Evaluación del uso adecuado de la laparoscopia hepatobiliar en la colelitiasis sintomática / Assessing the appropriate use of hepatobiliary laparoscopy in symptomatic chol elithiasis

ANTECEDENTES. La colelitiasis es una de las patologías más frecuentes del tubo digestivo. A pesar de los ensayos clínicos realizados que comparan las técnicas de colecistectomía abierta o laparoscópica, falta una lista de indicaciones para los diferentes perfiles de pacientes. Desde la introducción de la cirugía laparoscópica se ha abierto un amplio abanico de indicaciones para este procedimiento. El objetivo de este estudio fue desarrollar estándares de uso adecuado de la cirugía laparoscópica en pacientes con colelitiasis. MÉTODO. Se siguió el método RAND para elaborar criterios de uso adecuado de la laparoscopia hepatobiliar en la colelitiasis sintomática. Un panel de 7 expertos puntuó el grado de uso adecuado de cada indicación en una escala de 1 (muy inadecuado) a 9 (muy adecuado). Las puntuaciones se realizaron dos veces, en la primera ronda, de forma independiente por cada experto, y en la segunda ronda, durante una reunión presencial. Según la mediana de las puntuaciones de los panelistas y su nivel de acuerdo, cada indicación se clasificó como adecuada, dudosa o inadecuada. RESULTADOS. Los expertos señalaron que para la cirugía laparotómica, 2 indicaciones (12,5%) fueron consideradas adecuadas, 12 (75%) dudosas y 2 (12,5%) inadecuadas; mientras que para la cirugía laparoscópica, 9 indicaciones (56,25%) fueron consideradas adecuadas, 3 (18,75%) dudosas y 4 (25%) inadecuadas. CONCLUSIONES. Todavía hay incertidumbre con respecto a la gestión de la colelitiasis, mostrando la necesidad de una mayor investigación. La metodología RAM ayuda a dilucidar la adecuación de las diferentes opciones de tratamiento en situaciones clínicas específicas (AU)

BACKGROUND. Cholelithiasis is one of the most common diseases of the digestive tract. Despite clinical trials comparing the techniques of laparotomy or laparoscopic cholecystectomy, there is a lack of a list of indications for different patient profiles. Since the introduction of laparoscopic surgery, a wide range of indications for this procedure have been started. The aim ofthis study was to develop standards for the appropriate use of laparoscopic surgery in patients with cholelithiasis. METHOD. We conducted a study following the RAND appropriateness method (RAM) to develop criteria for hepatobiliary laparoscopy in symptomatic cholelithiasis. A panel comprised of 7 experts rated the appropriateness of a set of indications, from 1 (very inappropriate) to 9 (very appropriate). The panelists performed ratings in 2 rounds. The first round was performed independently by every expert. The second round took place during a face-to-face meeting. According to the median ratings and agreement criteria, every indication was classified as appropriate, uncertain, or inappropriate. RESULTS. The experts indicated that for the laparotomy surgery, 2 (12.5%) indications were judged as appropriate, 12 (75%) as uncertain, and 2 (12.5%) as inappropriate; while for laparoscopic surgery, 9 indications (56.25%) were considered as appropriate, 3 (18.75%) as uncertain, and 4 (25%) as inappropriate CONCLUSIONS. There is still uncertainty with respect to the management of cholelithiasis, showing the necessity of further investigation. The RAM helps to elucidate appropriateness for the different treatment options in specific clinical settings (AU)

La vitamina K como profilaxis para la enfermedad hemorrágica del recién nacido / Prophylactic Vitamin K for Vitamin K Deficiency Bleeding of the Newborn

