The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.
Magnetic Resonance Imaging , Temporomandibular Joint Disc , Temporomandibular Joint Disorders , Humans , Retrospective Studies , Magnetic Resonance Imaging/methods , Male , Female , Adult , Temporomandibular Joint Disc/diagnostic imaging , Temporomandibular Joint Disc/pathology , Temporomandibular Joint Disorders/diagnostic imaging , Middle Aged , Reproducibility of Results , Adolescent , Young Adult , Arthroscopy , Aged , Child
Context: Several curricular initiatives have been developed to improve the acquisition of research competencies by Health Science students. Objectives: To know how students self-perceived of whether their participation in the XIV National Research Congress for Undergraduate Students of Health Sciences had helped them in the acquisition of 36 research-related transferable competencies (TCs) common to Health Science degrees. Methods: A survey design (Cronbach's alpha = 0.924), using a self-administered questionnaire, was conducted among undergraduate students who voluntarily participated in the Congress. Data analysis was performed using SPSS 25 and Statgraphics 19. Statistical significance was considered for P < 0.05. Results: Eighty-one students from 12 Health Science degree programs responded. Key findings are presented in a structured manner, using a Likert-5 scale. Twenty-five of the competencies surveyed obtained an average ≥ 4 highlighting: "Critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret, and communicate scientific and health information"; "To be able to formulate hypotheses, collect and critically evaluate information for problem solving, following the scientific method", "Critical analysis and research" and "Communicate effectively and clearly, orally and in writing with other professionals". Significance was found in 15 competencies. The development of the competencies "Teamwork", "Critical reasoning" and "Analysis and synthesis abilities" was considered to be of greater "personal utility" by the respondents. Conclusion: Participation in this event contributed to the development of research-related TCs, critical analysis and information management and communication, especially in relation to learning the sources of clinical and biomedical information, to know, following the scientific method, how to formulate hypotheses that allow students to solve problems in their professional activity. The experience was significantly influenced by the respondents' year, the type of participation in the event and the gender of the students. Limitations and suggestions regarding future research are discussed to encourage further exploration of the topic.
Hepatic ischemia/reperfusion injury (IRI) can seriously impair liver function. It is initiated by oxidative stress, resulting in inflammation and apoptosis-induced cellular damage. Glutathione (GSH) prevents oxidative stress. S-Adenosylmethionine (SAMet) is a GSH synthesis precursor that avoids the deficit in SAMet-synthetase activity and contributes to intracellular ATP repletion. It also acts as a methyl group donor, stabilizing hepatocyte membranes, among other functions. This study investigated the effect of SAMet on bacterial translocation and levels of proinflammatory cytokines, oxidative stress and apoptosis markers in male Wistar rats subjected to hepatic IRI. Animals were randomly divided into six groups: (1) sham operation, (3) animals undergoing 60 min of ischemia of the right lateral lobe for temporary occlusion of the portal vein and hepatic artery plus 10 min of reperfusion, and (5) the same as (3) but with a reperfusion period of 120 min. Groups 2, 4 and 6, respectively, are the same as (1), (3) and (5), except that animals received SAMet (20 mg/kg) 15 min before ischemia. GSH, ATP, lipid peroxidation (LPO), TNF-α, IL-1ß, IL-6, total caspase-1 and caspase-9, total and cleaved caspase-3, and phosphatidylcholine were determined in the liver. Endotoxin, TNF-α, IL-1ß, IL-6, IL-10 and LPO in vena cava and portal vein blood samples were also measured. Endotoxin and LPO levels as well as proinflammatory cytokines and apoptotic markers increased significantly in animals undergoing IRI, both after 10 and 120 min of reperfusion. IRI produced a significant decrease in GSH, ATP, portal IL-10 and phosphatidylcholine. SAMet treatment prevented these effects significantly and increased survival rate. The study suggests that SAMet exerts protective effects in hepatic IRI.
