Real-world evidence of adjuvant immunotherapy in resected stage III and IV melanoma patients: CADIM trial final results. Experience from 2 tertiary referral centers. / Evidencia en práctica clínica del tratamiento adyuvante con inmunoterapia en pacientes con melanoma estadio III y IV resecados: Resultados finales del estudio CADIM. Experiencia de dos centros de tercer nivel.

INTRODUCTION: Clinical trials have validated the use of nivolumab and pembrolizumab as adjuvant therapies regarding relapse-free survival (RFS) in patients with resected stage III and IV melanoma. Evidence in real-world patients is currently limited. MATERIAL AND METHOD: The CADIM trial (Characterization of adjuvant immunotherapy in melanoma patients) recruited a total of 81 patients with resected stage III and IV melanoma on nivolumab or pembrolizumab as adjuvant therapy from February 2018 through December 2022. RESULTS: The stage distribution rate was 81.5% (n = 71) for stage III, while 15 patients (18.5%) had resected stage IV. Among stage III patients, 38 were stage IIIC (46.9%). With a median follow-up of 22.8 months, the RFS in the intention-to-treat (ITT) population was 84% at 1 year and 81.5% at 2 years. The overall survival (OS) rate was 99% at 1 year and 91.4% at 2 years. Grade 3-4 treatment-related adverse events were reported in 12.3% of the patients. CONCLUSIONS: This study shows the results of resected stage III and IV melanoma patients on adjuvant therapy with anti-PD-1, and eventually confirmed the safety and efficacy profile described by clinical trials. Comparing clinical trial data with real-world evidence is necessary for a more practical, reliable, and accessible use of these drugs.

S100A12 protein as a porcine health status biomarker when quantified in saliva samples.

The S100A12 protein was validated as a biomarker of health status in porcine saliva samples using a semi-quantitative approach based on Western blotting in four healthy and sixteen diseased animals, and in four animals with severe respiratory disease during three days of antibiotic therapy. Afterwards, a non-competitive sandwich immunoassay was then developed, validated, and used to quantify S100A12 in clinical porcine samples, using 14 healthy and 25 diseased pigs. Finally, the S100A12 concentrations in the saliva of ten pigs with respiratory disease were monitored during antibiotic therapy. Diseased animals showed higher concentrations of S100A12 than healthy animals, and the high concentrations of S100A12 in pigs with respiratory distress were reduced after antimicrobial therapy. The assay developed showed good precision and accuracy, as well as a low limit of detection of 3.19 ng/mL. It was possible to store saliva samples at -20 °C, or even at 4 °C, for two weeks before analysis without losing the validity of the results. The concentrations of S100A12 observed in serum and saliva samples showed a moderately positive association with a correlation coefficient of 0.48. The concentrations of the new validated biomarker S100A12 are highly associated with the novel salivary biomarker of inflammation, adenosine deaminase, and moderately to highly associated with the total oxidant status. The results reported in this study provide a new way of evaluating inflammatory diseases in pigs using saliva samples, which should be further explored for disease prevention and monitoring in the field.

Abordaje laparoscópico mediante puerto único versus técnica convencional en el tratamiento quirúrgico del cáncer de endometrio / Single port laparoscopic approach versus conventional technique in the surgical treatment of endometrial cancer

Objetivo: El objetivo de este estudio es comparar el abordaje laparoscópico convencional con el acceso por puerto único en el tratamiento quirúrgico del cáncer de endometrio. Materiales y métodos: Estudio retrospectivo sobre 36 pacientes, 18 operadas con técnica convencional y 18 con acceso por puerto único mediante una única incisión en la piel y 3 en la fascia, para la inserción de un trócar de 10mm y 2 de 5mm. Resultados: Se obtiene menor dolor postoperatorio (22,3% vs. 83,3%, p<0,001) y un mejor resultado estético (10 vs. 8, p=0,001) en el grupo de pacientes intervenidas por puerto único. El tiempo quirúrgico fue mayor en el grupo con técnica convencional (120 vs. 180min; p=0,027). En cuanto a estancia hospitalaria (2,5 vs. 2,5 días, p=0,69), pérdida sanguínea (1,15 vs. 1,25g/dl, p=1), número de ganglios extirpados (16,5 vs. 18; p=0,78) y complicaciones intra (0% vs. 5%, p=0,19) y posquirúrgicas (16,6% vs. 11,1%, p=0,63) no hubo diferencias significativas. Conclusión: El abordaje por puerto único es una técnica factible, segura y efectiva en el tratamiento del cáncer ginecológico, presentando una menor tasa de dolor postoperatorio y un mejor resultado estético.(AU)

