Bibliometric study of the advances made in clinical dermatological research in Spain from 2015 through 2021: update of the MaIND project and interactive online map. / Estudio bibliométrico sobre la evolución de la investigación clínica dermatológica española entre 2015 y 2021: actualización del proyecto MaIND y mapa interactivo en línea.

INTRODUCTION: A clinical dermatological research was conducted in Spain from 2005 through 2014 as part of the MaIND project with the provinces or centers with the highest number of published articles. However, a low level of evidence in scientific production was confirmed as the overall result. The aim of this study is to update the Spanish clinical dermatological research in bibliometric terms from 2015 through 2021 with comparisons between both periods of time. MATERIAL AND METHODS: We conducted a bibliometric study to replicate the methodology used in the article to be updated. We included articles whose corresponding authors' affiliation was a Spanish dermatological center, which met the criteria for clinical research in dermatology, including a level of evidence ≤ 4. RESULTS: A total of 1674 out of the 10199 articles met the inclusion criteria. An interactive map representing quantitative and qualitative indicators calculated for the 2005-2021 is presented here. In the study period, we found an increasing trend both in the number of published articles (p < 0.002) and in the mean number of citation-years per article (p < 0.01). A total of 22 of the articles had a level of evidence > 4, with a positive trend towards more articles having a higher level of evidence (p < 0.03). Actas Dermosifilográficas still maintains its position as the journal with the highest number of articles received (18%, a total of 302 articles). CONCLUSIONS: The results of this study show that, in Spain, the scientific production of dermatology represents an upward trend in quantity, impact, and level of evidence.

Revisión de revisiones sobre la eficacia de los tratamientos psicológicos para adolescentes con trastorno de la personalidad límite / Review of reviews on the efficacy of psychological treatments for adolescents with borderline personality disorder

La literatura científica señala que es importante llevar a cabo una intervención psicológica temprana en el trastorno de la personalidad límite (TPL)debido a que en la adolescencia es cuando se observa un mayor auge de los síntomas graves. Sin embargo, existe poca literatura científica sobrequé tratamientos psicológicos son más eficaces para esta población. El objetivo de este trabajo es realizar una revisión de revisiones sobre losdatos de eficacia de los tratamientos psicológicos para adolescentes con rasgos o diagnóstico de TPL o desregulación emocional. Se seleccionaron revisiones que evaluaran la eficacia de tratamientos psicológicos en adolescentes (entre 12 y 19 años) con esta problemática. Se realizó unabúsqueda de literatura científica en diversas bases de datos (Web of Science, PsycInfo, Pubmed, Dialnet) y se incluyeron un total de 5 revisiones.Resultados: La Terapia Dialéctica Comportamental para adolescentes (DBT-A) y la Terapia Basada en la Mentalización para adolescentes (MBT-A)han demostrado su eficacia para reducir la ideación suicida, los síntomas de TPL, los niveles de ansiedad y depresión, así como mejorar la adaptación social y la calidad de vida después de la intervención. Sin embargo, algunas revisiones sugieren que la MBT-A podría no ser tan efectiva debidoa las altas tasas de abandonos. Las intervenciones psicológicas con más evidencia consiguen reducir los síntomas más graves y mejorar la calidadde vida de los adolescentes con este problema. Es fundamental intervenir lo antes posible, lo que ayudará a prevenir el desarrollo y cronicidad deun trastorno grave y difícil de tratar. (AU)

The scientific literature indicatesthat it is important to carry out early psychological intervention in borderline personality disorder (BPD) due to the fact that adolescence is when agreater upsurge of the most severe symptoms is observed. However, there is little scientific literature on which psychological treatments are mosteffective for this population. The aim of this paper is to conduct a review of reviews on the efficacy data of psychological treatments for adolescentswith traits or diagnosis of BPD or emotional dysregulation. We selected reviews that evaluated the efficacy of psychological treatments in adolescents (between 12 and 19 years old) with this problem. A search of scientific literature was carried out in various databases (Web of Science,PsycInfo, Pubmed, Dialnet) and a total of 5 reviews were included. Dialectical Behavior Therapy for Adolescents (DBT-A) and Mentalization-BasedTherapy for Adolescents (MBT-A) have demonstrated efficacy in reducing suicidal ideation, BPD symptoms, anxiety and depression levels, as wellas improving social adjustment and quality of life after the intervention. However, some reviews suggest that MBT-A may not be as effective due tohigh dropout rates. Psychological interventions with more evidence achieve to reduce the most severe symptoms and improve the quality of life ofadolescents with this problem. It is essential to intervene as early as possible, which will help prevent the development and chronicity of a severeand difficult-to-treat disorder. (AU)

Sports supplements use in mountain runners: differences by sex and competitive level.

