The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

The impact of exposure to tobacco smoke and e-cigarettes on asthma-related outcomes: Systematic review informing the EAACI guidelines on environmental science for allergic diseases and asthma.

To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence).

The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted.

Knowledge and practices regarding prostate cancer screening in Spanish men: The importance of personal and clinical characteristics (PROSHADE study).

INTRODUCTION: Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. METHODS: A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. RESULTS: Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001). CONCLUSIONS: Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.

Recommendations on self-management interventions for adults living with obesity: COMPAR-EU project.

Self-management interventions (SMIs) may improve disease management in adults living with obesity. We formulated evidence-based recommendations for SMIs within the context of the COMPAR-EU project. The multidisciplinary panel selected critical outcomes based on the COMPAR-EU core outcome set and established decision thresholds for each outcome. Recommendations were informed by systematic reviews of effects, cost-effectiveness, and a contextual assessment. To assess the certainty of the evidence and formulate the recommendations, we used the GRADE approach guidance. Overall, SMIs were deemed to have a small impact, but the absence of harmful effects and potential cumulative benefits indicated a favourable balance of effects, despite low certainty. SMIs showed variations in structure, intensity, and resource utilisation, but overall are likely to be cost-effective. Adapting SMIs to local contexts would enhance equity, acceptability, and feasibility, considering patients' values, and availability of resources and teamwork. Consequently, the panel made conditional recommendations favouring SMIs over usual care. The rigorous and explicit recommendations demonstrated the effectiveness of SMIs for adults living with obesity. However, the gaps in the literature influenced the panel to make only conditional recommendations in favour of SMIs. Further research is needed to strengthen the evidence base and improve recommendations' certainty and applicability.

COMPAR-EU Recommendations on Self-Management Interventions in Type 2 Diabetes Mellitus.

Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation.

Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials.

Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF.

Exploring the Effectiveness of Self-Management Interventions in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Chronic diseases are a leading cause of global morbidity and mortality. In response to this challenge, self-management interventions (SMIs) have emerged as an essential tool in improving patient outcomes. However, the diverse and complex nature of SMIs pose significant challenges in measuring their effectiveness. This work aims to investigate the comparative effectiveness of SMIs on Type 2 diabetes mellitus (T2DM) outcomes. METHODS: A rigorous analytical framework was employed to assess the relative effectiveness of different SMIs, encompassing both pairwise and network meta-analysis (NMA), as well as component network meta-analysis (CNMA). Various outcomes were considered, including glycated hemoglobin (HbA1c) control, body mass index (BMI) reduction and low-density lipoprotein (LDL) cholesterol. Visualization tools were also utilized to enhance the interpretation of results. RESULTS: SMIs were found promising in improving clinical outcomes and patient-reported measures. However, considerable heterogeneity and inconsistency across studies challenged the validity of NMA results. CNMA along with various visualization tools offered insights into the contributions of individual SMI components, highlighting the complexity of these interventions. DISCUSSION/CONCLUSIONS: SMIs represent a valuable approach to managing chronic conditions, but their effectiveness is context-dependent. Further research is needed to elucidate the contextual factors influencing SMI outcomes. This work contributes to a comprehensive understanding of SMIs' role in T2DM management, aiming to aid decision-makers, clinicians, and patients in selecting tailored interventions.

Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map.

Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms 'self-management', 'adult' and 'T2DM' for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10-14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care.

Desarrollo de guías de práctica clínica basadas en evidencia en Perú desde el sector público / The development of evidence-based clinical practice guidelines in Peru for public healthcare facilities

En el Perú, la elaboración de guías de práctica clínica tiene exigencia normativa desde el año 2005 (NT N° 027-MINSA/DGSP-V.01); sin embargo, su desarrollo ha ténido poco énfasis en la calidad metodológica de las mismas, prefiriendo el tipo narrativo. Desde hace varios años se realizan esfuerzos dispersos para mejorar la calidad metodológica, principalmente que su elaboaración esté basada en evidencias científicas. Actualmente se cuenta con una nueva normativa (NT N° 302-2015/MINSA) que pone mayor enfasis en esta exigencia y algunas instituciones ya trabajan para adecuarse a estandares internacionales y poder generar impactos positivos en nuestro sistema de salud a través del adecuado desarrollo de guias de practica clínica en nuestro pais

