Estudio comparativo de efectividad entre la Hipnosis y la intervención Cognitivo-Conductual para la Deshabituación Tabáquica / Comparative study of effectiveness between Hypnosis and Cognitive-Behavioral intervention for Smoking Cessation

Introducción: El consumo de tabaco es la primera causa de muerte evitable. A muchos fumadores les gustaría dejar el hábito. Aun así, a pesar de la eficacia demostrada de las intervenciones, muchos no están dispuestos a realizar un intento debido a las altas tasas de recaída y al miedo a los efectos secundarios de los tratamientos empleados, inclinándose a probar métodos alternativos.Objetivo: Conocer si la intervención avanzada individual (multicomponente cognitiva-conductual) es más efectiva que la intervención con hipnoterapia en pacientes fumadores, como tratamiento para dejar de fumar.Metodología: Estudio cuasiexperimental. Se incluyeron pacientes fumadores con antecedentes de patología respiratoria. Fueron asignados, según su preferencia, a un grupo de intervención avanzada individual en tabaquismo (grupo A) - al que se realizó una terapia multicomponente para dejar de fumar- o a un grupo de hipnoterapia (grupo B) en el que se realizó hipnosis para dejar de fumar.Todos los pacientes recibieron el tratamiento farmacológico y las pautas de actuación habituales que se utilizan en las consultas externas para tratar la enfermedad.Resultados: Se encontraron diferencias significativas en la cesación del consumo de tabaco a los 6 meses, encontrándose valores inferiores tanto en el abandono como en la disminución del consumo en los pacientes a los que se les realizó hipnoterapia versus terapia multicomponente (p 0,023 y p 0,031 respectivamente). Conclusiones: La intervención para el abandono del tabaco que incorpora la hipnosis no ha demostrado ser tan eficaz como la terapia multicomponente en la población estudiada. (AU)

Introduction: Tobacco use is the number one preventable cause of death. Many smokers would like to kick the habit. Still, despite the proven efficacy of the interventions, many are reluctant to try due to high relapse rates and fear of side effects of the treatments used, and are inclined to try alternative approaches.Objetive: To know if the individual advanced intervention (cognitive-behavioural multicomponent) is more effective than the intervention with hypnotherapy in smokers, as a treatment to quit smoking.Methodology: Quasi-experimental study. Smokers with a history of respiratory pathology were included. They were assigned, according to their preference, to an advanced individual smoking cessation intervention group (group A) - which underwent multicomponent therapy to quit smoking - or to a hypnotherapy group (group B) in which hypnosis was performed to quit smoking. of smoking.All patients received the pharmacological treatment and the usual action guidelines that are used in outpatient clinics to treat the disease.Results: Significant differences were found in the cessation of tobacco consumption at 6 months, with lower values both in quitting and in the reduction of consumption in patients who underwent hypnotherapy versus multicomponent therapy (p 0.023 and p 0.031, respectively).Conclusions: Smoking cessation intervention incorporating hypnosis has not been shown to be as effective as multicomponent therapy in the population studied. (AU)

Treatment of transsphincteric fistula-in-ano with growth factors from autologous platelets: results of a phase II clinical trial.

PURPOSE: The aim of this paper is to evaluate to the safety, feasibility and efficacy of a novel treatment for transsphincteric cryptoglandular fistula: injection of autologous plasma rich in growth factors (PRGF) into the fistula tract accompanied by sealing using a fibrin plug created from the activated platelet-poor fraction of the same plasma. METHOD: This article is a prospective, phase II clinical trial. The procedure was externally audited. Thirty-six patients diagnosed with transsphincteric fistula-in-ano were included. All patients underwent follow-up examinations at 1 week and again at 3, 6 and 12 months after discharge. Main outcome measures safety (number of adverse events), feasibility and effectiveness of the treatment. RESULTS: A total of 36 patients received the study treatment, with the procedure found to be feasible in all patients. A total of seven adverse events (AE) related to the injected product or surgical procedure were identified in 4 of 36 patients. At the end of the follow-up period (12 months), 33.3% of patients (12/36) had achieved complete fistula healing and 11.1% of patients (4/36) had achieved partial healing. In total, this amounted to 44.4% of patients (16/36) being asymptomatic at final follow-up. In successfully healed patients, a gradual reduction in pain was observed, as measured using a Visual Analog Scale (VAS) (p = 0.0278). Compared to baseline, a significant improvement in Wexner score was seen in patients achieving total or partial healing of the fistula (p = 0.0195). CONCLUSIONS: The study treatment was safe and feasible, with apparently modest efficacy rates. Continence and pain improvement following treatment may be considered predictive factors for healing.

Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: a case series.

