Guía de práctica clínica para la atención a niños y adolescentes con enfermedad renal crónica

La enfermedad renal crónica constituye un problema de salud por su impacto sobre los individuos, la sociedad y la economía. Teniendo en cuenta lo anterior, y luego de una amplia búsqueda bibliográfica, se diseñó una guía de práctica clínica en el Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río, dirigida a los profesionales de la atención primaria de salud, con el objetivo de mejorar la calidad de vida de niños y adolescentes con dicha enfermedad. Esta fue elaborada por los métodos de la medicina basada en la evidencia, según el consenso y la opinión de los expertos. Se logró generalizar esta herramienta, emitir recomendaciones y actualizarla acorde con las nuevas evidencias médicas. Finalmente, resultó evaluada por los expertos como muy recomendada.

Chronic renal disease constitutes a health problem due to its impact on individuals, society and economy. Taking into account the above-mentioned, and after a wide literature search, a clinical practice guide was designed in Luis Augusto Turcios Lima Polyclinic from Pinar del Río province, directed to primary health care professionals, aimed at improving the life quality of children and adolescents with this disease. It was elaborated by medicine methods based on the evidence, according to the consent and opinion of experts. It was possible to generalize this tool, give recommendations and up to date according to the new medical evidences. Finally, it was evaluated by experts as very recommended.

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association)

A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.

Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) / Diretrizes brasileiras para o tratamento farmacológico pulmonar na fibrose cística. Documento oficial da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

RESUMO A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.

Guia de boas práticas de enfermagem à parturiente em maternidade pública no norte do Brasil / Guide to good nursing practices for parturient women in a public maternity hospital in northern Brazil

Resumo: Este trabalho apresenta a elaboração de um Guia de Boas Práticas de Enfermagem na Assistência à Parturiente, a fim de guiar a prática dos profissionais de enfermagem envolvidos nesse cuidado, desde a admissão na maternidade até o pós-parto imediato. O objetivo da pesquisa foi desenvolver com os profissionais de enfermagem um guia para nortear o cuidado prestado à parturiente. Trata-se de pesquisa metodológica que percorreu as fases de reconhecimento da realidade, construção do instrumento e consenso entre a equipe com relação ao material elaborado. Na fase de reconhecimento, realizou-se visita no local de pesquisa e reuniões com a gerente de enfermagem e coordenadora do Núcleo de Educação Permanente da maternidade cenário da pesquisa, a fim de conhecer a realidade e as necessidades do serviço, no que tange a protocolos e guias de práticas. Na fase de construção do instrumento, procedeu-se à busca de protocolos, políticas governamentais, diretrizes governamentais, resoluções, guias, bem como artigos científicos publicados pertinentes ao tema. Após a busca, desenvolveram-se oficinas presenciais seguindo roteiro baseado na metodologia de Quatro Erres (RS), com as fases de reconhecimento, revelação, repartir e repensar. As oficinas contaram com a participação de 31 profissionais de enfermagem, sendo três enfermeiros obstetras, seis residentes de enfermagem em obstetrícia, oito enfermeiros generalistas e 14 técnicos em enfermagem. Durante as oficinas, foi possível perceber as fragilidades, potencialidades e o conhecimento dos participantes relacionado às Boas Práticas de Atenção ao Parto. Ao final das oficinas, elaborou-se um quadro contendo os temas dos capítulos e as referências para serem utilizadas na elaboração do guia pela pesquisadora. O quadro foi aprovado por consenso entre os participantes. Como produto desta pesquisa, produziu-se um guia disponibilizado no formato digital e físico, composto por sete capítulos, totalizando quarenta e três páginas. Conclui-se que o objetivo da pesquisa foi alcançado, e a tecnologia desenvolvida poderá auxiliar a equipe de enfermagem na realização do cuidado de enfermagem baseado nas boas práticas, bem como auxiliará no processo de educação permanente em saúde, possibilitando a replicação. Agência do registro: Câmara Brasileira do Livro. Número do produto: ISBN 978-65-00-58214-7 DA-2022-028946

