Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement. / Desarrollo de criterios de uso adecuado para la artroscopia de cadera en pacientes con choque femoroacetabular.

INTRODUCTION: The use of hip arthroscopy as a treatment for femoroacetabular impingement (FAI) has increased exponentially in recent years without robust evidence or consensus about the patients who benefit from it. OBJECTIVE: To develop explicit criteria for the appropriate indication of hip arthroscopy in FAI. METHOD: A panel of experts was formed with 11 traumatologists following the RAND/UCLA method to identify the appropriateness criteria for hip arthroscopy in patients with FAI. The panel made independent evaluations of each indication using a nine-point adequacy scale, then met face-to-face to vote using an iterative discussion process. The influence of the variables on the final score was studied using multinomial logistic regression models. The Classification and Regression Tree (CART) analysis was used to summarize the results in the form of decision trees. RESULTS: Twenty-three point four percent of the 192 scenarios evaluated in the face-to-face meeting was considered appropriate (40% agreement), 26.6% uncertain and 50% inappropriate (75% agreement). The most influential variables in considering the use of arthroscopy appropriate were: joint symptoms compatible with shock test, duration of symptoms, functionality, age and Hip Outcome Score (HOS) scale. CONCLUSIONS: We developed an explicit set of criteria for the appropriate use of hip arthroscopy in FAI using the RAND/UCLA method, providing a tool that would identify patients who are potential candidates for surgical treatment using arthroscopic hip surgery.

Complicaciones y preservación nerviosa de la prostatectomía en relación con el intervalo de tiempo desde la biopsia diagnóstica / Complications and Nerve Preservation in Prostatectomy According to the Time Interval from Diagnostic Biopsy

Objetivos: Sintetizar la evidencia disponible sobre las complicaciones y la capacidad de preservación nerviosa bilateral de la prostatectomía radical en pacientes con cáncer próstatico en función del tiempo transcurrido de la biopsia diagnóstica (superior o inferior a las seis semanas). Material y métodos: Se identificaron los estudios relevantes utilizando estrategias de búsqueda estructuradas y específicas para cada una de las bases de datos consultadas sin ninguna limitación. Se evaluó la calidad metodológica de cada uno de los estudios incluidos y se extrajeron los datos de forma independiente. Resultados: Para la prostatectomía radical abierta, dos de los estudios concluyeron que el intervalo de tiempo transcurrido entre la realización de la biopsia prostática y la cirugía inferior a las 4 o 6 semanas no influye en la tasa de complicaciones posquirúrgicas y la capacidad de preservación nerviosa durante la cirugía. En cuanto a la prostatectomía radical laparoscópica asistida por robot el estudio incluido concluye que la realización de este tipo de intervenciones dentro de un periodo de tiempo inferior a las cuatro o seis semanas posteriores a la biopsia diagnóstica, se asocia a un mayor riesgo de sufrir complicaciones postquirúrgicas. No obstante, estos estudios contaban con importantes limitaciones metodológicas. Conclusiones: El intervalo de tiempo entre la realización de la biopsia diagnóstica y la cirugía abierta no influye en la tasa de complicaciones o preservación nerviosa. En cambio, un periodo de tiempo inferior a las cuatro semanas entre la biopsia diagnóstica y la cirugía laparoscópica se asocia con mayor riesgo de complicaciones quirúrgicas (AU)

Objectives: To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). Material and methods: Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. Results: For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. Conclusions: The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications (AU)

[Complications and nerve preservation in prostatectomy according to the time interval from diagnostic biopsy]. / Complicaciones y preservación nerviosa de la prostatectomía en relación con el intervalo de tiempo desde la biopsia diagnóstica.

OBJECTIVES: To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). MATERIAL AND METHODS: Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. RESULTS: For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. CONCLUSIONS: The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications.

Eficacia de la colonografía por tomografía computarizada frente a la colonoscopia como prueba de cribado del cáncer colorrectal / Efficacy of CT colonography versus colonoscopy in screening for colorectal cancer

Objetivo. Determinar la eficacia y efectividad de la colonografía por tomografía computarizada (CTC) frente a la colonoscopia como pruebas de cribado para el cáncer colorrectal (CCR). Material y métodos. Se realizó una revisión sistemática de la literatura científica que incluyó todos los estudios que evaluaran la eficacia de la CTC como prueba de cribado del CCR. Quedaron excluidos aquellos artículos que analizaran la eficacia de otras técnicas de cribado para el CCR o los que utilizaran la CTC como técnica diagnóstica o en poblaciones sintomáticas. De las 213 referencias obtenidas se seleccionaron 9 estudios tras lectura crítica. Resultados. La especificidad demostrada para la CTC en el cribado del CCR fue alta y disminuía con el diámetro del pólipo a detectar. La sensibilidad para la CTC para detectar pólipos de diámetro igual o menor de 6mm resultó ser muy baja y heterogénea, aunque aumentaba para la detección de pólipos de más de 9mm de diámetro. Conclusión. La CTC demostró tener alta especificidad y una sensibilidad muy heterogénea, aunque en la mayoría de los casos no alcanzó los porcentajes de sensibilidad y especificidad logrados por la colonoscopia (AU)

