Javier Moraga C

Confiabilidad de la escala MINCIR para valorar calidad metodológica de estudios de terapia

Validation of a scale for assessing methodological quality of therapy studies. Pilot study Introduction: The methodological quality (MQ) is a complex multidimensional concept that assesses multiple items as design, methodology and analysis. There are few tools to assess MQ of studies in the field of therapy and these are also partially validated. The aim of this study is to determine the intra and inter observer reliability of the MINCIR scale for assess MQ of therapy articles. Methods: Study of validation scales. Was calculate sample size considering confidence level of 95%, accuracy of 2 points and standard deviation of 4.95, which gives 21 articles, select by simple random probabilistic sampling with Stata 10.0. Was determined intra and inter observer reliability of the scale and each one of its domains using intraclass correlation coeffi - cient (ICC). Results: The ICC for interobserver reliability was 0.9. The ICC observed for the domains one, two and three was 0.97, 0.88 and 0.64 respectively. The ICC observed for intraobserver reliability was 0.99. The ICC observed for the domains one, two and three were 1; 1 and 0.91 respectively. Conclusion: Interob- server and intraobserver reliability for the MINCIR scale to assess MQ of therapy articles were determined.

Publicaciones de autores chilenos en revistas quirúrgicas durante los últimos diez años

Resumen es: Introduccion: Caracterizar la produccion cienti fi ca personal, institucional o nacional es una necesidad para comprender y mejorar la generacion de cono...

Impacto y visibilidad de la Revista Chilena de Cirugía tras su indización en las bases de datos SciELO e ISI: Análisis bibliométrico

Objetivo: Caracterizar la visibilidad internacional e impacto de la Revista Chilena de Cirugia (RCC) tras su indizacion en las bases SciELO (2006) e ISI (2009). Metodo: Busqueda en la plataforma WOK de Thomson-Reuters de las citaciones ISI de articulos de la RCC en el periodo pre-indizacion (1992-2005), indizacion SciELO (2006-2008), e indizacion ISI (2009-2011). Las variables analizadas fueron: numero total y promedio anual de citas a la RCC, de articulos de la RCC citados y de articulos que citan a la RCC; autores, revistas e instituciones que citaron, asi como su caracter (nacional e internacional), y las citas trienales. Resultados: El promedio anual de citas ISI en el periodo pre-indizacion, SciELO e ISI fue de 16,9; 58,3 y 164,7, respectivamente; mientras que el grado de internacionalizacion de los articulos que originaron las citas a nivel de autores-instituciones/revistas para cada periodo fue de 8,6% / 32,4%; 8,5% / 38,3%; y 25,8% / 33,6%, respectivamente; las citas trienales de cada periodo fueron 3, 12 y 34. Las revistas con mas citas a RCC fueron Rev Med Chile, RCC, World J Surg y Cir Esp, mientras que a nivel de autores-instituciones vemos una concentracion en la Universidad de Chile, Pontificia Universidad Catolica y Universidad de La Frontera. Conclusion: La indizacion de RCC en las bases SciELO e ISI ha traido un incremento en su impacto (citas) y visibilidad internacional, aunque persiste una fuerte citacion endogamica que debe ser resuelta a fin de alcanzar un buen nivel internacional.

¿Es el absceso hepático de origen h¡datídico un factor de riesgo para el desarrollo de complicaciones postoperatorias en pacientes intervenidos por hidatidosis hepática?

Liver abscess of hydatid origin as a risk factor for postoperative complications in hydatidosis Background: Cyst infection and subsequent abscess formation is considered a complication of hepatic echinococcosis (HE). Aim: To determine whether liver abscess of hydatid origin (LAHO) is a risk factor for the development of postoperative complications (POC) in patients operated by HE. Material and Methods: Prospective cohort study. Patients consecutively operated by HE between 2000 and 2007 were studied. LAHO was considered as exposure and POC as outcome. Results: Fifty two patients with LAHO, aged 50 ± 21 years (52% females) and 126 without LAHO, aged 48 ± 20 years (56% females) were studied. Patients with LAHO had a higher frequency of coexistent cyst lesions and a lower frequency of biliary communications. The frequency of complications was 28.9 and 11.1% among patients with and without LAHO, respectively (p < 0.01, crude risk ratio of 2.6, 95% confidence intervals 1.4-5.0). Logistic regression showed a significant interaction of alkaline phosphatases with risk calculation. The risk ratio, adjusting by this variable, changed to 2.45 (95% confidence intervals 1.3-5.0). Conclusions: LAHO is a risk factor for the development of POC in patients operated by HE.

