Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations.

BACKGROUND: Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients. METHODS: This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process. RESULTS: The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements. CONCLUSION: The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.

Ibero-American consensus on learning outcomes for the acquisition of competencies by medical students through clinical simulation.

OBJECTIVE: Our aim was to reach expert consensus on specific learning outcomes (LOs) that can be achieved through clinical simulation aimed at developing the competencies that medical students need to be able to successfully manage patients and assume general clinical responsibilities. MATERIALS AND METHODS: The six-member scientific committee peer-reviewed Spanish reference documentation (in line with the Bologna Process) on required competencies in medical undergraduate students to select an initial set of 16 competencies that could feasibly be developed through simulation and a corresponding set of 75 LOs. Snowball sampling was used to identify candidates for an international panel of simulation experts. Applying a set of pre-defined criteria, 19 panelists from seven Spanish-speaking regions were recruited to participate in a modified two-round Delphi procedure based on electronic questionnaires and aimed at reaching formal consensus on appropriate LOs for simulated medical training. RESULTS: Final agreement between the panelists was high: no mean score fell below 7.26 of a maximum of 9, and all 75 LOs were agreed on, 74 in the first round and only one requiring the second round. The 16 LOs with mean scores in the top 25th percentile were selected as a set of core LOs to attain via simulation. CONCLUSIONS: This Ibero-American consensus on observable and measurable LOs, reflecting competencies that can feasibly be developed via clinical simulation, is a framework that aims at helping medical schools' plans and delivering specific kinds of undergraduate medical training through simulation. It is also proposed in a set of core LOs as a starting point for less experienced schools to design a simulated training program.

Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP).

AIMS: To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception. DESIGN: Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. PARTICIPANTS AND STUDY PERIOD: A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016). RESULTS: The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. CONCLUSIONS: Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.

Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology.

PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.

Barriers associated with poor control in Spanish diabetic patients. A consensus study.

BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática / Consensus on the Clinical Impact of the New Scientific Evidence Available on Benign Prostatic Hyperplasia

Objetivos: Explorar la opinión técnica de un panel experto y alcanzar un consenso de criterio profesional en relación con la más reciente evidencia científica en hiperplasia benigna de próstata (HBP) en los ámbitos del diagnóstico, de los criterios de progresión, del tratamiento médico y del tratamiento quirúrgico. Material y métodos: Revisión sistematizada de la literatura de los últimos 10 años en HBP por medio de un comité científico y elaboración de un cuestionario de 64 preguntas repartidas en tres áreas estratégicas: a) diagnóstico y estratificación de los pacientes con HBP atendiendo a los factores de riesgo de progresión; b) novedades en el tratamiento médico; y c) nuevas aportaciones en el tratamiento quirúrgico y mínimamente invasivo en HBP. Se seleccionó un panel de 50 urólogos destacados en el conocimiento de la HBP repartidos por toda la geografía nacional, instaurando para el estudio la metodología Delphi mediante la aplicación de dos encuestas sucesivas on line. Resultados: Los 50 expertos consultados completaron las dos rondas del cuestionario. En la primera se apreció un consenso de criterio en 50 de las 64 cuestiones analizadas, logrando en la segunda ronda un consenso en 59/64 ítems (92,5%) que incluyen aspectos de morbilidad de los síntomas del tracto urinario inferior (STUI), pruebas diagnósticas necesarias en la evaluación inicial del especialista, estratificación de los pacientes en relación con el riesgo de progresión, estrategias de terapia médica escalonada y de combinación en pacientes con riesgo de retención aguda de orina (RAO) o cirugía y de las indicaciones de terapia quirúrgica y el papel de los nuevos tratamientos menos invasivos. Conclusiones: En una patología de alta prevalencia, como la HBP, donde hemos asistido en los últimos años a cambios de calado en todo su espectro, la consecución de un elevado consenso al que han contribuido un amplísimo número de especialistas de referencia en esta patología, será de gran importancia para el manejo clínico habitual de esta enfermedad (AU)

