Share
array:23 [ "pii" => "S2173579417301111" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.02.013" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1173" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2017;92:403-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669117300692" "issn" => "03656691" "doi" => "10.1016/j.oftal.2017.02.009" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1173" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2017;92:403-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 98 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 84 "PDF" => 10 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> La oftalmología en la era del sobrediagnóstico y el sobretratamiento" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "405" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> Ophthalmology in the era of over-diagnosis and over-treatment" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Vallès Fernández, J. González Martín-Moro, N. Prat Gil, J.M. Bonet Simó, D. Mingo-Botín" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Vallès Fernández" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "González Martín-Moro" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Prat Gil" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Bonet Simó" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Mingo-Botín" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579417301111" "doi" => "10.1016/j.oftale.2017.02.013" "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/S2173579417301111?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300692?idApp=UINPBA00004N" "url" => "/03656691/0000009200000009/v1_201708280004/S0365669117300692/v1_201708280004/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579417300427" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.02.008" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1108" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2017;92:406-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Cilioretinal obstruction during pregnancy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "411" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción de la arteria ciliorretiniana durante el embarazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1224 "Ancho" => 1790 "Tamanyo" => 202964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) Right eye funduscopy showed retinal infarct area in the inter-papillomacular zonal due to cilioretinal retinal artery occlusion. (B) OCT shows intraretinal edema at the level of the lesion. (C) Visual field showing centrocecal scotoma in the same eye.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Vila-Arteaga, M.M. Suriano, A. Martínez-Lajara" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Vila-Arteaga" ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Suriano" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Lajara" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116302246" "doi" => "10.1016/j.oftal.2016.10.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116302246?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300427?idApp=UINPBA00004N" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300427/v2_201708291316/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2173579419300039" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.11.007" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1447" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2019;94:53-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Re-thinking overdiagnosis and over-treatment in ophthalmology. Introduction to the concept of futility" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "54" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Repensando el sobrediagnóstico y el sobretratamiento en oftalmología. Introducción al concepto de futilidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Jiménez Benito" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Jiménez Benito" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118303575" "doi" => "10.1016/j.oftal.2018.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118303575?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300039?idApp=UINPBA00004N" "url" => "/21735794/0000009400000002/v1_201902010639/S2173579419300039/v1_201902010639/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> Ophthalmology in the era of over-diagnosis and over-treatment" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "405" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Vallès Fernández, J. González Martín-Moro, N. Prat Gil, J.M. Bonet Simó, D. Mingo-Botín" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Vallès Fernández" "email" => array:1 [ 0 => "rvallesf@gencat.cat" ] "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" => "J." "apellidos" => "González Martín-Moro" "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" ] ] ] 2 => array:3 [ "nombre" => "N." "apellidos" => "Prat Gil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Bonet Simó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "D." "apellidos" => "Mingo-Botín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grado de Medicina, Universidad Francisco de Vitoria, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> La oftalmología en la era del sobrediagnóstico y el sobretratamiento" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At present, in the developed world we are living in an environment of excess, also known as “too much”. We have within reach an excess of products that go beyond what is necessary to cover our basic needs and which market pressures prompt us to desire and consume. These social changes inevitably influence medicine as well.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Without a doubt, progress has brought very positive consequences for mankind and, even though medicine has never been able to prepare diagnostics with greater precision or achieved so many recoveries, the fact remains that not always more medicine leads to better results. For instance, the country in which public health expenditure <span class="elsevierStyleItalic">per capita</span> is highest is probably the United States<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> even though other countries are well beyond in many health indicators. This has given rise to a current of thought which, under the motto “less is more”, endeavors to alert society about the pitfalls of excessive medicine.