Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta-analysis.

There is a lack of large, randomized, double-blind studies that address antihistamine updosing for chronic spontaneous urticaria (CSU). The objective of this systematic review is to explore and analyse available data to provide clinical evidence for the efficacy of antihistamine updosing. We searched the literature in Medline, Scopus, Google Scholar, Embase, Web of Science and Cochrane databases using the keywords 'chronic, urticaria, antihistamines' to identify studies published between January 1990 and November 2014. We assessed quality using the Jadad score that evaluates quality of randomization, double-blinding and losses to follow-up. We identified 1042 articles and 15 articles were included in the final evaluation. We performed two meta-analyses, one that included studies that analysed treatment response among groups receiving different antihistamine dosages vs. placebo, and another that analysed antihistamine updosing in those patients who did not respond to standard dosages. Only five articles obtained a high quality level score. We did not find significant differences in response rates or number of weals in those patients who received a standard dosage vs. a high dosage. We found a significant improvement only in the pruritus variable of the Urticaria Activity Score scale. The estimated relative risk for improvement by increasing the antihistamine dosage was 2·27 [95% confidence interval (CI) 1·68-3·06]; however, there was significant heterogeneity. The proportion of nonrespondent patients with CSU who responded to antihistamine updosing was 63·2% (95% CI 57-69·6). We found that updosing antihistamines significantly improved control of pruritus but not weal number. However, the relative weakness of the studies and the significant heterogeneity among them made it difficult to reach a final conclusion.

How to fill an application for accreditation of Continuing Medical Education activity in Allergology.

Continuing medical education (CME) is a critical tool as well as a generally accepted concern for physicians, while being both a commitment and an obligation for the Administration. In Spain, during the past decades, CME has been a constant concern of many groups; however, it was not until the end of the eighties when efforts at accreditation began to emerge. A significant step was the establishment of the Commission on Continuing Education of Health Professions of the National Health System, an agency of the Consejo Interterritorial (Inter-regional Council), whose accreditation system started in 1998, using the figure of Sector Conference, included in Articles 5 and 8 of the Ley de Régimen Jurídico de las Administraciones Públicas y del Procedimiento Administrativo Común (Law on Legal Regime of Public Administration and Common Administrative Procedures), as Senior Technical Body on the matter. Since then, various Regional Committees and the Spanish Accreditation System of Continuing Medical Education (SEAFORMEC) have been created. Although we earlier published a guide, in this manuscript we have updated the steps that must be taken to apply for accreditation of CME activity in Allergology, explaining the different items in the official application form, clarifying to whom the request should be addressed, and outlining the foundations on which the activities will be evaluated for accreditation purposes, in order to ensure that the training meets the highest standards for quality, so that the objectives that lead to achieving maximum performance and competence of health professionals may be reached.

How to fill an application for accreditation of Continuing Medical Education activity in Allergology

Continuing medical education (CME) is a critical tool as well as a generally accepted concern forphysicians, while being both a commitment and an obligation for the Administration. In Spain, during the past decades, CME has been a constant concern of many groups; however, it was not until the end of the eighties when efforts at accreditation began to emerge. A significant step was the establishment of the Commission on Continuing Education of Health Professions of the National Health System, an agency of the Consejo Interterritorial (Inter-regional Council), whose accreditation system started in 1998, using the figure of Sector Conference, included in Articles 5 and 8 of the Ley de Régimen Jurídico de las Administraciones Públicas y del Procedimiento Administrativo Común (Law on Legal Regime of Public Administration and Common Administrative Procedures), as Senior Technical Body on the matter. Since then, various Regional Committees and the Spanish Accreditation System of Continuing Medical Education (SEAFORMEC) have been created. Although we earlier published a guide, in this manuscript we have updated the steps that must be taken to apply for accreditation of CME activity in Allergology, explaining the different items in the official application form, clarifying to whom the request should be addressed, and outlining the foundations on which the activities will be evaluated for accreditation purposes, in order to ensure that the training meets the highest standards for quality, so that the objectives that lead to achieving maximum performance and competence of health professionals may be reached

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Efficient bibliographic searches on allergy using ISI databases.

The aim of this article is to provide an introduction to using databases from the Thomson ISI Web of Knowledge, with special reference to Citation Indexes as an analysis tool for publications, and also to explain the meaning of the well-known Impact Factor. We present the partially modified new Consultation Interface to enhance information search routines of these databases. It introduces distinctive methods in search bibliography, including the correct application of analysis tools, paying particular attention to Journal Citation Reports and Impact Factor. We finish this article with comment on the consequences of using the Impact Factor as a quality indicator for the assessment of journals and publications, and how to ensure measures for indexing in the Thomson ISI Databases.

