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Heili-Frades S, Carballosa de Miguel MDP, Naya Prieto A, Galdeano Lozano M, Mate García X, Mahillo Fernández I, Fernández Ormaechea I, Álvarez Suárez L, Ezzine de Blas F, Checa Venegas MJ, González Mangado N, Peces Barba G. Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe? Arch Bronconeumol 2019; 55:634-641. [PMID: 31587917 DOI: 10.1016/j.arbres.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Historically, it has been assumed that Intermediate Respiratory Care Units (IRCU) were efficient, because they saved costs by reducing the number of admissions to intensive care units (ICU), and effective, because they specialized in respiratory diseases. METHODS The number of IRCU admissions and mortality rate, historically and in 2016, were evaluated. For 2016, the grouped Related Diagnostic Groups (DRGs) were also described, and the savings achieved under all budgetary headings by avoiding UCI stays were calculated. A multivariate analysis was performed to associate costs with mean weights and complexity, and multiple logistic regression was performed on all patients admitted from 2004 to 2017 to describe the variables associated with mortality in our unit. RESULTS An IRCU generates savings of €500,000/year by reducing length of ICU stay. Analysis of the 2016 cohort shows that costs correlate with mean weight and mortality, and consequently complexity. The multivariate logistic regression analysis of the 2004-2017 cohort found respiratory frequency, leukopenia, anemia, hyperkalemia, and acidosis to be the variables best associated with mortality. The area under the curve for the logistic model was 0.75. CONCLUSION The IRCU analyzed in our study was efficient in terms of 'avoided costs' and savings associated with complexity. Our results suggest that IRCUs have a lower mortality rate than other similar units, and are therefore a safe environment for patients.
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Affiliation(s)
- Sarah Heili-Frades
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España.
| | - María Del Pilar Carballosa de Miguel
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Alba Naya Prieto
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Marina Galdeano Lozano
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, Hospital Universitario Sagrat Cor, Grupo Quirón Salud. Universitat de Barcelona, REVA (Réseau Européen de Ventilation Artificielle), Barcelona, España
| | - Xavier Mate García
- Dirección General y Gerencia, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, Barcelona, España
| | | | - Itziar Fernández Ormaechea
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Laura Álvarez Suárez
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Farah Ezzine de Blas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - María José Checa Venegas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Nicolás González Mangado
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Germán Peces Barba
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
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Sobradillo Ecenarro P, García-Rivero JL, López Caro JC. [Bronchodilator therapy in the prevention of COPD exacerbations]. Semergen 2019; 45:479-488. [PMID: 31540819 DOI: 10.1016/j.semerg.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/26/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
The natural course of chronic obstructive pulmonary disease usually includes exacerbations. chronic obstructive pulmonary disease patients suffer from 1-4 exacerbations per year on average. These are associated with worsening quality of life and increased mortality. Reducing and controlling the number of exacerbations is one of the main goals of chronic obstructive pulmonary disease treatment. Among current treatments, tiotropium is the active substance with the strongest evidence in the reduction of moderate/severe exacerbations, together with a good safety and tolerability profile. The addition of olodaterol to tiotropium offers well-tolerated and effective double bronchodilation for improving lung function, quality of life, and decreased dyspnoea compared to its single components. This also reduces the annual rate of moderate/severe exacerbations vs. tiotropium by 7%, although not reaching the pre-specified statistical significance level of P<.01.
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Affiliation(s)
- P Sobradillo Ecenarro
- Servicio de Neumología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - J L García-Rivero
- Servicio de Neumología, Hospital de Laredo, Laredo, Cantabria, España
| | - J C López Caro
- Médicina de familia, Centro de Salud Cotolino, Castro Urdiales, Cantabria, España
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Amores Bermúdez J, Osman García I, Unda Urzáiz M, Jiménez Marrero P, Ledo Cepero MJ, Llarena R, Flores Martín J, Abad Vivas-Pérez JI, Rodrigo Aliaga M, Juarez Soto A. Safety of nivolumab in metastatic renal cell carcinoma patients: A real-life experience in a Spanish urology setting. Actas Urol Esp 2019; 43:364-370. [PMID: 31097211 DOI: 10.1016/j.acuro.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Nivolumab is an immunotherapy agent that has been an approved treatment for previously treated patients with advanced renal cell carcinoma (RCC). Experience in real-life settings, especially regarding immune- related adverse events, is scarce. We present our experience with reference to the safety of nivolumab in patients with metastatic RCC (mRCC) treated in 9 hospitals in Spain. MATERIAL AND METHODS Retrospective, multicentre study of patients with mRCC treated with nivolumab between 2016 and 2018. Data on baseline socio-demographic and clinical characteristics and drug-related adverse events were collected. RESULTS The mean age of the 26 patients included was 63.7±11.5 years; 96% were ECOG 0-1 and 78% had favourable or intermediate MSKCC risk scores; 73% had the clear cell histological subtype and 30% metastatic disease. Median follow-up was 9 months (range 1-14). All patients experienced an adverse event at different grades, with fatigue, fever and anaemia being the most common (27%). Grade 3 adverse events occurred in 23% of patients. Adverse reactions led to treatment suspension in 3 patients (11%). CONCLUSION In the real-life clinical setting, nivolumab shows favourable outcomes, similar to those reported by other studies.
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Affiliation(s)
- J Amores Bermúdez
- Servicio de Urología, Hospital Universitario de Jerez, Jerez, España.
| | - I Osman García
- Servicio de Urología, Hospital Virgen del Rocío, Sevilla, España
| | - M Unda Urzáiz
- Servicio de Urología, Hospital Universitario Basurto, Bilbao, España
| | - P Jiménez Marrero
- Servicio de Urología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - M J Ledo Cepero
- Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - R Llarena
- Servicio de Urología, Hospital de Cruces, Baracaldo, España
| | - J Flores Martín
- Servicio de Urología, Complejo Hospitalario de Jaén, Jaén, España
| | | | - M Rodrigo Aliaga
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, España
| | - A Juarez Soto
- Servicio de Urología, Hospital Universitario de Jerez, Jerez, España
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Sirvent JM, Cordon C, Cuenca S, Fuster C, Lorencio C, Ortiz P. Application, verification and correction from an elaborate checklist with some of the recommendations («do and do not do») of the SEMICYUC working groups. Med Intensiva 2019; 45:88-95. [PMID: 31477342 DOI: 10.1016/j.medin.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Based on some of the recommendations of the SEMICYUC working groups, we developed a checklist and applied it in 2 periods, analyzing their behavior as a tool for improving safety. DESIGN A comparative pre- and post-intervention longitudinal study was carried out. SETTING The Intensive Care Unit (ICU) of a 400-bed university hospital. PATIENTS Random cases series in 2 periods separated by 6 months. INTERVENTIONS We developed a checklist with 24 selected indicators that were randomly applied to 50 patients. Verification was conducted by a professional not related to care (prompter). We analyzed the results and compliance index and carried out corrective measures with training. With 6 months of preparation, we again applied the random checklist to 50 patients (post-intervention period) and compared the compliance indexes between the two timepoints. RESULTS There were no differences in demographic characteristics or evolution between the periods. The compliance index at baseline was 0.86±0.12 versus 0.91±0.52 in the post-intervention period (P=.023). An acceptable compliance index was obtained with the 24 indicators, though at baseline the compliance index was<0.85 for 5 recommendations. These detected non-compliances were worked upon through training in the second phase of the study. The post-intervention checklist evidenced improvement in compliance with the recommendations. CONCLUSIONS The checklist used to assess compliance with a selection of recommendations of the SEMICYUC applied and moderated by a prompter was seen to be a useful instrument allowing us to identify points for improvement in the management of Intensive Care Unit patients, increasing the quality and safety of care.
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Affiliation(s)
- J-M Sirvent
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España.
| | - C Cordon
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - S Cuenca
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - C Fuster
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - C Lorencio
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - P Ortiz
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
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Moreno-Jiménez S, Martínez-Vaca N, Pérez-Aguilar B, Gómez-Calva B, Díaz-Chávez JJ, Mondragón-Soto MG. Usefulness and safety from stereotactic biopsy in posterior fossa lesions in adult patients. CIR CIR 2019; 87:554-558. [PMID: 31448801 DOI: 10.24875/ciru.19000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Stereotactic biopsy has been reported as a useful and safety procedure in pediatric patients. In adult patients exist more controversy because a greater number of diagnostic options. Objective To demonstrate its usefulness and safety in adult patients with posterior fossa pathology. Method From 2006-2014, 23 patients were operated from posterior fossa. Variables: age, gender, state, pre- and postoperative diagnosis, stereotactic device, location and complications. Results 52.2% females and 47.8% males. The location was ponto-mesencephalic 43.5%, cerebellum 39.1%, bulbar 13% and pineal region 4.3%. The preoperative diagnosis was brainstem glioma 78.2%, lymphoma 8.7%, and meningioma, metastasis and abscess 4.3% each one. In 73.9% Zamorano-Dujovni device was used and in 26.1% the CRW. The definitive diagnosis was pilocytic astrocytoma 17.4%, diffuse astrocytoma 13%, inflammatory response 13%, anaplastic astrocytoma 8.7%, gliosis 8.7%, glioblastoma, neuroectodermic primitive tumor, germinoma, pineocytoma and cryptococcosis 4.3% each one. In 17.4% there was no diagnosis. The preoperative diagnosis was concordant in 43.5%. One transient deficit and one pin displacement 4.3% were present. 91.4% without complications. Conclusions It is a useful, necessary and safety procedure in adult patients.
