Ética e inteligencia artificial / Ethics and artificial intelligence

La relación entre ética e inteligencia artificial en medicina es un tema crucial y complejo y se encuadra en su contexto más amplio. Así, la ética en inteligencia artificial médica implica asegurar que las tecnologías sean seguras, justas y respeten la privacidad de los pacientes. Esto incluye preocuparse de la precisión de los diagnósticos proporcionados por la inteligencia artificial, la equidad en el tratamiento de pacientes y la protección de los datos personales de salud. Los avances en inteligencia artificial pueden mejorar significativamente la atención médica, desde diagnósticos más precisos hasta tratamientos personalizados. Sin embargo, es esencial que los desarrollos en inteligencia artificial médica se realicen con una consideración ética fuerte, involucrando a los pacientes, profesionales de la salud e inteligencia artificial y especialistas en ética para guiar y supervisar su implementación. Por último, es fundamental la transparencia en los algoritmos de inteligencia artificial y la formación continua para los profesionales médicos. (AU)

The relationship between ethics and artificial intelligence in medicine is a crucial and complex topic that falls within its broader context. Ethics in medical artificial intelligence involves ensuring that technologies are safe, fair, and respect patient privacy. This includes concerns about the accuracy of diagnoses provided by artificial intelligence, fairness in patient treatment, and protection of personal health data. Advances in artificial intelligence can significantly improve healthcare, from more accurate diagnoses to personalized treatments. However, it is essential that developments in medical artificial intelligence are carried out with strong ethical consideration, involving healthcare professionals, artificial intelligence experts, patients, and ethics specialists to guide and oversee their implementation. Finally, transparency in artificial intelligence algorithms and ongoing training for medical professionals are fundamental. (AU)

Ethics and artificial intelligence.

The relationship between ethics and artificial intelligence in medicine is a crucial and complex topic that falls within its broader context. Ethics in medical artificial intelligence (AI) involves ensuring that technologies are safe, fair, and respect patient privacy. This includes concerns about the accuracy of diagnoses provided by artificial intelligence, fairness in patient treatment, and protection of personal health data. Advances in artificial intelligence can significantly improve healthcare, from more accurate diagnoses to personalized treatments. However, it is essential that developments in medical artificial intelligence are carried out with strong ethical consideration, involving healthcare professionals, artificial intelligence experts, patients, and ethics specialists to guide and oversee their implementation. Finally, transparency in artificial intelligence algorithms and ongoing training for medical professionals are fundamental.

Spanish psychometric properties of the moral distress scale-revised: a study in healthcare professionals treating COVID-19 patients.

BACKGROUND: Moral distress appears when a healthcare professional is not able to carry out actions in accordance with their professional ethical standards. The Moral Distress Scale-Revised is the most widely used to assess levels of moral distress, but it is not validated in Spanish. The aim of the study is to validate the Spanish version of the Moral Distress Scale - utilised within a sample of Spanish healthcare professionals treating COVID-19 patients. METHODS: The original (english) and the portuguese and french versions of the scale were translated into spanish by native or bilingual researchers and reviewed by an academic expert in ethics and moral philosophy as well as by a clinical expert. RESEARCH DESIGN: Descriptive cross-sectional study carried out using a self-reporting online survey. The data was collected between June- November 2020. A total of 661 professionals responded to the survey (N = 2873). PARTICIPANTS: healthcare professionals with more than two weeks of experience treating COVID-19 patients at the end of their life and working in the public sector of the Balearic Islands Health Service (Spain). Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability. The study was approved by the Research Ethics Committee at the University of Balearic Islands. RESULTS: An unidimensional model in which a general factor of moral distress explained by 11 items of the Spanish version of the MDS-R scale was an adequate representation of the data: χ2(44) = 113.492 (p 0.001); Comparative Fit Index = 0.965; Root Mean Square Error of Approximation = 0.079[0.062,0.097]; and Standarized Root Mean-Square = 0.037. Evidence of reliability was excellent: Cronbach's alpha = 0.886 and McDonald's omega = 0.910. Moral distress was related to discipline, with nurses having statistically significant higher levels than physicians. Additionally, moral distress successfully predicted professional quality of life, with higher levels of moral distress being related to poorer quality of life. CONCLUSIONS: The Spanish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by health professionals. This tool will be highly useful for managers and applicable to a variety of healthcare professionals and settings.