Objective. To determine the efficacy and effectiveness of CT colonography in comparison with those of colonoscopy in screening for colorectal cancer. Material and methods. We systematically reviewed all the studies in the scientific literature that assessed the efficacy of CT colonography in screening for colorectal cancer. We excluded articles that assessed the efficacy of other screening techniques for colorectal cancer and those that used CT colonography in the diagnostic workup of suspected lesions or symptomatic patients. After a critical reading of the 213 references obtained, we selected nine studies. Results. The specificity of CT colonography in screening for colorectal cancer was high, although it decreased with the diameter of the polyp to be detected. The sensitivity of CT colonography in the detection of polyps less than or equal to 6mm in diameter was very low and heterogeneous, although it was higher for polyps greater than 9mm in diameter. Conclusion. CT colonography has high specificity but very heterogeneous sensitivity, although in most cases it was not as sensitive or specific as conventional colonoscopy (AU)

La vitamina K como profilaxis para la enfermedad hemorrágica del recién nacido / Prophylactic Vitamin K for Vitamin K Deficiency Bleeding of the Newborn

Objetivo La administración de vitamina K inmediatamente después del nacimiento ha demostrado un descenso significativo de la incidencia de hemorragias neonatales, pero no existe evidencia suficiente que determine la forma de administración más adecuada. El objetivo de esta revisión es determinar la eficacia de la vitamina K administrada por vía oral frente a la vía intramuscular en la prevención de la enfermedad hemorrágica del recién nacido. Métodos Se realizó una revisión sistematizada de las principales bases de datos (Medline, Embase y Cochrane), entre otras sin limitación por fecha, idioma ni tipo de estudio. Los estudios seleccionados evaluaban la eficacia de la vitamina K. Se excluyeron aquellos estudios realizados en embarazadas, niños pretérmino o en pacientes afectos de alguna enfermedad. La validez de estos estudios fue evaluada mediante herramientas CASPe para revisiones sistemáticas y ensayos clínicos. Resultados Los estudios incluidos fueron cuatro ensayos clínicos y una revisión sistemática. Únicamente dos estudios evaluaron aspectos clínicos en los cuales se observó un descenso en la incidencia de hemorragias en el recién nacido tras la profilaxis con vitamina K por vía intramuscular. Con respecto a la vía oral, diferentes estudios analizaron la eficacia de la vitamina K mediante la determinación de parámetros bioquímicos (factor X, índice y tiempo de protrombina, vitamina K1 en plasma y antígeno de protrombina, entre otros) con resultados poco concluyentes en cuanto a la vía de administración y al número de dosis. Conclusiones(..)(AU)

Background The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of haemorrhagic disease of newborn (HDN).Methods We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials. Results Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K1 in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses. Conclusions There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which cannot be correlated with the actual coagulation status of the newborn due to lack of scientific evidence(AU)

[Efficacy of CT colonography versus colonoscopy in screening for colorectal cancer]. / Eficacia de la colonografía por tomografía computarizada frente a la colonoscopia como prueba de cribado del cáncer colorrectal.

OBJECTIVE: To determine the efficacy and effectiveness of CT colonography in comparison with those of colonoscopy in screening for colorectal cancer. MATERIAL AND METHODS: We systematically reviewed all the studies in the scientific literature that assessed the efficacy of CT colonography in screening for colorectal cancer. We excluded articles that assessed the efficacy of other screening techniques for colorectal cancer and those that used CT colonography in the diagnostic workup of suspected lesions or symptomatic patients. After a critical reading of the 213 references obtained, we selected nine studies. RESULTS: The specificity of CT colonography in screening for colorectal cancer was high, although it decreased with the diameter of the polyp to be detected. The sensitivity of CT colonography in the detection of polyps less than or equal to 6mm in diameter was very low and heterogeneous, although it was higher for polyps greater than 9mm in diameter. CONCLUSION: CT colonography has high specificity but very heterogeneous sensitivity, although in most cases it was not as sensitive or specific as conventional colonoscopy.

[Prophylactic vitamin K for vitamin K deficiency bleeding of the newborn]. / La vitamina K como profilaxis para la enfermedad hemorrágica del recién nacido.

BACKGROUND: The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of hemorrhagic disease of newborn (HDN). METHODS: We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials. RESULTS: Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K1 in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses. CONCLUSIONS: There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which can not be correlated with the actual coagulation status of the newborn due to lack of scientific evidence.