Medicina de Familia-SEMERGEN最新文献

Objective

To know the perception of nurses about the management and exposure of methotrexate in primary care nursing staff of the Orihuela Health Department.

Material and method

This is a descriptive qualitative study carried out through semi-structured interviews with a sample of 15 intentionally selected nurses.

Results

The participants expressed concern about the handling and exposure of methotrexate, which allowed them to perceive training as the greatest concern in the study unit. A main category called “knowing” was established, which encompasses all the reflections about the nurse's performance during the process of handling and exposure of cytostatics. From this main category, the following subcategories are developed: lack of knowledge, demand for training, personal protective equipment, cytostatic residues, exposure and ventilation.

Conclusion

Our study shows that it is necessary to accredit and reaccredit the professional skills of nurses to carry out the management of methotrexate correctly, facilitating the use of instruments to standardize variability and seeking strategies to update knowledge and skills.

The aggressions suffered by healthcare personnel (HCP) is a growing problem in the field of public health in Spain that negatively affects the quality of care. The objective is to analyze the causes of the aggressions towards the HCP and what implications they have for the healthcare service and its personnel. The methodology is based on a systematic review in PubMed, Scopus, Web of Science and Medes.

The triggers of the aggressions are multifactorial and can lead to post-traumatic stress disorder in the HCP. The most affected services are primary care, emergency care, emergencies, and psychiatry. Women are the most assaulted, while men are responsible for most of the assaults. Although professional associations, autonomous communities and the Ministry of Health and Social Services are making efforts to prevent the problem, it continues to be invisible due to the under-reporting of complaints, the lack of academic research and society in general.

Purpose

To determine the prevalence and incidence of electrocardiographic abnormalities (EKG-abn).

Material and methods

Design. 2 stage study: 1st: descriptive cross-sectional, 2nd: prospective cohort. Location. 28 urban primary health centers in Barcelona city area. Participants. The study population was composed by patients who had participated in the population based ARTPER multicentric study. This study has two phases where each patient had one EKG, physical examination and blood test to obtain the secondary variables. The available EKG from both phases were reviewed, achieving a total of 2,727 patients with EKG. 601 (22%) individuals with CV disease were excluded. A total of 2.126 patients were studied of whom 392 (18%) had 2 EKG, one at each phase. Mean measurements. The association between the presence of EKG-abn and explanatory variables was performed using multivariate logistic regression, obtaining odds ratios (OR) and their 95% confidence intervals (95% CI).

Results

58% women and average age 66 years. 32% (95% CI: 30%-34%) (n = 671) presented EKG-abn of whom 60% (n = 402) were minor and 40% (n = 269) major disorders. The most common EKG-abn were the conduction disturbances. EKG-abn were associated with males (OR: 1.7; 95% CI: 1.4-2.1) and patients older than 65 (OR: 1.6; 95% CI: 1.4-2.0). Among the 345 people without EKG-abn at baseline and with 2 available EKG, 71 showed an EKG-abn at the second EKG (incidence in 4.7 years of 21% (95% CI: 16%-25%).

Conclusion

EKG abnormalities are common in healthy general population. EKG-abn are more common in male and elderly patients.

Introduction

The foundation of virtual consultation is to improve the cooperation and the coordination between Primary Care and other specialties. However, in its use inequities related to socioeconomic determinants have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource.

Material and methods

Descriptive study of virtual and non-virtual consultations requested by Primary Care doctors from other specialists doctors in Aragon between 1 January 2020 and 31 December 2022. Characteristics of the interconsultations and variables specific to the patient treated were recorded and analyzed; and the request rate for virtual consultations by specialty and the standardized rates by age by Basic Health Zone and stratified by sex were calculated.

Results

Progressive increase in the number of virtual consultations for the study period, being Traumatology, Neurology, Urology, General Surgery and Dermatology the specialties that received the most. The standardized rates by age and stratified by sex were higher in women and the Health Areas of Huesca, Calatayud and Alcañiz. The request was higher in 2022 and the specialized referral was the main type of response. Regarding variables of the patients treated, virtual consultations were requested more in urban and less dispersed areas, women, patients with lower adjusted morbidity and with free pharmacy, pensioners and active users with income less than €18,000/year.

Conclusions

Despite the rise of telemedicine and its potential advantages, it is necessary to adapt it to the needs of the local population, to mitigate inequalities in access, and to integrate it with face-to-face care.

Aim

To evaluate the opinions of the new internal resident physicians (IRP) on family and community medicine (FCM) and professional and personal issues.

Methods

Anonymous survey of 837 new IRPs in the Madrid Region.

Results

Mean age was 25.6 ± 3.5 years, 525 (62.7%) had a specific subject of FCM during medical school, 799 (95.5%) did FCM practices during their medical degree, and 606 (72.4%) considered relevant to be some months in FCM during their medical residence. Only 103 (12.3%) consider becoming parents during residency, 416 (49.7%) have suffered from anxiety, 99 (11.8%) from depression, and 19 (2.3%) had previous suicidal thoughts. Although 638 (76.2%) have received training in ethical decisions, 345 (41.2%) did not know how to implement these decisions, 120 (14.3%) had studied artificial intelligence and 744 (88.9%) have a positive view of the College of Physicians.

Conclusión

Most new medical residents of Madrid consider a Primary Care rotation relevant during their training, but only 63% have completed specific training in FCM as an undergraduate. A total of 12% reported previous depression and half anxiety.

Background

Science integrity initiatives require specific recommendations for randomised clinical trials (RCT).

Objective

To prepare a set of statements for RCT integrity through an international multi-stakeholder consensus.

Methods

The consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percent of majority opinions; and, a final consensus development meeting.

Results

There were 30 stakeholders representing 15 countries from 5 continents including trialists, ethicists, methodologists, statisticians, consumer representative, industry representative, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with 8 additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n = 6), design and approval (n = 11), conduct and monitoring (n = 19), reporting of protocols and findings (n = 20), post-publication concerns (n = 12), and future research and development (n = 13).

Conclusion

Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.

Self-reported penicillin allergy is highly prevalent. Different studies estimate that 10% of the population is labeled as such.

This label, confirmed or suspected, forces us to take precautions and replace the antibiotic treatment of choice (frequently beta-lactams) with other 2 nd or 3 rd choice alternatives with worse overall results: side effects, resistance, costs, etc.

The penicillin allergy label, once placed, remains in the medical record. It is only confirmed in less than 5% of patients, either because it has been placed inappropriately or because over time the sensitivity decreases and may disappear.

Penicillin Allergy Decision Rule –PEN-FAST– is a validated and simple clinical prediction rule that estimates the risk of presenting an allergic reaction. Its use, together with algorithms that involve primary care in the study and delabeling of low-risk patients, can change our clinical practice.