Objective: The objective of this study is to compare conventional laparoscopy with transumbilical single-port access for the surgical treatment of endometrial cancer. Materials and methods: A retrospective study was performed with 36 patients, of whom 18 were operated using conventional laparoscopy, and 18 using a transumbilical single-port access (laparoendoscopic single-site surgery, or LESS) by making a single incision in the umbilical skin of 2-3cm, and 3 incisions in the fascia. One 10-mm trocar and two 5-mm trocars were inserted next to each other to access the abdominal cavity. Results: There were no statistical differences between groups in postoperative changes in haemoglobin concentration (1.15 vs. 1.25g/dL, P=1), hospital stay (2.5 vs. 2.5 days, P=.69), intraoperative complication rate (0% vs. 5%, P=.19), postoperative complications (16.6% vs. 11.1%, P=.63), number of pelvic lymph nodes (16.5 vs. 18, P=.78), and number of para-aortic lymph nodes (9 vs. 10, P=.64). Patients in the LESS group experienced less postoperative pain (22.3% vs. 83.3%, P<.001), and had a higher rate of satisfaction with the cosmetic results (10 vs. 8, P=.001). The median operating time was lower in the LESS group (120-180min, P=.027). Conclusion: Laparoendoscopic single-site surgery is a feasible, safety and effective technique for the treatment of endometrial cancer, with less postoperative pain and better cosmetic results.(AU)

Contracción paradojal del puborrectal como causa de defecación obstructiva: resultados a corto plazo del tratamiento con biofeedback y rehabilitación pelviperineal / Puborectal paradoxical contraction as a cause of obstructive defecation: short-term outcomes of treatment with biofeedback and pelviperineal rehabilitation

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.

Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.

Metástasis hepáticas en cáncer colorrectal: Situación en el Hospital Central de la Defensa "Gómez Ulla" entre los años 2012 y 2017 / Colorectal cancer liver metastases: Current state at "Gómez Ulla" military hospital between 2012 and 2017

Antecedentes: El carcinoma colorrectal es la afectación maligna más común del tubo digestivo. Las metástasis hepáticas más frecuentes son las del cáncer colorrectal, siendo un importante condicionante de la supervivencia de estos pacientes. Alrededor del 25% de los pacientes con cáncer colorrectal presentan metástasis al diagnóstico (metástasis sincrónicas). Más del 30% las desarrollará durante la evolución de su enfermedad (metástasis metacrónicas). Es decir, entre el 55-60% desarrollarán metástasis en algún momento de su vida, generalmente en un periodo de tres años. Objetivo: Revisar la frecuencia de metástasis hepáticas en pacientes diagnosticados de cáncer colorrectal en el Hospital Central de la Defensa "Gómez Ulla" durante los años 2012, 2013 y 2014, realizando su seguimiento hasta 2017. Material y Métodos: Se realizó un estudio observacional transversal longitudinal retrospectivo. Se tomaron datos de pacientes del Servicio de Cirugía General y del Aparato Digestivo diagnosticados de neoplasia colorrectal durante los años 2012, 2013 y 2014, realizando su seguimiento hasta 2017, teniendo en cuenta las revisiones realizadas posteriormente. Resultados: Se recogieron datos de 210 pacientes. De ellos, 27 pacientes presentaron metástasis hepáticas sincrónicas (13%) y 25 presentaron metástasis hepáticas metacrónicas (12%). Conclusiones: En nuestro hospital el porcentaje de pacientes que presenta metástasis hepática sincrónica (12%) es menor que el indicado en la literatura (25%), aun siendo el tamaño muestral inicial pequeño. La evidencia científica indica que más del 30% de los pacientes las desarrollarán metástasis metacrónicas, siendo en nuestro centro únicamente descritas el 12%. Estudios posteriores determinarán la reducción de estas cifras en nuestro centro