Abstract: This paper presents the elaboration of a Guide to Good Nursing Practices in Assistance to Parturient Women in order to guide the practice of nursing professionals involved in this care, from admission to the maternity ward until the immediate postpartum period. The objective of the research was to develop a guide with the nursing professionals to guide the care provided to the parturient woman. This is a methodological research that went through the stages of recognition of reality, construction of the instrument and consensus among the team regarding the elaborated material. In the recognition phase, a visit was made to the research site and meetings were held with the nursing manager and coordinator of the Permanent Education Center of the maternity hospital where the research was carried out, in order to learn about the reality and needs of the service in terms of protocols and guidelines for practices. In the construction phase of the instrument, a search was made for protocols, government policies, government guidelines, resolutions, guides, as well as published scientific articles relevant to the topic. After the search, face-to-face workshops were carried out following a guiding script in the Quatro Erres (RS) methodology, with the phases o frecognition, revelation, sharing and rethinking. The workshops were attended by 31 nursing professionals, including 03 obstetric nurses, 06 nursing residents in obstetrics, 08 generalist nurses and 14 nursing technicians. During the workshops, it was possible to perceive the weaknesses, strengths and knowledge of the participants related to Good Practices in Childbirth Care. At the end of the workshops, it was possible to prepare a table containing the themes of the chapters and references to be used in the elaboration of the guide by the researcher. The framework was approved by consensus among the participants. As a result of this research, a guide was made available in digital and physical format, consisting of seven chapters, totaling forty-three pages. It is concluded that the objective of this research was achieved, and the technology developed will be able to help the nursing team in carrying out nursing care based on good practices, as well as helping in the process of permanent education in health, enabling its replication. Registration agency: Brazilian Book Chamber. Product number: ISBN 978-65-00-58214-7 DA-2022-028946

Guía de Práctica Clínica en atresia esofágica / Clinical practice guide on esophageal atresia

La atresia esofágica es una de las anomalías congénitas más frecuentes en la práctica quirúrgica neonatal. Se estima que tiene una incidencia de 1 por cada 3500 recién nacidos vivos a nivel mundial. La preparación de guías de actuación y protocolos asistenciales es tendencia en la práctica médica actual. Esta Guía de Práctica Clínica se elaboró respondiendo a la necesidad de protocolizar la atención médico-quirúrgica de la atresia esofágica. En el Centro Territorial de Cirugía Neonatal de Holguín, donde se regionaliza la atención a neonatos de las cinco provincias orientales del país con afecciones congénitas y quirúrgicas de alta complejidad, la atresia esofágica fue la afección quirúrgica más frecuente en los últimos diez años, con una supervivencia ascendente que alcanzó 94,4 por ciento en 2019. La guía que se presenta se aprobó en el Primer Consenso Nacional de Guías de Prácticas Clínicas en Cirugía Pediátrica, en Varadero, Matanzas en 2019. Incluye las principales pautas para el diagnóstico, tratamiento y seguimiento de los pacientes afectados y se considera una herramienta eficiente para mejorar los resultados en la asistencia médica y quirúrgica neonatal(AU)

Esophageal atresia is one of the most common congenital anomalies in neonatal surgical practice. It is estimated to have an incidence of 1 per 3500 live newborns globally. The preparation of action guides and care protocols is a trend in current medical practice. This Clinical Practice Guide was prepared in response to the need to protocolize the medical-surgical care of esophageal atresia. In the Territorial Center for Neonatal Surgery of Holguín, where the care of neonates from the five eastern provinces of the country with congenital and surgical conditions of high complexity is regionalized, esophageal atresia was the most frequent surgical condition in the last ten years, with an ascending survival that reached 94.4 percent in 2019. The guideline presented was approved in the First National Consensus of Clinical Practice Guidelines in Pediatric Surgery, in Varadero, Matanzas in 2019. It includes the main guidelines for the diagnosis, treatment and follow-up of affected patients and is considered an efficient tool to improve outcomes in neonatal medical and surgical care(AU)

Úlceras varicosas: Revisão integrativa acerca de recomendações de cuidado de enfermagem / Úlceras varicosas: Revisión integradora sobre las recomendaciones de atención de enfermería / Varicose ulcers: Integrative review about nursing care recommendations

Objetivo: identificar as recomendações, baseadas em evidências científicas, para o cuidado de enfermagem a pessoas com úlceras varicosas. Método: trata-se de revisão integrativa da literatura, realizada por meio de consulta às bases de dados. Foram incluídos estudos publicados de 2016 a 2021 nos idiomas inglês e português. Resultados: foram encontrados sete artigos originais. Os achados reforçam o uso da terapia compressiva no tratamento das úlceras varicosas, seja elástica, inelástica ou multicamadas. Os resultados trazem novas tecnologias de cuidado, como a compressão ajustável, o manguito de resfriamento e o uso da gaze Petrolatum® com Plasma Rico em Plaquetas. Como orientações para equipe de enfermagem, destaca-se a importância do enfermeiro na visita domiciliar para acompanhamento do tratamento das úlceras, bem como de um planejamento de ações (itinerário terapêutico). Conclusão: Evidenciam a eficácia da terapia compressiva, traz novas tecnologias de cuidado e ressalta a importância do enfermeiro no cuidado da úlcera varicosa.(AU)

Objective: to identify recommendations, based on scientific evidence, for nursing care in people with varicose ulcers. Method: this is an integrative review of the literature, carried out through the consultation of databases. Studies published from 2016 to 2021 in English and Portuguese. Results: seven original articles were found. The findings reinforce the use of compressive therapy in the treatment of varicose ulcers, whether elastic, inelastic or multilayer. The results bring new care technologies, such as adjustable compression, cooling sleeve and the use of petroleum jelly gauze® with PRP. As guidelines for the nursing team, the importance of nurses in the home visit to monitor the treatment of ulcers is highlighted, as well as an action planning (therapeutic itinerary). Final considerations: The findings of this study show the efficacy of compressive therapy, bring new assistive technologies, and highlight the importance of nurses in the care of varicose ulcers.(AU)