Objetivo La administración de vitamina K inmediatamente después del nacimiento ha demostrado un descenso significativo de la incidencia de hemorragias neonatales, pero no existe evidencia suficiente que determine la forma de administración más adecuada. El objetivo de esta revisión es determinar la eficacia de la vitamina K administrada por vía oral frente a la vía intramuscular en la prevención de la enfermedad hemorrágica del recién nacido. Métodos Se realizó una revisión sistematizada de las principales bases de datos (Medline, Embase y Cochrane), entre otras sin limitación por fecha, idioma ni tipo de estudio. Los estudios seleccionados evaluaban la eficacia de la vitamina K. Se excluyeron aquellos estudios realizados en embarazadas, niños pretérmino o en pacientes afectos de alguna enfermedad. La validez de estos estudios fue evaluada mediante herramientas CASPe para revisiones sistemáticas y ensayos clínicos. Resultados Los estudios incluidos fueron cuatro ensayos clínicos y una revisión sistemática. Únicamente dos estudios evaluaron aspectos clínicos en los cuales se observó un descenso en la incidencia de hemorragias en el recién nacido tras la profilaxis con vitamina K por vía intramuscular. Con respecto a la vía oral, diferentes estudios analizaron la eficacia de la vitamina K mediante la determinación de parámetros bioquímicos (factor X, índice y tiempo de protrombina, vitamina K1 en plasma y antígeno de protrombina, entre otros) con resultados poco concluyentes en cuanto a la vía de administración y al número de dosis. Conclusiones(..)(AU)

Background The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of haemorrhagic disease of newborn (HDN).Methods We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials. Results Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K1 in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses. Conclusions There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which cannot be correlated with the actual coagulation status of the newborn due to lack of scientific evidence(AU)

[Prophylactic vitamin K for vitamin K deficiency bleeding of the newborn]. / La vitamina K como profilaxis para la enfermedad hemorrágica del recién nacido.

BACKGROUND: The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of hemorrhagic disease of newborn (HDN). METHODS: We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials. RESULTS: Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K1 in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses. CONCLUSIONS: There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which can not be correlated with the actual coagulation status of the newborn due to lack of scientific evidence.

Assessing the appropriate use of laparoscopic surgery for hepatobiliary diseases.

BACKGROUND: The range of indications for laparoscopic surgery has widened since it was first introduced. The aim of the present study was to develop standards for the appropriate use of laparoscopic surgery in patients with choledocholithiasis or cholelithiasis. METHOD: We conducted a study following the RAND appropriateness method (RAM) to develop criteria for hepatobiliary laparoscopy. A panel comprised of 7 experts rated the appropriateness of a set of indications, from 1 (very inappropriate) to 9 (very appropriate). The panelists performed ratings in 2 rounds. The first round was performed independently by every expert. The second round took place during a face-to-face meeting. According to the median of panelists' ratings and agreement criteria, every indication was classified as appropriate, uncertain, or inappropriate. RESULTS: In the first round, 112 (46.7%) indications were judged as appropriate, 102 (42.5%) as uncertain, and 26 (10.8%) as inappropriate. In the second round, 99 indications (48.5%) were considered as appropriate, 81 (39.7%) as uncertain, and 24 (11.8%) as inappropriate. Disagreement between panelists decreased in the second round compared with the first round. Thirteen indications were rated as disagreement (6.4%), 125 as uncertain (61.3%), and 66 as agreement (32.3%), while in the first round, the results and proportions were 44 (18.3%), 132 (55.0%), and 64 (26.7%), respectively. CONCLUSIONS: By using RAM, the panel was able to develop detailed explicit appropriateness criteria for the proper application of hepatobiliary laparoscopy. The criteria may be used prospectively to help in making clinical decisions or retrospectively to assess the overuse of clinical procedures.

[18F-fluorodeoxyglucose positron emission tomography in the evaluation of therapy response assessment in lymphomas. Systematic literature review and meta-analysis]. / Tomografía de positrones con 18F-fluorodesoxiglucosa en la valoración de la respuesta de los linfomas al tratamiento. Revisión sistemática de la literatura y metaanálisis.

This systematic review of literature analyze the utility of positron emission tomography (PET or PET-CT) with 18F-fluorodeoxyglucose, as a diagnostic tool in the assessment of response to chemotherapy and immunotherapy in lymphomas, in terms of diagnostic accuracy in prospective publications. A literature search was conducted in major databases and through manual review from the reference lists of articles that were recovered. The methodological quality of the selected items was evaluated using the QUADAS questionnaire. 9 publications were analyzed after the filtering process. The methodological quality of the same was broadly acceptable. In patients with LH, the negative predictive value of FDG-PET after 2-3 cycles of chemotherapy, was ranged between 93.4% (95% CI, 92.6-94.3) and 100% (95% CI, 99.3-100%), and after the treatment, the negative predictive value of PET-FDG, was between 94.3% (95% CI, 92.8-95.7) and 100% (95% CI, 97.1-100). In patients with residual masses and LH, the meta-analysis of results showed a sensitivity of 100% (95% CI, 0.753-1) and a specificity of 84% (95% CI, 0.699-0.934). PET-FDG seems to be a useful tool to evaluate the response to treatment of patients with lymphoma. However, it recommended further prospective studies and that possibly conducted in hybrid PET-CT scans, to determine its usefulness.

