Consensus document for the kangaroo mother care method.

INTRODUCTION: Currently, kangaroo mother care (KMC) is an intervention whose implementation in clinical practice varies widely. The aim of this document is to gather the latest evidence-based recommendations in an attempt to reduce interprofessional variation and increase the quality of neonatal care. METHODS: The document was developed following the guidelines provided in the Methodological Manual for the Development of Clinical Practice Guidelines of the National Health System: formulation and prioritization of clinical questions, literature search, critical reading, development of the document and external review. The target population was preterm (PT) and/or low birth weight (LBW) newborn infants admitted to a neonatal unit. RECOMMENDATIONS: Based on the current evidence, recommendations have been issued to address 18 clinical questions regarding the impact of KMC (morbidity and mortality, physiological stability, neurodevelopment, feeding, pain, families), including infants with vascular access or respiratory support devices. It also describes the KMC procedure (transfer, positioning), the facilitators and barriers related to the implementation of KMC and how to implement KMC in extremely preterm newborns (less than 28 weeks of postmenstrual age in the first days of life). CONCLUSIONS: Kangaroo mother care is a beneficial practice for PT infants, LBW infants and their families. The implementation of these recommendations may be useful in everyday clinical practice and may improve KMC outcomes and the quality of care provided to neonatal patients.

Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up.

The management of urinary tract infection (UTI) in infants and children has changed significantly over the past few decades based on scientific evidence that questioned the efficacy of strategies used to prevent kidney injury and subsequent progression to chronic kidney disease, which is very unlikely in most paediatric cases. However, there is still substantial heterogeneity in its management and uncertainty regarding the diagnosis, indication of imaging tests, treatment or follow-up in these patients. The Spanish clinical practice guideline has been updated through the review of the literature published since 2009 and a rigorous evaluation of current clinical practice aspects, taking into account the evidence on the benefits of each intervention in addition to its risks and drawbacks to attempt to provide more precise recommendations.

[Impact of the implementation of the international best practice guidelines programme (BPSO®) on health outcomes in a public hospital]. / Impacto de la implantación del programa internacional de Guías de Buenas Prácticas (BPSO®) en los resultados de salud en un hospital público.

OBJECTIVE: To analyze the impact on patient health outcomes after implementing 4 Good Practice Guidelines (GPG) in a level II public university hospital. METHOD: A quasi-experimental pre-post study was carried out at the Hospital Universitario Fundación Alcorcón, belonging to the Servicio Madrileño de Salud (SERMAS) of the Community of Madrid. Anonymized patient health indicator data from February 2018 to December 2022 from a total of 4853 patient records were analyzed. Inclusion criteria all patients defined in the scope of each GBP. The sample analyzed was patients discharged in the last 5 working days of the month for all GBPs, except in Ostomy and Stroke, for which 100% of patients discharged during the month were included. RESULTS: The main results were: incidence of pressure injury from 2.70% (2017) to 1.03% (2022); stoma marking from 66.67% (2017) to 75% (2022); exclusive breastfeeding from 50% (2017) to 61.54% (2022); neurological assessment on admission from 75.56% (2017) to 85.60% (2022). CONCLUSIONS: The implementation of the GBPs led to an improvement in the health indicators of patients admitted to the target units. Improvements were observed in both process and outcome indicators.

Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. / Guías impresas en 3D: ¿mejoran el control local y la supervivencia global en el tratamiento de los sarcomas pélvicos? Estudio de validación clínica.

BACKGROUND AND OBJECTIVES: 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS: A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS: The 3D group achieved a higher rate of free margins (80% vs 66.7%, p = 0.345). Local recurrence (50% vs 60%, P=.244) and distant disease relapse (20% vs 47%, p = 0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p = 0.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS: The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.

Methodological and strategic insights for online survey studies: an analysis based on the CHERRIES checklist.