Objectives: To study the technical opinion of an expert panel and reach a consensus of professional criterion in relation to the most recent scientific evidence in Benign Prostatic Hyperplasia(BPH) in the scopes of diagnosis, progression criteria, medical treatment and surgical treatment. Material and methods: Systematized review of the literature of the last 10 years in BPH by means of a scientific committee and elaboration of a 64-question questionnaire divided into three strategic areas: 1.- Diagnosis and stratification of the patients with BPH considering the progression risk factors. 2.-Novelties in the medical treatment and 3.- New contributions in the surgical and minimally invasive treatment in BPH. A panel of 50 urologists standing out for their knowledge in BPH distributed throughout the national geographic area was chosen, establishing the Delphi methodology for the study through the application of two successive online surveys. Results: The 50 experts consulted completed the two groups of the questionnaire. In the first, a consensus of criterion was observed in 50 out of the 64 questions analyzed, achieving a consensus in 59/65 (92.5%) in the second round, which included aspects of morbidity of the lower urinary tract symptoms (LUTS), diagnostic tests necessary in the initial evaluation of the specialist, stratification of the patients in relation to the risk of progression, strategies of step-by-step medical therapy and combination in patients with risk of Acute Urinary Retention(AUR) or surgery and of the indications of surgical therapy and the role of new less invasive treatments. Conclusions: In a condition of the high prevalence of BPH, in which we have seen important changes in its entire spectrum in recent years, the obtaining of an elevated consensus to which a large number of reference specialists in this condition have contributed will be of great importance for the usual clinical management of this disease (AU)

[Consensus on the clinical impact of the new scientific evidence available on benign prostatic hyperplasia]. / Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática.

OBJECTIVES: To study the technical opinion of an expert panel and reach a consensus of professional criterion in relation to the most recent scientific evidence in Benign Prostatic Hyperplasia (BPH) in the scopes of diagnosis, progression criteria, medical treatment and surgical treatment. MATERIAL AND METHODS: Systematized review of the literature of the last 10 years in BPH by means of a scientific committee and elaboration of a 64-question questionnaire divided into three strategic areas: 1.- Diagnosis and stratification of the patients with BPH considering the progression risk factors. 2.-Novelties in the medical treatment and 3.- New contributions in the surgical and minimally invasive treatment in BPH. A panel of 50 urologists standing out for their knowledge in BPH distributed throughout the national geographic area was chosen, establishing the Delphi methodology for the study through the application of two successive online surveys. RESULTS: The 50 experts consulted completed the two groups of the questionnaire. In the first, a consensus of criterion was observed in 50 out of the 64 questions analyzed, achieving a consensus in 59/65 (92.5%) in the second round, which included aspects of morbidity of the lower urinary tract symptoms (LUTS), diagnostic tests necessary in the initial evaluation of the specialist, stratification of the patients in relation to the risk of progression, strategies of step-by-step medical therapy and combination in patients with risk of Acute Urinary Retention (AUR) or surgery and of the indications of surgical therapy and the role of new less invasive treatments. CONCLUSIONS: In a condition of the high prevalence of BPH, in which we have seen important changes in its entire spectrum in recent years, the obtaining of an elevated consensus to which a large number of reference specialists in this condition have contributed will be of great importance for the usual clinical management of this disease.

Professional burnout and work satisfaction in Spanish allergists: analysis of working conditions in the specialty.

BACKGROUND: Burnout is a worrying problem in the medical profession and has proven to be highly prevalent in all the care settings and specialty areas in which it has been studied.We applied 2 widely used questionnaires to analyze the working conditions of Spanish allergists in terms of quality of professional life and degree of burnout perceived. METHODS: Participants completed 2 questionnaires: the 22-item Maslach scale, a structured questionnaire covering different aspects of the feelings and attitudes of professionals toward their work and patients; and the Spanish Quality of Professional Life Questionnaire (CPV-35), a 35-item questionnaire evaluating job satisfaction and perceived quality of life at work. RESULTS: We received 404 questionnaires from throughout Spain. The main sources of motivation were better pay (94.4%), more available resources/technology (85.1%), access to research activities (81%), and promotion in one's professional career (80.1%). Analysis of the scores from the Maslach scale revealed that two-thirds of the allergists interviewed experienced medium and high levels of negative burnout (67.9% and 66.2%, respectively, for emotional exhaustion and depersonalization). This situation was in part compensated for by the fact that a slightly lower proportion of the group (59.2%) obtained very high scores on personal accomplishment in their work. Analysis of the scores from the CPV-35 questionnaire revealed 3 complementary aspects of job satisfaction: perceptions of the workload borne (5.8), management support available to cope with daily patient workload (5.6), and levels of intrinsic motivation for work (7.7), which was the highest value. The score for the item summarizing self-perceived overall quality of working life was acceptable (6.4). CONCLUSION: Promoting intrinsic motivation of Spanish allergists using the motivating factors identified in this study could protect against professional burnout.

