{"id":115904,"date":"2018-03-11T10:44:41","date_gmt":"2018-03-11T10:44:41","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/utilidad-de-los-recursos-basados-en-la-evidencia-en-la-consulta-del-medico-de-familia\/"},"modified":"2018-03-11T10:44:41","modified_gmt":"2018-03-11T10:44:41","slug":"utilidad-de-los-recursos-basados-en-la-evidencia-en-la-consulta-del-medico-de-familia","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-clinicas\/utilidad-de-los-recursos-basados-en-la-evidencia-en-la-consulta-del-medico-de-familia\/","title":{"rendered":"Utilidad de los recursos basados en la evidencia en la consulta del m\u00e9dico de familia"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Domingo J. Rubira Lopez <\/strong><\/h2>\n<p>Objetivos 1) comparar caracter\u00edsticas de diferentes recursos basados en la evidencia disponibles en el punto de cuidado (poc). 2) describir sus caracter\u00edsticas formales. 3) analizar su utilidad para contestar dudas de m\u00e9dicos de familia (mf).  metodolog\u00eda   evaluaci\u00f3n realizada desde dos enfoques independientes:  a) formal: valorada por expertos en estas fuentes de documentaci\u00f3n. Se evalu\u00f3 idioma, cobertura, metodolog\u00eda para generar contenido, calidad de la evidencia y fuerza de las recomendaciones, accesibilidad y recomendaci\u00f3n del recurso para mf. Cada recurso fue evaluado por dos evaluadores independientes (&quot;peer-review&quot;). Ante discrepancias desempate por tercer evaluador. b) efectividad de recursos: explorando su capacidad para responder 100 preguntas cl\u00ednicas de mf de nuestro entorno. Se evalu\u00f3 proporci\u00f3n de preguntas con informaci\u00f3n de inter\u00e9s o respuesta completa, tipo de preguntas contestadas, tiempo invertido, evidencias que avalaban la informaci\u00f3n, actualizaci\u00f3n de respuestas y aspectos positivos o negativos de cada recurso. Proceso de evaluaci\u00f3n igual al de la valoraci\u00f3n formal (&quot;peer-review&quot;). para incluir recurso en el estudio deb\u00eda cumplir todos los criterios: elaboraci\u00f3n propia de informaci\u00f3n orientada al mf, revisi\u00f3n de evidencia, utilizaci\u00f3n de metodolog\u00eda de mbe, lengua castellana y\/o inglesa, accesible desde internet y preparado para emplearse poc. se evaluaron 19 recursos: best practice; dynamed; uptodate; mdconsult; clin-eguide; essential evidence plus; acp-pier; diseasedex+emergencies; drugdex; pepid; bancos de preguntas fisterra, preevid, cap-semfyc y trip answers; gu\u00edas cl\u00ednicas fisterrae, cks y ebm guidelines; cochrane library plus y dare. resultados  evaluaci\u00f3n formal. concordancia entre observadores muy buena ( =0,73; 0,62-0,85). La mayor\u00eda de recursos cubren todos los temas y tipos de preguntas. La fecha de actualizaci\u00f3n consta en 16 recursos (84%). Procedimiento de realizaci\u00f3n de b\u00fasquedas bibliogr\u00e1ficas y autor\u00eda de los apartados presentes en 9 recursos (47%). S\u00f3lo las gu\u00edas cl\u00ednicas de fisterrae, las preguntas semfyc y cochrane library plus reflejan un &quot;peer-review&quot;. Todos los recursos presentan referencias bibliogr\u00e1ficas excepto dare. Calidad de evidencia estaba clasificada en 13 recursos (68%) y recomendaciones en 5 (26%). Las referencias bibliogr\u00e1ficas de cada apartado no suelen estar clasificadas. El \u00fanico recurso no recomendable seg\u00fan los evaluadores es pepid.  evaluaci\u00f3n de efectividad. concordancia entre observadores moderada ( =0,43; 0,39-0,48). Los mejores resultados son para uptodate: alguna informaci\u00f3n en 87 de 100 preguntas y contestan a 50 y 79 para dos o un evaluador respectivamente. Dynamed tiene informaci\u00f3n en 72, contestando 42 y 70 respectivamente. Essential evidence plus con informaci\u00f3n en 70 (contesta 37 y 63 preguntas). Gu\u00edas cl\u00ednicas de fisterrae tiene informaci\u00f3n en 64, contestando 42 y 62 preguntas para dos o un evaluador respectivamente. La mejor combinaci\u00f3n de recursos fue con los recursos gratuitos, junto a uptodate y gu\u00edas cl\u00ednicas fisterrae (77 y 93 contestadas para uno o dos evaluadores). La media de tiempo de b\u00fasqueda fue 8,36\u00c2\u00b17,03 minutos. El rango oscila entre 3,77\u00c2\u00b14,59 minutos en las preguntas cl\u00ednicas semfyc y 10,98\u00c2\u00b18,38 en acp-pier. El 75% de las b\u00fasquedas se realizan en 10 minutos o menos. El modelo de regresi\u00f3n log\u00edstica que responde a m\u00e1s preguntas est\u00e1 relacionado con demora en la actualizaci\u00f3n menor de un a\u00f1o, informaci\u00f3n documentada sobre referencias bibliogr\u00e1ficas y con evidencia clasificada. conclusiones los recursos evaluados son diferentes en aspectos formales y en capacidad para responder dudas de los mf de nuestro medio. No se encuentra relaci\u00f3n entre calidad de los recursos y n\u00famero de preguntas cl\u00ednicas respondidas. No existe un \u00fanico recurso ideal, consiguiendo mejores resultados la asociaci\u00f3n de varios. Ser\u00eda muy recomendable disponer de uptodate, dynamed, gu\u00edas cl\u00ednicas fisterrae y essential evidence plus en la pr\u00e1ctica cl\u00ednica diaria de un mf de nuestro medio. Contestar las dudas de nuestros mf precisa todav\u00eda un tiempo excesivo.  objectives 1) to compare the characteristics of different resources in evidence-based medicine (ebm) that are available from where clinical assistance is provided (poc). 2) to describe their formal characteristics. 3) to analyze their usefulness in answering questions posed by family physicians (fp).  