Evaluación AGREE-II de guías de práctica clínica sobre radiodermatitis aguda. [AGREE-II evaluation of clinical practice guidelines in acute radiodermatitis]

RESUMEN: Objetivo: Evaluar y comparar la calidad de las guías de práctica clínica (GPC) sobre prevención y tratamiento de la radiodermatitis aguda (RDA). Metodología: Evaluación de la calidad metodoló- gica mediante el instrumento AGREE-II. Búsqueda de GPC en fuentes especializadas. Selección de GPC-RDA con antigüedad no superior a 5 años. Revisión por 3 evaluadores. Resultados: De siete GPC localizadas se seleccionaron 3 (dos mexicanas y una canadiense y cols.). La calidad media conseguida fue del 59% (calidad suficiente). Comparando los 6 Dominios AGREE, solo el primer dominio (alcance y objetivo), obtuvo calificación de buena calidad (>75%), siendo el “peor” el dominio 5 (aplicabilidad) que fue considerado de “baja calidad” (< 50%), en todas las GPC evaluadas. El resto de los dominios lograron una calidad suficiente (57,7%). Una GPC fue calificada como “no recomendable” y ninguna GPC fue considerada como “muy recomendada” por parte de los revisores. Conclusiones: La GPC Mexicana del IMSS y la GPC canadiense del grupo MASCC, fueron calificadas como “recomendables con condiciones”, debiendo mejorar aspectos clave como: utilizar una escala de evidencia de mayor rigor metodológico, actualizar las recomendaciones de evidencia, incluir un proceso de implementación viable y especificar la independencia editorial de la GPC. ABSTRACT: Objective: To evaluate and compare the quality of clinical practice guidelines (CPG) on prevention and treatment of acute radiodermatitis (RD). Methodology: Evaluation of methodological quality through the AGREE-II instrument. Search for CPG in specialized sources. Selection of CPGRD with an age of no more than 5 years. Review by three evaluators. Results: Of seven localized CPGs, 3 (two Mexican and one Canadian) were selected. The average quality achieved was 59% (sufficient quality). The first domain (scope and objective), obtained a good quality score (>75%), being the “worst” domain 5 (applicability) that was considered “low quality” (<50%) In all CPGGs evaluated. The rest of the domains achieved a sufficient quality (57.7%). A CPG was rated as “not recommended”, and no CPG was considered “highly recommended” by the reviewers. Conclusions: The CPG Mexicana of the IMSS and the Canadian GPC of the group MASCC, were considered as “recommended with conditions”; should improve key aspects such as: use a scale of evidence of greater methodological rigor, update the recommendations of evidence, include a viable implementation process and specify the editorial independence of the CPG

Colloidal stability of Ni(OH)₂ in water and its dispersion into a ceramic matrix from the reaction media to obtain Ni/Al₂O₃ materials

Ni/Al₂O₃ composites have been fabricated by slip casting of concentrated Ni(OH)₂/Al₂O₃ suspensions and subsequent in situ reduction to metallic nickel during sintering. For that, the synthesis assisted by ultrasound of both α- and β-Ni(OH)₂ polymorphs, as well as their colloidal stability, have been studied. The structural differences between both polymorphs have been thoroughly studied by means of XRD, FTIR, DTA-TG, SSA, SEM and TEM, in order to optimize the starting suspensions. This way, the IEP of both polymorphs have been established (9.7 y 12 for β- and α-Ni(OH)₂, respectively), as well as the optimal content of an anionic dispersant (PAA) to stabilize the particles (0.8 wt. % for beta phase and 3.0 wt. % for alpha phase). Three different Ni/Al₂O₃ composites, with a high dispersion degree of the metallic phase, have been obtained considering the potential vs. particles distance curve of the Ni(OH)₂, and their structure has been discussed in terms of the strength of the agglomerates and/or aggregates of the Ni(OH)₂.La obtención de materiales compuestos Ni/Al₂O₃ se ha llevado a cabo mediante colaje en molde de escayola de suspensiones concentradas de Ni(OH)₂/Al₂O₃ y su posterior reducción in situ para obtener la fase metálica. Para ello, se ha estudiado la síntesis asistida por ultrasonido de los polimorfos α- y β-Ni(OH)₂, así como su comportamiento coloidal en medio acuoso. Las diferencias estructurales entre ambos polimorfos han sido estudiadas en detalle mediante XRD, FTIR, ATD-TG, SSA, MEB y MET, para poder optimizar las suspensiones de partida. De esta manera, se ha establecido el PIE de ambos polimorfos (9.7 y 12 para las fases β- y α-Ni(OH)₂, respectivamente), así como el contenido óptimo de un dispersante aniónico (PAA) para la estabilización de las partículas (0.8 % p/p para la fase beta y 3.0 % p/p para la fase alfa). Tres materiales compuestos Ni/Al₂O₃ diferentes, con un alto grado de dispersión de la fase metálica, han sido obtenidos en función de la curva de potenciales de interacción frente a distancia entre partículas del Ni(OH)₂ y su estructura se ha discutido en función de la fortaleza de los aglomerados y/o agregados del Ni(OH)₂

