Automatic Irrigation Scheduling on a Hedgerow Olive Orchard Using an Algorithm of Water Balance Readjusted with Soil Moisture Sensors.

Recent technological advances have made possible automated irrigation scheduling using decision-support tools. These tools help farmers to make better decisions in the management of their irrigation system, thus increasing yields while preserving water resources. The aim of this study is to evaluate in a commercial plot an automated irrigation system combined with remote-sensing techniques and soil mapping that allows the establishment of regulated deficit irrigation (RDI) strategies. The study was carried out over 3 years (2015-2017) in a commercial hedgerow olive orchard of the variety 'Arbequina' located in Alvarado (Extremadura, Spain). An apparent electrical conductivity (ECa) map and a normalized difference vegetation index (NDVI) map were generated to characterize the spatial variability of the plot and classify the zones in homogeneous areas. Then, reference points were selected to monitor the different irrigation sectors. In 2015, the plot was irrigated according to the farmer's technical criteria throughout the plot. In 2016 and 2017, two different areas of the plot were irrigated applying an RDI strategy, one under expert supervision and the other automatically. The results show that in a heterogeneous plot the use of new technologies can be useful to establish the ideal location for an automatic irrigation system. Furthermore, automatic irrigation scheduling made it possible to establish an RDI strategy recommended by an expert, resulting in the homogenization of production throughout the plot without the need for human intervention.

Importance of the list of essential medicines in medical prescription.

The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists.La implementación en instituciones de salud de un cuadro básico permite adquirir y administrar una larga lista de medicamentos que presenta a los médicos las alternativas de tratamiento, así como la descripción académica colegiada de indicaciones, dosis, efectos secundarios, interacciones y análisis de costo-beneficio, con lo que se facilita la prescripción médica y la administración de insumos para la salud. El Comité de Ética y Transparencia en la Relación Médico-Industria emite diversas recomendaciones para la optimización de los beneficios generados por los cuadros básico de medicamentos.

Medical prescription: conditioned reflex or conscious reflection?

Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.

Self-medication and self-prescription.

Self-medication and self-prescription are actions undertaken by patients; the former, as an element of self-care that involves over-the-counter drugs, and the latter, as a violation of the Statute of Health, since it includes drugs that can only be dispensed with a medical prescription. All the drawbacks that have been attributed to self-medication are actually associated with self-prescription.La automedicación y la autoprescripción son acciones de los pacientes; la primera como elemento del autocuidado que involucra medicamentos de venta libre y la segunda como una violación a la ley de salud, pues comprende medicamentos que solo pueden expenderse con receta. Todos los inconvenientes que se han atribuido a la automedicación en realidad lo son de la autoprescripción.

Recommendations for the sale and promotion of dermocosmetic treatments at the office.

A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.

Conflictos de intereses en medicina. Recomendaciones del CETREMI.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Los conflictos de interés son situaciones en las que el juicio y la integridad de las decisiones o acciones médicas son influidas por un interés secundario, frecuentemente de tipo económico. El Comité de Ética y Transparencia en la Relación Médico-­Industria de la Academia Nacional de Medicina de México reconoce que estos conflictos ocurren en la vida diaria de los profesionales de la salud, pero también en las instituciones de servicios de salud públicas y privadas, así como en la academia y en la investigación. Por ello, es necesario identificar situaciones de conflicto y actuar siempre de acuerdo con el interés del paciente.

Libertad de prescripción médica.

Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.

Los médicos requieren flexibilidad para sus prescripciones. Sin embargo, algunos límites están marcados tanto por el conocimiento vigente como por las restricciones de acceso, normas y reglamentos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) propone varias sugerencias para ayudar a los pacientes, que incluyen la selección de las mejores alternativas para cada caso, la protocolización de variaciones a los estándares de prescripción (dosis, indicaciones, etcétera) por escrito en el expediente y eludir modas, novedades no probadas, argumentos simplemente publicitarios o promocionales y conflictos de interés.

Conflicts of interest in medicine. CETREMI recommendations.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Importancia de la investigación clínica independiente en la medicina: dificultades y recomendaciones.

Clinical research is the most important tool for the identification of diagnostic and therapeutic strategies that derive in higher efficacy and safety. Despite its significance, successful implementation of clinical research faces numerous difficulties, with one the most relevant being limited availability of resources for the performance of independent clinical trials. Generally, the pharmaceutical industry absorbs the costs associated with most clinical trials; however, this can generate dissociation between subjects of interest and health priorities when economic interest is the main driver of these protocols. In addition to the relevant role played by the pharmaceutical industry, it is important that government agencies favor adequate conditions, both in economic and regulatory aspects, for the implementation of independent clinical research that addresses subjects of medical and therapeutic interest, even if it does not generate corporate economic benefits.

