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array:23 [ "pii" => "S0014256514000678" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.02.006" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "923" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2014;214:200-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 538 "formatos" => array:2 [ "HTML" => 315 "PDF" => 223 ] ] "itemSiguiente" => array:19 [ "pii" => "S0014256513003998" "issn" => "00142565" "doi" => "10.1016/j.rce.2013.12.011" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "885" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Rev Clin Esp. 2014;214:202-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1042 "formatos" => array:2 [ "HTML" => 586 "PDF" => 456 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Actualización clínica</span>" "titulo" => "Como prevenir y tratar las hipoglucemias farmacológicas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "208" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "How to prevent and treat pharmacological hypoglycemias" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1691 "Ancho" => 1589 "Tamanyo" => 253713 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de tratamiento de la diabetes tipo 2 de la Asociación Americana de Endocrinólogos Clínicos (<span class="elsevierStyleItalic">American Association of Clinical Endocrinologists</span> [AACE]).</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fuente: adaptado de la AACE <span class="elsevierStyleItalic">Comprehensive Diabetes Management Algorithm</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El algoritmo expresa las recomendaciones de tratamiento de la AACE en función de los valores iniciales de HbA<span class="elsevierStyleInf">1c</span> y la presencia o no de síntomas. El uso de fármacos marcados con «*» se indica de forma jerárquica, en función de sus beneficios y/o perfil favorable de efectos adversos; el resto de fármacos incluidos en cada epígrafe deben usarse con precaución por este mismo motivo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Reyes García, P. Mezquita Raya" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Reyes García" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Mezquita Raya" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887414000137" "doi" => "10.1016/j.rceng.2013.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887414000137?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256513003998?idApp=WRCEE" "url" => "/00142565/0000021400000004/v1_201405061003/S0014256513003998/v1_201405061003/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0014256514000253" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.01.019" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "911" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2014;214:198-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 945 "formatos" => array:2 [ "HTML" => 537 "PDF" => 408 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Encuestas de satisfacción: una oportunidad para mejorar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "198" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Satisfaction surveys: An opportunity to improve" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Aranda Sánchez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Aranda Sánchez" ] 1 => array:1 [ "colaborador" => "Grupo de Trabajo Formación de SEMI" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514000253?idApp=WRCEE" "url" => "/00142565/0000021400000004/v1_201405061003/S0014256514000253/v1_201405061003/es/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Clinical decision making and cardiovascular risk factors: What about the Heart Team?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "201" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.-J. de Boer, H.J.G. Bilo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M.-J." "apellidos" => "de Boer" "email" => array:1 [ 0 => "menkojan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "H.J.G." "apellidos" => "Bilo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Radboud University Medical Center Nijmegen, The Netherlands" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Toma de decisions clínicas y factores de riesgo cardiovascuolar: ¿qué sucede con el Heart Team?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of the journal, a consensus document on clinical decisions in relation to risk factors for cardiovascular disease (CVD) is presented. The worldwide epidemic of obesity and metabolic syndrome has led to an increased risk profile of many subjects. They usually cannot be assessed and treated on evidence based medicine principles since evidence often is lacking or scarce, whereas the long term impact on health care is potentially enormous. As the authors correctly state: “<span class="elsevierStyleItalic">we have to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems</span>”<span class="elsevierStyleItalic">.</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The consensus document is a good example of translating common knowledge to modern day practice. Part of this very laudable effort to reach practical consensus through expert opinion could be enhanced or may be contradicted by known literature. For example, the expert opinions regarding assessment of cardiovascular risk and treatment of lipid profile disturbances are somewhat at odds and not as detailed as the presented evidence in the latest ACC/AHA guidelines.