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PubMed1997

[Impact of consensus conferences of hypercholesterolemia and hypertension in Spain].

BACKGROUND: In May 1989 and June 1990, consensus conferences of treatment of hypertension and hypercholesterolemia respectively were held in Spain, at the General Division of Health Planning from the Ministry of Health. The objective of this article is to assess the effect of such conferences of physicians' knowledge, attitudes and practices. SUBJECTS AND METHODS: Cross-sectional telephone survey was carried out in physicians of general medicine, family practice, internal medicine and cardiology specialties. 807 physicians were selected, 347 family physicians, 177 general practitioners, 156 cardiologists and 128 internists. A questionnaire of 30 items was designed to obtain information about demographic and professional characteristics, knowledge of the consensus conferences and attitudes related to a case of an otherwise healthy asymptomatic 48-years-old man. RESULTS: The response rate was 57% (463 physicians), and 60% of physicians had knowledge about the conferences, being general practitioners the ones who had less knowledge of the conferences. The items about recommendations of diet and pharmacological treatment were property answered (about 50% of the physicians answered correctly). The mean of serum cholesterol when diet and drugs are recommended was 232 mg/dl (SD 23) (6.01 mmol/l) and 260 mg/dl (SD 25) (6.7 mmol/l) respectively. The first-choice cholesterol lowering drugs were statines. A patient was considered as hypertensive it the mean of systolic blood pressure was 149 mmHg (9.4) and the mean for diastolic blood pressure was 92 mmHg (3.8). The mean of diastolic blood pressure considered for drug treatment was 96.7 mmHg (SD 4.6). The first-choice antihypertensive drugs were angiotensin conversive enzyme inhibitors. CONCLUSIONS: Diffusion of the conferences has been unequal, being general practitioners less knowledgeable about the content of the conferences. Although physicians know reasonably well the recommendations about diet and drug treatments, the attitude in practice is more aggressive than recommended. Globally, the knowledge of the contents of the conferences was acceptable, although there were differences between specialties; however the effect on clinical practice is still low.

Consensus Statements as Topic↗
PubMed1996

[Should we give up combining spinal anesthesia and anticoagulants?].

The risk of lumbar haematoma potentially increased by the association of regional anaesthesia and anticoagulant treatment has been widely debated. Few data are available in order to estimate the level of this risk, which is probably very low. However, even if it is now clear that regional anaesthesia is not potent enough to prevent postoperative deep vein thrombosis (DVT), a partial decrease in the DVT rate between 30 and 40% has been observed. Furthermore, no randomized double blind study has established the usefulness of the preoperative injection of heparin. Accordingly, when it is possible, it is best to avoid the preoperative injection and to start heparin treatment postoperatively. This solution is safe and effective.

Anesthesia, Spinal↗
PubMed1997

Evaluation of a workshop on Public Education Messages for Reducing Health Risks from Ultraviolet Radiation.

The objective of this paper is to assess the impact of the 1994 Workshop on Public Education Messages for Reducing Health Risks from Ultraviolet Radiation (UVR). The target audience was any organization in Canada doing education on the health risks of UVR. A mailed survey with telephone follow-up was distributed to 130 addresses, including workshop participants, recipients of the workshop report and 40 local public health units. The response rate was 62%. Public health messages from the workshop served as an added impetus or helped to initiate activities around UVR in approximately 40% of organizations over the two years since the workshop. The public health messages were used directly in programming by approximately 38% of all organizations responding. However, looking at those who had previously seen the messages, 61% used them directly in programming. Forty percent of those sampled had never seen a copy of the messages. The results suggest the need for improved dissemination of consensus statements.

Canada↗
PubMed1997

Counterpoint: to (measure apo) B or not to (measure apo) B: a critique of modern medical decision-making.

The measurement of apo B provides critical information that is complementary to that provided by the plasma and lipoprotein lipids for the assessment of coronary risk and the choice of appropriate pharmacological therapy. Why then is this measurement not in more widespread clinical use? I suggest two explanations. First, against the evidence, there is a lingering perception that problems persist in its measurement in routine clinical practice. Far from this being the case, however, the measurement of apo B has met every reasonable standard of laboratory precision and reliability to allow its widespread introduction in clinical laboratories. The second impediment is that the introduction of new tests has become subject to the authority of consensus conferences, a new approach to medical decision-making. The number of such conferences is increasing astronomically, and their reports are major determinants of clinical practice and allocation of resources. Notwithstanding the benefits they have brought, here I argue that, just as with any other scientific method, the merits of this new method of decision-making need to be examined critically; for if we do not, a process that was established to introduce change may, in fact, retard it or destroy it altogether.

Apolipoproteins B↗
PubMed1997

Oil protection.

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Consensus Statements as Topic↗