PubMed Health⌕ Search

Biomedical subjects

M López Piñera

Publications and source records attributed to M López Piñera.

7 recordsLinked to original sources
PubMed2003

[Minor surgery in primary care: is continuing education within the team a valid strategy for improving quality?].

OBJECTIVE: To evaluate the impact of continuing education within the team (FCI, in Spanish) on the quality of minor surgery. DESIGN: Study of level of quality. SETTING. Primary care. PARTICIPANTS: First evaluation: all the lesions referred for biopsy during 1998 (62 samples). Second evaluation: those referred in 1999-2000 (150). MAIN MEASUREMENTS: Four explicit criteria regulating procedure and result were designed: C1, sufficient information; C2, correct referral; C3, correct extirpation of lesion; C4, clinical-pathological concordance. Request forms and anatomical-pathological reports were assessed. Evaluation was before and after corrective measures (FCI and organisational changes designed to support FCI). The Kappa index of inter-observer concordance, the Compliance Index and Fisher's Z index were analysed. RESULTS: 62 lesions were included in the first evaluation, with high reliability for C1 and C4, good for C2 and moderate for C3. 150 lesions were included in the second evaluation. The compliance indices showed statistically significant increases from the first to the second evaluation for C1 (38.09% and 50.66%, relative improvement of 19%) and C4 (68.85% and 85.2%, relative improvement of 53%). C2 showed an improvement, but without statistical significance (87.30% and 92.66%). The compliance index for C3 dropped (94.73% and 87.50%). 5.33% of cases in the second evaluation (8 biopsies) were malignant or pre-malignant lesions, compared with 20.96% in the first (P<.05). 100% of these latter showed free resection limits. 77.99% of lesions studied through a biopsy in the second evaluation were nevus, seborrhoeic keratosis or dermatofibroma. CONCLUSIONS: FCI is a valid strategy for improving the quality of programmes of minor surgery in primary care. There was significant improvement in the identification of malignant and pre-malignant pathology, in correct referral and in the clinical-pathological concordance of the lesions.

Education, Medical, Continuing↗
PubMed1998

[Decile distribution of risk of mortality from ischemic cardiopathy in the male population registered at a health care center].

OBJECTIVE: To distribute the male population registered at our health centre into deciles of risk of death from ischaemic heart disease, using only the data in the clinical history. DESIGN: A crossover, retrospective and observational study, without random distribution. SETTING: Urban health centre. PATIENTS AND OTHER PARTICIPANTS: The work material was 2848 clinical histories of men aged between 25 and 55 1420 of these were histories with up-to-date data because the men had had a consultation during the preceding year. MEASUREMENTS AND MAIN RESULTS: The method proposed by Shaper to evaluate cardiovascular risk was used. The most prevalent risk factor was tobacco dependency, at 50.1% (CI 95%, 47.5-52.7), whereas hypertension and diabetes did not exceed 14.1% (CI, 12.3-15.9) and 2.5% (CI, 0.016-3.31), respectively, 90% of those under 35 were in the 10-30 deciles, while about half the over-45s were in the 40-90 deciles. CONCLUSIONS: Use of the Shaper method enabled us to distribute our male patients according to risk and identify 4% (2.56-5.37) as being at high risk of ischaemic heart disease.

Adult↗
PubMed1996

[Research in action. How to assist the integration of residents of family and community medicine in health centers].

OBJECTIVES: To find the causes of worry in second-year family and community medicine (FCM) residents on their arrival at health centres. DESIGN: A descriptive study. A survey with 4 questions on difficulties found in the on-demand clinic, in consultations by appointment, other causes of anxiety and problems foreseen a priori. SETTING: Health centres in the Murcia Region with second-year FCM residents. PARTICIPANTS: All the second-year FCM residents (28) on their arrival at health centres in November, 1995. RESULTS: The three points of most concern to residents were: 1. On-demand clinic: unfinishable consultations, lack of time and clinical problems. 2. Consultations by appointment: clinical problems, over-long consultations and difficulties in resolving the consultations. 3. Other causes of anxiety: not having the day off after being on call, research work and emergencies. 4. Problems foreseen a priori: a lot of patients in a short time, not creating problems for the tutor and unemployment at the end of the residency. CONCLUSIONS: The short time to attend each patient and clinical problems are what cause most difficulty. This was the first time the difficulties residents had to integrate into Health Centres were surveyed. The initiative was greatly appreciated by them.

Family Practice↗
PubMedDate not supplied

[Reasons for anxiety in primary care professionals. A resident-tutor comparison].

OBJECTIVES: 1) To find the reasons for PC professionals' anxiety when going about their normal work. 2) To check whether training and experience affect the assessment of the reasons of Family Doctors for anxiety. DESIGN: A descriptive study using a questionnaire. SETTING: PC health centres with second-year family and community medicine (FCM) residents from the Murcia Teaching Unit. PARTICIPANTS: All second-year FCM residents from the Teaching Unit (28) in December 1995 and their tutors. MEASUREMENTS: Open questionnaire based on three points: Causes of anxiety in on-demand consultations; causes of anxiety in scheduled consultations; other reasons for anxiety connected with the Health Centre. RESULTS: The three most anxiety-producing causes in relation to each question were: a) on-demand consultation: residents (R)--unfinishable consultations, lack of time, clinical problems; tutors (T)--unfinishable consultations, a lot of patients waiting outside, manipulative patients. b) Scheduled consultation: R--clinical problems, consultation too long, difficulties in reaching a solution; T--consultation too long, patients without an appointment and interruptions in the middle of the consultation. c) Other reasons for anxiety: R--not being off the day after being on call, having to do research work, and emergency calls; T--emergency calls, research work and temperature problems. CONCLUSIONS: Clinical problems are the causes of anxiety with the greatest difference between tutors and residents. Regulated training in the health centre and professional experience seem to act positively on some of the causes of anxiety.

Anxiety↗