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Still, many down to earth and valuable advices are formulated. Again as an example, life style interventions have proven to be successful in a primary care setting but certainly are not “one size fits all” recommendations and if we are to convince our patients we simply have to do more. This consensus document, where intuitive sense comes into play, may be the first step although additional measures have to be taken. Apart from smoking, diabetes has a predominant role in the identification of patients at risk for CVD, so many of the recommendations relate to diabetes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Diabetes has profound effects on the cardiovascular system and usually leads to a reduced life expectancy. Accelerated progression of atherosclerosis observed in diabetes necessitates a broad implementation of early and rather aggressive treatment of derangements of glucose metabolism, hypertension, and lipid profile disturbances. Still, in many patients, the presence of diabetes results in the need for cardiac intervention therapies. Revascularization of narrowed or occluded coronary vessels can be performed by surgeons or by interventional cardiologists. However the modalities are entirely different with regard to their mode of action.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Percutaneous coronary intervention (PCI) is targeted at the “culprit” lesion or lesions, whereas coronary artery bypass grafting (CABG) is directed at the epicardial vessel, including the “culprit” lesion or lesions and future culprits, a difference that may account for the superiority of CABG over PCI, at least in the intermediate term, in patients with diabetes, and in particular in those with multivessel disease.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> This need for early (partly preventive) medical measures combined with the increased need for invasive procedures necessitates a “shared decision making” and more specifically, a close collaboration between vascular internal medicine, interventional cardiology and cardiovascular surgery and is commonly referred to as the “Heart Team” concept.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Such a collaborative effort is an attempt to come to a “final common pathway” in presenting patients with diabetes and coronary artery disease the best treatment options available, whether it is optimal medical treatment (OMT), PCI or CABG.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> This applies to stable patients as well as patients presenting with acute coronary syndrome. In many patients a strategy of OMT (with delayed revascularization as needed) is the preferred and cost-effective treatment compared to prompt revascularization, but sometimes it is very difficult to convince patients that revascularization is not the first treatment option and the Heart Team can be of great help in these situations.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> On the other hand, patients with a high-risk profile may benefit from an invasive approach and should be identified as early as possible, though with an eye for cost-effectiveness and omitting costly, often unnecessary diagnostic procedures.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current consensus document<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> addresses every-day dilemmas in patients with, or at risk for CVD, but does not go beyond diagnostic procedures, medical treatment and/or modifiable risk factors. The next step will be to accomplish agreement on active treatment decisions made by cooperative efforts as presented with the Heart Team. In this document a practical and comprehensive format is used and it elegantly brings to light a common opinion on complex clinical questions but providing, as the authors state, simple answers. The methodology used in this paper seems to be an efficient and practical approach and may be extended to the “Heart Team” as a tool to optimize complex patient care issues.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical decisions in patients with diabetes and other cardiovascular risk factors. a statement of the Spanish Society of internal medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Gómez-Huelgas" 1 => "F. Pérez-Jiménez" 2 => "M. Serrano-Ríos" 3 => "P. González-Santos" 4 => "P. Román" 5 => "M. 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Holmes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2012.01.050" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "1870" "paginaFinal" => "1876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22595405" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0085" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economic outcomes of treatment strategies for type 2 diabetes and coronary artery disease in the BARI 2D trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Hlatky" 1 => "D.B. Boothroyd" 2 => "K.A. Melsop" 3 => "L. Kennedy" 4 => "C. Rihal" 5 => "W.J. Rogers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.912709" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2009" "volumen" => "120" "paginaInicial" => "2550" "paginaFinal" => "2558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19920002" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Choosing wisely or beyond the guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. de Boer" 1 => "E.E. van der Wall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12471-012-0352-0" "Revista" => array:6 [ "tituloSerie" => "Neth Heart J" "fecha" => "2013" "volumen" => "21" "paginaInicial" => "1" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23203730" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00142565/0000021400000004/v1_201405061003/S0014256514000678/v1_201405061003/en/main.assets" "Apartado" => array:4 [ "identificador" => "1020" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editoriales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021400000004/v1_201405061003/S0014256514000678/v1_201405061003/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514000678?idApp=WRCEE" ]
