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García-Onrubia L, Pacheco-Callirgos GE, García-Álvarez C, Muñoz-Moreno MF, García-Lagarto E, Almaraz-Gómez A, Saornil-Álvarez MA. Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases. Arch Soc Esp Oftalmol (Engl Ed) 2023:S2173-5794(23)00107-X. [PMID: 37369322 DOI: 10.1016/j.oftale.2023.06.012] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/07/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.
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Affiliation(s)
- L García-Onrubia
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Moorfields Eye Hospital NHS Foundation Trust, Londres, United Kingdom.
| | - G E Pacheco-Callirgos
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - C García-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M F Muñoz-Moreno
- Unidad de Tumores Oculares, Unidad de Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - E García-Lagarto
- Departamento de Patología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Almaraz-Gómez
- Departamento de Epidemiología y Medicina Preventiva, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - M A Saornil-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Ruiz-Rebollo ML, Muñoz-Moreno MF, Busta-Nistal R, Rizzo-Rodríguez MA, Izquierdo-Santerv Ás S. Recurrent acute pancreatitis is not uncommon in our clinical setting. Rev Gastroenterol Peru 2023; 43:31-37. [PMID: 37226067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Data on recurrent episodes of acute pancreatitis (RAP) are scarce. The aim of the study was to evaluate our rate of RAP and risks factors. This is a retrospective, single-center, study of consecutive patients admitted for AP and followed-up. Patients with more than one AP attack (RAP) were compared with patients with only a single AP episode (SAP) Clinical, demographic, outcome measures and severity were studied. 561 patients were included and follow-up over a mean 67.63 months' time. Our rate of RAP was 18,9%. Most patients suffered form only one episode of RAP (93%). Etiology of RAP episodes was mainly biliary (67%). On univariate analysis younger age (p 0.004), absence of high blood pressure (p 0.013) and absent of SIRS (p 0.022) were associated with recurrence of AP. On multivariate analysis only younger age was related to RAP (OR 1.015 95%IC 1.00-1.029). There were no statistical differences in outcome measures between both cohorts. RAP had a milder course in terms of severity (SAP 19% moderately severe/severe versus 9% in SAP). Almost 70% of the biliary RAP patients did not have a cholecystectomy performed. In this subset of patients, age OR 0.964 (95%IC 0.946-0.983), cholecystectomy OR 0.075 (95%IC 0.189-0.030) and cholecystectomy plus ERCP OR 0.190 (95%IC 0.219-0.055) were associated with absent of RAP. The rate of RAP in our series was 18,9%. Younger age was the only risk factor associated. Biliary etiology accounts for a large proportion of our RAP which could have been prevented with cholecystectomy or cholecystectomy plus ERCP.
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Affiliation(s)
| | - María Fe Muñoz-Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario, Valladolid, España
| | - Reyes Busta-Nistal
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, Valladolid, España
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Benito-Orejas JI, Ramírez-Salas JE, Mena-Domínguez EA, Duque-Holguera V, Muñoz-Moreno MF, Santos-Pérez J. Sordera súbita idiopática. ORL 2022. [DOI: 10.14201/orl.29939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introducción y objetivos: La sordera súbita idiopática se define habitualmente, como una pérdida auditiva superior o igual a 30 dB HL, en 3 o más frecuencias consecutivas, con un tiempo de instauración inferior a 72 horas, de causa desconocida. Siendo actualmente motivo de discusión el efecto de la terapia esteroidea en este síndrome, evaluaremos la eficacia del corticoide intratimpánico (CIT) como tratamiento de rescate. Como objetivo secundario, estudiaremos la influencia de determinados factores considerados de riesgo o pronóstico. Pacientes y métodos: Se comparan los resultados de dos grupos de población con edad y pérdida auditiva similar. El primero, de 99 pacientes, recibió exclusivamente tratamiento sistémico con corticoides. En el segundo de 70, con una sordera súbita idiopática refractaria al tratamiento general, instilamos corticoide intratimpánico. Comparamos las diferencias de umbral medio auditivo en el momento del diagnóstico y a los 3 meses, además del grado general de recuperación. Resultados: La aplicación intratimpánica de 3 dosis de dexametasona (8mg/ml) en la sordera súbita idiopática refractaria, no ha producido, en nuestra población, un cambio significativo respecto al tratamiento sistémico. Analizamos también la influencia de los factores pronósticos seleccionados. Discusión: Desconocemos la eficacia del tratamiento con corticoides en la sordera súbita idiopática. El tipo de lesión y las características del paciente podrían ser decisivos en el pronóstico final y en el resultado terapéutico. Conclusiones: El tratamiento de rescate con CIT, no ha aportado mejoría auditiva significativa en la población estudiada. Los factores con peor pronóstico son: la presencia de síntomas vestibulares, la hipoacusia de grado profundo, la caída audiométrica hacia tonos agudos, el inicio del tratamiento después de 2 semanas y fundamentalmente, la falta de mejoría de al menos 10 dB el 4º día de tratamiento.