Tomografía de positrones con 18F-fluorodesoxiglucosa en la valoración de la respuesta de los linfomas al tratamiento. Revisión sistemática de la literatura y metaanálisis / 18F-fluorodeoxyglucose positron emission tomography in the evaluation of therapy response assessment in lymphomas. Systematic literature review and meta-analysis

La presente revisión sistemática de la literatura pretende evaluar el rendimiento de la tomografía de positrones (PET o PET-TAC) de cuerpo entero con 18F-fluorodesoxiglucosa (FDG), como prueba diagnóstica, en la valoración de la respuesta a la quimioterapia y la inmunoterapia en los linfomas, en términos de validez y utilidad, para ello se utilizaron publicaciones de carácter prospectivo. Se realizó una búsqueda bibliográfica en las principales bases de datos disponibles y mediante revisión manual a partir de las listas de referencia de los artículos encontrados. La calidad metodológica de los artículos seleccionados se evaluó mediante el cuestionario QUADAS. Se analizaron 9 publicaciones tras el proceso de filtrado. La calidad metodológica de aquellos, en general, fue aceptable. En pacientes con linfoma de Hodgkin (LH) el valor predictivo negativo de la PET-FDG, después de 2-3 ciclos de quimioterapia, osciló entre el 93,4% (intervalo de confianza [IC] del 95%, 92,6-94,3) y el 100% (IC del 95%, 99,3-100%), y al finalizar el tratamiento el valor predictivo negativo de la PET-FDG osciló entre el 94,3% (IC del 95%, 92,8-95,7) y el 100% (IC del 95%, 97,1-100). En pacientes con LH y masas residuales el metaanálisis de resultados mostró una sensibilidad total del 100% (IC del 95%, 0,753-1) y una especificidad del 0,841% (IC del 95%, 0,699-0,934). La PET-FDG parece ser una herramienta útil en la valoración de la respuesta al tratamiento de pacientes con linfoma. No obstante, ha de recomendarse la realización de nuevos estudios de carácter prospectivo y que, a ser posible, sean con equipos híbridos PET-TAC para determinar su utilidad(AU)

This systematic review of literature analyze the utility of positron emission tomography (PET or PET-CT) with 18F-fluorodeoxyglucose, as a diagnostic tool in the assessment of response to chemotherapy and immunotherapy in lymphomas, in terms of diagnostic accuracy in prospective publications. A literature search was conducted in major databases and through manual review from the reference lists of articles that were recovered. The methodological quality of the selected items was evaluated using the QUADAS questionnaire. 9 publications were analyzed after the filtering process. The methodological quality of the same was broadly acceptable. In patients with LH, the negative predictive value of FDG-PET after 2-3 cycles of chemotherapy, was ranged between 93.4% (95% CI, 92.6-94.3) and 100% (95% CI, 99.3-100%), and after the treatment, the negative predictive value of PET-FDG, was between 94.3% (95% CI, 92.8-95.7) and 100% (95% CI, 97.1-100). In patients with residual masses and LH, the meta-analysis of results showed a sensitivity of 100% (95% CI, 0.753-1) and a specificity of 84% (95% CI, 0.699-0.934). PET-FDG seems to be a useful tool to evaluate the response to treatment of patients with lymphoma. However, it recommended further prospective studies and that possibly conducted in hybrid PET-CT scans, to determine its usefulness(AU)

[An economic assessment of genetic testing for familial adenomatous polyposis]. / Evaluación económica de la prueba genética de la poliposis adenomatosa familiar.

