Posts Tagged Artículos científicos

vaticano vs ciencia

lancet1papa

la postura oficial de la religión, al basarse en dogmas y creencias, choca a veces con la ciencia, que se basa en hipótesis, teorías y evidencias. los choques entre posiciones han sido constantes (galileo, darwin, …) y en la actualidad siguen vigentes. desde la oposición enconada a la investigación con células madre o a buscar la posibilidad de que un nuevo hijo pueda curar la enfermedad de su hermano, hasta las críticas a distintos tratamientos intrauterinos o al alivio de sufrimiento en pacientes terminales, pero a pesar de todo sigue sorprendiendo cómo se opta por hacer un discurso preventivo de abstención sexual en áfrica y negar el uso del preservativo para intentar atajar la transmisión del virus del sida.
aaids11
lógicamente, no vemos al papa como un posible adalid de la promoción de salud usando métodos de barrera, pero sería más lógico para él no hablar sobre el tema (muchos religiosos aconsejan en voz baja su uso y en el púlpito hablan de otras cosas), en vez de meterse solito en un avispero.
con la de patas que está metiendo últimamente (desde rehabilitar a gente que niega la existencia de campos de concentración a dejarse inmiscuir en asuntos políticos y de salud terrenales) habría que recomendarle que “si tiene un asesor, que lo despida, y si no lo tiene que lo contrate” por que en ese tren va hacia un descarrilamiento crónico.
ciencia y creencia riman en poesía (en consonante) pero en la vida no suelen casar. la ciencia es preguntarse, cuestionarse y replantearse y no dogmatizar.
hasta el lancet ha salido a replicarle:

The Lancet, Volume 373, Issue 9669, Page 1054, 28 March 2009 doi:10.1016/S0140-6736(09)60627-9Cite or Link Using DOI:
Redemption for the Pope?
Original TextThe Lancet
The Vatican felt the heat from an unprecedented amount of international condemnation last week after Pope Benedict XVI made an outrageous and wildly inaccurate statement about HIV/AIDS. On his first visit to Africa, the Pope told journalists that the continent’s fight against the disease is a problem that “cannot be overcome by the distribution of condoms: on the contrary, they increase it”.
The Catholic Church’s ethical opposition to birth control and support of marital fidelity and abstinence i …

y lo que es aún más llamativo, a nivel micro, el ideal, que más que un diario es la hoja parroquial de la provincia de granada (con mayoría de acciones de la editorial católica) publica la reprimenda:

http://www.ideal.es/granada/20090328/cultura/revista-medica-lancet-arremete-20090328.html

¡lo nunca visto!, ¿no era su santidad, en dos palabras como decía el maestro, que no por su cultura, de ubrique, In-falible?
salu2
fidel

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Pregunta clínica: ¿El reposo durante el embarazo mejora el pronostico de la preeclampsia?

Al revisar la bibliografía se localizan 7 referencias, dentro de estas se encontraron 4 revisiones sistemáticas, 1 cohorte, 1 casos y controles y 1 guía de práctica clínica para establecer la asociación entre el reposo y preeclampsia.

 

La preeclampsia es una complicación grave del embarazo que se presenta en aproximadamente el 2% al 8% de las mujeres. Se identifica por una mayor presión arterial y proteína en la orina, pero, pero con frecuencia, las mujeres no padecen síntomas iniciales. Mediante la constricción de los vasos sanguíneos en la placenta es posible que interfiera con el paso de alimentos y de oxígeno al recién nacido, por lo tanto, se produce una inhibición del crecimiento del recién nacido y un nacimiento demasiado temprano. Las mujeres pueden padecer afecciones en los riñones, el hígado, el cerebro y el sistema de coagulación. Se propuso el reposo como beneficioso para las mujeres con un riesgo mayor de preeclampsia, incluso las que presentan presión arterial normal. También se observan efectos adversos posibles como el potencial de un aumento del riesgo de coágulos sanguíneos en las piernas y la repercusión significativa de los períodos de reposo para la mujer y los miembros de su familia. 

