Efectividad de las normas de ética en la práctica clínica habitual

[spa] INTRODUCCIÓN: Las normas éticas de las profesiones sanitarias se hallan habitualmente recogidas en los códigos de ética. En la literatura científica es frecuente el estudio de la importancia de estas normas. Sin embargo no es así el estudio de la percepción de aplicación –efectividad- de las mismas en la práctica clínica habitual. OBJETIVO: Crear y estudiar la validez de tres nuevos instrumentos para medir la efectividad de las normas éticas entre los sanitarios y los pacientes. METODOLOGÍA: La construcción de los dos instrumentos de medición ha tenido como referencia el código de ética de las enfermeras de Barcelona, y los derechos de la Carta de Derechos y Deberes de los ciudadanos en relación con la salud y la atención sanitaria. La validez interna de los ítems se ha estudiado mediante procedimientos habituales de la Teoría Clásica de Test y de los modelos de Rasch. El estudio de las puntuaciones se relacionó con otras variables, como el conocimiento de las normas éticas, la edad o la confianza en los profesionales. RESULTADOS: Se han validado tres nuevas escalas para estudiar la percepción de la efectividad de las normas éticas en la práctica clínica habitual. Los resultados en el colectivo de enfermeras indican que la sensibilidad ética está influida por el conocimiento de las normas del código, los años de práctica profesional y el ámbito de asistencia (hospital o atención primaria). El instrumento basado en los derechos de la carta de derechos de los ciudadanos corrobora estos resultados. Asimismo, se ha probado que existen diferencias en la percepción de cumplimiento entre colectivos de profesionales y centros de atención primaria. En los pacientes, el estudio de validación ha demostrado que la confianza es una variable relevante en la percepción de práctica ética que realizan los profesionales. CONCLUSIONES: La efectividad de las normas éticas de práctica clínica está influenciada por factores como el conocimiento de las normas, la confianza en el profesional, el área asistencial o el centro de trabajo. Los trabajos presentados evidencian que es posible el estudio científico de la conducta moral de los profesionales con el objetivo de establecer un diálogo ético posterior. UTILIDAD DE RESULTADOS: Los instrumentos que han sido construidos presentan validez interna suficiente para utilizarse en posteriores estudios con el objetivo de examinar la percepción de práctica ética entre profesionales y la opinión que tienen los pacientes. La información de los estudios publicados ha contribuido a comprender el grado de compromiso que los médicos y enfermeras tienen con las normas teóricas que guían su práctica

Effectiveness of a new one-hour blood pressure monitoring method to diagnose hypertension: a diagnostic accuracy clinical trial protocol

Introduction 24-hour ambulatory blood pressure monitoring (ABPM) is the gold standard diagnostic method for hypertension, but has some shortcomings in clinical practice while clinical settings often lack sufficient devices to accommodate all patients with suspected hypertension. Home blood pressure monitoring (HBPM) and office blood pressure monitoring (OBPM) also have shortcomings, such as the white coat effect or a lack of accuracy. This study aims to study the validity of a new method of diagnosing hypertension consisting of monitoring blood pressure (BP) for 1 hour and comparing it with OBPM and HBPM and examining the sensitivity and specificity of this method compared with 24-hour ABPM. The patient experience will be examined in each method. Methods and analysis A minimum sample of 214 patients requiring a diagnostic test for hypertension from three urban primary healthcare centres will be included. Participants will undergo 24-hour ABPM, 1-hour BP measurement (1-BPM), OBPM for three consecutive weeks and HBPM. Patients will follow a random sequence to first receive 24-hour ABPM or 1-hour ABPM. Daytime 24-hour ABPM records will be compared with the other monitoring methods using the correlation coefficient and Bland Altman plots. The kappa concordance index and the sensitivity and specificity of the methods will be calculated. The patient’s experience will be studied, with selected indicators of efficiency and satisfaction calculated using parametric tests. Ethics and dissemination The protocol has been authorised by the research ethics committee of the Hospital Clinic of Barcelona (Ref. HCB/2014/0615): protocol details and amendments will be recorded and reported to ClinicalTrials.com. The results will be disseminated in peer-reviewed literature, and to policy makers and healthcare partners.Peer ReviewedPostprint (published version

Impact of the COVID-19 Pandemic on Primary Health Care Disease Incidence Rates: 2017 to 2020

We assessed the impact of the COVID-19 pandemic in Spain on new cases of diseases and conditions commonly seen in primary care. In 2020, there were significant reductions from 2017-2019 in the annual incidences of hypertension (40% reduction), hypercholesterolemia (36%), type 2 diabetes (39%), chronic kidney disease (43%), ischemic heart disease (48%), benign prostatic hypertrophy (38%), osteoporosis (40%), hypothyroidism (46%), chronic obstructive pulmonary disease (50%), alcohol use disorder (46%), benign colon polyps and tumors (42%), and melanomas (45%). Prioritization of COVID-19 care changed the physician-patient relationship to the detriment of face-to-face scheduled visits for chronic disease detection and monitoring, which fell by almost 41%. To return to prepandemic levels of diagnosis and management of chronic diseases, primary health care services should reorganize and carry out specific actions for groups at higher risk