Introduction: Introduction: sports supplements (SS) are widely used by all types of athletes to improve their performance. These SS are classified according to the ABCD system of the Australian Institute of Sports (AIS) from higher to lower scientific evidence. In mountain runners, their use could be necessary due to the physiological demands required by this sport. However, the literature on the use of SS by mountain runners is scarce. Objective: to analyze the pattern of SS consumption in mountain runners by studying differences according to sex and competitive level (regional vs national). Methodology: this was a descriptive and cross-sectional study on the consumption and use of SS by mountain runners participating in the Alcoy Solidarity Trail. Data were collected through a validated questionnaire based on content, applicability, structure, and presentation. This questionnaire was completed online by the athletes, who could fill it out voluntarily and at their convenience, as well as anonymously. Results: the results showed that 87.5 % of participants reported consuming SS, with no significant differences observed with respect to competitive level, although differences were found with respect to sex (92.7 % in men vs 70.6 % in women; p = 0.029), with a higher consumption found in men compared to women. The most consumed SS were sports bars (81.9 %), sports drinks (75.0 %), caffeine (48.6 %), magnesium (38.9 %), and electrolytes (27.8 %). Conclusions: among mountain runners consumption of SS is high, and 4 of the 5 most habitually consumed SS belong in the category of greater scientific evidence.

Introducción: Introducción: los suplementos deportivos (SS) son muy utilizados por todo tipo de deportistas para mejorar su rendimiento. Estos SS se clasifican según el sistema ABCD del Australian Institute of Sports (AIS) de mayor a menor evidencia científica. En corredores de montaña, su uso podría ser necesario debido a las exigencias fisiológicas de este deporte. Sin embargo, la literatura sobre el uso de SS por corredores de montaña es escasa. Objetivo: analizar el patrón de consumo de SS en corredores de montaña, estudiando las diferencias según el sexo y el nivel competitivo (autonómico vs. nacional). Metodología: se trata de un estudio descriptivo y transversal sobre el consumo y uso de SS por parte de los corredores de montaña participantes en el Trail Solidario de Alcoy. Los datos fueron recolectados a través de un cuestionario validado en base al contenido, la aplicabilidad, la estructura y la presentación. El cuestionario fue completado de manera online por los atletas que pudieron rellenarlo voluntariamente y a conveniencia, y de manera anónima. Resultados: los resultados mostraron que el 87,5 % de los participantes reportaron consumir SS, no observándose diferencias significativas con respecto al nivel competitivo, aunque sí se encontraron diferencias con respecto al sexo (92,7 % en hombres y 70,6 % en mujeres; p = 0,029), donde los hombres tenían un mayor consumo en comparación con las mujeres. Los SS más consumidos fueron las barritas deportivas (81,9 %), las bebidas deportivas (75,0 %), la cafeína (48,6 %), el magnesio (38,9 %) y los electrólitos (27,8 %). Conclusiones: entre los corredores de montaña, el consumo de SS es alto y 4 de los 5 SS más consumidos pertenecen a la categoría de mayor evidencia científica.

Sports supplements use in mountain runners: differences by sex and competitive level / Consumo de suplementos deportivos en corredores de montaña: diferencias en función del sexo y del nivel competitivo

Introduction: sports supplements (SS) are widely used by all types of athletes to improve their performance. These SS are classified according to the ABCD system of the Australian Institute of Sports (AIS) from higher to lower scientific evidence. In mountain runners, their use could be necessary due to the physiological demands required by this sport. However, the literature on the use of SS by mountain runners is scarce. Objective: to analyze the pattern of SS consumption in mountain runners by studying differences according to sex and competitive level (regional vs national). Methodology: this was a descriptive and cross-sectional study on the consumption and use of SS by mountain runners participating in the Alcoy Solidarity Trail. Data were collected through a validated questionnaire based on content, applicability, structure, and presentation. This questionnaire was completed online by the athletes, who could fill it out voluntarily and at their convenience, as well as anonymously. Results: the results showed that 87.5 % of participants reported consuming SS, with no significant differences observed with respect to competitive level, although differences were found with respect to sex (92.7 % in men vs 70.6 % in women; p = 0.029), with a higher consumption found in men compared to women. The most consumed SS were sports bars (81.9 %), sports drinks (75.0 %), caffeine (48.6 %), magnesium (38.9 %), and electrolytes (27.8 %). Conclusions: among mountain runners consumption of SS is high, and 4 of the 5 most habitually consumed SS belong in the category of greater scientific evidence. (AU)

Introducción: los suplementos deportivos (SS) son muy utilizados por todo tipo de deportistas para mejorar su rendimiento. Estos SS se clasifican según el sistema ABCD del Australian Institute of Sports (AIS) de mayor a menor evidencia científica. En corredores de montaña, su uso podría ser necesario debido a las exigencias fisiológicas de este deporte. Sin embargo, la literatura sobre el uso de SS por corredores de montaña es escasa. Objetivo: analizar el patrón de consumo de SS en corredores de montaña, estudiando las diferencias según el sexo y el nivel competitivo (autonómico vs. nacional). Metodología: se trata de un estudio descriptivo y transversal sobre el consumo y uso de SS por parte de los corredores de montaña participantes en el Trail Solidario de Alcoy. Los datos fueron recolectados a través de un cuestionario validado en base al contenido, la aplicabilidad, la estructura y la presentación. El cuestionario fue completado de manera online por los atletas que pudieron rellenarlo voluntariamente y a conveniencia, y de manera anónima. Resultados: los resultados mostraron que el 87,5 % de los participantes reportaron consumir SS, no observándose diferencias significativas con respecto al nivel competitivo, aunque sí se encontraron diferencias con respecto al sexo (92,7 % en hombres y 70,6 % en mujeres; p = 0,029), donde los hombres tenían un mayor consumo en comparación con las mujeres. Los SS más consumidos fueron las barritas deportivas (81,9 %), las bebidas deportivas (75,0 %), la cafeína (48,6 %), el magnesio (38,9 %) y los electrólitos (27,8 %). Conclusiones: entre los corredores de montaña, el consumo de SS es alto y 4 de los 5 SS más consumidos pertenecen a la categoría de mayor evidencia científica. (AU)

