Metodología para la confección de la guía de tratamiento integral del cáncer de pulmón, en Villa Clara / Methodology to prepare a comprehensive treatment guideline for lung cancer in Villa Clara

RESUMEN Introducción: En Cuba, la Estrategia Nacional de Control del Cáncer recomienda contextualizar las guías clínicas de diagnóstico y tratamiento a las condiciones específicas de cada provincia e institución sanitaria. Objetivo: Describir la metodología para la elaboración de la guía de diagnóstico y tratamiento del cáncer de pulmón en Villa Clara. Métodos: Se realizó una búsqueda bibliográfica en la Biblioteca Cochrane de revisiones sistemáticas y en la base de datos PubMed, en el periodo de 2007-2017. Se consultaron, además, las principales guías nacionales e internacionales relacionadas con el tratamiento del cáncer de pulmón. Se utilizó el consenso de expertos como sistemática de trabajo para la elaboración y validación de la guía. Resultados: Se estructuró un documento final en seis apartados (estadísticas de cáncer de pulmón, prevención y epidemiología, diagnóstico y tratamiento, seguimiento, conducta en la recidiva local y progresión de la enfermedad); con anexos relacionados con la pesquisa, descripción clínica, esquemas de tratamiento, instrumentos de calidad de vida e indicadores. La guía se encuentra implementada en hospitales y policlínicos de la provincia, desde el año 2013, y fue actualizada en 2017. Conclusiones: Esta guía fomenta la valoración multidisciplinaria de los pacientes, orienta a la Atención Primaria de Salud en la aplicación del algoritmo para la atención integral a los enfermos y el desarrollo de los ensayos clínicos con inmunoterapias, e incorpora indicadores de evaluación de desempeño en la red de atención médica.

ABSTRACT Introduction: the National Cancer Control Strategy, in Cuba, recommends contextualizing clinical guidelines for the diagnosis and treatment of the specific conditions in each health institution and province. Objective: to describe the methodology for the preparation of a diagnosis and treatment guideline for lung cancer in Villa Clara. Methods: a bibliographic search was carried out in the Cochrane Library of systematic reviews and in PubMed database, in 2007-2017. The main national and international guidelines related to the treatment of lung cancer were also consulted. The consensus of experts was used as a work system for the guideline preparation and validation. Results: a final document was structured in six sections (lung cancer statistics, prevention and epidemiology, diagnosis and treatment, follow-up, conduct in local recurrence and disease progression); with annexes related to the research, clinical description, treatment schemes, quality of life instruments and indicators. The guideline has been implemented in hospitals and polyclinics in the province since 2013, and was updated in 2017. Conclusions: this guideline promotes the multidisciplinary assessment of patients, guides Primary Health Care in the application of the algorithm for comprehensive care of patients and the development of clinical trials with immunotherapies, as well as incorporates performance evaluation indicators in the health care network.

Assessment of the Asian Neurogastroenterology and Motility Association Chronic Constipation Criteria: An Asian Multicenter Cross-sectional Study

BACKGROUND/AIMS: There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects. METHODS: This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator's judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC. RESULTS: The primary analysis comprised of 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4%. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator’s judgment criteria (388 subjects [93.7%]) compared with the Rome III criteria. CONCLUSION: This study demonstrates that the ANMA CC tool can be a useful for Asian patients with CC.

Knowledge and attitudes of low back pain in physicians based in clinical practice guidelines / Conhecimento e conduta em casos de lombalgia com base nas diretivas de prática clínica / Conocimientos y actitudes sobre lumbalgia de médicos basados en la guía práctica clínica

Objective: To determine the level of knowledge and attitudes of physicians in Tijuana based on Clinical Practice Guidelines (CPG) for the prevention, diagnosis and treatment of Nonspecific Low Back Pain (NLBP). Methods: Prospective, cross-sectional, descriptive study. Data were obtained from doctors who practice in clinics, private surgeries, and/or government institutions. Results: Of a total of 56 doctors surveyed, 37 were men and 19 women. None of the doctors said they had not seen a patient with Back Pain. 49% knew the GPC, and 51% did not know of its existence. Conclusions: Although some physicians reported knowledge of the GPC, according to the results, there was a lack of full knowledge of, and adherence to these guidelines. Not knowing the GPC did not make it impossible to complete the questionnaire. The doctors felt more connected to the health system, but with less confidence in the management of cases of NLBP.

Objetivo: Determinar o nível de conhecimentos e a conduta dos médicos de Tijuana, com base nas Diretivas de Prática Clínica (DPC) para prevenção, diagnóstico e tratamento da dor lombar não específica (DLNE). Métodos: Estudo prospectivo, transversal e descritivo. Os dados foram obtidos junto a médicos que prestam serviços em clínicas, consultórios particulares e/ou instituições governamentais. Resultados: Atingiu-se um total de 56 médicos entrevistados, dos quais 37 eram homens e 19 mulheres. Nenhum médico disse que não atende um paciente com dor lombar. Do total, 49% conhecem as DPC e 51% não sabiam da sua existência. Conclusões: Apesar de alguns médicos relatarem conhecer as DPC, de acordo com os resultados obtidos, falta-lhes maior domínio e conformidade com relação a essas diretivas. Não conhecer as DPC não impossibilita responder ao questionário. Os médicos sentem-se mais conectados ao sistema de saúde, mas com menos confiança na conduta em casos DLI.

Objetivo: Determinar el nivel de conocimientos y las actitudes de los médicos en Tijuana, con base en la Guía de Práctica Clínica (GPC) para la prevención, diagnóstico y tratamiento del Dolor Lumbar Inespecífico (DLI). Métodos: Estudio prospectivo, transversal y descriptivo. Los datos fueron obtenidos de los médicos que prestan sus servicios en clínicas, consultorios privados y/o instituciones de gobierno. Resultados: Se obtuvo un total de 56 médicos encuestados, 37 hombres y 19 mujeres. Ningún médico contestó que no atiende un paciente con dolor lumbar. El 49% conocen la GPC y el 51% no saben de su existencia. Conclusiones: A pesar de que algunos médicos refieren conocer la GPC, según los resultados obtenidos falta mayor dominio y apego de la misma. El no conocer la GPC no hace imposible contestar el cuestionario. Los médicos se sienten más conectados con el sistema de salud, pero con menor autoconfianza en el manejo del DLI.