Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas / Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed

Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology. / Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

[Diagnosis. Radiological study. Ultrasound, computed tomography and magnetic resonance imaging]. / Diagnóstico. Estudio radiológico. Ecografía, tomografía computarizada y resonancia magnética.

Because of its low cost, availability in primary care and ease of interpretation, simple X-ray should be the first-line imaging technique used by family physicians for the diagnosis and/or follow-up of patients with osteoarthritis. Nevertheless, this technique should only be used if there are sound indications and if the results will influence decision-making. Despite the increase of indications in patients with rheumatological disease, the role of ultrasound in patients with osteoarthritis continues to be limited. Computed tomography (CT) is of some -although limited- use in osteoarthritis, especially in the study of complex joints (such as the sacroiliac joint and facet joints). Magnetic resonance imaging (MRI) has represented a major advance in the evaluation of joint cartilage and subchondral bone in patients with osteoarthritis but, because of its high cost and diagnostic-prognostic yield, this technique should only be used in highly selected patients. The indications for ultrasound, CT and MRI in patients with osteoarthritis continue to be limited in primary care and often coincide with situations in which the patient may require hospital referral. Patient safety should be bourne in mind. Patients should be protected from excessive ionizing radiation due to unnecessary repeat X-rays or inadequate views or to requests for tests such as CT, when not indicated.

[Diagnosis: synovial fluid analysis]. / Diagnóstico. Examen del líquido sinovial.

Synovial fluid analysis in rheumatological diseases allows a more accurate diagnosis in some entities, mainly infectious and microcrystalline arthritis. Examination of synovial fluid in patients with osteoarthritis is useful if a differential diagnosis will be performed with other processes and to distinguish between inflammatory and non-inflammatory forms. Joint aspiration is a diagnostic and sometimes therapeutic procedure that is available to primary care physicians.

Diagnóstico. Estudio radiológico. Ecografía, tomografía computarizada y resonancia magnética / Diagnosis. Radiological study. Ultrasound, computed tomography and magnetic resonance imaging

La radiología simple, por su bajo coste, alta disponibilidad en atención primaria y fácil interpretación, debe ser la primera técnica de imagen que el médico de familia se plantee para el diagnóstico y/o seguimiento del paciente artrósico. No obstante, la indicación de esta prueba siempre debe estar fundamentada y si se solicita es porque puede influir en la toma de decisiones con el paciente. Pese al aumento de indicaciones en el paciente reumatológico, el papel de la ecografía en el paciente artrósico sigue siendo limitado. La tomografía computarizada (TC) tiene su utilidad, aunque limitada, en la artrosis, especialmente para el estudio de articulaciones complejas (como las sacroilíacas y las vertebrales interapofisarias). La resonancia magnética (RM) ha supuesto un avance importante a la hora de valorar el estado del cartílago articular y del hueso subcondral en el paciente con artrosis, pero el coste elevado y la rentabilidad diagnóstica-pronóstica de esta técnica obliga a indicarla en casos muy seleccionados. Las indicaciones de la ecografía, la TC y la RM en el paciente artrósico siguen siendo limitadas en atención primaria y, probablemente, coinciden a menudo con situaciones en las que puede ser necesario derivar al paciente al nivel hospitalario. El aspecto de la seguridad del paciente debe ser tenido en cuenta, intentando proteger al paciente de excesivas radiaciones ionizantes, mediante repeticiones innecesarias de radiografías o proyecciones inadecuadas, o por solicitud de pruebas como TC, cuando no están indicadas

Because of its low cost, availability in primary care and ease of interpretation, simple X-ray should be the first-line imaging technique used by family physicians for the diagnosis and/or follow-up of patients with osteoarthritis. Nevertheless, this technique should only be used if there are sound indications and if the results will influence decision-making. Despite the increase of indications in patients with rheumatological disease, the role of ultrasound in patients with osteoarthritis continues to be limited. Computed tomography (CT) is of some -although limited- use in osteoarthritis, especially in the study of complex joints (such as the sacroiliac joint and facet joints). Magnetic resonance imaging (MRI) has represented a major advance in the evaluation of joint cartilage and subchondral bone in patients with osteoarthritis but, because of its high cost and diagnostic-prognostic yield, this technique should only be used in highly selected patients. The indications for ultrasound, CT and MRI in patients with osteoarthritis continue to be limited in primary care and often coincide with situations in which the patient may require hospital referral. Patient safety should be bourne in mind. Patients should be protected from excessive ionizing radiation due to unnecessary repeat X-rays or inadequate views or to requests for tests such as CT, when not indicated

