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Pinés-Corrales PJ, Hanzu FA, Casañ Fernández R, Fernández Martínez A, Tejera Pérez C, Escalada San Martín FJ, Bretón Lesmes I. Survey on Endocrinology and Nutrition undergraduate teaching in Spain-2021. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:36-49. [PMID: 37604746 DOI: 10.1016/j.endien.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/10/2022] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Advances in endocrinology and nutrition (E&N) and the importance of its associated disorders require that its teaching within the medical degree meets adequate standards of quality and homogeneity Our objective was to expand the data on E&N undergraduate teaching in Spain. METHODS We designed an observational, cross-sectional web-based study addressed to the coordinators of E&N teaching at the 42 faculties of medicine that had taught the subject during the 2020-2021 academic year. RESULTS One in three faculties had a professor who was an E&N specialist, but less than half had a full professor of E&N. There is great variability in teaching programmes, although most of them dedicate 6 ECTS credits to the subject. Over two-thirds of the faculties maintain theoretical lessons with over 50 students per class. Most programmes dedicate between four and six hours to hypothalamic pituitary disorders, thyroid diseases and adrenal gland disorders. However, there is great variability in the time dedicated to diabetes and nutrition. In one-third of the faculties, students are not required to do a rotation in the E&N department. Teachers at the universities widely participate in undergraduate/master's students' final projects and master's degree studies. CONCLUSIONS The E&N specialty maintains a good position within universities, but there is still great heterogeneity in the teaching structure of the subject.
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Affiliation(s)
| | | | | | | | | | - F Javier Escalada San Martín
- Clínica Universidad de Navarra, CIBER Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Grupo de Obesidad y Adipobiología, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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García Blasco L, Pinés Corrales PJ, Hanzu F, Fernández Martínez A, Bretón Lesmes I, Escalada San Martín J. A survey on the perception of the specialty of Endocrinology and Nutrition among students preparing for the entrance exam for medical specialty training in Spain. ENDOCRINOL DIAB NUTR 2023; 70:240-244. [PMID: 37116969 DOI: 10.1016/j.endien.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/08/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION AND AIMS Previous studies have shown that there is decreasing interest in E&N among medical students. The aim of our study was to evaluate the perception of E&N among a sample of medical students. MATERIAL AND METHODS We surveyed 2252 students prior to taking the exam that allows access to specialised training in Spain. RESULTS Overall, 9.9% (222 participants) would probably choose E&N. The most positive aspects in includes of the specialty are its logical pathophysiological basis (54%) and that the work is dynamic and varied (27%), while the least attractive aspects are the few interventional techniques. The parts of the specialty that most attract students are hypothalamic-pituitary disease and diabetes mellitus. CONCLUSIONS The proportion of candidates who want to study E&N as their first choice is adequate in relation to the number of places available.
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Affiliation(s)
- Lourdes García Blasco
- Complejo Hospitalario Universitario de Albacete [University Hospital Complex of Albacete], Spain.
| | - Pedro J Pinés Corrales
- Complejo Hospitalario Universitario de Albacete [University Hospital Complex of Albacete], Spain
| | - Felicia Hanzu
- Hospital Universitari Clínic de Barcelona [Clinical University Hospital of Barcelona], Spain
| | | | - Irene Bretón Lesmes
- Hospital General Universitario Gregorio Marañón [Gregorio Marañón General University Hospital], Spain
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Pinés-Corrales PJ, Hanzu FA, Casañ Fernández R, Fernández Martínez A, Tejera Pérez C, Escalada San Martín FJ, Bretón Lesmes I. Encuesta sobre la docencia pregrado de Endocrinología y Nutrición en España-2021. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sifontes-Dubón M, García-López JM, González-Ortega N, Pazos-Couselo M. Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer. J Clin Med 2021; 10:jcm10235681. [PMID: 34884383 PMCID: PMC8658455 DOI: 10.3390/jcm10235681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer. Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015–2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment. Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not. Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.