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Affiliation(s)
- Sergio Moreno-Jiménez
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México.,Clínica de Radiocirugía, Centro Neurológico del Centro Médico ABC. Ciudad de México, México
| | - Néstor Martínez-Vaca
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
| | | | - Brenda Gómez-Calva
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
| | - Jorge J Díaz-Chávez
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
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Cruz-González I, Ince H, Kische S, Schmitz T, Schmidt B, Gori T, Foley D, de Potter T, Tschishow W, Vireca E, Stein K, Boersma LV. Left atrial appendage occlusion in patients older than 85 years. Safety and efficacy in the EWOLUTION registry. ACTA ACUST UNITED AC 2019; 73:21-27. [PMID: 30956034 DOI: 10.1016/j.rec.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Elderly patients with atrial fibrillation are at greater risk of both cardioembolic events and major bleeding than younger patients. Left atrial appendage occlusion (LAAO) could be an attractive alternative for these patients, but there are limited data on outcomes with LAAO in patients ≥ 85 years old. The aim of the present study was to assess the safety and efficacy of LAAO in patients ≥ 85 years old. METHODS A total of 1025 patients included in the EWOLUTION registry who underwent LAAO were analyzed and 84 patients ≥ 85 years old were identified and compared with the younger cohort. RESULTS Patients ≥ 85 years old had higher estimated stroke and hemorrhagic risks than younger patients (CHA2DS2-VASc: 5.2±1.2 vs 4.4±1.6, P <.0001; HAS-BLED: 2.7±1.1 vs 2.3±1.2; P=.003; ≥ 85 years vs <85 years). Procedural success was high and similar in both groups (98.8% vs 98.5%; P=.99). There were no differences in 7-day device- or procedure-related adverse event rates (2.6% in ≥ 85 years vs 3.1% in <85 years; P=.80). Despite the higher baseline stroke risk, there was no difference at follow-up between the groups in the annualized stroke rate (0.8/100 patient-years in ≥ 85 years vs 1.3/100 patient-years in <85 years; P=.649). CONCLUSIONS LAAO in patients ≥ 85 years is safe and effective even though these patients are at high risk for embolic and hemorrhagic events. LAAO may be a reasonable alternative to oral anticoagulation in these patients.
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Affiliation(s)
- Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain.
| | - Hueseyin Ince
- Kardiologie, Vivantes Klinikum Am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Stephan Kische
- Kardiologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Schmitz
- Kardiologie, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Boris Schmidt
- Kardiologie, Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Am Main, Germany
| | - Tommaso Gori
- Kardiologie, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | - David Foley
- Cardiology Deparment, Beaumont Hospital, Dublin, Ireland
| | - Tom de Potter
- Cardiologie, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | | | | | - Kenneth Stein
- Boston Scientific Corp, Minneapolis, Minessota, United States
| | - Lucas V Boersma
- Cardiologie, St Antonius Hospital, Nieuwegein, The Netherlands
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Alvaro-Gracia JM, Arredondo M, Daudén E, Meca-Lallana V, Morell A, Gisbert JP, Fernández-Jiménez G, García de Vicuña R, Aspa FJ, García de Yébenes MJ, Carmona L. Launch and preliminary analysis of Hospital de La Princesa's inter-specialists biological therapies unit. ACTA ACUST UNITED AC 2019; 15:63-8. [PMID: 30691949 DOI: 10.1016/j.reuma.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 11/23/2022]
Abstract
We herein describe an inter-specialists unit for the monitoring and management of biological therapies and analyze the utilization of biological agents across specialties and diseases. Protocols and therapeutic objectives, as well as outcomes and protocol deviations, are shared and discussed periodically between specialists. All patients treated at one centre with any biological treatment from January 2000 by rheumatology, gastroenterology, dermatology, or neurology, regardless diagnosis, are identified by Clinical Pharmacy and included in an ongoing database that detects use and outcome. The drugs, survival, and reasons for discontinuation differ significantly across specialties. This approach has helped us recognizing the challenges and size of the problem of sharing expensive medications across specialties, and has served as a starting point to contribute to the better use of these compounds.
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de Abreu P, Ávila-Pedretti G, Morel Z, Acosta MI, Cabrera-Villalba S, Melgarejo P, Franco M, Delgadillo P, Román L, Elizaur JG, Paredes E, Cordovilla DO, Palleiro D, Albanese M, Mazzoleni J. Safety and Survival Associated with Biologic Therapies: First Report of the Biobadaguay on the Paraguayan-Uruguayan Registry of Adverse Events with Biologic Therapies. Reumatol Clin (Engl Ed) 2019; 16:396-404. [PMID: 30595458 DOI: 10.1016/j.reuma.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10-6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10-2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10-8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified.
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Affiliation(s)
| | | | - Zoilo Morel
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay; Hospital de Clínicas Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Sonia Cabrera-Villalba
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay; Hospital de Clínicas Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Marco Franco
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Pedro Delgadillo
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Lourdes Román
- Hospital de Clínicas Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Ernesto Paredes
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | | | | | - Julio Mazzoleni
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
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Gómez VJ, Carrión-Barberá I, Salman Monte TC, Acosta A, Torrente-Segarra V, Monfort J. Effectiveness and Safety of Rituximab in Systemic Lupus Erythematosus: A Case Series Describing the Experience of 2 Centers. ACTA ACUST UNITED AC 2018; 16:391-395. [PMID: 30522941 DOI: 10.1016/j.reuma.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 05/01/2018] [Accepted: 08/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems. B cells have a critical role in the pathogenesis of SLE. Rituximab (RTX) is a drug composed of chimeric monoclonal antibodies against the CD20 protein, producing a depletion of B lymphocytes. OBJECTIVE To analyze the effectiveness and safety of RTX in patients with SLE in clinical practice. METHODS Collection of retrospective variables of the medical records of 20 patients with SLE treated with RTX in 2hospitals (Hospital de la Santa Creu i Sant Pau, and Hospital del Mar, in Barcelona, Spain). We evaluated demographic, clinical, serological and treatment variables. RESULTS There was a statistically significant association in the following variables collected in the study before and after treatment: there was a decrease in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (P<.001), erythrocyte sedimentation rate (P=.017), use of glucocorticoids (P=.025) and IgM values (P=.031), as well as an increase in the C4 values (P=.014) after treatment with RTX. A patient with SLE, antiphospholipid syndrome, complex comorbidity and multiorgan lupus involvement died after developing a septic process, months after receiving a single treatment cycle with RTX. CONCLUSIONS Although RTX currently has no official indication approved for SLE, our data suggest that it may be effective in reducing the activity of the disease and as a steroid-sparing agent, with an acceptable safety profile. However, larger follow-up periods with a greater number of patients are needed to solve the remaining doubts about the use of RTX in SLE.
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Affiliation(s)
- Vicenç Juan Gómez
- Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, España
| | - Irene Carrión-Barberá
- Servicio de Reumatología, Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, España
| | | | - Asunción Acosta
- Servicio de Reumatología, Hospital General de Cataluña, Barcelona, España
| | - Vicenç Torrente-Segarra
- Servicio de Reumatología, Hospital Comarcal Alt Penedés, Villafranca del Penedés, Barcelona, España
| | - Jordi Monfort
- Servicio de Reumatología, Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, España
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Castells Lao G, Rodríguez Reyes M, Roura Turet J, Prat Dot M, Soy Muner D, López Cabezas C. Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review. Med Intensiva 2018; 44:80-87. [PMID: 30262380 DOI: 10.1016/j.medin.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. DESIGN i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Articles published from 1990 to 2017 in English, Spanish and French were included. ii) Article quality was analyzed according to the stability studies practice guidelines. iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. SCOPE Spanish and international hospital ICU. RESULTS The systematic review included 29 studies (27 originals, 2 reviews). None of the included studies followed all the methodological requirements. However, 93% guaranteed correct reproducibility. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. CONCLUSIONS This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population.
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Affiliation(s)
- G Castells Lao
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España.
| | - M Rodríguez Reyes
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - J Roura Turet
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - M Prat Dot
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - D Soy Muner
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - C López Cabezas
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
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Esquinas C, Arance I, Pamplona J, Moraga A, Dorado JF, Angulo JC. Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Actas Urol Esp 2018; 42:473-482. [PMID: 29642999 DOI: 10.1016/j.acuro.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.
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Affiliation(s)
- C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - J Pamplona
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - A Moraga
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | | | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España.
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Cabadas Avión R, Leal Ruiloba MS, Muñoz Mella MA, Vázquez Lima A, Ojea Cendón M, Enríquez de Salamanca I. Continuous improvement of safety in the Intensive Care and Surgical environment according to UNE 179003:2013 standard: 8 years experience. ACTA ACUST UNITED AC 2018; 65:486-494. [PMID: 30153990 DOI: 10.1016/j.redar.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. METHODS A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. RESULTS The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. CONCLUSION The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard.