Psychometric properties of the Weight Locus of Control Scale (MWLCS): study with Spanish individuals of different anthropometric nutritional status.

INTRODUCTION: The Multidimensional Weight Locus of Control Scale (MWLCS) measures a person's beliefs regarding the locus of control or lack of locus of control over his/her body weight. PURPOSE: We aim to evaluate the factorial structure and psychometric properties of the MWLCS with Spanish normal weight, overweight and obese samples. METHODS: The research was carried out in two different studies. The first included a sample of 140 normal weight participants, selected out of a 274 sample recruited with an online survey. Study 2 was carried out in a sample of 633 participants recruited from the PREDIMED-Plus study. Out of them, 558 participants fulfilled the weight criteria and were categorized into: overweight (BMI 25 - < 29.99; N = 170), obese class I (BMI 30 - < 34.99; N = 266), and obese class II (BMI 35 - < 39.99; N = 122). Exploratory (EFA) and confirmatory (CFA) factor analyses were used to evaluate the factor structure of the MWLCS, and reliabilities and Spearman's correlations were estimated. Invariance measurement was tested across the three subgroups of weight in Study 2. RESULTS: A three-factor structure indicating weight locus of control factors (internal, chance, and powerful others) was supported, both via EFA in the normal weight sample and CFA in the overweight and obese samples. In the normal weight sample, the powerful others dimension was positively related to BMI and the dimensions of the Dutch Eating Behaviors Questionnaire. Additionally, the scale showed evidence of scalar invariance across the groups with different weight conditions. CONCLUSIONS: This scale seems to be a psychometrically appropriate instrument and its use is highly recommended when designing interventions for overweight or obese individuals. LEVEL OF EVIDENCE: Level V, descriptive study.

Method Effects and Gender Invariance of the Rosenberg Self-esteem Scale: A Study on Adolescents / Efectos de Método y Estabilidad entre Sexos de la Escala de Autoestima de Rosenberg: Un Estudio en Adolescentes

Abstract: Rosenberg's self-esteem scale has been extensively used in all areas of psychology to assess global self-esteem (Rosenberg, 1965, 1979). Its construct validity, and specifically its factor structure, has almost from the beginning been under debate. More than four decades after its creation the cumulated evidence points that the scale measures a single trait (self-esteem) but confounded by a method factor associated to negatively worded items. The aim of the study is to examine the measurement invariance of the RSES by gender and test potential gender differences at the latent (trait and method) variable level, while controlling for method effects, in a sample of Spanish students. A series of completely a priori structural models were specified, with a standard invariance routine implemented for male and female samples. The results lead to several conclusions. Conclusions: a) the scale seem gender invariant for both trait and method factors; b) there were small but significant differences between males and females in self-esteem, differences that favored male respondents; and c) there were statistically non-significant differences between men and women in the method factor's latent means.

Resumen: La Escala de Autoestima de Rosenberg (EAR) ha sido utilizada extensamente en todas las áreas de la Psicología para evaluar la autoestima (Rosenberg, 1965, 1979). Su validez de constructo, y particularmente su estructura factorial, ha estado en debate casi desde que fue construida. Más de cuatro décadas después de su creación, la evidencia acumulada señala que la escala evalúa un solo rasgo (autoestima), aunque se confunde con un método factorial asociado de manera negative con reactivos verbales. El objetivo de este estudio fue evaluar la estabilidad de la medición de la EAR entre sexos y poner a prueba potenciales diferencias entre los mismos en un nivel latente de la variable (rasgo y estado), controlando efectos de método, en una muestra de estudiantes españoles. Se especificaron una serie de modelos estructurales a priori, con rutinas implementadas de invarianza estándar para muestras de hombres y mujeres. Los resultados llevan a diferentes conclusiones: a) La escala parece ser invariable ante el sexo tanto para factores de rasgo como de estado; b) existieron diferencias pequeñas, pero significativas, entre hombres y mujeres en autoestima, favoreciendo ligeramente a los hombres; y, c) no existieron diferencias estadísticamente significativas entre hombres y mujeres en las medias de la variable latente del factor.