Introduction: Colorectal cancer is the most common malignant affection of the intestine. Liver metastases due to colorrectal cancer are the most frequent, being decisive for the survival of these patients. Nearly 25% of the patients have metastases at the time of the diagnosis (synchronous metastases). More than 30% will develop them during their follow-up (metachronous metastases). Ergo, between 55-60% will manifest metastases during the progression of their disease, usually in three years. Purpose: Review the frequency of liver metastases in patients with colorectal cancer who had been diagnosed at the "Gómez Ulla" military hospital during 2012, 2013 and 2014, tracking them until 2017. Methods: A retrospective longitudinal transversal observational study has been conducted. Patients from General and Digestive Surgery Department diagnosed of colorectal cancer during 2012, 2013 and 2014 have been analyzed, tracking them until 2017 considering the follows-up realized after their surgery. Results: 210 patients have been analyzed. 27 had synchronous liver metastases (13%) and 25 had metachronous liver metastases (12%). Conclusions: Despite the non-significant sample size, results show that the percentage of synchronous liver metastases at our hospital (12%) is smaller than the percentage reflected by the scientific knowledge (25%). The bibliography shows that more than 30% of the patients develop metachronous liver metastases. At our hospital, results showed than only 12% develop metachronous liver metastases. That means we have a smaller amount of liver metastasis

Mitotic rate as an important prognostic factor in cutaneous malignant melanoma.

BACKGROUND: Recently, the quantification of mitoses in cutaneous melanoma has been discharged from the main prognostic variables of the TNM classification. OBJECTIVE: To investigate the prognostic value of the presence of mitoses in primary cutaneous melanoma and to establish the number of mitoses per mm2 that may have prognostic significance. METHODS: A retrospective observational study was performed on 141 patients treated for cutaneous melanoma, who were assessed by the same pathologist, and who had a minimum follow-up of 2 years. Clinical, epidemiological, histopathological and follow-up variables were gathered and compared with the number of mitoses to distinguish the significance of differences by means of univariate, multivariate, and survival analyses. RESULTS: The cut-off level related to a better sensitivity and specificity was 1.50 mitoses per mm2. The presence of two or more mitoses/mm2 showed a better relationship with prognostic variables and both the overall and disease-free survival than the presence of 1 or more mitoses/mm2. This happens especially in melanomas thicker than 0.8 mm and it could affect the staging in cases with Breslow between 1 and 2 mm. CONCLUSIONS: A mitotic rate of two or more mitoses per mm2 in cutaneous melanoma should be considered as a more accurate prognostic factor than one or more mitoses per mm2, particularly in tumors equal or greater than 0.8 mm in thickness.

Cirugía oncológica ginecológica mediante puerto único y endoscopia operatoria por orificios naturales empleando equipamiento convencional / Combined laparoendoscopic single-site surgery (less) and natural orifice transluminal endoscopic surgery (NOTES) in gynaecologic oncology using conventional equipment

Objetivo: Describir y valorar la aplicabilidad de la combinación de las técnicas de puerto único y del natural orifice transluminal endoscopic surgery (NOTES) en el tratamiento quirúrgico del cáncer ginecológico empleando solo instrumental convencional. Material y métodos: Se realiza un estudio retrospectivo de 30 pacientes tratadas por cáncer ginecológico desde junio de 2012 hasta junio de 2014. Todos los procedimientos se hicieron mediante técnica de puerto único o NOTES híbrido. Se empleó equipamiento convencional, el mismo que empleamos en la laparoscopia multipuerto. Resultados: Ventiuna pacientes (70%) fueron operadas mediante puerto único umbilical; 8 casos (30%) mediante NOTES híbrido. En un caso se realizó un doble puerto único para abordaje retroperitoneal y transperitoneal simultáneo. Los procedimientos empleados fueron: histerectomía en 10 cánceres de endometrio y en 2 cánceres de cuello. En 6 casos se asoció además una linfadenectomía pélvica o una biopsia selectiva de ganglio centinela. En 3 casos, se realizó además una linfadenectomía paraaórtica. En un caso se realizó linfadenectomía pélvica y paraaórtica transperitoneal para estadificación de un cáncer de cérvix. Se realizó estadificación ovárica en 3 casos de carcinoma de ovario borderline y en 2 casos infiltrantes. Finalmente, en 3 casos se utilizó el puerto único para evaluación de resecabilidad. En 5 casos (16,66%) fue necesario utilizar algún trocar auxiliar para el abordaje paraaórtico. No fue necesaria ninguna conversión a laparotomía. No se observaron complicaciones intraoperatorias y tan solo se observaron complicaciones menores postoperatorias en 5 casos y una complicación mayor en una paciente de 72 años con un cáncer de células claras endometrial IAG3 que presentó insuficiencia cardíaca en el postoperatorio. Conclusión: Los procedimientos de puerto único y NOTES son procedimientos seguros y válidos para el manejo quirúrgico del cáncer ginecológico

