Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos / Differences in the CKD-EPI equation with MDRD for the estimation of glomerular filtration in hypertensive patients

Objetivo: Analizar las concordancias en el filtrado glomerular(FG) estimado con las ecuaciones de CKD-EPI y MDRDIDMS en una cohorte de pacientes hipertensos. Métodos: Se incluyeron 478 hipertensos consecutivamente, edad media57,58 años (DE = 12,34), el 68,3% hombres. La estimación del FG se realizó con las ecuaciones de MDRD-IDMS y CKD-EPI, valorando las concordancias entre ellas. Resultados: La estimación de FG con CKD-EPI fue 4,37 ml/min/1,73 m2 (IC 95%, 3,73-4,19) superior al MDRD-IDMS en global y por sexos (hombres3,99; mujeres 5,04). En menores de 65 años la diferencia fue mayor, 6,55 ml/min/1,73 m2 (IC 95%, 5,95-7,15), tanto en hombres(6,07) como en mujeres (6,48). Sin embargo, en mayores de 65 años no se encontró diferencia significativa. El coeficiente de correlación intraclase fue 0,904 (IC 95%, 0,886-0,919), en hombres 0,897 y en mujeres 0,917, y el índice kappa fue 0,848(IC 95%, 0,795-0,889), en hombres 0,845 y en mujeres 0,852.Conclusión: La ecuación de CKD-EPI estima un FG más alto en mayores de 65 años y reclasifica hacia estadio 1 a hipertensos catalogados en estadio 2 por MDRD-IDMS (AU)

Objective: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. Methods: We included consecutively 478 hypertensive patients, 57.58 (SD: 12.34)aged, 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. Results: The estimation of GFR with CKD-EPI was 4.37 (95%:3,73-4,19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females5.04). In patients under 65 years the difference was greater,6.55 (95%: 5,95-7,15) ml/min/1,73 m2 in both men 6.07 and women6.48. However, in over 65 years we found no significant difference. Intraclass correlation coefficient was 0.904 (95%CI:0,886-0,919), 0.897 men and 0.917 women and Kappa index0.848 (95% CI: 0.795-0.889), 0.845 men and 0.852 women. Conclusion: CKD-EPI equation estimated a higher FG in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS (AU)

La prevención de las lesiones de tráfico por los médicos de familia: algunas reflexiones sobre la situación actual / Traffic injury prevention by family doctors: some reflections on the current situation

No disponible

[Tackling tobacco dependency among a Health District's employees]. / Abordaje del tabaquismo entre los trabajadores de un distrito sanitario.

OBJECTIVE: To find the view of health and ancillary staff about tobacco consumption in Health Centres, smokers' profiles, and their degree of motivation to give up. DESIGN: Observational and crossover study.Setting. Primary Care district in the city of Barcelona (Eixample District). PARTICIPANTS: All the health and ancillary staff in the District (n=932). MEASUREMENTS: Personal questionnaire with anonymous reply on: personal details, tobacco habit, view on the function of example, compliance with regulations in force, and their attitude to tobacco in the work-place. MAIN RESULTS: 52% replied; 68.4% were women, with average age 46.9 (SD 9.9). 26.5% smoked; 43.8% had never smoked and 29.6% were ex-smokers. 87.5% thought example an important function; 68.1%, that prohibition signs were insufficient; 72.8%, that legal regulations were not complied with; 77.2% thought space should be reserved for smokers; and 61.2% were annoyed that there was smoking in the centre. 63.9% of the health staff counselled smoker patients as a matter of course. There was greater prevalence of smokers among clerical staff, nurses and the "others" group. Smokers consumed 16.6 cigarettes per day (SD 9.5), had been smoking for 23.2 years (SD 9.6). 54.3% had tried at least once to give it up. 59.1% had high dependency and 76.7% had high motivation. 64.8% would participate in activities to stop smoking and 72.4% thought that their employers should provide assistance. CONCLUSIONS: Those surveyed thought that example was an important function, signs were insufficient and the regulations in force were not respected. Half the smokers would be interested in taking part in activities to help them give up and think the company should help them.

