Revista clinica espanola最新文献

英文中文

Objeción de conciencia a la prestación de ayuda para morir: conocimientos, actitudes y prácticas en atención primaria 出于良心反对提供协助死亡：初级保健中的知识、态度和做法

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-04 DOI: 10.1016/j.rce.2025.502329

R. Triviño-Caballero , J. Franco , L. Sordo

Background/objective

The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.

Materials and methods

Cross-sectional knowledge, attitudes, and practices model study. A total of 434 active general practitioners working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.

Results

Of the general practitioners surveyed, 46.3% practised in Madrid; 75.2% were women, with an average age of 47; 84.8% had received training in bioethics; 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices; 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR = 2.98; 95% CI 1.16-5.34), those with religious beliefs (aOR = 5.23; 95% CI 2.78-9.80), and those opposed to MAID (aOR = 12.63; 95% CI 5.80-27.50).

Conclusions

The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.

背景/目的《安乐死管理法》规定了良心拒服兵役的权利。但是，几乎没有任何关于行使这种权利或反对理由的资料。本研究的目的是确定关于在初级保健中提供死亡医疗援助（MAID）的CO的知识、态度和做法，这是大多数提供医疗援助的护理水平。材料和方法横断面知识、态度和实践模型研究。通过自我填写的问卷，对在西班牙各地保健中心工作的434名在职全科医生进行了关于同性婚姻的知识、态度和做法的调查。对每个领域的回答进行了描述性分析，然后进行了多变量分析，以确定与反对或考虑这样做有关的因素。结果接受调查的全科医生中，46.3%在马德里执业；75.2%为女性，平均年龄47岁；接受过生命伦理学培训的占84.8%；54.9%的人表示知道法律，只有29%的人正确回答有关临终护理中一氧化碳的问题；35%的人反对或考虑反对。马德里执业者的反对率较高(aOR = 2.98；95% CI 1.16-5.34)，有宗教信仰的人(aOR = 5.23；95% CI 2.78-9.80)，反对MAID的患者(aOR = 12.63；95% ci 5.80-27.50)。反对的主要原因是道德和情感，尽管其他背景因素也会出现。鉴于对人们可以反对的做法的高度无知，需要改进培训和机构参与，以便负责任的做法和保证MAID。

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引用次数: 0

Comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada» 对一篇专题文章“卧床超声（POCUS）在病因不明的急性混淆综合征住院患者中的效用”的评论

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-03 DOI: 10.1016/j.rce.2025.502334

J.A. Mariz

引用次数: 0

Consenso de expertos sobre la enfermedad pulmonar intersticial asociada a enfermedades autoinmunes sistémicas. Resumen ejecutivo 关于与全身性自身免疫性疾病相关的间质性肺病的专家共识。执行摘要

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-05 DOI: 10.1016/j.rce.2025.502326

A. González-García , M. Akasbi , P. Brito-Zerón , J.L. Callejas , I. Cusacovich , F. Jiménez Segovia , M. Martín Cascón , S. Prieto-González , L. Sáez Comet , C.P. Simeón , R. Solans Laque , J.S. García Morillo , en representación del grupo de Enfermedades Autoinmunes Sistémicas (GEAS) de la Sociedad Española de Medicina Interna (SEMI)

Interstitial lung disease is a frequent and potentially fatal manifestation of systemic autoimmune diseases. Early screening, diagnosis, and treatment with immunomodulators, and in some cases, antifibrotics, as well as appropriate follow-up, are essential to improving patients’ quality of life and survival. The complexity of these diseases and the limited robust evidence to guide clinical decision-making lead to significant variability in management guidelines. In this article, a group of experts in systemic autoimmune diseases has developed recommendations for the screening, diagnosis, treatment, and follow-up of interstitial lung disease, considering the latest evidence, their clinical experience, and the results of a survey conducted among specialists. The diseases included are systemic sclerosis, Sjögren's disease, idiopathic inflammatory myopathy, ANCA-associated vasculitis, sarcoidosis and systemic lupus erythematosus.

间质性肺疾病是一种常见且可能致命的系统性自身免疫性疾病。早期筛查、诊断和免疫调节剂治疗，在某些情况下使用抗纤维化药物，以及适当的随访，对于改善患者的生活质量和生存率至关重要。这些疾病的复杂性和指导临床决策的有限有力证据导致管理指南的显著差异。在这篇文章中，一组系统性自身免疫性疾病的专家考虑到最新的证据、他们的临床经验和专家调查的结果，对间质性肺疾病的筛查、诊断、治疗和随访提出了建议。这些疾病包括系统性硬化症、Sjögren病、特发性炎性肌病、anca相关血管炎、结节病和系统性红斑狼疮。

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引用次数: 0

La contribución del PET/MRI en la diferenciación entre nódulos benignos y malignos en incidentalomas tiroideos detectados en imágenes FDG PET/CT PET/MRI对FDG PET/CT成像中发现的甲状腺结节良性和恶性的区别的贡献

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-16 DOI: 10.1016/j.rce.2025.502333

A. Nazari , S. Sager , S. Schenke , L.U. Beşli , C. Samancı , T. Öztürk , H.B. Sayman

Introduction and objectives

Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules.

