ABSTRACT
está disponible en el texto completo
The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.
ABSTRACT
Introducción: desde hace más de tres décadas la cirugía laparoscópica ha tomado fuerza y, en la actualidad, es uno de los procedimientos más empleados; pero este cambio de la cirugía convencional a la laparoscópica ginecológica hace que también cambien los programas de entrenamiento para ser realmente eficientes y acordes con la nueva curva de aprendizaje. Objetivo: seleccionar un procedimiento quirúrgico aplicable como programa de entrenamiento en cirugía ginecológica laparoscópica mediante simulador. Materiales y métodos: se seleccionaron los procedimientos quirúrgicos laparoscópicos frecuentemente utilizados en ginecología, por medio de un consenso de expertos; después se llevaron a cabo las prácticas en simulador seleccionando el más adecuado mediante la evaluación de los siguientes criterios: grado de dificultad, adquisición de habilidades, adaptabilidad a componente anatómico animal en simulador.Resultados: se seleccionó la ooforectomía laparoscópica como procedimiento experimental ya que este cumple con todos los requisitos previamente establecidos, ofreciendo al cirujano un espacio de formación ideal para adquirir destrezas básicas mediante ejercicios prácticos en simulador.Conclusiones: se propone a la ooforectomía laparoscópica como el procedimiento que mejor se adaptó al modelo de simulación para entrenamiento ajustable a los programas de formación existentes.
Introduction: Laparoscopic surgery has been gaining momentum over more than thirty years, and it is currently one of the most widely used procedures. However, this shift from conventional to laparoscopic surgery in gynecology has also brought about changes in training programs in order to make them truly efficient and consistent with the new learning curve. Objective: To select a surgical procedure applicable to a simulator-based training program in laparoscopic gynecological surgery. Materials and methods: Laparoscopic procedures used frequently in gynecology were selected in accordance with the opinion of an expert panel. Simulator practice sessions were then conducted in order to select the most suitable procedure on the basis of the following criteria: level of difficulty, skills acquisition, and adaptability to an animal anatomic component in the simulator. Results: Laparoscopic oophorectomy was selected as the experimental procedure, considering that it meets the criteria established and provides the surgeon with the ideal training situation for acquiring basic skills by means of practical exercises on the simulator.Conclusions: Laparoscopic oophorectomy is proposed as the procedure that is best suited as a simulation model for use within existing education programs.