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Affiliation(s)
- R Cabadas Avión
- Servicio de Anestesiología y Cuidados Intensivos, Hospital Povisa, Vigo, Pontevedra, España.
| | - M S Leal Ruiloba
- Servicio de Anestesiología y Cuidados Intensivos, Hospital Povisa, Vigo, Pontevedra, España
| | - M A Muñoz Mella
- Dirección de enfermería y calidad, Hospital Povisa, Vigo, España
| | - A Vázquez Lima
- Servicio de Anestesiología y Cuidados Intensivos, Hospital Povisa, Vigo, Pontevedra, España
| | - M Ojea Cendón
- Servicio de Anestesiología y Cuidados Intensivos, Hospital Povisa, Vigo, Pontevedra, España
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Ariza Jiménez AB, Martínez-Aedo Ollero MJ, López-Siguero JP. [Efficacy and safety of replacement treatment in isolated growth hormone deficiency]. An Pediatr (Barc) 2018; 90:285-292. [PMID: 29960877 DOI: 10.1016/j.anpedi.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/13/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Growth in patients with isolated growth hormone (GH) deficiency is heterogeneous despite treatment due to the low specificity of diagnostic tests, making it necessary to define efficacy variables. AIMS To evaluate efficacy of hormone replacement therapy in children with isolated GH deficiency. METHODS Observational-ambispective study of patients treated in our department in the last 14 years for isolated GH deficiency. This was defined as a GH level less than 7.4mg/dl in response to 2 stimulation tests in patients with height<2SD and a decreased growth rate. RESULTS The study included a total 97 patients, of whom 69% were boys. The large majority (89.58%) achieved final height. None of them had side effects. The median dose of GH used was 0.028mg/kg/day (0.03-0.025). There was a gain of 1.17 SD in final height. Around three-quarters (71.13%) of the patients were reassessed in adulthood, of whom 39.4% maintained the deficiency, and 79.31% achieved target range height. Target height, estimated height, and the total pubertal gain were positively correlated with final height, while the bone age/chronological age ratio and the initial insulin-like growth factor-1 showed a negative correlation. CONCLUSIONS A majority of patients reached target size, although only a few of them maintained the deficiency in adulthood. Target size, estimated adult height, and pubertal variables are directly related to adult height, while bone age/chronological age and insulin-like growth factor-1 were inversely related, and these can be used as efficacy variables. No adverse effects were observed in the sample with the doses used for the treatment.
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Unda-Urzaiz M, Alonso-Herreros JM, Fernandez-Gomez JM, Gaspar-Carreño M, Cozar-Olmos JM, Lleti ACC. Review of the evidence on handling drugs and hazardous products in Urology Departments. Consensus document between the Spanish Urological Association and the Spanish Society of Hospital Pharmacy. Actas Urol Esp 2018; 42:375-380. [PMID: 29685610 DOI: 10.1016/j.acuro.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHODS We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. RESULTS There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DISCUSSION Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. CONCLUSIONS After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.
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Affiliation(s)
- M Unda-Urzaiz
- Hospital Universitario Basurto, Bilbao, Vizcaya, España.
| | | | | | | | - J M Cozar-Olmos
- Hospital Universitario Virgen de las Nieves, Granada, España
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Franco Sereno MT, Pérez Serrano R, Ortiz Díaz-Miguel R, Espinosa González MC, Abdel-Hadi Álvarez H, Ambrós Checa A, Rodríguez Martínez M. Pharmacist Adscription To Intensive Care: Generating Synergies. Med Intensiva 2018; 42:534-540. [PMID: 29605582 DOI: 10.1016/j.medin.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING A medical and surgical ICU with 21 beds. PATIENTS Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units.
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Affiliation(s)
- M T Franco Sereno
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - R Pérez Serrano
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - R Ortiz Díaz-Miguel
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M C Espinosa González
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - H Abdel-Hadi Álvarez
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - A Ambrós Checa
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M Rodríguez Martínez
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Mañes-Sevilla M, Marzal-Alfaro MB, Romero Jiménez R, Herranz-Alonso A, Sanchez Fresneda MN, Benedi Gonzalez J, Sanjurjo-Sáez M. [Failure mode and effects analysis to improve quality in clinical trials]. J Healthc Qual Res 2018; 33:33-47. [PMID: 29456173 DOI: 10.1016/j.cali.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/04/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The failure mode and effects analysis (FMEA) has been used as a tool in risk management and quality improvement. The objective of this study is to identify the weaknesses in processes in the clinical trials area, of a Pharmacy Department (PD) with great research activity, in order to improve the safety of the usual procedures. METHODS A multidisciplinary team was created to analyse each of the critical points, identified as possible failure modes, in the development of clinical trial in the PD. For each failure mode, the possible cause and effect were identified, criticality was calculated using the risk priority number and the possible corrective actions were discussed. RESULTS Six sub-processes were defined in the development of the clinical trials in PD. The FMEA identified 67 failure modes, being the dispensing and prescription/validation sub-processes the most likely to generate errors. All the improvement actions established in the AMFE were implemented in the Clinical Trials area. DISCUSSION The FMEA is a useful tool in proactive risk management because it allows us to identify where we are making mistakes and analyze the causes that originate them, to prioritize and to adopt solutions to risk reduction. The FMEA improves process safety and quality in PD.
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Limousin B, Corella F, Del Campo B, Fernández E, Corella MÁ, Ocampos M, Vázquez T, Larrainzar-Garijo R. Metacarpophalangeal portal safety. An anatomical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:380-386. [PMID: 29198935 DOI: 10.1016/j.recot.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/22/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022] Open
Abstract
AIM To quantify the risk of dorsal innervation injury when performing direct metacarpophalangeal joint portals of the second to fifth fingers. MATERIAL AND METHOD An anatomical study of 11 upper limbs of fresh corpses was carried out. After placing them in a traction tower, the metacarpophalangeal portals were developed on both sides of the extensor tendon. The dorsal sensory branches were dissected and the distances between the portal and the nearest nerve were measured by a digital caliper. The portals of all the fingers were compared globally to assess the safest finger and two to two radial and ulnar portals were compared in each of the fingers to assess the safest portal within each finger. RESULTS The overall comparison of all portals and fingers showed that the third finger is the safest in any of its portals, while the ulnar side of the second and radial of the fourth are the portals with the highest risk of nerve injury (P=8.96·10-5). Comparing two to two of the radial and ulnar portals in each of the fingers showed that the ulnar portal is safer than the radial on the fourth finger (P=.042), while the radial is safer than the ulnar on the fifth finger (P=.003). CONCLUSIONS The third finger was the safest to perform metacarpophalangeal portals, while the ulnar side of the second finger and radial side of the fourth had the highest risk of nerve injury.
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Affiliation(s)
- B Limousin
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - F Corella
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España; Unidad de Cirugía de Mano, Hospital Beata María Ana, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, España
| | - B Del Campo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - E Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España
| | | | - M Ocampos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España; Unidad de Cirugía de Mano, Hospital Beata María Ana, Madrid, España
| | - T Vázquez
- Centro de Donación de Cuerpos y Salas de Disección, Facultad de Medicina, Universidad Complutense de Madrid, España
| | - R Larrainzar-Garijo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, España
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Sanchez-Piedra C, Hernández Miguel MV, Manero J, Roselló R, Sánchez-Costa JT, Rodríguez-Lozano C, Campos C, Cuende E, Fernández-Lopez JC, Bustabad S, Martín Domenech R, Pérez-Pampín E, Del Pino-Montes J, Millan-Arciniegas AM, Díaz-González F, Gómez-Reino JJ. Objectives and methodology of BIOBADASER phase iii. ACTA ACUST UNITED AC 2017; 15:229-236. [PMID: 28935290 DOI: 10.1016/j.reuma.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Describe the objectives, methods and results of the first year of the new version of the Spanish registry of adverse events involving biological therapies and synthetic drugs with an identifiable target in rheumatic diseases (BIOBADASER III). METHODOLOGY Multicenter prospective registry of patients with rheumatic inflammatory diseases being treated with biological drugs or synthetic drugs with an identifiable target in rheumatology departments in Spain. The main objective of BIOBADASER Phase III is the registry and analysis of adverse events; moreover, a secondary objective was added consisting of assessing the effectiveness by means of the registry of activity indexes. Patients in the registry are evaluated at least once every year and whenever they experience an adverse event or a change in treatment. The collection of data for phase iii began on 17 December 2015. RESULTS During the first year, 35 centers participated. The number of patients included in this new phase in December 2016 was 2,664. The mean age was 53.7 years and the median duration of treatment was 8.1 years. In all, 40.4% of the patients were diagnosed with rheumatoid arthritis. The most frequent adverse events were infections and infestations. CONCLUSIONS BIOBADASER Phase III has been launched to adapt to a changing pharmacological environment, with the introduction of biosimilars and small molecules in the treatment of rheumatic diseases. This new stage is adapted to the changes in the reporting of adverse events and now includes information related to activity scores.