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López M, Fernández-Castro M, Martín-Gil B, Muñoz-Moreno MF, Jiménez JM. Auditing completion of nursing records as an outcome indicator for identifying patients at risk of developing pressure ulcers, falling, and social vulnerability: An observational study. J Nurs Manag 2022; 30:1061-1068. [PMID: 35266605 DOI: 10.1111/jonm.13569] [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: 09/29/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. BACKGROUND Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. METHOD This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. RESULTS A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. CONCLUSIONS The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. IMPLICATIONS FOR NURSING MANAGEMENT Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.
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Affiliation(s)
- María López
- Nursing Faculty, University de Valladolid, Valladolid, Spain
| | | | - Belén Martín-Gil
- Department of Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María Fe Muñoz-Moreno
- Research Support Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Benito-Orejas JI, Parra-Morais L, Casasola-Girón M, Cicuéndez-Ávila R, Morais-Pérez D, Muñoz-Moreno MF. Resultados de aplicar un protocolo de seguridad al paciente traqueotomizado procedente de una unidad de cuidados críticos. ORL 2022. [DOI: 10.14201/orl.28030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: El incremento de traqueotomías en las unidades de cuidados críticos aumenta notablemente la morbimortalidad en la sala general. Para revertirlo, hemos implementado un programa de seguimiento multidisciplinar basado en la formación, la estandarización de los cuidados y la adopción de nuevas estrategias. Metodología: Estudio de cohorte prospectivo y observacional del seguimiento de 150 pacientes en un hospital universitario de tercer nivel, que carece de unidad de cuidados intermedios. Registramos y analizamos las variables clínicas, epidemiológicas y la evolución tras la aplicación del programa. Resultados: La edad media de los pacientes fue de 61 años, 67% varones y el 42% neurocríticos. 71% con traqueotomía percutánea. La mortalidad general fue del 17% y la de los pacientes con accidente cerebrovascular del 6,3%. Hubo un 8% de reingresos en la unidad de críticos. Detectamos un 23% de complicaciones de escasa gravedad. Se decanuló durante el ingreso a un 43% de pacientes y el 38% volvió a su domicilio, siendo dados de alta un 55% con alimentación oral. El tiempo medio de estancia en la unidad de críticos fue de 34 días y de 70 días la media de ingreso hospitalario. Conclusiones: Este trabajo describe los resultados obtenidos tras aplicar un protocolo de seguimiento multidisciplinar en la sala de hospitalización, del paciente traqueotomizado que procede de las UCC. La finalidad de este seguimiento es mejorar la seguridad de estos pacientes, a fin de disminuir su morbimortalidad. Las aplicación de nuevas estrategias permitirá su evaluación en relación con los datos obtenidos de este estudio.
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Tamayo-Velasco Á, Peñarrubia Ponce MJ, Álvarez FJ, Gonzalo-Benito H, de la Fuente I, Pérez-González S, Rico L, Jiménez García MT, Sánchez Rodríguez A, Hijas Villaizan M, Martín-Fernández M, Dueñas C, Gómez-Sánchez E, Heredia-Rodríguez M, Gorgojo-Galindo Ó, Fernández I, del Río L, Carnicero-Frutos I, Muñoz-Moreno MF, Tamayo E, Bernardo D, Martínez-Paz P. Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can. Front Immunol 2021; 12:726283. [PMID: 34721388 PMCID: PMC8548690 DOI: 10.3389/fimmu.2021.726283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.
