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Emergencias (Sant Vicenç dels Horts) ; 32(1): 45-48, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-185853


Objetivo. Evaluar los resultados de la formación mixta frente a la presencial en un curso de soporte vital básico/desfibrilador externo automático (SVB/DEA), así como su retención a los 9 meses. Método. Estudio experimental aleatorizado que compara los resultados de la formación en SVB/DEA entre un grupo control (GC) que recibió formación presencial de 4 horas frente a un grupo experimental (GE) que recibió formación en metodología mixta: 2 horas virtuales y 2 horas presenciales. Resultados. Participaron 89 alumnos (45 del GC y 44 del GE). Después de la formación, el GC obtuvo mejores puntuaciones en conocimientos [8,6 (DE 0,9) frente a 8,0 (DE 1,14), p = 0,013]. El GE obtuvo mejores puntuaciones en las habilidades del tiempo en segundos de "hands off" y en el porcentaje de la rexpansión completa del tórax. Los conocimientos decaen a los 9 meses, pero sin diferencias entre los dos grupos. La retención global baja de 8,31 (DE 1,1) a 6,04 (DE 1,6) (p = 0,001), en 9 meses, pero de forma similar en ambos grupos. En las habilidades prácticas no hubo diferencias entre los dos grupos ni al finalizar el curso ni a los 9 meses. Conclusiones. Con la metodología virtual se obtienen mejores resultados en algunos parámetros de las habilidades

Objective. To evaluate the immediate and 9-month results of blended versus standard training in basic life support and the use of an automatic external defibrillator (BLS/AED). Methods. Randomized trial comparing the results of standard BLS/AED training to blended training. The control group received 4 hours of standard instruction from a trainer and the experimental blended-training group received 2 hours of virtual training and 2 hours of in-person instruction. Results. Eighty-nine students participated, 45 in the control group and 44 in the experimental group. The controls achieved better mean (SD) knowledge scores immediately after training (8.6 [0.9] vs 8.0 [1.14] in the experimental group, P=.013). The blended training group scored better on certain skill markers (hands-off time in seconds and compressions followed by complete chest recoil). Participant knowledge had decreased at 9 months without significant between-group differences. Overall, retention fell from a score of 8.31 (1.1) to 6.04 (1.6) (P=.001) in 9 months and the loss was similar in the 2 groups. No differences in practical skills between the groups were observed at the end of the course or 9 months later. Conclusions. The blended training method led to better results on some skill ítems

Humanos , Feminino , Adulto , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Sociedades Médicas/normas , Reanimação Cardiopulmonar/educação , Parada Cardíaca , Índice de Massa Corporal
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983560


PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.

Institutos de Câncer/normas , Hospitais de Veteranos/normas , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Medicina Baseada em Evidências/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisão por Pares , Avaliação de Programas e Projetos de Saúde/normas , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
Gastroenterology ; 158(1): 67-75.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31479658


