Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

BACKGROUND/AIMS: Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. METHODOLOGY: The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. RESULTS: One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. CONCLUSIONS: a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

Hepatitis C Virus positivity prediction from serum samples using NIRS and L1-penalized classification.

AIMS: The hepatitis C virus (HCV) has developed a strategy to coexist with its host resulting in varying degrees of tissue and cell damage, which generate different pathological phenotypes, such as varying degrees of fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). However, there is no integrated information that can predict the evolutionary course of the infection. We propose to combine Near-infrared spectroscopy (NIRS) and machine learning techniques to provide a predictive model. In this work, we propose to discriminate HCV positivity in biobank patient serum samples. METHODS: 126 serum samples from 38 HCV patients in different stages of the disease were obtained from the Biobank of Hospital Universitario Fundación Alcorcon. NIRS spectrum was captured by a FT-NIRS Spectrum 100 (Perkin Elmer) device in reflectance mode. For each patient, the HCV positivity was identified (PCR) and labeled as detectable =1 and undetectable =0. We propose an L1-penalized logistic regression model to classify each spectrum as positive (1) or negative (0) for HCV presence (x). The regularization parameter is selected using 5- fold cross-validation. The penalized model will induce sparsity in the solution so that only a few relevant wavelengths will be different from zero. RESULTS: L1-penalized logistic regression model provided 167 wavelengths different from zero. The accuracy on an independent test set was 0.78. CONCLUSIONS: We present a straightforward promising approach to detect HCV positivity from patient serum samples combining NIRS and machine learning techniques. This result is encouraging to predict HCV progression, among other applications. Clinical relevance- We presented a simple while promising approach to use machine learning and NIRS to analyze viral presence on sample serums.

Anatomical study of surgical approaches to the talus. / Estudio y descripción anatómica de vías de abordaje del astrágalo.

Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction.

Radical robot-assisted laparoscopic nephrectomy with thrombectomy in the vena cava. / Nefrectomía radical laparoscópica asistida por robot con trombectomía en vena cava.

BACKGROUND: Renal cell carcinoma has a natural tendency to extend through the renal vein. When the thrombus reaches the vena cava, thrombectomy and the necessary reconstruction of the vena cava are typically performed by open pathway. Robot-assisted technology provides advantages for performing this complex technique, using a minimally invasive access. MATERIAL AND METHODS: We present the technique we employed in the first case performed in our department. After performing renal artery embolisation, we conducted the surgery with the Vinci S robotic system. The main steps of the surgery are as follows: detachment and Kocher manoeuvre; release of the lower renal pole; clamping and sectioning of the renal artery; endocavitary ultrasound to locate the thrombus; placement of tourniquets in the vena cava below and above the renal veins and in the left renal vein; closure of the 3 tourniquets; opening of the vena cava; resection and extraction of the thrombus; suture of the vena cava; opening of the tourniquets; complete release of the kidney; bagging and extraction of the specimen. RESULTS: The surgery was performed without complications. The patient required a transfusion of 2 units of packed red blood cells and was discharged with modest renal failure (creatinine level of 1.60mg/dl). CONCLUSIONS: Radical nephrectomy with thrombectomy in the vena cava is a technique susceptible to severe complications and has, to date, been performed in few centres. We believe that the technique is reproducible and has clear advantages for our patients.

[Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca]. / Lugar de atención, etiología y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca.

BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital. The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND METHODS: Observational prospective study. Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants). Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994. Exclussions: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers. Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after. RESULTS: 91 cases were investigated. 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005). 24 patients were hospitalized. 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasma was predominant in outpatients: 9 cases. S. pneumoniae in inpatients: 5 cases. Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics. Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005). CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers. M. pneumoniae is the predominant microbiological agent in outpatients and S. pneumoniae in inpatients. Erithromycin is the most used antibiotic in both groups of patients.

