[Project to improve the management of primary care complaints in Santiago de Compostela]

OBJECTIVE

To improve the quality of how Santiago's Primary Care Department manages complaints through two specific objectives: 1) Address patients' claims within a month or less; 2) Use an automated and data management tool to detect and record issues and activities of the health care centers. RESOURCES AND METHODS: The work consisted of improvements implemented in various phases: a) Quantifying the initial situation; b) Analyzing possible issues; c) Implementing corrective measures; d) Evaluating the implementation and monitoring; period of study 2007-2008.

RESULTS

In 2008, 83% of claims were addressed in a month or less (79.36% in 2007), taking into account that the number of complaints received in 2008 increased 49.5% from 2007 levels. In 2008, it took 19.46 days to respond to a complaint (22.82 days in 2007). The implementation of the new complaints management protocol in the health care centers allowed 67.9% of all claims in 2008 to be received with all pertinent facts (31.1% in 2007).

CONCLUSION

The application of new protocols and simple corrective measures to the identified issues allowed for a statistically significant improvement in the response rate to the user. The optimization of the automated tool for managing the claims facilitated the identification of breakdowns in the system and prospectively will help undertake improvement actions.

[Evaluation of the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in primary care: the PREseAP Study]

OBJECTIVES

To assess the efficacy of a comprehensive secondary prevention programme to reduce morbidity and mortality in patients who have suffered a cardiovascular (CV) event; to control CV risk factors and prophylactic treatment in order to prevent recurrence; and to improve the quality of life of patients with cardiovascular disease.

DESIGN

Randomised, pragmatic, open clinical trial in primary care.

SETTING

A total of 42 primary care centres of 8 different areas in Spain.

PARTICIPANTS

Men and women below 86 years old, diagnosed with coronary disease and/or stroke and/or peripheral vascular disease in the preceding year, and who have no serious or terminal disease.

INTERVENTION

Primary care centres will be randomised to following usual care (control group), or to following a comprehensive programme of secondary prevention (intervention group).

MAIN MEASUREMENTS

Cardiovascular fatal events, cardiovascular non-fatal events, total mortality and health-related quality of life (SF-36).

Reliable quantification of hematopoietic chimerism after allogeneic transplantation for acute leukemia using amplification by real-time PCR of null alleles and insertion/deletion polymorphisms

Increasing mixed chimerism (MC) after allogeneic stem cell transplantation (SCT) has been associated with a high risk of relapse in acute leukemia. We evaluated a new method for chimerism detection, based on the quantitative real-time PCR (qrt-PCR) amplification of null alleles or insertion/deletion polymorphisms (indels). All qrt-PCR assays with null alleles and indels attained a sensitivity of at least 10(-4), as well as good intra- and interassay concordance, and a high accuracy in experiments with cell mixtures. Informativeness was found in 80.3% of the 61 donor/recipient pairs tested. Nonrelapsed patients showed a progressive decrease in peripheral blood chimerism to values below 0.01% (complete chimerism (CC)). Bone marrow chimerism failed to reach CC more than 4 years after SCT. Increasing MC was observed prior to relapse in 88.2% of patients. Compared with conventional PCR amplification of variable number of tandem repeats, qrt-PCR predicted a significantly higher number of relapses (88.2 vs 44.4%) with a median anticipation period of 58 days. In conclusion, chimerism determination by qrt-PCR amplification of null alleles and indels constitutes a useful tool for the follow-up of patients with acute leukemia after SCT, showing better results than those obtained with conventional PCR.

Taurine increases rat survival and reduces striatal damage caused by 3-nitropropionic acid

Taurine acts as an antioxidant protecting neurons from free radical-mediated cellular damage. 3-nitropropionic acid (3-NP) inhibits energy metabolism, initiating oxidative stress. With the objective to examine whether taurine can protect glia and neurons from damage produced by 3-NP, male Wistar and Sprague-Dawley rats were treated with either (1) saline, (2) taurine (3) 3-NP and saline, or (4) 3-NP and taurine for 4 days. Survival was determined and brains were processed immunohistochemically. Large striatal lesions and increased GFAP, SOD, and taurine immunoreactivity were detected in the 3-NP group when compared with control groups. In contrast, animals receiving 3-NP and taurine exhibited less GFAP, SOD, and taurine immunoreactivity, along with increased survival rates. Results indicate that taurine treatment after 3-NP administration protects the striatum from damage.