Efficient bibliographic searches on allergy using ISI databases

The aim of this article is to provide an introduction to using databases from the Thomson ISI Web of Knowledge, with special reference to Citation Indexes as an analysis tool for publications, and also to explain the meaning of the well-known Impact Factor. We present the partially modified new Consultation Interface to enhance information search routines of these databases. It introduces distinctive methods in search bibliography, including the correct application of analysis tools, paying particular attention to Journal Citation Reports and Impact Factor. We finish this article with comment on the consequences of using the Impact Factor as a quality indicator for the assessment of journals and publications, and how to ensure measures for indexing in the Thomson ISI Databases

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Buscando la mejor "evidencia" en Alergología / Searching for the best evidence in allergology

La Alergología Clínica y las ciencias médicas generan día a día preguntas a los que las practicamos. Para responder a estas preguntas existen distintos tipos de fuentes; sin embargo, estamos obligados a buscar la mejor información posible para resolverlas. Los tiempos en los que vivimos y desarrollamos la profesión médica exigen información de calidad dado el mar de datos disponibles en las fuentes a nuestra disposición; de entre todas las conocidas, es Internet la que mayor volumen nos ofrece. El adecuado manejo de este recurso nos permitirá acceder a información que debería ser por regla general basada en la evidencia. El objetivo de este artículo es proponer una guía de recursos web de utilidad para la práctica diaria en alergología.(AU)

Clinic Allergology and medical sciences practice are constant generators of questions. To answer these questions there are multiple sources; however, we most search for the best possible information. Times we are living in and practice medical profession require high quality information because of the great sea of data we find in the available sources; from all of these, internet is the one that offers a great volume of information. An appropriate use of this resource will allow us to achieve information that should be always evidence based medicine. The objective of this article is to propose a guide of web resources useful in daily Allergology practice. (AU)

Efficient bibliographic searches on allergology using PubMed.

INTRODUCTION: PubMed is the most important of the non-specialized databases on biomedical literature. International and quickly updated is elaborated by the American Government and contains only information about papers published in scientific journal/s. Although it can be used as an unique Data Base, as a matter of fact is the addition of several subgroups (among them MEDLINE) that can be searched simultaneously. OBJECTIVES: To present the main characteristics of PubMed, as well as the most important procedures of search, for obtaining efficient results in searches on allergology. CHARACTERISTICS AND SEARCH PROCEDURES: PubMed is elaborated by the American Administration, that condition the character of the registered papers, 90 % of them are written in English in American (50 %) or British (20 %) Journals. Because of this, the information for certain specialties or countries must be obtained from other sources. This paper shows how PubMed allows to search in natural language due to the Automatic Term Mapping that links terms from the natural language with the descriptors producing searches with a higher sensitivity although with a low specificity. Nevertheless the MeSH (Medical Subject Headings) thesaurus allows to translate those terms from the natural language to the equivalent descriptor, as well as to make queries in the PubMed's documental language with a high specificity but with lower sensitivity than the natural language. The use of union (OR), intersection (AND) and exclusion (NOT) operators, as well as tags, such as delimiters of the search fields, allows to increase the specificity of the results. Similar results may be obtained with the use of Limits. Searches done using Clinical Queries are very interesting due to their direct clinical application and because allow to find systematic reviews, metaanalysis or clinically oriented papers (treatment, diagnostic, etiology, prognosis or clinical prediction guides) on the area of interest. Other procedures such as the Index, History of searches, and the widening of the selection using Related Articles and the storing of separate results in the Clipboard to be kept by the user, are presented in this paper.

