Update on the management of uncomplicated acute diverticulitis at our centre. Equally effective, more efficient. / Actualización del manejo de la diverticulitis aguda no complicada en nuestro centro. Igualmente efectivo, más eficiente.

GOALS: The current trend in the treatment of non-complicated diverticulitis is the outpatient management with antibiotic or even anti-inflammatory regimens in selected cases. We present a comparison of the results in our hospital with different protocols applied in 2016 and 2017. MATERIAL AND METHODS: All patients selected for this study were diagnosed with diverticulitis grade Ia of Hinchey's classification according to radiological findings on abdominal CT. We have analyzed two retrospective cohorts: 100 patients treated in 2016 according to the old protocol and 104 patients treated in 2017 with a new protocol. In 2016, the candidates for ambulatory treatment remained under observation for 24 hours before being discharged. The treatment consisted of 14 days of ciprofloxacin and metronidazole. In 2017, only patients with more acute symptoms were observed 24 hours and amoxicillin-clavulanic acid was prescribed for only 5 days. RESULTS: The persistence of the disease in 2016 was 6% and in 2017 was only 5.77% (p = 0.944). Recurrence during the first year was 13% in the first group, while in the second it was 5.7%, although this difference was not statistically significant. Likewise, a significant reduction in health costs was achieved. CONCLUSIONS: Outpatient treatment of acute uncomplicated diverticulitis with oral treatment seems to be a safe and effective therapeutic strategy in selected patients with low comorbidity.

[Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review]. / ¿Es efectiva la entrevista motivacional individual en la malnutrición por exceso? Una revisión sistemática de la literatura.

OBJECTIVE: To analyze the effectiveness of individual motivational interviewing (MI) in the ambulatory treatment of the overweight and obese. DESIGN: The protocol of this systematic review is registered in PROSPERO N° CDR42017058814. DATABASES: EBSCO-CINAHL, Pubmed, Scielo, PsycoINFO from 2010 to 2017. STUDY SELECTION: We included studies with overweight and obese adult participants, randomized trial and case control studies, with MI being applied individually and face to face, with primary or secondary results in changes in body composition (weight or BMI), published in English or Spanish, with available text and in peer-reviewed journals. DATA EXTRACTION: We obtained anthropometric, behavioral, psychosocial, and other variables as effects of MI. In addition, we collected descriptive variables of the interventions. RESULTS: Eleven articles were included in this revision. There is a great variability between the studies in terms of population, kind of intervention, and time of follow-up. In most of them, some effect was observed in reducing bodyweight, reaching a maximum of 7kg in the group that received the MI. There are positive variations in psychosocial and metabolic variables in the studies. CONCLUSIONS: Individual MI interventions have a modest effect on the variation of bodyweight, and could have a positive impact on behavioral, psychosocial, and other variables. More studies are needed to elucidate the best form of MI application with regard to effectiveness on different variables. The primary healthcare system is in an advantageous position for generating fruitful research on this motivational strategy.

[Early drop-outs and retentions in substance abuse outpatient clinics: a cross-sectional comparative study of factors that increase or decrease adherence]. / Abandono precoz y retención en servicios ambulatorios de drogodependencias: análisis transversal comparativo de factores que aumentan o disminuyen la adherencia.

AIM: The aim of this study is to define the risk factors associated with early discharge in out-patients clinics. DESIGN: Cross-sectional and observational study. SETTING: Substance abuse clinics in Girona (Catalonia, Spain). PARTICIPANTS: A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n=92). PROCEDURE: Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence. MAIN MEASUREMENTS: The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable. RESULTS: The results indicated that attending the appointments unaccompanied (OR=3.13), being female (OR=2.44), having cocaine related issues (OR=1.14), and being younger (OR=0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR=0.28). CONCLUSIONS: It is concluded that special attention must be devoted to the patients' families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users.

Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons. / Enfermedad diverticular complicada: toma de posición sobre tratamiento ambulatorio, intervención de Hartmann, lavado-drenaje peritoneal y cirugía laparoscópica. Documento de consenso de la Asociación Española de Coloproctología y Sección de Coloproctología de la Asociación Española de Cirujanos.

The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed.

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers. / Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares.

OBJECTIVE: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. METHODS: Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. RESULTS: Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. CONCLUSION: Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile.

Prospective study about the security and efficacy of treatment without antibiotic therapy of patients diagnosed with acute uncomplicated diverticulitis after launching a protocol at a tertiary hospital.

