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La histoplasmosis es la infección fúngica ocasionada, en humanos, por el hongo dimórfico Histoplasma spp. que afecta con mayor frecuencia a personas con compromiso del sistema inmune. En las personas que viven con el virus de la inmunodeficiencia humana (VIH) y se encuentran en un estadio avanzado de la enfermedad, la histoplasmosis es una infección oportunista de gran importancia, debido a su frecuencia de presentación, y consecuente impacto en morbilidad, mortalidad y altos costos. La problemática global de resistencia a los antimicrobianos, a la que contribuye el uso inapropiado o indiscriminado de antifúngicos, ha puesto en la mira a Histoplasma spp., por lo que resulta de importancia generar directrices que permitan orientar el uso adecuado de antifúngicos en el manejo de la histoplasmosis, con el objetivo de obtener mejores desenlaces clínicos y propender por un uso racional de antifúngicos. La presente guía contiene recomendaciones para el diagnóstico y tratamiento de la histoplasmosis en personas adultas que viven con el VIH, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica internacionales para el contexto colombiano.

La criptococosis es la infección fúngica ocasionada por el complejo de especies Cryptococcusneoformans y Cryptococcusgattii, desarrollada con mayor frecuencia en personas con compromiso del sistema inmune. En las personas que viven con el virus de la inmunodeficiencia humana (VIH), la criptococosis es una infección oportunista de gran importancia, con consecuencias devastadoras para los pacientes, la sociedad y el sistema de salud, debido al incremento en morbilidad, mortalidad y costos que genera. La presente guía contiene recomendaciones para el diagnóstico y tratamiento de la criptococosis en personas adultas que viven con el VIH, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica internacionales para el contexto colombiano.

ABSTRACT Introduction. Artificial intelligence and machine learning are technologies that assist in uncovering patterns in data that can inform clinical decision-making. The Registered Nurses’ Association of Ontario has used artificial intelligence techniques to assist in understanding impactful clinical practices and implementation strategies. This scoping review aimed to discover the adaptation and implementation of various artificial intelligence and machine learning techniques in various healthcare settings using different data systems that house nursing-related data. Methodology. In March 2022, a scoping review was conducted to search for peer-reviewed literature using the following terms: “nursing”, “artificial intelligence”, “data systems”, “statistics”, and “aggregated data”. Studies were excluded if they were not relevant to nursing, utilized qualitative or mixed-methods analyses, were literature review articles, and did not focus on artificial intelligence or the use of patient-level data. Results. A total of 2,627 articles were retrieved, with 1,518 articles remaining after de-duplication. Through title and abstract screening, 1,347 articles remained. Following the full-text screening, 13 studies remained. Artificial intelligence techniques used by healthcare data systems include regression, neural networks, classification, and graph-based methods, among others. Discussion. There is a gap in the application of artificial intelligence methods in data systems that evaluate the impact of implementing best practices in nursing. More data systems are needed that employ artificial intelligence techniques to support the evaluation of best practices in nursing and other health professions. Conclusions. Various artificial intelligence techniques in data systems housing nursing-related data were retrieved. However, more data systems and research are needed in this area. Keywords: Practice Guidelines as Topic; Evidence-Based Nursing; Machine Learning; Artificial Intelligence; Health Information Systems RESUMEN Introducción. La inteligencia artificial y el aprendizaje automático son tecnologías que ayudan a descubrir patrones en los datos que pueden informar la toma de decisiones clínicas. La Asociación de Enfermeras Registradas de Ontario ha utilizado técnicas de inteligencia artificial para ayudar a comprender las prácticas clínicas que generan impacto y las estrategias de implementación. El objetivo de esta revisión es descubrir la adaptación e implementación de diversas técnicas de inteligencia artificial y aprendizaje automático en varios entornos sanitarios, utilizando diferentes sistemas de datos que almacenan datos relacionados con la enfermería. Metodología. En marzo de 2022, se realizó una revisión de alcance para buscar literatura revisada por pares utilizando los siguientes términos: «enfermería», «inteligencia artificial», «sistemas de datos», «estadística» y «datos agregados». Se excluyeron los estudios si no eran relevantes para la enfermería, utilizaban análisis cualitativos o de métodos mixtos, si eran artículos de revisión bibliográfica y no se centraban en la inteligencia artificial o en el uso de datos a nivel de paciente. Resultados. Se recuperó un total de 2,627 artículos, de los cuales 1,518 quedaron tras la eliminación de duplicados. Tras la revisión de títulos y resúmenes, quedaron 1,347 artículos. Posteriormente, con la revisión del texto completo, quedaron 13 estudios. Las técnicas de inteligencia artificial utilizadas por los sistemas de datos sanitarios incluyen, entre otras, la regresión, las redes neuronales, la clasificación y los métodos basados en gráficos. Discusión. Existe un vacío en la aplicación de métodos de inteligencia artificial en los sistemas de datos que evalúan el impacto de la implementación de buenas prácticas en enfermería. Se necesitan más sistemas de datos que empleen técnicas de inteligencia artificial para apoyar la evaluación de buenas prácticas en enfermería y otras profesiones de la salud. Conclusiones. Se recuperaron diversas técnicas de inteligencia artificial en sistemas de datos que almacenan datos relacionados con la enfermería. Sin embargo, se necesitan más sistemas de datos e investigación en este ámbito. Palabras clave: Guías de Práctica Clínica como Asunto; Enfermería Basada en la Evidencia; Aprendizaje Automático; Inteligencia Artificial; Sistemas de Información en Salud RESUMO Introdução. A inteligência artificial e o aprendizado de máquina são tecnologias que ajudam a descobrir padrões em dados que podem informar a tomada de decisões clínicas. A Associação de Enfermeiras Registradas de Ontário vem utilizando técnicas de inteligência artificial para ajudar a entender as práticas clínicas que geram impacto e as estratégias de implementação. O de máquina em diversos ambientes de saúde, utilizando diferentes sistemas de dados que armazenam dados relacionados à enfermagem. Metodologia. Em março de 2022, foi realizada uma revisão de escopo para pesquisar literatura revisada por pares usando os seguintes termos: «enfermagem», «inteligência artificial», «sistemas de dados», «estatísticas» e «dados agregados». Foram excluídos os estudos que não se mostravam relevantes para a enfermagem, utilizavam análises qualitativas ou de métodos mistos, se eram de artigos de revisão de literatura e não focavam na inteligência artificial ou no uso de dados no nível do paciente. Resultados. Foram recuperados 2,627 artigos no total, dos quais 1,518 permaneceram após a eliminação das duplicatas. Após a revisão de títulos e resumos, restaram 1,347 artigos. Posteriormente, com a revisão do texto completo, restaram 13 estudos. As técnicas de inteligência artificial usadas pelos sistemas de dados de saúde incluem, entre outras, regressão, redes neurais, classificação e métodos baseados em gráficos. Discussão. Existe uma lacuna na aplicação de métodos de inteligencia artificial em sistemas de dados que avaliam o impacto da implementação de boas práticas de enfermagem. São necessários mais sistemas de dados que implementem técnicas de inteligência artificial para apoiar a avaliação de boas práticas em enfermagem e outras profissões de saúde. Conclusões. Diversas técnicas de inteligência artificial foram recuperadas em sistemas de dados que armazenam dados relacionados à enfermagem. No entanto, são necessários mais sistemas de dados e investigação nesta área. Palavras-chave: Guias de Prática Clínica como Assunto; Enfermagem Baseada em Evidências; Aprendizado de Máquina; Inteligência Artificial; Sistemas de Informação em Saúde