Diagnóstico. Examen del líquido sinovial / Diagnosis: synovial fluid analysis

El análisis del líquido sinovial en enfermedades reumatológicas permite llegar a un diagnóstico más exacto en algunas entidades, fundamentalmente en las artritis infecciosas y en las microcristalinas. Plantearse su estudio en un paciente artrósico tiene sentido en caso de que proceda realizar un diagnóstico diferencial con otros procesos o para etiquetar el cuadro de inflamatorio o no inflamatorio. La artrocentesis es un método diagnóstico y terapéutico en algunas ocasiones, que está al alcance de los médicos de atención primaria

Synovial fluid analysis in rheumatological diseases allows a more accurate diagnosis in some entities, mainly infectious and microcrystalline arthritis. Examination of synovial fluid in patients with osteoarthritis is useful if a differential diagnosis will be performed with other processes and to distinguish between inflammatory and non-inflammatory forms. Joint aspiration is a diagnostic and sometimes therapeutic procedure that is available to primary care physicians

Actualización: Este paciente ¿puede tener una conectivopatía? (diagnóstico precoz de las enfermedades difusas del tejido conectivo) / No disponible

Las enfermedades inflamatorias del tejido conjuntivo o del colágeno, "conectivopatías" o "colagenosis", son un conjunto heterogéneo de procesos de etiología desconocida con una base etiopatogénica común: la alteración de la inmunidad, con producción de autoanticuerpos y cierta predisposición genética. Se caracterizan por presentar manifestaciones articulares inflamatorias (artritis) en mayor o menor grado, afectación del estado general y manifestaciones viscerales en uno o varios órganos diana, como corazón, pulmón, riñón, piel, sistema nervioso o aparato digestivo. Son enfermedades sistémicas, potencialmente graves, que deben ser estudiadas por otras especialidades (reumatología, medicina interna, neumología, etc.). La sospecha inicial, sin embargo, puede y debe hacerse en atención primaria, aunque no está exenta de dificultad el hecho de realizarla lo más precozmente posible contribuye de forma sustancial a una mejor evolución y pronóstico. Aquí se repasarán las características clínicas (síntomas, signos —con imágenes—) y las pruebas complementarias de este grupo de enfermedades, y se hará una propuesta para facilitar su sospecha en nuestra práctica diaria (AU)

No disponible

El consumo sanitario inapropiado y la trivialización de la medicina / Inappropriate use of health resources and the trivialisation of medicine

Uno de los problemas de nuestro sistema sanitario es el consumo inapropiado cuyas consecuencias más notorias son el despilfarro de recursos y la iatrogenia que no está justificada por la expectativa de ningún beneficio en términos de salud. Entre las posibles causas del consumo inadecuado se destaca la banalización de la medicina, que conlleva la pérdida de respeto y la ausencia de miramientos y por eso facilita cuando no estimula la temeridad en el consumo. Una temeridad de la que son responsables tanto pacientes como sanitarios y seguramente todavía más gestores y políticos. Sin una efectiva emancipación que lleve a los usuarios y ciudadanos a controlar los determinantes de su salud no parece posible disminuir el consumo inapropiado ni la iatrogenia asociada (AU)

One of the main problems of our health care system is its excessive use. The most evident results of this misuse are the waste of resources and the iatrogenic consequences that are not justified by any expectations in health improvement. Among the possible causes of this inappropriate use, the trivialization of medical practice should be emphasized. This entails not only a loss of respect and consideration, but facilitates and even stimulates reckless use. Although patients and health care workers are both responsible for this recklessness, politicians and health care managers should be held responsible more so. Without a real emancipation allowing health care users and the population to control the factors that determine their health, it is unlikely that the inappropriate use of health resources and its associated iatrogenic consequences will be reduced (AU)

[Inappropriate use of health resources and the trivialisation of medicine]. / El consumo sanitario inapropiado y la trivialización de la medicina.

One of the main problems of our health care system is its excessive use. The most evident results of this misuse are the waste of resources and the iatrogenic consequences that are not justified by any expectations in health improvement. Among the possible causes of this inappropriate use, the trivialization of medical practice should be emphasized. This entails not only a loss of respect and consideration, but facilitates and even stimulates reckless use. Although patients and health care workers are both responsible for this recklessness, politicians and health care managers should be held responsible more so. Without a real emancipation allowing health care users and the population to control the factors that determine their health, it is unlikely that the inappropriate use of health resources and its associated iatrogenic consequences will be reduced.

Impact of a multifaceted intervention to improve the clinical management of osteoporosis. The ESOSVAL-F study.

