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Biomedical subjects

J Morera-Guitart

Publications and source records attributed to J Morera-Guitart.

13 recordsLinked to original sources
PubMed2003

[Variation in the pathology attended in out-patient Neurology Clinics: a demented future].

INTRODUCTION: We analyze the changes observed between 1996 and 2001 in the distribution of the pathology attended and the follow up model used by the out-patient Neurology Clinic in the Marina Alta area, in order to confirm possible variations that may have repercussions for Human Resource needs in the provision of adequate neurological care. METHODS: We prospectively registered the attendance records for visits made to the Out-patient Neurology Clinic of Marina Alta in 1996. The variation coefficients between both series were calculated and compared. RESULTS: The average age of patients increased in 5 years. The number of patients attended increased 42.3%, new patients 40%, visits 13%, the "Review visit/First Visit" ratio reduced 29%. The attendance of patients with Cognitive Impairment (Cog. Imp.) doubled. There were no changes in the origins of the patients. Requests due to Cog. Imp. and parkinsonism increased significantly from Primary Care and Emergency Department. The delay to be attended increased 23%. Discharges increased 43.9%, highlighting an increase of 144% observed in the Cog. Imp. group. CONCLUSIONS: Changes have been observed in: the age of the population studied; the follow up of patients; the delay in attending them; and the pathology attended, with a significant increase in demand due to neurodegenerative pathology (especially Cog. Imp.). All this requires an increase in care needs that the Health Service has not been able to assume, creating an incongruous care model: we suggest a direct follow up model and offer a consultancy model.

Adolescent↗
PubMed2001

[Consensus conference on consultation times in neurology. Recommendations on consultation times in neurology outpatients care in Spain].

INTRODUCTION: Developing recommendations about consultation times in neurology helps plan the endowment of human resources and can contribute to homogenize and improve quality of health-care. OBJECTIVES: To elaborate recommendations on the consultation times needed to obtain enough quality neurology visits. MATERIAL AND METHOD: We used consensus search techniques, in particular the Community Impression technique. An ad hoc committee developed a preliminary proposal which was later discussed during a unlimited attendance working meeting and eventually voted by members of the Spanish Society of Neurology. The committee drew up a final consensus report after analysing the debate results and counting the ballots. FINAL RECOMMENDATION: "It is necessary that the Spanish Society of Neurology establishes and recommends standardized consultation times for neurology outpatients visits in Spain. These standardized values refer to consultation time per patient, both in the first and follow-up visits, in a General Neurology Outpatients Clinic. Moreover, there must be considered 'recommendable times' on one hand, and 'minimal required times' on the other hand. Any time value below the minimal required time means that the consultation duration does not fulfill the minimal requirements needed to warrant a care with acceptable quality for the patient". These recommendations are: Time for first consultation. Recommendable time: 45 minutes (Minimal required time: 25 minutes). Time for follow-up consultation. Recommendable time: 20 minutes (Minimal required time: 15 minutes).

Humans↗
PubMed1998

[Cross-sectional multicenter study of outpatient neurological care in the autonomous region of Valencia. Commission on Analysis of Quality of the Neurological Society of Valencia].

INTRODUCTION: Studies of the use of resources is a method recommended for the determination of health care requirements in order to improve planning for this. OBJECTIVE: To analyze outpatient neurological care in the Autonomous Region of Valencia (CR). PATIENTS AND METHODS: A transverse multicentric study was done in different Neurology Clinics in the CV. For three days, chosen randomly, forms were filled in. RESULTS: Twenty neurologists participated. Analysis was done of 954 consultations. In 30% of these cases the neurologist was satisfied and in 30% he was not. Consultation took 9.5% more time than anticipated. Urgent unscheduled consultations made up 8.6%. Women made up 52% and were of an average age of 52 years. Delay was 29 days. Primary care services referred 42% of the patients. The commonest diagnoses were: cerebral infarct, migraine and parkinsonism. The conditions referred from Primary Care Services were similar to those from non-neurological specialists. First visits took 17.6 minutes and following visits 11.7 minutes. The most usual 'destination' was follow-up (75.2%), followed by AP (24%). CONCLUSIONS: Neurological care in the Neurology Clinics of the CV is easily accessible and of good quality. However, it is overloaded by the large demand, due to ambiguity of the health care system available. The different degrees of professional satisfaction felt by neurologists are probably due to the quality of health care available to patients depending on where they live and the type of centre they attend.

Ambulatory Care↗
PubMed1998

[Register Alacant: register of the treatment of supra-aortic trunk stenosis with angioplasty and stent placement. Study group of Register Alacant].

