Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement. / Desarrollo de criterios de uso adecuado para la artroscopia de cadera en pacientes con choque femoroacetabular.

INTRODUCTION: The use of hip arthroscopy as a treatment for femoroacetabular impingement (FAI) has increased exponentially in recent years without robust evidence or consensus about the patients who benefit from it. OBJECTIVE: To develop explicit criteria for the appropriate indication of hip arthroscopy in FAI. METHOD: A panel of experts was formed with 11 traumatologists following the RAND/UCLA method to identify the appropriateness criteria for hip arthroscopy in patients with FAI. The panel made independent evaluations of each indication using a nine-point adequacy scale, then met face-to-face to vote using an iterative discussion process. The influence of the variables on the final score was studied using multinomial logistic regression models. The Classification and Regression Tree (CART) analysis was used to summarize the results in the form of decision trees. RESULTS: Twenty-three point four percent of the 192 scenarios evaluated in the face-to-face meeting was considered appropriate (40% agreement), 26.6% uncertain and 50% inappropriate (75% agreement). The most influential variables in considering the use of arthroscopy appropriate were: joint symptoms compatible with shock test, duration of symptoms, functionality, age and Hip Outcome Score (HOS) scale. CONCLUSIONS: We developed an explicit set of criteria for the appropriate use of hip arthroscopy in FAI using the RAND/UCLA method, providing a tool that would identify patients who are potential candidates for surgical treatment using arthroscopic hip surgery.

Incidence of tuberculosis in HIV-infected patients in Spain: the impact of treatment for LTBI.

SETTING: Twenty hospitals in Spain. OBJECTIVE: To describe the incidence of active tuberculosis (TB) and factors related to TB development after treatment for latent tuberculous infection (TLTBI) in human immunodeficiency virus-1 (HIV-1) infected patients in the highly active antiretroviral therapy era. DESIGN: In a multicentre cohort of HIV-1-infected patients, we calculated TB incidence by tuberculin skin test (TST) results and TLTBI, and factors associated with a positive TST and the development of TB after TLTBI. RESULTS: Of 7902 patients, 6.5% had a history of TB at enrolment: 168 patients developed TB during 10,889 person-years (py) of follow-up, corresponding to an incidence rate of 1.54 cases per 100 py (95%CI 1.33-1.80). TB incidence in TST-positive patients who did not receive TLTBI was three times higher (6 cases/100 py) than in those who did (1.75 cases/100 py). In patients who received TLTBI, risk of development of TB was higher among cases aged <35 years (HR 6.14, 95%CI 1.12-33.73) and in those with a nadir CD4(+) cell count of <200 cells/µl (HR 5.64, 95%CI 1.34-23.70). CONCLUSIONS: TLTBI is effective in preventing the development of TB in HIV-infected patients, particularly in those who were TST-positive.

Evaluación del uso adecuado de la laparoscopia hepatobiliar en la colelitiasis sintomática / Assessing the appropriate use of hepatobiliary laparoscopy in symptomatic chol elithiasis

ANTECEDENTES. La colelitiasis es una de las patologías más frecuentes del tubo digestivo. A pesar de los ensayos clínicos realizados que comparan las técnicas de colecistectomía abierta o laparoscópica, falta una lista de indicaciones para los diferentes perfiles de pacientes. Desde la introducción de la cirugía laparoscópica se ha abierto un amplio abanico de indicaciones para este procedimiento. El objetivo de este estudio fue desarrollar estándares de uso adecuado de la cirugía laparoscópica en pacientes con colelitiasis. MÉTODO. Se siguió el método RAND para elaborar criterios de uso adecuado de la laparoscopia hepatobiliar en la colelitiasis sintomática. Un panel de 7 expertos puntuó el grado de uso adecuado de cada indicación en una escala de 1 (muy inadecuado) a 9 (muy adecuado). Las puntuaciones se realizaron dos veces, en la primera ronda, de forma independiente por cada experto, y en la segunda ronda, durante una reunión presencial. Según la mediana de las puntuaciones de los panelistas y su nivel de acuerdo, cada indicación se clasificó como adecuada, dudosa o inadecuada. RESULTADOS. Los expertos señalaron que para la cirugía laparotómica, 2 indicaciones (12,5%) fueron consideradas adecuadas, 12 (75%) dudosas y 2 (12,5%) inadecuadas; mientras que para la cirugía laparoscópica, 9 indicaciones (56,25%) fueron consideradas adecuadas, 3 (18,75%) dudosas y 4 (25%) inadecuadas. CONCLUSIONES. Todavía hay incertidumbre con respecto a la gestión de la colelitiasis, mostrando la necesidad de una mayor investigación. La metodología RAM ayuda a dilucidar la adecuación de las diferentes opciones de tratamiento en situaciones clínicas específicas (AU)