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Affiliation(s)
| | | | - Javier Manero
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | | | - Cristina Campos
- Hospital General Universitario de Valencia, Valencia, España
| | - Eduardo Cuende
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario de Santiago, Santiago, A Coruña, España
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Rodríguez-Díaz L, Ruiz-Frutos C, Vázquez-Lara JM, Ramírez-Rodrigo J, Villaverde-Gutiérrez C, Torres-Luque G. Effectiveness of a physical activity programme based on the Pilates method in pregnancy and labour. Enferm Clin 2017; 27:271-277. [PMID: 28689647 DOI: 10.1016/j.enfcli.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of a physical activity programme based on use of the Pilates method, over eight weeks in pregnant women, on functional parameters, such as weight, blood pressure, strength, flexibility and spinal curvature, and on labour parameters, such as, type of delivery, episiotomy, analgesia and newborn weight. METHOD A randomized clinical trial was carried out on pregnant women, applying a programme of physical activity using the Pilates method, designed specifically for this population. A sample consisting of a total of 105 pregnant women was divided into two groups: intervention group (n=50) (32.87±4.46 years old) and control group (n=55) (31.52±4.95 years old). The intervention group followed a physical activity programme based on the Pilates method, for 2 weekly sessions, whereas the control group did not follow the program. RESULTS Significant improvements (p<0.05) in blood pressure, hand grip strength, hamstring flexibility and spinal curvature, in addition to improvements during labour, decreasing the number of Caesareans and obstructed labour, episiotomies, analgesia and the weight of the newborns were found at the end of the intervention. CONCLUSION A physical activity programme of 8 weeks based on the Pilates method improves functional parameters in pregnant women and benefits delivery.
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Affiliation(s)
| | - Carlos Ruiz-Frutos
- Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, España
| | | | | | | | - Gema Torres-Luque
- Facultad Ciencias de la Salud, Universidad de Granada, Granada, España
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Mena-Vázquez N, Manrique-Arija S, Rojas-Giménez M, Ureña-Garnica I, Jiménez-Núñez FG, Fernández-Nebro A. Analysis of effectiveness, safety and optimization of tocilizumab in a cohort of patients with rheumatoid arthritis in clinical practice. ACTA ACUST UNITED AC 2019; 15:21-6. [PMID: 28676287 DOI: 10.1016/j.reuma.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) in clinical practice, establishing the optimized regimen and switching from intravenous (IV) to subcutaneous (SC) therapy. MATERIAL AND METHODS Retrospective observational study. We included 53 RA patients treated with TCZ. The main outcome was TCZ effectiveness at week 24. Secondary outcome variables included effectiveness at week 52, therapeutic maintenance, physical function and safety. The effectiveness of optimization and the switch from IV to SC was evaluated at 3 and 6 months. The efficacy was measured with the Disease Activity Score. Paired t-tests or Wilcoxon were used to evaluate effectiveness and survival time using Kaplan-Meier. RESULTS The proportion of patients who achieved remission or low disease activity at weeks 24 and 52 was 75.5% and 87.3%, respectively. The mean retention time (95% confidence interval [95% CI] was 81.7 months [76.6-86.7]). Twenty-one of 53 patients (39.6%) optimized the TCZ dose and 35 patients switched from IV TCZ to SC, with no changes in effectiveness. The adverse event rate was 13.6 events/100 patient-years. CONCLUSIONS Tocilizumab appears to be effective and safe in RA in clinical practice. The optimized regimen appears to be effective in most patients in remission, even when they change from IV to SC.
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Burgos-Vargas R, Cardiel M, Xibillé D, Pacheco-Tena C, Pascual-Ramos V, Abud-Mendoza C, Mahgoub E, Rahman M, Fan H, Rojo R, García E, Santana K. Tofacitinib, an oral Janus kinase inhibitor, in patients from Mexico with rheumatoid arthritis: Pooled efficacy and safety analyses from Phase 3 and LTE studies. ACTA ACUST UNITED AC 2017; 15:43-53. [PMID: 28552437 DOI: 10.1016/j.reuma.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/10/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We characterized efficacy and safety of tofacitinib in Mexican patients from RA Phase 3 and long-term extension (LTE) studies. METHODS Data from Mexican patients with RA and an inadequate response to disease-modifying antirheumatic drugs (DMARDs) were taken from four Phase 3 studies (pooled across studies) and one open-label LTE study of tofacitinib. Patients received tofacitinib 5 or 10mg twice daily, adalimumab (one Phase 3 study) or placebo (four Phase 3 studies) as monotherapy or in combination with conventional synthetic DMARDs. Efficacy up to Month 12 (Phase 3) and Month 36 (LTE) was assessed by American College of Rheumatology 20/50/70 response rates, Disease Activity Score (erythrocyte sedimentation rate), and Health Assessment Questionnaire-Disability Index. Safety, including incidence rates (IRs; patients with events/100 patient-years) for adverse events (AEs) of special interest, was assessed throughout the studies. RESULTS 119 and 212 Mexican patients were included in the Phase 3 and LTE analyses, respectively. Tofacitinib-treated patients in Phase 3 had numerically greater improvements in efficacy responses versus placebo at Month 3. Efficacy was sustained in Phase 3 and LTE studies. IRs for AEs of special interest were similar to those with tofacitinib in the global and Latin American RA populations. CONCLUSIONS In Mexican patients from the tofacitinib global RA program, tofacitinib efficacy was demonstrated up to Month 12 in Phase 3 studies and Month 36 in the LTE study, with a safety profile consistent with tofacitinib global population.
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Affiliation(s)
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Mexico
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72
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Calzada-León R. [How safe is the recombinant human growth hormone?]. Rev Med Inst Mex Seguro Soc 2017; 55:341-352. [PMID: 28440988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, several aspects related to the safety of the use of biosynthetic human growth hormone are reviewed. For example, its classification as a biosynthetic drug, the phases that need to be performed in Mexico to verify its safety (obtaining, purification, preclinical studies, clinical trials, and finally observational clinical studies), as well as the evidence that exists in relation to the association of intracranial hypertension, muscular events, scoliosis, slipped capital femoral epiphysis, obstructive sleep apnea, pancreatitis, alterations in cortisol, thyroid hormones alterations, cardiovascular disease, metabolic risk, mortality and cancer, adverse events not related to its use, and finally dosing and safety.
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Affiliation(s)
- Raúl Calzada-León
- Servicio de Endocrinología, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México.
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73
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de Lorenzo-Pinto A, Herranz-Alonso A, Cuéllar-Basterrechea B, Bellón-Cano JM, Sanjurjo-Sáez M, Bueno H. Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome. ACTA ACUST UNITED AC 2017; 70:825-831. [PMID: 28411029 DOI: 10.1016/j.rec.2016.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. METHODS We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. RESULTS A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P=.20). The estimated avoided cost was €95 113.6 per year, meaning that €10.1 would be obtained in return for each euro invested during the first year and €36.3 during the following years. CONCLUSIONS This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Begoña Cuéllar-Basterrechea
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Bellón-Cano
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Metodología y Bioestadística, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Héctor Bueno
- Servicio de Cardiología e Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación Multidisciplinar Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Atehortúa-López LH, Mendoza-Franco R, Escobar-Serna JF, Urrego LA, Alzate F, Jaimes F. Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery. Arch Cardiol Mex 2017; 88:100-106. [PMID: 28292572 DOI: 10.1016/j.acmx.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. OBJECTIVE To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. METHODS The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4mL/kg of HS or NS intravenously for 30min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. RESULTS Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59±14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. CONCLUSIONS Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group.
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Affiliation(s)
| | | | | | | | - Fernando Alzate
- Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Fabian Jaimes
- Universidad de Antioquia, Research Unit Hospital Pablo Tobón Uribe, Medellín, Colombia.
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Abstract
The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit.
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Affiliation(s)
| | - Luís López-Rodríguez
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, España; Hospital Virgen del Rocío, Sevilla, España
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76
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Díliz-Nava H, Meléndez-Sagaón I, Tamaríz-Cruz O, García-Benítez L, Araujo-Martínez A, Palacios-Macedo A. [Safety of repeat median sternotomy in the palliative treatment of patients with a univentricular heart]. Arch Cardiol Mex 2017; 87:302-306. [PMID: 28094119 DOI: 10.1016/j.acmx.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To establish the morbidity and mortality of patients with univentricular hearts who underwent a repeat median sternotomy at the Instituto Nacional de Pediatría. METHOD A retrospective review was performed on the clinical charts of all patients who underwent a repeat median sternotomy from 2001 to 2016. RESULTS Sixty-five patients underwent 76 surgeries by repeat median sternotomy. Fifty-nine patients had a first repeat median sternotomy, with a mean age of 36 months (range: 4-176 months) and a mean weight of 12.2 kg (range: 3.2-21.5 kg). Forty patients had a Glenn procedure, and 19 patients had a Fontan procedure. There were 17 patients with a second repeat median sternotomy, with a mean age of 89 months (range 48-156 months), and a mean weight of 22.7 kg (14.4-41 kg). A Fontan procedure was performed on all these 17 patients. A section of the right coronary artery with electrocardiographic changes and a right atrium tear that caused hypotension occurred during first repeat sternotomy. An aortic tear occurred during a second repeat sternotomy with massive bleeding and subsequent death. This represents 3.9% of re-entry injuries. CONCLUSION It is concluded that repeat median sternotomy is a safe procedure.