Development and Characterization of PEEK/B2O3-Doped 45S5 Bioactive Glass Composite Coatings Obtained by Electrophoretic Deposition

Three different glasses were synthesized by doping 45S5 bioactive glass with B2O3. The bioactivity of the glasses was evaluated by immersion in simulated body fluid (SBF) up to 3 days; all glasses showed the precipitation of hydroxyapatite (HAp) after one day of soaking in SBF. Electrophoretic deposition (EPD) was used to prepare PEEK/B2O3-doped 45S5 glass composite coatings on stainless steel substrates. The coatings were characterized by means of tape test (ASTM D3359-B), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), contact angle measurements, thermogravimetric analysis and in vitro bioactivity test. All composite coatings exhibited a porous and homogenous structure with a hydrophobic surface, according to the wettability test. The in vitro test in SBF demonstrated that the coatings were highly bioactive

Can Clinical Pathways be Developed to Offer Assistance in Child Care Cases?

Clinical and care pathways are increasingly being used to help with decision-making in various areas of health and social care. The value of these pathways is that they provide a standard approach to offering care, help maintain quality of delivery, and control cost. This paper reports on the first step in developing a pathway which may assist in the very difficult process of deciding the level of contact to birth parents of children after their removal from their care. The use of such a pathway in this area is fraught with difficulty, but if successful may help practitioners achieve the arrangements that are in the best interests of the child

Electrophoretic Deposition of Chitosan/h-BN and Chitosan/h-BN/TiO2 Composite Coatings on Stainless Steel (316L) Substrates

This article presents the results of an experimental investigation designed to deposit chitosan/hexagonal boron nitride (h-BN) and chitosan/h-BN/titania (TiO2) composites on SS316L substrates using electrophoretic deposition (EPD) for potential antibacterial applications. The influence of EPD parameters (voltage and deposition time) and relative concentrations of chitosan, h-BN and TiO2 in suspension on deposition yield was studied. The composition and structure of deposited coatings were investigated by FTIR, XRD and SEM. It was observed that h-BN and TiO2 particles were dispersed in the chitosan matrix through simultaneous deposition. The adhesion between the electrophoretic coatings and the stainless steel substrates was tested by using tape test technique, and the results showed that the adhesion strength corresponded to 3B and 4B classes. Corrosion resistance was evaluated by electrochemical polarization curves, indicating enhanced corrosion resistance of the chitosan/h-BN/TiO2 and chitosan/h-BN coatings compared to the bare stainless steel substrate. In order to investigate the in-vitro inorganic bioactivity, coatings were immersed in simulated body fluid (SBF) for 28 days. FTIR and XRD results showed no formation of hydroxyapatite on the surface of chitosan/h-BN/TiO2 and chitosan/h-BN coatings, which are therefore non bioactive but potentially useful as antibacterial coatings

he safety of the radiological patient, measurement through the legibility of the consent informed

