Núm 6, diciembre de 2013

Artículos destacados: Buenas prácticas en gestión clínica: Plan de prevención y atención a la parada cardiorrespiratoria en el Hospital Materno-Infantil de Málaga. Modelo de atención socio sanitaria: optimización de recursos y coordianción de la asistencia a pacientes institucionalizados en la residencia Manuel Ridruejo. Aplicación para la dispensación de medicamentos biológicos para el tratamiento de los pacientes con psoriasis (ADISBIO). Análisis de las prescripciones farmacológicas potencialmente inapropiadas en pacientes mayores en Atención Primaria. Boletín informativo sobre prácticas clínicas basadas en la mejor evidencia científica. Atención integral al paciente en situación terminal. Sala de acompañamiento.

Application of maldi-tof mass spectrometry in clinical virology: a review.

MALDI-TOF mass spectrometry is a diagnostic tool of microbial identification and characterization based on the detection of the mass of molecules. In the majority of clinical laboratories, this technology is currently being used mainly for bacterial diagnosis, but several approaches in the field of virology have been investigated. The introduction of this technology in clinical virology will improve the diagnosis of infections produced by viruses but also the discovery of mutations and variants of these microorganisms as well as the detection of antiviral resistance. This review is focused on the main current applications of MALDI-TOF MS techniques in clinical virology showing the state of the art with respect to this exciting new technology.

Niveles de evidencia clínica y grados de recomendación.

An update of the levels of scientific evidence stating the varying degrees of recommendation for asymptomatic patients, indicating which procedures are most appropriate and what should be avoided all the systems described, we seek one that meets the principle of simplicity and utility. We chose for our setting the valuation of the Centre for Evidence-Based Medicine, Oxford (OCEBM). This classification has the advantage that assures us the knowledge on each scenario, its high degree of specialization. It also has the prerogative to clarify how it affects the lack of methodological rigor to the study design, reducing its assessment not only in the grading of the evidence, but also on the strength of recommendations.

La evaluación de riesgos, una herramienta fundamental en la protección de la salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Calidad, Innovación y Salud Pública de la Consejería de Igualdad, Salud y Políticas Sociales

An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education.

BACKGROUND We evaluated a newly designed electronic portfolio (e-Portfolio) that provided quantitative evaluation of surgical skills. Medical students at the University of Seville used the e-Portfolio on a voluntary basis for evaluation of their performance in undergraduate surgical subjects. METHODS Our new web-based e-Portfolio was designed to evaluate surgical practical knowledge and skills targets. Students recorded each activity on a form, attached evidence, and added their reflections. Students self-assessed their practical knowledge using qualitative criteria (yes/no), and graded their skills according to complexity (basic/advanced) and participation (observer/assistant/independent). A numerical value was assigned to each activity, and the values of all activities were summated to obtain the total score. The application automatically displayed quantitative feedback. We performed qualitative evaluation of the perceived usefulness of the e-Portfolio and quantitative evaluation of the targets achieved. RESULTS Thirty-seven of 112 students (33%) used the e-Portfolio, of which 87% reported that they understood the methodology of the portfolio. All students reported an improved understanding of their learning objectives resulting from the numerical visualization of progress, all students reported that the quantitative feedback encouraged their learning, and 79% of students felt that their teachers were more available because they were using the e-Portfolio. Only 51.3% of students reported that the reflective aspects of learning were useful. Individual students achieved a maximum of 65% of the total targets and 87% of the skills targets. The mean total score was 345 ± 38 points. For basic skills, 92% of students achieved the maximum score for participation as an independent operator, and all achieved the maximum scores for participation as an observer and assistant. For complex skills, 62% of students achieved the maximum score for participation as an independent operator, and 98% achieved the maximum scores for participation as an observer or assistant. CONCLUSIONS Medical students reported that use of an electronic portfolio that provided quantitative feedback on their progress was useful when the number and complexity of targets were appropriate, but not when the portfolio offered only formative evaluations based on reflection. Students felt that use of the e-Portfolio guided their learning process by indicating knowledge gaps to themselves and teachers.

Boletín informativo sobre prácticas clínicas basadas en la mejor evidencia científica

Sección "Buenas prácticas en gestión clínica"

Mapa de competencias y buenas prácticas profesionales en bioética

La Escuela Andaluza de Salud Pública ha colaborado en la elaboración de este documento como apoyo al desarrollo de la Estrategia de Bioética del SSPA. Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Nuestro Compromiso por la Calidad / Bioética y Bioderecho / Competencias Profesionales en Bioética)

