Primera experiencia en Uruguay en enseñanza curricular de resucitación cardíaca avanzada en el Ciclo Internado Rotatorio en el período 2017-2018, Facultad de Medicina, Universidad de la República. Comunicación y evaluación / Inclusion of advanced cardiopulmonary resuscitation in curricular education of medical doctors in Uruguay. First experience in the Rotating Internship between 2017-2018. School of Medicine, University of Uruguay. Communication and Evaluation / Primeira experiência no Uruguai no ensino curricular de Reanimação Cardíaca Avançada no Ciclo de Estágios Rotatórios no período 2017-2018, Faculdade de Medicina, UdelaR. Comunicação e avaliação

Resumen: A partir del año 2017, la Facultad de Medicina de la Universidad de la República (UdelaR) incorpora la enseñanza en reanimación cardíaca avanzada como actividad curricular obligatoria durante el Ciclo Internado Rotatorio (CIR). Esto se justifica dada la relevancia que presenta en términos de morbilidad y mortalidad la patología cardiovascular, en particular los paros cardiorrespiratorios y específicamente la muerte súbita. Los cursos de reanimación permiten la adquisición de habilidades técnicas y no técnicas para dar respuesta tanto a esta patología tan prevalente como a la falta de estos cursos en la formación médica. Los objetivos del trabajo son comunicar y evaluar la primera experiencia durante el CIR 2017-2018. Para dichos objetivos se realizó un estudio transversal donde se analizaron los números de participantes y el porcentaje de aprobados. Además, se realizó una encuesta de valoración de autopercepción de habilidades previas y posteriores al curso y una evaluación de conformidad con éste. De los resultados se desprende la amplia aprobación en una primera instancia del curso y la valoración positiva que se realiza. También es positiva la mejora en la autopercepción de habilidades identificadas por los internos. Como debilidad se desprende el uso de un cuestionario no validado y que la evaluación no fue completada por todos los internos, ambos aspectos a mejorar en futuras evaluaciones. Como conclusión, se logró comunicar la experiencia, los cursos de Resucitación cardíaca avanzda (RCA) son una fortaleza en sí mismos y han sido un avance significativo en la formación profesional del futuro médico.

Summary: In 2017 the School of Medicine of the University of the Republic included advanced cardiopulmonary resuscitation as a mandatory curricular activity during the rotating internship. The decision is justified by morbility and mortality rates of heart disease, in particular cardiopulmonary arrests and sudden death. Resuscitation courses enable the acquisition of technical and non- technical skills to respond to a prevalent condition and to compensate the absence of this specific training in the training of medical doctors. The study aimed to communicate and evaluate the first experience during the 2017-2018 rotating internship. A transversal study was conducted to analyse the number of participants and the percentage of successful candidates. Likewise, a survey was designed to assess self-perception of skills prior to the course and skills acquired during the course, as well as a course satisfaction. Results revealed the high acceptance rate of this first instance of the course and its positive assessment. Similarly, interns evidenced improvement in their self-perception of identified skills. As to a weaknesses found, the questionnaire used had not been validated and not all Interns completed the assessment, both aspects that will be improved in future assessments. To conclude, we managed to inform about the experience, advanced cardiopulmonary resuscitation courses are an advantage in itself, and it has been a significant advance in the professional training of future medical doctors.

Resumo: A partir de 2017, a Faculdade de Medicina da Universidad de la República (UdelaR) incorporou o ensino de ressuscitação cardíaca avançada como atividade curricular obrigatória durante o ciclo de estágio rotativo (CIR). Isso se justifica dada a relevância das doenças cardiovasculares em termos de morbimortalidade, em especial a parada cardiorrespiratória e especificamente a morte súbita. Os cursos de reanimação permitem a aquisição de competências técnicas e não técnicas para responder, tanto a esta patologia prevalente, como à falta destes cursos na formação médica. Os objetivos deste trabalho são comunicar e avaliar a primeira experiência durante o Ciclo de Estágios Rotativo 2017-2018. Com esse fim foi realizado um estudo transversal onde foram analisados o número de participantes e o percentual de aprovação. Além disso, foi realizada uma pesquisa para avaliar a autopercepção de habilidades antes e depois do curso, bem como uma avaliação da adesão ao curso. Os resultados mostram a ampla aprovação na primeira instância do curso e a avaliação positiva que se faz do mesmo. A melhora na autopercepção das habilidades identificadas pelos estagiários também é positiva. Como fragilidade, surge a utilização de um questionário não validado e que a avaliação não foi respondida por todos os internos, aspectos que devem ser melhorados em avaliações futuras. Como conclusão foi possível comunicar a experiência, os cursos RCA são uma força em si e têm sido um avanço significativo na formação profissional do futuro médico.

