Recomendaciones de buenas prácticas para el diagnóstico genético de abortos espontáneos e interrupciones voluntarias del embarazo por presentar defectos congénitos / Good practice recommendations in the molecular diagnosis of miscarriage and abortion due to multiple congenital malformations

Objetivos: La aparición de defectos congénitos produce una gran ansiedad en la familia y una enorme demanda asistencial. El objetivo principal radica en la redacción de las recomendaciones de buenas prácticas que sirvan de guía a los profesionales sanitarios para el diagnóstico clínico-genético de defectos congénitos. Metodología: El protocolo que proponemos contempla un modelo de actuación óptimo que incluye, la recogida de la información clínica inicial, la obtención de las muestras biológicas y los protocolos de actuación. Resultado: Se ha elaborado un modelo de historia clínica que ayude a la recogida de la información clínica pertinente. En la obtención de las muestras biológicas se aconseja la obtención de muestras fetales (de las 3 capas embrionarias) y muestras de los progenitores que serán procesarán teniendo en cuenta el algoritmo de actuación propuesto para el correcto diagnóstico genético del defecto congénito correspondiente. Conclusión: Esta guía recoge por primera vez, las recomendaciones de buenas prácticas para el diagnóstico genético de abortos con defectos congénitos

Aims: Congenital anomalies can cause anxiety within a family and high healthcare demand. The aim of this study was to write good practice recommendations to guide health professionals in the clinical-genetic diagnosis of congenital defects. Methods: The proposed protocol focuses on an optimal case scenario that includes collection of initial clinical data, biological sampling, and diagnostic algorithms. Results: A model of the optimal clinical history form was created to facilitate the collection of initial clinical data. For sampling, it is recommended to obtain at least one fetal sample (of the three embryonic germ layers). Moreover, samples from both parents should be taken to exclude mosaicism, following the diagnostic algorithm proposed for the correct genetic diagnosis of the corresponding congenital defect. Conclusion: This document is the first to gather good practice recommendations for the pre- and post-natal genetic diagnosis of miscarriages and abortions due to congenital defects

Analysis of the independent power of age-related, anthropometric and mechanical factors as determinants of the structure of radius and tibia in normal adults. A pQCT study.

To compare the independent influence of mechanical and non-mechanical factors on bone features, multiple regression analyses were performed between pQCT indicators of radius and tibia bone mass, mineralization, design and strength as determined variables, and age or time since menopause (TMP), body mass, bone length and regional muscles' areas as selected determinant factors, in Caucasian, physically active, untrained healthy men and pre- and post-menopausal women. In men and pre-menopausal women, the strongest influences were exerted by muscle area on radial features and by both muscle area and bone length on the tibia. Only for women, was body mass a significant factor for tibia traits. In men and pre-menopausal women, mass/design/strength indicators depended more strongly on the selected determinants than the cortical vBMD did (p<0.01-0.001 vs n.s.), regardless of age. However, TMP was an additional factor for both bones (p<0.01-0.001). The selected mechanical factors (muscle size, bone lengths) were more relevant than age/TMP or body weight to the development of allometrically-related bone properties (mass/design/strength), yet not to bone tissue 'quality' (cortical vBMD), suggesting a determinant, rather than determined role for cortical stiffness. While the mechanical impacts of muscles and bone levers on bone structure were comparable in men and pre-menopausal women, TMP exerted a stronger impact than allometric or mechanical factors on bone properties, including cortical vBMD.

WITHDRAWN: Disability and length of stay of hospitalized older adults experiencing adverse events in postacute rehabilitation care: a prospective observational study.

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The pQCT 'Bone Strength Indices' (BSIs, SSI). Relative mechanical impact and diagnostic value of the indicators of bone tissue and design quality employed in their calculation in healthy men and pre- and post-menopausal women.