Efficient bibliographic searches on allergology using PubMed / Búsquedas eficientes en PubMed sobre alergología

Introduction: PubMed is the most important of the non-specialized databases on biomedical literature. International and quickly updated is elaborated by the American Government and contains only information about papers published in scientific journal/s. Although it can be used as an unique Data Base, as a matter of fact is the addition of several subgroups (among them MEDLINE) that can be searched simultaneously. Objectives: To present the main characteristics of PubMed, as well as the most important procedures of search, for obtaining efficient results in searches on allergology. Characteristics and search procedures: PubMed is elaborated by the American Administration, that condition the character of the registered papers, 90 % of them are written in English in American (50 %) or British (20 %) Journals. Because of this, the information for certain specialties or countries must be obtained from other sources. This paper shows how PubMed allows to search in natural language due to the Automatic Term Mapping that links terms from the natural language with the descriptors producing searches with a higher sensitivity although with a low specificity. Nevertheless the MeSH (Medical Subject Headings) thesaurus allows to translate those terms from the natural language to the equivalent descriptor, as well as to make queries in the PubMed's documental language with a high specificity but with lower sensitivity than the natural language. The use of union (OR), intersection (AND) and exclusion (NOT) operators, as well as tags, such as delimiters of the search fields, allows to increase the specificity of the results. Similar results may be obtained with the use of Limits. Searches done using Clinical Queries are very interesting due to their direct clinical application and because allow to find systematic reviews, metaanalysis or clinically oriented papers (treatment, diagnostic, etiology, prognosis or clinical prediction guides) on the area of interest. Other procedures such as the Index, History of searches, and the widening of the selection using Related Articles and the storing of separate results in the Clipboard to be kept by the user, are presented in this paper

Introducción: PubMed es la más importante de las Bases de Datos no especializadas de bibliografía biomédica, internacional y de actualización ágil, producida por organismos de la administración de los EEUU, que contiene exclusivamente información acerca de artículos publicados en revistas de carácter científico. Aunque puede ser utilizada como una única Base de Datos, en realidad es la suma de diversos subgrupos (entre ellos MEDLINE) que también pueden ser consultados de manera simultanea. Objetivos: Dar a conocer las características principales de PubMed, así como los procedimientos más importantes de consulta, con el fin de obtener resultados eficientes en las búsquedas sobre alergología. Características y Procedimientos de Consulta: PubMed es un producto de la administración de los EEUU, lo que condiciona el carácter de los artículos registrados, los cuales están publicados originalmente en inglés (90%), y en revistas de EEUU (50%) y Reino Unido (25%). Por ello, la información de ciertas especialidades o países debe ser obtenida de otras fuentes. En este artículo se muestra cómo PubMed permite búsquedas en lenguaje natural que gracias al Acotado Automático de Términos, que asocia los términos del lenguaje natural con los descriptores correspondientes, suelen resultar altamente sensibles, aunque poco específicas. Sin embargo, el Tesauro MeSH (Medical Subject Headings) permite traducir los términos del lenguaje natural al descriptor equivalente, así como hacer búsquedas en el propio lenguaje documental de PubMed, que son muy específicas, aunque de menor sensibilidad que en lenguaje natural. La utilización de operadores de unión (OR), intersección (AND) y exclusión (NOT), así como de las etiquetas como delimitadores del campo de búsqueda, permiten aumentar la especificidad de los resultados. En parte se pueden obtener resultados similares con el uso de Limits. Por su aplicación directa a la clínica, es muy interesante la búsqueda a través de Clinical Queries, que de manera muy sencilla para el usuario, permite localizar revisiones sistemáticas y metaanálisis, o bien trabajos de orientación clínica (tratamiento, diagnóstico, etiología, pronóstico, o clinical prediction guides) sobre la materia que interese. Otros procedimientos que se presentan en este artículo son el uso del Index, de la memoria de consultas (History), la ampliación de la selección a través de Related Articles, y la separación de resultados en el portapapeles para su conservación por el usuario

La indización de Alergología e Inmunología clínica en Index medicus/medline: ¿un reto en la actual sociedad de la información? / No disponible

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Las revistas nacionales y extranjeras como fuente de información científica de los cirujanos españoles / National and foreign journals as a source of scientific information for Spanish surgeons

