Utilidad y fiabilidad de la ecografía clínica abdominal en medicina familiar (1): hígado,vías biliares y páncreas

Ultrasound is a safe and reliable way to increase diagnosis capabilities, as well as an improving and speed up method for taking decisions for healthcare professionals of every medical specialty. Family doctor, who must be ready to address all kind of health problems for his patients, is the key person to incorporate this tool to his daily activity, acquiring the best managing skill, unknown nowadays, being quite large the clinical situations in the day by day practice, in which he can obtain benefit in a reliable and effective way.Due to this practice is explorer dependent, it's needed to assure the best competence of the professional who practice it, and define the benefits and potential risks its use can create, as well as its application scenarios, in order to avoid unnecessary explorations and minimize opportunity costs that this activity can add to a currently saturated agenda. This work pretends to summarize the current state of abdominal point of care ultrasound, and its utility for the family doctor, in those scenarios that can be potentially reliable and effective.     

Utilidad y fiabilidad de la ecografía clínica abdominal en medicina familiar (2): grandes vasos,bazo, nefrourológica y ginecológica

This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.     

Utilidad y fiabilidad de la ecografía clínica musculoesquelética en medicina familiar (2): lesiones musculares,artrosis, enfermedades reumatológicas y procedimientos ecoguiados

This article is a continuation of the review initiated in the previous issue about the usefulness of musculoskeletal point of care ultrasound in Primary Care, completing the scenarios of muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures.     

Características y contenidos de los programas de maestría en salud pública en España

ObjectiveTo compare the main academic characteristics and contents of the different master's programs in public health currently offered in Spain.MethodA systematic search has been carried out in the Register of Universities, Centers and Degrees of the Ministry of Education, Culture and Sports. The main academic characteristics and the contents (mandatory and optional) of the programs of 11 official master's degrees with the renewed accreditation in 2018 were analyzed based on the data published on the universities’ web pages.ResultsMost programs are 60 ECTS (European Credit Transfer and Accumulation System), face-to-face, taught in Spanish, include in their curriculum the completion of a master's thesis but not professional practices. Only contents related to statistics and basic epidemiology, and the training activity of master's thesis, are offers by all programs.ConclusionsThe majority of public health master's programs in Spain shows a certain homogeneity regarding their academic characteristics, but a great heterogeneity in relation to their contents. There is also a great heterogeneity in the credits granted to the different subjects, especially optional subjects. It would be advisable to standardize a common core, especially in the mandatory contents.     

Diagnóstico. Estudio radiológico. Ecografía,tomografía computarizada y resonancia magnética

Because of its low cost, availability in primary care and ease of interpretation, simple X-ray should be the first-line imaging technique used by family physicians for the diagnosis and/or follow-up of patients with osteoarthritis. Nevertheless, this technique should only be used if there are sound indications and if the results will influence decision-making.Despite the increase of indications in patients with rheumatological disease, the role of ultrasound in patients with osteoarthritis continues to be limited.Computed tomography (CT) is of some –although limited– use in osteoarthritis, especially in the study of complex joints (such as the sacroiliac joint and facet joints).Magnetic resonance imaging (MRI) has represented a major advance in the evaluation of joint cartilage and subchondral bone in patients with osteoarthritis but, because of its high cost and diagnostic-prognostic yield, this technique should only be used in highly selected patients.The indications for ultrasound, CT and MRI in patients with osteoarthritis continue to be limited in primary care and often coincide with situations in which the patient may require hospital referral.Patient safety should be bourne in mind. Patients should be protected from excessive ionizing radiation due to unnecessary repeat X-rays or inadequate views or to requests for tests such as CT, when not indicated.     

Familia,economía y servicios sanitarios: claves de los cuidados en pacientes con diabetes y amputación de miembros inferiores. Estudio cualitativo en Andalucía

Aim

To examine the experience of diabetic care in patients undergoing lower limb amputation.

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments.Study designObservational, cross-sectional survey.LocationPrimary Care Teaching Unit. Madrid.ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed.Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy.ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r =  −0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians’ self-perceived empathy and their patients’ perceptions.ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.     

Trabajo agrícola y migración en España: precariedad sociolaboral y salud (Proyecto AGROMISALUD)

ObjectiveTo assess the influence of job insecurity and social exclusion on the health of migrant men and women working in the agricultural sector in Spain.MethodQualitative and quantitative data will be collected in four Spanish autonomous regions (Catalonia, La Rioja, Murcia, and Andalusia) between 2021 and 2022. First, semi-structured personal interviews with at least 40 professional key informants or experts (from NGOs, associations, health, social services, trade unions, agricultural cooperatives, politics, and cultural mediators). Second, semi-structured personal interviews combined with participatory techniques (body mapping and photovoice) will be conducted with 40 migrant men and women working in agriculture. Thirdly, a cross-sectional study with an estimated sample of 400–500 migrants working in agriculture, based on the National Health Survey and the Living Conditions Survey.     

Estudio descriptivo y comparativo de factores de riesgo cardiovascular y actividad física en pacientes con síndrome coronario agudo

Aim

To analyse several cardiovascular risk factors by means of the physical activity performed by patients with acute coronary syndrome (ACS).

Anemia en la enfermedad renal crónica: protocolo de estudio,manejo y derivación a Nefrología

The objective of this protocol is to know which test are needed to study an anaemia in a patient with chronic kidney disease, the differential diagnosis of renal anaemia, to know and correct other deficiency anaemias, and the criteria for referral to Nephrology or other specialties of the anaemic patient with chronic kidney disease.     

ECoLaE: validación de un cuestionario sobre conocimientos y habilidades en lactancia materna para enfermería

ObjectiveTo validate the “Questionnaire on breastfeeding knowledge and skills” in Nurses (EcoLa).DesignA validation study, with prior linguistic adaptation, according to the skills and training of the nurses.LocationCantabria.ParticipantsGeneral nurses, paediatrics specialists, and midwives from the Cantabrian Health Service, with responsibility for mother-child care.Main measurements:The psychometric properties of the nursing version of ECoLa were evaluated. Internal consistency was measured using α-Cronbach for multiple choice and overall answer questions, and Kuder-Richardson's formula (KR20) for dichotomous response questions. Inter-observer concordance was measured using the kappa coefficient in items 18 and 21, and the test-retest reliability with 11 subjects using the intraclass correlation coefficient.ResultsThe mean score in the questionnaire was 21.15 ± 4.67 points. There were no statistically significant differences as regards the gender or number of children. There was an association between the score obtained in the questionnaire and previous experience in lactation, and with the professional profile (midwife 24.23 points, paediatric nurse 21.20 points, and general nurse 20 points; P < .01). The internal consistency showed a KR20 of 0.802, and the α-Cronbach for multiple-choice questions was 0.719, and 0.866 for overall. Interobserver concordance for Item 18 had a kappa = 0.6, for item 30 kappa = 0.825), and for total score the kappa = 0.856). The test-retest reliability overall score (CCI = 0.856, 95% CI 0.55-0.96), and for question 30 (CCI = 0.93, 95% CI 0.75-0.98).ConclusionsThe questionnaire scale has psychometric properties that make its use valid and reliable in the evaluation of the training of nursing professionals.