Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns.

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

Diagnóstico de meningitis/encefalitis en UCI con sistema de PCR múltiple. ¿Es tiempo de cambio? / Meningitis/Encephalitis diagnosis in ICU using Multiplex PCR system: is it time of change?

OBJETIVO: Evaluar el impacto clínico de la PCR-múltiple FilmArray(R) panel Meningitis/Encefalitis en el diagnóstico de infecciones del sistema nervioso central y comparar los resultados obtenidos y el tiempo necesario hasta el diagnóstico con las técnicas microbiológicas convencionales. PACIENTES Y MÉTODOS: Estudio prospectivo observacional en una Unidad de Cuidados Intensivos (UCI) de adultos de un hospital de tercer nivel. Se realizó punción lumbar a todos los pacientes y en el LCR extraído se realizó FilmArray(R) panel de meningitis /encefalitis, estudio citoquímico, Gram y cultivos microbiológicos convencionales. RESULTADOS: 21 pacientes ingresados con sospecha de Meningitis/Encefalitis. Edad: mediana 58,4 años (RIQ 38,1-67,3), APACHE II: mediana 18 (RIQ 12-24). La mediana de estancia en UCI fue de 4 días (RIQ 2-6) y la hospitalaria de 17 días (RIQ 14-28). Mortalidad 14,3%. Se estableció un diagnóstico clínico final de Meningitis/Encefalitis en 16 pacientes, con diagnóstico etiológico en 12 casos (75%). La etiología más frecuente fue Streptococcus pneumoniae (8 casos). FilmArray(R) permitió diagnóstico etiológico en 3 casos con cultivo negativo y el resultado implicó cambios en el tratamiento antibiótico de 7 de los 16 pacientes (43,8%). Para la totalidad de pacientes, FilmArray(R) presentó una sensibilidad y especificidad del 100% y 90% respectivamente. La mediana de tiempo hasta la obtención del resultado de FilmArray(R) fue de 2,9 horas (RIQ 2,1-3,8) y del cultivo incluyendo antibiograma 45,1 horas (RIQ 38,9-58,7). CONCLUSIONES: FilmArray(R) panel Meningitis/Encefalitis realiza un diagnóstico etiológico más precoz que los cultivos convencionales, muestra una mayor sensibilidad y permite realizar un tratamiento antimicrobiano dirigido

OBJECTIVE: To evaluate the clinical impact of Meningitis/Encephalitis FilmArray(R) panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques. PATIENTS AND METHODS: A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray(R) panel ME, cytochemical study, Gram, and conventional microbiological cultures. RESULTS: A total of 21 patients admitted with suspicion of Meningitis/Encephalitis. Median age of patients was 58.4 years (RIQ 38.1-67.3), median APACHE II 18 (RIQ 12-24). Median stay in ICU and median hospital stay was 4 (RIQ 2-6) and 17 days (RIQ 14-28), respectively. The overall mortality was 14.3%. A final clinical diagnosis of meningitis or encephalitis was established in 16 patients, obtaining the etiological diagnosis in 12 of them (75%). The most frequent etiology was Streptococcus pneumoniae (8 cases). FilmArray(R) allowed etiological diagnosis in 3 cases in which the culture had been negative, and the results led to changes in the empirical antimicrobial therapy in 7 of 16 cases (43.8%). FilmArray(R) yielded a global sensitivity and specificity of 100% and 90%, respectively. The median time to obtain results from the latter and conventional culture (including antibiogram) was 2.9 hours (RIQ 2.1-3.8) and 45.1 hours (RIQ 38.9-58.7), respectively. CONCLUSIONS: The Meningitis/Encephalitis FilmArray(R) panel was able to establish the etiologic diagnosis faster than conventional methods. Also, it achieved a better sensitivity and led to prompt targeted antimicrobial therapy

Use of Machine-Learning Algorithms in Intensified Preoperative Therapy of Pancreatic Cancer to Predict Individual Risk of Relapse.

