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Delgado-Lista J, Mostaza JM, Arrobas-Velilla T, Blanco-Vaca F, Masana L, Pedro-Botet J, Perez-Martinez P, Civeira F, Cuende-Melero JI, Gomez-Barrado JJ, Lahoz C, Pintó X, Suarez-Tembra M, Lopez-Miranda J, Guijarro C. Consensus on lipoprotein(a) of the Spanish Society of Arteriosclerosis. Literature review and recommendations for clinical practice. Clin Investig Arterioscler 2024:S0214-9168(24)00023-8. [PMID: 38599943 DOI: 10.1016/j.arteri.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
The irruption of lipoprotein(a) (Lp(a)) in the study of cardiovascular risk factors is perhaps, together with the discovery and use of proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor drugs, the greatest novelty in the field for decades. Lp(a) concentration (especially very high levels) has an undeniable association with certain cardiovascular complications, such as atherosclerotic vascular disease (AVD) and aortic stenosis. However, there are several current limitations to both establishing epidemiological associations and specific pharmacological treatment. Firstly, the measurement of Lp(a) is highly dependent on the test used, mainly because of the characteristics of the molecule. Secondly, Lp(a) concentration is more than 80% genetically determined, so that, unlike other cardiovascular risk factors, it cannot be regulated by lifestyle changes. Finally, although there are many promising clinical trials with specific drugs to reduce Lp(a), currently only iPCSK9 (limited for use because of its cost) significantly reduces Lp(a). However, and in line with other scientific societies, the SEA considers that, with the aim of increasing knowledge about the contribution of Lp(a) to cardiovascular risk, it is relevant to produce a document containing the current status of the subject, recommendations for the control of global cardiovascular risk in people with elevated Lp(a) and recommendations on the therapeutic approach to patients with elevated Lp(a).
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Affiliation(s)
- Javier Delgado-Lista
- Unidad de Lípidos y Aterosclerosis, Servicio de Medicina Interna, Hospital Universitario Reina Sofía; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba; IMIBIC, Córdoba; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España.
| | - Jose M Mostaza
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| | - Teresa Arrobas-Velilla
- Sociedad Española de Medicina de Laboratorio (SEQCML), Laboratorio de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Francisco Blanco-Vaca
- Departamento de Bioquímica Clínica, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona; Departamento de Bioquímica y Biología Molecular, Universitat Autònoma de Barcelona, 08193 Barcelona; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Tarragona, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Pablo Perez-Martinez
- Unidad de Lípidos y Aterosclerosis, Servicio de Medicina Interna, Hospital Universitario Reina Sofía; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba; IMIBIC, Córdoba; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - Fernando Civeira
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza; CIBER Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - Jose I Cuende-Melero
- Consulta de Riesgo Vascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - Jose J Gomez-Barrado
- Unidad de Cuidados Cardiológicos Agudos y Riesgo Cardiovascular, Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | - Carlos Lahoz
- Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, España
| | - Xavier Pintó
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge-Idibell-Universidad de Barcelona-CiberObn, España
| | - Manuel Suarez-Tembra
- Unidad de Lípidos y RCV, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Jose Lopez-Miranda
- Unidad de Lípidos y Aterosclerosis, Servicio de Medicina Interna, Hospital Universitario Reina Sofía; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba; IMIBIC, Córdoba; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España.
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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2
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Pavía-López AA, Magaña-Serrano JA, Cigarroa-López JA, Chávez-Mendoza A, Mayorga-Butrón JL, Araiza-Garaygordobil D, Ivey-Miranda JB, Méndez-Machado GF, González-Godínez H, Aguilera-Mora LF, Jordán-Ríos A, Olmos-Domínguez L, Olalde-Román MJ, Miranda-Malpica EM, Vázquez-Ortiz Z, Rayo-Chávez J, Mendoza AA, Márquez-Murillo MF, Chávez-Leal SA, Gabriel AÁS, Silva-García MA, Pacheco-Bouthiller AD, Aldrete-Velazco JA, Guizar-Sánchez CA, Gaxiola-López E, Guerra-López A, Figueiras-Graillet L, Sánchez-Miranda G, Mendoza-Zavala GH, Aceves-García M, Chávez-Negrete A, Arroyo-Hernández M, Montaño-Velázquez BB, Romero-Moreno LF, Baquero-Hoyos MM, Velasco-Hidalgo L, Rodríguez-Lozano AL, Aguilar-Gómez NE, Rodríguez-Vega M, Cossío-Aranda JE. Clinical practice guidelines for diagnostic and treatment of the chronic heart failure. Arch Cardiol Mex 2024; 94:1-74. [PMID: 38648647 DOI: 10.24875/acm.m24000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.
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Affiliation(s)
- Abel A Pavía-López
- Coordinador de las Guías Mexicanas de Práctica Clínica de la Sociedad Mexicana de Cardiología, Centro Médico ABC, Ciudad de México, México
| | - José A Magaña-Serrano
- Jefe de la División de Insuficiencia Cardiaca y Trasplante, Hospital Asociación Mexicana de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
- Presidente de la Asociación Mexicana de Insuficiencia Cardiaca, Ciudad de México, México
| | - José A Cigarroa-López
- Jefe de la Clínica de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Jefe de la Clínica de Insuficiencia Cardiaca Hospital de Día, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - José L Mayorga-Butrón
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Ibero American Agency for Development & Assessment of Health Technologies
| | - Diego Araiza-Garaygordobil
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan B Ivey-Miranda
- Adscrito a la Clínica de Insuficiencia Cardiaca Avanzada y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Gustavo F Méndez-Machado
- Cardiólogo Especialista en Insuficiencia Cardiaca, Imperial College, Londres, Reino Unido
- Unidad de Investigación Clínica Hospital Ángeles Xalapa, Veracruz, México
| | | | - Luisa F Aguilera-Mora
- Directora de la Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | - Antonio Jordán-Ríos
- Coordinador Digital, Sociedad Mexicana de Cardiología A.C., México
- Cardiólogo Clínico, Ecocardiografía Adultos, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis Olmos-Domínguez
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Marcos J Olalde-Román
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Rayo-Chávez
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Alexandra A Mendoza
- Cardióloga Especialista en Medicina Crítica, Centro Médico ABC Observatorio, Ciudad de México, México
- Jefa de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Manlio F Márquez-Murillo
- Cardiólogo Especialista en Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sergio A Chávez-Leal
- Clínica de Insuficiencia Cardiaca, SIMNSA Health Care, Tijuana, Baja California, México
| | - Amada Álvarez-San Gabriel
- Coordinadora del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Marissa A Silva-García
- Cardióloga Adscrita en el Hospital de Ginecología y Obstetricia No. 4 Luis Castelazo Ayala
| | - Alex D Pacheco-Bouthiller
- Director de la Clínica de Arritmias y Estimulación Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | | | - Carlos A Guizar-Sánchez
- Coordinador del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital Central Sur, PEMEX, Ciudad de México, México
| | | | | | | | | | - Genaro H Mendoza-Zavala
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Moisés Aceves-García
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Marisol Arroyo-Hernández
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Servicio de Neumología, Instituto Nacional de Cancerología, Tlapan, México
| | - Bertha B Montaño-Velázquez
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Luis F Romero-Moreno
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Médico Adscrito a la Fundación Hospital de la Misericordia, Bogotá, Colombia
| | - María M Baquero-Hoyos
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Liliana Velasco-Hidalgo
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Ana L Rodríguez-Lozano
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nancy E Aguilar-Gómez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mario Rodríguez-Vega
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Fuxman C, Sicilia B, Linares ME, García-López S, González Sueyro R, González-Lamac Y, Zabana Y, Hinojosa J, Barreiro-de Acosta M, Balderramo D, Balfour D, Bellicoso M, Daffra P, Morelli D, Orsi M, Rausch A, Ruffinengo O, Toro M, Sambuelli A, Novillo A, Gomollón F, De Paula JA. GADECCU 2022 Guideline for the treatment of Ulcerative Colitis. Adaptation and updating of the GETECCU 2020 Guideline. Gastroenterol Hepatol 2023; 46 Suppl 1:S1-S56. [PMID: 36731724 DOI: 10.1016/j.gastrohep.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Ulcerative colitis (UC) is a chronic inflammatory disease that compromises the colon, affecting the quality of life of individuals of any age. In practice, there is a wide spectrum of clinical situations. The advances made in the physio pathogenesis of UC have allowed the development of new, more effective and safer therapeutic agents. OBJECTIVES To update and expand the evaluation of the efficacy and safety of relevant treatments for remission induction and maintenance after a mild, moderate or severe flare of UC. RECIPIENTS Gastroenterologists, coloproctologists, general practitioners, family physicians and others health professionals, interested in the treatment of UC. METHODOLOGY GADECCU authorities obtained authorization from GETECCU to adapt and update the GETECCU 2020 Guide for the treatment of UC. Prepared with GRADE methodology. A team was formed that included authors, a panel of experts, a nurse and a patient, methodological experts, and external reviewers. GRADE methodology was used with the new information. RESULTS A 118-page document was prepared with the 44 GADECCU 2022 recommendations, for different clinical situations and therapeutic options, according to levels of evidence. A section was added with the new molecules that are about to be available. CONCLUSIONS This guideline has been made in order to facilitate decision-making regarding the treatment of UC, adapting and updating the guide prepared by GETECCU in the year 2020.