Predicting life satisfaction of the Angolan elderly: a structural model.

Satisfaction with life is of particular interest in the study of old age well-being because it has arisen as an important component of old age. A considerable amount of research has been done to explain life satisfaction in the elderly, and there is growing empirical evidence on best predictors of life satisfaction. This research evaluates the predictive power of some aging process variables, on Angolan elderly people's life satisfaction, while including perceived health into the model. Data for this research come from a cross-sectional survey of elderly people living in the capital of Angola, Luanda. A total of 1003 Angolan elderly were surveyed on socio-demographic information, perceived health, active engagement, generativity, and life satisfaction. A Multiple Indicators Multiple Causes model was built to test variables' predictive power on life satisfaction. The estimated theoretical model fitted the data well. The main predictors were those related to active engagement with others. Perceived health also had a significant and positive effect on life satisfaction. Several processes together may predict life satisfaction in the elderly population of Angola, and the variance accounted for it is large enough to be considered relevant. The key factor associated to life satisfaction seems to be active engagement with others.

Evidencia acumulada sobre los efectos de método asociados a ítems invertidos / Evidence gathered of method effects associated to negatively worded items

La recomendación de invertir ítems al medir constructos psicológicos mediante escalas ha estado presente casi desde siempre en la práctica psicométrica. Pese a esto, esta estrategia parece interferir en el examen de la estructura latente de las escalas, tal y como se ha demostrado en diversas investigaciones. Este trabajo pretende aportar evidencia empírica que permita clarificar el efecto de la formulación invertida de los ítems, utilizando dos versiones de la Escala de Autoestima de Rosenberg (1965), una en su formato original con ítems positivos e invertidos y otra transformada de modo que todos los ítems sean positivos, para comprobar si se mantienen o desaparecen los efectos de método encontrados en la literatura asociados a los ítems invertidos. Para ello, se ha contado con una muestra incidental de 390 estudiantes de instituto y universidad de la ciudad de Valencia. Se han llevado a cabo diversos modelos de ecuaciones estructurales (incluyendo CTCM) alternativos, comparando los índices de ajuste de éstos. A partir de los resultados, se obtienen dos puntos relevantes de información: por una parte, se observa de nuevo un efecto de método asociado a los ítems invertidos; por otra, se observa como estos ítems, cuando son formulados en positivo, no presentan tal efecto, de manera que la Escala de Autoestima de Rosenberg presenta una estructura de un solo factor: el factor de autoestima. Las implicaciones de estos resultados se recogen en las conclusiones y discusión(AU)

Negatively worded items have been long used in the measurement of psychological constructs, since almost the beginning of the psychometric practice. However, this strategy interferes in the examination of the scales’ latent structures, as it has been shown in several studies. This paper aims to provide new evidence on this topic, in order to clarify the negatively worded items effect, by using two versions of the Rosenberg’ Self-Esteem Scale (1965), one in its original form, with positive and negatively worded items, and the other one in a transformed version, in which all the items are positive, in order to test if, in this latest version, the method effect associated to negatively worded items still remains. The sample was composed by 390 high-school and university students from Valencia, Spain. Several alternative (including CTCM) structural equation models have been tested, and their fit indices are compared. Results offer empiric evidence on the method effect associated to negatively worded items. This effect disappears when items are worded in a positive way and, thus, Rosenberg’ Self-Esteem Scale structure is composed by just one factor: the self-esteem factor. Implications of these results are pointed out in the discussion(AU)

[The antiphospholipid syndrome, an update]. / Síndrome antifosfolípido, estado actual.

