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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 14 | 21 |
| 2024 Octubre | 72 | 46 | 118 |
| 2024 Septiembre | 53 | 42 | 95 |
| 2024 Agosto | 82 | 52 | 134 |
| 2024 Julio | 62 | 55 | 117 |
| 2024 Junio | 64 | 23 | 87 |
| 2024 Mayo | 54 | 35 | 89 |
| 2024 Abril | 66 | 34 | 100 |
| 2024 Marzo | 58 | 47 | 105 |
| 2024 Febrero | 56 | 39 | 95 |
| 2024 Enero | 57 | 43 | 100 |
| 2023 Diciembre | 59 | 34 | 93 |
| 2023 Noviembre | 49 | 57 | 106 |
| 2023 Octubre | 50 | 36 | 86 |
| 2023 Septiembre | 43 | 34 | 77 |
| 2023 Agosto | 33 | 22 | 55 |
| 2023 Julio | 33 | 51 | 84 |
| 2023 Junio | 49 | 34 | 83 |
| 2023 Mayo | 45 | 32 | 77 |
| 2023 Abril | 35 | 33 | 68 |
| 2023 Marzo | 34 | 36 | 70 |
| 2023 Febrero | 21 | 21 | 42 |
| 2023 Enero | 35 | 37 | 72 |
| 2022 Diciembre | 48 | 40 | 88 |
| 2022 Noviembre | 11 | 27 | 38 |
| 2022 Octubre | 13 | 18 | 31 |
| 2022 Septiembre | 14 | 50 | 64 |
| 2022 Agosto | 16 | 40 | 56 |
| 2022 Julio | 13 | 26 | 39 |
| 2022 Junio | 13 | 39 | 52 |
| 2022 Mayo | 33 | 45 | 78 |
| 2022 Abril | 34 | 41 | 75 |
| 2022 Marzo | 31 | 62 | 93 |
| 2022 Febrero | 19 | 38 | 57 |
| 2022 Enero | 17 | 49 | 66 |
| 2021 Diciembre | 21 | 49 | 70 |
| 2021 Noviembre | 23 | 56 | 79 |
| 2021 Octubre | 29 | 55 | 84 |
| 2021 Septiembre | 25 | 51 | 76 |
| 2021 Agosto | 23 | 37 | 60 |
| 2021 Julio | 29 | 38 | 67 |
| 2021 Junio | 25 | 36 | 61 |
| 2021 Mayo | 28 | 24 | 52 |
| 2021 Abril | 44 | 58 | 102 |
| 2021 Marzo | 71 | 13 | 84 |
| 2021 Febrero | 63 | 38 | 101 |
| 2021 Enero | 49 | 15 | 64 |
| 2020 Diciembre | 21 | 16 | 37 |
| 2020 Noviembre | 19 | 17 | 36 |
| 2020 Octubre | 11 | 15 | 26 |
| 2020 Septiembre | 27 | 10 | 37 |
| 2020 Agosto | 34 | 20 | 54 |
| 2020 Julio | 20 | 14 | 34 |
| 2020 Junio | 19 | 23 | 42 |
| 2020 Mayo | 17 | 16 | 33 |
| 2020 Abril | 17 | 12 | 29 |
| 2020 Marzo | 19 | 20 | 39 |
| 2020 Febrero | 0 | 2 | 2 |
| 2020 Enero | 0 | 6 | 6 |
| 2019 Diciembre | 0 | 15 | 15 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 9 | 9 |
| 2019 Septiembre | 0 | 4 | 4 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 6 | 6 |
| 2019 Junio | 0 | 2 | 2 |
| 2019 Mayo | 0 | 29 | 29 |
| 2019 Abril | 0 | 2 | 2 |
| 2019 Marzo | 0 | 12 | 12 |
| 2018 Noviembre | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 14 | 5 | 19 |
| 2018 Enero | 12 | 5 | 17 |
| 2017 Diciembre | 18 | 5 | 23 |
| 2017 Noviembre | 17 | 4 | 21 |
| 2017 Octubre | 10 | 3 | 13 |
| 2017 Septiembre | 15 | 2 | 17 |
| 2017 Agosto | 19 | 8 | 27 |
| 2017 Julio | 37 | 4 | 41 |
| 2017 Junio | 28 | 9 | 37 |
| 2017 Mayo | 12 | 4 | 16 |
| 2017 Abril | 27 | 5 | 32 |
| 2017 Marzo | 22 | 7 | 29 |
| 2017 Febrero | 16 | 9 | 25 |
| 2017 Enero | 20 | 4 | 24 |
| 2016 Diciembre | 27 | 10 | 37 |
| 2016 Noviembre | 29 | 3 | 32 |
| 2016 Octubre | 29 | 17 | 46 |
| 2016 Septiembre | 28 | 8 | 36 |
| 2016 Agosto | 30 | 3 | 33 |
| 2016 Julio | 31 | 6 | 37 |
| 2016 Junio | 8 | 7 | 15 |
| 2016 Mayo | 7 | 4 | 11 |
| 2016 Abril | 3 | 5 | 8 |
| 2016 Marzo | 5 | 5 | 10 |
| 2016 Febrero | 6 | 5 | 11 |
| 2016 Enero | 8 | 0 | 8 |
| 2015 Diciembre | 8 | 2 | 10 |
| 2015 Noviembre | 8 | 3 | 11 |
| 2015 Octubre | 9 | 2 | 11 |
| 2015 Septiembre | 8 | 2 | 10 |
| 2015 Agosto | 12 | 6 | 18 |
| 2015 Julio | 36 | 9 | 45 |
| 2015 Junio | 43 | 7 | 50 |
| 2015 Mayo | 61 | 13 | 74 |
| 2015 Abril | 44 | 16 | 60 |
| 2015 Marzo | 48 | 10 | 58 |
| 2015 Febrero | 29 | 16 | 45 |
| 2015 Enero | 29 | 13 | 42 |
| 2014 Diciembre | 30 | 32 | 62 |
| 2014 Noviembre | 35 | 18 | 53 |
| 2014 Octubre | 35 | 20 | 55 |
| 2014 Septiembre | 42 | 14 | 56 |
| 2014 Agosto | 36 | 14 | 50 |
| 2014 Julio | 52 | 25 | 77 |
| 2014 Junio | 56 | 10 | 66 |
| 2014 Mayo | 65 | 14 | 79 |
| 2014 Abril | 45 | 15 | 60 |
| 2014 Marzo | 56 | 13 | 69 |
| 2014 Febrero | 39 | 14 | 53 |
| 2014 Enero | 41 | 16 | 57 |
| 2013 Diciembre | 50 | 13 | 63 |
| 2013 Noviembre | 38 | 24 | 62 |
| 2013 Octubre | 31 | 11 | 42 |
| 2013 Septiembre | 33 | 16 | 49 |
| 2013 Agosto | 37 | 29 | 66 |
| 2013 Julio | 36 | 22 | 58 |
| 2013 Junio | 42 | 17 | 59 |
| 2013 Mayo | 34 | 9 | 43 |
| 2013 Abril | 19 | 16 | 35 |
| 2013 Marzo | 24 | 16 | 40 |
| 2013 Febrero | 12 | 15 | 27 |
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