Objetivo: identificar las recomendaciones, basadas en evidencia científica, para la atención de enfermería en personas con úlceras varicosas. Método: se trata de una revisión integradora de la literatura, realizada a través de la consulta de bases de datos. Estudios publicados de 2016 a 2021 en inglés y portugués. Resultados: se encontraron siete artículos originales. Los hallazgos refuerzan el uso de la terapia compresiva en el tratamiento de las úlceras varicosas, ya sean elásticas, inelásticas o multicapa. Los resultados traen nuevas tecnologías de cuidado, como la compresión ajustable, el manguito de enfriamiento y el uso de gasa vaselina® con PRP. Como pautas para el equipo de enfermería, se destaca la importancia de las enfermeras en la visita domiciliaria para monitorear el tratamiento de las úlceras, así como una planificación de la acción (itinerario terapéutico).Consideraciones finales: los hallazgos de este estudio muestran la eficacia de la terapia compresiva, aportan nuevas tecnologías asistenciales y destacan la importancia de las enfermeras en el cuidado de las úlceras varicosas.(AU)

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica.

ANTECEDENTES: Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO: Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS: Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS: Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES: Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Guía de práctica clínica para la prevención primaria y secundaria y diagnóstico temprano de cáncer gástrico / Clinical practice guide for primary and secondary prevention and early diagnosis of gastric cancer

Resumen Objetivo: Generar recomendaciones basadas en la evidencia, para la prevención primaria y secundaria, el tratamiento de las lesiones preneoplásicas y el diagnóstico temprano del cáncer gástrico en población adulta, con el propósito de reducir la carga de la enfermedad. Materiales y métodos: El grupo desarrollador estuvo integrado por profesionales de la salud y tomadores de decisiones. Se construyeron preguntas clínicas contestables y se realizó la graduación de los desenlaces. Se elaboró la búsqueda de la información en MEDLINE; EMBASE y CENTRAL, siendo actualizada el 18 de octubre de 2018. La pesquisa también abarcó otras fuentes de información como la Revista Colombiana de Gastroenterología y la lectura en "bola de nieve" de las referencias incluidas. Se contactó a expertos en la materia con el objetivo de identificar estudios relevantes no publicados. Para la construcción de las recomendaciones, se realizó un consenso acorde con los lineamientos propuestos por la metodología GRADE, sopesando los beneficios, los efectos adversos derivados de la intervención, las preferencias de los pacientes y el potencial impacto de las intervenciones sobre los costos. Resultados: Se presenta la versión corta de la "Guía de práctica clínica para la prevención primaria, secundaria y diagnóstico temprano de cáncer gástrico", junto con su evidencia de soporte y respectivas recomendaciones. Conclusiones: Como recomendación central para la implementación, se recomienda erradicar la infección por H. pylori en los pacientes con o sin factores de riesgo, como estrategia de prevención de las condiciones precursoras de cáncer gástrico. La Guía deberá actualizarse en tres años.

Abstract Objetive: Generate recommendations for primary and secondary prevention, treatment of gastric preneoplastic lesions, and early diagnosis of gastric cancer in the adult population, to increase the detection of gastric cancer in early stages. Material and methods: The developer group was made up of health professionals, decision-makers, and a representative of the patients. Answerable clinical questions were constructed and outcomes were graded. The search for information in MEDLINE was carried out; EMBASE and CENTRAL, being updated on October 18, 2018. The search also covered other sources of information such as the Colombian Journal of Gastroenterology and the "snowball" reading of the references included. Experts in the field were contacted to identify studies. For the construction of the recommendations, a consensus was made according to the guidelines proposed by the GRADE methodology, weighing the benefits, the adverse effects derived from the intervention, the preferences of the patients, and the potential impact of the interventions on costs. Results: The short version of the "Clinical practice guidelines for the primary, secondary, and early diagnosis of gastric cancer" is presented together with its supporting evidence and respective recommendations. Conclusions: As a central recommendation for implementation, it is recommended to eradicate H. pylori infection in patients with or without risk factors in whom it is detected to prevent gastric cancer precursor conditions. The Guide will need to be updated in three years.