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Affiliation(s)
- Claudia Fuxman
- Servicio de Gastroenterología, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Beatriz Sicilia
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España
| | - María Eugenia Linares
- Servicio de Gastroenterología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Santiago García-López
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, España
| | - Ramiro González Sueyro
- Servicio de Gastroenterología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Yago González-Lamac
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Yamile Zabana
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Mútua Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, España
| | - Joaquín Hinojosa
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital de Manise, Valencia, España
| | - Manuel Barreiro-de Acosta
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Domingo Balderramo
- Servicio de Gastroenterología, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Deborah Balfour
- Unidad de Enfermedades Inflamatorias, HIGEA Clínica de Gastroenterología, Mendoza, Argentina
| | - Maricel Bellicoso
- Área de Gastroenterología, Inmunología Buenos Aires, Buenos Aires, Argentina
| | - Pamela Daffra
- Servicio de Gastroenterología, Hospital Central de Mendoza, Mendoza, Argentina
| | - Daniela Morelli
- Departamento de Educación, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Marina Orsi
- Servicio de Gastroenterología Pediátrica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Astrid Rausch
- Servicio de Gastroenterología, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Orlando Ruffinengo
- Servicio de Gastroenterología, Hospital Provincial del Centenario, Rosario, Argentina
| | - Martín Toro
- Unidad de Enfermedades Inflamatorias, HIGEA Clínica de Gastroenterología, Mendoza, Argentina
| | - Alicia Sambuelli
- Sección de Enfermedades Inflamatorias Intestinales, Hospital Bonorino Udaondo, Buenos Aires, Argentina
| | - Abel Novillo
- Servicio de Gastroenterología, Sanatorio 9 de Julio, Tucumán, Argentina.
| | - Fernando Gomollón
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Instituto de Investigaciones Sanitarias de Aragón, Hospital Clínico Universitario Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestiva (CIBEREHD), Zaragoza, España
| | - Juan Andrés De Paula
- Servicio de Gastroenterología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Bautista-Molano W, Saldarriaga-Rivera LM, Junca-Ramírez A, Fernández-Aldana AR, Fernández-Ávila DG, Jaimes DA, Jauregui EA, Segura-Charry JS, Romero-Sanchez C, Felipe-Diaz OJ. 2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology. Reumatol Clin (Engl Ed) 2022; 18:191-199. [PMID: 35305953 DOI: 10.1016/j.reumae.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Axial Spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. OBJECTIVE To develop a set of recommendations based on the best available evidence for early detection, diagnosis, treatment and monitoring adult patients with axial spondyloarthritis. METHODS A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations with regard to diagnosis (n = 2), pharmacological treatment (n = 6), non-pharmacological treatment (n = 2) and monitoring (n = 1) are presented. RESULTS Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A is recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. CONCLUSIONS This set of recommendations provides an updated guide on the diagnosis, treatment and monitoring of patients with axial spondyloarthritis.
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Affiliation(s)
- Wilson Bautista-Molano
- Sección de Reumatología, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia.
| | - Lina M Saldarriaga-Rivera
- Servicio de Reumatología, Hospital Universitario San Jorge, Facultad de Medicina, Universidad Tecnológica de Pereira, Institución Universitaria Visión de las Américas, Clínica Los Rosales, Pereira, Colombia
| | - Alejandro Junca-Ramírez
- Servicio de Reumatología, Colsanitas, IPS Especializada, Colombia Bienestar IPS, Bogotá, Colombia
| | | | - Daniel G Fernández-Ávila
- Servicio de Reumatología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego A Jaimes
- Universidad de la Sabana, Clínicos IPS, Bogotá, Colombia
| | - Edwin A Jauregui
- Servicio de Reumatología, Riesgo de Fractura SA, Cayre IPS, Bogotá, Colombia
| | - Juan S Segura-Charry
- Servicio de Reumatología, Clínica Medilaser Neiva, Clínicos IPS, Bogotá, Colombia
| | - Consuelo Romero-Sanchez
- Servicio de Reumatología e Inmunología, Hospital Militar Central, Grupo Inmunología Celular y Molecular, Universidad del Bosque, Bogotá, Colombia
| | - Oscar J Felipe-Diaz
- Servicio de Reumatología, Medicarte SA, Clínica Las Vegas, Medellín, Colombia
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5
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. [Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies. Arch Bronconeumol 2022; 58:T150-T158. [PMID: 35971814 DOI: 10.1016/j.arbres.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, Spain
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião • CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, Spain
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, Spain
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, Spain
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, Spain
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, Spain
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, Spain
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, Spain
| | - José Sanz
- Sociedad Española de Inmunología Clínica•Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, Spain
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Pavía-López AA, Alcocer-Gamba MA, Ruiz-Gastelum ED, Mayorga-Butrón JL, Mehta R, Díaz-Aragón FA, Aldrete-Velasco JA, López-Juárez N, Cruz-Bautista I, Chávez-Mendoza A, Secchi-Nicolás NC, Guerrero-Martínez FJ, Cossio-Aranda JE, Mendoza-Zubieta V, Fanghänel-Salmon G, Valdivia-Proa M, Olmos-Domínguez L, Aguilar-Salinas CA, Dávila-Maldonado L, Vázquez-Rangel A, Pavia-Aubry V, Nava-Hernández MDLA, Hinojosa-Becerril CA, Anda-Garay JC, Ríos-Ibarra MODL, Berni-Betancourt AC, López-Cuellar J, Araiza-Garaygordobil D, Rivera-Reyes R, Borrayo-Sánchez G, Tapia-Hernández M, Cano-Nigenda CV, Guerra-López A, Elías-López J, Figueroa-Morales MA, Montaño-Velázquez BB, Velasco-Hidalgo L, Rodríguez-Lozano AL, Pimentel-Hernández C, Baquero-Hoyos MM, Romero-Moreno F, Rodríguez-Vega M. Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica. Arch Cardiol Mex 2022; 92:1-62. [PMID: 35275904 PMCID: PMC9290432 DOI: 10.24875/acm.m22000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
ANTECEDENTES Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.
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Affiliation(s)
| | - Marco A Alcocer-Gamba
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - José L Mayorga-Butrón
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
| | - Roopa Mehta
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Filiberto A Díaz-Aragón
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Nitzia López-Juárez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Ivette Cruz-Bautista
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Francisco J Guerrero-Martínez
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | | | - Guillermo Fanghänel-Salmon
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | - Luis Olmos-Domínguez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - María de Los A Nava-Hernández
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - Juan C Anda-Garay
- Colegio de Medicina Interna de México, Ciudad de México, México
- Hospital de especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - Romina Rivera-Reyes
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | - Gabriela Borrayo-Sánchez
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - Josué Elías-López
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Marco A Figueroa-Morales
- Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Bertha B Montaño-Velázquez
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
| | | | - Ana L Rodríguez-Lozano
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | | | | | - Mario Rodríguez-Vega
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
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Saldarriaga-Rivera LM, Bautista-Molano W, Junca-Ramírez A, Fernández-Aldana AR, Fernández-Ávila DG, Jaimes DA, Jáuregui EA, Segura-Charry JS, Romero-Sánchez C, Felipe-Diaz OJ. 2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology. Reumatol Clin (Engl Ed) 2022; 18:5-14. [PMID: 35033487 DOI: 10.1016/j.reumae.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Peripheral spondyloarthritis is a chronic inflammatory disease in which clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. OBJECTIVE To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment and monitoring of adult patients with peripheral spondyloarthritis. METHODS A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the formal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The Clinical Practice Guideline includes ten recommendations; related to monitoring of disease activity (n = 1) and treatment (n = 9). RESULTS In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids is recommended conditionally. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondyloarthritis associated to inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recommended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. CONCLUSIONS This set of recommendations provides an updated guide on the diagnosis and treatment of peripheral spondyloarthritis.
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Affiliation(s)
- Lina M Saldarriaga-Rivera
- Hospital Universitario San Jorge, Facultad de Medicina, Universidad Tecnológica de Pereira, Institución Universitaria Visión de las Américas, Clínica Los Rosales, Pereira, Colombia.
| | - Wilson Bautista-Molano
- Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Daniel G Fernández-Ávila
- Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego A Jaimes
- Universidad de la Sabana, Clínicos IPS, Bogotá, Colombia
| | - Edwin A Jáuregui
- Servicio de Reumatología, Riesgo de Fractura S.A. Cayre IPS, Bogotá, Colombia
| | - Juan S Segura-Charry
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia
| | | | - Oscar J Felipe-Diaz
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia; Servicio de Reumatología, Medicarte S.A. Clínica Las Vegas, Bogotá, Colombia
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8
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies. Arch Bronconeumol 2021; 58:150-158. [PMID: 34167859 DOI: 10.1016/j.arbres.2021.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, España
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, España
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião - CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, España
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, España
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, España
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, España
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, España
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, España
| | - José Sanz
- Sociedad Española de Inmunología Clínica-Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, España
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Monsonís-Filella B, Gea-Sánchez M, García-Martínez E, Folguera-Arnau M, Gutiérrez Vilaplana JM, Blanco-Blanco J. Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline. Enferm Clin (Engl Ed) 2021; 31:114-119. [PMID: 33334684 DOI: 10.1016/j.enfcli.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 08/26/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses' Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. METHOD Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) "Risk Assessment and Pressure Injury Prevention" carried out by the Ontario Nurses' Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. RESULTS A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. CONCLUSIONS The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.
