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3.
Helicobacter ; 24 Suppl 1: e12641, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31486244

RESUMEN

Endoscopic imaging of the stomach is improving. In addition to narrow band imaging, other methods, for example, blue light imaging and linked color imaging, are now available and can be combined with artificial intelligence systems to obtain information on the gastric mucosa and detect early gastric cancer. Immunohistochemistry is only recommended as an ancillary stain in case of chronic active gastritis without Helicobacter pylori detection by standard staining, and recommendations to exclude false negative H. pylori results have been made. Molecular methods using real-time PCR, droplet digital PCR, or amplification refractory mutation system PCR have shown a high accuracy, both for detecting H. pylori and for clarithromycin susceptibility testing, and can now be used in clinical practice for targeted therapy. The most reliable non-invasive test remains the 13 C-urea breath test. Large data sets show that DOB values are higher in women and that the cut-off for positivity could be decreased to 2.74 DOB. Stool antigen tests using monoclonal antibodies are widely used and may be a good alternative to UBT, particularly in countries with a high prevalence of H. pylori infection. Attempts to improve serology by looking at specific immunodominant antigens to distinguish current and past infection have been made. The interest of Gastropanel® which also tests pepsinogen levels was confirmed.


Asunto(s)
Pruebas Respiratorias/métodos , Pruebas Diagnósticas de Rutina/métodos , Endoscopía Gastrointestinal/métodos , Infecciones por Helicobacter/diagnóstico , Inmunoensayo/métodos , Técnicas de Diagnóstico Molecular/métodos , Pruebas Diagnósticas de Rutina/tendencias , Endoscopía Gastrointestinal/tendencias , Humanos , Inmunoensayo/tendencias , Técnicas de Diagnóstico Molecular/tendencias
4.
PLoS Negl Trop Dis ; 13(5): e0007372, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31150389

RESUMEN

Soil-transmitted helminths (STHs) affect more than 1.5 billion people. The global strategy to control STH infections requires periodic mass drug administration (MDA) based on prevalence among populations at risk determined by diagnostic testing. Widely used copromicroscopy methods to detect infection, however, have low sensitivity as the prevalence and intensity of STH infections decline with repeated MDA. More sensitive diagnostic tools are needed to inform program decision-making. Using an integrated product development process, PATH conducted qualitative and quantitative formative research to inform the design and development of a more sensitive test for STH infections. The research, grounded in a conceptual framework for ensuring access to health products, involved stakeholder analysis, key opinion leader interviews, observational site visits of ongoing STH surveillance programs, and market research including market sizing, costing and willingness-to-pay analyses. Stakeholder analysis identified key groups and proposed strategic engagement of stakeholders during product development. Interviews highlighted features, motivations and concerns that are important for guiding design and implementation of new STH diagnostics. Process mapping outlined current STH surveillance workflows in Kenya and the Philippines. Market sizing in 2016 was estimated around half a million tests for lower STH burden countries, and 1-2 million tests for higher STH burden countries. The cost of commodities per patient for a molecular STH diagnostic may be around $10, 3-4 times higher than copromicroscopy methods, though savings may be possible in time and staffing requirements. The market is highly price sensitive as even at $5 per test, only 27% of respondents thought the test would be used by surveillance programs. A largely subsidized STH control strategy and a semi-functional Kato-Katz test may have created few incentives for manufacturers to innovate in STH diagnostics. Diverse partnerships, as well as balancing needs and expectations for new STH diagnostics are necessary to ensure access to needed products.


Asunto(s)
Pruebas Diagnósticas de Rutina/tendencias , Helmintiasis/diagnóstico , Animales , Investigación Biomédica/economía , Investigación Biomédica/tendencias , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/métodos , Heces/parasitología , Helmintiasis/economía , Helmintiasis/parasitología , Helmintos/fisiología , Humanos , Kenia , Laboratorios/economía , Laboratorios/tendencias , Filipinas , Suelo/parasitología
5.
Magy Onkol ; 63(1): 16-25, 2019 Mar 19.
Artículo en Húngaro | MEDLINE | ID: mdl-30889617