Objective: To describe and assess the feasibility of combining natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery in gynaecological cancer using only conventional laparoscopic equipment. Material and methods: A retrospective review of 30 patients with gynaecological cancer, managed by either laparoendoscopic single-site surgery or hybrid natural orifice transluminal endoscopic surgery technique, from June 2012 to June 2014. Only conventional trocars, grasping forceps and sealing devices were used, similar to multiport laparoscopic surgery. Results: Twenty-one (70%) patients were managed by umbilical laparoendoscopic single-site surgery, while 8 (30%) patients underwent a hybrid natural orifice transluminal endoscopic surgery. One patient underwent a double retroperitoneal and transperitoneal single-site approach. Hysterectomy was performed in 10 cases of endometrial cancer and 2 of cervical cancer, while hysterectomy plus pelvic lymphadenectomy or sentinel node biopsy was conducted in 6 cases of endometrial cancer. Hysterectomy plus pelvic and para-aortic lymphadenectomy was performed in 3 patients with endometrial cancer. Transperitoneal pelvic and para-aortic lymphadenectomy was conducted in one case for cervical cancer staging. Staging was also performed in 3 patients with borderline ovarian cancer and in 2 cases of infiltrating cervical carcinoma. Single-port laparoscopic debulking surgery was performed in the remaining 3 cases. Additional 5-mm ports were used in 5 (16.66%) cases to perform para-aortic lymphadenectomy, but no conversion to laparotomy was needed. There were no intraoperative complications, with minor postoperative complications observed in only 5 cases. There was one postoperative major complication: Heart failure in a 72-year-old female patient with clear cell endometrial cancer stage IAG3, who needed to be referred to the cardiology department during her hospitalisation. Conclusion: Combined laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery is a safe and feasible procedure in the surgical treatment of gynaecological cancer

Effectiveness and failures of a fast track protocol after cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy in patients with peritoneal surface malignancies.

BACKGROUND: The aim of this study was to analyze the results short term perioperative of patients with peritoneal surface malignancies undergoing cytoreduction with peritonectomy and HIPEC under a controlled fast track protocol and evaluate the factors related to the failure of implementation of the protocol. PATIENTS AND METHOD: We prospectively analyzed a consecutive series of patients (N = 156) with peritoneal surface malignancies treated by cytoreductive surgery with peritonectomy procedures and HIPEC from September 2008 until December 2014, in whom a fast track protocol was implemented. We limited the protocol to patients who had optimal cytoreduction, HIPEC administration, and not more than one digestive anastomosis. All patients signed informed consent for surgery and the perioperative multimodal recovery program. RESULTS: A total of 156 consecutive patients, with a median age of 57 years were included in the study. Median PCI was 8 (IQR: 0-32). Morbidity rate (Clavien-Dindo) was 25.6%, with a major morbidity rate (Clavien-Dindo III-IV) of 11.5%. One hundred and three patients (66%) completed the protocol. Multivariate analysis identified the following independent factors, which were related to failure of the protocol: age over 57 years (OR = 3.159, 95% CI: 1.286-7.758, p < 0.05), the realization of a digestive anastomosis (OR = 3.834, 95% CI: 1.562-9.414, p < 0.005) and occurrence of postoperative complications (OR = 18.704, 95% CI: 6.888-50.790, p < 0.001) CONCLUSIONS: Our data support the idea that in selected patients undergoing cytoreductive surgery and HIPEC, with a low PCI and especially no necessity to perform a digestive anastomosis, the implementation of a fast track program is feasible.