Guía de práctica clínica para el manejo del dolor en pacientes oncológicos de una red de clínicas privadas, Lima - Perú / Clinical practice guideline for pain management in cancer patients from a network of private clinics, Lima - Peru

Introducción: El presente artículo resume el proceso de elaboración de la Guía de Práctica Clínica (GPC) para el manejo de dolor en pacientes oncológicos. Este proceso se llevó a cabo con la participación de un equipo multidisciplinario de médicos asistenciales, metodólogos y diversos revisores externos (especialistas con dominio en la metodología y el tema). La priorización de preguntas PICO fue realizada por el Grupo Elaborador de la GPC (GEG), acordando trabajar cinco preguntas PICO. Para dar respuesta a las preguntas se realizó una búsqueda sistemática de GPC, revisiones sistemáticas y estudios primarios. Se utilizó la metodología GRADE y los lineamientos de la normativa nacional para la formulación de recomendaciones. Se formularon 12 recomendaciones (10 fuertes y 2 débiles), 5 puntos de buena práctica clínica y 4 cuadros consensuados sobre el manejo de dolor oncológico. Los temas que abarcaron las recomendaciones para el manejo de dolor en pacientes oncológicos fueron: intervención temprana de tratamiento, terapia analgésica en dolor leve a moderado y en dolor moderado a severo, dolor neuropático e intervenciones no farmacológicas.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica / Mexican clinical practice guideline for the diagnosis and treatment of dyslipidemias and atherosclerotic cardiovascular disease

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Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level.

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals' knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel's knowledge must be implemented in Zone 7 centers.

Impacto de la implantación de la guía de buenas prácticas: valoración del riesgo y prevención de lesiones por presión en ámbito hospitalario / Impact of the implementation of the guide of good practices: risk assessment and prevention of pressure ulcers in hospital settings

Objetivo: Evaluar la implantación de la guía de buenas prácticas (GBP): Valoración del riesgo y prevención de lesiones por presión (LPP) en el ámbito hospitalario, en la unidad de medicina interna del Hospital Universitario Fundación Alcorcón (HUFA) de la Comunidad de Madrid. Metodología: Estudio cuasiexperimental pre-post donde se evalúan los indicadores de evaluación antes (2017) y después (2019) de la implantación de la GBP. Variables: LPP intrahospitalarias, valoración y revaloración del riesgo de LPP, aplicación de superficies de control de presión en pacientes con riesgo de LPP, momento de desarrollo de LPP y categorías de lesiones desarrolladas. Resultados: La muestra analizada fue de 764 pacientes. La incidencia de LPP en 2017 fue del 2,70%; en 2018, del 6,1%, y en 2019, del 4,1%. La valoración del riesgo de LPP en 2017 fue de 94,59% frente a un 98,57% en 2019. La revaloración del riesgo pasó de un 0% antes de la implantación de la guía a un 94,3% tras su implantación. La aplicación de superficies especiales de manejo de presión en 2017 fue del 7,69%, y a finales de 2019 ascendió a un 70,67%. Conclusiones: La implantación de la GBP produjo una disminución de la incidencia en el desarrollo de LPP durante el ingreso, un aumento significativo en la revaloración de los pacientes con riesgo de LPP y en la utilización de superficies especiales de manejo de presión (AU)

Objective: To evaluate the implementation of the good practice guide: risk assessment and prevention of pressure ulcers in a hospital environment, in the internal medicine unit of the University Hospital Fundación Alcorcón of the Community of Madrid. Methodology: a quasi-experimental, pre-post study in which indicators are evaluated before (2017) and after (2019) the implementation of the good practice guide. Variables: incidence rate of pressure injuries, assessment and reassessment of the risk of pressure injuries, application of pressure control surfaces in patients at risk of pressure injuries, time of development of pressure injuries, and categories of injuries developed. Results: the analyzed sample consists of 764 patients. The incidence rate of pressure injuries in 2017 was a 2.70%; a 6,1% in 2018 and a 4,1% in 2019. The risk assessment of pressure injuries in 2017 was 98,57%, compared to 94,3% in 2019. Regarding the reassessment, it goes from a 0% before the implementation a 96.49% after. The application of special surfaces for handling pressure in 2017 was a 7.69%, and a 70,67% at the end of 2019. Conclusions: a decrease of the incidence rate in the development of pressure injuries during the patients’ admission, a significant increase in the reassessment of the patients at risk of pressure injuries and in the use of special surfaces for handling pressure (AU)

Proceso de enfermería a adulto mayor con Diabetes tipo 2 hospitalizado por COVID-19 / Nursing process for an elderly person with type 2 Diabetes hospitalized

