Mejoras en la atención a personas con enfermedades crónicas en España. Declaración de posición común de la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina Familiar y Comunitaria
https://www.elsevier.es/es-revista-atencion-primaria-27-articulo-mejoras-atencion-personas-con-enfermedades-S0212656719307620
PARTICIPA
lunes, 30 de diciembre de 2019
sábado, 28 de diciembre de 2019
miércoles, 25 de diciembre de 2019
martes, 24 de diciembre de 2019
lunes, 23 de diciembre de 2019
sábado, 21 de diciembre de 2019
viernes, 20 de diciembre de 2019
miércoles, 18 de diciembre de 2019
lunes, 16 de diciembre de 2019
La formacion en ecografia de los medicos de familia canadienses.
Canadian
national survey of family medicine residents on point-of-care ultrasound
training
METHODS
A bilingual (English and French) online survey of
Canadian family medicine residents was administered between March and June
2017. The survey was developed by a group of 8 POCUS experts, including
ultrasound academic leads with extensive teaching experience and publications
related to POCUS, as well as input from family medicine residents and a medical
student. Our group included physicians from McGill University in Montreal, Que;
the University of Ottawa in Ontario; the University of Manitoba in Winnipeg; Memorial
University of Newfoundland in St John’s; the University of Toronto in Ontario;
and Western University in London, Ont. This survey was designed to ask similar
questions to our survey of family medicine program directors to allow for
direct comparison.21 Both of
these surveys also had strong influence from previous surveys conducted by
Steinmetz et al and Hall et al, which were each independently validated, and so
we did not repeat external validation and pilot testing of this survey.18,25 The questions
were reviewed internally by our group of POCUS experts and altered multiple
times to maximize their clarity and avoid any biased language. The survey and
study design were approved by the provincial Health Research Ethics Board of
Memorial University. The final survey consisted of 3 sections: current training
status, perceived relevance of POCUS to primary care, and demographic
characteristics. There are 23 items in the survey, including multiple-choice
questions with single or multiple answers, rating-scale questions, and
Likert-type scales.
All family medicine residents of the 17 Canadian
family medicine residency programs were included in the study. Enhanced skills
residents were excluded from the study, as many of these programs, such as
emergency medicine, already have an integrated POCUS curriculum.
The target population was estimated to be 2645
first- and second-year family medicine residents nationwide based on Canadian
Resident Matching Service data and verified by respective site administrators.
Survey participants were entered into a random draw for gift cards of $50.
The first survey invitation was sent out via
e-mail on March 15, 2017, with reminder e-mails sent 1 and 2 months after the
original invitation. The survey was closed on June 30, 2017, at midnight to
avoid changes in our survey population associated with the new cohort of
residents who started on July 1. The invitation contained a short cover letter,
an abstract describing the objectives of the study, and a link to the online
consent form and survey. The survey link was sent to the study population
through individual e-mail using a private e-mailing list sent by respective
resident site coordinators and program administrators; individual e-mail using
a private e-mailing list sent by respective resident representatives of the
College of Family Physicians of Canada Section of Residents; a survey link
included in the e-newsletter of the residency program; a survey link posted on
Facebook groups of the residency program; and a private e-mailing list of the
Society of Rural Physicians of Canada. To ensure multiple surveys were not
completed by the same respondent, only 1 survey submission was accepted from a
single IP (Internet protocol) address.
The survey was distributed by SurveyMonkey. Raw
data were exported from SurveyMonkey into a Microsoft Excel spreadsheet. A
single data abstractor analyzed the survey responses and reported them as
percentages in tabular format. Responses were kept anonymous and all data were
reported in aggregate.
DISCUSSION
Our survey results demonstrate that most
residents express a strong interest in POCUS training and support the use of
POCUS in primary care practice. However, a formal POCUS curriculum has not yet
been incorporated into most Canadian family medicine residency programs. This
reiterates the results of our recent study of family medicine program
directors, who also expressed an interest in establishing a POCUS curriculum.