There has been a regulation for generating clinical practice guidelines in Peru since 2005 (NT N° 027-MINSA/DGSP-V.01), which was issued by the Ministry of Health. However, its use has had little emphasis in the methodological quality of such guidelines, and a narrative style was preferred. Some isolated efforts aiming to improve the quality of such guidelines have taken place, especially with respect to have such documents produced based on evidence. Now we have a new regulation (NT N° 302-2015/MINSA), which places more emphasis in this requirement; and some institutions are already working in such way, in order to comply with international standards and be able to generate a positive impact in our healthcare system through the adequate development of clinical practice guidelines in our country

Guías de práctica clínica: evolución, metodología de elaboración y definiciones actuales / Clinical practice guidelines: evolution, methodology of elaboration and current definitions

Las guías de práctica clínica son una de las principales herramientas utilizadas por los sistemas de salud modernos y por los profesionales de la salud que practican una medicina basada en evidencias. Son instrumentos usados en beneficio del paciente y con un impacto positivo para los sistemas de salud. Su desarrollo ha ido evolucionando hasta convertirse en instrumentos confiables y de uso generalizado, siendo varios los conceptos que se han incorporado en la formulación de recomendaciones en salud: eficacia, seguridad, costo-efectividad, equidad y enfoque centralizado en la persona. Además, el desarrollo de metodologías propuestas para su elaboración y evaluación de calidad: AGREE, ADAPTE, GRADE entre otras. En el presente ensayo se hace una revisión de los aspectos relacionados a su evolución, metodología de elaboración y las definiciones actuales para su uso como herramientas en la práctica de la medicina basada en evidencias

Clinical practice guidelines are one of the main tools used by modern health systems and health professionals who practice evidence-based medicine. They are instruments used to benefit the patient and have a positive impact on health systems. Its development has evolved into reliable and widely used tools, and several concepts have been included in health recommendations: effectiveness, safety, cost-effectiveness, equity and a person-centered approach. Also, development of methodologies proposed for its elaboration and quality evaluation: AGREE, ADAPTE, GRADE among others. This paper reviews the aspects of the evolution of clinical practice guideline, methodology of elaboration and the current definition for its use as tools for the practice of evidence-based medicine

Autoinmunidad en dengue: revisión bibliográfica / Autoimmunity in dengue: literature review

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Guías de práctica clínica en el Perú: evaluación de su calidad usando el instrumento AGREE II / Clinical practice guidelines in Peru: evaluation of its quality using the AGREE II instrument

RESUMEN Con el fin de evaluar la calidad metodológica de las guías de práctica clínica (GPC) desarrolladas por el Ministerio de Salud (MINSA) de Perú, se evaluaron 17 GPC del MINSA publicadas entre 2009-2014, por tres expertos metodológicos, de forma independiente, usando el instrumento AGREE II. La puntuación de los dominios del AGREE II fue baja y muy baja en todas las GPC: alcance y propósito (mediana, 44%), claridad de la presentación (mediana, 47%), participación de decisores (mediana, 8%), rigor metodológico (mediana 5%), aplicabilidad (mediana, 5%), e independencia editorial (mediana, 8%). Se concluye que la calidad metodológica de las GPC del MINSA es baja. Como consecuencia, no es posible recomendar su uso. Urge la incorporación de metodología estandarizada para el desarrollo de GPC de calidad en el Perú.