INTRODUCTION: The main objective of our study is to analyze the results in our hospital after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis. METHODS: Our observational, prospective, single-center study was developed after launching a treatment protocol without antibiotic therapy for patients diagnosed with acute uncomplicated diverticulitis (AUD) in January 2021. The follow-up period was from January 1, 2021 to September 30, 2023. Variables evaluated by the study have included demographic and analytical variables, as well as those related to diagnosis and whether the patients needed to start antibiotic treatment, inpatient treatment, or surgical procedures. RESULTS: In total, 199 patients were diagnosed with AUD, 75 of whom were treated without antibiotic therapy as outpatients. Seven of these patients needed to start antibiotic treatment because of adverse evolution; none of these patients required surgical procedures. The need for inpatient treatment, urgent care, or surgical procedures is similar to the group of patients treated with antibiotics. The main risk factor of failure of outpatient treatment without antibiotic therapy identified by the study was the presence of bacteriuria at diagnosis. CONCLUSIONS: Our results confirm previous reports, observing that treatment without antibiotic therapy in selected patients with AUD is safe.

Results of a national survey about the management of patients with acute uncomplicated diverticulitis.

INTRODUCTION: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesión among national centres to these and others recommendations related to this pathology. METHODS: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. RESULTS: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centres, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centres that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centres with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (p ≤ .05). CONCLUSIONS: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.

[Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs]. / Tratamiento ambulatorio de la diverticulitis aguda no complicada: impacto sobre los costes sanitarios.

BACKGROUND: Outpatient treatment of uncomplicated acute diverticulitis is safe and effective. The aim of this study was to determine the impact of outpatient treatment on the reduction of healthcare costs. PATIENTS AND METHODS: A retrospective cohort study comparing 2 groups was performed. In the outpatient treatment group, patients diagnosed with uncomplicated acute diverticulitis were treated with oral antibiotics at home. In the hospital treatment group, patients met the criteria for outpatient treatment but were admitted to hospital and received intravenous antibiotic therapy. Cost estimates have been made using the hospital cost accounting system based on total costs, the sum of all variable costs (direct costs) plus overhead expenses divided by activity (indirect costs). RESULTS: A total of 136 patients were included, 90 in the outpatient treatment group and 46 in the hospital group. There were no differences in the characteristics of the patients in both groups. There were also no differences in the treatment failure rate in both groups (5.5% vs. 4.3%; P=.7). The total cost per episode was significantly lower in the outpatient treatment group (882 ± 462 vs. 2.376 ± 830 euros; P=.0001). CONCLUSIONS: Outpatient treatment of acute diverticulitis is not only safe and effective but also reduces healthcare costs by more than 60%.

[Results of the survey on care units and caring for eating disorders in Spain. SENPE Working Group on Eating Disorders]. / Resultados de la encuesta sobre unidades asistenciales y atención a trastornos de la conducta alimentaria en España. Grupo de Trabajo sobre Trastornos de la Conducta Alimentaria de SENPE.

Introduction: Introduction: eating disorders (EDs) entail a therapeutic challenge. Objective: to describe ED care from the perspective of Nutrition Units (NU) in relation to human and care resources, the activities carried out, and satisfaction with care in Spain; to collect demands from professionals to improve assistance. Methods: a cross-sectional, observational study based on a questionnaire sent online to members of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and to the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The data were analyzed according to number of beds of the hospitals surveyed (< 500/≥ 500). Results: 23 responses from 8 autonomous communities. In 87 % of NUs care was given to eating disorders; 65.2 % had a specific process; 91.3 % collaborated with Psychiatry; 34.8 % had their own hospitalization area; 56.5 % had a day hospital, but 21.7 % participated in it; 39.1 % had a monographic consultation office; nutritional education was carried out in 87 %, especially by nursing; individualized diets and oral supplements were frequently prescribed in 39.1 % and 56.5 %, respectively; only the largest hospitals participated in research on EDs (62.5 %), and 21.7 % collaborated with patient associations. Hospitals with ≥ 500 beds had more resources and were more satisfied. Professionals demanded resources and processes agreed with Psychiatry. Conclusions: resources and care practices are uneven in the NUs surveyed, as well as multidisciplinary collaboration. The collected evidence allows us to design improvement strategies in this area.