Introducción: el Síndrome Respiratorio Agudo Severo Coronavirus 2 es el agente causal de la COVID-19, una enfermedad emergente pandémica que requiere cuidados de enfermería basados en el proceso de enfermería desde el autocuidado. Objetivo: Aplicar el proceso de enfermería desde la perspectiva teórica del autocuidado a un adulto mayor con diagnóstico de diabetes tipo 2 hospitalizado por complicaciones de la COVID-19. Métodos: estudio de caso con Proceso de Enfermería a adulto mayor con COVID-19, para valoración se utilizó una cédula basada en conceptos de la Teoría General del Déficit de autocuidado de Orem, escala de ansiedad de Halminton y escala de riesgo de caídas, para la deducción diagnóstica, resultados e intervenciones se utilizó la taxonomía NANDA 2018-2020, clasificación de Resultados NOC, guías de práctica clínica y la clasificación de intervenciones NIC, respectivamente. Resultados: se identificaron 8 diagnósticos de enfermería, de los cuales, 4 son reales, 3 de riesgo, 1 de promoción a la salud. Se elaboraron 8 planes de cuidados con enfoque de educación para la salud e intervenciones con criterios de resultados del NOc e intervenciones de enfermería basadas en NIC y 4 Guías de práctica clínica sobre las respuestas humanas prioritarias; deterioro del intercambio de gases, diarrea, ansiedad y riesgo de glicemia inestable. Conclusiones: el Proceso de Enfermería vinculado con la teoría de Dorothea Orem permitió mejorar las prácticas de autocuidado y por consiguiente el autocontrol de la enfermedad respiratoria y metabólica en el adulto mayor[AU]

introduction: the Severe Acute Respiratory Syndrome Coronavirus 2 is the causal agent of COVID-19, an emerging pandemic disease that requires nursing care based on the nursing process from self-care. Objective: to apply the nursing process from the theoretical perspective of self-care to an older adult diagnosed with type 2 diabetes hospitalized for complications of COVID-19. Methods: case study with the Nursing Process of an elderly person with COVID-19, for assessment a card based on concepts of the General Theory of Deficit of Orem's self-care deficit, Halminton anxiety scale and risk of falls scale was used. For the diagnostic deduction, results and interventions, the 2018-2020NANDA taxonomy, NOC Results classification, clinical practice guidelines and the NIC intervention classification were used, respectively. Results: Eight nursing diagnoses were identified, of which 4 are real, 3 of risk, 1 of health promotion. 8 care plans were developed with a focus on health education and interventions with NOCresults criteria and NIC-based nursing interventions and 4 clinical practice guidelines on priority human responses; impaired gas exchange, diarrhea, anxiety and risk of unstable blood glucose. Conclusions: the Nursing Process linked to Dorothea Orem's theory allowed to improve self-care practices and consequently the self-control of respiratory and metabolic disease in the elderly[AU]

a Síndrome Respiratória Aguda Grave Coronavírus 2 é o agente causal da COVID-19, uma doença pandêmica emergente que requer cuidados de enfermagem baseados no processo de enfermagem a partir do autocuidado. Objetivo: aplicar o processo de enfermagem na perspectiva teórica do autocuidado a um idoso com diagnóstico de diabetes tipo 2 internado por complicações do COVID-19. Métodos: estudo de caso com o Processo de Enfermagem de uma pessoa idosa com COVID-19, para avaliação de uma ficha baseada nos conceitos da Teoria Geral do Déficit do Déficit de Autocuidado de Orem, Escala de Ansiedade Halminton e Escala de Risco de Quedas. Dedução diagnóstica, resultados e intervenções, a taxonomia NANDA2018-2020, classificação de resultados NOC, diretrizes de prática clínica e a classificação de intervenção NIC foram usados, respectivamente. Resultados: foram identificados 8 diagnósticos de enfermagem, sendo 4 reais, 3 de risco, 1 de promoção da saúde. 8 planos de cuidados foram desenvolvidos com foco em educação em saúde e intervenções com critérios de resultados NIC e intervenções de enfermagem baseadas em NIC e 4 diretrizes de prática clínica em respostas humanas prioritárias; alteração das trocas gasosas, diarreia, ansiedade e risco de glicose sanguínea instável. Conclusões: o Processo de Enfermagem atrelado à teoria de Dorothea Orem permitiu aprimorar as práticas de autocuidado e consequentemente o autocontrole das doenças respiratórias e metabólicas em idosos[AU]

Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic review.

OBJECTIVE: To assess the quality of Clinical Practice Guidelines (CPG) related to the management of paediatric dental emergencies applicable to the COVID-19 pandemic, through the use of the measuring instrument AGREE II (Appraisal of Guidelines for Research and Evaluation in Europe). SOURCES AND DATA COLLECTION: A rigurous online search of CPG was accomplished among the main CPG compilers: National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse, Agency for Healthcare, Research and Quality (AHRQ), Andalusian Health Technology Assessment Department (AETSA), American Academy of Family Physicians, Tripdatabase. Furthermore, because of the need to identify CPG that meet the inclusion criteria, a manual search, among the main national and international dental organizations as well as recognized web sites, was also accomplished. SELECTION OF RESEARCH STUDIES: All of the guides focused on paediatric dental emergencies, available in the database and "gray" literature, and published between 2000 and 2020 (applicable to COVID-19 pandemic) were included without any language restrictions. The CPG that did not contain the full paper or were addressed to adults or children with special needs, were excluded from the selection. The evaluation of the CPG, independently included, were achieved by four (04) experts by using AGREE II. RESULTS: Five (05) out of twenty-three (23) selected CPG, were classified as "acceptable" according to AGREE II. These five guides were evaluated to determine their "Recommendation degree". Only one (01) CPG "Guía Clínica AUGE de Urgencias Odontológicas Ambulatorias-Chile, 2011" reached a score of 75%, the highest among the other guides (5 domains with a score ≥ 60%, including the domain III "Rigour of Development") to be considered as a "highly recommended" CPG. CONCLUSIONS: According to the quality assessment and recommendation degrees criteria from AGREE II, high, middle and low quality CPG were identified. Only one CPG reached a score of 75%, to be classified as "highly recommended". Therefore, it is suggested that the existing CPG updates and future CPG use the available tools and methodologies during their elaboration, in order to guarantee their quality. CLINICAL SIGNIFICANCE: High quality CPG for the management of dental emergencies are designed to support dental health professionals in decision-making to adopt specific dental procedures in the current COVID-19 pandemic. As a matter of fact, these CPG might contribute to reduce the risk of transmission, in case of fresh outbreak of the illness. Likewise, they might help to determine which cases warrant medical attention in centres with special facilities for COVID-19.