El método clínico y el carácter científico de la medicina clínica / The clinical method and the scientific character of clinical medicine

Introducción: El cuestionamiento del carácter científico de la medicina clínica se incluye entre los problemas epistemológicos de las ciencias. Objetivo: Revisar la contribución de la medicina clínica como ciencia aplicada, con énfasis en la metódica que le distingue: el método clínico. Métodos: Se revisó la bibliografía especializada, complementada con el empleo de procedimientos de investigación cualitativa que incluyeron: entrevistas a profesionales de reconocida experiencia, trabajo con grupos focales y sesiones en profundidad. Desarrollo: El desarrollo histórico del pensamiento científico tuvo impacto en la medicina clínica, la cientificidad del método clínico explicada desde diferentes enfoques, la respuesta a las críticas del positivismo y la manera en que la medicina clínica cumple con los requerimientos para su aceptación como ciencia aplicada. Conclusiones: Se fundamentó la cientificidad de la medicina clínica desde un enfoque dialéctico distinguida por su carácter interdisciplinar, su condición de ciencia aplicada y por una metódica científica que posibilita el desempeño profesional del médico con el enfermo, el individuo en riesgo de enfermar y el hombre aparentemente sano: el método clínico(AU)

Introduction: The questioning the scientific character of clinical medicine is included among the epistemological problems of science. Objective: To review the contribution of clinical medicine as an applied science, with emphasis on the method that distinguishes it: the clinical method. Methods: The specialized bibliography was reviewed, complemented with the use of qualitative research procedures that included interviews with professionals with proven experience, working with focus groups and in-depth sessions. Findings: The historical development of scientific thought had an impact on clinical medicine, the scientificity of the clinical method explained from different approaches, the response to the criticisms of positivism and the way in which clinical medicine meets the requirements for its acceptance as applied science. Conclusions: The scientificity of clinical medicine was founded from a dialectical approach distinguished by its interdisciplinary nature, its condition of applied science and by a scientific method that enables the professional performance of the physician with the patient, the individual at risk of becoming ill and apparently healthy man: the clinical method(AU)

La comorbilidad y su valor para el médico generalista en Medicina Interna / Comorbidity and its value for the general doctor in Internal Medicine

Introducción: La comorbilidad es un fenómeno que complejiza el cumplimiento de las funciones del médico generalista en la atención a pacientes en salas de medicina interna. Objetivo: Fundamentar las bases de la comorbilidad como variable, en tanto se define en lo conceptual, lo operacional y relaciones esenciales internas y externas con el enfoque en sistema de las funciones del médico clínico en las salas de Medicina Interna de los hospitales. Material y Métodos: Se realizó una revisión bibliográfica que abordasen la comorbilidad y que facilitaran cumplir el objetivo de la investigación. Desarrollo: En el plano conceptual se define la comorbilidad como la asociación de enfermedades donde una tiene carácter protagonista Se presenta la definición conceptual de la comorbilidad. La relación entre enfermedades comórbidas puede estar explicada por asociaciones de clara dependencia patogénica o por coincidencia en el paciente sin relación patogénica directa. Existen numerosos y diversos instrumentos para operacionalizarla disponibles para su aplicación en investigación y la práctica clínica. Conclusiones: Las relaciones entre las diferentes enfermedades son multilaterales y requieren de una interpretación etiopatogénica y fisiopatológica profunda para ser comprendida y analizada en el cumplimiento de las funciones asistenciales, investigativa, docentes y administrativas del médico en salas de Medicina Interna(AU)

Introduction: The comorbidity is a phenomenon that complicates general doctor´s fulfillment of their functions regarding the care of patients at Internal Medicine Wards. Objective: To base the bases of comorbidity as a variable, insofar it is defined in the conceptual, the operational and essential internal-external relationships with a systemic approach of the functions of the clinical physician in the hospital´s Internal Medicine wards. Material and Methods: A bibliographic revision that take into account comorbidity and allow to satisfy the objective was performed. Development: Conceptually, comorbidity is defined as the association of diseases in which one has a leading role character. The conceptual definition of comorbidity is presented. The relationship between comorbid diseases can be explained by associations of a clear pathogenic dependence or by coincidence in the patient without direct pathogenic relationship. There are numerous and diverse instruments available to make it operable for its application in research and clinical practice. Conclusions: The relations between different diseases are multilateral and need a deep etiopathogenic and fisiopathological interpretation to be understood and examined in the fulfillment of its asitencials, investigative, teaching and administrative functions of the doctor at Internal Medicine wards(AU)

Analysis of clinical and biochemical spectrum of Wilson Disease patients.

