Evidence based medicine and patient centered medicine: Some thoughts on their integration [Medicina basada en la evidencia y medicina centrada en el paciente: algunas reflexiones sobre su integración]
Sacristan J.A.,Lilly Espana
Revista Clinica Espanola | Year: 2013
Evidence based medicine (EBM) and patient centered medicine (PCM) are two movements that have emerged with great force in health systems in recent years. EBM has a population approach, and its primary objective is the generalization and improvement of health outcomes in the average patient. PCM has a personalized approach, focuses on individualization and improving health outcomes in specific patients. While EBM has its conceptual anchor in research, PCM has it in medical care. Despite EBM and PCM may be perceived as conflicting movements, the profound changes that are currently taking place in health systems can facilitate the confluence of clinical research and medical care. This article constitutes a reflection on how research methods should approach the individual patient and medical practice should approach future patients. EBM and PCM, like research and medical practice are two sides of the same coin, which should complement and aid each other. It is difficult to see how one of them can reach its full potential without the other as a continual reference. Because PCM should not be practiced without being based on the best available evidence and it is impossible to imagine an EBM whose ultimate goal is disconnected from the individual patient. © 2013 Elsevier España, S.L.
Goday-Arno A.,Servicio de Endocrinologia y Nutricion |
Goday-Arno A.,Autonomous University of Barcelona |
Goday-Arno A.,Institute Hospital del Mar dInvestigacions Mediques IMIM |
Goday-Arno A.,CIBER ISCIII |
And 11 more authors.
Endocrinologia y Nutricion | Year: 2013
Background and objectives: To report the prevalence of obesity in a Spanish working population and its changes in recent years. Material and methods: Data were collected from routine medical examinations performed on workers by a national mutual insurance society for occupational accidents and diseases (Ibermutuamur). A structured questionnaire was completed and physical examinations were performed. Overweight was defined as BMI ranging from 25 and 29.9, obesity as BMI of 30-39.9, and morbid obesity as BMI≥40kg/m2. Results: Data from 1,336,055 medical examinations performed from May 2004 to November 2007 were collected. Prevalence rates in the population examined in 2004 (n = 230,684; 73% males; average age, 36.4 years) were: morbid obesity, 0.5% (0.6% males, 0.5% females); obesity, 14.5% (17.0% males, 7.7% females); overweight, 38.4% (44.8% males, 21.3% females). Prevalence rates of obesity and overweight were higher in blue-collar workers (16.4% and 40.5% respectively) as compared to white-collar workers (10.9% and 34.4% respectively). There was a progressive increase in prevalence of obesity during the 4-year study (2004-2007) in both males (17.0%, 17.6%, 17.9%, 18.2%) and females (7.6%, 8.0%, 8.4%, 8.7%). Conclusions: Prevalence of obesity and overweight in the Spanish working population is high, especially in male blue-collar workers, and is increasing. There is a need to promote early prevention programs and specific treatments for obesity. © 2012 SEEN.
Prevalence of metabolic syndrome and consistency in its diagnosis in type 2 diabetic patients in Spain [Prevalencia del síndrome metabólico y grado de concordancia en su diagnóstico en pacientes con diabetes mellitus tipo 2 en España]
Rodriguez Bernardino A.,Lilly Espana |
Garcia Polavieja P.,Lilly Espana |
Reviriego Fernandez J.,Lilly Espana |
Serrano Rios M.,Hospital Clinico San Carlos
Endocrinologia y Nutricion | Year: 2010
Objective: To determine the prevalence of metabolic syndrome, the degree of consistency among World Health Organization (WHO), The Third Report National Cholesterol Education Program (NCEP-ATP III) and the International Diabetes Federation (IDF) diagnostic criteria and the relationship with cardiovascular risk in a Spanish population of patients with type 2 diabetes. Material and methods: This descriptive, epidemiologic, multicenter and cross-sectional study included 1259 patients with type 2 diabetes. The primary variable was diagnosis of metabolic syndrome according to WHO, NCEP-ATP III and IDF criteria. Results: The prevalence of metabolic syndrome was 71.5% (WHO), 78.2% (NCEP-ATP III), and 89.5% (IDF). The prevalence of metabolic syndrome was higher in sedentary diabetic patients (WHO=79.3%, NCEP-ATP III=86.2%, and IDF=93.9) than in those who exercised moderately (WHO=61.4%, NCEP-ATP III=73.2%, and IDF=85.5%, [p<0.001]). The percentage of patients with metabolic syndrome and moderate/high cardiovascular risk was 38.9% (WHO), 33.6% (NCEP-ATP III), and 30.1%, (IDF). Consistency among WHO, NCEP-ATP III and IDF criteria was low. Only comparison of WHO vs NCEP-ATP III criteria was acceptable (k=0.52 [0.46-0.58]). Conclusions: The prevalence of metabolic syndrome in patients with type 2 diabetes in Spain is high, even when the low consistency among WHO, NCEP-ATP III and IDF criteria is considered. A standard definition of metabolic syndrome, according to routine clinical practice, is needed. Cardiovascular risk is greater when OMS and NCEP-ATP III criteria are used for the diagnosis of metabolic syndrome compared with IDF criteria. © 2009 SEEN.