Reduction in the incidence of pressure ulcers upon implementation of a reminder system for health-care providers.

PURPOSE: To measure the clinical impact of the introduction of a reminder system for healthcare professionals to alert patients who are at risk for pressure ulcers (PU). METHODS: This was a pre- and post-test study of patients who were discharged from 6 medical-surgical units of the University Hospital of Fuenlabrada in 2009 and 2010. Beginning in January 2010, implementation of an on-screen list of reminders was automatically updated daily on the units' computers including patient arrival date, last assessment of ulceration risk and location of any PU. The cumulative incidence of PU was measured for patients discharged in 2009 (group A: healthcare professionals were not exposed to on-screen reminder) and 2010 (group B: healthcare professionals were exposed to on-screen reminder list). The relative risk (RR) was estimated. The study was completed with a stratified analysis and binary logistic regression. RESULTS: In group A, there were 84 cases of PU among 9263 patients discharged (0.9%); whereas in group B, there were 59 cases among 9220 patients discharged (0.6%). The RR of PU for group B/group A was 0.706 (p=0.038). In the logistic regression analysis, after adjusting for study variables, the odds ratio of PU B/A was 0.558. CONCLUSION: A list of on-screen reminders at the beginning of a healthcare professional's shift to inform them of patients at risk for developing a PU was effective at reducing the incidence of these clinical burdens.

Creencias en salud oral de cuidadores de pacientes discapacitados y adultos mayores institucionalizados de la comuna de Quilaco, Región del Biobío / Oral health beliefs in caregivers of institutionalized disabled and elderly patients of the Quilaco commune, Biobío Region

El envejecimiento demográfico acelerado de la población de Chile supone un aumento en la prevalencia no solo de enfermedades crónicas, sino también de personas con discapacidad, y necesidad de ser cuidadas en forma permanente. En este sentido, tomando como grupo de estudio a los cuidadores de los adultos mayores institucionalizados de la comuna de Quilaco, Región del Biobío, analizamos las creencias en salud oral que los cuidadores poseen al momento de llevar a cabo la atención de los adultos mayores que se encuentran a su cargo.

The rapid aging of the population of Chile will produce an increase not only in the prevalence of chronic diseases, but also of people with disabilities, and their need to be cared for permanently. In this sense, taking the caregivers of the institutionalized elderly population of the Quilaco commune, Biobío Region, as a study group, we analyzed the oral health beliefs that caregivers have at the time of undertaking the care of older adults.

A new window to understanding individual differences in reward sensitivity from attentional networks.

Existing evidence suggests that the presence of reward cues modifies the activity in attentional networks, however, the nature of these influences remains poorly understood. Here, we performed independent component analysis (ICA) in two fMRI datasets corresponding to two incentive delay tasks, which compared the response to reward (money and erotic pictures) and neutral cues, and yielded activations in the ventral striatum using a general linear model approach. Across both experiments, ICA revealed that both the right frontoparietal network and default mode network time courses were positively and negatively modulated by reward cues, respectively. Moreover, this dual neural response pattern was enhanced in individuals with strong reward sensitivity. Therefore, ICA may be a complementary tool to investigate the relevant role of attentional networks on reward processing, and to investigate reward sensitivity in normal and pathological populations.

Grado de conocimientos y actitudes de la enfermería de la Comunidad Autónoma de Madrid (cam) ante el dolor: diplomados en enfermería y profesionales / No disponible