Background and Aims: Wilson disease (WD) is autosomal recessive disorder of copper metabolism. Wilson disease patients usually suffer from hepatic or neuropsychiatric complications. The symptoms appear between ages five to 35 but it can vary from two years to 72 years. Materials and Methods : Study was carried out from June 2008 to November 2010. This study included nine families with eleven cases of WD to determine clinical presentation, diagnostic findings (including laboratory results) and liver histology. It included 11 patients who presented with hepatic manifestations and/or Neuropsychiatric manifestations and/or family history suggesting features of WD. Patients with hepatitis B and C and those with history of taking antipsychotic drugs were excluded from the study. Patient's data was included in a well designed performa. Liver function test, serum ceruloplasmin, serum copper, 24 hour urinary copper, blood complete picture were analyzed. Quantitative data such as age, hemoglobin etc were expressed as mean with ± SD and quantitative variables such as sex, movement disorders, hepatic involvement etc were expressed as frequency and percentage. Results: There were five male and six female patients with evidence of various manifestations here (i) hepatic in which they had only liver dysfunction (ii) hepatic and neurological (iii) neurological. The mean age of presentation was 8.7±3.92 years (range 4-19 years) and 45% were male patients. Decreased serum ceruloplasmin, enhanced 24-h urinary copper excretion and signs of chronic liver damage were confirmed in all patients and Kayser-Fleischer rings (KF rings) in 72% of patients. In severe WD patients, serum prothrombin activity was less than 50%, serum ceruloplasmin were low and serum copper levels were high than those in non-severe WD patients. High degree of suspicion leads to early treatment with good outcome. Conclusions: The WD is rare but important cause of chronic liver disease. Clinical and biochemical analysis in cases of patients with unexplained liver disease with high degree of suspicion can lead to early treatment with good outcome.

Kikuchi-Fujimoto disease in fine needle aspiration smears: A clinico-cytologic study of 18 pediatric cases and correlation with 68 adult patients.

Objective: Kikuchi-Fujimoto disease (KFD) is a self-limiting disorder which usually affects young women. There are only a few studies on pediatric KFD patients and their fine-needle aspiration (FNA) cytodiagnosis. We report a series of pediatric KFD patients diagnosed by FNA cytology and compare them with adults. Materials and Methods: By routine FNA cytology and through retrospective review smears initially diagnosed as reactive hyperplasia of lymph node during the years 2004-2009, 18 pediatric and 68 adult KFD cases were detected. The clinico-cytologic features of these two groups were compared. Results: The age of the pediatric patients ranged from 6 to 18 years with a median of 13.5 years and adult cases were aged 19 to 54 years with a median of 30 years. Only 1 pediatric case (5.6%) and 20 (29.4%) adult cases were initially diagnosed as KFD (P = 0.0604). Arab:non-Arab ratios were 4.3:1 among the pediatric patients and 1:1.5 for the adults (P = 0.0043). FNA smears were highly cellular in 4 (22.2%) pediatric cases and 37 (54.4%) adult cases (P = 0.0180). More than 5% Kikuchi histiocytes was present in 8 (44.4%) pediatric and 49 (72.1%) adult cases (P = 0.0474). No significant difference was observed in male: female ratio, frequency of head & neck lymphadenopathy, time (season) of presentation, and presence of neutrophils and capillary networks, etc. Conclusions: Besides observation and interpretation errors, a significant difference between the two groups in respect of some clinico-cytomorphological features could have influenced the routine cytodiagnosis leading to lower pickup rate of pediatric KFD cases as compared to adults.

The Hippocratic oath: A comparative analysis of the ancient text's relevance to American and Indian modern medicine.