En las revisiones sistemáticas se concluye que las pruebas no son suficientes para determinar si el reposo es útil para la prevención de la preeclampsia y sus complicaciones en mujeres con presión arterial normal durante el embarazo.

En el estudio de cohortes y casos-controles, concluyen que puede ser una medida efectiva si se acompaña de un manejo integral tanto no farmacológico y cuando es necesario farmacológico.

La Guía de práctica clínica, lo recomienda como cambios en el estilo de vida a modificar, pero aclara que no se ha comprobado su efectividad. 

Total de Referencias:7

Metaanálisis: 4

Ensayos Clínicos: 0

Cohortes, casos controles, series de casos clínicos: 2

Consenso de profesionales: 0

 Guías de práctica clínica: 1

Goldenberg RL, Cliver SP, Bronstein J, Cutter GR, Andrews WW, Mennemeyer ST.  Bed rest in pregnancy. Obstet Gynecol. 1994 Jul;84(1):131-6. Review.

Moutquin JM, Garner PR, Burrows RF, Rey E, Helewa ME, Lange IR, Rabkin SW Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. CMAJ. 1997 Oct 1;157(7):907-19. Review.

– Meher S, Duley L. Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005939. Review.

– Cabrera ML, McDiarmid T, Mackler L, Januchowski R. Clinical inquiries. Does bed rest for preeclampsia improve neonatal outcomes? J Fam Pract. 2007 Nov;56(11):938-9. 

– Abenhaim HA, Bujold E, Benjamin A, Kinch RA Evaluating the role of bedrest on the prevention of hypertensive diseases of pregnancy and growth restriction.

Hypertens Pregnancy. 2008;27(2):197-205.

-Sibai BM, Barton JR, Akl S, Sarinoglu C, Mercer BM. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):879-84.

– Hypertension in pregnancy. ACOG Technical Bulletin No. 219. Washington DC: ACOG, January 1996A

 

ANTONIO

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Errors in administration of parenteral drugs in intensive care units: multinational prospective study

UN ARTICULO INTERESANTE

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Andreas Valentin, associate professor, director of intensive care unit 1,2, Maurizia Capuzzo, consultant in anaesthesia and intensive care medicine3, Bertrand Guidet, professor4,5,6, Rui Moreno, professor7, Barbara Metnitz, statistician8, Peter Bauer, professor and head of core unit of medical statistics and informatics8, Philipp Metnitz, professor9, on behalf of the Research Group on Quality Improvement of the European Society of Intensive Care Medicine (ESICM) and the Sentinel Events Evaluation (SEE) Study Investigators

1 Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria, 2 Rudolfstiftung Hospital, Medical Department II, Juchgasse 25, A-1030 Vienna, 3 Department of Anaesthesia and Intensive Care, University Hospital of Ferrara, Ferrara, Italy, 4 INSERM, Unité de Recherche en Epidemiologié, Systemes d’Information, et Modelisation, Paris, France, 5 Faculty of Medicine, University Pierre et Marie Curie, Paris, 6 Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, 7 Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de Lisboa (central, e.p.e), Lisbon, Portugal, 8 Section of Medical Statistics, Medical University of Vienna, Vienna, 9 Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna

Correspondence to: A Valentin andreas.valentin@meduniwien.ac.at

Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units.

Design Observational, prospective, 24 hour cross sectional study with self reporting by staff.

Setting 113 intensive care units in 27 countries.

Participants 1328 adults in intensive care.

Main outcome measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors.

Results 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses’ shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the unit (per increase of one patient: 0.73, 0.57 to 0.93).

Conclusions Parenteral medication errors at the administration stage are common and a serious safety problem in intensive care units. With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks can reduce the risk for such errors.

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Health and Physiological Effects of an Emotional Disclosure Intervention Adapted for Application at Home: A Randomized Clinical Trial in Rheumatoid Arthritis.