Despite this desire for training, currently only 3 family medicine residency programs
in Canada offer an established ultrasound curriculum.21
Implementing POCUS training in family medicine
residency programs has several potential barriers, including limited access to
ultrasound machines and qualified instructors.21 Aside from a
mandatory POCUS curriculum in residency programs, our results suggest a POCUS
elective or funding to take external POCUS training are potential solutions.
However, this can pose a substantial financial burden to residents, as these
electives and courses can cost between $1000 and $5000. Most residents (91.6%)
believed funding should come from residency programs to take these courses if
formal ultrasound training is unavailable. Increasingly, residency training
programs are facing budgetary constraints. Developing in-house training
programs or local POCUS electives would help mitigate these costs.
Most residents supported the inclusion of POCUS
in primary care practice and identified its main benefits as being a useful
adjunct to the physical examination and a rapid diagnostic tool, as well as
having the potential to reduce health care spending. Most residents would also
consider using POCUS regularly in their clinical practice if both the
appropriate training and access to an ultrasound machine were provided. These
views are similar to those in the previous study of family medicine program
directors, who also expressed favourable views of POCUS in primary care.21 Although
most evidence supporting POCUS use comes from emergency medicine, the movement
toward the inclusion of ultrasound in family medicine is supported by the
growing body of literature highlighting that POCUS use in primary care is
accurate, is safe, and has numerous applications for family practice.26–34
In conjunction with the results from our previous
survey, both residents and program directors believe ultrasound is useful in
clinical practice for AAA screening, obstetric indications, and procedural
guidance.21 The use of
ultrasound for these applications in primary care is well supported by
evidence. Research has demonstrated long-term mortality benefits associated
with ultrasound screening of asymptomatic patients for AAA. A recent Canadian
prospective study showed that office-based scans for AAA screening had a high
degree of correlation with hospital-based scans.13 The use of
ultrasound in primary care obstetrics is well documented, and the American
Academy of Family Physicians endorsed obstetric ultrasound as a core skill for
maternity care.35 A plethora
of literature supports the use of ultrasound by clinicians to guide a variety
of procedures commonly performed in primary care such as drainage of
subcutaneous abscesses, joint aspiration, intra-articular injection,
confirmation of intrauterine device placement, and paracentesis.15,36–39
Contrary to the results of the survey of program
directors, residents also considered the FAST examination and limited
echocardiography as useful applications. Although the FAST examination is well
established in the context of abdominal trauma to identify free fluid, it can
also be used in the primary care clinic to identify ascites.9 Residents
might consider it to be a useful POCUS application owing to their familiarity
with its use, as it is often the first application taught as an introduction to
bedside ultrasound. Evidence supporting the use of limited echocardiography in
primary practice is currently lacking. A study from Norway has demonstrated
that after undergoing an 8-hour training program, general practitioners were
able to assess left ventricular function using pocket-sized ultrasound with a
sensitivity and specificity of 78% and 83%, respectively.29 This skill
could be useful for family physicians to help determine the cause of patients
presenting with dyspnea including heart failure and pleural effusions.
Many primary care physicians work in a variety of
practice settings, including in community emergency departments, in palliative
care settings, and as hospitalists. This is also reflected in the residents’
responses (Table 1).
The use of POCUS is helpful in the many different practice settings in which
family physicians work.
Limitations
A limitation of this study was the overall
response rate of only 32.3% of Canadian family medicine residents. Previous
research on large population survey studies reported an average response rate
of 30% to e-mail surveys and our results are comparable.40,41 Similarly,
the 2007 National Physician Survey of Canadian physicians and residents
achieved an e-mail response rate of 29.9%.42 In a
meta-analysis of Web- and Internet-based surveys, Cook et al suggested that
response representativeness is more important than response rate.43 Representativeness
refers to how well the sample drawn for the questionnaire reflects the greater
population attributes. Overall, responses were fairly evenly distributed across
rural, urban or community, and academic teaching units, with 29.6%, 38.2%, and
32.2% response rates, respectively. Another limitation to our survey study is
the lack of flexibility in response format. In our study of this large
population, multiple-choice responses, binary responses, and Likert scales
better quantify the predominant opinions of the surveyed population, but in
doing so, we lose certain nuances in the opinions expressed. When possible, we
allowed for an “other (please specify)” option for individual responses.
