Medicina de Familia-SEMERGEN最新文献

{"title":"Utilidad de la ecografía abdominal en el estudio etiológico de la enfermedad tromboembólica venosa idiopática como método diagnóstico de la neoplasia oculta","authors":"C. Idoate Ortueta ,&nbsp;L. del Campo del Val ,&nbsp;N. Ruiz-Giménez Arrieta ,&nbsp;C. Suárez Fernández ,&nbsp;A. Friera Reyes ,&nbsp;P. Rodríguez Carnero","doi":"10.1016/j.semerg.2025.102449","DOIUrl":"10.1016/j.semerg.2025.102449","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the sensibility of abdominal ultrasound (US) in the screening of occult cancer in patients with idiopathic venous thromboembolism (iVTE).</div><div>To evaluate its sensitivity and specificity in different subgroups of patients with iVTE, in order to detect potential beneficiaries in whom the abdominal US screening may have greater diagnostic benefit.</div><div>Descriptive analysis of the use of abdominal US in these patients, and evaluation of its impact on their management.</div></div><div><h3>Material and methods</h3><div>We retrospectively searched all patients with confirmed iVTE (by Doppler-US, by CT angiography or V/Q scintigraphy) between 2011-2014, which had been performed an abdominal US for screening of occult malignancy as part as their aetiology study of VTE. As reference we set a follow-up period of 2<!--> <!-->years.</div></div><div><h3>Results</h3><div>280 patients were found, and 209 were included after inclusion and exclusion criteria were applied. Abdominal US was positive for malignancy in 7 patients (3.3%). The sensitivity and specificity for cancer detection were 43.75% and 99.48%, respectively. Cancer was found in 16 patients in the 2-year follow-up (7.6%). No significant differences were found in the different subgroups of patients. Nevertheless, 28 patients (13.4%) were diagnosed of other cause of VTE during aetiology study, mainly hypercoagulability disorders.</div></div><div><h3>Conclusions</h3><div>Abdominal US for screening of occult malignancy in patients with iVTE is a very specific test but has low sensitivity, which compromises its utility as a routine screening test in these patients. Its use could be optimised by performing it only in selected subgroups of patients that need to be established in future research.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 5","pages":"Article 102449"},"PeriodicalIF":0.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143297560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Encuesta sobre los conocimientos de la enfermedad hepática metabólica (EHMet) entre los médicos de Atención Primaria en España","authors":"C. Expósito Martínez ,&nbsp;S. Fernández Jorde ,&nbsp;A.B. García Garrido ,&nbsp;N. Fontanillas Garmilla ,&nbsp;J. Crespo García","doi":"10.1016/j.semerg.2025.102448","DOIUrl":"10.1016/j.semerg.2025.102448","url":null,"abstract":"<div><h3>Objective</h3><div>Improving the management of metabolic dysfunction-associated steatotic liver disease (MASLD) in Primary Care requires a good knowledge of the disease. This study evaluated the knowledge of biomarkers and comorbidities associated with the disease among Primary Care Physicians (PCPs), the resources available for diagnosis, and the relationship with hepatologists.</div></div><div><h3>Materials and methods</h3><div>Cross-sectional study based on an anonymous email survey sent to PCPs actively practicing at the time of distribution. Retired professionals were excluded. The survey comprised 29 questions grouped into 3<!--> <!-->sections: 1. Sociodemographic characteristics, 2. Relationship with the gastroenterology department, 3. Diagnosis and management of MAFLD.</div></div><div><h3>Results</h3><div>A total of 362 responses were received (10.23% participation). Of the respondents, 64.2% were women, and the most participative age group was 50-59 (29.4%). Cantabria, Catalonia, Andalusia, Castilla-León and Madrid were the regions with the highest response rates. 