Documento de consenso español para el algoritmo de tratamiento de la rosácea / Spanish Consensus Document on the Treatment Algorithm for Rosacea

Las últimas evidencias científicas y la incorporación de nuevos fármacos al arsenal terapéutico de la rosácea hacen necesario revisar y actualizar los criterios y estrategias de tratamiento. Con este fin, un grupo de 15 dermatólogos expertos en esta enfermedad aportaron y discutieron acerca de las diferentes terapias y los criterios de respuesta y cambio de tratamiento. Partiendo de la revisión crítica de la bibliografía y de la exposición de los hábitos de los dermatólogos españoles en su práctica clínica, se formularon distintas propuestas que fueron debatidas teniendo en consideración tanto la experiencia profesional como las preferencias de los pacientes o los criterios de equidad. Una vez validadas las propuestas, se formularon las recomendaciones finales que, junto con la evidencia aportada por las principales guías y estudios internacionales, dieron lugar al presente documento. El objetivo de este consenso es ofrecer al dermatólogo un enfoque práctico para abordar la rosácea

Recent scientific evidence and the incorporation of new drugs into the therapeutic arsenal against rosacea have made it necessary to review and update treatment criteria and strategies. To this end, a panel of 15 dermatologists, all experts in rosacea, was formed to share experiences and discuss treatment options, response criteria, and changes to treatment. Based on a critical review of the literature and a discussion of the routine practices of Spanish dermatologists, the panel proposed and debated different options, with consideration of the experience of professionals and the preferences of patients or equality criteria. Following validation of the proposals, the final recommendations were formulated and, together with the evidence from the main international guidelines and studies, used to produce this consensus document. The goal of this consensus document is to provide dermatologists with practical recommendations for the management of rosacea

Spanish Consensus Document on the Treatment Algorithm for Rosacea. / Documento de consenso español para el algoritmo de tratamiento de la rosácea.

Recent scientific evidence and the incorporation of new drugs into the therapeutic arsenal against rosacea have made it necessary to review and update treatment criteria and strategies. To this end, a panel of 15 dermatologists, all experts in rosacea, was formed to share experiences and discuss treatment options, response criteria, and changes to treatment. Based on a critical review of the literature and a discussion of the routine practices of Spanish dermatologists, the panel proposed and debated different options, with consideration of the experience of professionals and the preferences of patients or equality criteria. Following validation of the proposals, the final recommendations were formulated and, together with the evidence from the main international guidelines and studies, used to produce this consensus document. The goal of this consensus document is to provide dermatologists with practical recommendations for the management of rosacea.

[Rationale for a diagnostic approach in non-Graves' orbital inflammation--Report of 61 patients]. / Établissement d'un arbre décisionnel diagnostique dans les orbitopathies inflammatoires non basedowiennes chroniques--à propos de 61 patients.

INTRODUCTION: Orbital inflammatory syndromes include a wide variety of inflammatory intraorbital processes which are very different in terms of clinical presentation and prognosis. We currently prefer to differentiate so-called "specific" inflammations, for which an etiology is able to be identified, from idiopathic orbital inflammatory syndromes (IOIS), for which the etiology remains unknown and the histology is nonspecific. PURPOSE: To propose an efficient diagnostic approach for clinicians managing patients with non-Graves' orbital inflammations. MATERIALS AND METHODS: This is a retrospective and prospective study concerning 61 patients managed by the medical team for non-Graves' orbital inflammations between May, 1999 and May, 2013 in the ophthalmology departments of Nice and Limoges university hospitals in France. Seventeen specific inflammations, 19 orbital lymphomas and 25 idiopathic orbital inflammatory syndromes were included. Patients were divided into two groups. Thirty-six patients (group 1) underwent primary biopsy, while for the other 25 (group 2), therapy was begun empirically without biopsy. We could therefore compare both approaches in terms of diagnostic efficiency and time until identification of a specific etiology. RESULTS: Our statistical results show that an approach without primary biopsy leads to a number of specific diagnoses statistically much lower than that obtained by the approach with primary biopsy. Also, the risk of missing a specific inflammation (with as a consequence an inappropriate treatment and a risk of functional sequelae as well as a fatal risk of missing a lymphoproliferative pathology) is very clearly higher in the case of not performing primary biopsy. Finally, the average time elapsed between the initial consultation with the ophthalmologist and a specific diagnosis was one month in the case of the first approach, while this delay was almost three times higher with the second approach, with a mean of 2.91 months (P<0.01). DISCUSSION: Our study shows that biopsy should be the mainstay of diagnostic management. A trial of empiric treatment is only performed first in myositis or in locations where biopsy could jeopardize functional prognosis. It should only be done after biopsy in all other cases. Of course, in all cases of relapse or recurrence after treatment, biopsy should be performed or repeated. CONCLUSION: The diagnostic work-up of a patient with an orbital inflammatory process must of course include blood testing and orbital imaging, but also a systematic primary biopsy for histological examination in the vast majority of cases. It must be repeated at least in the case of any doubt about the diagnosis or in the case of any recurrence or resistance to treatment.