However, a qualitative study on the views of family medicine residents and
physicians would help to further our understanding of the role of POCUS in
primary care.
Finally, it is important to note that most of our
resident respondents do not have any formal training in POCUS. Only 33.2%
agreed or strongly agreed that they were familiar with the literature on POCUS
use. This is higher than family medicine program directors and academic leads,
of whom only 21% either agreed or strongly agreed.21 Thus, most
family medicine residents and program directors are not entirely familiar with
the current literature available on POCUS use, and so opinions on POCUS being
used to alter clinical decision making or having no negative effect on patient
care might not be evidence based. A future goal will be educating both
residents and program directors on the emerging evidence for POCUS use in
family medicine.
Conclusion
This is the largest survey identifying the
perceived need of family medicine residents for POCUS training. There is
overwhelming support for and interest in POCUS by family medicine residents
across Canada. Despite this, only 18.4% of residents currently receive formal
POCUS training through their residency programs. Consistent with our recent
family medicine program directors’ survey on POCUS, most believe training
should be incorporated into their residency curricula. Most residents believe
that POCUS would positively affect primary care and would consider using
ultrasound regularly in their clinical practice if they had the proper
training.
domingo, 15 de diciembre de 2019
Paliativos pediatria, importancia de los horarios de trabajo enhospital sobre resultados en salud.
The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians’ critical reflections
sábado, 14 de diciembre de 2019
viernes, 13 de diciembre de 2019
Changes in the Place of Death in the United States
TO THE EDITOR:
Where people die is an important determinant of patient and caregiver experience. To assess changes in place of death, we analyzed data from the Centers for Disease Control and Prevention and the National Center for Health Statistics database for natural deaths in the United States from 2003 through 2017. Cause of death was defined as the medical condition that had started the events that led directly to death, as recorded by the physician on the death certificate.1 Deaths from external causes were excluded. Between 2003 and 2017, there were nearly 35.2 million natural deaths (Figure 1). Most were attributed to cardiovascular disease (29.3%), followed by cancer (24.5%), respiratory disease (10.5%), dementia (7.9%), and stroke (5.9%).
In 2003, a total of 905,874 deaths occurred in hospitals (39.7%), which decreased to 764,424 (29.8%) in 2017, whereas the number of deaths at nursing facilities decreased from 538,817 (23.6%) to 534,714 (20.8%). The number of deaths at home increased from 543,874 (23.8%) in 2003 to 788,757 (30.7%) in 2017, whereas the number of deaths at hospice facilities increased from 5395 (0.2%) to 212,652 (8.3%). These trends were seen across all disease groups.
Younger patients, female patients, and racial and ethnic minorities had lower odds of death at home than did older patients, male patients, and white patients. Patients with cancer had the greatest odds of death at home and death at a hospice facility and the lowest odds of death at a nursing facility relative to other conditions. Patients with dementia had the greatest odds of death at a nursing facility, and patients with respiratory disease had the greatest odds of death at a hospital. Patients with stroke had the lowest odds of death at home, and patients with cardiovascular disease had the lowest odds of death at a hospice facility relative to other conditions.
Home has surpassed the hospital as the most common place of death in the United States for the first time since the early 20th century.2 Hospital deaths remained common in 2017, although the percentage in the United States was lower than in Canada (59.9%)3 and England (46.0%).4 Death at home is preferred by most people, but for many this might not be possible or preferable.5 Although we could not determine from the data whether hospice services were provided at home or at nursing facilities or whether some assisted-living facilities were categorized as home, data derived from death certificates provide the broadest assessment of place of death despite their limitations. The trends noted here represent progress; however, more information about the experience of patients dying at home is needed to develop policies and services that ensure high-quality end-of-life care. These findings should lead to prioritizing improvements in access to high-quality home care for older Americans with serious illnesses.
Sarah H. Cross, M.S.W., M.P.H.
Duke University Sanford School of Public Policy, Durham, NC
Duke University Sanford School of Public Policy, Durham, NC
Haider J. Warraich, M.D.
Veterans Affairs Boston Healthcare System, Boston, MA
hwarraich@partners.org
Veterans Affairs Boston Healthcare System, Boston, MA
hwarraich@partners.org
Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.