Construção e Validação de um Protocolo sobre Técnicas de Substituição Renal Intermitente num Serviço de Medicina Intensiva: Desenvolvimento de Competências em Enfermagem à Pessoa em Situação Crítica / Desenvolvimento de Competências em Enfermagem à Pessoa em Situação Crítica: Construção e Validação de um Protocolo sobre Técnicas de Substituição Renal Intermitente num Serviço de Medicina Intensiva / Construction and Validation of a Protocol on Intermittent Renal Replacement Techniques in an Intensive Care Unit: Development of Critical Care Nursing Skills

O presente relatório de estágio tem o propósito de evidenciar o desenvolvimento do percurso através de uma análise crítica e reflexiva nas competências comuns e específicas do enfermeiro mestre e especialista em enfermagem à pessoa em situação crítica. Numa primeira parte, foi realizada uma análise reflexiva sobre os ensinos clínicos realizados ao longo do curso, que contribuíram para a aquisição e desenvolvimento das competências de liderança, de investigação, tomada de decisão, melhoria contínua dos cuidados e autoaprendizagem, sendo fundamentais para a profissão de enfermagem. Numa segunda parte, foi desenvolvido um trabalho de investigação com os objetivos de avaliar o conhecimento dos enfermeiros de cuidados intensivos sobre técnicas de substituição renal intermitentes, construir e validar um protocolo para enfermeiros, e avaliar a utilidade e usabilidade do mesmo, na perspetiva dos enfermeiros. O método utilizado foi o quantitativo, de carácter descritivo. A amostra incluiu os enfermeiros de um serviço de medicina intensiva, e para validação do protocolo recorreu-se a um grupo de enfermeiros peritos especialistas em enfermagem médico-cirúrgica com mais de dez anos de experiência em hemodiálise, através da técnica de Delphi. Concluiu-se que em relação aos conhecimentos dos enfermeiros de cuidados intensivos sobre técnica de substituição renal intermitente, a equipa apresenta necessidades formativas sobre a técnica, pelo que após divulgação do protocolo, a equipa de enfermagem considera o protocolo útil e pretende usá-lo durante a prestação de cuidados a utentes que necessitem desta técnica.

The purpose of this internship report is to highlight the development of the course through a critical and reflective analysis of the common and specific skills of the master's degree nurse and the specialist in nursing care provided to critically ill patients. In the first part, a reflective analysis was conducted on the clinical teachings performed throughout the course, which contributed to the acquisition and development of leadership skills, research, decision-making, continuous improvement of care, and self-learning, which are fundamental to the nursing profession. In the second part, a research study was developed with the objectives of assessing the intensive care nurses' knowledge about intermittent renal replacement techniques, building and validating a protocol for nurses, and assessing its usefulness and usability from the nurses' perspective. The method used was quantitative and descriptive. The sample included nurses from an intensive care unit, and the validation of the protocol was performed by a group of expert nurses in medical-surgical nursing with more than ten years of experience in hemodialysis, using the Delphi technique. It was concluded that, regarding the intensive care nurses' knowledge about the intermittent renal replacement technique, the team has training needs on the technique. Therefore, after the dissemination of the protocol, the nursing team considers the protocol useful and intends to use it when providing care to patients who need this technique.

Science and environmental policy establishment: the case of the Forest Act in the State of São Paulo, Brazil / Ciência e implementação de política ambiental: o caso do Código Florestal no Estado de São Paulo, Brasil

Abstract Natural ecosystems are under severe threat worldwide and environmental policies are essential to minimize present and future impacts on biodiversity, ecosystem services and climate change. The New Forest Act in Brazil is the main policy to protect native vegetation in private lands, which comprise 54% of the remaining Brazilian native vegetation. However, conflicts between environmental and agricultural concerns in its implementation demand for balanced solutions based on scientific evidence. To face the challenge of applying science in environmental policy establishment, we developed a scientific project funded by the São Paulo State Research Foundation (FAPESP) to support the implementation of the New Forest Act in São Paulo State, as part of the Biota/FAPESP Program. The project was conducted differently from a regular research project: the broad objective was to provide scientific support to the State's implementation of the New Forest Act, based on a participatory interaction among stakeholders to build specific objectives, methods, and discussion of results, within an interdisciplinary and intersectoral research team. Here, we present the lessons learned during and after the four years of the research project development to evaluate how scientific knowledge can be produced and adopted in the implementation of a specific environmental policy. We present the main outcomes and the challenges faced in trying to include scientific data in the decision-making process. We also present current and future challenges in the New Forest Act implementation that could be solved with scientific evidence. The lessons learned showed that even designing the project in order to meet the needs to support the implementation of the environmental policy, avoiding difficulties normally pointed out by similar projects, there was a great difficulty for scientific contributions to be adopted in the decision-making process. Most of the scientific information and advice, even after discussion and common understanding among a diverse stakeholder group, were ignored or over-ruled in the final decision-making phases.