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Affiliation(s)
- Héctor Díliz-Nava
- Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Isis Meléndez-Sagaón
- Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Orlando Tamaríz-Cruz
- Anestesiología Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Luis García-Benítez
- Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Aric Araujo-Martínez
- Terapia Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México
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López-Aguilar C, Abundes-Velasco A, Eid-Lidt G, Piña-Reyna Y, Gaspar-Hernández J. [Percutaneous coronary intervention of unprotected left main coronary compared with coronary artery bypass grafting; 3 years of experience in the National Institute of Cardiology, Mexico]. Arch Cardiol Mex 2016; 88:83-92. [PMID: 27554363 DOI: 10.1016/j.acmx.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The best revascularisation method of the unprotected left main artery is a current and evolving topic. METHODS A total of 2439 percutaneous coronary interventions (PCI) were registered during a 3-year period. The study included all the patients with PCI of the unprotected left main coronary (n=48) and matched with patients who underwent coronary artery bypass graft (CABG) (n=50). Major adverse cerebral and cardiac events (MACCE) were assessed within the hospital and in outpatients during a 16 month follow up. RESULTS The cardiovascular risk was greater in the PCI group; logEuroSCORE 16±21 vs. 5±6, P=.001; clinical Syntax 77±74 vs 53±39, P=.04. On admission, the PCI group of patients had a higher frequency of ST segment elevation myocardial infarction (STEMI) and cardiogenic shock. The MACCE were similar in both groups (14% vs. 18%, P=.64). STEMI was less frequent in the PCI group (0% vs. 10%, P=.03). Cardiovascular events were lower in the PCI group (2.3% vs. 18%, P=.01), and there was a decrease in general and cardiac mortality (2.3% vs. 12%, P=.08 y 2.3% vs. 8%, P=.24), on excluding the patients with cardiogenic shock as a presentation. MACCE were similar in both groups in the out-patient phase (15% vs. 12%, P=.46). Survival without MACCE, general and cardiac death were comparable between groups (log rank, P=.38, P=.44 and P=.16, respectively). CONCLUSION Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG.
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Affiliation(s)
- Carlos López-Aguilar
- Servicio de Angiografía, Hospital Eugenio Espejo, Av. Gran Colombia SN y Yaguachi, Quito, Ecuador.
| | - Arturo Abundes-Velasco
- Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Dr. Ignacio Chávez, Juan Badiano N1, Sección XVI, del Tlalpan, C.P. 14080, Ciudad de México, México
| | - Guering Eid-Lidt
- Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Dr. Ignacio Chávez, Juan Badiano N1, Sección XVI, del Tlalpan, C.P. 14080, Ciudad de México, México
| | - Yigal Piña-Reyna
- Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Dr. Ignacio Chávez, Juan Badiano N1, Sección XVI, del Tlalpan, C.P. 14080, Ciudad de México, México
| | - Jorge Gaspar-Hernández
- Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Dr. Ignacio Chávez, Juan Badiano N1, Sección XVI, del Tlalpan, C.P. 14080, Ciudad de México, México
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Alió JL, Plaza-Puche AB, Cavas F, Yébana Rubio P, Sala E. An angle-supported foldable phakic intraocular lens for correction of myopia: A five-year follow-up. ACTA ACUST UNITED AC 2016; 92:4-11. [PMID: 27453580 DOI: 10.1016/j.oftal.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of an angle-supported foldable phakic intraocular lens (pIOL) for the correction of moderate to high myopia after 5 years follow-up. METHODS Prospective and retrospective, observational, longitudinal, non-randomised consecutive series of cases conducted on a total of 100 eyes of 67 patients with moderate to high myopia implanted with an Acrysof Cachet pIOL (Alcon Laboratories Inc.) with the aim of minimising the refractive error. The ages ranged between 18 to 60years. Uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), endothelial cells density, pIOL position, intraocular pressure, and complications were recorded preoperatively and during the 5 year follow-up. RESULTS Five years after implantation, the mean manifest spherical equivalent refraction reduced significantly from -11.62±3.35 dioptres (D) to -0.33±0.85D. UDVA was 20/20 or better in 5 of 25 cases (20%), and 20/40 or better in 22 cases (88%). CDVA was 20/20 or better in 17 cases (68%), and 20/32 or better in 23 cases (92%) of eyes. The residual refractive error was within ±0.50D of emmetropia in 12 cases (48%), and within ±1.00D in 19 cases (76%). Mean endothelial cell loss at 5 years was 11.8% central, and 13.7% peripheral. Mean endothelium-pIOL distance was 2.11±0.18mm, and mean pIOL-crystalline distance was 0.88±0.20mm. CONCLUSIONS This angle supported pIOL provided a favourable refractive correction and predictability, as well as acceptable safety in patients with moderate to high myopia. Although endothelial cell density decreased over 5years, the results are within the range reported in previous studies with other pIOLs.
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Affiliation(s)
- J L Alió
- Vissum Alicante, Departamento de Investigación, Desarrollo e Innovación, Alicante, España; División de Oftalmología, Departamento de Patología y Cirugía, Universidad Miguel Hernández, Alicante, España.
| | - A B Plaza-Puche
- Vissum Alicante, Departamento de Investigación, Desarrollo e Innovación, Alicante, España
| | - F Cavas
- Departamento de Expresión Gráfica, Universidad Politécnica de Cartagena, Cartagena, Murcia, España
| | - P Yébana Rubio
- Vissum Alicante, Departamento de Investigación, Desarrollo e Innovación, Alicante, España
| | - E Sala
- Vissum Alicante, Departamento de Investigación, Desarrollo e Innovación, Alicante, España
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Bianchi G, Martorana E, Ghaith A, Pirola GM, Rani M, Bove P, Porpiglia F, Manferrari F, Micali S. Laparoscopic access overview: Is there a safest entry method? Actas Urol Esp 2016; 40:386-92. [PMID: 26922517 DOI: 10.1016/j.acuro.2015.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. METHODS Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. RESULTS The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. CONCLUSION Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest.
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80
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Salgado-Garcia C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez-de-Mora E, Aroui T, Lopez-Aguilar R, Rivera-de-Los-Santos F, Ruiz-Frutos C. Safety of regadenoson in patients with severe chronic obstructive pulmonary disease. Rev Esp Med Nucl Imagen Mol 2016; 35:283-6. [PMID: 27160774 DOI: 10.1016/j.remn.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise in subjects with severe chronic obstructive pulmonary disease (COPD), referred for myocardial perfusion imaging (MPI). METHODS We studied prospectively 12 male patients with severe COPD. Stress was 4min of low-level exercise with bolus injection of regadenoson (0.4mg) at 1.5min, followed by (99m)Tc-MPI agent injection. Demographics, medical history, lung medications, adverse events, oxygen saturation (SatO2), MPI findings for coronary artery disease (CAD), and changes in systolic blood pressure (SBP), and heart rate (HR) were registered. RESULTS The observed adverse event profile of regadenoson was similar to that of patients with mild-moderate COPD. There was no clinical exacerbation of COPD. Adverse events were self-limiting: dyspnea (33.3%), fatigue (25.0%), chest pain, headache (16.7%, respectively), and gastrointestinal discomfort, dry mouth, flushing, feeling hot and dizziness (8.3%, respectively). 25.0% of patients did not report any symptoms. We observed significant increases in SBP and HR from baseline (142.6mmHg±22.3 vs 152.5mmHg±18.5, and 80 b.p.m.±18 vs 105 b.p.m.±22, respectively; p<0.05). CONCLUSIONS Regadenoson combined with low-level exercise is safe and well tolerated in stable patients with severe COPD undergoing MPI.
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Affiliation(s)
- C Salgado-Garcia
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain.
| | - A Jimenez-Heffernan
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - C Ramos-Font
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - J Lopez-Martin
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - E Sanchez-de-Mora
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - T Aroui
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - R Lopez-Aguilar
- Servicio de Cardiología, Hospital Juan Ramón Jiménez, Complejo Hospitalario Universitario de Huelva, Ronda Norte, s/n, 21005 Huelva, Spain
| | - F Rivera-de-Los-Santos
- Área de Metodología y Ciencias del Comportamiento, Universidad de Sevilla, 41018 Sevilla, Spain
| | - C Ruiz-Frutos
- Departamento de Biología Ambiental y Salud Pública, Universidad de Huelva, Huelva, Spain
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Inserting epidural patient controlled analgesia into a peripheral venous line. ACTA ACUST UNITED AC 2016; 63:e23-8. [PMID: 27062173 DOI: 10.1016/j.redar.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results.
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Manrique-Rodríguez S, Sánchez-Galindo AC, Fernández-Llamazares CM, Calvo-Calvo MM, Carrillo-Álvarez Á, Sanjurjo-Sáez M. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps. Med Intensiva 2016; 40:411-21. [PMID: 27026063 DOI: 10.1016/j.medin.2016.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. DESIGN Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. SETTING A tertiary level hospital pediatric intensive care unit. PARTICIPANTS Infusions delivered with infusion pumps in all pediatric intensive care unit patients. INTERVENTIONS Design of a drug library with safety limits for all intravenous drugs prescribed. MAIN VARIABLES Users' compliance with drug library as well as number and type of errors prevented were analyzed. RESULTS Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. CONCLUSIONS Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process.
