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Biomedical subjects

J González de Dios

Publications and source records attributed to J González de Dios.

At least 19 recordsLinked to original sources
PubMed2006

[Rational management of antibiotherapy in ORL infections in children: critical review of the best scientific evidences].

INTRODUCTION: Upper respiratory tract infections are the more prevalent infections in childhood and it is important to know the use and overuse of antibiotics. The objective of this article is to make a systematic and critical review of the best scientific evidence in bibliography in order to use antibiotics rationally in otorhinolaryngology (ORL) infections. MATERIAL AND METHODS: Systematic and structured review of the articles regarding antibiotherapy in ORL infections (pharyngitis, tonsillitis, otitis, sinusitis and laryngitis) in childhood published in secondary (Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc.) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). DATA SELECTION: study design, population, intervention, outcomes, main results and applicability in clinical practice. RESULTS: The main secondary information is found in The Cochrane Library and in Clinical practice guideline clearinghouses. The documents in Cochrane Library are, basically, clinical trials, systematic reviews and/or meta-analysis, mainly about otitis (13 documents), sinusitis/rhinosinusitis (6), pharyngitis/tonsillitis (3) and nasopharyngitis (3). We found 17 guidelines, mainly for otitis (8 guidelines), pharyngitis/tonsillitis (5), sinusitis (3) and laryngitis (1). Also, we found some relevant articles in Pubmed database, complementary to secondary publications. CONCLUSIONS: There are a high number of quality scientific studies who support an evidence-based decision making in clinical practice about the rational use of antibiotics in ORL infections in childhood, mainly in otitis, tonsillitis and sinusitis. Every decision in this field will have to be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources available. Doctor's knowledge (mainly in otorhinolaryngologists and pediatricians) of systematic and critical review of the current literature can help to modify prescribing habits about overuse and misuse of antibiotics in ORL infections.

Anti-Bacterial Agents↗
PubMed2005

[Consistency of clinical practice with the scientific evidence in the management of childhood asthma].

INTRODUCTION: There is substantial inconsistency between the evidence available on the management of childhood asthma and its application in practice. OBJECTIVE: To evaluate the degree of appropriateness of current management of childhood asthma. MATERIAL AND METHODS: We performed a structured review of the articles published on appropriateness in the recent biomedical literature (last 5 years). Methodological analysis and qualitative synthesis were performed. RESULTS: Twenty-three articles were identified that reflected the following problems: insufficient documentation on trigger factors, evolution of pulmonary function and symptoms, inadequate guidelines on the treatment of exacerbations, inadequate use of inhaler devices, insufficient use of anti-inflammatory drugs, unjustified heterogeneity in the selection of anti-inflammatory drugs, lack of correlation between severity and level of treatment, lack of written guidelines on customized self-management, unjustified use of antibiotics, and lack of pulmonary function testing devices. CONCLUSIONS: The management of childhood asthma should be reviewed since a large number of decisions made in clinical practice are not always based on valid scientific evidence.

Adolescent↗
PubMed2005

[Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine].

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in neonatal surgery. The aim of this article is to make an update of the controversies about the therapeutic management (time of surgery and modalities of medical stabilization) of CDH, by means of a systematic and critical review of the best scientific evidence in bibliography. METHODS: Systematic and structured review of the articles about therapeutic management of CDH (surgery, mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation, surfactant, etc) published in secondary (TRIPdatabase, systematic review in Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). RESULTS: The main secondary information is found in The Cochrane Library: 3 systematic review in the Neonatal Group (one specific about the time of surgery, and two related to the use of nitric oxide and extracorporeal membrane oxygenation in neonatal severe respiratory failure). But we found the main relevant articles in Pubmed database, mainly published in Journal Pediatric Surgery and with some clusters of investigation (Congenital Diaphragmatic Hernia Study Group in Texas University and Buffalo Institute of Fetal Therapy in New York University). CONCLUSIONS: From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear, but delayed surgical (with pre-operative stabilization) has become preferred approach in many centers, and foetal surgery is not better than neonatal one. Opinion regarding the time of surgery has gradually shifted from early repair to a policy of stabilization and delayed repair. Because of associated persistent pulmonary hypertension and/or pulmonary hypoplasia in CDH, medical therapy is focused toward optimizing oxygenation while avoiding barotrauma, using gentle ventilation and permissive hypercarbia. High frequency oscillatory ventilation, inhaled nitric oxide and extracorporeal membrane oxygenation are used in severe cases, but these treatments do not clearly improve the outcome in neonates with CDH. The usefulness of surfactant and partial liquid ventilation are based in animal model experimentation, because the clinical trials in newborns are little and non-conclusive. Challenges for the future in this thematic area include the need for bigger and better trials of therapy in this field, with long-term outcomes among surviving children.

Evidence-Based Medicine↗
PubMed2004

[Bibliometric analysis of systematic reviews in the Neonatal Cochrane Collaboration. Its role in evidence-based decision making in neonatology].

