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Effectiveness of Primary Care Physicians and Dermatologists in the Diagnosis of Skin Cancer: a Comparative Study in the Same Geographic Area
Estudio comparativo de la habilidad en el diagnóstico clínico del cáncer cutáneo entre el médico de familia y el dermatólogo en una misma área geográfica
Servicio de Dermatología, Hospital Comarcal de Sant Boi de Llobregat, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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"documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2011;102:39-47" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2472 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 1611 "PDF" => 818 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Dermatology Consultations in an Emergency Department Prior to Establishment of Emergency Dermatology Cover" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "39" "paginaFinal" => "47" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consultas dermatológicas en el Servicio de Urgencias: situación previa a la instauración de guardias de la especialidad" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.L. Martínez-Martínez, E. Escario-Travesedo, M. Rodríguez-Vázquez, J.M. Azaña-Defez, M.C. Martín de Hijas-Santos, L. Juan-Pérez-García" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.L." "apellidos" => "Martínez-Martínez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Escario-Travesedo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Azaña-Defez" ] 4 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín de Hijas-Santos" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Juan-Pérez-García" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901170751X?idApp=UINPBA000044" "url" => "/15782190/0000010200000001/v1_201304241536/S157821901170751X/v1_201304241536/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effectiveness of Primary Care Physicians and Dermatologists in the Diagnosis of Skin Cancer: a Comparative Study in the Same Geographic Area" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "52" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.M. Ojeda, J. Graells" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R.M." "apellidos" => "Ojeda" "email" => array:1 [ 0 => "rosam.ojeda@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Graells" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Comarcal de Sant Boi de Llobregat, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio comparativo de la habilidad en el diagnóstico clínico del cáncer cutáneo entre el médico de familia y el dermatólogo en una misma área geográfica" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-02-25" "fechaAceptado" => "2010-06-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec84834" "palabras" => array:4 [ 0 => "Primary care" 1 => "Family doctors" 2 => "Diagnostic agreement" 3 => "Nonmelanoma skin cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84835" "palabras" => array:4 [ 0 => "Atención primaria" 1 => "Médicos de familia" 2 => "Concordancia diagnóstica" 3 => "Cáncer cutáneo no melanoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Skin cancer is the most common malignant tumor in white individuals. Early diagnosis and treatment are key factors in reducing morbidity. We performed a prospective observational study throughout 2008 to assess the ability of primary care physicians to diagnose nonmelanoma skin cancer.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study was undertaken in a single geographic area corresponding to the region served by a primary health care center. Patients who were referred to a dermatologist were included if the primary care physician indicated skin cancer in the differential diagnosis on the referral form. Patients were also included if the dermatologist suspected skin cancer even if the referral from primary care had not indicated it.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Primary care physicians had a sensitivity of 0.45 and a specificity of 0.16 for the diagnosis of skin cancer, whereas dermatologists had a sensitivity of 0.97 and a specificity of 0.75. The κ statistic as a measure of agreement was –0.56.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The ability of primary care physicians to diagnose skin cancer was appreciably lower than that of dermatologists. This may result in substantial delays in the provision of appropriate care for patients with skin cancer considering the role played by primary care physicians in screening for the disease in the Spanish national health system.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El cáncer cutáneo es la neoplasia maligna más frecuente en la población de raza blanca. El diagnóstico y tratamiento precoces son claves para disminuir su morbilidad. Hemos realizado un estudio prospectivo observacional a lo largo del año 2008 para valorar la capacidad del médico de familia (MF) en el diagnóstico clínico del cáncer cutáneo no melanoma.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han incluido los pacientes de una única área geográfica remitidos desde el área básica de salud (ABS) al dermatólogo, en cuyo volante de derivación el MF sugirió cáncer cutáneo en el diagnóstico diferencial. También se incluyeron todos aquellos pacientes remitidos por el MF sin sospecha de cáncer cutáneo no melanoma en los que el dermatólogo (D) sí sospechó cáncer.