Introducción: Introducción: los trastornos de la conducta alimentaria (TCA) suponen un reto terapéutico. Objetivo: describir la asistencia a los TCA desde la perspectiva de las unidades de nutrición clínica y dietética (UNCyD) en relación con los recursos humanos y asistenciales, las actividades realizadas y la satisfacción con la atención en España; recoger demandas de los profesionales para mejorar la asistencia. Métodos: estudio transversal y observacional a partir de un cuestionario remitido online a socios de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y al Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN). Los datos se analizaron según las camas de los hospitales encuestados (< 500/≥ 500). Resultados: 23 respuestas de 8 comunidades autónomas. En el 87 % de las UNCyD se prestaba atención a los TCA; el 65,2 % contaban con un proceso específico; el 91,3 % colaboraban con Psiquiatría; el 34,8 % tenían área propia de hospitalización; el 56,5 % disponían de hospital de día pero participaban en él el 21,7 %; el 39,1 % tenían consulta monográfica; se realizaba educación nutricional en el 87 %, sobre todo por enfermería; se prescribían frecuentemente dietas individualizadas y suplementos orales en el 39,1 y el 56,5 %, respectivamente; solo los hospitales más grandes participaban en investigación sobre TCA (62,5 %); y el 21,7 % colaboraban con asociaciones de pacientes. Los hospitales con ≥ 500 camas disponían de más recursos y estaban más satisfechos. Los profesionales demandaban recursos y procesos consensuados con psiquiatría. Conclusiones: los recursos y las prácticas asistenciales son dispares en las UNCyD encuestadas, así como la colaboración multidisciplinar. La evidencia recogida permite diseñar estrategias de mejora en este ámbito.

[Tratamiento ambulatorio de la diverticulitis aguda no complicada. Análisis de nuestra experiencia]. / Outpatient treatment of uncomplicated acute diverticulitis. Analysis of our experience.

OBJECTIVE: Analyze the safety and efficacy of the outpatient treatment of uncomplicated acute diverticulitis and a costs analysis. METHOD: We conducted a prospective, non-randomized study between June 2014 and June 2017. We included all patients diagnosed of uncomplicated acute diverticulitis based on clinical and abdominal computed tomography scan in the Emergency Department of the University Hospital San Juan de Alicante (Spain). Outpatient treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanate or ciprofloxacin and metronidazole in patients with betalactamic allergy), liquid diet for 72 h and analgesics. Costs were evaluated according to the Law of Rates of Valencian Community. RESULTS: Ninety patients were included, 49 females and 41 males with a median age of 56 years. Success rate was 95.5% (n = 86) requiring hospital admission 4 patients (4.5%). Antibiotic treatment was amoxicillin-clavulanate in 82 patients (91.1%) and ciprofloxacin and metronidazole in 8 (8.9%). Cost savings per patient was approximately 1985 € comparing with hypothetically all inpatient treatment. CONCLUSIONS: Outpatient treatment of uncomplicated acute diverticulitis can be performed successfully in most patients allowing an important cost savings.

OBJETIVO: Evaluar la seguridad y la eficacia del tratamiento con antibiótico oral para la diverticulitis aguda no complicada, y realizar un análisis de costos. MÉTODO: Estudio prospectivo, no aleatorizado, entre junio de 2014 y junio de 2017. Se incluyeron todos los pacientes diagnosticados de diverticulitis aguda no complicada según la clínica y la tomografía abdominal en el servicio de urgencias del Hospital Universitario San Juan de Alicante (España). El tratamiento ambulatorio consistió en antibiótico oral durante 7 días (amoxicilina-ácido clavulánico o ciprofloxacino y metronidazol en alérgicos a los betalactámicos), dieta líquida durante 72 horas y analgésicos. Los costos fueron evaluados según la Ley de Tasas de la Comunidad Valenciana. RESULTADOS: Se incluyeron 90 pacientes, 49 mujeres y 41 hombres, con una mediana de edad de 56 años. La tasa de éxito fue del 95.5% (n = 86), necesitando ingreso hospitalario cuatro pacientes (4.5%). El tratamiento antibiótico empleado fue amoxicilina-ácido clavulánico en 82 pacientes (91.1%) y ciprofloxacino con metronidazol en ocho pacientes (8.9%). El ahorro por paciente fue de 1985 euros en comparación con el hipotético ingreso de todos los pacientes. CONCLUSIONES: El tratamiento ambulatorio de la diverticulitis aguda no complicada se completó con éxito en la mayoría de los pacientes, permitiendo una importante reducción del gasto.

Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares / Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

Objetivo mostrar la efectividad y seguridad del sevoflurano tópico tras la administración ambulatoria y prolongada en los pacientes con úlceras vasculares refractarias. Métodos estudio observacional retrospectivo de pacientes con úlceras vasculares dolorosas refractarias a terapias habituales y que fueron tratados con sevoflurano tópico durante al menos 36 meses. Se recogieron las variables: edad, sexo, antecedentes médicos, comorbilidad asociada, etiología de úlcera y tratamiento médico. Se analizó la mejoría clínica y la variación de la superficie de las úlceras vasculares. Para cuantificar la intensidad del dolor basal e irruptivo antes y después del tratamiento se utilizó la escala visual analógica. Resultados del total de pacientes tratados, 9 cumplían los criterios de inclusión. La edad media fue de 74,8 ± 7,5 años. Los casos 2 y 9 fallecieron durante el seguimiento. La acción analgésica del sevoflurano tópico fue rápida (3,1 ± 2,1 min), intensa (escala visual analógica: 7 ± 1,1 a 1,4 ± 1,1 puntos) y duradera (de 6 a 24 h). Salvo el caso 4, todos experimentaron una reducción de la superficie (15,1 ± 5,0 a 2,7 ± 4,2) de las úlceras vasculares y no se observó tolerancia a lo largo del tiempo. Conclusión la aplicación de sevoflurano tópico es una estrategia analgésica y reepitelizante para las úlceras vasculares que presenta un perfil correcto de seguridad (AU)