INTRODUCTION: The Cochrane Neonatal Collaborative Review Group (CNRG) is one of the most important collaborative review groups registered in the Cochrane Collaboration (CC) and provides a growing and readily accessible source of information to help neonatologists base their care on detailed, critical, and up-to-date reviews of the best available evidence. The objective of this article was to perform a bibliometric analysis (quantitative and qualitative) of the systematic reviews (SR) published in the Neonatal Cochrane Collaboration (NCC) and to identify the subject areas studied by the CNRG in which decision-making in clinical practice is based on the best available evidence. METHODS: We performed a bibliometric analysis of the Cochrane Database of Systematic Reviews in Neonatology, Issue 2, 2003 (n = 147 SR). The following variables were registered in each SR: subject area of the study, authors (number and country), dates (last review and update), characteristics of the clinical trials included (number and type), characteristics of included newborns (number and gestational age), reviewers' conclusions and potential conflicts of interest. RESULTS: The main subject areas of studies in the NCC were respiratory diseases (69 SR) and gastroenterology-nutrition (23 SR). Reviews were relatively scarce on some subjects that are very important in clinical practice in neonatology, such as cardiovascular diseases (10 SR), neurology (10 SR) and infectious diseases (6 SR). All the SR dealt with interventions for the treatment or prevention of diseases of the newborn infant (mainly preterm) and we found no reviews on diagnostic tests. Eighty-two per cent of the SR were signed by 2 or 3 authors, and we found four Bradford's zones of productivity. Ninety-two percent of the authors of SR were from four countries (Australia, United States, United Kingdom and Canada). Seventy-nine percent of all SR were published between 2000 and 2002, and 48 % have been updated. The median number of clinical trials per SR was 5 (range 0-30) and the median number of newborns included per SR was 559 (range 0-5448). Sixty percent of SR also included quasi-randomized clinical trials, and 67 % of SR included only preterm infants. In 54 % of the SR, the reviewers' conclusion was sufficient to infer probable effects (favorable or unfavorable) in clinical practice, and potential conflicts of interest were registered in 22 %. DISCUSSION: Although CC reviews are based on specific guidelines, errors and biases occur, suggesting the need to "review the reviews". The bibliometric analysis of the NCC shows that the quality of published SR varies, and the main conclusion is that almost half of the reviewers' conclusions are insufficient to infer probable effects in clinical practice. There is a lack of scientific evidence on many therapies in neonatology and, at the moment, the SR published in the NCC enable evidence-based decision making mainly in the subject area of respiratory diseases and gastroenterology-nutrition. Challenges for the future include the need for bigger and better clinical trials in this field (with long-term outcomes among surviving children), the preparation of systematic reviews on topics not yet covered, and keeping an increasing number of reviews up-to-date. Every decision in neonatology should be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources at our disposal.

Bibliometrics↗
PubMed2004

[Congresses of the Spanish Association of Pediatrics: bibliometric analysis as a springboard for debate].

BACKGROUND: Congresses are periodic meetings that are required to make known and discuss advances in the various fields of medicine. Bibliometric indicators are important tools used to determine the quality of scientific publications. However, this type of study is infrequently performed in free communications of congresses. MATERIAL AND METHODS: A bibliometric study of all the free communications published in the congresses of the Spanish Association of Pediatrics over 4 years, divided in two periods (1996-1997 and 2000-2001) (n = 2677) was performed. Bibliometric indicators were classified into quantitative (productivity), qualitative (statistical accessibility) and scientific evidence. RESULTS: Quantitative indicators: There were 928 free communications in 1996, 681 in 1997, 560 in 2000, and 508 in 2001. Eighty-eight percent were in poster format and 87 % were in structured format. There was a median of six authors per communication. The main subject areas were infectology, neonatology, hemato-oncology, neurology and endocrinology. Ninety-five per cent of communications were signed by hospitals with a marked contribution by hospitals in Andalusia and Madrid. Qualitative indicators: Statistical accessibility < 2 in 86 % and > 7 in 2.9 %. Scientific evidence indicators: The quality of scientific evidence was good in only 1 % and was average in 9 %, since 90 % of all the studies were descriptive (mainly clinical cases). Evidence-based methodological concepts were used in only 1.9 %. Compared with 1996-1997, in 2000-2001 there were fewer communications, more posters, and more structured communications, as well as greater statistical accessibility and better scientific evidence indicators, but these differences were not statistically significant. CONCLUSIONS: Bibliometric study of the congresses of the Spanish Association of Pediatrics is a good starting point to analyze the quality of pediatric meetings and discuss possible solutions: a rigorous scientific committee with quality criteria, more analytical and/or experimental studies and fewer descriptive studies (especially clinical cases); restricting the number of authors per communication, greater collaboration with epidemiologists and/or biostatisticians, and favoring structured communications would also improve quality.

Bibliometrics↗
PubMed2004

[Scientific information in pediatrics: utility of Indice Médico Español].

