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BACKGROUND: Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited. OBJECTIVE: To systematically explore the evidence regarding assessing patient safety climate in dentistry. METHODS: We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected. RESULTS: Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75. DISCUSSION: Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

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Keratinocyte cancer (KC) is the most common cancer worldwide. It is important to analyze the actual interventions that are available for the prevention of patients with a previous history of a KC. We aim to review the existent literature to assess the efficacy and safety of interventions to prevent KC in patients with a history of previous KC. We searched clinical trials in which the main outcome was the prevention of KC in patients with a previous history of KC using the strategy published in the International Prospective Register of Systematic Reviews (PROSPERO registry), CRD42016045981. We analyzed 18 clinical trials from which eight reported a benefit with their respective intervention but had methodological flaws and a variable risk of bias. Two clinical trials (regarding celecoxib and oral supplementation with nicotinamide) seemed to have the most beneficial results reducing the incidence of KC in treated groups. However, all of the studies are highly heterogeneous, which does not allow a meta-analysis to be performed. New studies with greater epidemiological value should be conducted.

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Keratosis pilaris is a common dermatosis observed in daily dermatologic practice. The diagnosis is clinical and usually asymptomatic, although sometimes patients may complain of mild pruritus and its cosmetic appearance. Few reports exist about its treatment. There are clinical trials assessing topical treatments and laser surgery, but no systematic reviews on its management were found in literature. An online research was conducted to identify evidence-based recommendations. Lactic acid, salicylic acid, and the 1064-nm Nd:YAG laser seem to be the most effective and safe treatment options for keratosis pilaris among patients aged 12 years and older; however, high-quality randomized controlled trials with long-term outcomes are required. (SKINmed. 2022;20:258-271).

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This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. PURPOSE: This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. METHODS: A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. RESULTS: Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. CONCLUSION: Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. REGISTRATION NUMBER: PROSPERO (CRD42020149563).

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INTRODUCTION: Dermoscopy is a tool that aids clinicians in the diagnosis of actinic keratosis; however, few diagnostic accuracy studies have determined its sensitivity and specificity for this diagnosis. OBJECTIVE: Determine the diagnostic accuracy of dermoscopy on actinic keratosis. METHODS: A systematic review was conducted on EMBASE, PubMed, Scopus and the Cochrane Central Registry of Controlled Trials from inception to August 2019. RESULTS: We screened 485 titles and abstracts. Two studies comprising 219 actinic keratoses were eligible for qualitative analysis. The number and heterogeneity of included studies limited a quantitative analysis. CONCLUSIONS: Studies that focus specifically on the diagnostic accuracy of dermoscopy for actinic keratosis are lacking.

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INTRODUCTION: Some clinical features have been associated with the progression and remission of alopecia areata (AA). We aim to determine possible prognostic factors in Mexican patients with AA. METHODS: This prospective study of a 1-year follow-up included Mexican patients with a clinical diagnosis of AA. We evaluated disease activity with the SALT score at the first visit and 1-year follow-up; progression, no progression, and remission were defined according to score changes. We used multiple linear regression model to detect factors associated with progression and remission. RESULTS: One hundred and four patients concluded the study. Ninety-seven patients (93.3%) had patchy AA. Fifteen patients showed disease progression and 89 no progression, of which 35 patients had remission. Body hair involvement was related to disease progression and adherence to treatment with disease remission and progression. CONCLUSIONS: Body hair involvement is related to poor prognosis. Adherence to treatment is a modifiable prognostic factor associated with the course of AA in Mexican patients.

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Keratinocyte cancer (KC) is the most common form of cancer in humans. To our knowledge, no previous publications assessing the methodological quality of clinical trials for the prevention of KC have been recently published. We aim to assess the methodological quality of clinical trials focused on the prevention of KC in high-risk groups not receiving immunosuppressive therapy (NRIT) and propose solutions to improve the design of future trials. We searched clinical trials in which the main outcome was the prevention of KC in high-risk NRIT groups using the strategy published in the International Prospective Register of Systematic Reviews (PROSPERO registry), CRD42016045981. Consolidated Standards of Reporting Trials (CONSORT) criteria and the Cochrane Collaboration risk of bias tool were used to assess methodological quality. We analyzed 23 clinical trials. We found a high risk of attrition and reporting bias in 86.9% and 60.9% of the trials, respectively. Regarding the CONSORT criteria, in at least 40% of the trials, the authors omitted the following information: a description of the trial design, the number of losses and exclusions after randomization, the results of subgroup and adjusted analysis, the estimated effect size and the precision of primary and secondary outcomes. Methodological quality was improved in the recently published clinical trials compared to those published before the CONSORT criteria development. All clinical trials should report in detail the information used to assess potential risks of bias.