BACKGROUND: Although surgical resection is the only potentially curative treatment for pancreatic cancer (PC), long-term outcomes of this treatment remain poor. The aim of this study is to describe the feasibility of a neoadjuvant treatment with induction polychemotherapy (IPCT) followed by chemoradiation (CRT) in resectable PC, and to develop a machine-learning algorithm to predict risk of relapse. METHODS: Forty patients with resectable PC treated in our institution with IPCT (based on mFOLFOXIRI, GEMOX or GEMOXEL) followed by CRT (50 Gy and concurrent Capecitabine) were retrospectively analyzed. Additionally, clinical, pathological and analytical data were collected in order to perform a 2-year relapse-risk predictive population model using machine-learning techniques. RESULTS: A R0 resection was achieved in 90% of the patients. After a median follow-up of 33.5 months, median progression-free survival (PFS) was 18 months and median overall survival (OS) was 39 months. The 3 and 5-year actuarial PFS were 43.8% and 32.3%, respectively. The 3 and 5-year actuarial OS were 51.5% and 34.8%, respectively. Forty-percent of grade 3-4 IPCT toxicity, and 29.7% of grade 3 CRT toxicity were reported. Considering the use of granulocyte colony-stimulating factors, the number of resected lymph nodes, the presence of perineural invasion and the surgical margin status, a logistic regression algorithm predicted the individual 2-year relapse-risk with an accuracy of 0.71 (95% confidence interval [CI] 0.56-0.84, p = 0.005). The model-predicted outcome matched 64% of the observed outcomes in an external dataset. CONCLUSION: An intensified multimodal neoadjuvant approach (IPCT + CRT) in resectable PC is feasible, with an encouraging long-term outcome. Machine-learning algorithms might be a useful tool to predict individual risk of relapse. A small sample size and therapy heterogeneity remain as potential limitations.

Utilidad de la PCR-múltiple (FilmArray Blood Culture Identification) en otros líquidos biológicos. Detección de Streptococcus pyogenes en absceso cerebral y líquido sinovial / Utility of multiplex PCR (FilmArray Blood Culture Identification) in other biological liquids. Detection of Streptococcus pyogenes in brain abscess and synovial fluid

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Muerte encefálica por neumoencéfalo y fístula dural en el postoperatorio de hernia discal lumbar / Brain death due to pneumocephalus and dural fistula in the post-operative period for a herniated lumbar disc

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Evaluación del impacto de una intervención de enfermería en la prevención y tratamiento de las úlceras por presión / The impact evaluation of a nursing intervention in the prevention and treatment of pressure ulcers

Objetivo: Evaluar el impacto de una intervención de enfermería en la prevención y tratamiento de úlceras por presión (UPP). Metodología: Diseño cuasi experimental pre- y postintervención. Resultados: La prevalencia global de UPP no varía tras la intervención (Chi2 = 1,059, p = 0,589). No obstante, descienden hasta 0 las UPP de grado III y IV, la prevalencia en la Unidad de Onco-Hematología, los pacientes con riesgo bajo que desarrollaron UPP y mejora el registro del riesgo de UPP al ingreso. Conclusiones: A pesar de estas mejoras, se continuará haciendo estudios de prevalencia para conocer la situación y poder implementar mejoras que disminuyan la tasa de prevalencia

Objective: To evaluate the impact of a nursing intervention in the prevention and treatment of pressure ulcers (PU). Methodology: Design quasi-experimental pre-post intervention. Results: The overall prevalence of PUs in our institution has not changed after surgery (Chi2 = 1.059, p = 0.589), remaining at 8.7%. However, it has fallen to 0 the number of ulcers of grade III and IV, has dropped significantly the prevalence of PU in Oncology-Hematology unit, the number of low-risk patients who developed PU and improved registration PU risk on admission. Conclusions: Despite these identified improvements will continue doing prevalence studies in order to know the situation and to implement improvement actions to reduce the prevalence rate

