. MEASUREMENTS AND MAIN RESULTS: The parameters evaluated were: the type of x-ray; the existence of otherwise of pathology; the physician requesting the x-ray; and the patient's age and sex. Results show greater use by the feminine sex (56%), with statistically significant differences (p less than 0.0008) (1 degree of freedom). The overall pathology rate was 43%, also with significant differences between different groups of doctors (p less than 0.0001) (3 degrees of freedom). 52% of the investigations were on patients over 50. CONCLUSIONS: In general, the high percentage in primary care of pathological explorations should be noted; as should the variation in pathology rates between different groups of doctors, which suggests possible differences of criteria in the use of radiological indicators. The high percentage of patients of an advanced age will have to be considered in the planning of radiological services.
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