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Originales. Volumen 46, Numero 08, Agosto 2010 Texto completo Anterior | Siguiente Descargar PDF Buscar en medline articulos de: Fernando Caballero Martinez Vicente Plaza Santiago Quirce Gancedo Margarita Fernandez Benitez Fernando Gomez Ruiz Antolin Lopez Vina Jesus Molina Paris Jose Antonio Quintano Jimenez Ramona Soler Vilarrasa Jose Ramon Villa Asensi Santiago Balmes Estrada Buscar: Busqueda avanzada Valoracion externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma Fernando Caballero Martineza; Vicente Plazab; Santiago Quirce Gancedoc; Margarita Fernandez Benitezd; Fernando Gomez Ruize; Antolin Lopez Vinaf; Jesus Molina Parisg; Jose Antonio Quintano Jimenezh; Ramona Soler Vilarrasai; Jose Ramon Villa Asensij; Santiago Balmes Estradab a Unidad de Formacion e Investigacion, Area 6 Servicio Madrileno Salud, Madrid, Espana b Servicio de Neumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Espana c Servicio de Alergologia, Hospital Universitario La Paz, Madrid, Espana d Servicio de Alergologia infantil, Clinica Universidad de Navarra, Pamplona, Navarra, Espana e Servicio de Medicina de Familia, Centro de Salud de Bargas, Toledo, Espana f Servicio de Neumologia, Hospital Universitario Puerta de Hierro, Madrid, Espana g Servicio de Medicina de Familia, EAP Francia I, Fuenlabrada, Madrid, Espana h Servicio de Medicina de Familia, Centro de Salud Lucena I, Lucena, Cordoba, Espana i Servicio de Otorrinolaringologia, Hospital de Son Dureta, Palma de Mallorca, Espana j Servicio de Neumologia pediatrica, Hospital Infantil del Nino Jesus, Madrid, Espana Arch Bronconeumol. 2010;46:411-9. Objetivos Valorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guia Espanola para el Manejo del Asma (GEMA) 2009. Material y metodos El estudio se efectuo en 4 fases: 1) constitucion del comite cientifico formado por los 9 coordinadores de GEMA2009, para la seleccion de las recomendaciones de la Guia que conforman el cuestionario Delphi del estudio (56 items); 2) seleccion de un panel estatal multicentrico con 74 expertos en asma de todas las especialidades implicadas en la Guia (neumologos, alergologos, medicos de familia, otorrinolaringologos, y especialistas de pediatria); 3) encuesta Delphi en 2 rondas (con valoracion personal de cada item mediante escala Likert de 5 puntos), por correo electronico, con informe a panelistas de resultados intermedios; y 4) analisis y discusion de resultados por el comite cientifico del proyecto. Resultados Se aprecio un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interaccion del panel, se lograron consensuar 53 items de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicacion de inmunoterapia en asma alergica, se aprecio una significativa disparidad de opinion entre especialidades. En otra, sobre las medidas de control ambiental en alergia a acaros, se aprecio una manifiesta oposicion del panel (55%), y en la ultima, sobre la necesidad de cambiar de trabajo en pacientes con sindrome reactivo de disfuncion de la via aerea, se observo una ausencia significativa de criterio establecido en buena parte de los encuestados (40% expresan «ni de acuerdo, ni en desacuerdo»). Conclusiones La valoracion externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93%). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. Estas cuestiones podrian representar areas susceptibles de un mayor esfuerzo investigador futuro. Palabras clave: Asma. Guia Practica Clinica. Consenso profesional. Delphi. External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma Objectives To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma. Materials and methods The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee. Results Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts. Conclusions The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.

Objectives To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma. Materials and methods The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee. Results Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts. Conclusions The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5 %). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.

Background: Adverse drug reaction (ADR) spontaneous reporting is the primary method of postmarketing drug surveillance: although it is an important part of postmarketing drug surveillance, it is underused. Before 2004, almost no ADRs were reported in our 400-bed hospital. As an electronic hospital information system was available in our hospital, we developed a tool (ADR-RS-IHIS) for ADR reporting integrated into the hospital information system to facilitate reporting through easy use, automatic input of certain information, increased accessibility, real-time review, and intervention. Objective: To analyze the efficacy of the ADR-RS-IHIS in increasing ADR reporting to the national drug surveillance system, propose and implement improvements to increase ADR reporting, and evaluate the impact of these improvements, Methods: Every ADR reported through the ADR-RS-IHIS was evaluated retrospectively. Two study phases for evaluating ADR-RS-IHIS efficacy were identified. Phase I took place April 2004-August 2006; in April 2006, an interim analysis was performed to propose improvements. Phase II took place September 2006-April 2007 for evaluation of the impact made by the proposed improvements. Efficacy in the phase I and improvement impact on phase II were measured as the number of ADRs reported to the national drug surveillance system Results: The rate of ADRs reported per month to the national system increased from 0 before 2004 to 0.91 in phase I and 1.62 in phase II (2.25 if delayed reporting was considered). Improvement measures included: allowing nurses to report ADRs in the same way as physicians and pharmacists, automatic form filling of certain information from the electronic hospital information system, easier ADR report analysis, and automatic notification to the allergy department regarding suspected allergies. Conclusions: An ADR reporting system integrated into the electronic hospital information system is effective for increasing the number of ADRs reported to the national drug surveillance system. Allowing nurses to report ADRs in a manner similar to that of physicians and pharmacists, as well as automatic entry of certain data into the form, contributes to the improvement of the system.

Esophagitis is an increasingly diagnosed disease. Patients with gastroesophagic reflux, dysphagia, vomiting or abdominal pain, with a torpid response to the treatment, could be suffering from it.A 37 year-old male patient with background of gastroesophagic reflux and dysphagia for solids since 2002, self-limited diarrhea episodes and intolerance to alcoholic drinks due to epigastric pain. Skin prick tests, specific IgE, histamine release test and basophil activation test were carried out.Skin prick test to the usual allergens with negative result; prick-prick tests to egg white and yolk, milk and apple with positive result to egg white; total serum IgE within normal levels, specific IgE to egg white with positive result; histamine release test (HRT) and basophil activation test (BAT) with positive result to egg white and yolk.The patient was diagnosed eosinophilic esophagitis. The commercial food extracts have a great variability in their allergenic composition, which could result in false negative results in the prick test. Prick-prick with the natural food is a more sensitive technique than prick in the diagnosis of food allergy. There are other useful in vitro techniques, apart from specific IgE, in the diagnosis of food allergy. In our case, an exclusion diet of the involved food was more effective than other treatments for remission of the symptoms.

We present the clinical case of uniovular twins with cerebral palsy, confirming the development of sensitisation to latex in one of the twins, due to the fact that he underwent surgery more times (nine) than his brother (four) as well as to his different clinical evolution.