Consenso de la SEPG sobre la depresión en el anciano / Consensus of the SEPG on depression in the elderly

Antecedentes. La limitación del conocimiento clínico epidemiológico y de la evidencia sobre efectividad terapéutica en la depresión en los pacientes ancianos y muy ancianos genera una excesiva variabilidad de prácticas en la atención clínica a estos pacientes en nuestro sistema sanitario. La Sociedad Española de Psicogeriatría (SEPG) se plantea la necesidad de unificar criterios mediante un método estructurado de consenso profesional. Objetivos. Desarrollar un consenso experto de recomendaciones clínicas para optimizar el abordaje clínico de la depresión en el paciente anciano en España, bajo auspicio de la Sociedad Española de Psicogeriatría (SEPG).Métodos. Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con representantes de la especialidad; 3) encuesta postal en dos rondas con procesamiento intermedio de opinión ese informe a los panelistas; y 4) discusión de resultados en sesión presencial del comité científico. Resultados. 61 expertos consultados completaron las dos rondas de evaluación del cuestionario. En la primera rondase logran consensuar 39 de las 54 cuestiones analizadas. Tras la interacción del panel se aumenta el consenso hasta un total de 46 ítems de la encuesta (85% de los contenidos propuestos). En las 8 cuestiones restantes no se consigue un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones. Se presenta un amplio listado de criterios profesionales y recomendaciones clínicas que pretenden racionalizar el manejo de la depresión en el paciente anciano y reducir el exceso de variabilidad en la práctica clínica. Las recomendaciones se cualifican según el grado de acuerdo profesional en que se sustentan y pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background. The limitation of clinical-epidemiological know-how and evidence regarding therapeutic efficiency in depression among the elderly and extremely elderly patients has given rise to an excessive variety of practices in clinical care of these patients in the Spanish health system. The Spanish Society of Psychogeriatrics (SEPG) has raised the question of the need to unify criteria through a structured approach based on professional consensus. Objectives. To develop an expert consensus of clinical recommendations to improve the clinical treatment of depression in elderly patients in Spain, sponsored by the Spanish Society of Psychogeriatrics (SEPG). Methods. Modified Delphi Consensus, in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee, project promoter and responsible for bibliographic review and formulation of recommendations for discussion 2) constitution of a multicenter Panel of Experts with representatives from this specialist field 3) postal survey comprised of two rounds, with interim processing of opinions and a report for the experts and 4) discussion of results during an onsite meeting of the Scientific Committee. Results. The survey evaluation was completed by 61experts consulted, in two rounds. In the first round, consensus was reached in 39 of the 54 questions analyzed. Following interaction by the panel, this consensus was increased to a total of 46 survey items (85% of the proposed contents). It was impossible to obtain a sufficiently unanimous consensus on the remaining 8questions, either due to differences of opinion among the professionals or a lack of established criterion in most of the experts. Conclusions. A full list of criteria and clinical recommendations for the purpose of rationalizing the treatment of depression in elderly patients and reducing excessive variability in clinical practice is presented. The recommendations are qualified in accordance with the degree of consensus of the professionals endorsing the mand can be considered valid until new scientific information becomes available that justifies their review (AU)

Consensus of the SEPG on depression in the elderly.

BACKGROUND: The limitation of clinical-epidemiological know-how and evidence regarding therapeutic efficiency in depression among the elderly and extremely elderly patients has given rise to an excessive variety of practices in clinical care of these patients in the Spanish health system. The Spanish Society of Psychogeriatrics (SEPG) has raised the question of the need to unify criteria through a structured approach based on professional consensus. OBJECTIVES: To develop an expert consensus of clinical recommendations to improve the clinical treatment of depression in elderly patients in Spain, sponsored by the Spanish Society of Psychogeriatrics (SEPG). METHODS: Modified Delphi Consensus, in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee, project promoter and responsible for bibliographic review and formulation of recommendations for discussion 2) constitution of a multicenter Panel of Experts with representatives from this specialist field 3) postal survey comprised of two rounds, with interim processing of opinions and a report for the experts and 4) discussion of results during an on-site meeting of the Scientific Committee. RESULTS: The survey evaluation was completed by 61 experts consulted, in two rounds. In the first round, consensus was reached in 39 of the 54 questions analyzed. Following interaction by the panel, this consensus was increased to a total of 46 survey items (85% of the proposed contents). It was impossible to obtain a sufficiently unanimous consensus on the remaining 8 questions, either due to differences of opinion among the professionals or a lack of established criterion in most of the experts. CONCLUSIONS: A full list of criteria and clinical recommendations for the purpose of rationalizing the treatment of depression in elderly patients and reducing excessive variability in clinical practice is presented. The recommendations are qualified in accordance with the degree of consensus of the professionals endorsing them and can be considered valid until new scientific information becomes available that justifies their review.

