RECALMIN II: información para la mejora de los Servicios de Medicina Interna del país / RECALMIN II: Information for improving the country's Internal Medicine Services

No disponible

Sistema sanitario y consumo de alcohol. ¿Es posible la convivencia? / Healthcare systems and alcohol consumption - can they coexist?

No disponible

Impact of 3-Monthly Vitamin D Supplementation Plus Exercise on Survival after Surgery for Osteoporotic Hip Fracture in Adult Patients over 50 Years: A Pragmatic Randomized, Partially Blinded, Controlled Trial.

OBJECTIVE: To determine whether 3-monthly supplementation of an oral vitamin D widely used in Spain (calcifediol) plus daily exercise could influence survival at one and four years after surgery for osteoporotic hip fracture. DESIGN: A pragmatic, randomized, partially single-blind placebo-controlled study. SETTING: Patients admitted to a tertiary university hospital for acute hip fracture. PARTICIPANTS: 675 healthy adult patients undergoing surgery for osteoporotic hip fracture were recruited from January 2004 to December 2007. INTERVENTION: Patients were randomized to receive either 3-monthly oral doses of 3 mg calcifediol (Hidroferol Choque®) or placebo in the 12 months postsurgery. Patients who received calcifediol were also given an exercise programme. The placebo group received standard health recommendations only. MEASUREMENTS: The primary endpoint was survival at 1 year and at 4 year follow-up. We also recorded new fractures, medical complications and anti-osteoporotic treatment compliance. RESULTS: We included a total of 88 patients, aged 62 to 99 years. Mean age was 82 years and 88.6% were women. At 12 months, 10 (11.3%) patients had died, 9 of them, from the non-intervention group. At 4 years after surgery, 20 (22.7%) had died, 3 (3.4%) from the intervention group and 17 (19.3%) from the non-intervention group. At this time, survival curve analysis showed 93% survival in the intervention group and 62% in the non-intervention group (p=0.001). At 12-month follow up, there were 18 new fractures, 9 in each group. The non-intervention group had more medical complications, with significant differences at visit 2 (p = 0.04) and 3 (p = 0.02) but not at visit 4 (p = 0.18). No significant differences between groups were found regarding treatment compliance. CONCLUSION: 3-monthly, oral supplements of 3 mg calcifediol plus daily exercise improved survival at one-year and four-year follow up after surgery for an osteoporotic hip fracture.

Statin-associated autoimmune myopathy: A distinct new IFL pattern can increase the rate of HMGCR antibody detection by clinical laboratories.

BACKGROUND AND OBJECTIVE: Statin-associated autoimmune myopathy (SAAM) with anti-HMGCR antibodies has recently been described. Several specific immunoassays are in use to detect HMGCR antibodies. In the course of systematic autoantibody screening we recognized a new distinct IFL staining pattern on rat liver sections that regularly coincided with anti-HMGCR antibodies. In this study we investigated whether this new IFL pattern is specifically associated to statin-associated autoimmune myopathy and corresponds to anti-HMGCR antibodies. PATIENTS AND METHODS: Twenty-three patients positive for anti-HMGCR antibodies (14 diagnosed with SAAM) were investigated for anti-HMGCR antibodies by two ELISA assays and confirmed by immmunoblot. HMGCR associated liver IFL pattern (HALIP) was detected by indirect IFL and the reactivity against HMGCR was confirmed by immunoabsorption using purified human HMGCR antigen. 90 patients with other autoimmune diseases and 45 non-autoimmune statin treated patients were studied as controls. RESULTS: 21 out of 23 (91%) anti-HMGCR positive patients were HALIP positive. The staining was completely and specifically removed by immunoabsorption with human purified HMGCR. None of the control sera from autoimmune patients or non-autoimmune statin treated subjects was positive for HALIP. Statistical concordance between HALIP and anti-HMGCR antibody specific tests was 98.7%, kappa 0.95. CONCLUSIONS: A new and distinct IFL staining pattern (HALIP) is associated to HMGCR associated myopathy. Absorption and concordance studies indicate that the antigen recognized in the liver by HALIP is HMGCR or a closely related protein. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin treated patients tested for autoimmune serology.