Objective To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. Methods Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. Results Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. Conclusion Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile (AU)

Home-based intravenous analgesia with elastomeric pump as an outpatient procedure for pain control after anterior cruciate ligament repair. / Analgesia intravenosa domiciliaria mediante bomba elastomérica como procedimiento ambulatorio de control del dolor en la reparación del ligamento cruzado anterior.

OBJECTIVE: To follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery. MATERIAL AND METHODS: 309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24-48-72hours following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered. RESULTS: 309 patients were assessed (264 males, 45 females), mean age 33 (range: 18 - 55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤ 3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications. DISCUSSION: There is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain. CONCLUSIONS: The use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results.

Resultados de la encuesta sobre unidades asistenciales y atención a trastornos de la conducta alimentaria en España. Grupo de Trabajo sobre Trastornos de la Conducta Alimentaria de SENPE / Results of the survey on care units and caring for eating disorders in Spain. SENPE Working Group on Eating Disorders

Introducción: los trastornos de la conducta alimentaria (TCA) suponen un reto terapéutico. Objetivo: describir la asistencia a los TCA desde la perspectiva de las unidades de nutrición clínica y dietética (UNCyD) en relación con los recursos humanos y asistenciales, las actividades realizadas y la satisfacción con la atención en España; recoger demandas de los profesionales para mejorar la asistencia. Métodos: estudio transversal y observacional a partir de un cuestionario remitido online a socios de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y al Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN). Los datos se analizaron según las camas de los hospitales encuestados (< 500/≥ 500). Resultados: 23 respuestas de 8 comunidades autónomas. En el 87 % de las UNCyD se prestaba atención a los TCA; el 65,2 % contaban con un proceso específico; el 91,3 % colaboraban con Psiquiatría; el 34,8 % tenían área propia de hospitalización; el 56,5 % disponían de hospital de día pero participaban en él el 21,7 %; el 39,1 % tenían consulta monográfica; se realizaba educación nutricional en el 87 %, sobre todo por enfermería; se prescribían frecuentemente dietas individualizadas y suplementos orales en el 39,1 y el 56,5 %, respectivamente; solo los hospitales más grandes participaban en investigación sobre TCA (62,5 %); y el 21,7 % colaboraban con asociaciones de pacientes. Los hospitales con ≥ 500 camas disponían de más recursos y estaban más satisfechos. Los profesionales demandaban recursos y procesos consensuados con psiquiatría. Conclusiones: los recursos y las prácticas asistenciales son dispares en las UNCyD encuestadas, así como la colaboración multidisciplinar. La evidencia recogida permite diseñar estrategias de mejora en este ámbito. (AU)

Introduction: eating disorders (EDs) entail a therapeutic challenge. Objective: to describe ED care from the perspective of Nutrition Units (NU) in relation to human and care resources, the activities carried out, and satisfaction with care in Spain; to collect demands from professionals to improve assistance. Methods: a cross-sectional, observational study based on a questionnaire sent online to members of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and to the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The data were analyzed according to number of beds of the hospitals surveyed (< 500/≥ 500). Results: 23 responses from 8 autonomous communities. In 87 % of NUs care was given to eating disorders; 65.2 % had a specific process; 91.3 % collaborated with Psychiatry; 34.8 % had their own hospitalization area; 56.5 % had a day hospital, but 21.7 % participated in it; 39.1 % had a monographic consultation office; nutritional education was carried out in 87 %, especially by nursing; individualized diets and oral supplements were frequently prescribed in 39.1 % and 56.5 %, respectively; only the largest hospitals participated in research on EDs (62.5 %), and 21.7 % collaborated with patient associations. Hospitals with ≥ 500 beds had more resources and were more satisfied. Professionals demanded resources and processes agreed with Psychiatry. Conclusions: resources and care practices are uneven in the NUs surveyed, as well as multidisciplinary collaboration. The collected evidence allows us to design improvement strategies in this area. (AU)

Tratamiento ambulatorio de la diverticulitis aguda no complicada / Outpatient Treatment of Acute Uncomplicated Diverticulitis