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Affiliation(s)
- Álvaro Tamayo-Velasco
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | - Francisco Javier Álvarez
- Department of Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - Hugo Gonzalo-Benito
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Research Unit of University Clinical Hospital of Valladolid, Institute of Health Sciences of Castile and Leon (IECSCYL), Soria, Spain
| | - Ignacio de la Fuente
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Sonia Pérez-González
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Lucía Rico
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | - Alba Sánchez Rodríguez
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Milagros Hijas Villaizan
- Hematology and Hemotherapy Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Marta Martín-Fernández
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Internal Medicine, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Carlos Dueñas
- Internal Medicine Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Esther Gómez-Sánchez
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Anesthesiology and Resuscitation Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - María Heredia-Rodríguez
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Anesthesiology and Resuscitation Service, University Clinical Hospital of Salamanca, Salamanca, Spain
| | - Óscar Gorgojo-Galindo
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Research Unit of University Clinical Hospital of Valladolid, Institute of Health Sciences of Castile and Leon (IECSCYL), Soria, Spain
| | - Itziar Fernández
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine (CIBERBBN), Carlos III National Institute of Health, Madrid, Spain
| | - Lourdes del Río
- Vascular Surgery Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Irene Carnicero-Frutos
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Research Unit of University Clinical Hospital of Valladolid, Institute of Health Sciences of Castile and Leon (IECSCYL), Soria, Spain
| | - María Fe Muñoz-Moreno
- Research Unit of University Clinical Hospital of Valladolid, Institute of Health Sciences of Castile and Leon (IECSCYL), Soria, Spain
| | - Eduardo Tamayo
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Anesthesiology and Resuscitation Service, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - David Bernardo
- Mucosal Immunology Laboratory, Institute of Biology and Molecular Genetics (IBGM), University of Valladolid-Spanish National Research Council, Valladolid, Spain
- Biomedical Research Networking Centre in Hepatic and Digestive Diseases (CIBEREHD), Carlos III National Institute of Health, Madrid, Spain
| | - Pedro Martínez-Paz
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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Vicente N, Saornil MA, Almaraz A, Muñoz-Moreno MF. Long-term results of visual function in posterior uveal melanoma patients treated with I125 episcleral brachytherapy in a Spanish referral Ocular Oncology Unit. Arq Bras Oftalmol 2021; 84:330-338. [PMID: 33567036 DOI: 10.5935/0004-2749.20210047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/10/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSES We analyzed patient, tumor and dosimetric characteristics of subjects in a Spanish population diagnosed with uveal melanoma treated with iodine 125 (I125) episcleral brachytherapy, who presented with post-treatment loss of useful visual acuity and global evolution of visual acuity. METHODS A single historic observational cohort study was undertaken. Patients with uveal melanoma were recruited between September 1995 and June 2015. Clinical, tumor and dosimetric data collection and visual acuity evaluations were performed under everyday practice conditions based on a useful visual acuity >0.1 on the decimal scale. The baseline analysis was performed using descriptive and survival analyses according to Kaplan-Meier curves. RESULTS A total of 286 of the 665 patients diagnosed with uveal melanoma received episcleral brachytherapy, and 198 were included in the study. The mean follow-up time was 75.3 months (95% CI = 68.0-82.6). Patients with post-treatment useful visual acuity loss (n=94, 47%) presented the following characteristics: visual symptoms (n=80, p-value = 0.001); iris color (brown n=33, hazel green n=49, p-value = 0.047); Collaborative Ocular Melanoma Study size (medium n=80, p-value = 0.159); tumor, node, metastasis stage (T2: n=38, T3: n=38, p=0.012); shape (nodular n=67, mushroom-shaped n=26, p=0.001); posterior pole involvement (n=47, p=0.04); recurrence (n=10, p=0.001); and dose administered in the fovea, optic nerve and center of the eye (p<0.002). Using Kaplan-Meier analysis, the mean overall survival of useful visual acuity was 90.19 months, and the probability of preserving useful visual acuity was 66% for one year, 45% for five years and 33% for ten years. CONCLUSION Patients most likely to present with visual acuity loss were those with the following profile: elderly males with dark irises who were diagnosed with visual symptoms and exhibited a medium/large melanoma with a mushroom shape in the posterior pole (near the fovea and/or optic nerve). All patients treated with episcleral brachytherapy are likely to present with visual acuity loss, which is more pronounced in the first few years following treatment.