BACKGROUND. Cholelithiasis is one of the most common diseases of the digestive tract. Despite clinical trials comparing the techniques of laparotomy or laparoscopic cholecystectomy, there is a lack of a list of indications for different patient profiles. Since the introduction of laparoscopic surgery, a wide range of indications for this procedure have been started. The aim ofthis study was to develop standards for the appropriate use of laparoscopic surgery in patients with cholelithiasis. METHOD. We conducted a study following the RAND appropriateness method (RAM) to develop criteria for hepatobiliary laparoscopy in symptomatic cholelithiasis. A panel comprised of 7 experts rated the appropriateness of a set of indications, from 1 (very inappropriate) to 9 (very appropriate). The panelists performed ratings in 2 rounds. The first round was performed independently by every expert. The second round took place during a face-to-face meeting. According to the median ratings and agreement criteria, every indication was classified as appropriate, uncertain, or inappropriate. RESULTS. The experts indicated that for the laparotomy surgery, 2 (12.5%) indications were judged as appropriate, 12 (75%) as uncertain, and 2 (12.5%) as inappropriate; while for laparoscopic surgery, 9 indications (56.25%) were considered as appropriate, 3 (18.75%) as uncertain, and 4 (25%) as inappropriate CONCLUSIONS. There is still uncertainty with respect to the management of cholelithiasis, showing the necessity of further investigation. The RAM helps to elucidate appropriateness for the different treatment options in specific clinical settings (AU)

Los informes de alta hospitalaria médica pueden ser una fuente insuficiente de información para evaluar la calidad de la asistencia / Hospital discharge reports may be an inadequate source of information to evaluate care quality

Objetivos. Examinar si en los informes médicos de alta hospitalaria (IMAH) hay disponible suficiente información para evaluar retrospectivamente la adecuación de la asistencia a pacientes con cardiopatía isquémica (CI), así como para relacionar la calidad con las decisiones de los médicos.Material y métodos. Estudio transversal en el que se evalúan 690 IMAH de pacientes ingresados por cardiopatía isquémica en tres hospitales universitarios de Sevilla. Se estimó la cumplimentación de 15 variables que representaban una adaptación de la normativa del conjunto mínimo básico de datos (CMBD) a la CI. El criterio de suficiencia de información se fijó en el 80 por ciento de los datos.Resultados. Sólo el 2,8 por ciento de los IMAH disponen de suficiente información. Se observa una importante variabilidad en la cumplimentación según el tipo de dato analizado. Hay diferencias significativas en la cumplimentación dependiendo del hospital y el tipo de enfermo, con mayor información en hombres de menor edad y comorbilidad. Conclusiones. El IMAH contiene poca información para evaluar la asistencia médica (AU)

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[Oral health of school children in Ceuta. Influences of age, sex, ethnic background and socioeconomic level]. / Salud oral de los escolares de Ceuta. Influencias de la edad, el género, la etnia y el nivel socioeconómico.

BACKGROUND: The objective of this study is that of gauging the prevalence of dental caries, periodontal disease and malocclusion among the school-age population of Ceuta and the spread thereof by age, sex, ethnic background and father's occupation. METHODS: Prevalence survey of a multistage, stratified, random sample of schoolchildren 7, 12 and 14 years of age (n = 347) in order to calculate DMFT and dmft indexes--permanent and deciduous dentition--, CPITN and malocclusion. Assessment of the statistical significance of the differences encountered according to age, sex, ethnic background and socioeconomic status using the Chi-Square, Student T and Snedecor F tests. To calculate, among schoolchildren ages 12 and 14, the odds ratios of showing a DMFT index over 4 and their 95% confidence intervals by gender, ethnic background and the socioeconomic status. RESULTS: Dmft (decayed, filled and missing teeth) was 3.02 at 7 and DMFT was 3.91 at 12 and 4.46 at 14. Odds ratios of DMFT > 4 were 2.26 by gender (95% CI = 1.27-4.05), 2.17 by ethnic group (95% CI = 1.18-3.99) and 1.8 by SES (95% CI = 0.85-3.81). In schoolchildren of low SES--unemployed father's--OR by ethnic group was 1.37 (95% CI = 0.28-7.0). No statistically significant differences were found in the distribution of malocclusion and periodontal disease--except by age. CONCLUSIONS: Dmft and DMFT values are in Ceuta higher than the mean national values and the proposed value of the WHO for the year 2000. Risk of DMFT higher than the median is 2.3 in girls compared with boys, 2.17 in Moslem compared with non Moslem and 1.8 in low SES schoolchildren--unemployed father's--compared to other SES schoolchildren. The increased risk related to ethnic background is influenced by SES.