Supplementary Material
jueves, 12 de diciembre de 2019
domingo, 8 de diciembre de 2019
miércoles, 4 de diciembre de 2019
Centre de Salut "El Raval" - Elx: Bon día, os dejo aquí el enlace sobre el algoritmo...
Centre de Salut "El Raval" - Elx: Bon día, os dejo aquí el enlace sobre el algoritmo...: Bon día, os dejo aquí el enlace sobre el algoritmo de Semfyc y redgdps publicado este año para completar la información acerca de la diabete...
martes, 3 de diciembre de 2019
domingo, 1 de diciembre de 2019
domingo, 24 de noviembre de 2019
viernes, 22 de noviembre de 2019
Portal del Medicamento (Los principales problemas de salud sobre Infecciones del tracto respiratorio: el año de las pautas cortas)
jueves, 14 de noviembre de 2019
¿Qué normativas han desarrollado las comunidades autónomas para avanzar en cultura de seguridad del paciente en sus organizaciones sanitarias? | Journal of Healthcare Quality Research
martes, 12 de noviembre de 2019
manuel sanchez molla compartió un enlace: The Dangers of Ignoring the Beers Criteria—The Prescribing Cascade | Humanities | JAMA Internal Medicine | JAMA Network
The Dangers of Ignoring the Beers Criteria—The Prescribing Cascade | Humanities | JAMA Internal Medicine | JAMA Network del Tweet de https://twitter.com/jamainternalmed/status/1188713527038447616?refsrc=email&s=11
Descarga la aplicación de Twitter
Descarga la aplicación de Twitter
Enviado desde mi iPad
manuel sanchez molla compartió un enlace: Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes | Archives of Disease in Childhood
Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes | Archives of Disease in Childhood del Tweet de https://twitter.com/bmj_company/status/1194163162934845440?refsrc=email&s=11
Descarga la aplicación de Twitter
Descarga la aplicación de Twitter
Enviado desde mi iPad
lunes, 11 de noviembre de 2019
sábado, 9 de noviembre de 2019
Salud, dinero y atención primaria: Mutualistas: influyentes camuflados entre insignif...
Salud, dinero y atención primaria: Mutualistas: influyentes camuflados entre insignif...: Igual que ocurría con el colectivo de médicos que reciben pagos de los laboratorios ( aquí ), en el colectivo mutualista se camuflan, ent...
viernes, 8 de noviembre de 2019
jueves, 7 de noviembre de 2019
Preevid: Cuándo iniciar el tratamiento del hipotiroidismo subclínico diagnosticado en el embarazo y con qué dosis de levotiroxina. / Subclinical hypothyroidism diagnosed in pregnancy: when and how to initiate treatment.
Cuándo iniciar el tratamiento del hipotiroidismo subclínico diagnosticado en el embarazo y con qué dosis de levotiroxina. La pregunta original del usuario era "¿A partir de qué niveles de TSH tenemos que tratar a una gestante, no diagnosticada de hipotiroidismo previamente? ¿Con qué dosis de levotiroxina hay que iniciar el tratamiento?" Subclinical hypothyroidism diagnosed in pregnancy: when and how to initiate treatment.
Una pregunta similar se contestó en 2017 (ver abajo). Se ha actualizado la búsqueda y tras la revisión realizada podemos resumir que para iniciar el tratamiento del hipotiroidismo subclínico en el embarazo habría que tener en cuenta las cifras de TSH y la presencia de anti-TPO, sin que exista un total consenso en los diferentes documentos seleccionados. De forma general, el tratamiento podría iniciarse con 1,2 mcg/Kg/día de levotiroxina.
