Análisis de la difusión y utilidad percibida a través de la implementación de una plataforma de formación virtual durante la pandemia por COVID-19 / Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic

Introducción: La pandemia de COVID-19 ha afectado a las oportunidades de formación de los profesionales sanitarios, en parte porque se anularon muchos cursos presenciales. En este estudio se analizan los resultados de participación y satisfacción de las sesiones del Aula Virtual AEC durante su primer año. Métodos: El Aula Virtual AEC incluye un formato combinado de seminarios semanales emitidos en directo que pueden ser visionados en diferido. En este estudio se evalúan los resultados en sus primeros 12 meses, considerando el número de participantes en directo, el número de visualizaciones en diferido y el alcance global, así como los resultados de la encuesta de satisfacción realizada en cada una de las sesiones (1-10) Resultados: Desde el 16 de abril de 2020 hasta el 15 de abril de 2021 se realizaron 50 sesiones del Aula Virtual AEC. El alcance medio de las sesiones ha sido de 509 ± 288 visualizaciones con un rango entre 196 y 1490. En los picos de la pandemia se observó un descenso de los participantes en directo: 275 ± 135 vs. 391 ± 233 (p = 0,032) La puntuación media sobre el formato fue 8,46 ± 0,31/10. Las sesiones mejor puntuadas fueron las de temática relacionada con coloproctología con una diferencia estadísticamente significativa en la puntuación media 8,79 ± 0,42 vs. 8,39 ± 0,27 (p = 0,035). Un 90,76% de usuarios consideraron las sesiones útiles. Un 97,2% consideraban que deben mantenerse tras la pandemia. Conclusiones: El Aula Virtual AEC ha tenido muy buenos resultados en los primeros 12 meses de desarrollo, resultando ser una herramienta útil de docencia quirúrgica que previsiblemente sobrevivirá a la época de pandemia. (AU)

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0–10). Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. Conclusions: The AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over. (AU)

Análisis de la difusión y utilidad percibida a través de la implementación de una plataforma de formación virtual durante la pandemia por COVID-19 / Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic

Introducción: La pandemia de COVID-19 ha afectado a las oportunidades de formación de los profesionales sanitarios, en parte porque se anularon muchos cursos presenciales. En este estudio se analizan los resultados de participación y satisfacción de las sesiones del Aula Virtual AEC durante su primer año. Métodos: El Aula Virtual AEC incluye un formato combinado de seminarios semanales emitidos en directo que pueden ser visionados en diferido. En este estudio se evalúan los resultados en sus primeros 12 meses, considerando el número de participantes en directo, el número de visualizaciones en diferido y el alcance global, así como los resultados de la encuesta de satisfacción realizada en cada una de las sesiones (1-10) Resultados: Desde el 16 de abril de 2020 hasta el 15 de abril de 2021 se realizaron 50 sesiones del Aula Virtual AEC. El alcance medio de las sesiones ha sido de 509 ± 288 visualizaciones con un rango entre 196 y 1490. En los picos de la pandemia se observó un descenso de los participantes en directo: 275 ± 135 vs. 391 ± 233 (p = 0,032) La puntuación media sobre el formato fue 8,46 ± 0,31/10. Las sesiones mejor puntuadas fueron las de temática relacionada con coloproctología con una diferencia estadísticamente significativa en la puntuación media 8,79 ± 0,42 vs. 8,39 ± 0,27 (p = 0,035). Un 90,76% de usuarios consideraron las sesiones útiles. Un 97,2% consideraban que deben mantenerse tras la pandemia. Conclusiones: El Aula Virtual AEC ha tenido muy buenos resultados en los primeros 12 meses de desarrollo, resultando ser una herramienta útil de docencia quirúrgica que previsiblemente sobrevivirá a la época de pandemia. (AU)

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0–10). Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. Conclusions: The AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over. (AU)

[Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic]. / Análisis de la difusión y utilidad percibida a través de la implementación de una plataforma de formación virtual durante la pandemia por COVID-19.

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10). Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. Conclusions: The AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.

Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic.

INTRODUCTION: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. METHODS: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10). RESULTS: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (P = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (P = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. CONCLUSIONS: The AEC Virtual Classroom has had very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.

Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. / Recomendaciones de actuación en cirugía oncológica hepatobiliopancreática durante la pandemia COVID-19.

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.

Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas / Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed

Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology. / Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

Protocolo de actuación quirúrgica en casos confirmados o sospechosos de enfermedad por Ébola y otras enfermedades víricas altamente transmisibles / Surgical protocol for confirmed or suspected cases of Ebola and other highly transmissible diseases

Las epidemias por virus altamente transmisibles como la enfermedad por virus del Ébola (EVE) pueden generar casos importados a Europa y América. Aunque la probabilidad de actuación quirúrgica en ellas es baja, la Asociación Española de Cirujanos ha elaborado un protocolo de actuación quirúrgica. INDICACIÓN: No está indicada la cirugía electiva. Puede necesitarse cirugía urgente en: personas en observación, casos probables y casos confirmados en fase precoz. En algunas condiciones de habitual tratamiento quirúrgico puede instaurarse una terapia médica conservadora con intención de evitar la intervención. HOSPITALES Y EQUIPOS: Los casos deben concentrarse en hospitales de alta especialización, únicos centros en los que se practique una eventual intervención quirúrgica. Estos deben garantizar la seguridad de los profesionales. Los equipos quirúrgicos han de recibir extensa formación mediante simulación. PROTOCOLO QUIRÚRGICO: Las recomendaciones se basan en protocolos de uso del equipo de protección individual, guías clínicas de otras sociedades y recomendaciones específicas para el área quirúrgica

Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment

Compliance with recommendations on surgery for primary hyperparathyroidism-from guidelines to real practice: results from an Iberian survey.

PURPOSE: Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes. METHODS: An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions. RESULTS: Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038). CONCLUSIONS: Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.

Surgical protocol for confirmed or suspected cases of Ebola and other highly transmissible diseases.

Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment.

[Definition, etiology, classification and presentation forms]. / Definición, etiopatogenia, clasificación y formas de presentación.

Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration.

Introducción / Introduction

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Definición, etiopatogenia, clasificación y formas de presentación / Definition, etiology, classification and presentation forms

La artrosis se define como un proceso degenerativo articular, consecuencia de trastornos mecánicos y biológicos que desestabilizan el equilibrio entre la síntesis y la degradación del cartílago articular, estimulando el crecimiento del hueso subcondral y con la presencia de sinovitis crónica. Actualmente se considera a la articulación como una unidad funcional que integra diferentes tejidos, principalmente el cartílago, la sinovial y el hueso subcondral, todos ellos implicados en la patogenia de la enfermedad. Se han descrito diferentes factores de riesgo relacionados con su aparición: los generales no modificables (edad, sexo y genética), los generales modificables (obesidad y factores hormonales) y los locales (anomalías articulares previas y sobrecarga articular), mientras que entre los principales factores relacionados con su progresión destacan los defectos de alineación articular y la artrosis generalizada. Se han propuesto diferentes maneras de clasificar la artrosis, aunque ninguna de ellas tiene gran relevancia para su manejo por el médico de atención primaria: la etiológica (formas primarias o idiopáticas y formas secundarias), la topográfica (localizaciones típicas y atípicas), la de Kellgren y Lawrence (repercusión radiológica) y la del American College of Rheumatology para la artrosis de manos, caderas y rodillas. La artrosis de rodilla tiene una prevalencia del 10,2% en España y muestra una importante disociación clinicorradiológica. La artrosis de manos, con una prevalencia de afectación sintomática de alrededor del 6,2% puede adoptar diferentes formas de presentación (artrosis nodal, artrosis generalizada, rizartrosis y artrosis erosiva). La artrosis sintomática de cadera afecta entre el 3,5 y 5,6% de los mayores de 50 años y tiene diferentes patrones radiológicos en función de la migración de la cabeza femoral

Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration

Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START / Inappropriate prescribing of drugs in older people attending primary care health centres: Detection using STOPP-START criteria

Objetivo. Conocer la prevalencia y características de prescripción inapropiada (PI) de los fármacos en los pacientes mayores de 65 años atendidos por un Equipo de Atención Primaria (EAP), utilizando los criterios STOPP-START. Material y método. Estudio transversal de muestra representativa de pacientes mayores de 65 años con historia activa en 2010, atendidos en 13 consultorios urbanos (muestreo sistemático aleatorizado; prevalencia esperada de PI del 40%; precisión: 5%; nivel de confianza: 95%). Se revisó la prescripción en las historias durante 2010, valorando los criterios STOPP-START. Resultados. Se seleccionaron 363 pacientes (56,7% mujeres); con una edad media de 75,2 años (DE: 7,02). Las enfermedades más frecuentes fueron cardiovascular (76,9%) y osteoarticular (57,6%), y el promedio de fármacos en prescripción crónica fue de 4,9 (DE: 3,32). Se detectó PI en 170 pacientes (46,8%, IC 95%: 41,7-52,0%), 42% en varones (IC 95%: 34,3-49,8%) y 46,6% en mujeres (IC 95%: 39,8-53,4%), sin diferencias entre sexos (p = 0,386) y con una mayor prevalencia si hay polimedicación o comorbilidad (p < 0,001). En cuanto al tipo de PI se cumplían criterios STOPP en 131 pacientes (36,1%, IC 95%: 31,1-41,0%) y START en 73 (20,1%, IC 95%: 16-24,2%), sin diferencias entre sexos (p = 0,623 para STOPP; p = 0,678 para START). Las PI STOPP más frecuentes se observan en indicadores del sistema musculoesquelético (50 pacientes: 38,2%, IC 95%: 29,8-46,5%) y las START en indicadores de endocrinología (38 pacientes: 52,1%, IC 95%: 40,0-63,9%). Conclusiones. La herramienta STOPP-START permite detectar y sistematizar la aplicación de criterios de PI en un porcentaje elevado de pacientes mayores atendidos por un EAP, pudiendo promover estrategias de mejora de la prescripción (AU)

ObjectiveTo determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria.Material and methodCross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria.ResultsA total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%).ConclusionsThe STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies (AU)

[Inappropriate prescribing of drugs in older people attending primary care health centres: detection using STOPP-START criteria]. / Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START.

OBJECTIVE: To determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria. MATERIAL AND METHOD: Cross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria. RESULTS: A total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%). CONCLUSIONS: The STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies.

["Difficult encounters" in primary care clinic: a patient and doctor perspective]. / <> en consultas de atención primaria: una perspectiva de pacientes y médicos.

OBJECTIVES: To find out the prevalence and causes of "difficult encounters" (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed. DESIGN: Cross-sectional, descriptive. SETTING: Urban health centre. PARTICIPANTS AND METHOD: Four doctors, their 4 residents and patients who went to their clinics (March-May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire. VARIABLES: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a "difficult professional" (DP) by the patient. RESULTS: There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8-11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6-5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (kappa=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1-8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3-18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6-5.5). CONCLUSIONS: The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP.

"Encuentros difíciles" en consultas de atención primaria: una perspectiva de pacientes y médicos / “Difficult Encounters” in Primary Care Clinic: a Patient and Doctor Perspective

Objetivos: conocer la prevalencia y las causas de ®encuentros difíciles» (ED) en consultas de atención primaria según pacientes y médicos, a quién se atribuye su responsabilidad y la concordancia de ED entre médicos y pacientes (CED).Diseño: descriptivo transversal.Emplazamiento: centro de salud urbano.Participantes y métodocuatro médicos, sus 4 residentes y los pacientes que acudieron a sus consultas (marzo-mayo de 2007). Los médicos seleccionaron los ED con criterios cualitativos, y los pacientes, mediante un cuestionario ad hoc no validado. Variables: sexo y edad de los pacientes, ED definidos, causas y responsabilidad del ED, cambios de médico por malestar y percepción de ®profesional difícil» (PD) por el paciente.Resultados: 415 visitas; 352 cuestionarios (participación, 85%); 212 (60,2%) mujeres; media±desviación estándar de edad, 54,7±18,2 años. Prevalencia de ED del 8,5%, según los médicos (intervalo de confianza [IC] del 95%, 5,8–11,9) (causa principal: idiosincrasia del paciente), en que se atribuía la causa del malestar siempre al paciente; el 3,1%, según los pacientes (IC del 95%, 1,6–5,5) (causa principal: escasa empatía del médico), en que se atribuía el malestar en un 81% al médico. CED insignificante (κ=0,003); 15 (4,3%) pacientes manifiestan malestar en alguna visita el último año; 18 (5,1%) se plantean cambiar de médico por el malestar (IC del 95%, 3,1–8); 53 (15,1%) han cambiado alguna vez por este motivo (IC del 95%, 11,3–18,8) y 11 (3,1%) consideran a su médico un PD (IC del 95%, 1,6–5,5).Conclusiones: la prevalencia de ED en nuestras consultas es similar a la descrita en otros estudios, pero inferior a la esperada para los pacientes, con una CED insignificante. Médicos y pacientes atribuyen habitualmente la responsabilidad del ED a la parte contraria. Pocos pacientes consideran a su médico un PD(AU)

Objectives: To find out the prevalence and causes of “difficult encounters” (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed.Design: Cross-sectional, descriptive.Setting: Urban health centre.Participants and method: Four doctors, their 4 residents and patients who went to their clinics (March–May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire. Variables: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a “difficult professional” (DP) by the patient.Results: There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8–11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6–5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (κ=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1–8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3–18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6–5.5).Conclusions: The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP(AU)