Perioperative analgesic effects of the erector spinae plane block with bupivacaine or bupivacaine-dexmedetomidine in dogs undergoing hemilaminectomy: A randomized controlled trial.

Objective: To compare the perioperative opioid requirements among dogs receiving an erector spinae plane (ESP) block with bupivacaine, with or without dexmedetomidine, and a control group. Animals and procedure: Thirty client-owned, healthy adult dogs undergoing hemilaminectomy were included in this randomized, prospective, blinded clinical study. Dogs were randomly assigned to 1 of 3 treatment groups: Group B, ESP block with bupivacaine; Group BD, ESP block with bupivacaine and dexmedetomidine; and Group C, control. Rescue intra- and postoperative analgesia consisted of fentanyl and methadone, respectively. Postoperative pain was evaluated using the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF). Results: In Group BD, 0/10 dogs required intraoperative fentanyl, compared to 9/10 in Group C (P < 0.001), whereas 1/10 required postoperative methadone, compared to 9/10 in Group B (P = 0.003) and 10/10 in Group C (P < 0.001). The total amount of intraoperative fentanyl (µg/kg) was 0 (0 to 4) in Group B and 0 (0 to 0) in BD, compared to 6 (0 to 8) in C (P = 0.004 and P < 0.001, respectively). Postoperative methadone (mg/kg) required during the first 12 h was 0.5 (0 to 1.4) in Group B (P = 0.003) and 0 (0 to 0) in BD (P < 0.001), compared to C (P = 0.003 and P < 0.001, respectively). Conclusion: An ESP block with bupivacaine, with or without dexmedetomidine, was associated with a reduction in perioperative opioid consumption and provided effective acute pain control.

Effets analgésiques périopératoires du bloc des érecteurs du rachis avec de la bupivacaïne ou de la bupivacaïne-dexmédétomidine chez les chiens subissant une hémilaminectomie: un essai contrôlé randomisé. Objectif: Comparer les besoins périopératoires en opioïdes chez les chiens recevant un bloc des érecteurs de la colonne vertébrale (ESP) avec de la bupivacaïne, avec ou sans dexmédétomidine, et un groupe témoin. Animaux et procédure: Trente chiens adultes en bonne santé appartenant à des clients subissant une hémilaminectomie ont été inclus dans cette étude clinique randomisée, prospective et en aveugle. Les chiens ont été répartis au hasard dans 1 des 3 groupes de traitement: groupe B, bloc ESP avec bupivacaïne; groupe BD, bloc ESP avec bupivacaïne et dexmédétomidine; et groupe C, témoin. L'analgésie de secours peropératoire et postopératoire consistait respectivement en fentanyl et en méthadone. La douleur postopératoire a été évaluée à l'aide du formulaire abrégé de l'échelle de mesure de la douleur de Glasgow (CMPS-SF). Résultats: Dans le groupe BD, 0/10 chiens ont eu besoin de fentanyl peropératoire, contre 9/10 dans le groupe C (P < 0,001), tandis que 1/10 ont eu besoin de méthadone postopératoire, contre 9/10 dans le groupe B (P = 0,003) et 10/10 dans le groupe C (P < 0,001). La quantité totale de fentanyl peropératoire (µg/kg) était de 0 (0 à 4) dans le groupe B et de 0 (0 à 0) dans le groupe BD, contre 6 (0 à 8) dans le groupe C (P = 0,004 et P < 0,001, respectivement). La méthadone postopératoire (mg/kg) nécessaire au cours des 12 premières heures était de 0,5 (0 à 1,4) dans le groupe B (P = 0,003) et de 0 (0 à 0) dans le groupe BD (P < 0,001), par rapport au groupe C (P = 0,003). et P < 0,001, respectivement). Conclusion: Un bloc ESP avec de la bupivacaïne, avec ou sans dexmédétomidine, a été associé à une réduction de la consommation peropératoire d'opioïdes et a permis un contrôle efficace de la douleur aiguë.(Traduit par Dr Serge Messier).

Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper / Recomendaciones de vacunación contra el virus sincitial respiratorio para adultos de 60 años o más: documento de posición del grupo de prevención NeumoExperts

Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.(AU)

Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper.

Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.

Primary care during COVID-19 pandemic - a survey to establish clinical needs and lessons learned in infectious respiratory diseases in Spain.

BACKGROUND: The COVID-19 pandemic has exposed gaps and areas of need in health care systems. General practitioners (GPs) play a crucial role in the response to COVID-19 and other respiratory infectious diseases (e.g., influenza). Knowing the current flow of these patients and the real needs of GPs is necessary to implement new therapeutic and diagnostic strategies. We sought to learn about the flow of COVID-19 and flu patients in Spanish primary health centers and understand the training needs in both the diagnosis and treatment of these diseases. METHODS: A total of 451 regionally representative GPs completed an online survey between January and February 2022. RESULTS: Most of the GPs had available infection containment measures (79%) and access to point-of-care (POC) rapid diagnostic testing (81%) in their centers. The availability of on-the-day diagnostic tests for COVID-19 was higher than that for influenza (80% vs. 20%). Most GPs referred 1 of 10 COVID-19 or flu patients with moderate to severe disease to the emergency department (80% and 90%, respectively). Training/knowledge was considered good regarding diagnostic tests and vaccines (85%) but null or low regarding antivirals (60%) and monoclonal antibodies (80%). CONCLUSIONS: This survey identified the conditions of Spanish GPs in terms of the diagnosis and treatment of COVID-19 and flu patients. Respondents' comments suggested that quite radical system-level adjustments are needed to allow GPs to capitalize on the potential benefits of POC tests for diagnosis, reduction of referrals, and monitoring of these diseases.

Vaccination against Community-Acquired Pneumonia in Spanish Adults: Practical Recommendations by the NeumoExperts Prevention Group.

In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.

El código postal como “código de barras” de las resistencias antimicrobianas / The postal code as a “bar code” of antimicrobial resistance

Introducción. La necesidad de integrar en la práctica clínica las resistencias locales es cada vez más urgente, especialmente en Atención Primaria, donde el tratamiento empírico es frecuente. Material y métodos. Se desarrolló un estudio retrospectivo observacional en el área de salud de Alcalá de Henares de los aislados microbiológicos positivos de Neisseria gonorrhoeae de cualquier localización (uretral, cervical, faríngea, rectal u orina). Se analizaron características sociodemográficas y resistencias a cefalosporinas, azitromicina, penicilina y quinolonas. Se relacionó cada aislado con su código postal de procedencia. Resultados. Se analizaron 256 muestras microbiológicas de N. gonorrhoeae, la mayoría pertenecientes a hombres (92,9%) con edad media de 33 años. La mitad de las muestras (49,8%) fueron resistentes a ciprofloxacino. La evolución temporo-espacial de las resistencias antimicrobianas se integró en mapas de calor con los códigos postales con más resistencias. Conclusión. Conocer las resistencias locales puede ayudar a pautar tratamientos empíricos más adecuados, especialmente en Atención Primaria, evitando la utilización de antibióticos inadecuados y disminuyendo las tasas de resistencias. (AU)

Introduction. The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent. Methods. A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin. Results. We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps. Conclusion. Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates. (AU)

Decalogue for the selection of oral antibiotics for lower respiratory tract infections / Decálogo para la selección del antibiótico oral en las infecciones respiratorias de vías bajas

Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options betalactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected (AU)

Las infecciones del tracto respiratorio inferior, incluyendo las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) y la neumonía adquirida en la comunidad (NAC), son uno de los motivos de consulta más frecuentes en atención primaria y los servicios de urgencias hospitalarios, y son la causa de una elevada prescripción de antimicrobianos. La selección del tratamiento oral más adecuado con antibióticos se basa en diferentes aspectos e incluye considerar en primer lugar una etiología bacteriana y no una infección vírica, conocer los patógenos bacterianos que más frecuentemente causa estas infecciones y la frecuencia local de su resistencia antimicrobiana. Además, el tratamiento debe prescribirse rápidamente y los antibióticos deben seleccionarse entre los que tienen un modo de acción más rápido, logrando el mayor efecto en el menor tiempo y con el menor número de efectos adversos (toxicidad, interacciones, resistencia y/o impacto ecológico). Siempre que sea posible, hay que rotar y diversificar los antimicrobianos y pasar a la vía oral lo antes posible. Con estas premisas, las guías de tratamiento oral de la exacerbación leve o moderada de la EPOC y NAC en España incluyen como primera opción los antibióticos betalactámicos (amoxicilina y amoxicilina-clavulánico y cefditoreno), en determinadas situaciones asociados a un macrólido, y relegando las fluoroquinolonas como alternativa, salvo en los casos en que se sospeche la presencia de Pseudomonas aeruginosa (AU)