La enfermera de práctica avanzada: Como líder en el cuidado a personas con heridas crónicas complejas / The advanced practice nurse as a leader in caring for people with complex chronic wounds

Objetivo: Evaluar el impacto de la implementación y puesta en marcha de la EPA-HCC en Andalucía desde la perspectiva de sus competencias y liderazgo en la optimización de las necesidades específicas de las personas con HCC y sus familias, garantizando la continuidad asistencial. Método: Se plantea un estudio descriptivo transversal que describe los roles principales que desarrollan las EPA-HCC en cuatro distritos sanitarios (DS) de Andalucía desde su puesta en marcha de junio del 2015 a junio del 2018. Las variables principales son las competencias en: consultoría, docencia y formación continuada, investigación, difusión del conocimiento y clínica. Resultados: Se ha conseguido un total de 4489 consultorías y asesorías, se han formado a un total de 4638 profesionales sanitarios con un total de 25 229 horas lectivas, se han realizado un total de 115 actividades de investigación entre proyectos de investigación, publicaciones, ponencias y comunicaciones tanto nacionales como internacionales. Se han tutorizado a 274 alumnos pre y posgrado en difusión del conocimiento entre cursos, seminarios, tutorizaciones, coordinaciones y desde la competencia clínica se ha llevado a cabo un total de 944 valoraciones, seguimientos y evaluaciones de pacientes con heridas crónicas complejas. Conclusiones: Las competencias que desarrolla la EPA-HCC conlleva una serie de atributos que la definen como una enfermera líder en la complejidad de los cuidados, coordinadora de atención compleja y gestión proactiva de problemas de salud, consultora y referente de aprendizaje, promotora de investigación y motor de cambio a través del liderazgo

Aim: To evaluate the impact of the implementation and creation of the EPA-HCC in Andalusia from the perspective of their competencies and the leadership in optimizing the specific needs of people with HCC and their families, ensuring continuity of care. Method: A cross-sectional descriptive study is presented that describes the main roles developed by the HPS-EPA in four health districts (HD) of Andalusia since its implementation from June 2015 to June 2018. The main variables are the competencies in: consulting, learning and continuous training, research, and knowledge dissemination and clinical. Results: A total of 4386 consultancies have been obtained, a total of 4638 health professionals have been trained with a total of 25 229 learning hours, and a total of 115 research activities have been carried out among national and international research projects, publications, presentations and communications. 274 students from pre and post grade have been tutorized in the dissemination of knowledge between courses, seminars, tutorials, coordination. From the clinic competence, a total of 944 assessments, follow-ups and evaluations of patients with complex chronic wounds have been carried out. Conclusions: The competences developed by the EPA-HCC entail a series of attributes that define it as a leader nurse in the complexity of care, a complex care coordinator and a proactive health problem management, a consultant and reference for learning, and a promoter of research and engine of change through leadership

Estudio y descripción anatómica de vías de abordaje del astrágalo / Anatomical study of surgical approaches to the talus

Estudio anatómico descriptivo de las diferentes vías de abordaje de astrágalo, con documentación fotográfica, utilizando técnica en 3 dimensiones. Este estudio tiene como objetivo evaluar puntos de referencia macroscópicos, planos anatómicos, estructuras en riesgo, campo de visualización y posible aplicabilidad de cada vía de abordaje para ayudar a la toma de decisiones en el momento de la planificación quirúrgica ante una fractura de astrágalo. Dieciocho especímenes frescos y 2 inyecciones con látex en la arteria poplítea fueron estudiados realizando 2 veces cada vía de abordaje con documentación fotográfica. Este estudio propone la necesidad de realizar una correcta planificación prequirúrgica para elegir la mejor vía de abordaje en cada caso y la importancia de realizar, en la gran mayoría de casos, la vía combinada para conseguir una reducción correcta

Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction

El trabajador con problemas de salud mental. Pautas generales de detección, intervención y prevención / Workers with mental health problems. General guidelines for detection, intervention and prevention

Numerosos estudios han demostrado las relaciones entre condiciones psicosociales del trabajo y la salud mental de los empleados, y especialmente cómo la combinación de bajo control percibido y altas demandas laborales predicen determinados problemas de salud mental. Trastornos mentales tales como los de ansiedad y depresión tienen un efecto muy negativo sobre la calidad de vida y la capacidad funcional en el trabajo. Además, la salud mental del trabajador puede afectar a la percepción de las características del trabajo. Como consecuencia, es fundamental diseñar trabajos saludables, programas de reducción de estrés para los empleados y para la reincorporación laboral de empleados con trastornos mentales. El objetivo del presente artículo es revisar las principales líneas de prevención, detección e intervención en las organizaciones, que pueden promover políticas saludables para la atención e integración de los trabajadores con trastorno mental (AU)