Papel de la enfermera coordinadora en el área de tumores hepatobiliopancreáticos / The role of the Nurse Navigator in the area of hepato-biliopancreatic tumours

INTRODUCCIÓN: los pacientes con cáncer de páncreas se enfrentan a procesos complejos y variados en los que actúan múltiples profesionales. La figura de una/o enfermera/o que coordine este proceso tiene un papel clave para facilitar la gestión y la asistencia del paciente a lo largo de toda la enfermedad. OBJETIVO: profundizar en el conocimiento de la figura de la enfermera coordinadora, en sus competencias, impacto en el cuidado de la salud y en su desarrollo en España. METODOLOGÍA: se realizó una revisión narrativa de la literatura en las bases de datos PubMed, CINAHL y en Google Académico de artículos publicados entre 1995 y 2013. Se utilizaron como palabras clave en inglés: patient navigation; nurse navigator; patient care; pancreatic cancer y en español: enfermera coordinadora; enfermera gestora; enfermera de enlace. RESULTADOS: se encontraron 25 artículos que abordan el tema. La enfermera coordinadora o patient navigator es una figura novedosa en el ámbito nacional, que surge según han ido apareciendo diferentes necesidades de salud. Se caracteriza por tener diversidad de competencias de gestión, asistencia e investigación. Tiene un impacto positivo en la satisfacción de los pacientes, pero todavía no se conoce el mismo sobre aspectos de supervivencia. CONCLUSIONES: esta figura está en creciente desarrollo y se destaca el beneficio de su intervención para abordar la complejidad del proceso de estos pacientes, coordinando y favoreciendo la atención multidisciplinar que requieren

INTRODUCTION: patients with pancreatic cancer must face complex and varied processes, where multiple professionals are involved. The figure of a nurse to coordinate this process plays a key role in order to facilitate patient management and care throughout their disease. OBJECTIVE: to probe into the awareness of the Nurse Navigator role, their responsibilities, impact on healthcare, and development in Spain. METHODOLOGY: a narrative review of literature was conducted in the PubMed and CINAHL databases, and in Academic Google, including articles published between 1995 and 2013. The following were used as key words in English: patient navigation; nurse navigator; patient care; pancreatic cancer, and in Spanish: enfermera coordinadora; enfermera gestora; enfermera de enlace.RESULTS: twenty-five (25) articles addressing this subject were found. The "enfermera coordinadora" or Patient Navigator is a novel role in our national setting, which has appeared at the same time as different health needs. Their main characteristic is to have diverse competencies in terms of management, patient care and research. This has a positive impact on patient satisfaction, but its impact on survival aspects is still unknown. CONCLUSIONS: this role is in increasing development, and the benefits of their intervention in order to address the complexity of these patients' process must be highlighted, by coordinating and assisting in the multidisciplinary care they require

Estudio de prevalencia de úlceras por presión en la Clínica Universidad de Navarra / Study of pressure ulcer prevalence in the University Clinic of Navarra

El objetivo del estudio es el conocimiento de la prevalencia de úlceras por presión en un centro hospitalario. Se realizó un estudio transversal utilizando un muestreo de conveniencia. La recogida de datos se realizó mediante un cuestionario elaborado y pilotado. En el análisis de los datos se empleó estadística descriptiva e inferencial. Este estudio nos ha permitido conocer la situación actual sobre la que partimos e implantar acciones de mejora como la difusión de los datos obtenidos, formación a los profesionales, unificación de la escala de valoración del riesgo y mejora de los registros y reevaluación de úlceras por presión (AU)

The objective of the study is the knowledge of the prevalence of ulcers by pressure in a hospital. A cross-sectional study was conducted using a sample of convenience. The collection of data was carried out using a questionnaire developed and piloted. The data analysis was descriptive and inferential statistics. This study has allowed us to know the current situation about which we assume and implement improvement actions as the dissemination of the obtained data, training professionals, unification of the scale of the risk assessment and improvement of records and re-evaluation of pressure sores (AU)