El dolor se ha convertido en el quinto signo vital (1-3) y es hoy día un tema crítico en la atención del paciente. El tratamiento eficaz del mismo sigue siendo uno de los problemas más importantes y urgentes del sistema de asistencia sanitaria de los países desarrollados de todo el mundo. Si bien el dolor en los pacientes es un tema muy en boga actualmente, sin embargo, lo que es poco cuestionado es la formación de los futuros profesionales de Enfermería en el cuidado de dichos pacientes. El estudio y el tratamiento del dolor deberían ser inculcados en los estudiantes de Enfermería dentro de su formación, tanto teórica como práctica. Es muy importante la labor que asumen también los docentes en el tema. El reto para la profesión de Enfermería consistiría en este terreno en que organice, estructure y apoye un programa consistente en la activación de programas docentes para estudiantes y enfermeros en ejercicio. Para iniciar nuestro trabajo de investigación realizamos un análisis por una parte, de los actuales programas curriculares de las distintas escuelas de enfermería de la CAM, con asignaturas con contenidos en dolor, analizándose la similitud o no entre ellos, los epígrafes tratados, etc., todo ello comparado con el esbozo curricular que la IASP (International Association of Study of Pain) propuso para los estudios de enfermería; y por otra, se describen los conocimientos y las actitudes de ambos grupos en enfermería ante el dolor, tanto profesionales como estudiantes de enfermería. Para observar el grado de conocimientos y actitudes ante el dolor de ambos grupos, se introdujo como herramienta el NKAS-RP (Nurses' Knowledge and attitudes Survey Regarding Pain) (4). El grupo de trabajo se propuso, por tanto, tres objetivos generales: el primero, descripción de los temarios de las asignaturas de la carrera de enfermería con contenidos en dolor, y el 2.º y 3.º objetivos, definir los conocimientos y las actitudes ante el dolor de los estudiantes de enfermería y de los profesionales enfermeros de la CAM. Se trata de un estudio descriptivo, observacional, aleatorio y multicéntrico, que analiza los conocimientos actuales, así como las actitudes del grupo de enfermería, tanto entre estudiantes (futuros diplomados en enfermería) como entre profesionales. Se llevó a cabo entre los años 2008 al 2010, utilizándose para dar a conocer los resultados del mismo el paquete estadístico SPSS versión 17.0. Como resultados, se obtuvieron, al igual que en estudios previos, a nivel mundial, unos pobres conocimientos en dolor y unas malas actitudes ante dicho síntoma. Se propone para mejorarlos, en el caso de los estudiantes, cambios en los programas curriculares de la diplomatura (futuro grado) de enfermería, y en el caso de los profesionales, formación continuada, así como actualización de conocimientos en dicho tema (AU)

The pain has become the fifth vital sign and is now a critical issue in patient care. Effective treatment of it is still one of the most important and urgent health care system in developed countries worldwide. While pain in patients is a very in vogue these days, however, which is unchallenged is the education of future nursing professionals in the care of such patients. The study and treatment of pain should be instilled in nursing students in their training, both theoretical and practical. The work is very important that teachers also take on the subject. The challenge for the nursing profession in this field would you organize, structure and support a program involving the activation of educational programs for students and practicing nurses. To start our research we made an analysis on the one hand, the current curricula of different schools of nursing in the CAM, with subjects with pain content, analyzing the similarity or not between them, the treated sections, etc. all this curriculum outline compared to the IASP (International Association of Study of Pain) proposed for nursing studies and, secondly, we describe the knowledge and attitudes of both groups in nursing to pain, both professional and qualified nurses. To observe the degree of knowledge and attitudes towards pain in both groups, was introduced as a tool the NKAS-RP (Nurses’ Knowledge and Attitudes Survey Regarding Pain). The working group is proposed, therefore, three general objectives: The first description of the curricula of the courses in the career of nursing content in pain, and el2 and 3 goals, define the knowledge and attitudes to pain nursing students and nurses of the CAM. This is a descriptive, observational, multicenter, randomized, which analyzes the current knowledge and attitudes of the nursing staff, both among students (future graduates in nursing) and among professionals. Was carried out between 2008 and 2010, used to publicize the results of the statistical package SPSS version 17.0. As results were obtained, as in previous studies, worldwide, a poor knowledge of pain and a bad attitude before that symptom. It is proposed to improve: in the case of students, changes in the curriculum of the Diploma (future degree) nurses, and in the case of professionals, continuing education and refresher courses in that subject (AU)

Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos / Impact of implementation of reminders to reduce adverse effects in patients with peripheral venous catheterizations