[Analysis of scientific production and bibliometric impact of a group of Spanish clinical researchers]. / Análisis de la producción científica y del impacto bibliométrico en un grupo de investigadores clínicos españoles.

BACKGROUND: To study the behaviour of several indicators of scientific production and repercussion in a group of Spanish clinical researchers and to evaluate their possible utility for interpreting individual or collective scientific pathways. METHOD: We performed a unicentric, ecological pilot study involving a group of physicians with consolidated research experience. From the Science Citation Index Expanded (SCI-Expanded) database, we obtained the number of publications of each author (indicator of production) and the number of citations, impact factor and h index (indicators of repercussion). These indicators were calculated individually for each of the years of research experience and we assessed the relationship between the experience of the researcher and the value of the indicator achieved, the relationship between these indicators themselves, and their temporal evolution, both individually and for the entire group. RESULTS: We analysed 35 researchers with a research experience of 28.4 (9.6) years. The h index showed the lowest coefficient of variance. The relationship between the indicators and research experience was significant, albeit modest (R2 between 0.15-0.22). The 4 indicators showed good correlations. The temporal evolution of the indicators, both individual and collective, adjusted better to a second grade polynomial than a linear function: individually, all the authors obtained R2>0.90 in all the indicators; together the best adjustment was produced with the h index (R2=0.61). Based on the indicator used, substantial variations may be produced in the researchers' ranking. CONCLUSIONS: A model of the temporal evolution of the indicators of production and repercussion can be described in a relatively homogeneous sample of researchers and the h index seems to demonstrate certain advantages compared to the remaining indicators. This type of analysis could become a predictive tool of performance to be achieved not only for a particular researcher, but also for a homogeneous group of resear-chers corresponding to a specific scientific niche.

Documento de consenso y recomendaciones sobre el uso de los péptidos natriuréticos en la práctica clínica / Consensus document and recommendations on the use of natriuretic peptides in clinical practice

Los péptidos natriuréticos son una herramienta de laboratorio útil en el diagnóstico, pronóstico y tratamiento de los pacientes con insuficiencia cardiaca. Su uso involucra a diferentes ámbitos sanitarios (consultas, urgencias, hospitalización, laboratorio) y a muy diferentes profesionales de la Atención Primaria o especializada. Sin embargo, su incorporación a la práctica asistencial aún es escasa y desigual. Para un correcto uso e interpretación en la práctica clínica se necesita un mínimo de conocimientos preanalíticos (fisiopatología), analíticos (métodos) y postanalíticos (interpretación e integración con los datos clínicos). Este documento de consenso elaborado por varias sociedades científicas tiene como objetivo actualizar los conceptos y conocimientos necesarios sobre los péptidos natriuréticos que permitan su aplicación para el diagnóstico, pronóstico y tratamiento de la insuficiencia cardiaca, en los diferentes ámbitos sanitarios (AU)

Natriuretic peptides are a useful laboratory tool for the diagnosis, prognosis and treatment of patients with heart failure. Natriuretic peptides are used in various healthcare settings (consultations, emergency department, hospitalization, laboratory) and by various primary care and specialised professionals. However, their use in clinical practice is still scare and uneven. Properly using and interpreting natriuretic peptides in clinical practice requires a minimum of prelaboratory (pathophysiology), laboratory (methods) and postlaboratory (interpretation and integration of clinical data) expertise. The objective of this consensus document, developed by several scientific societies, is to update the necessary concepts and expertise on natriuretic peptides that enable its application in the diagnosis, prognosis and treatment of heart failure, in various healthcare environments (AU)

Análisis de la producción científica y del impacto bibliométrico en un grupo de investigadores clínicos españoles / Analysis of scientific production and bibliometric impact of a group of Spanish clinical researchers