The use of online surveys has become a valuable and widely employed tool in health research. However, the use of such instruments necessitates methodological rigor and optimization in their design to achieve the best response rates. Drawing upon relevant literature and the international CHERRIES guidelines for the development of online surveys, this article addresses methodological aspects related to ethical considerations and data protection (with reference to the Association of Internet Research's online ethics guide), study design and validation, recruitment, data collection processes, and data management and analysis. In conclusion, given the context of overexposure to online surveys, which can influence recruitment and response rates, strategies for their maximization are provided, encompassing both static and dynamic aspects of survey design.

Guía clínica para la atención integral en salud de las personas con VIH / Clinical guide for comprehensive health care for people with HIV

La presente guía clínica se constituye en la actualización de la Guía clínica de atención integral en salud de las personas con VIH, de diciembre de 2014, la cual se hace necesaria para contribuir a los objetivos del Plan Estratégico Nacional Multisectorial (PENM) cuya misión es la de conducir acciones en la repuesta nacional al VIH y las ITS, garantizando el acceso a la atención de las personas con VIH e ITS con estándares internacionales, previniendo nuevas infecciones; propiciando un entorno de respeto a los derechos humanos, equidad de género y la diversidad sexual, encaminada hacia la eliminación del VIH en El Salvador, reducción de nuevas infecciones de VIH, reducción de muertes relacionadas a sida y eliminación de la transmisión materno infantil. En el presente documento se incluyen las recomendaciones de la Organización Mundial de la Salud (OMS), sobre nuevos medicamentos antirretrovirales en tratamientos de primera, segunda y tercera línea, en todas las poblaciones incluidas, embarazadas y mujeres en edad fértil; se presentan diferentes esquemas de tratamiento, con el propósito de mejorar la calidad en la atención de la persona con VIH

This clinical guide is an update of the Clinical Guide for Comprehensive Health Care for People with HIV, dated December 2014, which is necessary to contribute to the objectives of the National Multisector Strategic Plan (PENM), whose mission is that of leading actions in the national response to HIV and STIs, guaranteeing access to care for people with HIV and STIs with international standards, preventing new infections; promoting an environment of respect for human rights, gender equality and sexual diversity, aimed at eliminating HIV in El Salvador, reducing new HIV infections, reducing AIDS-related deaths and eliminating mother-to-child transmission. This document includes the recommendations of the World Health Organization (WHO) on new antiretroviral drugs in first, second and third line treatments, in all populations included, pregnant women and women of childbearing age; Different treatment schemes are presented, with the purpose of improving the quality of care for people with HIV.

Estudio comparativo de guías de atención prenatal en Latinoamérica / Comparative study of prenatal care guidelines in Latin America

Objetivo: Realizar una síntesis comparativa sobre las guías de control prenatal en países hispanohablantes de Latinoamérica. Métodos: Se seleccionaron las guías de atención prenatal más actualizadas de cada país latinoamericano y se expusieron sus criterios en un cuadro comparativo. Resultados: Se evidenció que la mayoría de las guías de control prenatal comparten criterios guiados por las recomendaciones dadas por la Organización Mundial de la Salud (OMS). Sin embargo, existen diferencias que dependen del riesgo epidemiológico o de exposición que se presente en cada país. Conclusión: A través de esta investigación, se ha reafirmado que el control prenatal desempeña un papel crucial en la promoción de la salud materno-fetal, permitiendo detectar y abordar de manera temprana factores de riesgo, así como proporcionar la atención y seguimiento adecuados durante el embarazo(AU)

Objective: To perform a comparative synthesis of prenatal care guidelines in Spanish-speaking countries of Latin America. Methods: The most up-to-date prenatal care guidelines from each Latin American country were selected, and their criteria were presented in a comparative table. Results: It was evident that the majority of prenatal care guidelines share criteria guided by recommendations from the World Health Organization (WHO). However, there are differences that depend on the epidemiological risk or exposure present in each country. Conclusion: Through this research, it has been reaffirmed that prenatal care plays a crucial role in promoting maternalfetal health by allowing the early detection and management of risk factors, as well as providing adequate care and monitoring during pregnancy(AU)

Restablecimiento de guía anterior con restauraciones adhesivas / Reestablishing of anterior guidance with adhesive restorations