Resumo Os ecossistemas naturais estão sob grave ameaça em todo o mundo e as políticas ambientais são essenciais para minimizar os impactos presentes e futuros na biodiversidade, nos serviços ecossistêmicos e nas mudanças climáticas. O Novo Código Florestal no Brasil é a principal política de proteção da vegetação nativa em terras privadas, que compreende 54% da vegetação nativa remanescente brasileira. No entanto, os conflitos entre as preocupações ambientais e agrícolas na sua implementação exigem soluções equilibradas e baseadas em evidências científicas. Para enfrentar o desafio de aplicar a ciência no estabelecimento de políticas ambientais, desenvolvemos um projeto científico financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) para apoiar a implementação do Novo Código Florestal no Estado de São Paulo, como parte do Programa Biota/FAPESP. O projeto foi conduzido de forma diferente de um projeto de pesquisa regular: o objetivo amplo foi fornecer suporte científico para a implementação do Novo Código Florestal pelo Estado, a partir de uma interação participativa entre as partes interessadas para construir objetivos específicos, métodos e discussão de resultados, dentro de uma equipe de pesquisa interdisciplinar e intersetorial. Aqui, apresentamos as lições aprendidas durante e após os quatro anos de desenvolvimento do projeto de pesquisa para avaliar como o conhecimento científico pode ser produzido e adotado na implementação de uma política ambiental específica. Apresentamos os principais resultados e os desafios enfrentados na tentativa de incluir dados científicos no processo decisório. Apresentamos também desafios atuais e futuros na implementação do Novo Código Florestal que podem ser resolvidos com evidências científicas. As lições aprendidas mostraram que mesmo concebendo o projeto de forma a atender as necessidades de apoio à implementação da política ambiental, evitando dificuldades normalmente apontadas por projetos semelhantes, houve uma grande dificuldade para que contribuições científicas fossem adotadas no processo decisório. A maioria das informações e conselhos científicos, mesmo após discussão e entendimento comum entre um grupo diversificado de partes interessadas, foi ignorada nas fases finais de tomada de decisão.

Recommendations for specialized nutritional-metabolic management of the critical patient: introduction, methodology and list of recommendations. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). / Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico: introducción, metodología y listado de recomendaciones. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).

The Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) has reviewed and updated the recommendations for specialized nutritional and metabolic support in critically ill patients published by the Group in 2011, with the primary aim of helping decision making in daily clinical practice. The recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically ill patients, and were drafted between March 2016 and February 2019. A level of evidence has been provided for each of the recommendations, based on the GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation Working Group). A grade of recommendation has also been produced, taking into account the clinical impact of the recommendation, regardless of the level of evidence established by the GRADE scale.

Evidencia científica sobre posconflicto en el contexto iberoamericano / Scientific evidence about the post-conflict in the Ibero-American context

Resumen Objetivo analizar la evidencia científica sobre posconflicto en Iberoamérica. Revisión documental de publicaciones científicas entre 2013 y 2018. Descriptores: "conflicto", "posconflicto", "construcción de paz", "desmovilización", "reintegración", "reconciliación", "excombatientes", "democracia", "deliberación", "América Latina" y "Latinoamérica" y sus correspondientes en inglés. Los artículos fueron analizados a partir del título, resumen, año de publicación, idioma, país y fuente de publicación. Las categorías: "posconflicto", "democracia", "cultura", "educación", "estado", "territorio", "economía" y "salud". Se analizaron 66 artículos. Conclusión, la evidencia científica muestra que el posconflicto es la primera fase de consolidación de paz, los países y actores involucrados deben generar estrategias viables para su cimentación.

Abstract The objective is to analyze the scientific evidence about the post-conflict in Ibero-America; document review of scientific publications between 2013 and 2018. Descriptors "conflict," "post-conflict," "peacebuilding," "demobilization," "reintegration," "reconciliation," "ex-combatants," "democracy," "deliberation," "Latin America," and their corresponding in English. The articles were analyzed based on the title, abstract, year of publication, language, country, and source of publication. The categories "post-conflict," "democracy," "culture," "education," "state," "territory," "economy," and "health." Sixty-six articles were analyzed. As a conclusion, scientific evidence shows that post-conflict is the first phase of peacebuilding, the countries and actors involved must generate viable strategies for its foundation.