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El MF obtuvo una sensibilidad (S) del 0,45 y una especificidad (E) del 0,16 en el diagnóstico del cáncer cutáneo, mientras que en el caso del D aquellas fueron del 0,97 y 0,75 respectivamente. El índice de concordancia Kappa fue de −0,56.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El MF mostró habilidades sensiblemente inferiores a las del D en el diagnóstico clínico del cáncer cutáneo. Esta circunstancia puede implicar retrasos importantes en el adecuado manejo terapéutico de esta patología, teniendo en cuenta su papel de cribado en el Sistema Nacional de Salud.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología del cáncer cutáneo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Molgó" 1 => "M.L. Sáenz" 2 => "A. Lubiano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2006" "volumen" => "1" "paginaInicial" => "9" "paginaFinal" => "13" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 14 | 20 |
| 2024 October | 72 | 46 | 118 |
| 2024 September | 53 | 42 | 95 |
| 2024 August | 82 | 52 | 134 |
| 2024 July | 62 | 55 | 117 |
| 2024 June | 64 | 23 | 87 |
| 2024 May | 54 | 35 | 89 |
| 2024 April | 66 | 34 | 100 |
| 2024 March | 58 | 47 | 105 |
| 2024 February | 56 | 39 | 95 |
| 2024 January | 57 | 43 | 100 |
| 2023 December | 59 | 34 | 93 |
| 2023 November | 49 | 57 | 106 |
| 2023 October | 50 | 36 | 86 |
| 2023 September | 43 | 34 | 77 |
| 2023 August | 33 | 22 | 55 |
| 2023 July | 33 | 51 | 84 |
| 2023 June | 49 | 34 | 83 |
| 2023 May | 45 | 32 | 77 |
| 2023 April | 35 | 33 | 68 |
| 2023 March | 34 | 36 | 70 |
| 2023 February | 21 | 21 | 42 |
| 2023 January | 35 | 37 | 72 |
| 2022 December | 48 | 40 | 88 |
| 2022 November | 11 | 27 | 38 |
| 2022 October | 13 | 18 | 31 |
| 2022 September | 14 | 50 | 64 |
| 2022 August | 16 | 40 | 56 |
| 2022 July | 13 | 26 | 39 |
| 2022 June | 13 | 39 | 52 |
| 2022 May | 33 | 45 | 78 |
| 2022 April | 34 | 41 | 75 |
| 2022 March | 31 | 62 | 93 |
| 2022 February | 19 | 38 | 57 |
| 2022 January | 17 | 49 | 66 |
| 2021 December | 21 | 49 | 70 |
| 2021 November | 23 | 56 | 79 |
| 2021 October | 29 | 55 | 84 |
| 2021 September | 25 | 51 | 76 |
| 2021 August | 23 | 37 | 60 |
| 2021 July | 29 | 38 | 67 |
| 2021 June | 25 | 36 | 61 |
| 2021 May | 28 | 24 | 52 |
| 2021 April | 44 | 58 | 102 |
| 2021 March | 71 | 13 | 84 |
| 2021 February | 63 | 38 | 101 |
| 2021 January | 49 | 15 | 64 |
| 2020 December | 21 | 16 | 37 |
| 2020 November | 19 | 17 | 36 |
| 2020 October | 11 | 15 | 26 |
| 2020 September | 27 | 10 | 37 |
| 2020 August | 34 | 20 | 54 |
| 2020 July | 20 | 14 | 34 |
| 2020 June | 19 | 23 | 42 |
| 2020 May | 17 | 16 | 33 |
| 2020 April | 17 | 12 | 29 |
| 2020 March | 19 | 20 | 39 |
| 2020 February | 0 | 2 | 2 |
| 2020 January | 0 | 6 | 6 |
| 2019 December | 0 | 15 | 15 |
| 2019 November | 0 | 2 | 2 |
| 2019 October | 0 | 9 | 9 |
| 2019 September | 0 | 4 | 4 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 6 | 6 |
| 2019 June | 0 | 2 | 2 |
| 2019 May | 0 | 29 | 29 |
| 2019 April | 0 | 2 | 2 |
| 2019 March | 0 | 12 | 12 |
| 2018 November | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 14 | 5 | 19 |
| 2018 January | 12 | 5 | 17 |
| 2017 December | 18 | 5 | 23 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 10 | 3 | 13 |
| 2017 September | 15 | 2 | 17 |
| 2017 August | 19 | 8 | 27 |
| 2017 July | 37 | 4 | 41 |
| 2017 June | 28 | 9 | 37 |
| 2017 May | 12 | 4 | 16 |
| 2017 April | 27 | 5 | 32 |
| 2017 March | 22 | 7 | 29 |
| 2017 February | 16 | 9 | 25 |
| 2017 January | 20 | 4 | 24 |
| 2016 December | 27 | 10 | 37 |
| 2016 November | 29 | 3 | 32 |
| 2016 October | 29 | 17 | 46 |
| 2016 September | 28 | 8 | 36 |
| 2016 August | 30 | 3 | 33 |
| 2016 July | 31 | 6 | 37 |
| 2016 June | 8 | 7 | 15 |
| 2016 May | 7 | 4 | 11 |
| 2016 April | 3 | 5 | 8 |
| 2016 March | 5 | 5 | 10 |
| 2016 February | 6 | 5 | 11 |
| 2016 January | 8 | 0 | 8 |
| 2015 December | 8 | 2 | 10 |
| 2015 November | 8 | 3 | 11 |
| 2015 October | 9 | 2 | 11 |
| 2015 September | 8 | 2 | 10 |
| 2015 August | 12 | 6 | 18 |
| 2015 July | 36 | 9 | 45 |
| 2015 June | 43 | 7 | 50 |
| 2015 May | 61 | 13 | 74 |
| 2015 April | 44 | 16 | 60 |
| 2015 March | 48 | 10 | 58 |
| 2015 February | 29 | 16 | 45 |
| 2015 January | 29 | 13 | 42 |
| 2014 December | 30 | 32 | 62 |
| 2014 November | 35 | 18 | 53 |
| 2014 October | 35 | 20 | 55 |
| 2014 September | 42 | 14 | 56 |
| 2014 August | 36 | 14 | 50 |
| 2014 July | 52 | 25 | 77 |
| 2014 June | 56 | 10 | 66 |
| 2014 May | 65 | 14 | 79 |
| 2014 April | 45 | 15 | 60 |
| 2014 March | 56 | 13 | 69 |
| 2014 February | 39 | 14 | 53 |
| 2014 January | 41 | 16 | 57 |
| 2013 December | 50 | 13 | 63 |
| 2013 November | 38 | 24 | 62 |
| 2013 October | 31 | 11 | 42 |
| 2013 September | 33 | 16 | 49 |
| 2013 August | 37 | 29 | 66 |
| 2013 July | 36 | 22 | 58 |
| 2013 June | 42 | 17 | 59 |
| 2013 May | 34 | 9 | 43 |
| 2013 April | 19 | 16 | 35 |
| 2013 March | 24 | 16 | 40 |
| 2013 February | 12 | 15 | 27 |
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