Comparación entre las técnicas de cribado de patología cervical y las conizaciones de tres hospitales en españa

Objetivo: Analizar las características poblacionales y los métodos diagnósticos de patología cervical para la prevención del cáncer de cérvix de tres hospitales españoles para mejorar y unificar los programas de cribado y prevención. Material y métodos: Estudio retrospectivo de las características demográficas y clínicas de 408 mujeres con patología cervical uterina diagnosticadas en 3 hospitales españoles. Se comparan los factores de riesgo, el proceso diagnóstico y la indicación de tratamiento de dos grupos: las que requirieron conización cervical (n=222) y las que no precisaron tratamiento quirúrgico (n=186). También se analizan las recomendaciones vacunales y su grado de cumplimiento. Resultados: Las mujeres conizadas usaron más anticoncepción hormonal y tienen un mayor hábito tabáquico mientras que el número de compañeros sexuales es mayor en pacientes no conizadas. Más del 50% de pacientes con biopsia cervical positiva presentaron un resultado igual o más grave en la anatomía patológica de la pieza quirúrgica. Existen diferencias significativas en sensibilidad y valor predictivo positivo de la citología y de la determinación de HPV entre hospitales. La recomendación de vacunación en ambos grupos fue similar, el porcentaje de mujeres que no la cumplieron fue elevado y significativamente mayor entre pacientes conizadas. Conclusión: En nuestro medio las mujeres conizadas tienen características clínicas y epidemiológicas diferentes a las no conizadas, existen diferencias entre las técnicas diagnósticas de distintos hospitales y sin embargo la concordancia entre biopsia y resultado del cono es elevada. Sigue siendo necesaria una correcta educación sanitaria en relación con la vacunación en mujeres con patología cervical. Background: To analyse the characteristics of the population and diagnostic methods related to the cervical cancer prevention program in three different-level hospitals of a Spanish region in order to improve and unify the screening program. Methods: We retrospectively studied demographic and clinical characteristics of 408 women with cervical lesions diagnosed in three hospitals in Aragon (Spain). Correlation between risk factors, diagnosis process and conisation indication was analysed divided in two groups: conisation required (n=222) or non-conisation (n=186). We also assessed the number of vaccine recommendations made to the patients and the degree of compliance. Results: Conisaited women more frequently used a combined hormonal contraceptive method and are more smokers, while the sexual partners are more in women without conisation. More than 50% of women con positive biopsy was confirmed after surgical treatment. There are significant differences between sensibility and positive predictive value of pap-smear and HPV determination in different hospitals. The recombinant vaccine was recommended to both groups at a similar rate. The percentage of women who were recommended to receive the vaccine but chose not to do it, was high in both groups but significantly higher in the Conisation group. Conclusion: In our environment conisaited women have different clinical and epidemiological profiles, there are differences between diagnosis techniques in different hospitals, however, the concordance between biopsy and definitive result is high. A good sanitary education is necessary in relation with the vaccination of women with cervical pathology

Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most

Manual de simulación clínica en especialidades médicas

Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado. La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente. Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto. El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes. La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu

Data from: Robust inference on large-scale species habitat use with interview data: the status of jaguars outside protected areas in Central America

Evaluating range-wide habitat use by a target species requires information on species occurrence over broad geographic regions, a process made difficult by species rarity, large spatiotemporal sampling domains, and imperfect detection. We address these challenges in an assessment of habitat use for jaguars (Panthera onca) outside protected areas in Central America. Occurrence records were acquired within 12 putative corridors using interviews with knowledgeable corridor residents. We developed a Bayesian hierarchical occupancy model to gain robust inference, allowing for heterogeneity introduced in the sampling process over space and time, using records of jaguar occurrence prone to false positives and false negatives. Probability of false detection of jaguars increased with the number of interviews conducted per unit (from 5.42% to 7.74% given <4 and ≥4 observers per unit). True probability of detection (mean=0.58) increased with the number of days interviewees spent in a survey unit per year. Failing to account for false positives biased predicted habitat use high (˜1.8x), especially where occurrence records were sparse. Probability of site use by jaguars increased with greater forest cover, prey richness, and distance from human settlements, and decreased with greater agricultural cover, elevation, and distance from protected areas. Site use probabilities averaged 0.15-0.97 by corridor, providing relatively fine-scale resolution of predicted jaguar occurrence consistent with known patterns of jaguar gene flow across Central America. Model validation, accounting for both false positives and negatives in the observation process, indicated moderate correspondence between model-predicted observations and actual observations for withheld data (0.65, 95% CRI 0.59–0.71), with sensitivity and specificity rates of 0.69 (0.61 – 0.77) and 0.59 (0.50 – 0.68), respectively. These results demonstrate that reliable predictions can be achieved despite the complexity of large-scale, interview-based analyses of species occurrence. Synthesis and applications. Our Bayesian hierarchical occupancy model accommodated heterogeneity caused by typical sampling inequities and idiosyncrasies associated with interview data, yielding robust estimates of jaguar habitat use. Our approach is applicable to any wide-ranging and readily identifiable species and has particular utility for rare species in human-dominated landscapes where traditional survey techniques (e.g., camera traps) may be impractical

Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016) Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016)

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2 ́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6 cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met

Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016) Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016)

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2 ́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6 cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met

The interest of the Spanish network of investigators in back pain for rehabilitation physician

Background: The Spanish Back Pain Research Network (REIDE) brings together teams of researchers and clinicians who are interested in nonspecific neck and back pain (BP). Its objective is to improve the efficacy, safety, effectiveness, and efficiency of the clinical management of BP. Method: The Network welcomes clinicians and researchers interested in BP. The only requirement to become a member of REIDE is to take part in one of its research projects, and any member can propose a new one. The Network supports those projects that are of interest to two or more groups by assuming their administration and management, which allows the researchers to focus on their task. Its working method ensures methodological quality, a multidisciplinary approach, and the clinical relevance of those projects that are carried out. Results: 179 researchers from 11 areas in Spain are involved in REIDE, including experts in all of the relevant fields of BP research. Most Spanish studies on BP that have been published in international scientific journals come from the teams involved in REIDE, and it currently has 13 ongoing research projects. Conclusions: The Network can help to enhance research among rehabilitation specialists who are interested in BP, and can contribute to the development of research projects which are of interest to the specialty. © 2005 Sociedad Española de Rehabilitación y Medicina Física (SERMEF) y Elsevier España, S.L