La investigación clínica es la herramienta de mayor importancia para la identificación de estrategias diagnósticas y terapéuticas que deriven en mayor eficacia y seguridad. A pesar de su trascendencia, la implementación exitosa de la investigación clínica presenta numerosas dificultades; entre las más relevantes se encuentra la poca disponibilidad de recursos para realizar ensayos clínicos independientes. Por lo general, la industria farmacéutica absorbe los costos asociados con la mayoría de los ensayos clínicos, sin embargo, esto puede generar una disociación entre los temas de interés y las prioridades en salud, al existir interés económico como principal motivación de estos protocolos. Además del papel relevante de la industria farmacéutica, es importante que las instancias gubernamentales favorezcan las condiciones, tanto económicas como regulatorias, para la implementación de investigación clínica independiente, que aborde temas de interés médico y terapéutico, aunque no genere beneficios económicos empresariales.

Sugerencias en torno a medicamentos de efectividad demostrada sin interés comercial para la industria farmacéutica.

Varios medicamentos de adecuada eficacia han sido retirados del mercado por razones financieras, ya sea por su reducido precio (la patente ha expirado) o porque han sido sustituidos por nuevos fármacos (con patentes vigentes); otros tantos no han sido desarrollados porque las enfermedades contra las que van dirigidos no son económicamente promisorias debido al tipo de población que las padece (estratos económicamente marginados o sin significación numérica). Deberán establecerse lineamientos e incentivos para la industria farmacéutica y de biotecnología.Several drugs with adequate efficacy have been withdrawn from the market for financial reasons, either due to their reduced price (the patent has expired) or because they have been substituted with new drugs (with patents in force); many others have not been developed because the diseases they are directed against are not economically promising owing to the type of population that suffers from them (economically marginalized or numerically non-significant strata). Guidelines and incentives for the pharmaceutical and biotechnological industry should be established.

Recomendaciones para la prescripción segura de opioides en el manejo del dolor crónico no oncológico.

El tratamiento del dolor crónico severo es una meta histórica de la medicina. Los opioides naturales (como la morfina) se han usado por muchos años y la aparición reciente de opioides sintéticos se ha sumado a esta opción terapéutica, sin embargo, el potencial adictivo de estas sustancias obliga a la reglamentación de su uso. Las agencias médicas internacionales recomiendan prudencia en el uso terapéutico de opioides.The treatment of chronic and severe pain is a principal goal of medicine. Natural opioids have been used for several years, and the recent development of synthetic opioids has increased therapeutic options; however, the addictive potential of these substances obliges the regulation of their use. International agencies recommend prudent rules in the therapeutic use of opioids.

[Recomendaciones a los cuerpos directivos de las agrupaciones médicas en su relación con la industria].

Continuing medical education activities are often financially supported by pharmaceutical and device companies. With the purpose to ensure ethics and accountability in the management of this assistance, the Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico formulates recommendations to medical associations' leaders in this text.

Las actividades de educación médica continua con frecuencia son apoyadas financieramente por la industria farmacéutica y de implementos médicos. Con el propósito de velar por la ética y rendición de cuentas en el manejo de estos apoyos, en el presente texto el Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi) de la Academia Nacional de Medicina de México formula recomendaciones a los directivos de agrupaciones médicas.

[El consentimiento informado: recomendaciones para su documentación].

Informed consent is an indispensable element to obtain adequate patient participation either in research protocols or in therapeutic design. The Committee of Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine developed several recommendations for informed consent to be documented.

El consentimiento informado es un elemento indispensable para obtener la adecuada participación del paciente, ya sea en protocolos de investigación o en diseños terapéuticos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) de la Academia Nacional de Medicina elaboró varias recomendaciones para documentar el consentimiento informado.

[What can doctors do to moderate healthcare costs?] / ¿Qué podemos hacer los médicos para moderar los costos de la atención médica?

Los costos de la atención médica pueden alcanzar niveles tales que marginen a algunos pacientes de los beneficios del avance científico y tecnológico. Las razones de estos elevados costos son diversas y en la mayoría de los casos no está en manos de los médicos moderarlos. En este escrito se proponen algunas acciones que los médicos podemos realizar para disminuir los costos de la atención médica. La magnitud del ahorro que se puede alcanzar con estas medidas es modesta, puesto que la mayor parte de los costos no dependen de los médicos, pero se trata de ofrecer nuestra contribución. Evitar todo lo superfluo: no más medicamentos ni estudios que los estrictamente necesarios, sin medicina defensiva; y no ceder ante la presión de pacientes y familiares para que se prescriban pruebas o medicamentos inútiles.

[Concept of "opinion leader": Recommendations of the Committee on Ethics and Transparency in the Medical-Industry Relationship (CETREMI) of the National Academy of Medicine (ANM)]. / Concepto de «líder de opinión¼: recomendaciones del Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) de la Academia Nacional de Medicina (ANM).

