[Evidence-based protocol on the urinary catheter cares in intensive care units]. / Protocolo basado en la evidencia de los cuidados de los catéteres urinarios en unidades de cuidados intensivos.

Urinary Tract Infections (UTIs) account for 24.92% of ICU nosocomial infections investigated. They are associated with increased morbidity and mortality, increased hospital stay and hospital costs, jeopardizing patient safety. Prevalence of UTI in ICU is directly related to the widespread use of urethral catheter (UC). It has been estimated that between 17% and 69% of UTIs associated with the UC can be prevented through an evidence-based prevention program. The Centers for Disease Control and Prevention recommend, based on strong evidence for its implementation, the use of packages based on evidence and ongoing training of health personnel in the extrinsic risk factors of UTI associated with UC-related nursing care (technique of insertion, maintenance and drainage system). The development of an evidence-based UC protocol of care for, dealt with in the latest clinical guidelines, and the systematic reviews extracted from the Cochrane, where the clinical cares that are most clearly shown to have a direct relation to decrease of UTI asssociated with UC are described, will make it possible for us to reach a consensus on the guidelines of our care to avoid their variability. This will also make it possible to evaluate and compare the quality of our cares with other ICUs, using quality indicators established by the National Surveillance Study of Nosocomial Infection in Medical Services Intensive.

[Idiotype vaccines in the treatment of follicular lymphoma: current status and future perspectives]. / Vacuna idiotípica en el tratamiento del linfoma folicular: situación actual y perspectivas futuras.

Follicular lymphoma is the second most prevalent non-Hodgkin lymphoma, representing 20% of all lymphomas. Follicular lymphoma is an indolent disease with a slow progression in which, although exhibiting a good response to treatment, relapse is very frequent and complete remission is not easy to maintain. Therefore, the disease is regarded as incurable. The search for new therapeutic strategies, together with a better understanding of the immune system, has led to the emergence of a new treatment named immunotherapy. Follicular lymphoma is a malignancy suitable for this kind of treatment given the fact that it is characterized by presenting a unique tumour-specific antigen: the idiotype of the monoclonal immunoglobulin displayed on the membrane of tumour cells. Several studies have been conducted to test immunotherapy as complementary to conventional treatment. In a previous study by our group, a clear benefit was evident is obtained after idiotypic vaccination, when an adequate immunization of the patient is obtained, in comparison to chemotherapy alone. In this sense, analysis is needed of whether idiotypic vaccination can produce not only long-lasting and complete remission, but even cure. It would be of great interest to consider an optimisation of the experimental design of clinical trials, an improvement of vaccine production, and the study of the molecular mechanisms of the tumour cell which modify the target immunoglobulin.

[Primary hyperparathyroidism in the pediatric population. Report of a case and review of the literature]. / Hiperparatiroidismo primario en la población pediátrica. Caso clínico y revisión de la literatura.

Parathyroid adenomas presenting as primary hyperparathyroidism are uncommon in children. We report a case in a 14 years-old male diagnosed as such illness who was studied by imaging tests (scintigraphy and IRM) that detected the responsible upper-left adenoma. He was operated without complications, with good postoperative evolution and normal calcium levels. Finally review the literature of this clinical entity in the pediatric population.

[Melkersson-Rosenthal syndrome. Report of a case with bilateral facial palsy]. / Síndrome de Melkersson-Rosenthal. A propósito de un caso con paráilisis facial bilateral.

Melkersson-Rosenthal syndrome is a rare illness characterized by secondary facial edema mainly located on the upper lip, recurrent facial palsy and plicated or fissured tongue. We report the clinical case of a 30-year-old female with the classic triad but severe bilateral affectation of the facial nerve. We describe the results of all the tests and complementary explorations we asked, besides the associated pathologies, that carried us to the definitive diagnosisjoint to her symptoms. Finally we have performed a short review of the literature at respect of this entity.

[New mutation in the CASK gene in a child with microcephaly syndrome and pontocerebellar hypoplasia]. / Nueva mutación en el gen CASK en un niño con síndrome de microcefalia e hipoplasia pontocerebelosa.

TITLE: Nueva mutación en el gen CASK en un niño con síndrome de microcefalia e hipoplasia pontocerebelosa.

[Sweet's syndrome and motor neuron disease associated with esophageal carcinoma]. / Síndrome de Sweet y afectación de motoneurona asociados a carcinoma de esófago.