Numerous studies have demonstrated the relationship between psychosocial work conditions and the mental health of employees, and especially the combination of low perceived control and high labor demands predicts mental health problems. Mental health disorders such us anxiety or depression have a big detrimental effect on the individual’s quality of life and the ability to function in the workplace. Mental health may also affect the perception of work characteristics. As a consequence, it is essential to design healthy jobs, stress reduction programs and return to work programs for employees with mental disorders. The aim of this paper is to review the main lines of prevention, detection and intervention in organizations that can promote healthy policies for the care and integration of workers with mental disorder (AU)

Utilidad preventiva del constructo “trastorno mental grave” en el ámbito sociosanitario / Preventive usefulness of the concept “serious mental disorder” in social-sanitary area

Introducción: El constructo “trastorno mental grave” (TMG) puede ser muy útil en la práctica clínica y no sólo en el ámbito de la gestión de los recursos, al permitir diseñar intervenciones preventivas, diagnósticas y terapéuticas efectivas, especialmente en el sector servicios y en profesiones de alta fiabilidad y seguridad (sanidad, defensa, transporte, etc.) en las que los errores suelen tener consecuencias directas adversas para la vida de las personas y los que se debe garantizar la máxima calidad y la seguridad de los usuarios.Objetivos: Revisar los principales aspectos a considerar en la elaboración de protocolos de intervención laboral ante trastornos mentales graves.Método: Revisión de la bibliografía disponible.Conclusiones: Se proponen herramientas y procedimientos de utilidad para afrontar los casos clínicosgraves en el ámbito laboral sanitario, mejorar la calidad asistencial y contribuir a garantizar la seguridad de los usuarios y de los sanitarios enfermos (AU)

Introduction: The concept of “serious mental disorder” (SMD) can be very useful in clinical medical practice, not only in the management resources area, allowing to design preventive, diagnostic and therapeutic effective interventions, but also in service area and in high reliability and security professions, such as health,defence, transport and so on. In these cases mistakes use to have direct and adverse consequences for people’s life that is way a maximum quality and safety must be guaranteed for the users.Objective: To check the principal aspects to consider in the production of intervention protocols formental serious disorders in the workplace.Method: Review of the available bibliography. Conclusions: This article proposes tools and procedures to deal with serious clinical cases in health professional field in order to improve the attendance quality, contributing to the safety of the health workers and users (AU)

El paciente que padece un trastorno depresivo en el trabajo / The patient with depression at work

La distinción entre sentimientos de tristeza normal, síndrome de desgaste profesional y los trastornos depresivos propiamente dichos, no siempre es fácil. En demasiadas ocasiones se carece de protocolos de actuación adecuados y las propias condiciones laborales impiden un abordaje satisfactorio e integral; es más, dichas condiciones pueden incluso actuar como desencadenantes, mantenedores o mediadores de muchos de estos problemas.La depresión es una enfermedad como otra cualquiera y que nos puede pasar a cualquiera, pero en más de la mitad de los casos tiende a cronificarse y/o complicarse con otras enfermedades. Las consecuencias serán muy negativas, tanto en los trabajadores como en las organizaciones, si no se diagnostica de forma precoz y no se trata de forma efectiva. Con este objetivo, se revisa cada subtipo de trastorno, sus posibles efectos y reconocimiento en el trabajo, el abordaje de la persona afectada y el tratamiento (AU)

The distinction among normal feelings of sadness, burnout and depressive disorders is not always easy to differentiate. In too many occasions, we lack the accurate procedures to deal with these problems and very often work conditions are an impediment to carry out a satisfactory and complete approach. These conditions can even originate, keep or mediate in many of the cases.Depression is a disease as any other and anyone can have it, but more of the 50% of the cases tend to cronify or complicate with other diseases. If we don’t do an early diagnosis to treat it in an effective way, the consequences will be very negative for workers and organizations. With this purpose we review each type of depressive disorder, its possible effects and recognition at work to approach an treat the ill person (AU)

Toxicidad pulmonar grave relacionada con la administración de gemcitabina / Fatal gemcitabine administration related pulmonary toxicity

No disponible

Alucinaciones por administración de una pauta estándar de claritromicina / No disponible

No disponible