[Hospital discharge reports may be an inadequate source of information to evaluate care quality]. / Los informes de alta hospitalaria médica pueden ser una fuente insuficiente de información para evaluar la calidad de la asistencia.

OBJECTIVES: To examine whether there is adequate available information in hospital discharge records (HDR) to retrospectively evaluate the adequacy of medical care to patients suffering from ischemic heart disease (IHD) and to relate care quality to physicians' decisions. MATERIAL AND METHODS: Cross-sectional study in which a total of 690 HDRs of patients admitted to three university teaching hospitals in Seville, Spain, on account of ischemic heart disease. The fulfillment of 15 parameters representing an adaptation to the CMBD regulation to IHD. The criterion of adequate information was set at 80% of data. RESULTS: Only 2.8% of HDRs contains adequate information. According to the analysed data, relevant fulfillment variability was observed. There were significant differences in fulfillment depending upon hospital and type of patient, with more information among younger patients and comorbidity. CONCLUSIONS: HDRs contain inadequate information to evaluate medical care.

[Medical history in the assessment of quality of care in ischemic cardiopathy: is it a valid information source?]. / La historia clínica en la evaluación de la calidad asistencial de la cardiopatía isquémica: es una fuente de información válida?

OBJECTIVE: To examine the availability of information in the clinical records (CR) to evaluate care quality in ischemic heart disease. MATERIAL AND METHODS: A total of 722 clinical records of patients admitted because of ischemic heart disease were evaluated. Based upon a bibliographic review and the criteria of an expert panel necessary data to evaluate care quality were selected. A CR was considered adequate when at least 80% of data considered necessary by the expert panel were available. RESULTS: 78.5% of CR had adequate data. The elderly, clinical presentation as ischemic equivalent and one of the hospitals studied had most deficient CR. CONCLUSIONS: The CR is valid to retrospectively evaluate medical care. Differences between hospitals were important and should be taken into consideration before studies on clinical quality are performed.

[A reproducibility and validity study of a systematic review on ischemic cardiopathy. The Study Group of the Quality of Care (GRECA)]. / Estudio de la reproducibilidad y validez de una revisión sistemática sobre cardiopatía isquémica. Grupo de Estudio de la Calidad Asistencial (GRECA).

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.

[Interprovincial variations in mortality from cancer: factorial and cluster analyses]. / Variaciones interprovinciales en la mortalidad por cáncer: análisis factorial y de clusters.

Cancer mortality rates among males, for sixteen sites in the fifty Spanish provinces were analyzed using two data reduction techniques, factor and cluster analysis. Five independent underlying factors were identified by factor analysis which appear to influence cancer mortality patterns. Cluster analysis aggregated provinces into different groups using these factor scores as the clustering criteria. Each of the groups thus defined a distinctive profile of site-specific cancer mortality rates.

[Ischemic heart disease, neoplasms and risk factors: ecological correlation]. / Cardiopatía isquémica, neoplasias y factores de riesgo: correlación ecológica.

In this paper, correlations between ischaemic heart disease and several cancers associated with cigarette smoking are examined. Also, tobacco consumption data are correlated against ischaemic heart disease mortality incidence rates. Furthermore, correlations between ischaemic heart disease incidences and per capita consumption of fattening foods (meat, milk and eggs) are analyzed. In this work, results referring to Spain, and at an ecologic level, confirm conclusions of observational and experimental studies carried out in other countries, which points out a strong association between ischaemic heart disease, cigarette consumption and fattening diet.