La estética ha llegado a formar una parte muy importante en la odontología actual. Sin embargo, no debemos sobreponer las necesidades estéticas sobre las necesidades funcionales. La pérdida de estructura dental asociada a bruxismo puede ser considerada patológica cuando compromete la guía anterior, la cual es la influencia en los movimientos mandibulares que proveen las superficies contactantes de los dientes maxilares anteriores con los mandibulares anteriores y evita contactos excéntricos dañinos en los dientes posteriores. El objetivo de este reporte de caso es presentar una alternativa conservadora para restablecer tanto la estética como la funcionalidad de una paciente de 34 años de edad que acudió a la Clínica de Prostodoncia de la Universidad Autónoma de Guadalajara en busca de rehabilitación estética de dientes anteriores. Una vez realizada su evaluación inicial se llegó al diagnóstico de pérdida de guía anterior por desgaste patológico asociado a bruxismo. El tratamiento incluyó tratamientos de conductos, remoción de caries y restauraciones mal ajustadas, coronas y carillas para restablecer la guía anterior. Se cumplieron con las expectativas estéticas que tenía la paciente al igual que con las necesidades funcionales que fueron objetivo desde el inicio, logrando un restablecimiento de la guía anterior de manera conservadora (AU)

Esthetics has become a very important part of dentistry today. However, we should not superimpose esthetic needs over functional needs. The loss of tooth structure associated with bruxism can be considered pathologic when it compromises the anterior guidance, which is the influence on mandibular movements that provides the contacting surfaces of the maxillary anterior teeth with the mandibular anterior teeth and avoids damaging eccentric contacts in the posterior teeth. The aim of this case report is to present a conservative way to restore both esthetics and function in a 34-year-old patient who came to the Prosthodontics Clinic of the Universidad Autónoma de Guadalajara in search of an esthetic appearance of her anterior teeth. After her initial evaluation, a diagnosis of anterior guide loss due to pathological wear associated with bruxism was made. Treatment included root canal treatment, removal of caries, and ill-fitting restorations, crowns, and veneers to reestablish the anterior guidance. The aesthetic expectations of the patient have met as well as the functional needs that were aimed from the beginning, achieving a conservative reestablishment of the anterior guidance system (AU)

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

La insuficiencia cardiaca crónica sigue siendo unas de las principales causas de afectación en el funcionamiento y en la calidad de vida de las personas que la presentan, así como una de las primeras causas de mortalidad en nuestro país y en todo el mundo. México tiene una alta prevalencia de factores de riesgo para desarrollar insuficiencia cardiaca, tales como hipertensión arterial, diabetes y obesidad, lo que hace imprescindible contar con un documento basado en la evidencia que brinde recomendaciones a los profesionales de la salud involucrados en el diagnóstico y el tratamiento de estos pacientes. Este documento establece la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología (SMC) en colaboración con la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario y multicolaborativo de expertos. Cumple con estándares internacionales de calidad, como los descritos por el Institute of Medicine de los Estados Unidos de América (IOM), el National Institute of Clinical Excellence (NICE) del Reino Unido, la Intercollegiate Network for Scottish Guideline Development (SIGN) de Escocia y la Guidelines International Network (G-I-N). El grupo de desarrollo de la guía se integró de manera interdisciplinaria con el apoyo de metodólogos con experiencia en revisiones sistemáticas de la literatura y en el desarrollo de GPC. Se llevó a cabo y se condujo metodología de panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. Esperamos que este documento contribuya para la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos que manejan pacientes con insuficiencia cardiaca crónica en todas sus etapas clínicas, y de esta manera logremos mejorar la calidad en la atención clínica, aumentar la calidad de vida de los pacientes y disminuir las complicaciones de la enfermedad.

Consensus on lipoprotein(a) of the Spanish Society of Arteriosclerosis. Literature review and recommendations for clinical practice. / Consenso sobre lipoproteína (a) de la Sociedad Española de Arteriosclerosis. Revisión bibliográfica y recomendaciones para la práctica clínica.

