Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development.

BACKGROUND: Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. METHODS: Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. RESULTS: In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. CONCLUSIONS: Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.

Mejoría del control de la diabetes en atención primaria tras implantar un programa de atención con la determinación instantánea en sangre capilar de hemoglobina glucosilada / Improving diabetes control in primary care after implementing a program to measure capillary glycosylated hemoglobin

OBJETIVO: Evaluar la efectividad de una intervención mixta, con componentes educativos, de autoevaluación y retroinformación, para optimizar el control de la diabetes mediante la consecución de concentración de HbA1c en sangre capilar. MATERIAL Y MÉTODOS: Se realizó un estudio piloto, descriptivo, prospectivo, de un año de duración, en el Centro de Salud Primaria «El Carmen» (Área VII Murcia Este). Se incluyeron 266 pacientes con diabetes tipo 2, mayores de 16 años. Cuando el paciente acudía a consulta se realizaba una determinación de HbA1c capilar instantánea utilizando un medidor de HbA1c DCA VANTAGE de SIEMENS. Los pacientes se separaron en 4 grupos dependiendo de los valores de HbA1c inicial y la necesidad o no de intensificar su tratamiento (A: buen control sin cambio de tratamiento [HbA1c < 7% y < 8% en mayores de 70 años]; B: buen control con intensificación; C: mal control sin cambios en tratamiento; y D: mal control con modificación del tratamiento). RESULTADOS: La edad media de los pacientes fue de 66,36 ± 12,56 años y un IMC medio de 29,72 ± 4,92 kg/m2. La media inicial de HbA1c se situaba en 7,78 ± 1,57% y descendió hasta un valor medio de HbA1c final de 6,91 ± 1,07% (p < 0,001). Se objetivó un cambio en la «inercia terapéutica» de los profesionales del centro que lograron, con modificación del tratamiento, que el 74,81% de los pacientes con DM2 cumplieran sus objetivos de control de la diabetes, junto con un descenso de -0,34 ± 1,04 kg/m2 del IMC (p < 0,001) CONCLUSIONES: El control de la HbA1c instantánea supone un método rápido, simple y eficaz para conseguir un mayor control de la diabetes. Es necesario concienciar al personal sanitario en atención primaria a adoptar este tipo de intervención, tanto educativa y/o farmacológica en el tratamiento de todos los pacientes con DM2

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a joint intervention, with educational, self-evaluation and feedback components, in order to optimize diabetes control by measuring HbA1c in capillary blood. MATERIAL AND METHODS: A prospective, pilot study, of one year duration was carried out in the Primary Care Health Centre «El Carmen» (VII Area Murcia East). A total of 266 patients over 16 years old were included in the study. Instant capillary HbA1c (DCA VANTAGE de SIEMENS) was measured on patients who attended the clinics. The patients were divided into 4 different groups, depending on HbA1c values and the requirement of intensifying treatment (Group A: patients with good control of their diabetes (HbA1c < 7%, or 8% in patients over 70 years old) and no changes in the treatment; B: patients with good control of their diabetes and required changes in the treatment; C: patients with poor control and no changes in treatment (non-optimization criteria); and D: patients with poor control and treatment intensification). RESULTS: The mean age was 66.36 ± 12.56 years, and the body mass index (BMI) was 29.72 ± 4.92 kg/m2. The initial HbA1c mean value was 7.79 ± 1.57%, which decreased to a final HbA1c mean value of 6.91 ± 1.07% (P < .001). A change in the therapeutic inertia was searched by the healthcare personnel, who found that the 74.81% of the diabetic patients reached the control objectives. BMI decreased by -0.34 ± 1.04 kg/m2 (P < .001). CONCLUSIONS: Instant capillary HbA1c is a simple, rapid and efficient method to improve diabetes control. It is necessary to sensitize the healthcare personnel in Primary Care to assume this kind of intervention, both educational and pharmacological, to improve values in type 2 diabetes patient

Psychoeducative groups help control type 2 diabetes in a primary care setting.

INTRODUCTION: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. METHODS: A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2).The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). RESULTS: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). CONCLUSIONS: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care.

