Portal of Clinical Practice Guidelines : Digital Strategy for the Dissemination of Clinical Practice Guidelines Developed in Colombia

Introducción: En respuesta a la necesidad de información concisa, veraz y práctica para sustentar la toma de decisiones clínicas, el Gobierno colombiano, en alianza con diversas universidades y sociedades científicas, ha hecho una gran inversión en el desarrollo de guías de práctica clínica (GPC). Objetivos: Desarrollar un portal web para la difusión y comunicación de las GPC y las recomendaciones clínicas consignadas en las guias. Metodología: Desarrollo del portal web colombiano de GPC basado en los principios de aprendizaje para adultos, desarrollo de aprendizaje en medicina basado en web (e-learmng) y mejoramiento de desarrollo web en educación médica, utilizando diversas herramientas informáticas. Resultados: El portal web cumple con el propósito de difundir las recomendaciones de las GPC, utilizando diversas alternativas para la presentación de los contenidos, así como para la creación de canales de comunicación entre los desarrolladores de las GPC y sus usuarios.Artículo original44-57Introduction: In response to the necessity of concise, accurate and practical information to support clinical decision making, the Colombian government, in partnership with universities and scientific societies, has heavily invested in the development of clinical practice guidelines (CPG). Objectives: To develop a Web portal for the dissemination and communication of CPG and its clinical recommendations. Methodology: Development of the Colombian GPC web portal based on the principles of adult learning, learning development in medicine based on the Web and improvement of web development for medical education, using various informatic tools. Results: A Web portal that fulfills the purpose of disseminating the recommendations of the GPC, using various alternatives for the presentation of content, as well as to create channels of communication between developers and users of the CPG Portal

The effect of an educational intervention, based on clinical simulation, on the diagnosis of rheumatoid arthritis and osteoarthritis

Q1Artículo original147-151Objective: The aim of the present study was to evaluate the effectiveness of an educational tool for general physicians, based on rheumatological clinical simulation, for the diagnosis of rheumatoid arthritis and osteoarthritis. Methods: A randomized clinical study was carried out, in which the physician research subjects were assigned to one of two groups: the experimental group (educational intervention for rheumatoid arthritis with clinical simulation) or the control group (educational intervention for the basic aspects of the diagnosis and treatment of osteoporosis). Four weeks after the educational intervention, the members of both groups completed an examination that included four clinical cases with real patients, two clinical cases with two clinical simulation models and six virtual clinical cases. In this examination, the participants noted clinical findings, established a diagnosis and defined the complementary tests they would request, if necessary, to corroborate their diagnosis. Results: A total of 160 doctors participated (80 in the active educational intervention for rheumatoid arthritis and 80 in the control group), of whom 89 were women (56%). The mean age was 35 (standard deviation 7.7) years. Success was defined as a physician correctly diagnosing at least 10 of the 12 cases presented. A significant difference of 81.3% (95% confidence interval 72–90%; p < 0.001) in success was found in favour of the active group (88.8% versus 7.5%). A greater number of correct answers was found in the active group compared with the control group in the detection of clinical findings and in the number of complementary tests requested (p < 0.001). Conclusions: The study showed the effectiveness of an educational intervention based on clinical simulation to improve the diagnostic approach to rheumatoid arthritis and osteoarthritis

Clinical practice guidelines for the prevention, early detection, diagnosis, treatment and monitoring of dyslipidemia : non-pharmacological treatment with exercise