The pQCT-assessed Bone Strength Indices (BSI's, SSI) depend on the product of a 'quality' indicator, the cortical vBMD (vCtD), and a 'design' indicator, one of the cross-sectional moments of inertia or related variables (MIs) in long bones. As the MIs vary naturally much more than the vCtD and represent different properties, it could be that the variation of the indices might not reflect the relative mechanical impact of the variation of their determinant factors in different individuals or circumstances. To understand this problem, we determined the vCtD and MI's in tibia scans of 232 healthy men and pre- and post-MP women, expressed in SD of the means calculated for each group, and analyzed the independent influence of 1 SD unit of variation of each factor on that of the indices by multiple correlations. Results showed: 1. that the independent influence of the MIs on the indices was generally larger than that of the vCtD, and 2. that in post-MP women the influence of the vCtD was larger than it was in the other groups. This confirms the view that inter-individual variation of vCtD is comparatively small, and that mechanical competence of human bone is mostly determined by 'design' factors.

Mineralization- and remodeling-unrelated improvement of the post-yield properties of rat cortical bone by high doses of olpadronate.

Some pharmacologic effects on bone modeling may not be evident in studies of remodeling skeletons. This study analyzes some effects of olpadronate on cortical bone modeling and post-yield properties in femurs diaphyses (virtually only-modeling bones) of young rats by mid-diaphyseal pQCT scans and bending tests. We studied 20/22 male/female animals traetad orally with olpadronate (45-90 mg/kg/d, 3 months) and 8/9 untreated controls. Both OPD doses enhanced diaphyseal cross-sectional moments of inertia (CSMI) with no change in cortical vBMD and elastic modulus. Yield stiffness and strength were mildly increased. Post-yield strength, deflection and energy absorption were strikingly enhanced. Ultimate strength was enhanced mainly because of effects on bone mass/geometry and post-yield properties. The large improvement of post-yield properties could be explained by improvements in bone geometry. Improvements in bone mass/geometry over weight-bearing needs suggest an enhanced modeling-related response to mechanical stimuli. Effects on tissue microstructural factors (not measured) could not be excluded. Results reveal novel olpadronate effects on bone strength and toughness unrelated to tissue mineralization and stiffness, even at high doses. Further studies could establish whether this could also occur in modeling-remodeling skeletons. If so, they could counteract the negative impact of anti-remodeling effects of bisphosphonates on bone strength.

pQCT-assessed relationships between diaphyseal design and cortical bone mass and density in the tibiae of healthy sedentary and trained men and women.

In a pQCT study of running-trained and untrained men and women we had shown that bone mass distribution along the tibia was adapted to the usage-derived stress pattern. To study the possible association between the efficiency of diaphyseal design and bone material stiffness, we extend the analysis of the same sample to correlate pQCT indicators of the distribution (CSMIs), mass (BMC), and density (vBMD) of cortical bone tissue as descriptors of "distribution/mass" (d/m) or "distribution/quality" (d/q) relationships. The d/m and d/c curves followed positive (exponential) and negative (hyperbolic-like) equations, respectively. Distribution curves of r coefficients throughout the bone were all bell-shaped, reaching a maximum towards the mid-diaphysis. The CSMIs and BMC were higher, and vBMD was lower in men than women and in runners than non-runners. The d/m relationships were described by unique curves for all groups while d/q relationships were better adjusted to separate curves for men and women. Results support that: 1. diaphyseal design reflects the relative influence of bending/torsion stress along the bones, tending to minimize bone mass; 2. there is a trade-off between cortical bone "quality" and distribution; 3. d/m and d/q relationships are related to bone mechanical environment, and 4. d/q relationships are affected by sex.