The irruption of lipoprotein(a) (Lp(a)) in the study of cardiovascular risk factors is perhaps, together with the discovery and use of proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor drugs, the greatest novelty in the field for decades. Lp(a) concentration (especially very high levels) has an undeniable association with certain cardiovascular complications, such as atherosclerotic vascular disease (AVD) and aortic stenosis. However, there are several current limitations to both establishing epidemiological associations and specific pharmacological treatment. Firstly, the measurement of Lp(a) is highly dependent on the test used, mainly because of the characteristics of the molecule. Secondly, Lp(a) concentration is more than 80% genetically determined, so that, unlike other cardiovascular risk factors, it cannot be regulated by lifestyle changes. Finally, although there are many promising clinical trials with specific drugs to reduce Lp(a), currently only iPCSK9 (limited for use because of its cost) significantly reduces Lp(a). However, and in line with other scientific societies, the SEA considers that, with the aim of increasing knowledge about the contribution of Lp(a) to cardiovascular risk, it is relevant to produce a document containing the current status of the subject, recommendations for the control of global cardiovascular risk in people with elevated Lp(a) and recommendations on the therapeutic approach to patients with elevated Lp(a).

Aspectos clinicoepidemiológicos de adultos con guía anterior de la oclusión dentaria disfuncional

Introducción: Los dientes anteriores tienen una función predominante en el sistema estomatognático, esencial para la estética, la fonación y la masticación. Objetivo: Caracterizar a los adultos con guía anterior de la oclusión dentaria disfuncional según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio descriptivo y transversal, desde octubre de 2021 hasta abril de 2022, en la Clínica Estomatológica Docente 3 de Octubre de Las Tunas. El universo estuvo conformado por 825 historias clínicas que contenían el diagnóstico de pacientes con bruxismo, oclusión traumática y trastornos temporomandibulares, quienes presentaban disfunción de la guía anterior de la oclusión dentaria. Mediante el muestreo no probabilístico intencional, fue seleccionada una muestra de 615 con fórmula dentaria íntegra o desdentamiento parcial de clase III de Kennedy y atención estomatológica concluida o inactivación de los procesos de caries e inflamatorios agudos. Resultados: Primaron el sexo femenino (54,8 %) y las edades de 40-49 años (33,5 %). El bruxismo prevaleció como diagnóstico clínico (41,9 %) con predominio del correspondiente al sueño (39,1 %), el secundario (51,2 %), el probable (59,7 %) y el moderado (69,4 %); entre sus clasificaciones más relevantes se destacó el sistema estomatognático disfuncional (84,4 %). Las manifestaciones clínicas dentarias predominantes fueron las facetas de desgaste (87,5 %). Conclusiones: La caracterización de los pacientes con guía anterior de la oclusión dentaria disfuncional permite establecer una panorámica actualizada de esta problemática de salud para un mejor seguimiento y tratamiento a dichos pacientes.

Introduction: Anterior teeth have a predominant function in the stomatognatic system, essential for the aesthetics, phonation and mastication. Objective: To characterize adults with anterior guide of dysfunctional dental occlusion according to clinical and epidemiological variables. Methods: A descriptive and cross-sectional study, was carried out from October, 2021 to April, 2022, in the 3 de Octubre Teaching Stomatological Clinic from Las Tunas. The universe was formed by 825 medical records that contained the diagnosis of patients with bruxism, traumatic occlusion and temporomandibular disorders who presented anterior guide of the dysfunctional dental occlusion. By means of the intentional non probabilistic sampling, a sample of 615 with entire dental formula or class III partial toothlessness of Kennedy and concluded stomatologic care or inactivation of the cavity and acute inflammatory processes was selected. Results: There was a prevalence of the female sex (54.8%) and the 40-49 age group (33.5%). Bruxism prevailed as clinical diagnosis (41.9%) with prevalence of the corresponding to sleep (39.1%), secondary (51.2%), probable (59.7%) and moderate (69.4%); among the most outstanding classifications was the dysfunctional stomatognatic system (84.4%). The predominant dental clinical manifestations were the wear facets (87.5%). Conclusions: The characterization of patients with anterior guide of the dysfunctional dental occlusion allows to establish an up-to-date panoramic of this health problem, for a better follow-up and treatment to these patients.