O uso de metoclopramida em mulheres em trabalho de parto: uma revisão sistemática com metanálise / The use of metoclopramide in women in labor: a systematic review with meta-analysis

Revisão sistemática com metanálise que buscou evidências científicas sobre o efeito do cloridrato de metoclopramida na evolução do trabalho de parto, a partir de ensaio clínico controlado randomizado e recomendações da Cochrane Collaboration. A busca atemporal e sem restrições de idioma, estruturada na estratégia PICOS-T, foi realizada em bases de dados Scopus, PubMed, EMBASE, Cochrane, CINAHL e Scielo, literatura cinzenta e referências cruzadas, com estratégias e descritores específicos. As ferramentas Rayyan e EndNote Basic foram adotadas para gerenciar as referências. O estudo foi conduzido por dois avaliadores independentes e a concordância entre eles foi medida pelo Índice Kappa. Foram identificados 2.884 artigos, mas apenas 04 eram elegíveis e a qualidade metodológica destes (risco de viés e sigilo de alocação) foi avaliada com base no Cochrane Collaboration Risk of Bias Tool. O Grades of Recommendation, Assessment, Development and Evaluation foi utilizado para avaliar qualidade das evidências e força das recomendações. O relato desta pesquisa foi baseado no Preferred Report Items for Systematic Reviews and Meta-Analyzes. Não houve conflitos de interesse e qualquer tipo de financiamento. Os estudos incluídos datam de 1982 a 1992, tem 734 parturientes, "Baixo Risco de Viés" (50%) ou "Risco de Viés Incerto" (50%) e "Sigilo de Alocação Adequado" (75%). Para Ahmed et al. (1982) a metoclopramida não é eficaz para iniciar a dilatação do colo uterino no trabalho de parto espontâneo. Para Vella et al. (1985) a metoclopramida não interfere no tempo de trabalho de parto. Para Rosemblatt et al. (1991) a metoclopramida pode atuar para coordenar as contrações do útero e melhorar a força expulsiva, reduzir o tempo e facilitar a passagem do feto. Para Rossemblatt et al. (1992) doses repetidas de metoclopramida provocam redução gradativa na duração de trabalho de parto, parto e dequitação. A metanálise com 02 estudos (92 parturientes) encontrou Mean Difference= 0.8116 e RR= 0.811 (IC 95%). O tempo médio de dilatação (horas) após uso de metoclopramida versus placebo foi 4.43 versus 2.21 para Ahmed et al., com RR= -2.22. Para Rosemlatt et al., este tempo foi 4.56 versus 8.74, com RR= 4.18. O p-valor= 0.7995 revelou que não tem diferença rejeitar ou não a hipótese nula referente ao desfecho clínico pesquisado (dilatação do colo uterino). O I2= 91,56% revelou alta heterogeneidade entre os estudos e limitada aplicabilidade de seus resultados. O Teste Q de Cochran= 11.84 mostrou que há diferença de efetividade entre os resultados, rejeitando a hipótese nula citada. O "Forest Plot" mostrou que as intensidades dos resultados individuais de cada estudo diferem entre si, o que significa ausência de efeito em relação ao desfecho clínico. Este estudo apresenta nível de evidência moderado e forte recomendação dos resultados. Não há comprovação científica de que a metoclopramida favorece a dilatação do colo uterino no trabalho de parto, portanto seu uso não é recomendado. As limitações deste estudo envolveram escassos estudos elegíveis e importantes diferenças nos resultados e medições dos estudos da amostra. Novas pesquisas experimentais devem ser realizadas. As evidências deste estudo são importantes para subsidiar a prática baseada em evidência na atenção ao parto e nascimento e melhorar os desfechos materno e neonatal

A systematic review with meta-analysis that sought scientific evidence on the effect of metoclopramide hydrochloride on the evolution of labor, from a randomized controlled clinical trial and recommendations from the Cochrane Collaboration. The timeless search and without language restrictions, based on the PICOS-T strategy, was performed in databases Scopus, PubMed, EMBASE, Cochrane, CINAHL and Scielo, gray literature and cross-references, with specific strategies and descriptors. The Rayyan and EndNote Basic tools were adopted to manage the references. The study was conducted by two independent evaluators and the agreement between them was measured by the Kappa. 2.884 articles were identified, but only 04 were eligible and their methodological quality (risk of bias and allocation secrecy) was evaluated based on the Cochrane Collaboration Risk of Bias Tool. The Grades of Recommendation, Assessment, Development and Evaluation was used to evaluate the quality of the evidence and the strength of the recommendations. The report of this research was based on the Preferred Report Items for Systematic Reviews and Meta-Analyzes. There were no conflicts of interest and any kind of financing. The included studies date from 1982 to 1992, have 734 parturients, "Low Risk of Bias" (50%) or "Uncertain Bias Risk" (50%) and "Adequate Allocation Secrecy" (75%). For Ahmed et al. (1982) metoclopramide is not effective in initiating cervical dilatation in spontaneous labor. For Vella et al. (1985) metoclopramide does not interfere with labor time. For Rosemblatt et al. (1991) metoclopramide can act to coordinate the contractions of the uterus and improve the expulsive force, reduce the time and facilitate the passage of the fetus. For Rossemblatt et al. (1992) repeated doses of metoclopramide cause a gradual reduction in the duration of labor, childbirth and placental clearence. The meta-analysis with 02 studies (92 parturients) found mean difference = 0.8116 and RR = 0811 (CI 95%). The mean time of dilation (hours) after use of metoclopramide versus placebo was 4.43 versus 2.21 for Ahmed et al., with RR =-2.22. For Rosemlatt et al., this time was 4.56 versus 8.74, with RR = 4.18. The P-value = 0.7995 revealed that it has no difference to reject or not the null hypothesis referring to the clinical outcome investigated (uterine cervix dilatation). The I2 = 91.56% showed high heterogeneity between studies and limited applicability of its results. The Cochran Q Test = 11.84 showed that there is a difference in effectiveness between the results, rejecting the null hypothesis cited. The "Forest Plot" showed that the intensities of the individual results of each study differ, which means no effect in relation to the clinical outcome. This study presents a moderate level of evidence and a strong recommendation of the results. There is no scientific evidence that metoclopramide favors uterine cervix dilation in labor, therefore its use is not recommended. The limitations of this study involved scarce eligible studies and important differences in the results and measurements of the sample studies. New experimental studies should be carried out. The evidences of this study are important to subsidize the evidence-based practice in childbirth care and birth and to improve maternal and neonatal outcomes