Satisfacción y experiencias de los pacientes en centros de rehabilitación asociados con su confianza en la profesionalidad de los fisioterapeutas / Patients’ satisfaction and experiences in rehabilitation units associated with their trust in the professionalism of the physiotherapists’

Introducción. Existe insuficiente conocimiento sobre qué confianza tienen los pacientes en quienes prestan cuidados de rehabilitación, sus determinantes y la asociación con la evaluación del servicio. Objetivos. Examinar la confianza en la profesionalidad del fisioterapeuta por parte de pacientes en fases post-agudas en Unidades externas de Rehabilitación; determinar los aspectos asistenciales de los pacientes que la condicionan y su relación con la satisfacción del paciente. Material y métodos. Estudio transversal mediante cuestionario autocumplimentado, realizado en Unidades de Rehabilitación de 3 hospitales de la red MAPFRE. Las medidas de resultado fueron: puntuación de problemas (de 0 a 100%) de las experiencias autoinformadas en 7 aspectos de los cuidados (pertenecientes al ambiente organizacional y las actitudes del profesional), satisfacción, confianza en la profesionalidad y, características sociodemográficas y de salud de los participantes. Resultados. Participaron 465 pacientes (respuesta: 90%) con una media de 39,4 (DE=11,9) años. La confianza fue completa en el 61,1% de los participantes. Mientras que la odds ratio (OR)de completa confianza se incrementa con la percepción de cambio funcional (OR=3,77), de crece con tener experiencias problemáticas en algunos aspectos asistenciales: «educación e información» (OR=0,99), «apoyo emocional» (OR=0,97) e «interrupciones durante las sesiones» (OR=0,99). La confianza presenta una correlación positiva con los niveles de satisfacción (p<0,01). Conclusiones. Son muchos los pacientes que desarrollan una completa confianza en los fisioterapeutas, especialmente los que presentan notable mejora funcional y pocas situaciones problemáticas en determinados aspectos asistenciales. Aunque no todos los aspectos asistenciales son igualmente determinantes de la confianza, esta siempre se relaciona con la satisfacción (AU)

Introduction. There is still insufficient knowledge about levels of trust in those who provide rehabilitation care, its determinants and association with service evaluation. Objectives. To examine trust in the professionalism of the physiotherapist who treats patients in post-acute phases in external rehabilitation units. To determine the care aspects of the patients that condition it and its relation with the patients' satisfaction. Materials and methods. A cross-sectional study using a self-administered questionnaire was carried out in the rehabilitation units of 3 private hospitals, belonging to the private network of MAPFRE. Outcome measurements were: scoring problems (from 0 to 100%) of the self-reported experiences in 7 care aspects (belonging to organizational setting and professionals' attitudes), satisfaction, trust in professionalism, and the patients' socio-demographic and health characteristics. Results. A total of 465 patients (response 90%) took part. Mean age was 39.4 years (SD=11.9) and 61.1% of participants had full trust in their physiotherapists. While the odds ratio of full trust increases with perception of functional change (OR=3.77), it decreases with having problematic experiences in certain care aspects: "education and information" (OR=.99), "emotional support" (OR=.97) and "interruptions during the sessions" (OR=.99). Trust has a positive correlation with satisfaction (P<.01). Conclusions. Many patients develop full trust in their physiotherapists, particularly those who experience functional improvement and have few problematic situations in certain care aspects. Although not all care aspects are equally decisive for trust, the latter is always associated with satisfaction (AU)

Outpatients' perceptions of their experiences in musculoskeletal rehabilitation care.