Introducción: Los cambios en el estilo de vida mejoran el control de los diabéticos tipo 2, pero no sabemos cuales son las estrategias más eficientes para conseguir estos cambios. Hemos medido el impacto de una intervención psicoeducativa grupal en diabetes mediante hemoglobina glicosilada (HbA1c), índice de masa corporal (IMC) y factores de riesgo cardiovascular (FRCV). Métodos: Se trata de un ensayo clínico controlado, randomizado y multicéntrico, de 72 pacientes diabéticos tipo 2, edad media 63,08 AÑOs, 50% mujeres, HbA1c media 6.98% e IMC medio 30,48 kg/m2. Se comparó el efecto terapéutico de una intervención psicoeducativa grupal(GSE) con una educación diabetológica convencional (GC). Resultados: El GSE presentó una mayor reducción media de HbA1c, -0,51 ± 1,07 vs -0,06 ± 0,53% (p 0,003), un mayor grado de cumplimiento de los objetivos de control óptimo de HbA1c, 80% vs 48% (p 0,005) y una mayor reducción media de peso, -1,93 ± 3,57 vs 0,52 ± 1,73 kg (p 0,002), que el GC. También se objetivó una mejoría significativa de colesterol total, colesterol LDL, triglicéridos, tensión arterial sistólica y diastólica en GSE (todas las p < 0,05). Conclusiones: Los GSE de diabéticos tipo 2 consiguieron una mejoría significativa de HbA1c, IMC y FRCV, y superaron a la educación diabetológica convencional en el grado de cumplimiento de los objetivos de control óptimo de la diabetes. Debemos plantearnos cambios estructurales en nuestros programas asistenciales para introducir estos avances más eficientes en educación terapeútica de diabetes en atención primaria.

Psychoeducative groups help control type 2 diabetes in a primary care setting / La terapia psicoeducativa grupal en atención primaria ayuda en el control de la diabetes tipo 2

Introduction: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. Methods: A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2). The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). Results: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). Conclusions: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care (AU)

Introducción: Los cambios en el estilo de vida mejoran el control de los diabéticos tipo 2, pero no sabemos cuales son las estrategias más eficientes para conseguir estos cambios. Hemos medido el impacto de una intervención psicoeducativa grupal en diabetes mediante hemoglobina glicosilada (HbA1c), índice de masa corporal (IMC) y factores de riesgo cardiovascular (FRCV). Métodos: Se trata de un ensayo clínico controlado, randomizado y multicéntrico, de 72 pacientes diabéticos tipo 2, edad media 63,08 años, 50% mujeres, HbA1c media 6.98% e IMC medio 30,48 kg/m2. Se comparó el efecto terapéutico de una intervención psicoeducativa grupal (GSE) con una educación diabetológica convencional (GC).Resultados: El GSE presentó una mayor reducción media de HbA1c, -0,51 ± 1,07 vs -0,06 ± 0,53% (p 0,003), un mayor grado de cumplimiento de los objetivos de control óptimo de HbA1c, 80% vs 48% (p 0,005) y una mayor reducción media de peso, -1,93 ± 3,57 vs 0,52 ± 1,73 kg (p 0,002), que el GC. También se objetivó una mejoría significativa de colesterol total, colesterol LDL, triglicéridos, tensión arterial sistólica y diastólica en GSE (todas las p < 0,05). Conclusiones: Los GSE de diabéticos tipo 2 consiguieron una mejoría significativa de HbA1c, IMC y FRCV, y superaron a la educación diabetológica convencional en el grado de cumplimiento de los objetivos de control óptimo de la diabetes. Debemos plantearnos cambios estructurales en nuestros programas asistenciales para introducir estos avances más eficientes en educación terapeútica de diabetes en atención primaria (AU)

Evaluation of a latex agglutination test (PYLOGEN) for the detection of Helicobacter pylori in stool specimens.

The aim of the study was to assess a new latex agglutination (LA) stool antigen assay (PYLOGEN; CerTest Biotec, Zaragoza, Spain) in the diagnosis of Helicobacter pylori infection and to monitor its eradication after treatment. The LA test has been approved for sale in Europe, and its approval from the US Food and Drug Administration is still pending. The individuals enrolled were classified into 3 groups of patients: Group 1 consisted of 38 patients who are H. pylori positive. The diagnosis of H. pylori infection was established if there was concordance between 2 test results (urea breath test [UBT], rapid urease test, and histopathologic study) or if the culture alone was positive. Patients with only 1 positive test were considered indeterminate and were excluded from the study. Group 2 comprised 9 patients without positive tests and who were considered to be H. pylori negative. Group 3 consisted of 57 patients who received eradication treatment. The sensitivity and specificity of the test were 78.9% and 100%, respectively. The results of the UBT of the patients were studied 6 weeks after eradication therapy. The sensitivity and specificity of the LA test relative to UBT for patients after treatment were 75% and 93.3%, respectively.

Comparison of stool antigen immunoassay methods for detecting Helicobacter pylori infection before and after eradication treatment.

The aim of the study was to compare 6 stool antigen immunoassays for detecting Helicobacter pylori before and after eradication treatment. We compared 3 enzyme immunoassay (EIA) and 3 monoclonal immunochromatographic assays in diagnosing infection and in determining H. pylori status after eradication treatment. We evaluated stool samples from 80 patients diagnosed with H. pylori infection and from 18 patients without infection. To confirm H. pylori eradication, we evaluated 40 patients who received H. pylori treatment. The sensitivity and specificity were 87.3% and 83.3% for Immundiagnostik ELISA, 92.5% and 72.2% for HpSA EIA test, 95% and 66.6% for HpStAR EIA, 83.8% and 66.6% for H. pylori Letitest, 52.5% and 94.4% for ImmunoCard HpSA, and 78.8% and 55.5% for RAPID HpStAR, respectively. From the 40 patients evaluated 6 weeks after eradication therapy, the best agreement between the urea breath tests and immunoassay tests was with HpStAR EIA (90%) and H. pylori Letitest (85%). HpStAR EIA and H. pylori Letitest could be used as a routine diagnostic tool in the microbiology laboratory for assessing clinical significance and eradication control of H. pylori infection.