El sumario de evidencia (SE) de Dynamed sobre la enfermedad tiroidea en el embarazo(1) recoge las recomendaciones sobre el manejo del hipotiroidismo subclínico de diferentes sociedades científicas:
- "American Thyroid Association"* (2017)(2): basa las recomendaciones en la presencia de anti-TPO:
- TSH por encima del rango específico para el embarazo y anti-TPO positivos: tratar con levotiroxina (recomendación fuerte, evidencia de calidad moderada);
- TSH > 10 mU/L y anti-TPO negativos: tratar con levotiroxina (recomendación fuerte, evidencia de calidad baja);
- TSH entre 2,5 mU/L y el límite superior para el embarazo con anti-TPO positivos: considerar levotiroxina (recomendación débil, evidencia de calidad moderada);
- TSH entre el límite superior específico en el embarazo y 10mU/L con anti-TPO negativos: considerar levotiroxina (recomendación débil, evidencia de baja calidad);
- TSH normal (o menor de 4 mU/L si los valores de referencia del embarazo no están disponibles) con anti-TPO negativos: no dar levotiroxina (recomendación fuerte, evidencia de alta calidad).
- "American College of Obstetrics and Gynecology" (2015)(3): no hace recomendaciones específicas para el tratamiento del hipotiroidismo subclínico de la mujer embarazada.
- "Endocrine Society" (2012)(4) -extraemos la recomendaciones directamente de la guía-:
- se recomienda el tratamiento para mujeres con anti-TPO positivos: recomendación grado B (evidencia suficiente) para resultados obstétricos y recomendación grado I (evidencia insuficiente para hacer la recomendación) para resultados neurológicos;
- se recomienda el tratamiento para mujeres con anti-TPO negativos: recomendación grado C (recomendación basada en el criterio del médico y las preferencias del paciente) para resultados obstétricos y recomendación grado I (evidencia insuficiente para hacer la recomendación) para resultados neurológicos.
- "European Thyroid Association" (2014)(5): recomienda iniciar el tratamiento con 1,2 μg/Kg/día (recomendación fuerte)*. Comprobamos que, aunque esta guía no marca ninguna cifra de TSH ni la presencia de anti-TPO para el inicio del tratamiento, indica que las pacientes recién diagnosticadas de hipotiroidismo subclínico deberían recibir tratamiento con levotiroxina (recomendación fuerte, evidencia moderada)* para normalizar los valores de TSH en suero materno dentro del rango de referencia de embarazo específico del trimestre.
Los autores del SE de UpToDate sobre el hipotiroidismo en el embarazo(6) proponen un algoritmo de tratamiento basado en las directrices de las GPC del "American Thyroid Association" (2) y la "Endocrine Society"(4):
- TSH con cifras entre 2,5 mU/L y el límite inferior de normalidad específico del trimestre serían pacientes eutiroideas y no precisarían tratamiento.
- TSH 2,6-4 mU/L (4 mU/L o el límite superior de normalidad específico del trimestre si está disponible):
- No tratar si anti-TPO negativos; habría que seguir monitorizando a las mujeres de alto riesgo;
- En caso de anti-TPO positivos algunos expertos proponen tratamiento con levotiroxina (50 μg/día); en caso de que se decida no iniciar tratamiento se medirá la TSH cada 4 semanas durante el primer trimestre y luego una vez en el segundo y tercer trimestres iniciando levotiroxina cuando la TSH aumente por encima de 4 mU/L.
- TSH >4 mU/L o del límite superior de normalidad específico del trimestre si está disponible:
- si la T4 libre está elevada se inicia tratamiento a dosis plenas (1,6 μg/Kg/día);
- si la T4 libre no está elevada (hipotiroidismo subclínico) se iniciaría levotiroxina a dosis intermedias (1 μg/día).
Y el SE de BMJ Best Practice sobre el hipotiroidismo primario(7) explica que en la mujer embarazada se recomienda el tratamiento con levotiroxina del hipotiroidismo subclínico cuando la TSH es mayor del rango de referencia específico para el embarazo y los anti-TPO son positivos. También se recomienda el tratamiento en caso de anti-TPO negativos si TSH >10 mU/L.
En nuestro medio, el documento de consenso de la Sociedad Andaluza de Endocrinología y Nutrición sobre el manejo de la disfunción tiroidea en la gestación (2015)(8) considera hipotiroidismo subclínico en el embarazo la presencia de T4 normal con TSH <10 y >P 97,5 de los valores de referencia propios.
- Cuando se ha detectado el hipotiroidismo subclínico durante el embarazo recomienda iniciar tratamiento con levotiroxina si anti-TPO positivos; en caso de anti-TPO negativos sugieren iniciar tratamiento ante TSH >4 μUI/ml; también plantean iniciar tratamiento si TSH > P97,5 independientemente de los niveles de anti-TPO.