The paraneoplastic syndromes are an a group of clinical manifestations of uncommon frequency that they are associated with tumors and they often are precursors of these. The Sweet's syndrome is a dermatosis characterized by fever, erythematous plaques and infiltrate consisting of mature neutrophils. It occurs occasionally in association with hematologic malignancies and is very rare with solid tumors. The isolated motor neuron disease is rare like paraneoplastic syndrome. We report the case of a patient with epidermoid carcinoma of esophagus that it was diagnosed after beginning clinically with two paraneoplastic syndromes: Sweet's syndrome and motor neuron disease.

Polarity compensation in ultra-thin films of complex oxides: the case of a perovskite nickelate.

We address the fundamental issue of growth of perovskite ultra-thin films under the condition of a strong polar mismatch at the heterointerface exemplified by the growth of a correlated metal LaNiO3 on the band insulator SrTiO3 along the pseudo cubic [111] direction. While in general the metallic LaNiO3 film can effectively screen this polarity mismatch, we establish that in the ultra-thin limit, films are insulating in nature and require additional chemical and structural reconstruction to compensate for such mismatch. A combination of in-situ reflection high-energy electron diffraction recorded during the growth, X-ray diffraction, and synchrotron based resonant X-ray spectroscopy reveal the formation of a chemical phase La2Ni2O5 (Ni(2+)) for a few unit-cell thick films. First-principles layer-resolved calculations of the potential energy across the nominal LaNiO3/SrTiO3 interface confirm that the oxygen vacancies can efficiently reduce the electric field at the interface.

[Skills accreditation as an impetus for continuous professional development]. / Utilidad de la acreditación de competencias profesionales en el desarrollo profesional continuo.

AIM: To analyse the perceived usefulness of continuous professional development (CPD) of the Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality, with 64 Skills Manuals available, one for each professional discipline. MATERIAL AND METHODS: A quantitative and longitudinal study by questionnaire. Field of the study: every professional who has finished their professional skills accreditation process. PERIOD OF STUDY: 2006-2009. A validated questionnaire on the perceived quality of the professional skills accreditation process was distributed online to the targeted population. The questionnaire analysed the professionals' perception on the usefulness of the accreditation process in the "self-learning and reflection of their practice", the "maintenance and improvement of their skills" and the "maintenance and improvement of their results". RESULTS: In 2009, 10,300 professionals were in some phase of the skills accreditation process, 1427 of whom have achieved some accreditation level. A total of 886 completed questionnaires were received (62.0%); the overall rating obtained by the Accreditation Programme was 7.7/10. The rating of the perceived usefulness in continuous professional development was: "self-learning and reflection of their practice": 7.8/10; "maintenance and improvement of their skills": 7.7/10; and "maintenance and improvement of their results": 7.5/10. The average length of their professional practice self-assessment was 168 days. CONCLUSIONS: The Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality was perceived by the professionals as useful for their continuous professional development.

Neonato con sobreinfección de un cefalohematoma complicado con meningitis: a propósito de un caso / Newborn with infected cephalohematoma complicated with meningitis: report of one case

INTRODUCCIÓN: La infección del cefalohematoma es una patología muy infrecuente, aunque potencialmente grave por las complicaciones asociadas que puede conllevar: osteomielitis del hueso subyacente, meningitis o sepsis. CASO CLÍNICO: Se expone un caso de una recién nacida por cesárea con antecedente de atresia duodenal intervenida, que desarrolla, al octavo día de vida, la infección de un cefalohematoma con cuadro séptico y meningitis asociada. Tras un drenaje del cefalohematoma y la administración de antibioterapia durante 3 semanas, la paciente evoluciona favorablemente. CONCLUSIÓN: Ante la sospecha de la infección de un cefalohematoma, el drenaje del mismo es la clave diagnóstica y terapéutica, ya que la antibioterapia de forma aislada puede no ser suficiente para erradicar el patógeno. Se deben descartar otras complicaciones asociadas, como meningitis, sepsis u osteomielitis del hueso subyacente

INTRODUCTION: The infection of a cephalohematoma is an infrequente but potentially fatal condition due to its possible complications such as osteomyelitis, meningitis or sepsis. CASE REPORT: The report describes a newborn delivered by cesarean section, and a history of duodenal atresia with surgical correction, who develops, at 8 days of life, an infection of a cephalohematoma with sepsis and meningitis. After aspiration of the cephalohematoma and a three week course of antibiotics, she showed a favorable outcome. CONCLUSION: When the infection of a cephalohematoma is suspected, its drainage is both a diagnostic and therapeutic tool, as antibiotic therapy alone is often insufficient. Possible complications such as meningitis, osteomyelitis and sepsis must be ruled out

[Epidemiological study of an epidemic outbreak of syphilis in Palmas de Gran Canaria]. / Estudio epidemiológico de un brote epidémico de sífilis en Las Palmas de Gran Canaria.