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A search in Pubmed can produce publications of the late 40s of the past century that already discuss unnecessary medical procedures, above all in surgery.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2–5</span></a> However, it was not until the 70s that the first articles using “overdiagnosis” and “overtreatment” in their title were published. Overdiagnosis is defined as the diagnostic of a disease that will not produce significant symptoms throughout the life of an individual but the treatment and follow-up of which could give rise to damages and costs without any clear benefit for the patient.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6,7</span></a> This does not involve diagnostic errors or false positives, it is rather the detection of abnormalities that do not produce symptoms and which will probably not shorten the life expectancy of an individual. The awareness of such abnormalities could induce iatrogeny due to diagnostic tests and unnecessary treatments, i.e., “overtreatment” induced by overdiagnosing.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Concern surrounding the issue has skyrocketed in recent years. In fact, over 90% of articles approaching it were published in this century, mostly in the last 5 years. Possibly the subject on which most publications have focused is on screening for breast, prostate and thyroid cancer as well as melanoma,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8–14</span></a> even though “excessive medicine” is not limited to oncology as it includes nearly any chronic disease.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14–18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Overtreatment and overdiagnosis has prompted scientific societies, health institutions and experts in different fields to prepare and disseminate recommendations supported by evidence-based medicine to diminish specific clinic practices that scarcely provide value. In recent years, said institutions have organized international meetings on the issue such as the international conference for prevention of overdiagnosis. The 4th edition of this conference was recently held in Barcelona. At these conferences, various prestigious scientific journals and blogs, including BMJ or JAMA or, in Spain, the Society of Primary Health Care Pharmacists of Spain, debated on the best approach to these problems, free from the pressures of the pharmaceutical industry.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some journals have set up sections specifically dedicated on said issue (<span class="elsevierStyleItalic">Too much medicine</span> in the case of BMJ and <span class="elsevierStyleItalic">less is more</span> in the case of JAMA). In this regard, one of the most internationally consolidated initiatives is the <span class="elsevierStyleItalic">Choosing Wisely</span> campaign launched in 2012 by the Foundation of the American Board of Internal Medicine (ABIM) with the support of several scientific societies. The objective of this initiative is to promote a national debate to avoid useless or unnecessary examinations, tests, medical treatments and procedures. The implementation of similar initiatives could have a significant impact in the future for adapting the use of health resources and help to diminish iatrogeny. A survey carried out by said foundation among 600 family doctors and other medical specialists reported that 30% of respondents admitted to carrying out tests or procedures they regarded as unnecessary with a frequency exceeding once a week, and that 3 out of 4 believed that unnecessary procedures and tests are a serious problem for the health system.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Similarly, since 2007 the National Institute for Health and Care Excellence (NICE) of the United Kingdom has made a list of some clinical practices they explicitly recommend avoiding (“Do not do”) either because they don’t yield any benefits, the risk-benefit ratio is not clear or because there is insufficient evidence to recommend systematic use thereof. By March 2014 the “Do not do” database comprised 972 recommendations.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our country, 3 similar initiatives have been implemented in parallel in the course of 2013, i.e., the “Commitment to Quality by Scientific Societies” led by the Ministry of Health, Social Services and Equality, that to date has been endorsed by 39 scientific societies including the Ophthalmological Society of Spain, even though no recommendations have been published yet. The second initiative is the <span class="elsevierStyleItalic">Essencial</span> project of the Health Quality and Evaluation Agency of Catalonia (AQuAS) and the third is the recommendations to abstain issued by the Society of Family and Community Medicine of Spain (semFYC).</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case of AQuAS, their blog published the results of the survey carried out in 2015 among primary health care physicians (specialists in family and pediatric medicine) of the Catalan Institute of Health of the North Metropolitan Area in order to explore the degree of awareness and viewpoints of physicians about practices that add very little value. Overall, 69% of 250 physicians indicated that said practices were frequent or very frequent in their daily activity and 80% indicated that at least once a week they found themselves in the situation of deciding about a request for a test or treatment they regarded as unnecessary.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In what concerns recommendations, the <span class="elsevierStyleItalic">Essencial</span> project has developed over 50 for health professionals as well as for patients. The document issued by semFYC describes 15 recommendations that basically involve situations of the daily clinical practice of family doctors. As in the Health Ministry project, none of the 2 initiatives comprises a specific recommendations in ophthalmology. However, the <span class="elsevierStyleItalic">Choosing Wisely</span> initiative comprises 10 recommendations about doubtful practices in the ophthalmic field issued by the American Association of Pediatric Opthalmology and Strabismus and the American Academy of Ophtalmology.