BACKGROUND: While patients' satisfaction with rehabilitation care is often measured, the knowledge of their experiences during delivery of care and of which characteristics may lead them to experience problems remains largely undocumented. AIM: To assess the quality of patients' experiences receiving post-acute care for musculoskeletal disorders in outpatient rehabilitation settings. To describe the extent to which variations in reported quality of patients' experiences were related to their characteristics. DESIGN: A cross sectional, self-reported survey. SETTING: 3 outpatient rehabilitation units. POPULATION: Four hundred sixty-five outpatients. Mean age 39.4 (SD=11.9). METHODS: A problem score (from 0 to 100%) of self-reported experiences was calculated on 7 specific aspects of care (belonging to organizational environment and professionals' attitudes and behaviors) and compared among participants' subgroups. RESULTS: Mean scores of the organizational environment area showed higher amount of problems (43.3%) than the professionals' attitudes and behaviours area (34.7%). Two multivariate linear regression models (with adjusted R(2) 9.3% and 4.9%) indicated that older patients and those with high global rating change were less likely to experience problems in the two areas. CONCLUSION: Problems on aspects of care were commonly experienced by patients with musculoskeletal disorders in outpatient rehabilitation settings. The age and health of patients were associated to these problems, but explained only a small variation in them. CLINICAL REHABILITATION IMPACT: Surveys measuring patients' experiences can be used to monitor the actual performance of rehabilitation settings and to pinpoint the exact issues needing to be addressed to improve quality as well as to make comparison among centres.

Abyssal undular vortices in the Eastern Mediterranean basin.

Abyssal temperature and velocity observations performed within the framework of the Neutrino Mediterranean Observatory, a project devoted to constructing a km(3)-scale underwater telescope for the detection of high-energy cosmic neutrinos, demonstrate cross-fertilization between subnuclear physics and experimental oceanography. Here we use data collected south of Sicily in the Ionian abyssal plain of the Eastern Mediterranean (EM) basin to show for the first time that abyssal vortices exist in the EM, at depths exceeding 2,500 m. The eddies consist of chains of near-inertially pulsating mesoscale cyclones/anticyclones. They are embedded in an abyssal current flowing towards North-Northwest. The paucity of existing data does not allow for an unambiguous determination of the vortex origin. A local generation mechanism seems probable, but a remote genesis cannot be excluded a priori. The presence of such eddies adds further complexity to the discussion of structure and evolution of water masses in the EM.

Sistema de triaje y evaluación de Urgencias pediátricas / Pediatric Emergency Department trige system

En las últimas décadas, se a registrado un aumento progresivo de las consultas a los Servicios de Urgencias hospitalarios. De ahí surge la necesidad de optimizar la organización de los mimos e instaurar sistemas de clasificación de los pacientes. El objetivo del trabajo es evaluar el funcionamiento de nuestro servicio y del sistema de triaje de Manchester en nuestro medio. Material y métodos. Se realizó una revisión de historias clínicas de las urgencias pediátricas atendidas durante el año 2009. Se registraron datos descriptivos y epidemiológicos y se estudiaron indicadores de calidad definidos por la SEUP e indicadores relacionados con el sistema de triaje. Resultados. El número total de urgencias atendidas fue de 23.173. el 32,7% de ellas han sido atendidas en el último trimestre del año, con una clara afluencia máxima en las últimas horas de la tarde. Con respecto a los indicadores de calidad, se cumplen los estándares en clasificación de pacientes, peticiones de radiología, porcentaje de ingresos y de readmisión. El 95,3% de los pacientes se clasificaron en los niveles 4 y 5. Existe una adecuada correlación entre el nivel de gravedad, el porcentaje de exploraciones complementarias y la tasa de hospitalización. Discusión. La utilización de un sistema de triaje informatizado es fundamental tanto para la selección de aquellos pacientes que requieren ser atendidos con mayor celeridad como para poder valorar la calidad de nuestros servicios de urgencias, los cuales se hallan colapsados mayoritariamente por patología banal (AU)

During the last decades, a progressive increase of the episodes visited in the emergency services has been reported. Thereefore, the optimization of the organization of these services in essential. The objective of this article is to evaluate the working our pediatric emergency unit and the applicability of the Manchester's triage system. Material and methods. We did a review of the Pediatric Urgency episodes visited during 2009. Descriptive and epidemiologic characteristics were registered and quality indicators defined by the SEUP and other quality indicators about the triage system were examinated. Results. The total number of episodes visited in the emergency services was 23, 173, 32,7% of them were visited during the last trimester of the year and mostly in the afternoon. The quality indicators reached were the standard of classification, the solicitude of radiology, the percentage of hospitalization and the percentage of readmitted patients. 95,3% of the patients were classified as level 4 and 5. It existed a good correlation between gravity level, percentage of complementary explorations and hospitalization rate. Conclusion. The use of a computerized triage system is essential in order to select those patients who have to be visited quickly and for the evaluation of the working of the emergency services (AU)