Fundamento: Investigar el comportamiento de varios indicadores de producción y repercusión científicos en un grupo de investigadores clínicos españoles y valorar su utilidad para interpretar trayectorias individuales o colectivas. Material y método: Estudio piloto ecológico unicéntrico en un grupo de médicos con trayectoria investigadora consolidada. A través de Science Citation Index Expanded se obtuvo el número de trabajos publicados por cada autor (indicador de producción) y el número de citas, el factor de impacto y el índice h (indicadores de repercusión). Los indicadores se calcularon para cada año de la trayectoria investigadora. Se relacionó la experiencia del investigador y el valor del indicador alcanzado, la relación entre indicadores y la evolución temporal, tanto individual como colectivamente. Resultados: Se analizaron 35 investigadores, con experiencia de 28,4 (9,6) años. El índice h fue el indicador con coeficiente de variación más bajo. La relación entre indicadores y experiencia investigadora es significativa pero discreta (R2 entre 0,15-0,22). Los cuatro indicadores mostraron buenas correlaciones entre ellos. La evolución temporal de los indicadores, tanto individual como colectiva, se ajustó mejor a una función polinómica de segundo grado que a una lineal: individualmente, todos los autores obtuvieron R2>0,90 en todos los indicadores; el mejor ajuste se produjo con el índice h (R2=0,61). En función del indicador utilizado, pueden producirse variaciones sustanciales en la ordenación de los investigadores. Conclusiones: Es posible describir, en una muestra relativamente homogénea de investigadores, un modelo de evolución temporal de los indicadores de producción y repercusión, y el índice h parece mostrar ciertas ventajas respecto al resto. Este análisis podría convertirse en una herramienta predictiva del rendimiento a alcanzar por investigadores individuales y para grupos homogéneos de investigadores correspondientes a un mismo nicho científico (AU)

Background: To study the behaviour of several indicators of scientific production and repercussion in a group of Spanish clinical researchers and to evaluate their possible utility for interpreting individual or collective scientific pathways. Method: We performed a unicentric, ecological pilot study involving a group of physicians with consolidated research experience. From the Science Citation Index Expanded (SCI-Expanded) database, we obtained the number of publications of each author (indicator of production) and the number of citations, impact factor and h index (indicators of repercussion). These indicators were calculated individually for each of the years of research experience and we assessed the relationship between the experience of the researcher and the value of the indicator achieved, the relationship between these indicators themselves, and their temporal evolution, both individually and for the entire group. Results: We analysed 35 researchers with a research experience of 28.4 (9.6) years. The h index showed the lowest coefficient of variance. The relationship between the indicators and research experience was significant, albeit modest (R2 between 0.15-0.22). The 4 indicators showed good correlations. The temporal evolution of the indicators, both individual and collective, adjusted better to a second grade polynomial than a linear function: individually, all the authors obtained R2>0.90 in all the indicators; together the best adjustment was produced with the h index (R2=0.61). Based on the indicator used, substantial variations may be produced in the researchers' ranking. Conclusions: A model of the temporal evolution of the indicators of production and repercussion can be described in a relatively homogeneous sample of researchers and the h index seems to demonstrate certain advantages compared to the remaining indicators. This type of analysis could become a predictive tool of performance to be achieved not only for a particular researcher, but also for a homogeneous group of researchers corresponding to a specific scientific niche (AU)

Consensus document and recommendations on the use of natriuretic peptides in clinical practice. / Documento de consenso y recomendaciones sobre el uso de los péptidos natriuréticos en la práctica clínica.

Natriuretic peptides are a useful laboratory tool for the diagnosis, prognosis and treatment of patients with heart failure. Natriuretic peptides are used in various healthcare settings (consultations, emergency department, hospitalization, laboratory) and by various primary care and specialised professionals. However, their use in clinical practice is still scare and uneven. Properly using and interpreting natriuretic peptides in clinical practice requires a minimum of prelaboratory (pathophysiology), laboratory (methods) and postlaboratory (interpretation and integration of clinical data) expertise. The objective of this consensus document, developed by several scientific societies, is to update the necessary concepts and expertise on natriuretic peptides that enable its application in the diagnosis, prognosis and treatment of heart failure, in various healthcare environments.