Materials and methods

We selected 108 patients (72 females, 36 males; mean age 54 ± 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm². SUVmax and ADC values were correlated with FNAC results.

Results

FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 ± 8.3 vs. 5.94 ± 5.2; P<.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 ± 0.6 × 10^-3 mm²/s vs. 1.8 ± 0.4 × 10^-3 mm²/s; P<.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = −0.355). Using a cut-off value of 6 for SUVmax and 1.56 × 10^-3 mm²/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7, 73.6, and 72.1%, respectively, while for ADC, they were 71.8, 69.7, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62, 51.32, 62.96, 43.94, and 92.86%.

Conclusion

This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.

简介和目的在接受FDG PET/CT成像进行分期或治疗反应评估的肿瘤患者中经常观察到甲状腺偶发瘤。本研究旨在探讨PET/MRI测量的SUVmax和ADC值在区分良性和恶性甲状腺结节中的应用。材料与方法选择108例患者，其中女性72例，男性36例；平均年龄54±12岁)，接受常规肿瘤FDG PET/CT扫描进行分期或治疗反应评估，结节大小大于1cm。全身PET/CT扫描后进行单床颈部PET/MRI扫描。测量SUVmax值，并使用b因子为50和1000 s/mm2的DWI创建ADC图。SUVmax和ADC值与FNAC结果相关。结果fnac结果显示，108例患者中良性结节76例（70.4%），恶性结节32例（29.6%）。恶性结节的平均SUVmax明显高于良性结节(10.6±8.3 vs. 5.94±5.2；术;措施)。同样，恶性结节的平均ADC值低于良性结节（1.4±0.6 × 10-3 mm2/s vs 1.8±0.4 × 10-3 mm2/s）；术;措施)。FNAC结果与平均SUVmax呈显著的弱相关（r = 0.335），与平均ADC值呈显著的弱负相关（r = - 0.355）。SUVmax的临界值为6，ADC的临界值为1.56 × 10-3 mm2/s， SUVmax的敏感性、特异性和准确性分别为68.7、73.6和72.1%，而ADC的敏感性、特异性和准确性分别为71.8、69.7和70.4%。PET/MRI系统的相对灵敏度、特异性、准确性、PPV和NPV分别为90.62%、51.32%、62.96%、43.94%和92.86%。结论本研究是文献中首次探索使用FDG PET/MRI这种单次停止装置来区分高灵敏度和NPV的甲状腺结节良恶性。

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引用次数: 0

Análisis multimodal de la congestión y utilidad pronóstica del protocolo VExUS en pacientes hospitalizados por insuficiencia cardiaca en un hospital terciario 多模式拥塞分析和VExUS方案对三级医院心力衰竭住院患者的预测效用

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-21 DOI: 10.1016/j.rce.2025.502332

A. Campos Sáenz de Santamaría , A. Alcaine Otín , S. Crespo Aznarez , C. Josa Laorden , L. Esterellas Sánchez , M. Sánchez Marteles , V. Garcés Horna , Z. Albines Fiestas , I. Giménez López , J. Rubio Gracia

Background

Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).

Methods

Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.

Results

A total of 100 patients were included (mean age 86 ± 8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥ 2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1 year (OR 2.52, 95% CI: 1.02-6.26, P = .046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (P < .001).

Conclusions

Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.

背景：多模式充血和静脉充血超声评估（VExUS）在急性心力衰竭（AHF）患者的容量评估和去充血治疗中起决定性作用。方法前瞻性、单中心和观察性研究在内科病房住院的AHF患者中进行，旨在探讨充血的患病率、预测因素和临床结果（VExUS评分）和充血性肾病的患病率。结果共纳入100例患者，平均年龄86±8岁，女性占51%。根据VExUS协议，49%的患者表现出中度至重度拥塞（VExUS 2-3）。这些患者临床充血更严重，CA125浓度和微量白蛋白/肌酐比更高，住院期间需要更大剂量的环状利尿剂。入院时充血性肾病患病率为38%。入院时VExUS评分≥2的患者1年内全因死亡率和/或HF住院的风险增加2.5倍（or 2.52, 95% CI: 1.02-6.26, P = 0.046）。在多变量分析中，尿素水平升高、下腔静脉直径增大和男性性别被确定为在VExUS评分基础上的独立预测因素，最终模型的曲线下面积为0.740 (P <；措施)。结论：中度至重度充血（VExUS分级2-3）与较高的临床充血评分、更需要利尿剂治疗和更差的临床结果相关，包括AHF患者死亡率和再住院率增加。此外，三分之一的AHF表现为充血肾病，这种情况与临床相关，可影响去充血治疗和最终结果。