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Affiliation(s)
| | - Montserrat Gea-Sánchez
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grupo de Investigación de Curas en Salud (GRECS), Instituto de Investigación Biomédica de Lleida-IRB Lleida, Lleida, España; Grupo de Estudios Sociedad, Salud, Educación y Cultura (GESEC), Universitat de Lleida, Lleida, España.
| | | | - Mercè Folguera-Arnau
- Hospital Universitario Santa María, Lleida, España; Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grupo de Investigación de Curas en Salud (GRECS), Instituto de Investigación Biomédica de Lleida-IRB Lleida, Lleida, España
| | - Josep Maria Gutiérrez Vilaplana
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grupo de Investigación de Curas en Salud (GRECS), Instituto de Investigación Biomédica de Lleida-IRB Lleida, Lleida, España; Hospital Universitario Arnau de Vilanova, Lleida, España
| | - Joan Blanco-Blanco
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grupo de Investigación de Curas en Salud (GRECS), Instituto de Investigación Biomédica de Lleida-IRB Lleida, Lleida, España; Grupo de Estudios Sociedad, Salud, Educación y Cultura (GESEC), Universitat de Lleida, Lleida, España
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10
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Botella-Estrada R, Boada-García A, Carrera-Álvarez C, Fernández-Figueras M, González-Cao M, Moreno-Ramírez D, Nagore E, Ríos-Buceta L, Rodríguez-Peralto JL, Samaniego-González E, Tejera-Vaquerizo A, Vílchez-Márquez F, Descalzo-Gallego MA, García-Doval I. Clinical Practice Guideline on Melanoma From the Spanish Academy of Dermatology and Venereology (AEDV). Actas Dermosifiliogr (Engl Ed) 2021; 112:142-152. [PMID: 32721390 DOI: 10.1016/j.ad.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022] Open
Abstract
Specialist approaches to the diagnosis and treatment of melanoma have undergone many changes. This guideline aims to provide Spanish dermatologists with evidence-based information for resolving the most common doubts that arise in clinical practice. Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating melanoma were invited to participate in drafting the guideline. The group developed a new guideline on the basis of existing ones, using the ADAPTE collaboration process, first summarizing the care process and posing relevant clinical questions, then selecting guidelines with the best scores according to the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. Finally, the group searched the selected guidelines for answers to the clinical questions, drafted recommendations, and sent them for external review. The guideline is structured around 21 clinical questions chosen for their relevance to issues that make clinical decisions about the management of melanoma difficult. Evidence from existing guidelines was used to answer the questions. A limitation of this guide derives from the scarce evidence available for answering some questions. Moreover, some areas are changing rapidly, so recommendations must be updated often. The present guideline offers answers to clinical questions about the routine management of melanoma in clinical practice and provides dermatologists with a reference to guide decisions, taking into consideration the resources available and patient preferences.
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Affiliation(s)
- R Botella-Estrada
- Servicio de Dermatología, Hospital Universitario La Fe, Valencia, España; Departamento de Medicina, Universitat de València, Valencia, España.
| | - A Boada-García
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - M Fernández-Figueras
- Área de Anatomía Patológica, Hospital Universitario General de Cataluña-Quirón Salud, Barcelona, España
| | - M González-Cao
- Translational Cancer Research Unit, Instituto Oncológico Dr. Rosell, Hospital Universitario Dexeus, Barcelona, España
| | - D Moreno-Ramírez
- Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - L Ríos-Buceta
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J L Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Samaniego-González
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
| | | | - F Vílchez-Márquez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
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11
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Díez-Manglano J, Sánchez Muñoz LÁ, García Fenoll R, Freire E, Isasi de Isasmendi Pérez S, Carneiro AH, Torres Bonafonte O. Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. Rev Clin Esp 2021; 221:33-44. [PMID: 32534804 DOI: 10.1016/j.rce.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 01/18/2023]
Abstract
AIM To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. RESULTS The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.
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Affiliation(s)
- J Díez-Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, España.
| | - L Á Sánchez Muñoz
- Servicio de Medicina Interna, Hospital Clínico Universitario, Valladolid, España
| | - R García Fenoll
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Freire
- Servicio de Medicina Interna, Centro Hospitalar e Universitário do Porto, Portugal
| | | | - A H Carneiro
- Departamento de Medicina, Urgência e UCI, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - O Torres Bonafonte
- Servicio de Medicina Interna, Hospital de Sant Pau, Universitat Autònoma de Barcelona, España
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12
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Díez-Manglano J, Sánchez Muñoz LÁ, García Fenoll R, Freire E, Isasi de Isasmendi Pérez S, Carneiro AH, Torres Bonafonte O; en nombre del Comité Directivo de la Guía de Práctica Clínica. Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. Rev Clin Esp 2021; 221:33-44. [PMID: 33998477 DOI: 10.1016/j.rceng.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022]
Abstract
AIM To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. RESULTS The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.
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13
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Zurita-Cruz JN, Torres-Tamayo M, Aguilar-Herrera BE, Miranda-Lora AL, Rivera-Hernández AJ, Calzada-León R, Morales-Pérez MA, Padrón-Martínez MM, Ruiz-Reyes ML, García-Morales LM, Barrón-Uribe C, Arguinzoniz-Valenzuela SL, Torres-Castañeda MC, Lizárraga-Paulin L, Núñez-Hernández JA, Cornejo-Barrera J, Vidal-González MT, Martínez-Alvarado MR, Nishimura-Meguro E, Bravo-Ríos LE, Garrido-Magaña EP, Orozco-Morales JA, Medina-Bravo PG, Coyote-Estrada N, Castilla-Peón MF. Monitoring during the treatment of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty. Bol Med Hosp Infant Mex 2020; 77:29-34. [PMID: 32614338 DOI: 10.24875/bmhim.20000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the monitorization of the treatment and follow-up of patients with central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.
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Affiliation(s)
- Jessie N Zurita-Cruz
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | | | | | | | - Aleida J Rivera-Hernández
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | | | | | | | | | | | | | | | | | | | - Jorge A Núñez-Hernández
- Hospital General Regional 220, IMSS, Estado de México. México.,Instituto Materno Infantil del Estado de México, Toluca, Estado de México. México
| | | | | | | | | | - Luz E Bravo-Ríos
- Sociedad Mexicana de Endocrinología Pediátrica, Ciudad de México. México
| | - Eulalia P Garrido-Magaña
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
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14
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Torres-Tamayo M, Zurita-Cruz JN, Aguilar-Herrera BE, Miranda-Lora AL, Calzada-León R, Rivera-Hernández AJ, Morales-Pérez MA, Padrón-Martínez MM, Ruiz-Reyes ML, García-Morales LM, Barrón-Uribe C, Arguinzoniz-Valenzuela SL, Torres-Castañeda MC, Lizárraga-Paulin L, Núñez-Hernández JA, Cornejo-Barrera J, Vidal-González MT, Martínez-Alvarado MR, Nishimura-Meguro E, Bravo-Ríos LE, Garrido-Magaña EP, Orozco-Morales JA, Medina-Bravo PG, Coyote-Estrada N, Castilla-Peón MF. Puberty blockade: Clinical guideline for the diagnosis and treatment of precocious puberty. Bol Med Hosp Infant Mex 2020; 77:19-25. [PMID: 32614332 DOI: 10.24875/bmhim.20000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the interventions for the inhibition of central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.
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Affiliation(s)
| | - Jessie N Zurita-Cruz
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | | | | | | | - Aleida J Rivera-Hernández
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | | | | | | | | | | | | | | | | | - Jorge A Núñez-Hernández
- Hospital General Regional 220, IMSS, Estado de México. México.,Instituto Materno Infantil del Estado de México, Toluca, Estado de México. México
| | | | | | | | | | - Luz E Bravo-Ríos
- Sociedad Mexicana de Endocrinología Pediátrica, Ciudad de México. México
| | - Eulalia P Garrido-Magaña
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
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15
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Torres-Tamayo M, Zurita-Cruz JN, Aguilar-Herrera BE, Miranda-Lora AL, Calzada-León R, Rivera-Hernández AJ, Morales-Pérez MA, Padrón-Martínez MM, Ruiz-Reyes ML, García-Morales LM, Barrón-Uribe C, Arguinzoniz-Valenzuela SL, Torres-Castañeda MC, Lizárraga-Paulin L, Núñez-Hernández JA, Cornejo-Barrera J, Vidal-González MT, Martínez-Alvarado MR, Nishimura-Meguro E, Bravo-Ríos LE, Garrido-Magaña EP, Orozco-Morales JA, Medina-Bravo PG, Coyote-Estrada N, Castilla-Peón MF. Methodology for the development of the Clinical guideline for the diagnosis and treatment of precocious puberty. Bol Med Hosp Infant Mex 2020; 77:1-6. [PMID: 32614334 DOI: 10.24875/bmhim.20000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The Mexican Society of Pediatric Endocrinology presents recommendations for the diagnosis and treatment of precocious puberty (PP), a condition defined as the development of sexual characteristics due to an increase in pituitary gonadotropin secretion before 8 or 9 years of age in girls and boys, respectively. Methods Three systematic reviews were conducted: controlled clinical trials on interventions for PP treatment, diagnostic tests, and observational studies on the long-term effects of PP. The quality evaluation and data extraction from the studies were conducted by two independent reviewers. The Scottish Intercollegiate Guidelines Network and the Oxford Center for Evidence-Based Medicine systems were used for grading the quality of evidence for recommendations on intervention and diagnosis, respectively. Recommendations were submitted to a consensus by a Delphi method and were validated by another 143 certified pediatric endocrinologists through an online questionnaire. Results The group generated 12 recommendations on the diagnosis of PP, seven on the diagnosis of secondary causes of PP, eight on interventions for inhibition of puberty, five on other interventions for PP treatment, and 14 for the monitoring and follow-up of these patients. The online questionnaires submitted to certified pediatric endocrinologists showed more than 90% of approval for each one of the recommendations. Conclusions Although a high degree of consensus for the recommendations for diagnosis, treatment, and monitoring of PP among pediatric endocrinologists was achieved, most of these recommendations showed a low level of evidence.
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Affiliation(s)
| | - Jessie N Zurita-Cruz
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | | | | | | | - Aleida J Rivera-Hernández
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | | | | | | | | | | | | | | | | | - Jorge A Núñez-Hernández
- Hospital General Regional 220, IMSS, Estado de México.,Instituto Materno Infantil del Estado de México, Toluca, Estado de México
| | | | | | | | | | | | - Eulalia P Garrido-Magaña
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
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16
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Pertuz-Cortes C, Navarro-Jiménez E, Laborde-Cárdenas C, Gómez-Méndez P, Lasprilla-Fawcett S. Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia. Rev Colomb Psiquiatr (Engl Ed) 2020; 49:102-108. [PMID: 32446416 DOI: 10.1016/j.rcp.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/18/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. METHODS For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. CONCLUSIONS The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.