methods   evaluation was assessed from two independent perspectives:  a) formal assessment: conducted by experts in these sources of documentation. Language, coverage, methodology used to generate content, quality of evidence and strength of recommendations, accessibility, and recommendation of the resource for fp were evaluated. Each resource was assessed by two independent evaluators (peer-review). Disagreements were reconciled by a third evaluator. b) efficacy assessment: by exploring their ability to answer 100 clinical questions from spanish fp. The proportion of questions on which information of interest and enough information was found, type of questions answered, time invested, evidences supporting the information, latest updates, and advantages and drawbacks of each resource were analysed. Assessment process was similar to the formal evaluation (peer-review).  all resources included in this assessment guarantee the following criteria:          own-developed information oriented to fp, reviewed evidence, use of ebm methodology, spanish and\/or english language, internet accessibility and readiness to be used from poc. 19 resources were evaluated: best practice; dynamed; uptodate; mdconsult; clin-eguide; essential evidence plus; acp-pier; diseasedex+emergencies; drugdex; pepid; repositories of clinical questions from fisterra, preevid, cap-semfyc and trip answers; guidelines from fisterrae, cks and ebm guidelines; cochrane library plus and dare. results  formal assessment. evaluators showed very good agreement ( =0.73; 0.62-0.85). Most of resources covered all contents and types of questions. Last update date was included in 16 resources (84%). Procedure for bibliografic search and authorship of sections were described in 9 sources (47%). Only fisterrae guidelines, semfyc answers, and cochrane library plus had a peer-review system. All resources showed bibliographical references except dare. Quality of evidence was classified in 13 resources (68%), and recommendations in 5 (26%). Bibliographical references of each section was not usually classified. Pepid is the only resource not recommended by evaluators. efficacy assessment. evaluators showed moderate agreement ( =0.43; 0.39-0.48). Best results corresponded to uptodate: in 87 out of 100 questions some information was found, while they were completely answered in 50 cases for both evaluators (79 cases for at least one evaluator). Dynamed had some information for 72 questions (42 were completely answered for both evaluators and 70 for at least one of them). Essential evidence plus had information in 70 (37 and 63 completely answered questions). Fisterrae guidelines had information in 64 (42 and 62 completely answered questions). Best combination of resources was free resources together with uptodate and fisterrae guidelines (77 and 93 completely answered questions by two or at least one evaluator respectively). Average invested time was 8.36\u00c2\u00b17.03 minutes, ranging from 3.77\u00c2\u00b14.59 minutes in semfyc answers to 10.98\u00c2\u00b18.38 in acp-pier. 75% of searches took place in 10 minutes or less.  Logistic regression showed that probability of finding an answer in a certain resource increased when it had an update delay lower than a year, bibliographical references supporting information, and classified evidence. conclusions evaluated resources differ in formal aspects and capacity to answer clinical questions from spanish fp. No relationship is found between resource quality and number of clinical questions answered. There is no one ideal resource and results are better using several resources concurrently. Uptodate, dynamed, fisterrae guidelines, and essential evidence plus would be recommended for routine clinical practice of spanish fp. Answering fp&apos;s clinical questions still takes an excessive amount of time.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Utilidad de los recursos basados en la evidencia en la consulta del m\u00e9dico de familia<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Utilidad de los recursos basados en la evidencia en la consulta del m\u00e9dico de familia <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Domingo J. Rubira Lopez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 26\/06\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Juan  Francisco Men\u00e1rguez Puche<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Alberto manuel Torres cantero <\/li>\n<li>isabel Mar\u00eda Hidalgo garcia (vocal)<\/li>\n<li>Jos\u00e9 Saura llamas (vocal)<\/li>\n<li>guillermo Garc\u00eda velasco (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Domingo J. Rubira Lopez Objetivos 1) comparar caracter\u00edsticas de diferentes recursos basados en la evidencia disponibles en [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[6314,155,8235],"tags":[23777,229066,103052,229067,60846,175437],"class_list":["post-115904","post","type-post","status-publish","format-standard","hentry","category-bases-de-datos","category-ciencias-clinicas","category-murcia","tag-alberto-manuel-torres-cantero","tag-domingo-j-rubira-lopez","tag-guillermo-garcia-velasco","tag-isabel-maria-hidalgo-garcia","tag-jose-saura-llamas","tag-juan-francisco-menarguez-puche"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115904","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=115904"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115904\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=115904"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=115904"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=115904"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}