ABSTRACT Introduction. Assessment and management of pain in older adults can be challenging, with persistent pain prevalence ranging from 25% to 80%, especially in long-term care homes (LTCH), where most seniors are unable to verbalize their pain. This article describes the implementation of the Registered Nurses’ Association of Ontario (RNAO) Assessment and Management of Pain (Third Edition) best practice guideline (BPG) in a LTCH in Toronto, Canada. Methodology. Using mixed descriptive study methodology, this 391-bed home housing older adults over 80 years implemented the Pain guideline using the knowledge-to-action framework and audit procedures to evaluate the impact of implementing this guideline. Key implementation activities included educating residents, families, and staff about pain while integrating validated pain screening and assessment tools into practice. A mixed methods approach of qualitative and quantitative data was utilized to monitor improvements in clinical and organizational outcomes. Results. The impact of implementing Pain BPG is: improved utilization of pain assessment and management tools, reduced incidence of worsening pain, improved pain scores and improved resident quality of life. The structured and integrated, evidence-based approaches to pain assessment and management reflected that long-term care residents don’t have to live with pain regularly, which leads to a better quality of life and resident/family satisfaction. Discussion. In conjunction with the structured approach of the knowledge-to-action framework and the Pain BPG, the LTCH utilized tailored approaches to meet the needs of their resident population. Recognizing the unique needs of seniors in a residential setting, organizational structural facilitators, and barriers and cultural needs, the LTCH developed multi-modal approaches based on a person and family-centred approach. This evidence-based and resident-focused approach was the key to the successful implementation and subsequent outcomes that were resultant. Conclusion. The systematic implementation of the RNAO pain BPG and the utilization of the knowledge-to-action framework was shown to improve resident outcomes, improve organizational processes and generate staff satisfaction. Participation and engagement of residents, their families and health professionals in the process was one of the greatest facilitators. Keywords: Practice Guidelines as Topic; Implementation Science; Long-Term Care; Nursing Homes; Frail Elderly; Pain Measurement; Pain Management; Quality Improvement RESUMEN Introducción. La evaluación y el tratamiento del dolor en los adultos mayores puede constituir un desafío, con una prevalencia de dolor persistente que oscila entre el 25 al 80%, especialmente en residencias de cuidados a largo plazo (LTCH por sus siglas en inglés), donde la mayoría de los ancianos son incapaces de verbalizar su dolor. Este artículo describe la aplicación de la guía de buenas prácticas (BPG por sus siglas en inglés) de la Asociación de Enfermeras Registradas de Ontario (RNAO por sus siglas en inglés) para la Evaluación y el Tratamiento del Dolor (Tercera Edición) en un centro de cuidados a largo plazo de Toronto, Canadá. Metodología. Utilizando una metodología de estudio descriptivo mixto, esta residencia de 391 camas que alberga a adultos mayores de 80 años implementó la guía sobre el dolor, utilizando el marco de conocimiento a la acción, al igual que procedimientos de auditoría, para evaluar el impacto de la implementación de la guía. Entre las actividades clave de la implementación se incluyeron la educación de los residentes, las familias y el personal sobre el dolor, así como la integración en la práctica de herramientas validadas de detección y evaluación del dolor. Se utilizó un enfoque metodológico mixto de datos cualitativos y cuantitativos para supervisar las mejoras en los resultados clínicos y organizativos. Resultados. El impacto de la implementación de la BPG sobre el dolor es: mejoría de la utilización de las herramientas de evaluación y manejo del dolor, reducción en la incidencia de empeoramiento del dolor, mejoría en puntuaciones del dolor, así como en la calidad de vida de los residentes. Los enfoques estructurados e integrados basados en la evidencia, dirigidos a la evaluación