Modelo predictivo de pronóstico generado en pacientes con cáncer en fase avanzada / No disponible

Objetivo: a) establecer qué variables funcionales, de tratamiento y analíticas tienen capacidad pronóstica independiente en pacientes con cáncer en situación de enfermedad terminal; y b) desarrollar una ecuación logística que defina un modelo predictivo útil para un paciente con cáncer terminal. Material y método: estudio prospectivo realizado en pacientes con cáncer avanzado sin tratamiento curativo. Variable dependiente: supervivencia igual o inferior a 30 días; variables independientes: situación funcional, tratamiento, parámetros bioquímicos y hematológicos procedentes de una muestra de sangre periférica y accesibles al médico de cabecera. Análisis estadístico: descriptivo; univariable mediante t de Student y Chi cuadrado y multivariable mediante regresión logística. Paquete SPSS Windows 2000. Resultados: se incluyeron 130 evaluaciones procedentes de 73 pacientes. La edad media fue de 68.89 (DT 11,54). El 60% fueron hombres. Las neoplasias más frecuentes fueron: tubo digestivo 39,2% y pulmón 21,5%. Las variables seleccionadas por el análisis univariable fueron: urea, proteínas totales, albúmina, prealbúmina, beta-globulina, hierro, LDH, ferritina, hematocrito, hemoglobina, leucocitos, neutrófilos, linfocitos, sodio, calcio, KPS y tratamiento con corticoides. Las variables seleccionadas por el análisis multivariable fueron: urea, albúmina, hierro, LDH, leucocitos, neutrófilos, CD8, Corticoides y KPS. La sensibilidad del modelo desarrollado alcanza el 76% y una especificidad del 92%. Valor predictivo positivo de 0,82 y valor predictivo negativo de 0,87%. Conclusión: el análisis conjunto de las variables seleccionadas por el análisis de regresión logística permite generar una ecuación logística que define un modelo predictivo útil para el cálculo de la probabilidad de supervivencia menor o igual a 30 días en pacientes con cáncer en situación de enfermedad terminal (AU)

Aim: a) to know which variables from functional assessment, treatment, or blood samples have prognostic value in advanced cancer patients; and b) to develop a logistic equation able to establish prognosis in advanced cancer patients. Patients and method: a prospective study in advanced cancer patients. Dependent variable: life lasting 30 or fewer days. Independent variables: performance status, treatment, biochemical and hematological parameters from a blood sample available for general practitioners. Statistics: A descriptive analysis – a univariate analysis using Student’s t-test and chisquared test; a multivariate analysis by logistic regression. SPSS Windows 2000. Results: 130 evaluations were included from 73 patients. Main age was 68.89 (DT 11.54). 60% were males. Most frequent tumors included: digestive tract, 39.2%; and lung cancer 21.5%. Variables selected by the univariate analysis were: urea, total protein, albumin, prealbumin, betaglobulin, iron, calcium, LDH, ferritin, hematocrit, hemoglobin, total white blood cell count, neutrophils, lymphocytes, sodium corticoids, and KPS. Variables selected by the multivariate analysis were: urea, albumin, iron, LDH, total white blood cell count, neutrophils, CD8, corticoids, and KPS. The model’s sensitivity was 76%, specificity was 92%. Positive predictive value was 0.82, and negative predictive value was 0.87%. Conclusions: selected variables in the multivariate analysis allow to develop a predictive model that is useful to establish the survival probability at 30 or fewer days for every advanced cancer patient (AU)

Evaluación funcional en Cuidados Paliativos: correlación entre diferentes escalas / Functional assessment in Palliative Care: Correlation between different scales

Objetivo: conocer el grado de correlación entre cuatro escalas de evaluación funcional (índice de Karnofsky, índice del Eastern Cooperative Oncology Group -ECOG-, índice de Barthel e índice de Katz) en cuidados paliativos. Material y método: estudio prospectivo realizado a través del registro de la situación funcional medida mediante las escalas de Karnofsky, ECOG, Barthel y Katz en pacientes mayores de 18 años afectos de neoplasias sólidas en fase avanzada o terminal no subsidiarias de tratamiento curativo. Se descartaron aquellos pacientes que no otorgaron su consentimiento y los que se encontraban en situación agónica. El análisis de la correlación se realizó de manera gráfica y mediante el test no paramétrico de Spearman. Resultados: se incluyeron 172 evaluaciones procedentes de 111 pacientes. La media de edad fue de 68,7 y la relación hombre mujer fue de 67/44. Las neoplasias más frecuentes fueron las del tubo digestivo 39% seguidas de las pulmonares 21,5% Los coeficientes de correlación obtenidos fueron significativos en todos los casos: KPS-ECOG: -0,899; KPS-BARTHEL: 0,785; KPS-KATZ: 0,816; ECOG-BARTHEL: -0,811; ECOG-KATZ: -0,849; BARTHEL-KATZ: 0,947. Conclusiones: existe buena correlación entre las cuatro escalas estudiadas. Las escalas Barthel y Katz, pese a su buena correlación con KPS y ECOG, parecen aportar una información diferente sobre todo en los casos de mayor dependencia (AU)