DESCRIPTION: The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. This review is framed around the 15 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field. This expert review also reflects the experiences of the authors, who are advanced endoscopists or hepatopancreatobiliary surgeons with extensive experience in managing and teaching others to care for patients with pancreatic necrosis. BEST PRACTICE ADVICE 1: Pancreatic necrosis is associated with substantial morbidity and mortality and optimal management requires a multidisciplinary approach, including gastroenterologists, surgeons, interventional radiologists, and specialists in critical care medicine, infectious disease, and nutrition. In situations where clinical expertise may be limited, consideration should be given to transferring patients with significant pancreatic necrosis to an appropriate tertiary-care center. BEST PRACTICE ADVICE 2: Antimicrobial therapy is best indicated for culture-proven infection in pancreatic necrosis or when infection is strongly suspected (ie, gas in the collection, bacteremia, sepsis, or clinical deterioration). Routine use of prophylactic antibiotics to prevent infection of sterile necrosis is not recommended. BEST PRACTICE ADVICE 3: When infected necrosis is suspected, broad-spectrum intravenous antibiotics with ability to penetrate pancreatic necrosis should be favored (eg, carbapenems, quinolones, and metronidazole). Routine use of antifungal agents is not recommended. Computed tomography-guided fine-needle aspiration for Gram stain and cultures is unnecessary in the majority of cases. BEST PRACTICE ADVICE 4: In patients with pancreatic necrosis, enteral feeding should be initiated early to decrease the risk of infected necrosis. A trial of oral nutrition is recommended immediately in patients in whom there is absence of nausea and vomiting and no signs of severe ileus or gastrointestinal luminal obstruction. When oral nutrition is not feasible, enteral nutrition by either nasogastric/duodenal or nasojejunal tube should be initiated as soon as possible. Total parenteral nutrition should be considered only in cases where oral or enteral feeds are not feasible or tolerated. BEST PRACTICE ADVICE 5: Drainage and/or debridement of pancreatic necrosis is indicated in patients with infected necrosis. Drainage and/or debridement may be required in patients with sterile pancreatic necrosis and persistent unwellness marked by abdominal pain, nausea, vomiting, and nutritional failure or with associated complications, including gastrointestinal luminal obstruction; biliary obstruction; recurrent acute pancreatitis; fistulas; or persistent systemic inflammatory response syndrome. BEST PRACTICE ADVICE 6: Pancreatic debridement should be avoided in the early, acute period (first 2 weeks), as it has been associated with increased morbidity and mortality. Debridement should be optimally delayed for 4 weeks and performed earlier only when there is an organized collection and a strong indication. BEST PRACTICE ADVICE 7: Percutaneous drainage and transmural endoscopic drainage are both appropriate first-line, nonsurgical approaches in managing patients with walled-off pancreatic necrosis (WON). Endoscopic therapy through transmural drainage of WON may be preferred, as it avoids the risk of forming a pancreatocutaneous fistula. BEST PRACTICE ADVICE 8: Percutaneous drainage of pancreatic necrosis should be considered in patients with infected or symptomatic necrotic collections in the early, acute period (<2 weeks), and in those with WON who are too ill to undergo endoscopic or surgical intervention. Percutaneous drainage should be strongly considered as an adjunct to endoscopic drainage for WON with deep extension into the paracolic gutters and pelvis or for salvage therapy after endoscopic or surgical debridement with residual necrosis burden. BEST PRACTICE ADVICE 9: Self-expanding metal stents in the form of lumen-apposing metal stents appear to be superior to plastic stents for endoscopic transmural drainage of necrosis. BEST PRACTICE ADVICE 10: The use of direct endoscopic necrosectomy should be reserved for those patients with limited necrosis who do not adequately respond to endoscopic transmural drainage using large-bore, self-expanding metal stents/lumen-apposing metal stents alone or plastic stents combined with irrigation. Direct endoscopic necrosectomy is a therapeutic option in patients with large amounts of infected necrosis, but should be performed at referral centers with the necessary endoscopic expertise and interventional radiology and surgical backup. BEST PRACTICE ADVICE 11: Minimally invasive operative approaches to the debridement of acute necrotizing pancreatitis are preferred to open surgical necrosectomy when possible, given lower morbidity. BEST PRACTICE ADVICE 12: Multiple minimally invasive surgical techniques are feasible and effective, including videoscopic-assisted retroperitoneal debridement, laparoscopic transgastric debridement, and open transgastric debridement. Selection of approach is best determined by pattern of disease, physiology of the patient, experience and expertise of the multidisciplinary team, and available resources. BEST PRACTICE ADVICE 13: Open operative debridement maintains a role in the modern management of acute necrotizing pancreatitis in cases not amenable to less invasive endoscopic and/or surgical procedures. BEST PRACTICE ADVICE 14: For patients with disconnected left pancreatic remnant after acute necrotizing mid-body necrosis, definitive surgical management with distal pancreatectomy should be undertaken in patients with reasonable operative candidacy. Insufficient evidence exists to support the management of the disconnected left pancreatic remnant with long-term transenteric endoscopic stenting. BEST PRACTICE ADVICE 15: A step-up approach consisting of percutaneous drainage or endoscopic transmural drainage using either plastic stents and irrigation or self-expanding metal stents/lumen-apposing metal stents alone, followed by direct endoscopic necrosectomy, and then surgical debridement is reasonable, although approaches may vary based on the available clinical expertise.

Gastroenterologia/normas , Pancreatite Necrosante Aguda/terapia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Desbridamento/instrumentação , Desbridamento/métodos , Drenagem/instrumentação , Drenagem/métodos , Endoscopia/instrumentação , Endoscopia/métodos , Nutrição Enteral , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents Metálicos Autoexpansíveis , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Estados Unidos
J Surg Res ; 245: 64-71, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31401249


BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.