Clinical Research in Dermatology and Venereology in Spanish Research Centers in 2005 Through 2014: Results of the MaIND Study. / Investigación clínica en dermatología y venereología de centros e instituciones españolas, 2005-2014. Resultados del estudio MaINDH.

BACKGROUND AND OBJECTIVE: Bibliometric indicators provide a useful measure of the number of clinical research articles published in scientific journals and their quality. This study aimed to assess the amount and quality of research carried out in Spanish dermatology centers and to describe the research topics. MATERIAL AND METHOD: Bibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in MEDLINE or Embase in which the corresponding author's affiliation was a Spanish hospital dermatology department or other center. RESULTS: Of 8,617 articles found, 1,104 (12.81%) met the inclusion criteria. The main reason for excluding articles was that they did not have an evidence level of 4 or better. The main vehicle for reporting was the journal Actas Dermosifiliográficas, which published 326 articles (29.53%). Melanoma, the disease the researchers studied most often, accounted for 134 articles (12.13%). LIMITATIONS: A limitation to bear in mind when interpreting the results is that we relied on the corresponding author's affiliation to identify articles reflecting research from a Spanish dermatology center. Thus, studies in which dermatologists participated would not be recognized if they were directed by other specialists. CONCLUSION: Only a small portion of articles published from Spanish dermatology centers can be considered clinical research, mainly because many publications provide a low level of scientific evidence. Most publications are case reports.

A Map of Clinical Dermatology Research Centers in Spain: Results of the MaIND Study. / Mapa de centros de investigación clínica dermatológica española: resultados del estudio MaIND.

BACKGROUND AND OBJECTIVE: Bibliometric indicators and analyses of clinical research articles can help to quantify the scientific production of hospitals and institutions and identify their main areas of research. The aim of this study was to draw up a bibliometric map of clinical research in dermatology by Spanish hospitals and institutions through an analysis of quantitative, qualitative, and topic-based variables. MATERIAL AND METHOD: Bibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in PubMed or Embase in which the corresponding author's affiliation was a Spanish dermatology department or institution. RESULTS: Barcelona and Madrid were the provinces with the highest number of articles and citations. The centers with the most articles and citations were Hospital Clínic and Instituto Valenciano de Oncología. Those 2 hospitals also produced the highest number of articles on the most common research topic identified: melanoma. Because the articles were selected on the basis of the affiliation of the corresponding author to a Spanish dermatology center, this analysis does not include collaborative studies or clinical research studies led by nondermatology centers. CONCLUSIONS: We have created a bibliometric map of clinical dermatology research in Spain that shows the distribution of scientific production and the main areas of research by province and hospital/institution. This map could be useful for education and research purposes.

Evidencia Científica para la Medicina Homeopática / Scientific Evidence for Homeopathic Medicine

Aunque muchos médicos convencionales expresan dudas sobre la eficacia de la Homeopatía y muchos escépticos tienen la idea de que no existen estudios científicos que sustenten al método médico clínico terapéutico configurado por Samuel Hahnemann, la cantidad de investigaciones sobre la acción y efectividad de los medicamentos homeopáticos es considerable y se encuentra en crecimiento. En efecto, las evidencias son cada vez más difíciles de ignorar, ya que se sustentan en metodologías adecuadas y los investigadores tienen mayor interés en mostrar sus resultados a través de revistas especializadas. Toda esta información está disponible para médicos, comunidad científica y público en general, pero a menudo se ignora, no se difunde o no se explica adecuadamente. Sin ser una revisión exhaustiva, este artículo ayuda a llenar este vacío, ya que presenta un resumen con algunos de los mejores estudios que se han realizado para comprobar el efecto de los medicamentos homeopáticos y el proceso de curación, con la particularidad de que la mayoría de ellos ha aparecido en publicaciones médicas y científicas convencionales.

¿Cuándo lo imparcial se convierte en sesgo? El dilema de las patogenesias homeopáticas y los modernos métodos de investigación / When does the impartial become bias? The dilemma of homeopathic pathogenesis and modern research methods

Desde los años sesenta, los homeópatas, junto con los físicos biomédicos, generalmente han reconocido al ensayo de control doble ciego aleatorio (ECA) como el "estándar de oro" para establecer la eficacia en una intervención clínica. Sin embargo, la profesión homeopática se ha mostrado ambivalente respecto a la incorporación del modelo ECA para la validación interna de los medicamentos homeopáticos. Este texto muestra importantes elementos del ECA, como la evaluación ciega, la aleatoriedad y la inferencia estadística, examinando algunos de los elementos históricos y científicos acerca de su inclusión en las experimentaciones homeopáticas.

