[Management optimization of neovascular age-related macular degeneration in Spain: Evolution towards proactive treatment models]. / Optimización del manejo de la degeneración macular asociada a la edad neovascular en España: evolución hacia modelos proactivos de tratamiento.

INTRODUCTION AND OBJECTIVE: Healthcare resources optimization is crucial to assume the growing demand of neovascular age-related macular degeneration (nAMD). This work provides guidelines and support so that each hospital can lead its change management. METHODS: The OPTIMUS project (n=10 hospitals) was based on face-to-face interviews with the key staff of the ophthalmology services, and alignment with the main responsible for each centre (nominal group) to identify potential needs for improving nAMD. The OPTIMUS nominal group was expanded to 12 centres (eVOLUTION). Through different remote work sessions, different guides and tools were defined and developed to implement proactive treatment strategies, one-step treatment administration and potential for remote visits (eConsult) in nAMD. RESULTS: The information collected from the OPTIMUS interviews and working groups (n=10 centres) defined roadmaps to promote the development of protocols and proactive treatment strategies, including healthcare workload optimization and one-stop treatment administration in nAMD. With eVOLUTION, processes and tools were developed to promote eConsult: (i) healthcare burden calculator; (ii) definition of potential patients for telematic management; (iii) definition of nAMD management archetypes; (iv) definition of processes for implementation of eConsult by archetype; and (v) key performance indicators for changing evaluation. CONCLUSIONS: Managing change is an internal task that requires an adequate diagnosis of processes and feasible implementation roadmaps. OPTIMUS and eVOLUTION provide the basic tools for an autonomous advance of hospitals in the optimization of AMD management, with the available resources.

Tratamientos psicológicos eficaces para el estrés post-traumático / Efficacious psychological treatments for post-traumatic stress disorder

El objetivo de este trabajo es el de ofrecer una revisión de los tratamientos psicológicos y farmacológicos que la investigación ha probado como más eficaces en el tratamiento del trastorno por estrés post-traumático (TEPT). Por lo que se refiere a los tratamientos psicológicos, los estudios más rigurosos se han llevado a cabo en el contexto de los acercamientos conductual-cognitivos. La evidencia empírica sugiere un mayor respaldo para la exposición prolongada (EP). También la reestructuración cognitiva y las técnicas para el manejo de la ansiedad dan lugar a efectos positivos a la hora de aliviar la sintomatología post-traumática. La investigación más reciente se dirige a la creación de programas de tratamiento que integran los distintos componentes mencionados. También, se anota la posible eficacia de la hipnoterapia. Por otra parte, se han utilizado diferentes tipos de fármacos para el tratamiento de TEPT. A pesar de los efectos beneficiosos que producen algunos de ellos para aliviar los diferentes síntomas, con frecuencia se han registrado efectos colaterales para casi todos ellos (AU)

The aim of this paper is to offer a review of the psychological and pharmacological treatments that the research has shown as more effective to treat the post-traumatic stress disorder (PTSD). Regarding the psychological treatments, the most rigorous studies have been carried out in the context of the cognitive-behavioral approaches. The empiric evidence suggests a bigger efficacy for the prolongued exposure (PE). The cognitive restructuring and the anxiety management training produces positive effects to alleviate the posttraumatic simptomatology too. More recent studies are dedicate to design treatment programs which integrate the several mentioned components. Also, it is noted the possible effectiveness of the hypnotherapy. On the other hand, different types of drugs have been used for the PTSD treatment. In spite of the beneficial effects that some drugs produce to alleviate the different symptoms, frequently have been registered collateral effects for nearly all of them (AU)

Comparative study of inhaled amiloride and inhaled furosemide in exercise-induced asthma.

