Thyroid abnormalities in patients with Hodgkin lymphoma: The importance of close surveillance.

INTRODUCTION: Survival in paediatric patients with Hodgkin lymphoma (HL) has increased over the last decades. However, these patients are at increased risk of developing late thyroid sequelae due to the treatment with irradiation and alkylating agents. METHODS: We conducted an observational and retrospective study in patients with a diagnosis of HL between 2007 and 2022, in a hospital that is a paediatric oncology reference centre, through the review of electronic health records. We collected data on demographic (age, sex), clinical, radiological and histopathological variables, the dosage of alkylating agents and radiotherapy (RT) and on thyroid disorders using Microsoft Excel. The data analysis was conducted with SPSS version 17, using the Fisher exact test for qualitative data, a nonparametric test for quantitative data and Kaplan-Meier curves. RESULTS: Sixty patients received a diagnosis of HL from 2007 to 2022. The median duration of follow-up was 78.5 months. There were 4 detected cases of hypothyroidism, 5 of thyroid nodules and 1 of subclinical hyperthyroidism. Treatment with RT was significantly associated with the development of hypothyroidism (P= .026), thyroid nodules (P= .01) and thyroid disease overall (P= .003). We estimated that the risk of thyroid disease increased 8-fold with each additional Grey received (hazard ratio, 1.081; 95% CI, 1.014-1.152; P= .017). CONCLUSION: Hodgkin lymphoma patients treated with RT are at increased risk of late thyroid disorders, mainly hypothyroidism and malignancy. This risk is greater the higher the RT dosage and the longer the follow-up. We did not find evidence of an association between the use of alkylating agents and an increase in the risk of thyroid disease.

Incidence of Suspected Serious Adverse Drug Reactions in Corona Virus Disease-19 Patients Detected by a Pharmacovigilance Program by Laboratory Signals in a Tertiary Hospital in Spain: Cautionary Data.

BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients vs. non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs including neutropenia, pancytopenia, thrombocytopenia, anemia, eosinophilia, leukocytes in cerebrospinal fluid, hepatitis, pancreatitis, acute kidney injury, rhabdomyolysis, and hyponatremia were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89-816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients, 95% CI 137.09-186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53-154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.

A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe.

BACKGROUND: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. METHODS: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. RESULTS: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients' median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.

[Costs associated to disease-related malnutrition and treatment: a literature review]. / Costes asociados a la desnutrición relacionada con la enfermedad y su tratamiento: revisión de la literatura.

INTRODUCTION: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. OBJECTIVE: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. METHODS: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. RESULTS: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. CONCLUSIONS: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial.

Costes asociados a la desnutrición relacionada con la enfermedad y su tratamiento: revisión de la literatura / Costs associated to disease-related malnutrition and treatment: a literature review

Introducción: la desnutrición relacionada con la enfermedad tiene una elevada prevalencia, con consecuencias clínicas potencialmente graves para el paciente y de alto impacto económico para el sistema sanitario. Objetivos: realizar una revisión de la literatura sobre los costes económicos de la desnutrición asociada a la enfermedad, analizar sus complicaciones y evaluar la utilidad de la nutrición enteral u oral bajo la perspectiva del análisis de costes. Métodos: se llevó a cabo una revisión de la literatura hasta junio de 2016 sobre los costes económicos de la desnutrición y el análisis de costes del tratamiento nutricional, priorizando las revisiones sistemáticas, los metaanálisis y los ensayos clínicos aleatorizados. Resultados: se identificaron 31 publicaciones, 15 sobre los costes de la desnutrición relacionada con la enfermedad y 16 de análisis de costes del tratamiento. La desnutrición relacionada con la enfermedad incrementa los costes sanitarios por una mayor estancia hospitalaria, mayor incidencia de complicaciones infecciosas y no infecciosas, mayor necesidad de tratamientos, incremento de los reingresos, estancias más prolongadas en unidades de cuidados intensivos y/o la necesidad de derivación al alta a centros de continuación de cuidados. Las publicaciones evaluadas sobre el tratamiento mediante suplementos nutricionales orales sugieren que los suplementos nutricionales orales son coste-efectivos y coste-útiles tanto en pacientes ambulatorios como en pacientes hospitalizados. Conclusiones: la desnutrición relacionada con la enfermedad produce un incremento de los costes sanitarios que podría minimizarse, entre otras formas, mediante un diagnóstico y tratamiento precoz de la misma, para lo cual los suplementos nutricionales orales constituyen una herramienta coste-eficaz y coste-útil

Introduction: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. Objective: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. Methods: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. Results: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. Conclusions: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial

La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico / The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact

Objetivos. Estudiar los efectos del tratamiento de los pacientes con fractura de cadera en una unidad ortogeriátrica conjunta entre los servicios de traumatología y geriatría comparados con el tratamiento hospitalario habitual y analizar las diferencias de costes entre ambos sistemas de asistencia. Material y métodos. Estudio prospectivo cuasi-experimental de intervención, aleatorizado, en 506 pacientes ingresados en un hospital terciario con el diagnóstico de fractura de cadera osteoporótica. El sistema habitual de tratamiento fue el ingreso a cargo de traumatología con interconsulta a geriatría (tipo IC) y el sistema a estudio consistió en el ingreso en una unidad ortogeriátrica (UOG) para el tratamiento conjunto integrado entre los especialistas en traumatología y geriatría. Éste incluyó la designación de un interlocutor único por cada servicio, seguimiento por la enfermera de ortogeriatría, valoración geriátrica precoz, atención clínica diaria coordinada, pase de visita conjunto semanal y planificación coordinada de la programación quirúrgica, del inicio de la deambulación y del destino y momento del alta. Resultados. Se incluyó a 255 pacientes consecutivos ingresados en la UOG y 251 tratados simultáneamente mediante IC. No existieron diferencias, salvo por una edad ligeramente inferior en el grupo de UOG, en las características previas ni en la tasa de intervención quirúrgica de ambos grupos. En los pacientes de la UOG fue más frecuente recibir rehabilitación en la fase aguda, ser capaz de caminar al alta y ser derivado a unidades de recuperación funcional (todas con p<0,05). Los pacientes ingresados en la UOG recibieron una valoración geriátrica más precoz y fueron intervenidos antes que los tratados mediante IC (p<0,01). La estancia en la planta de agudos fue un 34% menor en los pacientes de la UOG (media 12,48±5 frente a 18,9±8,6 días; p<0,001) (mediana de 12 [9-14] días frente a 17 [13-23]; p<0,001). La estancia hospitalaria total, incluida la estancia en las unidades de recuperación funcional, fue un 11% menor en los pacientes de la UOG (media 21,16±14,7 frente a 23,9±13,8 días; p<0,001) (mediana 14 [10-31] frente a 20 [14-30] días; p<0,001). La UOG obtuvo un ahorro de costes por paciente de entre 1.207 € y 1.633 € mediante el modelo de coste por proceso y de 3.741 € mediante el modelo de costes por estancias. Conclusiones. La UOG es un nivel asistencial que aporta mejoras en la evolución funcional de los pacientes y una reducción total de estancias hospitalarias. En base a ello reduce los costes de asistencia. Estos resultados hacen recomendable este sistema de atención a los pacientes con fractura de cadera en fase aguda(AU)

Objective. To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. Method. Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. Results. Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. Conclusions. The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients(AU)

[The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. / La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico.

OBJECTIVE: To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. METHOD: Prospective quasy-experimental randomized intervention study in 506 patients admitted to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. RESULTS: Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneously by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P < .05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P < .001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48 ± 5 vs 18.9 ± 8.6 days, P < .001) (median 12 [9-14] vs 17 [13-23] days, P < .001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ± 14.7 vs 23.9 ± 13.8 days, P < 0.05) (median 14 [10-31] vs 20 [14-30] days, P < .001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. CONCLUSIONS: The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.

Análisis de los Indicadores de Seguridad del Paciente de la Agency for Healthcare Research and Quality de los hospitales públicos de la Comunidad de Madrid / Analysis of the Agency for Healthcare Research and Quality Patient Safety Indicators in public hospitals of the Autonomous Region of Madrid (Spain)

Objetivo: Identificar la variabilidad de los Indicadores de Seguridad del Paciente (PSI) de la Agency for Healthcare Research and Quality (AHRQ) entre hospitales y por nivel de hospital en el ámbito del Servicio Madrileño de Salud (SERMAS) y evaluar la contribución de los registros del Conjunto Mínimo Básico de Datos (CMBD) a la variabilidad observada. Métodos: Se analizaron los datos procedentes del Sistema de Información de Atención Especializada (SIAE) y del CMBD del año 2006 procedentes de 20 hospitales públicos y concertados del SERMAS. Los indicadores AHRQ se obtuvieron del Área de Información Sanitaria de la Consejería de Sanidad de Madrid. Para el análisis estadístico se utilizó el coeficiente de correlación y la regresión lineal múltiple. Resultados: Las complicaciones quirúrgicas y las relacionadas con cuidados médicos o posquirúrgicos presentaron diferencias significativas por hospital y por nivel de hospital. Además mostraron asociación positiva con algunos registros del CMBD. Se encontraron coeficientes de correlación superiores a 0,78 entre úlceras de decúbito y peso medio de Grupos Relacionados con el Diagnóstico (GRD) médicos, y entre mortalidad en pacientes con complicaciones durante el ingreso, estancia media y peso medio total. La variabilidad de úlceras de decúbito, éxitus en GRD de baja mortalidad y mortalidad en pacientes con complicaciones durante el ingreso se explicaba significativamente por tres o más de las variables estudiadas. Conclusiones: La variabilidad encontrada en el SERMAS para los PSI es alta y está asociada a determinados registros del CMBD. Convendría confirmar estos hallazgos con estudios sucesivos y en otros territorios, y evaluar la posible aportación de algunas variables del CMBD a esta variabilidad (AU)

