Efficiency of pragmatic search strategies to update clinical guidelines recommendations.

BACKGROUND: A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. METHODS: We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. RESULTS: The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). CONCLUSIONS: The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.

Concordancia entre padres e hijos en la calidad de vida relacionada con la salud en niños con trastorno por déficit de atención con hiperactividad: estudio longitudinal / Parent-child agreement in the health related quality of life (HRQOL) of children with attention-deficit/hyperactivity disorder (ADHD): A longitudinal study

Objetivos: Evaluar la concordancia entre padres e hijos sobre los cambios producidos en la calidad de vida relacionada con la salud (CVRS) de niños tratados por trastorno por déficit de atención con hiperactividad (TDAH) durante un corto período de tiempo y comparar las puntuaciones con las normas de referencia de la población general. Métodos: Estudio prospectivo en niños de 6 a 12 años con TDAH. Los padres y sus hijos completaron la versión española del CHIP-CE (Child Health and Illness Profile-Child Edition ‘Perfil de salud infantil’) al iniciar el tratamiento y a las 8 semanas. Las puntuaciones del CHIP-CE de ambas visitas se compararon mediante el test de la t de Student para datos apareados, el tamaño del efecto (TE), los coeficientes de correlación intraclase (CCI) y los diagramas de dispersión. Las evaluaciones de padres e hijos se compararon con las puntuaciones del CHIP-CE de la muestra de referencia española. Resultados: En el análisis se incluyó a 31 niños y a sus padres. El mayor cambio entre la visita inicial y la visita de seguimiento se produjo en la dimensión de riesgos, tanto en los niños como en los padres (TE=0,24 y 0,49, respectivamente). El CCI presentó un intervalo de entre 0,44 (satisfacción) y 0,01 (riesgos). Las puntuaciones de los niños fueron similares a los valores de referencia poblacional. Todas las dimensiones de la versión de padres del CHIP-CE presentaron puntuaciones medias estandarizadas inferiores a los valores de referencia en la visita inicial y fueron próximas a los valores de referencia tras el tratamiento. Conclusiones: El presente estudio mostró poca concordancia entre padres e hijos y sugiere que se deberían recoger ambas perspectivas en futuros estudios del impacto y del tratamiento del TDAH (AU)

Objectives: To assess parent-child agreement on changes over a short-term period of time in the HRQOL of children treated for ADHD over a short period of time, and to compare child and parent ratings of children with ADHD with general population norms. Methods: Prospective study in children 6-12 years old with ADHD. Children and parents completed the Spanish versions of the Child Health and Illness Profile-Child Edition (CHIP-CE) before and after 8 weeks of treatment. CHIP-PE scores at both visits were compared using paired t tests and effect sizes (ES), intra-class correlation coefficients (ICC), and scatter plots. Child and parent ratings were compared with CHIP-CE scores for a general population sample. Results: Thirty-one children and parents were included in the analysis. The highest change between the first and the follow-up visit was on the Risk Avoidance domain both children and parents (effect size [ES]=0.24 and 0.40, respectively). The ICC ranged from 0.44 (Satisfaction) to 0.01 (Risk avoidance). Child self-ratings were close to general population values. All domains of the parent version presented standardized means below the reference values at the baseline visit and closer to the general population norm after treatment. Conclusions: This study found poor parent-child agreement and suggests that both ratings should be collected in future studies on the impact of ADHD and treatment effectiveness (AU)

[Parent-child agreement in the health related quality of life (HRQOL) of children with attention-deficit/hyperactivity disorder (ADHD): a longitudinal study]. / Concordancia entre padres e hijos en la calidad de vida relacionada con la salud en niños con trastorno por déficit de atención con hiperactividad: estudio longitudinal.

OBJECTIVES: To assess parent-child agreement on changes over a short-term period of time in the HRQOL of children treated for ADHD over a short period of time, and to compare child and parent ratings of children with ADHD with general population norms. METHODS: Prospective study in children 6-12 years old with ADHD. Children and parents completed the Spanish versions of the Child Health and Illness Profile-Child Edition (CHIP-CE) before and after 8 weeks of treatment. CHIP-PE scores at both visits were compared using paired t tests and effect sizes (ES), intra-class correlation coefficients (ICC), and scatter plots. Child and parent ratings were compared with CHIP-CE scores for a general population sample. RESULTS: Thirty-one children and parents were included in the analysis. The highest change between the first and the follow-up visit was on the Risk Avoidance domain both children and parents (effect size [ES]=0.24 and 0.40, respectively). The ICC ranged from 0.44 (Satisfaction) to 0.01 (Risk avoidance). Child self-ratings were close to general population values. All domains of the parent version presented standardized means below the reference values at the baseline visit and closer to the general population norm after treatment. CONCLUSIONS: This study found poor parent-child agreement and suggests that both ratings should be collected in future studies on the impact of ADHD and treatment effectiveness.