BACKGROUND: Certain diuretics such as furosemide, when inhaled, have been found to be useful in preventing Exercise-Induced Asthma (EIA). STUDY OBJECTIVE: To assess the possible preventive effect of inhaled amiloride in EIA. DESIGN: A double blind, randomized, cross-over study comparing the effect of inhaled amiloride, inhaled furosemide and placebo in EIA. PATIENTS: Sixteen asthmatic patients (8 males and 8 females) with an average age of 21 years (range 9-31) who presented a FEV1 decrease of over 15% in a previous free-running exercise test. INTERVENTIONS: Solutions were inhaled with a Hudson nebulizer connected to an oxygen source in different days before exercise testing. A Vitalograph Compact (Ohmeda, England) spirometer was used and FEV1 was obtained at baseline, three minutes after solution inhalation, immediately after exercise and then every 5 min. until 20 minutes post-exercise. The changes in FEV1 percentages (FEV1%) and the mean FEV1 decreases expressed as percentages for each solution were compared. RESULTS: Inhaled furosemide diminished the fall in the FEV1 at every time after exercise. The maximum decrease in mean FEV1 was at 5 minutes post-exercise and was 11 +/- 7% with furosemide, 24 +/- 14% (p < 0.01) with amiloride and 19 +/- 12% (p < 0.05) with placebo. Amiloride administration resulted in a slight but significative increase in the FEV1 fall (p < 0.01 when compared with placebo). CONCLUSIONS: Amiloride is not useful to protect EIA whereas Furosemide does it. These differences results may be related to the differents mechanisms of action of the two diuretics.

[Microepidemics of tuberculosis; apropos of 2 school outbreaks in the area 15 of the Valencia community]. / Microepidemias de tuberculosis: a propósito de dos brotes escolares en el área 15 de la Comunidad Valenciana.

Schools are settings with high concentrations of young people with little exposure to Mycobacterium tuberculosis and greater risk of developing disease when infection occurs as the result of sporadic localized outbreaks. We studied two outbreaks in two elementary schools (A and B) after two cases of bacilliferous pulmonary tuberculosis were detected in teachers in 1990 and 1994. Contacts were trace din school A by the primary care physician and in school B by the pneumologist and public health authorities. Contacts were classified as belonging to the risk group (RG) or the low risk group (LRG). The RG was composed of 187 contacts in school A and 59 in school B. Individuals in the LRG numbered 429 and 116 respectively. Mantoux positives numbered 108 in the RG and 45 in the LRG in school A (p < 0.001). In school B 50 RG individuals and 29 LRG individuals were positive (p < 0.001). The proportion of Mantoux positives was greater in the RG of school B than in the RG of school A (p < 0.01), probably owing to longer time of evolution of disease and possible laryngeal involvement in the index case. Likewise, tuberculin positives were fewer in the LRG of school A than in the LRG of school B (p < 0.001), owing to the small size of the LRG in school A. Thirteen cases of tuberculosis were seen in school A, six of which called for drug prophylaxis after contacts were traced. The nature of the index case and the conditions of exposure are both important in such outbreaks, demonstrating the need to act appropriately to trace contacts, preferably under the supervision of a pneumologists.

[Neurological education of general practitioners. Results of a survey carried out among 196 general practitioners]. / La formación en Neurología del médico general. Resultados de una encuesta realizada a 196 médicos de atención primaria.

We have carried out a survey among professional general practitioners in our province with the aim of getting to know their opinion concerning their own training in Neurology. The survey included questions about the adequacy of training, the nature of any deficiency therein (be it theoretical and/or practical) and ability to analyse and attend a neurological patient. The percentage of replies was 78% out of a total of 196 surveys. 78.8% of those questioned consider that their neurological training has not been sufficient either for clinical or general practice; while 43.8% believe that this insufficiency is due to a lack of practical training, 1.8% think the fault lies in a lack of theoretical training, and 54.32% consider that it is due to a lack of both practical and theorectical training. 61.2% of those questioned claim to have difficulties with neurological explorations, and 55.6% claim they have greater difficulties attending a neurological patient than other patients classified within other internal medical specialties. 76% consider that it is either partially or totally false to claim that these difficulties are unimportant due to the lack of treatment for neurological illnesses, although 69.4% consider it to be partially or totally true that they will never be able to achieve diagnosis of a neurological patient due to a lack of the required complementary investigations. 43.9% consider that continued training in Neurology is not useful because it is a repetition of training received at university. As a consequence, there is an imbalance between neurological training and the need to attend the patient at the level of general practice, which should be set right by making the theoretical training given during graduation more suitable, and by increasing and improving practical credits.