RESUMO
El objetivo de este estudio ha sido conocer la opinión de los internistas sobre el manejo de la anticoagulación y profilaxis tromboembólica en escenarios clínicos complejos en los que el balance riesgo/beneficio de la intervención es estrecho y elaborar un documento de consenso sobre el uso de fármacos anticoagulantes en este grupo de pacientes. Para ello, se identificaron por consenso las áreas clínicas de mayor incertidumbre, se elaboró una encuesta con 20 escenarios desplegados en 40 preguntas clínicas y se realizó una revisión bibliográfica específica. La encuesta se distribuyó entre los internistas de la Sociedad Española de Medicina Interna (SEMI) y fue cumplimentada por 290 de sus miembros. El proceso de consenso se desarrolló mediante una modificación del método Delphi-RAND de adecuación en un proceso anonimizado de doble ronda que permite al panel de expertos identificar áreas de acuerdo y de incertidumbre. En nuestro caso, además, se incorporaron al panel los resultados de la encuesta, innovación metodológica que permite aportar información adicional de la práctica clínica habitual. El resultado del proceso es un conjunto de 19 recomendaciones formuladas por expertos de la SEMI que permite establecer pautas de actuación sobre el tratamiento anticoagulante en escenarios complejos (alto riesgo o hemorragia activa, corta expectativa vital, coexistencia de tratamiento antiagregante o comorbilidades como enfermedad renal, hepática, etc.), que no son infrecuentes en la práctica clínica habitual
The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice
Assuntos
Humanos , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Tromboembolia Venosa/prevenção & controle , Fatores de Risco , Medicina Interna/organização & administração , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Assistência Ambulatorial/métodosRESUMO
The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice.
RESUMO
Objetivos. El objetivo del presente trabajo es analizar el peso que los escolares entre 8 y 12 años transportan en sus mochilas, y si éste está en relación con la distribución de la jornada diaria escolar. Se pretende también conocer las preferencias de los escolares a la hora de transportar el material escolar. Material y método. El estudio se lleva a cabo en dos Colegios de Primaria de la ciudad de Salamanca, uno de ellos con jornada única o continua (sólo mañanas) y otro con jornadas de mañana y tarde (jornada partida). Participan en el mismo todos los alumnos de 3.º, 4.º, 5.º y 6.º curso de ambos centros. Los estudiantes fueron pesados con y sin mochilas y se les realizó una pequeña encuesta que incluía distintas preguntas abiertas sobre el tipo de mochila, la forma de trasportarla y el modo de llegar al colegio. Así mismo se realizó otra encuesta a los profesores de los distintos cursos sobre su opinión en el tema de estudio. Resultados. El número total de alumnos estudiados es 203, su edad media es de 9,77 ± 1,279 años y su peso corporal medio es de 38,8 ± 9,15 kg. El peso medio de la mochila de los escolares es 3,91 ± 2,16 kg, siendo superior en los estudiantes del colegio de jornada continuada y estableciéndose diferencias estadísticamente significativas. La relación entre el peso del niño y el peso de la mochila presenta una media de 8,91 ± 4,58 %; del total de la muestra sólo el 23 % transporta una mochila sobrecargada, si bien, este porcentaje supera el 50 % en el colegio de jornada continua, estableciéndose diferencias significativas entre los dos centros. Conclusiones. La distribución en la jornada escolar (jornada continua-jornada partida) repercute directamente en el peso de las mochilas, pudiendo este hecho ser un factor de riesgo en la patología vertebral propia de los escolares
Objectives. The main object of this work is to analyse the weight that pupils between 8 and 12 years carry on their rucksacks, and if is related to the allocation of the daily school stage. It is tried to know the pupils preferences when they carry their school equipment, as well. Material and methods. This study carry out in two Primary School in Salamanca, once with full working day (mornings only) and the other with split shift (mornings and afternoons). The students of 3.º, 4.º, 5.º, and 6.º classes of both centres take part in this study. The students were weighing with and without rucksack, and a little survey which included differents open questions about the kind of rucksack, the way of carry it and the way taht they go to the school. Another survey was doing to the teachers about their opinions to this study subject so as. Results. The whole pupils studied is 203, their ages among is 9,77 ± 1,279 years, and the average body weight is 38,8 ± 9,15 kg. The average of the rucksack weight is 3,91 ± 2,16 kg, were highter in the full day school pupils, and appear diferences statistically expressive. The relationship between the child weigh and the rucksack weigh present an average of 8,91 ± 4,58 %; of the total of the sample only the 23 % carry a heavy rucksack, althought, this percentage exceeder the 50 % in the full day school, and statistically expressive appear when we compare both centers. Conclusions. The school work allocation (full day work-split shift) directly have repercusions on the rucksack weigh,and its possible that it is a risk factor of typical spine pathology of pupils