- En cuanto a las dosis de inicio recomiendan: TSH > P97,5 y < 5 μU/ml (o en su defecto 2,5-5): 25-50 μg; TSH 5-8 μU/ml: 50-75 μg; TSH > 8 μU/ml: 75-100 μg. Como alternativa sugieren iniciar a dosis media de 1,2 μg/kg. Y considerar un inicio progresivo en caso de que el tratamiento se vaya a iniciar a dosis altas (≥ 100 μg/día).
Por último, la actualización de 2018 del Programa de Actividades Preventivas y de Promoción de la Salud(9), explica que existe controversia en cuanto al abordaje del hipotiroidismo subclínico en el embarazo (TSH > percentil 97,5 para valores de referencia propios y < 10 con T4 libre normal) e indica que las pruebas de función tiroidea se deben interpretar con la utilización de rangos de TSH y T4 trimestre-específicos.
*Consultar niveles de evidencia y grados de recomendación en los documentos.
Enviado desde mi iPhone
PCR EN AP ANTIBIOTICOS Y DERIVACIONES
En un articulo reciente se realiza un metaanálisis sobre el efecto que puede tener el uso en cabecera "Point in care" de estas técnicas para disminuir consumo de antibioticos, derivaciones y complicaciones en adultos y en niños.
viernes, 1 de noviembre de 2019
martes, 29 de octubre de 2019
sábado, 26 de octubre de 2019
uso de la PCR en consulta ante exacerbación de EPOC
Hace mucho tiempo en un update de nuestra especialidad( La medicina Familiar y Comunitaria) tuve la suerte de escuchar los argumentos y utilidades de esta técnica y de otras en cabecera de paciente de la boca de DR Carles LLor. A mi, me sedujo sus planteamientos y durante todo un lustro he intentado seguir la evolución de este tema.
una revision la podemos encontrar en el enlace.
Pues bien acaba de salir una utilidad para discernir sobre el uso ono de antibioticos en el epoc y un editorial del NEW England sobre el tema
https://drive.google.com/open?id=1JDURByyTvYjb_4Cax9ekF_0em4Dkqemg
https://drive.google.com/open?id=1yojJ7tiiEGFSG5h3aUbt1FWrYMdBdlx7
una revision la podemos encontrar en el enlace.
Pues bien acaba de salir una utilidad para discernir sobre el uso ono de antibioticos en el epoc y un editorial del NEW England sobre el tema
https://drive.google.com/open?id=1JDURByyTvYjb_4Cax9ekF_0em4Dkqemg
https://drive.google.com/open?id=1yojJ7tiiEGFSG5h3aUbt1FWrYMdBdlx7
Quo vadis. Medicina de Familia.congreso nacional de estudiantes.
El pasado jueves tuve la suerte de intervenir en un simposio sobre la medicina familiar ,en el congreso nacional de estudiantes de medicina, donde titule a mi presentación Medicina Familia QuoVadis.
En ella me centre en que ante la presión asistencial y el burning, dos de los argumentos que incidí fue en el Not to do, hasta el 30% de las medicas no aportan valor, y eliminar absolutamente las tareas administrativas absurdas.
Curiosamente desayunaba el sabado y ya dos compañeros me avisaban del articulo en el pais de VIcente Baos ( blog amigo El supositorio) donde remarcaba lo absurdo de muchos tramites administrativos.
https://elpais.com/sociedad/2019/10/24/actualidad/1571913719_334103.html
En el VIcente Baos explica justificantes curiosos, yo en mi presentación aporte algunos casos muy significativos como Doctor justifiqueme que estoy vivo que me los piden en el banco, y por favor justifiqueme que puedo bucear a tres atmosfera,...sin comentarios.
Remarque en mi exposicion la reciente aparicion en el blog de Rafa Bravo de una intervencion desburocratizadora en este sentido de la JUnta Andalucia,
https://rafabravo.blog/2019/09/27/el-autentico-no-hacer-en-actividades-burocraticas/
y como en nuestra consellería se emitió hace muchos más años una instrucción similar que yo he utilizado en numerosas ocasiones(data del 2008) y que en ocasiones compañeros de mi misma comunidad desconocian. En esta instrucción se recogen practicamente todos los not to do administrativos de la junta andaluza y desde luego en mi humilde opinión aportó bastante a cambiar el panorama.