81.5% of PCPs did not have protocols for diagnosis and management, and while two-thirds were familiar with the Fib-4 marker, only half used it. Having protocols increased the use of Fib-4 (OR 4.41; 95%<span>C</span>I 1.68-11.53). A total of 81.5% recognized the importance of extrahepatic comorbidities, and 92% actively screened for cardiovascular risk factors. Elastography was considered useful by 58.7%, but only 11% had access to it. 72% of PCPs had no relationship with specialists, although 60% had access to a Hepatology Unit.</div></div><div><h3>Conclusions</h3><div>It is necessary to improve knowledge of MAFLD, strengthen collaboration between care levels, and establish standardized management protocols.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 5","pages":"Article 102448"},"PeriodicalIF":0.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reto diagnóstico: enfermedad de Creutzfeldt-Jakob esporádico","authors":"M. Bosi,&nbsp;S. Reviriego Mazaira,&nbsp;A. Angulo Morales","doi":"10.1016/j.semerg.2024.102425","DOIUrl":"10.1016/j.semerg.2024.102425","url":null,"abstract":"","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 5","pages":"Article 102425"},"PeriodicalIF":0.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilidad de la ecografía a pie de cama en Atención Primaria para el diagnóstico del tromboembolismo paucisintomático: a propósito de un caso","authors":"D. Martín-Enguix ,&nbsp;C. Marín López ,&nbsp;M. Guisasola Cárdenas ,&nbsp;R. Quintana Prego ,&nbsp;A. Segura-Grau","doi":"10.1016/j.semerg.2024.102432","DOIUrl":"10.1016/j.semerg.2024.102432","url":null,"abstract":"","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 6","pages":"Article 102432"},"PeriodicalIF":0.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La formación en Medicina Familiar y Comunitaria en el grado de Medicina en las universidades españolas: análisis de la situación actual","authors":"E. Jiménez-Martínez ,&nbsp;A. Fernández-Ramos ,&nbsp;S. Cinza-Sanjurjo ,&nbsp;V. Martín-Sánchez ,&nbsp;A. Barquilla-García ,&nbsp;R. Micó-Pérez","doi":"10.1016/j.semerg.2024.102437","DOIUrl":"10.1016/j.semerg.2024.102437","url":null,"abstract":"<div><h3>Objective</h3><div>To analyse the specific training in Family and Community Medicine (FCM) that is taught in the medical degrees in Spain.</div></div><div><h3>Method</h3><div>Descriptive and cross-sectional study based on the content analysis of the study programs and teaching guides based on the official information that universities offer on their study programs and teaching guides for the 2023-2024 academic year. The specific FCM subjects, the number of credits, their theoretical-practical nature and the clinical rotations were identified. The universities were classified according to their training offer in FCM, both theoretical and practical, and as a whole.</div></div><div><h3>Results</h3><div>There are 49 Spanish universities with a degree in Medicine, 35 public and 14 private. Of these, 40 degrees include some theoretical-practical subject with content on FCM, 27 of which with some specific subject on FCM and 13 degrees with more general subjects in which other specialties are also addressed. On the other hand, 44 degrees have clinical rotations or supervised internships that include MF&amp;C, 21 of which are specific to MF&amp;C and 23 general courses that include several specialties. In the overall classification, 7 universities would be at the level corresponding to the degrees in which there is sufficient training in theory and practice of MF&amp;C; 33 would be at an intermediate level, with some training in MF&amp;C in one of the two types of subjects considered, and 9 universities would be at the bottom level, with deficiencies both at the level of theoretical-practical subjects and clinical rotations.</div></div><div><h3>Conclusions</h3><div>The presence of MF&amp;C in the degrees of Medicine of Spanish universities has been increasing in recent years, but it is still insufficient. There is a great variability between universities, but at a general level there is a significant lack of theoretical-practical subjects specific to MF&amp;C and specific clinical rotations in Primary Care or with sufficient credits.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 4","pages":"Article 102437"},"PeriodicalIF":0.