Doença de Graves/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Tireoidectomia/normas , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Endocrinologia/normas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Sociedades Médicas/normas , Tireoidectomia/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
Acta otorrinolaringol. esp ; 70(6): 364-372, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184882


En noviembre 2014 la Sociedad Española de Otorrinolaringología, la Sociedad Española de Sueño y la Sociedad Española de Cirugía Maxilofacial propusieron y avalaron la elaboración de una Guía de Práctica Clínica sobre la exploración física de la vía aérea superior en pacientes con apnea obstructiva del sueño. La Guía ha seguido de forma estricta en toda su elaboración las recomendaciones del manual de elaboración de guías de práctica clínica del Sistema Nacional de Salud 2007 y 2009 y el manual de la Scottish Intercollegiate Guidelines Network (SIGN) 2015. El documento final puede ser altamente útil para los fines que se propuso inicialmente: ser un referente para unificar las regiones que deben ser exploradas en los pacientes con síndrome de apnea-hipoapnea obstructiva del sueño, mediante qué tipo de exploración y cómo gradarla, y expresada para todos los ámbitos asistenciales a los que estos pacientes pueden acudir. Las conclusiones y recomendaciones están basadas en una revisión exhaustiva y actualizada de la bibliografía con alto nivel de evidencia, además de la experiencia y conocimientos demostrados de todos los integrantes del grupo de elaboración. Dicho grupo se constituyó pensando siempre en la transversalidad del proyecto, y, por tanto, han participado especialistas de todos los ámbitos implicados (cirugía maxilofacial, medicina de familia, neumología, neurofisiología clínica, odontología y otorrinolaringología). Con la misma idea se seleccionaron los revisores externos del texto final

In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines

Humanos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Manuseio das Vias Aéreas/normas , Exame Físico/métodos , Sociedades Médicas/normas , Exame Físico/normas
Actas urol. esp ; 43(10): 551-556, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185261


Introducción: Las redes sociales (RRSS) ofrecen excelentes oportunidades para la difusión del conocimiento científico y su aplicación en el ámbito de la urología es cada vez mayor. Sin embargo, existe controversia alrededor de este tema. Los vídeos en directo compartidos a través de las plataformas de las RRSS ofrecen muchas ventajas y desventajas; existen riesgos potenciales con respecto a la confidencialidad, infracción de derechos de autor, entre otros. Nuestro objetivo fue evaluar el papel de los vídeos compartidos en RRSS durante los congresos de urología. Materiales y métodos: Desde enero de 2016 hasta junio de 2018, se llevó a cabo un estudio exhaustivo de los vídeos compartidos en RRSS durante el Congreso de la Asociación Europea de Urología. Se utilizaron las herramientas online Symplur (, Twitter, Periscope y YouTube para la recopilación de datos. Se analizaron las siguientes variables: el número de vídeos, el tiempo de retransmisión y las visualizaciones de cada uno. Los vídeos se clasificaron como en directo o pregrabados y como científicos o no científicos. Se utilizó SPSS V22.0 para el procesamiento de datos. Resultados: Identificamos 108 vídeos compartidos en RRSS, 292,42 minutos de retransmisión, 67732 visualizaciones. De estos 79 (73%) eran vídeos en directo, de los cuales 78 (72%) se consideraron científicos y 30 (28%) no científicos. Durante los años del estudio (2016-2018) se observó un aumento en el tiempo de retransmisión (p = 0,031), el número de vídeos, visualizaciones (p = 0,018) y vídeos en directo (p = 0,019) durante el congreso anual de la Asociación Europea de Urología. Conclusiones: La publicación de vídeos de congresos urológicos en RRSS está en constante aumento. Estos vídeos proporcionan ventajas para la comunicación, la divulgación científica y amplían el alcance de los congresos. Sin embargo, existe un riesgo potencial al compartir información en tiempo real que podría no estar en línea con las recomendaciones para el uso apropiado de las redes sociales

Introduction: Social Media (SoMe) offers excellent opportunities for scientific knowledge dissemination and its use has been extended in urology. However, there is controversy about its use. Live videos shared trough SoMe platforms offer many advantages, but at the same time disadvantages and potential risks including confidentiality, copyright infringement, among others. We aimed to assess the activity of shared videos on SoMe during urological conferences. Materials and methods: A comprehensive study of videos shared on SoMe during European Association of Urology congress was carried out from January 2016 to June 2018. The online tools Symplur (, Twitter, Periscope and YouTube were searched to collect data. Number of videos, transmission time and views were analyzed. Videos were classified as live or pre-recorded and as scientific or non-scientific. SPSS V22.0 was used to process data. Results: We identified 108 videos shared on SoMe, 292.42minutes of transmission, 67732 views. 79 of 108 (73%) were live streaming videos, 78 (72%) of which were considered scientific vs. 30 (28%) non-scientific. An increase was observed trough the years of study (2016-2018) in transmission time (p = .031) number of videos, views (p = .018) and live videos (p = .019) during the annual congress of the European Association of Urology. Conclusions: Shared videos on SoMe from urological conferences are increasing. These provide advantages for communication, scientific dissemination and expand the scope of conferences. However, there is potential risk of sharing information in real time; that could not be in line with the recommendations for appropriate use of social networks