The antiphospholipid syndrome is an antibody mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. Several studies have determined that the frequency of antiphospholipid syndrome in patients presenting with a venous thromboembolic event is between 4% and 14%. Classical criteria include the presence of anticardiolipin antibody or lupus anticoagulant with typical complications of thrombosis or pregnancy loss. Other common associated manifestations include livedo reticularis, thrombocytopenia, valvular heart disease, and nephropathy with renal insufficiency, hypertension and proteinuria. Because of the high risk for recurrent thromboembolism in these patients, current recommendations suggest a longer, potentially lifelong, course of antithrombotic therapy following an initial event. For an initial venous thromboembolic event, a target INR of 2.0 to 3.0 is supported by two prospective, randomized clinical trials. In contrast, relatively limited data exist for an initial arterial thromboembolic event in patients who have the antiphospholipid syndrome, and therapeutic recommendations range from aspirin to warfarin with a high target INR. Recurrent thromboembolic events can be extremely difficult to treat, and some patients may benefit from the addition of immunosuppressive therapies. It is very important to evaluate in this setting additional, coincident prothrombotic risk factors.

El ligando CD40 soluble: marcador potencial de riesgo cardiovascular / Soluble CD40 ligand: a potencial marker of cardiovascular risk

El ligando CD40 soluble, también denominado CD145 o gp 39, es un complejo formado por una proteína transmembrana estructural y una molécula soluble de adherencia tisular. Se expresa en los linfocitos y las plaquetas activadas y constituye el nexo entre el sistema inflamatorio y los procesos trombóticos vasculares. Su gen se localiza en el brazo largo del cromosoma X humano. Pertenece a la familia del factor de necrosis tumoral. La evaluación de la placa aterosclerótica fija residual es insuficiente para predecir la evolución clínica. Actualmente, ya se han realizado estudios demostrando la participación del sistema inmuno-inflamatorio en la génesis y las complicaciones del proceso aterosclerótico. En el futuro, los biomarcadores más específicos de vulnerabilidad serán de gran utilidad en la práctica cotidiana (interleucinas, CD40, etc.). El ligando CD40 soluble y su receptor CD40 están sobreexpresados en las lesiones ateroscleróticas, lo que conduce a un incremento de los mediadores del desarrollo de la placa de ateroma, y ambos contribuyen de manera importante al proceso inflamatorio que conduce a la aterosclerosis y a la trombosis

Recombinant human soluble CD40 ligand, also named CD145 or gp 39, is a 16.3 kD glycoprotein containing 149 aa residues comprising the receptor binding TNF-like domain of CD40 ligand. It is expressed on antigen-presenting cells such as B cells, macrophages, dendritic cells and thymic epithelial cells and it constitutes the nexus between the inflammatory system and the vascular thrombotic processes. Its gene is located in the long arm of the human X chromosome. Prognostic evaluation of the residual fixed atherosclerotic plaque is insufficient to predict clinical course. Currently, studies have been done that demonstrate the participation of the immunoinflammatory system in the genesis and complications of the atherosclerotic condition. In the future, the most specific biomarkers of vulnerability will be very useful in the daily practice (interleukins, CD40, etc.). The soluble CD40 ligand together with its CD40 receptor are overexpressed in experimental and human atherosclerotic lesions. This leads to an increase of mediators for the development of atherosclerosis. Both significantly contribute to the inflammatory processes that leads to atherosclerosis and thrombosis

[Soluble CD40 ligand: a potential marker of cardiovascular risk]. / El ligando CD40 soluble: marcador potencial de riesgo cardiovascular.

Recombinant human soluble CD40 ligand, also named CD145 or gp 39, is a 16.3 kD glycoprotein containing 149 aa residues comprising the receptor binding TNF-like domain of CD40 ligand. It is expressed on antigen-presenting cells such as B cells, macrophages, dendritic cells and thymic epithelial cells and it constitutes the nexus between the inflammatory system and the vascular thrombotic processes. Its gene is located in the long arm of the human X chromosome. Prognostic evaluation of the residual fixed atherosclerotic plaque is insufficient to predict clinical course. Currently, studies have been done that demonstrate the participation of the immunoinflammatory system in the genesis and complications of the atherosclerotic condition. In the future, the most specific biomarkers of vulnerability will be very useful in the daily practice (interleukins, CD40, etc.). The soluble CD40 ligand together with its CD40 receptor are overexpressed in experimental and human atherosclerotic lesions. This leads to an increase of mediators for the development of atherosclerosis. Both significantly contribute to the inflammatory processes that leads to atherosclerosis and thrombosis.