Ultrasound-guided erector spinae interfascial plane block for spinal surgery in three cats.

CASE SERIES SUMMARY: The erector spinae plane (ESP) block consists of an interfascial injection of local anaesthetic between the erector spinae muscle group and the transverse processes of the thoracic vertebrae. This block targets the dorsal rami of the thoracic spinal nerves to desensitise the cutaneous area near the dorsal midline, the paraspinal muscles, the dorsal vertebral laminae and the facet joints. The purpose of this case series is to describe the perioperative analgesic effect and complications of ultrasound-guided ESP block with bupivacaine in three cats undergoing spinal surgery. Only one cardiovascular response was recorded in this case series. Just one cat received intraoperative rescue analgesia. Cats 1 and 2 recorded just one high pain score in the first 24 h postoperatively, and cat 3 recorded three high pain scores. The total amount of methadone given in the 24 h postoperatively was 0.6 mg/kg in cat 1, 0.9 mg/kg in cat 2 and 0.8 mg/kg in cat 3. All three cats suffered mild and transient intraoperative complications, which were easily addressed. There were no postoperative complications. RELEVANCE AND NOVEL INFORMATION: This case series documents a novel locoregional anaesthesia technique as an alternative to traditional systemic analgesia. The technique is part of a multimodal analgesia approach for spinal surgery in cats. Perioperative analgesic effect and complications presented in this case series are evaluated and discussed.

CAPPRIC Study-Characterization of Community-Acquired Pneumonia in Spanish Adults Managed in Primary Care Settings.

The real burden of community-acquired pneumonia (CAP) in non-hospitalized patients is largely unknown. This is a 3-year prospective, observational study of ambulatory CAP in adults, conducted in 24 Spanish primary care centers between 2016-2019. Sociodemographic and clinical variables of patients with radiographically confirmed CAP were collected. Pneumococcal etiology was assessed using the Binax Now® test. Patients were followed up for 10 ± 3 days. A total of 456 CAP patients were included in the study. Mean age was 56.6 (±17.5) years, 53.5% were female, and 53.9% had ≥1 comorbidity. Average incidence of CAP was 1.2-3.5 cases per 1000 persons per year. Eighteen patients (3.9%) were classified as pneumococcal CAP. Cough was present in 88.1% of patients at diagnosis and fever in 70.8%. Increased pulmonary density (63.3%) and alveolar infiltrates with air bronchogram (16.6%) were the most common radiographic findings. After 14.6 ± 6.0 days (95% CI = 13.9-15.3), 65.4% of patients had recovered. Hospitalization rate was 2.8%. The most frequently prescribed antibiotics were quinolones (58.7%) and ß-lactams (31.1%). In conclusion, one-third of CAP patients did not fully recover after two weeks of empiric antibiotic therapy and 2.8% required hospitalization, highlighting the significant burden associated with non-hospitalized CAP in Spain.

Diagnostic performance of CerTest and Panbio antigen rapid diagnostic tests to diagnose SARS-CoV-2 infection.