Fundamento. Medir el impacto clínico de la implantación de un sistema de recordatorios, que avise de los pacientes que tienen riesgo de presentar un evento adverso (EA) relacionado con los catéteres venosos periféricos. Métodos. A partir de los registros que se utilizan para seguimiento de los catéteres intravenosos se desarrolló una consulta automatizada que elabora un listado de los pacientes ingresados que incluye fecha de ingreso, fecha colocación, vía y tipo de vía. Se actualiza por turno en los ordenadores de la unidad. Se implantó en enero de 2010. Se ha realizado un estudio cuasi experimental midiendo la incidencia acumulada de flebitis, extravasaciones y obstrucciones en los pacientes dados de alta en 2009 y en 2010. Se ha evaluado la asociación entre variables cualitativas con el test de Chicuadrado, se ha estimado riesgo relativo (RR) y el número necesario de pacientes a tratar (NNT). Resultados. En el año 2009 fueron dados de alta en las unidades de estudio 9.263 pacientes y en 2010, 9.220 pacientes. Los resultados encontrados han sido: Pacientes que desarrollan flebitis 2010/2009: RR: 0,827 (p<0,001). Pacientes que presentan extravasaciones 2010/2009: RR: 0,804 (p<0,001).Pacientes que presentan obstrucciones 2010/2009: RR:0,954 (p=0,554). Conclusiones. Un listado de recordatorios que incluye los pacientes con acceso vascular y la fecha de éste, ha servido para disminuir el número de flebitis y extravasaciones, pero no las obstrucciones(AU)

Background. The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter. Method. On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chisquared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. Results. Nine thousand two hundred and sixty-three patientswere registered in the studied units in the year 2009, and 9,220 patients in 2010. The results were the following: Patients with phlebitis 2010/2009: RR: 0.827 (p < 0.001). Patients with extravasations 2010/2009: RR: 0.804 (p < 0.001).Patients with obstructions 2010/2009: RR: 0.954 (p < 0.554).Conclusion. With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions(AU)

Incidence of hepatic artery variations in liver transplantation: does it really influence short- and long-term results?

BACKGROUND: Some variations of hepatic artery, which show 30% incidence, must be taken into account to avoid damage to the liver transplant during harvesting, we analyzed the incidence of variations and their influence on postoperative results. PATIENTS AND METHODS: We performed a retrospective study of 325 liver transplantation between 2001 and December 2011. RESULTS: Variations in the hepatic artery were detected in 91 transplantations (32%) including 29 donors (8.9%), 57 recipients (17.5%), and 5 both (1.5%). The main variation among donors was a right hepatic artery originating from the mesenteric artery (38.2%), and a left hepatic artery from the left gastric artery (35.3%). Recipients showed the same distribution: RHA-UMA (right hepatic artery from upper mesenteric artery) (38.7%) and LHA-LGA (left hepatic artery from left gastric artery) (12.9%). 48.5% of donor hepatic variations did not need bench reconstruction, but all RHA-UMA required it mainly due to the donor gastroduodenal artery (7; 58%) We did not observe significant difference in cold or warm ischemia time, surgical time, red blood cell requirement, postoperative mortality, or overall survival when there was or was not an arterial anomaly. But arterial complications were more frequent in cases where there were recipient anomalies or both versus without anomalies or with donor anomalies (20%, 7,8%, 0%, 5,6%; P = .06). Donor RHA-UMA was associated with worse overall survival (69, 2%; P = .07) and longer cold ischemia time and red blood requirement. Bench reconstruction held to longer cold ischemia time and blood cell requirements (P = .01) and shorter overall survival (82.4%). RHA-UMA was associated (P = .08) with worse actuarial survival and a needed for bench reconstruction (P = .01). CONCLUSION: One must be careful during liver harvest to detect hepatic artery variations to avoid damage. Hepatic artery anomalies do not influence liver transplant results except for the presence of an RHA from the UMA with a need for bench reconstruction.

Transplantation for acute liver failure: report of results in the region of Castilla y Leon (Spain) after 10 years of activity.

Acute liver failure is an uncommon disease but its overall mortality rate is still high without liver transplantation, which is the treatment of choice for patients achieving certain criteria. We have reported herein the experience and retrospectively analyzed results of liver transplantation for acute liver failure since the beginning of activity of our group, which is the only one in the region of "Castilla y Leon" (Spain). In 10 years, 14 patients underwent emergency transplantation among an overall series of 325 subjects. The patients were generally young men and women; the average wait list time was 2.14 days. The most common etiology was toxic exposure (no cases were related to acetaminophen overdose), followed by viral infection (all because of acute hepatitis B). Our posttransplant outcomes were: perioperative mortality, 0%; posttransplant in-hospital mortality, 14%; and 1-y, 3-y, and 5-year survival rates of 77.1%, 64.3%, and 64.3% respectively. Retransplantation rate was 7%. A major morbidity occurred in four patients: one primary dysfunction, one hyperacute rejection due to ABO blood group-incompatibility requiring retransplantation, two arterial complications, and two biliary leakages. Our outcomes of emergency transplantation were similar to those reported by both the European and Spanish Liver Transplantation Registries, despite the small number of patients.