Humanos , Disseminação de Informação/ética , Disseminação de Informação/métodos , Rede Social , Gravação em Vídeo/ética , Sociedades Médicas/ética , Urologia , Sociedades Médicas/normas
Presse Med ; 48(12): 1387-1392, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679896


The GERS-P (Exercise Rehabilitation Sports Prevention Group of the French Society of Cardiology) has decided to update current guidelines regarding the practice of EKG stress tests. Since the last update dates from 1997, the GERS judged it necessary to integrate data from new works and advancements made in the last 20 years. Good clinical practices and safety conditions are better defined regarding the structure, location, material, staff competency, as well as convention with hospital structures. The diagnosis of coronary artery disease remains the principal indication for a stress test. Interpretation of the results is crucial - it must be multivariate and provide either a low, intermediate or strong probability of the existence of coronary lesions, taking into account the studied population (risk factors, age, sex and symptoms). We no longer have to talk about a "positive, negative or litigious" test. Several new indications for a stress test have been defined for the assessment of cardiac pathologies. With such indications, the use of gas expiration measurements is highly recommended in order to provide a precise prognosis for all the various cardiac pathologies : congenital, ischemic, valvular, cardiomyopathy, congestive heart failure, rhythm and conduction disorders, pacemaker fine-tuning, or pulmonary hypertension. Indications for stress tests and contraindications are defined according to different population subgroups, for instance : athletes, women, children, the elderly, asymptomatic patients, diabetics, hypertensive patients, peripheral arteritis disease patients, or in the context of a non-cardiac surgery pre-op visit. The new guidelines are considerably different from those dating from 1997 and further pinpoint the relevance and importance of an EKG stress test within the arsenal of complementary cardiologic exams. With the improvements made in providing diagnostic value in CAD, as well as better prognostic value for any underlying pathology, the indication for an EKG stress test has extended to all cardiovascular disease.

Cardiologia/normas , Teste de Esforço/normas , Cardiologia/organização & administração , Doença da Artéria Coronariana/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Exercício/fisiologia , Teste de Esforço/métodos , Humanos , Prognóstico , Sociedades Médicas/normas
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 734-743, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185565


Antecedentes El conocimiento de las variaciones de las enfermedades dermatológicas a lo largo del año podría ser útil para la planificación en salud y el manejo de las enfermedades. Sin embargo, existe escasa información acerca de la variación de los diagnósticos dermatológicos en diferentes épocas del año en una muestra nacional representativa. Objetivos: Evaluar si existe variación en los diagnósticos clínicos dermatológicos entre la temporada de frío y calor en España. Material y métodos: Los datos se han obtenido mediante una encuesta anónima realizada a una muestra aleatoria y representativa de dermatólogos españoles estratificados por área. Cada uno de los participantes recogió todos los diagnósticos clínicos durante 6 días de consulta en 2016 (3 en la temporada de frío y 3 en la temporada de calor). Los diagnósticos se codificaron según la CIE-10. Resultados: Con una proporción de respuesta de 62%, se recolectaron 11.223 diagnósticos clínicos. Los grupos diagnóstico CIE-10 que mostraron variaciones entre temporadas fueron: otras neoplasias benignas de la piel (D23), rosácea (L71) y otros trastornos foliculares (L73), los cuales fueron más frecuentes en la temporada de calor, y acné (L70) el cual fue más frecuente en la temporada de frío. Además, describimos las diferencias en la población pediátrica y según el tipo de asistencia pública frente a privada. Algunas de estas diferencias podrían estar relacionadas con diferencias en la población que consulta en las distintas temporadas. Conclusiones: La frecuencia de la mayoría de los diagnósticos clínicos realizados por dermatólogos no sufre variaciones a lo largo del año. Solo algunos de los diagnósticos clínicos muestran variaciones entre la temporada de frío frente a calor. Estas variaciones observadas pueden estar en relación con las propias enfermedades o pueden ser debidas a cambios estacionales en la demanda de consultas dermatológicas