Hippocrates (460-375 B.C.), an ancient Greek physician considered the "Father of Medicine," constructed the groundwork for the principles of ethics in medicine over 2,500 years ago in his establishment of the Hippocratic Oath. One of the oldest binding documents in history, the text has remained the ethical template for physicians to this day. The changing cultural and social environment of modern society, accompanied by the advancement in scientific knowledge and therapeutic tools, has surfaced the need to reframe ethical perspective in modern medicine. Progress in aspects such as organ transplantation, stem cell technology, and genetic engineering has welcomed a new set of ethical dilemmas. These dilemmas have become intimately intertwined with the impact of commercialization, as seen by the interplay between legislation, health care, and pharmaceutical businesses. This paper seeks to dissect the principles of the original Hippocratic Oath and analyze the template in relation to the ethical dilemmas presented by contemporary medicine. Examination will provide a deeper understanding of the paradigm shift in modern medical ethics. Both the value of the Oath and the level of awareness of modern ethical dilemmas through the lens of American and Indian medical graduates will be assessed.

Clinical and laboratory evidence of Trichomonas vaginalis infection among women of reproductive age in rural area.

Background: Vaginitis is a commonly encountered complaint and one of the most frequent reasons for patient visit to obstetrician-gynaecologists. Three vaginal infections are frequent causes of a vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis and (3) trichomonas vaginitis. Differences in the clinical presentation are helpful in diagnosis. Characteristic signs and symptoms for these three vaginal infections are distinct, but on many occasions, they are overlapping. The aim of the present study was to find the prevalence and correlation between the clinical spectrum and laboratory evidence of Trichomonas vaginalis infection by simple, reliable, confirmatory and specific method, i.e. microscopic examination of wet mount preparation and acridine stain of vaginal fluid. Materials and Methods: Irrespective of HIV status, a total of 156 women with vaginal discharge were studied for establishing diagnosis of genital tract infection. The cases of bacterial vaginosis and vulvovaginal candidiasis were excluded from the study. Vaginal speculum assisted high vaginal swabs were collected from women with discharge, during collection vagina was inspected for obvious signs. Results: Of the 156 women with vaginal discharge, 19 (12.06 %) showed T. vaginalis infection. All the women belonged to active reproductive age group, i.e. 20-40 years. Itching dysuria, and offensive, malodorous, thin, yellowish vaginal discharge were the main and consistent complaints. Only in 2 (1.52%) cases, vaginal speculum examination revealed erythema and punctuate haemorrhage, the so-called "strawberry' vagina. The pH was recorded to be >4.5. Conclusion: Clinical differentiation of various forms of infectious vaginitis is unreliable. The prevalence of T. vaginalis infection at 12.06% was found among rural young women of reproductive age using simple and reliable screening wet mount microscopy.

Primary cutaneous amyloidosis: A clinico-pathological study with emphasis on polarized microscopy.

Background: Primary localized cutaneous amyloidosis (PCA) is a relatively rare condition characterized by amyloid deposition in dermis without systemic involvement. Although, histopathological examination of the lesion reveals amorphous eosinophilic deposits in papillary dermis examination of congo red stained slides under polarized light will give definitive diagnosis Aims: To study the clinicopathological features of cutaneous amyloidosis emphasizing the utility of polarized light in diagnosis. Materials and Methods : A clinicopathological study of primary cutaneous amyloidosis over a period of 8 years was undertaken. All the cases, clinically diagnosed and histopathologically proven as cutaneous amyloidosis were stained with congo red and studied under polarized light. Results and Conclusions: Of the 45 cases of clinically suspected amyloidosis, 32 cases were proven histopathologically as primary cutaneous amyloidosis and confirmed by congo red stain under polarized light which showed apple green birefringence. Among the two types of PCA, lichen amyloidosis was the most common variant accounting to 65.63% with pure cases of macular amyloidosis accounting for only 15.63%. Biphasic amyloidosis was seen in 18.75%. Knee was the commonest site of involvement with pruritis being the most common symptom. Histopathologically, the most common findings were hyperkeratosis, irregular acanthosis and expansion of dermal papillae by amyloid deposits showing apple green birefringence under polarized microscope with congo red staining. Although, H and E stain gives a clue for the diagnosis of amyloid nevertheless congo red staining under polarized light forms a very sensitive and definitive method for confirmation.