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Affiliation(s)
- S Manrique-Rodríguez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A C Sánchez-Galindo
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - M M Calvo-Calvo
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Á Carrillo-Álvarez
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
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Ruiz-Juretschke F, Vargas AJ, Gonzalez-Quarante LH, Gil de Sagredo OL, Montalvo A, Fernandez-Carballal C. Microsurgical treatment of trigeminal neuralgia in patients older than 70 years: An efficacy and safety study. Neurologia 2016; 32:424-430. [PMID: 26968821 DOI: 10.1016/j.nrl.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The increasing incidence of trigeminal neuralgia (TN) with age together with population ageing call for reexamination of surgical treatment options for refractory TN in elderly patients. METHODS Retrospective review of a consecutive series of patients older than 70 who underwent microvascular decompression (MVD) for refractory TN between 1997 and 2015. Outcomes based on the Barrow Neurological Institute pain intensity score (BNI score) and surgical complications were compared to those of patients younger than 70 undergoing MVD in the same period. RESULTS Forty patients older than 70 (mean = 74.8 years) underwent interventions. At a mean follow-up time of 34 months, 73% of the patients presented complete absence of pain without medication (BNI I) and 85% had good pain control with or without medication (BNI I-III). A comparison of these patients with the 85 patients younger than 70 treated surgically during the same period did not find a significant association between age and achievement of pain control (BNI I-II). However, there was a significant association between age older than 70 and complete pain relief (BNI I; P=.03). The mean hospital stay in patients over 70 was also significantly longer (P=.04), although the postsurgical complication rate was similar to that in younger patients. CONCLUSIONS Elderly patients with refractory TN may benefit from treatment with MVD and the probability of success and surgical risk are comparable to those in younger patients.
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Affiliation(s)
- F Ruiz-Juretschke
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A J Vargas
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L H Gonzalez-Quarante
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - O L Gil de Sagredo
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Montalvo
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Fernandez-Carballal
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
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Brogly N, Alsina E, de Celis I, Huercio I, Dominguez A, Gilsanz F. Perioperative temperature control: Survey on current practices. ACTA ACUST UNITED AC 2015; 63:207-11. [PMID: 26385450 DOI: 10.1016/j.redar.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/28/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. MATERIAL AND METHODS A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. RESULTS A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. DISCUSSION AND CONCLUSION Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future.
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Affiliation(s)
- N Brogly
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Alsina
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - I de Celis
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - I Huercio
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - A Dominguez
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
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85
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Muñoz Gómez M, Bisbe Vives E, Basora Macaya M, García Erce JA, Gómez Luque A, Leal-Noval SR, Colomina MJ, Comin Colet J, Contreras Barbeta E, Cuenca Espiérrez J, Garcia de Lorenzo Y Mateos A, Gomollón García F, Izuel Ramí M, Moral García MV, Montoro Ronsano JB, Páramo Fernández JA, Pereira Saavedra A, Quintana Diaz M, Remacha Sevilla Á, Salinas Argente R, Sánchez Pérez C, Tirado Anglés G, Torrabadella de Reinoso P. Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient. Med Intensiva 2015; 39:552-62. [PMID: 26183121 DOI: 10.1016/j.medin.2015.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/28/2023]
Abstract
In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.
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Affiliation(s)
- M Muñoz Gómez
- Medicina Transfusional Perioperatoria, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Mar, Barcelona, España
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | | | - A Gómez Luque
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - S R Leal-Noval
- Servicio de Cuidados Críticos y Urgencias, Hospital Virgen del Rocío, Sevilla, España
| | - M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - J Comin Colet
- Servicio de Cardiología, Hospital Universitario del Mar, Barcelona, España
| | - E Contreras Barbeta
- Banc de Sang i Teixits, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - J Cuenca Espiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - F Gomollón García
- Servicio de Gastroenterología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Izuel Ramí
- Servicio de Farmacia, Hospital Miguel Servet, Zaragoza, España
| | - M V Moral García
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J B Montoro Ronsano
- Servicio de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - A Pereira Saavedra
- Servicio de Hemoterapia y Hemostasia, Hospital Clínic de Barcelona, Barcelona, España
| | - M Quintana Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - Á Remacha Sevilla
- Servicio de Laboratorio de Hematología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - R Salinas Argente
- Territorial Banc de Sang i Teixits Catalunya Central, Barcelona, España
| | - C Sánchez Pérez
- Servicio de Anestesiología y Reanimación, Hospital General Universitario de Elda, Elda, Alicante, España
| | - G Tirado Anglés
- Unidad de Cuidados Intensivos, Hospital Royo Villanova, Zaragoza, España
| | - P Torrabadella de Reinoso
- Unidad de Cuidados Intensivos, Hospital Universitario Germans Trías i Pujol, Badalona, Barcelona, España
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Paredes-Atenciano JA, Roldán-Aviña JP, González-García M, Blanco-Sánchez MC, Pinto-Melero MA, Pérez-Ramírez C, Calvo Rubio-Burgos M, Osuna-Navarro FJ, Jurado-Carmona AM. [Failure mode and effects analysis on computerized drug prescriptions]. Rev Calid Asist 2015; 30:182-94. [PMID: 26051536 DOI: 10.1016/j.cali.2014.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. RESULTS Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. CONCLUSIONS Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription.
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Affiliation(s)
- J A Paredes-Atenciano
- Departamento de Hospitalización, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España.
| | - J P Roldán-Aviña
- F. E. en Cirugía General, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - Mercedes González-García
- F.E. de Farmacia Hospitalaria, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - M C Blanco-Sánchez
- Departamento de Hospitalización, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - M A Pinto-Melero
- Departamento de Enfermería Bloque Quirúrgico, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - C Pérez-Ramírez
- Servicio de Anestesiología, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - Miguel Calvo Rubio-Burgos
- F. E. en Ginecología, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
| | - F J Osuna-Navarro
- Departamento de Urgencias, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir) , Écija, Sevilla, España
| | - A M Jurado-Carmona
- F.E. de Urgencias, Hospital de Alta Resolución de Écija (Agencia Sanitaria Bajo Guadalquivir), Écija, Sevilla, España
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Luzuriaga Tomás C, Oyarzabal Irigoyen M, Caveda Cepas E, Vázquez Salvi LA, García-Pérez LE. [Safety and efficacy of growth hormone treatment: GeNeSIS study in Spain]. An Pediatr (Barc) 2015; 84:139-47. [PMID: 26139238 DOI: 10.1016/j.anpedi.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/21/2015] [Accepted: 05/04/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Country-specific information on pediatric GH therapy is available from multi-national studies. METHODS A total of 1294 children in Spain enrolled in the observational Genetics and Neuroendocrinology of Short-stature International Study (GeNeSIS). Adverse events were assessed in all GH-treated patients (n=1267) and effectiveness in those with GH deficiency (GHD, 78%). RESULTS Mean age at time of entry to the study was 9.8 years. GH was initiated at a median (Q1-Q3) 0.22 (0.20-0.25) mg/kg/week and administered for 2.8 (1.6-4.4) years. For 262 patients with GHD and 4-year data, mean (95% CI) height velocity was 4.3 (4.1 - 4.6) cm/year at baseline, 9.0 (8.7 to 9.4) cm/year at 1-year, and 5.5 (5.2 to 5.8) cm/year at 4-years. Height standard deviation score (SDS) was -2.48 (-2.58 to -2.38) at baseline and -1.18 (-1.28 to -1.08) at 4 years. Final height SDS minus target height SDS (n=241) was -0.09 (-0.20 to 0.02). In 1143 GH-treated patients with ≥1 year follow-up, 93 (8.1%) reported treatment-emergent adverse events. Serious events were reported for 7 children, with 2 considered GH-related. CONCLUSION These data confirm the benefit of GH replacement therapy on height gain for the patients in Spain. The safety profile was consistent with that already known for GH therapy.
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Affiliation(s)
- C Luzuriaga Tomás
- Unidad de Endocrinología Pediátrica, Hospital Marqués de Valdecilla, Santander, Cantabria, España
| | - M Oyarzabal Irigoyen
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - E Caveda Cepas
- Global Scientific Communications, Eli Lilly and Company, Alcobendas Madrid, España
| | - L A Vázquez Salvi
- Departamento Médico, Eli Lilly and Company, Alcobendas Madrid, España
| | - L E García-Pérez
- Global Medical Affairs, Eli Lilly and Company, Indianapolis, USA.
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Gómez-Moyano E, Hiraldo Gamero A, Vera Casaño Á, Crespo Erchiga V, González Enseñat MA, Vicente Villa MA, Zsolt Fradera I, Moreno Giménez JC. [Phase III study of the efficacy and safety of ciclopirox olamine cream in small children with dermatomycosis]. Rev Iberoam Micol 2015; 32:164-9. [PMID: 25728876 DOI: 10.1016/j.riam.2014.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/13/2014] [Accepted: 04/07/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is scarce information on the use of ciclopirox olamine in children. AIMS The aim of this study was to evaluate the efficacy and safety of ciclopirox olamine cream 1% for the treatment of dermatomycosis in pediatric patients. METHODS A multicenter, non-randomized, open-label, phase iii study was conducted on patients aged 3 months to 9 years diagnosed with dermatomycosis confirmed by direct microscopy and culture, and treated with ciclopirox olamine cream 1% for 28 days. Clinical and microbiological evaluations were performed before starting the treatment therapy, at 7, 14 and 28 days after starting the treatment, and 28 days after its completion. RESULTS Twenty-one patients with a median age of 2.7 years (range 3 months-9 years) were included. The most frequent mycosis location was the inguinal region (72%). The most frequently isolated etiological agent was Candida spp. (71%). No adverse events were reported in 62% of the patients. Among the mild and moderate reported adverse events, only one, irritative dermatitis, was considered as possibly related to the treatment. Safety evaluation was excellent in 95% of the patients, and good in 5%. After the first week of treatment, 12 patients out of 13 (92%) showed a clinical improvement, and 5 out of 7 (71%) had both clinical and mycological improvements. At the end of the treatment, clinical cure was observed in 7 out of 9 patients (78%). No relapses occurred. CONCLUSIONS Ciclopirox olamine cream 1% is a safe and feasible treatment for superficial cutaneous mycotic infections, especially Candida spp. infection, in children aged between 3 months and 10 years.