Plan estratégico de la Academia Española de Dermatología y Venereología (AEDV). FuturAEDV 2013-2017 / Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017

ANTECEDENTES: La Academia Española de Dermatología y Venereología (AEDV) ha planteado la necesidad de definir un plan estratégico para adaptarse y anticiparse al nuevo escenario. OBJETIVOS: 1) Posicionar a la AEDV como una sociedad con capacidad de influencia en todo lo relacionado con la dermatología; 2) contribuir al desarrollo de la especialidad reforzando el prestigio de la misma y de sus profesionales; y 3) introducir en el seno de la Academia un modelo de funcionamiento y de pensamiento estratégico que permita anticiparse a los retos del futuro y que se transmita a las sucesivas juntas directivas. MÉTODOS: Análisis de las tendencias del sistema sanitario, diagnóstico de la situación actual de la AEDV y de la dermatología mediante un análisis interno a través de encuestas y entrevistas a los académicos, análisis de los puntos fuertes y débiles, así como las amenazas y oportunidades, declaración de la misión, y finalmente, la identificación, el desarrollo y la realización de un mapa estratégico con la priorización de las líneas de acción estratégicas. RESULTADOS: Se definió un mapa estratégico con 16 objetivos generales agrupados en 4 ejes (alcanzar la visión, clientes internos y externos, procesos internos e innovación), encuadrados en un plan de acción con 19 iniciativas y acciones concretas para cada una de ellas. La monitorización de su desarrollo la realizará el comité de seguimiento del plan estratégico, formado por la junta permanente y los responsables de los 9 comités técnicos encargados de llevar a cabo cada una de las iniciativas. Comentario: El plan funcional debe guiar la gestión de la AEDV hasta 2017 y su implantación le permitirá posicionarse como referente en cuanto a su modelo funcional y contribuir al desarrollo y prestigio de la especialidad

BACKGROUND: The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments. OBJECTIVES: 1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges. METHODS: The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action. RESULTS: The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives. Comment: The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model

Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017.

BACKGROUND: The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments. OBJECTIVES: 1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges. METHODS: The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action. RESULTS: The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives. COMMENT: The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model.

[Blepharoplasty and upper eyelid malposition]. / Blépharoplastie et malposition du bord libre de la paupière supérieure.

Upper eyelid blepharoplasties are sometimes performed for functional purposes, but more often for cosmetic reasons. Upper eyelid malpositions, such as ptosis or lid retraction, are frequent and of varying causes. It is not rare for patients to present upper lid malposition, with or without functional consequences, associated with myocutaneous excess. Both functional and cosmetic outcomes are important. This article explores the etiologies of these pathologies and current surgical procedures. Furthermore we will discuss the advantages of combined procedures and different approaches to treat these concomitant pathologies.

Evaluación de la calidad de las prescripciones a los pacientes ingresados / Prescription quality evaluation in hospital patients

No disponible

[Injecting drug users from Eastern Europe in Barcelona, Spain]. / Ciudadanos del este de Europa consumidores de drogas en Barcelona.

From May 1999 to May 2001, we made contact with injecting drug users from Eastern Europe in the healthcare and prevention service of the Red Cross (servicio de atención y prevención sociosanitaria [SAPS]) in Barcelona (Spain). The users attended free therapeutic centers, but paid approximately 500 e for the trip. The users were aged between 18 and 30 years old and maintained family contact. The knew the risk of disease transmission, but often exchanged needles. The prevalence of hepatitis C (92%) and B (62%) was high but less than that of HIV (19%). If they did not stop taking drugs their return would be a failure and they would have difficulties in following methadone and antiretroviral treatments in their countries of origin. The healthcare provided in these centers should respond to user' needs: cultural mediation should be sought, as well as information from users' countries of origin. Centers receiving users from other countries should be supervised and alternatives should be designed for users who abandon treatment. International cooperation and programs to reduce the risk of drug consumption should be developed. Treatment should be prevented from becoming a business.

