Control del tabaquismo: evolución de la política impositiva de las labores del tabaco y su impacto en los precios de venta al público / Control of the smoking habit: evolution of the tax policy of tobacco products and its impact on the retail sales prices

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Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease.

AIMS: The objective of the current study was to compare two patient assessment strategies using colonoscopy and MRI alternatively as first- and second-line examinations. METHODS: Clinical data, endoscopy and magnetic resonance imaging (MRI) examinations of 100 patients diagnosed with ileocolonic Crohn's disease (CD) performed within 1 week were blindly reviewed by 4 clinical investigators. Two investigators evaluated MRI followed by colonoscopy for 50 cases and the same examinations in reverse order for another 50 cases; the other 2 investigators evaluated the same cases switching the order of examinations. The assessments included the likelihood of the presence of inflammation, stenosis, fistula and abscess, and therapeutic recommendations. RESULTS: Information from the first examination was considered sufficient for management in 80% of cases for MRI and only 34% of cases for colonoscopy (p < 0.001). Adding MRI to the information from colonoscopy changed the clinicians' confidence grade in a higher proportion of patients than adding colonoscopy to information from MRI for the diagnosis of disease activity (10 vs 4%, p = 0.03), stenosis (25 vs 9%, p < 0.001), fistula (31 vs 0%, p < 0.001) and internal abscess (27 vs 0%, p < 0.001). Indications for anti-tumour necrosis factor (TNF) therapy (51 vs 37%, F = 0.006), and surgery (12 vs 5%, F = 0.019) were more frequent after MRI than after colonoscopy as first examination. As a second examination, MRI led to change in therapy in a higher proportion of patients than colonoscopy (28 vs 8%, p < 0.001). CONCLUSIONS: In CD, information provided by MRI has a higher impact on patient management than colonoscopy and may be considered as a first-line examination for CD assessment.

Evolución de la formación continuada acreditada tras la puesta en marcha de la Estrategia para la Seguridad del Paciente / Evolution of the accredited continuing education after Patient Safety Strategy implementation

Objetivo. Analizar la evolución de las actividades de formación continuada acreditadas por el modelo andaluz de acreditación en las principales líneas de la Estrategia para la Seguridad del Paciente. Material y Métodos. Se ha realizado un estudio observacional de las actividades de formación continuada acreditadas por el modelo andaluz de acreditación, durante el periodo 2003-2010 y relacionadas con las líneas estratégicas de seguridad del paciente. Se realizaron análisis estadísticos descriptivos mediante frecuencias e inferencial con medidas de asociación como la X2, de los resultados obtenidos mediante el programa SPSS versión 16. Resultados. Fueron acreditadas 12975 actividades dirigidas a profesionales sanitarios, de las cuales 1002 actividades (7,7%) y un total de 13413 convocatorias estaban relacionadas con alguna o varias de las líneas de seguridad. Los principales colectivos destinatarios de esta formación fueron Enfermería con 4763 convocatorias (35,5%), Medicina con 4090 convocatorias (30,5%) y Técnicos Sanitarios con 1963 convocatorias (14,6%). Conclusiones. La implantación y consolidación de la Estrategia para la Seguridad del Paciente, ha fomentado el desarrollo de actividades acreditadas de formación continuada relacionadas con la materia de seguridad, así como un aumento del valor cualitativo de estas actividades(AU)

Objetive. To analyse the evolution of continuing education activities in the main areas of the Strategy for Patient Safety of the Andalusian Accreditation Model. Material and methods. An observational study was carried out on continuing education activities related to patient safety according to the Andalusian Accreditation Model, during 2003-2010. Results were evaluated (Fisher's exact test) by SPSS v.16 program. Results. A total of 12,975 health professional activities were accredited, of which 1,002 (7.7%) activities and 13,413 meetings were related to one or more of safety lines. The main target groups of this training were Nursing with 4,763 meetings (35.5%), Medicine with 4,090 meetings (30.5%), and Medical Technicians with 1,963 meetings (14.6%). Conclusions. The implementation and consolidation of the Strategy for Patient Safety, has encouraged the development of accredited continuing education activities related to safety, as well as an improvement in the qualitative value of this activities(AU)

[Evolution of the accredited continuing education after Patient Safety Strategy implementation]. / Evolución de la formación continuada acreditada tras la puesta en marcha de la Estrategia para la Seguridad del Paciente.

OBJECTIVE: [corrected] To analyse the evolution of continuing education activities in the main areas of the Strategy for Patient Safety of the Andalusian Accreditation Model. MATERIAL AND METHODS: An observational study was carried out on continuing education activities related to patient safety according to the Andalusian Accreditation Model, during 2003-2010. Results were evaluated (Fisher's exact test) by SPSS v.16 program. RESULTS: A total of 12,975 health professional activities were accredited, of which 1,002 (7.7%) activities and 13,413 meetings were related to one or more of safety lines. The main target groups of this training were Nursing with 4,763 meetings (35.5%), Medicine with 4,090 meetings (30.5%), and Medical Technicians with 1,963 meetings (14.6%). CONCLUSIONS: The implementation and consolidation of the Strategy for Patient Safety, has encouraged the development of accredited continuing education activities related to safety, as well as an improvement in the qualitative value of this activities.

Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease.

OBJECTIVE: Assessment of disease extension and activity is crucial to guide treatment in Crohn's disease. The objective of the current cross-sectional study was to determine the accuracy of MR for this assessment. DESIGN: 50 patients with clinically active (n = 35) or inactive (n = 15) Crohn's disease underwent ileocolonoscopy (reference standard) and MR. T2-weighted and precontrast and postcontrast-enhanced T1-weighted sequences were acquired. Endoscopic activity was evaluated by CDEIS (Crohn's Disease Endoscopic Index of Severity); in addition endoscopic lesions were classified as absent, mild (inflammation without ulcers) or severe (presence of ulceration). RESULTS: The comparison of intestinal segments with absent, mild and severe inflammation demonstrated a progressive and significant (p<0.001) increase in the following MR parameters: wall thickness, postcontrast wall signal intensity, relative contrast enhancement, presence of oedema, ulcers, pseudopolyps and lymph node enlargement. Independent predictors for CDEIS in a segment were wall thickness (p = 0.007), relative contrast enhancement (p = 0.01), presence of oedema (p = 0.02) and presence of ulcers at MR (p = 0.003). There was a significant correlation (r = 0.82, p<0.001) between the CDEIS of the segment and the MR index calculated according to the logistic regression analysis coefficients. The MR index had a high accuracy for the detection of disease activity (area under the receiver operating characteristic (ROC) curve 0.891, sensitivity 0.81, specificity 0.89) and for the detection of ulcerative lesions (area under the ROC curve 0.978, sensitivity 0.95, specificity 0.91) in the colon and terminal ileum. CONCLUSION: The accuracy of MR for detecting disease activity and assessing severity brings about the possibility of using MR as an alternative to endoscopy in the evaluation of ileocolonic Crohn's disease.

Patogenia e inmunoterapia de la enfermedad inflamatoria intestinal: lecciones de los modelos animales / Pathogenesis and immunotherapy in inflammatory bowel disease: lessons from animal models

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[Primary tumors of the parotid. An anatomicoclinical review]. / Tumores primarios de parótida. Revisión anatomoclínica.

It was studied 54 cases of tumors of parotid treated in the Hospital Universitario of Granada from 1978 to 1989. It was also studied the patient age and sex, the year and month of disease arise, the tumors stages at diagnosis, the different treatments followed and the histological classification. Finally the results are discussed.