Lineamientos para la prevención y el tratamiento de la osteoporosis inducida por glucocorticoides en pediatría / Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis in pediatrics

Objetivo. Proporcionar un marco para profesionales de la salud que tratan a pacientes pediátricos bajo terapia con glucocorticoides (GC) y desarrollar recomendaciones para la prevención y el tratamiento de la osteoporosis inducida por GC en la población pediátrica. Métodos. Un panel de expertos en enfermedades óseas y pediátricas generó una serie de preguntas PICO que abordan aspectos relacionados con la prevención y el tratamiento de osteoporosis en pacientes bajo tratamiento con GC. Siguiendo la metodología GRADE, se realizó una revisión sistemática de la literatura, se resumieron las estimaciones del efecto y se calificó la calidad de la evidencia. Luego se procedió a la votación y a la formulación de las recomendaciones. Resultados. Se desarrollaron 7 recomendaciones y 6 principios generales para osteoporosis inducida por GC en población pediátrica. Conclusión. Estas recomendaciones proporcionan orientación para los médicos que deben tomar decisiones en pacientes pediátricos bajo tratamiento con GC.

Objective. To provide a framework for healthcare professionals managing pediatric patients who are on active glucocorticoid (GC) therapy and to develop recommendations for the prevention and treatment of GC-induced osteoporosis in the pediatric population. Methods. A panel of experts on bone and pediatric diseases developed a series of PICO questions that address issues related to the prevention and treatment of osteoporosis in patients on GC therapy. In accordance with the GRADE approach, we conducted a systematic review of the literature, summarized effect estimations, and classified the quality of the evidence. Then, voting and the formulation of recommendations followed. Results. Seven recommendations and six general principles were developed for GC-induced osteoporosis in the pediatric population. Conclusion. These recommendations provide guidance for clinicians who must make decisions concerning pediatric patients undergoing treatment with GC.

Guía de práctica clínica para la atención a niños y adolescentes con enfermedad renal crónica / Clinical practice guide for the care to children and adolescents with chronic renal disease

La enfermedad renal crónica constituye un problema de salud por su impacto sobre los individuos, la sociedad y la economía. Teniendo en cuenta lo anterior, y luego de una amplia búsqueda bibliográfica, se diseñó una guía de práctica clínica en el Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río, dirigida a los profesionales de la atención primaria de salud, con el objetivo de mejorar la calidad de vida de niños y adolescentes con dicha enfermedad. Esta fue elaborada por los métodos de la medicina basada en la evidencia, según el consenso y la opinión de los expertos. Se logró generalizar esta herramienta, emitir recomendaciones y actualizarla acorde con las nuevas evidencias médicas. Finalmente, resultó evaluada por los expertos como muy recomendada.

Chronic renal disease constitutes a health problem due to its impact on individuals, society and economy. Taking into account the above-mentioned, and after a wide literature search, a clinical practice guide was designed in Luis Augusto Turcios Lima Polyclinic from Pinar del Río province, directed to primary health care professionals, aimed at improving the life quality of children and adolescents with this disease. It was elaborated by medicine methods based on the evidence, according to the consent and opinion of experts. It was possible to generalize this tool, give recommendations and up to date according to the new medical evidences. Finally, it was evaluated by experts as very recommended.

Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain.

INTRODUCTION AND OBJECTIVES: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. METHODS: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. RESULTS: Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). CONCLUSIONS: In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

[Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]. / Evaluación de una guía de codificación de determinantes sociales de la salud en las consultas de atención primaria: Estudio mixto.

OBJECTIVE: To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow. DESIGN: Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative). LOCATION: All the primary care teams of the Central Catalonia Management (32 teams). PARTICIPANTS AND SETTING: All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023. METHODS: A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective. RESULTS: The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline. CONCLUSIONS: The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.

