Conocimiento y perfil de uso de la biblioteca Cochrane en médicos asistentes a un congreso de Medicina Interna / Knowledge and use profile of the Cochrane library in doctors attendees of an Internal Medicine congress

Introducción: las Revisiones Sistemáticas (RS) son herramientas para practicar Medicina Basada en la Evidencia. La Colaboración Cochrane genera RS, pero el conocimiento y uso de la Biblioteca Cochrane (BC) es heterogéneo. Nuestro objetivo fue describir el nivel de conocimiento y el perfil de uso de la BC entre asistentes a una Conferencia Mundial de Medicina Interna (WCIM). Método:estudio transversal vía encuesta electrónica entre asistentes al XXXI WCIM, recabando información demográfica de los participantes; su conocimiento, acceso y usos de la BC. Resultados: 413 asistentes aceptaron participar y 198 (47,9 por ciento) de 24 países respondieron. 91,4 por ciento eran Latinoamericanos, 50,5 por ciento eran internistas. El conocimiento de la BC fue del 96,5 por ciento. El 76% de quienes respondieron usaban la BC al menos una vez al mes. No encontramos diferencias en la frecuencia de uso según edad o ámbito académico. Las principales razones para utilizar RS-BC fueron: toma de decisiones clínicas (67,6 por ciento), actualización (64,2 por ciento) y docencia (31,8 por ciento); 46 por ciento consideraron la BC muy útil para sus propósitos. Los <35 años utilizaban significativamente más la BC para guiar las decisiones clínicas que los >35 años (70 por ciento vs 53 por ciento, p: 0,017). Quienes consideraron muy útil la BC la utilizaron significativamente más para propósitos docentes (41 por ciento vs. 24 por ciento, p: 0,019) y toma de decisiones clínicas (79 por ciento vs. 58 por ciento, p: 0,003) que quienes la declararon como a veces útil o no útil. Hubo también diferencias estadísticamente significativas en la distribución del acceso a la BC según región geográfica (p: 0,001). Conclusiones: encontramos un alto nivel de conocimiento de la BC entre los asistentes a WCIM. Los usuarios describen un uso frecuente para diversos propósitos, considerándola útil para estos. (AU)

Introduction: Systematic Reviews (SR) are tools for practicing Evidence Based Medicine. Cochrane Collaboration generates SRs, but awareness and uses of Cochrane SR, changes over time and across different countries and medical specialties. We aimed to describe awareness and user's profile of Cochrane Library (CL) SR among attendants to a World Conference of Internal Medicine (WCIM). Methods: Cross sectional online survey study among attendants to the XXXI WCIM asking about demographic information, awareness of, access to and uses of CL-SRs. Results: 413 attendants to WCIM volunteered to participate and 198 (47.9 percent) from 24 countries replied; 91.4 percent) were from Latin-America. Mean age was 37 years and 50.5 percent) were general internists or internal medicine subspecialists. Awareness of the CL was 96.5 percent). The frequency of CL-SR use was at least once a month for 76 percent) of responders. We found no difference in frequency of use according to age or academic setting. Main reasons to use CL-SR were: guide clinical decisions (67.6 percent)), personal update (64.2 percent) and teaching (31.8 percent)); 46 percent) considered CL-SR very useful to their purposes. People <35y used CL-SR significantly more for guiding clinical decisions than those >35y (70 percent) vs 53 percent), p: 0.017). Users who considered CL-SR very useful use it significantly more for teaching purposes (41 percent) vs 24 percent), p: 0.019) and for clinical decision-making (79 percent) vs 58 percent), p: 0.003) than those declaring CL-SR as sometimes useful or not useful. Also there was statistically significant difference in distribution of access to CL by geographic region (p: 0.001). Conclusions: We found high awareness of CL-SRs among attendants to WCIM. Users describe frequent use, for several purposes and find it helpful for their purposes; however, access varied across regions. (AU)

Análisis crítico de un artículo: terapia de reemplazo de la nicotina, efectividad en un escenario real / Critically appraised article: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation

Objective: To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions. Methods: A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed by 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined. Results: Almost one-third of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for > 6 weeks either with (p = 0.117) or without (p = 0.159) professional counseling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68). Conclusions: This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

Tabaquismo en Atención Primaria: Perfil de fumadoras consultantes, creencias y actitudes de los equipos de salud y oportunidades de intervención / Smoking interventions in Primary Health Care: Smoking profile of women and beliefs and attitudes of local health care teams

Background: Chile has one of the highest prevalence rate of smoking in the world. Brief counseling interventions for smoking cessation at the primary health care level are effective. Compliance with counseling intervention is strongly associated with beliefs and attitudes of the primary health care team that deliver it. The effectiveness of these interventions improve if they are applied to smoking populations with higher motivation of change and high self-efficacy for quitting. Aim: To study the smoking profile of a group of smoking women in Santiago and to identify beliefs and attitudes of the primary health care team members to implement smoking cessation interventions. Material and Methods: A cross-sectional design that included 306 women smokers attending two primary health care clinics in Santiago. Perceptions, beliefs and attitudes of 34 primary care team members from three clinics in Santiago were explored using a qualitative methodology. Results: The study identified a subgroup of 18% of women highly motivated to quit (decisional stage of change) and a 58% with a high self-efficacy. Beliefs and attitudes of staff at the clinics were characterized by invisibility, ambivalence and fatalism regarding the effectiveness of smoking cessation interventions. Conclusions: There is a subgroup of smoking women with a high probability of quitting if they receive an appropriate counseling. Developing a systematic approach for smoking cessation intervention at the primary care setting in Chile should consider the invisibility, ambivalence and fatalism of primary health care team members towards this topic.

Análisis crítico de un artículo: Cáncer de próstata inicial ¿operar o esperar? / Early prostate cancer: Radical prostatectomy or watchful waiting?

Background In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. Methods: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; thesecondary end points were death from any cause, metastasis, and local progression. Results: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). Conclusions: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial.