Revista clinica espanola最新文献_第4页

E-consulta entre Atención Primaria y Medicina Interna: implementación, accesibilidad, beneficios e implicaciones 初级保健和内科之间的电子会诊：实施、可及性、益处和影响

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.003

F.J. Suárez-Dono , C. Martínez-Rey , J. Novo-Platas , C. Fernández Peña , M.L. Rodríguez Méndez , A. Pérez Iglesias , E. Casariego-Vales

Aim

This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine.

Methods

This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed.

Results

A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15 to 102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5,645 patients (49.4%) were given an in-person appointment. For the remaining 5,789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (p < 0.0001), visited the emergency department more times (one month: p = 0.04; three months: p = 0.001), were admitted to the hospital more times (one month: p = 0.0001; three months: p = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% p = 0.0001). On the Cox analysis, only in-person appointments (RR = 1.11; p = 0.04) and age (RR = 1.09; p < 0.01) were independent factors of mortality. No complaints or claims of any kind were registered.

Conclusions

These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.

目的这项工作旨在评估电子会诊（e-consults）是否是在初级保健和内科之间评估患者的一种临床有用、安全的工具。方法这是一项回顾性队列研究，研究对象是2019年9月至2023年12月期间初级保健科向内科下达的所有电子会诊。结果共记录了 11,434 次电子会诊（55.4% 为女性），平均年龄为 62.1 岁（SD19.4），年龄跨度较大（15 至 102 岁）。平均回复时间为 2.55 天（标准差 1.6 天）。通过电子会诊，5,645 名患者（49.4%）获得了面诊预约。其余 5789 名患者（50.6%）获得了书面回复。在获得预约的患者中，从回复到面诊之间的时间不到五天（95% 的病例）。与未获得预约的患者相比，亲自预约的患者年龄更大（p <0.0001），去急诊科就诊的次数更多（一个月：p = 0.04；三个月：p = 0.001），入院治疗的次数更多（一个月：p = 0.0001；三个月：p = 0.0001），一年后的死亡率更高（12.7% 对 9.8% p = 0.0001）。在 Cox 分析中，只有亲自预约（RR = 1.11；P = 0.04）和年龄（RR = 1.09；P < 0.01）是影响死亡率的独立因素。结论这些数据表明，电子会诊是一种临床实用、安全的工具，可用于评估从初级保健转诊到内科的患者。

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引用次数: 0

Utilidad del 18F-FDG-PET/TC en la detección de vasculitis de gran vaso extracraneal en pacientes con polimialgia reumática o arteritis de células gigantes: revisión sistemática y metaanálisis 18F-FDG-PET/CT在检测多发性风湿痛或巨细胞动脉炎患者颅外大血管炎中的作用：系统综述和荟萃分析。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.04.016

A. González-García , M. Fabregate , G. Serralta , B. de Miguel Campo , A. Noblejas Mozo , Á. Robles-Marhuenda , en representación de la Sección de Autoinmunes de la Sociedad de Medicina Interna Madrid-Castilla La Mancha

Objective

Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using ¹⁸F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA).

Materials and methods

PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I² statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and ¹⁸F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test.

Results

268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial VGV by ¹⁸F-FDG PET/CT was 54.5% [95% CI: 42.6% to 66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, P= .006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial VGV (61.1% vs. 46.9%; P= .010). No publication bias was observed.

Conclusions

The ¹⁸F-FDGPET/CT test may be useful in the detection of extracranial VGV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.

目的系统回顾目前的证据，利用 18F-FDG PET/CT 分析多发性风湿痛（PMR）或巨细胞动脉炎（GCA）患者颅外大血管炎（LVV）的患病率。研究质量采用修订版纽卡斯尔-渥太华量表进行评估。研究之间的异质性采用 I2 统计量和 Q 检验进行评估。根据疾病类型、研究质量和 18F-FDG PET/CT 摄取标准进行了进一步的亚组分析。通过漏斗图和 Egger 检验对发表偏倚进行了评估。结果共发现 268 篇文献，其中 17 篇符合筛选标准，被纳入荟萃分析。通过18F-FDG PET/CT汇总的颅外VGV总患病率为54.5%[95% CI：42.6%至66.1%]。GCA患者的患病率明显高于PMR患者（60.1%对41.8%，P= .006）。同样，偏倚风险较低的研究报告了较高的颅外VGV患病率（61.1% vs. 46.9%；P= .010）。结论18F-FDGPET/CT检查可用于检测颅外VGV，无论是PMR患者还是GCA患者。这种累及在 GCA 患者中更为常见，而且可能因研究质量而异。