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Affiliation(s)
| | | | | | - Pedro Gómez-Méndez
- Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
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17
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Del Rio-Martínez P, López-García M, Nieto-Martínez C, Cabrera-Cabrera MA, Harillo-Acevedo FD, Mengibar-Carrillo A, González-Gallego M, Maestre-García MÁ. Application and evaluation of the best practice guideline: Breastfeeding. Enferm Clin (Engl Ed) 2020; 30:168-175. [PMID: 32417115 DOI: 10.1016/j.enfcli.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/18/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyse the progress of care in the promotion of breastfeeding and describe breastfeeding results following the implementation of the RNAO guideline in various types of national health centres. METHOD Quantitative descriptive longitudinal study of the results of implementing the recommendations of the RNAO-Breastfeeding guideline in 9 national health centres following the implementation methodology of the programme of the Best Practice Spotlight Organization®. Process and result variables are collected at hospital level and in primary care by registering on the CAREVID platform. The weighted mean was calculated as a summary statistic. RESULTS The implementation of the recommendations of the Breastfeeding guideline was associated with a relative increase in: skin-to-skin contact 57,7% (p < 0,000), exclusive breastfeeding in the 1st intake 47,8% (p < 0,000), exclusive breastfeeding on hospital discharge 18,4% (p < 0,000) and prenatal education 63,95% (p < 0,00). CONCLUSION The implementation of the RNAO-Breastfeeding guideline in different national health centres has increased the application of the recommendations based on scientific evidence, generalising appropriate breastfeeding care (such as prenatal education, application of skin-to-skin contact and exclusive breastfeeding in the first intake) and is consequently significantly approaching the international recommendations on breastfeeding.
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Affiliation(s)
| | - Maribel López-García
- Unidad de Tocoginecología, Hospital de Mendaro, OSI Debabarrena, Gipuzkoa, España.
| | | | | | | | | | | | - Mª Ángeles Maestre-García
- Unidad de Ginecología y Obstetricia, Hospital Doctor José Molina Orosa, Área de Salud de Lanzarote, Gerencia de Servicios Sanitarios, Arrecife, Lanzarote, España
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18
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego MA, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. Actas Dermosifiliogr (Engl Ed) 2020; 111:291-299. [PMID: 32241529 DOI: 10.1016/j.ad.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists. MATERIAL AND METHODS Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREEII (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review. RESULTS The highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered. CONCLUSIONS This new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences.
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Affiliation(s)
- F Vílchez-Márquez
- Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, España.
| | | | - L Barchino-Ortiz
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Ruíz-de-Casas
- Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Palacios-Álvarez
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
| | - A Soria-Rivas
- Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - L Ríos-Buceta
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
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19
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Saiz Vinuesa MD, Albornos-Muñoz L, Fernández Núñez ML, López-García M, Moreno-Casbas T, González Sánchez JÁ. Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). Enferm Clin (Engl Ed) 2020; 30:212-221. [PMID: 32354560 DOI: 10.1016/j.enfcli.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
AIM to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.
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Affiliation(s)
| | - Laura Albornos-Muñoz
- Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii). REDISSEC, Instituto de Salud Carlos III, Madrid, España
| | - M Luz Fernández Núñez
- Área de Calidad, Formación, Docencia e Investigación de la Gestión de Atención Especializada, Áreas III y IV, Hospital Comarcal Sierrallana, Torrelavega, Cantabria, España
| | - Maribel López-García
- Unidad de Tocoginecología, Hospital de Mendaro, OSI Debabarrena, Mendaro, Gipuzkoa, España.
| | - Teresa Moreno-Casbas
- Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii). CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - José Ángel González Sánchez
- Área de Procesos, Investigación, Innovación y Sistemas de Información, Hospital Clínico San Carlos, Madrid, España
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20
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Piñero Sáez S, Sanz Aznarez AC, Ruiz García MV, González García MJ, Mena Sucunza L, Córcoles Jiménez MP. Implementation of the Best practice guideline: Stroke assessment across the continuum of care in hospitalised patients. Enferm Clin (Engl Ed) 2020; 30:160-167. [PMID: 32303467 DOI: 10.1016/j.enfcli.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/31/2019] [Accepted: 10/23/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. OUTCOME VARIABLES Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients.
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Affiliation(s)
- Sonia Piñero Sáez
- Servicio de Urgencias, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | | | - Leire Mena Sucunza
- Unidad de Planta de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
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Morales-Romero A, González-María E, Ramos-Ramos MA, Hidalgo-López L, Zurita-Muñoz AJ, Quiñoz-Gallardo MD, Cano-Caballero Gálvez MD, Albornos-Muñoz L. Implementation of the assessment and care of adults at risk for suicidal ideation and behaviour: A guideline of the Registered Nurses' Association of Ontario (RNAO). Enferm Clin (Engl Ed) 2020; 30:155-159. [PMID: 32139246 DOI: 10.1016/j.enfcli.2019.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour». METHOD A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue.
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Affiliation(s)
- Antonio Morales-Romero
- Hospital Universitario Virgen de las Nieves, Granada, España; Grupo de Investigación «Ee12-HYGIA», Instituto de Investigación Biomédica, Granada, España
| | - Esther González-María
- Unidad de investigación en Cuidados y Servicios de Salud (Investén-ISCIII), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red. Área de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España.
| | | | | | - Antonio José Zurita-Muñoz
- Hospital Universitario Virgen de las Nieves, Granada, España; Grupo de Investigación «Ee12-HYGIA», Instituto de Investigación Biomédica, Granada, España
| | - María Dolores Quiñoz-Gallardo
- Hospital Universitario Virgen de las Nieves, Granada, España; Grupo de Investigación «Ee12-HYGIA», Instituto de Investigación Biomédica, Granada, España
| | | | - Laura Albornos-Muñoz
- Unidad de investigación en Cuidados y Servicios de Salud (Investén-ISCIII), Instituto de Salud Carlos III, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
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Giner Galvañ V, Bonig Trigueros I, Fácila Rubio L, Morillas Blasco P, Martínez Hervás S, Pascual Fuster V, Valls Roca F, Soler Portmann C, Tamarit García JJ, Pallarés Carratalá V; en representación del Grupo de Trabajo MEJORA-LO CV., Componentes del grupo de Trabajo MEJORALO-CV. Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project. Rev Clin Esp 2020; 220:282-9. [PMID: 31744620 DOI: 10.1016/j.rce.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/14/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm. METHOD We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. RESULTS A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly. CONCLUSIONS The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity.
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Celis-Rodríguez E, Díaz Cortés JC, Cárdenas Bolívar YR, Carrizosa González JA, Pinilla DI, Ferrer Záccaro LE, Birchenall C, Caballero López J, Argüello BM, Castillo Abrego G, Castorena Arellano G, Dueñas Castell C, Jáuregui Solórzano JM, Leal R, Pardo Oviedo JM, Arroyo M, Raffán-Sanabria F, Raimondi N, Reina R, Rodríguez Lima DR, Silesky Jiménez JI, Ugarte Ubiergo S, Gómez Escobar LG, Díaz Aya DP, Fowler C, Nates JL. Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients. Med Intensiva 2019; 44:171-184. [PMID: 31492476 DOI: 10.1016/j.medin.2019.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.
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Affiliation(s)
- E Celis-Rodríguez
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Departamento de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad del Rosario, Universidad de Los Andes, Bogotá, Colombia.
