La neuromodulació d'arrels sacres en el tractament de la incontinència fecal

Incontinència fecal; Plexe lumbar; Estimulació elèctrica transcutània del nerviIncontinencia fecal; Plexo lumbosacro; Estimulación eléctrica transcutánea del nervioFecal incontinence; Lumbar plexus; Transcutaneous electrical nerve stimulationL'estimulació de les arrels sacres (ERS) mitjançant un dispositiu mèdic que genera impulsos elèctrics (elèctrode més un estimulador) és un tractament mínimament invasiu de la incontinència fecal (IF), que es planteja com a alternativa terapèutica a les persones que no responen al tractament conservador i tenen un esfínter estructuralment intacte o amb lesions parcials de tots dos esfínters. La incidència i l'impacte personal, familiar, laboral i social de la IF, així com el cost de la ERS fan imprescindible revisar l'eficàcia i seguretat d'aquest tractament per valorar la seva introducció i millorar el tractament de les persones afectades.La estimulación de las raíces sacras (ERS) mediante un dispositivo médico que genera impulsos eléctricos (electrodo más un estimulador) es un tratamiento mínimamente invasivo de la incontinencia fecal (IF), que se plantea como alternativa terapéutica a las personas que no responden al tratamiento conservador y tienen un esfínter estructuralmente intacto o con lesiones parciales de ambos esfínteres. La incidencia y el impacto personal, familiar, laboral y social de la IF, así como el coste de la ERS hacen imprescindible revisar la eficacia y seguridad de este tratamiento para valorar su introducción y mejorar el tratamiento de las personas afectadas.Sacral nerve stimulation (SNS) by means of an (electrode and stimulator) electronic device is a minimally invasive treatment for fecal incontinence (FI), which arises as a therapeutic alternative to people who do not respond to conservative treatment and have a structurally intact sphincter or partial lesions of both sphincters. The incidence and the personal, family, work and social impact, together with the cost of SNS, make it imperative to review the effectiveness and safety of this treatment to assess its introduction and improve the quality of care for affected people

La neuromodulació d’arrels sacres en el tractament de la incontinència fecal

Incontinència fecal; Plexe lumbar; Estimulació elèctrica transcutània del nerviIncontinencia fecal; Plexo lumbosacro; Estimulación eléctrica transcutánea del nervioFecal incontinence; Lumbar plexus; Transcutaneous electrical nerve stimulationL'estimulació de les arrels sacres (ERS) mitjançant un dispositiu mèdic que genera impulsos elèctrics (elèctrode més un estimulador) és un tractament mínimament invasiu de la incontinència fecal (IF), que es planteja com a alternativa terapèutica a les persones que no responen al tractament conservador i tenen un esfínter estructuralment intacte o amb lesions parcials de tots dos esfínters. La incidència i l'impacte personal, familiar, laboral i social de la IF, així com el cost de la ERS fan imprescindible revisar l'eficàcia i seguretat d'aquest tractament per valorar la seva introducció i millorar el tractament de les persones afectades.La estimulación de las raíces sacras (ERS) mediante un dispositivo médico que genera impulsos eléctricos (electrodo más un estimulador) es un tratamiento mínimamente invasivo de la incontinencia fecal (IF), que se plantea como alternativa terapéutica a las personas que no responden al tratamiento conservador y tienen un esfínter estructuralmente intacto o con lesiones parciales de ambos esfínteres. La incidencia y el impacto personal, familiar, laboral y social de la IF, así como el coste de la ERS hacen imprescindible revisar la eficacia y seguridad de este tratamiento para valorar su introducción y mejorar el tratamiento de las personas afectadas.Sacral nerve stimulation (SNS) by means of an (electrode and stimulator) electronic device is a minimally invasive treatment for fecal incontinence (FI), which arises as a therapeutic alternative to people who do not respond to conservative treatment and have a structurally intact sphincter or partial lesions of both sphincters. The incidence and the personal, family, work and social impact, together with the cost of SNS, make it imperative to review the effectiveness and safety of this treatment to assess its introduction and improve the quality of care for affected people

La estimulación de raíces sacras para el tratamiento de la incontinencia fecal: revisión de la eficacia y análisis de coste-efectividad