The international bibliographic databases (Medline, Embase, Current Contents, etc.) are one of the main sources of information in medicine. Because only some Spanish journals are included in these databases, knowledge and use of the Indice Médico Español (IME) is also important because this database includes almost all Spanish biomedical and scientific journals (basic, experimental and clinical), which provides certain well known advantages for authors and editors in Spain. Of the journals indexed at any given time in the IME (461 journals), those related to pediatrics constitute 5.2 % of the total (24 journals) with a total of 21,006 documents. Only 34 % of all the pediatrics documents in the IME are included in PubMed. The most productive pediatrics journals in the IME are Anales Españoles de Pediatría (8,639, plus 912 registered from 2002 as Anales de Pediatría), Revista Española de Pediatría (2,564), Acta Pediátrica Española (2,189), Archivos de Pediatría (1,365), Pediatrika (1,314), and Cirugía Pediátrica (685). Anales de Pediatría is the third most productive journal in the IME, after Medicina Clínica (13,323) and Revista Clínica Española (9,603). Overall, pediatrics is the second most productive field of research in medicine in Spain after internal medicine. A complementary tool of the IME is the hypothetical study of the national and international impact factor (IF) of Spanish biomedical journals. The hypothetical national IF of Anales de Pediatría (0.334) is noteworthy among Spanish medical journals overall and is much higher than those of Acta Pediátrica Española (0.134), Pediatrika (0.119), Cirugía Pediátrica (0.099) and Revista Española de Pediatría (0.079). The international IF of Anales de Pediatría (0.372) is higher than that of some pediatrics journals included in the Science Citation Index. The IME should be included in bibliographic search strategies for scientific information in pediatrics as a complement to international databases.

Bibliometrics↗
PubMed2002

[Anales Españoles de Pediatría 2001. Bibliometric indicators of scientific quality].

UNLABELLED: BACKGROUND. One important objective of Anales Españoles de Pediatría (An Esp Pediatr) is to be included in Journal Citation Reports-Science Citation Index and the main step to achieve this is to increase the scientific quality of this Spanish journal. Bibliometric indicators are important tools used to determine the quality of scientific publications. MATERIAL AND METHODS: A bibliometric study of all the original articles published in An Esp Pediatr in 2001 (n 76) was performed; bibliometric indicators were classified into quantitative and qualitative (statistical analyses and level of scientific evidence). The results were compared with the original articles published in the journal from 1994 to June 2000 (n 733) and with the original articles published in Pediatrics in 2001 (n 276). RESULTS: The differences found in An Esp Pediatr between the two study periods were the following in 2001: greater collaboration between epidemiologists and/or biostatisticians in the authorship of articles (19.7 %), increased complexity of statistical analyses (statistical accessibility > 7 in 25 %) and greater use of evidence-based methodological concepts (19.7 %). However, no improvement was found in the scientific evidence (evidence was good in only 1.4 % and average in 25.7 %). Other aspects of interest were a lower number of original articles (due to an increase in other types of articles, such as Letters to the Editor or Special Articles) and a greater percentage of articles on evidence-based medicine or articles using its methodology. The differences in bibliometric indicators of quality found between An Esp Pediatr and Pediatrics continued to be considerable: statistical accessibility, evidence-based methodological concepts and scientific evidence (for example, good evidence was 22 times more frequent in Pediatrics). CONCLUSIONS: The scientific quality of An Esp Pediatr improved in 2001 compared with that of previous years, but the differences found between this journal and the gold standard of Pediatrics are still considerable. We found greater interest in articles related to the new scientific paradigm of evidence-based medicine, which uses the medical literature more effectively to guide medical practice.

Bibliometrics↗
PubMed2000

[Laser treatment of cutaneous vascular lesions in childhood: prospective analysis of our experience with 95 children].

BACKGROUND: Recently the flashlamp-pumped dye laser has improved treatment of cutaneous vascular lesions results since this laser acts much more vessel specific than other laser (argon, Nd:Yag). The objective of this manuscript is to analyze our experience in the treatment of vascular lesions in infancy with the pulsed dye laser. MATERIAL AND METHODS: Ninety-five patients 18 years with vascular lesions (85 nevus flammeus and 10 hemangiomas) were treated prospectively with the flashlamp-pumped dye laser. The patients received therapy until the lesion was almost clear, or until the lesion failed to respond. All patients were examined during the course of their treatment to assess the clinical evolution and the incidence of adverse effects associated with the use of the laser. RESULTS: The study consisted of 54 females and 41 males ranged in age from 3 months to 18 years, with the average age being 7.3+/-5.2 years. Only six children were treated with less than six months of age. Seventy-eight vascular lesions were located on the face, nine on the neck, eight on the extremities, five on the trunk, and two on other regions (perineal area and scalp). The number of treatment sessions needed for the resolution of the cutaneous vascular lesion (in 52 nevus flammeus and 10 hemangiomas, at the moment) was 9.8+/-7.5 (range 1 to 36), with variations in relation to the type of vascular lesion (more sessions in nevus flammeus than hemangiomas) and their anatomical location (more sessions in the face and less in shoulder, arms and lips). The adverse effects were slights and transitories. CONCLUSIONS: Laser therapy is useful and safe in the treatment of cutaneous vascular lesions in infancy. Major determinants of treatment response are type of cutaneous vascular lesion and location, and also size and patient's age.

Adolescent↗