RESUMEN

Prostate cancer is one of the most frequently occurring malignancies in men. It is increasingly recognized in patients above 40 years of age. The discovery of prostate-specific antigen (PSA) nearly 50 years ago and the subsequent capability to measure it on automated immunoassay platforms have led to a widespread use in laboratory diagnostics. However, the plethora of the elevated PSA values resulted in premature invasive treatments in several cases, so the term 'overdiagnosis of prostate cancer' has been created. Beside the classical total PSA test, several new methods have emerged in the past years that considerably enhanced the specificity of PSA-based diagnostics and this paved the way for more adequate clinical decisions. Some of these new and complex laboratory tests are not yet financed in Hungary, but the techniques are already available. In addition to the measurement of various proteins by immunoassays, large attention is devoted to molecular tests that not only help to establish the underlying pathophysiological process, but may also aid in determining the proper prognostic subgroup.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/tendencias , Neoplasias de la Próstata/diagnóstico , Humanos , Hungría , Masculino , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Sensibilidad y Especificidad
6.
Theranostics ; 9(2): 491-525, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30809289

RESUMEN

Traditional tissue biopsy is limited in understanding heterogeneity and dynamic evolution of tumors. Instead, analyzing circulating cancer markers in various body fluids, commonly referred to as "liquid biopsy", has recently attracted remarkable interest for their great potential to be applied in non-invasive early cancer screening, tumor progression monitoring and therapy response assessment. Among the various approaches developed for liquid biopsy analysis, surface-enhanced Raman spectroscopy (SERS) has emerged as one of the most powerful techniques based on its high sensitivity, specificity, tremendous spectral multiplexing capacity for simultaneous target detection, as well as its unique capability for obtaining intrinsic fingerprint spectra of biomolecules. In this review, we will first briefly explain the mechanism of SERS, and then introduce recently reported SERS-based techniques for detection of circulating cancer markers including circulating tumor cells, exosomes, circulating tumor DNAs, microRNAs and cancer-related proteins. Cancer diagnosis based on SERS analysis of bulk body fluids will also be included. In the end, we will summarize the "state of the art" technologies of SERS-based platforms and discuss the challenges of translating them into clinical settings.


Asunto(s)
Biomarcadores de Tumor/sangre , Pruebas Diagnósticas de Rutina/métodos , Biopsia Líquida/métodos , Neoplasias/diagnóstico , Espectrometría Raman/métodos , Pruebas Diagnósticas de Rutina/tendencias , Humanos , Biopsia Líquida/tendencias
7.
Crit Care ; 23(1): 51, 2019 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-30777114

RESUMEN

BACKGROUND: Data on the methods used for microbiological diagnosis of hospital-acquired pneumonia (HAP) are mainly extrapolated from ventilator-associated pneumonia. HAP poses additional challenges for respiratory sampling, and the utility of sputum or distal sampling in HAP has not been comprehensively evaluated, particularly in HAP admitted to the ICU. METHODS: We analyzed 200 patients with HAP from six ICUs in a teaching hospital in Barcelona, Spain. The respiratory sampling methods used were divided into non-invasive [sputum and endotracheal aspirate (EAT)] and invasive [fiberoptic-bronchoscopy aspirate (FBAS), and bronchoalveolar lavage (BAL)]. RESULTS: A median of three diagnostic methods were applied [range 2-4]. At least one respiratory sampling method was applied in 93% of patients, and two or more were applied in 40%. Microbiological diagnosis was achieved in 99 (50%) patients, 69 (70%) by only one method (42% FBAS, 23% EAT, 15% sputum, 9% BAL, 7% blood culture, and 4% urinary antigen). Seventy-eight (39%) patients underwent a fiberoptic-bronchoscopy when not receiving mechanical ventilation. Higher rates of microbiological diagnosis were observed in the invasive group (56 vs. 39%, p = 0.018). Patients with microbiological diagnosis more frequently presented changes in their empirical antibiotic scheme, mainly de-escalation. CONCLUSIONS: A comprehensive approach might be undertaken for microbiological diagnosis in critically ill nonventilated HAP. Sputum sampling determined one third of microbiological diagnosis in HAP patients who were not subsequently intubated. Invasive methods were associated with higher rates of microbiological diagnosis.


Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Neumonía Asociada a la Atención Médica/diagnóstico , Neumonía Asociada a la Atención Médica/microbiología , Anciano , Lavado Broncoalveolar/métodos , Líquido del Lavado Bronquioalveolar/microbiología , Broncoscopía/métodos , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/tendencias , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Aspiración Respiratoria/microbiología , Estudios Retrospectivos , España , Esputo/microbiología
8.
Eur J Clin Microbiol Infect Dis ; 38(6): 1015-1022, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30710202

RESUMEN

The emergence and spread of antimicrobial resistance is one of the major global issues currently threatening the health and wealth of nations, with effective guidelines and intervention strategies urgently required. Such guidelines and interventions should ideally be targeted at individuals, communities, and nations, requiring international coordination for maximum effect. In this respect, the European Joint Programming Initiative on Antimicrobial Resistance Transnational Working Group 'Antimicrobial Resistance - Rapid Diagnostic Tests' (JPIAMR AMR-RDT) is proposing to consider a 'mix-and-match' package for the implementation of point-of-care testing (PoCT), which is described in this publication. The working group was established with the remit of identifying barriers and solutions to the development and implementation of rapid infectious disease PoCT for combatting the global spread of antimicrobial resistance. It constitutes a multi-sectoral collaboration between medical, technological, and industrial opinion leaders involved in in vitro diagnostics development, medical microbiology, and clinical infectious diseases. The mix-and-match implementation package is designed to encourage the implementation of rapid infectious disease and antimicrobial resistance PoCT in transnational medical environments for use in the fight against increasing antimicrobial resistance.


Asunto(s)
Antibacterianos/farmacología , Enfermedades Transmisibles/diagnóstico , Conducta Cooperativa , Farmacorresistencia Bacteriana , Pruebas en el Punto de Atención , Antibacterianos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Pruebas Diagnósticas de Rutina/tendencias , Personal de Salud , Humanos , Sistemas de Atención de Punto/organización & administración , Sistemas de Atención de Punto/tendencias , Pruebas en el Punto de Atención/tendencias , Salud Pública
9.
J Immunoassay Immunochem ; 40(1): 109-122, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30663510

RESUMEN

Traditionally, definitive diagnosis of infectious diseases is made by cultivation of the causative agent, while various antigens and antibodies as biomarkers of various diseases are detected by commercially available ELISA kits. PCR has emerged as a major innovation that greatly accelerated the accumulation of genomic and transcriptomic data, yet it has also revolutionized microbial diagnostics by enabling the detection of pathogen nucleic acid. Despite the advantages of and vast experience in ELISA and PCR, the next generation research and diagnostic tools have to fulfill the requirements of systems and synthetic biology era. Multiplex bead assays hold this promise by providing a more complete multi-parametric picture of the biological phenomenon of interest at a fraction of time, sample volume and cost required for conventional assay systems. To date, numerous multiplex bead assays have been described to detect multiple antigen, antibody and nucleic acid targets of both microbial pathogens and immune response. These assays have been successfully used in diagnostic, cohort screening and research setups.


Asunto(s)
Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/inmunología , Pruebas Diagnósticas de Rutina/métodos , Enfermedades Transmisibles/microbiología , Pruebas Diagnósticas de Rutina/tendencias , Humanos
10.
J Emerg Med ; 56(2): 153-165, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30598296