BACKGROUND: A study to evaluate the impact of a combined intervention (in-class and on-line training courses, a practicum and economic incentives) to improve anti-osteoporosis treatment and to improve recordkeeping for specific information about osteoporosis. METHODS/DESIGN: A before/after study with a non-equivalent control group to evaluate the impact of the interventions associated with participation in the ESOSVAL-R cohort study (intervention group) compared to a group receiving no intervention (control group). The units of analysis are medical practices identified by a Healthcare Position Code (HPC) referring to a specific medical position in primary care general medicine in a Healthcare Department of the Region of Valencia, Spain. The subjects of the study are the 400 participating "practices" (population assigned to health care professionals, doctors and/or nurses) selected by the Healthcare Departments of the Valencia Healthcare Agency for participation as associate researchers in the ESOSVAL-R study (intervention group), compared to 400 participating "practices" assigned to primary care professionals NOT selected for participation as associate researchers in the ESOSVAL-R study, who are selected on the basis of their working in the same Healthcare Centers as the practices receiving the interventions (control group). The study's primary endpoint is the appropriateness of treatment according by the Spanish National Health System guide (2010) and the National Osteoporosis Foundation (NOF, 2008) and International Osteoporosis Foundation guidance (IOF, 2008).The study will also evaluate a series of secondary and tertiary endpoints. The former are the suitability of treatment and evaluation of the risk of fracture; and the latter are the volume of information registered in the electronic clinical records, and the evaluation of risks and the suitability of treatment.

Determinant factors of osteoporosis patients' reported therapeutic adherence to calcium and/or vitamin D supplements: a cross-sectional, observational study of postmenopausal women.

BACKGROUND: Among the various treatments for osteoporosis, calcium and/or vitamin D supplements are frequently included. OBJECTIVE: The objective of the study was to analyse adherence to calcium and/or vitamin D treatment and to identify related predictors of non-adherence in a sample of postmenopausal women treated for osteoporosis in primary care. METHODS: A cross-sectional, observational study was conducted in a sample of postmenopausal women receiving pharmaceutical treatment for osteoporosis with vitamin D and/or calcium. Sociodemographic, general and osteoporosis-related data were collected. Patient's perceptions of the adverse effects of treatment, their knowledge of osteoporosis (Batalla test), their attitude towards treatment (Morisky-Green test) and their self-reported therapeutic adherence (Haynes-Sackett test) were assessed. RESULTS: Of 630 women (mean age +/- SD 64.1 +/- 8.7 years) evaluated, 36.2% (95% CI 32.4, 39.9) had problems with treatment tolerability, 63.5% (95% CI 59.7, 67.3) had good knowledge of osteoporosis, 20.5% (95% CI 17.3, 23.6) had a good attitude to treatment and 50.0% (95% CI 46.1, 53.9) had good self-reported adherence to treatment. Patients in the poor adherence group had higher mean body mass index (p = 0.014), more concurrent pathologies (p = 0.003), more tolerability problems (p < 0.001) and worse attitude to treatment (p < 0.001). The multivariate model showed a positive relationship between therapeutic adherence and good attitude to treatment (odds ratio [OR] = 11.7; p < 0.001), not having tolerability problems (OR = 3.3; p < 0.001) and no polymedication (OR = 0.80; p = 0.017). CONCLUSIONS: Only one in two postmenopausal women with osteoporosis who take calcium and/or vitamin D have good self-reported therapeutic adherence to this treatment. Determinant factors of adherence to calcium and/or vitamin D treatment were patient's attitude to the treatment, tolerability problems with the treatment and number of concurrent treatments.

Necesidad de leer e interpretar la bibliografía adecuadamente cuando se revisa la evidencia. Respuesta de los autores / No disponible

No disponible

Efectividad de los fármacos utilizados como modificadores de la enfermedad artrósica / Effectiveness of drugs used in degenerative joint diseases (arthroses)

No disponible

No disponible

Revisión de la evidencia sobre los fármacos sintomáticos de acción lenta en la artrosis (SYSADOA) / Review of the evidence about drugs used as SYSADOA

No disponible

Prevención de cáncer ginecológico y de mama

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : prevención del cáncer de mama, cáncer de cérvix, cáncer de ovario y cáncer de endometrio. También incluye una guía de consulta rápida.

Osteoporosis

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : consideraciones generales; cómo sospechar quién tiene o puede tener baja masa ósea patológica; cómo diagnosticar la baja masa ósea patológica; una vez diagnosticada : cómo la estudio, qué le pido; a quién trato, con qué y cómo la trato; cuando lo derivo.

Dolor de espalda

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : dolor de espalda : generalidades, patología cervical, dorsal y lumbar : cuadros clínicos, puntos clave y algoritmos. También incluye una guía de consulta rápida.