[Taking advantage of information sources for clinical practice]. / El aprovechamiento de las fuentes de información para la práctica clínica.

Information sources are the books, journals and electronic systems which support the academic work of physicians. Doctors have not taken enough advantage of these sources for their clinical decisions because they trend to rely on a routine undue confidence in experience, and because they do not have the skills for so-called health documentation. Many patients, consequently, have access to the best alternatives for solving their medical problems. The proper use of these sources implies some skills such as reflexive practice, the ability for recovering information, and critical reading and enough determination to apply the results of scientific research to individual patients, taking into consideration the patient's circumstances and the evaluation of outcomes. In this way, there is real integration of medical care, research, and continuing medical education.

[Design and applicability of a clinical guide for appropriate attention in acute respiratory infections]. / Diseño y aplicabilidad de una guía clínica para la atención apropiada en las infecciones respiratorias agudas.

Clinical guidelines provide continuing education and help physicians in the clinical decision-making process. Clinical guidelines to manage acute respiratory infections (ARI) were developed comprehensively from a perspective where prevention, diagnosis, treatment and the patient's education were considered. Methodology. The guideline development process was comprised of two stages: 1. The building stage consisted of several steps: definition of the problem, definition of the potential users of the guidelines, and the appropriate level of care; review of updated bibliographies, and validation using the Delphi technique. 2. The start-up stage consisted of evaluating the guidelines applicable to out-patient settings. Twenty family physicians participated, using the guidelines with 115 patients. Agreement between the family physicians' diagnosis and the criteria stated in the guidelines was tested using unweighted kappa. Differences in the use of the guidelines to manage ARI patients were tested by using the X2 test or the exact Fisher test. Results. Development of guidelines considered the patient's age group. Therefore, guidelines to manage patients under five years of age and to manage patients above this age were constructed. The application of the guidelines was increased from 40 to 60%. As a result, inappropriate prescribing of antibiotics and cough syrups decreased. Although the guidelines could be helpful in treating ARI, its efficacy and effectiveness remain to be tested.

Sulbenicilina sodica en el tratamiento de infecciones severas. / Sodium solbenicillin in the treatment of severe infections

Una de las principales causas de ingreso y defuncion en las Unidades de Cuidados Intensivos son los procesos infecciosos en su mayoria causados por germenes gramnegativos, particularmente Escherichia coli.Pseudomonas y Proteus. En el presente estudio se trato de demostrar el efecto terapeutico de la sulbenicilina sodica en pacientes infectados por estos germenes y la buena tolerancia o posible alteracion de las funciones hepaticas o renales.Se valoraron 30 pacientes, de los cuales 25 cursaban con infeccion grave sin estado de hipoperfusion: la respuesta anti-bacteriana y terapeutica se catalogo de excelente por la evolucion clinica, de laboratorio y gabinete. Sin embargo, en cinco pacientes con falla organica multiple, a pesar de la negativizacion de los cultivos, la muerte fue inevitable, lo cual indica que el control de la bacteremia, aunque es muy importante, no detiene el proceso citoquimico alterado en la hipoperfusion celular