y manejo del dolor reflejaron que los residentes del LTCH no deben vivir con dolor habitualmente, lo que conduce a una mejor calidad de vida y satisfacción del residente y/o familia. Discusión. Junto con el enfoque estructurado del marco del conocimiento a la acción y la BPG del dolor, la residencia de cuidados a largo plazo utilizó enfoques adaptados para satisfacer las necesidades de su población residente. Reconocer las necesidades únicas de los mayores en un entorno residencial, los facilitadores estructurales organizativos y las Este enfoque basado en la evidencia y centrado en el residente fue la clave del éxito de la implantación y de los subsecuentes resultados obtenidos. Conclusiones. Se evidenció que la implantación sistemática de la BPG del dolor de la RNAO y la utilización del marco del conocimiento a la acción mejoraron los resultados de los residentes, los procesos organizativos y generaron mayor satisfacción en el personal. La participación y el compromiso de los residentes, sus familias y los profesionales de salud fue uno de los mayores facilitadores en el proceso. Palabras clave: Guías de Práctica Clínica como Asunto; Ciencia de la Implementación; Cuidados a Largo Plazo; Casas de Salud; Anciano Frágil; Dimensión del Dolor; Manejo del Dolor, Mejoramiento de la Calidad. RESUMO Introdução. A avaliação e o tratamento da dor em idosos podem ser desafiadores, com a prevalência de dor persistente variando de 25 a 80%, especialmente em hospitais de longa permanência (LTCH por suas siglas em inglês), onde a maioria dos idosos não consegue verbalizar sua dor. Este artigo descreve a aplicação do guia de boas práticas (BPG por suas siglas em inglês) da Associação de Enfermeiras Registradas de Ontário (RNAO por suas siglas em inglês) para Avaliação e Tratamento da Dor (Terceira Edição) em uma instituição de cuidados de longo prazo em Toronto, Canadá. Metodologia. Utilizando uma metodologia de estudo descritiva, essa casa com 391 leitos que acolhe idosos com mais de 80 anos de idade implementou o guía para o manejo da dor, utilizando a estrutura do conhecimento para a ação, bem como procedimentos de auditoria, para avaliar o impacto da implementação do guia. As principais atividades de implementação incluíram a educação dos residentes, famílias e funcionários sobre a dor, bem como a integração na prática de ferramentas validadas de detecção e avaliação da dor. Foi utilizada uma abordagem metodológica mista de dados qualitativos e quantitativos para monitorar melhorias nos resultados clínicos e organizacionais. Resultados. O impacto da implementação do BPG para o manejo da dor é: melhoria na utilização de ferramentas de avaliação e manejo da dor, redução na incidência de piora da dor, melhora nos escores de dor, bem como na qualidade de vida dos residentes. Abordagens estruturadas e integradas baseadas em evidências, destinadas à avaliação e manejo da dor refletiram que os residentes do LTCH não devem conviver rotineiramente com a dor, levando à melhoria da qualidade de vida e à satisfação dos residentes e/ou familiares. Discussão. Juntamente com a abordagem articulada da estrutura do conhecimento para a ação e o BPG para o manejo da dor, a cassa de cuidados de longo prazo utilizou abordagens adaptadas para satisfazer as necesidades da sua população residente. O reconhecimento das necessidades únicas dos idosos num ambiente residencial, dos facilitadores estruturais organizacionais e das barreiras e necessidades culturais, permite que os LTCH desenvolvam abordagens multimodais, centradas na pessoa e na família. Esta abordagem baseada em evidências e centrada no residente foi a chave para o sucesso da implementação e os resultados subsequentes obtidos. Conclusões. Ficou evidente que a implementação sistemática do BPG para o manejo da dor da RNAO e o uso da estrutura do conhecimento para a ação melhoraram os resultados dos residentes e os processos organizacionais, e geraram maior satisfação do pessoal. A participação e o comprometimento dos residentes, seus familiares e profissionais de saúde foi um dos maiores facilitadores do processo. Palavras-chave: Guias de Prática Clínica como Assunto; Ciência da Implementação; Assistência de Longa Duração; Casas de Saúde; Idoso Fragilizado; Medição da Dor; Manejo da Dor; Melhoria de Qualidade