OBJECTIVES: Antigen rapid diagnostic tests (Ag-RDT) have been developed as reliable tools to control the SARS-CoV-2 pandemic. The objective of our study was to evaluate the diagnostic performance of two Ag-RDTs. METHODS: We evaluated CerTest SARS-CoV-2 Ag One Step Card Test and Panbio COVID-19 Ag Rapid Test Device Ag-RDTs. We included 320 nasopharyngeal samples: 150 PCR negative samples to assess the specificity and 170 PCR positive samples to evaluate the sensitivity. We also evaluated their sensitivity according to cycle threshold (Ct) values and the time from the onset of symptoms. Tests were compared using the McNemar's test and agreement was evaluated using the kappa score (k). RESULTS: Both Ag-RDTs showed a specificity of 100 %. Overall sensitivity was 53.5 % for CerTest and 60.0 % for Panbio. For samples with Ct≤ 25, sensitivity was 94.0 % for CerTest and 96.4 % for Panbio (p = 0.500). Regarding samples with Ct>25, sensitivity was 14.0 % for CerTest and 24.4 % for Panbio (p = 0.004). Sensitivity for samples within the first 5 days after the onset of symptoms were 84.8 % for CerTest and 91.3 % for Panbio (p = 0.250) and notably decreased for samples taken after the fifth day. Both Ag-RDTs showed an excellent agreement between them (agreement = 96.7 %, k = 0.920). Agreement with PCR was also excellent for high viral load samples (Ct<25) for CerTest (98.0 %, k = 0.954) and Panbio (98.8 %, k = 0.973). CONCLUSIONS: CerTest SARS-CoV-2 and Panbio COVID-19 Ag showed excellent performance and agreement results for samples with high viral loads (Ct ≤ 25) or samples taken within the first 5 days after the onset of symptoms.

Panbio antigen rapid test is reliable to diagnose SARS-CoV-2 infection in the first 7 days after the onset of symptoms.

BACKGROUND: RT-qPCR is the current recommended laboratory method to diagnose SARS-CoV-2 acute infection, several factors such as requirement of special equipment, time consuming, high cost and skilled staff limit the use of these techniques. A more rapid and high-throughput method is essential. METHODS: We analyzed clinical data and nasopharyngeal samples, collected during September 2020, from patients attended at the emergency department of a secondary hospital and in two primary healthcare centers in Madrid. The performance of the Panbio™ COVID-19 AG Rapid Test Device for the detection of SARS-CoV-2 antigen was compared to RT-qPCR. RESULTS: 255 nasopharyngeal swabs, including 150 from the emergency department and 105 from primary helthcare centers, were tested. 184 patients were symptomatic (72.1 %). Amongst the 60 positive RT-qPCR samples, 40 were detected by the rapid antigen test, given an overall sensitivity of 73.3 %. All the samples detected positive with the rapid antigen test were also positive with RT-qPCR. The median cycle threshold was 23.28 (IQR 18.5-30.16). Patients with less than seven days onset of symptoms showed a higher viral load, and sensitivity for rapid antigen test (86.5 %), compared to those with more days (sensitivity of 53.8 %)(p < 0.004). CONCLUSIONS: The rapid antigen test evaluated in this study showed a high sensitivity and specificity in samples obtained during the first week of symptoms and with high viral loads. This assay seems to be an effective strategy for controlling the COVID-19 pandemic for the rapid identification and isolation of SARS-CoV-2 infected patients.

Estimando el número de casos de COVID-19 a tiempo real utilizando un formulario web a través de las redes sociales: Proyecto COVID19-TRENDS / Estimation of the number of cases of COVID-19 in real time using a web form through social networks: Project COVID19-TRENDS

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Abordaje mínimamente invasivo para el drenaje de infecciones cervicofaciales profundas. Estudio retrospectivo / Minimally invasive approach to drainage of deep cervicofacial infections. Retrospective study

