Artículos recomendados

The incidence of cholangiocarcinoma in the general population is low; nevertheless, patients with primary sclerosing cholangitis face a lifetime risk of cholangiocarcinoma that is as high as 10%.1 Lazaridis and LaRusso (Sept. 22 issue)2 suggest the use of endoscopic retrograde cholangiopancreatography (ERCP)–guided cytobrushing of the bile duct for cytologic and fluorescence in-situ hybridization (FISH) analysis when strictures in the biliary system predominate, since in these cases the exclusion of cancer is mandatory but can be extremely challenging when noninvasive radiologic imaging is used. Both cytologic analysis and FISH have dismal positive and negative predictive values — 50% and 83%, respectively, for cytologic analysis and 86% and 88% for FISH.3. The use of new endoscopic techniques, such as ERCP-guided single-operator peroral cholangioscopy (SOPC) and probe-based confocal laser endomicroscopy (pCLE), may increase the positive predictive value (to 100% and 82%, respectively) and the negative predictive value (to 95% and 100%) in affected patients with indeterminate dominant strictures. Leer más…

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Randomized clinical trials serve as the standard for clinical research and have contributed immensely to advances in patient care. Nevertheless, several shortcomings of randomized clinical trials have been noted, including the need for a large sample size and long study duration, the lack of power to evaluate efficacy overall or in important subgroups, and cost. These and other limitations have been widely acknowledged as limiting medical innovation.1 Adaptive trial design has been proposed as a means to increase the efficiency of randomized clinical trials, potentially benefiting trial participants and future patients while reducing costs and enhancing the likelihood of finding a true benefit, if one exists, of the therapy being studied.

Citado: Bhatt DL, Mehta C. Adaptive Designs for Clinical Trials. N Engl J Med [Internet]. 2016 [citado 7 Nov 2017];375(1).

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Over the past 70 years, randomized, controlled trials (RCTs) have reshaped medical knowledge and practice. Popularized by mid-20th-century clinical researchers and statisticians aiming to reduce bias and enhance the accuracy of clinical experimentation, RCTs have often functioned well in that role. Yet the past seven decades also bear witness to many limitations of this new “gold standard.” The scientific and political history of RCTs offers lessons regarding the complexity of medicine and disease and the economic and political forces that shape the production and circulation of medical knowledge.

Citado: Bothwell LE, Greene JA, Podolsky SH, Jones DS. Assessing the Gold Standard– Lessons from the History of RCTs. N Engl J Med [Internet]. 2016 [citado 7 Nov 2017];374(22).

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¿Qué es lo que los médicos ofrecen (y ofrecerán en el futuro) que no puede ser brindado por otros profesionales de la salud? Esa interrogante la lanzaba un comentario editorial del British Medical Journal a lo que, también respondía: “Diagnóstico, diagnóstico, diagnóstico”. Un enfermero pudiera trasplantar un corazón un día, un técnico anestesiar a un paciente y un farmacéutico controlar un tratamiento medicamentoso complejo. Pero siempre se necesitarán médicos para que hagan diagnósticos.
Por otra parte, para actividades de gran importancia en nuestro sector, como las de promoción de salud, prevención y rehabilitación, tampoco los médicos siempre tienen el papel protagónico y, en ocasiones, no son imprescindibles. Leer más…

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Abstract: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM. Methods: We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model.
Results: There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. Leer más…

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Resumen: Las descripciones originales de las enfermedades que realizan los médicos, cuyo epónimo usamos a diario, no dejan de ser magníficas observaciones clínicas hechas a través del tiempo por destacadas personalidades incluidas en la historia de la medicina. Se abordan los epónimos médicos en el campo de la Reumatología. En publicaciones de los últimos años, existen contradicciones entre los que están a favor o en contra de los epónimos médicos. Estar al lado de los que pretenden mantenerlos o no invita a reflexiones en el presente artículo. Motivar a la búsqueda de otros cientos, enriquecería el conocimiento, tanto de estudiantes, como de profesionales. Honor a quienes honor merecen.

Citado: Serra Valdés MÁ. Los epónimos médicos y la reumatología. Revista Cubana de Reumatología [Internet]. 2016 [citado 7 Nov 2017];18(1).

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