Es aun mas curioso que un gran numero de comunidades no dispongan alguna medida en este sentido. Gran percepción, a mi juicio muy positiva, de los estudiantes de medicina por nuestra especialidad.
En ella me centre en que ante la presión asistencial y el burning, dos de los argumentos que incidí fue en el Not to do, hasta el 30% de las medicas no aportan valor, y eliminar absolutamente las tareas administrativas absurdas.
Curiosamente desayunaba el sabado y ya dos compañeros me avisaban del articulo en el pais de VIcente Baos ( blog amigo El supositorio) donde remarcaba lo absurdo de muchos tramites administrativos.
https://elpais.com/sociedad/2019/10/24/actualidad/1571913719_334103.html
En el VIcente Baos explica justificantes curiosos, yo en mi presentación aporte algunos casos muy significativos como Doctor justifiqueme que estoy vivo que me los piden en el banco, y por favor justifiqueme que puedo bucear a tres atmosfera,...sin comentarios.
Remarque en mi exposicion la reciente aparicion en el blog de Rafa Bravo de una intervencion desburocratizadora en este sentido de la JUnta Andalucia,
https://rafabravo.blog/2019/09/27/el-autentico-no-hacer-en-actividades-burocraticas/
y como en nuestra consellería se emitió hace muchos más años una instrucción similar que yo he utilizado en numerosas ocasiones(data del 2008) y que en ocasiones compañeros de mi misma comunidad desconocian. En esta instrucción se recogen practicamente todos los not to do administrativos de la junta andaluza y desde luego en mi humilde opinión aportó bastante a cambiar el panorama.
Es aun mas curioso que un gran numero de comunidades no dispongan alguna medida en este sentido. Gran percepción, a mi juicio muy positiva, de los estudiantes de medicina por nuestra especialidad.
martes, 22 de octubre de 2019
Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions - GOV.UK
domingo, 13 de octubre de 2019
martes, 8 de octubre de 2019
lunes, 7 de octubre de 2019
domingo, 6 de octubre de 2019
sábado, 5 de octubre de 2019
jueves, 3 de octubre de 2019
Apuntes sobre la seguridad de las sulfonilureas | El rincón de Sísifo
Chuleta indispensable desde Rincon de Sisifo.
https://elrincondesisifo.org/2017/02/03/apuntes-sobre-la-seguridad-de-las-sulfonilureas/
Enviado desde mi iPhone
https://elrincondesisifo.org/2017/02/03/apuntes-sobre-la-seguridad-de-las-sulfonilureas/
Enviado desde mi iPhone
jueves, 26 de septiembre de 2019
lunes, 23 de septiembre de 2019
manuel sanchez molla compartió un enlace: Use of Telehealth Screening to Detect Diabetic Retinopathy and Other Ocular Findings in Primary Care Settings | Telemedicine and e-Health
Use of Telehealth Screening to Detect Diabetic Retinopathy and Other Ocular Findings in Primary Care Settings | Telemedicine and e-Health del Tweet de https://twitter.com/jvalaball/status/1176165664828133376?refsrc=email&s=11
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Descarga la aplicación de Twitter
Enviado desde mi iPad
sábado, 21 de septiembre de 2019
E-SCOPE: A Strategic Approach to Identify and Accelerate Imp... : Medical Care
Muy interesante desde tweet Ernesto Barrera. Acortar tiempo desde evidencia a implementación
https://journals.lww.com/lww-medicalcare/Pages/articleviewer.aspx?year=2019&issue=10001&article=00009&type=Fulltext
Enviado desde mi iPhone
https://journals.lww.com/lww-medicalcare/Pages/articleviewer.aspx?year=2019&issue=10001&article=00009&type=Fulltext
Enviado desde mi iPhone
Tweet de Lorenzo Fácila en Twitter
 | Lorenzo Fácila (@mi_cardiologo) |
Valoración fragilidad en paciente con #IC #ICCongress @SVCardio @paullacer pic.twitter.com/bBpkkEuGwG | |
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Enviado desde mi iPhone
Asteriscología – ATensión Primaria
Este post del blog atension primaria recupera gran relevancia.