Incontinencia fecal; Plexo lumbosacro; Estimulación eléctrica transcutánea del nervioIncontinència fecal; Plexe lumbar; Estimulació elèctrica transcutània del nerviFecal incontinence; Lumbar plexus; Transcutaneous electrical nerve stimulationLa estimulación de las raíces sacras (ERS) mediante un dispositivo médico que genera impulsos eléctricos (electrodo más un estimulador) es un tratamiento mínimamente invasivo de la incontinencia fecal (IF), que se plantea como alternativa terapéutica a las personas que no responden al tratamiento conservador y tienen un esfínter estructuralmente intacto o con lesiones parciales de ambos esfínteres. La incidencia y el impacto personal, familiar, laboral y social de la IF, así como el coste de la ERS hacen imprescindible revisar la eficacia y seguridad de este tratamiento para valorar su introducción y mejorar el tratamiento de las personas afectadasSacral nerve stimulation (SNS) by means of an (electrode and stimulator) electronic device is a minimally invasive treatment for fecal incontinence (FI), which arises as a therapeutic alternative to people who do not respond to conservative treatment and have a structurally intact sphincter or partial lesions of both sphincters. The incidence and the personal, family, work and social impact, together with the cost of SNS, make it imperative to review the effectiveness and safety of this treatment to assess its introduction and improve the quality of care for affected people.L'estimulació de les arrels sacres (ERS) mitjançant un dispositiu mèdic que genera impulsos elèctrics (elèctrode més un estimulador) és un tractament mínimament invasiu de la incontinència fecal (IF), que es planteja com a alternativa terapèutica a les persones que no responen al tractament conservador i tenen un esfínter estructuralment intacte o amb lesions parcials de tots dos esfínters. La incidència i l'impacte personal, familiar, laboral i social de la IF, així com el cost de la ERS fan imprescindible revisar l'eficàcia i seguretat d'aquest tractament per valorar la seva introducció i millorar el tractament de les persones afectades

Translational research: A concept emerged from health sciences and exportable to education sciences

The objective of this paper was to analyze the concept and evolution of translational research in order to explore if it can be used in fields other than health sciences such as higher education. A mini review was conducted using Medline as a main source for identifying papers. We selected papers that appeared to be relevant according to our objective. Data extraction of these papers was made by summarizing documents using short textual descriptions. Search results yielded 1186 papers, 28 of which were finally selected for the mini review. The main aim of translational research is bridging the know do gap. Several multiphase models have been identified. The first described model had two phases (T1, T2) but there are models with three (T1-T3) or four phases (T1-T4). However, regardless of the model used, three main gaps exist that can be placed in the knowledge chain underpinning translational research. Translational research could be seen as a bidirectional bridge connecting the laboratory to practice either in health or in education. Its interdisciplinary back and forth ultimately contributes to improved health or education outcomes. This improvement can be achieved if the three gaps of the knowledge chain are overcome. Namely, these gaps are located: (1) between the discovery of new knowledge and dissemination to potential users of that knowledge; (2) between knowledge dissemination to potential users and its routine application to health or education practice; and (3) between clinical or educational practice and improvement of health or education outcomes.L'objectiu d'aquest treball va ser analitzar el concepte i l'evolució de la investigació translacional per tal d'explorar si es pot utilitzar en altres àmbits a part de les ciències de la salut com ara l'educació superior.El objetivo de este trabajo fue analizar el concepto y la evolución de la investigación translacional para explorar si se puede utilizar en otros ámbitos aparte de las ciencias de la salud como la educación superior

Evaluation of a Clinical Decision Support System for Dyslipidemia Treatment (HTE-DLPR) by QoE questionnaire

Introduction: Clinical decision support systems (CDSS) are computer systems designed to assist clinicians with patient-related decision making, such as diagnosis and treatment. CDSS have shown to improve both patient outcomes and cost of care.Methods: A multi-center observational prospective study was conducted. Ten physicians agreed to participate. Seventy-seven patients with high or very high cardiovascular risk were included. After using CDSS for dyslipidemia (HTE-DLPR) for a 3 months period, participants were asked to evaluate their experience with HTE-DLPR using a quality of experience questionnaire (QoE) tool for mHealth applications.Results: Total score on the QoE was 3.89 out of 5. The highest scores were received for precision, ease of use and content quality. The lowest scores were given to security, appearance and performance. Physicians were in strong agreement with the 1st HTEDLPR recommendation in 86.1% and the system’s use was described as comfortablein 85% of cases. Users positively evaluated the development of a new version of HTEDLPR in the future receiving a total score of 4.25 out of 5.Conclusions: A CDSS for dyslipidemia (HTE-DLP) has been positively evaluated by physicians using QoE questionnaire

Xpert Bladder Cancer Monitor for the Early Detection of Non-Muscle Invasive Bladder Cancer Recurrences: Could Cystoscopy Be Substituted?