PAUTAS DE CHEQUEO, PARTE II: QUOROM Y PRISMA

cheklists, part ii: QuOrum and Prisma Systematic reviews, especially those that include meta-analysis, are the designs that provide the highest level of evidence. However, like other research designs, they can present with low quality reports that undermine the contribution they can make to readers, generating doubts about their validity. To address this situation, various actors in the biomedical sciences developed in the mid 1990s the qUORUM statement, consisting of 18 items grouped into six domains, with the aim of improving the quality of reports of metaanalyzes. In 2009 the same group published the PRISMA statement as an evolution of the previous one, allowing conducting systematic reviews of randomized clinical trials and other types of design, consisting of 7 domains with 27 items. Like other checklists, their impact in the practice has been variable, but certainly contributes to the improvement of the report. This article describes both checklists for use by the authors of the Revista Chilena de Cirugia, in order to achieve an improvement of their articles in a simple and efficient way.

Pautas de chequeo, parte I: consort y trend

cheklists, part i: cOnsOrt and trend One of the most common problems in scientific articles is its poor reporting, a situation that leads to lack of information, affecting internal and external validity, questioning his contribution and usefulness. This has been studied leading to propositions by the international scientific community, reflected in a series of guidelines or checklists as COnSORT and TRE nD for randomized clinical trials (RCTs) and non-randomized intervention studies (nRISs) respectively. The COnSORT checklist was created in 1996, with a final version in 2010, consisting of 25 items, grouped into 6 domains: Title and Summary, Introduction, Methods, Results, Discussion, and Other information; representing the critical points in a RCT report. In many cases RCTs are no feasible so other research designs such as nRISs has to be executed, for this design the TREn D checklist was developed in 2004, consisting of 22 items, grouped into 5 domains: Title and Summary, Introduction, Methods, Results and Discussion. Even when the evidence has been contradictory regarding the impact of these checklists, they represent an important tool to improve biomedical research. This article tries to explain these checklists and encourage its use by the authors of the Revista Chilena de Cirugia, in function to contribute to continuous improvement of their articles in a simple and efficient way.

Aspectos clínico-quirúrgicos de la hidatidosis hepática, una zoonosis de creciente preocupación

La hidatidosis es una zoonosis endemica en el sur de Chile, por lo que tenemos la oportunidad de tratar un numero importante de pacientes, especialmente hepatica, localizacion mas comun de esta enfermedad. La hidatidosis hepatica (HH) tiene morbilidad y mortalidad propia debido a sus complicaciones evolutivas, a lo que se agrega el riesgo de complicaciones asociados a los procedimientos quirurgicos, cuya morbilidad se ha reportado entre 11% y 86%; la que se ha relacionado con intervenciones previas por HH, complicaciones evolutivas de los quistes, la necesidad de realizar procedimientos adicionales como el tratamiento de la enfermedad en otras localizaciones simultaneas. La mortalidad reportada es inferior al 5%. Sin embargo, tanto morbilidad como mortalidad persisten altas a pesar de los avances tecnologicos terapeuticos. El tratamiento quirurgico de la HH se puede dividir en cuatro fases: aislamiento de la zona quirurgica, evacuacion del quiste, tratamiento de las complicaciones del quiste; y tratamiento de la cavidad residual. Por otro lado, la cirugia de la HH se puede clasificar en procedimientos conservadores (marsupializacion, quistostomia, operacion de Posadas y quistoyeyunostomia) y resectivos (periquistectomia, quistectomia subtotal y resecciones hepaticas). Por ultimo, cabe senalar el rol de la cirugia laparoscopica, que aun se encuentran en evaluacion.