Objective: To identify variability in the Patient Safety Indicators (PSI) of the Agency for Healthcare Research and Quality (AHRQ) among hospitals and by hospital level in the Madrid Health Service and to evaluate the contribution of the minimum basic data set (MBDS) records to the variability observed. Methods: Data on healthcare resources were obtained from the Specialized Care Information System and from MBDS records for 2006 from 20 public and state-assisted hospitals within the Madrid Health System. AHRQ PSI were obtained from the Health Information Area of the Madrid Health Council. Data analysis included correlation coefficients and multiple linear regression. Results: Surgical complications and complications due to medical or postsurgical care showed significant differences among hospitals and by hospital level. These differences were positively associated with values in some of the MBDS records. We found correlations above 0.78 between decubitus ulcer and the average weight of medical diagnosis-related groups (DRG) and between failure to rescue and average length of hospital stay and the overall average weight. At least three of the variables analyzed explained the variability in decubitus ulcer, death in low-mortality DRGs and failure to rescue. Conclusions: The variability found in the Madrid Health System for the PSI is high and is associated with certain records of the MBDS. These findings should be confirmed in successive studies and in other regions, and the possible contribution of some variables of the MBDS to this variability should be assessed (AU)

The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture.

We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG model). The study model involved admission to an acute orthogeriatric unit (OGU model), with joint care provided by geriatricians and orthopaedic surgeons which included immediate geriatric assessment, coordinated daily clinical care, weekly combined ward rounds, and joint planning of the surgical schedule, initial mobilisation, discharge date and destination. No differences were found between CG patients (123) and OGU patients (101) in terms of previous characteristics, number of patients surgically treated, functional level obtained, or discharge destination. OGU patients had earlier geriatric assessment (median 1 day, P25-P75: 1-2) than CG patients (median 4 days, P25-P75: 3-8), earlier surgery (median 5 days from admission to OGU, P25-P75: 3-6, versus 6 days in the CG group, P25-P75: 5-9), and had a shorter acute hospital stay (33% reduction, median 12 days in OGU, P25-P75: 9-14, versus 18 days, P25-P75: 13-23 in the CG group) and total (acute and subacute) hospital stay (30% reduction, median 14 days in OGU, P25-P75: 10-31, versus 20 days, P25-P75: 14-30 in the CG group). All these comparisons were statistically significant (p<0.01). The organization of an OGU in a tertiary hospital allowed hip fracture patients to receive earlier geriatric assessment and surgical treatment. Acute hospital stay was reduced by 33%, and total hospital stay was reduced by 30% with no differences at discharge in clinical and functional outcomes.

Impact of a clinical pathway in patient care following surgery on laparoscopic radical prostatectomy.

PURPOSE: The aim of this study was to evaluate the impact of clinical pathway (CP) implementation in laparoscopic radical prostatectomy (LRP) has had on patient care and clinical evolution after discharge. MATERIALS AND METHODS: Eighty-six patients were included in 2 groups: first group was composed of patients operated since the new technique (LRP) was used until the CP was implemented (26 patients operated in 2002) and, second group, with 60 patients, followed the CP during 2004 and 2005. RESULTS: The operative time was reduced from 377.7 to 172.3 minutes after the CP implementation. The duration of bladder catheterization decreased by more than 10 days (from 26.17 to 15.85 days) and that of thromboprophylaxis was reduced from 6.44 to 3.38 days. No difference was found in the rate of complications in the first month after surgery, nor was there any difference in the rate of occurrence of erectile dysfunction, incontinence, and biochemical recurrence during the first year after surgery. CONCLUSION: After the implementation of the CP, there have been better results in patient care, such as reduction in the duration of catheterization and thromboprophylaxis. In comparison with other studies, we observed a clear reduction in length of stay and operative time. However, there is still room for improvement in reducing the duration of catheterization.