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引用次数: 0

Tratamiento anticoagulante oral en la fibrilación auricular: AFIRMA, el estudio de vida real realizado mediante procesamiento de lenguaje natural y aprendizaje automático 心房颤动的口服抗凝疗法：AFFIRM，利用自然语言处理和机器学习进行的真实生活研究

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.005

J. Cosín-Sales , M. Anguita , C. Suárez , C. Arias-Cabrales , L. Martínez-Sanchez , S.R. group , D. Arumi , S. Fernández de Cabo

Introduction

Oral anticoagulation (OAC) is key in atrial fibrillation (AF) thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).

Materials and methods

This retrospective study included AF patients on OAC from 15 Spanish hospitals (2014-2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.

Results

Among 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy were included, 80.7% receiving Vitamin K antagonists (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA₂DS₂-VASc score. The most frequent treatment switch was from DOAC to acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, apixaban was the most chosen (35.2%).

Conclusions

Utilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.

导言口服抗凝药（OAC）是心房颤动（AF）血栓预防的关键，但西班牙缺乏大量的实际证据。我们旨在利用自然语言处理（NLP）和机器学习（ML）分析接受 OAC 的房颤患者的患病率、临床特征和治疗模式。我们使用 EHRead®（包括 NLP 和 ML）和 SNOMED_CT，从电子健康记录中提取并分析了患者的人口统计学特征、合并症和 OAC 治疗。结果在我们队列中的 4,664,224 名患者中，房颤患病率介于 1.9% 到 2.9% 之间。共纳入了 57190 名接受 OAC 治疗的患者，其中 80.7% 接受维生素 K 拮抗剂 (VKA)，19.3% 接受直接作用 OAC (DOAC)。中位年龄分别为 78 岁和 76 岁，男性占 53%。高血压（76.3%）、糖尿病（48.0%）、心力衰竭（42.2%）和肾病（18.7%）等并发症很常见，在 VKA 使用者中更为常见。超过 50% 的患者 CHA2DS2-VASc 评分较高。最常见的治疗转换是从 DOAC 到醋硝香豆素（58.6% 到 70.2%）。结论利用 NLP 和 ML 提取 RWD，我们建立了迄今为止最全面的使用 OAC 的房颤患者西班牙队列。分析表明，房颤患病率高、患者病情复杂，且患者明显偏好 VKA 而非 DOAC。重要的是，在 VKA 向 DOAC 过渡时，阿哌沙班是首选。

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引用次数: 0

Valor de la ecografía multimodal en la evaluación de la sarcopenia en pacientes en hemodiálisis de mantenimiento 多模态超声波在评估维持性血液透析患者肌少症中的价值。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.004

X. Zhang, Y. Yang

Introduction

Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients.

Methods

MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients.

Results

The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511 - 0.121 * MT - 0.609 * CSA - 0.172 * PA + 0.011 * EI - 2.205 * MV (p < 0.05), with a cut-off value of 0.69.

Conclusions

Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.

引言肌肉疏松症是维持性血液透析（MHD）患者常见的并发症之一，与预后不良有关。我们旨在研究超声波在评估血液透析患者肌肉疏松症中的有效性和可靠性。方法根据亚洲肌肉疏松症工作组（AWGS）2019 年的诊断标准，将血液透析患者分为肌肉疏松症组和非肌肉疏松症组。对MHD患者和健康对照组的腓肠肌左内侧头进行超声检查，以获得肌肉厚度（MT）、羽状角（PA）、筋膜长度（FL）、横截面积（CSA）、回声强度（EI）、弹性模量（E）、剪切波速度（SWV）和微血管速度（MV）。结果肌肉疏松症组的 MT、CSA、PA 和 MV 均低于非肌肉疏松症组和对照组；而 EI 较高，肌肉疏松症组的 FL 低于非肌肉疏松症组，肌肉疏松症组的 E 和 SWV 则高于对照组。接收器操作特征曲线分析表明，超声综合指数具有良好的诊断价值，模型 Y = 13.511 - 0.121 * MT - 0.609 * CSA - 0.172 * PA + 0.011 * EI - 2.205 * MV (p < 0.05)，临界值为 0.69。结论多模态超声是一种安全、无创、实时的成像检查方法，可提供肌肉结构、僵硬度和灌注信息，有望成为预测 MHD 患者肌肉疏松症的潜在工具。