Síndrome antifosfolípido, estado actual / The antiphospholipid sindrome, an update

El síndrome antifosfolípido afecta al campo de la practica médica de varias especialidades; es un estado de hipercoagulabilidad mediado por anticuerpos caracterizado por episodios de tromboembolismos arteriales y venosos, su frecuencia en pacientes que sufren un episodio de tromboembolismo venoso oscila entre un 14 a un 45%. Los criterios clásicos incluyen la presencia de anticuerpos anticardiolipina o anticoagulante lúpico, las complicaciones trombóticas y los abortos espontáneos. Otras manifestaciones frecuentes incluyen la livedo reticularis, trombocitopenia, enfermedad valvular cardiaca, nefropatía con insuficiencia renal, hipertensión y proteinuria. Se aconseja un tratamiento anticoagulante prolongado después del primer episodio trombótico, en caso de que ocurra un tromboembolismo venoso, se recomienda mantener el INR entre 2 y 3, por el contrario existen menos datos referentes al tratamiento en caso de que la afectación sea arterial en cuyo caso se aconseja el uso de aspirina y/o warfarina manteniendo niveles mas altos de INR. En caso que se presenten episodios tromboembólicos recurrentes de tromboembolismo algunos pacientes se pueden beneficiar del tratamiento con inmunosupresores, y en cualquier caso se debe de realizar un estudio que valore la existencia de factores protrombóticos

The antiphospholipid syndrome is an antibody mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. Several studies have determined that the frequency of antiphospholipid syndrome in patients presenting with a venous thromboembolic event is between 4% and 14%. Classical criteria include the presence of anticardiolipin antibody or lupus anticoagulant with typical complications of thrombosis or pregnancy loss. Other common associated manifestations include livedo reticularis, thrombocytopenia, valvular heart disease, and nephropathy with renal insufficiency, hypertension and proteinuria. Because of the high risk for recurrent thromboembolism in these patients, current recommendations suggest a longer, potentially lifelong, course of antithrombotic therapy following an initial event. For an initial venous thromboembolic event, a target INR of 2.0 to 3.0 is supported by two prospective, randomized clinical trials. In contrast, relatively limited data exist for an initial arterial thromboembolic event in patients who have the antiphospholipid syndrome, and therapeutic recommendations range from aspirin to warfarin with a high target INR. Recurrent thromboembolic events can be extremely difficult to treat, and some patients may benefit from the addition of immunosuppressive therapies. It is very important to evaluate in this setting additional, coincident prothrombotic risk factors

[The etiology of urinary tract infections and the antimicrobial susceptibility of urinary pathogens]. / Etiologia de las infecciones del tracto urinario y sensibilidad de los uropatogenos a los antimicrobianos.

Antibiotic treatment of urinary tract infections in adults is usually empirical, and use of urine culture is an exception. The choice of antibiotic is normally made based on the results of published case studies (positive urine cultures), which are used to determine the most probable etiology and likely antimicrobial susceptibility. The results of studies published in recent years were reviewed, detailing the differences in relation to the place of residence and characteristics of the patients, and any temporary trends. In lower urinary tract infections in patients without risk factors, treatment must mainly cover Escherichia coli. Nevertheless, in complicated urinary tract infections or in patients with risk factors, the available clinical epidemiological data do not provide for safe empirical choice of antibiotic without the use of urine culture. There has been a reduction in the susceptibility of E. coli to various antibiotics, and this shows wide geographic variations; the reduction in the activity of fluoroquinolones could limit its empirical use in the future.

Etiología de las infecciones del tracto urinario y sensibilidad de los uropatógenos a los antimicrobianos / The etiology of urinary tract infections and the antimicrobial susceptibility of urinary pathogens

El tratamiento antibiótico de la infección urinaria en el adulto se realiza habitualmente de forma empírica, siendo excepcional la realizaciónde urocultivo. La elección del antibiótico se sustenta en los resultados de las series de casos publicadas (urocultivos positivos), de las que seextrae el perfil etiológico más probable y la sensibilidad esperada. Presentamos los resultados de los estudios publicados en los últimos años,detallando las diferencias en función de la procedencia y características de los pacientes, y su tendencia temporal. En las infecciones urinariasde vías bajas sin factores de riesgo el tratamiento debe cubrir fundamentalmente Escherichia coli. Sin embargo, en las infecciones urinariascomplicadas o con factores de riesgo la información clínico-epidemiológica disponible no permite la elección empírica segura en ausenciade urocultivo. Asimismo, llama la atención el descenso de la sensibilidad de E. coli a diversos antibióticos, con grandes variacionesgeográficas; el descenso de actividad de las fluoroquinolonas podría comprometer en un futuro su uso empírico