</p><p id="par0055" class="elsevierStylePara elsevierViewall">There are very few publications that approach the issue of overdiagnosing in ophthalmology,<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">19,20</span></a> although without a doubt ophthalmologists produce overdiagnosis and overtreatment in our daily practice. For instance, in the field of glaucoma we have seen in recent years a significant expansion of what is considered to be a disease. At present, a significant proportion of the ophthalmological community considers that ocular hypertension and normotensive glaucoma should be treated even though a thorough reading of the <span class="elsevierStyleItalic">Ocular hypertension treatment study</span> indicates that the number requiring treatment, in the order of 20, probably does not justify the systematic treatment of ocular hypertension.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the fact that the glaucoma subspecialty is the area in which overdiagnosis is probably most relevant, the fact is that in all subspecialties we can find similar examples. To restrict the systematic pre-surgery requests for the majority of ophthalmological surgeries and avoiding the prescription of antibiotic prophylaxis prior to cataract surgery are clear examples of well identified overuse.</p><p id="par0065" class="elsevierStylePara elsevierViewall">It can be concluded that the “excess of medicine” is a current problem that affects ophthalmologists and that must be approached and corrected in order to provide safer and more efficient healthcare for our patients. We may disagree in the dimensions of the problem but no one can deny that overdiagnosis exists and that “too much ophthalmology” is also counterproductive. It is obvious that addressing this issue is one of the ethical challenges of present day ophthalmology because it goes against the health interests of individuals, gives rise to social alarm and diminishes the efficiency of the health system.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> It would be interesting to identify the most prevalent forms of overuse in our specialty and to have the backing of a list of “Do not do” recommendations in our daily clinical practice. We should never forget that on many occasions it could be indicated to “undiagnose and unprescribe”. Only by becoming aware of this issue we shall be able to include 21st-century ophthalmology in the <span class="elsevierStyleItalic">Choosing Wisely</span> culture.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vallès Fernández R, González Martín-Moro J, Prat Gil N, Bonet Simó JM, Mingo-Botín D. <span class="elsevierStyleItalic">Too much Ophthalmology?</span> La oftalmología en la era del sobrediagnóstico y el sobretratamiento. Arch Soc Esp Oftalmol. 2017;92:403–405.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monitoring health for the SDGs, sustainable development goals. WHO Library Cataloguing-in-Publication Data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Statistics 2016" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "WHO Press, World Health Organization" "editorialLocalizacion" => "Ginebra, Suiza" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unnecessary surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Horwitz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Ann Dist Columbia" "fecha" => "1947" "volumen" => "16" "paginaInicial" => "605" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18896113" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0125" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safeguard against unnecessary surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.M. Dealy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mod Hosp" "fecha" => "1948" "volumen" => "70" "paginaInicial" => "90" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18905172" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0130" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "If hospitals are to eliminate unnecessary surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.J. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hospitals" "fecha" => "1949" "volumen" => "23" "paginaInicial" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18119356" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0135" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The legal and moral aspects of unnecessary surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.U. Letourneau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hospitals" "fecha" => "1953" "volumen" => "27" "paginaInicial" => "82" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13108289" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0140" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventing overdiagnosis: how to stop harming the healthy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Moynihan" 1 => "J. Doust" 2 => "D. Henry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "344" "paginaInicial" => "e3502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22645185" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0145" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Walking the tightrope: communicating overdiagnosis in modern healthcare" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.J. McCaffery" 1 => "J. Jansen" 2 => "L.D. Scherer" 3 => "H. Thornton" 4 => "J. Hersch" 5 => "S.M. Carter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2016" "volumen" => "352" "paginaInicial" => "i348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26850726" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0150" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer screening: the clash of science and intuition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.S. Kramer" 1 => "J.M. Croswell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev.med.60.101107.134802" "Revista" => array:6 [ "tituloSerie" => "Annu Rev Med" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "125" "paginaFinal" => "137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18803476" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0155" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdiagnosis in cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.G. Welch" 1 => "W.C. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jnci/djq099" "Revista" => array:6 [ "tituloSerie" => "J Natl Cancer Inst" "fecha" => "2010" "volumen" => "102" "paginaInicial" => "605" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20413742" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0160" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdetection in screening for prostate cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Hugosson" 1 => "S. Carlsson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOU.0000000000000054" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Urol" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "256" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24670870" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0165" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ‘epidemic’ of melanoma between under- and overdiagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W. Weyers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2011.01831.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "9" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22211330" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0170" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Carter" 1 => "R.J. Coletti" 2 => "R.P. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2015" "volumen" => "350" "paginaInicial" => "g7773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25569206" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0175" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.G. Welch" 1 => "P.C. Prorok" 2 => "A.J. O’Malley" 3 => "B.S. Kramer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1600249" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "375" "paginaInicial" => "1438" "paginaFinal" => "1447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27732805" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdiagnosis of TIA and minor stroke: experience at a regional neurovascular clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.J. Martin" 1 => "G. Young" 2 => "T.P. Enevoldson" 3 => "P.R. Humphrey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "1997" "volumen" => "90" "paginaInicial" => "759" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9536340" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdiagnosis of multiple sclerosis and magnetic resonance imaging criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Nielsen" 1 => "T. Korteweg" 2 => "F. Barkhof" 3 => "B.M. Uitdehaag" 4 => "C.H. Polman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.20632" "Revista" => array:7 [ "tituloSerie" => "Ann Neurol" "fecha" => "2005" "volumen" => "58" "paginaInicial" => "781" "paginaFinal" => "783" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16240352" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508513012791" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdiagnosis of dementia in young patients – a nationwide register-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.C. Salem" 1 => "B.B. Andersen" 2 => "T.R. Nielsen" 3 => "J. Stokholm" 4 => "M.B. Jorgensen" 5 => "M.H. Rasmussen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000345485" "Revista" => array:6 [ "tituloSerie" => "Dement Geriatr Cogn Disord" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "292" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23208125" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0195" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: a 3-year European multicenter study with repeat [123I]FP-CIT SPECT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.L. Marshall" 1 => "C.B. Reininger" 2 => "M. Marquardt" 3 => "J. Patterson" 4 => "D.M. Hadley" 5 => "W.H. Oertel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mds.22108" "Revista" => array:6 [ "tituloSerie" => "Mov Disord" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "500" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19117369" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0200" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overdiagnosis: how our compulsion for diagnosis may be harming children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.R. Coon" 1 => "R.A. Quinonez" 2 => "V.A. Moyer" 3 => "A.R. Schroeder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2014-1778" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2014" "volumen" => "134" "paginaInicial" => "1013" "paginaFinal" => "1023" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25287462" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0205" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in Roman]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Overdiagnosis in glaucoma – a real problem?]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Zemba" 1 => "B. Cucu" 2 => "A. Stinghe" 3 => "G. Furedi" 4 => "V. Zugravu" 5 => "M. Lacusteanu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oftalmologia" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "81" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19149124" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0210" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Over-diagnosis and over-treatment in Ophthalmology: a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Gonzalez-Martin-Moro" 1 => "J. Zarallo-Gallardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2016.03.014" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "526" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27125187" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0215" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[discussion 829–30]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Kass" 1 => "D.K. Heuer" 2 => "E.J. Higginbotham" 3 => "C.A. Johnson" 4 => "J.L. Keltner" 5 => "J.P. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Ophthalmol" "fecha" => "2002" "volumen" => "120" "paginaInicial" => "701" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12049574" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0220" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical ethics and ophthalmology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Jimenez Benito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2016.10.013" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "99" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27939805" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417301111/v2_201708291316/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000009/v2_201708291316/S2173579417301111/v2_201708291316/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301111?idApp=UINPBA00004N" ]