INTRODUCTION: The Register Alacant is a clinico-radiological register of patients in Alicante province with symptomatic carotid or vertebral artery stenosis, treated by means of percutaneous transluminal angioplasty and subsequent placement of a Stent-type endovascular prosthesis. DEVELOPMENT: The aims of the register are as follows: 1. To evaluate the safety of this type of treatment. 2. To measure the clinical ultrasonographic and radiological efficacy of the technique in the short, intermediate and long term. In this article we consider the rational basis which led to its introduction and present the design of this register and aspects of organization which make it work in practice. There is only one centre (HG SVS Alicante) where this technique is used for treatment and another seven centres from which patients are 'recruited' and sent for angioplasty. Whilst the procedure is being carried out, the patient is monitored by transcranial Doppler using both medial cerebral arteries. On completion of the angioplasty the patients is immediately assessed clinically and subsequently daily for the first two post-operative days. Further follow-up is done in the centre which initially corresponded to each patient. Carotid eco-Doppler is done weekly as follow-up. Digital angiography is done one year later. All patients are followed-up indefinitely. The minimum follow-up period is one year, although three years or more are recommended. CONCLUSION: The register was started in April 1998 and monthly meetings are held to discuss and programme each case, and all the investigators participate in this.

Angioplasty↗
PubMedDate not supplied

[Neurological assistance as a product. Evaluation of the process in neurology].

INTRODUCTION: Appraisal of the process of assistance is a fundamental step in determination of the quality of medical assistance given. DEVELOPMENT AND CONCLUSIONS: In this paper we review the concept of medical assistance as a product, establishing a parallel between medical assistance and a process of industrial production. We consider the similarities and differences between them. From the point of view of production management we may distinguish different elements: the setting, structure, process of production, result and evaluation. All these are also found in healthcare assistance. We review the concept of the process of assistance both from the limited point of view of the management of disease and its complications, and from a broader perspective which includes the activities of patients in seeking and obtaining assistance. Different aspects and methods of appraisal of the process of assistance are considered: medical audit and monitoring. Finally, we approach the problem of appraisal of the process in outpatient assistance, the importance of this and the methods used in evaluation. We comment on experience of this aspect obtained in the Neurology Unit of the Hospital Marina Alta in Denia.

Evaluation Studies as Topic↗
PubMedDate not supplied

[Emergency CAT in stroke-why?].

INTRODUCTION: A stroke is considered to be a neurological emergency, and it is recommended that an immediate CAT scan should be done in all patients. However, its usefulness may be controversial in the early stages. OBJECTIVE: To show the diagnostic usefulness of early CAT scans following strokes. PATIENTS AND METHODS: We made a retrospective study of a random sample of the requests for cranial CAT scans in suspected cerebrovascular disease between October 1998 and April 2000. We analyzed the diagnostic and therapeutic variations before and after CAT scans (pre CAT and post CAT moments). RESULTS: We selected 210 cases. Average age: 72 10.4 (57% males). There was no difference in CAT findings (normal or vascular) related to the day it was done. Pre CAT diagnosis: non specific, 39.3%; intracranial haemorrhage (ICH), 17%. Post CAT diagnosis: the commonest was thrombotic infarct (23.7%), followed by non vascular , 20%. Pre CAT treatment: no treatment 47.9%; antiaggregant 30.4%; low molecular weight heparin 7.4%. Post CAT treatment: no treatment 17%, 21.7% of the patients with ICH received antiaggregants or anticoagulants prior to cranial CAT. Hemiplegia was more often associated with a vascular CAT scan whilst isolated dysarthria was with a normal CAT scan. Nineteen patients died and all of these had vascular CAT scans. The patients with vascular CAT scans were more often admitted to hospital. CONCLUSIONS: The findings of cranial CAT scans during the acute stage of strokes are unpredictable. Early CAT scans in stroke patients permits improved diagnosis and treatment of patients, avoids serious errors of treatment and affects the outcome.

Anticoagulants↗
PubMedDate not supplied

[Analysis of the patients who missed their appointments at the neurology clinic of the Marina Alta].

OBJECTIVES: To analyze the frequency, reasons and characteristics of patients who missed their appointments (NP) at the Neurology Clinic (CEN). To compare the characteristics of the NP with the patients who did not miss their appointment. Suggest measures to reduce avoidable causes of NP. PATIENTS AND METHODS: During the period 1/10/99 to 30/4/2000 the cases of NP were prospectively recorded and compared with a sample of patients who attended the CEN during the same period. We analyze the data on age, sex, distance of home from CEN, diagnosis, type of consultation and date of last consultation. The NP were contacted by phone and asked why they had not gone for their appointments. The reasons given were then classified as avoidable or unavoidable. RESULTS: Of the 1,842 consultations scheduled, 19% were NP. When the NP and the patients who did attend were compared we found statistically significant differences regarding the distance home/CEN. According to the diagnosis, the NP had more 'symptoms/signs' and other MIA, whilst those who attended the clinic had more 'neuropathies' and 'awaiting diagnosis'. The commonest avoidable reasons (55.8%) for NP were forgetting, administrative error and communication failure, and for unavoidable reasons (44.2%) physical disability, other priorities and improvement. CONCLUSIONS: There is a large proportion of NP in the CEN of the Marina Alta. The distance from home to CEN (over 25 km) was the main factor affecting the rate of NP. Since 56% of the NP were due to avoidable causes, strategies could be designed to reduce this percentage. In the NP group, the main causes were forgetting, administrative errors and communication failure.