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Affiliation(s)
- Nélida Vicente
- Ophthalmology Department, Hospital General de Segovia, Segovia, Spain
| | - Maria Antonia Saornil
- Intraocular Tumors Referral Unit National Health System, Hospital Clínico Universitario, Valladolid, Spain
| | - Ana Almaraz
- Epidemiology and Preventive Medicine Department, Valladolid University, Spain
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Poves-Álvarez R, Gómez-Sánchez E, Martínez-Rafael B, Bartolomé C, Alvarez-Fuente E, Muñoz-Moreno MF, Eiros JM, Tamayo E, Gómez-Pesquera E. Parental Satisfaction With Autonomous Pediatric Ambulatory Surgery Units. Qual Manag Health Care 2021; 30:145-152. [PMID: 34086652 DOI: 10.1097/qmh.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Ambulatory surgery is much favored in children, as they are usually healthy with no major comorbidities. Obvious benefits are minimization of health costs, optimal utilization of resources, decreased exposure to infections, and psychological and emotional advantages of avoiding admission of the patient, especially for the family. Parental satisfaction is a challenge in pediatric surgery processes. The objective of this study was to compare satisfaction in parents whose children underwent surgery without overnight stays with parents whose children were operated on in an autonomous major ambulatory surgery unit (hospital isolated). METHODS This was a prospective observational study of 200 children who received surgery on an outpatient basis (133 were included in an outpatient unit and 67 in a hospital setting). Different variables were collected, including sex, age, type of surgery, and length of stay in the hospital and location, and a telephone perception survey was conducted (questionnaire of satisfaction of 14 questions with possible answers from 1 to 4 on a Likert scale and a 15th question on global satisfaction, with an answer from 0 to 10). RESULTS Overall satisfaction during the hospital stay was higher in the group operated on in the autonomous major surgery unit (3.54 ± 0.57 vs 3.28 ± 0.64, P = .004). Whether parents respond as being very satisfied with the hospital stay is influenced by several factors, among which are: being treated at major ambulatory surgery units (odds ratio [OR] = 2.16), good or very good information received prior to surgery (OR = 2.03), and good or very good information received at discharge (OR = 2.48). CONCLUSIONS Parents of children who received surgery on an outpatient basis were more satisfied if the procedure was performed in an autonomous major ambulatory surgery unit compared with hospitalization, even if it was not overnight. The information received during the care process influenced the parents' satisfaction. These findings suggest that efforts should be devoted to the creation of autonomous units for ambulatory surgery and to the improvement of perioperative information.
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Affiliation(s)
- Rodrigo Poves-Álvarez
- Anaesthesiology and Postoperative Intensive Care Department (Drs Poves-Álvarez, Gómez-Sánchez, Martínez-Rafael, Bartolomé, Alvarez-Fuente, Tamayo, and Gómez-Pesquera) and Research Support Unit (Dr Muñoz-Moreno), Clinic University Hospital, Valladolid, Valladolid, Spain; Biomedicine Research Group in Critical Care, Biocritic, Valladolid, Spain (Drs Poves-Álvarez, Gómez-Sánchez, Martínez-Rafael, Bartolomé, Alvarez-Fuente, Tamayo, and Gómez-Pesquera); and Faculty of Medicine, Valladolid University, Valladolid, Spain (Drs Eiros and Tamayo)
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de la Varga-Martínez O, Gómez-Pesquera E, Muñoz-Moreno MF, Marcos-Vidal JM, López-Gómez A, Rodenas-Gómez F, Ramasco F, Álvarez-Refojo F, Barón MS, Tamayo E, Heredia-Rodríguez M, Gómez-Sánchez E. Influence of intraoperative and postoperative factors on the predictive capacity of the delirium risk model for cardiac surgery patients (DELIPRECAS): An observational multicentre study. J Clin Anesth 2021; 72:110282. [PMID: 33873005 DOI: 10.1016/j.jclinane.2021.110282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Olga de la Varga-Martínez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain
| | - María Fe Muñoz-Moreno
- Unit of Research, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain
| | - José Miguel Marcos-Vidal
- Department of Anaesthesiology, Hospital de León, University Hospital Complex, Altos de Nava, s/n, 24071 León, Spain
| | - Amparo López-Gómez
- Department of Anaesthesiology, Hospital Universitario y Politéctnico la Fe, Fernando Abril, Martorell Ave. 106, 46026 Valencia, Spain
| | - Frederic Rodenas-Gómez
- Department of Anaesthesiology, Hospital Universitari Germans Trias i Pujol, Canyet Rd s/n, 08916 Badalona (Barcelona), Spain
| | - Fernando Ramasco
- Department of Anaesthesiology, Hospital Universitario de la Princesa, Diego de León st. 62, 28006 Madrid, Spain
| | - Felisa Álvarez-Refojo
- Department of Anaesthesiology, Complejo Universitario Hospitalario A Coruña, As Xubias st. 84, 15006 A Coruña, Spain
| | - Marc San Barón
- Department of Intensive Care, Hospital Universitario de la Princesa, Diego de León st. 62, 28006 Madrid, Spain
| | - Eduardo Tamayo
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain
| | - María Heredia-Rodríguez
- BioCritic, Group for Biomedical Research in Critical care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain; Department of Anaesthesiology, University Hospital of Salamanca, 37007 Salamanca, Spain.
