Browsing by Author "Riquelme, Arnoldo"
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Item Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile(Sociedad Chilena de Infectología, 2016) Hernández-Rocha, Cristián; Pidal, Paola; Ajenjo, Cristina; Quera, Rodrigo; Quintanilla, Marcela; Lubascher, Jaime; Jemenao, Irene; Ibáñez, Patricio; Álvarez-Lobos, Manuel; Diomedi, Alexis; Marcotti, Alejandra; Acuña, Mirta; Arab, Juan; Riquelme, Arnoldo; Candia, Roberto; Carvajal, SergioBackground: Clostridium dijfficile-associated diarrhea (CDAD) has become very important due to the increase in its incidence, severity, recurrence and the associated economic burden. Having a national consensus guideline is essential to improve its management. Objective: To build a multidisciplinary and evidence-based consensus in prevention, diagnosis and treatment of CDAD. Methods: We convened a panel of experts in the field of infectious diseases, gastroenterology, evidence-based medicine and consensus methodology. The panel conducted a structured review of published literature in CDAD evaluating evidence levels and recommendation degree according to the methodology proposed by the GRADE working-group. A modified three-round Delphi technique was used to reach a consensus among the experts. Results: A group of 16 experts was established, 12 of them answered 18 clinically relevant questions. The levels of agreement achieved by the panel of 16 experts were 79% in the first round and 100% in the second and third round. The main consensus recommendations in prevention are: restricting the use of proton-pump inhibitors, primary prophylaxis with probiotics in antibiotics users, education of health personnel, isolation for patients hospitalized with CDAD, and cleaning the rooms exposed to C. difficile with products based in chlorine or hydrogen peroxide. In the diagnosis: use of biology molecular-based techniques is preferred and if not available, glutamate dehydrogenase-based algorithms may be recommended. With regard to treatment: the use of oral metronidazole in mild-moderate CDAD and oral vancomycin in severe CDAD are recommended. Treat the first recurrence with the same antibiotics according to severity. In the case of second and subsequent recurrences consider prolonged therapy with vancomycin, rifaximin or fecal microbiota transplant. Conclusion: The first Chilean consensus on prevention, diagnosis and treatment of CDAD is presented, which is a major step in improving national standards in the management of this disease.Item Desarrollo y validación de encuesta de percepción del portafolio en estudiantes de medicina de pregrado(2011) Riquelme, Arnoldo; Méndez, Benjamín; De La Fuente, Paloma; Padilla, Oslando; Benaglio, Carla; Sirhan, Marisol; Labarca, JaimeBackground: Portfolio is an innovative instrument that promotes reflection, creativity and professionalism among students. Aitn: To describe the development and validation process of a questionnaire to evalúate the use of portfolio in undergraduate medical students. Material andMethods: Focus groups with students and teachers were employed to identify aspects related with portfolio in undergraduate teaching. The Delphi technique was used to prioritize relevant aspects and construct the questionnaire. The validated questionnaire, consistingin 43 Ítems and 6factors, was appliedto 97students (response rote of99.9%) in2007and 100students (99.2%) in 2008. Each question had to be answered using a Likert scale,from 0 (completely disagree) to 4 (completely agree) The validity and reliability of the questionnaire was evaluated. Results: The questionnaire showed a high reliability (Cronbach alpha = 0.9). The mean total scores obtained in 2007 and 2008 were 106.2 ± 21.2 (61.7% ofthe maximal obtainable score) and 104.6 ± 34.0 (60.8% ofthe maximal obtainable score), respectively No significant differences were seen in the analysis by factors. Changes in portfolio during 2008 showed differences in Ítems related with organization, evaluation and regulation. Conclusions: The questionnaire is a valid and highly reliable instrument, measuringperceptions about the portfolio by undergraduate medical students. The students perceived an improvement in their creativity and professionalism as one ofthe strengths of portfolio. The weaknesses identified during the implementation process helped us to focus changes in organization and evaluation to improve the portfolio as a dynamic processItem Development and validation of a questionnaire on perception of portfolio by undergraduatemedical students(2011) Riquelme, Arnoldo; Méndez, Benjamín; Fuente, Paloma de la; Padilla, Oslando; Benaglio, Carla; Sirhan, Marisol; Labarca, JaimeBackground: Portfolio is an innovative instrument that promotes reflection, creativity and professionalism among students. Aim: To describe the development and validation process of a questionnaire to evaluate the use