Ambulatory Care↗
PubMedDate not supplied

[Prevalence and characteristics of multiple sclerosis in the health district of the Marina Alta].

OBJECTIVES: To determine the prevalence and characteristics of multiple sclerosis (EM) in the Marina Alta health district. PATIENTS AND METHODS: A descriptive, retrospective study localizing cases (crossed register method). Day of prevalence: 1/05/01. Registers of the area analyzed: hospital admission, Neurology Clinic, Emergency Department of the hospital and Health Centres. The criteria of Poser were used for diagnosis. We analyzed the demographic, clinical and paraclinical aspects of the episodes and treatment (interferon-beta). RESULTS: Male/female ratio: 2.4. Average age: 46.6 years. Prevalence of definite EM: 40.3/100,000. Prevalence of autochthonous cases of EM: 28.7/100,000. Average age at onset: 32.6 years. Average duration of illness: 12.5 years. Commonest clinical form: remitting relapsing (48.1%), followed by progressive relapsing (7%), benign (5.5%) and primary progressive (1.8%). 5.5% died, all with the progressive secondary form. EDSS disability: greater in the progressive secondary form. Magnetic resonance (MR) was the commonest investigation used (84% of the results in concordance and 13% normal). Positive BOC in 70% of cases. We studied 202 episodes. The systems most affected were: sensory and pyramidal. Worsening of EDSS after recovery from the episode: 51.7%. 29% received interferon-beta, with five cases (31%) of major side effects (one psychotic outbursts, three with neutropenia and one generalized allergic reaction). CONCLUSIONS: In the Marina Alta the prevalence of EM adjusted for the autochthonous population is in the medium risk zone. The clinical features and course of the disease in our patients are similar to those seen in other national and foreign series. The most worthwhile tests were cranial MR and BOC CSF. Treatment with interferon-beta requires strict control in view of the high frequency of serious side effects seen.

Adult↗
PubMedDate not supplied

[Aetiological diagnosis of cerebral infarction in a county hospital].

INTRODUCTION: Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. PATIENTS AND METHODS: We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN 98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. RESULTS: Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN 98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of incomplete studies was the absence of carotid Doppler. CONCLUSIONS: The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI.

Aged↗
PubMedDate not supplied

[An update on the diagnosis of vascular dementia].

INTRODUCTION: Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. CONCLUSIONS: Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.

Dementia, Vascular↗
PubMedDate not supplied

[Neuropathic pain as the reason for visiting Neurology: an analysis of its frequency].

INTRODUCTION: Neuropathic pain (NP) is defined as pain that begins with or is caused by a primary injury or by a dysfunction in the nervous system. AIMS: Our aim was to evaluate how often patients visit Neurology as outpatients with NP as the main reason for referral. PATIENTS AND METHODS: A descriptive, cross sectional study was carried out on the use of the health care services; patients attended for the first time in a Neurology Screening visit were included consecutively. The variables studied were the following: the number of first visits and the total number of patients attended per visiting session, rate of patients with NP per visiting day, the topography and probable causation of the NP, and the rate of patients referred to the monographic NP clinic; the different quantitative variables are expressed in terms of their mean and standard deviation (SD), whereas the qualitative variables are given as their absolute value and the percentage. A total of 1,972 patients were attended, of whom 1,422 (72.1%) were first visits, with an average of 17.5 (SD: 2.5) new patients per visiting session. RESULTS: In all 113 patients clinically diagnosed with NP were identified, which represents a rate of 7.95% of the first visits. CONCLUSIONS: NP may be among the most frequent causes of the demand for neurological ambulatory care. The most common causes of NP were found to be trigeminal neuralgia, post-herpes neuralgia and diabetic polyneuropathy.

Ambulatory Care Facilities↗
PubMedDate not supplied

[Preventive treatment with topiramate enhances the quality of life of patients with migraine].

INTRODUCTION: Topiramate has recently proved to be safe and effective in the prevention of migraine and is currently the only neuromodulatory drug indicated for the prevention of migraine in Spain. AIM: To evaluate the adherence, effectiveness and safety of preventive treatment with topiramate in patients diagnosed with migraine. PATIENTS AND METHODS: A prospective, observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were those with migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed or for whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of the treatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment was evaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6). RESULTS: A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of 100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason for dropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentage of patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%), regular (11%) and poor (9%). CONCLUSIONS: Preventive treatment with topiramate significantly reduces the impact of migraine and the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients.

Adolescent↗