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Affiliation(s)
- Mildred Sifontes-Dubón
- Doctoral Programme in Medicine Clinical Research, International PhD School of the University of Santiago de Compostela (EDIUS), 15782 Santiago de Compostela, Spain
- Endocrinology Department, Mateu Orfila General Hospital, 07703 Mahón, Spain
- Correspondence: or ; Tel.: +34-971487325
| | - Jose Manuel García-López
- Endocrinology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - Marcos Pazos-Couselo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
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Gómez-Pérez AM, Fernández-García JC, Iglesias P, Díez JJ, Álvarez-Escolá C, Lecumberri B, Lucas-Martín A, Donnay S, Cabrejas-Gómez C, Menéndez-Torre E, Galofré JC. Diagnosis and treatment of thyroid nodules in Spain. Results of a national survey. ACTA ACUST UNITED AC 2020; 67:438-445. [PMID: 31926931 DOI: 10.1016/j.endinu.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Thyroid nodule (TN) is a common reason for consultation in daily practice. The purpose of this study was to evaluate the diagnosis and treatment of TNs in our environment and to assess the current status regarding the existence and structure of high-resolution TN clinics. MATERIAL AND METHODS Members of the Spanish Society of Endocrinology and Nutrition were invited in 2018 to participate in an online survey on the diagnostic and therapeutic processes of TN. RESULTS A total of 211 valid surveys were received. Of all respondents, 30.8% stated that there were high-resolution TN clinics in their environment, with the endocrinologist being the main person responsible for performing ultrasonography (87.7%) and fine needle aspiration (FNA) (69.2%). For ultrasound classification of TNs, 32.7% used the ATA criteria, 32.2% the TI-RADS criteria, and 22.7% no classification. In situ verification of sample suitability was performed in 35.5% of the cases, and molecular analysis in 8.1%. With regard to clinical discharge, 65.4% would consider it after 5 years of follow-up and with a benign FNA. In the event of a Bethesda III result, 50.2% of respondents would repeat FNA and 35.5% would opt for surgery; if a Bethesda IV result was found, 95.8% would opt for surgery. CONCLUSIONS High-resolution TN clinics are structures increasingly implemented in our environment where the endocrinologist is the main person responsible for performing ultrasonography and FNA. The standard clinical practice in our specialty is consistent with most recommendations concerning clinical practice guidelines for TNs.
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Affiliation(s)
- Ana María Gómez-Pérez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, España
| | - José Carlos Fernández-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, España.
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, España
| | - Juan J Díez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, España
| | | | - Beatriz Lecumberri
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, España
| | - Anna Lucas-Martín
- Servicio de Endocrinología y Nutrición, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Sergio Donnay
- Servicio de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Edelmiro Menéndez-Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan Carlos Galofré
- Servicio de Endocrinología y Nutrición, Clínica Universidad de Navarra. Pamplona, Navarra, España
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Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics. J Clin Med 2019; 8:jcm8122172. [PMID: 31818026 PMCID: PMC6947274 DOI: 10.3390/jcm8122172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. DESIGN AND METHODS A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. RESULTS A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. CONCLUSION In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.
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Carral F, Ayala MDC, Jiménez AI, García C, Robles MI, Porras E, Vega V. Diagnostic performance of the American Thyroid Association ultrasound risk assessment of thyroid nodules in endocrinology (the ETIEN 3 study). ACTA ACUST UNITED AC 2019; 67:130-136. [PMID: 31129037 DOI: 10.1016/j.endinu.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION No study has been published to date in Spain about the value of the American Thyroid Association (ATA) ultrasound risk assessment of thyroid nodules applied by endocrinologists. OBJECTIVES To assess the diagnostic performance of ATA thyroid nodule risk classification applied by endocrinologists with respect to histological results. METHODS A retrospective, observational study of 317 patients (mean age, 51.7±13.7 years; 83.3% women) with thyroid nodules (maximum diameter: 3.2±1.4cm) who underwent US-guided FNA in endocrinology between October 2015 and December 2018, were classified based on the ATA ultrasound risk assessment. Surgery was performed in all of them. Quality criteria of the ultrasound classification were assessed as compared to histological results. RESULTS Overall, 61.2% of nodules assessed were classified as benign (n=3) and very low (n=60) or low suspicion (n=131), 11.7% as intermediate suspicion (n=37), and 27.1% as high suspicion (n=86). Benign nodular disease was found in 260 patients, and thyroid cancer in 57 patients. There were 14 incidental papillary microcarcinomas. Classification of thyroid nodules as high suspicion showed a high diagnostic performance to identify malignant nodules (87.7% sensitivity, 86.2% specificity, negative predictive value 97.0%), improving sensitivity (93.0%) and reducing specificity (73.1%) when considering high and intermediate suspicion nodules as a risk for thyroid cancer. CONCLUSIONS Application by endocrinologists of the ATA ultrasound risk assessment of thyroid nodules shows a high diagnostic performance to identify malignant thyroid nodules before surgery.