Las infecciones asociadas a la atención de la salud (IAAS) son el evento adverso más frecuentemente reportado en todo el mundo, siendo la infección del sitio quirúrgico (ISQ) la IAAS con mayor incidencia en los países de ingresos bajos y medios, como Colombia, con consecuencias importantes para los pacientes, la sociedad y el sistema de salud, debido al incremento en morbilidad, mortalidad y costos que genera. La presente guía contiene recomendaciones perioperatorias para la prevención de la ISQ, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica para el contexto colombiano.

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Las guías de práctica clínica han contribuido a resolver un problema al sintetizar la evidencia y ponerla al alcance del profesional sanitario, pero su desarrollo e implementación creciente en los últimos años ha dado lugar a nuevos inconvenientes que aún no han sido resueltos. En este artículo editorial, la autora repasa cuestiones no tenidas en cuenta por las guías de práctica clínica, incluso aquellas consideradas de buena calidad de acuerdo a los estándares actuales, y reflexiona en especial sobre el uso del tiempo de los médicos en la consulta, aspecto desatendido que atenta contra la sustentabilidad del modelo actual de cuidado propuesto por estas recomendaciones.

La infección de vías urinarias complicada es la infección que ocurre en alguna de las estructuras del tracto urinario, en pacientes con comorbilidad, o con anoma-lías estructurales o funcionales del tracto urinario. La infección de vías urinarias complicada tiene un alto impacto en morbilidad, mortalidad y en la problemática actual de resistencia a los antimicrobianos, por lo que resulta de importancia generar directrices que permitan orientar el adecuado diagnóstico y tratamiento en este grupo de pacientes, con el objetivo de obtener mejores desenlaces clínicos y propender por un uso racional de antibióticos. La presente guía contiene recomendaciones para el diagnóstico y tratamiento de pacientes adultos con infección de vías urinarias complicada, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica para el contexto colombiano.

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Las guías de práctica clínica tienen como objetivo reunir y evaluar toda la evidencia relevante disponible sobre un tema en particular. Se establecen para ayudar a los médicos a seleccionar la mejor estrategia de tratamiento posible para un paciente en específico, que sufre una enfermedad determinada, no solo teniendo en cuenta el resultado final, sino también sopesando los riesgos y los beneficios de un procedimiento diagnóstico o terapéutico concreto. Esta es una guía de práctica clínica para el tratamiento de la pericarditis aguda, definida como un síndrome originado por la inflamación del pericardio por diversas etiologías. Se describen sus agentes causales, presentación clínica, métodos diagnósticos y la conducta a seguir ante la presencia de una pericarditis aguda. Concluye con una guía de evaluación, enfocada en los aspectos más importantes a cumplir en el tratamiento a los pacientes.

Clinical practice guidelines aim at collecting and evaluating all the relevant evidence available on a particular topic. They are established to help doctors select the best possible treatment strategy for a specific patient, who suffers from a certain disease, not only taking into account the final result, but also weighing the risks and benefits of a diagnosis or concrete therapeutic procedure. This is a clinical practice guide for the treatment of acute pericarditis, defined as a syndrome caused by inflammation of the pericardium due to various etiologies. Its causal agents, clinical presentation, diagnostic methods and the management of acute pericarditis are described. It concludes with an evaluation guide, focused on the most important aspects to be met for proper patients´ treatment.

Community-acquired pneumonia is common in pediatric age. The objective of this work is to present a medical practice guideline, which helps addressing elements on diagnosis, epidemiology, etiology, risk factors, classification and management of children with community-acquired pneumonia. In the environment which is the context to this Guide, diagnosis and treatment, in most cases, is carried out in the primary care level, with a high incidence rate. Although very few patients require hospital care, the etiological diagnosis and the optimization of antibiotic treatment remain difficult challenges to overcome.

Foundation: the comprehensive visit to the family contributes achieving the actions and the specific functions declared in the Program of the Family Doctor and Nurse in Cuba. It must be executed by basic health teams in each of the doctor's offices. Objective: to propose a methodological guide for the comprehensive visit to the family by the members of the basic health team. Methods: this research responds to a development project and was carried out from March to September 2018. The nominal group technique was applied with the participation of experts (postgraduate methodologists from different areas and municipalities of the province) following the established stages: list preparation, list presentation, voting and assessment and debate of the results achieved with the contribution of all the members of the group. The inclusion of individual trials was achieved until arriving to a consensus in the proposals. Results: the guide provides the steps to follow in the comprehensive visit to the family, among which stand out: characteristics, state of health, material, hygienic-sanitary and epidemiological conditions, family scheme, family functioning, etc., including a joint action doctor-family plan, to solve the problems detected.Conclusion: the methodological guide for developing the comprehensive visit to the family by the basic team members contributes to the achievement of main basic action with the required quality, fulfilling the proposed objectives in the Program of the Family Doctor and Nurse.