Background: Knowledge of seasonal variation of cutaneous disorder may be useful for heath planning and disease management. To date, however, descriptions of seasonality including all diagnoses in a representative country sample are very scarce. Objectives: To evaluate if clinical dermatologic diagnosis in Spain change in the hot vs. cold periods. Materials and methods: Survey based on a random sample of dermatologists in Spain, stratified by area. Each participant collected data during 6 days of clinical activity in 2016 (3 in the cold period of the year, 3 in the hot period). Clinical diagnoses were coded using ICD-10. Results: With a 62% response proportion, we got data on 10999 clinical diagnoses. ICD-10 diagnostic groups that showed changes were: other benign neoplasms of skin (D23), rosacea (L71) and other follicular disorders (L73), which were more common in the hot period and acne (L70) which was more frequent in the cold period. We describe differences in the paediatric population and in private vs. public practice. Some of these differences might be associated to differences in the population demanding consultations in different periods. Conclusions: The frequency of most clinical diagnosis made by dermatologists does not change over the year. Just a few of the clinical diagnoses made by dermatologists show a variation in hot vs. cold periods. These variations could be due to the diseases themselves or to seasonal changes in the demand for consultation

Humanos , Dermatopatias/diagnóstico , Clima Frio , Calor Extremo , Dermatopatias/epidemiologia , Espanha/epidemiologia , Estações do Ano , Sociedades Médicas/estatística & dados numéricos , Sociedades Médicas/normas , Análise Estatística
Rinsho Ketsueki ; 60(9): 1366-1371, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597865


A conflict of interest (COI) is a conflict between private interests and one's official responsibilities. COI is unavoidable and thus needs to be managed. Debates about COI in medical research area began in the United States in the 1980s. COI clause was added to the Helsinki Declaration in the year of 2000 after the Gelsinger affair. Discussions in Japan subsequently followed, and COI management guidelines have been sequentially presented by different organizations, particularly after the Diovan incident in 2013. Guidelines presented by the Japan Medical Association (JMA) in 2017 are currently regarded as standard. COI disclosure is required at research presentations and medical practice guideline announcements, among others, and should be carefully managed in the latter. In 2018, the Japanese Society of Hematology announced revision of the Japanese Society of Internal Medicine common guidance, presenting it in accordance with the JMA's guidelines. In the "Specific Clinical Research" section defined in the "Clinical Research Method Enforcement Rule", people who should not take a representative position or who should pay special attention when taking it are defined.

Conflito de Interesses , Hematologia/normas , Sociedades Médicas/normas , Revelação , Japão
Spine (Phila Pa 1976) ; 44(20): E1206-E1210, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31574066


STUDY DESIGN: This was a correlational study. OBJECTIVE: Determine the range of pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) scores for patients treated for adolescent idiopathic scoliosis (AIS) and assess correlation with Scoliosis Research Society-22 (SRS-22) domain scores. SUMMARY OF BACKGROUND DATA: Patient reported outcome (PRO) measures are important metrics for measuring health status in diverse patient populations. PROMIS is increasingly being used in orthopedic practice. Existing literature compares PROMIS measures favorably to legacy measures in numerous adult orthopedic conditions. This study sought to define the range of PROMIS mobility, pain interference, and peer relationships scores for adolescents treated for AIS. Furthermore, correlations between these domains and equivalent domains in the legacy PRO, SRS-22, were determined. METHODS: Pediatric PROMIS and SRS-22 were obtained at routine clinical visits for AIS at a tertiary care children's hospital from January 2017 to October 2017. Spearman correlations were performed to examine the associations between three pediatric PROMIS domains and the SRS-22 domains. Only patients who completed both PRO measures were included in the analyses. Radiographic measurements were performed at each visit assessing sagittal and coronal deformity and overall spinal balance. RESULTS: One hundred thirteen patients with a mean age of 14.4 (standard deviation [SD] = 2.1) years completed the assessments. The mean pediatric PROMIS domain scores included: mobility 50.9 (interquartile range [IQR] 36.2-65.6); pain interference 45.9 (IQR 28.9-62.9); peer relations 52.6 (IQR 38.3-64.9).PROMIS mobility was strongly correlated with SRS-22 function (r = 0.65; P < 0.001). PROMIS pain interference was strongly correlated with SRS-22 pain (r = 0.70; P < 0.001). PROMIS peer relations was moderately correlated with SRS-22 Mental Health (r = 0.41; P < 0.001) and self-image (r = 0.34; P < 0.001). CONCLUSION: In AIS patients pediatric PROMIS pain interference and mobility correlate strongly with SRS-22 pain and function domains, while PROMIS peer relationships demonstrates moderate correlations with SRS-22 mental health and self-image. LEVEL OF EVIDENCE: 2.

Nível de Saúde , Sistemas de Informação/normas , Medidas de Resultados Relatados pelo Paciente , Escoliose/diagnóstico , Escoliose/cirurgia , Sociedades Médicas/normas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Dor/diagnóstico , Dor/epidemiologia , Dor/cirurgia , Medição da Dor/métodos , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Escoliose/epidemiologia