RESUMEN

BACKGROUND: Delayed diagnoses of unstable thoracolumbar spine (TL-spine) fractures can result in neurologic deficits and avoidable pain, so it is important for clinicians to reach prompt diagnostic decisions. There are no validated decision aids for determining which trauma patients warrant TL-spine imaging. OBJECTIVE: Our aim was to quantify the diagnostic accuracy of the injury mechanism, physical examination, associated injuries, clinical decision aids, and imaging for evaluating blunt TL-spine trauma patients. METHODS: A search strategy for studies including adult blunt TL-spine trauma using PubMed, Embase, Scopus, CENTRAL, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov was performed. Excluded studies lacked data to construct 2 × 2 tables, were duplicates, were not primary research, did not focus on blunt trauma, examined associated injuries without any utility in identifying TL-spine injuries, only studied cervical-spine fractures, were non-English, had a pediatric setting, or were cadaver/autopsy reports. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies. Diagnostic predictors were analyzed with a meta-analysis of sensitivity, specificity, and likelihood ratios. RESULTS: In blunt trauma patients in the emergency department, the weighted pretest probability of a TL-spine fracture was 15%. The estimates for detection of TL-spine fractures with plain film were: positive likelihood ratio (+LR) = 25.0 (95% confidence interval [CI] 4.1-152.2; I2 = 94%; p < 0.001) and negative likelihood ratio (-LR) = 0.43 (95% CI 0.32-0.59; I2 = 84%; p < 0.001), and for computed tomography (CT) were: +LR = 81.1 (95% CI 14.1-467.9; I2 = 87%; p < 0.001) and -LR = 0.04 (95% CI 0.02-0.08; I2 = 23%; p = 0.26). CONCLUSIONS: CT is more accurate than plain films for detecting TL-spine fractures. Injury mechanism, physical examination, and associated injuries alone are not accurate to rule-in or rule-out TL-spine fractures.


Asunto(s)
Diagnóstico por Imagen/normas , Pruebas Diagnósticas de Rutina/normas , Vértebras Lumbares/lesiones , Vértebras Torácicas/lesiones , Heridas y Traumatismos/diagnóstico , Diagnóstico Tardío/efectos adversos , Diagnóstico por Imagen/tendencias , Pruebas Diagnósticas de Rutina/tendencias , Humanos , Vértebras Lumbares/anomalías , Anamnesis/métodos , Anamnesis/normas , Examen Físico/métodos , Examen Físico/normas , Radiografía/métodos , Radiografía/normas , Vértebras Torácicas/anomalías , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas
11.
J Sci Med Sport ; 22(4): 484-487, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30442547

RESUMEN

OBJECTIVES: Professional athletes undergo annual pre-season laboratory screening, although clinical evidence supporting the practice is limited and no uniform set of guidelines on pre-season laboratory screening exists. The aim of this study was to assess the clinical value of annual pre-season laboratory screening tests for a major professional sports team over multiple years. DESIGN: Retrospective chart review. METHODS: A retrospective analysis was performed of all laboratory results as well as screening ECGs for a single major professional sports team over a 9-year timeframe (2009-2017). RESULTS: The data show that 10.01% of initial screening test results were abnormal and 40.32% of abnormal tests resulted in additional testing. Overall, only 0.35% of initial tests resulted in a clinically significant outcome. Non-US born players showed a significantly higher average rate of abnormal tests/year compared to US-born players (p-value 0.006), but there was no difference in clinically significant outcomes. There was no relationship between athlete age and laboratory screening outcomes. CONCLUSIONS: In our study population, yearly pre-season laboratory screening of professional athletes did not yield substantial clinically significant outcomes and would not be warranted under normal clinical standards. Future best practice guidelines should combine research concerning effects of family medical history, race, gender, country of origin, and type of sport on athlete health when creating recommendations for which pre-season laboratory screenings may be pertinent even with evidence of little utility.


Asunto(s)
Técnicas de Laboratorio Clínico/tendencias , Pruebas Diagnósticas de Rutina/tendencias , Tamizaje Masivo/tendencias , Medicina Deportiva/métodos , Atletas , Electrocardiografía , Humanos , Estudios Retrospectivos
12.
Clin Microbiol Rev ; 32(1)2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30487166

RESUMEN

HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.


Asunto(s)
Pruebas Diagnósticas de Rutina , Infecciones por VIH/diagnóstico , Pruebas Diagnósticas de Rutina/historia , Pruebas Diagnósticas de Rutina/tendencias , VIH , Infecciones por VIH/prevención & control , Historia del Siglo XX , Historia del Siglo XXI , Humanos
13.
Clin Microbiol Infect ; 25(3): 290-309, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29730224