La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

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Fundamento: la parada cardiaca primaria es un problema de salud mundial y una de sus soluciones es disponer, tanto la población como los profesionales de la salud, de conocimientos en reanimación cardiopulmocerebral. El proyecto para la formación e investigación en apoyo vital en emergencias y desastres puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del socorrismo. Métodos: taller nacional realizado en julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del socorrismo tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso “Apoyo vital socorrista” permiten el abordaje de la enseñanza de los primeros auxilios tanto a la población como a grupos especializados de socorristas.

Fundamento: en situaciones de desastres, cuando el número de enfermos o lesionados es alto y los recursos limitados, la atención médica precisa de cambios de estructura y procesos si se quiere salvar un número elevado de personas. El personal de salud debe estar entrenado para enfrentar esta situación cada vez más frecuente. El “Proyecto para la formación e investigación en apoyo vital en emergencias y desastres” puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante víctimas múltiples. Métodos: taller nacional realizado el 10-11 de julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del apoyo vital en situaciones de desastres, tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso “Apoyo vital avanzado ante víctimas múltiples” permiten la preparación de los profesionales de la salud para brindar asistencia médica en situaciones de desastres, con escasos recursos y en ambientes complejos.

Foundation: Primary cardiac failure is a worldwide Health problem and one of its solutions is to count on health professionals and the population in general with knowledge in cardio-pulmonary-cerebral resuscitation. The project for the training and research in life support in emergencies and disasters may be an academic framework to achieve it. Objective: to update, for the project, the teaching guides and strategy for first aids. Methods: national workshop developed in July 2018 in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming, and nominal group, semi-structured questionnaire and documentary review were used. Results: it is proposed for teaching first aids to undergraduate students and postgradutes as well: the objectives, specific aspects, teaching strategy, contents, scope, skills to develop, future research, and areas for inter-institutional collaboration. Conclusion: academic proposals for the course “Life Support” allows approaching treaching first aids to the population and specialized groups as well.

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course “Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments.

Introducción: el uso de sales de platinos en patologías oncológicas es ampliamente usado, una de las preocupaciones de los profesionales de la salud es la presencia de eventos adversos en este grupo de pacientes que suelen ser vulnerables, por lo que es necesario la generación de consensos para realizar una selección óptima de pacientes candidatos a terapias basadas en platinos Objetivo: Realizar un consenso de expertos para la inelegibilidad al uso de platinos de acuerdo a varios criterios para realizar un tratamiento óptimo de acuerdo a la selección y categorización de pacientes Pregunta de salud cubierta por la Guía: ¿Qué pacientes portadores de cáncer de origen otorrinolaringológico no son elegibles para tratamiento con platinos? Población: La población objetivos son pacientes adultos con cáncer otorrinolaringológico. Resultados: Se establecieron consensos para la inelegibilidad al uso de platinos sobre los siguientes criterios: Edad >70 años, ECOG >1, Pérdida involuntaria de peso >20%, función auditiva “borderline”: alteraciones Grado I, Alteraciones neurológicas Grado I, Trastornos de la función renal: CrCL

Objective. To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. Method. A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. Results. Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. Conclusions. The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities. [ABSTRACT FROM AUTHOR]

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en el Seguro Social de Salud del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 4 preguntas clínicas a ser respondidas por la presente GPC. Para cada una de estas preguntas se realizó búsquedas de revisiones sistemáticas y de estudios primarios (cuando se consideró pertinente) en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y el flujograma de manejo. Resultados. La presente GPC abordó 4 preguntas clínicas sobre el tamizaje, diagnóstico, tratamiento de elección y tratamiento adyuvante. En base a estas preguntas se formularon 6 recomendaciones (4 fuertes y 2 condicionales), 19 puntos de buena práctica clínica y 1 flujograma de manejo. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en EsSalud.

Objetivo: proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y –cuando fue considerado pertinente– estudios primarios en Medline y Cochrane Controlled Register of Trials durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de diagnóstico y tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2019. Resultados: la presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, tratamiento, soporte y rehabilitación. En base a estas preguntas se formularon 28 recomendaciones (8 fuertes y 20 condicionales), 38 puntos de buena práctica clínica, 1 nota de implementación y 2 flujogramas. Conclusión: el presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud.

Introduction: Knowledge translation and knowledge appropriation social interventions apply knowledge to improve health services and outcomes. These interventions can be implemented routinely to improve patient adherence to clinical practice guidelines. Objective: To assess the effectiveness of knowledge translation interventions to improve patient and community adherence to clinical practice guidelines. Materials and methods: We performed a systematic review of these interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: Medline (Ovid), Embase, Scopus, Central (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. Results: Eight studies were included. Patient adherence to recommendations was observed in two studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high: a 60% risk of performance bias, 50% risk of attrition bias, 25% risk of selection and reporting bias, and 15% risk of detection bias. The quality of evidence was moderate for the outcomes of adherence and mortality. The interventions that used a combination of strategies, such as with the group of health professionals, could improve some clinical outcomes in the patients (Average deviation: -3.00; 95% IC: -6.08-0.08). Conclusions: Knowledge translation interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results.