OBJETIVOS: La mayoría de las infecciones cervicales profundas son polimicrobianas y de origen dental, y es necesario un tratamiento apropiado y oportuno. El propósito de esta investigación es describir la eficacia de las incisiones mínimamente invasivas para el drenaje de infecciones cervicales profundas. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo y longitudinal en pacientes con infecciones cervicales profundas, que requirieron ingreso hospitalario, tratados quirúrgicamente con múltiples incisiones mínimamente invasivas. Los datos recopilados incluyeron epidemiología, etiología, órganos dentales y espacio cervicofacial involucrado, tamaño de los abscesos, cantidad de material obtenido, tiempo de hospitalización, tiempo de evolución antes del drenaje, técnica anestésica, método de intubación, método quirúrgico y complicaciones. RESULTADOS: Fueron incluidos un total de 88 pacientes, con un promedio de edad de 39 +/- 14,05 años y una mayor prevalencia del género femenino. El factor etiológico principal fueron los focos sépticos dentales. El espacio más afectado fue el submandibular, en un 39,2 %. El tiempo de evolución antes del drenaje varió entre 1 y 8 días. El promedio del tamaño de los abscesos fue de 6,47 +/- 2,34, 4,03 +/- 1,64, 3,71 +/- 1,59 cm. Un 88,6 % de los pacientes fueron intervenidos bajo anestesia local y un 11,8 % bajo anestesia general. El promedio de la cantidad de material obtenido fue de 104,41 +/- 9 cc. El tiempo promedio de hospitalización fue de 9,43 +/- 3,89 días. No hubo complicaciones locales ni sistémicas. CONCLUSIONES: Las incisiones mínimamente invasivas constituyen una alternativa eficaz, segura y con escasas morbilidades para el drenaje de infecciones cervicales profundas

AIM: Most of deep cervical infections are polymicrobial and come from a dental origin, and an appropriate treatment is necessary. The present paper aims to describe the efficiency of minimally invasive incisions for the drainage of deep cervical infections. MATERIALS AND METHODS: A descriptive, retrospective and longitudinal study in patients with deep cervical infections, who required hospital admission. Patients were surgically treated with multiple minimally invasive incisions. Collected data included: epidemiology, etiology, teeth and cevicofacial spaces involved, size of drained abscesses, amount of material obtained, time of total patient admission, time of evolution before drainage anaesthetic technique, intubation method, surgical method and complications. RESULTS: A total of 88 patients were included in this study, with an average age of 39 +/- 14.05 years and a higher prevalence in women. Teeth infections were the etiological factor in 100 % of the sample. The most affected space was the submandibular with a 39.2 %. The evolution time before drainage varied between 1-8 days. The mean abscess size was 6.47 +/- 2.34, 4.03 +/- 1.64, 3.71 +/- 1.59 cm. In terms of anaesthetic techniques, 88.6% patients were treated under local anesthesia and 11.3 % patients were treated under general anesthesia. The average of the amount of material obtained was 104.41 +/- 9 cc. The average hospitalization time was 9.43 +/- 3.89 days. There were no systemic or local complications. CONCLUSIONS: Minimally invasive incisions represent an effective and safe alternative, with low morbidity, for the drainage of deep cervical infections

El nuevo calendario vacunal oficial del adulto no contempla la prevención de la neumonía neumocócica / The new official vaccine calendar for adults does not include the prevention of pneumococcal pneumonia

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Optimisation in the multidisciplinary approach to patients with hepatitis C in the era of direct-acting antivirals. / Optimización en el abordaje multidisciplinar del paciente con hepatitis C en la era de los antivirales de acción directa.

The advents of current direct-acting antiviral treatments has revolutionised the therapeutic approach to hepatitis C, increasing cure rates to above 90% and substantially simplifying treatment, which translates into benefits for patients, clinicians and the health system. These new drugs allow cure to be achieved, irrespective of the patient's characteristics, with tolerability similar to that of placebo and few drug reactions with concomitant medication. This in turn improves patients' quality of life and wellbeing. Moreover, these drugs allow multidisciplinary optimisation of the approach to patients with hepatitis C, thus reducing both short- and long-term costs. All these factors facilitate treatment universality, with treatments that are less influenced by specific factors and that allow better results to be obtained in a larger number of patients. Elimination of hepatitis C is now a real possibility. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.

Medicina de Urgencias en Operaciones, un anhelo de la Sanidad Militar / Emergency Medicine in Operations: a Longing of the Military Health System

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Tweet if you want to be sustainable: a thematic analysis of a Twitter chat to discuss sustainability in nurse education.