ABSTRACT To evaluate the methodological quality of clinical practice guidelines (CPGs) put into practice by the Peruvian Ministry of Health (MINSA), 17 CPGs from the ministry, published between 2009 and 2014, were independently evaluated by three methodologic experts using the AGREE II instrument. The score of AGREE II domains was low and very low in all CPGs: scope and purpose (medium, 44%), clarity of presentation (medium, 47%), participation of decision-makers (medium, 8%), methodological rigor (medium, 5%), applicability (medium, 5%), and editorial independence (medium, 8%). In conclusion, the methodological quality of CPGs implemented by the MINSA is low. Consequently, its use could not be recommended. The implementation of the methodology for the development of CPGs described in the recentlypublished CPG methodological preparation manual in Peru is a pressing need.

Absceso hepático: características clínicas, imagenológicas y manejo en el Hospital Nacional Arzobispo Loayza en 5 años / Liver abscess: clinical, imaging and management features in a 5 year study in the Arzobispo Loayza National Hospital

El absceso hepático (AH) sigue siendo causa de alta morbilidad y mortalidad en el mundo. Objetivo : Conocer las características demográficas, presentación clínico - imagenológica y manejo en el Hospital Nacional Arzobispo Loayza en 5 años.Métodos: Estudio descriptivo û retrospectivo, basado en la revisión de historias clínicas de pacientes con diagnóstico de AH entre Enero 2003 a Diciembre 2007. Resultados : De 106 historias clínicas revisadas, 46 ingresaron al estudio. La edadmedia fue de 47,8 años (95 por ciento IC 41,9-53,8 años), 21 pacientes eran mayores de 50 años (45,6 por ciento) y 52,2 por ciento fueron varones. Los síntomas principales fueron fiebre (95,6 por ciento) y dolor en hipocondrio derecho (73,5 por ciento); el tiempo promedio de enfermedad fue 2,5 semanas. Encontramos elevada frecuencia de hipoalbuminemia, incremento de fosfatasa alcalina, leucocitosis y anemia. El diagnóstico principalmente fue ecográfico (97,8 por ciento), como absceso único (73 por ciento), ubicado en lóbulo derecho (77), con un diámetro promedio de 70mm (p25-75: 44-90mm) y 69,6 por ciento tuvieron más de 5 cm de diámetro. Todos recibieron antibioticoterapia por 18,6 días en promedio (rango: 3-30); siendo la combinación más frecuente metronidazol y ciprofloxacino. Diecisiete pacientes (36,9 por ciento) fueron operados, 7 pacientes (15,2 por ciento) recibieron drenaje externo con catéter percutáneo y en 10,9 por ciento (5 pacientes) se manejó con aspiración directa. Conclusión : El AH es una patología aguda o subaguda, de mediana edad, sin preferencia de género, cuya sintomatología principal es fiebre y dolor en hipocondrio derecho. Es necesario protocolizar el manejo de esta patología.

The liver abscess (LA) continues to cause a high morbidity and mortality worldwide. Objetives: To determine demographic characteristics, clinical presentation, imaging and management at the Arzobispo Loayza Hospital in 5 years. Methods: A descriptive retrospective study, based on medical records of patients diagnosed with LA between January 2003 to December 2007. Results : Of 106 medical records reviewed, 46 entered the study. The mean age was 47.8 years (95 percent CI 41.9-53.8 years), 21 patients were over 50 years (45.6 percent) and 52.2 percent were male. The main symptoms were fever (95.6 percent) and right upper quadrant pain (73.5 percent). The average time of disease was 2.5 weeks. We found high frequency of hypoalbuminemia, elevated alkaline phosphatase, leukocytosis and anemia. The diagnosis was mostly based on ecography (97.8 percent), AH were mainly a single abscess (73 percent) located in the right lobe (77 percent), with an average diameter of 70 mm (p25-75: 44-90mm), and 69.6 percent had more than 5 cm in diameter. Antibiotics were administered for 18.6 days (range: 3-30), being the combination administered more frequently metronidazole and ciprofloxacin. Seventeen patients (36.9 percent) underwent surgery, 7 patients (15.2 percent) received external drainage by percutaneous catheter and 10.9 percent (5 patients) was aspirated directly. Conclusion : LA is an acute or subacute disease of middle age without gender bias, whose main symptoms are fever and right upper quadrant pain. It is necessary to protocolize the management of this condition.