INTRODUCTION: In the last times there has been an increased incidence of syphilis especially among homosexual men. In our department we have diagnosed 11 cases of early syphilis in 6 months during 2006, thus confirming an epidemic outbreak. MATERIAL AND METHODS: We carried out an epidemiological survey of patients with early syphilis. RESULTS: Syphilis was secondary in five cases and primary in six. All patients were men, 70 % homosexual with a mean age of 38.1 years. All patients had or have had other sexually transmitted diseases (STD), six were HIV positive. Ninety percent of the patients admitted having had promiscuous sexual contacts in the past year, and among these, 50 % never used protection, no protection was taken in cases of oral sex and only 25 % reported protection during anal sex. CONCLUSIONS: Currently, there is excessive slackening of protection practices as a method of STD prophylaxis, which leads to an increased number of cases. We consider relevant to insist in the use of barrier methods during oral sex as it is an important source of infection.

Buenas prácticas profesionales en la atención a las personas con dolor / No disponible

Introducción: El dolor tiene graves consecuencias emocionales, sociales y económicas para las personas que lo sufren, e incrementa por cinco la probabilidad de utilización de los servicios sanitarios. Por primera vez en España, la Consejería de Salud de la Junta de Andalucía ha puesto en marcha un Plan de Atención a las Personas con Dolor que pretende garantizar la atención integral de éstas, mejorando su calidad de vida y la atención de sus necesidades a lo largo de todo el proceso asistencial. Desde el año 2004, la Agencia de Calidad Sanitaria de Andalucía, como entidad certificadora del Sistema de Acreditación del Sistema Sanitario Público de Andalucía (SSPA), ha establecido un Modelo de Acreditación de la Competencia Profesional que pretende reconocer la excelencia de los profesionales y ayudarles en su desarrollo y mejora continua. Este modelo se basa en un proceso a través del cual los profesionales verifican la proximidad entre sus competencias y buenas prácticas reales, y las definidas en sus correspondientes Manuales de Competencias. Objetivo: Este trabajo pretende describir los elementos relacionados con la atención a las personas con dolor, contenidos en los Manuales de Competencias y puestos de manifiesto por los profesionales que han alcanzado la acreditación de sus competencias mediante el Modelo de Acreditación del SSPA. Material y método: Análisis descriptivo transversal de los elementos relacionados con la atención a las personas con dolor contenidos en los Manuales de Competencias, y porcentaje de cumplimiento de dichos elementos aportados por los profesionales que accedieron al Programa. Resultados: El Manual que presentó mayor número de elementos relacionados con el abordaje del dolor fue el de Medico/a de Equipos y/o Centros de Coordinación de Emergencias Sanitarias. Los Manuales en los que más del 70% de los profesionales acreditados han aportado evidencias relacionadas con el dolor corresponden a...(AU)

Introduction: Pain has serious emotional, social and economic consequences for people who suffer it, moreover these people are five times more likely to use health services. For the first time in Spain, the Regional Ministry of Health has launched a Plan to give special attention to people in pain, with the objective of not only reducing the pain but also improving their quality of life and the attention to their needs throughout the medical process. Since 2004, the Andalusian Agency for Healthcare Quality, as a certifying body of the Andalusian Public Health System (SSPA) Accreditation System, has established the Competence Accreditation Model which aims to recognize the professionals’ excellence and help them in their development and continuous improvement. This model is based on a process through which the professionals verify the proximity between their real competences and best practices and those defined in their Competences Manuals. Objectives: This study tries to describe the elements related to the attention given to people in pain contained in the Competences Manuals and highlighted by the professionals who have reached their competences accreditation by the SSPA Accreditation Model. Material and methods: Transversal descriptive analysis of the elements related to the attention given to people in pain contained in the Professional Competences Manuals and fulfilment of these elements submitted by professionals who access the programme. Results: The Doctors of Health Emergencies Coordination Teams and/or Centres Manual is the one that had the most elements related to the pain attention. Manuals in which more than 70% of accredited professionals have submitted evidences related to people in pain correspond to: —Orthopaedic surgeon. —Doctor in casualties...(AU)

Vacuna idiotípica en el tratamiento del linfoma folicular: situación actual y perspectivas futuras / Idiotype vaccines in the treatment of follicular lymphoma: current status and future perspectives

