GPC Manejo de resultados anormales en tests de rastreo de Cancer Cuello Uterino.

2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests
“A group of 146 experts representing 29 organizations and professional societies met to develop revised evidence-based, consensus guidelines for managing women with abnormal cervical cancer screening tests. Recommendations for managing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion (LSIL) are essentially unchanged. Changes were made for managing these conditions in adolescents for whom cytological follow-up for 2 years was approved. Recommendations for managing high-grade squamous intraepithelial lesion (HSIL) and atypical glandular cells (AGC) also underwent only minor modifications. More emphasis is placed on immediate screen-and-treat approaches for HSIL. Human papillomavirus (HPV) testing is incorporated into the management of AGC after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for HPV testing as an adjunct to cervical cytology for screening in women 30 years of age and older was formally adopted with only very minor modifications.”
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937807009301.pdf

American Journal of Obstetrics and Gynecology October 2007;. © 2007 Mosby, Inc.
Wright, Thomas C.; Massad, L. Stewart; Dunton, Charles J.; Spitzer, Mark; Wilkinson, Edward J.; Solomon, Diane.
Correspondence to Dr. Wright: tcw1@columbia.edu
www.ajog.org

Cochrane PEARLS: antidepresivos y tabaquismo

Which antidepressants are effective in aiding long term smoking cessation?

Bottom line: Both bupropion and nortriptyline double the odds of cessation when compared to placebo (median NNT* = 11 and 10respectively). The efficacy of bupropion and nortriptyline appears to be similar to that for nicotine replacement and is not restricted to people with a history of depression or depressive symptoms during smoking abstinence. Selective serotonin reuptake inhibitors (SSRIs),venlafaxine and moclobemide show no evidence of benefit.* NNT = number needed to treat to benefitone individual.

Caveat: Bupropion can cause insomnia, dry mouth, nausea and seizures (estimated risk = 1 in1000). Nortriptyline can cause dry mouth, constipation, nausea and sedation, and can be dangerous in overdose.

Context: Smoking is the most preventable cause of premature death, accounting for about17% of all deaths in developed countries.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 18, September 2007
Bupropion and nortriptyline aid long term smoking cessation but selective serotonin reuptake inhibitors do not.
Brian R McAvoy Published by the Cochrane Primary Care Group.
Posted on Global Family Doctor 30 October, 2007

Inmunizaciones: Varicela

Prevention of Varicella. Recommendations of the Advisory Committee on Immunization Practices (ACIP)- CDC
In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines for prevention of varicella. This report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of varicella.
The new recommendations include:
1) implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12–15 months and the second dose at age 4–6 years;
2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose;
3) routine vaccination of all healthy persons aged >13 years without evidence of immunity;
4) prenatal assessment and postpartum vaccination;
5) expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15%–24% and adolescents and adults with CD4+T lymphocyte counts >200 cells/µL; and
6) establishing middle school, high school, and college entry vaccination requirements.
ACIP also approved criteria for evidence of immunity to varicella.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm

Task Force EEUU 2007

“Guide to Clinical Preventive Services, 2007”
Recommendations of the U.S. Preventive Services Task Force http://www.ahrq.gov/clinic/pocketgd07/pocketgd07.pdf

“CT Colonography as Effective as Colonoscopy in Detecting Advanced Neoplasia”

Conclusions: Primary CTC and OC screening strategies resulted in similar detection rates for advanced neoplasia, although the numbers of polypectomies and complications were considerably smaller in the CTC group. These findings support the use of CTC as a primary screening test before therapeutic OC.
Journal Watch General Medicine (October 3, 2007)
http://general-medicine.jwatch.org/cgi/content/full/2007/1003/1
New England Journal of Medicine (October 4, 2007)
http://content.nejm.org/cgi/content/full/357/14/1403?linkType=FULL&journalCode=nejm&resid=357/14/1403

GPC Lumbalgia

“Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society”
Annals of Internal Medicine, 02 de Octubre de 2007.
http://www.annals.org/cgi/content/full/147/7/478

“Suicide intervention: how to recognize risk, focus on patient safety”

This review article describes a practical, commonly accepted approach to suicide risk assessment and intervention, based on the B-SAFE model (Basic Suicide Assessment Five-step Evaluation) proposed by Jacobs et al. Using this method to assess suicide risk can help you answer questions such as:
• Which factors are most important to consider when evaluating suicide risk in my patient?
• What questions should I ask my patient to find out if he or she is suicidal?
• How do I know if a patient is at risk for suicide?
• What emergent interventions are called for when managing the acutely suicidal patient?
• How should I document a suicide risk assessment?.”
http://www.globalfamilydoctor.com/search/GFDSearch.asp?itemNum=7222

Diabetes tipo 2 – Guías ALAD

Se encuentran disponibles la última edición de la guía para el manejo de DBT tipo 2 de la Asociación Latinoamericana de Diabetes (Guías ALAD).
http://rapidshare.com/files/55053556/Guias_ALAD_DM_Tipo2_lLATINOAMERICANA_2007.pdf

Parálisis de Bell

“Parálisis de Bell: Diagnóstico y tratamiento” según la AFP
Bell’s palsy is a peripheral palsy of the facial nerve that results in unilateral facial weakness. Approximately 70 to 80 percent of patients will have their symptoms resolve spontaneously; however, treatment started within three days of the onset of symptoms is recommended to increase the likelihood of complete recovery.
http://www.aafp.org/afp/20071001/997.pdf
Patient Information:http://www.aafp.org/afp/20071001/1004ph.html

Seguridad Social y Atención Primaria en Argentina

Está disponible en nuestra biblioteca virtual un texto escrito hace 10 años por quien fuera fundador y Presidente de la Fundación Aequus. En el se hace un breve resumen de la inédita experiencia de reforma de un agente de la seguridad social Argentina, centrada en la estrategia de la APS.

“…A partir de noviembre de 1992 se enca­ró el Programa de Atención Primaria,… Esta política demostró ser útil para los cambios estructurales que el sistema re­quería y contribuyó, junto a un conjunto de medidas de racionalización administra­tiva y de auditoría y control de gestión, iniciadas ya en 1990, a preservar el siste­ma social y solidario de la Seguridad So­cial para este grupo de trabajadores…”
http://www.fundacionaequus.com.ar/biblioteca/jec-ospecon97.pdf