Introducción: La diverticulitis aguda es la complicación más frecuente de la enfermedad diverticular del colon y causa de ingresos hospitalarios. Su tratamiento ha sido evaluado en los últimos años y muestra una tendencia a limitar el tratamiento quirúrgico y potenciar el de tipo conservador. Objetivo: Realizar una revisión sobre la aplicabilidad, la seguridad y la eficacia del tratamiento ambulatorio de la diverticulitis aguda no complicada en pacientes seleccionados. Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en las bases de datos SciELO, Medline (Pubmed), así como Google académico, donde se escogieron un total de 36 referencias. Desarrollo: Históricamente los pacientes diagnosticados de diverticulitis aguda han sido internados en centros hospitalarios para estudio y tratamiento dietético, antibiótico y analgésico. En los últimos años ha crecido la tendencia en el mundo a tratar estos pacientes de forma ambulatoria una vez comprobado que no se encuentra complicada, lo que ha demostrado con nivel de evidencia, que estos logran presentar una evolución favorable sin necesidad de ingreso, con menos gastos para el sistema de salud. Conclusiones: El tratamiento ambulatorio de la diverticulitis aguda no complicada no solo es eficaz y seguro, sino también aplicable en la mayoría de los pacientes, siempre que toleren la ingesta oral y dispongan de un entorno familiar adecuado(AU)

Introduction: Acute diverticulitis is the most frequent complication of diverticular colon disease and cause of hospitalizations. Its treatment has been assessed in recent years; there is a tendency to limit surgical treatment and promote conservative treatment instead. Objective: To review the applicability, safety and efficacy of outpatient treatment of acute uncomplicated diverticulitis in selected patients. Methods: A bibliographic review was carried out in sources of information available in the SciELO and Medline (Pubmed) databases, as well as in Google Scholar, by means of which a total of 36 references were selected. Development: Historically speaking, patients diagnosed with acute diverticulitis have been admitted to hospitals for study and dietary, antibiotic and analgesic treatment. In recent years, there has been a growing tendency worldwide to treat these patients on an outpatient basis once it has been proven that the condition is not complicated, which has shown, with level of evidence, that patients present a favorable evolution without the need for admission, with less expenses for the health system. Conclusions: Outpatient treatment of acute uncomplicated diverticulitis is not only effective and safe, but also applicable in most patients, given that they can tolerate oral intake and have an adequate family environment(AU)

Práctica Basada en Evidencia en Adicciones: Conocimientos y Habilidades de Psicoterapeutas del Noroeste de México / Evidence-Based Practice in Addictions Area: Knowledge and Skills of Therapists from Northwestern Mexico

Resumen La Práctica Basada en Evidencia (PBE) es un proceso que inicia con el conocimiento de las evidencias disponibles y concluye con la selección de la mejor intervención para su implementación en escenarios clínicos lo cual impacta la efectividad de las intervenciones. Objetivo. Caracterizar el perfil de los terapeutas que laboran en 17 centros de tratamiento ambulatorio en adicciones del noroeste de México, además de sus conocimientos y habilidades en el uso de la PBE (fuentes de consulta, uso de manuales) y percepción de su autoeficacia. Método. Participaron 102 terapeutas, se contemplaron dos etapas: cuantitativa basada en la aplicación del CUTEA y cualitativa con aplicación de entrevista semi-estructurada, buscando contrastar las respuestas. Resultados. La mayoría de los participantes tuvo dificultad para describir el concepto de PBE, solo el 37.25% logró una adecuada definición sin embargo, reportaron altos niveles (95.91%) de autoeficacia para implementarla. En relación a las fuentes de consulta el 50% reportó utilizar cualquier buscador comercial en internet, mientras que el 46.08% referían usar los manuales de la institución. Al ingreso a su trabajo, no contaban con capacitación en adicciones ni en el área clínica. Discusión. Se aborda la necesidad del entrenamiento en la PBE y no solo en la implementación de tratamientos específicos.

Abstract Introduction. Evidence-Based Practice (EBP) is a process which starts with the knowledge of available evidence and concludes with the evaluation and selection of the best intervention for the implementation in clinical settings, this process impact the efficacy of the interventions. The variables which can impact on the EBP could be: personal and institutional variables and therapist skills and variables of the interventions. However, to make decisions in the clinical context, it has prevailed a position based on the risks and needs of the clients, which would justify using any treatment, regardless of its effectiveness, which makes the professional psychologist a passive subject who is dedicated only to implementing interventions that institutions request. Therefore, EBP demands that the psychologist be critical of the research and this allows the identification of the best evidence available and also must have the skills to adapt that evidence to their particular context. The objective is to characterize the profile of therapists working in 17 outpatient treatment centers in Mexico, as well as the skills related to the use of EBP (sources of consultation and use of manuals, transfer of knowledge to the population and other therapists) and perception of their self-efficacy. Method. This is a cross-sectional research in which 102 therapists participated. Two stages were considered: quantitative, based on the application of a questionnaire, and the second was qualitative, seeking to contrast the responses. Results. Most of the participants had difficulties in explaining EBP, but reported high levels of self-efficacy to implement it. At the beginning of their work, they had no training in addictions or in the clinical area. Discussion. The need for training in EBP from undergraduate studies is addressed so that future therapists will find it more natural to implement it in clinical settings, through the analysis of scientific articles and, if possible, its application.