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引用次数: 0

El internista joven a la vanguardia de la investigación clínica 走在临床研究前沿的年轻内科医生

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.002

F. Pérez-Jiménez , P. Pérez-Martínez

引用次数: 0

Determinantes sociales de la salud y su impacto en la medicina interna 健康的社会决定因素及其对内科医学的影响

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-06-01 DOI: 10.1016/j.rce.2024.04.013

M. Montserrat Chimeno Viñas , P. Pérez-Martínez

引用次数: 0

Asociación entre los niveles séricos de α-Klotho y la prevalencia de osteoartritis entre adultos de mediana edad y mayores: un análisis de la National Health and Nutrition Examination Survey 2007-2016 血清 α-Klotho 水平与中老年人骨关节炎患病率之间的关系：对 2007-2016 年全国健康与营养调查的分析

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-06-01 DOI: 10.1016/j.rce.2024.04.007

Q. Xu , J. Wang , H. Li , Y. Gao

Background

As individuals age, the prevalence of osteoarthritis tends to increase gradually. α-Klotho is a hormone renowned for its anti-aging properties. However, the precise role of serum α-Klotho in osteoarthritis is still not fully comprehended.

Methods

We conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. Serum α-Klotho levels were measured using an enzyme-linked immunosorbent assay (ELISA). Osteoarthritis was assessed through self-reported questionnaires. Through univariate and multivariate logistic regression analyses, smooth curve fitting, threshold effect analysis, and subgroup analyses, we delved into the potential association between them.

Results

The study encompassed a cohort of 10,265 participants. In fully adjusted models of multivariate logistic regression analysis, we identified a negative correlation between serum ln α-Klotho and OA (OR = 0.77, 95% CI: 0.65-0.91, p = 0.003). When stratifying serum α-Klotho levels into tertiles, individuals in the highest tertile exhibited a 26% reduced risk of OA compared to those in the lowest tertile (OR = 0.84, 95% CI: 0.73-0.97, p = 0.014). Subsequent analyses indicated a linearly negative association. In subgroup analyses, we explored the relationship between serum ln α-Klotho and osteoarthritis across diverse populations, revealing the persistence of this association in the majority of subgroups.

Conclusion

Serum α-Klotho levels exhibit a significant negative linear correlation with the prevalence of osteoarthritis in middle-aged and elderly populations in the United States.

背景随着年龄的增长，骨关节炎的发病率呈逐渐上升趋势。然而，血清中的α-Klotho在骨关节炎中的确切作用仍未得到充分了解。方法我们利用美国国家健康与营养调查（NHANES）2007年至2016年的数据进行了一项横断面研究。使用酶联免疫吸附测定法（ELISA）测量血清中的α-Klotho水平。骨关节炎通过自我报告问卷进行评估。通过单变量和多变量逻辑回归分析、平滑曲线拟合、阈值效应分析和亚组分析，我们深入研究了它们之间的潜在关联。在多变量逻辑回归分析的完全调整模型中，我们发现血清 ln α-Klotho 与 OA 之间存在负相关（OR = 0.77，95% CI：0.65-0.91，p = 0.003）。将血清α-Klotho水平分为三等分时，与最低三等分的人相比，最高三等分的人患OA的风险降低了26%（OR = 0.84，95% CI：0.73-0.97，p = 0.014）。随后的分析表明两者呈线性负相关。在亚组分析中，我们探讨了不同人群中血清 ln α-Klotho 与骨关节炎之间的关系，结果表明这种关联在大多数亚组中持续存在。

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引用次数: 0

Tiempo dedicado a la actividad física entre los residentes médicos: ¿existen diferencias basadas en el género o el tipo de especialidad? 医学住院医师用于体育活动的时间：性别或专业类型是否存在差异？

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-06-01 DOI: 10.1016/j.rce.2024.04.009

O. Pujol , L. Vila-Castillo , C. Álvaro , M. Aguilar , N. Joshi , J. Minguell

Introduction

Physical activity (PA) is associated with positive health outcomes such as prevention of chronic diseases, psychological well-being and improved work performance. Medical residents are subjected to sleep deprivation, extended work schedule and high burnout prevalence. These conditions may lead to the neglect of personal health and the restriction of time dedicated to PA. The objective of the present study was to analyze the time dedicated to PA of medical residents, comparing women vs men residents and surgical vs clinical residents.

Methods

It is a cross-sectional study performed in a Spanish third-level university hospital. All medical residents from our institution were invited to voluntarily participate in the study answering a web-based questionnaire on June 2022. Data regarding demographics, residency and PA practice was recorded.