Fiebre prolongada como manifestación de aspergiloma pulmonar en un paciente con antecedente de tuberculosis / Long fever as manifestation of pulmonary aspergilloma in a patient with tuberculosis antecedent

Reportamos el caso de un varón de 50 años con antecedente de tuberculosis pulmonar que presenta síndrome febril durante 66 días, sin tos, hemoptisis o dolor torácico. La presencia de fiebre y síntomas generales (disnea, baja de peso) se ha asociado a menos del 7% de casos de aspergiloma pulmonar, y el síndrome febril prolongado como única forma de presentación no ha sido descrita adecuadamente con anterioridad. Por lo que el caso que presentamos constituye una forma de presentación infrecuente de aspergiloma pulmonar. Al paciente se le practicó lobectomía superior derecha como tratamiento definitivo con remisión del cuadro febril.

We report the case of a 50-year-old male with antecedent of pulmonary tuberculosis who presents with fever syndrome for 66 days, without cough, hemoptisis or thoracic pain. The presence of fever and general symptoms (dyspnea, loss of weight) has been associated with less than 7% of cases of pulmonary aspergilloma, and the long fever syndrome as the only way of presentation has not been described adequately before. Therefore, this case constitutes a form of infrequent presentation of pulmonary aspergiloma. An upper right lobectomy was practiced as definitive treatment with remissionof the fever.

Microembolismo tumoral y cor-pulmonar como manifestación de carcinoma hepatocelular / Tumoral microembolism and cor-pulmonar as manifestation of hepatocelular carcinoma

El micro-embolismo tumoral pulmonar es una rara condición caracterizada por la oclusión de arteria pulmonares pequeñas, arteriolas y capilares alveolares septales, acompañado de trombosis. Desarrolla ocasionalmente hipertensión pulmonar como primera manifestación de una neoplasia oculta, en series de autopsias se ha reportado una incidencia de 3 a 26 por ciento en tumores sólidos, siendo clínicamente evidentes en un 8 por ciento. Pocos casos se han documentado de esta condición en pacientes con carcinoma hepatocelular; nosotros reportamos el caso de un varón de 16 años que acude a la emergencia con signos de insuficiencia cardiaca y cor pulmonar cuyo estudio anatomopatológico confirmó la presencia de un hepatocarcinoma asociado a un compromiso tumoral micro-embólico masivo a nivel pulmonar.

The tumour pulmonary micro-embolism is a rare condition characterized by occlusion of pulmonary small arteries, arteriolas and alveolar capillaries septales, accompanied of trombosis. Occasionally the development of pulmonary hypertension is the first manifestation of an occult neoplasia, in series of autopsies, an incidence from 3 to 26 percentage has been reported in solid tumors, being clinical evident in 8 percentage. Few cases have documented the development of this condition in patients with carcinoma hepatocelular, we report the case of a 16 year-old male who comes to the emergency with signs of cardiac insufficiency and cor pulmonare wose anatomophatological study confirmed a tumour massive microembolic compromise at pulmonary level and hepatocarcinoma.

Conocimientos, actitudes y prácticas de la medicina basada en evidencias en médicos asistentes y residentes en dos hospitales de Lima-Perú / Differences in attitudes, knowledge and practice of evidence based medicine exist between internal physicians and residents

