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Polaino Moreno V, Caballero-Bermejo AF, Artés Caselles M, Serrano González J, Remírez Arriaga X, González Alcolea N, Equisoain Azcona A, Iglesias García E, Lucena de la Poza JL, Sánchez Movilla A, Ruiz-Antorán B. Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial. Trials 2024; 25:122. [PMID: 38355562 PMCID: PMC10868096 DOI: 10.1186/s13063-024-07922-3] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26-37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. METHOD The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). DISCUSSION This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. TRIAL REGISTRATION EudraCT Number: 2021-003376-14. Registered on November 26, 2021.
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Affiliation(s)
- Verónica Polaino Moreno
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Antonio F Caballero-Bermejo
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
| | - Mariano Artés Caselles
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | | | | | | | - Aritz Equisoain Azcona
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Eva Iglesias García
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - José Luis Lucena de la Poza
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Arsenio Sánchez Movilla
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
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Salido-Vallejo R, González-Velasco M, Guilabert M, García EI, Mira JJ. [The perception of care received by patients with actinic keratosis]. J Healthc Qual Res 2018; 33:360-369. [PMID: 30497970 DOI: 10.1016/j.jhqr.2018.09.005] [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: 05/31/2018] [Revised: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse barriers limiting an integral approach in the care process of patients with actinic keratosis, and to validate a questionnaire of their perception in order to assess this approach. METHOD A qualitative study (Focus Group) was conducted to assess the perception of the healthcare process of professionals (dermatologists, family doctors, nurses, pharmacists and managers), and patients. A validation study of a new tool was conducted, defining the scope and contents of a questionnaire of perceived quality. Reliability, consistency and validity were analysed after inviting a convenience sample of 225 patients to respond. RESULTS Underdiagnosis in primary care, a higher variability in resources, and access to the health care circuit, together with gaps in patient information about actinic keratosis, are relevant barriers to achieve comprehensive care in this disease condition. The result of the focus groups advised to elaborate 14 reactive items. A total of 224 patients responded (mean age 71.6, SD 11.1), of which 153 (68%) were men. Two factors were isolated including 12 items (explained variance of 58%). The consistency of this factorial solution was .87, the split-half reliability being .76, with the scores in the factors showing an adequate predictive capacity. CONCLUSIONS The coordination between levels and to reduce to variability in equipment and clinical decision making in Primary Care are the most prominent barriers. The questionnaire has appropriate metric properties and it explores the information and care by the medical staff and the information and advice provided by the pharmacist.
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Affiliation(s)
| | - M González-Velasco
- Vocalía de Dermofarmacia del Colegio Oficial de Farmacéuticos de Sevilla, Sevilla, España
| | - M Guilabert
- Universidad Miguel Hernández, Elche, España.
| | | | - J J Mira
- Universidad Miguel Hernández, Elche, España; Departamento de Salud Alicante Sant Joan, Alicante, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
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Moreno-Ramírez D, Ruiz-Villaverde R, de Troya M, Reyes-Alcázar V, Alcalde M, Galán M, García-Lora E, García EI, Linares M, Martínez L, Pulpillo Á, Suárez C, Vélez A, Torres A. Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV). Actas Dermosifiliogr 2016; 107:391-9. [PMID: 26826882 DOI: 10.1016/j.ad.2015.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/05/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.
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Affiliation(s)
- D Moreno-Ramírez
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Virgen Macarena, Sevilla, España
| | - R Ruiz-Villaverde
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M de Troya
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Costa del Sol, Marbella, España
| | | | - M Alcalde
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Torrecárdenas, Almería, España
| | - M Galán
- Unidad de Gestión Clínica de Dermatología MQyV, Complejo Hospitalario de Jaén, Jaén, España
| | - E García-Lora
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Virgen de las Nieves, Granada, España
| | - E I García
- Facultad de Enfermería, Universidad de Cádiz, Cádiz, España
| | - M Linares
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Puerta del Mar, Cádiz, España
| | - L Martínez
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Regional de Málaga, Málaga, España
| | - Á Pulpillo
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - C Suárez
- Unidad de Gestión Clínica de Dermatología MQyV, Complejo Hospitalario de Huelva, Huelva, España
| | - A Vélez
- Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Reina Sofía, Córdoba, España
| | - A Torres
- Agencia de Calidad Sanitaria de Andalucía, Sevilla, España.
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Ruiz-Villaverde R, Moreno-Ramírez D, Galán-Gutierrez M, de Troya M, Reyes-Alcázar V, Alcalde M, García EI, Linares M, Martínez L, Pulpillo Á, Suárez C, Vélez A, García-Lora E, Torres A. Clinical Pathway for Patients with Acute or Chronic Urticaria: A Consensus Statement of the Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV). Actas Dermosifiliogr 2016; 107:482-8. [PMID: 26803228 DOI: 10.1016/j.ad.2015.11.005] [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: 11/02/2015] [Revised: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022] Open
Abstract
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.
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Affiliation(s)
- R Ruiz-Villaverde
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - D Moreno-Ramírez
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Galán-Gutierrez
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Complejo Hospitalario de Jaén, Jaén, España
| | - M de Troya
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Costa del Sol, Marbella, España
| | | | - M Alcalde
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Torrecárdenas, Almería, España
| | - E I García
- Facultad de Enfermería, Universidad de Cádiz, Cádiz, España
| | - M Linares
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - L Martínez
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Regional de Málaga, Málaga, España
| | - Á Pulpillo
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - C Suárez
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Complejo Hospitalario de Huelva, Huelva, España
| | - A Vélez
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España
| | - E García-Lora
- Unidad de Gestión Clínica de Dermatología Médico-quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - A Torres
- Agencia de Calidad Sanitaria de Andalucía, Sevilla, España
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García EI. [Nursing facing the new propositions for hospital organization]. Enferm Intensiva 1995; 6:170-1. [PMID: 8715361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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