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TILAHUM.
2009 Mar 9;78(3):145-151.

Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.

Background: The efficacy of emotional disclosure in alleviating psychological and physical stress has been well documented in controlled laboratory studies. A next step is to evaluate its clinical utility in ‘real world’ settings. We adapted the emotional disclosure intervention for use in home-based settings by stimulating the suggested effective ingredients of cognitive-emotional processing, and evaluated its psychological and clinical effectiveness. Reviews indicated the need to examine the physiological changes brought about by emotional disclosure, which may be particularly relevant in immune-mediated diseases. This study was the first to examine neuroendocrine and immune changes after emotional disclosure in patients with rheumatoid arthritis. Methods: Sixty-eight patients were randomly assigned to four weekly oral emotional disclosure or time management sessions. At baseline and 1 week and 3 months after the sessions, depressed and cheerful mood, joint scores, erythrocyte sedimentation rate, cortisol, noradrenaline, interleukin-6 (IL-6), interferon-gamma (IFN-gamma), and IL-10 were evaluated. Repeated measures analyses of variance were performed. Results: No effect on psychological well-being and clinical outcome was found (p >/= 0.10). Cortisol (p = 0.01) and the serum level of the pro-inflammatory cytokine IFN-gamma (p = 0.05) were differentially affected by the two conditions. The change of IL-6 nearly reached significance (p = 0.07). Conclusions: The physiological changes are in agreement with theories on the mechanisms underlying emotional disclosure benefits and are suggestive of better disease control after emotional disclosure. General and study-specific reasons for the absence of psychological and clinical effects are discussed. The findings warn against widespread implementation of this home-based emotional disclosure intervention in unselected rheumatoid arthritis samples. Copyright © 2009 S. Karger AG, Basel.

PMID: 19270469 [PubMed

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importance of male circumsion

National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA. tquinn@jhmi.edu

PURPOSE OF REVIEW: To review the recent literature on male circumcision and its effect on HIV acquisition. RECENT FINDINGS: The report from the randomized clinical trial of male circumcision in South Africa demonstrating a 60% protective effect in preventing HIV acquisition

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still serious problem existes

HIV infection in patients with tuberculosis in Kinshasa, Zaire.

Project SIDA, Department of Public Health, Belgian Zairian Medical Cooperation, Kinshasa.

To better define the interrelationship of infection with human immunodeficiency virus (HIV) and tuberculosis (TB), we conducted three HIV serosurveys of inpatients and outpatients with confirmed or suspected TB in Kinshasa, Zaire. HIV seroprevalence in hospitalized sanatorium patients did not change significantly in serosurveys conducted in 1985 and 1987 (92/231 [40%] versus 85/234 [36%]). These proportions were significantly higher than the 17% HIV seroprevalence observed in a 1987 serosurvey of 509 consecutive patients with an initial diagnosis of pulmonary TB seen at an outpatient TB diagnostic center in Kinshasa (p less than 0.001). HIV seroprevalence was higher in sanatorium patients with extrapulmonary TB (22/46 [48%]) and suspected pulmonary TB (60/132 [45%]) than in patients with bacteriologically confirmed pulmonary TB (94/287 [33%]) (p less than 0.02). Mycobacterium sputum isolation rates were similar in HIV-seropositive (28/34 [82%]) and HIV-seronegative patients (135/159 [85%]). All isolates were Mycobacterium tuberculosis. Eighteen (21%) of 84 HIV-seropositive sanatorium patients in 1987, who were followed for two months after admission, had died, compared with 11 (9%) of 128 HIV-seronegative patients (p less than 0.01). However, clearance rates of acid-fast bacilli from sputum after standard therapy were equally good in HIV-seropositive and HIV-seronegative survivors. With the growing AIDS problem, the serious TB burden in sub-Saharan Africa may become even more onerous and may critically overload the stressed African health care systems.

PMID: 2496632 [PubMed –

 

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