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple inhaled therapy of formoterol/glycopyrrolate/budesonide reduces the use of oral corticosteroids and antibiotics during COPD exacerbations in real-world conditions","authors":"A. Calderón-Montero ,&nbsp;J. de Miguel Diez ,&nbsp;R. de Simón Gutiérrez ,&nbsp;S. Campos Téllez ,&nbsp;A.D. Chacón Moreno ,&nbsp;R. Alonso Avilés ,&nbsp;N. González Alonso ,&nbsp;A. Montero Solís ,&nbsp;D. Escribano Pardo","doi":"10.1016/j.semerg.2024.102418","DOIUrl":"10.1016/j.semerg.2024.102418","url":null,"abstract":"<div><h3>Introduction</h3><div>Triple inhaled therapy (TT) in one device has been shown in clinical trials to reduce exacerbations and in some cases mortality compared to dual inhaled therapy (DT) in one device in the population of moderate to very severe COPD patients and previous exacerbations. This evidence must be contrasted in real-world conditions.</div></div><div><h3>Patients and methods</h3><div>Non-intervention retrospective cohort study comparing the incidence of moderate and severe exacerbations in COPD patients treated with TT (formoterol, glycopyrrolate and budesonide, 5<!--> <!-->mcg/72<!--> <!-->mcg/320<!--> <!-->mcg, <em>n</em> <!-->=<!--> <!-->112) and DT (LAMA/LABA/ or LABA/inhaled glucocorticoid, <em>n</em> <!-->=<!--> <!-->107) for 26 weeks under clinical practice conditions. Moderate exacerbations were evaluated by the use of oral corticosteroids and/or courses of oral antibiotics and/or attendance at the emergency room (&lt;24<!--> <!-->h) without hospitalization. Severe exacerbations were analyzed for hospitalizations for all causes, respiratory causes, cardiovascular causes, and pneumonia. Descriptive statistics for qualitative and quantitative variables, Chi square, Student's <em>t</em>-test and multivariate analysis were performed.</div></div><div><h3>Results</h3><div>Both cohorts were homogeneous except for age (71.46 vs 66.65 TT vs DT, <em>p</em> <!-->&lt;<!--> <!-->0.01). TT reduced the use of oral corticosteroids by 42% (HR 0.58; 95%CI 0.41–0.82, <em>p</em> <!-->&lt;<!--> <!-->0.01) and the use of antibiotics by 25% (HR 0.75; 95%CI 0.60–0.94, <em>p</em> <!-->&lt;<!--> <!-->0.01). Hospitalizations due to respiratory causes were 11% lower in the TT cohort (HR 0.89; 95%CI 0.79–0.99, <em>p</em> <!-->=<!--> <!-->0.044) with no difference in the incidence of pneumonia.</div></div><div><h3>Conclusions</h3><div>Triple inhaled therapy in one device reduces the use of oral corticosteroids and antibiotics during COPD period of exacerbations and reduces respiratory hospitalizations without increasing the incidence of pneumonia in comparision with dual inhaled therapy.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 4","pages":"Article 102418"},"PeriodicalIF":0.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluación de las propiedades psicométricas de la escala Morisky de adherencia terapéutica de 8 ítems (MMAS-8) para anticoagulantes orales en población española","authors":"A. Borrás-Gallén ,&nbsp;D. Orozco-Beltrán ,&nbsp;J.A. Quesada ,&nbsp;C. Carratalá-Munuera ,&nbsp;A. López-Pineda ,&nbsp;R. Nouni-García ,&nbsp;V. Pérez-Jover","doi":"10.1016/j.semerg.2024.102439","DOIUrl":"10.1016/j.semerg.2024.102439","url":null,"abstract":"<div><h3>Aim</h3><div>The use of oral anticoagulants has increased due to the rising prevalence of auricular fibrillation, a condition that raises the risk of thromboembolic events. These drugs are effective in preventing such events, but their success depends on therapeutic adherence, which requires validated tools for assessment. The aim of this study is to evaluate the suitability of the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire in its adapted version for the Spanish population.</div></div><div><h3>Materials and methods</h3><div>An observational, descriptive, cross-sectional study was conducted in health centres in Jávea and Pego between 2017 and 2022. A total of 211 patients treated with oral anticoagulants for at least 6<!--> <!-->months participated. To assess adherence, the Spanish version of the MMAS-8 questionnaire was used. Reliability was determined using McDonald's Omega coefficient and the test-retest method, while validity was assessed through factor analysis.