INTRODUCTION: In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. METHODS: A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score-mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score-MCIS-NISS). Casualty severity were grouped by severity levels (mild-scores: 1-8, moderate-scores: 9-15, severe-scores: 16-24, and critical-scores: 25-75). RESULTS: Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. CONCLUSION: Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.
Military Personnel , Wounds and Injuries , Wounds, Gunshot , Adult , Cross-Sectional Studies , Female , Humans , Injury Severity Score , Male , Retrospective Studies , Wounds, Gunshot/epidemiology
BACKGROUND: The treatment of high-grade arteriovenous malformations (AVMs) remains challenging. Microsurgery provides a rapid and complete occlusion compared with other options but is associated with undesirable morbidity and mortality. The aim of this study was to compare the occlusion rates, incidence of unfavorable outcomes, and cost-effectiveness of embolization and stereotactic radiosurgery (SRS) as a curative treatment for high-grade AVMs. METHODS: A retrospective series of 57 consecutive patients with high-grade AVM treated with embolization or SRS, with the aim of achieving complete occlusion, was analyzed. Demographic, clinical, and angioarchitectonic variables were collected. Both treatments were compared for the occlusion rate and procedure-related complications. In addition, a cost-effectiveness analysis was performed. RESULTS: Thirty patients (52.6%) were men and 27 (47.4%) were women (mean age, 39 years). AVMs were unruptured in 43 patients (75.4%), and ruptured in 14 patients (24.6%). The presence of deep venous drainage, nidus volume, perforated arterial supply, and eloquent localization was more frequent in the SRS group. Complications such as hemorrhage or worsening of previous seizures were more frequent in the embolization group. No significant differences were observed in the occlusion rates or in the time necessary to achieve occlusion between the groups. The incremental cost-effectiveness ratio for endovascular treatment versus SRS was $53.279. CONCLUSIONS: Both techniques achieved similar occlusion rates, but SRS carried a lower risk of complications. Staged embolization may be associated with a greater risk of hemorrhage, whereas SRS was shown to have a better cost-effectiveness ratio. These results support SRS as a better treatment option for high-grade AVMs.
Endovascular Procedures/methods , Intracranial Arteriovenous Malformations/therapy , Radiosurgery/methods , Adolescent , Adult , Aged , Aged, 80 and over , Cerebral Intraventricular Hemorrhage/physiopathology , Child , Child, Preschool , Cost-Benefit Analysis , Endovascular Procedures/economics , Female , Humans , Intracranial Arteriovenous Malformations/physiopathology , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/physiopathology , Male , Middle Aged , Radiosurgery/economics , Seizures/physiopathology , Treatment Outcome , Young Adult
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery
La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes, las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC), ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva
Humans , Consensus Development Conferences as Topic , Societies, Medical/organization & administration , Antibiotic Prophylaxis/standards , Surgical Procedures, Operative/standards , Societies, Medical/standards , Antibiotic Prophylaxis/methods , Infection Control/organization & administration
La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery
Humans , Consensus Development Conferences as Topic , Consensus , Societies, Medical/standards , Antibiotic Prophylaxis/standards , Surgical Procedures, Operative/standards , Surgical Wound Infection/prevention & control , Projects
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
Communicable Diseases , Surgeons , Antibiotic Prophylaxis , Consensus , Humans , Surgical Wound Infection/prevention & control
La infección de localización quirúrgica se asocia a prolongación de la estancia hospitalaria, aumento de la morbilidad, mortalidad y gasto sanitario. La adherencia a paquetes sistematizados que incluyan medidas de prevención validadas científicamente consigue disminuir la tasa de infección postoperatoria. La Sección de Infección Quirúrgica de la Asociación Española de Cirujanos ha realizado una revisión crítica de la evidencia científica y las más recientes guías internacionales, para seleccionar las medidas con mayor grado de evidencia a fin de facilitar su aplicación en los servicios de cirugía españoles. Cuentan con mayor grado de evidencia: no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica, descontaminación de la piel con soluciones alcohólicas, profilaxis antibiótica sistémica adecuada (inicio 30-60 minutos antes de la incisión, uso preferente en monodosis, administración de dosis intraoperatoria si indicada), mantenimiento de la normotermia y el control de la glucemia perioperatoria
Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60 minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels
Humans , Preoperative Care/methods , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis/methods , Baths , Blood Glucose , Body Temperature , Disinfection/methods , Gloves, Surgical , Hair Removal , Hand Hygiene , Immune System , Immunologic Factors/administration & dosage , Malnutrition/therapy , Negative-Pressure Wound Therapy , Nutritional Status , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Surgical Attire , Surgical Drapes , Spain
Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels.