BACKGROUND: Faecal incontinence (FI) is both a medical and social problem, with an underestimated incidence. For patients with internal anal sphincter damage, implantation of biomaterial in the anal canal is a recognised treatment option. One such material, Gatekeeper™, has previously shown promising short- and medium-term results without any major complications, including displacement. The main aim of the present study is to assess the degree to which displacement of Gatekeeper prostheses may occur and to determine whether this is associated with patient outcomes. METHODS: Seven patients (six females) with a mean age of 55.6 years [50.5-57.2] and a mean FI duration of 6 ± 2 years were prospectively enrolled in the study. Each subject was anaesthetised and underwent implantation of six prostheses in the intersphincteric region, guided by endoanal 3D ultrasound (3D-EAU). Follow-up was performed at post-interventional months 1, 3, and 12 (median 12 ± 4 months), during which data were obtained from a defaecation diary, Wexner scale assessment, anorectal manometry (ARM), 3D-EAU, and a health status and quality of life questionnaire (FIQL). RESULTS: At 3-month follow-up, 3D-EAU revealed displacement of 24/42 prostheses in 5/7 patients. Of these, 15 had migrated to the lower portion and 9 to the upper portion of the anal canal and rectum. Despite this migration, treatment was considered successful in 3/7 patients. In one patient, it was necessary to remove a prosthesis due to spontaneous extrusion. CONCLUSIONS: We have shown that displacement of the Gatekeeper™ prosthesis occurs, but is not associated with poorer clinical outcomes.

Effectiveness of a three-dimensional anorectal ultrasound in perianal Crohn's disease: incompatibility with clinical and surgical examinations.

PURPOSE: We have correlated the 3D anorectal ultrasound (3D ARU) findings with clinical examination and the surgical findings and examined its capacity to provide ancillary information, which potentially alters patient management. PATIENTS AND METHODS: This is a prospective analysis conducted at a tertiary academic hospital. A total of 95 patients were included. We screened for sphincter defects and the presence of perianal Crohn's disease (PACD)-related lesions. RESULTS: We performed 150 3D ARUs. Exploratory ultrasound coincided with the rationale for diagnosis in 67.7% of cases, and fistulae were detected in 79% of cases where there was clinical suspicion. Fistulae were associated with abscesses in 29 cases, and isolated abscesses were identified in 19 cases (17.7%), only 12 of which (63.2%) were clinically suspected. Sphincter defects were observed in 15 cases with 7 cases (77.8%) presenting with clinical fecal incontinence. The operative findings coincided with ultrasonographic findings in 81.3% of the analyzed cases. The inter-observer variability of endosonographic classification resulted in a kappa score of 0.86. Ultrasonographic data altered the therapeutic plan of management in 73 cases (48.6%). CONCLUSIONS: Three-dimensional ARU is accurate in the diagnosis of fistula type in PACD and in the delineation of ancillary suspected and unsuspected abscess collections. Its use impacts therapeutic management in about half the cases examined. A new ultrasonographic-based PACD classification system is presented which has high inter-observer agreement but which requires future prospective validation in clinical PACD patients.

Percutaneous neuromodulation of the posterior tibial nerve for the treatment of faecal incontinence - mid-term results: is retreatment required?

AIM: Posterior tibial nerve stimulation (PTNS) has emerged in recent years as a therapy for faecal incontinence. Its long-term effectiveness is yet to be established, along with what the form of retreatment should be in the event of loss of effectiveness. The present study aimed to establish the mid-term results to identify the proportion of patients who may need further treatment, and if so when. METHOD: A prospective study including 30 patients was conducted at an academic hospital. The patients underwent 12 weekly outpatient treatment sessions, each lasting 30 min (first PTNS phase). Neuromodulation was discontinued in those patients who did not have a 40% decrease in their pretreatment Wexner score. Patients having a better than 40% response were offered another 12-week course of complete treatment (second PTNS phase), following which they received no further PTNS treatment (phase without PTNS) but were assessed at 6 months and 2 years. RESULTS: All patients finished the first phase and 22/30 patients continued to the second phase. During this phase 11 patients showed an improved Wexner score (baseline/first phase/second phase: 14.3 ± 4.2 vs 9.9 ± 5.4 vs 6.8 ± 5.4). After a 6-month period without any treatment, the score was still improved in 11/30 patients (9.1 ± 6.2). At 2 years there was improvement in 16/30 patients (8.8 ± 7.1). There was a significant improvement in three variables of the quality of life questionnaire: lifestyle, coping behaviour and embarrassment. CONCLUSION: The response to first and second phase PTNS was maintained for up to 2 years. Retreatment was not required in about half of patients, even when they had finished the treatment 6 months or 2 years previously.