Morbilidad postoperatoria en pacientes con hidatidosis hepática no complicada: Utilización de una propuesta de clasificación de complicaciones

Introduccion: La cirugia de la hidatidosis hepatica (HH) es habitual en hospitales del sur de Chile. El numero de publicaciones relacionadas es escasa y los resultados disimiles. Hablar de morbilidad postoperatoria es complejo debido a la diversidad en la gravedad e implicancias para el paciente; basado en ello, Clavien publico una clasificacion basada en la gravedad de la morbilidad postoperatoria. El objetivo de este estudio es reportar la morbilidad postoperatoria en pacientes intervenidos por HH no complicada aplicando la clasificacion de Clavien. Material y Metodo: Estudio de cohorte prospectiva. Se incluyeron pacientes intervenidos quirurgicamente por HH no complicada, en el Hospital Hernan Henriquez Aravena de Temuco, entre 1997 y 2008. La variable resultado principal fue desarrollo de morbilidad postoperatoria aplicando la escala de Clavien. Otras variables de interes fueron estancia hospitalaria, mortalidad y recurrencia. Las tecnicas quirurgicas empleadas fueron periquistectomia total o subtotal y reseccion hepatica. Se calcularon porcentajes, medidas de tendencia central y dispersion; intervalos de confianza de 95% e incidencia. Resultados: 116 pacientes, con mediana de edad de 40,5 anos; 60,3% de genero femenino. La mediana del diametro ultrasonografico de los quistes fue de 15,0 cm. El tiempo quirurgico promedio fue de 115,4 ± 23,2 min. La incidencia de morbilidad fue de 8,6%; 90% de los cuales eran Grado I o II de Clavien. La etiologia fue 5,2% de complicaciones medicas y 3,4% de complicaciones quirurgicas. No se registro mortalidad. Con una mediana de seguimiento de 95 meses, se verifico recurrencia en 1 paciente, lo que representa una incidencia de 0,9%. Conclusiones: Se describe la morbilidad postoperatoria de una cohorte de pacientes con HH no complicada con enfasis en la gravedad de esta. La morbilidad observada es inferior a la publicada y de bajo nivel de gravedad.

¿Es la comunicación quisto-biliar, un factor de riesgo para el desarrollo de morbilidad postoperatoria en pacientes con hidatidosis hepática?

Intrabiliary rupture of hydatid cysts as a risk factor for postoperative complications Background: Intrabiliary rupture is a complication of hepatic hydatid cysts. Aim: To determine if intrabiliary rupture is a risk factor for postoperative complications of hydatid cysts. Material and Methods: Prospective follow up of patients operated for hepatic hydatid cysts between 1996 and 2006. Patients were evaluated every six months during the first years and every 12 months thereafter. The presence of intrabiliary rupture was evaluated as a risk factor to develop complications during the follow up. Results: Ninety six patients with and 156 patients without intrabiliary rupture, 56% females, aged 42 years, were followed for a mean of 86.5 months. The overall incidence of complications was 17%. The incidence in patients with and without intrabiliary rupture was 9,4 and 21,8% respectively (p = 0.01). The bivariate analysis showed differences between patients with and without complications in leukocyte count, serum bilirubin, alkaline phosphatases, transaminases, cyst diameter, hospital stay and cyst complications. The relative risk for complications of intrabiliary rupture was 3,4 (95% confidence intervals 2,6-4,2). Conclusions: The presence of intrabiliary rupture of a hepatic hydatid cyst is an independent risk factor for the development of complications in the postoperative period.

DÓNDE Y CÓMO BUSCAR EVIDENCIA CIENTÍFICA EN MEDICINA

Where and how to search scientific medical evidence? The practice of evidence based medicine requires strategies to efficiently search relevant medical infor mation. This paper provides tools to optimize literature searches and access the best papers available. There are several electronic databases that can be consulted such as MEDLINE, LILACS, Web of Knowledge, The Cochrane Library, TRIP database, EMBASE and Google Scholar. Prior to the search, a research question must be formulated, structured according to the mnemonic rule PICO (Patient, Intervention, Comparator and Outcome). The question must be adapted to the language of the search engine with the help of Boolean operators, MeSH terms, keywords and methodological filters such as type of study, type of population, clinical category and sensitivity. These techniques will allow the performance of an efficient literature search in a shorter lapse.