Preoperative Care/methods , Surgical Wound Infection/prevention & control , Administration, Oral , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis/methods , Baths , Blood Glucose , Body Temperature , Carrier State/drug therapy , Disinfection/methods , Gloves, Surgical , Hair Removal , Hand Hygiene , Humans , Immune System , Immunologic Factors/administration & dosage , Malnutrition/therapy , Negative-Pressure Wound Therapy , Nutritional Status , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Surgical Attire , Surgical Drapes , Therapeutic Irrigation , Withholding Treatment
Objective: Our aim was to describe our antimicrobial stewardship program and the methodology based on the results in a surgical department. Methods: Our study was a quasi-experimental study conducted from January 1, 2009, through September 30, 2017. The site was the General and Digestive Surgery Department in a public primary referral center, the University Hospital of Getafe (Madrid, Spain). We implemented the antimicrobial stewardship program following a prospective audit and feedback model, with a surgeon incorporated into the manaagement group. We studied the deaths and 30-day re-admission rates, length of stay, prevalence of gram-negative bacilli, meropenem resistance, and days of treatment with meropenem. Results: After three years of the program, we recorded a significant decrease in Pseudomonas aeruginosa prevalence, a significant increase in Klebsiella pneumoniae prevalence, a decrease in meropenem resistance, and a reduction in meropenem days of treatment. Conclusions: Antimicrobial stewardship programs have a desirable effect on patients. In our experience, the program team should be led by a staff from the particular department. When human resources are limited, the sustainability, efficiency, and effectiveness of interventions are feasible only with adequate computer support. Finally, but no less important, the necessary feedback between the prescribers and the team must be based on an ad hoc method such as that provided by statistical control charts, a median chart in our study.
Antimicrobial Stewardship , Surgery Department, Hospital , Aged , Aged, 80 and over , Antimicrobial Stewardship/methods , Antimicrobial Stewardship/organization & administration , Cross Infection/epidemiology , Cross Infection/prevention & control , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/prevention & control , Hospital Mortality , Hospitals, University/organization & administration , Hospitals, University/statistics & numerical data , Humans , Klebsiella Infections/epidemiology , Klebsiella Infections/prevention & control , Klebsiella pneumoniae , Length of Stay , Middle Aged , Patient Readmission/statistics & numerical data , Program Development , Pseudomonas Infections/epidemiology , Pseudomonas Infections/prevention & control , Spain , Surgery Department, Hospital/organization & administration
BACKGROUND: Transcylindrical cholecystectomy (TC) can be performed under local anaesthesia and sedation (LAS) in ambulatory surgery (AS). The aim of this study was to assess the feasibility and results of TC under LAS. METHODS: TC under LAS was proposed to 583 consecutive patients with cholelithiasis in an AS unit. For the TC procedure, a cylindrical retractor with a transparent plunger was inserted into the hepatocystic triangle, and cholecystectomy was performed through the retractor with reusable open instruments. Pre-, intra-, and post-operative variables were prospectively registered, including complications, reasons for conversion to general anaesthesia (GA), non-programmed admissions, readmissions, pain assessments, and satisfaction with the procedure. RESULTS: Five hundred patients were eligible for LAS, with GA being required in 128 (25.6%) of them. AS was programmed for 447 patients. The rates of non-programmed admissions, readmissions, and conversion to laparotomy were 8.7% (39), 0.8% (4), and 2.6% (13), respectively. There was no main bile duct injury. At 24 h, physical status was good or excellent in 80.4% of the patients. A history of acute cholecystitis, male sex, a body mass index (BMI) ≥ 39.5 kg/m2, and non-suspected acute cholecystitis were found to be independent variables associated with conversion to GA. CONCLUSIONS: TC under LAS is a safe procedure in AS and is feasible in 74% of cholelithiasis patients. Male sex, BMI, gallbladder wall thickness, and a history of acute cholecystitis are factors that increase the probability of conversion to GA. This prospective study was approved by the ethics committee of Badajoz for patient protection for biomedical research and has been retrospectively registered under the research registry UIN: researchregistry3979.
