Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo / Description and study of risk factors for the diagnostic delay of pediatric inflammatory bowel disease

INTRODUCCIÓN: El retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. PACIENTES Y MÉTODOS: Un total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. RESULTADOS: El tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. CONCLUSIONES: Aunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico

INTRODUCTION: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. PATIENTS AND METHODS: A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis. RESULTS: The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children. CONCLUSIONS: Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out

[Description and study of risk factors for the diagnostic delay of pediatric inflammatory bowel disease]. / Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo.

INTRODUCTION: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. PATIENTS AND METHODS: A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis. RESULTS: The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children. CONCLUSIONS: Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out.

[Survey on the needs expressed by primary care doctors for continuing education in drug therapy]. / Encuesta sobre las necesidades sentidas por médicos de atención primaria sobre la formación continuada en terapéutica farmacológica.

OBJECTIVE: To describe the aspects of continuing education in pharmacological therapeutics considered as most relevant by the primary health care physicians. DESIGN: Observational study.Setting. Physicians filled-up the questionnaires during 45 minutes at their primary health care centres. PARTICIPANTS: Primary health care physicians involved in the Fundation Institut Català de Farmacologia continuing education activities since 1997 were selected. MAIN MEASUREMENTS: A specific questionnaire was designed to collect the physicians' opinion on different topics regarding continuing education in pharmacological therapeutics. RESULTS: 180 physicians from 21 primary health care centres answered the questionnaire. 68% of the responding physicians considered that continuing education has to be useful to improve routine clinical practice. Regular seminars and methods stimulating active participation administered by primary health care professionels are preferred. Continuing education in pharmacological therapeutics should be focused to health problems rather than being drug-oriented. They referred being more interested in drug selection issues and in the role of new drug in comparison with the existing alternatives rather than in regulation and drug consumption issues. 66,3% of the responding physicians considered that continuing education in pharmacological therapeutics should be compulsory. Public health authorities and primary health care physicians should share the responsibility in setting-up continuing education in pharmacological therapeutics programs, according to the opinion of almost 70% of the physicians. CONCLUSIONS: Primary health care physicians are interested in continuing education in pharmacological therapeutics as far as it is practical and useful to solve problems of their routine clinical practice.

Encuesta sobre las necesidades sentidas por médicos de atención primaria sobre la formación continuada en terapéutica farmacológica / Survey on the needs expressed by primary care doctors for continuing education in drug therapy

Objetivo. Describir qué aspectos de la formación en terapéutica farmacológica consideran los médicos de atención primaria como más necesarios. Diseño. Estudio observacional. Emplazamiento. Los médicos fueron citados en su centro para contestar las encuestas. Participantes. Participaron médicos de centros de atención primaria a los que habitualmente la Fundación Institut Catalá de Farmacología dirige su programa de formación. Mediciones principales. Se elaboró un cuestionario, diseñado específicamente para recoger la opinión de los médicos sobre la formación continuada en terapéutica farmacológica. Resultados. La encuesta fue realizada en 21 centros de atención primaria de Barcelona. Respondieron a la encuesta 180 médicos. El 68 por ciento de médicos considera que la formación continuada ha de ser útil para mejorar su práctica clínica habitual. Prefieren realizar seminarios periódicos, métodos docentes participativos y consideran que las personas que han de impartir habitualmente la formación han de ser cercanas a la atención primaria. Prefieren una formación dirigida al abordaje terapéutico de los problemas de salud. Con respecto a la información sobre medicamentos, están más interesados en la selección de los mismos y su lugar terapéutico que en temas de regulación o consumo farmacológico. El 66,3 por ciento de los encuestados considera que la formación continuada debería ser obligatoria. Casi un 70 por ciento considera que la responsabilidad en la elaboración de los programas de formación debería ser compartida por las instituciones sanitarias y los propios profesionales. Conclusiones. Los médicos de atención primaria están interesados en una formación continuada sobre terapéutica farmacológica de carácter práctico, que dé respuestas a las cuestiones que se le plantean en su actividad clínica habitual (AU)

The impact of advances in radiologic biliary imaging on the diagnosis of obstructive jaundice. Comparative analysis of two groups of patients hospitalized at a 5-year interval.

The study evaluates the impact of advances in biliary imaging techniques on the accuracy and rapidity of diagnosis in patients with obstructive jaundice. Two series of patients hospitalized at an interval of 5 years in the same clinic were prospectively analyzed. In both series, the results of ultrasonography (US) and percutaneous transhepatic cholangiography (PTC) were compared with the intraoperative findings. The performances of US in the assessment of ductal dilatation and choledocholithiasis significantly improved during this period. The fine-needle biopsies taken from the solid masses in liver or pancreatic parenchyma under US guidance in the second series of patients contributed to the greater proportion of correct preoperative diagnoses in this group. The number of PTC investigations increased in the second group (p less than 0.001) given the clinicians' confidence in the safety and easy performance of this method. Using both methods, the etiology of biliary obstruction was correctly diagnosed preoperatively in 85.2 per cent of the second series of patients, significantly more frequently than in the first series of patients (62.7 per cent) (p less than 0.05). The mean period in hospital necessary for the diagnosis decreased during the period analyzed from 15.4 +/- 10.8 days to 10.2 +/- 7.8 days (p less than 0.05), a fact with direct impact on the course of disease, and also on the hospital costs.

The effect of cimetidine and ranitidine on serum high density lipoprotein subfractions.

Of the two major subfractions of high density lipoprotein (HDL), HDL2 cholesterol (HDL2-C) and not HDL3 cholesterol (HDL3-C) correlates negatively with coronary heart disease. To study the effect of cimetidine and ranitidine on HDL subfractions, 6 healthy males received cimetidine (600 mg bid) ranitidine (150 mg bid) and placebo (one tab bid) for 1 week each, in random order. Measurements of HDL cholesterol (HDL-C), HDL2-C, HDL3-C were made on day 7 of each week. Comparing cimetidine with placebo, HDL2-C/HDL-C, HDL2-C/total cholesterol and HDL2-C/HDL3-C increased significantly while HDL3-C/HDL-C decreased. There was no difference in HDL-C parameters between ranitidine and placebo. Cimetidine treatment results in redistribution of HDL subfractions in favour of HDL2. The mechanism is not H2-receptor antagonism as ranitidine had no such effect.