Guía de práctica clínica para el manejo del dolor en pacientes oncológicos de una red de clínicas privadas, Lima - Perú / Clinical practice guideline for pain management in cancer patients from a network of private clinics, Lima - Peru

Introducción: El presente artículo resume el proceso de elaboración de la Guía de Práctica Clínica (GPC) para el manejo de dolor en pacientes oncológicos. Este proceso se llevó a cabo con la participación de un equipo multidisciplinario de médicos asistenciales, metodólogos y diversos revisores externos (especialistas con dominio en la metodología y el tema). La priorización de preguntas PICO fue realizada por el Grupo Elaborador de la GPC (GEG), acordando trabajar cinco preguntas PICO. Para dar respuesta a las preguntas se realizó una búsqueda sistemática de GPC, revisiones sistemáticas y estudios primarios. Se utilizó la metodología GRADE y los lineamientos de la normativa nacional para la formulación de recomendaciones. Se formularon 12 recomendaciones (10 fuertes y 2 débiles), 5 puntos de buena práctica clínica y 4 cuadros consensuados sobre el manejo de dolor oncológico. Los temas que abarcaron las recomendaciones para el manejo de dolor en pacientes oncológicos fueron: intervención temprana de tratamiento, terapia analgésica en dolor leve a moderado y en dolor moderado a severo, dolor neuropático e intervenciones no farmacológicas.

Guía de Práctica Clínica para el Manejo del Dolor en pacientes Oncológicos de una Red de Clínicas Privadas, Lima - Perú / Clinical Practice Guide for Pain Management in Oncological Patients from a Network of Private Clinics, Lima - Peru

Introducción: El presente artículo resume el proceso de elaboración de la Guía de Práctica Clínica (GPC) para el manejo de dolor en pacientes oncológicos. Este proceso se llevó a cabo con la participación de un equipo multidisciplinario de médicos asistenciales, metodólogos y diversos revisores externos (especialistas con dominio en la metodología y el tema). La priorización de preguntas PICO fue realizada por el Grupo Elaborador de la GPC (GEG), acordando trabajar cinco preguntas PICO. Para dar respuesta a las preguntas se realizó una búsqueda sistemática de GPC, revisiones sistemáticas y estudios primarios. Se utilizó la metodología GRADE y los lineamientos de la normativa nacional para la formulación de recomendaciones. Se formularon 12 recomendaciones (10 fuertes y 2 débiles), 5 puntos de buena práctica clínica y 4 cuadros consensuados sobre el manejo de dolor oncológico. Los temas que abarcaron las recomendaciones para el manejo de dolor en pacientes oncológicos fueron: intervención temprana de tratamiento, terapia analgésica en dolor leve a moderado y en dolor moderado a severo, dolor neuropático e intervenciones no farmacológicas.

Background: The article summarizes the process of elaboration of the Clinical Practice Guide (CPG) for the management of cancer patients. The elaboration process was carried out with the participation of a multidisciplinary team of assisting physicians, methodologists and various external reviewers (specialists with mastery in the methodology and the subject). The prioritization of PICO questions was carried out by the GPC Elaboration Group (GEG), after which 05 PICO questions were concluded. To answer the questions, a systematic search of CPGs, systematic reviews and primary studies was carried out. The "GRADE" methodology and the guidelines of national regulations were used to formulate recommendations. Twelve recommendations were made (ten strong and two weak),5 points of good clinical practice,04 consensus tables on the management of cancer pain. The topics that covered the recommendations for pain management in cancer patients were: early treatment intervention, analgesic therapy in mild to moderate pain and moderate to severe pain, neuropathic pain and non-pharmacological interventions

Encuentro sobre educación de cuidado paliativo en Latinoamérica. Recomendaciones sobre enseñanza en el pregrado y en el primer nivel de atención de salud / Meeting on Palliative Care Education in Latin America Recommendations for teaching undergraduates and primary care health professionals

