Revista médica de Chile
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Revista médica de Chile · Oct 2004
Review[Consensus report on the diagnosis and management of non palpable thyroid nodules].
With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term
, is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. ⋯ The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on tbe management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking. -
Revista médica de Chile · Oct 2004
[The evaluation of decision making capacity in health care and its relationship to informed consent].
The decision making capacity of patients will acquire special relevance with the introduction of informed consent in clinical practice and the new normative that will appear in the future when the bills about health services are approved in the Congress. This paper reviews the concept of decision making capacity in the context of health care and its legal background in Chile. The main problems that arise from the comprehension, use and assessment of decision making capacity, are analyzed. ⋯ These specilized physicians will evaluate the mental health of the subject and its implications in the capacity to make decisions. In practice, it is difficult to integrate the concept of capacity from the law or health care perspective. It is concluded that the elaboration of criteria, standards and procedures to evaluate the decision capacity of patients, is mandatory.
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Revista médica de Chile · Sep 2004
Editorial Comment[Prediction rules in community acquired pneumonia].
The determination of site of care is an essential decision in the management of patients with community-acquired pneumonia (CAP). Patients with mild to moderate CAP may be safely treated at home. Instead, those patients with severe pneumonia must be hospitalized to assure an effective treatment. ⋯ However, this rule requires to be validated in the ambulatory setting before its wide spread use is suggested. Prediction rules are objective and relatively accurate models to assess prognosis that may aid clinicians to evaluate patient's risks and to improve hospitalization decisions. Nevertheless, although the prediction rules may guide the initial management of patients with CAP, they are not intended to replace the clinical judgment, which remains as the "art of medicine."
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Bone marrow edema syndrome (BMES) is a rare clinical condition. Its etiology is unknown and it can be seen in different locations. In the case of the hip, avascular necrosis is the main differential diagnosis. ⋯ It is important to be aware of this condition as part of the differential diagnosis of hip pain to avoid aggressive and unnecessary diagnostic and therapeutic procedures.
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Revista médica de Chile · Jul 2004
[Spirometric reversibility to salbutamol in chronic obstructive pulmonary disease (COPD). Differential effects on FEV1 and on lung volumes].
In recent years it has been suggested that in COPD, lung volumes can be modified more than expiratory flows, with bronchodilators. ⋯ Our results demonstrate that changes in lung volumes, and consequently in dynamic lung hyperinflation, take place more frequently than changes in maximal expiratory flows during the spirometric test in patients with COPD. Assessment of spirometric reversibility based only on changes in FEV1 underestimates the effect of bronchodilator drugs in these patients.