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Alopecia areata (AA) is a nonscarring alopecia with an autoimmune etiology, unpredictable course, multiple presentations, and variable psychological distress. We conducted a cross-sectional study which included 126 patients with AA. A complete medical history was documented using the Severity Alopecia Tool (SALT) to assess the severity of the disease, and the following questionnaires were applied to the participants: the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Plutchik Suicide Risk Scale, and the Perceived Stress Scale (PSS-14) for adults. The Child Dermatology Life Quality Index (cDLQI) and the Birleson Depression Self-Rating Scale questionnaires were applied for children. Quality of life (QoL) disturbance was detected in 77.6% of adult participants, 65.9% of them had signs of depression or anxiety, and 12.8% were at risk of committing suicide. The PSS-14 average score for adults was 24.5. QoL disturbance was detected in 76.7% of children participants, and 6.3% of them showed signs of depression with the Birleson Depression Self-Rating Scale. We conclude that patients with AA could experience changes in their QoL and signs of depression, anxiety, and suicide risk, mainly in the adult population, during the course of the disease.

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BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.

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BACKGROUND: Psoriasis is an autoimmune skin disease that may be associated with articular manifestations, and the most common clinical presentation is the variety "in plaques". In Mexico, in the Centro Dermatológico Pascua, it is the eighth leading cause of consultation. The aim of this study was to determine the diagnostic process of patients in a reference center for diseases of the skin. METHODS: Performing an analytical cross-sectional study that included 100 patients where the diagnostic process was questioned, clinimetric scales were applied and evaluated anthropometric. RESULTS: It was found that 70% of patients had taken over a month to get medical care (median: 3 months; IQR: 11 months), having consulted in 61% to a general physician as a doctor of first contact and 89% being diagnosed by a dermatologist. Eighty-eight percent of the patients were overweight or obese. We found as a factor of delay, a partnership with the variable of having an Institutional Medical Service (p = 0.019; U = 695.5). CONCLUSION: it is necessary to design a system to shorten the diagnostic process, not only in psoriasis, in addition to emphasizing dermatological education.

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INTRODUCTION: Acne is considered a multifactorial skin disease secondary to an obstructive process of pilosebaceous units. Some studies suggest a relationship between insulin levels and the presence of acne, but this has not yet been demonstrated. OBJECTIVE: To compare the levels of insulin in patients with and without comedonal acne. MATERIAL AND METHODS: From January to July 2012, we conducted a cross-sectional study in the Dr. Ladislao de la Pascua Dermatologic Center in Mexico city. We recruited men and women from 14 to 25 years old with and without comedonal acne. We measured the insulin levels in all patients with DXI 800 Beckman Coulter equipment in a blood sample. RESULTS: Twenty patients with acne and 20 patients without acne were studied, with an average age of 17 (±3) and 19 (±4) years, respectively. Both groups were different in terms of gender. Body mass index was similar in both groups. We did not find a difference in insulin levels between groups (p=0.818). The average level of insulin was 7.15±4.7 uU/ml for the acne group and 7.85±3.3 uU/mL for the control group. CONCLUSION: Insulin levels are similar in patients with and without comedonal acne. There is no direct relationship between hyperinsulinemia and acne.

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UNLABELLED: Abstract Background: Recalcitrant facial flat warts are caused by human papillomavirus and may persist for years despite treatment. Isotretinoin has demonstrated benefits in the treatment of recalcitrant, genital and common warts, but placebo-controlled trials have not been performed. OBJECTIVE: To determine whether isotretinoin is safe and effective for recalcitrant facial flat warts. METHODS: Isotretinoin 30 mg/day or placebo was administered to 16 and 15 patients, respectively, in double-blind, randomized fashion for 12 weeks. Cutaneous lesions were assessed and adverse events including serologic and ophthalmologic changes were recorded. It is considered that warts were recalcitrant if the patient was treated for at least 3 years with at least three of the following options: retinoids, 5-fluorouracil, imiquimod and cryotherapy using liquid nitrogen. RESULTS: Each patient in the istotretinoin group showed complete clearance of all flat warts, while none of the patients in the placebo group showed any improvement (p=0.0001). The most frequent adverse event was cheilitis. There were no statistically significant changes in the laboratory findings. LIMITATIONS: The study design does not permit complete blinding of the dermatologist who can easily recognize the adverse effects of isotretinoin. The clinical findings, however, were so dramatic that this would not have impacted the findings. Another limitation of the study is a lack of follow-up to assess for recurrence after the drug was discontinued. CONCLUSIONS: Isotretinoin is an effective treatment for recalcitrant flat facial warts with a well-known, manageable safety profile.