RESUMEN

BACKGROUND: Parasitic diseases are one of the world's most devastating and prevalent infections, causing millions of morbidities and mortalities annually. In the past, many of these infections have been linked predominantly to tropical or subtropical areas. Nowadays, however, climatic and vector ecology changes, a significant increase in international travel, armed conflicts, and migration of humans and animals have influenced the transmission of some parasitic diseases from 'book pages' to reality in developed countries. It has also been noted that many patients who have never travelled to endemic areas suffer from blood-borne infections caused by protozoa. In the light of existing knowledge, this new trend can be explained by the fact that in the process of migration a large number of asymptomatic carriers become a part of the blood bank donor and transplant donor populations. Accurate and rapid diagnosis represents the crucial weapon in the fight against parasitic infections. AIMS: To review old and new approaches for rapid diagnosis of parasitic infections. SOURCES: Data for this review were obtained through searches of PubMed using combinations of the following terms: parasitological diagnostics, microscopy, lateral flow assays, immunochromatographic assays, multiplex-PCR, and transplantation. CONTENT: In this review, we provide a brief account of the advantages and limitations of rapid methods for diagnosis of parasitic diseases and focus our attention on current and future research in this area. The approximate costs associated with the use of different techniques and their applicability in endemic and non-endemic areas are also discussed. IMPLICATIONS: Microscopy remains the cornerstone of parasitological diagnostics, especially in the field and low-resource settings, and provides epidemiological assessment of parasite burden. However, increased use and availability of point-of-care tests and molecular assays in modern era allow more rapid and accurate diagnoses and increased sensitivity in the identification of parasitic infections.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/tendencias , Enfermedades Parasitarias/diagnóstico , Parasitología/métodos , Parasitología/tendencias , Animales , Pruebas Diagnósticas de Rutina/economía , Humanos , Microscopía , Técnicas de Diagnóstico Molecular , Parásitos , Enfermedades Parasitarias/epidemiología , Pruebas en el Punto de Atención
14.
Neonatology ; 115(3): 189-196, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30580336

RESUMEN

Recent advances in molecular and mass screening technologies have paved the way for discovery of novel diagnostic tests and/or biomarkers for accurate identification of specific diseases and organ injuries. However, new diagnostic tests/biomarkers should be subjected to thorough evaluation before introduction into routine clinical practice. This review focuses on the up-to-date methodology in designing and evaluating diagnostic tests/biomarkers, and assessing their clinical utilities for improving health care efficiency, cost-effectiveness and outcomes. In addition to improved diagnostic utilities, future diagnostic tests should be developed in collaboration with our industrial partners and be applicable at the bedside for disease surveillance.


Asunto(s)
Biomarcadores/análisis , Pruebas Diagnósticas de Rutina/normas , Pruebas Diagnósticas de Rutina/tendencias , Conducta Cooperativa , Análisis Costo-Beneficio , Humanos , Proyectos de Investigación
15.
J Gen Intern Med ; 33(12): 2113-2119, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30187374

RESUMEN

BACKGROUND: Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED). OBJECTIVE: To compare the care processes of LEP patients in the ED. DESIGN: Retrospective cohort study. SETTING: ED in a large tertiary care academic medical center. PATIENTS: Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care. MAIN MEASURES: Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED. KEY RESULTS: We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57). CONCLUSIONS: ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.


Asunto(s)
Barreras de Comunicación , Servicios Médicos de Urgencia/tendencias , Servicio de Urgencia en Hospital/tendencias , Lenguaje , Adolescente , Adulto , Anciano , Estudios de Cohortes , Pruebas Diagnósticas de Rutina/tendencias , Servicios Médicos de Urgencia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente/tendencias , Estudios Retrospectivos , Centros de Atención Terciaria/tendencias , Adulto Joven
16.
Future Microbiol ; 13: 1157-1164, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30113214

RESUMEN

General practitioners stand at the front line of healthcare provision and have a pivotal role in the fight against increasing antibiotic resistance. In this respect, targeted antibiotic prescribing by general practitioners would help reduce the unnecessary use of antibiotics, leading to reduced treatment failures, fewer side-effects for patients and a reduction in the (global) spread of antibiotic resistances. Current 'gold standard' antibiotic resistance detection strategies tend to be slow, taking up to 48 h to obtain a result, although the implementation of point-of-care testing by general practitioners could help achieve the goal of targeted antibiotic prescribing practices. However, deciding on which antibiotic resistances to include in a point-of-care diagnostic is not a trivial task, as outlined in this publication.