Community-acquired pneumonia is common in pediatric age. The objective of this work is to present a medical practice guideline, which helps addressing elements on diagnosis, epidemiology, etiology, risk factors, classification and management of children with community-acquired pneumonia. In the environment which is the context to this Guide, diagnosis and treatment, in most cases, is carried out in the primary care level, with a high incidence rate. Although very few patients require hospital care, the etiological diagnosis and the optimization of antibiotic treatment remain difficult challenges to overcome. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour., Methods: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality., Results: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use., Conclusions: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations., (Copyright © 2022 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Foundation: the comprehensive visit to the family contributes achieving the actions and the specific functions declared in the Program of the Family Doctor and Nurse in Cuba. It must be executed by basic health teams in each of the doctor's offices. Objective: to propose a methodological guide for the comprehensive visit to the family by the members of the basic health team. Methods: this research responds to a development project and was carried out from March to September 2018. The nominal group technique was applied with the participation of experts (postgraduate methodologists from different areas and municipalities of the province) following the established stages: list preparation, list presentation, voting and assessment and debate of the results achieved with the contribution of all the members of the group. The inclusion of individual trials was achieved until arriving to a consensus in the proposals. Results: the guide provides the steps to follow in the comprehensive visit to the family, among which stand out: characteristics, state of health, material, hygienic-sanitary and epidemiological conditions, family scheme, family functioning, etc., including a joint action doctor-family plan, to solve the problems detected. Conclusion: the methodological guide for developing the comprehensive visit to the family by the basic team members contributes to the achievement of main basic action with the required quality, fulfilling the proposed objectives in the Program of the Family Doctor and Nurse. [ABSTRACT FROM AUTHOR]

Objectives: To validate an elaborate care protocol for clients after coronary transluminal angioplasty. Methods: For the validation of the protocol, the Delphi technique was used, counting on a panel of nine judges, all nurses with expertise in the area of cardiology. In addition to the qualitative evaluation, as recommended by the Delphi technique, we used quantitative measures such as the content validity index and the agreement rate. Results: According to the suggestions made by the experts in each round, the document was adjusted to reach the agreement rate and content validity index of at least 0,9, requiring three rounds of questionnaires. Conclusion: The validated protocol is considered a tool to guide the practice of nurses working in this specific area. [ABSTRACT FROM AUTHOR]

Objective: To describe the evidence-based recommendations for the integral management of oncological pain. Methodology: Literature review based on a search of clinical practice guidelines for the comprehensive management of oncological pain, from 2012 to 2017. From the included references, it was obtained information related the evaluation, classification, indications of treatment, principles of pharmacological management and not pharmacological. Results: We included 12 studies related for the management of oncological pain, after the elimination of duplicates. The synthesis and analysis of relevant aspects focused on 1) pain assessment; 2) classification of oncological pain; 3) principles and goals of pain management, as well as pharmacological and non-pharmacological management; and 4) follow-up. It is recommended that patients with mild pain (score of 1 to 3) who have not been previously treated with opioids, should be treated with acetaminophen or NSAIDs. For patients with mild pain who do not respond to non-opioids and for patients with pain intensity greater than or equal to four, short-acting opioids are recommended. Conclusion: Oncological pain inadequately treated constitutes a public health problem, which is why adequate evaluation is essential to ensure proper management from the moment of diagnosis, with follow-up at regular intervals and when a new treatment is initiated, in order to find best balance between efficacy and safety of the interventions, and maximizing functionality and improving the patient's quality of life. The management of oncological pain therefore requires a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Odontología Universidad de Antioquia is the property of Universidad de Antioquia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course "Life support in the presence of mass casualty" allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments. [ABSTRACT FROM AUTHOR]

Foundation: Primary cardiac failure is a worldwide Health problem and one of its solutions is to count on health professionals and the population in general with knowledge in cardio-pulmonary-cerebral resuscitation. The project for the training and research in life support in emergencies and disasters may be an academic framework to achieve it. Objective: to update, for the project, the teaching guides and strategy for first aids. Methods: national workshop developed in July 2018 in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming, and nominal group, semi-structured questionnaire and documentary review were used. Results: it is proposed for teaching first aids to undergraduate students and postgradutes as well: the objectives, specific aspects, teaching strategy, contents, scope, skills to develop, future research, and areas for inter-institutional collaboration. Conclusion: academic proposals for the course "Life Support" allows approaching treaching first aids to the population and specialized groups as well. [ABSTRACT FROM AUTHOR]