Caracterización clínica, antropométrica y de laboratorio, de mujeres con diabetes mellitus tipo 2 / Clinical, anthropometric and laboratory characterization of women with type 2 diabetes mellitus

Introducción: la diabetes mellitus es un problema de salud pública cuya mejor comprensión ayudaría a reducir sus complicaciones. Objetivo: caracterizar las pacientes con diabetes mellitus tipo 2 a partir de variables clínicas, antropométricas y de laboratorio. Métodos: estudio transversal descriptivo en el municipio Holguín a una muestra probabilística por conglomerados de 134 mujeres con factores de riesgo. Se aplicó el ANOVA, la prueba de Mann-Whitney y X2 con α = 0,05 en SPSS. Resultados: la frecuencia de diabetes mellitus fue del 43,2 por ciento. Las diabéticas presentaron valores superiores de la edad, circunferencia abdominal, del índice cintura/cadera, de la presión arterial, de la glucemia y los triglicéridos que el grupo sin diabetes mellitus (n = 74), lo contrario ocurrió con la circunferencia de cadera. Se encontró una asociación significativa entre la diabetes mellitus y la presencia del síndrome metabólico (X2 = 41,570; p = 0,000). La diabetes se relacionó con el exceso de peso corporal (X2 = 7,506; p = 0,023), la cardiopatía isquémica (X2 = 6,778; p = 0,009) y la hipertensión arterial (X2 = 5,245, p = 0,022), aunque no se asoció con el hábito de fumar (X2 = 0,233, p = 0,629). Conclusiones: es importante la caracterización de la diabetes mellitus por la elevada frecuencia de comorbilidad como el síndrome metabólico, la cardiopatía isquémica, la hipertensión arterial, la obesidad, las dislipidemias aterógenas, y se recomienda la intervención de estas pacientes con cambios en el estilo de vida, la incorporación de nuevas variables y la extensión de la investigación a la provincia Holguín.

Introduction: The diabetes mellitus is a public health problem and its understanding would help to reduce complications. Objective: Characterizing the patients with type 2 diabetes mellitus based on clinical, anthropometric, and laboratory variables. Methods: Cross-sectional study in the municipality of Holguin to a prospective sample per groups of 134 women with risk factors. We applied the ANOVA, the Mann-Whitney test and X2 with α = 0,05, in SPSS. Results: The diabetes mellitus frequency was 43,2 per cent. Diabetic women had higher values of age, waist circumference, waist/hip ratio, blood pressure, blood glucose and triglycerides than patients without diabetes mellitus (n = 74); the opposite occurred with the hip circumference. It was found a significant association between the diabetes mellitus and the presence of the metabolic syndrome ( X2 = 41,570; p = 0,000). The diabetes was associated with the body weight excess ( X2 = 7,506; p = 0,023), the ischemic heart disease ( X2 = 6,778; p = 0,009), and the arterial hypertension ( X2 = 5,245, p = 0,022), although it was not associated with smoking ( X2 = 0,233, p = 0,629). Conclusions: It is important the characterization of the diabetes mellitus because of the high frequency of co-morbidities such as the metabolic syndrome, the ischemic heart disease, the arterial hypertension, the obesity, the atherogenic dyslipidemia. We recommend the intervention of these patients with changes in their lifestyle, incorporating new variables and extending the research to the province of Holguin.

La enseñanza clínica: el caso de la recorrida de sala / Clinical teaching: the case of bedside rounds # / Clinical teaching: the case of the ward tour / Clinical teaching: the case of bedside rounds #

Posiblemente la enseñanza al lado de la cama del paciente sea tan antigua como la medicina misma. Grandes maestros de la medicina como F. Silvio o Sir W. Osler abogaron por un uso intenso de la misma destacando sus virtudes. En la era moderna, se le reconoce a la enseñanza en las recorridas múltiples aspectos que no pueden ser enseñados en el aula, como el aprendizaje de las habilidades de la comunicación, de la exploración física, la enseñanza de los aspectos humanísticos, etc., pero también múltiples barreras que dificultan una exitosa implementación. En este artículo, se detallan las barreras que con mayor frecuencia impiden que el docente promueva un aprendizaje significativo y profundo, y una serie de propuestas prácticas que favorecen su adecuada implementación. (AU)

Possibly, bedside teaching in medicine is as old as medicine itself. Through history, well-known professors like F. Silvio and Sir W. Osler considered the strength of this teaching strategy and promoted it extensively. In the modern age, it is recognized that bedside teaching covers a variety of aspects that can not be taught in the classroom, such as learning of communication skills, physical examination, etc.; but at the same time, multiple barriers to its successful implementation have been identified. In this article, we describe the most common barriers that teachers should overcome to promote a meaningful and deep learning; as well as a series of practical proposals that are indicated to favour a proper implementation.(AU)

Acompanhamento clínico tardio pós-cirurgia de Fontan: cuidados a serem tomados / Long term clinical follow-up of Fontan operation: care to be taken