Exactitud del test de procalcitonina en el diagnóstico de bacteriemia oculta en pediatría: revisión sistemática y metanálisis / Accuracy of the procalcitonin test in the diagnosis of occult bacteremia in paediatrics: A systematic review and meta-analysis

Objetivos: Evaluar la exactitud diagnóstica del test de procalcitonina (PCT) sérica para detectar la infección bacteriana grave (IBG) en pacientes pediátricos ambulatorios que consultan en urgencias por fiebre sin foco (FSF). Material y métodos: Se realizó una búsqueda de artículos recogidos en los repertorios MEDLINE, OVID y EMBASE (hasta enero 2010). Se incluyeron aquellos artículos que valoraban la exactitud diagnóstica de la determinación de la PCT sérica para detectar IBG en niños que, estando previamente sanos, consultaron en urgencias por fiebre sin foco. Se evaluó su calidad metodológica mediante criterios de validez predefinidos (QUADAS, CASPE) y se incluyeron para el análisis solo los de la máxima calidad. El metanálisis estadístico se realizó mediante el programa Meta-DiSc versión 1.1.1 bajo un entorno Windows. Resultados: La búsqueda identificó 115 publicaciones. Solo 6 estudios (observacionales analíticos de cohortes prospectivas) cumplieron los criterios de inclusión, acumulando una muestra de 1.139 pacientes. La prevalencia de IBG, osciló entre un 12,8–29% con una media ponderada de 18%. La Sensibilidad global fue del 0,771 (IC 95%=0,707–0,826), la especificidad global fue del 0,804 (IC95%=0,777–0,830), la razón de verosimilitudes para resultados positivos (RVpos) global fue 3,610 (IC95%=2,481–5,253) y la razón de verosimilitudes para resultados negativos (RVneg) global fue 0,218 (IC95%=0,106–0,446). La odds ratio diagnóstica (ORD) fue 18,922 (IC95%=10,076–35,534), la curva ROC resumen (SROC) presentó un área bajo la curva (AUC)=0,8801 (IC95%=0,821–0,939), y el punto de umbral diagnóstico óptimo fue Q*=0,8106 (IC95%=0,7512–0,8699). Conclusiones: Los resultados de nuestro trabajo sugieren que, de entre los niños con fiebre sin foco no hospitalizados, la prueba de PCT identifica con exactitud a los que presentan IBG. Estos resultados no pueden extrapolarse a un espectro diferente de pacientes pediátricos (AU)

Objective: To evaluate the diagnostic accuracy of serum procalcitonin (PCT) to detect severe bacterial infection (SBI) in ambulatory children attended in the emergency room (ER) for fever without source (FWS). Material and methods: A search was made in MEDLINE, OVID and EMBASE (to January 2010). We searched for papers that evaluated the diagnostic accuracy of serum PCT to detect SBI in children that, being previously well, were seen in the ER for FWS. We rated the methodological quality of each paper using objective validity criteria (QUADAS, CASPE) and included only those with the maximum quality in the analysis. The statistical meta-analysis was performed using the software, Meta-DiSc 1.1.1 for Windows. Results: The search identified 115 papers. Only 6 studies (prospective observational and analytic cohorts) fitted the inclusion criteria, with a sample size of 1139 patients. The prevalence of SBI was between 12.8% and 29% with a weighted mean of 18%. The overall senstivity was 0.771 (95% CI=0.707–0.826), the overall specificity was 0.804 (95% CI=0.777–0.830), the overall positive likelihood ratio was 3.610 (95% CI=2.481–5.253) and the overall negative likelihood ratio was 0.218 (95% CI=0.106–0.446). The diagnostic OR was 18.922 (95% CI=10.076–35.534), the Area under the SROC curve was 0.8801 (95% CI=0.821–0.939), and the optimal diagnostic cut-off value was Q*=0.8106 (95% CI=0.7512–0.8699). Conclusions: On the basis of our analysis, in children with FWS seen in the ER, the serum PCT test accurately identifies those that have a SBI. We cannot extrapolate these results to other types of patients (AU)