El linfoma folicular (LF) está considerado como elsegundo tipo de linfoma no-Hodgkin más común, representandomás del 20% del total de los linfomas. Es unaenfermedad de progresión lenta y curso indolente enla que, a pesar de la buena respuesta al tratamiento,las recaídas son muy frecuentes y cada vez es más difícilconseguir respuestas completas. Por ello, se puedeconsiderar que hasta el momento, el LF es incurable.La búsqueda continua de nuevas estrategias terapéuticasen enfermedades neoplásicas, junto con un mejorconocimiento del sistema inmunitario, ha llevado ala aparición de una nueva disciplina, conocida con elnombre de inmunoterapia, que aprovecha la capacidaddel sistema inmunitario de atacar lo extraño sin dañarlo propio. El LF es un tumor muy apropiado para estetipo de tratamiento por presentar un antígeno específicode tumor: el idiotipo de la inmunoglobulina monoclonalexpresada en la membrana de todas las célulastumorales. Se han realizado diversos estudios en losque se ha probado la inmunoterapia como tratamientocomplementario al tratamiento convencional. Recientemente,nuestro grupo ha publicado un estudio en el quese observa claramente que los resultados que se obtienentras la vacunación idiotípica, cuando se consigue lainmunización adecuada del paciente, son mejores quelos obtenidos con quimioterapia sola. En este sentido,es necesario seguir investigando para aclarar si la vacunaciónidiotípica pudiera no sólo mantener remisionescompletas duraderas en los pacientes vacunados, sinoincluso conseguir la curación de los mismos. Por ello,resulta interesante abordar un mejor planteamiento delos ensayos clínicos, la mejora de la producción de lavacuna y el estudio de mecanismos de la célula tumoralcapaces de modificar la inmunoglobulina específica del tumor(AU)

Follicular lymphoma is the second most prevalentnon-Hodgkin lymphoma, representing 20% of all lymphomas.Follicular lymphoma is an indolent diseasewith a slow progression in which, although exhibitinga good response to treatment, relapse is very frequentand complete remission is not easy to maintain. Therefore,the disease is regarded as incurable. The searchfor new therapeutic strategies, together with a betterunderstanding of the immune system, has led to theemergence of a new treatment named immunotherapy.Follicular lymphoma is a malignancy suitable for thiskind of treatment given the fact that it is characterizedby presenting a unique tumour-specific antigen: theidiotype of the monoclonal immunoglobulin displayedon the membrane of tumour cells. Several studies havebeen conducted to test immunotherapy as complementaryto conventional treatment. In a previous study byour group, a clear benefit was evident is obtained afteridiotypic vaccination, when an adequate immunizationof the patient is obtained, in comparison to chemotherapyalone. In this sense, analysis is needed of whetheridiotypic vaccination can produce not only long-lastingand complete remission, but even cure. It would be ofgreat interest to consider an optimisation of the experimentaldesign of clinical trials, an improvementof vaccine production, and the study of the molecularmechanisms of the tumour cell which modify the targetimmunoglobulin(AU)

Utilidad de la acreditación de competencias profesionales en el desarrollo profesional continuo / Skills Accreditation as an impetus for continuous professional development

Objetivos. Analizar la utilidad percibida para el desarrollo profesional continuo (DPC) del Programa de acreditación de competencias profesionales de la Agencia de Calidad Sanitaria de Andalucía (ACSA), que dispone en la actualidad de 64 Manuales de Competencias para otras tantas disciplinas profesionales. Material y método. Estudio cuantitativo y longitudinal mediante cuestionario. Ámbito: todos los profesionales que han finalizado su proceso de acreditación de competencias profesionales. Periodo de estudio: 2006-2009. Se hace llegar vía online un cuestionario validado de calidad percibida con el proceso de acreditación de competencias profesionales a todos los participantes. El cuestionario valora, entre otros aspectos, la percepción de los profesionales sobre la utilidad del proceso de acreditación en el «autoaprendizaje y reflexión de su práctica», en el «mantenimiento y mejora de sus competencias» y en el «mantenimiento y mejora de sus resultados». Resultados. A finales de 2009, 10.300 profesionales estaban en alguna fase del proceso de acreditación de sus competencias; de ellos, 1.427 profesionales han obtenido algún nivel de acreditación. Se recibieron 886 cuestionarios (62%); la valoración global obtenida por el programa de acreditación fue de 7,7/10. Las valoraciones de la utilidad percibida en el desarrollo profesional continuo fueron: «autoaprendizaje y reflexión de la práctica», 7,8/10; «mantenimiento y mejora de sus competencias», 7,7/10, y «mantenimiento y mejora de sus resultados», 7,5/10. El tiempo medio de la autoevaluación de su práctica profesional fue 168 días. Conclusiones. El Programa de acreditación de competencias profesionales de ACSA fue percibido por los profesionales como útil para su desarrollo profesional continuo(AU)

