Browsing by Author "Letelier Saavedra, Luz María"
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- ItemActinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature.(2008) Acevedo Claros, Francisco Nicolás; Baudrand Biggs, René; Letelier Saavedra, Luz María; Pablo GaeteActinomycosis is a rare, chronic disease caused by a group of anaerobic Gram-positive bacteria that normally colonize the mouth, colon, and urogenital tract. Infection involving the cervicofacial area is the most common clinical presentation, followed by pelvic region and thoracic involvement. Due to its propensity to mimic many other diseases and its wide variety of symptoms, clinicians should be aware of its multiple presentations and its ability to be a 'great pretender'. We describe herein three cases of unusual presentation: an inferior caval vein syndrome, an acute cholecystitis, and an acute cardiac tamponade. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.
- ItemAmiodarone versus other pharmacological interventions for prevention of sudden cardiac death(2015) Claro, J. C.; Candia Balboa, Roberto; Rada G., Gabriel; Baraona Reyes, Fernando Exequiel; Larrondo Castro, Luis Fernando; Letelier Saavedra, Luz María; Claro, J. C.; Candia Balboa, Roberto; Rada G., Gabriel; Baraona, F.; Larrondo Castro, Luis Fernando; Letelier Saavedra, Luz María
- ItemAnálisis crítico de un artículo: critical appraisal: enteral nutrition is better than parenteral nutrition for patients with acute pancreatitis.(2005) Manríquez, Juan Jorge; Letelier Saavedra, Luz MaríaObjective To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. Data sources Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. Study selection Randomized controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomized controlled trials and were included for data extraction. Data extraction Six studies with 263 participants were analyzed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The metaanalysis was performed with the random effects model. Data synthesis Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P= 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P= 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P <0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P= 0.16) between the two groups of patients. Conclusions Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.
- ItemAntimicrobial lock solutions for preventing catheter-related infections in haemodialysis(2018) Arechabala Mantuliz, Ma. Cecilia; Catoni S., María Isabel; Claro, Juan Carlos ; Rojas Silva, Noelia Pilar; Rubio, Miriam E.; Calvo, Mario A.; Letelier Saavedra, Luz María
- ItemAntimicrobial lock solutions for preventing catheter-related infections in haemodialysis (Protocol)(2013) Arechabala Mantuliz, Ma. Cecilia; Catoni S., María Isabel; Claro García-Atance, Juan Carlos; Rojas Silva, Noelia Pilar; Rubio Acuña, Miriam; Calvo Arellano, Mario; Letelier Saavedra, Luz María
- ItemClinical epidemiologic study of patients admitted to the intensive care unit, according to age.(1997) Dougnac Labatut, Alberto; Andresen, M.; Giacaman, P.; Díaz, O.; Letelier Saavedra, Luz María; Arriagada, D.Introducción: Últimamente hemos observado un aumento en el ingreso a unidades de cuidados intensivos de pacientes mayores de 65 años, probablemente debido al aumento de la esperanza de vida que se está presentando en Chile. Objetivo: Comparar la frecuencia de ingresos a unidades de cuidados intensivos en pacientes mayores de 65 años, sus diagnósticos, su gravedad y evolución hospitalaria, con la de pacientes más jóvenes. Pacientes y métodos: Se revisaron los prontuarios de todos los pacientes ingresados en una unidad de cuidados intensivos de un Hospital Universitario, durante un año. El diagnóstico que motivó el ingreso fue considerado como enfermedad principal. La gravedad en el momento del ingreso se evaluó mediante el puntaje de Apache. Resultados: Un total de 777 pacientes ingresaron durante el período de estudio. Veinte tuvieron que ser excluidos debido a la falta de datos confiables. Cuatrocientos treinta y dos (57%) tenían más de 65 años. Las enfermedades cardiovasculares fueron la principal causa de ingreso en pacientes jóvenes y ancianos. La mortalidad fue del 14,8% de los pacientes mayores de 65 años y del 18,7% en los más jóvenes. Las principales causas de muerte fueron paro cardíaco, shock cardiogénico, sepsis y enfermedad cerebrovascular. No se observaron diferencias en las causas de muerte entre pacientes jóvenes y ancianos. Conclusiones: Los pacientes mayores de 65 años ingresados en unidades de cuidados intensivos son muy similares a sus contrapartes más jóvenes en su pronóstico y causas de ingreso.