AIM: To explore the concept of sustainability in nursing using social media as a vehicle for discussion on the topic. BACKGROUND: There is a need for an increased awareness among nurses of the issues that are crucial for the healthcare sector to prepare for climate change and contribute to sustainable development. However, topics about sustainability and climate change are not a requirement of nursing curricula in Europe; social media provides an opportunity to raise issues and promote discussion. DESIGN: A thematic analysis of a Twitter discussion. METHODS: A Twitter discussion session hosted by @WeNurses took place on 24 March 2015 over 1 hour. Data were gathered via this online discussion hosted on Twitter, a social media platform. Following the discussion a thematic analysis of the posted Tweets was conducted. FINDINGS: One hundred and nineteen people posted nine hundred and ninety six Tweets, a reach of 3,306,368. Tweets broadly followed the questions posted by the team. Several threads related to the sustainable use of healthcare resources and the need to reduce waste was evident. A Word Cloud of the Tweets highlighted prominent words in the discussion: sustainability, nursing/nurses, curriculum, important, waste, practice, resources, student, plastic, health, gloves. CONCLUSION: Social media is an effective way of engaging nurses and students in a discussion on challenging issues. Sustainability appears to be important for nurses, with a particular emphasis on resource use and the importance of sustainability topics in nurse education.

[Murine typhus in Tenerife. Clinicoepidemiological study and differential clinical features with Q fever]. / Tifus murino en Tenerife. Estudio clinicoepidemiológico y características clínicas diferenciales con la fiebre Q.

BACKGROUND AND OBJECTIVE: Our aim was to conduct a study to define the clinical and epidemiological characteristics of patients with murine typhus in Tenerife island (Canary islands, Spain). Moreover, we investigated the differential clinical features of this disease with regard to Q fever. PATIENTS AND METHOD: 5-year prospective study of patients with murine typhus (1998-2002) admited in a reference hospital in Tenerife, Spain. RESULTS: Thirty two patients were included. Flea bite and rat exposure were iuncommon (6.25%). The monthly distribution showed a peak of incidence in January, August and September, without a clear seasonal prevalence. Fever and headache were the most common clinical features. Rash was present in 28% of the cases. Both an increase in liver enzyme levels (88%) and thrombocytopenia (37.5%) were the most relevant laboratory findings. Organ complications were uncommon (18.75%). Antibiotics were administered to 90% of patients and cure was achieved in all them. Compared with Q fever, patients with murine typhus more commonly had rash (p = 0.006) and thrombocytopenia (p < 0.001). CONCLUSION: Murine typhus is an emerging rickettsiosis in Tenerife and must be considered in the differential diagnosis with Q fever.

Tifus murino en Tenerife. Estudio clinicoepidemiológico y características clínicas diferenciales con la fiebre Q / Murine typhus in Tenerife. Clinicoepidemiological study and differential clinical features with Q fever

FUNDAMENTO Y OBJETIVO: El objetivo del estudio fue definir las características clínicas y epidemiológicas del tifus murino en la isla de Tenerife, Canarias. También se investigaron aspectos clínicos diferenciales con la fiebre Q. PACIENTES Y MÉTODO: Estudio prospectivo de los casos de tifus murino ingresados en un hospital de referencia en Tenerife durante el período 1998-2002. RESULTADOS: Se diagnosticó a 32 pacientes. La exposición a picaduras de pulga o ratas fue infrecuente (6,25 por ciento). La distribución mensual de los casos mostró un pico de incidencia en los meses de enero, agosto y septiembre, aunque no observamos una clara prevalencia estacional. La fiebre y la cefalea fueron los síntomas más frecuentes. El 28 por ciento de los pacientes presentó erupción cutánea. Los hallazgos de laboratorio más relevantes fueron la alteración enzimática hepática (88 por ciento) y la trombocitopenia (37,5 por ciento). El 18,75 por ciento de los casos presentó alguna complicación. Se administró tratamiento antibiótico al 90 por ciento de los pacientes. La evolución fue hacia la curación en todos los casos. Los pacientes con tifus murino presentaron con más frecuencia erupción cutánea (p = 0,006) y trombocitopenia (p < 0,001), comparados con los pacientes con fiebre Q. CONCLUSIÓN: El tifus murino es una rickettsiosis emergente en Tenerife y debe considerarse en el diagnóstico diferencial con la fiebre Q (AU)