Spanish nurses' credentialing in the 20th century.

BACKGROUND: Nurses credentialing as healthcare professionals commenced in Western Europe and in the USA by the end of the 19th and the beginning of the 20th century, boosted by the protestant reform movement. In Spain, it started in 1915, during the kingdom of Alfonso XIII (1902-1931). This historical period was marked by great political instability and big flaws in the healthcare delivery system. AIM: To describe the regulatory pathway that gave rise to the nursing profession in Spain, through official credentialing and regulation during the first third of the 20th century. METHOD: Documental, historical and regulatory documental research describing and analysing the national legislative sources used to regulate the professional development, as well as the education, training and competencies of the nursing practice in Spain, as compared with the developments in the European and American context. CONCLUSIONS: Professional development of the nursing profession in Western Europe and in the USA is consolidated during the 20th century as resulting in educational and training enhancement and the establishment of national and international professional bodies. In Spain, the regulatory and legal recognition of the nursing profession come into being in 1915 in response to a request from a female religious congregation.

Longitudinal analysis of acute-phase proteins in saliva in pig farms with different health status.

This study assesses the utility of saliva samples to monitor the time course of the acute-phase response to different viruses in pigs under field conditions by using time-resolved immunofluorometric assays (TR-IFMA). A total of 30 pigs from three different farms, located in Southeast Spain, were used. Farm 1 had outbreaks of porcine circovirus type 2, farm 2 had infections with porcine reproductive and respiratory syndrome virus and farm 3 had concomitant infections with both viruses. Serology was used to determine the time of seroconversion of pigs to two different pathogens. The levels of two acute-phase proteins (APPs), C-reactive protein (CRP) and haptoglobin (Hp), were measured in saliva and serum samples and compared with pig's serology. Kinetic curves of both APPs across the study obtained in saliva samples were similar to those of serum, with R of 0.68 and 0.78 for CRP and Hp, respectively. The median CRP and Hp concentrations in saliva were higher around the theorized time of infection, according to previous experimental studies, and at seroconversion of animals. CRP increments were apparent 1 week before the increments obtained in Hp. These findings indicate that salivary APP concentrations, by using TR-IFMA, can be used in longitudinal studies as non-invasive early indicators of health status.

[Impact of implementation of reminders to reduce adverse effects in patients with peripheral venous catheterizations]. / Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos.

BACKGROUND: The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter. METHOD: On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010 and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chi-squared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. RESULTS: Nine thousand two hundred and sixty-three patients were registered in the studied units in the year 2009, and 9,220 patients in 2010. The results were the following: Patients with phlebitis 2010/2009: RR: 0.827 (p < 0.001). Patients with extravasations 2010/2009: RR: 0.804 (p < 0.001). Patients with obstructions 2010/2009: RR: 0.954 (p < 0.554). CONCLUSION: With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions.

A clinical perspective: anti tau's treatment in Alzheimer's disease.

Alzheimer΄s Disease (AD) physiopathology is not yet totally established. Nevertheless it is known that a metabolism dysfunction of the amyloid beta precursor protein (APP) and the abnormal tau protein phosphorylation lead to the formation of neuritic plaques and neurofibrillary tangles, respectively. These events finally drive to the clinical expression of dementia. Formally approved during the past decade, treatments for AD are lacking of an updating, being essentially symptomatic. Anticholinesterase agents have failed in providing a substantial improvement in the mental health condition of AD patients. On the other hand, antiamyloid strategies, have failed in their efficacy or security on their last development phases. In this context, tau represents a potential therapeutic target, by the action of drugs that diminish its aggregation, or acting by altering its phosphorylation or filaments formation. There is also anti-tau miscellaneous strategies such as normal microtubule-stabilizing agents. Thus, it might be possible that in a near future the neurodegenerative process could be stopped.