Antibiotic treatment of urinary tract infections in adults is usually empirical, and use of urine culture is an exception. The choice of antibioticis normally made based on the results of published case studies (positive urine cultures), which are used to determine the most probableetiology and likely antimicrobial susceptibility. The results of studies published in recent years were reviewed, detailing the differences in relationto the place of residence and characteristics of the patients, and any temporary trends. In lower urinary tract infections in patients withoutrisk factors, treatment must mainly cover Escherichia coli. Nevertheless, in complicated urinary tract infections or in patients with riskfactors, the available clinical epidemiological data do not provide for safe empirical choice of antibiotic without the use of urine culture. Therehas been a reduction in the susceptibility of E. coli to various antibiotics, and this shows wide geographic variations; the reduction in theactivit  fluoroquinolones could limit its empirical use in the future

La infección por el VIH/sida y atención primaria / HIV/AIDS infection and primary care

No disponible

[Appropriateness of treatment of acute pharyngotonsillitis according to the scientific evidence]. / Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica.

OBJECTIVE: To evaluate the appropriateness of antibiotic prescriptions in children with acute pharyngotonsillitis. METHODS: A descriptive study was performed in a series of pediatric patients diagnosed with acute pharyngotonsillitis in the emergency rooms of 11 Spanish hospitals. The appropriateness of antibiotic prescriptions was assessed by comparing our clinical practice in the use of antibiotics for pharyngotonsillitis with consensus guidelines developed for this study. RESULTS: We collected data from 1716 patients with acute pharyngotonsillitis. Antibiotics were prescribed in 80.9 %, mainly according to empirical criteria. The most commonly used antibiotics were amoxicillin (36 %), amoxicillin-clavulanate (22.5 %), cefixime (6.6 %), azithromycin (5.8 %) and cefuroxime (5.2 %). A total of 39.5 % of the patients were aged less than 3 years, of which 75.9 % were treated empirically. Of the prescribed treatments, 22.8 % were considered as the treatment of choice; 22.4 % as alternatives and 54.8 % as inappropriate. CONCLUSIONS: Antibiotic treatment was prescribed in most of the cases of pharyngotonsillitis and nearly always according to empirical criteria. The number of antibiotic prescriptions was far higher than the expected cases of bacterial pharyngotonsillitis and, in many cases, the antibiotic prescriptions were inappropriate.

Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica / Appropriateness of treatment of acute pharyngotonsillitis according to the scientific evidence

Objetivos Analizar la idoneidad de los hábitos de prescripción de antibióticos en los pacientes pediátricos diagnosticados de faringoamigdalitis aguda. Métodos: Estudio descriptivo de una serie de pacientes pediátricos diagnosticados de faringoamigdalitis aguda en los servicios de urgencias de 11 hospitales españoles. Estudio de idoneidad mediante la elaboración de estándares de referencia de uso apropiado y comparación de los datos del estudio descriptivo con tales estándares. Resultados Se revisan 1.716 casos diagnosticados de faringoamigdalitis aguda. En el 80,9 por ciento de ellas se prescribieron antibióticos, en su mayoría siguiendo criterios empíricos. Los antibióticos más empleados fueron: amoxicilina (36,0 por ciento), amoxicilina-ácido clavulánico (22,5 por ciento), cefixima (6,6 por ciento), azitromicina (5,8 por ciento) y cefuroxima (5,2 por ciento). El 39,5 por ciento correspondían a menores de 3 años, de los que el 75,9 por ciento recibieron tratamiento empírico. El 22,8 por ciento de las prescripciones se clasificaron como de primera elección, el 22,4 por ciento de uso alternativo y el 54,8 por ciento inapropiadas. Conclusiones En la mayoría de las faringoamigalitis se prescribió tratamiento antibiótico y en casi todos los casos se hizo de forma empírica. Además de la prescripción de antibióticos, en una proporción muy superior a la prevista de amigdalitis bacterianas, en un número no despreciable de casos se indicaron otros antibióticos diferentes a los considerados idóneos para esta enfermedad. (AU)

[Antibiotic prescription in acute respiratory infections in adults: its variability and appropriateness in 10 Spanish hospitals]. / Prescripción antibiótica en las infecciones respiratorias agudas del adulto: su variabilidad e idoneidad en diez hospitales españoles.