| | - J C Díaz Cortés
- Anestesiología, Medicina Crítica y Epidemiología, Clínica Marly JCG, Universidad del Rosario, Bogotá, Colombia
| | - Y R Cárdenas Bolívar
- Medicina Crítica y Cuidado Intensivo, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J A Carrizosa González
- Medicina Crítica y Cuidado Intensivo, Epidemiología, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D-I Pinilla
- Anestesiología, Medicina Crítica, Hospital Universitario Fundación Santa Fe de Bogotá, Hospital Mayor de Mederi, Bogotá, Colombia
| | - L E Ferrer Záccaro
- Anestesiología y Medicina Crítica, Universidad de Los Andes, Universidad El Bosque, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Birchenall
- Medicina Interna y Cuidado Intensivo, Clínica Universitaria Colombia, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
| | - J Caballero López
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de LLeida, Institut de Recerca Biomèdica de LLeida IRBLleida, Departament de Medicina de la Universitat Autònoma de Barcelona UAB, España
| | - B M Argüello
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Hospital Central de Managua, Managua, Nicaragua
| | - G Castillo Abrego
- Cirugía General, Medicina Crítica y Cuidado Intensivo, Pacífica Salud-Hospital Punta Pacífica, Panamá, República de Panamá
| | - G Castorena Arellano
- Anestesiología y Medicina Crítica, Hospital General Manuel Gea González, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - C Dueñas Castell
- Neumología y Medicina Crítica, Universidad de Cartagena, UCI Gestión Salud, UCI Santa Cruz de Bocagrande, Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva, Cartagena, Colombia
| | | | - R Leal
- Anestesiología, Fundación Clínica Médica Sur, Ciudad de México, México
| | - J M Pardo Oviedo
- Medicina Interna y Medicina Crítica y Cuidados Intensivos, Universidad del Rosario, Universidad del Bosque, Hospital Universitario Mayor-Mederi, Fundación Cardio-infantil, Universidad del Rosario, Bogotá, Colombia
| | - M Arroyo
- Medicina Crítica y Cuidado Intensivo, Servicio de Terapia Intensiva, Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - F Raffán-Sanabria
- Anestesiología y Medicina Crítica, Universidad del Bosque, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - N Raimondi
- Medicina Crítica y Cuidado Intensivo, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - R Reina
- Medicina Crítica y Cuidado Intensivo, Hospital Interzonal de Agudos General José de San Martín, Buenos Aires, Argentina
| | - D R Rodríguez Lima
- Medicina de Emergencias y Medicina Crítica y Cuidado Intensivo Universidad del Rosario, Hospital Mayor Mederi, Bogotá, Colombia
| | - J I Silesky Jiménez
- Medicina Crítica y Cuidado Intensivo, Casa Hospital San Juan de Dios/ Hospital CIMA, San José, Costa Rica
| | - S Ugarte Ubiergo
- Medicina Interna y Medicina Crítica y Cuidado Intensivo, Universidad Andrés Bello, Clínica INDISA, Red de Medicina Intensiva, Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva, Santiago de Chile, Chile
| | - L G Gómez Escobar
- Medicina, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D P Díaz Aya
- Medicina, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Fowler
- Research Services & Assessment Manager, Research Medical Library, The University of Texas MD Anderson Cancer Center, Texas, EE. UU
| | - J L Nates
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Departamento de Medicina Crítica, Cuidado Intensivo y Terapia Respiratoria; The University of Texas MD Anderson Cancer Center, Houston, Texas, EE. UU
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Gálvez-Caballero D, Huaringa-Marcelo J, Conde-Vela C, Alarcón-Ruiz CA, Fernández-Chinguel JE, Taype-Rondan A, Dyck-Arbulú HV, Espinoza-Rivas GM, Morón-Castro JA, Ortega-Díaz JL, Rodríguez-Urteaga ZI, Timaná-Ruiz R. Clinical practice guideline for the evaluation and management of patients with severe aortic stenosis for the Peruvian Social Security. Arch Cardiol Mex 2019; 89:53-67. [PMID: 31448765 DOI: 10.24875/acme.m19000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction This article summarizes the clinical practice guide (CPG) for the evaluation and management of patients with severe aortic stenosis in the Social Security of Peru (EsSalud). Objective To provide clinical evidence-based recommendations for the evaluation and management of patients with severe aortic stenosis in the EsSalud. Methods A local guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies, were conducted in PubMed during 2018. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of evaluation and management. Finally, the CPG was approved with Resolution N.° 47 - IETSI - ESSALUD - 2018. Results This CPG addressed 7 clinical questions regarding two issues: the initial evaluation and the management of severe aortic stenosis. Based on these questions, 9 recommendations (1 strong recommendation and 8 weak recommendations), 16 points of good clinical practice, and 1 flowchart were formulated. Conclusion This article summarizes the methodology and evidence-based conclusions from the CPG for the evaluation and management of patients with severe aortic stenosis in the EsSalud.
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Affiliation(s)
| | - Jorge Huaringa-Marcelo
- Clinical Practice Guidelines, Drug Safety Monitoring and Techno-surveillance Directorate, Institute for Health Technologies Evaluation and Research, EsSalud
| | | | - Christoper A Alarcón-Ruiz
- Research Unit for the Generation and Synthesis of Evidence in Health, Universidad San Ignacio de Loyola. Lima
| | | | - Alvaro Taype-Rondan
- Clinical Practice Guidelines, Drug Safety Monitoring and Techno-surveillance Directorate, Institute for Health Technologies Evaluation and Research, EsSalud
| | | | | | | | | | | | - Raúl Timaná-Ruiz
- Clinical Practice Guidelines, Drug Safety Monitoring and Techno-surveillance Directorate, Institute for Health Technologies Evaluation and Research, EsSalud
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Menchon JM, Bobes J, Alamo C, Alonso P, García-Portilla MP, Ibáñez Á, Real E, Bousoño M, Saiz-Gonzalez MD, Saiz-Ruiz J. Pharmacological treatment of obsessive compulsive disorder in adults: A clinical practice guideline based on the ADAPTE methodology. Rev Psiquiatr Salud Ment (Engl Ed) 2019; 12:77-91. [PMID: 30850318 DOI: 10.1016/j.rpsm.2019.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 01/04/2023]
Abstract
Despite the existence of effective evidence-based treatments for the management of obsessive-compulsive disorder (OCD), the therapeutic approach to this disease remains suboptimal. The availability of a therapeutic pharmacological guideline for OCD could help to improve the management of the disease in our setting and to reduce the burden of disease for the patient. With the sponsorship of the Spanish Society of Psychiatry, a group of experts has developed a guideline for the pharmacological treatment of OCD based on the recommendations of existing guidelines and following the methodology of the ADAPTE Collaboration. This article summarises the process of preparing this guideline and the recommendations adopted by consensus by a guideline panel grouped into five areas of interest: acute treatment, duration of treatment, predictors of response and special symptoms, partial response to lack of response to treatment, and special populations.
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Affiliation(s)
- Jose M Menchon
- Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregrat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM).
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Departamento. de Medicina - Psiquiatría, Universidad de Oviedo, Oviedo, Asturias, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Cecilio Alamo
- Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Pino Alonso
- Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregrat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
| | - María Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Departamento. de Medicina - Psiquiatría, Universidad de Oviedo, Oviedo, Asturias, España
| | - Ángela Ibáñez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Eva Real
- Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregrat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
| | - Manuel Bousoño
- Departamento. de Medicina - Psiquiatría, Universidad de Oviedo, Oviedo, Asturias, España
| | | | - Jeronimo Saiz-Ruiz
- Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enferm Infecc Microbiol Clin 2019; 36:112-119. [PMID: 29412895 DOI: 10.1016/j.eimc.2017.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Affiliation(s)
- Fernando Chaves
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Luis Del Pozo
- Área de Enfermedades Infecciosas, Servicio de Microbiología, Clínica Universidad de Navarra, Pamplona, España.
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; CIBER de Enfermedades Respiratorias, CibeRes, Instituto de Salud Carlos III, Madrid; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | | | - Marina de Cueto
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Ángeles Domínguez
- Servicio de Microbiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Marta Fernández Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Jesús Fortún
- Unidad de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Guembe
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Leonardo Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Jose Ramón Paño
- Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Paula Ramírez
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia; CIBER de Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, España
| | - Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Miguel Sánchez
- Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jordi Vallés
- Unidad de Cuidados Intensivos, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2018; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Lozano-Polo L, Puig-Campmany M, Herrera-Mateo S, Mateo-Roca M, Santos-Rodríguez JA, Benito-Vales S. Diagnosis of pulmonary embolism in the elderly: adherence to guidelines and age-adjusted D-dimer concentration values. Emergencias 2018; 30:321-327. [PMID: 30260116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES . The main purpose was to assess our emergency department's level of adherence to clinical practice guidelines (CPGs) for the diagnosis of pulmonary embolism in different age groups. The secondary aims were to study the utility and estimated the number of avoidable CT angiography with this approach of age-adjusted D-dimer concentrations in combination with the Wells score in the diagnosis of pulmonary embolism. MATERIAL AND METHODS Retrospective observational study of a series of hemodynamically stable patients suspected of having pulmonary embolism in the emergency department of a tertiary care university hospital in 2012. Cases were identified in hospital discharge records on the basis of orders for D-dimer assays and computed tomography (CT) angiography of pulmonary arteries justified by suspicion of pulmonary embolism. We analyzed the degree of adherence to CPGs according to age groups, calculated the specificity and sensitivity of combining age-adjusted D-dimer test results and the Wells score, and estimated the number of potentially avoidable CT angiography procedures. RESULTS We found a total of 785 patients (mean age, 69 years; range, 18-97 years) suspected of having pulmonary embolism; 403 (51.3%) were women. Significant differences were detected in adherence to CPGs, depending on which clinical prediction models were used and patient age (50 years or younger, 69.7%-76.5% adherence; 65-74 years, 32.3%-53.2%; 75-84 years, 29.1%-46.8%; 85-89 years, 32.7%-41.8%; and 90 years or older, 24.4%-46.7%). Adherence was increased when D-dimer test result and the simplified Wells score were combined (increments of 10.4%, 8.0%, 13.6%, 11.1%, respectively in the following age groups: 65-74 years, 75-84 years, 85-89 years, and 90 years or older). Using an ageadjusted D-dimer cut-point increased diagnostic specificity (34.2% without such a cut-point vs 45.8% with one). The positive predictive value of the test also increased when an age-adjusted D-dimer cut-point was used (to 11.4%, from 9.6% without age adjustement). Seventy CT angiograph procedures (12.5%) could have been avoided by using age-adjusted cut-points. CONCLUSION We observed different degrees of age-related adherence to CPGs in cases in which pulmonary embolism was suspected. Using the simplified Wells score combined with an age-adjusted cut-point for D-dimer assay positivity improved the specificity and positive predictive value of the D-dimer assessment in comparison with standard practice. Using age-adjusted D-dimer cut-points could decrease the number of pulmonary artery CT angiograms required.
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Affiliation(s)
- Laura Lozano-Polo
- Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
| | - Mireia Puig-Campmany
- Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
| | - Sergio Herrera-Mateo
- Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
| | - Miriam Mateo-Roca
- Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
| | - José Alberto Santos-Rodríguez
- Servicio de Medicina Intensiva, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
| | - Salvador Benito-Vales
- Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España
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Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, Del Pozo JL, Gruss E, Ramírez de Arellano M, Fontseré N, Arenas MD, Merino JL, García-Revillo J, Caro P, López-Espada C, Giménez-Gaibar A, Fernández-Lucas M, Valdés P, Fernández-Quesada F, de la Fuente N, Hernán D, Arribas P, Sánchez de la Nieta MD, Martínez MT, Barba Á; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2017; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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Maza-Krzeptowsky LCDL, Romero-Esquiliano G, Ramírez-Segura EH, Obieta-Cruz ED, Vega-Sosa A, Cárdenas-Mejía A, Juan-Orta DS, Castillo-Herrera M, Aguilar-Castillo SJ, Ávila-Ordóñez MU, Cordero-Guzmán LM, Escobar-Cedillo RE, Fraire-Martínez MI, Franco-Lira MO, González-Jaime JJ, Paz-Navarro CE, Ramos-Peek JN, Shkurovich-Bialik P, Silva-Cerecedo P, Tello-Valdés CA, Zavala-Reina ÁA, López-Rodríguez J, Sosa-García O. [Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities]. CIR CIR 2018; 86:132-139. [PMID: 29809190 DOI: 10.24875/ciru.m18000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Intraoperative neurophysiological monitoring (IONM) is a procedure that uses neurophysiological techniques in order to evaluate the motor and sensitive systems during surgeries that endanger the nervous system. Method The approach, scope, target population, and clinical questions to be answered were defined. A systematic search of the evidence was conducted step by step; during the first stage, clinical practice guidelines were collected, during the second stage systematic reviews were obtained, and during the third stage, clinical trials and observational studies were procured. The MeSH nomenclature and free related terminology were used, with no language restrictions and a 5-10 years frame. The quality of the evidence was graded using the CEPD and SIGN scales. Results Obtained using the search algorrhythms of 892 documents. Fifty-eight were chosen to be included in the qualitative synthesis. A meta-analysis was not possible due to the heterogeneity of the studies. Conclusions Eighteen recommendations were issued and will support the adequate use of the IONM.