Apendicitis aguda en el niño: guía de práctica clínica / Acute appendicitis in children. Clinical Pratice Guide

En las últimas décadas se ha prestado mayor atención a los resultados de la actividad quirúrgica debido al peso económico que esta actividad genera en los servicios de salud, el avance ocurrido en la mejora de los cuidados perioperatorios y la creciente ocupación institucional por la calidad de la asistencia y la satisfacción de la población. A este propósito han contribuido el desarrollo y aplicación de guías de práctica clínica. Estas guías reducen la variación en los cuidados del paciente quirúrgico y aumentan su eficiencia, lo que permite que los pacientes se beneficien de iniciativas institucionales encaminadas a mejorar la calidad de la asistencia sanitaria. La apendicitis aguda es sin dudas la enfermedad que tipifica la atención quirúrgica de urgencia en la mayoría de los centros dedicados a la atención sanitaria de niños y adolescentes. Su frecuencia, variación en las características clínicas en los diferentes grupos de edad y los crecientes reportes sobre la posibilidad de tratarse por métodos no quirúrgicos, hizo necesaria una revisión del tema. En el IV Simposio Nacional de Cirugía Pediátrica (Varadero, Matanzas, 1- 3 de julio de 2019), fue presentada, discutida y aprobada una Guía de Práctica Clínica de Apendicitis Aguda en el niño. Compartir la guía a través de su publicación, permitiría a servicios de cirugía pediátrica emplearla como referencia, aplicarla en sus propias instituciones y beneficiar a un gran número de pacientes(AU)

In the last decades, it has been paied attention to the results of the surgical activity due to the economic weight this activity yields in the health services, the advances in the improvement of perioperative cares and the growing institutional occupation due to the quality in the care and the population´s satisfaction. The development and implementation of clinical practice guides have contributed to that purpose. These guides reduce the variation in the cares of surgical patients and increase their efficiency, which allows patients to be benefited by institutional initiatives aimed to improve health care´s quality. Acute appendicitis is, with no doubts, the disease that characterizes emergencie´s surgical care in most of the facilities devoted to children and adolescents´health care. Its frequency, the variation of clinical characteristics in the different age groups and the increasing reports on the possibility of being treated by non-surgical approaches makes necessary a review on the topic. At the IV National Symposium on Pediatric Surgery (Varadero, Matanzas, 2019 July 1-3), a Clinical Practice Guide for Acute Appendicitis was presented, discussed and approved. Sharing the guideline through publication would allow similar services to use it as a reference for applying the model in their own institutions, benefiting a greater number of patients(AU)

Guía de práctica clínica: tamizaje, diagnóstico y manejo de episodios agudos y profilaxis del angioedema hereditario ­ Parte I: Enfoque diagnóstico / Clinical practice guidelines: screening, diagnosis and management of acute events and prophylaxis of hereditary angioedema ­ Part I: Diagnostic approach

El angioedema hereditario (AEH) es una enfermedad genética rara, con una prevalencia aproximada entre 1 por cada 50.000 habitantes, caracterizada por episodios de edemas a nivel subcutáneo y de mucosas (abdominal, genitourinario, respiratoria), siendo potencialmente mortal cuando hay afectación de la laringe. En Perú se estiman 600 pacientes con AEH. El AEH se puede clasificar del siguiente modo: con deficiencia del inhibidor de C1 (tipos I y II), y sin deficiencia del inhibidor de C1 (denominado anteriormente tipo III). El diagnóstico de laboratorio incluye prueba de complemento C4, prueba cuantitativa y cualitativa para inhibidor de C1 esterasa, y estudios genéticos.