Ciudadanos del este de Europa consumidores de drogas en Barcelona / Injecting drug users from Eastern Europe in Barcelona, Spain

Desde mayo de 1999 hasta mayo de 2001, hemos contactado en el SAPS (Servicio de Atención Social y Sanitaria) de Barcelona con usuarios de drogas de países del este de Europa. Acuden a centros terapéuticos gratuitos, aunque pagan por la organización del viaje unos 500 euros. Son jóvenes entre 18 y 30 años y mantienen el contacto con sus familiares. Conocen los riesgos de transmisión de enfermedades, pero suelen reutilizar las jeringas. Es alta la prevalencia de hepatitis C (92 por ciento) y B (62 por ciento) y menor la de infección por el VIH (19 por ciento).Si no abandonan las drogas, el retorno es un fracaso y tienen dificultades para proseguir los tratamientos con metadona o antirretrovirales. La respuesta asistencial ha de adecuarse a sus necesidades. Se debe procurar la mediación cultural y la información en los lugares de origen, supervisar los centros terapéuticos y diseñar alternativas a los abandonos. Hay que desarrollar la colaboración internacional, estimular programas de disminución de riesgos derivados del consumo y evitar que del tratamiento se haga un comercio (AU)

From May 1999 to May 2001, we made contact with injecting drug users from Eastern Europe in the healthcare and prevention service of the Red Cross (servicio de atención y prevención sociosanitaria [SAPS]) in Barcelona (Spain). The users attended free therapeutic centers, but paid approximately 500 € for the trip. The users were aged between 18 and 30 years old and maintained family contact. The knew the risk of disease transmission, but often exchanged needles. The prevalence of hepatitis C (92%) and B (62%) was high but less than that of HIV (19%). If they did not stop taking drugs their return would be a failure and they would have difficulties in following methadone and antiretroviral treatments in their countries of origin. The healthcare provided in these centers should respond to user' needs: cultural mediation should be sought, as well as information from users' countries of origin. Centers receiving users from other countries should be supervised and alternatives should be designed for users who abandon treatment. International cooperation and programs to reduce the risk of drug consumption should be developed. Treatment should be prevented from becoming a business (AU)

Prevención de la gastropatía por antiinflamatorios no esteroides: seguimiento de la adherencia al protocolo / Prevention of non-steroidal antiinflammatory drugs-induced gastropathy: follow up of protocol adherence

Objetivo: consensuar y evaluar el cumplimiento del protocolo para la profilaxis de la gastropatía inducida por antiinflamatorios no esteroides, con omeprazol 20 mg al día.Pacientes y método: se han realizado 3 estudios transversales de los pacientes ingresados en nuestro hospital antes de la implantación del protocolo, inmediatamente después y al cabo de 6 meses.Resultados: entre el 16 y 24 por ciento de los pacientes ingresados en nuestro hospital toman fármacos antiinflamatorios no esteroides.Antes de la aplicación del protocolo un 34,7 por ciento de la prescripciones coincidían con él. Tras su implantación la adherencia de los médicos prescriptores al protocolo mejoró hasta el 51,8 por ciento ( 2 =5,27 p=0,02) y a los 6 meses se alcanzó un 51,4 por ciento de adherencia, mejoría que continuó siendo significativa respecto a la fase previa ( 2 =5,74 p=0,01). El principal motivo de incumplimiento fue la utilización de ranitidina en lugar de omeprazol. Uno de los métodos más útiles para mejorar la adhesión ha sido la reunión con los servicios médicos que más emplean los antiinflamatorios, centrada específicamente en la utilización del protocolo.Conclusiones: el seguimiento del protocolo muestra una mejoría del cumplimiento tras la fase de implantación que se mantiene al cabo de 6 meses. La adherencia de los médicos prescriptores al tratamiento, sin embargo, es inferior a la esperada. (AU)

Prevention of non-steroidal antiinflammatory drugs-induced gastropathy: follow up of protocol adherence.