Asunto(s)
Farmacorresistencia Microbiana , Medicina General/tendencias , Sistemas de Atención de Punto/tendencias , Antibacterianos/uso terapéutico , Pruebas Diagnósticas de Rutina/normas , Pruebas Diagnósticas de Rutina/tendencias , Farmacorresistencia Microbiana/genética , Medicina General/normas , Humanos , Prescripción Inadecuada/prevención & control , Microbiota/genética , Relaciones Médico-Paciente , Sistemas de Atención de Punto/normas , Pruebas en el Punto de Atención/normas
19.
An. sist. sanit. Navar ; 41(2): 161-169, mayo-ago. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-173594

RESUMEN

Fundamento: El objetivo de este estudio es conocer el grado de implantación, las características y la formación de la ecografía a pie de cama, realizada por médicos de urgencias (MU), en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Método: Estudio descriptivo basado en una encuesta realizada a los responsables de los SUH públicos de Cataluña y estructurada en tres bloques: dificultad de implementación de la técnica y motivos percibidos en dicha dificultad, aparataje disponible en urgencias y su uso, y formación de los MU. Resultados: Contestaron la encuesta el 96,3% de los SUH públicos. En el 63,5% los MU realizan ecografía a pie de cama. El 86,5% manifestaron un elevado grado de dificultad para implementar la ecografía y el 78,8% disponen de ecógrafo propio. El uso más frecuente es la exploración abdominal (87,9%), torácica (72,7%) o vascular periférica (69,7%). Es escasa la presencia de protocolos y registros de la actividad. La formación no es uniforme entre médicos de plantilla y de guardia. No se encontraron diferencias significativas en función del tipo de hospital, del grado de actividad o de la presencia de radiólogo las 24 horas del día, excepto para el protocolo FAST, más empleado en hospitales comarcales que en el resto (89,5% vs. 42,9%; p=0,007). Conclusiones: La ecografía a pie de cama hecha por MU se usa en más de la mitad de los SUH públicos catalanes. Es necesario que el uso de la ecografía en el SUH se extienda, sea más reglado, registrado de manera adecuada y que participen de él todos los médicos que trabajan en urgencias


Background: The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia. Methods: Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians. Results: The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-ofcare ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007). Conclusions. Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department


Asunto(s)
Humanos , Sistemas de Atención de Punto/tendencias , Ultrasonografía , Tratamiento de Urgencia/métodos , Pruebas Diagnósticas de Rutina/tendencias , Servicio de Urgencia en Hospital/organización & administración , Calidad de la Atención de Salud , Encuestas de Atención de la Salud/estadística & datos numéricos , Epidemiología Descriptiva
20.
PLoS One ; 13(6): e0198070, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29879170

RESUMEN

BACKGROUND: According to the 2016 World Malaria Report, the malaria incidence in Haiti declined by > 40% between 2010 and 2015. Though elimination efforts have likely contributed, this time period also corresponded to a national change in diagnostic methods. METHODS: Monthly reports of aggregated patient data were acquired from five clinics in the Ouest Department of Haiti. Generalized linear models were used to compare the number of febrile patients tested, the number of positive tests, and the proportion of tests that were positive (TRP) before and after the national adoption of rapid diagnostic tests (RDTs). RESULTS: Prior to the earthquake when microcopy was used for diagnosis, a total of 1,727 patients with 557 (32.3%) positive; post-earthquake testing was reduced and the TPR was variable; during the post recovery period when RDTs were used exclusivly, a total of 5,132 patients were tested using RDTs, only 83 (1.62%) were positive. Compared to the pre-earthquake period, there was a 69% increase in the number of patients tested (IRR: 1.69; 95% CI IRR 1.59, 2.79), and a 97.0% decrease in the proportion of patients with a positive test result (IRR: 0.03; 95% CI IRR 0.02, 0.04) in the post-recovery period. CONCLUSIONS: While the decline in malaria indicators between 2010 and 2015 has been cited as evidence of progress towards elimination, these reports derived estimates of the malaria burden in Haiti using two different diagnostic tests. Thus, comparison of these periods in the context of malaria elimination should be made with caution.


Asunto(s)
Pruebas Diagnósticas de Rutina/tendencias , Malaria/diagnóstico , Terremotos , Haití , Humanos , Microscopía , Factores de Tiempo
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