Vía Clínica. Tratamiento Del Hepatocarcinoma / The clinical pathway of treatment of hepatocellular carcinoma

Introducción: la práctica clínica habitual nos muestra la gran variabilidad presente en la atención médica en pacientes con una misma patología. Las vías clínicas son planes asistenciales integrados y sistematizados para determinados procesos. El desarrollo del proceso asistencial del tratamiento del hepatocarcinoma (HCC) se encuentra dentro del marco asistencial de los departamentos del Área de Tumores HPB (Hepatobiliopancreática), Hepatología y Cirugía General de la Clínica Universidad de Navarra (CUN). Objetivos: elaborar una vía clínica capaz de organizar, homogeneizar y estandarizar la atención de los pacientes diagnosticados de HCC y que se pueda aplicar desde el inicio hasta el final en el transcurso de esta enfermedad. Metodología: se ha definido el conjunto de actos asistenciales necesarios para atender de la mejor forma posible a un paciente que acuda a la Clínica para ser tratado de hepatocarcinoma. El ámbito del estudio se encuentra en la CUN, clínica privada que forma parte de la Universidad de Navarra. Resultado: se ha desarrollado la vía clínica del tratamiento del hepatocarcinoma, centrada en el tratamiento quirúrgico y el trasplante hepático. Conclusiones: las vías clínicas suponen una disminución de la variabilidad y un control de calidad en la práctica clínica, permitiendo analizar la información que nos proporcionan los indicadores, las encuestas de satisfacción y el registro informático de los datos(AU)

Introduction: The regular clinical practise slows a wide variability present in medical care in patients with the same pathology. The clinical pathways are integrated and systematized care plans for certain processes. The development of the hepatocarcinoma's (HCC) health care treatment is within the care frame of Tumoral Area's departments, Hepatology and General Surgery in the Clinic University Of Navarra (CUN). Objectives: To conduct a clinical pathway able to organize, homogenize and standardize the care of patients diagnosed with hepatocarcinoma and that could be applied from the beginning to the end of the course of this disease. Methodology: The identification of the set of care procedures wich would be necessary to achieve the best possible result in a patient who comes to the clinic to be treated for an hepatocarcinoma. The study' scope has taken place at the CUN, a private clinic that is a part of the University of Navarra. Result: The clinical pathway of the hepatocarcinoma's treatment has been developed centered on the surgical treatment and the hepatic transplant. Conclusion: The clinical pathways represents a decrease in variability and quality control in clinical practice, and the ability to analyze the information that indicators provide us, the satisfaction surveys and the computerized registration of electronic data(AU)

[The clinical pathway of treatment of hepatocellular carcinoma]. / Vía clínica. Tratamiento del hepatocarcinoma.

INTRODUCTION: The regular clinical practise slows a wide variability present in medical care in patients with the same pathology. The clinical pathways are integrated and systematized care plans for certain processes. The development of the hepatocarcinoma's (HCC) health care treatment is within the care frame of Tumoral Area's departments, Hepatology and General Surgery in the Clinic University of Navarra (CUN). OBJECTIVES: To conduct a clinical pathway able to organize, homogenize and standardize the care of patients diagnosed with hepatocarcinoma and that could be applied from the beginning to the end of the course of this disease. METHODOLOGY: The identification of the set of care procedures wich would be necessary to achieve the best possible result in a patient who comes to the clinic to be treated for an hepatocarcinoma. The study scope has taken place at the CUN, a private clinic that is a part of the University of Navarra. RESULT: The clinical pathway of the hepatocarcinoma's treatment has been developed centered on the surgical treatment and the hepatic transplant. CONCLUSION: The clinical pathways represents a decrease in variability and quality control in clinical practice, and the ability to analyze the information that indicators provide us, the satisfaction surveys and the computerized registration of electronic data.

Experiencia de la diálisis con albúmina (Sistema Mars®) en un paciente con sindrome hepato-renal / No disponible

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