Parto Natural. ¿Qué nos dice la evidencia? / Natural birth. What does the evidence tell us?

Introducción: Es deseable que el proceso del parto concluya con una madre y un recién nacido sano, y sea un momento especial e íntimo. El Parto Natural, ha sido propuesto como una opción para mejorar la satisfacción de las mujeres con el proceso del parto. Sin embargo, no existen definiciones serias respecto a qué es el Parto Natural, introduciendo dificultades en la atención de mujeres que solicitan un Parto Natural. Métodos: El objetivo de este artículo es revisar la mejor evidencia disponible para entender cómo debe definirse un Parto Natural y analizar si se asocia a riesgos mayores que los de la atención médica habitual del parto. Resultados: Hemos comprobado que no existen definiciones científicas consensuadas para precisar qué es el Parto Natural, dejando espacio para discusión sobre su verdadero significado. No existen estudios de diseño aleatorizado y controlado que comparen el resultado materno/perinatal del parto natural comparado con la atención habitual del parto. Las intervenciones médicas, usadas en la atención médica del parto, y que podrían ser evitadas en el Parto Natural, producen algunos cambios favorables y otros deletéreos respecto de la salud materna y perinatal. Conclusiones: La decisión de optar por el Parto Natural debe ser discutida con las mujeres que lo solicitan, precisando con ella y su pareja cuál es su concepto de parto natural o qué es lo que desean incluir o evitar, los riesgos y beneficios asociados a cada una de las intervenciones deben ser expuestos por el equipo médico, para adoptar un plan de manejo individualizado.(AU)

Introduction: It is desirable that the birth process concludes with a healthy mother and newborn, while at the same time being a special and intimate moment. Natural childbirth has been proposed as a recent option to improve the satisfaction of women with the process of childbirth. However, there are no serious definitions regarding what is or should be a Natural Childbirth, introducing difficulties in the care of women who request a Natural Birth. Methods: The objective of this article is to review the best available evidence to understand how Natural Childbirth should be defined and to analyze if it is associated with greater maternal or perinatal risks than those of usual medical care at birth. Results: We verified that there are no agreed scientific definition to specify what Natural Childbirth is, leaving space for discussion about its true meaning. There are no randomized, controlled trials comparing the maternal/ perinatal outcome of natural childbirth compared to usual medical care during labor/delivery. Medical interventions used in childbirth are that could be avoided in natural birth produce some favorable changes and some deleterious changes in maternal and perinatal health. Conclusions: The decision to choose Natural Childbirth must be discussed with the women who request it, specifying with her and her partner´s concept of natural childbirth or what they wish to include or avoid, the risks and benefits associated with these interventions must be exposed by the medical team, to adopt an individualized management plan.(AU)

Doctor, quiero aparatos movibles, aparatos fijos, tal o cual bracket o técnica que evite las extracciones, que disminuya el tiempo del tratamiento, con tapita, transparentes, invisbles / Doctor, I want removable devices, removable or fixed appliances, such or such bracket or technique that avoids extractions, short treatment duration, with transparent, invisible covers

Los intereses económicos de las casas comerciales parecen tener que ver con la fe de los profesionales en los materiales y los instrumentos por sobre los fundamentos básicos de la ortodoncia; es decir, sobre la elaboración de un correcto diagnóstico y la de un plan o varios planes de tratamiento más adecuados. La ortodoncia basada en la evidencia nos da la posibilidad de elegir tratamientos desde lo científico, más que desde opiniones y publicidades.

Relevancia del esbozo protocolar en las investigaciones biomédicas / Relevance of the draft protocol on biomedical research

Introducción: un protocolo de investigación biomédica está vinculado con procesos que deben posibilitar su ejecución viable y sostenible. Es posible desarrollarlos adecuadamente cuando se dispone de los elementos básicos para asumirlos.Objetivo: destacar la relevancia del esbozo protocolar en las investigaciones biomédicas. Material y Métodos: se realizó una revisión bibliográfica en las bases de datos SciELO, Medline y Lilacs, en las que se encontró información relacionada con el tema. Desarrollo: el proceso de elaboración de un protocolo forma solo uno de los elementos necesarios para el adecuado desarrollo de investigaciones biomédicas. Se destaca la relevancia técnica para la concepción y elaboración los mismos. Se enfatiza como idea clave para la gestión de protocolos de investigaciones biomédicas, en el trabajo de equipo, el manejo creativo en la búsqueda de soluciones, el sostenimiento de un buen flujo de información y de comunicación, la flexibilidad, contextualización y pertinencia.Conclusiones: el adecuado esbozo protocolar en las investigaciones biomédicas garantizará efectividad, eficiencia y eficacia en lo que se desee analizar, para que los profesionales continúen formándose con herramientas que decidan sus componentes, la mejor estructura y diseño, que contribuyan a resultados positivos en beneficio de la sociedad(AU)