- ItemConocimiento y perfil de uso de la biblioteca Cochrane en médicos asistentes a un congreso de Medicina Interna(2017) Letelier Saavedra, Luz María; Acuna Schlegel, María Paz; Viviani Garcia, Paola Mariluz; Ewoldt Pizarro, Sebastián Ignacio; Diaz Fabres, Ana Paz; Rivera Mercado, Solange Tatiana XimenaIntroducción: las Revisiones Sistemáticas (RS) son herramientas para practicar Medicina Basada en la Evidencia. La Colaboración Cochrane genera RS, pero el conocimiento y uso de la Biblioteca Cochrane (BC) es heterogéneo. Nuestro objetivo fue describir el nivel de conocimiento y el perfil de uso de la BC entre asistentes a una Conferencia Mundial de Medicina Interna (WCIM). Método: estudio transversal vía encuesta electrónica entre asistentes al XXXI WCIM, recabando información demográfica de los participantes; su conocimiento, acceso y usos de la BC. Resultados: 413 asistentes aceptaron participar y 198 (47,9%) de 24 países respondieron. 91,4% eran Latinoamericanos, 50,5% eran internistas. El conocimiento de la BC fue del 96,5%. El 76% de quienes respondieron usaban la BC al menos una vez al mes. No encontramos diferencias en la frecuencia de uso según edad o ámbito académico. Las principales razones para utilizar RS-BC fueron: toma de decisiones clínicas (67,6%), actualización (64,2%) y docencia (31,8%); 46% consideraron la BC muy útil para sus propósitos. Los <35 años utilizaban significativamente más la BC para guiar las decisiones clínicas que los >35 años (70% vs 53%, p: 0,017). Quienes consideraron muy útil la BC la utilizaron significativamente más para propósitos docentes (41% vs. 24%, p: 0,019) y toma de decisiones clínicas (79% vs. 58%, p: 0,003) que quienes la declararon como a veces útil o no útil. Hubo también diferencias estadísticamente significativas en la distribución del acceso a la BC según región geográfica (p: 0,001). Conclusiones: encontramos un alto nivel de conocimiento dela BC entre los asistentes a WCIM. Los usuarios describen un uso frecuente para diversos propósitos, considerándola útil para estos
- ItemConsenso: Manejo racional del paciente con cáncer, neutropenia y fiebre(2005) Santolaya de P., María Elena; Rabagliati B., Ricardo; Bidart H., Teresa; Payá G., Ernesto; Guzmán D., Ana M.; Morales I., Ricardo; Braun J., Stephanie; Bronfman F., Lucía; Ferrés G., Marcela; Flores P., Claudio; García C., Patricia; Letelier Saavedra, Luz María; Puga L., Bárbara; Salgado M., Carmen; Thompson M., Luis; Tordecilla C., Juan; Zubieta A., Marcela
- ItemEffectiveness of education in evidence-based healthcare: the current state of outcome assessments and a framework for future evaluations.(2007) Nabulsi, Mona; Harris, Janet; Letelier Saavedra, Luz María; Ramos, Kathleen; Hopayian, Kevork; Parkin, Claire; Porzsolt, Franz; Sestini, Piersante; Slavin, Mary; Summerskill, WilliamBackground A discipline which critically looks at the evidence for practice should itself be critically examined. Credible evidence for the effectiveness of training in evidence-based healthcare (EBHC) is essential. We attempted to summarise the current knowledge on evaluating the effectiveness of training in EBHC while identifying the gaps. Methods A working group of EBHC teachers developed a conceptual framework of key areas of EBHC teaching and practice in need of evidence mapped to appropriate methods and outcomes. A literature search was conducted to review the current state of research in these key areas. Studies of training interventions that evaluated effectiveness by considering learner, patient or health system outcomes in terms of knowledge, skills, attitude, judgement, competence, decision-making, patient satisfaction, quality of life, clinical indicators or cost were included. There was no language restriction. Results Of 55 articles reviewed, 15 met the inclusion criteria: six systematic reviews, three randomised controlled trials and six before-after studies. We found weak indications that undergraduate training in EBHC improves knowledge but not skills, and that clinically integrated postgraduate teaching improves both knowledge and skills. Two randomised controlled trials reported no impact on attitudes or behaviour. One before-after study found a positive impact on decision-making, while another suggested change in learners' behaviour and improved patient outcome. We found no studies assessing the impact of EBHC training on patient satisfaction, health-related quality of life, cost or population-level indicators of health. Conclusions Literature evaluating the effectiveness of training in EBHC has focused on short-term acquisition of knowledge and skills. Evaluation designs were methodologically weak, controlled trials appeared inadequately powered and systematic reviews could not provide conclusive evidence owing to weakness of study designs.