Pour une linguistique marxiste

L'ouvrage se propose de faire connaître l'héritage théorique du linguiste soviétique Evgenij Dmitrievic Polivanov (1891-1938), sociolinguiste, phonologue, spécialiste de poésie et de dialectologie, un des principaux acteurs de l'« édification linguistique » en URSS. Accompagné d'une présentation et de commentaires, ce choix de textes offre une nouvelle clé de lecture pour comprendre la politique linguistique en Union soviétique dans les années 1920-1930. Derrière des initiatives souvent présentées comme politiques, on redécouvre les idées de Polivanov sur le rapport entre langue et société, entre dialecte et langue normée, entre alphabet et politique, entre marxisme et linguistique. La préface d'Elena Simonato rappelle le contexte historique et épistémologique dans lequel est née la « linguistique marxiste » de Polivanov. Suivent quatre textes en version bilingue. Le lecteur y découvrira une pensée d'une grande modernité. L'oeuvre de Polivanov constitue la base des idées du Cercle de Prague et de l'école linguistique de Leningrad, à la source de deux disciplines qui ont marqué le xxe siècle : la phonologie et la sociolinguistique

Escuela de familias, un sitio web para la participación e implicación de las familias en el proceso educativo

Boletín semanal para profesionales sanitarios de la Secretaría General de Calidad, Innovación y Salud Pública de la Consejería de Igualdad, Salud y Políticas Sociales

Guía de práctica clínica para el cuidado de personas que sufren quemaduras

Publicaciones complementarias: Folleto: Guía de prevención y cuidados de las personas con quemaduras. Folleto desplegable: Guía rápida de consulta para el cuidado de personas que sufren quemaduras

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation.

BACKGROUND The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.

Claudin-19 mutations and clinical phenotype in Spanish patients with familial hypomagnesemia with hypercalciuria and nephrocalcinosis.

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is an autosomal recessive tubular disorder characterized by excessive renal magnesium and calcium excretion and chronic kidney failure. This rare disease is caused by mutations in the CLDN16 and CLDN19 genes. These genes encode the tight junction proteins claudin-16 and claudin-19, respectively, which regulate the paracellular ion reabsorption in the kidney. Patients with mutations in the CLDN19 gene also present severe visual impairment. Our goals in this study were to examine the clinical characteristics of a large cohort of Spanish patients with this disorder and to identify the disease causing mutations. We included a total of 31 patients belonging to 27 unrelated families and studied renal and ocular manifestations. We then analyzed by direct DNA sequencing the coding regions of CLDN16 and CLDN19 genes in these patients. Bioinformatic tools were used to predict the consequences of mutations. Clinical evaluation showed ocular defects in 87% of patients, including mainly myopia, nystagmus and macular colobomata. Twenty two percent of patients underwent renal transplantation and impaired renal function was observed in another 61% of patients. Results of the genetic analysis revealed CLDN19 mutations in all patients confirming the clinical diagnosis. The majority of patients exhibited the previously described p.G20D mutation. Haplotype analysis using three microsatellite markers showed a founder effect for this recurrent mutation in our cohort. We also identified four new pathogenic mutations in CLDN19, p.G122R, p.I41T, p.G75C and p.G75S. A strategy based on microsequencing was designed to facilitate the genetic diagnosis of this disease. Our data indicate that patients with CLDN19 mutations have a high risk of progression to chronic renal disease.

Incendis històrics a l'alta muntanya pirinenca : anàlisi dels carbons sedimentaris a la torbera de Montarenyo (Lladorre, Pallars Sobirà)

Les zones europees d’alta muntanya, concretament les mediterrànies, han estat utilitzades des de temps remots per l’ésser humà, a través de l’aprofitament de boscos i prats mitjançant activitats com l’agricultura, la ramaderia, la silvicultura i la metal·lúrgia. Però, des de fa temps, amb l’abandonament de les àrees rurals, estem davant d’una falta de gestió dels boscos, degut a la pèrdua de les activitats tradicionals. L’objectiu d’aquest treball és el de determinar l’impacte provocat per les societats antigues sobre els boscos, amb la utilització del foc com a eina de gestió, així com l’anàlisi dels processos d’antropització de les zones de muntanya que utilitzaven aquest recurs. En aquest treball l’anàlisi de l’evolució del paisatge es fa mitjançant l’estudi de les comunitats vegetals històriques i la dinàmica d’incendis, a través de dues metodologies basades en testimonis sedimentaris: l’anàlisi de carbons i l’anàlisi del pol·len. El testimoni sedimentari ha estat extret de la torbera ombrotròfica de Montarenyo, situada a la vessant sud dels Pirineus, a la Vall de Cardós, al Pallars Sobirà. Aquestes dues disciplines han permès indagar en la geohistòria ambiental, per tal d’establir les relacions entre l’ambient i la societat. Els resultats mostren que el foc ha estat utilitzat per nombroses activitats, creant unes dinàmiques forestals característiques. El paisatge actual és conseqüència de les pressions que va haver de patir el bosc durant anys, unes pressions que, amb major o menor mesura han gestionat les masses forestals. Cal doncs conèixer quina ha estat la gestió històrica del bosc per entendre’n el seu estat actual i poder escollir la gestió més adequada per conservar-lo.