Comportamiento de la enfermedad inflamatoria pélvica aguda en la atención primaria de salud. Matanzas, 2017-2018

RESUMEN Introducción: la enfermedad inflamatoria pélvica aguda es una entidad frecuente en mujeres jóvenes en edad reproductiva, y constituye causa de infertilidad y otras complicaciones. Objetivo: caracterizar el comportamiento de la enfermedad inflamatoria pélvica aguda en pacientes atendidas en el Policlínico Docente Samuel Fernández, del municipio Matanzas, en el período de enero de 2017 a enero de 2018. Materiales y métodos: se realizó un estudio descriptivo, longitudinal y prospectivo a 76 mujeres, a las que se les hizo caracterización sociodemográfica y clínico-ecográfica, que permitió su clasificación como pacientes con enfermedad inflamatoria pélvica aguda leve-moderada, requerida de tratamiento y seguimiento en atención primaria. Se evaluó la respuesta clínico-ecográfica al tratamiento médico indicado, a partir de la disminución de la intensidad del dolor pélvico y de las modificaciones de los hallazgos ecográficos iniciales. Resultados: la enfermedad inflamatoria pélvica aguda leve-moderada representó el 87,4 % de los casos evaluados en Consulta Ginecológica de la atención primaria de salud, en el período estudiado. La media de edad fue de 31,2 años. Clínicamente predominaron los casos con dolor severo. El hallazgo ecográfico inicial más frecuente fue el de anejos engrosados. La antibioticoterapia oral combinada y el uso de antiinflamatorios fue la terapia médica empleada, con resultados clínico-ecográficos favorables en el 98,4 y el 92,2 % de los casos, respectivamente. Conclusiones: la enfermedad inflamatoria pélvica leve-moderada resultó una entidad frecuente en el Servicio de Ginecología de la atención primaria de salud en el período estudiado, con evolución satisfactoria al tratamiento médico.

ABSTRACT Introduction: acute inflammatory pelvic disease is a frequent entity in young women in reproductive age, and is cause of infertility and other complications. Objective: to characterize the behavior of the acute inflammatory pelvic disease in patients attended at the TeachingPoliclinic Samuel Fernandez, of the municipality of Matanzas, in the period from January 2017 to January 2018. Materials and methods: a descriptive, longitudinal and prospective study was carried out in 76 women, who were object of socio-demographic and clinic-echographyc characterization that allowed their classification as patients with mild-moderated acute inflammatory pelvic disease requiring treatment and follow up in primary care services. The clinic-echographyc answer to medical treatment was evaluated from the decrease of the intensity of the pelvic pain and the modification of the baseline echographyc findings. Results: mild-moderated acute inflammatory pelvic disease represented 87.4 % of the cases evaluated in the primary care Gynecological consultation in the studied period. The average age was 31.2 years. The cases with severe pain predominated clinically. The most frequent baseline echographyc finding was increased annexes. Oral combined antibiotic therapy and the use of anti-inflammatory drugs was the used medical therapy, with favorable clinic-echographyc results in 98.4 % and 92.2 % of cases respectively. Conclusions: mild-moderated inflammatory pelvic disease was a frequent entity in the Gynecology service of the primary health care in the studied period, with satisfactory evolution to medical treatment.

Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso / Periodic plasmapheresis as maintenance treatment in relapsing-remitting multiple sclerosis, a new therapeutic line? A case report