Cholecystectomy/methods , Cholelithiasis/surgery , Adult , Aged , Anesthesia, Local , Cholecystectomy/instrumentation , Conscious Sedation , Feasibility Studies , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Minimally Invasive Surgical Procedures/methods , Prospective Studies , Surgical Wound
Anisakiasis is a global disease caused by consumption of raw or lightly cooked fish parasitised with Anisakis spp. third-stage larvae. Cases in the literature show colocalised anisakiasis and colorectal cancer, and the incidental finding of Anisakis larvae at the tumour site was reported. Data from our group suggested an epidemiological link between previous infection and gastrointestinal cancer. Furthermore, it has recently been reported that Anisakis products lead to inflammation and DNA damage. Based on these facts, the aim was to investigate whether Anisakis antigens are able to induce changes in the proliferation of epithelial cells in vitro or in the expression of serum microRNA (miRNA) in Sprague-Dawley rats. Anisakis complete extract (CE) induced increases in cell proliferation and decreases in apoptosis compared with nontreated cells, which resulted in a significant increase in the absolute number of viable cells at 48 h of exposure (P < .05). Furthermore, the miRNAs mmu-miR-1b-5p and mmu-miR-10b-5p (a cancer-related miRNA) were significantly decreased (P < .05) in sera from the rats inoculated with Anisakis CE, compared with control rats inoculated with saline. Additionally, based on their relative quantification values, four other cancer-related miRNAs were considered to be differently expressed, rno-miR-218a-5p and mmu-miR-224-5p (decreased) and rno-miR-125a-3p and rno-miR-200c-3p (increased). Anisakis CE was able to induce changes both in epithelial cells in vitro and in an animal model. The results obtained with Anisakis CE, in terms of increasing cell proliferation, decreasing apoptosis and inducing changes in the expression of serum cancer-related miRNAs in rats, suggest that Anisakis could have tumourigenic potential.
Anisakiasis/parasitology , Anisakis/isolation & purification , Neoplasms/parasitology , Animals , Anisakiasis/genetics , Anisakiasis/metabolism , Anisakiasis/physiopathology , Anisakis/classification , Anisakis/genetics , Apoptosis , Cell Proliferation , DNA Damage , Disease Models, Animal , Epithelial Cells/cytology , Epithelial Cells/metabolism , Epithelial Cells/parasitology , Humans , Male , MicroRNAs/genetics , MicroRNAs/metabolism , Neoplasms/genetics , Neoplasms/metabolism , Neoplasms/physiopathology , Pilot Projects , Rats , Rats, Sprague-Dawley
BACKGROUND: Malnutrition is particularly prevalent among intensive care unit (ICU) patients, being associated with poor clinical results. Enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established by the Spanish Society of Critical Care (SEMICYUC) as a clinical quality indicator (CQI; EN patients correctly monitorized / all EN patients, as %). However, no results have been published on its regulated monitoring. OBJECTIVES: Assessing CQI's compliance, identifying difficulties and possibilities for its use. METHODS: In a recent 18-month period, the CQI was assessed in ICU patients following SEMYCIUC criteria. RESULTS AND CONCLUSION: This CQI, although offered as a unique indicator, has different components, giving rise to multiple results. The settled standard (100%) was only reached by some of these components, i.e.: feeding tube position control plus verification of vomiting, regurgitation and aspiration. We propose to elaborate a daily checklist, including the different components that integrate this CQI, for its joint completion by nurses and physicians for all patients receiving EN.