https://atensionprimaria.wordpress.com/2009/07/01/asteriscologia/
Enviado desde mi iPhone
https://atensionprimaria.wordpress.com/2009/07/01/asteriscologia/
Enviado desde mi iPhone
jueves, 19 de septiembre de 2019
manuel sanchez molla compartió un enlace: Respiratory syncytial virus infection in adults | The BMJ
Respiratory syncytial virus infection in adults | The BMJ del Tweet de https://twitter.com/bmj_latest/status/1174745411162124288?refsrc=email&s=11
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Descarga la aplicación de Twitter
Enviado desde mi iPad
martes, 17 de septiembre de 2019
lunes, 16 de septiembre de 2019
viernes, 13 de septiembre de 2019
The Influence of Inpatient Physician Continuity on Hospital Discharge
The Influence of Inpatient Physician Continuity on Hospital Discharge
jueves, 12 de septiembre de 2019
miércoles, 11 de septiembre de 2019
lunes, 9 de septiembre de 2019
viernes, 6 de septiembre de 2019
miércoles, 4 de septiembre de 2019
FP2 FRENTE MASCARILLAS CONVENCIONALES PROTECCION GRIPE.
N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care PersonnelA Randomized Clinical Trial
https://jamanetwork.com/journals/jama/fullarticle/2749214
rafa bravo comenta en twitter articulo medicina clinica
Los criterios ACC/AHA supondrían un aumento del 25,9% en la prevalencia de HTA, considerando hipertensas 2 de cada 3 personas adultas.
https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S002577531930507X?returnurl=null&referrer=null
https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S002577531930507X?returnurl=null&referrer=null
RELEER CLASICOS DE MEDICINA FAMILIAR
The Gatekeeper and the Wizard: a fairy tale
Nigel Mathers, Paul Hodgkin
El distinto papel de primaria y de hospitalaria.
https://drive.google.com/file/d/1uLCgfjnVGBuAF_2AIPzTzny_gQvm40Zb/view?usp=sharing
Nigel Mathers, Paul Hodgkin
El distinto papel de primaria y de hospitalaria.
https://drive.google.com/file/d/1uLCgfjnVGBuAF_2AIPzTzny_gQvm40Zb/view?usp=sharing
martes, 3 de septiembre de 2019
Gripe en Australia, al final los efectos fueron menores a los esperados.
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm
Key Messages
- Activity – Currently, overall influenza and influenza-like illness (ILI) activity is lower than average for this time of year compared to previous years, and current activity is consistent with activity in previous years following a peak. At the national level, notifications of laboratory-confirmed influenza continued to decrease in the past fortnight following an apparent peak in early July.
- Severity – Clinical severity for the season to date, as measured through the proportion of patients admitted directly to ICU, and deaths attributed to influenza, is considered low.
- Impact – Impact for the season to date, as measured through the number of sentinel hospital beds occupied by patients with influenza and the rate of Flutracking respondents absent from normal duties, is considered to be low to moderate.
- Virology – The majority of confirmed influenza cases reported nationally were influenza A in the year to date (79.5%) and reporting fortnight (70.7%). Of the influenza A cases that were subtyped, there has been a higher proportion of influenza A(H3N2) compared to influenza A(H1N1)pdm09. The proportion of cases attributed to influenza B has increased slightly in the past fortnight, following a steady decline during July.
- Vaccine match and effectiveness – Antigenic analysis of circulating influenza viruses in Australia in 2019 shows that the influenza A(H1N1)pdm09 and influenza B/Yamagata-lineage viruses are well matched to the 2019 influenza vaccine while some A(H3N2) and B/Victoria-lineage viruses are less well matched. Overall vaccine effectiveness appears good and as expected based on preliminary estimates from sentinel general practice (ASPREN) and sentinel hospital (FluCAN-PAEDS) surveillance systems, noting that effectiveness typically ranges from around 40-60% each year.
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