Producción científica e impacto bibliométrico de un grupo representativo de internistas españoles con trayectoria investigadora consolidada / Scientific production and bibliometric impact of a representative group of Spanish internists with established research careers

Objetivo. Estudiar la evolución temporal de los índices bibliométricos de internistas con una trayectoria investigadora consolidada, con el fin de predecir el comportamiento futuro de un investigador y evaluar si la producción centrada en un área concreta de la medicina interna permite obtener mayor visibilidad que en medicina interna general. Material y método. Se analizó un grupo representativo de miembros de la Sociedad Española de Medicina Interna a partir de los datos obtenidos de la Web of Science. Como indicador de productividad se analizó el número de artículos publicados y como indicadores de repercusión el factor de impacto, el número de citas y el índice h. Resultados. Se analizó a 42 internistas, con una media de 30 años de experiencia y un total de 6.655 publicaciones. La media (DE) del número de trabajos fue de 158 (96), el número de citas 2.850 (2.865), el factor de impacto 711 (549) y el índice h 25 (11), siendo superiores estos datos en los internistas especializados respecto a los generalistas. Hubo buena relación entre indicadores de repercusión y de productividad (R2=0,61-0,89) y poca entre estos y los años de experiencia (R2=0,13-0,19). La evolución temporal de estos indicadores para cada investigador individual, y para todos ellos en conjunto, se ajustó a un modelo polinomial de segundo grado, teniendo el índice h las R2 más altas. Conclusiones. El índice h es el que mejor se ajusta y menos variabilidad presenta, lo cual podría permitir predecir la producción e impacto científico futuro de los internistas. Los investigadores especializados obtienen más visibilidad que los generalistas (AU)

Objective. To study the temporal evolution of the bibliometric indices of internists with established research experience in order to predict the future behavior of researchers and to assess whether output focused on a specific area of internal medicine helps obtain greater visibility than in general internal medicine. Material and method. We analyzed a representative group of members of the Spanish Society of Internal Medicine (SEMI) based on data obtained from the Web of Science. As an indicator of productivity, we analyzed the number of articles published. As impact indicators, we studied the impact factor (IF), the number of citations and the h-index. Results. We analyzed 42 internists, with a mean experience of 30 years and a total of 6655 publications. The mean (SD) number of studies was 158 (96), the number of citations was 2,850 (2,865), the IF was 711 (549) and the h-index was 25 (11). These figures were higher for the specialist internists than for the general internists. There was a good relationship between the impact and productivity indicators (R2=.61-.89) and a poor relationship between these indicators and the years of experience (R2=.13-.19). The temporal evolution of these indicators for each individual researcher and for all researchers as a whole was adjusted to a second-degree polynomial model, with the h-index having the highest R2 values. Conclusions. The h-index is the factor that had the best adjustment and least variability and could therefore help predict the future scientific output and impact of internists. The specialist researchers achieved greater visibility than the general internists (AU)

Scientific production and bibliometric impact of a representative group of Spanish internists with established research careers. / Producción científica e impacto bibliométrico de un grupo representativo de internistas españoles con trayectoria investigadora consolidada.

OBJECTIVE: To study the temporal evolution of the bibliometric indices of internists with established research experience in order to predict the future behavior of researchers and to assess whether output focused on a specific area of internal medicine helps obtain greater visibility than in general internal medicine. MATERIAL AND METHOD: We analyzed a representative group of members of the Spanish Society of Internal Medicine (SEMI) based on data obtained from the Web of Science. As an indicator of productivity, we analyzed the number of articles published. As impact indicators, we studied the impact factor (IF), the number of citations and the h-index. RESULTS: We analyzed 42 internists, with a mean experience of 30 years and a total of 6655 publications. The mean (SD) number of studies was 158 (96), the number of citations was 2,850 (2,865), the IF was 711 (549) and the h-index was 25 (11). These figures were higher for the specialist internists than for the general internists. There was a good relationship between the impact and productivity indicators (R(2)=.61-.89) and a poor relationship between these indicators and the years of experience (R(2)=.13-.19). The temporal evolution of these indicators for each individual researcher and for all researchers as a whole was adjusted to a second-degree polynomial model, with the h-index having the highest R(2) values. CONCLUSIONS: The h-index is the factor that had the best adjustment and least variability and could therefore help predict the future scientific output and impact of internists. The specialist researchers achieved greater visibility than the general internists.

