A Systematic Review of Clinical Decision of Influenza

Estimados amigos , les dejo este artículo interesante sobre la desición clínica de Influenza en una revisión sistematica.

Es absolutamente libre y pueden bajarlo usando el link que es encuentra al final.

Saludos

Dr. Carlos Erazo

"ABSTRACT

PURPOSE In this study, we assessed whether multivariate models and clinical
decision rules can be used to reliably diagnose influenza.
METHODS We conducted a systematic review of MEDLINE, bibliographies of relevant
studies, and previous meta-analyses. We searched the literature (1962-2010)
for articles evaluating the accuracy of multivariate models, clinical decision rules, or simple heuristics for the diagnosis of infl uenza. Each author independently reviewed and abstracted data from each article; discrepancies were resolved by consensus discussion. Where possible, we calculated sensitivity, specifi city, predictive value, likelihood ratios, and areas under the receiver operating characteristic curve. RESULTS A total of 12 studies met our inclusion criteria. No study prospectively validated a multivariate model or clinical decision rule, and no study performed a split-sample or bootstrap validation of such a model. Simple heuristics such as the so-called fever and cough rule and the fever, cough, and acute onset rule were each evaluated by several studies in populations of adults and children.
The areas under the receiver operating characteristic curves were 0.70 and 0.79,
respectively. We could not calculate a single summary estimate, however, as the
diagnostic threshold varied among studies.
CONCLUSIONS The fever and cough, and the fever, cough, and acute onset heuristics
have modest accuracy, but summary estimates could not be calculated.
Further research is needed to develop and prospectively validate clinical decision
rules to identify patients requiring testing, empiric treatment, or neither."


Ann Fam Med 2011;9:69-77. doi:10.1370/afm.1192.



http://www.annfammed.org/cgi/reprint/9/1/69

Training family physicians and residents in family medicine in shared decision

Este es un artículo interesante que se lo puede descargar libre en el siguiente link.
http://www.biomedcentral.com/content/pdf/1471-2296-12-3.pdf

El abstract fue copiado directamente del artículo.

Saludos

Dr. Carlos Erazo


"To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.
Methods/design The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patient consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: preintervention (baseline) including 175 patients with ARIs in each study arm, and postintervention including 175 patients with ARIs in each study arm (total n=700). The primary outcome will be the proportion of patients reporting a decision to use
antibiotics immediately after consulting their physician. Secondary outcome measures
4 include: 1) physicians and patients’ decisional conflict; 2) the agreement between the parties’ decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision,
consultation for the same reason, decisional regret, and quality of life will be assessed.
Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.
Discussion DECISION+2 has the potential to reduce antibiotics use for ARIs by priming
physicians and patients to share decisional process and empowering patients to make
informed, value-based decisions."

Trial Registration: ClinicalTrials.gov NCT01116076

Saludos a todos los que hacen Medicina Familiar

Esta semana se estan llevando a cabo las XXIV Jornadas Internacionales Vozandes en Quito-Ecuador , el tema Principal "LA MEDICINA FAMILIAR".

Estamos contentos con la gran asistencia de participantes de diferentes partes del país y aún más felices con la participación de personas extranjeras.

Hemos tenido gran acogida y los expositores han sido como siempre muy buenos y habiles al exponer cada uno de los temas preparados.

Esperamos que el dia viernes al terminar estas Jornadas, todos nos sintamos satisfechos y al mismo tiempo ansiosos por saber el tema de las próximas jornadas del 2012.

Saludos

Dr. Carlos Erazo