[Cross-cultural adaptation of the Spanish version of the Child Health and Illness Profile, Child Edition (CHIP-CE)]. / Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE).

OBJECTIVES: To obtain a Spanish version of the CHIP-CE semantically and culturally equivalent to the original version. METHOD: The methodology used was based on the forward-backward method. Two translations into Spanish were performed. After the first reconciled version, 44 cognitive interviews were carried out with children aged 6-11 years old, selected from two schools in Barcelona. The interviews were recorded and transcribed. A qualitative content analysis of the textual data was carried out. A panel of experts developed the second reconciled version taking into account the children's comments. A back-translation into English was carried out and was compared with the original version. RESULTS: Of a total of 45 items induced in the first reconciled version, 21 were considered equivalent, 23 required changes and 1 was considered not equivalent. Comprehension of abstract concepts differed according to age. Older children differentiated among concepts and gave different examples of experiences related to these concepts, while younger children (6 to 7-year olds) provided similar examples for different concepts. The children's comments were used in the reformulation of the items. An illustrative figure reinforced understanding. Children aged 7 or more started to use an adequate recall period and used the response options correctly. CONCLUSIONS: The Spanish version of the CHIP-CE seems appropriate for children aged 6-11 in Spain. The present study shows that children from the age of 6 years onwards are able to describe the health concepts included in the CHIP-CE.

Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE) / Cross-cultural adaptation of the Spanish version of the child health and illness profile, child edition (CHIP-CE)

Objetivos: Obtener una versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE), semántica y culturalmente equivalente a la versión original. Método: Se ha seguido la metodología de traducción directa e inversa. Se obtuvieron dos traducciones iniciales al español. Tras la primera versión consensuada se realizaron 44 entrevistas cognitivas a niños/as de 6 a 11 años de dos colegios de Barcelona. Las entrevistas fueron grabadas y transcritas. Se realizó un análisis cualitativo de contenido temático de los datos textuales. Con los comentarios de los niños, y tras un panel de expertos, se obtuvo la segunda versión consensuada. Se realizó la retrotraducción al inglés y se comparó con la versión original. Resultados: De los 45 ítems de la primera versión consensuada, 21 se consideraron equivalentes, 23 requirieron modificaciones y uno fue considerado no equivalente. Se observó una diferencia según la edad en la comprensión de los conceptos abstractos. Los niños/as de más edad diferenciaban los conceptos y daban ejemplos distintos de experiencias relacionadas con ellos, los de menor edad (6-7 años) describieron ejemplos similares para conceptos diferentes. Los comentarios de los niños/as ayudaron a la reformulación de las preguntas. La figura representó un refuerzo para la comprensión. A partir de los 7 años enmarcaron sus respuestas en un período recordatorio adecuado, y utilizaron correctamente las opciones de respuesta. Conclusiones: La versión española del CHIP-CE parece adecuada para los niños de 6-11 años de edad en nuestro medio. El presente estudio ha mostrado que los niños/as son capaces de describir los aspectos de su salud que se incluyen en el CHIP-CE (AU)

[Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. ]. / Opiniones, vivencias y percepciones de los ciudadanos en torno a las listas de espera para cirugía electiva de catarata y artroplastia de cadera y rodilla.

OBJECTIVES: The aim of this study is to describe the views, perceptions and personal experience around elective cataract and hip and knee replacement waiting lists in Catalonia in order to improve their management. DESIGN: Qualitative methodology: four focus groups for each procedure. PLACE: Conducted between February-March 2000 at the Catalan Health Services headquarters. PARTICIPANTS: Each focus group included consultants (ophtalmologists, orthopedic surgeons, rheumatologists, rehabilitators, GPs), other related health professionals (nurses, social workers, physiotherapists, opticians/optometrist, GPs), patients and relatives and general population. Participants were selected through researchers and the clinical scientific committees. All of them followed a pre-established inclusion criteria. MAIN MEASURES: The analysis of the information was performed using the content analysis technique (contents of sessions were transcripted and information classified according to themes). RESULTS: Ten themes were identified. Waiting lists were argued to be a consequence of lack of resources, bad management and conflict of interest among consultants. Overall, the health care authority responsibility for the solution was acknowledged, although some participants claim more citizen participation. Among proposed solutions, prevention and education, more resources and improved management were found. Furthermore, a better physician-patient communication was considered essential. All the groups disagreed with the implicit current prioritisation system, however none wanted to assume the responsibility. CONCLUSIONS: Citizen's perceptions and personal experiences point to a multifactorial approach to waiting lists management, which would ameliorate the problem and lead to a better social acceptance.