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Affiliation(s)
| | | | - Eduardo H Ramírez-Segura
- Escuela de Posgrado en Sanidad Naval, Secretaría de Marina-Armada de México, Ciudad de México. México
| | - Enrique De Obieta-Cruz
- Hospital General Naval de Alta Especialidad, Secretaría de Marina-Armada de México, Ciudad de México. México
| | - Alfonso Vega-Sosa
- Hospital General Naval de Alta Especialidad, Secretaría de Marina-Armada de México, Ciudad de México. México
| | | | - Daniel San Juan-Orta
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México. México
| | | | - Sergio J Aguilar-Castillo
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - Mario U Ávila-Ordóñez
- Hospital General Naval de Alta Especialidad, Secretaría de Marina-Armada de México, Ciudad de México. México.,Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente, Ciudad de México. México.,Hospital Psiquiátrico Dr. Samuel Ramírez Moreno, Ciudad de México. México
| | | | | | | | | | - José J González-Jaime
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal. México
| | | | | | | | | | | | - Álvaro A Zavala-Reina
- Hospital Médica Sur, Ciudad de México. México.,Hospital regional Lic. Adolfo López Mateos, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México. México
| | - Jaime López-Rodríguez
- Neurology and Neurological Sciences, and Neurosurgery Stanford University School of Medicine, CA, Estados Unidos, Ciudad de México. México
| | - Ojino Sosa-García
- Dirección de Integración de Guías de Práctica Clínica, Centro Nacional de Excelencia Tecnológica en Salud, Ciudad de México. México
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Borau A, Adot JM, Allué M, Arlandis S, Castro D, Esteban M, Salinas J. A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. Actas Urol Esp 2018; 42:5-16. [PMID: 28413135 DOI: 10.1016/j.acuro.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.
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Rumbo-Prieto JM, Arantón-Areosa L, Palomar-Llatas F, Romero-Martín M. Quality of clinical practice guidelines of lower extremity venous ulcers. Enferm Clin (Engl Ed) 2017; 28:49-56. [PMID: 29162388 DOI: 10.1016/j.enfcli.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022]
Abstract
The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted. It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II. After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence.
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Affiliation(s)
| | - Luis Arantón-Areosa
- Dirección de Procesos de Enfermería, Gerencia de Gestión Integrada de Ferrol, Ferrol, España
| | - Federico Palomar-Llatas
- Cátedra Hartmann de Integridad y Cuidados de la Piel, Universidad Católica de Valencia, Valencia, España
| | - Manuel Romero-Martín
- Facultad de Enfermería y Podología de Ferrol, Universidad de A Coruña, Ferrol, España
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Núñez-Batalla F, Jáudenes-Casaubón C, Sequí-Canet JM, Vivanco-Allende A, Zubicaray-Ugarteche J. Diagnosis and treatment of otitis media with effusion: CODEPEH recommendations. Acta Otorrinolaringol Esp (Engl Ed) 2019; 70:36-46. [PMID: 29033123 DOI: 10.1016/j.otorri.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/24/2022]
Abstract
The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of sugical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.
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Villena-Jimena A, Gómez-Ocaña C, Amor-Mercado G, Núñez-Vega A, Morales-Asencio JM, Hurtado MM. To What Extent do Clinical Practice Guidelines Respond to the Needs and Preferences of Patients Diagnosed with Obsessive-Compulsive Disorder? ACTA ACUST UNITED AC 2017; 47:98-107. [PMID: 29754712 DOI: 10.1016/j.rcp.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/27/2017] [Accepted: 02/20/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The number of Clinical Practice Guidelines (CPG) to help in making clinical decisions is increasing. However, there is currently a lack of CPG for Obsessive-Compulsive Disorder that take into account the requirements and expectations of the patients. OBJECTIVE The aim of the present study was to determine whether recommendations of the NICE guideline, "Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder" agrees with the needs and preferences of patients diagnosed with OCD in the mental health service. MATERIAL AND METHOD Two focal groups were formed with a total of 12 participants. They were asked about the impact of the disorder in their lives, their experiences with the mental health services, their satisfaction with treatments, and about their psychological resources. Preferences and needs were compared with the recommendations of the guidelines, and to facilitate their analysis, they were classified into four topics: information, accessibility, treatments, and therapeutic relationship. RESULTS The results showed a high agreement between recommendations and patients preferences, particularly as regards high-intensity psychological interventions. Some discrepancies included the lack of prior low-intensity psychological interventions in mental health service, and the difficulty of rapid access the professionals. CONCLUSIONS There is significant concordance between recommendations and patients preferences and demands, which are only partially responded to by the health services.
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Affiliation(s)
- Amelia Villena-Jimena
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional de Málaga, Málaga, España
| | - Clara Gómez-Ocaña
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional de Málaga, Málaga, España
| | - Gisela Amor-Mercado
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional de Málaga, Málaga, España
| | - Amanda Núñez-Vega
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional de Málaga, Málaga, España.
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Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. [Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)]. Aten Primaria 2017; 49:177-194. [PMID: 28238460 PMCID: PMC6875999 DOI: 10.1016/j.aprim.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022] Open
Abstract
In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each.
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Affiliation(s)
- F Mearin
- Coordinación de la GPC, Comité Roma de Trastornos Funcionales Intestinales, Asociación Española de Gastroenterología (AEG), Centro Médico Teknon, Barcelona, España
| | - C Ciriza
- Grupo de Trastornos Funcionales, Sociedad Española de Patología Digestiva (SEPD), Hospital Universitario Doce de Octubre, Madrid, España
| | - M Mínguez
- AEG y SEPD, Hospital Clínico Universitario, Universitat de Valencia, Valencia, España
| | - E Rey
- SEPD, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J J Mascort
- Secretaría Científica, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), España.
| | - E Peña
- Coordinación de Digestivo, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), España
| | - P Cañones
- Coordinación de Digestivo, Sociedad Española de Médicos Generales y de Familia (SEMG), España
| | - J Júdez
- Departamento de Gestión del Conocimiento, SEPD, España
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Aragonès E, Comín E, Cavero M, Pérez V, Molina C, Palao D. [A computerised clinical decision-support system for the management of depression in Primary Care]. Aten Primaria 2017; 49:359-367. [PMID: 28081896 PMCID: PMC6875988 DOI: 10.1016/j.aprim.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/01/2016] [Accepted: 09/18/2016] [Indexed: 12/05/2022] Open
Abstract
A pesar de su relevancia clínica y de su importancia como problema de salud pública existen importantes deficiencias en el abordaje de la depresión. Las guías clínicas basadas en la evidencia son útiles para mejorar los procesos y los resultados clínicos, y para facilitar su implementación se ha ensayado su transformación en sistemas informatizados de apoyo a las decisiones clínicas. En este artículo se describen los fundamentos y principales características de una nueva guía clínica informatizada para el manejo de la depresión mayor desarrollada en el sistema sanitario público de Cataluña. Esta herramienta ayuda al clínico a establecer diagnósticos de depresión fiables y precisos, a elegir el tratamiento idóneo a priori según las características de la enfermedad y del propio paciente, y enfatiza en la importancia de un seguimiento sistemático para evaluar la evolución clínica y adecuar las intervenciones terapéuticas a las necesidades del paciente en cada momento.
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Affiliation(s)
- Enric Aragonès
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España.
| | - Eva Comín
- Centre d'Atenció Primària Pare Claret, Institut Català de la Salut, Barcelona, España
| | - Myriam Cavero
- Centre Salut Mental Esquerra Eixample, Hospital Clínic, Barcelona, España; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España
| | - Víctor Pérez
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; CIBERSAM, Madrid, España
| | - Cristina Molina
- Pla Director de Salut Mental i Addiccions, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Diego Palao
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; CIBERSAM, Madrid, España; Servei de Salut Mental, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
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Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. [Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)]. Aten Primaria 2017; 49:42-55. [PMID: 28027792 PMCID: PMC6875955 DOI: 10.1016/j.aprim.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.
