Guía de práctica clínica. Diagnóstico y prevención del cáncer colorrectal. Actualización 2018 / Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update

Este documento actualiza las recomendaciones realizadas por la Sociedad Española de Medicina Familiar y Comunitaria y la Asociación Española de Gastroenterología para el diagnóstico y la prevención del cáncer colorrectal (CCR). Para establecer la calidad de la evidencia y los niveles de recomendación de las intervenciones se ha utilizado la metodología basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Este documento establece intervalos de demora óptimos en función de los síntomas y el test de SOH inmunológico (SOHi) y recomienda reducir las barreras para la confirmación diagnóstica en los pacientes con síntomas. En cuanto al cribado en población de riesgo medio, se proponen estrategias para conseguir la implantación universal del cribado poblacional basado en SOHi bienal e incrementar la participación de la población diana, incluyendo la implicación de atención primaria. Esta guía de práctica clínica recomienda el cribado universal del síndrome de Lynch mediante la inmunohistoquímica de las proteínas reparadoras o la inestabilidad de microsatélites en los CCR incidentes y el uso de paneles de genes en los pacientes con poliposis adenomatosas. También actualiza las estrategias para reducir la incidencia y la mortalidad tanto de CCR como de otros tumores asociados a los síndromes hereditarios. En cuanto al CCR familiar no hereditario y la vigilancia tras resección de CCR, adenomas y lesiones serradas, se establecen recomendaciones en función del riesgo atribuible y la reducción del riesgo de la intervención propuesta. Finalmente, en el documento se incluyen recomendaciones respecto a los intervalos de vigilancia en la enfermedad inflamatoria intestinal y la actitud ante la displasia

This document updates the recommendations made by the Spanish Society of Family and Community Medicine and the Spanish Association of Gastroenterology for the diagnosis and prevention of colorectal cancer (CRC). In order to evaluate the quality of the evidence and determine the recommendation levels of the interventions, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. This document establishes optimal delay intervals based on symptoms and the faecal immunochemical test (FIT) and recommends reducing the barriers for diagnostic confirmation in symptomatic subjects. With regard to CRC screening in the average-risk population, we propose strategies to achieve the universal implementation of organised CRC screening programmes based on biennial FIT and to increase the participation of the target population, including the involvement of Primary Healthcare. This Clinical Practice Guideline recommends universal screening for Lynch syndrome with mismatch repair proteins immunohistochemistry or microsatellite instability in incident CRCs and the use of gene panels in patients with adenomatous polyposis. It also updates the strategies to reduce the incidence and mortality of both CRC and other tumours associated with hereditary syndromes. Regarding non-hereditary familial CRC and surveillance after resection of adenomas, serrated lesions or CRC, we established the recommendations based on the attributable risk and the risk reduction of the proposed intervention. Finally, the document includes recommendations regarding surveillance intervals in inflammatory bowel disease and the attitude towards dysplasia

Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update. / Guía de práctica clínica. Diagnóstico y prevención del cáncer colorrectal. Actualización 2018.

This document updates the recommendations made by the Spanish Society of Family and Community Medicine and the Spanish Association of Gastroenterology for the diagnosis and prevention of colorectal cancer (CRC). In order to evaluate the quality of the evidence and determine the recommendation levels of the interventions, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. This document establishes optimal delay intervals based on symptoms and the faecal immunochemical test (FIT) and recommends reducing the barriers for diagnostic confirmation in symptomatic subjects. With regard to CRC screening in the average-risk population, we propose strategies to achieve the universal implementation of organised CRC screening programmes based on biennial FIT and to increase the participation of the target population, including the involvement of Primary Healthcare. This Clinical Practice Guideline recommends universal screening for Lynch syndrome with mismatch repair proteins immunohistochemistry or microsatellite instability in incident CRCs and the use of gene panels in patients with adenomatous polyposis. It also updates the strategies to reduce the incidence and mortality of both CRC and other tumours associated with hereditary syndromes. Regarding non-hereditary familial CRC and surveillance after resection of adenomas, serrated lesions or CRC, we established the recommendations based on the attributable risk and the risk reduction of the proposed intervention. Finally, the document includes recommendations regarding surveillance intervals in inflammatory bowel disease and the attitude towards dysplasia.