Professional survey on knowledge and clinical patterns of pain management in Spanish medical oncology

Cancer pain is still not treated adequately. The barriers impeding its appropriate treatment include lack of knowledge, erroneous beliefs and inappropriate attitudes with regard to pain, which are sustained by some or all of those involved in the problem. The present study shows the results of an exploratory survey using a large sample of specialists in clinical oncology. Its main objective is to evaluate daily analgesic practices and compliance with clinical guidelines in order to identify areas that should be improved in this particular therapeutic field. Information collection from the responders was in the form of a self-administered written questionnaire, structured in three thematic areas: clinical patterns and resources used in pain treatment in clinical practice, pain and pain-relief therapy, and theoretical knowledge and decision-making in clinical practice. The study identified those skills that most need improvement in the treatment of pain (scientific and technical knowledge and clinical decision-making capacity of professionals) in order to reduce the unjustified variability in current clinical practice (AU)

Treatment initiation in epilepsy: an expert consensus in Spain.

OBJECTIVE: The goals of this study were to explore the diverse criteria surrounding indications for antiepileptic therapy and to establish a consensus on drug selection for initial monotherapy in adult patients with epilepsy. METHODS: The study was performed using the modified Delphi method, which aims to achieve professional consensus by means of a series of questionnaires. Three different groups of items were evaluated: the beginning of antiepileptic treatment, the drug selected for initial monotherapy with respect to the type of epilepsy, and the drug selected for initial monotherapy with respect to comorbidity. RESULTS: Sixty experts completed two rounds of a questionnaire. In the first round, consensus was reached on 135 of the 194 questions analyzed. After the second round, consensus was reached on 148 items. The main findings of the survey revealed a consensus on beginning treatment after the first seizure when the EEG showed abnormalities such as generalized spike-wave discharges, when MRI demonstrated an epileptogenic brain lesion, and in elderly patients. Regarding to the antiepileptic drug selected for initial monotherapy with respect to type of epilepsy, levetiracetam and lamotrigine were recommended for generalized tonic-clonic seizures regardless of sex or age; levetiracetam was recommended for myoclonic epilepsy regardless of sex; valproic acid, ethosuximide, levetiracetam, and lamotrigine were chosen for absence epilepsy; and carbamazepine, levetiracetam, lamotrigine, and oxcarbazepine were recommended for partial epilepsy regardless of age or sex. Finally, in the evaluation of drug selection with respect to comorbidity, first-generation drugs were less recommended than second-generation drugs, which were clearly preferable. The drugs on which there was a greater consensus were levetiracetam, lamotrigine, valproic acid, and topiramate. CONCLUSIONS: There is a tendency to begin treatment after the first seizure, depending on the results of additional testing. In general, first-generation drugs are less recommended for different types of epilepsy, especially in the presence of a comorbid condition. However, the authors are conveying perceptions and opinions, the effect of which on treatment outcomes has not been evaluated.

Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica / Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology

Antecedentes: Tras la finalización y análisis de resultados del estudio CIVIC, la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC) plantea la necesidad de revisar sus recomendaciones para la prevención del VRS en niños con cardiopatías congénitas. Para considerar tanto la valoración de las nuevas evidencias disponibles como la experiencia preventiva acumulada por los cardiólogos infantiles, se propone efectuar dicha actualización mediante un método estructurado de consenso profesional. Objetivos: Desarrollar un consenso clínico español sobre la prevención de la infección por virus respiratorio sincitial, bajo el auspicio de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Métodos: Consenso Delphi modificado en 2 rondas. El estudio se efectuó en 4 fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con 75 representantes de la especialidad; 3) encuesta postal en 2 rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Cincuenta y cinco expertos consultados completaron las 2 rondas de evaluación del cuestionario. En la primera ronda se lograron consensuar 44 de las 70 cuestiones analizadas. Tras la interacción del panel, se aumentó el consenso hasta un total de 54 ítems de la encuesta (el 77% de los contenidos propuestos). En las 16 cuestiones restantes no se consiguió un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones: Se presenta y actualiza una lista de recomendaciones profilácticas frente al virus respiratorio sincitial, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. Objectives: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Methods: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Results: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Conclusions: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review (AU)

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.]. / Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica.