| | - Esther Gómez-Sánchez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain
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Ortega-Loubon C, Cano-Hernández B, Poves-Alvarez R, Muñoz-Moreno MF, Román-García P, Balbás-Alvarez S, de la Varga-Martínez O, Gómez-Sánchez E, Gómez-Pesquera E, Lorenzo-López M, Tamayo E, Heredia-Rodríguez M. The Overlooked Immune State in Candidemia: A Risk Factor for Mortality. J Clin Med 2019; 8:jcm8101512. [PMID: 31547077 PMCID: PMC6832466 DOI: 10.3390/jcm8101512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts <0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700-0.867, p < 0.001), and lymphocyte count <1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716-0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39-10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24-8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.
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Affiliation(s)
- Christian Ortega-Loubon
- Department of Cardiac Surgery, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
| | - Beatriz Cano-Hernández
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Rodrigo Poves-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - María Fe Muñoz-Moreno
- Unit of Research, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Patricia Román-García
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Sara Balbás-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Olga de la Varga-Martínez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Esther Gómez-Sánchez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Estefanía Gómez-Pesquera
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Mario Lorenzo-López
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Eduardo Tamayo
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - María Heredia-Rodríguez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
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11
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Poves-Alvarez R, Cano-Hernández B, Muñoz-Moreno MF, Balbás-Alvarez S, Román-García P, Gómez-Sánchez E, Martínez-Rafael B, Gómez-Pesquera E, Lorenzo-López M, Alvarez-Fuente E, de la Varga O, Flores M, Eiros JM, Tamayo E, Heredia-Rodríguez M. Impact of empirical treatment with antifungal agents on survival of patients with candidemia. Rev Esp Quimioter 2019; 32:6-14. [PMID: 30499639 PMCID: PMC6372967] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with candidemia at a Spanish tertiary hospital. METHODS A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups: surviving patients (n = 92) and non-surviving patients (n = 87). RESULTS The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812). CONCLUSIONS Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen.
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Affiliation(s)
- Rodrigo Poves-Alvarez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Beatriz Cano-Hernández
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | | | - Sara Balbás-Alvarez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Patricia Román-García
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Esther Gómez-Sánchez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Beatriz Martínez-Rafael
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Mario Lorenzo-López
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Elisa Alvarez-Fuente
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Olga de la Varga
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Miguel Flores
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - José María Eiros
- Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain,Department of Microbiology, Faculty of Medicine, University of Valladolid, Spain
| | - Eduardo Tamayo
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - María Heredia-Rodríguez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
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12
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Poves-Alvarez R, Cano-Hernández B, Balbás-Alvarez S, Román-García P, Heredia-Rodríguez M, Gómez-Sánchez E, Gómez-Pesquera E, Lorenzo-López M, Martínez-Rafael B, Muñoz-Moreno MF, Eiros JM, Tamayo E. Antifungal treatment with echinocandins: a 10-year clinical experience. Rev Esp Quimioter 2017; 30:413-421. [PMID: 29141400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The number of studies evaluating the use of echinocandins, whether or not its indication meets international guidelines, in clinical practice is limited. The objective of the present study was to determine the use of echinocandins in a tertiary Spanish hospital in 10 years of clinical practice, and to evaluate its impact on prognosis. METHODS This retrospective study involved adult nonneutropenic ill patients with suspicion of fungal invasion who started treatment with echinocandins between 2006 and 2015. RESULTS The number of patients treated with echinocandins was 153, and candidemia was detected thereafter in 25.5%. Factors associated with in-hospital mortality in patients receiving echinocandins were: sex male, septic shock, Charlson comorbidity index, and total stay at the hospital. In-hospital mortality after 7, 30 and 90 days was 13.7%, 24.8%, and 56.8%, respectively. From patients receiving echinocandins, 98 did no show multifocal colonization, 50 had Candida score <2.5, and 49 did not meet Ostrosky-Zeichner prediction rule. A total of 19 patients did not show any of these 3 potential risk factors for candidemia. CONCLUSIONS The use of echinocandins in 10 years of clinical practice in our tertiary hospital has been performed according to international guidelines; however, candidemia was only diagnosed thereafter in only 25.5% of cases. Furthermore, according to our results, the adequate use of echinocandins seems not to be associated with reduced mortality rates. Further studies, involving a large cohort of patients and more hospitals, are required to corroborate these results.