Guía de práctica clínica. Diagnóstico y prevención del cáncer colorrectal. Actualización 2018 / Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update

[{"text": "Este documento actualiza las recomendaciones realizadas por la Sociedad Española de Medicina Familiar y Comunitaria y la Asociación Española de Gastroenterología para el diagnóstico y la prevención del cáncer colorrectal (CCR). Para establecer la calidad de la evidencia y los niveles de recomendación de las intervenciones se ha utilizado la metodología basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Este documento establece intervalos de demora óptimos en función de los síntomas y el test de SOH inmunológico (SOHi) y recomienda reducir las barreras para la confirmación diagnóstica en los pacientes con síntomas. En cuanto al cribado en población de riesgo medio, se proponen estrategias para conseguir la implantación universal del cribado poblacional basado en SOHi bienal e incrementar la participación de la población diana, incluyendo la implicación de atención primaria. Esta guía de práctica clínica recomienda el cribado universal del síndrome de Lynch mediante la inmunohistoquímica de las proteínas reparadoras o la inestabilidad de microsatélites en los CCR incidentes y el uso de paneles de genes en los pacientes con poliposis adenomatosas. También actualiza las estrategias para reducir la incidencia y la mortalidad tanto de CCR como de otros tumores asociados a los síndromes hereditarios. En cuanto al CCR familiar no hereditario y la vigilancia tras resección de CCR, adenomas y lesiones serradas, se establecen recomendaciones en función del riesgo atribuible y la reducción del riesgo de la intervención propuesta. Finalmente, en el documento se incluyen recomendaciones respecto a los intervalos de vigilancia en la enfermedad inflamatoria intestinal y la actitud ante la displasia.", "_i": "es"}, {"text": "This document updates the recommendations made by the Spanish Society of Family and Community Medicine and the Spanish Association of Gastroenterology for the diagnosis and prevention of colorectal cancer (CRC). In order to evaluate the quality of the evidence and determine the recommendation levels of the interventions, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. This document establishes optimal delay intervals based on symptoms and the faecal immunochemical test (FIT) and recommends reducing the barriers for diagnostic confirmation in symptomatic subjects. With regard to CRC screening in the average-risk population, we propose strategies to achieve the universal implementation of organised CRC screening programmes based on biennial FIT and to increase the participation of the target population, including the involvement of Primary Healthcare. This Clinical Practice Guideline recommends universal screening for Lynch syndrome with mismatch repair proteins immunohistochemistry or microsatellite instability in incident CRCs and the use of gene panels in patients with adenomatous polyposis. It also updates the strategies to reduce the incidence and mortality of both CRC and other tumours associated with hereditary syndromes. Regarding non-hereditary familial CRC and surveillance after resection of adenomas, serrated lesions or CRC, we established the recommendations based on the attributable risk and the risk reduction of the proposed intervention. Finally, the document includes recommendations regarding surveillance intervals in inflammatory bowel disease and the attitude towards dysplasia.", "_i": "en"}]

Guía de práctica clínica sobre el manejo del estreñimiento crónico en el paciente adulto. Parte 2: Diagnóstico y tratamiento / Clinical practice guidelines for the management of constipation in adults. Part 2: Diagnosis and treatment

El estreñimiento es un trastorno muy frecuente que afecta negativamente el bienestar y la calidad de vida de las personas. Para el correcto manejo y tratamiento eficiente y seguro de los pacientes, las guías de práctica clínica basadas en la evidencia son un elemento esencial. El objetivo de esta guía es proporcionar a los profesionales sanitarios encargados de la asistencia a pacientes con estreñimiento crónico una herramienta que les permita tomar las mejores decisiones sobre la prevención, el diagnóstico y el tratamiento del estreñimiento. La metodología utilizada en la elaboración de esta guía de práctica clínica se describe en la Parte 1. En este artículo expondremos las recomendaciones en el manejo, tanto diagnóstico como terapéutico del estreñimiento

Constipation is a very common disorder that adversely affects well-being and quality of life. Evidence-based clinical practice guidelines are an essential element for proper patient management and safe, effective treatment. The aim of these guidelines is to provide health care professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of constipation. The methodology used to draw up these guidelines is described in the Part 1. In this article we will discuss the recommendations for the diagnostic and therapeutic management of constipation

Guía de práctica clínica sobre el manejo del estreñimiento crónico en el paciente adulto. Parte 1: Definición, etiología y manifestaciones clínicas / Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations

La guía de práctica clínica sobre el manejo del paciente con estreñimiento en los pacientes adultos se fundamenta en una serie recomendaciones y estrategias con el objetivo de proporcionar a los profesionales sanitarios encargados de la asistencia a pacientes con estreñimiento crónico una herramienta que les permita tomar las mejores decisiones sobre la prevención, diagnóstico y tratamiento del estreñimiento. Esta guía de práctica clínica persigue una atención eficiente del estreñimiento a partir de un trabajo coordinado y multidisciplinar con la participación de la atención primaria y especializada. La guía va dirigida a los médicos de familia, a los profesionales de enfermería de atención primaria y especializada, a los gastroenterólogos, a otros especialistas que atienden a pacientes con estreñimiento y a las personas afectadas con esta problemática. La elaboración de esta guía se justifica fundamentalmente por la elevada frecuencia del estreñimiento crónico, el impacto que este tiene en la calidad de vida de los pacientes y por los avances recientes en el manejo farmacológico del estreñimiento. Para clasificar la evidencia científica y la fuerza de las recomendaciones se ha utilizado el Grading of Recommendations Assessment, Development and Evaluation Working Group (sistema GRADE)