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INTRODUCTION: Currently, strategies are needed to identify the population at risk for skin cancer in order to implement prevention and for early diagnosis. There are no validated Spanish language instruments to measure skin cancer risk. OBJECTIVES: To design and validate a self-applied questionnaire to quantify the risk of melanoma and non-melanoma skin cancer in a Mexican population. METHODS: A self-applied questionnaire was designed to measure risk factors for skin cancer. Face and content validity was assessed by five experts in skin cancer. The value of each item was weighted according to the relative risk of the risk factors. The questionnaire was applied to extreme groups in order to measure the construct validity. Reliability was evaluated using test-retest method two weeks after the first application. RESULTS: The questionnaire was applied to patients with (n = 147) and without (n = 249) skin cancer from the Dermatologic Center "Dr. Ladislao de la Pascua". The total score of the questionnaire was different in both groups (U = 2,104.5, p = 0.0001) and ROC curve determined that five points or more equals high risk for skin cancer (area 0.964; 95% CI: 0.946-0.981; p = 0.0001). The reliability of the instrument was 0.971 (95% CI: 0.943-0.986; p = 0.0001). CONCLUSION: This is the first Spanish language questionnaire valid to measure risk of skin cancer, whose application at the population level would be useful to identify high-risk individuals who need preventative interventions.

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BACKGROUND: potentially inappropriate prescribing (IP) includes the use of drugs that represent greater risk than benefit to the patient, the STOPP-START instrument, allows its detection, the aim was to evaluate its utility. METHODS: a descriptive cross-sectional study was performed. Randomly selecting records of older adults with at least one chronic degenerative disease, as last query had more than two months and have completed their monthly meeting at least four citations in the last 6 months were analyzed. RESULTS: the files from 285 patients were reviewed, females were 60 %, and the mean age was 74 ± 6 years. A total of 1749 prescriptions included 126 different drugs. The prevalence of inappropriate prescribing was 55 % (95 % CI = 49-61) and 87 % polypharmacy (95 % CI = 83-91). The cardiovascular, endocrine and skeletal muscle system diseases had the highest number of prescriptions and inappropriate prescribing. It was detected the omission of one or more drugs listed in 72 % of 75 % specific clinical circumstances. CONCLUSIONS: the STOPP-START instrument is useful for detecting inappropriate prescribing. Also, the omission of indicated preventive treatments required for older adults with chronic degenerative diseases.

Introducción: la prescripción potencialmente inapropiada incluye el uso de medicamentos que representan mayor riesgo que benefi cio para el paciente. El objetivo fue evaluar la utilidad del instrumento STOPP-START para su detección. Métodos: se realizó un estudio transversal descriptivo, con selección aleatoria de expedientes de adultos mayores con al menos una enfermedad crónica degenerativa, cuya última consulta tuviera máximo dos meses y que hubiesen cumplido con su cita mensual cuando menos cuatro veces en el últimos semestre. Resultados: de los 285 expedientes revisados, 60 % de los pacientes fueron mujeres; la edad promedio fue de 74 ± 6 años. Se revisaron 1749 prescripciones de 126 medicamentos diferentes. La prescripción inapropiada tuvo una prevalencia de 55 % (IC 95 % = 49-61) y la polifarmacia de 87 % (IC 95 % = 83-91). En los padecimientos cardiovasculares, endocrinos y musculoesqueléticos se registró el mayor número de prescripciones y de prescripción potencialmente inapropiada. Se detectó la omisión de uno o más medicamentos indicados en 72 % de 75 circunstancias clínicas específi cas. Conclusiones: el STOPP-START es útil para detectar prescripción potencialmente inapropiada. Es frecuente la omisión de tratamientos preventivos indicados para el adulto mayor con enfermedades crónicas degenerativas.