Abordaje del tabaquismo entre los trabajadores de un distrito sanitario / Tackling tobacco dependency among a health district's employees

Objetivo. Conocer la opinión del personal sanitario y no sanitario acerca del consumo de tabaco en los centros sanitarios, el perfil de los fumadores y su grado de motivación para el abandono. Diseño. Estudio observacional, transversal. Emplazamiento. Distrito de Atención Primaria de Barcelona ciudad (DAP Eixample).Participantes. Todos los profesionales sanitarios y no sanitarios del DAP (n = 932).Mediciones. Encuesta personalizada de respuesta anónima, sobre: datos personales, hábito tabáquico, opinión sobre función modélica, cumplimiento de la normativa vigente y actitud respecto al tabaco en el ámbito laboral. Resultados principales. Respondió un 52 por ciento; mujeres, 68,4 por ciento; edad media, 46,9 años (DE, 9,9); fumadores, 26,5 por ciento; no fumadores, 43,8 por ciento, y ex fumadores, 29,6 por ciento. Consideran importante la función modélica, 87,5 por ciento; prohibición insuficientemente señalizada, 68,1 por ciento; incumplimiento de la normativa legal, 72,8 por ciento; reservar espacios para fumadores, 77,2 por ciento, y molesta que se fume en el centro, 61,2 por ciento. Un 63,9 por ciento de los sanitarios aconseja habitualmente a los pacientes fumadores. Hay mayor prevalencia de fumadores entre los administrativos/as, enfermeros/as y el colectivo 'otros'. Los fumadores consumen 16,6 cigarrillos/día (DE, 9,5), hace 23,2 años (DE, 9,6) que fuman y el 54,3 por ciento ha hecho al menos un intento para dejarlo. Tiene dependencia alta un 59,1 por ciento y motivación elevada el 76,7 por ciento. Un 64,8 por ciento participaría en actividades para dejar de fumar y el 72,4 por ciento considera que la empresa debería facilitar ayuda. Conclusiones. Los encuestados consideran importante la función modélica, insuficiente la señalización y que se incumple la normativa vigente. La mitad de los fumadores estaría interesada en participar en actividades para abandonar el hábito y opinan que la empresa les debería ayudar (AU)

Diseño de un método para la evaluación de la competencia clínica en atención primaria / Design of a method to evaluate clinical competence in primary care

Objetivo. Medir la competencia clínica en atención primaria (AP). Diseño. Estudio descriptivo, transversal. Emplazamiento. Seis equipos de AP de Barcelona. Participantes. Veinticinco médicos de familia voluntarios, de un total de 60. Mediciones y resultados principales. Se realizaron 3 visitas simuladas en 3 días diferentes, asignadas de forma aleatoria en la cita previa, relacionadas con la hipertensión arterial. Se midió la competencia clínica según los criterios de Miller, mediante un método que combina entrevista clínica con pacientes estandarizados (PE), auditoría de historias clínicas (HC) y autoevaluación del médico (AM) con preguntas abiertas de respuesta corta. Se evaluaron los siguientes componentes competenciales (CC): anamnesis, exploración física, exploraciones complementarias, diagnóstico diferencial, manejo, historia clínica y comunicación. Completaron el estudio 22 médicos. El peso de cada uno de los CC fue ponderado por un grupo de expertos, que consensuaron también dos niveles mínimos de competencia, el 50 y el 60 por ciento. La puntuación final de cada médico resulta del sumatorio de cada uno de los 3 casos, dividido por la puntuación máxima posible. Los valores obtenidos de los CC son siempre superiores con el método de los PE respecto a los otros métodos. Un 63,3 por ciento de los médicos superó el estándar 60, y el 90,9 por ciento el 50. La consistencia interna, medida con el test de alfa de Cronbach, es para cada uno de los casos clínicos de 0,94, 0,73 y 0,67, respectivamente. El test de kappa para la reproductividad es de 0,25. Conclusiones. La utilización del PE es un buen método para evaluar, al permitirnos valorar la anamnesis, el manejo del paciente, la exploración física y la comunicación. El estudio ofrece una elevada fiabilidad, con una reproductividad baja, que probablemente se deba a los pocos casos utilizados (AU)

[Design of a method for the evaluation of clinical competence in primary care]. / Diseño de un método para la evaluación de la competencia clínica en atención primaria.