Comparison of Conventional vs. Oncoplastic Breast-Conserving Surgery in a Breast Unit with Oncoplastic Training

Purpose: Oncoplastic Breast Conserving Surgery (OBCS) has been tested in oncological terms demonstrating that it is as effective as Standard Lumpectomy (SL) nowadays; Patients-Reported Outcomes (PRO) have become a relevant way to assess breast cancer treatment. The aim of this work was to compare OBCS with SL using a PRO measurement, BREAST-Q Breast Conserving Therapy (BCT) module. Methods: One hundred and sixty-five patients with early primary breast cancer treated with BCT were questioned using BREAST-Q Version 2.0 BCT Module, postoperative scales, in Spanish, after radiotherapy treatment was administered. The patients filled in the questionnaire in a paper-andpencil format at our breast unit. The sample size was estimated to observe differences of 7 points in the satisfaction with breast domain (postoperative scale) between both approaches. This difference is slightly higher than 10% of the median of satisfaction with breast domain reported in published studies. An analysis was done to compare statistics. Results: SL was used in 108 patients and OBCS in 57. Patients treated with OCBS had a larger radiological lesion than patients treated with SL (median 20 mm vs. 15 mm) corresponding with a higher pathological tumor (17 mm vs. 13 mm). The time from the radiotherapy end date to when the questionnaire was filled in was longer in those patients treated with OBCS (mean 8 vs. 15.5 months). No significant statistical differences were found in the BREAST-Q postoperative domain scores between both approaches. Conclusion: The quality of life and the satisfaction with the oncoplastic breast conserving approach or the standard lumpectomy evaluated by the BREAST-Q were similar in our breast unit

Laparoscopic resection of renal cyst. Case report

La implementación y el desarrollo de la cirugía video laparoscópica en la Especialidad de Urología han revolucionado la mayoría de las técnicas quirúrgicas y han demostrado su efectividad a través del tiempo; en la actualidad prácticamente cualquier intervención quirúrgica urológica tiene su contraparte laparoscópica, incluso las oncológicas complejas y las reconstructivas. Se presenta una paciente femenina de 70 años con antecedentes de salud hasta hace varios meses que notó aumento de volumen a nivel del hemiabdomen derecho asociado a dolor lumbar tipo cólico. Se le diagnosticó quiste renal tabicado y se le realizó resección de quiste renal derecho a través de vía laparoscópica. La paciente evolucionó satisfactoriamente, lo que apoya el uso de esta técnica quirúrgica, que marca el inicio de la cirugía laparoscópica urológica en la Provincia de Villa Clara.Implementation and development of laparoscopic video surgery in the Urology specialty have revolutionized most surgical techniques and they have proven their effectiveness over time; at present practically any urological surgery has its laparoscopic counterpart, even complex oncological and reconstructive ones. It presents a female patient of 70 years old with a health history until several months ago who noticed a volume increase at the level of the right hemiabdomen associated with back pain colic. It was diagnosed partitioned kidney cyst and a resection of the right renal cyst was performed through a laparoscopic way. The patient evolved satisfactorily, which supports the use of this surgical technique, that marks the beginning of laparoscopic urological surgery in the Villa Clara Province

Face-to-Face and Tele-Consults: A Study of the Effects on Diagnostic Activity and Patient Demand in Primary Healthcare

Primary healthcare services have changed from face-to-face to tele-consults during the two COVID-19 years. We examined trends before and during the COVID-19 pandemic years based on groups of professionals, patient ages, and the associations with the diagnostic registry. We analyzed proportions for both periods, and ratios of the type of consults in 2017-2019 and 2020-2021 were calculated. The COVID-19 period was examined using monthly linear time trends. The results showed that consults in 2020-2021 increased by 24%. General practitioners saw significant falls in face-to-face consults compared with 2017-2019 (ratio 0.44; 95% CI: 0.44 to 0.45), but the increase was not proportional across age groups; patients aged 15-44 years had 45.8% more tele-consults, and those aged >74 years had 18.2% more. Trends in linear regression models of face-to-face consults with general practitioners and monthly diagnostic activity were positive, while the tele-consult trend was inverse to the trend of the diagnostic registry and face-to-face consults. Tele-consults did not resolve the increased demand for primary healthcare services caused by COVID-19. General practitioners, nurses and primary healthcare professionals require better-adapted tele-consult tools for an effective diagnostic registry to maintain equity of access and answer older patients' needs and priorities in primary healthcare

300 GHz CMOS video detection using broadband and active planar antennas

Using CMOS transistors for terahertz detection is currently a disruptive technology that offers the direct integration of a terahertz detector with video preamplifiers. The detectors are based on the resistive mixer concept and performance mainly depends on the following parameters: type of antenna, electrical parameters (gate to drain capacitor and channel length of the CMOS device) and foundry. Two different 300 GHz detectors are discussed: a single transistor detector with a broadband antenna and a differential pair driven by a resonant patch antenna