INTRODUCCIÓN: la desnutrición es particularmente prevalente en unidades de cuidados intensivos (UCI), asociándose con malos resultados clínicos. La nutrición enteral (NE) presenta múltiples beneficios en pacientes críticos y su monitorización ha sido establecida por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) como indicador clínico de calidad (ICC; pacientes con NE correctamente monitorizados/todos los pacientes con NE, en %). Sin embargo, no se han publicado resultados sobre su monitorización reglada. OBJETIVOS: evaluar el cumplimiento del ICC "monitorización de la NE", identificando dificultades y posibilidades para su utilización. METODOLOGÍA: durante 18 meses, el ICC fue monitorizado en pacientes de UCI según criterios de SEMICYUC. RESULTADOS Y CONCLUSIÓN: el ICC, aunque se presenta como único, tiene múltiples componentes, originando múltiples resultados difíciles de compilar. El estándar establecido (100%) solo fue alcanzado en control de la sonda y verificación de vómitos, regurgitación y broncoaspiración. Proponemos elaborar un listado de verificación diaria, incluyendo todos los aspectos contemplados, para su puesta en común entre los estamentos médicos y de enfermería, para cada paciente con NE.
Enteral Nutrition/methods , Intensive Care Units/standards , Monitoring, Physiologic/methods , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care/standards , Female , Humans , Male , Middle Aged , Young Adult
Introducción: la desnutrición es particularmente prevalente en unidades de cuidados intensivos (UCI), asociándose con malos resultados clínicos. La nutrición enteral (NE) presenta múltiples beneficios en pacientes críticos y su monitorización ha sido establecida por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) como indicador clínico de calidad (ICC; pacientes con NE correctamente monitorizados/todos los pacientes con NE, en %). Sin embargo, no se han publicado resultados sobre su monitorización reglada. Objetivos: evaluar el cumplimiento del ICC "monitorización de la NE", identificando dificultades y posibilidades para su utilización. Metodología: durante 18 meses, el ICC fue monitorizado en pacientes de UCI según criterios de SEMICYUC. Resultados y conclusión: el ICC, aunque se presenta como único, tiene múltiples componentes, originando múltiples resultados difíciles de compilar. El estándar establecido (100%) solo fue alcanzado en control de la sonda y verificación de vómitos, regurgitación y broncoaspiración. Proponemos elaborar un listado de verificación diaria, incluyendo todos los aspectos contemplados, para su puesta en común entre los estamentos médicos y de enfermería, para cada paciente con NE (AU)
Background: Malnutrition is particularly prevalent among intensive care unit (ICU) patients, being associated with poor clinical results. Enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established by the Spanish Society of Critical Care (SEMICYUC) as a clinical quality indicator (CQI; EN patients correctly monitorized / all EN patients, as %). However, no results have been published on its regulated monitoring. Objectives: Assessing CQIs compliance, identifying difficulties and possibilities for its use. Methods: In a recent 18-month period, the CQI was assessed in ICU patients following SEMYCIUC criteria. Results and conclusion: This CQI, although offered as a unique indicator, has different components, giving rise to multiple results. The settled standard (100%) was only reached by some of these components, i.e.: feeding tube position control plus verification of vomiting, regurgitation and aspiration. We propose to elaborate a daily checklist, including the different components that integrate this CQI, for its joint completion by nurses and physicians for all patients receiving EN (AU)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Critical Care/methods , Enteral Nutrition/standards , Nutrition Disorders/diet therapy , Monitoring, Physiologic/methods , Malnutrition/diet therapy , Intensive Care Units/standards , Quality of Health Care/standards , Quality Indicators, Health Care/trends , Nutritional Support/standards , Enteral Nutrition/adverse effects
BACKGROUND: Early enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established as a clinical quality indicator (CQI) for intensive care units (ICU) by the Spanish Society of Critical Care (SEMICYUC). However, no results have been published on the systematized monitoring of this CQI. OBJECTIVE: To assess the compliance of the CQI "Early EN" at ICU. METHODS: A retrospective longitudinal study was conducted on 386 consecutive ICU patients receiving EN. Data were collected including time from admission until EN was started, as well as clinical results. SPSS statistics software was used for analysis and the CQI was assessed according to SEMYCIUC criteria. RESULTS AND CONCLUSION: CQI's compliance was 70.2%, not reaching the settled standard of 100%. Barriers preventing CQI compliance ought to be analyzed and its standard of 100% reconsidered.