- ItemEl análisis crítico de la información publicada en la literatura médica(2004) Letelier Saavedra, Luz María; Pantoja Calderón, Tomás; Neumann Burotto, Gonzalo Ignacio
- ItemEl «ciego» en los ensayos clínicos ¿importa?(2004) Letelier Saavedra, Luz María; Manríquez Moreno, Juan; Claro García-Atance, Juan Carlos
- ItemEvaluación de docentes clínicos de Postgrado: desarrollo y propiedades psicométricas del instrumento MEDUC-PG14(2015) Pizarro Rojas, Margarita Alicia; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier Saavedra, Luz María; Aizman, Andrés; Sarfatis Feige, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitrán Carreño, Marcela; Arab Verdugo, Juan Pablo; Riquelme Pérez, Arnoldo; Pizarro, Margarita; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier Saavedra, Luz María; Aizman, Andrés; Sarfatis Feige, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitrán Carreño, Marcela; Arab Verdugo, Juan Pablo; Riquelme Pérez, Arnoldo
- ItemEvidence based medicine: a view after a decade.(2003) Letelier Saavedra, Luz María; Moore, PhilippaEvidence based medicine (EBM) appeared early in the 1990s and since then it has been developed and expanded worldwide. A decade later we summarize the history of EBM, the initial debates and the evolution to the current concept of evidence based health care (EBHC) as a tool for clinical decision making. We also describe the process of EBHC, some insights to current dilemmas and the situation of EBM in Chile.
- ItemExploring Language Barriers to Evidence-based Health Care (EBHC) in Post-graduate Medical Students: A Randomised Trial(2007) Letelier Saavedra, Luz María; Zamarín Brocco, Nicolás Felipe; Andrade Anziani, Maricarmen Soledad; Gabrielli, L.; Caiozzi Apablaza, Gianella Caterina; Viviani García, Paola; Riquelme, A.Background: Understanding the written English language might be a barrier when teaching Evidence-based Health Care (EBHC) to Spanish-speaking physicians. Aim: To quantify the magnitude of this potential barrier. Method: Cochrane Review abstracts in English or in Spanish were randomly distributed among first-year residents at the Pontificia Universidad Catolica of Chile. Residents answered investigator-designed questionnaires to measure their comprehension while the time needed to complete the task was recorded. Results: Groups were similar at baseline. Mean score for those reading in Spanish was 11.9 ± 2.8 (range 5 to 18) compared to 10.5 ± 3.8 (range 1 to 17) for those reading in English (p=0.04). Low scores (£ 9) were twice as frequent for the English group than for the Spanish group (16.7% vs 34.7%; p=0.042). The time to complete the task was also longer for the group reading in English. Conclusion: Language should be taken into account when teaching EBHC to Spanish-speaking physicians.
- ItemImportancia de la intención de tratar y el seguimiento en la validez interna de un estudio clínico randomizado(2004) Capurro, Daniel; Gabrielli, Luigi; Letelier Saavedra, Luz María
- ItemInfección respiratoria aguda por coronavirus Sars-CoV-2 en personal de salud. Implementación de un programa de detección precoz y seguimiento de casos en un hospital universitario(2020) Poblete Umanzor, Rodrigo Eduardo; Saldías Peñafiel, Fernando; Ugarte, N. S.; Valverde, A. V.; Ceriani Bravo, Alejandro Andrés; Pernas, S. S.; Letelier Saavedra, Luz María; Scheuch, J. I. G.; Rabagliati, Ricardo
- ItemIs acetaminophen beneficial in patients with cancer pain who are on strong opioids? A randomized controlled trial(2023) Leiva, Ofelia; Letelier Saavedra, Luz María; Rojas Orellana, Luis; Viviani García, Paola; Castellano, Joel; González Candia, Antonio Felipe; Pérez Cruz, PedroContextPain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime.ObjectiveTo assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids.MethodsIn this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients’ perception of improved pain control.ResultsAmong 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation (SD)) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval(CI) [-0.49;1.32];p=0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24;26.1];p=0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (p=0.81).ConclusionAmong patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.
- ItemPercepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna(2015) Pérez Hernández, Iván Modesto; Claudia Vergara.; Goens Guzmán, María Cristina|Viviani García, Paola; Letelier Saavedra, Luz María
- ItemRandomized double-blind controlled trial to assess the efcacy of intravenous acetaminophen associated with strong opioids in the treatment of acute pain in adult cancer patients: study protocol(2022) Leiva, Ofelia; Castellano, Joel; Letelier Saavedra, Luz María; Rojas Orellana, Luis; Viviani García, Paola; González Candia, Antonio Felipe; Pérez Cruz, PedroBackground: Cancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient’s quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain. Methods: We will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated. Discussion: The randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results.
- ItemRevisiones sistemáticas y metaanálisis: ¿son la mejor evidencia?(2005) Letelier Saavedra, Luz María; Manríquez M., Juan J.; Rada G., GabrielLas RS representan el más alto nivel de evidencia, sí y sólo sí, han sido realizadas con las precauciones necesarias para reducir la posibilidad de sesgo durante su realización, de modo que sintetice de manera confiable toda la evidencia de alta calidad disponible.