[Accuracy of the procalcitonin test in the diagnosis of occult bacteremia in paediatrics: a systematic review and meta-analysis]. / Exactitud del test de procalcitonina en el diagnóstico de bacteriemia oculta en pediatría: revisión sistemática y metanálisis.

OBJECTIVE: To evaluate the diagnostic accuracy of serum procalcitonin (PCT) to detect severe bacterial infection (SBI) in ambulatory children attended in the emergency room (ER) for fever without source (FWS). MATERIAL AND METHODS: A search was made in MEDLINE, OVID and EMBASE (to January 2010). We searched for papers that evaluated the diagnostic accuracy of serum PCT to detect SBI in children that, being previously well, were seen in the ER for FWS. We rated the methodological quality of each paper using objective validity criteria (QUADAS, CASPE) and included only those with the maximum quality in the analysis. The statistical meta-analysis was performed using the software, Meta-DiSc 1.1.1 for Windows. RESULTS: The search identified 115 papers. Only 6 studies (prospective observational and analytic cohorts) fitted the inclusion criteria, with a sample size of 1139 patients. The prevalence of SBI was between 12.8% and 29% with a weighted mean of 18%. The overall senstivity was 0.771 (95% CI=0.707-0.826), the overall specificity was 0.804 (95% CI=0.777-0.830), the overall positive likelihood ratio was 3.610 (95% CI=2.481-5.253) and the overall negative likelihood ratio was 0.218 (95% CI=0.106-0.446). The diagnostic OR was 18.922 (95% CI=10.076-35.534), the Area under the SROC curve was 0.8801 (95% CI=0.821-0.939), and the optimal diagnostic cut-off value was Q*=0.8106 (95% CI=0.7512-0.8699). CONCLUSIONS: On the basis of our analysis, in children with FWS seen in the ER, the serum PCT test accurately identifies those that have a SBI. We cannot extrapolate these results to other types of patients.

Desarrollo de un instrumento basado en el auto-informe del paciente para medir la Discapacidad en las Actividades de Movilidad (DIAM) / Development of a self-report instrument to measure disability in mobility activities (DIMA)

Objetivo: Desarrollar un instrumento basado en el auto-informe para medir la discapacidad en cada uno de los subdominios de las actividades de movilidad de la Clasificación internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), que pueda ser usado en pacientes ambulatorios con problemas musculoesqueléticos. Material y métodos: El cuestionario se desarrolló en tres etapas implicando a 718 pacientes ambulatorios con problemas musculoesqueléticos de tres centros con Fisioterapia, y a 24 expertos en discapacidad. El proceso de generación de ítems utilizó aportaciones de literatura relevante, expertos y pacientes. La reducción inicial se logró con las aportaciones de investigadores, expertos y pacientes. La reducción final se realizó usando análisis factoriales (AF) y pruebas de comprobación de la unidimensionalidad de cada factor identificado. Resultados: Se obtuvo un cuestionario (DIAM) de 22 ítems con cinco opciones de respuesta. Los resultados de los AF produjeron dos factores unidimensionales en el subdominio «cambiar y mantener la posición del cuerpo» (1. Implicando bipedestación; 2. Implicando sólo sedestación y/o decúbito), dos en el subdominio «llevar, mover y usar objetos» (1. Usando la mano y el hombro; 2. Usando la mano y/o antebrazo), y un factor en el subdominio «andar y moverse» (AU)