OBJETIVO: Evaluar la legibilidad de los documentos de consentimiento informado (CI) que utiliza el Servicio de Radiodiagnóstico (RXD) de la Xerencia de Xestión Integrada de Ferrol (XXIF). METODOLOGÍA: Estudio observacional descriptivo realizado en 2015. Selección de todos los C.I. disponibles en el RXD del XXIF. Uso del método de legibilidad de Flesch-Szigriszt . Análisis de textos a través del programa informático INFLESZ® RESULTADOS:Se evaluaron 33 documentos de C.I. específicos de RX. CONCLUSIONES: La legibilidad no es un método exacto, pero si indicativo de lo compleja que puede llegar a ser la información escrita. Los valores de legibilidad obtenidos en este estudio nos “advierten” de que los pacientes realmente pueden no comprender toda la información que se les está intentando transmitir y que deben revisarse para lograr mayor comprensión y seguridad para el paciente.OBJECTIVE: To evaluate the readability of the documents of informed consent (CI) used by the Radiodiagnosis Service (RXD) of the Integrated Management of Ferrol Xerencia (XXIF). METHODOLOGY: Descriptive observational study conducted in 2015. Selection of all C.I. available in the RXD of the XXIF. Use of the readability method of Flesch-Szigriszt. Text analysis through the INFLESZ® computer program RESULTS: 33 documents from C.I. specific to RX. CONCLUSIONS: Readability is not an exact method, but it is indicative of how complex written information can be. The readability values obtained in this study "warn" that patients may not really understand all the information that they are trying to transmit and that they should be reviewed to achieve greater understanding and safety for the patient.Comunicación - póster presentada en VI Xornadas de calidade e seguridade do Sergas. V Congreso de calidade e seguridade de SOGALCA. "Ética, valores y derechos: componentes de la calidad", celebrado en Santiago de Compostela el 3 y 4 de junio de 2015

Evaluación AGREE-II de guías de práctica clínica sobre radiodermatitis aguda: AGREE-II evaluation of clinical practice guidelines in acute radiodermatitis

Objective: To evaluate and compare the quality of clinical practice guidelines (CPG) on prevention and treatment of acute radiodermatitis (RD). Methodology: Evaluation of methodological quality through the AGREE-II instrument. Search for CPG in specialized sources. Selection of CPGRD with an age of no more than 5 years. Review by three evaluators. Results: Of seven localized CPGs, 3 (two Mexican and one Canadian) were selected. The average quality achieved was 59% (sufficient quality). The first domain (scope and objective), obtained a good quality score (>75%), being the “worst” domain 5 (applicability) that was considered “low quality” (<50%) In all CPGGs evaluated. The rest of the domains achieved a sufficient quality (57.7%). A CPG was rated as “not recommended”, and no CPG was considered “highly recommended” by the reviewers. Conclusions: The CPG Mexicana of the IMSS and the Canadian GPC of the group MASCC, were considered as “recommended with conditions”; should improve key aspects such as: use a scale of evidence of greater methodological rigor, update the recommendations of evidence, include a viable implementation process and specify the editorial independence of the CPG.Objetivo: Evaluar y comparar la calidad de las guías de práctica clínica (GPC) sobre prevención y tratamiento de la radiodermatitis aguda (RDA). Metodología: Evaluación de la calidad metodoló- gica mediante el instrumento AGREE-II. Búsqueda de GPC en fuentes especializadas. Selección de GPC-RDA con antigüedad no superior a 5 años. Revisión por 3 evaluadores. Resultados: De siete GPC localizadas se seleccionaron 3 (dos mexicanas y una canadiense y cols.). La calidad media conseguida fue del 59% (calidad suficiente). Comparando los 6 Dominios AGREE, solo el primer dominio (alcance y objetivo), obtuvo calificación de buena calidad (>75%), siendo el “peor” el dominio 5 (aplicabilidad) que fue considerado de “baja calidad” (< 50%), en todas las GPC evaluadas. El resto de los dominios lograron una calidad suficiente (57,7%). Una GPC fue calificada como “no recomendable” y ninguna GPC fue considerada como “muy recomendada” por parte de los revisores. Conclusiones: La GPC Mexicana del IMSS y la GPC canadiense del grupo MASCC, fueron calificadas como “recomendables con condiciones”, debiendo mejorar aspectos clave como: utilizar una escala de evidencia de mayor rigor metodológico, actualizar las recomendaciones de evidencia, incluir un proceso de implementación viable y especificar la independencia editorial de la GPC