OBJECTIVE: To report the variability in antibiotic prescribing habits for patients diagnosed of non-specified acute respiratory infections (ARI) (according to the International Classification of Diseases 9MC) at Emergency Departments of ten Spanish hospitals, and to evaluate the appropriateness of antimicrobial prescription for such patients, after specifically elaborating some reference patterns for appropriate antimicrobial use. DESIGN: Descriptive study of variability in clinical practice by means of a prospective series of cases. Study of appropriateness by means of elaborating reference standards for appropriate use and comparison with the data from the descriptive study with such standards. DURATION: six months. SETTING: Emergency Department in ten Spanish hospitals from different autonomic communities: Andalucía, Islas Canarias, Castilla-León, Cataluña, Galicia, Madrid, Murcia and Valencia for a 6-month period. PATIENTS: Patients with the diagnosis of community ARI attended at emergency departments. SAMPLE SIZE: 903 cases. INTERVENTIONS: Collection of cases in a unified database with the following variables: age, sex, ARI type, diagnosis of comorbidity, prescribed antimicrobial, hospital admission and type of prescriber. A panel of experts was commissioned to elaborate the gold standards for the appropriate use of antibiotics or the lack of indication for the different locations of ARI. RESULTS: The adjusted proportion of the inappropriate prescription for the group with laryngo-tracheal-influenza-rhinopharyngitis-multiple ARI or non specified infections was 67.9%. CONCLUSIONS: Concerning antibiotic prescription, significant inter-center variability and relevant heterogeneity were observed.

Surgical treatment of the acute cholecystitis in the laparoscopic age. A comparative study: laparoscopy against laparatomy.

OBJECTIVE: The aim of this study was to assess the complications and results of the laparoscopic opposite to open treatment of the acute cholecystitis. METHODS: A retrospective randomized study with two groups of 30 patients each one. The parameters tested were age, sex, risk factors, surgical time, hospital stay, cholecystitis type, and early or late complications. RESULTS: In the two groups there were no significant differences in age, sex, risk factors, type of cholecystitis and surgical time. The average of hospital stay was significantly longer for open cholecystectomy (9.5) than for laparoscopic technique (2.30) (p < 0.001). The complication rate was higher (7.30%) in open cholecystectomy. CONCLUSIONS: The laparoscopic cholecystectomy should be the standard procedure for the treatment of the acute cholecystitis.

Vertical ring gastroplasty (VRG) in the treatment of the serious clinical obesity. Results and complications.

OBJECTIVE: The morbid obesity is a serious polysystematic disease to which it is necessary to offer a surgical solution when the conservative alternatives fail. METHODS: In a period of five years, 50 patients with vertical ring gastroplasty (VRG) have been evaluated and protocolized in the program of surgery of the morbid obesity, with an average weight of 134.3 kg corresponding to an overweight and body mass index (BMI) average respectively, of 69.7 kg and 49.8 kg/m2. RESULTS: The early morbidity has been scarce and the postoperative average stay of 7 days. The decrease of the percentage of weight, overweight and BMI was maximum 2 years later, with losses of 52 kg, with a percentage of loss of average overweight of 76.8% and a fall of 21 points in the BMI; however there was a partial recovery of the indexes in the following years. The accompanying pathology was solved in the period of studied time, although 84% of the patients referred vomits and practically 100% dietary limitations. CONCLUSIONS: The gastroplasty is a quick, simple technique and of scare morbimortality, although it is being subjected to criticism for the restrictions in the diet, quality of life and disruptions of the line of clamped. However, nowadays there is not a consensus on the ideal bariatric solution, and as a surgical alternative, the vertical gastroplasty can represent one of the techniques of choice for certain selected types of serious obesity.