BACKGROUND: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. OBJECTIVES: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. METHODS: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. RESULTS: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. CONCLUSIONS: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review.

Criterios profesionales sobre el papel de ezetimiba en el manejo clínico del paciente dislipémico en el ámbito de atención primaria / Professional criteria about the role of ezetimibe in clinical management of dyslipidemia in primary care

Introducción: A pesar de que ezetimiba fue introducida en España hace más de 5 años, existen todavía diferencias de criterio sobre el papel actual de este fármaco en el manejo de la dislipemia en atención primaria. Objetivos: Promover un consenso sobre el uso clínico de ezetimiba entre profesionales de atención primaria. Material y métodos: El estudio fue dividido en cuatro fases: 1) creación de un comité científico multidisciplinar (atención primaria, endocrinología y medicina interna) para revisión bibliográfica y formulación de un uestionario de 46 ítems sobre dislipemia y ezetimiba; 2) selección del panel de 91 médicos de atención primaria expertos en este campo; 3) encuesta Delphi en dos rondas, enviada por correo electrónico, y 4) sesión presencial final de discusión de resultados. Resultados: Participaron 87 profesionales que, en la primera ronda, lograron consensuar 34 de las 46 cuestiones analizadas. Tras la interacción del panel, el consenso aumentó hasta 42 ítems. En las 4 cuestiones restantes el consenso fue insuficiente, debido a las opiniones dispares o a la ausencia de criterio en la mayoría de los encuestados. Conclusiones: En este consenso, se presenta una amplia lista de criterios profesionales y/o recomendaciones para el uso de ezetimiba en atención primaria, que resumen la opinión profesional vigente entre los expertos de esta especialidad (AU)

Background: Since ezetimibe was first marketed in Spain more than 5 years ago, differences in criteria continue to exist about the current role played by ezetimibe in treating dyslipaemia in the primary care in Spain. Objectives: To develop consensus regarding the clinical use of ezetimibe in treating dyslipaemia in primary care. Methods: The study was divided into four stages: 1) constitution of a multidisciplinary scientific committee (primary care, endocrinology, internal medicine) for bibliographic review and formulation of a 46-items survey about dyslipaemia and ezetimibe; 2) constitution of a panel of 84 primary care professionals with expertise in this field; 3) Delphi survey in two rounds, sent by mail; and 4) a final discussion of the results in a face-to-face meeting. Results: Eighty-seven experts participated and, during the first round, reached a consensus in 34 out of 46 analysed questions. Following interaction by the panel, the consensus increased until 42 items. In the remaining 4 questions, insufficient consensus was obtained, due to opinion disparities existing among the professionals or to the absence of an established criterion for most of the experts. Conclusions: In this consensus, a long list of professional criteria and/or recommendations is included for the use of ezetimibe in primary care, summarising prevailing professional opinion of primary care experts (AU)

Alergológica 2005. Methodological aspects and sample characteristics of the study.

BACKGROUND: In this article we present the basic methodological aspects of the clinical epidemiologic study Alergológica-2005, a project launched by the Spanish Society of Allergology and Clinical Immunology replicating the objectives and methods of a similar study carried out in 1992. OBJECTIVE: The aim of this nation-wide study was to describe the profile of the patients treated in Spanish allergology departments, the normal clinical practice followed by the specialists in these departments, the social and healthcare repercussions of allergic diseases in Spain together with the additional objective of identifying any possible relevant changes that may have taken place regarding these factors during the decade since the original study was completed (1992-2005). METHODS: An observational, descriptive, cross-sectional study was carried out over the year 2005 using a convenience sample of allergic patients (recruited consecutively from a different random date for each researcher participating in the study) who were treated in the departments, both private and public, of 340 specialists in allergology working in the Spanish healthcare system. The sample was stratified geographically by autonomous region in a ratio proportional to the population of each geographical area. RESULTS: Clinical, epidemiological, diagnostic, therapeutic, social and general healthcare data were collected from 4991 allergic patients presenting for the first time in the departments of the researchers involved in the study. The results and conclusions will be presented classified by disorder in the following research articles published in this issue. CONCLUSIONS: The methodological aspects described guarantee the accuracy of the estimates made in the current study and the comparability of the results with those of Alergológica-92 project.

[Prevalence and factors associated with burnout in a health area]. / Prevalencia y factores asociados al burnout en un área de salud.