Hereditary angioedema (HAE) is a genetic rare disease with a prevalence of approximately 1 per 50,000 inhabitants, characterized by episodes of edema at the subcutaneous level and mucous membranes (abdominal, genitourinary, respiratory), being potentially fatal when there is involvement of the larynx. In Peru, there are an estimated 600 patients with HAE. HAE can be classified as follows: with C1 inhibitor deficiency (types I and II), and without C1 inhibitor deficiency (previously called type III). Laboratory diagnosis includes C4 complement test, quantitative and qualitative tests for C1 inhibitor esterase, and genetic studies. In this first part of the Clinical Practice Guide, we present the recommendations for the diagnostic approach of HAE.

Guía de práctica clínica: tamizaje, diagnóstico y manejo de episodios agudos y profilaxis del angioedema hereditario ­ Parte II: Manejo y tratamiento / Clinical practice guidelines: screening, diagnosis and management of acute events and prophylaxis of hereditary angioedema ­ Part II: Management and treatment

El angioedema hereditario (AEH) es una enfermedad genética rara, con una prevalencia aproximada entre 1 por cada 50.000 habitantes, caracterizada por episodios de edemas a nivel subcutáneo y de mucosas (abdominal, genitourinario, respiratoria), siendo potencialmente mortal cuando hay afectación de la laringe. En Perú se estiman 600 pacientes con AEH. El AEH se puede clasificar del siguiente modo: con deficiencia del inhibidor de C1 (tipos I y II), y sin deficiencia del inhibidor de C1 (denominado anteriormente tipo III). El diagnóstico de laboratorio incluye prueba de complemento C4, prueba cuantitativa y cualitativa para inhibidor de C1 esterasa, y estudios genéticos. Existen tratamientos específicos a nivel mundial para crisis agudas y profilaxis en AEH. Sin embargo, en Perú el único tratamiento registrado actualmente es el ecallantide, útil en crisis agudas; además, podemos utilizar tratamientos alternativos como el ácido tranexámico y el danazol. En esta segunda parte de la Guía de Práctica Clínica, presentamos las recomendaciones para el manejo y el tratamiento del AEH.

Hereditary angioedema (HAE) is a genetic rare disease with a prevalence of approximately 1 per 50,000 inhabitants, characterized by episodes of edema at the subcutaneous level and mucous membranes (abdominal, genitourinary, respiratory), being potentially fatal when there is involvement of the larynx. In Peru, there are an estimated 600 patients with HAE. HAE can be classified as follows: with C1 inhibitor deficiency (types I and II), and without C1 inhibitor deficiency (previously called type III). Laboratory diagnosis includes C4 complement test, quantitative and qualitative test for C1 inhibitor esterase, and genetic studies. There are specific treatments worldwide for acute crises and prophylaxis in HAE; in Peru the only currently registered treatment is ecallantide, useful in acute crises; we can also use alternative treatments such as tranexamic acid and danazol. In this second part of the Clinical Practice Guide, we present the recommendations for the management and treatment of HAE.

Aleitamento materno: conhecimentos, atitudes e práticas dos participantes de um congresso de pediatria em Minas Gerais / Breastfeeding: knowledge, attitudes and practices of participants in a pediatrics congress in Minas Gerais

Apesar de a recomendação da Organização Mundial de Saúde de manter o aleitamento materno exclusivo por seis meses e continuado por dois anos ou mais, as taxas de prevalência do aleitamento materno são baixas. Têm sido explorados os determinantes do desmame precoce e, entre os fatores mais relacionados a ele, está a falta de informação materna sobre amamentação. Aliado a isso, a falta de conhecimento dos profissionais de saúde que atuam na assistência à criança, em relação ao aleitamento materno, tem sido estudado, visando melhorar a informação às gestantes e lactantes e, assim, aumentar a prevalência das crianças em aleitamento materno. O objetivo do presente estudo é investigar o conhecimento, as práticas e atitudes dos participantes de um congresso mineiro tradicional na área de pediatria sobre o aleitamento materno. Foi realizado um estudo transversal, por meio da aplicação de um questionário, para os participantes inscritos no Congresso Mineiro de Pediatria, realizado no período de 6 a 8 de junho de 2018, em Belo Horizonte, Minas Gerais. A proficiência dos participantes, quanto ao conhecimento sobre aleitamento materno, variou entre nove a 32 pontos, em um total de 33 pontos. Foi encontrada diferença estatística significativa entre a proficiência dos estudantes e dos profissionais (p-valor: 0,01), com uma média maior entre os profissionais. O ano de formatura também influenciou na nota, mostrando que os profissionais formados entre 2013 a 2017 tiveram maior nota que os formados em anos anteriores (p-valor: <0.0001). Foi encontrada diferença estatística significativa também no cenário de atividade profissional: os participantes que exercem a maior parte de sua atividade profissional, no setor público, apresentaram maior proficiência (p-valor: 0,01) assim como os profissionais que fizeram residência médica em Pediatria (p-valor: 0,02). As outras variáveis analisadas não mostraram diferenças significativas. É possível que alguns fatores tenham influenciado positivamente na proficiência dos participantes, como, por exemplo, a Iniciativa do Hospital Amigo da Criança e a participação em Congressos Médicos de atualização. Apesar disso, os participantes do Congresso Mineiro de Pediatria, no ano de 2018, apresentaram proficiência abaixo do mínimo esperado em aleitamento materno, o que aponta para a necessidade de capacitações periódicas dos profissionais e uma maior ênfase no currículo de graduação sobre o tema

