Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial.

BACKGROUND: Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease. METHODS: This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP's quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables. DISCUSSION: The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.

Terapia larval, una buena herramienta para el desbridamiento de úlceras complejas / Larval therapy, a good tool for the debridation of complex ulcers

Las úlceras afectan predominante-mente a los miembros inferiores. A nivel mundial representan un impor-tante problema sanitario, en cuanto a su prevalencia, gasto de recursos eco-nómicos y afectación socio funcional de los pacientes, que ven mermada en gran medida su calidad de vida y en ocasiones pueden ser precursoras de una pérdida de la extremidad. En nuestra práctica diaria dispone-mos un amplio abanico de opcio-nes de tratamiento con pomadas y apósitos con diferentes propiedades. Deberemos escoger el más adecua-do en cada caso, en función de la etiología de la úlcera, del aspecto de la misma o de la presencia o no de infección. Para el desbridamiento de úlceras difíciles y complejas la terapia larval resulta útil y efectiva cuando los medios habituales no han sido efectivos, favoreciendo y acelerando el proceso de limpieza de la úlcera con eliminación de la fibrina y del bio-film hasta favorecer su granulación. Pueden utilizarse en úlceras infecta-das con muy buenos resultados, su manejo es sencillo y bien tolerado por el paciente. (AU)

Ulcers predominantly affect the lower limbs. Worldwide, they rep-resent an important health prob-lem, in terms of their prevalence, expenditure of economic resources and socio-functional affectation of patients, who see their quality of life greatly diminished and can some-times be precursors of a loss of the limb.In our daily practice we have a wide range of treatment options to wound care with ointments and dressings with different properties. We must choose the most appropri-ate in each case, depending on the etiology of the ulcer, its appearance or the presence or absence of infec-tion. For the debridement of difficult and complex ulcers, larval therapy is useful and effective when the usual means have not been effective, fa-voring and accelerating the process of cleaning the ulcer with the elim-ination of fibrin and biofilm until it favors granulation. They can be used in infected ulcers with very good results, their handling is simple and well tolerated by the patient. (AU)

Síndrome de robo de la subclavia tras tratamiento endovascular de aorta torácica / Subclavian steal syndrome after endovascular treatment of the thoracic aorta

Introducción: el síndrome de robo de la subclavia es una entidad poco habitual que se presenta en pacientes con estenosis u oclusión de la arteria subclavia, habitualmente la izquierda, y secundario a ateroesclerosis. Los síntomas derivados de esta entidad son: la isquemia del miembro superior y los síntomas neurológicos. Caso clínico: se presenta un caso de un varón que, tras cinco meses de tratamiento endovascular de úlcera de aorta torácica penetrante, presenta síntomas neurológicos. Se realizó diagnóstico del síndrome a través de eco Doppler y se confirmó con angio RM. Finalmente, y debido a la incapacidad que producían los síntomas, se decidió tratamiento quirúrgico mediante cirugía de bypass carótido subclavio izquierdo. Discusión: el síndrome del robo de la subclavia es una entidad que raramente se presenta asociada a síntomas. Debe tenerse una alta sospecha para diagnosticarlo y tratarlo si es necesario. Aunque la tendencia actual es el tratamiento endovascular, en ocasiones la cirugía de derivación tradicional es la única opción. Siempre que sea posible, debe estudiarse la dominancia de las arterias vertebrales antes de ocluir la arteria subclavia en los procedimientos. (AU)

Introduction: subclavian steal syndrome is a rare entity, occurring in patients with stenosis or occlusion of the subclavian artery, usually the left subclavian artery and secondary to atherosclerosis. The symptoms derived from this entity are: ischemia of the upper limb and neurological symptoms. Case report: we present a case of a man who, after five months of endovascular treatment of penetrating thoracic aortic ulcer, presented neurological symptoms. The syndrome was diagnosed by echo-Doppler and confirmed by MRI angiography. Finally, due to the incapacity caused by the symptoms, surgical treatment was decided by left carotid-subclavian bypass. Discussion: subclavian steal syndrome is an entity rarely presents with symptoms, it must be highly suspected in order to diagnose it and, if necessary, treat it. Although, the current trend is endovascular treatment, sometimes traditional bypass surgery is the only option. Whenever possible, the dominance of the vertebral arteries should be studied before occluding the subclavian artery in the procedures. (AU)

A propósito de un caso de fístula aortocava / Aortic-vena cava fistula

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