Aim: to establish the correlation between four functional assessment scales: Karnofsky Index, ECOG Index, Barthel Index, and Katz Index. Material and method: a prospective study based on functional records using four assessment tools - KPS, Barthel, ECG, and Katz - in advanced cancer patients over 18 years of age. Patients refusing to participate, on specific treatments, or in their last days of life were excluded. The correlation index was established using Spearman's non-parametric test. Results: in all, 172 evaluations from 111 patients were included. Mean age was 68.7 years. The male-to-female ratio was: 67/44. Most frequent malignancies were from the digestive tract (39%) and lung (21.5%). All correlation coefficients were significant: KPS-ECOG: -0.899; KPS-BARTHEL: 0.785; KPS-KATZ: 0.816; ECOG-BARTHEL: -0.811; ECOG-KATZ: -0.849; BARTHEL-KATZ: 0.947. Conclusions: there is good correlation between the Karnofsky Index, ECOG Index, Barthel Index, and Katz Index as analyzed in advanced cancer patients. Barthel and Katz indices seem to provide information differing from that of KPS and ECOG in very low performance status situations (AU)

Principios éticos y legales en la práctica pericial psiquiátrica / Ethical and legal principles at the psychiatric expert practice

Se plantea un análisis ético de la práctica pericial psiquiátrica, realizando una reflexión crítica a partir de las referencias clásicas de la bioética y la deontología, aplicadas a la relación clínica convencional. Se concluye con una selección de los principios éticos que, adaptados a la especificidad de la psiquiatría forense, podrían servir de referencia para la excelencia en la práctica de esta rama de la medicina legal

An ethical analysis of psychiatric expert practice has been raised, carrying a critical thought out from classic references of bioethics and deontology, applied to conventional clinical relation. Concluding with a selection of the ethical principles which, adapted to the specifity of forensic psychiatry, could make use of reference superbly to the practice of this subspeciality of legal medicine

La doble faz de la técnica: informatización y confidencialidad en la historia clínica / The double face of technology: computerisation and the confidentiality of clinical records

No disponible

No disponible

La relación con la industria farmacéutica: una cuestión ética de alta prevalencia en medicina de familia / The relationship with the prarmaceutical industry: a very common ethical question in family medicine

No disponible

Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study.

OBJECTIVE: The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption. METHODS: A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii). RESULTS: There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level. CONCLUSIONS: Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain.

[Multicenter study on the efficacy of advice for the prevention of alcoholism in primary health care]. / Estudio multicéntrico sobre la eficacia del consejo para la prevención del alcoholismo en atención primaria (EMPA).

BACKGROUND: The aim of this study was to analyse and to verify the efficacy of systematic advice for alcoholism prevention, assessing the reduction of the number in risk drinkers. PATIENTS AND METHODS: A multicenter randomized controlled clinical trial was designed, to perform in general practitioner setting, on a sample of risk drinkers (alcohol intake > 280 g weekly, without dependence) sent by random in intervention group (systematic brief advice with support material and a five visit program during a year) and control group (once brief advice and a control in 1 year). The procedure to incorporate in both groups included physical exam, a blood test and the MALT questionnaire. A descriptive and analytic study on included variables was realised, assessing the percentage of drinkers who reduced alcohol intake below risk limit at the end of a year follow up, as well as the reduction intake in each group. RESULTS: Of the 139 included males, 75 were in the intervention group and 64 in the control group. The percentage of patients not excluded by MALT > 10, and/or liver disease, that finished the 1 year follow up, was 46%, being the sample average age of 43 +/- 11.8. Patients included in both groups were initially comparable. At the end of a year follow up there were statistically significant differences in: percentage of risk drinkers who decreased alcohol intake below 280 g weekly (82% intervention group; 47% control group); percentage of reduction in GPT, GGT, triglycerides, systolic blood pressure and the MALT questionnaire. CONCLUSIONS: The efficacy of isolated advice of general practitioner was proved to achieve the alcohol intake reduction below the risk limit accepted in male risk drinkers without alcohol dependence. The systematic follow up during a year significantly improves the results achieved with the isolated advice.