OBJECTIVE: To reach a consensus on and evaluate the compliance of the protocol for the prophylaxis of gastropathy induced by non-steroidal anti-inflammatory drugs with 20 mg omeprazole per day. PATIENTS AND METHOD: Three transversal studies have been carried out on patients admitted to our hospital before establishing the protocol, immediately after and 6 months later. RESULTS: Between 16 and 24% of patients admitted to our hospital take non-steroidal anti-inflammatory drugs. Before the application of the protocol 34.7% of prescriptions coincided with this use. After its establishment adherence by the prescribing doctors improved to 51.8% (c2 = 5.27, p = 0.02) and at 6 months it reached 51.4% adherence, an improvement that continued being significative (c2 = 5.74, p = 0.01). The main reason for non-compliance was the use of ranitidine instead of omeprazole. One of the most useful methods for improving adhesion has been meeting with the medical services that most use the anti-inflammatory drugs, focussing specifically on the use of the protocol. CONCLUSIONS: The follow-up of the protocol shows an improvement in compliance after the establishment stage which is maintained after 6 months. Adherence by the prescribing doctors to the treatment, nevertheless, is lower than had been hoped.

[Community collection of syringes by parenteral drug users complementary to syringe exchange programs]. / RECOJE: recogida comunitaria de jeringas por usuarios de drogas por vía parenteral como complemento a los programas de intercambio.

OBJECTIVES: To contribute to harm reduction in injecting drug users (IDUs) by the implementation of a programme to withdraw abandoned syringes from public places, as well as to collaborate on the social reinsertion of IDUs. METHODS: Descriptive study of the Syringe Withdrawal Community (RECOJE in Spanish), carried out from 1997 to 1999 by IDUs, the We Are Helpful Association (ASUT in Spanish) and the Social and Health Prevention and Attention Service (SAPS in Spanish) of the Red Cross, in Ciutat Vella (Barcelona, Spain). RESULTS: 4,332 syringes were withdrawn, 849 in 1997, 1,324 in 1998 and 2,159 in 1999. The mean number of syringes withdrawn each time was 57 33. 45 different IDUs worked in RECOJE. 74.2% of the abandoned syringes were found in parks, gardens, car parks and open spaces. CONCLUSIONS: RECOJE can be a valid programme for harm reduction complementary to the exchange syringe programmes. It could improve the self-esteem, external image and organization of IDUs, contributing to their social reinsertion.

RECOJE: recogida comunitaria de jeringas por usuarios dedrogas por vía parenteral como complemento a los programasde intercambio / Community collection of syringes by parenteral drug users complementary to syringe exchange programs

Objetivo: Reducir riesgos para los usuarios de drogas por vía parenteral (UDVP) y la comunidad a través de un programa de recogida de jeringas abandonadas en lugares públicos y contribuir a la reinserción social de los UDVP. Método: Estudio descriptivo de la recogida comunitaria de jeringas (RECOJE) abandonadas, realizada entre 1997 y 1999por UDVP, la asociación somos útiles (ASUT) y el servicio de atención y prevención sociosanitaria (SAPS) de la Cruz Roja,en la Ciutat Vella de Barcelona. Resultados: Se recogieron 4.332 jeringas; 849 en 1997, 1.324en 1998 y 2.159 en 1999. La media de jeringas recogidas por salida fue de 57 ± 33. Un total de 45 UDVP realizaron RECOJE. La mayoría de jeringas (74,2%) se localizaron en parques, jardines, aparcamientos y descampados. Conclusiones: La recogida comunitaria de jeringas es un programa válido para la reducción de riesgos, complementario al intercambio de jeringas. Mejora la autoestima, imagen externa y organización de los UDVP y contribuye a su reinserción social (AU)

Objectives: To contribute to harm reduction in injecting drug users (IDUs) by the implementation of a programme to withdraw abandoned syringes from public places, as well as to collaborate on the social reinsertion of IDUs. Methods: Descriptive study of the Syringe Withdrawal Community(RECOJE in Spanish), carried out from 1997 to 1999by IDUs, the We Are Helpful Association (ASUT in Spanish)and the Social and Health Prevention and Attention Service(SAPS in Spanish) of the Red Cross, in Ciutat Vella (Barcelona,Spain).Results: 4,332 syringes were withdrawn, 849 in 1997,1,324 in 1998 and 2,159 in 1999. The mean number of syringes withdrawn each time was 57 ± 33. 45 different IDUs worked in RECOJE. 74.2% of the abandoned syringes were found in parks, gardens, car parks and open spaces. Conclusions: RECOJE can be a valid programme for harm reduction complementary to the exchange syringe programmes. It could improve the self-esteem, external image and organization of IDUs, contributing to their social reinsertion (AU)