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Garcia-Segui A, Verges A, Galán-Llopis JA, Garcia-Tello A, Ramón de Fata F, Angulo JC. "Knotless" laparoscopic extraperitoneal adenomectomy. Actas Urol Esp 2015; 39:128-36. [PMID: 25034540 DOI: 10.1016/j.acuro.2014.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. METHODS A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. RESULTS The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. CONCLUSIONS "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique.
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Affiliation(s)
- A Garcia-Segui
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
| | - A Verges
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - J A Galán-Llopis
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Garcia-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - F Ramón de Fata
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
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Turnes J, Díaz R, Hernandez-Guerra M, Gómez M, Castells L, Bustamante J, Espinosa MD, Fernández-Castroagudín J, Serrano T, Rendón P, Andrade R, Salgado M, Arenas J, Vergara M, Sala M, Polo BA, Granizo IM, Gonzálvez ML, Viudez A. [Therapeutic decisions in the treatment of hepatocellular carcinoma and patterns of sorafenib use. Results of the international observational GIDEON trial in Spain]. Gastroenterol Hepatol 2015; 38:263-73. [PMID: 25583146 DOI: 10.1016/j.gastrohep.2014.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION GIDEON is a non-interventional, prospective, international study that evaluated the safety of sorafenib in patients with unresectable hepatocellular carcinoma (HCC) in daily clinical practice, including Child-Pugh B patients. OBJECTIVES To analyze data collected in Spain on the safety and efficacy of sorafenib and treatment patterns. METHODS Data were collected during follow-up on demographic and disease characteristics, the initial dose used, treatment-emergent adverse events (AEs) and dose modifications. Overall survival was evaluated, as well as time to disease progression. Efficacy and safety were analyzed according to the Child-Pugh classification and the initial dose. RESULTS We included 143 patients from 19 Spanish hospitals. A total of 24.5% of the patients were Child-Pugh B. An initial dose of 400 mg/12 h was used in 90.9% of patients. In Child-Pugh A patients, dose modifications occurred more frequently and the treatment duration was longer. The incidence of AEs and drug-related AEs were similar in Child-Pugh A and B patients, although serious AEs were more frequent in Child-Pugh B patients. The most common AEs were diarrhea, fatigue and hand-foot skin reactions. The median overall survival was 384 days and was higher in Child-Pugh A patients (593 vs. 211 days in Child-Pugh B). The median time to disease progression was 177 days, similar in both subgroups. CONCLUSION The safety profile of sorafenib in Spanish patients with unresectable HCC is independent of liver function. Child-Pugh status does not seem to influence the approach to sorafenib dosage or time to progression but does seem to be a strong prognostic factor for survival.
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Datino T, Miracle Blanco Á, Núñez García A, González-Torrecilla E, Atienza Fernández F, Arenal Maíz Á, Hernández-Hernández J, Ávila Alonso P, Eidelman G, Fernández-Avilés F. Safety of Outpatient Implantation of the Implantable Cardioverter-defibrillator. ACTA ACUST UNITED AC 2014; 68:579-84. [PMID: 25435093 DOI: 10.1016/j.rec.2014.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/03/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators. METHODS A retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of intervention-related complications was compared between 232 patients (58%) whose implantation was performed in the outpatient setting and 169 patients (42%) whose intervention was performed in the inpatient setting. RESULTS The mean age (standard deviation) of the patients was 62 (14) years; 336 (84%) were male. Outpatients had lower left ventricular ejection fraction and a higher percentage had an indication for primary prevention of sudden death, compared to inpatients. Only 21 outpatients (9%) required subsequent hospitalization. The rate of complications until the third month postimplantation was similar for outpatients (6.0%) and inpatients (5.3%); P = .763. In multivariate analysis, only previous anticoagulant therapy was related to the presence of complications (odds ratio = 3.2; 95% confidence interval, 1.4-7.4; P < .01), mainly due to an increased rate of pocket hematomas. Each outpatient implantation saved approximately €735. CONCLUSIONS Outpatient implantation of implantable cardioverter-defibrillators is safe and reduces costs. Close observation is recommended for patients receiving chronic anticoagulation therapy due to an increased risk of complications.
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Affiliation(s)
- Tomás Datino
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ángel Miracle Blanco
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Núñez García
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esteban González-Torrecilla
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza Fernández
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Arenal Maíz
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Hernández-Hernández
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Ávila Alonso
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gabriel Eidelman
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Guerrero-Ramos F, Villacampa-Aubá F, Jiménez-Alcaide E, García-González L, Ospina-Galeano I, de la Rosa-Kehrmann F, Rodríguez-Antolín A, Passas-Martínez J, Díaz-González R. Renal biopsy with 16G needle: a safety study. Actas Urol Esp 2014; 38:584-8. [PMID: 24533921 DOI: 10.1016/j.acuro.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/01/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVE The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. MATERIAL AND METHODS A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. RESULTS Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P=.09) previous anticoagulation (P=.099) or previous antiaggregation (P=.603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. CONCLUSIONS Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance.
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93
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Salazar de la Guerra R, Ferrer Arnedo C, Labrador Domínguez MJ, Sangregorio Matesanz A. [Nursing service certification. Norm UNE-EN-ISO 9001-2008]. Rev Calid Asist 2014; 29:350-354. [PMID: 25533239 DOI: 10.1016/j.cali.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. MATERIAL AND METHOD The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. RESULTS The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean=35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. CONCLUSION The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements.
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94
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Velasco Sanz TR, Ronda Delgado de la Fuente M, Sánchez de la Ventana AB, Reyes Merino Martínez M. [Cuff pressure control at the intersinve care unit: influence of nursing professionals' training]. Enferm Intensiva 2014; 26:40-5. [PMID: 25441721 DOI: 10.1016/j.enfi.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 05/19/2014] [Accepted: 06/10/2014] [Indexed: 10/24/2022]
Abstract
OBJETIVE To analyze proper control of endotracheal cuff pressure in an intensive care unit. The specific objective is to verify whether training of nursing professionals improves monitoring endotracheal cuff pressure. BASIC PROCEDURES the study type is descriptive, observational and retrospective. All patients were admitted to the Critical Unit II of the Clínico San Carlos Hospital between May 2010-November 2011, requiring either a tracheal tube or tracheal cannula. Studied variables were: number of in range measures, number of intubated patients, or with tracheal cannula and register. Four cuts were made on all admitted patients admitted during the study period in order to measure endotracheal cuff pressure. Two cuts were performed before the professional nurses training and the other two cuts after a specific training with respect to endotracheal cuff pressure and Zero pneumonia. RESULTS There were 74 measurements. The first cut obtained 40.74% of measures in range. In the second cut 61.90% of measures were identified in range. In the third cut, it was found that 85.7% of measures were in range and in the fourth court, it was noted the 89.47% of measures were in range. CONCLUSIONS Monitoring of the endotracheal cuff pressure was inadequate before specific training of professionals. Nursing professionals training facilitates the correct measurement of the endotracheal cuff pressure, which improves patient safety.
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Affiliation(s)
- T R Velasco Sanz
- Departamento de Medicina Intensiva, Hospital Clínico San Carlos, Madrid, España.
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95
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Abstract
Dapagliflozin is the first novel sodium-glucose co-transporter-2 (SGLT2) inhibitor approved by the European Medicines Agency (EMA) for the treatment of type 2 diabetes. By inhibiting SGLT2, dapagliflozin blocks reabsorption of filtered glucose in the kidney, increasing urinary glucose excretion and reducing blood glucose levels. Its mechanism of action is independent of pancreatic β cell function and modulation of insulin sensitivity. The results of phase III clinical trials showed that dapagliflozin, at a dose of 5 or 10mg/day for 24 weeks as monotherapy in previously untreated patients, or as add-on combination therapy with metformin, glimepiride, pioglitazone or insulin-based therapy, significantly reduced both HbA1c and fasting plasma glucose levels compared with placebo. In addition, dapagliflozin was noninferior to glipizide, in terms of glycemic control after 52 weeks, when used as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin. In most clinical trials, dapagliflozin reduced body weight. The combination of both effects (improved glycemic control and weight loss) is achieved to a greater extent in treatments that include dapaglifozin. Longer-term extension studies indicated that the efficacy of dapagliflozin on the glycemic control and weight reducción is maintained for up to 2 and 4 years. Dapagliflozin was well tolerated. Genital infections and urinary tract infections were more frequent in patients who received dapagliflozin than in placebo recipients. Hypoglycemic episodes were scarce with dapagliflozin. In conclusion, dapagliflozin is a novel option for the management of type 2 diabetes, particularly when used as add-on therapy.