Introduction: biomedical research protocol is linked to processes that should enable their viable and sustainable implementation. It is possible to properly develop when you have the basics to assume them. Objective: highlight the importance of the protocol outline in biomedical research. Material and Methods: A review on SciELO, Medline and Lilacs Databases was done, where information related to the subject was found. Development: the process of developing a protocol is just one of the elements necessary to the appropriate development of biomedical research. It is highlighted the technical relevance for the design and development of them and emphasized like a key idea the management protocols for biomedical research, teamwork, creative management in the search for solutions, the maintenance of a good flow of information and communication, flexibility, context and relevance idea. Conclusions: appropriated protocol outline in biomedical research will ensure effectiveness, efficiency and effectiveness in what is to be scanned, so that professionals continue forming tools that decide its components, the best structure and design that contribute to positive outcomes for the benefit of society(AU)

How sample size influences research outcomes

Sample size calculation is part of the early stages of conducting an epidemiological, clinical or lab study. In preparing a scientific paper, there are ethical and methodological indications for its use. Two investigations conducted with the same methodology and achieving equivalent results, but different only in terms of sample size, may point the researcher in different directions when it comes to making clinical decisions. Therefore, ideally, samples should not be small and, contrary to what one might think, should not be excessive. The aim of this paper is to discuss in clinical language the main implications of the sample size when interpreting a study.

O cálculo amostral faz parte dos estágios iniciais de realização de um estudo epidemiológico, clínico ou laboratorial. Há indicações éticas e metodológicas para o seu emprego na elaboração de um trabalho científico. Duas pesquisas, realizadas com a mesma metodologia obtendo resultados equivalentes, e que diferem apenas no tamanho da amostra, podem apontar para diferentes direções no processo de tomada de decisão clínica. Portanto, as amostras estudadas idealmente não devem ser pequenas e, ao contrário do que pode-se pensar, não devem ser excessivas. O objetivo desse artigo é discutir, numa linguagem clínica, as principais implicações do tamanho das amostras na interpretação de um estudo.

[Challenges in care of trauma patient in Spain. The need for implementation of scientific evidence including secondary prevention]. / Retos asistenciales en la atención al paciente traumatizado en España. La necesidad de implementación de la evidencia científica incluyendo la prevención secundaria.

The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role. The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement. The application of diagnostic or therapeutic actions with scientific evidence is associated with lower mortality, but as in other areas of medicine, the application of scientific evidence in trauma patients is barely 50%. Moreover, nearly 90% of trauma deaths occur in the crash site or in the first 72h of hospitalization, the vast majority as a result of injuries incompatible with life. In these circumstances it is clear that prevention is the most cost-effective activity. As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma.

Algunas consideraciones para el diseño de protocolos en la actividad de Enfermería / Some considerations to design protocols on nursing practices

Introducción: la Enfermería es una profesión de ayuda, que tiene un cuerpo de conocimientos abstractos formado por una serie de teorías y modelos enriquecidos con los resultados que se obtienen de la investigación. Objetivo: Valorar el estado actual acerca de la construcción de protocolos de cuidados. Material y Métodos: se realizó una revisión bibliográfica sobre el tema, se tuvieron en cuenta los resultados de investigaciones sobre protocolos de cuidados publicados entre los últimos 5 y 10 años disponibles en Scielo, Lilacs, Fisterra, Medline y Conhrane. Se utilizó como motor de búsqueda Google y los términos protocolos de cuidado de Enfermería, guías prácticas, evidencia científica, práctica de Enfermería basada en evidencia. Resultados: este instrumento recibe diversidad de denominaciones y su estructura es variable. Enfermería enfrenta dificultades ante su elaboración y los propósitos para los cuales se construyen son diversos. Se declara la flexibilidad, dinamismo y cientificidad aunque se propone homogeneización en estructura, dada la diversidad de diseños existentes dentro de un mismo país, existe coincidencias en que deben sustentarse en las mejores evidencias científicas. Conclusiones: los protocolos permiten normalizar la práctica asistencial, reducir la variabilidad clínica, facilita la adopción de decisiones y mejorar la calidad de la atención. No se encontró homogeneidad de estructura en la literatura revisada debido a la complejidad de los servicios donde se utilizan, la disponibilidad de recursos materiales y humanos con que cuentan las instituciones para la actividad asistencial(AU)

Introduction: the nursing is a profession of help; with herself abstract knowledge formed by conceptual nursing models and theory, enriched with the outcome getting from the research. Objective: to assess the Art of State Knowledge about the writing Care or Medical attention protocols. Material and Methods: we did a bibliography review of literature using searching motor Google about the topic studied taking in consideration the available published literature in Scielo, Lilacs, Cochrane, Medline and Fisterra during the last 5 and 10years; we support our bibliography revision too on the results of nursing research about effective care protocols, practice clinical guide and recommendations between last five and 10 years. For that we use the topic: scientific evidence, practice clinic guide, protocol of care nursing. Results: we find some differences between each instrument that are use in health services. Between their characteristic are: flexibility, dynamism and scientific; although some authors propose homologous in the structure into the countries and that the nursing activities must be supporting on the best clinical practice evidences. Conclusion: the protocol help to standardize the assistance nursing practice, reducing the variability on the clinical practice, make easy the decision taking and improve the quality of attention(AU)