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Solari L.,Peruvian University of Applied Sciences
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2015

Peru is negotiating the Transpacific Partnership Agreement, a commercial treaty that could have deleterious implications for the health systems of the included partners. Transparency and Intellectual Property chapters are the most controversial elements. The first mostly because it opens the possibility for groups of interest to refuse decisions being taken by the sanitary authorities concerning the incorporation of health technologies to the public health systems. The second because it poses restrictions to the entrance of generic medical products, widening the period of data exclusivity and implementing mechanisms of opposition to their registry. Other chapters include strategies to block the states from regulating the consumption of alcohol, tobacco and processed foods. We ought to create surveillance systems to evaluate the impact of the agreement if it is signed, and generate mechanisms that prevent the little resources we already have devoted for health to be deviated to top technology that will not necessarily have a positive impact at a population level. © 2015, Instituto Nacional de Salud. All rights reserved.


Pereyra-Elias R.,Peruvian University of Applied Sciences
Revista de gastroenterología del Perú : órgano oficial de la Sociedad de Gastroenterología del Perú | Year: 2011

To determine the proportion of abstracts presented at the Congreso Peruano de Gastroenterología (the major Peruvian gastroenterological scientific meeting), that had been published in scientific journals, the date of publication and its associated factors. Longitudinal retrospective and analytic study; the publicationrate of all the abstracts presented in the biennial Congreso Peruano de Gastroenterología between 1998 and 2008 was assessed. Google Scholar engine was used. The searching strategy performed included: ("Study location" AND "population studied" AND "main outcome") AND (autor:First OR autor:Second OR autor:Last). Logistic regression was used, considering p<0.05 statistically significant. Publication rate was 8.2% (34/217), statistically significant differences were found among meeting years (p<0.001). There were also differences between study design, objectives (more in analytic studies) and measurement (more in longitudinal studies (p<0.001). 82.4% were published in the Revista de Gastroenterología del Perú. The median time for publication was 10.8±10.4 months; this variable and the meeting year, study type, journal of publication or accordance between the abstract and publication characteristic showed no statistical differences. The mean authors' number was 5.02±2.4; analytic studies have less authors than the descriptive ones (3.6 vs 6.1; p=0.012). The Congreso Peruano de Gastroenterología presents a low publication rate of the abstracts presented, which can be used as a quality indicator of the abstracts and the reviewing process.


Whiting P.F.,University of Bristol | Whiting P.F.,Kleijnen Systematic Reviews Ltd | Wolff R.F.,Kleijnen Systematic Reviews Ltd | Deshpande S.,Kleijnen Systematic Reviews Ltd | And 12 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

IMPORTANCE: Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. OBJECTIVE: To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. DATA SOURCES: Twenty-eight databases from inception to April 2015. STUDY SELECTION: Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. RESULTS: A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], -0.46 [95% CI, -0.80 to -0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, -0.36 [95% CI, -0.69 to -0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. CONCLUSIONS AND RELEVANCE: There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs. Copyright 2015 American Medical Association. All rights reserved.


Kaw R.,Cleveland Clinic | Bhateja P.,Respiratory Institute | Mar H.P.,Medicine Institute Center for Value Based Care Research | Hernandez A.V.,Cleveland Clinic Lerner Research Institute | And 3 more authors.
Chest | Year: 2016

BACKGROUND: Among patients with OSA, a higher number of medical morbidities are known to be associated with those who have obesity hypoventilation syndrome (OHS) compared with OSA alone. OHS can pose a higher risk of postoperative complications after elective noncardiac surgery (NCS) and often is unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those of patients with OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, apnea-hypopnea index [AHI]). Multivariable logistic and linear regression models were used for dichotomous and continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS and overlap syndrome are more likely to experience postoperative respiratory failure (OR, 10.9; 95% CI, 3.7-32.3; P .0001), postoperative heart failure (OR, 5.4; 95% CI, 1.9-15.7; P = .002), prolonged intubation (OR, 3.1; 95% CI, 0.6-15.3; P = .2), postoperative ICU transfer (OR, 10.9; 95% CI, 3.7-32.3; P .0001), and longer ICU (b-coefficient, 0.86; SE, 0.32; P = .009) and hospital (b-coefficient, 2.94; SE, 0.87; P = .0008) lengths of stay compared with patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression. CONCLUSIONS: Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.


Champin D.,Peruvian University of Applied Sciences
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2014

At present, competency-based curriculum is considered to be the most appropriate model in medical education. Much has been written about this model; however, a crucial aspect of the model is the assessment of competency development which is a different point compared to the traditional model of cognitive assessment. Assessment in the context of the competencybased curriculum model must be aligned with the profile of the competencies that the institution offers. This publication reports the evaluation experience in a Medical School of Peru that applies a competency-based curriculum. © 2014, Instituto Nacional de Salud. All rights reserved.

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