Introducción: El tratamiento de la esclerosis múltiple remitente-recurrente ha evolucionado significativamente en los últimos años con el descubrimiento de nuevas moléculas eficaces como tratamiento de mantenimiento. Por otro lado, el tratamiento de los brotes de esta enfermedad se basa clásicamente en corticoides, y en los casos refractarios a esta terapia se utiliza plasmaféresis. Presentamos un caso de esclerosis múltiple remitente-recurrente tratada periódicamente con una terapia que se ha utilizado clásicamente para los brotes: plasmaféresis. Caso clínico: Mujer de 39 años con esclerosis múltiple remitente-recurrente de inicio en el posparto, gran carga lesional y curso agresivo, en quien, ante una respuesta subóptima a terapias modificadoras de la enfermedad (alemtuzumab y ocrelizumab), se decide iniciar un tratamiento combinado junto con plasmaféresis periódicas ambulatorias cada tres semanas como tratamiento de mantenimiento. Se constata una buena tolerancia a esta terapia y evolución, y se produce estabilidad clínica. No ha requerido nuevos ingresos hospitalarios por brotes desde febrero de 2020 a marzo de 2021. Conclusión: Aunque es necesario que se realicen más estudios, este caso ofrece información sobre un potencial tratamiento de mantenimiento para pacientes con esclerosis múltiple remitente-recurrente refractaria a terapias con fármacos modificadores de la enfermedad.(AU)

Introduction: Relapsing-remitting multiple sclerosis (RRMS) treatment has significantly changed in recent years because of the discovery of new molecules that have shown efficacy as maintenance treatment. However, the classical treatment for acute attacks is based on corticosteroids administration, being the periodical plasmapheresis the alternative treatment in the case of refractory patients. We introduce a case of relapsing-remitting multiple sclerosis treated with a classical acute attacks therapy: plasmapheresis. Case report: The case of a 39-year-old patient who was diagnosed with relapsing-remitting multiple sclerosis, postpartum debut and aggresive course, who, after suboptimal response to disease modifying therapies (alemtuzumab and ocrelizumab), receives combination treatment with outpatient periodic plasmapheresis every 3 weeks as maintenance therapy. Good tolerance and response. Clinical stability with this treatment. She has not required new hospital admissions for acute attacks of multiple sclerosis from February 2020 to March 2021. Conclusion: Although more specific studies are needed, this case provides information on a potential new maintenance treatment for patients with relapsing-remitting multiple sclerosis refractory to disease-modifying drug therapies.(AU)

Resultados de una encuesta nacional sobre el manejo de los pacientes diagnosticados de diverticulitis aguda no complicada / Results of a national survey about the management of patients with acute uncomplicated diverticulitis

Introducción: El manejo de los pacientes diagnosticados de diverticulitis aguda no complicada ha evolucionado en los últimos años, y según diversas guías clínicas internacionales actuales, el tratamiento ambulatorio y sin antibioterapia puede ser utilizado en pacientes seleccionados. El objetivo de este estudio es evaluar la adhesión de los distintos centros nacionales a estas y otras recomendaciones en esta enfermedad. Métodos: Se realizó una encuesta online a nivel nacional que se dio a conocer a través de diversas aplicaciones informáticas y se analizaron estadísticamente los resultados obtenidos. Resultados: Participaron 104 cirujanos, representando 69 centros hospitalarios nacionales. En el 82,6% de los centros, se realiza manejo ambulatorio de los pacientes diagnosticados de diverticulitis aguda no complicada. El 23,2% de los centros tiene implantado un protocolo de tratamiento sin antibioterapia en pacientes seleccionados, mientras que en los centros que no siguen estas recomendaciones, las razones principales son las dificultades logísticas para su desarrollo (49,3%) y la ausencia de evidencia actual para ello (44,8%). Se han encontrado diferencias estadísticamente significativas al comparar la implantación de dichos protocolos entre centros con unidades acreditadas avanzadas y aquellas que no, con mayores tasas de manejo ambulatorio y sin antibioterapia en los centros acreditados avanzados (p≤0,05). Conclusiones: A pesar de ser una enfermedad muy frecuente, existe mucha heterogeneidad en su tratamiento a nivel nacional, por lo que sería recomendable la unificación de criterios diagnósticos y de tratamiento mediante la colaboración de las sociedades científicas y la simplificación de la puesta en marcha de protocolos hospitalarios.(AU)

Introduction: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesion among national centres to these and others recommendations related to this pathology. Methods: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. Results: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centers, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centers that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centers with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (P≤.05). Conclusions: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.(AU)

Herniorrafia de Mohan P. Desarda modificada en la reparación de hernia inguinal sin prótesis / Modified Mohan P. Desarda herniorraphy in inguinal hernia repair with no prosthesis