Objetivo: Evaluar el impacto del ejerciciocomo una intervención no farmacológica parala prevención primaria y secundaria de eventoscardio y cerebrovasculares asociados a dislipidemiaen personas con hipercolesterolemia.Métodos: Se elaboró una guía de práctica clínicasiguiendo los lineamientos de la guía metodológicadel Ministerio de Salud y ProtecciónSocial para recolectar de forma sistemática laevidencia científica y formular las recomendacionesutilizando la metodología GRADE. Setomó la información específica acerca de ejerciciocomo medida terapéutica en el tratamientode dislipidemia. Resultados: Tanto el ejercicioaeróbico como el de resistencia se asocian adisminución en el colesterol con lipoproteínasde baja densidad y los triglicéridos, cambiosque fueron estadísticamente significativos; peroestos no son clínicamente relevantes, dado quese trata de una reducción mínima. No se encontróun cambio estadísticamente significativo enlos valores de colesterol de alta densidad. Conclusiones:Se presenta evidencia a favor del usode ejercicio como parte fundamental del tratamientode hipercolesterolemia. Aunque no seencontraron diferencias clínicamente significativasen los valores de colesterol o triglicéridos,el ejercicio físico es una actividad con ampliosbeneficios para el paciente en otros dominiosclínicos de interés, por lo que al considerar elriesgo y el beneficio de esta práctica, los beneficiosson claros y superan ampliamente el bajoriesgo al que se expone una persona al realizaruna rutina de ejercicio, como parte de su vidacotidiana.Artículo original34-43Objective: To evaluate the impact of exercise as a non-pharmacological intervention for primary and secondary prevention of cardiovascular events in people with hypercholesterolemia. Methods: A clinical practice guideline was developed following the guidelines of the methodological guidance of the Ministry of Health and Social Protection to collect systematically the evidence and make recommendations using the GRADE methodology. Results: Both aerobic and resistance exercise are associated with decreased LDL cholesterol and triglycerides, changes were statistically significant, but these changes are not clinically relevant since it is a minimal reduction in these values. No statistically significant change was found in HDL cholesterol values. Conclusions: Recommendations for the use of exercise as a fundamental part of the treatment of hypercholesterolemia are formulated. Although no clinically significant differences in the values of cholesterol or triglycerides, exercise is an activity with great benefits for the patient in other clinical domains of interest, being part of healthy lifestyles and exposure to low risk, so when you consider the risks and benefits of this practice, the benefits are clear and far outweigh the low risk to which a person is exposed when performing an exercise routine as part of their daily lives

Lo glocal y el turismo. Nuevos paradigmas de interpretación.

El estudio del turismo se realiza desde múltiples escalas y enfoques, este libro aborda muchos temas que es necesario discutir desde diversas perspectivas; es el caso de la reflexión sobre la propia disciplina y sus conceptos, así como los asuntos específicos referidos al impacto territorial, los tipos de turismo, las cuestiones ambientales, el tema de la pobreza, la competitividad, las políticas públicas, el papel de las universidades, las áreas naturales protegidas, la sustentabilidad, la cultura, el desarrollo, la seguridad, todos temas centrales documentados y expuestos con originalidad y dominio del asunto. Lo multiescalar es básico para la comprensión del sistema turístico, sistema formado de procesos globales, regionales y locales. El eje de discusión del libro es lo glocal, esa interacción entre lo nacional y local con lo global

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P &lt;0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Memorias de investigación: Feria de Semilleros y Jornadas de Investigación de uniminuto, Seccional Antioquia - Chocó.

Feria de Semilleros y Jornadas de Investigación de uniminuto, Seccional Antioquia - Chocó.Esta publicación busca divulgar investigaciones y producción académica en diferentes disciplinas, realizadas por estudiantes y docentes de UNIMINUTO Seccional Antioquia – Chocó, así como dar a conocer los semilleros de investigación que participaron en la V Feria de Semilleros, con el fin de visibilizar el trabajo que realiza el Centro de Investigación para el Desarrollo de UNIMINUTO Bello —CIDUB—, con respecto a debates académicos y espacios de interlocución. Igualmente, permite que la comunidad educativa conozca los temas de investigación y las discusiones que se están dando entre los semilleros y grupos de investigación, para así buscar puntos de encuentro y sinergias entre los investigadores. Adicionalmente, el texto se convierte en una invitación para que se vinculen otros investigadores, docentes, estudiantes e incluso otras instituciones a los procesos investigativos coordinados desde el CIDUB