Enteral Nutrition/methods , Intensive Care Units , Nutrition Assessment , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care , Critical Illness , Female , Humans , Longitudinal Studies , Male , Middle Aged , Retrospective Studies , Young Adult
Introducción: la nutrición enteral (NE) precoz presenta múltiples beneficios en pacientes críticos y su monitorización ha sido establecida por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) como indicador clínico de calidad (ICC) para unidades de cuidados intensivos (UCI). Sin embargo, no se han publicado resultados sobre la monitorización reglada de dicho indicador. Objetivo: evaluar el cumplimiento del ICC NE precoz. Métodos: estudio longitudinal retrospectivo en 386 pacientes consecutivos de UCI que recibieron NE. Se recogieron variables básicas, número de horas transcurridas desde el ingreso hasta instaurarse la NE y resultado clínico de los pacientes. Para el análisis estadístico se empleó el software SPSS Statistics y el ICC fue evaluado mediante criterios de SEMICYUC. Resultados y conclusión: el cumplimiento del ICC fue del 70,2%, no alcanzando el estándar establecido (100%). Es necesario analizar las barreras que impiden el cumplimiento del estándar de este ICC y reconsiderar su valor del 100% (AU)
Background: Early enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established as a clinical quality indicator (CQI) for intensive care units (ICU) by the Spanish Society of Critical Care (SEMICYUC). However, no results have been published on the systematized monitoring of this CQI. Objective: To assess the compliance of the CQI «Early EN» at ICU. Methods: A retrospective longitudinal study was conducted on 386 consecutive ICU patients receiving EN. Data were collected including time from admission until EN was started, as well as clinical results. SPSS statistics software was used for analysis and the CQI was assessed according to SEMYCIUC criteria. Results and conclusion: CQI's compliance was 70.2%, not reaching the settled standard of 100%. Barriers preventing CQI compliance ought to be analyzed and its standard of 100% reconsidered (AU)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Enteral Nutrition , Critical Care/methods , Quality of Health Care , Longitudinal Studies , Retrospective Studies , 28599
Las epidemias por virus altamente transmisibles como la enfermedad por virus del Ébola (EVE) pueden generar casos importados a Europa y América. Aunque la probabilidad de actuación quirúrgica en ellas es baja, la Asociación Española de Cirujanos ha elaborado un protocolo de actuación quirúrgica. INDICACIÓN: No está indicada la cirugía electiva. Puede necesitarse cirugía urgente en: personas en observación, casos probables y casos confirmados en fase precoz. En algunas condiciones de habitual tratamiento quirúrgico puede instaurarse una terapia médica conservadora con intención de evitar la intervención. HOSPITALES Y EQUIPOS: Los casos deben concentrarse en hospitales de alta especialización, únicos centros en los que se practique una eventual intervención quirúrgica. Estos deben garantizar la seguridad de los profesionales. Los equipos quirúrgicos han de recibir extensa formación mediante simulación. PROTOCOLO QUIRÚRGICO: Las recomendaciones se basan en protocolos de uso del equipo de protección individual, guías clínicas de otras sociedades y recomendaciones específicas para el área quirúrgica
Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment
Humans , Hemorrhagic Fever, Ebola/complications , Clinical Protocols , Virus Diseases/complications , Marburg Virus Disease/complications , Lassa Fever/complications , Hemorrhagic Fever, Crimean/complications
Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment.
Hemorrhagic Fever, Ebola , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fevers, Viral/epidemiology , Humans