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引用次数: 0

Contrarréplica: comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada» 答辩：对一篇专题文章“卧床超声在病因不明的急性混淆综合征住院患者中的效用”的评论

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-05 DOI: 10.1016/j.rce.2025.502337

S. Carrasco-Molina , Á. Robles-Marhuenda , J.J. Ríos-Blanco , Y. Tung-Chen

引用次数: 0

El impacto futuro de la imagen avanzada y la inteligencia artificial en el diagnóstico e I + D de las enfermedades raras 先进成像和人工智能对罕见疾病诊断和研发的未来影响

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-03 DOI: 10.1016/j.rce.2025.502327

M. Moreno-Higueras , G. Fatoul-del Pino , S. García-Linares , T. Martín-Noguerol

引用次数: 0

Predictores de la aparición de alteraciones radiológicas a los 12 meses tras una neumonía por COVID-19 2019年新冠肺炎后12个月内放射线变化预测

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-03 DOI: 10.1016/j.rce.2025.502325

C. Roig-Martí , I. Pérez-Catalán , S. Folgado-Escudero , M. Varea-Villanueva , A. Navarro-Ballester , M.P. Fernández-García , A. Segura-Fábrega , M.-L. Mateu-Campos , J. Usó-Blasco , J.-M. Ramos-Rincón

Background and objective

The radiological evolution after COVID-19 pneumonia is unknown. We propose to analyze the main radiological findings one year after COVID-19 pneumonia, as well as identify possible factors that may influence it.

Material and methods

Cohort study of patients with COVID-19 pneumonia undergoing high-resolution computed tomography (HRCT) 12 months after hospital discharge. A descriptive study of the radiological findings and a multivariate analysis are carried out to identify the factors of the appearance of radiological anomalies.

Results

One hundred thirty-nine patients, with a mean age of 63 years and 66.2% male. The most frequent radiological findings were ground-glass opacities (59%), followed by bronchiectasis (42.4%), subpleural parenchymal bands (32.4%), atelectasis (13.7%), septal thickening (12.9%) and fibrotic tracts (9.4%). Male sex was associated with the presence of bronchiectasis (ORa = 3.55; P=.026), peak admission IL-6 levels > 133 ng/L with the detection of subpleural parenchymal bands (ORa = 3.58; p = 0.048) and obesity with the occurrence of atelectasis (ORa = 3.70; P=.014). Systemic corticotherapy during admission decreased the risk of fibrotic tracts (ORa = 0.02; P=.003).

Conclusions

Lung damage persists with high frequency one year after COVID-19 pneumonia. Male sex, high peak admission IL-6 levels and obesity were risk factors for radiological abnormalities while systemic corticosteroid therapy decreased the occurrence of fibrotic tracts 12 months after hospital admission.

背景与目的新型冠状病毒肺炎后影像学进展尚不清楚。我们建议分析COVID-19肺炎一年后的主要影像学表现，并确定可能影响其的因素。材料与方法对COVID-19肺炎患者出院后12个月行高分辨率计算机断层扫描（HRCT）的简短研究。对放射学结果进行描述性研究，并进行多变量分析，以确定放射学异常出现的因素。结果139例患者，平均年龄63岁，男性占66.2%。最常见的影像学表现为毛玻璃混浊（59%），其次是支气管扩张（42.4%）、胸膜下实质带（32.4%）、肺不张（13.7%）、间隔增厚（12.9%）和纤维化束（9.4%）。男性与支气管扩张相关(ORa = 3.55；P= 0.026)，峰值入院IL-6水平>；133 ng/L胸膜下实质带检测(ORa = 3.58；p = 0.048)，肥胖与肺不张的发生相关(ORa = 3.70；P = .014)。入院时全身皮质治疗可降低纤维化束的风险(ORa = 0.02；P = .003)。结论新型冠状病毒肺炎后1年肺损伤发生率较高。男性、入院时峰值IL-6水平和肥胖是放射学异常的危险因素，而全身皮质类固醇治疗可减少住院后12个月纤维化束的发生。

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引用次数: 0

El aprendizaje asistido por pares mejora las habilidades no técnicas en la educación en fisioterapia pediátrica 同侪协助学习提高儿科物理治疗教育中的非技术技能

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 Epub Date: 2025-07-03 DOI: 10.1016/j.rce.2025.502328

T.T. Ma , Q. Zhang , H.B. Zhao , H.X. Li

引用次数: 0

En respuesta al artículo de Ivars N, et al. «Características clínicas, manejo en urgencias y mortalidad de los episodios de insuficiencia cardiaca aguda en pacientes con enfermedad pulmonar obstructiva crónica» 对Ivars N等人的文章“慢性阻塞性肺病患者急性心力衰竭发作的临床特征、急诊管理和死亡率”的回应

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-06-01 Epub Date: 2025-05-14 DOI: 10.1016/j.rce.2025.502298

A. Gil-Rodrigo , M.-J. Luque-Hernández , L. Cuesta-García , C. Martínez-Buendía

引用次数: 0

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