Formación continuada en un equipo de atención primaria: análisis de las sesiones docentes 1996-1998

ObjetivoDescribir las sesiones docentes de un equipo de atención primaria en el trienio 1996-1998. Identificar los profesionales que las realizaron, así como estudiar las áreas del conocimiento abordadas.DiseñoEstudio descriptivo transversal, retrospectivo.EmplazamientoCentro de salud docente perteneciente a una zona de salud rural.ParticipantesTotal de sesiones docentes realizadas durante el trienio estudiado (n = 249).IntervencionesDe la hoja de registro mensual del programa de formación continuada de nuestra gerencia, se extrajeron las siguientes variables: fecha actividad, duración, número de asistentes, tipo de sesión, profesional docente y contenido de actividad (clasificada por patología según órganos y sistemas para sesión bibliográfica, clínica y con experto; cartera servicios de atención primaria-INSALUD 1996 para sesión sobre programa; informática).Mediciones y resultados principalesSesiones por mes: media 6,9 (DE, 4,8). Media asistentes: 9,3 (DE, 3,01). Duración media: 36,5 minutos (DE, 11,0). Tipo de sesión: bibliográfica, 65,2%; sobre programa, 18; sesión con experto, 7,2; informática, 5,6; clínica, 4. Responsables docentes: médico residente, 39,4%; médico de familia tutor, 34,9; médico de familia no tutor, 7,2; ATS, 6,4; médico hospitalario, 4; médico de familia sustituto, 3,6; farmacéutico, 2,8; pediatra, 1,2; fisioterapeuta, 0,4. Contenido actividades más frecuentes: patología general inespecífica, 16,1%; enfermedades de la piel, 8,8, y enfermedades del sistema endocrino, 7,6%.ConclusionesBaja frecuencia de sesiones clínicas. Los responsables docentes fueron mayoritariamente médicos de familia tutores y médicos residentes, siendo escasa la participación del resto de personal.ObjectivesTo describe the teaching sessions of a primary care team in the three-year period 1996-1998. To identify the professionals who ran them and study the areas of knowledge tackled. Design. A retrospective, cross-over, descriptive study.SettingTeaching health centre belonging to a rural health district.ParticipantsAll the teaching sessions that took place during the three-year period (n = 249). Interventions. The following variables were extracted from the monthly register sheet of the ongoing training programme of our management: date of activity, duration, number attending, type of session, teaching professional and contents of activity (classified by pathology according to organs and systems for bibliographic, clinical and expert sessions; portfolio of 1996 Primary Care- INSALUD services for session on programme; computer studies).Measurements and main resultsMean sessions per month: 6.9 (SD: 4.8). Mean attendance: 9.3 persons (SD: 3.01). Mean length: 36.5 minutes (SD: 11.0). Type of session: bibliographic 65.2%, on programme 18%, session with expert 7.2%, computer studies 5.6%, clinical 4%. Responsible for teaching: intern 39.4%; family doctor tutor 34.9%; family doctor not a tutor 7.2%; nurse 6.4%; hospital doctor 4%; locum family doctor 3.6%; pharmacist 2.8%; paediatrician 1.2%; physiotherapist 0.4%. Most common contents: non-specific general pathology (16.1%), skin diseases (8.8%), diseases of the endocrine system (7.6%).ConclusionsLow frequency of clinical sessions. The teachers in charge were mainly family doctor tutors and interns, with the rest of the staff participating little

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogé[email protected]