Objetivo. Identificar las revistas científicas que ejercen mayor influencia sobre los autores españoles en cirugía general y digestiva; nuestra hipótesis principal fue que la máxima influencia proviene de la bibliografía americana y británica, pero que también la española tiene una alta visibilidad y repercusión. Material y método. Se comparan los resultados obtenidos en el análisis de Cirugía Española con el de las referencias contenidas en los 483 artículos de cirugía publicados en Revista Española de Enfermedades Digestivas entre 1991 y 1995, así como con otras revistas médicas españolas. La relación de revistas citadas fue obtenida directamente de la sección de bibliografía de cada uno de los artículos. De cada referencia se identificaron la revista citada y su nacionalidad, y de cada artículo citador, el área temática de la que se ocupa. Resultados. Más del 90 por ciento de las citas contenidas en artículos de tema quirúrgico corresponden a revistas. Las publicaciones citadas por la Revista Española de Enfermedades Digestivas fueron en orden decreciente de repercusión, además de ella misma, Annals of Surgery, American Journal of Surgery y Surgery, Gynecology and Obstetrics. En Cirugía Española, fueron Annals of Surgery, la propia Cirugía Española, American Journal of Surgery, y Surgery, Ginecology and Obstetrics. Conclusiones. Se confirma la elevada influencia de las publicaciones americanas, británicas y españolas, pero estas últimas limitadas a Revista Española de Enfermedades Digestivas y Cirugía Española. La repercusión de las revistas sobre los autores españoles difiere de la estimada en Science Citation Index (impact factor), lo que demuestra que las fuentes de información utilizadas por éstos son diferentes a las de los americanos (AU)

Bronchial asthma prevalence in childhood.

BACKGROUND: at the moment there is a considerable interest in the international comparison of the bronchial asthma prevalence, stimulated by the growing evidence of an increment in the frequency. The comparison among studies of bronchial asthma prevalence present the problem of the varied and different methodologies used by the authors, as well as of the lack of a clear definition of what is considered bronchial asthma. METHODS: in this work we try to offer a global vision of the studies published on childhood asthma prevalence in the world. CONCLUSIONS: in the studies carried out at European level, they highlight the high figures found in the British Islands superiors to those referred in the countries from the continent to exception of those observed in Switzerland. In Spain the figures of the studies carried out at national level are something below the countries of our environment, although there have been higher figures in studies carried out in Barcelona and Huelva. In Oceannia they are observed from all over the world in general the highest figures, above the American countries and very above the countries of Asia and Africa to exception of South Africa. Although there are considerable geographical differences in its presentation, bronchial asthma is an illness in constant increase in the entire world. It is for this reason that efforts should be carried out in the search of the causes of this increment, as well as in the standardization of the instruments of measure of the appearance of the illness.

Does medical treatment of mild intraocular hypertension prevent glaucoma?

Glaucoma is a serious disease that may cause a decrease in peripheral vision as well as blindness. Although the treatment of extreme levels of high intraocular pressure (p > 35 mm) reduces the risk of glaucoma it is not known if the treatment of mild and moderate intraocular pressure prevents the onset of glaucoma. A bibliographic search in Medline CD-ROM was performed from 1967 to 1995, as well as in SIGLE CD-ROM. The keywords used were 'glaucoma prevention' and 'glaucoma suspects'. After the search 18 papers which treated moderate and mild intraocular pressure were selected. Of all these papers, those that used the same methodology; randomization and timolol as treatment, were chosen. The possibility of publication bias was controlled by plotting effect size vs. number of papers, as well as effect size vs. year of publication. A meta-analysis using two methods, weighted zetas and adding zetas, was performed. The combined effect size was -6.25%, and the weighted effect size was -6.45%. We computed the pooled z by two methods: adding Zs and adding weighted Zs. The Z obtained by adding Zs has a value of 2.31120 p = 0.0177, one tail). Using the method of adding weighted Zs we obtained a value of 2.4201 (p = 0.0082, one tail). Our results show that the treatment with timolol of patients with mild and moderate intraocular pressure may help to prevent the onset of glaucoma.

Helmet use by drivers and passengers of motorcycles in Pamplona (Spain), 1992.

In 1992 a new Traffic Rules Code was enacted in Spain. This Code included a helmet law that came into force on 1 September 1992. Since then, helmet use is compulsory for motorcycles in urban areas. Previously, helmet use had been obligatory only for motorcycle in highways. To evaluate driver and passenger compliance with the helmet law, an observational prevalence survey of helmet use in Pamplona (a city of 183,539 inhabitants in the north of Spain) was performed. The utilization of helmet by motorcycle drivers and their passengers was recorded three months before and three after the helmet law took effect. Helmet use increased from 19.7% in the first period to 94.8% in the second period. After the law took effect helmet use was higher among drivers 97.5% than among passengers 77.5%. Passengers used helmet more frequently when the driver was also using helmet. The prevalence ratio of helmet use, in those passengers whose driver used helmet versus those who didn't, was 9.91 (95% CI = 1.52, 64.83). Health education and law enforcement efforts should be targeted to drivers to prevent them from giving a ride to passengers without helmet.