Opiniones, vivencias y percepciones de los ciudadanos en torno a las listas de espera para cirugía electiva de catarata y artroplastia de cadera y rodilla / Citizen´s opinions, experiences and perceptions around cataract and hip and knee replacement surgical waiting lists

Objetivo. Describir las opiniones, vivencias y percepciones en torno a las listas de espera de cirugía electiva de cataratas y de artroplastia de cadera y rodilla entre los ciudadanos de Cataluña. Diseño. Cuatro grupos focales para cada procedimiento. Emplazamiento. Entre los meses de febrero y marzo de 2000, en Cataluña. Participantes. Cada grupo focal incluyó a especialistas (oftalmólogos, traumatólogos, rehabilitadores, reumatólogos, médicos de familia), profesionales relacionados (enfermería, asistentes sociales, médicos de familia, fisioterapeutas, ópticos/optometristas), pacientes y familiares y población general. Los participantes se seleccionaron a partir de los investigadores y los comités científicos clínicos del estudio, de acuerdo con unos criterios de selección preestablecidos. Mediciones principales. El análisis de la información se hizo aplicando la técnica del análisis de contenido (transcripción del contenido de las sesiones, clasificación de la información según las líneas temáticas).Resultados. Se identificaron 10 líneas temáticas. Entre las principales causas de las listas de espera se mencionaron la falta de recursos, su mala gestión y el conflicto de intereses de los especialistas. Todos coincidieron en que la responsabilidad de la solución es de la Administración, aunque algunos reclaman más participación ciudadana. Para solucionar el problema se propuso la prevención y educación sanitaria, más recursos y una mejor gestión. Se puso de manifiesto una comunicación médico paciente deficitaria. Los grupos estuvieron en desacuerdo con el actual sistema implícito de priorización, pero ninguno quiso asumir esta responsabilidad. Conclusiones. Los ciudadanos apuntan a que un abordaje multifactorial de las listas de espera podría mitigar el problema y contribuir a su mejor aceptación social (AU)

N1,N1-diethyl-N2-(2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)acetamidine.

The solid-state conformation of the title compound, C(20)H(32)N(2)O(9), has been determined at 150 K. The pyranose ring has a distorted chair conformation. Among the possible conformations of the C-N glycosidic bond, that of the E rotamer is observed and a short intramolecular C(methyl)...O contact may partly stabilize this conformation. Crystal cohesion is stabilized by an extensive network of weak C--H...O hydrogen bonds and close contacts.

Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature.

Available evidence suggests that fracture prediction with bone densitometry may improve when used on people at high risk of osteoporotic fractures. The objectives of this literature review were: (1) to identify risk factors for fracture that are associated with the development of a low bone mass for both men and women; (2) to describe and assess the relationship between these factors and the risk of fracture; and (3) to classify them according to the strength of their association with fracture incidence. Studies were identified from MEDLINE (1982-1997), HealthSTAR (1975-1997) and The Cochrane Library (1997) databases. Pre-stated inclusion criteria (original analytic studies assessing risk factors for osteoporotic fractures in men and women) and methodologic quality were assessed by two independent investigators. Information on the study design and analysis, characteristics of participants, exposure (risk factor) and outcome measures (relative risk and odds ratios for fracture incidence), control for potential confounding factors and risk estimates was extracted using a standardized protocol. Qualitative and meta-analytic techniques were used for data synthesis. As a result, risk factors were classified into three groups according to their strength of association with fracture: high risk (RR > or = 2), moderate risk (1 < RR < 2) and no risk or protective (RR < or = 1). Of approximately 80 risk factors identified from 94 cohort and 72 case-control studies, 15% were classified in the high-risk group, including low body weight, loss of weight, physical inactivity, the consumption of corticosteroids or anticonvulsants, primary hyperparathyroidism, diabetes mellitus type 1, anorexia nervosa, gastrectomy, pernicious anemia, and aging (> 70-80 years). Eighteen percent and 8% of risk factors were classified in the moderate and no risk group respectively, whereas 60% showed either a lack of scientific evidence confirming their association with fracture or contradictory results. An efficient strategy for bone densitometry provision may thus be its selective use in those individuals who present with several strong or moderate risk factors for fracture related to bone mass loss.

Trade-offs in prenatal detection of Down syndrome.

OBJECTIVES: This paper presents the results of different screening policies for prenatal detection of Down syndrome that would allow decision makers to make informed choices. METHODS: A decision analysis model was built to compare 8 screening policies with regard to a selected set of outcome measures. Probabilities used in the analysis were obtained from official administrative data reports in Spain and Catalonia and from data published in the medical literature. Sensitivity analyses were carried out to test the robustness of screening policies' results to changes in uptake rates, diagnostic accuracy, and resources consumed. RESULTS: Selected screening policies posed major trades-offs regarding detection rates, false-positive results, fetal loss, and costs of the programs. All outcome measures considered were found quite robust to changes in uptake rates. Sensitivity and specificity rates of screening tests were shown to be the most influential factors in the outcome measures considered. CONCLUSIONS: The disclosed trade-offs emphasize the need to comprehensively inform decision makers about both positive and negative consequences of adopting one screening policy or another.