OBJECTIVE: To analyze the cost-effectiveness of genetic testing for first-degree relatives of patients with colon cancer to identify mutations in the APC gene (Adenomatous Polyposis Coli). METHODOLOGY: Analyses were performed from the perspective of the health system. We used a Markov model. We compared genetic testing for the APC gene, the cause of familial adenomatous polyposis (FAP), which results in colon cancer, versus no genetic testing for said gene. The effectiveness measure used was quality-adjusted life-years (QALYs), and costs were measured in euros for 2005. The costs of interventions were extracted from the costs of health services provided by centers under the Andalusian Public Health System, and other parameters were obtained from the literature. RESULTS: The performance of genetic testing is the dominant strategy when compared to the absence of genetic testing given the latter option has an incremental cost of 7,676.34 euros and is less effective. A sensitivity analysis found that genetic testing remains the dominant strategy for a plausible range of costs of the test itself, and for the probability of developing adenocarcinoma. CONCLUSIONS: Our analysis showed that in this patient group genetic testing to detect APC gene mutations is on average less costly and improves QALYs versus no testing.

Evaluación económica de la prueba genética de la poliposis adenomatosa familiar / No disponible

Objetivo: analizar el coste-utilidad de la prueba genética a familiaresde primer grado de pacientes con cáncer de colon para determinarmutaciones del gen APC (Adenomatous Polyposis Coli).Metodología: los análisis se realizaron desde el punto de vistadel sistema sanitario. Se utilizó un modelo de Markov. Realizaciónde la prueba genética para el gen APC, causante de la poliposisadenomatosa familiar (PAF), que produce cáncer de colon frentea la no realización de la misma. La medida de efectividad utilizadafueron los años de vida ajustados por calidad (AVAC) y la unidadde coste los euros de 2005. Los costes de las intervenciones fueronextraídos de los precios públicos de los servicios sanitariosprestados por centros dependientes del Sistema Sanitario PúblicoAndaluz y los valores de la efectividad y de utilidad de la literatura.Resultados: la realización de la prueba genética se muestracomo una estrategia dominante a la no realización de la misma,ya que esta última tiene un coste incremental de 7.676,34 €, ademásde una menor efectividad. Los análisis de sensibilidad mostraronque la realización de la prueba genética se mantiene como laestrategia dominante dentro de un amplio rango de coste de laprueba y de probabilidad de desarrollar adenocarcinomas.Conclusiones: los análisis mostraron que, para este grupo depacientes, la realización de la prueba genética para la detecciónde la mutación del gen APC es en promedio menos costosa yademás produce una mejora en AVAC comparado con la no realizaciónde la misma

Objective: to analyze the cost-effectiveness of genetic testingfor first-degree relatives of patients with colon cancer to identifymutations in the APC gene (Adenomatous Polyposis Coli).Methodology: analyses were performed from the perspectiveof the health system. We used a Markov model. We comparedgenetic testing for the APC gene, the cause of familialadenomatous polyposis (FAP), which results in colon cancer,versus no genetic testing for said gene. The effectiveness measureused was quality-adjusted life-years (QALYs), and costswere measured in euros for 2005. The costs of interventionswere extracted from the costs of health services provided bycenters under the Andalusian Public Health System, and otherparameters were obtained from the literature.Results: the performance of genetic testing is the dominantstrategy when compared to the absence of genetic testing giventhe latter option has an incremental cost of € 7,676.34 and is lesseffective. A sensitivity analysis found that genetic testing remainsthe dominant strategy for a plausible range of costs of the test itself,and for the probability of developing adenocarcinoma.Conclusions: our analysis showed that in this patient groupgenetic testing to detect APC gene mutations is on average lesscostly and improves QALYs versus no testing

Comparación de costes y supervivencia en pacientes intervenidos quirúrgicamente de cáncer colorrectal según diferentes modelos organizativos / A comparison of costs and survival in colorrectal cancer patients undergoing surgery according to different organizational models

Objetivo: determinar la efectividad y los costes de los diferentesmodelos organizativos en la atención a los pacientes con cáncercolorrectal, ya sea a través de las unidades funcionales de gestiónclínica o servicios clínicos tradicionales.Método: se analizó la mortalidad postoperatoria y a largo plazo(30 días y 5 años) en función del número de pacientes sometidosa tratamiento quirúrgico en el hospital para su cáncer colorrectal,ajustado por factores confundentes a nivel de pacientes.Para ello se realizó una revisión exhaustiva de la literatura y con lainformación obtenida se realizó un meta-análisis de efectos aleatorios.En cuanto a los costes se realizó una búsqueda bibliográficapara describir las diferencias entre los hospitales según el númerode pacientes atendidos al año.Resultados: se encontró que aquellas intervenciones realizadasen hospitales de gran volumen mostraban un menor coste porintervención y una menor media en días de estancia hospitalaria.El meta-análisis mostró que el riesgo de morir a los 30 días y5 años en los hospitales de alto volumen es menor que aquelloscon bajo volumen (OR: 1,112; IC95% 0,986-1,255 y OR:1,114; IC95% 1,105-1,183 respectivamente).Conclusiones: la mortalidad postoperatoria a corto y largoplazo es menor en hospitales con alto volumen de casos al año