Introduction: Colombian clinical practice guidelines for health care are published in the Web Portal of the Ministry of Health and Social Protection. Objective: To analyze the traffic of the clinical guidelines portal through web consultation metrics. Materials and methods: The website traffic analysis was performed over a period of 20 months using Google Analytics and Megalytic. Results: 190 115 users logged in, and 125 475 of them (≈66%) were first-time visitors, while 63 118 (≈33%) were repeated users. 126 994 users visited 608 745 pages, with an average of 3.2 pages per session, query time of 3.45 minutes per visit and average rebound rate of 46.74%. 40% of users interacted with at least three pages and 40% left the site without interacting with a second page. The sessions originated in Colombia, Mexico, Peru and Spain; the first country represented 169 666 visits and Bogotá D.C. recorded the highest number of visits (32%), followed by Medellín (12.3%), Cali (8.3%), Barranquilla (4.1%) and Bucaramanga (3.3%), for a total of 60% of the traffic. The most visited guides were handling pregnancy and infection of the urogenital tract. Conclusions: The portal had an acceptable traffic during the first 20 months of operation. An innovative portal that improves the dissemination of the guides must remain active.

Objetivo: Explorar las percepciones sobre el acceso a los medicamentos del Componente Especializado de la Asistencia Farmacéutica (CEAF) del Sistema Único de Salud brasileño (que incluye los medicamentos de alto costo), por parte de los actores involucrados en el ámbito asistencial del CEAF. Métodos: Estudio cualitativo descriptivo. Para la recolección de los datos se realizaron un grupo focal con siete usuarios/as y 11 entrevistas semiestructuradas a profesionales de la salud (medicina y farmacia) del estado de Santa Catarina. Resultados: Según los/las participantes, el acceso a medicamentos del CEAF ha mejorado. Se encontraron también dos percepciones sobre los Protocolos Clínicos y Directrices de Tratamiento del CEAF: las exigencias son burocracia que limita el acceso y los requisitos aumentan la demanda de exámenes y especialistas, superando la capacidad de la red de servicios de salud. A partir de estas percepciones se generan vías alternativas de acceso que evidencian una concepción frágil del derecho a la salud, desinformación y dependencia por parte de los usuarios, las cuales pueden tener consecuencias en la salud de las personas y en el sistema de salud. Según los/las participantes, debido a las dificultades en el acceso de los servicios de salud en general, el pleno acceso a los medicamentos aún es un objetivo por alcanzar. Conclusión: De acuerdo con las percepciones encontradas, aunque el acceso a los medicamentos del CEAF ha mejorado, persisten dificultades para garantizar su oportunidad y su integralidad.

There are various guidelines for the treatment of obesity, and thus the quality of these clinical guidelines has become a matter of concern. The objective was to describe and assess the quality of clinical guidelines for treatment of obesity in adults. We collected several studies, dated from 1998 to 2016, produced by different countries. The literature search included the National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), PubMed (MEDLINE), Scopus, Web of Science, webpages of health institutions from different countries, and search sites, with the criterion: “clinical guidelines for treatment of obesity in adults and published until the 2016”. The guidelines were assessed with the Appraisal of Guidelines for Research & Evaluation (AGREE II), according to the domains of the instrument. The search identified 21 guidelines: nine from Europe, six from North America, three from Latin America, and one each from Asia and Oceania and a transnational association. The Australian guideline had the best assessment. Of the six guidelines with the highest scores, five had been elaborated by the government sector responsible for the country’s health. The domains “scope and purpose” and “clarity of presentation” had the highest score. Except for the Canadian guideline, the three guidelines drafted before the elaboration of AGREE II had the worst quality. In the domain “stakeholder involvement”, only four guidelines (Australia, Scotland, France, and England) mentioned patient participation. Guideline development and quality enhancement are ongoing processes requiring systematic appraisal of the guideline production process and existing guidelines.

Mediante un proceso de adaptación de guías de práctica clínica se seleccionaron y evaluaron guías de infección de vías urinarias en mujeres premenopáusicas no embarazadas; se identificaron 3 de alta calidad. Con base en las evidencias y las recomendaciones aportadas por estas guías, se realizó un consenso para realizar recomendaciones para personal de salud —médicos, personal de laboratorio y enfermeros— sobre el diagnóstico de las infecciones urinarias —cistitis y pielonefritis—, sus tratamientos y prevención de la recurrencia.

INTRODUCCIÓN:el correcto diagnóstico en endodoncia permite la selección de un tratamiento endodóntico adecuado. Los términos utilizados para la nominación de cada patología, deben asociarse a las condiciones clínicas particulares. La unificación de la terminología diagnóstica en endodoncia ha sido un tema ampliamente discutido en el ámbito clínico y académico. El objetivo de esta investigación fue desarrollar la adaptación y actualización de la Guía de diagnóstico clínico, para patologías pulpares y periapicales bajo los parámetros de la metodología ADAPTE, para la difusión y socialización dentro de la comunidad académica y profesional. MÉTODOS: para la búsqueda de las guías, organismos recopiladores como National Guideline Clearinghouse (NGC), el Centro Nacional de Guías de EEUU y la Agency for Health Research and Quality (AHRQ). Para la selección de la guía se utilizó la herramienta AGREE II, donde se reconoció el documento "Consensus Conference Recommended Diagnostic Terminology" de la (AAE) (2009), como "recomendable", iniciando el proceso de adaptación con ADAPTE. Las bases de datos utilizadas, Cochrane, PubMed, Tripdatabase, las palabras claves verificables en DeCS y MeSH. La valoración de la literatura se hizo con los lineamientos del Scottish Intercollegiate Guidelines Network (SIGN) y del National Institute for Clinical Excellence (NICE). RESULTADOS:adaptación y actualización de la Guía de diagnóstico clínico para patologías pulpares y periapicales. Conclusiones: la unificación de la terminología permitirá identificar las condiciones del tejido pulpar y periapical. La elaboración de guías de práctica clínica debe soportarse en la evidencia científica y en metodologías consensuadas.