Planck 2018 results. IV. Diffuse component separation

We present full-sky maps of the cosmic microwave background (CMB) and polarized synchrotron and thermal dust emission, derived from the third set of Planck frequency maps. These products have significantly lower contamination from instrumental systematic effects than previous versions. The methodologies used to derive these maps follow closely those described in earlier papers, adopting four methods (Commander, NILC, SEVEM, and SMICA) to extract the CMB component, as well as three methods (Commander, GNILC, and SMICA) to extract astrophysical components. Our revised CMB temperature maps agree with corresponding products in the Planck 2015 delivery, whereas the polarization maps exhibit significantly lower large-scale power, reflecting the improved data processing described in companion papers; however, the noise properties of the resulting data products are complicated, and the best available end-to-end simulations exhibit relative biases with respect to the data at the few percent level. Using these maps, we are for the first time able to fit the spectral index of thermal dust independently over 3 degree regions. We derive a conservative estimate of the mean spectral index of polarized thermal dust emission of beta_d = 1.55 +/- 0.05, where the uncertainty marginalizes both over all known systematic uncertainties and different estimation techniques. For polarized synchrotron emission, we find a mean spectral index of beta_s = -3.1 +/- 0.1, consistent with previously reported measurements. We note that the current data processing does not allow for construction of unbiased single-bolometer maps, and this limits our ability to extract CO emission and correlated components. The foreground results for intensity derived in this paper therefore do not supersede corresponding Planck 2015 products. For polarization the new results supersede the corresponding 2015 products in all respects

Planck 2018 results. XII. Galactic astrophysics using polarized dust emission

We present 353 GHz full-sky maps of the polarization fraction $p$, angle $\psi$, and dispersion of angles $S$ of Galactic dust thermal emission produced from the 2018 release of Planck data. We confirm that the mean and maximum of $p$ decrease with increasing $N_H$. The uncertainty on the maximum polarization fraction, $p_\mathrm{max}=22.0$% at 80 arcmin resolution, is dominated by the uncertainty on the zero level in total intensity. The observed inverse behaviour between $p$ and $S$ is interpreted with models of the polarized sky that include effects from only the topology of the turbulent Galactic magnetic field. Thus, the statistical properties of $p$, $\psi$, and $S$ mostly reflect the structure of the magnetic field. Nevertheless, we search for potential signatures of varying grain alignment and dust properties. First, we analyse the product map $S \times p$, looking for residual trends. While $p$ decreases by a factor of 3--4 between $N_H=10^{20}$ cm$^{-2}$ and $N_H=2\times 10^{22}$ cm$^{-2}$, $S \times p$ decreases by only about 25%, a systematic trend observed in both the diffuse ISM and molecular clouds. Second, we find no systematic trend of $S \times p$ with the dust temperature, even though in the diffuse ISM lines of sight with high $p$ and low $S$ tend to have colder dust. We also compare Planck data with starlight polarization in the visible at high latitudes. The agreement in polarization angles is remarkable. Two polarization emission-to-extinction ratios that characterize dust optical properties depend only weakly on $N_H$ and converge towards the values previously determined for translucent lines of sight. We determine an upper limit for the polarization fraction in extinction of 13%, compatible with the $p_\mathrm{max}$ observed in emission. These results provide strong constraints for models of Galactic dust in diffuse gas

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Molecular profiling of immunoglobulin heavychain gene rearrangements unveils new potential prognostic markers for multiple myeloma patients

Multiple myeloma is a heterogeneous disease whose pathogenesis has not been completely elucidated. Although B-cell receptors play a crucial role in myeloma pathogenesis, the impact of clonal immunoglobulin heavy-chain features in the outcome has not been extensively explored. Here we present the characterization of complete heavychain gene rearrangements in 413 myeloma patients treated in Spanish trials, including 113 patients characterized by next-generation sequencing. Compared to the normal B-cell repertoire, gene selection was biased in myeloma, with significant overrepresentation of IGHV3, IGHD2 and IGHD3, as well as IGHJ4 gene groups. Hypermutation was high in our patients (median: 8.8%). Interestingly, regarding patients who are not candidates for transplantation, a high hypermutation rate (≥7%) and the use of IGHD2 and IGHD3 groups were associated with improved prognostic features and longer survival rates in the univariate analyses. Multivariate analysis revealed prolonged progression-free survival rates for patients using IGHD2/IGHD3 groups (HR: 0.552, 95% CI: 0.361−0.845, p = 0.006), as well as prolonged overall survival rates for patients with hypermutation ≥7% (HR: 0.291, 95% CI: 0.137−0.618, p = 0.001). Our results provide new insights into the molecular characterization of multiple myeloma, highlighting the need to evaluate some of these clonal rearrangement characteristics as new potential prognostic markers