Evaluación del impacto asistencial de una vía clínica de trasplante renal / Evaluation of the impact of a clinical pathway for kidney transplantation

Objetivo: Revaluar el impacto asistencial de una vía clínica (VC) de trasplante renal en un hospital universitario tras 4 años de implantación. Material y método: Estudio experimental tipo antes-después con control retrospectivo. El grupo de estudio estuvo formado por los pacientes sometidos a trasplante renal con posterioridad a la implantación de la VC en 1999 en el Hospital Universitario La Paz y como grupo control, los pacientes trasplantados antes de su establecimiento. Resultados: Se estudió a 32 pacientes del grupo control y 121 del grupo de estudio. La estancia se redujo de 20 días del primer grupo a 14 días del segundo. Se observó una reducción en la incidencia de infección de localización quirúrgica (el 12,5 contra el 1,7%). No hubo diferencias en las complicaciones quirúrgicas ni en los eventos posteriores al alta. La reducción observada en el uso inadecuado de antimicrobianos no fue significativa, mientras que ésta sí lo fue con los protectores gástricos. También disminuyó entre ambos grupos el tiempo transcurrido entre el trasplante y la retirada de la sonda vesical y la vía central (de 12 a 8 días en ambos casos). Conclusiones: La VC ha demostrado ser una herramienta efectiva y eficiente, pues con su implantación se observó una reducción en la estancia hospitalaria y de otros efectos adversos para el paciente, con lo que se estima una mejora en la calidad asistencial

Aim: To reassess the impact of a clinical pathway for kidney transplantation in a university hospital after a 4-year period. Material and method: We performed an experimental "before and after" study with a retrospective control group. The experimental group was composed of patients who underwent kidney transplantation after the starting date of implementation of the clinical pathway (1999) at the Hospital La Paz (Madrid, Spain). The control group included a selection of patients who underwent the same procedure before 1999. Results: There were 32 patients in the control group and 121 in the experimental group. The length of stay before discharge was reduced from 20 days in the control group to 14 days in the experimental group. The surgical site infection rate decreased from 12.5% to 1.7%. No differences were found in the development of other surgical complications or undesired events after discharge. The reduction observed in antibiotic use was non-significant, whilst a significant reduction was found in the use of gastric protectors. Moreover, the time elapsed from kidney transplantation to withdrawal of the vesical and central catheters diminished in both groups (from 12 to 8 days). Conclusions: The clinical pathway has proved to be an effective and efficient tool to reduce the length of hospital stay and the development of undesired events, thus improving health care quality

Utilidad del PSA-Complex en el diagnóstico del carcinoma de próstata / Utility of complexed PSA in the diagnosis of carcinoma of the prostate

OBJETIVOS: Desde el hallazgo del antígeno prostático específico (PSA), como marcador del cáncer de próstata, han sido muchos los intentos de mejorar su eficacia diagnóstica. Uno de ellos ha sido el estudio del comportamiento de las diferentes formas plasmáticas de PSA en su unión a distintas antiproteasas, entre las que destaca la 1-antiquimiotripsina, con la que forma el PSA complex (PSA-c). El objetivo es estudiar la validez del PSA-c para aumentar la especificidad sin variar la sensibilidad, frente al uso del PSA total (PSA-t).MÉTODOS: Entre septiembre de 1998 y marzo de 1999 se tomaron muestras de sangre a 96 pacientes que fueron sometidos a biopsia prostática por sospecha de cáncer de próstata. En estos pacientes se determinó el PSA-c, PSAt (ambos realizados por el Sistema Technicon Immuno 1 de Bayer) y se calculó el PSA-c/PSA-t. RESULTADOS: Se calcularon las curvas ROC y se hallaron los puntos de corte óptimos, para los cuales, ante un valor de sensibilidad semejante (90 por ciento), la especifici dad resultó mayor en el PSA-c (44,6 por ciento [IC 95 por ciento, 32-57]) frente al PSA-t (35,4 por ciento [IC 95 por ciento, 25-49]), y la ratio PSAc/PSA-t (38,5 por ciento[IC 95 por ciento, 27-51]). Para otros valores de sensibilidad el comportamiento del PSA-c fue análogo. CONCLUSIÓN: el PSA-c mejora la especificidad frente al PSA-t y el PSA-c/PSA-t, por lo cual sería posible con su uso una reducción de biopsias innecesarias sin dejar de detectar el mismo número de cánceres de próstata (igual sensibilidad) (AU)