En muchos países de Latinoamérica el desarrollo del cuidado paliativo es aún incipiente. Una razón fundamental es que la formación de los profesionales de la salud en esta disciplina, aunque intensa y progresivamente mayor, es todavía insuficiente y de calidad variable. Diferentes instituciones y organizaciones relacionadas con la promoción e implementación del cuidado paliativo promovieron un primer encuentro regional sobre aspectos técnicos de la enseñanza de cuidado paliativo en el pregrado y el primer nivel de atención. La reunión se celebró en Buenos Aires, Argentina, en noviembre de 2012 y contó con la participación de 60 profesionales de diversas disciplinas con actividad docente en cuidado paliativo procedentes de 11 diferentes países latinoamericanos. Se identificaron y analizaron temas centrales en la enseñanza básica de cuidado paliativo, se identificaron aspectos que deben ser optimizados y se efectuaron recomendaciones para hacerlo. Todo el grupo estuvo de acuerdo con que el cuidado paliativo debería estar disponible y ser accesible para la mayor cantidad posible de pacientes con enfermedades de riesgo vital en estadios avanzados. También con la evidencia que muestra que más pacientes pueden recibir atención adecuada provista por profesionales del primer nivel de atención de salud, si adquieren los conocimientos, habilidades y actitudes básicas del cuidado paliativo. Este reporte describe el diseño y la organización del encuentro y se presentan los resultados y recomendaciones relacionadas con la docencia en el pregrado y el primer nivel de asistencia

In many Latin American countries Palliative Care development is still in the initial stages. A key reason is that the training of health professionals in this discipline, although intense and gradually increasing, is still insufficient, and with variable quality. The different institutions and organizations involved in the promotion and implementation of Palliative Care sponsored the first regional meeting on technical aspects of Palliative Care teaching to undergraduates and primary care health professionals. The meeting was held in Buenos Aires, Argentina in November 2012, and was attended by 60 professionals from diverse disciplines with teaching activity in Palliative Care from 11 different Latin American countries. Key issues in basic education in Palliative Care were identified and analyzed, challenges were identified, and recommendations were made overcome them. All the participants were in agreement that palliative care should be available and accessible for the majority of the patient population with life threatening conditions. Also, with the evidence that indicates that more patients may be able to receive appropriate care provided by primary care health care professionals, as long as they have the basic palliative care knowledge, skills and attitudes. This report describes the design and organization of the meeting and presents the results and recommendations related to teaching at the undergraduate and the primary care level

Prevalence of low back pain in Latin America: a systematic literature review.

BACKGROUND: Chronic low back pain is considered as a high-impact condition that affects the working population of Latin America, with long reaching social and economic repercussions. Its true frequency is unknown due to the absence of well-designed clinical trials that use standardized definitions and criteria. OBJECTIVES: To evaluate the prevalence of chronic non-specific low back pain among the Latin American population. STUDY DESIGN: A systematic review of chronic non-specific low back pain in Latin America. SETTING: Meeting of Change Pain Latin America, Mexico. METHODS: Data sources included relevant literature identified through searches of published studies between August 30, 2002, and August 30, 2012, in 7 electronic databases: Cochrane BVS, Pubmed, Medline, Lilacs, Scielo, Hinari, and MedCarib. Publications dealing with low back pain of a post-traumatic, infectious, or malignant origin were excluded. Two reviewers selected in an independent manner all eligible studies using the MOOSE checklist and extracted data on both prevalence and risk factors associated with low back pain. A narrative synthesis of the results was drafted, which was later validated by a panel of clinical experts on pain. RESULTS: Twenty-eight studies were included in the review, comprising a total of 20,559 subjects from 7 countries in the region. Four of these studies, with significant methodological differences between them, measured the frequency of chronic low back pain with results that varied from 4.2% to 10.1%. Four studies are part of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) program reports, and were pooled and analyzed separately because of their particular design. Their prevalence estimations varied between 1.8% and 11.3%. The remaining 20 studies evaluated a total population of 6,992 subjects, and found a prevalence of low back pain of 31.3%. Based on an epidemiological model constructed on both times to resolution and low back pain recurrence rates, the prevalence of chronic low back pain in Latin America was estimated to be around 10.5%. Some risk factors reported by the authors are long working hours with the worker in the sitting position, obesity and overweight, pregnancy, smoking, advanced age, lifting and carrying heavy loads, domestic work, sedentary lifestyles, and duration of current employment. A subgroup analysis of the population under study yielded an estimated prevalence of low back pain of 16.7% for the population exposed to a lower number of risk factors and 65% for the higher risk subgroup. In this review, we made an exhaustive search of studies evaluating the epidemiology of chronic low back pain in the Latin America region. LIMITATIONS: The large topographic and chronologic variability in definitions of low back pain, interviewer bias, and subject selection bias. CONCLUSIONS: Despite the sparse information and the methodological heterogeneity of the studies, pooled results allowed for an indirect estimation of the prevalence of low back pain in the region that was pretty consistent with the published results obtained from other settings. New studies need to be carried out to supplement and overcome the methodological weaknesses of those previously conducted.