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Affiliation(s)
- F Mearin
- Coordinación de la guía de práctica clínica (GPC), Comité Roma de Trastornos Funcionales Intestinales, Asociación Española de Gastroenterología (AEG), Centro Médico Teknon, Barcelona, España
| | - C Ciriza
- Grupo de Trastornos Funcionales, Sociedad Española de Patología Digestiva (SEPD), Hospital Universitario Doce de Octubre, Madrid, España
| | - M Mínguez
- AEG y SEPD, Hospital Clínico Universitario, Universitat de Valencia, Valencia, España
| | - E Rey
- SEPD Hospital Clínico Universitario San Carlos, Madrid, España
| | - J J Mascort
- Secretaría Científica, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), España.
| | - E Peña
- Coordinación de Digestivo, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), España
| | - P Cañones
- Coordinación de Digestivo, Sociedad Española de Médicos Generales y de Familia (SEMG), España
| | - J Júdez
- Departamento de Gestión del Conocimiento, SEPD, España
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Castro Coyotl DM, Rosas Huerta XO, Sánchez Vázquez JJ, Díaz Sánchez MI, Rodríguez Peralta JS, Tetitla Munive JM, Peralta Porras ML, Arellano Cruz AJ, Sosa García JO, Fareli González CJ. [Guide to clinical practice for the diagnosis, treatment and rehabilitation of non-syndromic craniosynostosis on 3 levels of care]. CIR CIR 2017; 85:401-10. [PMID: 28034516 DOI: 10.1016/j.circir.2016.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Craniosynostosis is a congenital anomaly resulting from the premature fusion of the cranial sutures changing growth patterns of the skull. METHODOLOGY Focus, scope, target population and clinical questions to be solved were defined. A systematic search for evidence in different databases (Medline, Embase, KoreaMed, Cochrane Library and the website of the World Health Organization) in stages was performed: clinical practice guidelines; systematic reviews, and clinical trials and observational studies; using MeSH, Decs and corresponding free terms, unrestricted language or temporality. Risk of bias was evaluated using appropriate tools (AMSTAR, Risk of Bias or STROBE). The quality of evidence was graduated using the GRADE system. Modified Delphi Panel technique was used to assign the recommendation's strength and direction, as well as the degree of agreement with it, taking into account the quality of evidence, balance between risks and benefits of interventions, values and preferences of patients and availability of resources. RESULTS There were 3,712 documents obtained by search algorithms; selecting 29 documents for inclusion in the qualitative synthesis. Due to heterogeneity between studies, it was not possible to perform meta-analysis. CONCLUSIONS We issued 7 recommendations and 8 good practice points, which will serve as support for decision-making in the comprehensive care of patients with craniosynostosis.
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Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. [Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)]. Semergen 2016; 43:43-56. [PMID: 27810257 DOI: 10.1016/j.semerg.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/19/2022]
Abstract
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.
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Affiliation(s)
- F Mearin
- Coordinación de la guía de práctica clínica (GPC), Comité Roma de Trastornos Funcionales Intestinales, Asociación Española de Gastroenterología (AEG), Centro Médico Teknon, Barcelona, España
| | - C Ciriza
- Grupo de Trastornos Funcionales, Sociedad Española de Patología Digestiva (SEPD), Hospital Universitario Doce de Octubre, Madrid, España
| | - M Mínguez
- AEG y SEPD, Hospital Clínico Universitario, Universitat de Valencia, Valencia, España
| | - E Rey
- SEPD Hospital Clínico Universitario San Carlos, Madrid, España
| | - J J Mascort
- Secretaría Científica, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), España
| | - E Peña
- Coordinación de Digestivo, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), España.
| | - P Cañones
- Coordinación de Digestivo, Sociedad Española de Médicos Generales y de Familia (SEMG), España
| | - J Júdez
- Departamento de Gestión del Conocimiento, SEPD, España
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- Sociedad Española de Patología Digestiva (SEPD), Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Sociedad Española de Médicos Generales y de Familia (SEMG)
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Sánchez-Tamayo T, Espinosa Fernández MG, Affumicato L, González López M, Fernández Romero V, Moreno Algarra MC, Salguero García E. [Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns]. An Pediatr (Barc) 2016; 85:291-299. [PMID: 27443828 DOI: 10.1016/j.anpedi.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An unexpected increase in the incidence of necrotising enterocolitis (NEC) cases was observed in our hospital. Just in case, our feeding policy could be responsible, it was decided to conduct a systematic review and develop a clinical guideline regarding enteral nutrition of very low birth weight infants (VLBW). OBJECTIVE To assess the impact of the new feeding protocol in the incidence of NEC. METHOD A "before" (2011) and "after" (May 2012 - April 2013) study was performed on the new feeding protocol. This included initiation of enteral feeding in the absence of haemodynamic problems, a trophic feeding period of 5-7 days, and subsequent increments of 20-30ml/kg/day, of breast milk/donor human milk from the beginning. Probiotics were not administered. PRIMARY OUTCOME incidence of NEC II 2 Bell's stage. SECONDARY OUTCOMES focal intestinal perforation, overall mortality and mortality due to NEC, nosocomial sepsis; weight at 28 days and 36 weeks; % of infants with weight <p10 at discharge; and length of stay. RESULTS Of the 270 VLBW infants, 155 were included in the "before" group, and 115 in the "after" group. NEC significantly decreased (12/155 vs 1/115, P=.008). A decrease in mortality rate was also observed (17.4% vs 7.8%, P=.02). In four cases NEC was part of the sequence of events that led to death in the first cohort, with none in the second. There was no difference in the incidence of focal intestinal perforation or of the other secondary variables analysed. CONCLUSIONS Implementation of an evidence-based enteral feeding protocol leads to a decrease in incidence of NEC, without increasing hospital stay or the incidence of sepsis.
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Affiliation(s)
- Tomás Sánchez-Tamayo
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - María Gracia Espinosa Fernández
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Laura Affumicato
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - María González López
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Verónica Fernández Romero
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - María Concepción Moreno Algarra
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Enrique Salguero García
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
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Sánchez Díaz N, Duarte Osorio A, Gómez Restrepo C, Bohórquez Peñaranda AP. [Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia]. ACTA ACUST UNITED AC 2016; 45:60-6. [PMID: 27132754 DOI: 10.1016/j.rcp.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/02/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. METHOD The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. RESULTS The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2)outcome indicators. CONCLUSION The GPC_E implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline.
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Serra J, Mascort-Roca J, Marzo-Castillejo M, Delgado Aros S, Ferrándiz Santos J, Rey Diaz Rubio E, Mearin Manrique F. Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. Gastroenterol Hepatol 2016; 40:132-141. [PMID: 27048918 DOI: 10.1016/j.gastrohep.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/05/2016] [Indexed: 02/07/2023]
Abstract
Clinical practice guidelines for the management of constipation in adults aim to generate recommendations on the optimal approach to chronic constipation in the primary care and specialized outpatient setting. Their main objective is to provide healthcare professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of this condition. They are intended for family physicians, primary care and specialist nurses, gastroenterologists and other health professionals involved in the treatment of these patients, as well as patients themselves. The guidelines have been developed in response to the high prevalence of chronic constipation, its impact on patient quality of life and recent advances in pharmacological management. The Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) system has been used to classify the scientific evidence and strengthen the recommendations.
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Affiliation(s)
- Jordi Serra
- Unitat de Motilitat i Trastorns Funcionals Digestius, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Juanjo Mascort-Roca
- Centro de Asitencia Primaria (CAP) Florida Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España; Departament de Ciències Clíniques, Campus Bellvitge, Facultat de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca- Institut d'Investigació d'Atenció Primària (IDIAP) Jordi Gol Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut; Científico de semFYC, Barcelona, España
| | - Silvia Delgado Aros
- Neuro-Enteric Translational Science (NETS) group coordinator, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-Parc de Salut Mar. Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, España
| | | | - Enrique Rey Diaz Rubio
- Hospital Clínico San Carlos, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Fermín Mearin Manrique
- Servicio de Aparato Digestivo, Instituto de Trastornos Funcionales y Motores Digestivos, Barcelona, España
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Trujillo-Martín MM, Rúa-Figueroa Fernández de Larrinoa I, Ruíz-Irastorza G, Pego-Reigosa JM, Sabio Sánchez JM, Serrano-Aguilar P. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management]. Med Clin (Barc) 2016; 146:413.e1-14. [PMID: 26975887 DOI: 10.1016/j.medcli.2016.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 12/22/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups.
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Affiliation(s)
- María M Trujillo-Martín
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), La laguna, Santa Cruz de Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | | | - Guillermo Ruíz-Irastorza
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - José María Pego-Reigosa
- Servicio de Reumatología, Hospital Meixoeiro, Vigo, España; IRIDIS (Investigation in Rheumatology and Immuno-Mediated Diseases) Group, Instituto de Investigación Biomédica (IBI) de Vigo, Pontevedra y Ourense, España
| | | | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Servicio de Evaluación y Planificación (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, España
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Santin M, García-García JM, Domínguez J. Guidelines for the use of interferon-γ release assays in the diagnosis of tuberculosis infection. Enferm Infecc Microbiol Clin 2016; 34:303.e1-13. [PMID: 26917222 DOI: 10.1016/j.eimc.2015.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in low-prevalence countries. However, there is no consensus on their application. The objective of this study was to develop guidelines for the use of interferon-gamma release assays in specific clinical scenarios in Spain. METHODS A panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, formulated the clinical questions and outcomes of interest. They conducted a systematic literature search, summarized the evidence and rated its quality, and prepared the recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. RESULTS The panel prepared recommendations on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in the contact-tracing study (both adults and children), health care workers, immunosuppressed patients (patients infected with human immunodeficiency virus, patients with chronic immunomediated inflammatory diseases due to start biological therapy and patients requiring organ transplant) and for the diagnosis of active tuberculosis. Most recommendations were weak, mainly due to the lack of good quality evidence to balance the clinical benefits and disadvantages of the interferon-gamma release assays as compared with the tuberculin skin test. CONCLUSION This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or with suspicion of active disease. The guidelines will be applicable in specialist and primary care and in public health settings.
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Affiliation(s)
- Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | | | - José Domínguez
- Service of Microbiology, Research Institute Trias i Pujol, Hospital Gremans Trias i Pujol, Barcelona, Spain; Department of Genetics and Microbiology, Universidad Autónoma de Barcelona, Barcelona, Spain; CIBER Respiratory Diseases, Madrid, Spain.
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Basora M, Colomina MJ, Moral V, Asuero de Lis MS, Boix E, Jover JL, Llau JV, Rodrigo MP, Ripollés J, Calvo Vecino JM. Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing non-cardiac surgery. Rev Esp Anestesiol Reanim 2016; 63:29-47. [PMID: 26343809 DOI: 10.1016/j.redar.2015.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience.