La relación que involucra al médico y la industria abarca un espectro amplio de formas, para lo cual se requiere una exposición clara y transparente de términos y principios. Uno de los objetivos primordiales de la industria es contar con un respaldo académico que le permita dar a conocer las características y las propiedades de sus productos -eficacia, eficiencia y seguridad- con el propósito de ser prescritos y usados. Los fines de la industria son la venta de sus productos, el reconocimiento como empresas de prestigio y la ganancia económica. Implícitamente, para CETREMI el principio de mayor importancia en esta relación es indudablemente el beneficio del enfermo.

[Ethics and transparency committee of physicians in their relationship with the pharmaceutics: Industry recommendations for physician support]. / Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI); recomendaciones a la industria para el apoyo de los médicos.

Las siguientes recomendaciones a la industria farmacéutica se fundamentan en los principios éticos del CETREMI: - El paciente es lo primero: • Que la atención sea óptima para todos los pacientes. Que las compañías farmacéuticas apoyen las decisiones del médico que garanticen el tratamiento más eficaz, seguro, accesible y adecuado. • Que las compañías farmacéuticas colaboren para que los pacientes tengan acceso fácil y oportuno a los medicamentos. • Que las compañías farmacéuticas colaboren para que la información sobre los tratamientos beneficie a los pacientes en todos los rubros, incluyendo el económico.

Post-implementation surveillance of a non-pharmacological health technology within a national health service.

OBJECTIVES: The aim of this study was to describe 8-year results from post-implementation surveillance of neuroreflexotherapy (NRT), a health technology proven effective for treating neck and back pain. METHODS: Post-implementation surveillance included all patients undergoing NRT across five regions within the Spanish National Health Service (SNHS). Validated methods were used to assess pain, disability, adverse events, use of health resources, and patient satisfaction. Logistic regression models were developed to identify the variables associated with the risk of a pain episode requiring more than one NRT intervention. The number of relapses among discharged patients during the 8-year period was calculated. RESULTS: Between January 1, 2004, and June 30, 2012, 9,023 patients (median age: 53 years), presenting 11,384 subacute (25.2 percent) and chronic (74.8 percent), neck or back pain episodes, were discharged after receiving NRT. Spinal pain improved in 89 percent of cases, 83 percent abandoned drugs, and 0.02 percent required spine surgery. The only adverse event was skin discomfort (8.0 percent of patients). Number of patient complaints was 0, and answers to a standardized questionnaire reflected a high degree of satisfaction (response rate: 76.7 percent). Of the pain episodes, 18.9 percent required more than one NRT intervention; logistic regression models identified the variables associated with this. Over the 8-year period, the proportion of discharged patients referred for treatment due to relapse at the same level for neck, thoracic, and low back pain, was 16.4 percent, 6.5 percent, and 14.5 percent respectively. CONCLUSIONS: Post-marketing surveillance for a non-pharmacological technology is feasible within the SNHS. These results support generalizing NRT across the entire SNHS under the current validated application conditions.

Lumbar spine: agreement in the interpretation of 1.5-T MR images by using the Nordic Modic Consensus Group classification form.

PURPOSE: To evaluate intra- and interobserver agreement for the interpretation of lumbar 1.5-T magnetic resonance (MR) images in a community setting. MATERIALS AND METHODS: The study design was approved by the Institutional Review Board of the Ramón y Cajal Hospital. According to Spanish law, for this type of study, no informed consent was necessary. Five radiologists from three hospitals twice interpreted lumbar MR examination results in 53 patients with low back pain, with at least a 14-day interval between assessments. Radiologists were unaware of the clinical and demographic characteristics of the patients and of their colleagues' assessments. At the second assessment, they were unaware of the results of the first assessment. Reports on Modic changes, osteophytes, Schmorl nodes, diffuse defects, disk degeneration, annular tears (high-signal-intensity zones), disk contour, spondylolisthesis, and spinal stenosis were collected by using the Spanish version of the Nordic Modic Consensus Group classification. The kappa statistic was used to assess intra- and interobserver agreement for findings with a prevalence of 10% or greater and 90% or lower. kappa was categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), or poor (<0.00). RESULTS: Endplate erosions and spondylolisthesis were observed in less than 10% of images. Intraobserver reliability was almost perfect for spinal stenosis; substantial for Modic changes, Schmorl nodes, disk degeneration, annular tears, and disk contour; and moderate for osteophytes. Interobserver reliability was moderate for Modic changes, Schmorl nodes, disk degeneration, annular tears, and disk contour; fair for osteophytes; and poor for spinal stenosis. CONCLUSION: In conditions close to those of clinical practice, there was only moderate interobserver agreement in the reporting of findings at 1.5-T lumbar MR imaging. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090706/-/DC1.