Introducción: La afección herniaria es uno de los procesos mejor estudiados y cuyo tratamiento persigue la excelencia, aunque todavía quedan muchas controversias por resolver. Objetivo: Valorar los resultados de la aplicación de la técnica del Dr. Mohan P. Desarda modificada en el Servicio de Cirugía del Hospital General Docente Enrique Cabrera. Métodos: Se realizó un estudio prospectivo aleatorio de 1 010 pacientes intervenidos quirúrgicamente con el diagnóstico de hernia inguinal desde enero del 2004 hasta diciembre del 2017. A estos pacientes se les realizó la técnica quirúrgica del Dr. Mohan P. Desarda modificada, los cuales fueron evolucionados por consulta externa y finalmente por teléfono. Resultados: La mayor incidencia ocurrió en el sexo masculino con 915 (90,6 por ciento) pacientes y la edad promedio fue de 58,3 años. La localización más frecuente fue la derecha en 497 (49,0 por ciento) pacientes. Se aplicó la anestesia local a 690 (68,3 por ciento) pacientes. Se trataron de manera ambulatoria 783 (77,4 por ciento) pacientes. En 46 (34,5 por ciento) pacientes se diagnosticaron complicaciones. La recidiva se observó en 6 pacientes (0,6 por ciento) del total. Conclusiones: Con la herniorrafia de Mohan P. Desarda modificada, se obtienen resultados satisfactorios al igual que con las técnicas protésicas, aportando ahorros económicos importantes(AU)

Introduction: Hernia is one of the best studied processes in order to achieve treatment of excellence, but there are still many pending controversies to be solved. Objective: To determine the results of the modified Mohan P. Desarda technique in the surgical service of Enrique Cabrera general teaching hospital. Method: A prospective randomized study was performed on 1010 surgical patients with the diagnosis of inguinal hernia from January 2004 to December 2017. These patients were operated on by using modified Dr Mohan P. Desarda's technique and they were followed up in the outpatient service and finally by phone. Results: The highest incidence rate was found in males, with 915 (90.6 percent) patients and the average age was 58.3 years. The most common location was on the right side of 497 (49 percent) patients. Local anesthesia was used in 690 (68.3 percent) patients and 783 (77.4 percent) were treated as outpatients. Forty six (34.5 percent) patients suffered complications. Recurrence occurred in 6 patients, which accounted for 0.6 percent of the total number. Conclusions: Modified Mohan P. Desarda herniorraphy achieves satisfactory results as well as the other prosthetic techniques, thus contributing important economic savings(AU)

Herniorrafia de Mohan P. Desarda modificada en la reparación de hernia inguinal sin prótesis / Modified Mohan P. Desarda herniorraphy in inguinal hernia repair with no prosthesis

Introducción: La afección herniaria es uno de los procesos mejor estudiados y cuyo tratamiento persigue la excelencia, aunque todavía quedan muchas controversias por resolver. Objetivo: Valorar los resultados de la aplicación de la técnica del Dr. Mohan P. Desarda modificada en el Servicio de Cirugía del Hospital General Docente Enrique Cabrera. Métodos: Se realizó un estudio prospectivo aleatorio de 1 010 pacientes intervenidos quirúrgicamente con el diagnóstico de hernia inguinal desde enero del 2004 hasta diciembre del 2017. A estos pacientes se les realizó la técnica quirúrgica del Dr. Mohan P. Desarda modificada, los cuales fueron evolucionados por consulta externa y finalmente por teléfono. Resultados: La mayor incidencia ocurrió en el sexo masculino con 915 (90,6 por ciento) pacientes y la edad promedio fue de 58,3 años. La localización más frecuente fue la derecha en 497 (49,0 por ciento) pacientes. Se aplicó la anestesia local a 690 (68,3 por ciento) pacientes. Se trataron de manera ambulatoria 783 (77,4 por ciento) pacientes. En 46 (34,5 por ciento) pacientes se diagnosticaron complicaciones. La recidiva se observó en 6 pacientes (0,6 por ciento) del total. Conclusiones: Con la herniorrafia de Mohan P. Desarda modificada, se obtienen resultados satisfactorios al igual que con las técnicas protésicas, aportando ahorros económicos importantes(AU)

Introduction: Hernia is one of the best studied processes in order to achieve treatment of excellence, but there are still many pending controversies to be solved. Objective: To determine the results of the modified Mohan P. Desarda technique in the surgical service of Enrique Cabrera general teaching hospital. Method: A prospective randomized study was performed on 1010 surgical patients with the diagnosis of inguinal hernia from January 2004 to December 2017. These patients were operated on by using modified Dr Mohan P. Desarda's technique and they were followed up in the outpatient service and finally by phone. Results: The highest incidence rate was found in males, with 915 (90.6 percent) patients and the average age was 58.3 years. The most common location was on the right side of 497 (49 percent) patients. Local anesthesia was used in 690 (68.3 percent) patients and 783 (77.4 percent) were treated as outpatients. Forty six (34.5 percent) patients suffered complications. Recurrence occurred in 6 patients, which accounted for 0.6 percent of the total number. Conclusions: Modified Mohan P. Desarda herniorraphy achieves satisfactory results as well as the other prosthetic techniques, thus contributing important economic savings(AU)