Biomarker; Bladder cancer; SurveillanceBiomarcador; Cáncer de vejiga; VigilanciaBiomarcador; Càncer de bufeta; VigilànciaXBM was prospectively assessed in spontaneous urine collected just before flexible cystoscopy and washing cytology carried out within the first 2 years follow-up of 337 patients with NMIBC. Recurrences were pathologically confirmed in 49 patients (14.5%), 22 of them being high-risk (6.5%). The XBM sensitivity for detecting any type of recurrence was 69.4% and 63.6% in the cases of high-risk NMIBC. Negative predictive value (NPV) for XBM was 93% for all recurrences and 96.2% for high-risk recurrences. XBM could have avoided 213 invasive controls but missed the detection of 15 recurrences (30.6%)-8 of them of high-risk (36.4%). XBM false positive elevations were detected in 90 patients (26.7%), whereas 10 patients with the invasive method had a false positive result (3%), p <0.001. However, early detection of recurrences during the first year's follow-up after an XBM false positive result was observed in 18 patients (20%). On the other hand, 19 recurrences were detected during this period among the rest of the patients (7.7%)-p = 0.003, and odds ratio (OR) 3.0 (95% CI 1.5-6.0). Regarding one-year follow-up recurrences, 10% were high-risk recurrences in the XBM false positive group and 3.2% in the rest of the patients-p = 0.021, and OR 3.3 (95% CI 1.2-8.9). Additionally, 11.3% of the patients without false positive results developed a recurrence, p = 0.897, for any recurrence, being 10% and 5.2%, respectively, and high-risk and low-risk recurrences, p = 0.506. After searching for the best XBM cutoff for detecting the 38 high-risk initial recurrences and the early high-risk recurrences after a one-year follow-up, a linear discriminant analysis (LDA) of 0.13 could have avoided 11.3% of cystoscopies and bladder wash cytologies, as this cutoff missed only 1 high-risk recurrence (2.6%). More extensive and well-designed studies will confirm if XBM can improve the surveillance of NMIBC

Wearable lifestyle tracking devices: Are they useful for teenagers?

open11siCarrion, Carme; Caon, Maurizio; Carrino, Stefano; Moliner, Liliana Arroyo; Lang, Alexandra; Atkinson, Sarah; Mazzola, Marco; Perego, Paolo; Standoli, Carlo Emilio; Castell, Conxa; Espallargues, MireiaCarrion, Carme; Caon, Maurizio; Carrino, Stefano; Moliner, Liliana Arroyo; Lang, Alexandra; Atkinson, Sarah; Mazzola, Marco; Perego, Paolo; Standoli, CARLO EMILIO; Castell, Conxa; Espallargues, Mirei

APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology

Attention deficit hyperactivity disorder; Evidence-based medicine; Meta-analysisTrastorn per dèficit d'atenció amb hiperactivitat; Medicina basada en l'evidència; MetaanàlisiTrastorno por déficit de atención con hiperactividad; Medicina basada en la evidencia; MetanálisisPurpose: Clinical practice guidelines (CPGs) have become fundamental tools for evidence-based medicine (EBM). However, CPG suffer from several limitations, including obsolescence, lack of applicability to many patients, and limited patient participation. This paper presents APPRAISE-RS, which is a methodology that we developed to overcome these limitations by automating, extending, and iterating the methodology that is most commonly used for building CPGs: the GRADE methodology.Method: APPRAISE-RS relies on updated information from clinical studies and adapts and automates the GRADE methodology to generate treatment recommendations. APPRAISE-RS provides personalized recommendations because they are based on the patient's individual characteristics. Moreover, both patients and clinicians express their personal preferences for treatment outcomes which are considered when making the recommendation (participatory). Rule-based system approaches are used to manage heuristic knowledge.Results: APPRAISE-RS has been implemented for attention deficit hyperactivity disorder (ADHD) and tested experimentally on 28 simulated patients. The resulting recommender system (APPRAISE-RS/TDApp) shows a higher degree of treatment personalization and patient participation than CPGs, while recommending the most frequent interventions in the largest body of evidence in the literature (EBM). Moreover, a comparison of the results with four blinded psychiatrist prescriptions supports the validation of the proposal.Conclusions: APPRAISE-RS is a valid methodology to build recommender systems that manage updated, personalized and participatory recommendations, which, in the case of ADHD includes at least one intervention that is identical or very similar to other drugs prescribed by psychiatrists.This work was supported by European Regional Development Fund (ERDF), the Spanish Ministry of the Economy, Industry and Competitiveness (MINECO) and the Carlos III Research Institute [PI19/00375], Fundació Pascual i Prats & Campus Salut, UdG [AIN2018E], Generalitat de Catalunya [2017 SGR 1551]