Aim. To analyse the perceived usefulness of continuous professional development (CPD) of the Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality, with 64 Skills Manuals available, one for each professional discipline. Material and methods. A quantitative and longitudinal study by questionnaire. Field of the study: every professional who has finished their professional skills accreditation process. Period of study: 2006-2009. A validated questionnaire on the perceived quality of the professional skills accreditation process was distributed online to the targeted population. The questionnaire analysed the professionals’ perception on the usefulness of the accreditation process in the “self-learning and reflection of their practice”, the “maintenance and improvement of their skills” and the “maintenance and improvement of their results”. Results. In 2009, 10,300 professionals were in some phase of the skills accreditation process, 1427 of whom have achieved some accreditation level. A total of 886 completed questionnaires were received (62.0%); the overall rating obtained by the Accreditation Programme was 7.7/10. The rating of the perceived usefulness in continuous professional development was: “self-learning and reflection of their practice”: 7.8/10; “maintenance and improvement of their skills”: 7.7/10; and “maintenance and improvement of their results”: 7.5/10. The average length of their professional practice self-assessment was 168days. Conclusions. The Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality was perceived by the professionals as useful for their continuous professional development(AU)

Estudio epidemiológico de un brote epidémico de sífilis en Las Palmas de Gran Canaria / Epidemiological study of an epidemic outbreak of syphilis in Palmas de Gran Canaria

Introducción. En los últimos tiempos se ha detectado un aumento en los casos de sífilis, sobre todo en el colectivo de homosexuales masculinos. En nuestro Servicio hemos detectado 11 casos de sífilis precoz en 6 meses del 2006, constatando la presencia de un brote epidémico. Material y métodos. Pacientes con sífilis temprana a los que se realizó una encuesta epidemiológica. Resultados. Cinco casos eran de sífilis secundaria y 6 casos de primaria. Todos los pacientes eran varones, con un 70 % de homosexuales. La edad media era de 38,1 años. Todos los pacientes tenían o habían tenido otras enfermedades de transmisión sexual (ETS), 6 eran positivos para el virus de la inmunodeficiencia humana (VIH+). El 90 % reconocía haber tenido contactos sexuales promiscuos en el último año, y de ellos el 50 % nunca utilizaba preservativo, no lo usaban en el sexo oral, y sólo el 25 % lo empleaba en el sexo anal. Conclusiones. Existe en el momento actual una relajación excesiva en la protección como método de prevención de ETS, lo que conlleva el incremento de casos. Nos parece importante insistir expresamente en la utilización de métodos de barrera en el sexo oral, dado que es una fuente importante de contagio

Introduction. In the last times there has been an increased incidence of syphilis especially among homosexual men. In our department we have diagnosed 11 cases of early syphilis in 6 months during 2006, thus confirming an epidemic outbreak. Material and methods. We carried out an epidemiological survey of patients with early syphilis. Results. Syphilis was secondary in five cases and primary in six. All patients were men, 70 % homosexual with a mean age of 38.1 years. All patients had or have had other sexually transmitted diseases (STD), six were HIV positive. Ninety percent of the patients admitted having had promiscuous sexual contacts in the past year, and among these, 50 % never used protection, no protection was taken in cases of oral sex and only 25 % reported protection during anal sex. Conclusions. Currently, there is excessive slackening of protection practices as a method of STD prophylaxis, which leads to an increased number of cases. We consider relevant to insist in the use of barrier methods during oral sex as it is an important source of infection

Síndrome de Sweet y afectación de motoneurona asociados a carcinoma de esófago / Sweet´s syndrome and neuron motor disease associated with esophagus carcinoma

Los síndromes paraneoplásicos son cuadros clínicos infrecuentes que se asocian a neoplasias, siendo a menudo precursores de éstas. El síndrome de Sweet es una dermatosis caracterizada por fiebre y placas eritematosas con infiltrado de neutrófilos maduros. Ocasionalmente acompaña a tumores de tipo hematológicos y más raramente a tumores sólidos. La lesión aislada de motoneurona es rara como síndrome paraneoplásico. Presentamos el caso de un paciente con carcinoma epidermoide de esófago que se diagnosticó tras debutar clínicamente con dos síndromes paraneoplásicos: dermatosis neutrofílica febril y afectación de motoneurona (AU)