Objective: to determine the effectiveness and costs of differentorganizational models in caring for colorectal cancer patientsthrough either clinical management functional units or traditionalclinical services.Method: post-operative and long-term (after 30 days and5 years) mortality was analyzed according to number of patientsundergoing surgery because of colorectal cancer. Mortality wasadjusted for patient-related confounding factors. With that purposea thorough review of the literature was conducted; informationobtained was used in a meta-analysis of randomiszd effects. Concerningcosts, a literature search was run to describe differences innumber of patients per year between hospitals.Results: surgery costs were found to be smaller, and meanhospital stay shorter, in big-sized hospitals. The meta-analysisshowed that the risk of death at 30 days and 5 years was lower inbig hospitals versus smaller ones (OR: 1.112; 95% CI 0.986-1.255, and OR: 1.114; 95% CI 1.105-1.183, respectively).Conclusions: short- and long-term postoperative mortality islower in hospitals with a high number of cases per year

La teoría sistémica. Su aproximación al profesional de Cuidados Paliativos y su familia / No disponible

Objetivo: la atención familiar utiliza elementos de la terapia familiar sistémica para realizar intervenciones familiares sencillas en la asistencia sanitaria. Aporta instrumentos útiles para atender a las familias en Cuidados Paliativos (CP), y comprender y cuidar mejor a las nuestras. El objetivo del trabajo es conocer el modelo de atención familiar desde la teoría sistémica, valorar su utilidad en cuidados paliativos, y en el cuidado de las familias de los profesionales. Material y métodos: revisamos bibliografía sobre la teoría familiar sistémica para resumir sus contenidos fundamentales. Realizamos una revisión exhaustiva, no sistemática sobre «La familia del profesional», de la cual seleccionamos dos artículos que nos orientan hacia algunas repercusiones del trabajo en cuidados paliativos sobre el sistema familiar del profesional. Resultados: la revisión de la teoría sistémica nos recuerda que la familia es un sistema constituido por elementos que interactúan entre sí, se organizan en subsistemas y se relacionan con su entorno. La familia y sus elementos cumplen unas funciones, que van cambiando dinámicamente en las fases del ciclo vital familiar. A veces se generan crisis de desarrollo en los cambios de fase. La revisión sobre la familia del profesional nos apunta posibles repercusiones del trabajo en CP sobre nuestras familias, debidas a búsqueda de apoyo emocional en la pareja como mecanismo de afrontamiento, dedicación profesional fuera del horario laboral, dedicación profesional camuflada, cansancio por guardias y turnos, guardias localizadas, etc. Conclusiones: el conocimiento del modelo de atención familiar facilita el abordaje integral en CP, y permite, junto con la revisión sobre el profesional y su familia, plantear algunas preguntas que nos ayuden a reflexionar sobre cómo cuidar a nuestras familias (AU)

Objective: to understand the family care model in systemic theory, useful in palliative care and for the caring of our own families. Family care employs Systemic Family Therapy elements to perform uncomplicated family interventions. It provides useful instruments to assist the family of patients in palliative care (PC), and to better understand and care for ours. Material and methods: we perform a review of systemic family theory and summarize its main topics. We make a non-systematic review of «PC professional family», and select two articles about PC work repercussion son the families of practitioners. Results: this family care review reminds us that the family is a system that consists of elements that interact together, who organize themselves in sub-systems, and have relations with the environment. Both family and elements keep some functions that change along a family's life cycle. Sometimes growth crises occur, typically during change between two phases. Article reviews point to some possible familiar repercussions of palliative care work, including the search for emotional support in partners as a coping mechanism, professional dedication out of hours, fatigue from night duties and turns, duty on call, etc. Conclusions: learning this family care model improves palliative care, and raises some issues regarding the caring for our own families (AU)

[Applications of proteomic techniques in clinical practice: present situation and perspectives]. / Aplicaciones de las técnicas proteómicas en medicina asistencial: situación actual y perspectivas.