Eines per a la presa de decisions clíniques a Catalunya

Presa de decisions clíniques; Catalunya; Eines;Toma de decisiones clínicas; Cataluña; HerramientasClinical decisions making; Catalonia; ToolsLa majoria de països amb entorns culturals i científics similars al nostre aborden la millora de la qualitat de la pràctica clínica des de diverses perspectives. Els diferents instruments d’ajuda a la presa de decisions clíniques basats en l’evidència són un element clau per reduir la variabilitat en la pràctica mèdica i basada en la millor evidència científica existent. Les guies de pràctica clínica (GPC), conjuntament amb altres productes basats en l’evidència (APBE) com els protocols, les vies o les rutes assistencial, són eines que es troben a l’abast dels diferents professionals del món sanitari i que han demostrat que poden millorar la qualitat en la prestació de serveis del sistema sanitari, tant a nivell micro, com meso o macro. Dins del marc del Pla de Salut (2011-2015) de Catalunya s’inclou l’objectiu de potenciar l’avaluació sistemàtica de tecnologies, qualitat i recerca en salut, de manera que es pretén impulsar el desenvolupament i ús d’aquestes eines a casa nostra. Així doncs, l’objectiu d’aquest informe és principalment descriure l’estat de situació de les eines d’ajut a la presa de decisions clíniques en els diferents centres de titularitat pública d’atenció primària, especialitzada, sociosanitària i salut mental de Catalunya. Per assolir aquest objectiu s’ha dissenyat un estudi descriptiu, transversal, realitzat mitjançant una enquesta electrònica, que s’ha distribuït entre les 130 organitzacions sanitàries, de titularitat pública, que existeixen fins avui (març 2014) a Catalunya. En l’enquesta s’han inclòs 21 preguntes que fan referència a tres aspectes diferents: identificació del centre, ús i organització de les eines d’ajut a la presa de decisions clíniques I identificació de les guies més emprades en el maneig de les malalties cròniques prioritzades pel Pla de Salut per a l’any 2012.La mayoría de los países con entornos culturales y científicos similares al nuestro abordan la mejora de la calidad de la práctica clínica desde diferentes perspectivas. Los diferentes instrumentos de ayuda a la toma de decisiones clínicas basadas en la evidencia son un elemento clave para reducir la variabilidad en la práctica médica y basada en la mejor evidencia científica existente. Las guías de práctica clínica (GPC), junto con otros productos basados en la evidencia como los protocolos, vías o rutas asistenciales, son herramientas que se encuentran al alcance de los diferentes profesionales del mundo sanitario y que han demostrado que pueden mejorar la calidad en la prestación de servicios del sistema sanitario, tanto a nivel micro, como meso o macro. Dentro del marco del Plan de Salud (2011-2015) de Cataluña se incluye el objetivo de potenciar la evaluación sistemática de tecnologías, calidad e investigación en salud, de manera que se pretende impulsar el desarrollo y uso de estas herramientas en nuestro entorno. Así pues, el objetivo de este informe es principalmente describir el estado de situación de las herramientas de ayuda a la toma de decisiones clínicas en los diferentes centros de titularidad pública de atención primaria, especializada, sociosanitaria y salud mental de Cataluña. Para alcanzar este objetivo se ha diseñado un estudio descriptivo, transversal, realizado mediante una encuesta electrónica, que se ha distribuido entre las 130 organizaciones sanitarias de titularidad pública que existen a día de hoy en Cataluña (marzo 2014). En la encuesta se han incluido 21 preguntas que hacen referencia a tres aspectos diferentes: identificación del centro, uso y organización de las herramientas de ayuda a la toma de decisiones clínicas e identificación de las guías más utilizadas en el manejo de las enfermedades crónicas priorizadas por el Plan de Salud para el año 2012.Most countries with cultural and scientific backgrounds similar to ours address the improvement of the quality of clinical practice from different angles. Different evidence-based tools for clinical decision-making are key to reduce variability in medical practice based on the best available scientific evidence. Clinical practice guidelines (CPGs), together with other evidence-based products (EBPs), such as protocols, care pathways or routes, are tools that are available to different healthcare professionals. These tools have been shown to improve the quality standards of the health service delivery system, at micro, meso or macro level. One of the aims of the Health Plan (2011-2015) of Catalonia is to promote the systematic assessment of technology, quality and health research. Specifically, there is a need to establish a “CPG Office”, the objective of which would be to boost the development and use of these tools within our scope of action. Thus, the objective of this report is primarily to describe the state of the art of tools that aid clinical decision- making in the different public primary care, specialised care, long-term care and mental health care centres of Catalonia. To reach this goal, we have designed a descriptive, cross-sectional study, conducted through an online survey, which was distributed among 130 healthcare organizations, of public ownership, currently in operation in Catalonia (March 2014). The survey included 21 questions that referred to three different aspects: identification of the centre, use and organization of tools that help in clinical decision-making, and identification of the most widely used CPGs in the management of chronic diseases, as prioritized by the Health Plan for the year 2012