of portfolio in undergraduate medical students. Material and Methods: Focus groups with students and teachers were employed to identify aspects related with portfolio in undergraduate teaching. The Delphi technique was used to prioritize relevant aspects and construct the questionnaire. The validated questionnaire, consisting in 43 items and 6 factors, was applied to 97 students (response rate of 99.9%) in 2007 and 100 students (99.2%) in 2008. Each question had to be answered using a Likert scale, from 0 (completely disagree) to 4 (completely agree) The validity and reliability of the questionnaire was evaluated. Results: The questionnaire showed a high reliability (Cronbach alpha = 0.9). The mean total scores obtained in 2007 and 2008 were 106.2 +/- 21.2 (61.7% of the maximal obtainable score) and 104.6 +/- 34.0 (60.8% of the maximal obtainable score), respectively. No significant differences were seen in the analysis by factors. Changes in portfolio during 2008 showed differences in items related with organization, evaluation and regulation. Conclusions: The questionnaire is a valid and highly reliable instrument, measuring perceptions about the portfolio by undergraduate medical students. The students perceived an improvement in their creativity and professionalism as one of the strengths of portfolio. The weaknesses identified during the implementation process helped us to focus changes in organization and evaluation to improve the portfolio as a dynamic process. (Rev Med Chile 2011; 139: 45-53).Item Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices(2010) Pérez-Ayuso, Rosa María; Valderrama, Sebastián; Espinoza, Manuel; Rollán, Antonio; Sánchez, René; Otarola, Francisco; Medina, Brenda; Riquelme, ArnoldoBackground. Gastroesophageal variceal bleeding is a common complication of portal hypertension. Currentguidelines recommend β-blockers for primary prophylaxis. However, evidence suggests that endoscopic va-riceal ligation (EVL) reduce bleeding episodes. Aims. To compare endoscopic EVL with propranolol (PPL)for primary prophylaxis of variceal bleeding. Methods. We conducted a randomized controlled trial. Over a9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and alloca-ted to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survi-val, source of bleeding and serious adverse events. Analyses were made by intention-to-treat. Results.Baseline characteristics were similar. Medium follow-up was 1647±1096 days. Complete follow-up wasachieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17).The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVLand 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal blee-ding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group(7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death.Conclusions. The present study supports that PPL should be considered the first choice in primary pro-phylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVLItem Experiencia de educación continua en línea en gastroenterología para médicos no especialistas(2019) Isbej, Lorena; Uribe, Javier; Carrasco, Olga; Villarroel, Isaac; Pizarro, Margarita; Jirón, María Isabel; Sanhueza, Edgar; Álvarez, Manuel; Hernández, Cristián; Díaz, Luis; Cerda, María; Kramer, Tomás; Munizaga, Fernando; Riquelme, Arnoldo; Rollán, Antonio; Monsalve, XimenaBackground: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.Item Fair reliability of eckardt scores in achalasia and non-achalasia patients: Psychometric properties of the eckardt spanish version in a multicentric study(2020) Cisternas, Daniel; Monrroy, Hugo; Riquelme, Arnoldo; Padilla, Oslando; Fuentes-López, Eduardo; Valle, Arturo; Mejia, Ricardo; Hani, Albis; Ardila-Hani, Andres F; Leguizamo, Ana Maria; Bilder, Claudio; Ditaranto, Andres; Remes-Troche, Jose Maria; Ruiz de León, Antonio; Pérez de la Serna, Julio; Marin, Ingrid; Serra, JordiBackground: Eckardt symptom score (ESS) is the most used tool for the evaluation of esophageal symptoms. Recent data suggest that it might have suboptimal reliability and validity. The aims of this study were as follows: (a) Develop and validate an international Spanish ESS version. (b) Perform psychometric ESS evaluation in patients with achalasia and non-achalasia patients. Methods: Eckardt symptom score translation was performed by Delphi process. ESS psychometric evaluation was done in two different samples of patients referred for manometry. First sample: 430 dysphagia non-achalasia patients. Second sample: 161 achalasia patients. Internal consistency was evaluated using Cronbach's α and Guttman coefficient (<0.5 = unacceptable. 