Clinical practice guidelines for the management of constipation in adults aim to generate recommendations on the optimal approach to chronic constipation in the primary care and specialized outpatient setting. Their main objective is to provide healthcare professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of this condition. They are intended for family physicians, primary care and specialist nurses, gastroenterologists and other health professionals involved in the treatment of these patients, as well as patients themselves. The guidelines have been developed in response to the high prevalence of chronic constipation, its impact on patient quality of life and recent advances in pharmacological management. The Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) system has been used to classify the scientific evidence and strengthen the recommendations

Clinical practice guidelines for the management of constipation in adults. Part 2: Diagnosis and treatment. / Guía de práctica clínica sobre el manejo del estreñimiento crónico en el paciente adulto. Parte 2: Diagnóstico y tratamiento.

Constipation is a very common disorder that adversely affects well-being and quality of life. Evidence-based clinical practice guidelines are an essential element for proper patient management and safe, effective treatment. The aim of these guidelines is to provide health care professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of constipation. The methodology used to draw up these guidelines is described in the Part 1. In this article we will discuss the recommendations for the diagnostic and therapeutic management of constipation.

Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. / Guía de práctica clínica sobre el manejo del estreñimiento crónico en el paciente adulto. Parte 1: Definición, etiología y manifestaciones clínicas.

Clinical practice guidelines for the management of constipation in adults aim to generate recommendations on the optimal approach to chronic constipation in the primary care and specialized outpatient setting. Their main objective is to provide healthcare professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of this condition. They are intended for family physicians, primary care and specialist nurses, gastroenterologists and other health professionals involved in the treatment of these patients, as well as patients themselves. The guidelines have been developed in response to the high prevalence of chronic constipation, its impact on patient quality of life and recent advances in pharmacological management. The Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) system has been used to classify the scientific evidence and strengthen the recommendations.

Manejo del paciente con dispepsia. Guía de práctica clínica. Actualización 2012. Resumen ejecutivo / Managing of the patient with dyspepsia. Clinical Practice Guideline. Update 2012

El programa de «Elaboración de guías de práctica clínica en enfermedades digestivas, desde la atención primaria a la especializada» es un proyecto compartido por la Asociación Española de Gastroenterología (AEG), la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) y el Centro Cochrane Iberoamericano (CCI). Presentamos la actualización de la guía sobre el manejo de la dispepsia que se publicó en el año 2003. En su elaboración se han tenido en cuenta los criterios esenciales contemplados en el instrumento Appraisal of Guidelines, Research and Evaluation for Europe (AGREE). Para clasificar la evidencia científica y fuerza de las recomendaciones se ha utilizado el sistema Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE)(AU)

The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations(AU)

[Managing of the patient with dyspepsia. Clinical Practice Guideline. Update 2012]. / Manejo del paciente con dispepsia. Guía de práctica clínica. Actualización 2012. Resumen ejecutivo.

The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations.

Assessment of a rapid referral pathway for suspected colorectal cancer in Madrid.

OBJECTIVE: To assess the results achieved with a rapid referral pathway for suspected colorectal cancer (CRC), comparing with the standard referral pathway. METHODS: Three-year audit of patients suspected of having CRC routed via a rapid referral pathway, and patients with CRC routed via the standard referral pathway of a health care district serving a population of 498,000 in Madrid (Spain). Outcomes included referral criteria met, waiting times, cancer diagnosed and stage of disease. RESULTS: Two hundred and seventy-two patients (mean age 68.8 years, SD 14.0; 51% male) were routed via the rapid referral pathway for colonoscopy. Seventy-nine per cent of referrals fulfilled the criteria for high risk of CRC. Fifty-two cancers were diagnosed: 26% Stage A (Astler-Coller), 36% Stage B, 24% Stage C and 14% Stage D. Average waiting time to colonoscopy for the rapid referral patients was 18.5 days (SD 19.1) and average waiting time to surgery was 28.6 days (SD 23.9). Colonoscopy was performed within 15 days in 65% of CRC rapid referral patients compared to 43% of standard pathway patients (P = 0.004). Overall waiting time for patients with CRC in the rapid referral pathway was 52.7 days (SD 32.9); while for those in the standard pathway, it was 71.5 days (SD 57.4) (P = 0.002). Twenty-six per cent Stage A CRC was diagnosed in the rapid referral pathway compared to 12% in the standard pathway (P < 0.001). CONCLUSION: The rapid referral pathway reduced waiting time to colonoscopy and overall waiting time to final treatment and appears to be an effective strategy for diagnosing CRC in its early stages.

Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud / Organizational procedures and health care management. A point of view from primary care centres

ObjetivoConocer la utilización de medidas organizativas relacionadas con la práctica asistencial de los centros de salud (CS) a través de la valoración de las comisiones directivas.DiseñoEstudio multicéntrico, descriptivo, transversal.EmplazamientoÁrea 11 Atención Primaria, Madrid.ParticipantesComisiones Directivas de los Equipos de Atención Primaria (n=38).MedicionesSe utilizó un cuestionario semiestructurado autoadministrado con 21 preguntas principales sobre procedimientos y utilización de medidas organizativas internas relacionadas con la práctica asistencial en los CS, agrupadas en 5 apartados: consultas previsibles y no previsibles (carácter asistencial o administrativo) y gestión de agendas/atención al usuario.ResultadosTasa de respuesta 100%. El 69% dispone de circuito interno y/o aplicación informática para renovación de recetas crónicas y el 55% para incapacidad temporal. En el 71%, las consultas de enfermería participan en emisión y entrega de recetas crónicas. El 42% realiza trámites administrativos atribuibles a atención especializada. El 21% no se ajusta a la frecuencia recomendada de visitas de seguimiento en los programas asistenciales y el 29% duplica la actividad entre medicina y enfermería. El 97% dispone de circuito específico interno para atención urgente. El 84% facilita citación autoconcertada desde las consultas y un 29% tiene agenda disponible para un período superior a 6 meses.ConclusionesExiste variabilidad en la utilización de determinadas medidas organizativas y procedimientos relacionados con la práctica asistencial en los centros de salud. Sería recomendable una mayor investigación para determinar si los cambios organizativos y del profesional pudieran contribuir a una mejor eficiencia y satisfacción del paciente(AU)

ObjectiveWe aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting.DesignMulticentre cross-sectional descriptive study.SettingArea 11 Madrid Primary Care Service, Spain.ParticipantsAll directive teams of primary care centres (PCC) (n=38).MeasurementsData were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management.Results100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don’t get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months.ConclusionsA wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction(AU)

[Organizational procedures and health care management. A point of view from primary care centres]. / Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud.

OBJECTIVE: We aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting. DESIGN: Multicentre cross-sectional descriptive study. SETTING: Area 11 Madrid Primary Care Service, Spain. PARTICIPANTS: All directive teams of primary care centres (PCC) (n=38). MEASUREMENTS: Data were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management. RESULTS: 100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don't get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months. CONCLUSIONS: A wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction.

Atención primaria se mueve / Primary care gets moving

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Integración del Modelo EFQM y el despliegue Hoshin Kanri en un área de atención primaria / Integration of the EFQM Model and Hoshin Kanri policy deployment in a primary care area

Introducción: La experiencia del Área 11 (atención primaria, Instituto Madrileño de la Salud) se ha encaminado hacia la integración de la autoevaluación con el modelo EFQM de excelencia y el despliegue factible y ordenado de políticas y objetivos (modelo Hoshin Kanri) aplicando de forma sistematizada la priorización estratégica. Metodología: En el seno de un proceso de planificación estratégica se ha contemplado de forma secuencial la integración de herramientas evaluadoras contrastadas (modelo de excelencia EFQM y modelo GIB para el entorno interno y externo, respectivamente), así como técnicas que relacionaran los aspectos estratégicos y operativos (modelo Hoshin Kanri) para el despliegue por políticas. En cada fase, se ha cuidado el rigor metodológico disponiendo de técnicas clásicas y avanzadas en calidad (tormenta de ideas, diagrama de afinidades, diagrama de árbol, DAFO, etc.), así como de priorización (matriz de priorización de Saaty o método analítico completo, matriz de Hanlon, etc.).Conclusiones: De forma estratégica, se refuerza la oportunidad de integrar las políticas institucionales con la habitual planificación operativa de área de atención primaria, orientándose hacia la mejora de la calidad de una forma integrada. La aplicación de un sistema gerencial de administración por políticas y objetivos (Hoshin Kanri) y el despliegue factible y ordenado de objetivos, tras la autoevaluación con el modelo EFQM de excelencia, han facilitado una mayor implicación tanto directiva como de los profesionales, y han orientado el área sanitaria hacia la mejora de la calidad de una forma integrada (AU)