</div></div><div><h3>Results</h3><div>The Omega coefficient of 0.69 indicated moderate internal consistency. Items 1 and 8 showed moderate agreement, while the other items demonstrated weak agreement, resulting in overall moderate concordance. Construct validity analysis showed little variability, suggesting that the scale does not clearly reflect a unidimensional structure.</div></div><div><h3>Conclusions</h3><div>The MMAS-8 scale demonstrated moderate internal consistency and low temporal stability. Furthermore, the results suggest that the scale is not suitable for measuring adherence in patients treated with oral anticoagulants due to its lack of robustness in the studied population.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 4","pages":"Article 102439"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actualización del diagnóstico y tratamiento de dismenorrea","authors":"G. Rubio Pérez ,&nbsp;A. Quevedo Córdoba ,&nbsp;L. Varela Silva ,&nbsp;E. Álvarez Silvares","doi":"10.1016/j.semerg.2024.102331","DOIUrl":"10.1016/j.semerg.2024.102331","url":null,"abstract":"<div><div>Dysmenorrhea is defined as pain of uterine origin during menstruation. It's one of the most frequent symptoms in women of childbearing age and an important cause of school or work absenteeism as well as a frequent reason for scheduled or urgent consultation.</div><div>In the diagnosis, it's of great importance to take an adequate anamnesis that includes personal and gynecological-obstetric history, detailed description of the pain and chronology regarding the beginning of menstrual bleeding and previous treatments. Ultrasound is not routinely indicated and is the test of choice in those cases in which pelvic pathology is suspected as the cause of dysmenorrhea.</div><div>Both Paracetamol and NSAIDs have demonstrated superior efficacy in relieving pain compared to placebo. Hormonal treatment with either</div><div>combined hormonal contraceptives or progestin-only contraceptives is considered an effective treatment for primary and secondary dysmenorrhea.</div><div>The recent Organic Law 1/2023 provides for disabling dysmenorrhea to be covered by the temporary incapacity benefit through the creation of a new special type of this contingency «in order to reconcile the right to health with employment».</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 1","pages":"Article 102331"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prueba de Chi cuadrado de homogeneidad en estudios clínicos: una herramienta para analizar diferencias entre tratamientos","authors":"R.M. Montaña ,&nbsp;Á. Roco-Videla ,&nbsp;A.R. Nieves ,&nbsp;S.V. Flores","doi":"10.1016/j.semerg.2024.102332","DOIUrl":"10.1016/j.semerg.2024.102332","url":null,"abstract":"<div><div>This article explores the application of the chi-squared test of homogeneity in the context of clinical studies, using a previous study on the efficacy of two analgesics for treating headache as an example. The sample included 215 patients, whose responses to treatment were assessed and recorded across four pain intensity categories. The test allowed for the identification of significant differences between the treatments evaluated, proving to be a valuable statistical tool for comparing groups in clinical research. This approach provides clarity and precision in the interpretation of categorical data, essential for informed decision-making in medical practice.</div></div>","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 1","pages":"Article 102332"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulantes orales directos: un nuevo escenario clínico en el manejo del tromboembolismo venoso","authors":"E. Martín Riobóo ,&nbsp;M. Turégano-Yedro ,&nbsp;J.F. Peiró Morant ,&nbsp;V. Pallarés-Carratalá","doi":"10.1016/j.semerg.2024.102305","DOIUrl":"10.1016/j.semerg.2024.102305","url":null,"abstract":"","PeriodicalId":53212,"journal":{"name":"Medicina de Familia-SEMERGEN","volume":"51 1","pages":"Article 102305"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}