ABSTRACT
BACKGROUND AND OBJECTIVES: Allergology has been a recognized medical specialty in Spain, with fully defined aims and competencies for more than 4 decades. However, in recent years, its visibility seems to have decreased somewhat. Objectives: To identify which specific factors have contributed to the waning of the importance of the specialty and find tangible solutions to consolidate its place as a front-line medical specialty. MATERIAL AND METHODS: An online population survey comprising 60 items of interest was prepared. The degree of agreement and the level of satisfaction with each item were assessed, and implementable initiatives in the short, medium, and long terms were defined in order to provide solutions to the issues identified. RESULTS: The survey was completed by a total of 167 specialists with an average of 18 years' experience. Most were from public reference hospitals, and 29.3% were heads of department. The line of action for which a good degree of agreement was achieved was to promote the inclusion of an allergist in multidisciplinary teams. The priority lines of action were to improve undergraduate and graduate training in allergology and specialized nursing, to identify curricula in Spain, and to develop robust teaching projects. CONCLUSIONS: The results revealed a high degree of homogeneity between professionals. The basic pillars highlighted were as follows: quality training, knowledge, and research in immunotherapy; an innovative portfolio of services endorsed by clinical practice guidelines; and presence in multidisciplinary teams and relevant hospital committees.
Subject(s)
Allergy and Immunology/trends , Career Choice , Hypersensitivity/epidemiology , Biomedical Research , Humans , Interdisciplinary Communication , Medicine , Spain/epidemiologyABSTRACT
Background: Allergology has been a recognized medical specialty in Spain, with fully defined aims and competencies for more than 4 decades. However, in recent years, its visibility seems to have decreased somewhat. Objectives: To identify which specific factors have contributed to the waning of the importance of the specialty and find tangible solutions to consolidate its place as a front-line medical specialty. Material and methods: An online population survey comprising 60 items of interest was prepared. The degree of agreement and the level of satisfaction with each item were assessed, and implementable initiatives in the short, medium, and long terms were defined in order to provide solutions to the issues identified. Results: The survey was completed by a total of 167 specialists with an average of 18 years experience. Most were from public reference hospitals, and 29.3% were heads of department. The line of action for which a good degree of agreement was achieved was to promote the inclusion of an allergist in multidisciplinary teams. The priority lines of action were to improve undergraduate and graduate training in allergology and specialized nursing, to identify curricula in Spain, and to develop robust teaching projects. Conclusions: The results revealed a high degree of homogeneity between professionals. The basic pillars highlighted were as follows: quality training, knowledge, and research in immunotherapy; an innovative portfolio of services endorsed by clinical practice guidelines; and presence in multidisciplinary teams and relevant hospital committees. (AU)
Antecedentes: En nuestro país, la alergología constituye una especialidad médica reconocida con fines y competencias completamente definidos desde hace más de cuatro décadas. Sin embargo, en los últimos tiempos parece hacer frente a una cierta disminución de su visibilidad y reconocimiento. Objetivos: Identificar qué factores específicos contribuyen a esta dilución de su peso específico y buscar soluciones tangibles que la afiancen como especialidad médica de primera línea. Material y métodos: Se elaboró una encuesta poblacional online compuesta por 60 ítems considerados de interés. Se valoró el grado de acuerdo y el nivel de satisfacción con cada uno, definiendo iniciativas implantables a corto, medio y largo plazo que aporten soluciones para las cuestiones identificadas. Resultados: La encuesta fue respondida por un total de 167 especialistas con una media de 18 años de experiencia, la mayoría procedentes de hospitales de referencia públicos, siendo un 29,3% jefes del servicio. La línea de acción que obtuvo un mayor grado de acuerdo fue promover la presencia del alergólogo en los equipos multidisciplinares. Como línea de acción más prioritaria se seleccionó mejorar la formación de pregrado y posgrado en alergología, así como la de enfermería especializada, identificando planes de estudio en nuestro país y elaborando proyectos docentes robustos. Conclusiones: Los resultados revelaron un elevado grado de homogeneidad entre los profesionales, destacando como pilares básicos la formación de calidad, los conocimientos e investigación en inmunoterapia, una cartera de servicios novedosa avalada por Guías de Práctica Clínica y la presencia en equipos multidisciplinares y comisiones hospitalarias relevantes. (AU)
Subject(s)
Humans , Allergy and Immunology/trends , Biomedical Research , Career Choice , Interdisciplinary Communication , SpainABSTRACT
Five cases (3.5%) of reversible cephapirin-induced neutropenia were observed in 132 patients receiving this antibiotic. The disorder was severe (agranulocytosis) in 3 cases. Simultaneous maculopapular rash was observed in all of them and in 4 cases fever occurred. All the cases observed were female (p not significant). Neutropenia developed only after administration of high doses of the antibiotic for a prolonged period of time. In contrast to another 127 patients treated with cephapirin who did not develop neutropenia, neutropenic patients had received a mean daily dose, total dose, mean daily dose per kilogram and total dose per kilogram of body weight significantly larger (p = 0.05, 0.02, 0.001 and 0.001, respectively). The duration of therapy was significantly longer in the neutropenic group (p = 0.001). Neutropenia did not occur below 90 g of total dose, but when this amount was exceeded, the incidence of the disorder reached 26.3% (p less than 0.001). We conclude that when this drug must be used either for long periods of time or at high doses, a hematologic vigilance is recommendable.
Subject(s)
Agranulocytosis/chemically induced , Cephalosporins/adverse effects , Cephapirin/adverse effects , Neutropenia/chemically induced , Adult , Aged , Cephapirin/administration & dosage , Female , Humans , Male , Middle Aged , Neutropenia/complications , Retrospective Studies , Time FactorsABSTRACT
Antecedentes y objetivos: La utilidad de las pruebas cutáneas en el diagnóstico de la alergia a las penicilinas está bien demostrada; sin embargo, no siempre existe una buena relación entre la anamnesis y el resultado de estas pruebas. Casos clínicos: Se presentan tres pacientes en los que la anamnesis, ya por el tiempo de aparición de la reacción, ya por el tipo de lesión, sugiere una hipersensibilidad inmediata o acelerada con posible participación de la IgE; las pruebas cutáneas fueron positivas de forma muy tardía, entre 2 y 3 semanas después de su aplicación. Conclusión: No siempre existe un patrón clínico que permita predecir el resultado de las pruebas cutáneas por lo que aconsejamos realizar el estudio alergológico aún cuando la sospecha de hipersensibilidad sea baja
Background and objectives: The useful of skin tests in diagnosis of penicillin allergy is well known; however, there is not always a good correlation between history and results from these tests. Cases: Three cases are presented in which the history, due to the time of appearance or the type of lesions, suggests an potentially IgE-mediated immediate or accelerated hypersensitivity; skin tests were positive very late, between 2 and 3 weeks after their application. Conclusion: There is not always a clinic pattern which permits to predict results of skin tests, so we recommend to perform the allergy study even with a low index of suspicion