La incorporación de la Medicina Basada en Evidencias en países en vías de desarrollo plantea dificultades particulares. Suficiente información de cómo se realiza en el Perú no existe. Objetivo: Describir los conocimientos, actitudes y prácticas de la MBE en médicos asistentes y residentes, así como determinar las barreras que perciben para la inserción de esta en nuestro país. Material y Métodos: Diseño: analítico. Instrumento: cuestionario .Lugar: Hospital Arzobispo Loayza y Guillermo Almenara. Población: 104 médicos asistentes y residentes de medicina interna de ambos hospitales. Principales variables de estudio: actitud hacia la MBE, habilidad para acceder e interpretar la evidencia, barreras percibidas para la practica de la MBE. Resultados: De los 104 médicos, 62 aceptaron contestar el cuestionario. De estos últimos, 31 por ciento asistentes y 19 por ciento residentes definieron el concepto de MBE adecuadamente. 92 por ciento asistentes y 89 por ciento residentes tuvieron una opinión favorable hacia la MBE. EL segundo paso en la práctica de MBE - búsqueda bibliográfica - fue el único adecuadamente realizado. La principal dificultad para la incorporación de la MBE fue su poca promoción - 37 por ciento de los encuestados-. Conclusiones: Los médicos no tienen un adecuado concepto de la MBE, sin embargo, poseen una actitud favorable hacia esta; los médicos muestran un incompleto uso de MBE en su práctica clínica y la principal barrera identificada para la incorporación de la MBE fue la deficiente promoción de esta. No se encontraron diferencias estadísticamente significativas en los conocimientos, actitudes y practicas de MBE entre médicos asistentes y residentes.

Definición operacional de pérdida en seguimiento en pacientes VIH/SIDA en tratamiento antirretroviral de gran actividad (TARGA) en Lima - Perú / Operational definition of loss in tracing of patients with HIV/AIDS in Antiretroviral Therapy Highly Active (ARTHA) in Lima, Peru

Introducción: No existe una definición estándar sobre cuánto tiempo debe transcurrir para catalogar a un paciente como en "pérdida en seguimiento". Los estudios realizados en otras regiones pueden no ser extrapolables a nuestro contexto. Objetivo: evaluar el mejor punto de corte para definir "pérdida en seguimiento". Diseño: Cohorte retrospectiva, se incluirán a los pacientes que abandonen >=30 días el tratamiento. En estos se definirán diferentes puntos de corte basados en los días transcurridos a partir de la primera cita perdida. Se compara el rendimiento de cada punto de corte para identificar sujetos que abandonan el tratamiento >365 días y no reingresan hasta el fin del periodo de estudio. Se determinara la sensibilidad y especificidad en cada punto, se realizaran curvas ROC para determinar el mejor punto de corte. Resultados: 131 pacientes fueron incluidos, de estos 73 pacientes se reportaron como ausente >365 días al final de la observación. El mejor punto de corte para "perdida en seguimiento" fue >399 días (sensibilidad 90,4 por ciento; especificidad 93,1 por ciento), otros puntos de corte plausibles fueron >365 días (sensibilidad 90,4 por ciento; especificidad 91,4 por ciento) y 180 días (sensibilidad 91,8 por ciento; especificidad 69,0 por ciento). Conclusión: La mejor definición de pérdida de seguimiento es mayor a la reportada en otros estudios. Existe un grupo de pacientes que retornan a la terapia a pesar de estar en "pérdida" tiempo prolongados.

Introduction: There is no standard definition about the period of time must elapse to label a patient as "lost to follow up." Studies in other regions cannot be extrapolated to our populations. Objective: To assess the best cutoff point to define "lost to follow up". Design: Retrospective cohort including patients who abandon treatment >=30 days. Different cutoff points to los to follow up will be defined based on number of days from the first missed appointment. We compare the performance of each cutoff point for identifying subjects who stop >365 days and not readmitted until the end of the study period Sensitivity is determined at each point as well as specificity, ROC curves were he Id to determine the best cutoff point. Results: 131 patients were included, of these 73 patients were reported as missing> 365 days at the end of the observation. The best cutoff point for "lost to follow up" was >399 days (sensitivity 90.4 per cent, specificity 93.1 per cent), other plausible cutoff points were >365 days (sensitivity 90.4 per cent, specificity 91.4 per cent) and 180 days (sensitivity 91.8 per cent, specificity 69.0 per cent). Conclusion: The best definition of loss to follow up is greater than that reported in other studies. There is a group of patients in our study who return to therapy despite being in "lost" for long time periods.