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Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods. Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results. Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions. Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM. [ABSTRACT FROM AUTHOR]

Objective. Characterize the implementation process, barriers, and facilitators of evidence- based recommendations in the context of developing clinical practice guidelines (CPGs) generated by the Ministry of Health of Chile, in order to make proposals to optimize the process. Methods. Qualitative "action-oriented research" study. Nineteen semi-structured interviews were conducted and nine discussion groups were organized at various levels of the Chilean public health system. The analysis was conducted using Atlas.ti® software and manually, in a content analysis framework, by categorizing and coding information according to pre-specified dimensions and with the inclusion of emerging categories where relevant. Results. The main challenge mentioned with regard to implementing recommendations is the lack of an explicit and structured process. Actors in the health system recognize difficulties specific to the context in which the recommendations are followed. In this unprecedented institutional review, participants suggested a series of strategies that could be implemented to overcome these challenges, presented in a management flow chart optimized for the development and implementation of CPGs. This process has raised awareness of the importance of implementing CPGs in Chile. Conclusion. After characterizing the implementation process, barriers, and facilitators, a plan to implement recommendations was developed in order to guide and monitor the process. It would facilitate the implementation of strategies and the introduction of improvements to the CPG development process if key informants inside and outside of the Ministry of Health were included in the review process. Studies of this kind should be conducted with physicians and patients in order to complement the collected information. [ABSTRACT FROM AUTHOR]

Introduction: Sedation is a practice frequently used in multiple settings outside the operating room. Currently, it is employed by different interdisciplinary groups. It is imperative toensure safe, standardized practices and proper training of the personnel involved. Objectives: To update available information, create minimum standards of care for performing high-quality sedation procedures based on the best available evidence. These standars lead to safe and effective care practices, reducing unjustified variability. Materials and methods: A group of different health professionals with experience in sedationoutside the operating room and representatives of scientific and patient societies developedthe guideline. Through a non-formal consensus of thematic and methodological experts, the content, scope and objectives, study populations and questions to be examined wereall defined. A systematic review of the literature was performed to formulate the recommendations with graduated levels of evidence in accordance with GRADE methodology. Results: A summarized version of the Clinical Practice Guideline with recommendations for the administration of sedation as part of diagnostic or therapeutic procedures outside the operating room in patients over the age of 12. Conclusions: The Clinical Practice Guideline presents evidence-based recommendations in order to standardize the procedure, improving the quality of care and reducing morbidity of patients that require sedation outside of the operating room. [ABSTRACT FROM AUTHOR]

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Las enfermedades infecciosas son las causantes de la mayoría de las trece condiciones clínicas otorrinolaringológicas que se presentan. Se incluyen aquellas causadas por virus, bacterias u hongos; la presencia de una u otra cambia dependiendo de la edad del paciente o del estado inmunológico. A manera de ejemplo, la infección bacteriana en un cuadro de faringo amigdalitis en menores de tres años es muy poco probable, debido a que a esa edad aún no se han desarrollado receptores para estreptococo beta hemolítico del grupo A, principal agente causal de faringoamigdalitis bacteriana, por lo cual sería poco útil proporcionar antibióticos. En este grupo poblacional es más probable que se trate de una infección viral. Existen patologías de etiología idiopática o multicausal como la parálisis facial, explicada por teoría infecciosa, autoinmune o vascular. Otros cuadros son el vértigo y la epistaxis. Algunas situaciones no requieren intervenciones farmacológicas para ser controladas. El control ambiental, cambio en el estilo de vida y modificaciones de factores de riesgo juegan un papel crucial en el control de esas enfermedades. En la rinitis se debe evitar la exposición a alergenos e irritantes de la vía aérea. De forma similar ocurre en el síndrome apnea/hipopnea del sueño, donde las modificaciones en el estilo de vida son determinantes: disminución de peso, evitar consumo de alcohol y adoptar medidas de higiene del sueño. En niños es usual motivo de consulta la presencia de cuerpos extraños en naríz, oídos o vía aérea. La cuarta causa de muerte accidental más común es debida a la asfixia secundaria a aspiración de cuerpos extraños, por lo cual representan una urgencia vital. Los profesionales del área de la salud que realizan atención en urgencias o consulta externa deben tener conocimiento preciso de las principales condiciones que afectan oídos y las vías aereofaríngeas en adultos y niños.