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Affiliation(s)
- R Poves-Alvarez
- Rodrigo Poves Álvarez, Anesthesiology and Surgical Critical Care Department Clinic Universitary Hospital of Valladolid, Avenida Ramón y Cajal 3. 47003. Valladolid, Spain.
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13
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Ramoa R, Saornil MA, García-Alvarez C, Diezhandino P, Alonso-Martínez P, García-Lagarto E, Muñoz-Moreno MF, Lopez-Lara F. Intraocular metastasis: comparison of clinical presentation with a known and unknown primary tumour. ACTA ACUST UNITED AC 2017; 93:7-14. [PMID: 28739193 DOI: 10.1016/j.oftal.2017.06.003] [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: 03/28/2017] [Revised: 06/04/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics. METHODS Retrospective study of consecutive cases diagnosed of intraocular metástasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded. RESULTS A total of 21 patients, with a mean age 62.7 years (31-89) were diagnosed with intraocular metástasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group. CONCLUSIONS Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient.
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Affiliation(s)
- R Ramoa
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M A Saornil
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - C García-Alvarez
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - P Diezhandino
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - P Alonso-Martínez
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - E García-Lagarto
- Unidad de Tumores Intraoculares del Adulto, Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M F Muñoz-Moreno
- Unidad de Tumores Intraoculares del Adulto, Unidad de Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - F Lopez-Lara
- Unidad de Tumores Intraoculares del Adulto, Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, España
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14
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de Santos-Castro PÁ, Esteban-Velasco JV, Villalobos-Ordoñez LA, Barbero-Bajo S, Arranz-Díez B, Muñoz-Moreno MF. [Evaluation of inappropriate prescriptions on patients over 65 years old in a third level hospital]. Rev Esp Geriatr Gerontol 2016; 51:121-122. [PMID: 26310684 DOI: 10.1016/j.regg.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Pedro Ángel de Santos-Castro
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España; Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | | | | | - Soledad Barbero-Bajo
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Belén Arranz-Díez
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - María Fe Muñoz-Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
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15
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Hernández-Ramajo R, Martin-Ferrero MA, Simón-Pérez C, Muñoz-Moreno MF. [Results of surgical treatment of carpal scaphoid pseudarthrosis using the Fisk-Fernández technique]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:229-36. [PMID: 24647038 DOI: 10.1016/j.recot.2014.02.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/28/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of the study was to evaluate the clinical and radiological results obtained in the treatment of carpal scaphoid non-union treated at the University Hospital of Valladolid using the Fisk Fernandez technique. MATERIAL AND METHODS A review was performed on 43 cases of surgically treated non-union using Fisk Fernandez technique with a minimum of 6 months follow-up. The time until surgery, previous treatment, the mechanism of injury, type of non-union, and the existence of radio-carpal arthrosis were evaluated. A subjective evaluation was performed using the "Scaphoid Score" and the DASH, plus an objective assessment with the modified Green & O'Brien, together with the measurement of the intra-scaphoid, radioulnar, scapholunate angles, and carpal height. RESULTS The median time to healing in the series was between 16 to 24 weeks, except in 3 patients who failed to heal and required salvage surgery. There was a statistically significant variation between the preoperative and postoperative angles and carpal height measured in the X-rays. DISCUSSION There are different osteosynthesis techniques and materials for the treatment of non-union. The evaluation of results performed using objective and subjective scales showed variable results between studies. Different techniques are aimed at preventing the progression of the disease. CONCLUSION The Fisk Fernandez technique enables the deformity of the scaphoid to be corrected by wedge grafting and internal fixation with Kirschner wires or screws.
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Affiliation(s)
- R Hernández-Ramajo
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - M A Martin-Ferrero
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - C Simón-Pérez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M F Muñoz-Moreno
- Unidad de Investigación Biomédica, Hospital Clínico Universitario de Valladolid, Valladolid, España
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