Results

The response rate was 20.73% (114/550). The 32.5% of the residents considered themselves to be physically inactive and mean time dedicated to PA in a regular week was 3.62 ± 2.22 hours. Men residents dedicated more time to PA than women residents (4.23 ± 2.42 hours vs 3.14 ± 1.95 hours, p = 0.012) and surgical residents dedicated more time than clinical residents (4.33 ± 2.36 hours vs 3.23 ± 2.05 hours, p = 0.01).

Conclusions

One third of the medical residents consider themself physically inactive. Women and clinical residents practice PA less time than men and surgical residents. Efforts should be made to encourage PA among residents, especially in women and non-surgeons.

导言体力活动（PA）与积极的健康结果相关，如预防慢性疾病、心理健康和提高工作绩效。医学住院医师睡眠不足、工作时间长、职业倦怠率高。这些情况可能会导致住院医师忽视个人健康，并限制其用于体育锻炼的时间。本研究的目的是分析医学住院医师的个人防护时间，比较女性住院医师与男性住院医师、外科住院医师与临床住院医师的个人防护时间。我院邀请所有住院医师自愿参与研究，并于 2022 年 6 月回答了一份网络问卷。结果回复率为 20.73%（114/550）。32.5%的住院医师认为自己不爱运动，每周用于运动疗法的平均时间为（3.62 ± 2.22）小时。男性住院医师比女性住院医师（4.23 ± 2.42 小时 vs 3.14 ± 1.95 小时，P = 0.012）花费更多时间进行体育锻炼，外科住院医师比临床住院医师（4.33 ± 2.36 小时 vs 3.23 ± 2.05 小时，P = 0.01）花费更多时间进行体育锻炼。女性和临床住院医师进行体育锻炼的时间少于男性和外科住院医师。应努力鼓励住院医师（尤其是女性和非外科医生）进行体育锻炼。

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引用次数: 0

Carta al editor sobre el artículo «Resumen ejecutivo del documento de consenso sobre el manejo de la anemia perioperatoria en España» 就文章 "西班牙围手术期贫血管理共识文件执行摘要 "致编辑的信。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-06-01 DOI: 10.1016/j.rce.2024.04.011

F.J. Teigell Muñoz, M. Mateos González

引用次数: 0

Rendimiento comparativo del exudado vulvovaginal frente al endocervical para la detección de Chlamydia, Gonorrhea, Mycoplasma genitalium y Tricomoniasis: un estudio transversal en España 外阴阴道拭子与宫颈内膜拭子在检测衣原体、淋病、生殖器支原体和滴虫病方面的性能比较：西班牙的一项横断面研究。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-06-01 DOI: 10.1016/j.rce.2024.04.014

M. Linares-Rufo , P. Galicia , A. Rojas , Á.M. Benito , J. Cuadros-González , J.M. Ramos-Rincón

Introduction

The global increase in sexual transmitted infections (STI) makes it necessary to seek public health strategies that facilitate rapid and minimally invasive diagnosis. The objective was to evaluate the concordance between vaginal and endocervical samples for STI diagnosis.

Materials and methods

A retrospective cross-sectional study was carried out on vaginal and endocervical samples from women attended in our reference area with symptoms suggestive of vulvovaginitis or for STI screening during the study period.

Results

A total of 130 paired samples were analyzed; fifty-seven and 59 samples were positive for vaginal and endocervical specimens (Kappa index of 0.969 (Standard error = 0.022). The sensitivity of the vaginal samples was 96.5% (IC95%: 87.2-99.4), with a specificity of 100% (IC95%: 93.0-100).

Discussion

The introduction of STI screening in vaginal samples in our environment can facilitate rapid and effective diagnosis and allow early treatment of STI. Additionally, it facilitates sample collection and diagnosis in the community setting, essential for optimal screening.

导言性传播感染（STI）在全球范围内呈上升趋势，因此有必要寻求有利于快速和微创诊断的公共卫生策略。本研究旨在评估阴道样本和宫颈内膜样本在性传播感染诊断中的一致性。材料与方法本研究对研究期间在我们的参照区就诊的、有外阴阴道炎症状或接受性传播感染筛查的妇女的阴道样本和宫颈内膜样本进行了回顾性横断面研究。阴道样本的灵敏度为 96.5%（IC95%：87.2-99.4），特异性为 100%（IC95%：93.0-100）。此外，它还有助于在社区环境中进行样本采集和诊断，这对优化筛查至关重要。

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引用次数: 0