OBJECTIVES: The main objective was to determine the prevalence of the burnout syndrome among health workers and its distribution by social, demographic and work variables. The secondary aim was to detect potentially modifiable causes. DESIGN: Descriptive cross-sectional study. SETTING: Primary care. PARTICIPANTS: All the 354 doctors, nurses and clinical auxiliaries belonging to the 22 primary care teams of Area VI, Madrid. MEASUREMENTS AND MAIN RESULTS: A self-administered, anonymous questionnaire was sent out by internal mail. This had three instruments: a questionnaire on social and demographic variables, the validated questionnaire known as the Maslach Burnout Inventory and an open opinion section. High levels of burnout were detected: 30.6% in the high range on the emotional tiredness sub-scale, with higher scores among men (p = 0.026). There were also more paediatric staff affected in personal achievements. There was scant relationship of the syndrome to social variables. 43.9% thought they suffered or had suffered from some kind of physical or psychological disorder directly related to exercising their profession. 38.3% associated directly their burnout with the excess demand habitually experienced in clinics. CONCLUSIONS: We detected worryingly high levels of this syndrome among our professionals, similar to other surveys in Spain. The subjects of the survey linked their unease with certain work factors that could easily be modified. The training received in techniques of self-control and stress management is clearly insufficient.

Prevalencia y factores asociados al burnout en un área de salud / Prevalence and factors associated with 'burnout' in a health district

Objetivos. Principal: determinar la prevalencia del síndrome de burnout entre trabajadores sanitarios, así como su distribución según diferentes variables sociodemográficas y laborales. Secundario: detectar posibles factores causales del síndrome de burnout potencialmente modificables. Diseño. Estudio transversal, descriptivo. Emplazamiento. Atención primaria. Participantes. Dirigido a la totalidad (354) de médicos, enfermeras y auxiliares clínicos pertenecientes a los 22 EAP que forman el Área VI de Madrid. Mediciones y resultados principales. Se envió cuestionario autoadministrado y anónimo por correo interno, compuesto por tres instrumentos; una encuesta sobre variables sociodemográficas, el cuestionario validado Maslach Burnout Inventory y un apartado abierto de opinión. Se consiguió una participación del 45 por ciento. Se detectaron considerables niveles de burnout: un 30,6 por ciento dentro del rango alto para la subescala de cansancio emocional y con mayores puntuaciones en los varones (p = 0,026). Destacó también mayor afectación entre el personal pediatra en cuanto a logros personales. Se observa escasa relación del síndrome con las variables de tipo social. Un 43,9 por ciento considera presentar o haber presentado algún tipo de alteración física o psíquica relacionada directamente con el desarrollo de su profesión, y el 38,3 por ciento asocia directamente su desgaste con el exceso de demanda soportado habitualmente en sus consultas. Conclusiones. Detectamos niveles de este síndrome preocupantemente elevados entre nuestros profesionales y similares a los encontrados en otras encuestas nacionales. Los encuestados asocian su malestar con algunos factores laborales que podrían ser fácilmente modificables. La formación recibida en cuanto a técnicas de autocontrol y manejo del estrés son claramente insuficientes (AU)

[Cutaneous cryosurgery in family medicine: dimethyl ether-propane spray versus liquid nitrogen]. / Criocirugía cutánea en medicina familiar: spray de dimetiléter-propano frente al nitrógeno líquido.

OBJECTIVE: To compare the efficacy, tolerance and safety of two types of cryotherapy, performed by family physicians, for benign cutaneous lesions: low freezing (-59 degrees C) with dimethyl either-propane cryogenic spray (DMEP) and intense freezing (196 degrees C) with conventional liquid nitrogen (LN). DESIGN: A randomised, multi-centered, controlled clinical trial, with single-blind assessment. SETTING: Three primary care teaching teams in the Community of Madrid. PATIENTS AND OTHER PARTICIPANTS: Ten MIR from family & community medicine intervened. There were 124 patients, who had 174 benign cutaneous lesions, suitable for cryotherapy. There were 3 voluntary withdrawals, none because of an adverse reaction. Interventions, in each case there was local application for a standard time of the randomised agent. Control-group intervention, 81 cases: swab soaked in LN. Study-group intervention, 93 cases: swab saturated with DMEP spray. Maximum of three freezings per case, at weekly intervals. MEASUREMENTS AND MAIN RESULTS: A doctor made a blind assessment of the results (elimination, adverse reaction, aesthetic result) 15 days after treatment. CONCLUSIONS: No clinically relevant differences between the efficacy, tolerance and safety of the two cryogenic agents used in primary care were found. The low freezing of DMEP was sufficient for the cryotherapy of benign lesions.