Guía de atención para pacientes con maloclusión de clase II con dentición permanente en crecimiento activo

Fundamento la maloclusión de clase II presenta la mayor prevalencia entre las alteraciones dentoesqueléticas. Objetivo: proponer una guía de atención para pacientes con maloclusión de clase II con dentición permanente en crecimiento activo. Métodos: se realizó una investigación de innovación tecnológica de enfoque mixto en el Departamento de Ciencias Clínicas de la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, en el periodo comprendido entre los años 2020 y 2023. El universo de estudio estuvo constituido por todos los especialistas de Ortodoncia de la provincia de Villa Clara, Sancti Spíritus y Cienfuegos, a partir del cual se realizó un muestreo no probabilístico intencional por criterios y quedó constituida la muestra por 20 especialistas y siete expertos (especialistas de categoría superior) con criterios de inclusión. Resultados: la documentación revisada aportó información valiosa para determinar el estado actual de la atención de la maloclusión de estudio. Los especialistas emitieron diferentes criterios sobre el diagnóstico y tratamiento de la maloclusión de clase II. Los expertos establecieron los elementos invariables para su clasificación. Finalmente se diseñó una guía de atención para los pacientes con maloclusión de clase II con dentición permanente en crecimiento activo, valorada por los especialistas con la categoría de excelente. Conclusiones: la guía propuesta contiene elementos invariables de diagnóstico y pautas de tratamiento con el fin de lograr una atención más integral y eficiente de la maloclusión.

Foundation: Class II malocclusion has the highest prevalence among dentoskeletal disorders. Objective: to propose a care guide for patients with class II malocclusion with actively growing permanent dentition. Method: a mixed approach technological innovation research was carried out in the Clinical Sciences Department from the Stomatology Faculty of the Villa Clara Medical Sciences University, from 2020 to 2023. The studied universe was all the Orthodontic specialists in the Villa Clara province, Sancti Spíritus and Cienfuegos, from which an intentional non-probabilistic sampling was carried out by criteria and the sample was made up of 20 specialists and seven experts (higher category specialists) with criteria of inclusion. Results: The reviewed documentation provided valuable information to determine the current state of care for malocclusion under study. Specialists issued different criteria on the diagnosis and treatment of class II malocclusion. The experts established the invariable elements for their classification. Finally, a care guide was designed for patients with class II malocclusion with actively growing permanent dentition, rated by specialists as excellent. Conclusions: the proposed guide contains invariable diagnostic elements and treatment guidelines in order to achieve more comprehensive and efficient malocclusion care.

Incisões e retalhos: orientações e guia prático / Incisions and flaps: guidelines and pratical guide

Na cirurgia oral, dois princípios básicos são o acesso adequado e uma boa visualização. Em diversos casos, isto somente é alcançado afastando os tecidos moles adjacentes do local operado através de retalhos cirúrgicos. Os principais retalhos descritos na literatura para cirurgia oral são: envelope, em L ou triangular, trapezoidal e em Y. As técnicas para a realização de incisões e retalhos são essenciais para o acesso de determinados dentes ou patologias que surgem de maneira rotineira na clínica odontológica, além de também serem usadas para contornar complicações cirúrgicas, como fraturas radiculares. O objetivo deste trabalho é, através de um guia prático, expor os princípios para uma técnica adequada e a sequência para realização dos retalhos mais utilizados em cirurgia oral.

In oral surgery, two basic principles are access and good visualization. In many cases, this is only achieved by moving adjacent soft tissues away from the operated site using surgical flaps. The main flaps described in the literature for oral surgery are: envelope, L-shaped or triangular, trapezoidal and Y-shaped. Techniques for performing incisions and flaps are essential for accessing certain teeth or pathologies that arise routinely in the dental clinic, in addition to being used to circumvent surgical complications, such as root fractures. The objective of this work is, as a practical guide, to expose the principles for an adequate technique and a sequence for the realization of the most used flaps in oral surgery.