The prevalence rates on breastfeeding are low despite the recommendation of the World Health Organization to maintain exclusive breastfeeding for six months, continued for another two years or more. The determinants of early weaning have been explored, and the lack of maternal information on breastfeeding is among the most prominent factors. Furthermore, the lack of knowledge of childcare health professionals regarding breastfeeding has been studied to improve the information for pregnant and lactating women and, thus, increase the prevalence of breastfeeding. The objective of this study is to investigate the knowledge, practices, and attitudes of the participants of a traditional conference in pediatrics, concerning breastfeeding, held in the state of Minas Gerais, Brazil. A cross-sectional study was carried out by applying a questionnaire to the participants registered in the Minas Gerais Conference on Pediatrics, held from June 6th to 8th, 2018, in Belo Horizonte, Minas Gerais. The proficiency demonstrated by the participants regarding the knowledge on breastfeeding ranged from nine to 32 points, in a total of 33 points. A statistically significant difference was found between the proficiency of students and professionals (p-value: 0.01), with a higher average among professionals. The year of graduation also influenced the score, showing that the professionals who graduated between 2013 and 2017 had a higher score than those who graduated in previous years (p-value: <0.0001). Another statistically significant difference was found in the scenario of professional activity, in which the participants who perform most of their professional activity in the public sector (p-value: 0.01) and those who completed a medical residency in Pediatrics (p-value: 0.02) showed higher proficiency. The other variables analyzed showed no significant differences. Some factors may have positively influenced the proficiency of the participants, such as the Baby-Friendly Hospital Initiative and participation in updating Medical Conferences. Despite this, the participants of the Minas Gerais Conference on Pediatrics, held in 2018, showed proficiencies below the minimum expected in breastfeeding, which indicates the need for periodic training of professionals and a greater emphasis on the undergraduate curriculum on the subject.

[Evaluation of good practices about breastfeeding in a mother and child hospital.] / Evaluación de buenas prácticas en lactancia materna en un hospital materno infantil.

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.

OBJETIVO: La protección, promoción y apoyo a la lactancia materna (LM) está considerada como un área de atención prioritaria de salud pública, así como un factor determinante de la salud infantil y materna. La utilización de guías de buenas prácticas mejora los resultados de salud y la seguridad de los pacientes. El objetivo del estudio fue evaluar el impacto en la lactancia materna tras la implantación de la Guía de Buenas Prácticas Clínicas "Lactancia Materna" en el centro Materno Infantil del Hospital Universitario Virgen de las Nieves de Granada. METODOS: Se realizó un estudio descriptivo transversal. Se estudiaron madres y recién nacidos atendidos desde 2015 a 2018. Se examinaron variables de proceso y de resultados, realizando análisis descriptivo y bivariante para la comparativa entre años. RESULTADOS: La tasa de LM exclusiva al alta pasó del 58,3 % al 72,2 %. Se encontraron diferencias significativas para la primera toma de LM exclusiva en los partos eutócicos (del 90,8% al 93,2%) y en las cesáreas (del 21,7% al 60%). Se obtuvieron mejoras en la valoración de la toma, la educación postnatal y el inicio y duración del contacto piel con piel. CONCLUSIONES: Las acciones protocolizadas posnatales que realizan los profesionales de la salud, como la valoración de la toma de LM y la educación postnatal, resultan eficaces para instaurar la lactancia. El momento de inicio del contacto piel con piel y su duración son aspectos que deben ser reforzados para un apoyo efectivo.

[Clinical Practice Guide for Anaphylaxis in Latin America (Galaxia-Latam)]. / Guía de Actuación en Anafilaxia en Latinoamérica. Galaxia-Latam.

Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.

La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. Sus manifestaciones clínicas son muy variadas, pudiendo afectar la piel, el sistema cardiovascular, el aparato respiratorio y el digestivo, entre otros. El tratamiento de elección, mediante la inyección intramuscular de adrenalina, debe ser precoz. Por lo anterior, es vital estar preparados para reconocerla adecuadamente. El objetivo de la presente guía de actuación clínica es mejorar el conocimiento de los profesionales sanitarios sobre anafilaxia y, consecuentemente, optimizar el tratamiento y manejo a largo plazo de esta entidad. La guía está adaptada a las peculiaridades de América Latina, especialmente en los aspectos relativos al tratamiento. Se destaca la necesidad de introducir los autoinyectores de adrenalina en los países que no dispongan de ellos.