OBJECTIVE: To measure clinical competence in primary care (PC). DESIGN: Descriptive cross-sectional study. SETTING: Six PC teams in Barcelona. PARTICIPANTS: 25 family doctors volunteering out of a total of 60. MEASUREMENTS AND MAIN RESULTS: Three simulated visits took place on three different days, allocated at random as a prior appointment for hypertension. Clinical competence was measured through the Miller criteria, a method with open short-reply questions combining the clinical interview with standardised patients (SP), review of clinical histories (CH) and doctor's self-evaluation (DS). The following components of competence (CC) were evaluated: anamnesis, physical examination, further tests, differential diagnosis, management, clinical history and communication. 22 doctors completed the study. Each CC was weighted by a group of experts, who also agreed two minimum levels of competence, 50% and 60%. Each doctor's final score was the result of the addition of each of the three cases divided by the maximum score possible. The CC values were always higher with SP than otherwise. 63.3% of doctors surpassed the 60% mark, and 90.9% the 50% mark. Internal consistency, measured with Cronbach's alpha, was 0.94, 0.73 and 0.67 for each clinical case. The kappa reproduction test was 0.25. CONCLUSIONS: The use of SP is a good method of evaluation, as it enables anamnesis, management of the patient, physical examination and communication to be assessed. The study is very reliable, with low reproduction, which is probably due to the few cases used.

[Mid-term evaluation of a help program for smokers]. / Evaluación a medio plazo de un programa de ayuda a los fumadores.

BACKGROUND: Medical counsel to smokers is an intervention that has proved useful to motivate smokers to stop smoking. This study pretends evaluate the long-term impact (2 years and 9 months) of systematic and structured health counsel on the smoke habit from the primary health care. MATERIAL AND METHODS: In April 1990, in four primary care centers from Barcelona and Zaragoza, Spain, a program of systematic counselling to stop smoking with an offer of subsequent follow-up was initiated in all adult smokers (15-65 years of age). According to the answer, every patient was classified on one of seven established categories that allowed a individualized follow-up. Data from the total population included in the program from the beginning till January 1993, are analyzed. RESULTS: From 683 known smokers (59.2% males and 40.8% women), 20 were excluded for different reasons and 343 were included in the program (56.4% cover). Average age of included smokers was 35.1 years (SE = 0.6) and average number of visits of 5.3 (SE = 0.2) which was significantly higher than those not included in the program (33.4; SE = 0.6, and 2.7; SE = 0.1). An average follow-up of 14.3 months (SE = 0.5) and of 2.6 (SE = 0.1) interventions on each individual were done. The average daily number of cigarettes was 18.4 (SE = 0.6) in the initial period and 13.3 (SE = 0.6) on the last program evaluation. The final answers showed a 18.1% of quitters and a decrease of more than 50% on the initial consume on 32.6%. In 12% the answer was negative. CONCLUSIONS: Programs of systematic help for smokers show a higher level of favourable responses than does normal counselling.

[The annual evaluation of a program to aid the smoker]. / Evaluación anual de un programa de ayuda al fumador.

OBJECTIVE: To evaluate the impact over a year of a systematic, structured intervention with smokers, called the Smokers' Aid Project (SAP), at a primary care centre in Barcelona. DESIGN: Observational study with a descriptive intervention. SETTING: Urban primary care centre. PATIENTS AND OTHERS PARTICIPANTS: Between April, 1990, and March, 1991, every adult (over 15) who smoked more than one cigarette a day was counselled verbally and/or in writing. The different replies were placed into eight groups and a personal follow-up was made for each category. The groups were: winner, reduction, alone, with help, doubtful, backslider, negative and pending. MEASUREMENTS AND MAIN RESULTS: There was a follow-up on 178 people. Among those monitored, the initial cigarette average was 15.0 (SD 11.4) and the final, 12.45 (SD 11.45). The response was favorable (winner or reduction) in 35.4%, with 10.6% showing a favorable attitude (alone and with help) and 16.3% showing a negative response. A follow-up programme of 7.5 months (SD 3.5) was implemented, with an average of 1.82 (SD 1.05) interventions for each individual. CONCLUSIONS: Programmes of systematic help to the smoker appear to provide more favorable responses than isolated counselling. The SAP can be put into practice within our Primary Care system, although effectiveness will have to be assessed over longer-term follow-ups.

[Effectiveness of the physician's advice to quit smoking: evaluation of the impact a year after the fact]. / Efectividad del consejo médico para dejar de fumar: evaluación del impacto al año de la intervención.

The results of a physician-based intervention on smoking done by general practitioners in Barcelona (Spain) are described one month and one year after its inception. Among the 208 smokers in the intervention group there were more attempts to quit, and they were more successful than in the 216 smokers in the control group. The proportions of quitters after a year was 5.3% and 2.3% in each group (p less than 0.05). Among the variables related to success in quitting are self-reliance, the willingness to reduce or quit smoking, the intensity of the habit and the family environment.