A operação de Fontan, descrita para o coração univentricular anatômico e funcional, originalmente para a atresia tricúspide em 1971, constitui-se na técnica paliativa hoje mais empregada na cardiologia pediátrica, em vista da mudança substancial da história natural dessas anomalias, em especial proporcionada após a modificação da técnica original para a cavopulmonar em 1988 por deLevall. No entanto, o “princípio Fontan” persiste e não se observa nele uma fisiologia ideal, dada a ausência de cavidade ventricular em conexão com a circulação pulmonar, e, por isso, o sistema hemodinâmico é pouco eficiente. Assim, observa-se que o débito cardíaco é diminuído e a pressão venosa sistêmica aumentada e, desses fatores, surgem complicações difíceis de serem evitadas a longo prazo. Constituem-se em causas de piora da qualidade de vida e até de morte, dependentes da disfunção hepática, anormalidades da coagulação sanguínea, enteropatia perdedora de proteínas, bronquite plástica, disfunção cardíaca, arritmias cardíacas, principalmente supraventriculares, tromboembolismo, hipoxemia e, daí, o surgimento de inúmeras outras consequências orgânicas. Essas alterações foram minimizadas com a técnica cavopulmonar, no entanto, necessitam de profilaxia mais cuidadosa ainda pela obediência rigorosa aos critérios de indicação da operação estabelecidos por Choussat, nos idos de 1977. Como principais, figuram presença de ritmo sinusal, função ventricular normal, desenvolvimento adequado da árvore arterial pulmonar, pressão média pulmonar menor que 15 mm Hg e resistência vascular pulmonar menor que 2 UW, além da boa função das valvas atrioventriculares. Em vista dos progressos diagnósticos, terapêuticos e cirúrgicos, portadores da operação de Fontan evoluem para a idade adulta com maior frequência, mas se constituem na causa principal da necessidade de transplante cardíaco dentre todas as cardiopatias congênitas nesta faixa etária.

Clinical judgement & evidence-based medicine: time for reconciliation.

There is a popular perception that clinical judgement and evidence-based medicine are at loggerheads with each other. We examine the concepts of evidence and judgment as applied to clinical practice, and attempt to understand the reasons behind this imaginary divide.

A revisão sistemática na prática clínica baseada em evidência / The systematic review in the evidence based clinical practice

A prática clínica baseada em evidência tem como componentes a experiência clínica, as preferências do paciente e a melhor evidência disponível. O método de avaliação de maneira aberta e crítica sobre a evidência disponível é a revisão sistemática. O passo-a-passo da revisão sistemática inicia-se com a elaboração estruturada da dúvida clínica, seguido da busca crítica, nas bases de informação científica, da evidência que responde à questão. A extração dos resultados dos estudos incluídos para a análise será realizada após a avaliação crítica dos estudos selecionados: pelo nível da evidência e por instrumentos como o escore JADAD e New-Castle. Nessa análise, os diferentes efeitos podem ou não ser combinados (metanálise), não sendo este o objetivo principal da revisão, que é sempre a expressão do benefício, dano ou ausência de benefício (síntese da evidência), a fim de auxiliar o médico na tomada de decisão.

The Evidence based clinical practice is composed by the clinical experience, the preferences of the patients and the best available evidence. The method of evaluationg the available evidence in an open and critical way is the Systematic Review. The step by step of the Systematic Review begins with the structured construction of the clinical question, followed by critical search in the scientific information database of the evidence that answers the question. The extraction of the study results included for the analysis will be done after the critical appraisal of the selected studies according to the evidence level and instruments like JADAD and New-Castle scores. In this analysis the different effects may or may not be combined (meta-analysis), which is not the main objective of the review. Instead, the main objective of the review is always the expression of the benefit, harm of absence of benefit (Evidence Synthesis) in order to help the physician's decision-make process.

Conceptos básicos sobre la medicina basada en la evidencia / Basic concept of medicine based on evidence

La medicina basada en la evidencia se ha definido como "el uso consciente, explícito y prudente de la mejor evidencia médica actual en la toma de decisiones acerca de la atención de pacientes individuales". Plantea la identificación de los problemas de los pacientes en forma de preguntas estructuradas que darán origen a la búsqueda sistemática de la bibliografía y la valoración de la calidad de los artículos encontrados. En el momento de su aplicación, el juicio clínico se pone de manifiesto en su globalidad, y se confrontan las evidencias con la experiencia clínica y los valores y preferencias de los pacientes.