Purpose: To develop a questionnaire to measure perception for disability in International Classification of Functioning, Disability and Health (ICF) subdomains of mobility activities, that can be used in outpatients with musculoskeletal problems. Material and methods: The questionnaire was developed by a three-step process involving a 718 outpatients with musculoskeletal problems from three physiotherapy setting and 24 experts in disability issues. The item-generation process utilized input from relevant literature, experts and outpatients. Initial item reduction utilized researchers and the same experts and outpatients. Final item reduction was achieved by FA and tests for unidimensionalidad of identified factors. Results: The final questionnaire, called DIAM, is a 22-item self-administered questionnaire with five response categories. Results of AF provided two unidimensional factors in subdomain «Changing and maintaining body position » (1. Involving the standing; 2. Involving only sitting and/or lying down position), two in subdomain «Carrying, moving and handling objects» (1. Using hand and shoulder; 2. Using hand and/or forearm), and one factor in subdomain «Walking and moving» (AU)

¿Puede mejorarse la validez de los protocolos para el tratamiento fisioterápico en la cervicalgia? / Can validity of physical therapy clinical guidelines for neck pain treatment improve?

Objetivo. Evaluar la validez de los contenidos de los protocolos de tratamiento fisioterápico de la cervicalgia y determinar si la metodología de los ciclos de mejora puede incrementarla. Material y métodos. El ámbito de estudio corresponde a centros de Atención Primaria de la Región de Murcia. Los participantes fueron todos los protocolos de fisioterapia para pacientes con cervicalgia elaborados desde 1990. Se realizó una evaluación inicial de los protocolos y tras esta evaluación se propusieron medidas correctoras resultando un nuevo protocolo de cervicalgia para toda la región. En la evaluación inicial se evaluó el nivel de evidencia de las referencias bibliográficas vinculadas a cada recomendación de los protocolos, y se compararon con un listado de recomendaciones con evidencia científica elaborado para este estudio, cuantificando la frecuencia de su ausencia. Resultados. En 9 protocolos evaluados inicialmente, no ha sido posible evaluar mediante las referencias del protocolo el nivel de evidencia de las recomendaciones. Evaluadas de forma independiente, el 20,8 % de las recomendaciones de tratamiento propuestas tienen validez demostrada. Tras las medidas correctoras adoptadas, todas las recomendaciones tienen una referencia vinculada y se ha incrementado la presencia de las recomendaciones presentes en el listado con evidencia. Conclusiones. La aplicación de la metodología de los ciclos de mejora consigue una mejora significativa en la calidad

Objective. To evaluate validity of the contents of the physical therapy clinical guidelines to neck pain elaborated in Murcia and to determine if the methodology of the quality improvement cycles can increase it. Material and methods. The setting were centers of Primary Attention of the Region of Murcia. The participants were all the physical therapy clinical guidelines for patient with neck pain elaborated from 1990. It was carried out an initial evaluation of the clinical guidelines and intervention intended being a new guideline for the whole region. In the initial evaluation it was evaluated the level of evidence of the bibliographical references it is evaluated linked to each recommendation of the protocols, and they are compared with a listing of recommendations with evidence scientist elaborated for this study, quantifying the frequency of their absence. Results. In 9 clinical guidelines evaluated initially, it doesn't consist neither it has been possible to evaluate based on the references of the guidelines the evidence level of the existent recommendations. Evaluated in an independent way 20.8 % of the proposed treatment recommendations has demonstrated validity. After the corrective measures, all the recommendations have a linked reference and the presence of the present recommendations has been increased in the used listing of reference. Conclusions. The application of the methodology of the cycles of improvement gets a significant improvement in the quality

Variabilidad en la valoración del paciente con cervicalgia mecánica en fisioterapia. Un estudio usando protocolos