Study of the human proteome has given rise to the appearance of abundant and increasing scientific literature. This has resulted in the proposal to use proteomic techniques in the management of some diseases and the suggestion of its future use in clinical laboratories. In order to identify which proteomic techniques are being used or may be used in the near future in the clinical practice, a survey was made to experts in proteomics and the bibliometric study was done. Concordance between this study and a survey was observed. However, in general, standardized uses of proteomic techniques in the current clinical practice were not found. In regards to possible applications in the short-middle term, the experts have different opinions, from those who mention specific techniques (coinciding with the most repeated aspects of the bibliometric study) to those who think that its use in a near future is unlikely.

Aplicaciones de las técnicas proteómicas en medicina asistencial: situación actual y perspectivas / Applications of proteomic techniques in clinical practice: present situation and perspectives

El estudio del proteoma humano ha dado lugar a la aparición de abundante y creciente literatura, llegándose a plantear el uso de técnicas proteómicas en el manejo de algunas enfermedades y sugiriéndose su futura utilización en laboratorios clínicos. A fin de identificar técnicas proteómicas en uso o de previsible uso próximo en medicina asistencial, se realizó una encuesta a expertos en el ámbito de la proteómica y un estudio bibliométrico. Se observó concordancia entre dicho estudio y la encuesta: no se hallaron, en general, usos estandarizados de la proteómica en medicina asistencial. En cuanto a posibles aplicaciones a corto-medio plazo hay diversidad de pareceres entre expertos, desde los que citan técnicas concretas (coincidentes con los aspectos más iterativos del estudio bibliométrico), hasta los que piensan que es poco probable que se usen en un futuro cercano (AU)

Study of the human proteome has given rise to the appearance of abundant and increasing scientific literature. This has resulted in the proposal to use proteomic techniques in the management of some diseases and the suggestion of its future use in clinical laboratories. In order to identify which proteomic techniques are being used or may be used in the near future in the clinical practice, a survey was made to experts in proteomics and the bibliometric study was done. Concordance between this study and a survey was observed. However, in general, standardized uses of proteomic techniques in the current clinical practice were not found. In regards to possible applications in the short-middle term, the experts have different opinions, from those who mention specific techniques (coinciding with the most repeated aspects of the bibliometric study) to those who think that its use in a near future is unlikely (AU)

[A comparison of costs and survival in colorectal cancer patients undergoing surgery according to different organizational models]. / Comparación de costes y supervivencia en pacientes intervenidos quirúrgicamente de cáncer colorrectal según diferentes modelos organizativos.

OBJECTIVE: To determine the effectiveness and costs of different organizational models in caring for colorectal cancer patients through either clinical management functional units or traditional clinical services. METHOD: Post-operative and long-term (after 30 days and 5 years) mortality was analyzed according to number of patients undergoing surgery because of colorectal cancer. Mortality was adjusted for patient-related confounding factors. With that purpose a thorough review of the literature was conducted; information obtained was used in a meta-analysis of randomized effects. Concerning costs, a literature search was run to describe differences in number of patients per year between hospitals. RESULTS: Surgery costs were found to be smaller, and mean hospital stay shorter, in big-sized hospitals. The meta-analysis showed that the risk of death at 30 days and 5 years was lower in big hospitals versus smaller ones (OR: 1.112; 95% CI 0.986-1.255, and OR: 1.114; 95% CI 1.105-1.183, respectively). CONCLUSIONS: Short- and long-term postoperative mortality is lower in hospitals with a high number of cases per year.