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Affiliation(s)
- M Basora
- Anestesiología y Reanimación, Hospital Clínic, Barcelona, España.
| | - M J Colomina
- Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - V Moral
- Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - M S Asuero de Lis
- Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Boix
- Anestesiología y Reanimación, Hospital Universitario del Vinalopó, Elche, Alicante, España
| | - J L Jover
- Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoi, Alicante, España
| | - J V Llau
- Anestesiología y Reanimación, Hospital Clínico Universitario, Valencia, España
| | - M P Rodrigo
- Anestesiología y Reanimación, Hospital de Basurto, Bilbao, España
| | - J Ripollés
- Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - J M Calvo Vecino
- Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, España
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Tamayo Martínez N, Bohórquez Peñaranda AP, García Valencia J, Jaramillo González LE, Ávila MJ, Gómez-Restrepo C, Arenas González ML. [Hematological Evaluation and Monitoring in Adult Patients Diagnosed With Schizophrenia]. ACTA ACUST UNITED AC 2015; 44:131-6. [PMID: 26578412 DOI: 10.1016/j.rcp.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/13/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To guide the clinician in taking decisions on the best strategies for assessing and monitoring the risk of blood disorders in adults diagnosed with schizophrenia in pharmacological treatment. METHOD A clinical practice guideline was developed following the guidelines of the Methodological Guide of the Ministry of Social Protection to collect evidence and grade recommendations. De novoliterature researchwas performed. RESULTS With the use of antipsychotics there isriskofreducción in the leukocyte count and the risk of agranulocytosis,the later associated with the use of clozapine, although it is a rare event(0.8%) can be fatal; this effect occurs most frequently in the first twelve weeks of treatment and the risk is maintained aroundthe first year of it. CONCLUSION The recommendations were considered strongin all hematologic related monitoring.A blood count should be taken at the start of pharmacological treatment. If the patient is started on clozapine one shouldbe taken weekly during the first three months, monthly until completing one year and every six months thereafter. If there is a decrease in white blood cell count the patient should be monitored regularly, stopping if is a less than 3,500 cells/mm(3) and consider referral if is less than 2,000 cells/mm(3).
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Affiliation(s)
- Nathalie Tamayo Martínez
- Médica psiquiatra, candidata a magístra Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora titular del Departamento de Psiquiatría, Facultad de Medicina. Universidad de Antioquia., Medellín, Antioquia, Colombia
| | | | - Mauricio J Ávila
- Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio., Bogotá, Colombia.
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Oviedo GF, Gómez Restrepo C, Bohórquez Peñaranda A, García Valencia J, Jaramillo LE, Tamayo N, Arenas ML, Vélez Fernández C. [Metabolic Control, Evaluation and Follow-up Interventions in Patients With Schizophrenia]. ACTA ACUST UNITED AC 2015; 44:220-9. [PMID: 26578473 DOI: 10.1016/j.rcp.2015.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. CONCLUSION Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations.
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Bohórquez Peñaranda A, Gómez Restrepo C, Oviedo Lugo GF, de la Hoz Bradford AM, Castro Díaz SM, García Valencia J, Jaramillo González LE, Ávila-Guerra M. [Types of Care for Adult Patients Diagnosed With Acute and Maintenance Phase Schizophrenia]. Rev Colomb Psiquiatr 2015; 44 Suppl 1:101-109. [PMID: 26576466 DOI: 10.1016/j.rcp.2015.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/04/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assist the clinician in making decisions about the types of care available for adults with schizophrenia. To determine which are the modalities of treatment associated with better outcomes in adults with schizophrenia. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS Patients who were in Assertive community treatment had a lower risk of new hospitalizations. For the intensive case management, the results favored this intervention in the outcomes: medium term readmissions, social functioning and satisfaction with services. The crisis resolution teams was associated with better outcomes on outcomes of readmissions, social functioning and service satisfaction in comparison with standard care. CONCLUSION The use of different modalities of care leads to the need of a comprehensive approach to patients to reduce the overall disability associated with the disease. Evidence shows overall benefit for most outcomes studied without encountering hazards for health of patients. This evaluation is recommended to use the professional ways of providing health services that are community-based and have a multidisciplinary group. It is not recommended the modality "day hospital" during the acute phase of schizophrenia in adults.
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Affiliation(s)
- Adriana Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Carlos Gómez Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gabriel Fernando Oviedo Lugo
- Médico psiquiatra, psiquiatra de enlace, Profesor departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana. Delegado Asociación Colombiana de Psiquiatría, Bogotá, Colombia
| | - Ana María de la Hoz Bradford
- Médica, magístra en Epidemiología Clínica. Profesora instructora del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora asociada del Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Mauricio Ávila-Guerra
- Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia
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Bohórquez Peñaranda A, Gómez Restrepo C, García Valencia J, Jaramillo González LE, de la Hoz AM, Arenas Á, Tamayo Martínez N. [Antipsychotic Treatment of the Adult Patient in the Acute Phase of Schizophrenia]. ACTA ACUST UNITED AC 2015; 44 Suppl 1:13-28. [PMID: 26576459 DOI: 10.1016/j.rcp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/22/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To determine the efficacy and safety of different antipsychotic drugs in the management of patients diagnosed with schizophrenia in the acute phase. To formulate evidence-based recommendations on the antipsychotic (AP) drug management strategies for the treatment of the adult diagnosed with schizophrenia in the acute phase. METHOD Clinical practice guidelines were prepared, using the guidelines of the Methodology Guide of the Ministry of Health and Social Protection, in order to identify, synthesise, and evaluate the evidence and formulate recommendations as regards the management and follow-up of adult patients diagnosed with schizophrenia. The evidence of the NICE 82 guideline was adopted and updated, which answered the question on the management of the acute phase of adults with a diagnosis of schizophrenia. The evidence and its level were presented to the Guideline Development Group (GDG) in order to formulate recommendations following the methodology proposed by the GRADE approach. RESULTS Clozapine, olanzapine, risperidone, ziprasidone, amisulpride, paliperidone, haloperidol, quetiapine, and aripiprazole were more effective than placebo for the majority of psychotic symptoms and the abandonment of treatment, but asenapine was not. Paliperidone, risperidone, quetiapine, clozapine, and olanzapine showed significant increases in weight compared to placebo. Haloperidol, risperidone, ziprasidone, and paliperidone had a higher risk of extrapyramidal symptoms than placebo. There was a significant risk of sedation or drowsiness with, risperidone, haloperidol, ziprasidone, quetiapine, olanzapine, and clozapine in the comparisons with placebo. Of the results of the comparisons between AP, it was shown that clozapine and paliperidone had a clinically significant effect compared to haloperidol and quetiapine, respectively. Olanzapine and risperidone had a lower risk of abandoning the treatment in general, and due to adverse reactions in two comparisons of each one, haloperidol was the drug with more risk of abandoning due to adverse effects, followed by clozapine. Amisulpride, haloperidol and ziprasidone had favourable results as regards weight increase in several comparisons. Aripiprazole and paliperidone obtained a higher number of favourable results as regards sedation, and all the atypical drugs (except paliperidone) had a lower risk than the use of anti-parkinsonian drugs. Of the evidence from observational studies, it was found that, in subjects with risk factors for diabetes, such as age, hypertension, and dyslipidaemia, the initial treatment and current treatment with olanzapine, as well as current treatment with clozapine, may promote the development of this disease. CONCLUSION Although it is imperative to prescribe an antipsychotic for treatment of the acute phase, the selection of the drug depends on the particular clinical condition of each patient and their collateral effects profile.
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Affiliation(s)
- Adriana Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Carlos Gómez Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora asociada del Departamento de Psiquiatría, Facultad de Medicina. Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Ana María de la Hoz
- Médica y cirujana, Magister en Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro Arenas
- Médico psiquiatra, Magister en Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Nathalie Tamayo Martínez
- Médica psiquiatra, candidata a magístra Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia
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Gómez-Restrepo C, Bohórquez Peñaranda AP, Ávila MJ, Jaramillo González LE, Vélez Fernández C, Vélez Traslaviña Á, García Valencia J, Pinzón-Amado A. [Pharmacological Treatment for Adult Diagnosed With Schizophrenia With Agitation or Violent Behavior]. Rev Colomb Psiquiatr 2015; 44 Suppl 1:59-65. [PMID: 26576462 DOI: 10.1016/j.rcp.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/05/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the most effective pharmacological intervention and to bring recommendations for decision-making in the management of adults with schizophrenia with violent behavior or agitation. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS It is recommended the use of parenteral drugs in all agitated patient who does not respond to the measures of persuasion. The drugs with better evidence on effectiveness (control of violent behavior) are haloperidol and benzodiazepines, administered jointly or individually. Olanzapine is also an option considering that should only be used in institutions where a psychiatrist is available 24hours. Ziprasidone can be considered as a second-line drug. The information about the side effects associated with these drugs is insufficient and has low quality. CONCLUSION Violent behavior in adults with schizophrenia represents a risk for themselves and for those around them, so the opportune implementation of interventions aimed to calm the patient, in order to prevent potential negative outcomes is necessary. It is recommended to initiate these interventions with measures of verbal persuasion, and if these measures are not effective, appropriate use of parenteral drugs: haloperidol and benzodiazepines as first-line and olanzapine and ziprasidone as second choices.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mauricio J Ávila
- Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Carolina Vélez Fernández
- Médica cirujana, Residente de Psiquiatría Pontificia Universidad Javeriana. Asistente de investigación, Bogotá, Colombia
| | | | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora titular del Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Alexander Pinzón-Amado
- Médico psiquiatra. Magister en Epidemiología Clínica. Profesor Asistente, Universidad Industrial de Santander, Bucaramanga. Delegado Asociación Colombiana de Psiquiatría, Colombia
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