[Fast-track multimodal rehabilitation programs in laparoscopic colorectal surgery]. / Programas de rehabilitación multimodal (fast-track) en cirugía laparoscópica colorrectal.

For the last two decades, general and digestive surgeons have attempted to improve the postoperative course of surgical patients. Classical perioperative treatment can be described as a period of preoperative dehydration caused by fasting and intensive colon preparation followed by fluid overload generally due to excessively prolonged serum therapy. There is also perioperative surgical stress, the trauma of surgery itself, and a long period of drainage and nasogastric tubes. The patient is thus literally confined to bed and mobilization is, at the very least, difficult. Moreover, the use of opiates delays intestinal peristalsis and consequently oral nutrition. All together, these factors prolong the length of hospital stay and hamper recovery. All these perioperative treatment modalities have been questioned by Kehlet, resulting in a set of new, more realistic and evidence-based modalities, currently known as the fast-track program. The aim of this program is to decrease perioperative stress, reduce organ involvement produced by surgical trauma and hasten the patient's general recovery. Major advantages of this program consist not only of shorter length of hospital stay but also of a concurrent improvement in patients' quality of life and a reduction in mortality. The present review article analyzes all these modalities, with special emphasis on laparoscopic colorectal surgery. This approach is presented as one of the elements of the fast-track program.

Programas de rehabilitación multimodal (fast-track) en cirugía laparoscópica colorrectal / Fast-Track multimodal rehabilitation programs in laparoscopic colorectal surgery

Desde las 2 últimas décadas, los cirujanos dedicados a la cirugía general y digestiva intentan hacer más digno el curso postoperatorio de los pacientes sometidos a una intervención quirúrgica. El tratamiento peroperatorio clásico se puede resumir como un período de deshidratación preoperatoria causada por el ayuno preoperatorio y una preparación intensiva de colon seguida en el curso postoperatorio por un período de encharcamiento producido por un tratamiento con suero por lo general prolongado y excesivo. A todo ello se acumula el estrés quirúrgico peroperatorio, el traumatismo quirúrgico infligido y un largo período de drenajes y sonda nasogástrica. Todo ello hace que el paciente esté literalmente "fijo" a la cama y la movilización sea al menos dificultosa. Además, el uso de opiáceos retrasa la aparición del peristaltismo intestinal y, con ello, la alimentación por vía oral. Todo ello hace que la estancia del paciente sea larga y su recuperación llena de dificultades. La puesta en duda de todas estas modalidades de tratamiento peroperatorias, realizado por Kehlet, ha resultado en una suma de nuevas modalidades, más realistas y basadas en la evidencia, actualmente llamado programa fast-track o trayecto rápido. Su fin es el de disminuir el estrés peroperatorio, la afectación orgánica producida por el traumatismo quirúrgico y acelerar la recuperación general del paciente. Importantes ventajas de este programa no son sólo la estancia más corta, sino al mismo tiempo un aumento de la calidad de vida de los pacientes, y una disminución de la morbilidad. En este artículo de revisión se analizan todas estas modalidades, sobre todo en relación con la cirugía colorrectal y en especial su abordaje laparoscópico. En él se llega a definir este abordaje laparoscópico como una parte más de este programa fast-track (AU)

For the last two decades, general and digestive surgeons have attempted to improve the postoperative course of surgical patients. Classical perioperative treatment can be described as a period of preoperative dehydration caused by fasting and intensive colon preparation followed by fluid overload generally due to excessively prolonged serum therapy. There is also perioperative surgical stress, the trauma of surgery itself, and a long period of drainage and nasogastric tubes. The patient is thus literally confined to bed and mobilization is, at the very least, difficult. Moreover, the use of opiates delays intestinal peristalsis and consequently oral nutrition. All together, these factors prolong the length of hospital stay and hamper recovery. All these perioperative treatment modalities have been questioned by Kehlet, resulting in a set of new, more realistic and evidence-based modalities, currently known as the fast-track program. The aim of this program is to decrease perioperative stress, reduce organ involvement produced by surgical trauma and hasten the patient's general recovery. Major advantages of this program consist not only of shorter length of hospital stay but also of a concurrent improvement in patients' quality of life and a reduction in mortality. The present review article analyzes all these modalities, with special emphasis on laparoscopic colorectal surgery. This approach is presented as one of the elements of the fast-track program (AU)