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The process of prescribing a medication is complex and includes: deciding whether it is indicated, choosing the best option, determining the dose and the appropriate management scheme to the physiological condition of the patient, and monitoring effectiveness and toxicity. We have to inform patients about the expected side effects and indications for requesting a consultation. Specific clinical questions were designed based on the acronym PICOST. The search was made in the specific websites of clinical practice guidelines, was limited to the population of older adults, in English or Spanish. We used 10 related clinical practice guidelines, eight systematic reviews and five meta-analyses. Finally, we made a search of original articles or clinical reviews for specific topics. The development and validation of clinical practice guidelines for "rational drug prescriptions in the elderly" is intended to promote an improvement in the quality of prescription through the prevention and detection of inappropriate prescribing in the elderly and, as a result of this, a decrease in the adverse events by drugs, deterioration of health of patients and expenditure of resources.

El proceso de prescribir un medicamento incluye decidir si está indicado, elegir el mejor, determinar una dosis y un esquema de administración adecuados a la condición fisiológica del paciente, el seguimiento de la eficacia y toxicidad. Debe informarse a los pacientes sobre los efectos secundarios esperados y las indicaciones para solicitar la consulta. Para la elaboración de esta guía se formularon preguntas clínicas específicas, con base en el acrónimo PICOST. La búsqueda se realizó en los sitios web específicos de guías de práctica clínica, en inglés o español, y se limitó a la población de adultos mayores. Se usaron 10 guías de práctica clínica relacionadas, ocho revisiones sistemáticas y cinco metaanálisis. Por último, se realizó una búsqueda de artículos originales o revisiones clínicas para aspectos específicos. La elaboración y validación de una guía de práctica clínica para "prescripción farmacológica razonada en el adulto mayor" tiene el propósito de promover una mejora en la calidad de la prescripción médica, mediante la prevención y detección de la prescripción inapropiada en el anciano y como resultado de esto disminuir los eventos adversos originados por fármacos, el deterioro de la salud de los pacientes y el gasto no justificado de los recursos.

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Patent ductus arteriosus (PDA) is the most common congenital heart disease in Mexico. The clinical manifestations of the PCA are from asymptomatic patients to the presence of heart failure. Its management should be individualized based on clinical, hemodynamic data and presence of pulmonary hypertension. Our objective was to provide current medical recommendations based on the best, available scientific evidence for the diagnosis, study and therapeutic decisions of the PCA. Established a standardized sequence to search for Practice Guidelines, based on the clinical questions about PCA diagnosis and treatment. Most of the recommendations were taken from selected guidelines and supplemented with the remaining material. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the study design and type of publications. Currently produces large amounts of medical information in a relatively short period of time which is necessary to have evidence-based CPG to facilitate and standardize the diagnostic decision-treatment to provide better care for children and adults with PCA.

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Preeclampsia remains a major cause of worldwide pregnancy related maternal and neonatal mortality and morbidity, it accounts for more than 50,000 maternal deaths each year. The World Health Organization estimates that at least one woman dies every 7 minutes from a complication of preeclampsia. It is the main cause of maternal death in Mexico and Latin America. Standarized assessment and surveillance of women with preeclampsia is associated with reduced maternal risk. Standarized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of preeclampsia-eclampsia. The working group selected clinical practice guidelines found in the Cochrane Library, Medline and PubMed. The results were expressed as levels of evidences and grade of recommendation. Evidence suggests, that treatment of severe hypertension, seizures prophylaxis with magnesium sulfate, and management by experienced health-care professionals will improve maternal, fetal and neonatal outcomes. Treatment remains supportive with pregnancy termination being the only definitive cure.

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Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.

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The advance in the knowledge and technology is growing quickly and greater quantity, so it is difficult for the health professional to access to whole information that is generated every day on diagnostic and therapeutic strategies more effective, so the clinic practice guidelines (CPG) is a resource to support the updating of the health professional and support them in making clinical decisions. The CPG is also a better support to the manager of health services in making decisions regarding the strategies that have performed for the patient and less risk to the individual and collective health. They also support the response capacity of the medical units and hospitals and guide the planning of services to the optimization of the resources. This paper summarizes the methodology of a national project for the development of GPC coordinated by the Mexican Social Security Institute with the collaboration of more than 1200 health professionals of the institution in a great effort institutional update and make information accessible to the entire health sector, which also defines the steps to upgrade and maintain the updating of knowledge and technology expressed in them.

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