Objetivos. Identificar y comparar las recomendaciones para anamnesis, valoración del dolor y exploración física preliminar de pacientes con cervicalgia mecánica con los protocolos existentes de fisioterapia. Material y métodos. Las recomendaciones utilizadas para valorar la cervicalgia mecánica fueron agrupadas siguiendo la estructura del proceso de atención (anamnesis, evaluación del dolor, exploración física), y se compararon cuantificando su aparición en los protocolos. Resultados. Un total de 20 protocolos clínicos fueron identificados. Había una gran variabilidad entre las recomendaciones que contenían. De un total de 166 recomendaciones diferentes, la ausencia de alguna recomendación fue común en todos los protocolos. En relación a la anamnesis, los tratamientos previos para la cervicalgia, y los datos personales de los pacientes estuvieron presentes en 50 % de los protocolos. Para la evaluación del dolor cervical, siete características diferentes fueron identificadas de los 20 protocolos, siendo el promedio por protocolo de 2,5 (rango: 0-7), y el criterio para localizar el dolor fue el más frecuentemente recomendado (60 %). Para la exploración física, el promedio fue de 4,3 recomendaciones por protocolo (rango: 0-13) y el 85 % de los protocolos contenían siete o menos recomendaciones. Conclusiones. La variabilidad observada cuestiona la fiabilidad y, consecuentemente, la validez de los protocolos analizados. Los protocolos clínicos para la valoración de pacientes con cervicalgia deberían ser revisados y rediseñados con mayor rigor científico

Objectives. To identify and to compare the recommendations for anamnesis, pain assesment and preliminary physical examination of patients suffering from mechanical neck pain, stated in the existing clinical physiotherapy protocols. Methods. The recommendations to assess mechanical neck pain are grouped following the structure of the process flowchart, and then compared quantifying how often they appear in the assessed documents, identified through a nation-wide census. Results. A total of 20 clinical protocols were identified. There was a great variability among the recommendations they contain. From a total of 166 different recommendations, no recommendation is common to all protocols. In relation to anamnesis, previous treatments for neck pain, and the patient's personal records of interest, are present in 50 % of protocols. For assessing neck pain, seven different characteristics are outlined out of the 20 protocols, being the average per protocol 2.5 (range: 0-7), and the criteria to locate the pain the one most often recommend (60 %). For physical examination, the average is 4.3 recommendations per protocols (range 0-13), 85 % contain 7 or less recommendations. Conclusions. The observed variability questions the reliability and, consequently, the validity of the analysed guidelines. Clinical protocols for the examination of patients with neck pain should be revised and redesigned with greater scientific rigour

[Thrombophlebitis of the lateral sinuses. A difficult diagnostic case for nine otorhinolaryngologists]. / Tromboflebitis del seno lateral. Un difícil diagnóstico para los nuevos otorrinolaringólogos.

Since the advent of antibiotic era lateral sinus thrombophlebitis has become an scarce complication in otology. The clinical picture can present under several aspects, specially if given a course of antibiotics previously, which complicates the diagnose. We report a case recently treated and compare ours with the classic symptomatology quoted in the literature.

Enfermedad de kikuchi-fujimoto: una entidad a considerar en el diagnóstico diferencial de las adenopatías cervicales. A propósito de tres casos / Kikuchi-Fujimoto disease: an entity to consider in differential diagnosis of the cervical adenopathy. Regard of three cases

La enfermedad de Kikuchi-Fujimoto es una rara entidad de causa desconocida que cursa con adenopatías cervicales persistentes que no responde a antibióticos ni antiinflamatorios. Aunque generalmente es benigna, ha sido confundida con linfomas malignos; por tanto, otorrinolaringólogos y patólogos deben de conocer esta enfermedad. Presentamos tres casos que han ocurrido recientemente en nuestro hospital (AU)

Educación del paciente con cervicalgia / Patient's education with neck pain

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