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Medicina Clínica 05/2013; · 1.38 Impact Factor
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Atención Primaria 04/2012; 44(6):369. · 0.63 Impact Factor
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ABSTRACT: Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found. Conclusions: There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement.
European Journal of Pediatrics 02/2012; 171(7):1109-19. · 1.88 Impact Factor
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ABSTRACT: To determine which medical journals are read by Primary Care doctors, their language preferences, publication format and the ways of accessing them.
Telephone interview.
All the autonomous communities of Spain.
A total of 300 Primary Care physicians selected by proportional stratified sampling by autonomous community and type of professional (general practitioners and paediatricians).
A structured 18-question survey on reading habits administered by telephone using computer-assisted techniques.
Respondents declared they preferably read specialty journals and are inclined to the printed format, although the online version is the option of younger doctors and paediatricians. The general practitioners prefer to read case studies (73%) and paediatricians opt for the reviews (74%). Overall, 48% read 1 to 4 articles per week. The search tools preferred by 70% of respondents were Google and Yahoo, followed by databases (29%). Eighty eight per cent stated an interest in having a free online service to find quality Spanish journals. As regards language, 80% find it more useful to read articles in Spanish than in English, and 70% believe that there are no quality differences between the publications in both languages.
The publications in Spanish are used as the preferred sources of information by a high percentage of Primary Care physicians. These professionals believe that Spanish-language databases make it easier to access these publications, and are useful and necessary for professional practice.
Atención Primaria 06/2011; 43(12):629-36. · 0.63 Impact Factor
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Medicina Clínica 05/2011; 136(13):601-2. · 1.38 Impact Factor
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ABSTRACT: The Cochrane Collaboration provides growing and readily accessible resources to help ensure that medical decision-making is based on detailed, methodical, and up-to-date reviews of the best available evidence. We analyzed systematic reviews in the field of pediatric cardiology published by the Cochrane Collaboration's 50 Collaborative Review Groups. We found a total of 20 systematic reviews: 13 published by the Cochrane Neonatal Group, 6 by the Cochrane Heart Group, and 1 by the Cochrane Peripheral Vascular Disease Group. Systematic reviews in pediatric cardiology appear infrequently. They only concern evidence-based decision-making in the therapeutic management of patent ductus arteriosus and arterial hypotension in preterm infants, and in the management of children with Kawasaki disease. The quality of the clinical trials contained in the systematic reviews of acute rheumatic fever or obesity in children is limited. Consequently, the reviewers' conclusions provide an inadequate basis for inferring probable effects in clinical practice. In pediatric cardiology, many therapies continue to be used without supportive evidence. We found no systematic reviews of important cardiologic topics in childhood such as heart failure, shock, hypertension, congenital cardiopathy, and arrhythmia. Clinical practice guidelines complement systematic reviews, which can recommend only strategies that are supported by strong evidence or suggest further research when scientific evidence is inadequate.
Revista Espa de Cardiologia 10/2005; 58(9):1093-106. · 2.53 Impact Factor
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Medicina Clínica 05/2005; 124(12):478-9. · 1.38 Impact Factor
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 4, 2006.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 4, 2006.
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Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 71, Nº. 5, 2009, pags. 379-382.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 2, 2006.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 1, Nº. 1, 2005.
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ABSTRACT: Presentamos una revisión de la evidencia sobre los procedimientos diagnósticos más empleados en la bronquiolitis aguda (BA). Las pruebas de diagnóstico rápido de infección por virus respiratorio sincitial son aceptablemente válidas, presentando una moderada-alta sensibilidad y una alta especificidad en relación a otras pruebas de referencia. Las pruebas más empleadas, por su escasa complejidad y rapidez (técnicas de enzimoinmunoanálisis, inmunocromatografía e inmunoensayo óptico), presentan una menor sensibilidad que la inmunofluorescencia directa. Con ellas, un resultado positivo es válido, pero un resultado negativo no permite descartar con suficiente seguridad la presencia de infección. Las muestras respiratorias obtenidas mediante aspirado nasofaríngeo son las más válidas para la identificación del virus respiratorio sincitial. No se ha demostrado la utilidad de la radiografía de tórax en el manejo de la bronquiolitis, existiendo una relación riesgo-beneficio desfavorable, por la exposición a radiación ionizante. No existen signos o síntomas concretos que permitan identificar a los pacientes que se beneficiarán de la realización de una radiografía de tórax. La medición de la saturación de oxígeno resulta útil en la valoración inicial o en el control de los cambios clínicos de los pacientes. Los pacientes con BA tienen un riesgo muy bajo de infección bacteriana coincidente (fundamentalmente infección urinaria), por lo que el uso sistemático de pruebas de cribado de infección bacteriana no resulta útil. No existen criterios clínicos con suficiente capacidad predictiva como para seleccionar los casos que se beneficiarían de dichas pruebas.
Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 72, Nº. 4, 2010, pag. 284.
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ABSTRACT: Presentamos una revisión de la evidencia sobre el tratamiento de la bronquiolitis aguda. Hay pruebas suficientes de la falta de eficacia de la mayoría de las intervenciones evaluadas en la bronquiolitis. Aparte de la oxigenoterapia, la fluidoterapia intravenosa, la aspiración de secreciones y la ventilación mecánica, pocas opciones de tratamiento son beneficiosas. Existen dudas sobre la eficacia de broncodilatadores inhalados (salbutamol o adrenalina), con o sin suero salino hipertónico, lo que sugiere que debe hacerse un uso selectivo de los mismos como ensayos terapéuticos en bronquiolitis moderada-graves. En casos con fracaso respiratorio parecen útiles el heliox y las técnicas de ventilación no invasiva, en pacientes con apneas las metilxantinas y en pacientes graves intubados el surfactante y la ribavirina inhalados. La evidencia disponible es contraria al uso del salbutamol vía oral, la adrenalina vía subcutánea, los fármacos anticolinérgicos, los corticoides inhalados o sistémicos, los antibióticos, la inmunoglobulina intravenosa o en aerosol, la fisioterapia respiratoria y otros (óxido nítrico, desoxirribonucleasa humana recombinante, interferón recombinante, furosemida nebulizada, etc).
Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 72, Nº. 4, 2010, pag. 285.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 3, Nº. 2, 2007.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 1, Nº. 1, 2005.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 2, 2006.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 3, 2006.
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Evidencias en pediatría, ISSN 1885-7388, Vol. 2, Nº. 2, 2006.
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Revista Pediatría de Atención Primaria, ISSN 1139-7632, null 9, Nº. 34, 2007, pags. 89-97.