0.5-0.7 = fair. >0.7 = acceptable). Key results: Our data show that in patients without and with achalasia, ESS behaves similarly. Both show a fair reliability with Cronbach's α of 0.57 and 0.65, respectively. Based on our results, we recommend interpretation of the Spanish ESS be done with caution. The psychometric quality of the ESS could not be improved by removal of any items based on the single-factor structure of the scale and no items meeting criteria for elimination. Conclusions and inferences: Eckardt symptom score Spanish translation was developed. ESS showed a fair reliability for the evaluation of patients with any causes of dysphagia. Our results highlight the need for development and psychometric validation of new dysphagia scoring tools.Item Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus(Baishideng Publishing Group, 2014) Rollan, Antonio; Arab, Juan; Camargo, Constanza; Candia, Roberto; Harris, Paul; Ferreccio, Catterina; Rabkin, Charles; Gana, Juan; Cortés, Pablo; Herrero, Rolando; Durán, Luisa; García, Apolinaria; Toledo, Claudio; Espino, Alberto; Lustig, Nicole; Sarfatis, Alberto; Figueroa, Catalina; Torres, Javier; Riquelme, ArnoldoAIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.Item Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review(WJG Press, 2014) Arab, Juan; Candia, Roberto; Zapata, Rodrigo; Muñoz, Cristián; Arancibia, Juan; Poniachik, Jaime; Soza, Alejandro; Fuster, Francisco; Brahm, Javier; Sanhueza, Edgar; Contreras, Jorge; Cuellar, Carolina; Arrese, Marco; Riquelme, ArnoldoAIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice. METHODS: NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts. RESULTS: A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form ofNAFLD), although the long-term safety and efficacy of these therapies have not yet been established. CONCLUSION: Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events.Publication Percepción del ambiente educacional de postgrado en residentes de especialidades médicas de universidades chilenas(2022) González, Carolina; Ahtamon, Alina; Brokering, Walter; Budge, María Catalina; Cadagan, María José; Jofré, Pamela; Muñoz, Nadia; Ocampo, Ximena; Pizarro, Felipe; Reyes, Nakita; San Martín, Pamela; Silva, María Paz; Ugarte, María Gabriela; Vega, Ernesto; Vergara, Loreto; Yuri, Francisca; Kleinsteuber, Karin; Avaria, María de los Angeles; Riquelme, ArnoldoThe Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. Aim: To assess the learning environment (LE) among medical residents of 64 specialties. Material and Methods: Two validated instruments “Postgraduate Hospital Education Environment Measure” (PHEEM) and “Ambulatory Care Learning Educational Environment” (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. Results: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. activities. Conclusions: LE among medical specialties had more positive than negative features, but with areas that should be improved.Publication Terapias cuádruples son superiores a terapia triple estándar en primera línea de erradicación de Helicobacter pylori en Chile(2022) Reyes, Diego; Ortiz, Javier; Fuentes-López, Eduardo; Budnik, Sigall; Gándara, Vicente; Gallardo, Andrea; Seydewitz, María Francisca; Candia, Roberto; Vargas, José Ignacio; Rollan, María Paz; Godoy, Javiera; Rollan, Antonio; Mansilla, Rodrigo; Arenas, Alex; Chahuán, Javier; Espino, Alberto; Pizarro, Margarita; Riquelme, ArnoldoIntroducción: La infección por Helicobacter pylori afecta aproximadamente al 70% de lapoblación chilena. Es un problema de salud pública cuyo tratamiento de erradicación formaparte de políticas públicas en Chile.Objetivos: Caracterizar los esquemas de erradicación de primera línea de H. pylori más uti-lizados en nuestro medio y evaluar su eficacia.Métodos: Se realizó un estudio observacional retrospectivo donde, en pacientes con infecciónpor H. pylori certificada, se evaluó el esquema de erradicación indicado por el médico tratante,su eficacia, adherencia y efectos adversos.Resultados: Se analizaron 242 pacientes y 4 esquemas de erradicación; terapia triple estándar,terapia dual, concomitante y cuadriterapia con bismuto. Se observaron tasas de erradicaciónde 81,9% (IC 95% 74,44---87,63), 88,5% (IC 95% 73,13---95,67), 93,7% (IC 95% 78,07---98,44) y 97,6%(IC 95% 84,81---99,67) respectivamente, siendo más eficaces la terapia concomitante (RR: 1,14;IC 95% 1,01---1,29; p = 0,028) y cuadriterapia con bismuto (RR: 1,19; IC 95% 1,09---1,31; p <0,001) que la triple terapia estándar. La tasa de efectos adversos reportados fue de 58,5%(IC 95% 50,66---65,92), 35,4% (IC 95% 24,6---48,11), 22,9% (IC 95% 11,81---37,14) y 63,4% (IC95% 47,8---76,64), para la terapia triple estándar, dual, concomitante, y cuádruple con bis-muto, respectivamente. La terapia dual y concomitante tuvieron menos efectos adversos encomparación con la terapia estándar.Conclusiones: Las cuadriterapias son superiores a la triple terapia estándar por lo que deberíanser consideradas como tratamiento de primera línea en Chile. La terapia dual es promisoria.Más estudios serán requeridos para determinar qué esquemas son más costo-efectivos.© 2021 Elsevier Espa˜na, S.L.U. Todos los derechos reservados.