Protocolo de derivación a terapia visual

Introduction: This paper presents the design of a protocol for the referral of patients with clinical findings of visual disturbances that require vision therapy through the design of algorithms based on decision trees for their clinical management and visual rehabilitation supported by clinical evidence; the absence of standardization of processes makes it impossible to make a referral decision, which can generate uncertainty in making timely and correct provisions. Objective: Design a protocol to refer to vision therapy from the optometric consultation. Methodology: This research is qualitative, quantitative descriptive, because results were obtained based on the experience of 162 professionals surveyed; This research was conducted in the province of Manabí, although a national survey was applied to visual health professionals; Based on the data obtained, the protocol for referral to vision therapy was designed. Results: the action protocol was designed with five algorithms: amblyopia, remote PPC, strabismus in distant and near vision, and oculomotor dysfunction, accommodation, and decreased stereopsis dysfunctions. Conclusions: The basic tests identified that should be performed based on visual function are visual acuity, refraction, contrast vision and color vision; for visual efficiency: ocular motility, accommodation, and stereopsis; the structure of the protocol for referral to the visual therapy area was established through easy-to-interpret flowcharts. The standardization and management of equality of procedures is a useful tool for conducting research and multicenter studies where there must be equality.Introducción: Se presenta en este trabajo el diseño de un protocolo para la derivación de pacientes con hallazgos clínicos de alteraciones visuales que requieren terapia visual, mediante el diseño de algoritmos basados en árbol de decisiones para su manejo clínico y rehabilitación visual apoyados en la evidencia clínica; la ausencia de la estandarización de procesos imposibilita la decisión de derivación, lo que puede generar incertidumbre en la toma de disposiciones oportunas y acertadas. Objetivo: Diseñar un protocolo para derivar a terapia visual desde la consulta optométrica. Metodología: Esta investigación es de tipo cualitativo, descriptiva cuantitativa, debido que se obtuvieron resultados en base a la experiencia de 162 profesionales encuestados; esta investigación se desarrolló en la provincia de Manabí básicamente, aunque se aplicó una encuesta a nivel nacional para los profesionales de la salud visual; en base a los datos obtenidos, se diseñó el protocolo de derivación a terapia visual. Resultados: se diseñó el protocolo de actuación con cinco algoritmos: ambliopía, PPC alejado, estrabismo en visión lejana, próxima y disfunciones oculomotoras, de acomodación y estereopsis disminuida. Conclusiones: Las pruebas básicas identificados que se proponen realizar en base a la función visual son: agudeza visual, refracción, visión al contraste y visión al color; para la eficacia visual: motilidad ocular, acomodación y estereopsis; se estableció la estructura del protocolo para derivación al área de terapia visual mediante flujogramas de fácil interpretación. La estandarización y manejo en igualdad de procedimientos es una herramienta útil para hacer investigación, y estudios multicéntricos para obtener igualdad

Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes

Purpose: The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods: This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 μg/dL (confirmed ACS if >5 μg/dL and possible ACS if 1.8–5 μg/dL) in the absence of spe cific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results: The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS–PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS–PA and PA-only patients was simil ar, except for older age and larger tumor size of the adrenal lesion in the ACS–PA group. When comparing the ACS–PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64–22.32)) and cardiovascular events (OR 5.0 (2.29–11.07)) was higher in ACS–PA patients than in ACS patients. The coexistence of ACS in patien ts with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS–PA and PA-only groups. Conclusion: Co-secretion of cortisol and aldosterone affects almost one-thi rd of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS–PA and PA-only are similar