Current status of General Pathology training in Spain.

BACKGROUND AND OBJECTIVES: One of the core subjects in university training of the physicians has been General Pathology. Responsibility for this has historically fallen on Internal Medicine specialists. However, we are unaware if this situation is currently maintained. METHODS: A questionnaire was sent to the coordinators of the subject of the 39 Spanish medical schools to know, among other things, the current denomination of the subjects (traditionally known as «General Pathology¼), number of credits, teaching activities included in the subject and number and specialty of the professors responsible for it. Some data from the medical schools that did not respond were obtained from their web pages. RESULTS: A total of 28 of the 39 (72%) medical schools existing in Spain answered the survey. The current denomination of the subject «General Pathology¼ varied greatly. The mean number of credits (one credit=20-25 h) was 11.2 (range 3 to 29). In 22 of 34 schools (65%), the subject was taught in the third year of the studies, but in 21% of the schools, it was partially and in 15% of the schools, totally, taught in the second year. More than half of the professors (54%) who taught the subject were Internal Medicine specialists, although this responsibility was shared with other specialists in a large proportion. CONCLUSIONS: Teaching of General Pathology shows a marked heterogeneity that does not seem to be due to teaching or pedagogic criteria among the different schools of Spain. These facts may be due to less presence in the university setting of Internal Medicine compared to other specialties.

Competencias básicas de la medicina interna / Core competencies in Internal Medicine

El grupo de trabajo de Competencias del Internista de la Sociedad Española de Medicina Interna (SEMI) expone los principales conocimientos, habilidades y aptitudes que debería poseer todo internista en España. Este listado de competencias representa el núcleo de la Medicina Interna dentro de un escenario futuro de troncalidad de las especialidades en ciencias de la salud(AU)

The working group of the Spanish Society of Internal Medicine (SEMI) on “Competencies of the Internist” has defined the basic medical knowledge, skills and attitudes that all internists in Spain should have. This list of competencies represents the Internal Medicine core curriculum within the context of the future educational framework of medical specialties in Health Sciences(AU)

[Core competencies in internal medicine]. / Competencias básicas de la medicina interna.

The working group of the Spanish Society of Internal Medicine (SEMI) on "Competencies of the Internist" has defined the basic medical knowledge, skills and attitudes that all internists in Spain should have. This list of competencies represents the Internal Medicine core curriculum within the context of the future educational framework of medical specialties in Health Sciences.

Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: a cross-sectional study in a low cardiovascular disease risk geographical area.

OBJECTIVE: Prevalence of cardiovascular disease is high in schizophrenia. Our aim is to estimate the prevalence of cardiovascular risk factors (CVRF) among schizophrenia patients. METHOD: National cross-sectional study in patients diagnosed with schizophrenia under treatment with second generation antipsychotics and admitted to short-stay hospitalisation units. RESULTS: A sample of 733 consecutively admitted patients was enrolled; the most prevalent CVRFs were smoking 71% (95% CI: 67-74%) and hypercholesterolemia 66% (61-70%) followed by hypertriglyceridemia 26% (26-32%), hypertension 18% (15-21%) and diabetes 5% (4-7%). Metabolic syndrome showed 19% (95% CI: 16-23%) prevalence or, according to updated definitions (Clin Cornerstone 7 [2005] 36-45), 24% (95% CI: 20-28%). The rate of patients within the high-risk range of a 10-year fatal cardiovascular event was 6.5%. CVRFs under routine management were diabetes (60%), hypertension (28%) and, to a lesser extent, dyslipemia (14%). Treatment for CVRFs was associated to gender, men for hypertension OR = 25.34, p < 0.03 and women for diabetes OR = 0.02, p < 0.03. CONCLUSION: We found that CVRFs in schizophrenia were prevalent and under-diagnosed, and thus with insufficient therapeutic management.

Insuficiencia cardíaca con función sistólica conservada: fisiopatología / No disponible

No disponible