El trabajo en Cuidados Paliativos, ¿repercute en nuestras familias? / No disponible

Objetivos: conocer posibles repercusiones del trabajo en Cuidados Paliativos sobre nuestras propias familias, debidas a búsqueda de apoyo emocional en la pareja como mecanismo de afrontamiento, dedicación profesional fuera del horario laboral, dedicación profesional camuflada, cansancio por guardias y turnos, guardias localizadas, etc. Reflexionar sobre estos aspectos y sobre cómo la formación en Atención Familiar (AF) puede ayudarnos a trabajar mejor y cuidar a nuestras familias. Material y métodos: realizamos una encuesta a todos los alumnos de un curso avanzado de CP y a los médicos y enfermeras de los equipos de CP de una ciudad, así como a sus parejas o representantes familiares. Resultados: las dudas en las preguntas sobre el Ciclo Vital Familiar indican que conocemos poco los instrumentos de la atención familiar sistémica. Las respuestas indican que dedicamos al trabajo, investigación, docencia y estudio, más horas de las que creemos, y nuestras parejas lo toleran bien. Conclusiones: a veces llevamos el rol profesional a la vida familiar, dedicando tiempo extra a nuestros pacientes y a los problemas de salud de nuestra red social. A menudo compartimos con la pareja el impacto emocional de nuestra profesión. Nuestras parejas dicen que todo eso no genera malestar ni interfiere en nuestras funciones familiares. ¿Será que nos quieren mucho? Tal vez lo estemos haciendo bien en casa, e incluso podamos mejorarlo (AU)

Objectives: To gain insight on the potential familial repercussions ofPC work: search for emotional support in partner as coping mechanism, professional dedication out of hours, camouflaged professional dedication, tiring about night duties and turns, duty on call, etc. To reflect upon these topics, and on how Familial Care training can help us work better and still care for our own families. Methods: We passed a questionnaire to all pupils in an advanced PC course, to all nurses and doctors working in PC in a specific town, and to their partners or equivalent family representatives. Results: Uncertain answers to Family Vital Cycle questions suggest that our knowledge of family care instruments is insufficient. These answers indicate we spend more hours than expected in working, investigating, and learning, and that our partners tolerate it. Conclusions: Sometimes we take our professional role home, devoting extra time to our patients and health problems in our social network. We share our professional emotional burden with our spouses and partners, yet they state that all this does not disturb or interfere with our family functions. Maybe they love us too much. Perhaps we are doing well at home, and surely can do even better (AU)

Rehabilitación respiratoria: aproximación a la situación en España / Respiratory rehabilitation: situation in Spain

Objetivo. Estimar la implantación y la coberturade los programas de rehabilitación respiratoria en el sistemasanitario público español, describir las características delos programas existentes y explorar las barreras para la ampliaciónde su implantación.Métodos. Se realizó una entrevista semiestructurada, caraa cara, a seis informadores clave, elegidos por destacar comoinvestigadores en el campo de la rehabilitación respiratoria ocomo representantes de las sociedades científicas, siendoclínicos al mismo tiempo.Resultados. Los informadores clave están de acuerdo enque la rehabilitación respiratoria entendida como fisioterapiarespiratoria está bien difundida por los hospitales de primernivel y que se dirige principalmente a pacientes con enfermedadpulmonar obstructiva crónica (EPOC). Sin embargo,sólo una minoría de centros públicos incluye en el programade rehabilitación el entrenamiento al esfuerzo, que es el componentede beneficio mejor demostrado y la rehabilitaciónrespiratoria sólo llega a una pequeña proporción de los pacientesque la necesitan. La enseñanza de técnicas de relajacióny el apoyo para dejar de fumar no son constantes.Conclusiones. Actualmente, la atención al paciente conEPOC, con una correcta rehabilitación respiratoria, está lejosde quedar garantizada en el sistema sanitario público español

Objective. To consider the implantation andthe cover of the programs of respiratory rehabilitation in theSpanish Health System; to describe the characteristics ofthe existing programs and to explore the barriers for theextension them. Methods. Semistructured interview, to six key informants,chosen by prestige criteria in the field of the respiratory rehabilitationresearch or by the scientific societies, being clinicalat the same time.Results. The informants agree in which the respiratory fisiotherapyas a component of RR programs is extended bythe first level hospitals and that mainly goes to patients withchronic obstructive pulmonary disease (COPD). Nevertheless,the exercise training, the more effective intervention, isinclude in only a minority of public centers (hospitals) withrehabilitation program, and only a small proportion of the patientswho need RR are provided. The relax techniques andthe smoking cessation support are not always included.Conclusions. At the moment, the attention to the patientwith COPD with a correct respiratory rehabilitation is farfrom being guaranteed in the Spanish Health System