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Affiliation(s)
- Olga González Albarrán
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Javier Ampudia-Blasco
- Unidad de Referencia de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España.
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96
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Jimenez Ruiz CA, Solano Reina S, de Granda Orive JI, Signes-Costa Minaya J, de Higes Martinez E, Riesco Miranda JA, Altet Gómez N, Lorza Blasco JJ, Barrueco Ferrero M, de Lucas Ramos P. The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes. Arch Bronconeumol 2014; 50:362-7. [PMID: 24684764 DOI: 10.1016/j.arbres.2014.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 11/28/2022]
Abstract
The electronic cigarette (EC) is a device formed by three basic elements: battery, atomizer and cartridge. When assembled, it looks like a cigarette. The cartridge contains different substances: propylene glycol, glycerine and, sometimes, nicotine. When the user "vapes", the battery is activated, the atomizer is heated and the liquid is drawn in and vaporized. The smoker inhales the mist produced. Various substances have been detected in this mist: formaldehyde, acetaldehyde and acrolein and some heavy metals. Although these are found in lower concentrations than in cigarettes, they may still be harmful for the human body. Several surveys show that 3-10% of smokers regularly use e-cigarettes. A randomized study has shown that the efficacy of e-cigarettes for helping smokers to quit is similar to nicotine patches. Nevertheless, the study has relevant methodological limitations and reliable conclusions cannot be deduced. This report sets down the Position Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and safety of e-cigarettes. This statement declares that e-cigarettes should be regulated as medicinal products.
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Affiliation(s)
- Carlos A Jimenez Ruiz
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España.
| | - Segismundo Solano Reina
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Jose Ignacio de Granda Orive
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Jaime Signes-Costa Minaya
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Eva de Higes Martinez
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Juan Antonio Riesco Miranda
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Neus Altet Gómez
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Jose Javier Lorza Blasco
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Miguel Barrueco Ferrero
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Pilar de Lucas Ramos
- Grupo de trabajo del Programa Integrado de Investigación en Tabaquismo y del Área de Tabaquismo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
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Sirgo Rodríguez G, Olona Cabases M, Martin Delgado MC, Esteban Reboll F, Pobo Peris A, Bodí Saera M. Audits in real time for safety in critical care: definition and pilot study. Med Intensiva 2014; 38:473-82. [PMID: 24508337 DOI: 10.1016/j.medin.2013.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/14/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED Adverse events significantly impact upon mortality rates and healthcare costs. PURPOSE To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. METHODS A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. RESULTS The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. CONCLUSIONS Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors.
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Affiliation(s)
- G Sirgo Rodríguez
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain.
| | - M Olona Cabases
- Preventive Medicine Department, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - M C Martin Delgado
- Intensive Care Unit, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain
| | - F Esteban Reboll
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - A Pobo Peris
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - M Bodí Saera
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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98
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García-Sánchez MJ, Fernández-Guerrero C, López-Toribio P, Bueno-Cavanillas A, Prieto-Cuéllar M, Guzmán-Malpica EM, Cuevas-Valenzuela P, Moreno-Abril E, Lara-Ramos P. [Quality of the anesthesiologist written record during the transfer of postoperative patients: Influence of implementing a structured communication tool]. ACTA ACUST UNITED AC 2013; 61:6-14. [PMID: 24290786 DOI: 10.1016/j.redar.2013.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/31/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The lack of communication is a major cause of health care errors, especially during patient transfer between practitioners and/or healthcare units, when standardization of communication is a recommended practice. In our study we wanted to assess whether the application of the structured communication SBAR tool could influence the quality of the information written on the progress sheet by the anesthesiologist involved in the transfer of the patient after surgery. MATERIAL AND METHODS This is an observational, retrospective, randomized, quality review of the written record made by the anesthesiologist during the transfer of patients from the surgical area to the postoperative recovery unit, by applying a validated list. We evaluated three observation periods: a control period of two months in 2011 (preSBAR) and a second period of two months in 2012 (postSBAR); in the latter two groups of patients were transferred (postSBAR +) or without SBAR (postSBAR-). RESULTS The strength of agreement between raters obtained an intraclass correlation coefficient of 0.8459 (p <0.001). There were significant differences in the study group, with highest average score in the group with SBAR (postSBAR + group: mean ± SD 7.56 ± 1.20 versus postSBAR-group: 5.41 ± 2.98, p <0.001) and depending on the anesthesiologist responsible for the intervention participated in the study (mean ± SD: 7.00 ± 1.99, compared to 4.81 ± 3.24 in the non-participants, p <0.001). CONCLUSIONS There was an improvement in the quality of written records made in 2012 during the implementation of the SBAR, without the actual application of this instrument appearing to influence it. The anesthesiologists that were involved in new forms of patient safety were also those who made written records of highest quality.
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Affiliation(s)
- M J García-Sánchez
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España.
| | - C Fernández-Guerrero
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P López-Toribio
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - A Bueno-Cavanillas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España
| | - M Prieto-Cuéllar
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - E M Guzmán-Malpica
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P Cuevas-Valenzuela
- Servicio Anestesiología, Reanimación y Terapia del Dolor, AGS Sur de Granada, Granada, España
| | - E Moreno-Abril
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P Lara-Ramos
- Unidad de Reanimación, Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
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López Cortés LF, Martínez E, von Wichmann MÁ. [Safety profile of rilpivirine: general and neuropsychiatric tolerability, safety in patients with hepatitis B or C viruses, and lipid profile]. Enferm Infecc Microbiol Clin 2013; 31 Suppl 2:6-11. [PMID: 24252528 DOI: 10.1016/s0213-005x(13)70137-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently available data on the safety and tolerability of rilpivirine come from the product information document, a phase IIb, dose-finding clinical trial (TMC278-C204), the phase III ECHO and THRIVE clinical trials, and the preliminary data from the STaR and SPIRIT clinical trials, with a total of 1,728 patients. The comparator has usually been efavirenz. All studies have found a lower incidence and severity of neuropsychiatric adverse effects, a better lipid profile, and a lower number of patients with subclinical transaminase elevation in patients treated with rilpivirine. However, because of the relatively low number of patients coinfected with hepatitis B or C virus, definitive conclusions cannot be drawn. Similarly, experience in patients with mild or moderate liver failure is limited and there are no safety data in patients with advanced liver failure.
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Affiliation(s)
- Luis F López Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
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100
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Angulo JC, Khullar V, Nitti VW, Siddiqui E. Evidence available on the use of the selective β3-adrenoceptor agonist mirabegron for the treatment of overactive bladder. Actas Urol Esp 2013; 37:640-51. [PMID: 23850394 DOI: 10.1016/j.acuro.2013.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Mirabegron, the selective β3-adrenoceptor agonist, heralds the latest development for the treatment of overactive bladder (OAB). OBJECTIVE To present the evidence available on the efficacy and tolerability of mirabegron and to discuss this treatment's potential in our setting. EVIDENCE ACQUISITION We reviewed 11 studies conducted with mirabegron in patients with OAB (2 phase II, 9 phase III), all studies were compared to placebo with 6 studies also including tolterodine as an additional arm. Greater emphasis shall be given to the main phase III trials performed in Europe, the USA and Australia evaluating efficacy and safety after 12 weeks (NCT00662909, NCT00689104, NCT00912964) and safety after 12 months (NCT00688688). The combined analyses of these 12 week studies is also available, with emphasis on global efficacy (FAS), efficacy with regard to incontinence (FAS i) and safety (SAF). More than 50% of patients had previously discontinued anticholinergics medication for OAB, thus allowing us to obtain data on the effectiveness of mirabegron in patients already treated with anticholinergics. EVIDENCE SYNTHESIS Mirabegron is an efficacious drug which presents a statistically significant reduction in the number of incontinence episodes and in urinary frequency as of 4 weeks, with a higher percentage of dry patients and a higher percentage of patients with reduction ≥50% in the number of incontinence episodes than placebo. The efficacy of mirabegron 50 and 100mg in the reduction of incontinence episodes occurs in de novo patients and who have received antimuscarinics, with adjusted mean difference and improvement in urinary frequency greater in treated patients. Its tolerability is very similar to placebo particularly for the adverse effects of the antimuscarinics (dry mouth, constipation and blurred vision). A minimal, non-clinically significant change is observed in systolic and diastolic blood pressure and pulse. Its efficacy is long-term. Mirabegron at the doses of 50 and 100mg presents an improvement versus placebo in patient satisfaction, health-related quality of life (HRQoL), symptom bother and patient's perception of bladder condition (PPBC). In the 12 week Phase III European study tolterodine delivered a lesser degree of improvement than mirabegron versus placebo in patient satisfaction, HRQoL, symptom bother and PPBC. CONCLUSIONS Mirabegron is the first of a new class of compounds with a novel mechanism of action that is different to the antimuscarinics. It presents significant and clinically important efficacy in the treatment of the symptoms of OAB. It has advantages with regard to the results described by the patient in treatment satisfaction. Studies on its combined use with anticholinergics are ongoing.
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Affiliation(s)
- J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
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