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Affiliation(s)
- Florentino Carral
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España.
| | - María Del Carmen Ayala
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - Ana Isabel Jiménez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - Concepción García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - María Isabel Robles
- Unidad de Gestión Clínica de Cirugía General, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - Eulalia Porras
- Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - Vicente Vega
- Unidad de Gestión Clínica de Cirugía General, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
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García Pascual L, Surralles ML, Morlius X, González Mínguez C, Viscasillas G, Lao X. Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. ACTA ACUST UNITED AC 2019; 66:495-501. [PMID: 30858021 DOI: 10.1016/j.endinu.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda categoryI cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda categoryI results. PATIENTS AND METHOD A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories BethesdaII and BethesdaVI. RESULTS Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda categoryI results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). CONCLUSIONS Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda categoryI, whose risk has been higher in older subjects and with larger nodules.
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Affiliation(s)
- Luis García Pascual
- Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - Maria Lluïsa Surralles
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Morlius
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Clarisa González Mínguez
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Guillem Viscasillas
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Lao
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
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Díaz-Soto G, García Calvo S, Martínez-Pino I, Álvarez-Quiñones M. Learning curve of thyroid fine-needle aspiration citology in a thyroid nodule clinic. ACTA ACUST UNITED AC 2018; 65:421-423. [PMID: 29859730 DOI: 10.1016/j.endinu.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/14/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Gonzalo Díaz-Soto
- Unidad de Alta Resolución de Tiroides, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, IEN-Universidad de Valladolid, Valladolid, España.
| | - Susana García Calvo
- Unidad de Alta Resolución de Tiroides, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, IEN-Universidad de Valladolid, Valladolid, España
| | - Isabel Martínez-Pino
- Servicio de Epidemiología, Dirección General de Salud Pública, Junta de Castilla y León, CIBERESP-ISCIII, Valladolid, España
| | - María Álvarez-Quiñones
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Zambrana-García JL, Torres-Jiménez M, Rubio-Sánchez JM, Montijano-Cabrera A, Peña-Ojeda JA, Velasco-Malagón MJ. [Clinical processes in a high resolution clinic of specialist outpatient clinics]. ACTA ACUST UNITED AC 2016; 32:82-88. [PMID: 27793461 DOI: 10.1016/j.cali.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The high resolution clinic (HRC) is an outpatient care process by which treatment and diagnosis are established, recorded, and completed in a single day. The aim of this study was to assess the extent to which patients with medical conditions may benefit from a single consultation system. MATERIAL AND METHODS A descriptive study of 795 first visit events, randomly selected as high-resolution consultations in cardiology, gastroenterology, internal medicine, and chest diseases. A discussion is presented on the percentage of patients who benefited from HRC and the complementary tests performed. RESULTS A total of 559 (70%, 95% CI: 67-73%) of all first visits became HRCs, and 483 (61%, 95% CI: 57%-64%) required a diagnostic test that was reviewed on the same day. There were differences between medical consultations (86% in cardiology versus 44% in gastroenterology consultations, P<.001). Performing a test on the same day significantly increased the percentage of HRCs (49 versus 22%, P<.001). Ischaemic heart disease, dyspepsia, headache, and asthma were the conditions most commonly leading to HRC. The most common tests were cranial tomography, blood analysis, and ultrasound. CONCLUSIONS Medical consultations may largely benefit from an HRC system, only requiring some organisational changes and no additional costs.
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Affiliation(s)
- J L Zambrana-García
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España.
| | - M Torres-Jiménez
- Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, España
| | - J M Rubio-Sánchez
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España
| | | | - J A Peña-Ojeda
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España
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